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For example generic benzac 20 gr with amex, the enteric plexus is the extensive network of axons and neurons in the wall of the small and large intestines buy benzac 20 gr on line. The enteric plexus is actually part of the enteric nervous system, along with the gastric plexuses and the esophageal plexus. They have connective tissues invested in their structure, as well as blood vessels supplying the tissues with nourishment. The outer surface of a nerve is a surrounding layer of fibrous connective tissue called the epineurium. Within the nerve, axons are further bundled into fascicles, which are each surrounded by their own layer of fibrous connective tissue called perineurium. Finally, individual axons are surrounded by loose connective tissue called the endoneurium (Figure 13. With what structures in a skeletal muscle are the endoneurium, perineurium, and epineurium comparable? Cranial Nerves The nerves attached to the brain are the cranial nerves, which are primarily responsible for the sensory and motor functions of the head and neck (one of these nerves targets organs in the thoracic and abdominal cavities as part of the parasympathetic nervous system). They can be classified as sensory nerves, motor nerves, or a combination of both, meaning that the axons in these nerves originate out of sensory ganglia external to the cranium or motor nuclei within the brain stem. Three of the nerves are solely composed of sensory fibers; five are strictly motor; and the remaining four are mixed nerves. Learning the cranial nerves is a tradition in anatomy courses, and students have always used mnemonic devices to remember the nerve names. A traditional mnemonic is the rhyming couplet, “On Old Olympus’ Towering Tops/A Finn And German Viewed Some Hops,” in which the initial letter of each word corresponds to the initial letter in the name of each nerve. The names of the nerves have changed over the years to reflect current usage and more accurate naming. An exercise to help learn this sort of information is to generate a mnemonic using words that have personal significance. It is also responsible for lifting the upper eyelid when the eyes point up, and for pupillary constriction. The trochlear nerve and the abducens nerve are both responsible for eye movement, but do so by controlling different extraocular muscles. The trigeminal nerve is responsible for cutaneous sensations of the face and controlling the muscles of mastication. The facial nerve is responsible for the muscles involved in facial expressions, as well as part of the sense of taste and the production of saliva. The glossopharyngeal nerve is responsible for controlling muscles in the oral cavity and upper throat, as well as part of the sense of taste and the production of saliva. The vagus nerve is responsible for contributing to homeostatic control of the organs of the thoracic and upper abdominal cavities. The spinal accessory nerve is responsible for controlling the muscles of the neck, along with cervical spinal nerves. Three of the cranial nerves also contain autonomic fibers, and a fourth is almost purely a component of the autonomic system. The oculomotor fibers initiate pupillary constriction, whereas the facial and glossopharyngeal fibers both initiate salivation. The loss of vision comes from swelling around the optic nerve, which probably presented as a bulge on the inside of the eye. Another important aspect of the cranial nerves that lends itself to a mnemonic is the functional role each nerve plays. The sentence, “Some Say Marry Money But My Brother Says Brains Beauty Matter More,” corresponds to the basic function of each nerve. The trigeminal and facial nerves both concern the face; one concerns the sensations and the other concerns the muscle movements. The facial and glossopharyngeal nerves are both responsible for conveying gustatory, or taste, sensations as well as controlling salivary glands. This is not an exhaustive list of what these combination nerves do, but there is a thread of relation between them. There are eight pairs of cervical nerves designated C1 to C8, twelve thoracic nerves designated T1 to T12, five pairs of lumbar nerves designated L1 to L5, five pairs of sacral nerves designated S1 to S5, and one pair of coccygeal nerves. The nerves are numbered from the superior to inferior positions, and each emerges from the vertebral column through the intervertebral foramen at its level. The same occurs for C3 to C7, but C8 emerges between the seventh cervical vertebra and the first thoracic vertebra. For the thoracic and lumbar nerves, each one emerges between the vertebra that has the same designation and the next vertebra in the column. The nerves in the periphery are not straight continuations of the spinal nerves, but rather the reorganization of the axons in those nerves to follow different courses. This occurs at four places along the length of the vertebral column, each identified as a nerve plexus, whereas the other spinal nerves directly correspond to nerves at their respective levels. In this instance, the word plexus is used to describe networks of nerve fibers with no associated cell bodies.

Peristalsis is so powerful that foods and liquids you swallow enter your stomach even if you are standing on your head buy 20 gr benzac. Mechanical digestion is a purely physical process that does not change the chemical nature of the food order 20gr benzac with visa. It includes mastication, or chewing, as well as tongue movements that help break food into smaller bits and mix food with This OpenStax book is available for free at http://cnx. Although there may be a tendency to think that mechanical digestion is limited to the first steps of the digestive process, it occurs after the food leaves the mouth, as well. The mechanical churning of food in the stomach serves to further break it apart and expose more of its surface area to digestive juices, creating an acidic “soup” called chyme. Segmentation, which occurs mainly in the small intestine, consists of localized contractions of circular muscle of the muscularis layer of the alimentary canal. These contractions isolate small sections of the intestine, moving their contents back and forth while continuously subdividing, breaking up, and mixing the contents. By moving food back and forth in the intestinal lumen, segmentation mixes food with digestive juices and facilitates absorption. In chemical digestion, starting in the mouth, digestive secretions break down complex food molecules into their chemical building blocks (for example, proteins into separate amino acids). Food that has been broken down is of no value to the body unless it enters the bloodstream and its nutrients are put to work. This occurs through the process of absorption, which takes place primarily within the small intestine. There, most nutrients are absorbed from the lumen of the alimentary canal into the bloodstream through the epithelial cells that make up the mucosa. Lipids are absorbed into lacteals and are transported via the lymphatic vessels to the bloodstream (the subclavian veins near the heart). Digestive System: From Appetite Suppression to Constipation Age-related changes in the digestive system begin in the mouth and can affect virtually every aspect of the digestive system. A slice of pizza is a challenge, not a treat, when you have lost teeth, your gums are diseased, and your salivary glands aren’t producing enough saliva. Swallowing can be difficult, and ingested food moves slowly through the alimentary canal because of reduced strength and tone of muscular tissue. Neurosensory feedback is also dampened, slowing the transmission of messages that stimulate the release of enzymes and hormones. Pathologies that affect the digestive organs—such as hiatal hernia, gastritis, and peptic ulcer disease—can occur at greater frequencies as you age. Conditions that affect the function of accessory organs—and their abilities to deliver pancreatic enzymes and bile to the small intestine—include jaundice, acute pancreatitis, cirrhosis, and gallstones. However, most digestive processes involve the interaction of several organs and occur gradually as food moves through the alimentary canal (Figure 23. Regulatory Mechanisms Neural and endocrine regulatory mechanisms work to maintain the optimal conditions in the lumen needed for digestion and absorption. These regulatory mechanisms, which stimulate digestive activity through mechanical and chemical activity, are controlled both extrinsically and intrinsically. Neural Controls The walls of the alimentary canal contain a variety of sensors that help regulate digestive functions. These include mechanoreceptors, chemoreceptors, and osmoreceptors, which are capable of detecting mechanical, chemical, and osmotic stimuli, respectively. For example, these receptors can sense when the presence of food has caused the stomach to expand, whether food particles have been sufficiently broken down, how much liquid is present, and the type of nutrients in the food (lipids, carbohydrates, and/or proteins). This may entail sending a message that activates the glands that secrete digestive juices into the lumen, or it may mean the stimulation of muscles within the alimentary canal, thereby activating peristalsis and segmentation that move food along the intestinal tract. The walls of the entire alimentary canal are embedded with nerve plexuses that interact with the central nervous system and other nerve plexuses—either within the same digestive organ or in different ones. Extrinsic nerve plexuses orchestrate long reflexes, which involve the central and autonomic nervous systems and work in response to stimuli from outside the digestive system. Short reflexes, on the other hand, are orchestrated by intrinsic nerve plexuses within the alimentary canal wall. Short reflexes regulate activities in one area of the digestive tract and may coordinate local peristaltic movements and stimulate digestive secretions. For example, the sight, smell, and taste of food initiate long reflexes that begin with a sensory neuron delivering a signal to the medulla oblongata. In contrast, food that distends the stomach initiates short reflexes that cause cells in the stomach wall to increase their secretion of digestive juices. The main digestive hormone of the stomach is gastrin, which is secreted in response to the presence of food. The Mouth The cheeks, tongue, and palate frame the mouth, which is also called the oral cavity (or buccal cavity). The labial frenulum is a midline fold of mucous membrane that attaches the inner surface of each lip to the gum. The next time you eat some food, notice how the buccinator muscles in your cheeks and the orbicularis oris muscle in your lips contract, helping you keep the food from falling out of your mouth.

While a patient or physician may be anxious to assign a psychiatric diagnosis to the syndrome presented purchase benzac 20gr without prescription, a failure to look for and detect a possibly underlying medical cause or contributing factor could unnecessarily prevent the alleviation of order 20gr benzac amex, extend, or deepen this world of doom the patient endures. Properly examined, diagnosed, and treated, the client with a hidden medical illness may have the good fortune of being rescued from the dustbin of “nonresponsive to treatment” and find hope and relief under the watchful eye of his physician. Lifestyle Changes That Improve Mental Health Christine Berger In recent years there has been an increase in people seeking multiple methods of treatment for mental illness and, subsequently, an increase in research on the role of lifestyle choices and their impact on mental health. The message from both clinical practice and a large and growing body of research has been that, while it requires more responsibility to make healthy choices, the positive outcomes for physical and mental health are worthwhile. In this chapter we examine the roles that diet, exercise, sleep, time in nature, and social support play in improving mental health. First, we examine one of the key factors in the success of lifestyle choices: self-efficacy and motivation. Reframing Lifestyle Choices as Empowering Decisions While certain components or factors of mental illness are beyond our control, recent research has demonstrated that many choices we can make on a daily basis improve our mental health or at least minimize symptoms. However, numerous factors tend to predict whether individuals will take full 38 | Complementary and Alternative Medicine Treatments in Psychiatry responsibility for their lifestyle and specifically mental health. One important factor is self-efficacy, a concept introduced by psychologist Albert Bandura (Bandura 1977) that indicates one’s level of ability to accomplish a specific task. Two research reports examined numerous studies looking at self-efficacy as a predictor of health behavior and found not only strong correlations between self-efficacy and promotive health behaviors but also that self-efficacy could be enhanced with proper guidance (O’Leary 1985) (Strecher 1986). One study that investigated the relationship between depression, obesity, and self-efficacy found gender differences. Self-efficacy has been shown to have a negative relationship with depression (Gecas 1989) especially in the fact that self-efficacy seems to mediate between some forms of stress and depression. Motivational Interviewing Regarding lifestyle choice, self-efficacy speaks to a person’s given response to a situation. Clients may state that they desire to make the change but then they may fail to do so. A scale is available (Prochaska 1986) to determine if the individual is completely ready to make the changes or if he is only in the initial and more ambivalent stages ranging from pre- contemplation to action. Once motivation is assessed the provider could implement motivational interviewing (Miller 2002). This is a fairly easily taught psychotherapeutic technique where a series of questions and interactions lead a client to greater awareness about her level of motivation for change and assist in increasing that motivation. A provider would likely refer the client to a professional trained in motivational interviewing or to a psychotherapist either for motivational interviewing or longer-term psychotherapy to address the self- defeating thoughts and beliefs. Lifestyle Changes That Improve Mental Health | 39 Food as Medicine Certain foods and categories of foods impact mental wellness and this impact is becoming increasingly better understood and its correction more urgent. Recent research is demonstrating that the modern Western diet is sorely lacking in essential vitamins, minerals and other healthful properties. With the rise of fast and easy to prepare foods, the natural, healthful components included in fresh fruits and vegetables are not ingested, leading to an imbalance in multiple body systems such as the digestive system and the nervous system. The best course of action is to increase intake of fruits, vegetables, whole grains and lean, organic meats free of added hormones. However, due to issues of income level and access, this is a challenge, and the use of supplements may help where this is not fully possible (Weil, 2006). Two topics of interest include foods that increase inflammation and foods that are toxic to the mind-body system (Hyman 2007). Physician Mark Hyman has written extensively about the ill effects of ingesting toxins and other substances that lead to inflammation. He found through his clinical experience and a review of the research that over time, these problems seem to contribute to depression, anxiety and mood swings. Shifting one’s diet from processed and chemicalized foods to a diet full of fruits, vegetables, whole grains and clean lean proteins seems to have a dramatic impact on physical and mental health. Integrative health physician Andrew Weil has written extensively on foods that contain nutrients required by the body for optimum health, and his experience emphasizes the need to take in omega-3 fatty acids, whole grains, fish, and fresh vegetables and fruits (Weil 2006). Other research has shown that folate and vitamin B12 have a positive impact on mental health (Alpert 2000), as well as omega- 3 fatty acids (Settle 2001). One study surveyed 4644 New Zealand adults about their fish consumption (omega-3) and mental 40 | Complementary and Alternative Medicine Treatments in Psychiatry health, and a significant association was found between higher fish consumption and better mental health (Silvers 2002). Many healthy, simple meals can be prepared that help buffer against mental illness or as a supplementary treatment. Andrew Weil’s Eating Well for Optimum Health (2000) or Mark Hyman’s The UltraMind Solution (2010) and The UltraSimple Diet (2009) are good resources for further education about these foods and both include some simple recipes. Exercise: Free Mental Health Care In the past twenty years, the critical role that physical exercise plays in mental wellness has been demonstrated scientifically, but this has failed to make the clinical connection in the mainstream treatment of mental illness (Callaghan, 2004).

The tectum and tegmentum of the midbrain are the roof and floor of the cerebral aqueduct discount benzac 20gr on-line, respectively discount benzac 20gr free shipping. The floor of the fourth ventricle is the dorsal surface of the pons and upper medulla (that gray matter making a continuation of the tegmentum of the midbrain). Cerebrospinal fluid is produced within the ventricles by a type of specialized membrane called a choroid plexus. Observed in dissection, they appear as soft, fuzzy structures that may This OpenStax book is available for free at http://cnx. By surrounding the entire system in the subarachnoid space, it provides a thin buffer around the organs within the strong, protective dura mater. From the dural sinuses, blood drains out of the head and neck through the jugular veins, along with the rest of the circulation for blood, to be reoxygenated by the lungs and wastes to be filtered out by the kidneys (Table 13. Without a steady supply of oxygen, and to a lesser extent glucose, the nervous tissue in the brain cannot keep up its extensive electrical activity. These nutrients get into the brain through the blood, and if blood flow is interrupted, neurological function is compromised. When the blood cannot travel through the artery, the surrounding tissue that is deprived starves and dies. Sometimes, seemingly unrelated functions will be lost because they are dependent on structures in the same region. Along with the swallowing in the previous example, a stroke in that region could affect sensory functions from the face or extremities because important white matter pathways also pass through the lateral medulla. Loss of blood flow to specific regions of the cortex can lead to the loss of specific higher functions, from the ability to recognize faces to the ability to move a particular region of the body. With physical, occupational, and speech therapy, victims of strokes can recover, or more accurately relearn, functions. Ganglia can be categorized, for the most part, as either sensory This OpenStax book is available for free at http://cnx. Under microscopic inspection, it can be seen to include the cell bodies of the neurons, as well as bundles of fibers that are the posterior nerve root (Figure 13. Also, the small round nuclei of satellite cells can be seen surrounding—as if they were orbiting—the neuron cell bodies. Also, the fibrous region is composed of the axons of these neurons that are passing through the ganglion to be part of the dorsal nerve root (tissue source: canine). If you zoom in on the dorsal root ganglion, you can see smaller satellite glial cells surrounding the large cell bodies of the sensory neurons. This is analogous to the dorsal root ganglion, except that it is associated with a cranial nerve instead of a spinal nerve. For example, the trigeminal ganglion is superficial to the temporal bone whereas its associated nerve is attached to the mid-pons region of the brain stem. The other major category of ganglia are those of the autonomic nervous system, which is divided into the sympathetic and parasympathetic nervous systems. The sympathetic chain ganglia constitute a row of ganglia along the vertebral column that receive central input from the lateral horn of the thoracic and upper lumbar spinal cord. Three other autonomic ganglia that are related to the sympathetic chain are the prevertebral ganglia, which are located outside of the chain but have similar functions. The neurons of these autonomic ganglia are multipolar in shape, with dendrites radiating out around the cell body where synapses from the spinal cord neurons are made. The neurons of the chain, paravertebral, and prevertebral ganglia then project to organs in the head and neck, thoracic, abdominal, and This OpenStax book is available for free at http://cnx. Another group of autonomic ganglia are the terminal ganglia that receive input from cranial nerves or sacral spinal nerves and are responsible for regulating the parasympathetic aspect of homeostatic mechanisms. These two sets of ganglia, sympathetic and parasympathetic, often project to the same organs—one input from the chain ganglia and one input from a terminal ganglion—to regulate the overall function of an organ. For example, the heart receives two inputs such as these; one increases heart rate, and the other decreases it. The terminal ganglia that receive input from cranial nerves are found in the head and neck, as well as the thoracic and upper abdominal cavities, whereas the terminal ganglia that receive sacral input are in the lower abdominal and pelvic cavities. Terminal ganglia below the head and neck are often incorporated into the wall of the target organ as a plexus. This can apply to nervous tissue (as in this instance) or structures containing blood vessels (such as a choroid plexus). For example, the enteric plexus is the extensive network of axons and neurons in the wall of the small and large intestines. The enteric plexus is actually part of the enteric nervous system, along with the gastric plexuses and the esophageal plexus. They have connective tissues invested in their structure, as well as blood vessels supplying the tissues with nourishment. The outer surface of a nerve is a surrounding layer of fibrous connective tissue called the epineurium.