By P. Ramirez. University of Houston, Downtown.

Again buy generic olanzapine 20 mg on line, Baumeister and his colleagues have found a number of indications that people who believe that they have been abducted may be using the belief as a way of escaping self-consciousness order 5mg olanzapine with mastercard. Hypnosis as sole anesthesia for major surgeries: Historical & contemporary perspectives. Cognitive stage regression through hypnosis: Are earlier cognitive stages retrievable? Hypnosis in the treatment of trauma: A promising, but not fully supported, efficacious intervention. International Journal of Clinical Experimental Hypnosis, 48, 225–238; Montgomery, G. International Journal of Clinical and Experimental Hypnosis, 48(2), 138–153; Patterson, D. Restricted environmental stimulation techniques in health enhancement and disease prevention. Effects of flotation rest (restricted environmental stimulation technique) on stress related muscle pain: Are 33 flotation sessions more effective than 12 sessions? Progressive muscle relaxation and restricted environmental stimulation therapy for chronic tension headache: A pilot study. Restricted environmental stimulation and smoking cessation: A 15-year progress report. Mindfulness-based stress reduction and health-related quality of life in a heterogeneous patient population. Impact of Transcendental Meditation® on cardiovascular function at rest and during acute stress in adolescents with high normal blood pressure. Electrophysiological characteristics of sensory processing and mobilization of hidden brain reserves. Long-term meditators self-induce high- amplitude gamma synchrony during mental practice. Long-term meditators self-induce high- amplitude gamma synchrony during mental practice. Escaping the self: Alcoholism, spirituality, masochism, and other flights from the burden of selfhood. Escaping the self: Alcoholism, spirituality, masochism, and other flights from the burden of selfhood. Consciousness is functional because we use it to reason logically, to plan activities, and to monitor our progress toward the goals we set for ourselves. Freud‘s personality theories differentiated between the unconscious and the conscious aspects of behavior, and present-day psychologists distinguish between automatic (unconscious) and controlled (conscious) behaviors and between implicit (unconscious) and explicit (conscious) cognitive processes. The French philosopher René Descartes (1596–1650) was a proponent of dualism, the idea that the mind, a nonmaterial entity, is separate from (although connected to) the physical body. In contrast to the dualists, psychologists believe the consciousness (and thus the mind) exists in the brain, not separate from it. Sleep researchers have found that sleeping people undergo a fairly consistent pattern of sleep stages, each lasting about 90 minutes. Sleep has a vital restorative function, and a prolonged lack of sleep results in increased anxiety, diminished performance, and if severe and extended, even death. Sleep deprivation suppresses immune responses that fight off infection, and can lead to obesity, hypertension, and memory impairment. Freud believed that the primary function of dreams was wish fulfillment, and he differentiated between the manifest and latent content of dreams. Other theories of dreaming propose that we dream primarily to help with consolidation—the moving of information into long-term memory. The activation-synthesis theory of dreaming proposes that dreams are simply our brain‘s interpretation of the random firing of neurons in the brain stem. Psychoactive drugs are chemicals that change our states of consciousness, and particularly our perceptions and moods. The use (especially in combination) of psychoactive drugs has the potential to create very negative side effects, including tolerance, dependence, withdrawal symptoms, and addiction. Stimulants, including caffeine, nicotine, cocaine, and amphetamine, are psychoactive drugs that operate by blocking the reuptake of dopamine, norepinephrine, and serotonin in the synapses of Attributed to Charles Stangor Saylor. Some amphetamines, such as Ecstasy, have very low safety ratios and thus are highly dangerous. They are widely used as prescription medicines to relieve pain, to lower heart rate and respiration, and as anticonvulsants. Toxic inhalants are some of the most dangerous recreational drugs, with a safety index below 10, and their continued use may lead to permanent brain damage. Opioids, including opium, morphine, heroin, and codeine, are chemicals that increase activity in opioid receptor neurons in the brain and in the digestive system, producing euphoria, analgesia, slower breathing, and constipation.

Fifty years later cheap 20 mg olanzapine with amex, approximately 30 per cent of the adult population still smoke even though most of Fig buy olanzapine 10 mg on line. In fact, research exploring whether smokers appreciate the risks of smoking in comparison with the risks of murder and traffic accidents showed that smokers were accurate in their perception of the risks of smoking and showed similar ratings of risk to both ex-smokers and never smokers (Sutton 1998b). The early health promotion campaigns focused mainly on the determinants of smoking in adult men, but over recent years there has been an increasing interest in smoking in children. It is therefore difficult to distinguish between actual initiation and maintenance of smoking behaviour. Smoking in children Doll and Peto (1981) reported that people whose smoking is initiated in childhood have an increased chance of lung cancer compared with those who start smoking later on in life. This is particularly significant as most adult smokers start the habit in childhood and very few people start smoking regularly after the age of 19 or 20 (Charlton 1992). Lader and Matheson (1991) reviewed the data from national surveys between 1982 and 1990 and indicated that smoking behaviour in 11- to 15-year-old school boys – including those boys who have just tried a cigarette – had fallen from 55 per cent to 44 per cent and that smoking in school girls of a comparable age had fallen from 51 per cent to 42 per cent. Although this showed a decrease, it was less than the decrease shown in adult smoking, and the data showed that in 1990 nearly a half of the school children had at least tried one cigarette. In fact, many children try their first cigarette whilst at primary school (Murray et al. Psychological predictors of smoking initiation In an attempt to understand smoking initiation and maintenance, researchers have searched for the psychological and social processes that may promote smoking behaviour. Models of health behaviour such as the health belief model, the protection motivation theory, the theory of reasoned action and the health action process approach (see Chapter 2) have been used to examine the cognitive factors that contribute to smoking initiation (e. Additional cognitions that predict smoking behaviour include associating smoking with fun and pleasure, smoking as a means of calming nerves and smoking as being sociable and building confidence, all of which have been reported by young smokers (Charlton 1984; Charlton and Blair 1989; see also Chapter 11 for a discussion of smoking and stress reduction). Social predictors of smoking initiation and maintenance Much research focuses on the individual and takes the individual out of their social context. Individual cognitions may predict smoking behaviour but they are a product of the individual’s socialization. Interactions within the individual’s social world help to create and develop a child’s beliefs and behaviour. The main factor that predicts smoking is parental smoking, with reports that children are twice as likely to smoke if their parents smoke (Lader and Matheson 1991). In addition, parents’ attitudes to smoking also influence their offsprings’ behaviour. For example, if a child perceives the parents as being strongly against smoking, he or she is up to seven times less likely to be a smoker (Murray et al. The results showed that individuals who are identified by themselves and others as being problem-prone, doing poorly at school, rarely involved in school sports, high in risk-taking behaviour such as alcohol and drug use, and with low self-esteem were more likely to have smoked (Mosbach and Leventhal 1988; Sussman et al. On the other hand, research has also found that high rates of smoking can also be found in children who are seen as leaders of academic and social activities, have high self-esteem and are regarded as popular by their peers (Mosbach and Leventhal 1988). Another factor that influences whether children smoke is the attitude of their school to smoking behaviour. A Cancer Research Campaign study (1991) found that smoking prevalence was lower in schools that had a ‘no smoking’ policy, particularly if this policy included staff as well as students. In summary, social factors such as the behaviour and beliefs of parents, peers and schools influence the beliefs and behaviours of children. Using an entirely different methodology, Graham used interviews with low income women with pre-school children to explore the contextual factors which may maintain smoking behaviour. She argued that although smoking is seen by researchers as unhealthy and something to be prevented, the women in her study regarded smoking as central to their attempts to ‘reconcile health keeping and housekeeping when their reserves of emotional and physical energy may be seriously depleted’ (Graham 1987: 55). She stated that smoking works to promote these women’s sense of well-being and to help them cope with caring. She reports that smoking can be seen as ‘the only activity they do, just for themselves’. Smoking is therefore a product not only of beliefs but also an individual’s social world. Alcohol initiation and maintenance Most people try alcohol at some time in their lives. The most common reasons for never drinking alcohol were religion and not liking it. Therefore, rather than examining predictors of drinking ‘ever’ or ‘occasionally’, this section examines what factors predict developing a problem with drinking. Psychological predictors of alcohol initiation and maintenance The tension-reduction hypothesis (Cappell and Greeley 1987) suggests that individuals may develop a drink problem because alcohol reduces tension and anxiety. However, it has been suggested that it is not the actual effects of alcohol use that promote drinking but the expected effects (George and Marlatt 1983). Therefore, because a small amount of alcohol may have positive effects people assume that these positive effects will continue with increased use. This perspective is in line with the social learning model of addictive behaviours and emphasizes the role of reinforcement and cognitions.

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He sued the University for libel and won $40 generic olanzapine 2.5 mg amex,000 in court buy 5mg olanzapine overnight delivery, but he did not return to the institution. Subsequently, he returned to Leipzig and earned his Instead, he attempted further application of psychologi- doctorate with Wundt, although his correspondence with cal testing when he founded the Psychological Corpora- his parents revealed that Cattell did not hold Wundt in tion, a company organized to promote commercial psy- high esteem as a scientist. His entrepreneurial abilities failed him ters also depict Cattell as arrogant, self-confident, and in this endeavor, however; the company earned only disrespectful of others. After he left, the or- proved on existing psychological instrumentation and in- ganization began to prosper, and today, the Psychologi- vented new ways to study psychological processes. Cattell contin- After leaving Germany, Cattell taught briefly in the ued his work as a spokesperson for applied psychology United States, then traveled to England and worked with until his death. Raymond Bernard Cattell 1905-1998 American psychologist who designed personality and intelligence tests and espoused controversial theories of eugenics. In a career spanning over half a century he wrote more than 50 books and 500 research articles, and his contributions to personality and intelligence testing are widely regarded as invaluable. Yet some of his theories about natural selection, particularly as put forth in a philos- ophy known as Beyondism, were attacked as racist and caused a bitter controversy only months before his death. Cattell was born in Hilltop, England, on March 20, Raymond Cattell (Archives of the History of American 1905. He attended the University of London, where he received his undergraduate degree in chemistry in 1924 and his Ph. He Cattell retired from the University of Illinois in 1973 taught briefly and worked at a psychology clinic until and after five years in Colorado moved to Hawaii. There, 1937, when he moved to the United States to take a teach- he accepted a part-time position at the University of ing position at Columbia University. From there he moved Hawaii, where he continued to teach, conduct research, on to Clark University and Harvard before arriving in 1946 and write. He also took the opportunity to spend leisure at the University of Illinois, where he stayed for 27 years. Innovator of personality tests Beyondism and a storm of controvery During the Second World War, in addition to his teaching duties, Cattell worked in the Adjutant General’s The publication of Beyondism: Religion from Sci- office, where he devised psychological tests for the mili- ence in 1987 dramatically altered the remainder of Cat- tary. Throughout his career, Cattell created a number of tell’s life as well as his scientific legacy. Cattell intended such tests to measure intelligence and to assess personal- the book to be a discussion of his theories on evolution ity traits. However, his advocacy of eugenics personality traits, such as emotional stability (easily (the study of improving the human race), was extremely upset vs. Cattell measured with what Cattell calls “second-order factors,” claimed, for example, that among the tenets of Be- including extroversion, anxiety, and independence. The yondism was the idea that races as we know them today test is still widely used by corporations and institutions would not exist in the future. The fact that Cattell had ac- knowledged Arthur Jensen and William Shockley— two scientists who had claimed that blacks were geneti- cally less intelligent than whites—in his book only fur- thered people’s suspicions. Cattell, ninety-two years old and in failing health, attempted to resolve the furor by declining the award. He asserted that he detested racism, and that he had only ever advo- cated voluntary eugenics. His health declined further, and he died quietly on February 2, 1998, at home in Hawaii. Milite Further Reading The brain and spinal cord comprise the central nervous Cattell, Raymond B. At the right is a magnified view of the spinal cord York Praeger Publishers, 1987. Factor Analysis: An Introduction and individual axon covered with a myelin sheath. The junction between the axon of one cell and the dendrite of another is a minute gap, eighteen millionths of an inch wide, which is called a synapse. Central nervous system The spinal cord is a long bundle of neural tissue In humans, that portion of the nervous system that continuous with the brain that occupies the interior lies within the brain and spinal cord; it receives im- canal of the spinal column and functions as the primary pulses from nerve cells throughout the body, regu- lates bodily functions, and directs behavior. It is the origin of 31 bilateral pairs of spinal nerves which radiate outward from the central nervous system The central nervous system contains billions of through openings between adjacent vertebrae. The spinal nerve cells, called neurons, and a greater number of sup- cord receives signals from the peripheral senses and re- port cells, or glia. Its sensory neurons, which send the only function of glial cells—whose name means sense data to the brain, are called afferent, or receptor, “glue”—was to hold the neurons together, but current re- neurons; motor neurons, which receive motor commands search suggests a more active role in facilitating commu- from the brain, are called efferent, or effector, neurons. The neurons, which consist of three elements— dendrites, cell body, and axon—send electrical impulses The brain is a mass of neural tissue that occupies the from cell to cell along pathways which receive, process, cranial cavity of the skull and functions as the center of store, and retrieve information. It is com- posed of three primary divisions: the forebrain, midbrain, Cerebral cortex and hindbrain, which are divided into the left and right hemispheres and control multiple functions such as re- See Brain ceiving sensory messages, movement, language, regulat- ing involuntary body processes, producing emotions, thinking, and memory. The first division, the forebrain, is the largest and most complicated of the brain structures and is responsible for most types of complex mental ac- Character tivity and behavior. It is involved in a huge array of re- sponses, including initiating movements, receiving sensa- General term in psychology used to describe be- tions, emoting, thinking, talking, creating, and imagining. Its parts, which are covered by the Character is most often used in reference to a set of cerebral cortex, include the corpus callosum, striatum, basic innate, developed, and acquired motivations that septum, hippocampus, and amygdala.

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Upon arrival discount olanzapine 7.5 mg on line, she does not open her eyes olanzapine 7.5mg without a prescription, is verbal but not making any sense, and withdraws to painful stimuli. As you prepare to intu- bate the patient, a colleague notices that her left pupil has become dilated compared to the right. The man tells you his name and complains of right-sided chest pain and difficulty breathing. On primary survey, his airway is patent and his oropharynx has no blood or displaced teeth. He is breathing at 32 beats per minute with retractions and an oxygen saturation of 88% on 15 L of oxygen. These individuals are often amnestic to the event and frequently ask the same questions over and over again (perseverations). Headache with or without vomiting is generally present; however, there are no focal neurologic findings on examination. Diffuse axonal injury (b) is caused by microscopic shearing of brain nerve fibers. Patients typically present unconscious and remain in a coma for a prolonged period of time. The clinical features of a cerebral contusion (c) are similar to those of a concussion except neuro- logic dysfunction is more profound and prolonged and focal deficits may be present if contusions occur in the sensorimotor area. Posttraumatic epilepsy (d) is associated with intracranial hematomas and depressed skull fractures. Some scientists believe that head trauma predis- poses to Alzheimer disease (e); however, this would take years to develop. Although they are all associated with potentially fatal complications, they should be viewed clinically as a continuous spec- trum of myocardial damage: concussion (no permanent cell damage), contu- sion (permanent cell damage), infarction (cell death), tamponade (bleeding into the pericardium), and rupture (exsanguination). The mechanism of injury in a cardiac contusion involves a high-speed deceleration, which causes the heart to move forward, forcibly striking the sternum. In addition, the direct force of hitting an object (eg, the steering wheel) also can damage 148 Trauma Answers 149 the heart. The right ventricle is the most commonly injured because it is the most anterior aspect of the heart and is closest to the sternum. The earliest signs of hemorrhagic shock are tachycardia and cutaneous vaso- constriction. The amount of blood loss present can be estimated based on the individual’s initial clinical presentation. Many of these injuries are treat- able mainly because the patients are young and otherwise healthy. The pri- mary role of the emergency physician is to assess, resuscitate, and stabilize the trauma patient by priority. The first, classified as immediate death, is the period with the greatest number of fatalities. This occurs within seconds to minutes of the injury and these patients generally die at the scene. The cause is most commonly because of massive head injury, followed by high cervical spine injury with spinal cord disruption, cardiac and great vessel rupture, and airway obstruc- tion. The second peak period, classified as early death, occurs within min- utes to a few hours of injury. This is the period called the “golden hour” where intervention is critical and significantly reduces the morbidity and mortality rate in these patients. Death in these patients is generally sec- ondary to subdural and epidural hematomas. Other causes of death in this group include ruptured spleen, lacerated liver, hypovolemic shock, fracture 150 Emergency Medicine of pelvis or multiple long bones, hemopneumothorax, tension pneumotho- rax, cardiac tamponade, and aortic dissection or rupture. The third peak period, classified as delayed death, occurs days to weeks following the ini- tial injury. Death in these patients is usually a result of multisystem organ failure and sepsis. It is inexpensive, nonin- vasive, and confirms the presence of hemoperitoneum in minutes. The minimum amount of intraperitoneal fluid needed for detection by ultra- sound is approximately 70 cc. It is considered an unstable fracture and is associated with C2 fractures 40% of the time. On plain radi- ograph, it is best seen on the open-mouth odontoid view as the lateral masses are shifted laterally. It is associated with diving accidents and in this scenario, “spearing” in a football game, which places an increased axial load to the cervical spine. Trauma Answers 151 (a) Odontoid fractures occur when there is a fracture through the odontoid process of the C2 vertebra. This injury disrupts all of the cervical ligaments, facet joints, and causes a triangular fracture of a portion of the vertebral body. The most likely cause is cardiac tam- ponade, which occurs in approximately 2% of anterior penetrating chest traumas.