Indapamide

By S. Sibur-Narad. Columbus State University.

These kinds of trauma include disasters purchase 1.5 mg indapamide otc, accidents 1.5 mg indapamide with amex, physical abuse, rape, and other forms of severe stress (Cloninger & [17] Dokucu, 2008). Although the personality of people who are experiencing dissociative amnesia remains fundamentally unchanged—and they recall how to carry out daily tasks such as reading, writing, and problem solving—they tend to forget things about their personal lives—for instance, their name, age, and occupation—and may fail to recognize family and friends (van der [18] Hart & Nijenhuis, 2009). A related disorder, dissociative fugue, is a psychological disorder in which an individual loses complete memory of his or her identity and may even assume a new one, often far from home. The individual with dissociative fugue experiences all the symptoms of dissociative amnesia but also leaves the situation entirely. The fugue state may last for just a matter of hours or may continue for months, as it did with Jeffrey Ingram. Dissociative Identity Disorder You may remember the story of Sybil (a pseudonym for Shirley Ardell Mason, who was born in 1923), a person who, over a period of 40 years, claimed to possess 16 distinct personalities. Mason was in therapy for many years trying to integrate these personalities into one complete self. Sybil suffered from the most severe of the dissociative disorders, dissociative identity disorder. Dissociative identity disorder is a psychological disorder in which two or more distinct and individual personalities exist in the same person, and there is an extreme memory disruption regarding personal information about the other personalities (van der Hart & Nijenhuis, [20] 2009). Dissociative identity disorder was once known as “multiple personality disorder,‖ and this label is still sometimes used. In some cases of dissociative identity disorder, there can be more than 10 different personalities in one individual. Switches from one personality to another tend to occur suddenly, often [21] triggered by a stressful situation (Gillig, 2009). The host personality is the personality in control of the body most of the time, and the alter personalities tend to differ from each other in [22] terms of age, race, gender, language, manners, and even sexual orientation (Kluft, 1996). A shy, introverted individual may develop a boisterous, extroverted alter personality. Each [23] personality has unique memories and social relationships (Dawson, 1990). Women are more frequently diagnosed with dissociative identity disorder than are men, and when they are [24] diagnosed also tend to have more “personalities‖ (American Psychiatric Association, 2000). In part because they are so unusual and difficult to diagnose, clinicians and researchers disagree about the legitimacy of the disorders, and particularly about dissociative identity disorder. Some experts claim that Mason was highly hypnotizable and that her therapist unintentionally “suggested‖ the existence of her multiple personalities (Miller & [26] Kantrowitz, 1999). Explaining Anxiety and Dissociation Disorders Both nature and nurture contribute to the development of anxiety disorders. In terms of our evolutionary experiences, humans have evolved to fear dangerous situations. Those of us who had a healthy fear of the dark, of storms, of high places, of closed spaces, and of spiders and snakes were more likely to survive and have descendants. A fear of elevators may be a modern version of our fear of closed spaces, while a fear of flying may be related to a fear of heights. Neuroimaging studies have found that anxiety disorders are linked to areas of the brain that are associated with emotion, blood pressure and heart rate, decision making, and action [29] monitoring (Brown & McNiff, 2009; Damsa, Kosel, & Moussally, 2009). People who were abused in childhood are more likely to be anxious than those who had normal childhoods, even with the same genetic disposition to anxiety sensitivity [31] (Stein, Schork, & Gelernter, 2008). Although our life expectancy and quality of life have improved over the past 50 years, the same period has also created a sharp increase in anxiety [32] levels (Twenge, 2006). These changes suggest that most anxiety disorders stem from perceived, rather than actual, threats to our well-being. A single dog bite can lead to generalized fear of all dogs; a panic attack that follows an embarrassing moment in one place may be generalized to a fear of all public places. Behaviors become compulsive because they provide relief from the torment of anxious thoughts. Similarly, leaving or avoiding fear-inducing stimuli leads to feelings of calmness or relief, which reinforces phobic behavior. In contrast to the anxiety disorders, the causes of the dissociative orders are less clear, which is part of the reason that there is disagreement about their existence. Unlike most psychological orders, there is little evidence of a genetic predisposition; they seem to be almost entirely environmentally determined. Severe emotional trauma during childhood, such as physical or sexual abuse, coupled with a strong stressor, is typically cited as the underlying cause (Alpher, [33] [34] 1992; Cardeña & Gleaves, 2007). Kihlstrom, Glisky, and Angiulo (1994) suggest that people with personalities that lead them to fantasize and become intensely absorbed in their own personal experiences are more susceptible to developing dissociative disorders under stress. Does the anxiety keep you from doing some things that you would like to be able to do? Selective attention and emotional vulnerability: Assessing the causal basis of their association through the experimental manipulation of attentional bias. The epidemiology and cross-national presentation of obsessive-compulsive disorder.

Phytostanols are added to foods (margarine spreads and salad dressings) and sold as supplements; studies have shown that phytostanols and stanol esters can lower cholesterol levels indapamide 1.5 mg visa. It may enhance the effects of blood-thinning drugs and supplements so dosage adjustments may be necessary; it is not recommended during pregnancy or breast-feeding discount 2.5 mg indapamide with mastercard. They are also present in some fermented dairy foods (live culture yogurt), although potency and stability is questionable. They provide many health benefits by protecting against infection by harmful bacteria (yeast and bacteria), aiding in detoxification, producing vitamins, aiding digestion, and supporting immune function. Research supports benefits for travellers’ diarrhea, constipation, irritable bowel, ulcerative colitis, eczema, aller- gies, and tooth decay. They also improve immune function, reduce cholesterol, prevent and treat yeast infections, and enhance ulcer treatment. Choose products that are tested for potency and stability, and made from human strains. Studies have found it beneficial for improving symptoms of an enlarged prostate; it may also be beneficial for prostatitis (prostate infection). It is often combined with saw palmetto or nettle root, which are also beneficial for reducing prostate symptoms, and is very well tolerated. Recent research has focused on its isoflavones, which work as phytoestrogens, with possible benefits for menopause. It may help reduce cholesterol levels and protect against osteoporosis by re- ducing bone loss. It is not recommended during pregnancy, breast-feeding, or for use by those with breast or uterine cancer. It may enhance the effect of blood-thinning drugs, so dosage adjustments may be necessary. It promotes relaxation without sedation, normalizes stress hormones, and reduces stress-related eating. Studies have demonstrated benefits for reducing fatigue and enhancing mental function. Preliminary research suggests that it may help with altitude sickness and may aid cancer chemotherapy by pro- tecting the liver against drug-induced damage. Research shows that supplements can benefit those with depression, os- teoarthritis, liver disease, and fibromyalgia. It may also reduce depression associated with Parkinson’s disease, and is generally well tolerated, but may cause mild upset stomach. It is not recommended for those with bipolar disorder; use cautiously with other antidepressant products. Studies show that it can help reduce an enlarged prostate and improve urinary symptoms, similarly to prescription drugs, but it is better tolerated. It may also be helpful for the treatment of prostatitis, and is generally well tolerated. Soy iso- flavones may help reduce menopausal symptoms (hot flashes); preliminary research suggests it may reduce the risk of breast, uterine, and colon cancer, and benefit those with osteoporosis and osteoarthritis. It is not recommended for those with impaired thyroid function; high supplemental intake is not recommended during pregnancy. John’s wort is an herb with a long history of use for treating emotional disorders. Research supports its use for mild to moderate depression and seasonal affective disorder with effects comparable to those of prescription drugs. It may reduce the efficacy of many drugs, including oral contraceptives, organ transplant medications, digoxin, statins, warfarin, proton-pump inhibitors (ulcer drugs), and anaesthetics; consult with your pharmacist before taking this herb. Preliminary research suggests benefits for improving the quality of sleep and enhancing learning performance, reducing the symptoms of premenstrual syn- drome, heightening mental acuity, promoting concentration, reducing negative side effects of stress and caffeine, and supporting immune function. Topical products have been found effective for improving acne and athlete’s foot, but may cause skin irritation in some individuals. Some studies have found benefits with valerian when it is combined with hops and/or lemon balm. It is generally well tolerated, and does not cause next-day drowsiness when taken at bedtime. It contains salicin, which is purified to salicylic acid (similar to the active ingredient in aspirin). It may also help with dysmenor- rhea, tension and migraine headaches, rheumatoid arthritis, tendonitis, and bursitis. It is generally well tolerated, but may cause upset stomach, although not to the same extent as aspirin, which causes stomach irritation and bleeding. It may enhance the effect of blood-thinning products, so dosage adjustments may be necessary. While these advances in science are exciting and offer great hope, how do we take this information and put it into practical use in our own lives?

Alterations in sensory perception may occur indapamide 1.5 mg line, and the indi- vidual may experience hallucinations cheap 1.5 mg indapamide visa. Unless the client is placed in a protective environment, death can occur from exhaustion or injury. Assign a private room, if pos- sible, with soft lighting, low noise level, and simple room decor. In the hyperactive state, the client is extremely distractible, and responses to even the slightest stimuli are exaggerated. He or she feels more secure in a one-to-one rela- tionship that is consistent over time. Remove hazardous objects and substances from client’s environment (including smoking materials). Stay with the client to offer support and provide a feeling of security as agitation grows and hyperactivity increases. Provide structured schedule of activities that includes estab- lished rest periods throughout the day. Provide physical activities as a substitution for purpose- less hyperactivity (examples: brisk walks, housekeeping chores, dance therapy, aerobics). Physical exercise pro- vides a safe and effective means of relieving pent-up tension. Antipsychotic drugs are commonly prescribed for rapid relief of agitation and hyperactivity. Client exhibits no evidence of physical injury obtained while experiencing hyperactive behavior. Maintain low level of stimuli in client’s environment (low light- ing, few people, simple decor, low noise level). Close observation is required so that intervention can occur if required to ensure client’s (and others’) safety. Remove all dangerous objects from client’s environment (sharp objects, glass or mirrored items, belts, ties, smoking Mood Disorders: Bipolar Disorders ● 151 materials) so that in his or her agitated, hyperactive state, client may not use them to harm self or others. Try to redirect the violent behavior with physical outlets for the client’s hostility (e. Intervene at the first sign of increased anxiety, agitation, or verbal or behavioral aggression. Offer empathetic response to client’s feelings: “You seem anxious (or frustrated, or an- gry) about this situation. Have sufficient staff available to indicate a show of strength to client if necessary. This conveys to the client evidence of control over the situation and provides some physical secu- rity for staff. If the client is not calmed by “talking down” or by medi- cation, use of mechanical restraints may be necessary. The avenue of the “least restrictive alternative” must be selected when planning interventions for a violent client. Restraints should be used only as a last resort, after all other interven- tions have been unsuccessful, and the client is clearly at risk of harm to self or others. If restraint is deemed necessary, ensure that sufficient staff is available to assist. The physician must reissue a new order for restraints every 4 hours for adults and every 1 to 2 hours for children and adolescents. The Joint Commision requires that the client in restraints be observed every 15 minutes to ensure that circulation to extremities is not compromised (check temperature, color, pulses); to assist client with needs related to nutrition, hy- dration, and elimination; and to position client so that com- fort is facilitated and aspiration can be prevented. As agitation decreases, assess client’s readiness for restraint removal or reduction. In collaboration with dietitian, determine the number of calo- ries required to provide adequate nutrition for maintenance or realistic (according to body structure and height) weight gain. Provide client with high-protein, high-calorie, nutritious finger foods and drinks that can be consumed “on the run. The likelihood is greater that he or she will consume food and drinks that can be carried around and eaten with little effort. Nutritious intake is required on a regular basis to compensate for increased caloric requirements due to hyperactivity. This information is necessary to make an accurate nutritional assessment and maintain client’s safety. Determine client’s likes and dislikes, and collaborate with dietitian to provide favorite foods. Administer vitamin and mineral supplements, as ordered by physician, to improve nutritional state. Presence of a trusted individual may provide feeling of security and decrease agitation. Encouragement and posi- tive reinforcement increase self-esteem and foster repeti- tion of desired behaviors. Client may have inadequate or inaccurate knowledge regarding the contribution of good nutrition to overall wellness.