By Z. Goose. Maharishi University of Management. 2018.

Many parents worry that stimulant medication may cause their child to become susceptible to future addiction order amaryl 1mg with mastercard. In addition cheap 4mg amaryl amex, stimulant treatment appears to decrease drug-related criminal behavior in 29 adults when they are taking their medication compared to when they are not purchase 1 mg amaryl with visa. Refills cannot be routinely ordered and phone orders to pharmacies to dispense these medications are severely limited. To achieve or maintain their “high,” recreational users also use methods to get stimulants into their blood stream quicker by snorting it or taking it intravenously. Parents should inform the child’s doctor if medication is missing or being taken inappropriately. As a general rule, these medications are best dispensed daily by a parent, unless the child is away at college. Common and predictable side effects from stimulant medication include reduced appetite, weight loss, problems sleeping, headaches, and stomach pain. Some children may experience a delay in growth in height during the first two years of treatment, but growth proceeds at a normal rate thereafter. Common side effects experienced with the non-stimulant medications clonidine and guanfacine may include a drop in heart rate and blood pressure, fainting, dizziness, drowsiness, fatigue, irritability, constipation, and dry mouth. Though there is a potential for a rapid rise in blood pressure and risk of stroke if these medications are stopped suddenly, this problem has not been reported with their extended release forms. Another non-stimulant, atomoxetine (Strattera), has been associated with the following more common side effects: nausea, vomiting, tiredness, upset stomach, headaches, weight loss in younger children, and sexual dysfunction in older adolescents/young adults. Side effects usually are not dangerous, but they should all be reported to your child’s doctor—especially if they cause discomfort or interfere with your child’s everyday activities. Side effects often can be reduced by adjusting the dose, adjusting the time of day it is administered, using another form of the medication, or switching to another medication. How can I best manage some of the common medication side effects my child may experience? If your child’s reduced appetite leads to weight loss, your child’s prescribing doctor may stop or reduce the dose of the medication in the summertime or on the weekends. If that doesn’t provide enough benefit, the doctor may lower the stimulant dose or switch to another stimulant medication with less effect on decreasing appetite. Regardless of the cause of your child’s sleep problems, setting up a healthy bedtime routine should help them get to sleep. Also, it is wise to restrict activities involving stimulating and distracting electronics, such as cell phones, video games, and television, before bedtime. There is some research indicating that blue- light emitting electronics such as computers and cell phones can decrease melatonin, a natural sleep 31 agent the body produces to induce sleep. If your child is taking a stimulant medication and a bedtime routine does not help the sleep problems, talk with your doctor about administering the medication earlier in the day. For children taking a long- acting stimulant medication, you can ask about changing to a shorter-acting medication (8 hours instead of 12 hours, for example). If your child is already taking short-acting medication, you can talk to the doctor about reducing the dose or stopping the medication in the afternoon to help your child get to sleep. Or, in certain instances, clonidine or guanfacine, melatonin, or a very low dose of a short-acting stimulant can be given at night to help with sleep. Snoring or an irregular breathing pattern may be an indicator of sleep apnea, a condition in which your child may have periods of not breathing while asleep. Drowsiness: If your child is taking a non-stimulant, guanfacine (Tenex, Intuniv), and/or clonidine (Catapres, Kapvay) and becomes sleepy in the daytime, your child’s doctor may recommend giving the medication at bedtime instead of in the morning, dividing the dose and administering the medication twice a day, or lowering the dose to reduce drowsiness. This is called “rebounding” by some doctors since the change in behavior occurs about the same time the stimulant medication is wearing off. Other Side Effects: If you have questions or concerns about these or other side effects, contact your child’s doctor. These include heart- related problems, hallucinations and agitation, suicidal thoughts, and liver problems that are both rare and serious. Since then, larger studies involving over 400,000 patients have 32,33 failed to identify any new cases. It has not been possible to determine whether or not a hidden heart defect, the medication, or a combination of the two caused the heart-related problems in the early reports. Be sure to tell the doctor if your child has a history of heart problems or symptoms, such as fainting, dizziness, or irregular heart rate. Also, inform the doctor if there is a family history of major heart problems or sudden death in young relatives. Taking the non-stimulant medication atomoxetine (Strattera) is associated with this rare, but potentially worrisome side effect. Children with a history of drug abuse may be at increased risk of misusing their stimulant medication.

Reporting from family and caregivers may be the way that the physician becomes aware of these impairments generic 2mg amaryl with visa. When at-risk individuals were asked to identify whether a facial expression represented fear purchase 1 mg amaryl free shipping, sadness buy amaryl 2mg online, or happiness, performances were signifcantly impaired. It is hypothesized that this early impairment may be associated with growing diffculties in social relations. It is important to note that understanding of emotions and memory for emotions is intact, it is the identifcation of emotion based on the complex processing of the face that becomes diffcult. Spouses often complain that their once-punctual spouse is often late and mis-estimates how long activities will take. For instance, the judgment of where the body is in relation to walls, corners or tables may be disturbed, resulting in falls and accidents. Although they were able to detect the smells, they were less able to identify what the smell was. Performances on traditional memory tests were intact although smell identifcation was impaired. Although not universal, this perceptual impairment can be associated with signifcant problems in daily life. They may be unable to recognize their own disabilities or evaluate their own behavior. However, unawareness may lead to anger and frustration when the individual cannot understand why he can no longer work at the same job, or enjoy the same freedom as before. It is sometimes called “organic denial,” or anosognosia, and is a condition that may last a lifetime. Organic denial can be confusing to health professionals, friends, and family members who may interpret the individual’s unawareness of symptoms as a willful decision to ignore what is known to be true, when the reality is that the individual simply does not perceive that what is happening to him or her represents symptoms of a disease. In such a case, the focus should be on mitigating the individual symptoms without repeatedly confronting the issue of the underlying diagnosis. Where there is noncompliance with therapy or nursing care because of unawareness, it may be useful to develop a contract that creates incentives for compliance while sidestepping discussion of the diagnosis. Executive Effciency Executive functions involve the highest forms of cognitive processing. Executive functions involve fundamental abilities that regulate the primary cognitive processes in the brain. These fundamental abilities include (but are not limited to) speed of cognitive processing, attention, planning and organization, initiation, perseveration, impulse control, and other regulatory processes impacting cognition. Changes to cognition are part of a constellation of behavioral and personality changes that are referred to as the “dysexecutive syndrome” in Chapter 6, the Psychiatric Disorder, later in this book. It appears that the brain compensates for dysfunctional circuitry by using “effortful” processing to do tasks that were once automatic, and by recruiting alternate areas of the brain for cognitive tasks, all of which slows processing speed. Divided attention is needed to drive a car while listening to the radio, talking to other passengers or reading a map. For most people, divided attention is impaired when we are tired, sick, or stressed. Daily tasks, such as attempts to follow a recipe, to maintain a daily planner, to complete a list of household errands, or to fll out applications or forms may become diffcult and frustrating, leading to outbursts of irritation and emotion. Even those who never before used daily planners or computer calendars may need to start. A lack of initiation is often misinterpreted as laziness, apathy or lack of interest, and may be a reason for poor performance at work. Perseveration, or being fxed on a specifc thought or action, can occur when behaviors are inadequately regulated by the brain. For instance, travel out of town, or a visit to the doctor or dentist, may disrupt a safe routine. As symptoms of the cognitive disorder, these outbursts may be caused by the loss of impulse control, from confusion or feelings of being overwhelmed, from a disruption in the ability to track time, or by frustration that one’s needs (however reasonable or unreasonable) are not being met. Assessing for and treating a mood disorder may diminish irritability and temper outbursts. Identifying the underlying causes of irritability and temper outbursts may help diminish their frequency and severity. Caregiver reporting may be an important means of tracking outbursts and their severity. You may fnd that family members or caregivers wish to speak with you privately about their loved one’s irritability and emotional outbursts. While irritability often passes quickly, outbursts do have the potential to become violent. Safety should always come frst and caregivers should be encouraged to prepare an exit strategy for leaving the house or calling for help if an outburst threatens to get out of control. Treatment for irritability and temper outbursts are discussed in detail in Chapter 6, the Psychiatric Disorder, later in this book. Language Communication, or the transfer of information from one person to another, requires a complex integration of thought, muscle control, and breathing.

You also learned how to incorporate applied tension into your exposure hierarchy in a safe manner purchase amaryl 1mg. In other words discount amaryl 2 mg overnight delivery, your interpretations buy generic amaryl 1mg on-line, beliefs, predictions, and asso- ciations regarding these situations determine whether you experience fear. Understanding the relationship between perceptions and fear lends some insight into why some people have medical phobias and others don’t. Quite sim- ply, people who perceive these situations as threatening or dangerous experience fear, whereas people who perceive them as safe are able to approach such situations with minimal anxiety. For example, if you have a history of fainting upon exposure to blood, your belief that you’re likely to faint the next time you see blood may indeed be a realistic one. For example, although it is true that dental treatment is sometimes uncomfortable, many people overestimate the amount of pain they’ll experience next time they go to the dentist. People who fear fainting during a blood test may overesti- mate just how terrible it would be to actually faint. It is these exaggerated or unrealistic beliefs and assumptions that this chapter is meant to help change. The strategies described in this chapter are often referred to as cognitive strategies or cognitive therapy. The word “cognitive” simply refers to processes involving thought, such as ruminating, thinking, imagining, remem- bering, paying attention, and related processes. Cognitive therapy involves helping people identify their patterns of negative thinking and replace negative thoughts with more balanced or realistic thoughts that are based on a thorough analysis of the evidence concerning the beliefs. Note that almost all studies on the treatment of blood and needle phobias are based on the exposure strategies discussed in chapter 5 (often combined with the tension exercises described in chapter 6 for those with a history of fainting). Most experts believe that exposure to a feared situation is the most powerful way to combat fear. The techniques described in this chapter are not meant to be used instead of the exposure-based strat- egies. Rather, they are meant to be used in addition to exposure, or perhaps to give you the courage you need to do the exposure exercises. For example, exposure may well be effective because it provides evidence that challenges anxious beliefs and assumptions. In fact, avoiding feared situations tends to increase the intensity of negative thinking. For example, Kent (1985) found that people with dental anxiety who visit the dentist infrequently are more likely to predict that their next visit to the dentist will be a negative experience, com- pared to people with the same level of dental anxiety who visit the dentist on a regular basis (probably because they believe they will need more extensive treatment). The effectiveness of the cognitive strategies described in this chapter is well established for certain types of anxiety problems, including panic disorder, in which people have rushes of panic out of the blue, and social anxiety disorder, in which people experience anxi- ety in social or performance situations (see Antony and Swinson 2000). However, unlike exposure-based treat- ments, cognitive therapies have not been studied much for fears of blood, needles, doctors, and dentists. In fact, there have been no large-scale studies on the effective- ness of cognitive therapy on blood and needle phobias in particular, though some initial case studies suggest that these strategies may be useful (Panzarella and Garlipp 1999; Thompson 1999). In the case of dental phobia, however, there are a few larger, well-controlled studies showing that changing your thoughts (often in addition to exposure) can lead to a reduction in dental anxiety (de Jongh et al. In many cases, the assumptions, perceptions, and predictions that contribute to fear occur very quickly, often outside of our awareness. In fact, the fear we experience in reaction to the situations we fear may seem to occur almost auto- matically. However, that doesn’t mean that our fear is not triggered by our perceptions of the situation. There are many examples of how our perceptions can influence our behavior even when we’re not aware that this is happening. When you first learn to drive, you need to think carefully about every little thing you do. You must pay attention to what’s happening on the road in front of you, but you also need to check your rearview mirror on occa- sion and attend to what’s happening off to the side. You may also check your speedometer, talk to the person in the passenger seat, make sure your feet are on the right pedals, and remember to change gears when necessary. However, over time, driving becomes second nature, and you can do many of these things automatically, paying only minimal attention. That doesn’t mean you aren’t interpreting your surroundings and making decisions based on your percep- tions. The fear you experience upon exposure to blood, needles, doctors, or dentists may be quick and automatic, but it’s probably changing your thoughts 119 related to your perception that the situation is dangerous or threatening in some way. The first step in changing your thoughts is to figure out what they are in the first place.