By H. Arokkh. Vanderbilt University.

It is hypothesized (Edrya et al 2006) that voluntary slow deep breathing functionally resets the autonomic Depression nervous system through stretch-induced inhibitory signals and hyperpolarization currents propagated Manipulation and depression through both neural and non-neural tissue which syn- • Depression retards benefits of physical treatment chronizes neural elements in the heart 10mg metoclopramide with mastercard, lungs order metoclopramide 10 mg without prescription, limbic methods: While anxiety had little or no effect system and cortex buy 10mg metoclopramide with amex. Both musculoskeletal pain, involving a inhibitory impulses and hyperpolarization current are multidisciplinary treatment program known to synchronize neural elements, leading to the incorporating myofascial technique physical modulation of the nervous system and decreased therapy, clinical psychophysiology metabolic activity indicative of the parasympathetic (biofeedback, counseling), medications and state. It is proposed that pranayama’s (breathing trigger point injections (Sorrell et al 2003). The patients were given baseline assessments Physical medicine therapeutic measures including pain visual analog scale, Profile of for cardiovascular disease Mood States, and the Global Well-being Scale. Patients were re-evaluated attention to ribs 1, 2 and 3 and the upper thoracic at the end of the 3-day session and at weekly spine, is potentially helpful in cases of congestive intervals throughout the course of care. The Profile of Mood States the quality of life with regard to factors of reflected favorable changes in all areas. The trial involved three patients whose depression is reactive – for example, massage sessions at set times and sessions in people suffering from phobic conditions and panic in two control groups of relaxation and attacks. Under the control conditions there was Osteopathic manipulative therapy, depression and no touching. The effects of depression-specific panic disorder variables were measured by both the patients’ Michaud (2004) tested the proposal that an osteo- own assessment and that of an independent pathic approach could be seen as an alternative treat- observer. Results: Under conditions of both ment to the two types of presently proposed therapies, massage and control, comparison of before and alone or combined (pharmacological, psychological). These diagnosis; (b) psychological evaluation with groups were compared to each other and to a the six questionnaires; (c) osteopathic non-depressed group at the end of pregnancy. The massage therapy group participants • Step 2: Osteopathic therapy: four sessions of received two 20-minute therapy sessions (by osteopathic treatment according to protocol their significant others) each week for 16 weeks (around 1 hour each). The relaxation group provided re-evaluating the subjects with the same themselves with progressive muscle relaxation psychological questionnaires as in step 1. Results: First, the results that were of anxiety and depressed mood and less leg 452 Naturopathic Physical Medicine and back pain. Clinically, massage group had higher dopamine and encouraging depressed patients to engage in serotonin levels and lower levels of cortisol physical activity is likely to have potential and norepinephrine. Twenty depressed, community- suggest that depressed pregnant women and dwelling older adults (average age = 69) their offspring can benefit from massage completed a pilot study of ballroom dance therapy. Field lessons from a selection of six dances (foxtrot, et al (2005) report that in studies in which waltz, rumba, swing, cha-cha and tango) from cortisol was assayed either in saliva or in urine, the National Dance Council of America’s significant decreases were noted in cortisol syllabus. In studies efficacy and hopelessness as outcome in which the activating neurotransmitters predictors. Participant feedback indicated the (serotonin and dopamine) were assayed in dance lessons were enjoyable and urine, an average increase of 28% was noted well-received. These studies between exercise and mental well-being have combined demonstrate the stress-alleviating been well documented. A meta-analysis of 11 effects (decreased cortisol) and the activating treatment outcome studies of individuals with effects (increased serotonin and dopamine) of depression yielded a very large combined massage therapy on a variety of medical effect size for the advantage of exercise over conditions and stressful experiences. Based on these findings naturopaths are strongly Naturopathic care of individuals with depression encouraged to consider the role of exercise interven- should clearly consider incorporating massage as part tions in care of depressed patients. Hydrotherapy and depression Exercise and depression There is a modest degree of support for the value of • Physical activity and depression: A 10-year study spa therapy (thermal, flotation, chemical) in treatment by Harris et al (2006) examined associations of moderate depression; however, since the majority between physical activity, exercise coping and of spas do not accept individuals with serious behav- depression in a sample of initially depressed ioral problems or those who are at risk of suicide, this patients. These patients (n = 424) completed form of therapeutic intervention offers only limited measures of physical activity, exercise coping, evidence of value in such conditions (Dubois 1973, depression, and other demographic and Dubois & Arnaud 1983, Guillard 1990). Physical activity counteracted the reduce anxiety and depression in patients with chronic effects of medical conditions and negative life pain (Kjellgren et al 2001). It appears that physical cedure in which the individual was immersed in a activity may be especially helpful in the tank filled with water of an extremely high salt con- context of depression associated with medical centration. The results indicated that the most severe perceived pain intensity was significantly reduced, Patients with diagnosed fibromyalgia received whereas low perceived pain intensity was not influ- 30 chiropractic treatments that combined ischemic enced. After 30 days there was an average dence offered suggests that additional benefit is avail- lessening of 77. The improvement in the three outcome measures was maintained after 1 month without Physical medicine therapeutic treatment. The treatment approach involves extensive • Spa treatment appears to offer benefit for some education related to nutrition, diet, and people with depression. The syndrome (see also instinctive sleep nutritional education consisted of encouraging postures in Chapter 9) patients to increase vegetable consumption and reduce Apart from pain, fatigue is one of the most wide- dietary animal protein. Supplementation consisted of spread of symptoms (Lane et al 1990), ranging from ground barley plant tablets, a digestive enzyme, and mild to extreme, intermittent and fluctuating to con- trace minerals. Clearly, with These tests commonly involve strength assessment of etiologies that range from endocrine to nutritional, the arm or leg. During the test, while in the supine psychological to physiological and/or pathological, position, the patient is asked to think about the chief there are no magic bullets for remedying fatigue, any complaint, or the major stress in their life. The treating doctor then places coping systems and/or excessive demands of a physi- the patient prone and uses leg-length assessment in an cal or psychological nature, or just plain breakdown attempt to evaluate ‘balance’. Causes, as with most health length variations other than anatomical variations that problems, usually lie in a combination of the three would suggest autonomic imbalance, then a treatment major influences: biochemical, psychosocial or biome- is administered. Self-regulating processes that are over- hand on the back of the skull of the prone patient, and whelmed or underfunctioning need to be identified the other on the sacrum.

French physicians could not understand the absence of full-time doctors in British (or Irish) asylums cheap metoclopramide 10 mg otc. Dr Francis White was appointed Inspector 3987 of Lunatics metoclopramide 10 mg line, joined some time afterwards by Dr John Nugent buy 10mg metoclopramide with visa. According to a Select Committee of 1814/15, corpses were simply left in some rooms where there were patients, and two or three patients were in the one single bed. In 1861, Ireland officially had 7,065 lunatics and 7,033 idiots, both categories being divided equally between the sexes. McClelland (1988) posits two chief reasons for the 3990 increase in Irish asylum provision : recognition of the numerical frequency of the problem in the community and the prevailing poverty that meant that relatives could not afford home-based care. Kelly (2010), while discussing the modern early intervention in psychosis debate, suggested that Hallaran advocated early, frequent and prolonged use of emetics in psychotic patients and quoted Hallaran as insisting that patients became more subdued as a result of this intervention! Walsh (1992a) hailed Norman as ‘probably the most far-sighted and perceptive of all Irish psychiatrists’. Asylums become known as psychiatric hospitals following the 1925 Local Government Act. In 1947 the law for the first time allowed for the admission of voluntary patients to Irish psychiatric hospitals under the Mental Treatment Act of 1945. In recent years the high walls around institutions were torn down, community-based services were developed to a variable degree, psychiatric in-patient and outpatient services were developed at general 3997 hospitals. Alexander Jackson (1767-1848) was the first physician to the Richmond Asylum, Dublin, from 1815; started private asylum, Farnham, at Finglas north of Dublin. The 2001 Act has considerable resource implications and caused some unease when it was introduced. The Brahmans 3999 of India practiced suttee where widows fell on the pyre of her late husband. An 1823 Act in Britain abolished the practice of burying suicides and murderers in unconsecrated ground. Anthony Clare (1942-2007) Finally, in 2002, the then Irish Division of the Royal College of Psychiatrists spawned separate Sections for the Republic and for Northern Ireland. This move, following hard on the heels of the inauguration of the Irish Psychiatric Association, was in response to the necessity of having a separate organisation to deal with issues directly relating to the Republic. In 2002 the Republic Section of the Irish Division became the Irish College of Psychiatrists (Coláiste Sīciatraithe na hĒireann). Political changes in Britain spurred moves to 4000 an autonomous Irish college, The College of Psychiatry of Ireland (Coláiste Sicīatrachta na hĒireann) which came into being on January 1, 2009. Dr William Battie, in the same period, noted that staff was ignorant, disinterested, and transient. His first attendant, George Jepson, employed a humanitarian approach, with Bible readings, discussions on healthy living, and seaside outings. Dr Thomas Story Kirbride of the Pennsylvania Hospital commenced formal instruction in 1843. In 1851, Dr W A F Browne, of the Crichton Royal Hospital, Dumfries, in Scotland, started an organised course for attendants. The world’s first School of Nursing, at McLean Hospital, was opened in 1879 (some authors date it from 1882), another being opened at Buffalo State Hospital in 1883. The first national training scheme for mental nurses/attendants started in 1891, successful candidates receiving a Certificate of Proficiency in Nursing the Insane. Males 4001 were not accepted as members of the Royal College of Nursing until 1960. The Asylum Workers’ Association was formed in 1896 to improve the low status of asylum workers. The Asylum Workers’ Union started in 1910, followed eight years later by industrial action. The College incorporates the Irish Psychiatric Training Committee, the Irish College of Psychiatrists, and the Irish Psychiatric Association. According to Nolan (1991), the introduction of courses and certificates did little to improve the lot of attendants, and may have helped to prompt the formation of unions in protest at poor working conditions. Lena Peat of Warlingham Park Hospital, Surrey, with the backing of the hospital’s medical superitentent T 4002 P Rees, became the first community psychiatric nurse in Britain in 1954. A nursing post created to look after the chronically ill in the community has become increasingly aligned with primary care and, arguably, 4003 the less severely ill. Project 2000 in England removed nurse education from hospitals (apprenticeship model) and into 4004 universities (theoretical model). An 18-month foundation programme was followed by a further 18- month period of largely theoretical specialisation.

Features of acute haematogenous osteomyelitis in childhood – principles of early diagnosis generic 10mg metoclopramide with mastercard, most common mistakes discount 10mg metoclopramide with visa, X-ray discount 10 mg metoclopramide overnight delivery, principles of treatment. Ръководство по хирургия с атлас, том ХІІІ-Детска хирургия, под редакцията на проф. Professional practice examination: No Principal lecturer Professor or Associated professor from the department of Ophthalmology. Features of ophthalmology - High demand for ophthalmic care - Complex character - Close liaison with other medical specialties 4. History of ophthalmology 291 - Prehistoric times - Ancient civilizations: Assyria and Babylonia, Ancient Egypt, Judaic culture, Ancient Indian culture; Ancient Chinese culture, ancient cultures in America. Essentials of vision - Definition of light: theory, photometric units - Conversion of light energy into nerve impulses 8. Light perception - Definition: absolute sensitivity, descriminative sensitivity - Adaptation: to light and dark, methods for examination of adaptation - Disturbances in adaptation (hemeralopia): symptomatic, functional. Anatomy of orbit - Composition of the orbit - Features of the walls of the orbit - Major openings in the orbit - Contents of the orbit - Changes in the position of the eyeball 2. Static and dynamic clinical refraction - far point of view in different clinical refractions 7. Accommodation - definition - near point of view - mechanism of accommodation - field of accommodation - range of accommodation 8. Morbid changes in the conjunctiva: hyperemia – conjunctival and ciliary, chemosis, foliculae, papilae, phlyctena, discharge – catarrhal, purulent, fibrinous 4. Tumours of the orbit - Benign: dermoid cyst, holesteatoma, angioma, - Malignant: sarcoma, carcinoma, glioma, meningioma lymphoma. Diseases of the eyelids - Congenital anomalies - Diseases of the eyelid skin: noninflammatory and inflammatory - Diseases of eyelashes - Static and dynamic disorder of the eyelids: entropium, ektropium, blepharospasm, lagoftalm, ptosis of eyelids - Eyelid tumors: benign and malignant. Diseases of the cornea - Function of cornea - Methods for corneal investigation - Pathological changes in cornea: opacities – infiltration, cicatrix, degeneration; vascularisation: superficial, deep 1. Inflammatory corneal diseases - Superficial nonpurulent keratitides - Superficial purulent keratitides - Deep /stromal/ keratitides - Trophyc keratitides 3. Trachoma - distribution - etiology - clinical signs - differential diagnosis - complications - treatment 5. Classification of Uveitis - according to etiology: infectious – exogenous and endogenous, non-infectious - according to duration: acute, subacute and chronic - according to exudation: serous, fibrinous, purulent and hemorrhagic - according to histopathology: granulomatous and nongranulomatous - according to anatomical localization: Anterior uveitis, Intermediate uveitis, Posterior uveitis and Panuveitis 3. Anterior uveitis - subjective symptoms - objective symptoms - exogenous anterior uveitis - endogenous anterior uveitis: acute infectious diseases, chronic infectious diseases, focal infectious, metabolic diseases, rheumatological diseases - therapy of acute anterior uveitis: topical and systemic. Posterior uveitis (chorioretinitis) - subjective symptoms - objective symptoms - clinical types: diffuse, multifocal, focal, central, peripheral, juxtapapillary - complications - therapy 6. Diseases, connected with changes in lens transparency  acquired cataract: age-related, traumatic, pathologic, complicated, radiation-induced  management of the acquired cataract: medical and surgical  congenital cataract: types, clinical features, management. Primary angle-closure glaucoma - pathogenesis: relative papillary block, narrowing anterior chamber angle, plateau iris, vitreo-lenticular block - clinical features 297 - differential doagnosis 2. Primary open-angle glaucoma - pathogenesis: dystrophic changes in different parts of the aqueous drainage system, combined with partial block of the anterior chamber angle by the iris’ root or goniosynechiae. Retinal detachment - Rhegmatogenouse retinal detachment - Exudative retinal detachment - Tumour retinal detachment 10. Classification of ocular traumatism - contusions - injures: penetrating and non-penetrating – with or without foreign body - combustions A. Globe trauma - contusions - injures: non-penetrating and penetrating, with or without foreign bofy - explosive injures D. Types of blindness -absolute 300 -practic -work -professional -pedagogical -monolateral and bilateral -reversible and irreversible 4. Visit to the outdoor patients office: methods of examination of the anterior and posterior segments of the eye, visual charts, correction lenses, direct and indirect ophthalmoscopes, perimeter, tonometer, bio-microscope, instruments. Static and dynamic anomalies in the lids position: entropion, ectropion, blepharospasmus, lagophthalmus, ptosis of the eyelids. Pathologic changes in the conjunctiva: hyperemia- conjunctival and cilliary, edema, follicules, papillas, phlyctenas, secretion – catarrhal, purulent, fibrin. Inflammation of the conjunctiva ( conjunctivitis ) – acute, mild, chronic conjunctivitis, catarrhal, purulent, membranous, pseudo membranous, chlamidial, allergic conjunctivitis, conjunctiva-corneal damage in skin diseases, other conjunctivitis. Examination of the lachrymal pathway: - Canalicule test - nasal test - Anel test – demonstration. Pathologic changes in the cornea: opacities – infiltration, cicatrix, degeneration, pathologic vessels: superficial, deep. Inflammatory diseases of the cornea: - superficial, non purulent keratitis - superficial purulent keratitis - deep ( parenchimal ) keratitis - trophic keratitis 4. Pathologic changes in iridocyclitis – changes of the structure of the iris, precipitates, Tyndall effect, posterior synechiae, opacities. Differential diagnosis between iridocyclitis, conjunctivitis, keratitis and acute closure angle glaucoma. Examination of a patient with a cataract in one eye and transparent lens in the other eye by focal illumination, trans illumination and bio microscopy. Demonstration of patients and differential diagnosis between open angle glaucoma and cataract.