By E. Thordir. Centenary College of New Jersey.
Flattening of affect can accompany frontal lobe lesions as part of an apathetic-akinetic syndrome buy flagyl 500 mg with amex. Anxiety is characterised by apprehensiveness and tension order flagyl 400mg, but the stimulus is ill defined and may be totally intrapsychic buy flagyl 250 mg free shipping, e. It has been suggested by many authors that anxiety disorders properly belong with the affective disorders. Phobias (simple, social, agoraphobic): patient recognises their irrationality; they persist despite rational argument; and they lead to avoidance of what is feared. Derealisation: similar notions about the external environment (things are bigger or smaller, closer or further away, two- dimensional, flat). Both states are common in severe anxiety from any cause and do not of necessity indicate that the patient is ill – it is very difficult for someone to describe an unpleasant state of loss of normal emotional responsiveness; causes include normal emotional upset, tension or fatigue; a symptom of psychiatric or physical illness; and primary cases, the so-called ‘depersonalisation disorder’. Ambivalence: mixed feelings or opposing impulses experienced about something or someone experienced simultaneously. The patient who finds out that he has a month to live and who then goes around with a smile on his face and joins the local football team might be using the defence mechanism called reaction formation (doing the opposite to what one might expect like crying, feeling depressed, looking for a second opinion, preoccupied, etc). Obsessional thoughts consist of words, beliefs, ideas or images that the subject recognises as his own but that intrude forcibly into consciousness, are usually distasteful, and the subject tries to exclude them. Obsessional ruminations consist of an argument going on in the mind in which the pros and cons are gone over ad infinitum. In obsessional doubting the subject worries lest he has failed to complete some action, done harm, or told the priest all his sins in the confessional (scrupulosity). Obsessional impulses urge the patient to perform acts, often of a violent or socially embarrassing variety. Obsessional rituals are either repetitive, meaningless acts or some mental activity like repetitive counting e. It should be noted that obsessional rituals may raise or lower anxiety levels in different instances. Psychomotor retardation: slowing or sluggish thinking and movement; common in depression. Negativistic behaviour: associated with naughty children and schizophrenia; patient does the opposite of what is asked for no apparent reason, e. These two phenomena occur in schizophrenia, organic brain damage, and Tourtette disorder. Catatonic patients may reply to a question by echoing the content of the question but using different words, so-called echologia. Stereotypy: an action, or group of actions, or words monotonously repeated (see and contrast with perseveration), or a posture maintained long after tiredness would normally have forced the person to quit; non-goal-directed, e. Tic: involuntary, sudden, rapid, recurrent, non-rhythmic stereotyped motor movements or vocalisations; can be simple like blinking or complex such as smelling or jumping. Narcoleptic syndrome: narcolepsy, Hypnagogic hallucinations, sleep paralysis (frightening - cannot move for a minute or so on waking or going to sleep or coming out of a nap), and cataplexy (sudden, transient loss of muscle tone and muscular weakness, often brought on by heightened emotion, e. Catalepsy: increased muscle tone and rigid posture; may occur in schizophrenia, ‘hysteria’ or organic 129 disorders. Waxy flexibility (flexibilitas cerea): found in catatonic schizophrenia, stuporose type: resistance to passive limb movement resembling that found on bending candles of olden days; a limb left in any position will remain there despite gravity (as when a patient does not lower the arm after the doctor has finished taking the radial pulse). Form of thinking may be concrete (literal interpretation of everything, including proverbs: found in normal children, organic brain syndromes, schizophrenia, and intellectual disability), abstract (ability to formulate concepts and to generalise from the particular, as in normal adults – categorical attitude refers to abstract attitude: the ability to shift readily from concrete to abstract as needed), dereistic (silly - typically found in 130 schizophrenia), autistic (inner fantasies dominate ), or over-inclusive (full of irrelevancies). Proverb interpretation might be tested thus: ‘Tell me how you would explain the saying ‘Don’t cry over spilled milk’ to a young child’. Proverb interpretation is closely related to academic achievement and level of acculturation and a better test is to ask about similarities and differences between objects. There may be difficulty in appreciation the emotional tone of another person’s speech (receptive aprosodia). A non-dominant lobe dysfunction – may follow a stroke 128 Legal automatisms are divided into internal (‘insane’ – arise from internal factors) and external (‘sane’). It was argued that somnambulism was genetic (internal, arising from a certain sleep stage) and therefore carried a risk of recurrence. To examine prosody stand behind the patient (so he cannot see your face) and say ‘I’m going to leave now’ in neutral, sad, happy, and angry tones. Then ask the patient the patient reproduce these four feelings whilst saying the same sentence. One should, of course, normally be on the lookout for disordered prosody during the interview. Apperception: perception modified by emotion, memory or bias; from a cognitive theorist’s viewpoint this includes all perception! On the other hand, syntaxic mode refers to a mode of perception that forms whole, coherent pictures of reality that can be validated by others.
In: Robson T (ed) An Churchill Livingstone discount flagyl 250mg online, Edinburgh Chapter 1 • Physical Medicine in a Naturopathic Context 23 Rich G 2002 Massage therapy: the evidence for practice purchase 500 mg flagyl with amex. Timmons B best 500mg flagyl, Ley R (eds) 1994 Behavioural and Braumueller, Vienna psychological approaches to breathing disorders. Roithmann R, Demeneghi P, Faggiano R, Cury A 2005 Plenum Press, New York, p 118–119 Effects of posture change on nasal patency. Revista Tortora G, Grabowski S 1993 Principles of anatomy Brasileira de Otorrinolaringologia (English ed. HarperCollins, New York, 71(4):478 p 69 Selye H 1946 The general adaptation syndrome and the diseases of adaptation. Journal of Oral Rehabilitation research study on the use of complementary therapies 10:957–962 among patients with inﬂammatory bowel disease. Select Committee Vlaeyen J, Crombez G 1999 Fear of movement, on the Deﬁnition of Naturopathic Medicine. 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Selye described stages in which an initial defensive/protective (‘ﬁght/ Schamberger’s malalignment model 42 ﬂight’) alarm phase occurs in response to a stressor Beyond dysfunction towards pathology 43 (Rosch 1999) (see Fig. Rosch apparently expressed the view that had his knowledge of attempts to explain the choice by Selye of the word English been better he would have gone down in history ‘stress’ that he used to describe the background to as the father of the ‘strain’ concept. Finding an acceptable deﬁnition of stress was a Rosch points out that although Selye was ﬂuent in many problem that exercised Selye for the rest of his life. He languages, including English, his choice of the word noted to Rosch that 24 centuries previously Hippocrates ‘stress’ to describe the non-speciﬁc response syndrome had written that disease was not only pathos (suffering), he discovered was probably an error of judgment. He but also ponos (toil), as the body fought to restore had used the word ‘stress’ in his initial letter to the normalcy. Editor of Nature in 1936, who suggested that it be Ultimately, because many people viewed stress as an deleted since this word implied nervous strain, unpleasant threat, Selye created a new word, ‘stressor’, recommending that he use the term ‘alarm reaction’ in order to distinguish between stimulus and response. Even Selye had difﬁculties when he tried to extrapolate Selye was unaware that the word ‘stress’ had been his laboratory research to humans. In helping to prepare used for centuries in physics to explain elasticity, the the First Annual Report on Stress in 1951, Rosch property of a material that allows it to resume its original included the comments of one critic, who, using size and shape after being compressed or stretched by verbatim citations from Selye’s own writings concluded: an external force. As expressed in Hooke’s Law, the ‘Stress, in addition to being itself, was also the cause of magnitude of an external force, or stress, produces a itself, and the result of itself. An evolution of these models has included recogni- tion of an altered version of homeostasis – Stress is deﬁned by Selye in his writings (1976) as the allostasis – that produces exaggerated, or insufﬁcient, non-speciﬁc response of the body to any demand, responses to stressors (Fig. Chapter 2 • Adaptation and the Evolution of Disease and Dysfunction 27 Infections Genetic predisposition Psychosocial Early intense stress Intact psychosocial homeostatic Health stress (abuse, Toxins etc. Appropriate treatment to C improve immune defense and Recovery, repair functions or to improvement reduce adaptive demands: drugs, manual methods, acupuncture, exercise, psychotherapy, dietary changes, etc. Reproduced with permission from B Chaitow (2003a) Many of Selye’s ﬁndings and concepts ﬁt intimately In this model, a spectrum of adaptive changes – many with naturopathic thought, as outlined in Chapter 1 of which produce symptoms, some benign and others (Selye 1976): serious or sinister – is seen to emerge from a back- ground of the interaction of variable (in degree, variety The fact that the state of stress, even if due to the same and chronicity) idiosyncratic adaptive demands, agent, can cause different effects in different superimposed on the individual’s unique acquired individuals, has been traced to ‘conditioning factors’ and inherited biochemical, biomechanical and psy- that can selectively enhance or inhibit one or the other chosocial characteristics, qualities and attributes – stress effect. This conditioning may be endogenous sometimes called polymorphism (Williams 1956). Under the inﬂuence of such conditioning Stress explained factors, a normally well-tolerated degree of stress can even become pathogenic, selectively affecting those A close colleague of Selye, Istvan Berczi, provides parts of the body that are particularly sensitized both insights into Selye’s thinking regarding disease causa- by those conditioning factors and by the speciﬁc effects tion, from the perspective of the general adaptation of the eliciting agent, just as physical tensions of equal syndrome (Berczi 2005): strength in different chains will break the particular link that is the weakest, as a result of internal or The prediction by Dr. For this reason, damaged area that include mast cells, endothelial cells, in most cases, it is necessary to interfere with these platelets. The released mediators attract blood borne defense mechanisms at more than one point to leucocytes, such as neutrophilic granulocytes, cause disease. The redundancy of immune effector monocytes/macrophages, lymphocytes, eosinophils and mechanisms (Berczi & Nagy 1994, Clark & Kamen basophils that release additional mediators, and thus 1987) or the recent recognition that it is necessary to contribute to the inﬂammatory response. Thus, with the recent discovery of was ﬁrst presented, and in 1955, when explaining the cytokines and our increasing recognition of their progress his research had achieved and how much functions, we have begun to ﬁll in the gaps in Dr. The resulting corticotropic hormone excess causes enlargement of the adrenal cortex with signs of increased corticoid hormone production. The term Similarly, it is not quite clear, as yet, whether ‘stress’ implies only non-speciﬁcity of causation; corticoids destroy the circulating lymphocytes it does not presume to distinguish between directly, or whether they inﬂuence the lymphocyte manifestations of damage and of defense. Also, count merely by diminishing lymphocyte formation in depending upon the simultaneous application of the lymphatic organs. Probably both these mechanisms certain ‘conditioning agents’, both systemic stress and are operative. Circulating lymphocytes (Lymphopenia increased -globulin and antibodies Kidney Joints in blood) Heart Blood vessels (Myocarditis (Nephrosclerosis) (Polyarthritis) (Periarteritis infarcts nodosa) Aschoff’s (? Schematized drawing indicating that non-speciﬁc damage causes clinical shock, loss of body weight and nitrogen, gastrointestinal ulcers, temporary rise in plasma potassium with fall in plasma Cl, through unknown pathways (nervous stimulus?
Recommended course contents (a) An introduction to the following disciplines: —Biochemistry; —Physiology; —Pharmacology and toxicology; —Nuclear medicine order flagyl 250 mg fast delivery. Introduction Nuclear medicine remains a highly technical field that not only uses advanced instrumentation but also applies numerical techniques discount 500mg flagyl otc. The direct use of unsealed sources of radiation calls for particular attention to radiation safety order 200 mg flagyl otc. As in the case of the radiopharmacist, the medical physicist is not necessarily required on a full time basis in small departments but should be available for consultation. Since the medical physicist’s role is largely advisory and super- visory, the number of medical physicists working in the field is small. It is therefore difficult to justify the development of training courses in most countries. Where medical physics is established as an academic specialty, there are well developed postgraduate courses, suitable for general training. Enrolment is, however, expensive so that opportunities for funded attendance are limited. The role of the medical physicist As in the case of other nuclear medicine professionals, the role of the medical physicist varies from country to country, depending to some extent on the stage of development of nuclear medicine practice. There is an overlap of duties with those of other professionals, and in some countries the distinction between the medical physicist and the technologist is hard to define. The medical physicist and the technologist in any event work closely together in many areas. The physicist is responsible for the following areas: (a) Radiation safety The radiation safety officer is normally a trained medical physicist, although responsibility in a small department may be delegated to another professional, provided advice can be sought from an available expert. Frequently, software needs to be developed or adapted with the subsequent validation of newly developed procedures. General education of medical physicists A good general education is possibly the most important aspect of a medical physicist’s training and is a factor that is often underestimated. Most medical physicists enter the field having completed a degree in physics or a similar discipline such as engineering or occasionally computer science. The ability to tackle technical or numerical problems and to apply lateral thinking to their solution requires an education that includes mathematics and a broad understanding of technical and scientific principles. The physicist should be comfortable with advanced mathematical concepts, have experience in experimental design and scientific methods, and be conversant with applied statistics, electronic troubleshooting, computer programming and instrument design. These topics are not normally covered in sufficient depth in the vocational degrees intended for health professionals such as technologists or radiographers. Postgraduate courses Most specific courses in medical physics are offered at the master’s level and are intended for individuals who already have a degree in physics. The content is usually intended to provide an overview of the applications of physics to medicine and recognizes the fact that most graduates in physics have little or no background in medicine. Courses therefore usually cover anatomy and physiology and provide an introduction to other areas of medical science. The medical physics coverage is often quite broad and includes applications in therapy and general diagnostic imaging. Bridging the gap between pure physics and medicine is achievable, whereas providing the necessary mathematical and scientific background to a non-physics graduate with a background in medical science would necessitate further undergraduate study in the relevant field. Most master’s programmes include some component of project work that aims to develop relevant research skills, while some programmes involve full-time research only. Few programmes, if any, provide a sufficient amount of practical experience relevant to the workplace. Vocational training The relatively small number of physicists in many countries makes it very difficult to establish and maintain postgraduate teaching programmes, with the 46 2. The turnover of physicists is far lower than that of technologists so that the number of vacancies cannot even justify broad courses that encompass radiotherapy. This makes it difficult for a physicist who may be working alone in an institution to gain the necessary experience by working alongside nuclear medicine technologists. Short, focused, courses in fields such as radiation safety can be quite effective, as can workshops on quality control or specific computer skills. However, the nature of the work, which is often advisory or developmental rather than involving routine activities, can be difficult to learn in a short attachment since the exact role of the physicist and the equipment can vary considerably between individual departments. Of paramount importance is the physicist’s general education as well as his or her ability to find out and synthesize information when required, and to be aware of the existence of resources. The ability to find solutions from first principles, when faced with a question, can only develop with exposure to multiple situations and problems. This normally requires a relatively long attachment working with experienced staff.