Maxolon

Michael B. Kays, PharmD, FCCP

• Associate Professor, Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette and Indianapolis
• Adjunct Associate Professor, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana

https://www.pharmacy.purdue.edu/directory/kaysm

A comparative study of frontal bone morphology among Pleistocene hominin fossil groups gastritis migraine buy discount maxolon online. A morphometric analysis of maxillary molar crowns of Middle-Late Pleistocene hominins 7 day gastritis diet generic maxolon 10mg amex. The role of climate in the interpretation of human movements and cultural transforma tions in Western Asia gastritis in pregnancy discount maxolon 10 mg otc. Modernity gastritis diet áåòñèòè buy maxolon 10mg line, enhanced working memory gastritis long term buy discount maxolon 10 mg line, and the Middle to Upper Paleolithic record in the Levant gastritis pills order maxolon 10 mg mastercard. Anatomic landmarks to estimate the length of the diaphragm from chest radiographs: effects of emphysema and lung volume reduction surgery. Fifty years after: Egbert, an early Upper Paleolithic juvenile from Ksar Akil, Lebanon. High-resolution U-series dates from the Sima de los Huesos hominids yields 600 kyrs: impli cations for the evolution of the early Neanderthal lineage. A craniological approach to the origin of anatomically modern Homo sapiens in Africa and implications for the appearance of modern Europeans. Encephalization and allometric trajectories in the genus Homo: evidence from the Neandertal and modern lineages. Medial clavicular length and upper thoracic shape in Neandertals and Europeans early modern humans (abstract). Particulate versus integrated evolution of the upper body in Late Pleistocene humans: a test of two models. Stratigraphic, chronological and behavioural contexts of Pleistocene Homo sapiens from Middle Awash, Ethiopia. Tooth wear, Neanderthal facial morphology and the anterior dental loading hypothesis. The Mousterian populations of the Near East: on the presence of Neanderthals in the Near East. Shanidar 10: A Middle Paleolithic immature distal lower limb from Shanidar Cave, Iraqi Kurdistan. Another look at an old face: biomechanics of the Neandertal facial skeleton reconsid ered. Direct radiocarbon dates for the Mid Upper Paleolithic (eastern Gravettian) burials from Sunghir, Russia. Cross-sectional geometry and morphology of the mandibular sym physis in Middle and Later Pleistocene Homo. Neandertal mesosterna and noses: implications for activity and biogeographical patterning. Internal nasal floor configuration in Homo with special reference to the evolution of Neandertal facial form. A comprehensive morphometric analysis of the frontal and zygomatic bone of the Zuttiyeh fossil from Israel. The carnivore remains from the Sima de los Huesos Middle Pleistocene site (Sierra de Atapuerca, Spain). Middle Palaeolithic burial is not a dead issue: the view from Qafzeh, Saint-Cesaire, Kebara, Amud, and Dederiyeh. Grun R, Stringer C, McDermott F, Nathan R, Porat M, Robertson S, Taylor L, Mortimer G, Eggins S, McCulloch M. The origin of modern human behavior: critique of the models and their test implications. Body size and proportions in the Late Pleistocene western Old World and the ori gins of modern humans. Hominid remains from Amud Cave in the context of the Levantine Middle Palaeolithic. The Geography of Neandertals and Modern Humans in Europe and Greater Mediterranean. The Mousterian site of Zafarraya (Andalucia, Spain): Dating and implications on the Palaeolithic peopling process of western Europe. Respiratory adaptation in the Indian natives of the Peruvian Andes, studies at high altitude. Mind the gap: questions of continuity in the evolution of anatomically modern humans as seen from the Levant. Krings M, Capelli C, Tschentscher F, Geisert H, Meyer S, von Haeseler A, Grossschmidt K, Possnert G, Paunovic M, Paabo S. Towards a theory of modern human origins: geography, demography, and diversity in recent human evolution. Neandertal and early modern human mobility patterns: comparing archaeolog ical and anatomical evidence. Behavioral differences between archaic and modern humans in the Levantine Mousterian. The anatomy, physiology, acoustics, and perception of speech: essential elements in analysis of the evolution of human speech. A quantitative assessment of infraorbital morphology in Homo: testing for character independence and evolutionary significance in the human midface. Opponens pollicis mechanical effectiveness in Neandertals and early modern humans. Human hyoid bones from the Middle Pleistocene site of the Sima de los Huesos (Sierra de Atapuerca, Spain). La variabilite morpho-metrique du nez: derive genique dans la lignee neandertalienne Mass-spectrometric U-series dates for Israeli Neanderthal/early modern hominid sites. Thermoluminescence date for the Mousterian burial site of Es Skhul, Mount Carmel. Izuchenie mustierskoi stoyanki i pogrebenia neandertaltsa v grote Teshik-Tash, Yuzhnyi Uzbekistan, Srednyaya Azia. Activity, climate and postcranial robusticity: implications for modern human origins and scenarios of adaptive change. The Neanderthal dead: exploring mortuary variability in Middle Paleolithic Eurasia. In: Akazawa T, Aoki K, Bar-Yosef O, editors, Neandertals and Modern Humans in Western Asia. Chronological, paleoecological and taphonomical aspects of the Middle Paleolithic site of Qafzeh, Israel. On the differences between two pelvises of Mousterian context from the Qafzeh and Kebara caves, Israel. Morphological variation in Homo neanderthalensis and Homo sapiens in the Levant: a biogeographic model. Medial mandibular ramus: ontogenetic, idiosyncratic, and geographic variation in recent Homo, great apes, and fossil hominids. Opening the stone: a multivariate reassessment of the Neandertal status of the Teshik-Tash child. Postcranial robusticity in Homo I: temporal trends and mechanical interpretations. The Roc de Marsal Neandertal child: a reassessment of its status as a deliberate burial. The Neanderthal type site revisited: interdisciplinary investigations of skeletal remains from the Neander Valley, Germany. Paleolithic hominin remains from Eshkaft-e Gavi (southern Zagros Mountains, Iran): description, affinities, and evidence for butchery. Temperature alters solute transport in growth plate cartilage measured by in vivo multiphoton microscopy. An ectocranial lesion on the Middle Pleistocene human cranium from Hulu Cave, Nanjing, China. Experimental tests of Middle Palaeolithic spear points using a cali brated crossbow. Neandertal and early modern human behavioral variability: A regional-scale approach to the lithic evidence for hunting in the Levantine Mousterian. Behavioral differences between Middle and Upper Paleolithic Homo sapiens in the East Mediterranean Levant: the roles of interspecific competition and dispersal from Africa. Climatically-forced extinctions of Homo sapiens and Neanderthals in the east Mediterranean Levant. Behavioral interpretations of changes in craniofacial morphology across the archaic/ modern Homo sapiens transition. Circum-Mediterranean biological connections and pattern of Late Pleistocene human evolution. The adaptive basis of Neandertal facial form, with some thoughts on the nature of modern human origins. Biomechanical analysis of masticatory system configuration in Neandertals and Inuits. Neandertal cervical vertebrae with special attention to the Shanidar Neandertals from Iraq. The Neanderthal skeletal remains from Shanidar Cave, Iraq: a summary of findings to date. Increase in length of leg relative to trunk in Japanese children and adults from 1957 to 1977: comparison with British and with Japanese Americans. Biochronology of the Middle Palaeolithic and dispersal events of hominids in the Levant. Biochronology, paleoecology, and dispersal events of hominids in the southern Levant. The faunal sequence of the Southwest Asian Middle Paleolithic in relation to hominid dispersal events. New human remains from Kebara Cave (Mount Carmel): the place of the Kebara hominids in the Levantine Mousterian fossil record. Ontogenetic variation in Late Pleistocene Homo sapiens from the Near East: implica tions for methodological bias in reconstructing evolutionary biology. Les Enfants Mousteriens de Qafzeh: Interpretation Phylogenetique et Paleoauxologique. The earliest Homo sapiens (sapiens): biological, chronological and taxonomic perspec tives. The Neandertal face: Evolutionary and functional perspectives on a recent hominid face. Morphological contrasts between the Near Eastern Qafzeh-Skhul and late archaic human samples: grounds for a behavioral difference Femoral neck-shaft angles of the Qafzeh-Skhul early modern humans, and activity levels among immature Near Eastern Middle Paleolithic hominids. Lieberman, the rise and fall of seasonal mobility among hunter gatherers: the case of the southern Levant. Diaphyseal cross-sectional geometry of Near Eastern Middle Palaeolithic humans: the humerus. Diaphyseal cross-sectional geometry of Near Eastern Middle Palaeolithic humans: the tibia. Diaphyseal cross-sectional geometry of Near Eastern Middle Palaeolithic humans: the femur. Upper limb versus lower limb loading patterns among Near Eastern Middle Paleolithic hominids. Thermoluminescence dates for the Neanderthal burial site at Kebara (Mount Carmel, Israel). Continuity and Discontinuity in the Peopling of Europe: One Hundred Fifty Years of Neanderthal Study. Were Neandertal and modern human cranial differences produced by natural selection or genetic drift. Close correspondence between quantitative and molecular-genetic divergence times for Neandertals and modern humans. The Paleolithic child from the Teshik-Tash Cave in southern Uzbekistan (Central Asia). Thoracic morphology in Near Eastern Neandertals and early modern humans compared with recent modern humans from high and low altitudes. Burial evidence for the social differentiation of age classes in the Early Upper Paleolithic. Interestingly, the issue has always been much less contentious at another geographical edge of the Pleistocene human range, namely East Asia, particularly China, which has produced the most abundant fossil record for human evolution in the eastern part of the Old World.

While disease-related and social threat related attentional biases were previously found in individuals with psoriasis [11] gastritis diet plan uk cheap maxolon 10 mg with mastercard, it is unknown whether they also occur on a behavioral level gastritis upper abdominal pain discount maxolon line. As theorized in disease-avoidance models [12] gastritis diet êàðòèíêè buy discount maxolon 10 mg on line, visible cues of disease chronic gastritis risks discount generic maxolon canada, such as skin lesions gastritis diet advice discount 10 mg maxolon mastercard, may activate disgust reactions and motivate behavioral avoidance gastritis and diarrhea discount 10 mg maxolon. Disgust related brain regions were found to be activated in healthy participants when they were shown pictures of stigmatized groups [e. Given that people with skin conditions may experience and/or anticipate these disgust reactions, they may develop a behav ioral avoidance bias to social threat-related information. In line with this, a reduced ability to identify disgusted faces, and diminished associated brain activity, was found in psoriasis; this suggests an avoidance-based coping mechanism [15]. In addition to social threat related stimuli, biases may also be present for disease-related stimuli. An eye-tracking study showed that people with acne automatically gazed more at acne lesions than did controls, which suggests an attentional bias [16]. Also, in pathological skin picking, greater behavioral avoidance of pictures of skin irregularities was found compared to controls [17]. No research has yet focused on these biases in signifcant others of individuals with chronic skin conditions. However, indications of a larger implicit preference for clear skin were found in people from the general popula tion who knew someone with a skin condition than in people who did not. The authors explained this fnding by suggesting that these individuals attempted to suppress their stereotypical reaction, which required cognitive efort [19]. The two skin conditions were exploratively compared, with the expectation that both conditions would show similar biases. Attentional bias to disease-related and social threat related words was assessed with a modifed Stroop task ([20]; Table S3). Last, questionnaires were administered regarding disease severity, self-perceived visibility, psychological distress, social anxiety, and fear of negative evaluation. These results provide preliminary support for the idea that people with skin conditions and their signifcant others difer from healthy controls regarding their implicit reactions to stigmatization-related stimuli. Further more, in contrast to what was initially expected, these processes may difer between 4 specifc skin conditions. In contrast to a previous study [11], an attentional bias was found in individuals with alopecia, but not with psoriasis. In contrast, hair loss in alopecia may provoke fewer direct social responses, as the majority of patients tend to hide their condition. However, the signifcant disease-related distress and illness-related cognitive preoccupation reported in this patient group suggest that alopecia patients are psychologically afected by their condition [22], and these psy chological efects may be refected in an attentional bias to disease-related words. No attentional biases to social threat-related words were found for any of the groups. In a pilot validation study, these words were selected based on their high ratings of stigmatization combined with their negative emotional valence. However, as words were not specifcally selected on ratings of individual threat, they may have been insuf fciently threatening in comparison to words used in previous research [11]. Behavioral avoidance bias was examined using social threat-related and disease-relat ed stimuli. Instead, for people with psoriasis, the stigmatization experience seems to be better captured by their fear and avoidance of disgust reac tions of others. Indications toward a social threat-related bias were found in psoriasis, but not in alopecia. This is in line with the idea that disgust reactions are more relevant in psoriasis and with the fnding that the neural response of people with psoriasis to disgusted faces is consistent with an avoidance-based coping mechanism [15]. Limitations of this study include the diferences between groups in certain sociode mographic and psychological characteristics; this limits the comparability of the groups and calls for a cautious interpretation of results. As this study was the frst of its kind, further studies are needed to examine the psycho metric properties of the implicit measures used. Another possible limitation was that this study used several stimulus catego ries in each task. As responses on each stimulus may infuence subsequent responses, we cannot exclude the possibility that this confounded the results. These results provide preliminary support for the idea that, compared with healthy individuals, people with chronic skin conditions show diferent implicit cognitive and behavioral reactions to stigmatization-provoking stimuli. Furthermore, these processes may difer between skin conditions, with people with psoriasis being more afected by reactions of others, and those with alopecia being more afected by disease-related cues relating to self-stigma. An attitudinal study of responses to a range of dermato logical conditions using the implicit association test. Evaluative conditioning: A possible explanation for the acquisition of disgust responses Helplessness as predictor of perceived stigmatization in patients with psoriasis and atopic dermatitis. Unravelling the contexts of stigma: from internalisation to resistance to 4 change. Attentional bias for psoriasis specifc and psychosocial threat in patients with psoriasis. Avoidance of emotional facial expressions in social anxiety: the approach-avoidance task. Diminished neural and cogni tive responses to facial expressions of disgust in patients with psoriasis: A functional magnetic resonance imaging study. Implicit processes in pathological skin picking: responses to skin irregularities predict symptom severity and treatment susceptibility. Psoriasis has a major secondary impact on the lives of family members and partners. Measuring individual diferences in implicit cognition: the implicit association test. Appearance modifying behaviours adopted by wig users with alopecia in social interactions. Three indirect tasks assessing implicit threat associations and behavioral response tendencies. When mood meets memory: Neural and behavioural perspectives on emotional memory in health and depression [dissertation]. The validity of the Hospital Anxiety and Depression Scale: an updated literature review. People with alopecia and psoriasis were asked to invite a signifcant other (partner, family member, or friend) to participate. Study participants from the general population were recruited by contacting a subsample of the Nijmegen Biomedical Study, a population-based survey ( Inclusion criteria for patients were a diagnosis of alopecia or psoriasis, age 18 years, 4 and a sufcient understanding of the Dutch language. The regional medical ethics committee indicated that the study did not need formal approval due to its non-invasive nature. Materials & procedure In this study, several implicit tasks and self-report questionnaires were administered in a laboratory setting. Attentional bias: modifed Stroop task To assess attentional bias for word stimuli, a modifed Stroop task [20] was used. Partici pants are instructed to name aloud the print color of the words presented, as quickly and accurately as possible. The assumption of the task is that the saliency of words interferes with the color-naming task and results in longer response latencies, indicating an attentional bias. The aim was to assess processing of words without emotional or disease-related content (neutral), threatening emotional words (negative), and non-threatening emotional words (positive; see Table S3). People with skin conditions may show longer reaction times to disease-related words, which would indicate an implicit 76 Chapter 4 emotional reaction. Disease-related and social threat-related stigmatization words were validated in a pilot study consisting of 43 people with skin conditions, healthy individuals, and medi cal psychology professionals. The pilot study examined both the extent to which stimuli refected the underlying constructs and their emotional valence. Words were presented against a black background, in random order, in a blocked design: 1 screen per word category, containing 8 words repeated 5 times. The experimenter, who was blind to word category, recorded re sponse latencies (automated via mouse click at start and end of category), and number of errors (hand-scored) per category. For these tasks, participants were seated behind a 19-inch computer screen (resolution: 1024x786 pixels) and instructed to respond to each picture on the screen, as quickly and accurately as possible, with a joystick that was tightly fastened to the table. Depending on an irrelevant stimulus feature, partici pants had to either push the joystick away (avoidance, picture size decreases) or pull it towards them (approach, picture size increases). Whether participants had to push or pull in response to the irrelevant feature was determined randomly. If the participant responded correctly, the picture disappeared when the joystick was pushed or pulled by approximately 30 degrees. The pictures of psoriasis had been previously validated in the pilot study described above; the neutral control pictures had been used in previous research [17]. Participants had to respond with push or pull according to whether the picture was tilted to the left or to the right. The task was introduced by 10 practice trials (pictures of empty frames), followed by 200 experimental trials distributed across two blocks. Participants now had to respond with push or pull according to whether the picture color was grey or sepia. The task was introduced by 10 practice trials (checkerboard pictures), followed by 324 experimental trials distributed across two blocks. Questionnaires 4 Self-reported questionnaires were administered regarding disease severity, self-per ceived visibility, psychological distress, social anxiety, and fear of negative evaluation. People with alopecia indicated their degree of hair loss as alopecia areata (circular patches of hair loss), androgenetica (female pattern baldness), totalis (total loss of hair on scalp), or universalis (total loss of hair on scalp and body). This consists of an anterior and posterior silhouette on which people mark their afected areas, and three scales on which patients score the redness, thickness, and scaliness of their afected areas (range = 0 [complete remission] 72 [most severe psoriasis]). To assess psychological distress, social anxiety, and fear of negative evaluation, three questionnaires were administered: the Hospital Anxiety and Depression Scale, the Liebowitz Social Anxiety Scale, and the Fear of Negative Evaluation Scale. On a 4-point scale, participants rate their levels of anxiety (from none to severe) and avoidance (from never to always) of 24 social situations. All other par ticipants were included in the analyses, to provide the most accurate description of un altered data. Repeating analyses on log-transformed variables, and on log-transformed variables in which outlying cases were given the value of the next-highest score, did not alter levels of signifcance. These results were reported unaltered to provide an accurate description of the sample used for analyses. If signifcant efects emerged, post-hoc tests were conducted to examine for which specifc groups and/or conditions the efects were signifcant. In the case of signifcant between-group diferences on sociodemographic variables or self-report questionnaires regarding psychological variables, these variables were controlled for in secondary analyses. Of the people with 4 alopecia, 54% had alopecia universalis, 18% alopecia totalis, 26% alopecia areata, and 2% alopecia androgenetica. Furthermore, the psoriasis group was less highly educated than the alopecia group and the healthy controls (p. Participants were generally slower to respond to neutral faces than to the other faces 2 (F(3, 140) = 13. Similarly to the alopecia group, participants were generally slower to respond to neutral 2 faces than to other faces (F(3, 142) = 11. Participants showed relatively more avoidance of disgusted and neutral faces than of sad and smil 2 ing faces (F(3, 142) = 12. English translation of the word stimuli used in the modifed Stroop task Social threat haira Skinb negative Positive neutral Insecure Alopecia Skin disorder Bombs Good-humored Mug Shame Hair loss Rash War Friendly Kettle Inferior Downy hair Scaling Fight Honest Nutcracker Bullying Hair growth Eczema Grenade Helpful Refrigerator Unhappy Scalp hair Flaking Pistol Funny Kitchen Secluded Baldness Psoriasis Murder Polite Tablecloth Not understood Hair falling out Blisters Violent Nice Light bulb Vulnerable Wig Bumps Explosion Cheerful Doorknob Note. Studies were included if they fulflled the following six criteria: (1) randomized controlled trial, (2) internet-based interventions, (3) based on cognitive behavioral therapy, (4) therapist-guided, (5) adult ( 18 years old) patients with an exist ing chronic somatic condition, and (6) published in English. Standardized mean diferences were calculated between intervention and control con ditions for each outcome and pooled using random efects models when appropriate. Interventions with a longer treatment duration (> 6 weeks) led to more consistent efects on depression. The most consistent improvements were found for disease specifc outcomes, which supports the possible relevance of tailoring interventions to specifc patient groups.

Q: Has the plaintiff presented with inconsistent complaints or symptoms gastritis surgery buy generic maxolon 10mg on-line, which are out of proportion to the objective medical evidence in this case Malingering the most common psychiatric conditions that are intentionally produced by (continued) plaintiffs include: (1) amnesia (2) mental retardation (3) organic impairment (4) posttraumatic residual chronic gastritis forum order 10mg maxolon. Even for experienced clinicians gastritis vomiting order maxolon amex, it is sometimes difficult to distinguish between malingering and a true illness or a somatoform gastritis diet milk buy maxolon master card, factitious gastritis diet ïùùïäó cheap 10mg maxolon amex, or conversion disorder chronic gastritis zinc buy 10 mg maxolon otc. This is especially true when the malingerer has high intellectual functioning (as most do), and has acquired information about a particular illness or injury and can produce symptoms consistent with that condition. Plaintiffs with a long list of subjectively reported symptoms stemming from a relatively minor accident are frequently seen in neurological settings. In litigious settings, the estimated incidence of malingering is around 10-20%, but may actually be higher due to under-reporting by health care practitioners. Q: To the best of your knowledge, has the plaintiff ever been involved in previous litigation The malingerer may have a prior history of litigation or observed a family member or friend in a litigious context. In factitious disorder (like malingering) there is also symptom simulation and exaggeration but the motivation is an internal one (compared to external) and the desired effect is to be placed in the "sick role". Malingerers are able to effectively lie and manipulate without remorse and many have a history of criminal behavior. The overall prevalence of antisocial personality disorder in community samples is about 3% in males and 1% in females. The Rey 15 item test is a commonly used neuropsychological test designed to detect malingering. It is based on the belief that persons faking a brain injury will perform more poorly than those with severe brain injury. A card is presented to the patient with 5 rows of 3 stimuli organized sequentially. There are three scales used for validity, the "L" (lie) scale, the "F" (faking) scale, and the "K" (defensiveness) scale. Elevated F scores may be considered evidence of malingering and suggest unusual and contradictory ways of answering the items on the test. However, the F scale can fail at detecting malingering in cases of personal injury because some questions require the patient to admit things that malingerers try to avoid admitting. Plaintiffs with antisocial behaviors may be Behavior professional thieves, racketeers, or drug dealers. Profile: this category should be considered when the focus of clinical attention is V62. A misdiagnosis may cause an incorrect assessment of potential Functioning adaptive functioning. This behavior may include isolated antisocial acts Antisocial displayed by the child or adolescent. Relational problems should be considered when the plaintiff has interpersonal problems or patterns of interaction that are associated with clinically significant impairment in functioning. Treatment or attention is focused directly on the interpersonal problem which may include difficulties in interpersonal relationships as well as difficulties with co-workers. The reasons for noncompliance may include discomfort With Treatment resulting from treatment (medication side-effect), expense of treatment, decisions based on personal value judgments or religious or cultural beliefs about the advantages and disadvantages of the proposed treatment, maladaptive personality traits or coping styles (denial of illness) or the presence of a mental disorder (schizophrenia, avoidant personality disorder). Examples include entering school, Problem leaving parental control, changes in marriage, divorce, career, or retirement. Individuals with this Cognitive condition may report problems remembering names or appointments or may Decline experience difficulty in solving complex problems. As part of their reaction to the loss, some grieving Bereavement individuals present with symptoms characteristic of a Major Depressive Episode. The bereaved individual typically regards the depressed mood as "normal, " although the person may seek professional help for relief of associated symptoms such as insomnia or anorexia. The duration and expression of "normal" bereavement varies considerably among different cultural groups. The diagnosis of Major Depressive Disorder is generally not given unless the symptoms are still present two months after the loss. However, the presence of certain symptoms that are not characteristic of a "normal" grief reaction may be helpful in differentiating bereavement from a Major Depressive Episode. Examples include distressing experiences that involve loss or Religious or questioning of faith, problems associated with conversion to a new faith, or Spiritual questioning of spiritual values that may not necessarily be related to an organized Problem church or religious institution. Culture-bound syndromes are generally limited to specific societies or culture areas and are localized, folk, diagnostic categories that frame coherent meanings for certain repetitive, patterned, and troubling sets of experiences and observations. This is an area that is often overlooked by clinicians as well as forensic experts. Though there are quite a few culture-bound syndromes studied and acknowledged in clinical practice in North America, the most common culture-bound syndromes encountered in litigation encompass two ethnic groups: Asian and Latin cultures. Therefore, if a plaintiff presents with symptoms that appear consistent with a culture-bound syndrome, additional information should be obtained, as well as an independent medical examination by an expert from that area. Latin Culture-Bound Syndromes An idiom of distress principally reported among Latinos from the Caribbean but ataque de recognized among many Latin American and Latin Mediterranean groups. Dissociative experiences, seizure-like or fainting episodes, and suicidal gestures are prominent in some attacks but absent in others. Ataques de nervios frequently occurs as a direct result of a stressful event relating to the family. People may experience amnesia for what occurred during the ataque de nervios, but they otherwise return rapidly to their usual level of functioning. Ataques span the range from normal expressions of distress not associated with having a mental disorder to symptom presentations associated with the diagnoses of Anxiety, Mood, Dissociative, or Somatoform Disorders. The underlying cause of these syndromes is thought to be strongly experienced bilis and colera anger or rage. Anger is viewed among many Latino groups as a particularly also referred powerful emotion that can have direct effects on the body and can exacerbate to as muina existing symptoms. The major effect of anger is to disturb core body balances (which are understood as a balance between hot and cold valences in the body and between the material and spiritual aspects of the body). Symptoms can include acute nervous tension, headache, trembling, screaming, stomach disturbances, and, in more severe cases, loss of consciousness. The person usually hears and understands what is occurring around him or her but feels powerless to move. This may correspond to a diagnosis of Conversion Disorder or a Dissociative Disorder. A term used by Latinos in the United States and Latin America to refer to a severe locura form of chronic psychosis. The condition is attributed to an inherited vulnerability, to the effect of multiple life difficulties, or to a combination of both factors. Symptoms exhibited by persons with locura include incoherence, agitation, auditory and visual hallucinations, inability to follow rules of social interaction, unpredictability, and possible violence. Nervios refers both to a general state of vulnerability to stressful life experiences and to a syndrome brought on by difficult life circumstances. The term nervios includes a wide range of symptoms of emotional distress, somatic disturbance, and inability to function. Common symptoms include headaches and "brain aches, " irritability, stomach disturbances, sleep difficulties, nervousness, easy tearfulness, inability to concentrate, trembling, tingling sensations, and mareos (dizziness with occasional vertigo-like exacerbations). Nervios tends to be an ongoing problem, although variable in the degree of disability manifested. Nervios is a very broad syndrome that spans the range from cases free of a mental disorder to presentations resembling Adjustment, Anxiety, Depressive, Dissociative, Somatoform, or Psychotic Disorders. Differential diagnosis will depend on the constellation of symptoms experienced, the kind of social events that are associated with the onset and progress of nervios, and the level of disability experienced. Asian Culture-Bound Syndromes In China, a condition characterized by physical and mental fatigue, dizziness, shenjing headaches, other pains, concentration difficulties, sleep disturbance, and memory shuairuo loss. Other symptoms include gastrointestinal problems, sexual dysfunction, ("neurasthenia") irritability, excitability, and various signs suggesting disturbance of the autonomic nervous system. Symptoms are attributed to excessive semen loss from frequent intercourse, masturbation, nocturnal emission, or passing of "white turbid urine" believed to contain semen. A Korean folk label for a syndrome in which initial phases are characterized by shin-byung anxiety and somatic complaints (general weakness, dizziness, fear, anorexia, insomnia, gastrointestinal problems), with subsequent dissociation and possession by ancestral spirits. Q: Is the plaintiff exhibiting any behaviors which may be representative of a culture-bound syndrome Analysis of these cases is essential because: (1) There are many cases of manipulated symptoms related to organic brain syndrome. Although there are an alarming number of real head injuries each year, defense counsel must be able to recognize spurious head injury claims. Neuropsychology is recognized by the American Psychological Association as a specialty, with board certification through the American Board of Professional Psychology. These aspects of the evaluation help quantify behavioral or neurological changes that may have resulted from a brain injury or other central nervous system disturbance. In most cases, a plaintiff is referred for neuropsychological testing in order to determine their cognitive status and perhaps, their prognosis for future functioning. These evaluations are typically used by the plaintiff as proof of damages, related to a proximately caused brain injury. Unfortunately, some neuropsychologists are reluctant to give up this information, citing ethical dilemmas. For example, some psychological and neuropsychological tests include practice sensitive items. Many of these and other psychological tests are protected by licensing agreements between the publisher of the test and the individual psychologist that uses the test materials. In many cases, the psychologist will refuse to release or hand-over the test questions because of the requirements of these arrangements. Psychologists also believe that the individual test questions will be taken out of context and ridiculed because, taken individually, they may not appear to be related to any valid scientific purpose. Which, if any, materials must be retained as confidential by the psychologist or neuropsychologist Are the opinions of the neuropsycholgical witness based on the data provided by the use of these items Can the administration of these test items change from test to test or between neuropsychologists Would "good men differ" on the use, protocol, administration or findings of these test components Does the "reading" or interpretation of these items differ in value or importance from other items commonly examined such as x-rays Will the jury arrive at a more thoroughly informed decision by seeing these items (probative value) Would exposure of these items before a jury and courtroom observers actually cause test changes in later tests given to any of these individuals Have the particular items in question ever been revealed to the public in other ways, such as scien tific research articles or text Does the court of jurisdiction have the authority to weigh and determine these legal problems Defense counsel should be aware of these issues during the discovery phase of any case in which neuropsychological evidence is being presented by the plaintiff. Q: Describe your training specific to the administration of neuropsychological tests. Neuropsychological testing is conducted for research purposes, to aid in diagnosis, to evaluate treatment efficacy, or to provide information for a legal matter. The purpose for the testing often determines what questions should be addressed and particularly what areas of testing to concentrate on (reference 31, p. Executive functioning includes problem-solving skills, abstract thinking, planning and reasoning abilities. In cases of trauma, neuropsychological testing should not be given during the acute or postacute stages. During this time the plaintiff may be experiencing rapid changes including fatigue and depression which can result in poor performance. Generally, 3-6 months post-trauma is sufficient for restoration of stamina and mental capabilities. A full day of testing may result in fatigue for an otherwise healthy person, not to mention a person possibly suffering from physical, emotional, and other difficulties. Neuropsychologists will often use a technician to assist with the administration of the tests for reasons of time and cost. However, as a result, the neuropsychologist does not become familiar with the plaintiff and cannot identify testing errors or provide firsthand descriptions of test behaviors. Having a family member help the plaintiff with the test may also invalidate the results. The ideal neuropsychological test protocol would be baseline testing at six months post-trauma, a second testing at one year post-trauma and a third testing at a year and half post-trauma. Most persons with valid head injury have a dramatic recovery curve that will be evidenced over this period of time. If there is a significant delay in the reporting of cognitive complaints this may be due to a subdural hematoma, or it may be due to a non-organic depressive pseudodementia, or medication side-effects. Comparison standards should not be used unless the skills being measured can be performed by all intact adults without variability of age, sex, education or general mentality. Therefore a neuropsychological test evaluating vocabulary level should not use a comparison standard because it is based on varying social class and education level. Rather an individual standard (based on premorbid information) should be utilized to clearly demonstrate a deficit or rate of change in an individual. Questions the test selection process is an important step in the neuropsychological evaluation, (continued) and the following factors should be considered: (reference 31, pp.

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