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Comas may also be caused by metabolic abnor- Because each person’s neurons are unique purchase keppra 250mg visa treatment of scabies, each of malities that impair the functioning of the brain through us sees color somewhat differently keppra 500mg fast delivery treatment 30th october. In general, treatment of a Further Reading coma involves avoiding further damage to the brain by Herman, Judith Lewis. New York: Basic maintaining the patient’s respiratory and cardiac func- Books, 1992. Combat neurosis The preferred term to describe mental disturbances related to the stress of military combat; also known by such alternative terms as combat fatigue syn- Communication skills and drome, shell shock, operational or battle fatigue, disorders combat exhaustion, and war neurosis. The skills needed to use language (spoken, written, signed, or otherwise communicated) to interact Combat neurosis describes any personality distur- with others, and problems related to the develop- bance that represents a response to the stress of war. Symptoms of the Language employs symbols—words, gestures, or disturbance may appear during the battle itself, or may spoken sounds—to represent objects and ideas. Children first acquire the skills to receive commu- known then according to the American Psychiatric As- nications, that is, listening to and understanding what sociation as “gross stress reaction. Next, plied to personality disturbances resulting from catastro- they will begin experimenting with expressing them- phes other than war as well. Speaking will attention from both the general public and the medical begin as repetitive syllables, followed by words, phrases, community has focused on the combat neuroses experi- and sentences. Later, children will acquire the skills of enced by those who fought during the Vietnam and Per- reading and writing, the written forms of communica- sian Gulf Wars. Although milestones are discussed for the develop- are triggered by war or combat; rather, in most cases, the ment of these skills of communication, many children disturbance begins with feelings of mild anxiety. Parents should refrain from attaching too signs are typically increased irritability and problems with much significance to either deviation from the average. As the disturbance progresses, symptoms in- When a child’s deviation from the average milestones of clude depression, bereavement-type reactions (character- development cause the parents concern, they may con- ized as guilt over having survived when others did not), tact a pediatrician or other professional for advice. The in- Spoken language problems are referred to by a num- ability to concentrate and loss of memory are also com- ber of labels, including language delay, language dis- mon. Emotional indifference, withdrawal, lack of atten- ability, or a specific type of language disability. In gener- tion to personal hygiene and appearance, and self-endan- al, experts distinguish between those people who seem to gering behaviors are also possible signs of combat neuro- be slow in developing spoken language (language delay) sis. Individuals suffering from combat neurosis often react and those who seem to have difficulty achieving a mile- to these symptoms by abusing alcohol or drugs. Language Combat neuroses can be a severe mental disorder disorders include stuttering; articulation disorders, such and the potential success of treatment varies consider- as substituting one sound for another (tandy for candy), ably. Some patients are treated successfully with antide- omitting a sound (canny for candy), or distorting a sound pressant and antianxiety medications. For a small per- (shlip for sip); and voice disorders, such as inappropriate centage, however, hospitalization may be required. Consequently it is possible for a defen- dant to be competent for certain kinds of legal proceed- ings, but not for others. There are a number of questions that evaluators Comparative psychology might seek to answer when making a competency deter- mination. A subfield of experimental psychology which fo- Does he appreciate the possible penalties? Does he ap- cuses on the study of animals for the purpose of comparing the behavior of different species. Can he provide mean- Studies of animal behavior have taken two main di- ingful testimony in his own defense? The type of research petence can arise at any point during criminal proceed- most often practiced in the United States has been ani- ings, and may be initiated by the defense, by the prose- mal research, involving the study of animals in laborato- cutor, or by the judge. Prior to 1972, defendants found to ries and emphasizing the effects of environment on be- be incompetent could be confined to mental hospitals havior. European research, by comparison, has been for very lengthy periods of time—sometimes for a more closely associated with the area of inquiry known longer period than they would have served if they had as ethology, which concentrates on studying animals in been found guilty. Supreme Court ruling in 1972 their natural environment and emphasizes the evolution restricted the length of time a defendant could be hospi- of behavioral patterns which are typical of a particular talized because of incompetence to stand trial. Prompting an increase in the study of animal be- havior, ethology has laid the groundwork for an under- Once the question of competence arises, a compe- standing of species-typical behavior and also led to tency evaluation will be conducted. The evaluation typi- progress in relating and contrasting behaviors among cally takes place in a special hospital or clinic. Comparative psychology serves a num- of professionals may be qualified to conduct such exami- ber of functions.

Although many other countries rely on judges to make judgments in civil and criminal trials purchase 500mg keppra otc treatment plan goals, the jury is the foundation of the legal system in the United States keppra 500mg low cost medicine 7 year program. The notion of a ―trial by one‘s peers‖ is based on the assumption that average individuals can make informed and fair decisions when they work together in groups. But given the potential for group process losses, are juries really the best way to approach these important decisions? As a small working group, juries have the potential to produce either good or poor decisions, depending on the outcome of the characteristics of the individual members as well as the group process. In terms of individual group characteristics, people who have already served on juries are more likely to be seen as experts, are more likely to be chosen to be the jury foreman, and give more input during the deliberation. It has also been found that status matters; jury members with higher status occupations and education, males rather than females, and those who talk first are more likely be chosen as the foreman, and these individuals also contribute more to [9] the jury discussion (Stasser, Kerr, & Bray, 1982). However, although at least some member characteristics have an influence on jury decision making, group process plays a more important role in the outcome of jury decisions than do member characteristics. Like any group, juries develop their own individual norms, and these norms can have a profound impact on how they reach their decision. Analysis of group process within juries shows that different juries take very different approaches to reaching a verdict. Some spend a lot of time in initial planning, whereas others immediately jump into the deliberation. Some juries base their discussion around a review and reorganization of the evidence, waiting to make a vote until it has all been considered, whereas other juries first determine which decision is preferred in the group by taking a poll and then (if the first vote does not lead to a final verdict) Attributed to Charles Stangor Saylor. These two approaches are used quite equally but may in some [10] cases lead to different decisions (Davis, Stasson, Ono, & Zimmerman, 1988). Perhaps most importantly, conformity pressures have a strong impact on jury decision making. This does not mean that minorities can never be persuasive, but it is very difficult for them to do so. The strong influence of the majority is probably due to both informational conformity (i. When the majority of the 6 initially favored voting guilty, the jury almost always voted guilty; when the majority of the 6 initially favored voting innocent, the jury almost always voted innocent. The juries were frequently hung (could not make a decision) when the initial split was 3–3. However, despite these concerns, the evidence suggests that juries may not do as badly as we would expect. The deliberation process seems to cancel out many individual juror biases, and the importance of the decision leads the jury members to carefully consider the evidence itself. Using Groups Effectively Taken together, working in groups has both positive and negative outcomes. On the positive side, it makes sense to use groups to make decisions because people can create outcomes working together that any one individual could not hope to accomplish alone. In addition, once a group makes a decision, the group will normally find it easier to get other people to implement it, because many people feel that decisions made by groups are fairer than are those made by individuals. Yet groups frequently succumb to process losses, leading them to be less effective than they should be. Furthermore, group members often don‘t realize that the process losses are occurring around them. For instance, people who participate in brainstorming groups report that they have been more productive than those who work alone, even if the group has actually not done that [11] well (Nijstad, Stroebe, Lodewijkx, 2006; Stroebe, Diehl, & Abakoumkin, 1992). The tendency for group members to overvalue the productivity of the groups they work in is known as theillusion of group productivity, and it seems to occur for several reasons. For one, the productivity of the group as a whole is highly accessible, and this productivity generally seems quite good, at least in comparison to the contributions of single individuals. The group members hear many ideas expressed by themselves and the other group members, and this gives the impression that the group is doing very well, even if objectively it is not. And, on the affective side, group members receive a lot of positive social identity from their group memberships. These positive feelings naturally lead them to believe that the group is strong and performing well.

Weston (1996) suggests myocyte death depends upon work load (oxygen demand) cheap 250 mg keppra otc medications reactions, prior episodes of ischaemia and collateral flow keppra 500 mg on-line symptoms of strep. Collateral circulation Like most body systems, the cardiovascular system is dynamic, changing to meet physiological needs. With progressive obliteration of flow, arteries can develop collateral circulation to bypass obstructions. Collateral vessels are small, weak and tortuous, offering temporary relief rather than permanent solutions, although they may limit infarct size. Oestrogen production during reproductive years protects women from atherosclerosis, making men under 55 up to four times more likely to suffer from coronary artery disease than women (Lessig & Lessig 1998). However, the earlier development of coronary artery disease in men also means earlier development of collateral circulation; the sudden reduction in oestrogen levels during and following menopause exposes women to rapid atherosclerosis (Sloane et al. Before the ischaemic muscle dies, contraction ceases, prolonging the interval before irreversible damage (Ganong 1995); this interval provides an important window for treatment, especially for thrombolysis. Reperfusion of any ischaemic tissue releases vasoactive substances, many prolonging pathological processes (see Chapter 23). The uncontrolled release of oxygen free radicals and cytokines causes myocardial stunning (deBono 1992; Grech et al. Recovery of any injured tissue can be complicated by reperfusion injury; fortunately cardiac function is normally monitored so thoroughly that the early detection and resolution of problems is more likely than with most tissues. Acute myocardial infarction 247 Alcohol Recent media publicity about positive cardiac benefits from alcohol have encouraged public misconceptions, providing excuses for further alcohol abuse. Current evidence is inconclusive, but it suggests that mild drinking (1–6 drinks each week) may reduce mortality (Francome & Marks 1996) -revastoral (in red wine) or salicylic acid (the main ingredient of aspirin) may be the effective agents (Francome & Marks 1996). Alcohol consumption may be under-reported, so that nurses can usefully provide patients and families with information to discourage excessive consumption. Identifying and measuring levels of enzymes enables diagnosis of which cells are damaged. It is also released from the brain and skeletal muscle, and so serum levels are raised by intramuscular injections, surgery and any other bleeding/bruising (Wilson 1983). Angiography Angiography can confirm a diagnosis of coronary thrombi, and can be used to dilate coronary vessels (see Chapter 30), which may increasingly replace traditional surgical approaches of coronary artery bypass grafting (see Chapter 30). Angina may also be caused by coronary artery spasm, and so nitrates can usefully dilate coronary arteries and reduce preload. Although a link between myocardial infarction and severe pain have long been established, O’Connor’s (1995) pilot study found that nurses underestimate pain in 23–46 per cent of cases, while Gaston-Johansson et al. Popular connotations of the heart make many patients fear cardiac disease more than disease of any other organ. Some patients, who have been told to take one aspirin tablet a day and do not recognise the difference between tablet strengths, take one 300-mg tablet each day. Aspirin (and other platelet inhibitors) may offer most cardiac protection when taken in the evening, ensuring maximum effectiveness when platelets are stickiest. Isosorbide dinitrate can be given sublingually, enabling ready access and quick absorption. It may be given long term to reduce reocclusion (Weston 1996), and Hockings and Donovan (1997) recommended heparin for 6–12 hours following thrombolysis. A recent revival of interest in hirudin (leech extract), a thrombin inhibitor which, unlike heparin, is not neutralised by activated platelets, has proved disappointing; one trial was stopped due to adverse outcomes (Galvani et al. Thrombolysis Thrombolytics are best given within six hours (and preferably earlier) following infarction, although later use (e. Nearly one-third of patients receiving thrombolytics suffer reocclusion within three months (Weston 1996). It activates plasminogen into plasmin (Ganong 1995), causing lysis for 12–24 hours. Being a streptococcal product, it can cause anaphylaxis; this is rare with first doses as antibodies develop after 4 days, but subsequent doses may be problematic, and so repeat doses should be avoided after 4 days (Kynman 1997). Due to possible anaphylaxis, patients should be given information sheets informing them (and other healthcare workers) when second doses may be safely given.