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The treatment of a child with multiple personality takes far less time than treatment of an adult buy generic flonase 50 mcg line allergy medicine link to alzheimer's. In the treatment of children Kluft and Fagan and McMahon utilized various techniques including play therapy discount flonase 50mcg otc allergy medicine guide, hypnotherapy, and abreaction in order to bring about integration [25, 26]. Kluft placed particular emphasis on family intervention and agency involvement both to prevent further abuse and to alter pathological patterns of interaction. The psychiatric syndrome of multiple personality is associated with an extremely high incidence of physical and/or sexual abuse during childhood. The abuse is usually severe, prolonged, and perpetrated by family members. Multiple personality may be difficult to diagnose because of the subtlety of the presenting symptoms. Currently multiple personality is usually diagnosed in adults who are in their late 20s or early 30s. The diagnosis of multiple personality in children is even more difficult because of the subtlety of symptoms and the ease with which these symptoms are confused with fantasy. Although individuals with multiple personality do not usually abuse their own children, the incidence of psychiatric disturbance in their children is high. Multiple personality is much easier to treat if diagnosed early in childhood or adolescence. Therefore, in order to decrease the morbidity of multiple personality and decrease the psychiatric disturbance in children of multiple personality parents, it behooves the clinician to become well acquainted with the syndrome of multiple personality, to diagnose multiple personality as early as possible, and to insure that the individual with multiple personality obtains effective treatment. The differential diagnosis of multiple personality: A comprehensive review. Journal of Abnormal and Social Psychology 39:281-300 ( 1944]. Journal of Nervous and Mental Disease 168:577-596 (1980). Multiple personalities: A report of 14 cases with implications for schizophrenia. Archives of General Psychiatry 257:1388-1397 (1980). Psychosexual disturbances in multiple personality: Characteristics. In: Childhood Antecedents of Multiple Personality, R. In: The Standard Edition of the Complete Psychological Works. The multiple personality epidemic: Additional cases and inferences regarding diagnosis. Journal of Nervous and Mental Disease 170:302-304 [1982). A symptom profile of patients with multiple personalities including MMPI results. Journal of Nervous and Mental Disease 172:197-202 (1984). The development of multiple personality disorder: Predisposing. In: Childhood Antecedents of Multiple Personality, R. Psychiatric Clinics of North America 7:121-134 (1984). Journal of Nervozts and Mental Disease 172:26-36 (1984). Journal of the American Academy, of Child Psychiatry 24:495-501 (1985). The children of parents with multiple personality disorder.

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She had been engaging in self-injurious behaviors for about 5 years buy flonase 50mcg on line allergy treatment and medicare. You started self injuring when you were 13 years old purchase flonase 50 mcg mastercard allergy symptoms black mold. Do you remember why and what that was like for you at that young age? Janay: I think I read a book about a cutter and wanted to see how strong I was. Janay: I cut with a piece of broken lightbulb, so light it barely broke the skin. I remember being late to school one day and, as I was crossing the grass, just for no reason turned around and went to a corner of the school campus and cut myself with an exacto knife. Janay: I was really kind of upset from the night before and that morning over a fight with my mom. I had the exacto knife on me because I used to help my mom with various crafts. David: From previous guests, we have learned that many people start self-injuring possibly as a way to handle certain feelings stemming from sexual abuse. David: In the letter you sent me, you said: "I (used to) self injure because it was the only way I knew to relieve extreme stress or emotion, i. The more extreme the pain or confusion, the less I felt, so the deeper I cut. Janay: I think it was more that she was ashamed of me - having a crazy daughter. When I was younger I was "so smart, so pretty, I could be whatever I wanted," and then they found out about my cousin (sexual abuse) from someone else. She was just dissapointed in me, that I turned out the way I am. David: We have a lot of audience questions for you, Janay. I was furious, but at the same time it made me feel good that they even cared enough to tell. Now I am 22 and stopped doing it at the end of last year. I wanted to stop because I knew it was getting out of hand - cuts were reaching muscle. I saw a therapist, told my mum, and stopped lying to myself. Every day is a battle to not SI but, so far, I am getting there. When was the first time you received professional treatment and what were the circumstances? My mom said I was a smart ass, so she put me in the hospital to scare me. Most of my stays were only 3-5 days because of insurance. A lot were just for "suicidal ideation," 2 for overdoses. And the cops put me in a few times because my mom told them I was suicidal. David: So, in combination with the self-injury, you were suffering from depression. Did you get anything positive out of treatment/therapy? Janay: Yeah, I am diagnosed with depression, and anorexia, bulimia, and OCD, and a billion other things. I see no point in hospitalization, because if I want to hurt myself, I can do it in the hospital or at home.

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The relevance of these findings to humans is unclear generic 50mcg flonase mastercard extended allergy forecast. The no-effect doses for these observations in male rats were 30 mg/kg body weight/day for thyroid tumors and 60 mg/kg body weight/day for liver tumors purchase 50 mcg flonase visa allergy symptoms medications, which are over 15 and 30 times, respectively, clinical exposure on a mg/m2 basis. Repaglinide was non-genotoxic in a battery of in vivo and in vitro studies: Bacterial mutagenesis (Ames test), in vitro forward cell mutation assay in V79 cells (HGPRT), in vitro chromosomal aberration assay in human lymphocytes, unscheduled and replicating DNA synthesis in rat liver, and in vivo mouse and rat micronucleus tests. Fertility of male and female rats was unaffected by repaglinide administration at doses up to 80 mg/kg body weight/day (females) and 300 mg/kg body weight/day (males); over 40 times clinical exposure on a mg/m2 basis. Repaglinide was not teratogenic in rats or rabbits at doses 40 times (rats) and approximately 0. Because animal reproduction studies are not always predictive of human response, Prandin should be used during pregnancy only if it is clearly needed. Because recent information suggests that abnormal blood glucose levels during pregnancy are associated with a higher incidence of congenital abnormalities, many experts recommend that insulin be used during pregnancy to maintain blood glucose levels as close to normal as possible. Offspring of rat dams exposed to repaglinide at 15 times clinical exposure on a mg/m2 basis during days 17 to 22 of gestation and during lactation developed nonteratogenic skeletal deformities consisting of shortening, thickening, and bending of the humerus during the postnatal period. Relevant human exposure has not occurred to date and therefore the safety of Prandin administration throughout pregnancy or lactation cannot be established. In rat reproduction studies, measurable levels of repaglinide were detected in the breast milk of the dams and lowered blood glucose levels were observed in the pups. Cross fostering studies indicated that skeletal changes (see Nonteratogenic effects above) could be induced in control pups nursed by treated dams, although this occurred to a lesser degree than those pups treated in utero. Although it is not known whether repaglinide is excreted in human milk some oral agents are known to be excreted by this route. Because the potential for hypoglycemia in nursing infants may exist, and because of the effects on nursing animals, a decision should be made as to whether Prandin should be discontinued in nursing mothers, or if mothers should discontinue nursing. If Prandin is discontinued and if diet alone is inadequate for controlling blood glucose, insulin therapy should be considered. No studies have been performed in pediatric patients. In repaglinide clinical studies of 24 weeks or greater duration, 415 patients were over 65 years of age. In one-year, active-controlled trials, no differences were seen in effectiveness or adverse events between these subjects and those less than 65 other than the expected age-related increase in cardiovascular events observed for Prandin and comparator drugs. There was no increase in frequency or severity of hypoglycemia in older subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals to Prandin therapy cannot be ruled out. Prandin has been administered to 2931 individuals during clinical trials. Approximately 1500 of these individuals with type 2 diabetes have been treated for at least 3 months, 1000 for at least 6 months, and 800 for at least 1 year. The majority of these individuals (1228) received Prandin in one of five 1-year, active-controlled trials. The comparator drugs in these 1-year trials were oral sulfonylurea drugs (SU) including glyburide and glipizide. Over one year, 13% of Prandin patients were discontinued due to adverse events, as were 14% of SU patients. The most common adverse events leading to withdrawal were hyperglycemia, hypoglycemia, and related symptoms (see PRECAUTIONS ). Mild or moderate hypoglycemia occurred in 16% of Prandin patients, 20% of glyburide patients, and 19% of glipizide patients. The table below lists common adverse events for Prandin patients compared to both placebo (in trials 12 to 24 weeks duration) and to glyburide and glipizide in one year trials. The adverse event profile of Prandin was generally comparable to that for sulfonylurea drugs (SU). Commonly Reported Adverse Events (% of Patients)*Placebo controlled studiesActive controlled studiesIn one-year trials comparing Prandin to sulfonylurea drugs, the incidence of angina was comparable (1. The incidence of other selected cardiovascular events (hypertension, abnormal EKG, myocardial infarction, arrhythmias, and palpitations) was ?-T 1% and not different between Prandin and the comparator drugs. The incidence of total serious cardiovascular adverse events, including ischemia, was higher for repaglinide (4%) than for sulfonylurea drugs (3%) in controlled comparator clinical trials.

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