Mark Corson

O. Rendell. Baker University.

Bipolar disorder is more likely to be diagnosed when it is initially observed at an early age 500mg ampicillin, when the frequency of depressive episodes is high buy ampicillin 500 mg cheap, and when there is a sudden onset of the [11] symptoms (Bowden order 500 mg ampicillin free shipping, 2001). Explaining Mood Disorders Mood disorders are known to be at least in part genetic, because they are heritable. Serotonin, dopamine, and norepinephrine are all known to influence mood (Sher & [13] Mann, 2003), and drugs that influence the actions of these chemicals are often used to treat mood disorders. The brains of those with mood disorders may in some cases show structural differences from [14] those without them. Videbech and Ravnkilde (2004) found that the hippocampus was smaller in depressed subjects than in normal subjects, and this may be the result of reduced neurogenesis (the process of generating new neurons) in depressed people (Warner- [15] Schmidt & Duman, 2006). Antidepressant drugs may alleviate depression in part by [16] increasing neurogenesis (Duman & Monteggia, 2006). People who experience stressful life events, for instance involving threat, loss, humiliation, or defeat, are likely to experience depression. But biological-situational models suggest that a person‘s sensitivity to stressful events depends on his or her genetic makeup. The researchers therefore expected that people with one type of genetic pattern would show depression following stress to a greater extent than people with a different type of genetic pattern. One group had a short version (orallele) of the gene, whereas the other group did not have the short allele of the gene. The participants also completed a measure where they indicated the number and severity of stressful life events that they had experienced over the past 5 years. The events included employment, financial, housing, health, and relationship stressors. The dependent measure in the study was the level of depression reported by the participant, as [18] assessed using a structured interview test (Robins, Cottler, Bucholtz, & Compton, 1995). But for the participants who did not have a short allele, increasing stress did not increase depression (bottom panel). Furthermore, for the participants who experienced 4 stressors over the past 5 years, 33% of the participants who carried the short version of the gene became depressed, whereas only 17% of participants who did not have the short version did. This important study provides an excellent example of how genes and environment work together: An individual‘s response to environmental stress was influenced by his or her genetic makeup. But psychological and social determinants are also important in creating mood disorders and depression. In terms of psychological characteristics, mood states are influenced in large part by our cognitions. Negative thoughts about ourselves and our relationships to others create negative moods, and a goal of cognitive therapy for mood disorders is to attempt to change people‘s Attributed to Charles Stangor Saylor. Negative moods also create negative behaviors toward others, such as acting sad, slouching, and avoiding others, which may lead those others to respond negatively to the person, for instance by isolating that person, which then creates even more depression (Figure 12. You can see how it might become difficult for people to break out of this “cycle of depression. These differences seem to be due to discrepancies between individual feelings and cultural expectations about what one should feel. People from European and American cultures report that it is important to experience emotions such as happiness and excitement, whereas the Chinese report that it is more important to be stable and calm. If the depression continues and becomes even more severe, the diagnosis may become that of major depressive disorder. Give a specific example of the negative cognitions, behaviors, and responses of others that might contribute to a cycle of depression like that shown inFigure 12. Given the discussion about the causes of negative moods and depression, what might people do to try to feel better on days that they are experiencing negative moods? Aspinall, Apsychology of human strengths: Fundamental questions and future directions for a positive psychology (pp. Hedonic tone and activation level in the mood-creativity link: Toward a dual pathway to creativity model. Hippocampal neurogenesis: Opposing effects of stress and antidepressant treatment. Identify the biological and social factors that increase the likelihood that a person will develop schizophrenia. The term schizophrenia, which in Greek means “split mind,‖ was first used to describe a psychological disorder by Eugen Bleuler (1857–1939), a Swiss psychiatrist who was studying patients who had very severe thought disorders. Schizophrenia is a serious psychological disorder marked by delusions, hallucinations, loss of contact with reality, inappropriate affect, disorganized speech, social withdrawal, and deterioration of adaptive behavior. Schizophrenia is the most chronic and debilitating of all psychological disorders. It affects men and women equally, occurs in similar rates across ethnicities and across cultures, and affects at any one time approximately 3 million people in the United States (National Institute of Mental [1] Health, 2010). Onset of schizophrenia is usually between the ages of 16 and 30 and rarely Attributed to Charles Stangor Saylor. Symptoms of Schizophrenia Schizophrenia is accompanied by a variety of symptoms, but not all patients have all of them (Lindenmayer & Khan, 2006). Finally, cognitive symptoms are the changes in cognitive processes that accompany schizophrenia (Skrabalo, 2000). Auditory hallucinations are the most common and are reported by approximately three quarters [6] of patients (Nicolson, Mayberg, Pennell, & Nemeroff, 2006). Schizophrenic patients frequently report hearing imaginary voices that curse them, comment on their behavior, order them to do [7] things, or warn them of danger (National Institute of Mental Health, 2009).

According to their tests generic ampicillin 500mg with mastercard, they found almost half of newer of training are available for students who want to the young order 250 mg ampicillin overnight delivery, white male recruits and some 80% of Eastern place more emphasis on practice and less on doing re- European immigrants to be “morons buy 500mg ampicillin with amex. In addition to university graduate programs, a think the uses of intelligence tests, especially because of large number of professional schools have been estab- opinions like that of journalist Walter Lippman, who rec- lished, often offering a Psy. D (doctor of psychology) de- ommended that the “intelligence testers and their tests gree. Currently, some 4,000 students graduate each year should be sunk without warning in the… sea. The over- denied entrance into this country, and intelligence testing whelming majority of these graduates go into clinical or laid the base for human eugenics laws that allowed individ- applied work, although changing conditions in the health uals who were found “intellectually unfit” to be sterilized. With the introduction of psy- A field as broad as psychology, which stretches from choanalysis into this country, people wanted to “adjust” the study of brain cells to that of prison cells, is an active, through self-examination and the probing of the uncon- argumentative, and exciting adventure that offers oppor- scious. The scientific psychologists were dismayed at the tunities in science, practice, and social policy. Most of the excesses of pseudopsychologists, whose ranks included pressing economic and social issues of our generation, mind readers and charlatans. Psychological clinicians such as the environment, health needs, poverty, and vio- were concerned as well and took steps to develop a stan- lence, will only be alleviated if we understand the ways in dard of ethics and ways of identifying appropriately which people create or creatively solve the problems that trained psychologists. The student who is interested in unraveling the secrets of the human brain to see the mind With the advent of the Second World War, psycholo- at work, who is fascinated about how children grow up gists joined the military effort and were surprised them- and become competent adults, who is dedicated to bring- selves by how much they had to offer. Human factors psy- ing people together to resolve conflict, who is committed chologists designed airplane cockpits and the lighting on to helping people with physical, emotional, or behavioral runways that we still use today. Gestalt psychologists difficulties, or who is challenged by the desire to develop taught American citizens how to identify enemy planes social policy in the public interest is welcomed in psy- should they fly overhead. We hope this encyclopedia will provide useful guide missiles toward enemy targets. Psychologists information that will help students and others understand worked for the Office of Strategic Services (which eventu- this fascinating field and its opportunities. Division of Clinical Psychology and the American Asso- She has been on the faculties of Emory University and the ciation for Applied and Preventive Psychology; she was a University of Massachusetts in Amherst as a teacher, re- Founder and on the first Board of Directors of the Ameri- searcher, administrator, clinician, and consultant. An advocate for minority con- Diplomate in Clinical Psychology, she has also been in cerns, she has published more than a hundred scholarly practice for over 35 years. Abnormal behavior is defined as behavior that is The capacity to learn, commonly known as aptitude, considered to be maladaptive or deviant by the social and the demonstration of skills and knowledge already culture in which it occurs. Though disagreement exists learned, called achievement, are among the factors used regarding which particular behaviors can be classified as to evaluate intelligence. When evaluating or comparing abnormal, psychologists have defined several criteria for subjects, two kinds of abilities are considered: verbal purposes of classification. One is that the behavior oc- ability, including reading comprehension, ability to con- curs infrequently and thus deviates from statistical verse, vocabulary, and the use of language; and problem- norms. Another is that the behavior deviates from social solving ability, which includes a person’s capacity to norms of acceptable behavior. Lastly, abnormal- Relatively straightforward tests of ability are often ity may be defined based on the subjective feelings of used by employers to determine an applicant’s skills. For misery, depression, or anxiety of an individual rather example, a person applying for a job as a word processor than any behavior he exhibits. See also Achievement tests; Scholastic Assessment Test; Stanford-Binet intelligence scales; Vocational Apti- While psychologists use similar criteria to diagnose tude Test abnormal behavior, their perspectives in understanding and treating related disorders vary greatly. For instance, Further Reading a psychologist with a psychoanalytic approach would ex- Atkinson, Rita L. And a psychologist While abortion is practiced throughout society, in all with a biological perspective would consider a chemical socioeconomic strata, poor women are three times more imbalance in the nervous system of a depressed individ- likely to have an abortion than their well-off counterparts. Many studies have White women have 63% of all abortions, but the shown that a number of these factors may come into play non-white abortion rate is more than twice the white in the life of an individual suffering from a mental disor- rate—54 per 1,000 versus 20 per 1,000. Social reasons include fear of motherhood, fear of los- Personality Disorders and the Five-Factor Model of Personality. Abortion is a complex issue that raises a plethora of medical, ethical, political, legal, and psychological ques- Abortion tions, and is viewed by proponents and opponents as one of society’s fundamental problems. Invasive procedure resulting in pregnancy termina- Simmons has written (Butler and Walbert, 1992), “is re- tion and death of the fetus. More than half (53%) of the unplanned the two camps has been difficult, seemingly impossible, pregnancies happen among the 10% of women who prac- because opinions are often based on strong feelings and tice no contraception. An additional obstacle to dialogue is the fact that young: 55% are under 25, including 21% teenagers. Pro-life discourse often draws its strength from the Christian axiom about the sanctity of life, while pro- choice thinking proceeds from the belief that an individ- ual woman has the freedom to act in her best interest. Vulsellum Vagina While vulnerable to moral condemnation, and even ha- rassment, adult women have the protection of liberal legisla- Uterus tion in seeking an abortion (in Roe v. Teenagers, however, are subject to state laws; in 25 states, a minor cannot seek an abortion without parental consent. Tra- ditionally, any medical treatment of a minor requires Embryonic parental consent, and as the Planned Parenthood Fact Sheet tissue “Teenagers, Abortion, and Government Intrusion Laws” points out, a physician treating a minor without parental con- sent is committing the common law equivalent of battery. Speculum However, “in the area of abortion, there have never been Extraction tube criminal penalties for treating a minor on her own consent. In addition, Planning Attitudes and Experiences of Low-Income scientists cannot determine with absolute certainty how Women. Scientists have discovered that cognitive “Teenagers, Abortion, and Government Intrusion Laws. The method of testing for the absolute threshold is similar for different sensory systems. Thus, the tester can Acculturation briefly present a light or a sound (or any other kind of The process of adapting to or adopting the prac- stimulus) at different, low intensities until the observer is tices of a culture different from one’s own. In such a task, the person may undergo thousands of trials before Acculturation is the process of learning about and the researcher can determine the threshold.

Practice According to this theory buy ampicillin 250 mg free shipping, nurses use their spe- cialized capabilities to create a helping system in Summary Nurses use their specialized capabilities to References create a helping system in situations where persons are deemed to have an existent or potential self-care deficit generic ampicillin 250 mg overnight delivery. According to Orem (2001) discount ampicillin 500mg, it is the special focus on human beings that distinguishes or differenti- situations where persons are deemed to have an ex- ates nursing from other human services. When the answer is the nurse, a wholly tions of the Self-Care Deficit Nursing Theory pro- compensatory system of helping is appropriate. The aspect situations, the goal of nursing is to empower of the Self-Care Deficit Nursing Theory that has the person to meet their self-care requirements by generated the most research of this type is the doing for (wholly compensatory system), doing relationship posited between basic conditioning with (partly compensatory system), or developing factors and self-care agency. Dorothy Johnson (1959), in the Self-Care Deficit Nursing Theory states that in- her treatise on nursing theory development, viewed dividuals’ abilities to engage in self-care (self-care this attribute of a theory as its value for the profes- agency) are conditioned by age, developmental sion, its social utility. This proposition offers direction to nurses Research interested in engaging in theory-based research. Basic conditioning factors are defined as “condi- Dorothea Orem’s theory is offering clear direction tions or events in a time-place matrix that affect the to nurses in the advancement of nursing science in value of person’s abilities to care for themselves” this millennium. It is important to note that the influence of tical science that is comprised of both theoretical the basic conditioning factors on self-care agency is and practical knowledge, a point of view that is not assumed to be operative at all times. There the basic conditioning factors assumed to be oper- are parallels between Orem’s description of nursing ative at all times. Because the influence of these fac- as a practical science and Donaldson and Crowley’s tors occurs within a time-place matrix, research is discussion of nursing as a professional discipline. Both perspectives address the between the basic conditioning factors and the sub- need for nurses to develop both theoretical and stantive structure of self-care agency can then be practical knowledge. Scholarly work of this type is vital to kinds of knowledge about persons with existent or the advancement of the theoretical knowledge of potential health-related self-care deficits. The theory is the result singularly and in combination, on individuals’ self- of Stage 1. Several studies (1981) studied the influence of family as a social designed to determine the nature of the influence of support system on the self-care agency of adults variations in health state on self-care abilities are re- with diabetes mellitus. Research suggests influence of basic conditioning factors on the self- that this relationship is particularly salient in prac- care agency of persons enrolled in a weight-loss tice situations in which persons are experiencing program. The work of selected in- of family variables and caregiver variables on the vestigators is presented here to exemplify this line of self-care abilities of the spouses of patients with a inquiry. Baker (1991) explored the predic- the self-care abilities of persons with coronary tive effect of basic conditioning factors on the self- artery disease has been studied with both American care agency and self-care in adolescents with cystic and Dutch adult patient populations (Isenberg, fibrosis. Across these ence of basic conditioning factors on the self-care studies, changes in health state were found to be capabilities of unmarried women at risk for sexu- critical determinants of the quality of the self-care ally transmitted disease. As the health tualized personality as a basic conditioning factor state of patients improved, so did their capabili- and tested the model with a healthy population and ties for self-care. Conversely, self-care capabilities a comparative clinical population with chronic tended to decline as patients experienced recur- renal disease. The findings re- ence of basic conditioning factors on the self-care vealed a positive relationship between health state abilities of a healthy and clinical adult population and self-care agency in patients with cardiac disease. In addition to the study of variation in health Baiardi (1997) explored the influence of health state due to pathophysiology, the conditioning in- state and caregiving factors on the self-care agency fluence of health state on self-care agency has also of the caregivers of cognitively impaired elders. West ined the influence of personal and environmental (1993) investigated the influence of clinical varia- factors on the self-care behaviors among patients tions in the level of depression, conceptualized as a with congestive heart failure. In a study with Dutch psychiatric patients, Deficit Nursing Theory have been greatly enhanced Brouns (1991) also reported that variations in men- by the measurement work with self-care concepts tal health state significantly influenced patients’ that has transpired over the past 20 years. In both studies a positive rela- portant to note that the theory-testing studies cited tionship between health state and self-care agency above were made possible by the development and was revealed. Higher levels of mental health were psychometric testing of instruments to measure the correlated with higher self-care agency scores. Instruments are currently These findings verified the conditioning influence available to measure the self-care agency of adoles- of health state on the self-care agency of patients’ cent populations (Denyes, 1982), adult populations experience variations in physical and mental health. The availability The conditioning influence of other basic fac- of valid and reliable measures of self-care agency tors on the self-care abilities of clinical and non- has been vital to the advancement of the theoretical clinical populations has been the focus of inquiry component of self-care nursing science. Intervention studies therapeutic self-care demand, self-care agency, and designed to enhance self-care performance are also the self-care actions of individuals with chronic ob- under way. Health state was found to gram of research focused on the self-care of cancer offer significant explanation of variations in the patients who were receiving chemotherapy or radi- self-care actions of this population. Her early descriptive studies clarified universal, developmental, and health deviation self- the health-deviation self-care requisites of this pop- care requisites, Riley (1996) developed a tool to ulation and documented the therapeutic self-care measure the performance and frequency of the self- demand (Dodd, 1982, 1984). More recent work de- care actions of patients with chronic obstructive scribed specific self-care behaviors initiated by pa- lung disease. This tool has the potential to be useful tients receiving these therapies and led to the as an outcome measure in future intervention stud- identification of a patient profile of self-care that ies designed to enhance the self-care abilities of this can be used in practice to target specific patient population. Dodd’s intervention studies Nursing Theory as the basis for her program of re- demonstrated that with targeted information, search with children. She has developed the Child patients can learn more about their treatment and and Adolescent Self-Care Practice questionnaire, can perform more effective self-care behaviors which can be used to assess the self-care perfor- (Dodd, 1997). Children with higher Through her 20-year program of descriptive, pre- self-concept scores were found to perform more dictive, and intervention studies based on self-care self-care activities than children with low self- theory, Dodd’s research has demonstrated how to concept scores (Mosher & Moore, 1998). Investigators have used Orem’s theory to iden- The utility of the Self-Care Deficit Nursing Theory tify the self-care requisites and self-care capabilities beyond our national borders can be explained in of patients across a broad range of health devia- tions. Based on the theory, Utz and Ramos (1993) The utility of the Self-Care Deficit Nursing have conducted a sequence of studies to explore Theory beyond our national borders can and describe the self-care needs of people with be explained in part by the fact that symptomatic mitral valve prolapse.

On rare occasions assailants injure their penises during a sexual act ampicillin 250 mg discount, and this may be the source of blood found in the vagina cheap ampicillin 500mg visa. The quantity of semen in the vagina will diminish progressively with time order ampicillin 500mg online, usually as a result of drainage. The posture and activity of the complain- ant subsequent to the act are likely to affect this. Drainage of semen from the vagina may also result in soiling of intimate clothing items worn at the time, and these can prove valuable sources of body fluids. It has been observed that spermatozoa can be isolated for longer periods in the endocervix. Studies that compared paired swabs from the vagina and cervix have found that 2 days or more after vaginal ejaculation there is a larger quantity of spermatozoa on endocervical swabs compared with the vaginal swabs (115). Therefore, it is recommended that if a complainant presents 48 hours or more after alleged vaginal intercourse, an endocervical swab be taken in addition to the swabs from the vagina. There is interest in the possibility of determining the timing of inter- course by changes in spermatozoa. Spermatozoa may remain motile in the vagina for up to 24 hours and longer in the cervical mucosa (50,118,119), but the periods for persistence are extremely variable. For example, Rupp (120) observed that motile spermatozoa persisted longer in menstruating women but added that identification is hindered by the presence of red blood cells, and Paul (121) reported that the period of spermatozoa motility ranged Sexual Assualt Examination 91 from 1–2 hours at the end of the menstrual cycle to as long as 72 hours at the time of ovulation. However, the morphology of the spermatozoa does show more consis- tent temporal changes. In particular, the presence of large numbers of sperma- tozoa with tails is indicative of recent intercourse. The longest time after intercourse that spermatozoa with tails have been found on external vaginal swabs is 33 hours and 120 hours on internal vaginal swabs (122). Examination Methods The forensic practitioner should inspect the mons pubis and note the color, coarseness, and distribution (Tanner stages 1–5) of any pubic hair. A note should also be made if the pubic hair appears to have been plucked (including bleeding hair follicles), shaved, cut, or dyed. Then the vulval area must be carefully inspected before the insertion of a speculum, because even gentle traction on the posterior fourchette or fossa navicularis during a medical examination can cause a superficial laceration at these sites. Whenever possible, the vagina and cervix should be inspected via the transparent speculum after the high vaginal samples have been ob- tained. Colposcopy and the application of toluidine blue dye are two special- ist techniques used by some forensic practitioners during female genitalia examinations. Colposcopy A colposcope is a free-standing, binocular microscope on wheels that is most commonly used for direct visualization of the cervix (using a bivalve speculum) after the detection of abnormal cervical cytology. Many centers, particularly those in the United States, advocate the use of the colposcope for external and, where relevant, internal genital and/or anal assessments of com- plainants of sexual assault. The colposcope undoubtedly provides considerable advantages over gross visualization. First, it provides magnification (5–30 times) and greater illumi- nation, enabling detection of more abnormalities. Slaughter and Brown (123) demonstrated positive colposcopic findings in 87% of female complainants of nonconsensual penile penetration within the previous 48 h, whereas gross 92 Rogers and Newton visualization has historically identified positive genital findings in only 10– 40% of cases (37–39,124,125). Second, with the attachment of a still or video camera, the colposcope allows for a truly contemporaneous, permanent video/photographic record of the genital/anal findings without resorting to simultaneous dictation, which has the potential to distress the complainant. If a video is used, it will docu- ment the entire genital examination and will show any dynamic changes, such as reflex anal dilatation. If appropriate, the medical findings can be demon- strated to the complainant and carer; some teenagers have apparently appreci- ated the opportunity to have any fears of genital disfigurement allayed by the use of this equipment. Finally, if a remote monitor is used, the whole examination can be viewed by another doctor for corroboration or teaching purposes without additional parties having to be present during the intimate examination. Obviously, it is important that in all cases the colposcopic evidence be interpreted in the context of the limited information that is currently available regarding colposcopic assessments after consensual sexual acts (90,126,127). Toluidine Blue Toluidine blue stains nuclei and has been used on the posterior fourchette to identify lacerations of the keratinized squamous epithelium that were not apparent on gross visualization (128,129). Use of toluidine blue increased the detection rate of posterior fourchette lacerations from 4 to 58% in adult (older than 19 years) complainants of nonconsensual vaginal intercourse, from 4 to 28% in sexually abused adolescents (11–18 years old), and from 16. The same frequency of posterior fourchette lacerations has been identi- fied by use of the stain in adolescents after consensual penile penetration and nonconsensual sexual acts (129). In contrast, adult complainants of nonconsensual vaginal intercourse and sexually abused children had signifi- cantly more lacerations demonstrable by toluidine blue staining than control groups (130), although such staining does not identify lacerations that cannot be detected using a colposcope (123). Therefore, if a colposcope is not avail- able, toluidine blue may be an adjunct to the genital assessment of prepubertal and adult complainants of vaginal penetration (129,130). Furthermore, some centers use the stain during colposcopy to provide a clear pictorial presenta- tion of the injuries for later presentation to juries (123). Toluidine blue (1%) is then painted on the posterior fourchette, using Sexual Assualt Examination 93 a swab, before any instrumentation. After a few seconds, the residual stain is removed with lubricating jelly and gauze (128). The time parameters within which the use of toluidine blue is beneficial in highlighting injuries have not been identified. Injuries Little information is available regarding the incidence and type of geni- tal injuries that result from consensual sexual acts involving the female geni- talia. Although penile–vaginal penetration is the most frequent sexual act performed by heterosexual couples, anecdotal reports from doctors who regu- larly conduct nonforensic assessments of the female genitalia (general prac- titioners, gynecologists, or genitourinary physicians) suggest that injuries resultant from sexual activity are rarely identified.