It focuses on sleep medicine - sleep disorders, sleep stages, DSM classification, types, classifications, and pharmacological and non pharmacological management.
Second generation atypical anti-psychotic used for mental disorders more extensively for bipolar disorder. have very low side effects than other SGA Medications
Depression: What Is It and What Are My Treatment Options? (Community Lecture)Summit Health
In this community lecture, Summit Medical Group practitioners share insights regarding the warning signs of depression and offer options for treatment, including therapy and medication.
It focuses on sleep medicine - sleep disorders, sleep stages, DSM classification, types, classifications, and pharmacological and non pharmacological management.
Second generation atypical anti-psychotic used for mental disorders more extensively for bipolar disorder. have very low side effects than other SGA Medications
Depression: What Is It and What Are My Treatment Options? (Community Lecture)Summit Health
In this community lecture, Summit Medical Group practitioners share insights regarding the warning signs of depression and offer options for treatment, including therapy and medication.
Effective treatment for insomnia in Mindheal Homeopathy clinic ,Chembur, Mum...Shewta shetty
"Treatment & remedies for insomnia find promising homeopahty treatment.Personalised online consultancy & treatments provided at our clinic by efficient panel of doctors in our center at mumbai,Bombay,Chembur, India.Contact us.
"/>
Effective treatment for insomnia in Mindheal Homeopathy clinic ,Chembur, Mum...Shewta shetty
"Treatment & remedies for insomnia find promising homeopahty treatment.Personalised online consultancy & treatments provided at our clinic by efficient panel of doctors in our center at mumbai,Bombay,Chembur, India.Contact us.
"
Depression is a mental disorder and has become most common in recent years. This slide or presentation deals with all types of aetiologies of depression, theories that are involved in development of depression, pathophysiology of drepression, various classes anti-depressant their pharmacology with the adverse events or effects. This also gives a brief note on difference between depression and sadness.
Christian Schussele Men of ProgressOil on canvas, 1862Coope.docxtroutmanboris
Christian Schussele Men of Progress
Oil on canvas, 1862
Cooper Union, New York, New York
Transfer from the National Gallery of Art; gift of Andrew W. Mellon, 1942
NPG.65.60
Edward Sorel, “People of Progress” 1999, Cooper Union, New York, New York
Syllabus
The clerks of the Department of State of the United States may be called upon to give evidence of transactions in the Department which are not of a confidential character.
The Secretary of State cannot be called upon as a witness to state transactions of a confidential nature which may have occurred in his Department. But he may be called upon to give testimony of circumstances which were not of that character.
Clerks in the Department of State were directed to be sworn, subject to objections to questions upon confidential matters.
Some point of time must be taken when the power of the Executive over an officer, not removable at his will, must cease. That point of time must be when the constitutional power of appointment has been exercised. And the power has been exercised when the last act required from the person possessing the power has been performed. This last act is the signature of the commission.
If the act of livery be necessary to give validity to the commission of an officer, it has been delivered when executed, and given to the Secretary of State for the purpose of being sealed, recorded, and transmitted to the party.
In cases of commissions to public officers, the law orders the Secretary of State to record them. When, therefore, they are signed and sealed, the order for their being recorded is given, and, whether inserted inserted into the book or not, they are recorded.
When the heads of the departments of the Government are the political or confidential officers of the Executive, merely to execute the will of the President, or rather to act in cases in which the Executive possesses a constitutional or legal discretion, nothing can be more perfectly clear than that their acts are only politically examinable. But where a specific duty is assigned by law, and individual rights depend upon the performance of that duty, it seems equally clear that the individual who considers himself injured has a right to resort to the laws of his country for a remedy.
The President of the United States, by signing the commission, appointed Mr. Marbury a justice of the peace for the County of Washington, in the District of Columbia, and the seal of the United States, affixed thereto by the Secretary of State, is conclusive testimony of the verity of the signature, and of the completion of the appointment; and the appointment conferred on him a legal right to the office for the space of five years. Having this legal right to the office, he has a consequent right to the commission, a refusal to deliver which is a plain violation of that right for which the laws of the country afford him a remedy.
To render a mandamus a proper remedy, the officer to whom it is directed must be one to who.
Christian EthicsChristian ethics deeply align with absolutism. E.docxtroutmanboris
Christian Ethics
Christian ethics deeply align with absolutism. Ethical absolutism claims that moral principles do exist. According to Christians, God created moral absolutes. These absolutes can be seen in God’s revelation. God’s special and general revelation reveal his moral truths. This does not mean that only Christians can understand moral truths. Because humans are made in God’s image, they can recognize moral truths even if they do not believe in God
[1]
. These absolutes were instated by God. Therefore, they apply to all of humanity. This worldview is in direct opposition to the idea of relativism. Christian ethics cannot be viewed through a relativistic point of view. According to relativism, there is no moral truths. There is no absolute distinction between right and wrong within this way of thinking. Right and wrong can be decided by individuals or groups of people. Cultures decide what is right for themselves and their way of life. Even individuals have the ability to decide their own personal moral code. This can seem somewhat reasonable at times. Some things that were considered moral or immoral in the past are viewed differently today. Even with this understanding, Christians deny the idea of relativism. Christians hold to the belief that moral truths come from God. Therefore, these truths do not change. God himself never changes; therefore, his moral truths remain the same. According to Christian ethics, mankind is expected to hold to the moral absolutes mandated by God himself. This understanding is not compatible with relativism. Relativism makes no place of a God. From a relativistic point of view, mankind decides their own morality. Right and wrong are not fixed. In Christian ethics, right and wrong are permanently decided by the God of the universe.
The subjective aspects of Christian ethics can look similar to relativism. The areas that are somewhat subjective in Christian aspects are referred to as the liberties of a Christian. There are some matters that are not said to be morally wrong in the Bible. Some see these issues to be wrong; therefore, they are. Others do not find certain issues to be morally wrong. These individuals are claiming their Christian liberty. One of these issues is drinking alcohol. Some Christians believe that ingesting any amount of alcohol is morally wrong. According to the idea of Christian liberty, it would be wrong for the individuals who hold to this belief to drink alcohol. Others do not have this conviction and are not doing wrong by consuming alcohol. On the surface, the idea of Christian liberty can seem to be related to relativism, but upon closer inspection these ideas are not closely related. Christian liberty is a Biblical concept that harmonize well with the overall message of the Bible. Relativism is nowhere found in the Bible. The Bible is clear that there are universal moral laws. These laws are placed upon humanity by God himself. There are some areas where the Bible remain.
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Effective treatment for insomnia in Mindheal Homeopathy clinic ,Chembur, Mum...Shewta shetty
"Treatment & remedies for insomnia find promising homeopahty treatment.Personalised online consultancy & treatments provided at our clinic by efficient panel of doctors in our center at mumbai,Bombay,Chembur, India.Contact us.
"/>
Effective treatment for insomnia in Mindheal Homeopathy clinic ,Chembur, Mum...Shewta shetty
"Treatment & remedies for insomnia find promising homeopahty treatment.Personalised online consultancy & treatments provided at our clinic by efficient panel of doctors in our center at mumbai,Bombay,Chembur, India.Contact us.
"
Depression is a mental disorder and has become most common in recent years. This slide or presentation deals with all types of aetiologies of depression, theories that are involved in development of depression, pathophysiology of drepression, various classes anti-depressant their pharmacology with the adverse events or effects. This also gives a brief note on difference between depression and sadness.
Christian Schussele Men of ProgressOil on canvas, 1862Coope.docxtroutmanboris
Christian Schussele Men of Progress
Oil on canvas, 1862
Cooper Union, New York, New York
Transfer from the National Gallery of Art; gift of Andrew W. Mellon, 1942
NPG.65.60
Edward Sorel, “People of Progress” 1999, Cooper Union, New York, New York
Syllabus
The clerks of the Department of State of the United States may be called upon to give evidence of transactions in the Department which are not of a confidential character.
The Secretary of State cannot be called upon as a witness to state transactions of a confidential nature which may have occurred in his Department. But he may be called upon to give testimony of circumstances which were not of that character.
Clerks in the Department of State were directed to be sworn, subject to objections to questions upon confidential matters.
Some point of time must be taken when the power of the Executive over an officer, not removable at his will, must cease. That point of time must be when the constitutional power of appointment has been exercised. And the power has been exercised when the last act required from the person possessing the power has been performed. This last act is the signature of the commission.
If the act of livery be necessary to give validity to the commission of an officer, it has been delivered when executed, and given to the Secretary of State for the purpose of being sealed, recorded, and transmitted to the party.
In cases of commissions to public officers, the law orders the Secretary of State to record them. When, therefore, they are signed and sealed, the order for their being recorded is given, and, whether inserted inserted into the book or not, they are recorded.
When the heads of the departments of the Government are the political or confidential officers of the Executive, merely to execute the will of the President, or rather to act in cases in which the Executive possesses a constitutional or legal discretion, nothing can be more perfectly clear than that their acts are only politically examinable. But where a specific duty is assigned by law, and individual rights depend upon the performance of that duty, it seems equally clear that the individual who considers himself injured has a right to resort to the laws of his country for a remedy.
The President of the United States, by signing the commission, appointed Mr. Marbury a justice of the peace for the County of Washington, in the District of Columbia, and the seal of the United States, affixed thereto by the Secretary of State, is conclusive testimony of the verity of the signature, and of the completion of the appointment; and the appointment conferred on him a legal right to the office for the space of five years. Having this legal right to the office, he has a consequent right to the commission, a refusal to deliver which is a plain violation of that right for which the laws of the country afford him a remedy.
To render a mandamus a proper remedy, the officer to whom it is directed must be one to who.
Christian EthicsChristian ethics deeply align with absolutism. E.docxtroutmanboris
Christian Ethics
Christian ethics deeply align with absolutism. Ethical absolutism claims that moral principles do exist. According to Christians, God created moral absolutes. These absolutes can be seen in God’s revelation. God’s special and general revelation reveal his moral truths. This does not mean that only Christians can understand moral truths. Because humans are made in God’s image, they can recognize moral truths even if they do not believe in God
[1]
. These absolutes were instated by God. Therefore, they apply to all of humanity. This worldview is in direct opposition to the idea of relativism. Christian ethics cannot be viewed through a relativistic point of view. According to relativism, there is no moral truths. There is no absolute distinction between right and wrong within this way of thinking. Right and wrong can be decided by individuals or groups of people. Cultures decide what is right for themselves and their way of life. Even individuals have the ability to decide their own personal moral code. This can seem somewhat reasonable at times. Some things that were considered moral or immoral in the past are viewed differently today. Even with this understanding, Christians deny the idea of relativism. Christians hold to the belief that moral truths come from God. Therefore, these truths do not change. God himself never changes; therefore, his moral truths remain the same. According to Christian ethics, mankind is expected to hold to the moral absolutes mandated by God himself. This understanding is not compatible with relativism. Relativism makes no place of a God. From a relativistic point of view, mankind decides their own morality. Right and wrong are not fixed. In Christian ethics, right and wrong are permanently decided by the God of the universe.
The subjective aspects of Christian ethics can look similar to relativism. The areas that are somewhat subjective in Christian aspects are referred to as the liberties of a Christian. There are some matters that are not said to be morally wrong in the Bible. Some see these issues to be wrong; therefore, they are. Others do not find certain issues to be morally wrong. These individuals are claiming their Christian liberty. One of these issues is drinking alcohol. Some Christians believe that ingesting any amount of alcohol is morally wrong. According to the idea of Christian liberty, it would be wrong for the individuals who hold to this belief to drink alcohol. Others do not have this conviction and are not doing wrong by consuming alcohol. On the surface, the idea of Christian liberty can seem to be related to relativism, but upon closer inspection these ideas are not closely related. Christian liberty is a Biblical concept that harmonize well with the overall message of the Bible. Relativism is nowhere found in the Bible. The Bible is clear that there are universal moral laws. These laws are placed upon humanity by God himself. There are some areas where the Bible remain.
Christian Ethics BA 616 Business Ethics Definiti.docxtroutmanboris
Christian Ethics
BA 616 Business Ethics
Definition of Christian Ethics
A system of values based upon the Judeo/Christian Scriptures
Principles of behavior in concordance with the behaviors of Christian teachings
Standards of thought and behavior as taught by Jesus.
Discussion
What are some of the “ethical” attributes presented in the teachings of Jesus?
What are some ethical attributes presented in the teachings of other religious persons?
Quotes about Christian Ethics
Quotes on Christian Ethics
Recognize the value of work
“And when you reap the harvest of your land, you shall not reap your field right up to its edge, nor shall you gather the gleanings after your harvest. You shall leave them for the poor and for the sojourner: I am the Lord your God.” (Leviticus 23:22).
Do not give the poor the food, rather allow the poor to work for themselves
Discussion
What are examples of the value of work?
Today, some U.S. state governors are trying to get those “able bodied” individuals to work for welfare. They are meeting great resistance politically, why do you think this is?
The value of work
Confirmed by Elton Mayo
Fulfills social, psychological and economic needs of the individual
“If a man will not work, he shall not eat” (2 Thessalonians 3:10)
Christian Ethics
The fruit of a people that have inwardly committed their lives to Christ and are outwardly aligning their actions with His teachings.
“May the favor of the Lord our God rest on us; establish the work of our hands for us— yes, establish the work of our hands” (Psalms. 90:17).
Employees with a Christian Code of Ethics
Welcome accountability
Happy to show their efforts
A system of checks and balances
Sees possible training moment
Fosters collaboration with management
“Those who work their land will have abundant food, but those who chase fantasies have no sense” (Proverbs 12:11)
Employees with a Christian Code of Ethics
Not motivated by greed
Work is its own reward
Measure success in a non-monetary way
Seek payment for the work they do
Money is second to obedience
“Whatever you do, work at it with all your heart, as working for the Lord, not for human masters” (Colossians 3:23).
Employees with a Christian Code of Ethics
Are highly productive
Are work focused
Work hard throughout the day
Find value in completing assigned tasks
Understand that they are there to work
“Diligent hands will rule, but laziness ends in forced labor” (Proverbs 12:24).
Employees with a Christian Code of Ethics
Have a strong work ethic
Believe in a Biblical perspective of work
Reliable
Recognize the value of work
Relate their job to their faith
“All hard work brings a profit, but mere talk leads only to poverty” (Proverbs 14:23)
Employees with a Christian Code of Ethics
Bring a cooperative spirit to the workplace
Supportive of management
Strong contribu.
CHPSI think you made a really good point that Howard lacks poli.docxtroutmanboris
CH/PS
I think you made a really good point that Howard lacks political aspects-especially for presidency. I have no heard his speeches quite yet (since I tend to stray away from politics altogether because people are so aggressive), do you think he is a great leader-type and is he charismatic at all? Great leaders, especially for presidency, should be honest, charismatic, and not only cater to the audience's needs but to the entire country's needs without sugar coating things.
Also, I am not sure what you mean by "In order to improve his leadership style, Jeff should change his model of carrying out business activities. This is because it can be copied and imitated by other companies (Mauri, 2016)".- how can it be imitted by other companies? In what way?
Do you think Jeff Bezos is a bad leader? and why?
CH/AR
I found your comparison of Howard Schultz and Jeff Bezos interesting and compelling. When I was looking at the list of leaders to select from, it was staggering to me how many of the corporate leaders have run or are planning to run for political office. I'm not sure, given our current political environment, that running a large corporation is the right background and experience for the leader of the United States. We'll see what happens in the next year and a half!
Amazon is an amazing, transformative company to watch. I work in the financial services industry and one of our leaders recently described our competition not as other financial services firms but as Amazon. Financial services firms pretty much all offer the same products and services and at a very reasonable price point. Amazon, however, has excelled in service delivery. I would imagine that at sometime in the future, Amazon will partner with a financial service firm to deliver products and services. I'll admit that I was and still am skeptical about Amazon's purchase of Whole Foods, but Bezos seems to be up for trying just about anything.
In your analysis of the two leaders, you didn't mention directly the challenges faced by either the leaders or the organization. Last year, Starbucks was all over the news regarding the incident involving two African American gentlemen and how they were treated by a manger at Starbucks. I'm curious how you or others in the class through about how Schultz led the organization through that crisis. Bezos, as well, has not been immune to controversy with his recent affair and divorce becoming public. How do the personal lives and behaviors of leader impact the organizations they lead? Should it matter?
SO
The first leader I chose to research is Sundar Pichai, the CEO of Google. Sundar began to show in interest in technology at an early age, and eventually earned a degree in Metallurgy, and an M.B.A from the Wharton School of the University of Pennsylvania. He then began working at Google in 2004 as the head of product management and development (Shepherd). From there, he assisted in the development of many different departme.
Chosen brand CHANELStudents are required to research a fash.docxtroutmanboris
Chosen brand:
CHANEL
Students are required to research a fashion brand of their choice and analyze its positioning strategy in the market.
● The report will assess students’ ability to collect data, in an efficient manner and use this data to scrutinise the marketing aspects of a fashion brand.
● The report will be covering the following subjects:
1. Analysis Of The Macro And Micro-environment of the brand.
2. Positioning Strategy Of The Brand: Target Customer(Pen Portrait)
3. Competitor Analysis.
4. Critical evaluation of the marketing communications strategy of the brand
supporting the development of the individual report, using relevant PRIMARY and SECONDARY RESEARCH.
NB: Please kindly devise a survey (Google forms) and make up some responses to it so as to then incorporate PRIMARY results into the report. Thanks
see attached file
word count: 2000 words
.
Chose one person to reply to ALBORES 1. Were Manning’s acti.docxtroutmanboris
Chose one person to reply to:
ALBORES
1. Were Manning’s actions legal under the Foreign Corrupt Practices Act, and what are the possible penalties for violating the act?
The Foreign Corrupt Practices Act states (1977) “It shall be unlawful for any issuer...to offer, payment, promise to pay, or authorization of the payment of any money, or offer, gift, promise to give... “. Manning assumed the duty of an issuer because he attended dinner with the prime minister to discuss the contract. Then, Manning offered to fly the prime minister to New York, which he then promised to pay for all of the prime minister's expenses. However, according to the Foreign Corrupt Practices Act (1977) a promise or offer is acceptable if the expense was ”reasonable and bona fide expenditure, such as travel and lodging expenses, incurred by or on behalf of a foreign official… was directly related to the promotion, demonstration, or explanation of products or services”. Manning promised to fly out the prime minister because he wanted to “discuss business further” (UMUC, 2019). Further, Manning used company funds to take the prime minister to luxurious activities and restaurants because he wanted to retain the contract from the prime minister.
Even though Manning did not directly give money to the prime minister, he authorized payment for the prime minster’s two-week stay, which did not involve discussing the contract. Out of the two weeks, business was only conducted for a day. In addition, Manning can be held responsible for bribing the customs officials at Neristan. According to the Foreign Corrupt Practices Act (1977), it is unlawful to influence “any act or decision of such foreign official in his official capacity... omit to do any act in violation of the lawful duty of such official”. Manning influenced the customs officials because Manning gave each custom official $100 to clear the shipment. Custom officials act on behalf of the Neristan government and sometimes require large shipments to be inspected. Manny will likely be held responsible for offering payment to the customs officials in exchange for expediting the company’s shipment.
If Manning violated the Foreign Corrupt Practices Act, he could face imprisonment. Also, the company may have to pay the penalty. The penalty for violating the act is “a fine of up to $2 million per violation. Likewise, an individual may face up to five years in prison and/or a fine of $250,000 per violation of the anti-bribery provision” (Woody, 2018, p. 275).
2. Were Manning’s actions legal under the UK Bribery Act and what are the possible penalties for violating the act?
Based on the UK Bribery Act (2010), an individual is guilty of bribing an official if “intention is to influence F (government official) in F's capacity as a foreign public official...intend to obtain or retain business, or an advantage in the conduct of business.”. Manning bribed the prime minister because he stated: “If, after we are done conducting busi.
Choosing your literary essay topic on Disgrace by J. M. Coetzee .docxtroutmanboris
Choosing your literary essay topic on
Disgrace
by J. M. Coetzee is the first step to writing your literary analysis paper.
After reading the novel, you should be able to decide in which direction you'd like to take your paper.
Topics/ approaches
(Focus on only one of the following, though some may overlap):
Analyze one of the minor characters, such as Petrus.
Example
: Analyze not only the chosen characters' personality but also what role they played in advancing the overall theme of the novel.
The protagonist's conflict, the hurdles to be overcome, and how he resolves it.
Examples:
It could be hope for change, both in South Africa and in David Lurie. OR: the disgrace David Lurie has suffered over the affair with a student and how that matches the disgrace South Africa has suffered through apartheid.
The function of setting to reinforce theme and characterization.
Example
: post-apartheid South Africa is a setting arguably more important than anything else in the novel. Your outside sources would be a bit of history concerning apartheid.The use of literary devices to communicate theme: imagery, metaphor, symbolism, foreshadowing, irony
Symbolism in the novel--
Examples:
Determine if David Lurie represents the old, white authorities of South Africa, while Lucy represents the new white people of South Africa. OR: Analyze what dogs symbolize in this story. Another example: What is symbolized by the opera David Lurie is writing on Byron?
Careful examination of one or more central scenes and its/their crucial role in plot development, resolution of conflict, and exposition of the theme.
Example:
Analyze one or more scenes in which hope that change for the better is possible through a character's remorse and subsequent action, for example, the scene in which David Lurie apologizes to the parents OR the scene in which Lucy gets raped.
The possible issue to be addressed in introduction or conclusion:
Characteristics that make the work typical (or atypical) of the period, the setting, or the author that produced it. For this information, you must go to a library database (you must read "How to Access Miami Dade Databases" if you don't know how) or a valid search site, such as Google Scholar (there is often a fee for this one).
Do
not
open or close with biographical material on the author. Biographical material is important as it influences the author’s writing only and should not be a focus of your paper.
Guidelines for Literary Essay
Be aware that you will be writing about a novel, which in its broadest sense is any extended fictional narrative almost always in prose, in which the representation of character is often the focus. Good authors use the elements of fiction, such as plot, theme, setting etc. purposefully, with a very clear goal in mind. One of the paths to literary analysis is to discover what the author's purpose is with each of his choices. Avoid the problem th.
Choosing your Philosophical Question The Final Project is an opp.docxtroutmanboris
Choosing your Philosophical Question
The Final Project is an opportunity for you to investigate one of the discussion questions to a much greater degree than in the forums. For your Final Project you will choose a philosophical question (stage 1), conduct an analysis of the claims and arguments relevant to the question by reading the primary texts of the philosopher (stage 2), and then take a position on the chosen question and offer an argument in support of your position (stage 3).
For this first stage of your Final Project assignment, (a) choose a question that appears as a discussion question (listed below, with some exceptions). You may choose one that you have previously begun to answer in the discussion forums, or one that you have yet to consider, then (b) explain briefly why you are interested in exploring this philosopher, the primary text and the question further. Submit this assignment on a Word .docx.
Week Four: Philosopher: Thomas Aquinas, Primary Text: Summa Theologica, Part 1, Question 2, Article 1-3
Q1. Does God really exist?
Question to write on, and answer the question fully in all its parts. Be mindful of the question. You are making a claim about something and offering support for it. Try to use examples from the Primary Texts you have read and/or your own experiences in that support.
DISCUSSION QUESTION CHOICE #1: Philosophy of Religion. Study Aquinas' five "ways" of demonstrating God's existence in the learning resources then engage in the study of ontology by examining your belief in God:
Answer the question: Does God really exist?
Use Aquinas and your own reasoning in your argument.
Kreeft, Peter. A Shorter Summa: The Essential Philosophical Passages of St. Thomas Aquinas'
Summa Theologica, Ignatius Press (San Francisco, 1993), chapter II.
Summa Theologica, Part 1, Question 2, Articles 1-3
The Existence of God
Because the chief aim of sacred doctrine is to teach the knowledge of God, not only as He is in
Himself, but also as He is the beginning of things and their last end, and especially of rational
creatures, as is clear from what has been already said, therefore, in our endeavor to expound this
science, we shall treat: (1) Of God; (2) Of the rational creature’s advance towards God; (3) Of
Christ, Who as man, is our way to God.
In treating of God there will be a threefold division: For we shall consider (1) Whatever concerns
the Divine Essence; (2) Whatever concerns the distinctions of Persons; (3) Whatever concerns the
procession of creatures from Him
Concerning the Divine Essence, we must consider: (1) Whether God exists? (2) The manner of His
existence, or, rather, what is not the manner of His existence; (3) Whatever concerns His
operations — namely, His knowledge, will, power.
Concerning the first, there are three points of inquiry: (1) Whether the proposition “God exists” is
self-evident? (2) Whether it is demonstrable? (3) Whether God exists?-
FIRST ARTICLE
Whether the Existence .
Choosing Your Research Method in a NutshellBy James Rice and.docxtroutmanboris
Choosing Your Research Method in a Nutshell
By James Rice and Marilyn K. Simon
Research Method Brief Type
Action research Participatory ‐ problem identification, solution,
solution review
III
Appreciative inquiry Helps groups identify solutions III, IV
Case Study research Group observation to determine how and why a
situation exists
III
Causal‐comparative research Identify causal relationship among variable that
can't be controlled
IV
Content analysis Analyze text and make inferences IV
Correlational research Collect data and determine level of correlation
between variables
I
Critical Incident technique Identification of determining incident of a critical
event
III
Delphi research Analysis of expert knowledge to forecast future
events
I, IV
Descriptive research Study of "as is" phenomena I
Design based research/ decision analysis Identify meaningful change in practices II
Ethnographic Cultural observation of a group
Evaluation research Study the effectiveness of an intervention or
program
IV
Experimental research Study the effect of manipulating a variable or
variables
II
Factor analysis Statistically assess the relationship between large
numbers of variables
I
Grounded Theory Produce a theory that explains a process based on
observation
III, IV
Hermeneutic research Study the meaning of subjects/texts (exegetics is
text only) by concentrating on the historical
meaning of the experience and its developmental
and cumulative effects on the individual and society
III
Historical research historical data collection and analysis of person or
organization
IV
Meta‐analysis research Seek patterns in data collected by other studies and
formulate principals
Narrative research Study of a single person's experiences
Needs assessment Systematic process of determine the needs of a
defined demographic population
Phenomenography Answer questions about thinking and learning
Phenomenology Make sense of lived experiences of participants
regarding a specified phenomenon.
III, IV
Quasi‐experimental Manipulation of variables in populations without
benefit of random assignment or control group.
II
Q‐method A mixed‐method approach to study subjectivity ‐
patterns of thought
I
Regression‐discontinuity design (RD) Cut‐off score assignment of participants to group
(non‐random) used to study effectiveness of an
intervention
II
Repertory grid analysis Interview process to determine how a person
interprets the meaning of an experience
I
Retrospective record review Study of historic data collected about a prior
intervention (both effected and control group)
II
Semiology Studies the meaning of symbols II, III
Situational analysis Post‐modernist approach to grounded theory
(holistic view rather than isolated variables) by
studying lived experiences around a phenomenon
Trend Analysis research Formulate a f.
Choose two of the systems (education, work, the military, and im.docxtroutmanboris
Choose
two
of the systems (education, work, the military, and immigration). Explain how they fit into the domain of social work and the social justice issues social workers should be aware of in these systems.
How does the education, military, workplace, or immigration system rely on social workers?
What is one social justice issue found in education, the military, the workplace, or immigration that influences the practice of social work?
.
Choose two disorders from the categories presented this week.C.docxtroutmanboris
Choose
two disorders from the categories presented this week.
Create
a 15- to 20-slide Microsoft® PowerPoint® presentation that includes the following:
Describes the disorders and explains their differences
Discusses how these disorders are influenced by the legal system
Discusses how the legal system is influenced by these disorders
Include
a minimum of two peer-reviewed sources.
Format
your presentation consistent with APA guidelines.
Submit
your assignment.
*3 slides on How is the legal system influenced by schizophrenia with speaker notes*
.
Choose ONE of the following topics Length 750-900 words, .docxtroutmanboris
Choose
ONE
of the following topics
Length:
750-900 words, double spaced, 12 pt. font
Identify the different forms of religious groups that are comprised in the typology outlined by the classic sociologists of religion. Explain the basic characteristics of each and provide examples.
Establish a distinction between the popular misuses of the term "myth" and its meaning in the scholarly context of Religious Studies. Explain the functions of myth according to the scholar Joseph Campbell.
.
Choose one of the following topicsAmerica A Narrative.docxtroutmanboris
Choose
one
of the following topics
America: A Narrative History
notes Thomas Jefferson's election to the presidency set the tone of "republican simplicity". In what ways was this still true in 1850 following the "Market Revolution" and in what ways was it not?
Connect the technological improvements in water transportation of the early 19th century to the territory acquired in the LA Purchase.
.
Choose one of the following topics below. Comparecont.docxtroutmanboris
Choose
one
of the following topics below.
Compare/contrast the role women played in Puritan Society in colonial Massachusetts with their role in the Great Awakening of the 18th century.
Why is the Declaration of Independence considered historically as a product of the Age of Enlightenment?
500 words
.
Choose one of the following topics below. Comparecon.docxtroutmanboris
Choose
one
of the following topics below.
Compare/contrast the role women played in Puritan Society in colonial Massachusetts with their role in the Great Awakening of the 18th century.
Why is the Declaration of Independence considered historically as a product of the Age of Enlightenment?
requirement of this assignment
Write a 500 word essay
.
Choose one of the states of RacialCultural Identity Development.docxtroutmanboris
Choose one of the states of Racial/Cultural Identity Developmental Model and reflect on how you will intervine with a client in that stage.
Stages:
Conformity
Dissonance and Appreciating
Resistance and immersion
Introspection
Integrative Awareness
.
Choose one of the following topicsNative AmericansWomenEnvi.docxtroutmanboris
Choose
one of the following topics:
Native Americans
Women
Environment
Latin Americans
Sexual liberation
Read
at least three different newspaper articles between 1968 and 1980 that cover important changes affecting your topic. In the University Library, use the ProQuest
®
historical newspaper archive (available under
General Resources > ProQuest >
Advanced Search
>
Search Options
>
Source Type
), which includes the following major newspapers, among others:
New York Times
Washington Post
Wall Street Journal
Los Angeles Times
Christian Science Monitor
Write
a 700- to 1,050-word paper in which you describe the status of the chosen group or idea and how that group or idea was affected by the changes brought about during the 1960s. Include information gleaned from the newspaper articles as well as other material.
.
Choose one of the following films for review (with faculty’s appro.docxtroutmanboris
Choose
one of the following films for review (with faculty’s approval). Put yourself in the movie by choosing one character to follow. What cultural issues would you face? What are cultural challenges? Write a short paper describing the film and your observations. Present your findings in class.
•
Secret Lives of Bees
•
Chocolate
•
Under the Same Moon
•
Maid in Manhattan
•
Walk in the Clouds
•
Get Rich or Die Trying (Gang Culture
) "I like this one"
•
Mu
lan
•
Mississippi Burning
•
A Time to Kill - "
I Also like this one
"
•
Only Fools Rush In
.
Choose and complete one of the two assignment options.docxtroutmanboris
Choose
and
complete
one of the two assignment options:
Option 1: Forecasting Comparison Presentation
Identify
a state, local, or federal policy that impacts your organization or community.
Create
an 8- to 10-slide Microsoft® PowerPoint® presentation in which you complete the following:
Describe how forecasting can be used to implement this policy and highlight any limitations of the usage of forecasting.
Compare and contrast the different forms of forecasting used to aid decision-makers when evaluating policy outcomes.
Discuss the types of information needed to ensure forecasts are accurate.
Analyze the relationship between forecasting, monitoring of observed policy outcomes, and normative futures in goals and agenda setting.
Include
speaker notes with each slide. The presentation should also contain and at least four peer-reviewed references from the University Library.
I live in Lawrence, KS if you can find a policy within this community.
.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Thesis Statement for students diagnonsed withADHD.ppt
47PATIENT FILEThe Case The sleepy woman with anxiety.docx
1. 47
PATIENT FILE
The Case: The sleepy woman with anxiety
The Question: How can you be anxious and narcoleptic at the
same time?
The Dilemma: Finding an effective regimen for recurrent,
treatment
resistant anxious depression while juggling complex treatments
for sleep
disorders
Pretest Self Assessment Question (answer at the end of the
case)
Which of the following are approved treatments for treatment
resistant
depression?
A. Deep brain stimulation
B. Transcranial magnetic stimulation
C. Vagal nerve stimulation
D. Aripiprazole (Abilify)
E. Quetiapine (Seroquel)
F. MAO inhibitors
Patient Intake
• 44-year-old woman with a chief complaint of anxiety
2. Psychiatric History
• The patient had onset of anxiety and depression at about age
15, which
she began self-medicating with alcohol
• After graduating from high school, she began college and was
about to
leave for study abroad when she experienced a panic attack for
which
she was treated in the emergency room
• She was then hospitalized and treated for alcohol abuse at age
18,
and has remained sober ever since, although she does admit to
some
possible alprazolam (Xanax) abuse in 1999 as well as one
overdose
with alprazolam
• Her history also includes multiple hospitalizations for major
depression
– Age 19 (approximately one year after her release from the
hospital
for alcohol abuse) because she became suicidal
– Age 24 due to recurrence of depression
– Age 26 with an overdose following a divorce and recurrence
of
depression
– Age 27 due to recurrence of depression
– Age 29 after two miscarriages, with a possible postpartum
element
and some discontinuation of her medications at that time to try
4. • She continues to be disabled from depression and has a great
deal
of anxiety, subjectively more disturbed by her anxiety than by
her
depression
Social and Personal History
• Married since 1996 (second marriage); no children from either
marriage
• Non smoker
• Husband an architect, supportive
• Little contact with her family of origin
• Few friends or outside interests
Medical History
• Narcolepsy
• Restless legs syndrome
• Nighttime urinary incontinence possibly related to highly
sedating
medications
• BMI 26
• BP 120/78
• Normal fasting glucose and triglycerides
Family History
• Grandmother: depression and who has received ECT with good
results
Current Medications
• Bupropion (Wellbutrin XL) 450 mg/day (thinks it is helpful as
she
6. • Sodium oxybate (Xyrem) 9 mg in one dose at night for
narcolepsy and
daytime sleepiness (not taken in recommended split dose)
• DDAVP (the peptide Desmopressin) 0.4 mg/night for
bedwetting
Based on just what you have been told so far about this
patient’s history
and current symptoms, would you consider her to fall within the
bipolar
spectrum?
• Yes
• No
Would you continue her “mood stabilizing” medications?
• Yes, continue both ziprasidone (Geodon) and lamotrigine
(Lamictal)
• Continue ziprasidone but discontinue lamotrigine
• Continue lamotrigine (Lamictal) but discontinue ziprasidone
(Geodon)
• No, discontinue both ziprasidone (Geodon) and lamotrigine
(Lamictal)
Attending Physician’s Mental Notes: Initial Psychiatric
Evaluation
• Nothing unexpected on mental status examination which
showed
depression and anxiety
• Because she has had numerous recurrences, this makes her
8. this
patient?
• What about details concerning the diagnosis of narcolepsy and
of
restless legs syndrome, the treatments given and the responses
to
those treatments?
– During the past year as her depression has recurred and
worsened,
she has developed excessive daytime sleepiness
– She had an overnight sleep polysomnogram done in another
city
that supposedly showed sleep onset REM (rapid eye movement)
periods, but you do not have a copy of the report and do not
know
if it was done while taking any medications, or after the
withdrawal
of any medications
– During the past year she has also complained of restless legs
worse in the evening when trying to fall asleep
– Because of her diagnosis of narcolepsy, she was prescribed
methyphenidate extended release (Concerta) which helps a bit
for
her daytime sleepiness, but because she was still sleepy, sodium
oxybate (Xyrem) was added without further improvement of
daytime alertness although she gets to sleep right away and also
sleeps well through the night now
– In fact, she sleeps too well through the night now, and has
bed wetting, for which she has been prescribed DDAVP
10. PATIENT FILE
Attending Physician’s Mental Notes: Initial Psychiatric
Evaluation, Continued
• The patient’s complaint of excessive daytime sleepiness can
be
diffi cult to assess given all the medications she is taking,
especially
sodium oxybate (Xyrem) and gabapentin (Neurontin), which can
cause
excessive daytime sleepiness
• It can also be diffi cult to determine whether her sleepiness
represents
narcolepsy or really represents “hypersomnia” as an associated
symptom of depression
• It can be similarly diffi cult to determine whether her restless
legs
represent restless legs syndrome or really represent
psychomotor
agitation as an associated symptom of anxiety or whether
restless
legs represent a side effect of bupropion (Wellbutrin) rather
than
restless legs syndrome
• It is even possible that her sleep disorder treatments are
interfering
with her treatments for depression and anxiety
• Thus, her sodium oxybate (Xyrem) was tapered, and then her
DDAVP
(Desmopressin) discontinued, and her pramipexole (Mirapex)
11. was
also tapered over the next month following her initial
assessment
Case Outcome: First and Second Interim Followup Visits,
Weeks 2 and 4
• The patient experienced some initial insomnia and restless
sleep
as sodium oxybate (Xyrem) was withdrawn, but this resolved in
several days, as did her incontinence; her daytime sleepiness
actually
improved somewhat but she continued to have problems falling
asleep
some nights
• Next, her pramipexole (Mirapex) was tapered without
worsening of
restless legs, or of insomnia, or mood
• Finally, her daytime gabapentin (Neurontin) was tapered to
half
dose with improvement in daytime sleepiness, but this was only
intermittently tolerated, because of re-emergence of anxiety;
however,
higher gabapentin (Neurontin) doses caused daytime sleepiness
• She continued to have depression; also, her anxiety continued
to
wax and wane day and night, with some relief by additional
doses of
gabapentin (Neurontin), but, unsatisfactory overall results; if
anxiety
and agitation occur at night, she also has insomnia
Downloaded from http://stahlonline.cambridge.org
13. resistant
depression and available at the time of this evaluation)
– VNS involves surgical implant of a stimulation device in the
upper
left side of the chest (intended as a permanent implant, though
it
can be removed)
– The pulse generator can be programmed to deliver electrical
impulses to the vagus nerve at various durations, frequencies,
and
currents
– Stimulation typically lasts 30 seconds and occurs every fi ve
minutes
– After an initial wave of enthusiasm for this treatment, use of
VNS
for depression has waned due to disappointing results, high
costs and some complications, include the hassle of having the
stimulator and electrode removed
• Transcranial magnetic stimulation (TMS) (approved for
treatment-
resistant depression)
– Generally done on an outpatient basis
– Electromagnetic coil is placed against the scalp near the
forehead
and turned off and on repeatedly for 30 to 50 minutes per
treatment
– Typical treatment duration is fi ve daily treatments a week for
four to
15. neurostimulator is located
– DBS is an experimental procedure available at only a few
medical
centers with research protocols that may cover some or all of
the
costs
– Risks and benefi ts of DBS remain unknown in treatment
resistant
depression, so DBS is reserved for patients who have failed
many
treatments, such as this patient
• After discussion of these options, the patient asked to defer
action on
them so she could research VNS, TMS and DBS, and in the
meantime,
she asked to try some other medications
Would you continue her methylphenidate extended release
(Concerta)
for daytime sleepiness?
• Yes
• No
Attending Physician’s Mental Notes: Second Interim Followup,
Week 4, Continued
• On one hand, methylphenidate extended release (Concerta)
seems
to be helpful for her daytime sleepiness and one could even
consider
raising the dose to try to alleviate her depression
17. 54
PATIENT FILE
Attending Physician’s Mental Notes: Second Interim Followup,
Week 4, Continued
• Lithium
– Could help to boost her mood and mitigate risk of future
relapse
– If added it may not be necessary to give her a full dose as
she is
already on other mood stabilizing medications
• MAOI
– May help boost mood, as this has been effective for patients
with
anxious depression
– However, this could also be activating for some patients and
cause
problems with sleep and anxiety
– If added, an MAOI would require discontinuation of
bupropion
– Transdermal selegiline (Emsam) does not require dietary
restriction
and may be a preferable formulation
• Mirtazapine (Remeron)
– May boost mood and also potentially treat anxiety
• Quetiapine (Seroquel)
– May boost mood (approved for depressed phase of bipolar
disorder
and as adjunct for unipolar depression)
18. – May also be helpful for anxiety (anecdotal reports as adjunct)
– If added, it may require careful dosing to avoid daytime
sedation
• Aripiprazole (Abilify)
– May boost mood (approved as adjunct for unipolar
depression)
– Can be activating and cause problems with anxiety
• The patient was encouraged to switch from bupropion
(Wellbutrin)
to mirtazapine (Remeron), but instead opted for aripiprazole
(Abilify)
augmentation of her current medications (bupropion,
lamotrigine,
gabapentin, methylphenidate), while discontinuing ziprasidone.
Case Outcome: Multiple Interim Followups to Week 24
• Aripiprazole (Abilify) titration from 2 mg to 5 mg while
ziprasidone
(Geodon) was discontinued showed no real changes good or bad
for
the fi rst month (week 12)
• Aripiprazole was then increased to 10 mg, with slight
improvement
(week 16)
• After a second month at 10 mg of aripiprazole, no further
improvement in depression and anxiety and overall results not
satisfactory (week 20)
• The patient was switched from aripiprazole to quetiapine
(Seroquel),
which was not associated with improvement of mood or anxiety,
and
20. • Her current relapse is causing her disability and is not fully
responsive
to the 8 medications she was taking on initial referral
(bupropion,
lamotrigine, ziprasidone, gabapentin, sodium oxybate, DDAVP,
methylphenidate and pramipexole)
• It seems possible that her sleep symptoms are more related to
her
anxious depression rather than to additional diagnoses of
narcolepsy
and restless legs syndrome and, in any event, her treatments for
these
sleep disorders did not improve her symptoms; discontinuation
of
several sleep medications (sodium oxybate, pramipaxole and
DDAVP)
if anything improved her symptoms; other clinicians may have
opted
to continue these medications
• Following simplifi cation of her medication regimen from 8
medications
to 5, she failed to respond to augmentation with aripiprazole or
with
quetiapine
• Possibly because of her prior response to ECT (and a fi rst
degree
relative also responded to ECT), she was an excellent candidate
for
VNS
Take-Home Points
• It can be diffi cult to determine whether insomnia with anxiety
22. • What could have been done better here?
– Did it take too long to get to the VNS recommendation?
– Should she have been pushed harder to try mirtazapine or an
MAOI rather than augmentation with two additional, three total,
atypical antipsychotics?
– Did it take too long to clarify the sleep issues?
– Should we have tried harder to get a copy of the written
results of
the polysomnogram?
• Possible actions for improvement in practice
– Make sure that augmentation with atypical antipsychotics is
not
the only option offered, or the only option offered early, since
these
drugs are expensive and can have notable side effects
– Despite less robust comparative data, agents such as
mirtazapine
and MAOIs, and also VNS and ECT, can be considered earlier
in the
treatment algorithm
– Get husband more involved as patient is at high risk for long
term
depression, and he is her major support system
– Consider psychotherapy earlier rather than after VNS and
assess
whether the patient is a good candidate for interpersonal or
cognitive behavioral approaches
Tips and Pearls
24. disorders
International Classifi cation Of Sleep Disorders
Diagnostic Criteria Of Narcolepsy
• Patient complains of excessive sleepiness or sudden muscle
weakness
• Recurrent daytime naps or lapses into sleep almost daily for at
least 3 months
• Possible sleep-onset REM (rapid eye movement) periods,
hypnagogic hallucinations, and sleep paralysis
• With cataplexy
• Sudden bilateral loss of postural muscle tone in association
with intense emotion
• Hypersomnia not better explained by another disorder
• Should be confi rmed by PSG (polysomnogram) followed by
MSLT (multiple sleep latency test, see below) which should
show
a mean sleep latency of 8 minutes and two more sleep-onset
REM periods (SOREMPs) following normal sleep
• May be confi rmed by orexin levels in the cerebrospinal fl uid
(CSF) <110 pg/ml or, 1/3 of mean normal control levels
Narcolepsy is estimated to occur in 0.03–0.16% of the general
population,
with its development mostly beginning in the teens. Narcoleptic
sleep
attacks usually occur for 10–20 minutes and, on awakening, the
patient
26. 58
PATIENT FILE
Multiple Sleep Latency Test (MSLT)
• Dark comfortable room at an ambient temperature
• Smoking, stimulants and vigorous physical activity avoided
during the day, only light breakfast and lunch given
• Instructions are to
– “Lie quietly in comfy position, keep eyes closed, try to fall
asleep”
• Five nap opportunities as 2 hour intervals – initial nap
opportunity 1.5–3 hours after termination of usual sleep
• Between naps patient out of bed and awake
• Sleep onset determined by time from “lights out” to fi rst
epoch of
any sleep stage
• To assess occurrence of REM sleep the test continues for 15
minutes from fi rst sleep epoch
• Session terminated if sleep does not occur after 20 minutes
The Multiple Sleep Latency Test is carried out in sleep
laboratories often
after a night of PSG and a week fi lling in a sleep diary.
Downloaded from http://stahlonline.cambridge.org
29. 60
PATIENT FILE
Cardinal diagnostic features of RLS (restless legs
syndrome)
1 Urge to move limbs usually associated with paresthesias or
dysesthesias
2 Symptoms start or become worse with rest
3 At least partial relief with physical activity
4 Worsening of symptoms in the evening or at night
Patients with RLS experience an urge to move their legs to rid
themselves
of unpleasant sensations (prickling, tingling, burning or
tickling;
numbness; “pins and needles’’ or cramp-like sensations). This
movement
typically relieves the sensations, which can occur at any time
but are
most disruptive when one is trying to fall asleep.
Primary hypersomnia
Differential Diagnosis
• Substance-induced hypersomnia
Drug of abuse
Medication use
Exposure to a toxin
31. Diagnostic measures in narcolepsy and hypersomnia
(data from Bassetti et al 2003)
ESS = Epworth Sleepiness Scale
MSLT = Multiple Sleep Latency Test
Lat = latency
SOREMP = Sleep onset REM Periods
CSF = Cerebrospinal Fluid
ESS MSLT
Lat.
(min)
MSLT #
SOREMP
CSF
Hypocretin
pg/ml
Narcolepsy with
Cataplexy
18 3.38 3.5 96.5
Narcolepsy without
Cataplexy
19 2.75 2.5 277.3
Primary Hypersomnia 17 6 0 226.8
Hypersomnia in
32. Psychiatric Disorders
18 7.83 0 278
Major
Depressive
Disorder
Attention
Defi cit
Hyperactivity
Disorder
Narcolepsy Obstructive
Sleep Apnea
Shift-Work
Sleep
Disorder
Mood +++ – – + –
Sleepiness + + +++ +++ +++
Fatigue ++ + ++ ++ ++
Concentration ++ +++ ++ ++ ++
Overlap of symptoms in sleep and psychiatric disorders
Many of the symptoms seen in sleep disorders are common in
psychiatric
disorders and vice versa. This chart compares the frequency of
different
symptoms among common sleep and psychiatric disorders,
which is
34. – Involves two surgical procedures, one to implant electrodes
in the
brain and a second to implant a neurostimulator in the chest
– Stimulation is generally constant but can be temporarily
turned off
by holding a magnetic device over the area of the chest where
the
neurostimulator is located
– This is an experimental procedure available at only a few
medical
centers with research protocols that may cover some or all of
the
costs
– Risks and benefi ts remain unknown so this is reserved for
patients
who have failed many treatments
B. Transcranial magnetic stimulation (approved for treatment-
resistant
depression)
– Generally done on an outpatient basis
– Electromagnetic coil is placed against the scalp near the
forehead
and turned off and on repeatedly for 30 to 50 minutes per
treatment
– Typical treatment duration is fi ve daily treatments a week
for four to
six weeks
– Insurance coverage is variable for a course of this treatment
35. which
costs several thousand dollars
– TMS has been best studied in patients who have failed a
single
antidepressant, and not necessarily indicated for more
complicated
cases, or for cases with multiple antidepressant failures or
failure
of ECT
C. Vagal nerve stimulation (approved for treatment-resistant
depression)
– Involves surgical implant of a stimulation device in the
upper left
side of the chest (intended as a permanent implant, though it
can
be removed)
– The pulse generator can be programmed to deliver electrical
impulses to the vagus nerve at various durations, frequencies,
and
currents
– Stimulation typically lasts 30 seconds and occurs every fi ve
minutes
– Studied in patients with more treatment failures than those
patients
studied with TMS, aripiprazole, or quetiapine
– After an initial wave of enthusiasm for this treatment, use of
VNS
for depression has waned due to disappointing results, high
37. antidepressants
F. MAO inhibitors (not approved for treatment resistant
depression)
– Although almost always used for treatment resistant
depression
and almost never used fi rst line, is currently only approved for
fi rst
line use and not for treatment resistant depression
• Clinical practice and numerous anecdotes suggest that some
patients who do not respond to one or more antidepressants,
including ECT, may respond to MAO inhibitors, but no
controlled
studies. Activating for some patients and may cause problems
with
sleep and anxiety
Answer: B, C, D and E
References
1. Stahl SM, Antidepressants, in Stahl’s Essential
Psychopharmacology, 3rd edition, Cambridge University Press,
New
York, 2008, pp 511–666
2. Stahl SM, Disorders of Sleep and Wakefulness and their
Treatment,
in Stahl’s Essential Psychopharmacology, Cambridge University
Press, New York, 2008, pp 815–862
3. Stahl SM, Aripiprazole, in Stahl’s Essential
Psychopharmacology The
Prescriber’s Guide, 3rd edition, Cambridge University Press,
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NURS 6630: Psychopharmacologic Approaches to Treatment of
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A man appears to be tossing and turning, unable to sleep.
Week 7: Therapy for Clients With Pain and Sleep/Wake
Disorders
From negative changes in mood to problems concentrating, pain
and sleep/wake disorders can have a tremendous impact on
clients’ lives. When clients suffer from these disorders, they
often seek medical care with the intent of receiving medications
42. to manage symptoms. However, many of the medications used
to treat pain and sleep/wake disorders may be addictive, making
thorough client assessments and close follow-up care essential.
To prescribe appropriate therapies with client safety in mind,
you must understand not only the pathophysiology of these
disorders, but also the pharmacologic agents used to treat them.
This week, as you study therapies for individuals with pain and
sleep/wake disorders, you examine the assessment and treatment
of clients with these disorders. You also explore ethical and
legal implications of these therapies.
Photo Credit: [riskms]/[iStock / Getty Images Plus]/Getty
Images
Discussion: Sleep/Wake Disorders
It is not uncommon to experience a night or two of disrupted
sleep when there is something major going on in your life.
However, sleep/wake disorders are much more than an
occasional night of disrupted sleep. A recent report from the
Centers for Disease Control and Prevention estimated that
between 50 and 70 million American have problems with
sleep/wake disorders (CDC, 2015). Although the vast majority
of Americans will visit their primary care provider for treatment
of these disorders, many providers will refer patients for further
evaluation. For this Discussion, you consider how you might
assess and treat the individuals based on the provided client
factors.
43. Learning Objectives
Students will:
Assess client factors and history to develop personalized
therapy plans for clients with sleep/wake disorders
Analyze factors that influence pharmacokinetic and
pharmacodynamic processes in clients requiring therapy for
sleep/wake disorders
Evaluate efficacy of treatment plans for clients presenting for
sleep/wake therapy
Apply knowledge of providing care to adult and geriatric clients
presenting for sleep/wake disorders
Learning Resources
Note: To access this week’s required library resources, please
click on the link to the Course Readings List, found in the
Course Materials section of your Syllabus.
Required Readings
Note: All Stahl resources can be accessed through the Walden
Library using this link. This link will take you to a log-in page
for the Walden Library. Once you log into the library, the Stahl
website will appear.
44. Stahl, S. M. (2013). Stahl’s essential psychopharmacology:
Neuroscientific basis and practical applications (4th ed.). New
York, NY: Cambridge University Press.
To access the following chapters, click on the Essential
Psychopharmacology, 4th ed tab on the Stahl Online website
and select the appropriate chapter. Be sure to read all sections
on the left navigation bar for each chapter.
Chapter 11, “Disorders of Sleep and Wakefulness and Their
Treatment”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New
York, NY: Cambridge University Press.
To access information on the following medications, click on
The Prescriber’s Guide, 5th ed tab on the Stahl Online website
and select the appropriate medication.
45. Review the following medications:
For insomnia
alprazolam
amitriptyline
amoxapine
clomipramine
clonazepam
desipramine
diazepam
doxepin
flunitrazepam
flurazepam
hydroxyzine
imipramine
lorazepam
46. nortriptyline
ramelteon
temazepam
trazodone
triazolam
trimipramine
zaleplon
zolpidem
American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders (5th ed.). Washington,
DC: Author.
Note: Retrieved from Walden Library databases.
Davidson, J. (2016). Pharmacotherapy of post-traumatic stress
disorder: Going beyond the guidelines. British Journal of
Psychiatry, 2(6), e16-e18. doi:10.1192/bjpo.bp.116.003707.
Retrieved from http://bjpo.rcpsych.org/content/2/6/e16
47. To prepare for this Discussion:
Note: By Day 1 of this week, your Instructor will have assigned
you to one of the following case studies to review for this
Discussion. To access the following case studies, click on the
Case Studies tab on the Stahl Online website and select the
appropriate volume and case number.
Case 1: Volume 2, Case #16: The woman who liked late-night
TV
Case 2: Volume 2, Case #11: The figment of a man who looked
upon the lady
Case 3: Volume 1, Case #5: The sleepy woman with anxiety
Review this week's Learning Resources and reflect on the
insights they provide.
Go to the Stahl Online website and examine the case study you
were assigned.
Take the pretest for the case study.
Review the patient intake documentation, psychiatric history,
patient file, medication history, etc. As you progress through
48. each section, formulate a list of questions that you might ask
the patient if he or she were in your office.
Based on the patient’s case history, consider other people in his
or her life that you would need to speak to or get feedback from
(i.e., family members, teachers, nursing home aides, etc.).
Consider whether any additional physical exams or diagnostic
testing may be necessary for the patient.
Develop a differential diagnoses for the patient. Refer to the
DSM-5 in this week’s Learning Resources for guidance.
Review the patient’s past and current medications. Refer to
Stahl’s Prescriber’s Guide and consider medications you might
select for this patient.
Review the posttest for the case study.
Note: For this Discussion, you are required to complete your
initial post before you will be able to view and respond to your
colleagues’ postings. Begin by clicking on the "Post to
Discussion Question" link and then select "Create Thread" to
complete your initial post. Remember, once you click on
Submit, you cannot delete or edit your own posts, and you
cannot post anonymously. Please check your post carefully
before clicking on Submit!
By Day 3
Post a response to the following:
49. Provide the case number in the subject line of the Discussion.
List three questions you might ask the patient if he or she were
in your office. Provide a rationale for why you might ask these
questions.
Identify people in the patient’s life you would need to speak to
or get feedback from to further assess the patient’s situation.
Include specific questions you might ask these people and why.
Explain what physical exams and diagnostic tests would be
appropriate for the patient and how the results would be used.
List three differential diagnoses for the patient. Identify the one
that you think is most likely and explain why.
List two pharmacologic agents and their dosing that would be
appropriate for the patient’s sleep/wake therapy based on
pharmacokinetics and pharmacodynamics. From a mechanism of
action perspective, provide a rationale for why you might
choose one agent over the other.
If your assigned case includes “check points” (i.e., follow-up
data at week 4, 8, 12, etc.), indicate any therapeutic changes
that you might make based on the data provided.
Explain “lessons learned” from this case study, including how
you might apply this case to your own practice when providing
care to patients with similar clinical presentations.
Resources
Learning Resources
Note: To access this week’s required library resources, please
click on the link to the Course Readings List, found in the
50. Course Materials section of your Syllabus.
Required Readings
Note: All Stahl resources can be accessed through the Walden
Library using this link. This link will take you to a log-in page
for the Walden Library. Once you log into the library, the Stahl
website will appear.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology:
Neuroscientific basis and practical applications (4th ed.). New
York, NY: Cambridge University Press.
To access the following chapters, click on the Essential
Psychopharmacology, 4th ed tab on the Stahl Online website
and select the appropriate chapter. Be sure to read all sections
on the left navigation bar for each chapter.
Chapter 11, “Disorders of Sleep and Wakefulness and Their
Treatment”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New
York, NY: Cambridge University Press.
51. To access information on the following medications, click on
The Prescriber’s Guide, 5th ed tab on the Stahl Online website
and select the appropriate medication.
Review the following medications:
For insomnia
alprazolam
amitriptyline
amoxapine
clomipramine
clonazepam
desipramine
53. Note: Retrieved from Walden Library databases.
Davidson, J. (2016). Pharmacotherapy of post-traumatic stress
disorder: Going beyond the guidelines. British Journal of
Psychiatry, 2(6), e16-e18. doi:10.1192/bjpo.bp.116.003707.
Retrieved from