Running head: GUIDED IMAGERY AND PROGRESSIVE MUSCLE RELAXATION
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Guideline Watch for the Practice Guideline for the Treatment of Patients With Bipolar Disorder 1
GUIDELINE WATCH:
PRACTICE GUIDELINE FOR THE TREATMENT
OF PATIENTS WITH BIPOLAR DISORDER,
2ND EDITION
Robert M. A. Hirschfeld, M.D.
APA’s Practice Guideline for the Treatment of Patients With Bipolar Disorder, 2nd Edition, was
published in April 2002 (1). Since that time, a number of controlled treatment studies on as-
pects of bipolar disorder have been completed and published or are in press, including studies
of second-generation (atypical) antipsychotics as monotherapy and as adjunctive treatment
(with more traditional mood stabilizers) for the acute treatment of mania, studies of antiepileptic
agents for the acute treatment of mania, trials for three medications for the acute treatment of
bipolar depression, four monotherapy and one combination therapy relapse prevention studies,
and studies of psychosocial interventions for maintenance. The evidence from these studies
supports a substantially expanded set of options for clinicians who treat patients with bipolar
disorder. This guideline watch briefly reviews the most important of the studies. The majority
of the st.
Respond to at least two of your colleagues who were assigned to a di.docxpeggyd2
Respond to at least two of your colleagues who were assigned to a different case than you. Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings.
If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained.
If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective.
Case #29 The depressed man who thought he was out of options.
The patient is a 69-year-old male with unremitting chronic depression. He has suffered from depressive episodes for 40 years and has always had a good response to treatment until 5 years ago when he relapsed on venlafaxine. Two years ago, he underwent nine treatments of ECT with partial response. He has tried every known antidepressant and augmentation available in the past few years.
The patient should be asked about recent stressful life events, consumption of illicit drugs, alcohol abuse, current medical conditions and prescribed medications (Preda, 2018). If the patient was in my office, I would also want to ask questions to gain an understanding of the severity of his depression. It is important to assess the overall severity of depression symptoms because symptom severity corelates with suicide risk (Preda, 2018). The PHQ-9 screening could be used, and this screening asks about feelings of hopelessness, loss of pleasure in doing things, and feelings of being better off dead. A focused severity assessment for hopelessness, suicidal ideation, and psychotic symptoms is recommended; these symptoms independently increase the risk for suicide (Preda, 2018). This patient reports feeling severely depressed and demoralized, as well as, helplessness, hopelessness, and worthlessness. His depression is the worst it has ever been.
Family members are helpful informers, they can ensure medication compliance, and can encourage patients to change behaviors that continue depression (Halverson, 2019). Some questions I would ask family members would include whether the patient is taking their medication and I would ask the family to provide some insight as to how the patient behaves at home. The wife reports that she feels he is letting go and giving up.
There are no lab tests that will confirm depressive disorder, however, labs can be ordered to rule out illnesses that may present as depressive disorder such as endocrinological or neurological diseases. Labs tests may include TSH, B12, RPR, HIV test, electrolytes, BUN and creatinine, blood alcohol, and blood and urine toxicology screening. Neuroimaging can help clarify the nature of the neurologic illness that may produce psychiatric symptoms, but these studies are costly and may be of questionable value in patients without discrete neurologic deficits (Halvers.
Critical appraisal of evidence/journal clubdassoumitradr
journal club: A Randomized Double-Blind Study of Risperidone
and Olanzapine in the Treatment of Schizophrenia
or Schizoaffective Disorder(Am J Psychiatry 2001; 158:765–774)
Role of atypical antipsychotics in the treatement of generalized anxiety diso...Paul Coelho, MD
This review article examines the evidence for using atypical antipsychotics as adjunctive therapy or monotherapy to treat generalized anxiety disorder (GAD). The most evidence has been collected for quetiapine, which approximately 50% of participants tolerated, most commonly experiencing sedation and fatigue. Among those who continued treatment, significant reductions in anxiety were demonstrated when used as adjunctive therapy or monotherapy. While atypical antipsychotics show promise based on evidence from other disorders, their use for GAD remains off-label and careful consideration of risks and benefits is needed, especially regarding long-term use.
Efficacy and Behavioral Benefits of the Use of Lamictal in the Treatment the ...Ross Finesmith M.D.
Adult patients with medically refractory epilepsy and a developmental disability were treated with the anti-convulsive, lamotrigine (Lamictal). The study measured the change in frequency of seizures and behavioral problems. There were significant improves in both outcome measures. The behavioral benefits may be related to a reduction in seizure frequency and subsequent improved cognitive functioning. It is also possible the reduction in behavioral problems was a result of the mood stabilizing effects of lamotrigine.
Abilify Long Acting Injectable in Patients with Schizoaffective DisorderGeoffrey Brown, PharmD
This study evaluated the tolerability and effectiveness of aripiprazole long-acting injectable (LAI) in 18 outpatients with schizoaffective disorder. Patients received monthly injections of 400mg aripiprazole LAI for 6 months. Effectiveness was measured using PANSS and CGI-S scales, showing statistically significant improvements. Tolerability was good, with weight gain and akathisia reported as adverse effects in a small number of patients. While limited by sample size, the study provides preliminary evidence that aripiprazole LAI may be an effective and well-tolerated treatment for schizoaffective disorder. A larger randomized controlled trial is needed.
This document summarizes key findings from recent research studies. It discusses research showing that benzodiazepines are often inappropriately prescribed to patients with certain conditions like depression, COPD, or substance abuse issues. Another study found that antidepressants were not effective for treating complicated grief on their own but did help reduce depressive symptoms when added to psychotherapy for grief. A third study examined global sleep patterns and found that while social factors influence bedtimes, biological clocks primarily determine wake times, meaning later bedtimes can lead to less sleep.
The document provides information on bipolar disorder with comorbid obsessive compulsive disorder. It discusses the history of recognizing this condition, higher rates of comorbidity than either disorder alone, and clinical
Respond to at least two of your colleagues who were assigned to a di.docxpeggyd2
Respond to at least two of your colleagues who were assigned to a different case than you. Explain how you might apply knowledge gained from your colleagues’ case studies to you own practice in clinical settings.
If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained.
If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective.
Case #29 The depressed man who thought he was out of options.
The patient is a 69-year-old male with unremitting chronic depression. He has suffered from depressive episodes for 40 years and has always had a good response to treatment until 5 years ago when he relapsed on venlafaxine. Two years ago, he underwent nine treatments of ECT with partial response. He has tried every known antidepressant and augmentation available in the past few years.
The patient should be asked about recent stressful life events, consumption of illicit drugs, alcohol abuse, current medical conditions and prescribed medications (Preda, 2018). If the patient was in my office, I would also want to ask questions to gain an understanding of the severity of his depression. It is important to assess the overall severity of depression symptoms because symptom severity corelates with suicide risk (Preda, 2018). The PHQ-9 screening could be used, and this screening asks about feelings of hopelessness, loss of pleasure in doing things, and feelings of being better off dead. A focused severity assessment for hopelessness, suicidal ideation, and psychotic symptoms is recommended; these symptoms independently increase the risk for suicide (Preda, 2018). This patient reports feeling severely depressed and demoralized, as well as, helplessness, hopelessness, and worthlessness. His depression is the worst it has ever been.
Family members are helpful informers, they can ensure medication compliance, and can encourage patients to change behaviors that continue depression (Halverson, 2019). Some questions I would ask family members would include whether the patient is taking their medication and I would ask the family to provide some insight as to how the patient behaves at home. The wife reports that she feels he is letting go and giving up.
There are no lab tests that will confirm depressive disorder, however, labs can be ordered to rule out illnesses that may present as depressive disorder such as endocrinological or neurological diseases. Labs tests may include TSH, B12, RPR, HIV test, electrolytes, BUN and creatinine, blood alcohol, and blood and urine toxicology screening. Neuroimaging can help clarify the nature of the neurologic illness that may produce psychiatric symptoms, but these studies are costly and may be of questionable value in patients without discrete neurologic deficits (Halvers.
Critical appraisal of evidence/journal clubdassoumitradr
journal club: A Randomized Double-Blind Study of Risperidone
and Olanzapine in the Treatment of Schizophrenia
or Schizoaffective Disorder(Am J Psychiatry 2001; 158:765–774)
Role of atypical antipsychotics in the treatement of generalized anxiety diso...Paul Coelho, MD
This review article examines the evidence for using atypical antipsychotics as adjunctive therapy or monotherapy to treat generalized anxiety disorder (GAD). The most evidence has been collected for quetiapine, which approximately 50% of participants tolerated, most commonly experiencing sedation and fatigue. Among those who continued treatment, significant reductions in anxiety were demonstrated when used as adjunctive therapy or monotherapy. While atypical antipsychotics show promise based on evidence from other disorders, their use for GAD remains off-label and careful consideration of risks and benefits is needed, especially regarding long-term use.
Efficacy and Behavioral Benefits of the Use of Lamictal in the Treatment the ...Ross Finesmith M.D.
Adult patients with medically refractory epilepsy and a developmental disability were treated with the anti-convulsive, lamotrigine (Lamictal). The study measured the change in frequency of seizures and behavioral problems. There were significant improves in both outcome measures. The behavioral benefits may be related to a reduction in seizure frequency and subsequent improved cognitive functioning. It is also possible the reduction in behavioral problems was a result of the mood stabilizing effects of lamotrigine.
Abilify Long Acting Injectable in Patients with Schizoaffective DisorderGeoffrey Brown, PharmD
This study evaluated the tolerability and effectiveness of aripiprazole long-acting injectable (LAI) in 18 outpatients with schizoaffective disorder. Patients received monthly injections of 400mg aripiprazole LAI for 6 months. Effectiveness was measured using PANSS and CGI-S scales, showing statistically significant improvements. Tolerability was good, with weight gain and akathisia reported as adverse effects in a small number of patients. While limited by sample size, the study provides preliminary evidence that aripiprazole LAI may be an effective and well-tolerated treatment for schizoaffective disorder. A larger randomized controlled trial is needed.
This document summarizes key findings from recent research studies. It discusses research showing that benzodiazepines are often inappropriately prescribed to patients with certain conditions like depression, COPD, or substance abuse issues. Another study found that antidepressants were not effective for treating complicated grief on their own but did help reduce depressive symptoms when added to psychotherapy for grief. A third study examined global sleep patterns and found that while social factors influence bedtimes, biological clocks primarily determine wake times, meaning later bedtimes can lead to less sleep.
The document provides information on bipolar disorder with comorbid obsessive compulsive disorder. It discusses the history of recognizing this condition, higher rates of comorbidity than either disorder alone, and clinical
This document provides an overview of aripiprazole for the treatment of schizophrenia. It discusses:
1. The history of antipsychotic medications and the limitations of typical antipsychotics that led to the development of atypical antipsychotics like aripiprazole.
2. Aripiprazole's unique receptor binding profile as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors, which allows it to control positive and negative symptoms with a low risk of extrapyramidal side effects.
3. Clinical trial evidence demonstrating aripiprazole's efficacy in treating schizophrenia, including improvements in symptoms and functioning, and a better side effect and tolerability profile compared to
Hanipsych, aripiprazole as antidepressantHani Hamed
This document discusses the use of aripiprazole as an adjunctive treatment for major depressive disorder.
1) A study found that adjunctive aripiprazole resulted in significantly greater improvement in depressive symptoms compared to placebo, as measured by the MADRS scale. Remission rates were also higher with aripiprazole.
2) Adjunctive aripiprazole was well tolerated with completion rates similar to placebo and lower discontinuation due to adverse events.
3) Aripiprazole's mechanism of action as a partial agonist at dopamine and serotonin receptors provides a unique pharmacological profile that may improve outcomes for patients with treatment resistant depression when used as an adjunct
My Role Salesforce DeveloperMy Working Client Truck Rental Com.docxroushhsiu
My Role: Salesforce Developer
My Working Client: Truck Rental Company
Purpose:
This assignment is a written assignment where students will demonstrate how this course research has connected and put into practice within their own career.
Description:
Provide a reflection of at least 500 words (2 pages double spaced) of how the knowledge, skills, or theories of this course have been applied, or could be applied, in a practical manner to your current work environment.
Deliverable:Prepare a 2 page (excluding title and reference page) APA styled Microsoft Word document that shares a personal connection that identifies specific knowledge and theories from this course as well as demonstrates a connection to your current work environment.
Critique the decision making of two of your peers in your response posts.
1. Do you agree/disagree with their medication choice? Why?
2. Is there anything else you recommend including?
3. Compare peer's decision making to yours—what are the advantages and disadvantages of each?
Your response should include evidence of review of the course material through proper citations using APA format.
Reply one:
1)Psychosis: Again, the diagnosis of schizophrenia is best made over time because repeated observations increase the reliability of the diagnosis. A diagnosis of schizophrenia is reached through an assessment of patient-specific signs and symptoms, as described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Schizophrenia presents with four symptom clusters: positive, negative, cognitive, and affective disturbances. Positive symptoms can include hallucinations, delusions, thought disorders/behaviors, and movement disorders. Negative symptoms include a flat affect, alogia, anhedonia, lack of self-motivation, social withdrawal. Cognitive symptoms include poor executive function, difficulty focusing, memory deficits. And finally, affective disturbances include odd expressions or actions, poor self-esteem, depression with an increased risk of suicide (Dunphy, Winland-Brown, Porter, & Thomas, 2011).
The diagnostic criteria for schizophrenia include the persistence of two or more of the following active-phase symptoms, each lasting for a significant portion of at least a one-month period: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms. At least one of the qualifying symptoms must be delusions, hallucinations, or disorganized speech (DSM-5, 2013). Patient Andy presents with delusions, auditory/cenesthetic hallucinations, and increasing social withdrawal extending upon two months. As well, an estimated 80% of clients affected by a psychotic disorder experience their first episode between the ages of 16-30. In men, the symptoms tend to present between 18 and 25 years of age. In women, the onset of symptoms has two peaks, the first between 25 years of age and the mid-30s, and the second after 40 years of age (Hol ...
RespireRx Pharmaceuticals Inc. Announces Publication of Phase 2B PACE Study: ...RespireRX
Subjects receiving 10mg/day of dronabinol expressed the highest overall satisfaction with treatment (p=0.04). In comparison to placebo, dronabinol dose-dependently reduced AHI by 10.7±4.4 (p=0.02) and 12.9±4.3 (p=0.003) events/hour at doses of 2.5 and 10 mg/day, respectively. Dronabinol at 10 mg/day reduced ESS score by -3.8±0.8 points from baseline (p<0.0001) and by -2.3±1.2 points in comparison to placebo (p=0.05). Body weights, MWT sleep latencies, gross sleep architecture and overnight oxygenation parameters were unchanged from baseline in any treatment group. The number and severity of adverse events and treatment adherence (0.3±0.6 missed doses/week) were equivalent among all treatment groups.
OSA affects approximately 30 million Americans, according to the American Academy of Sleep Medicine. Besides causing next day sleepiness, a major cause of motor vehicle and industrial accidents, OSA is co-morbid with cardiovascular disease, type 2 diabetes, and other conditions. Treatment options are limited and the most effective treatment, the CPAP device, has an extremely high non-compliance rate. “There is a tremendous need for effective, new treatments in obstructive sleep apnea,” said Dr. Carley in a press release by the University of Illinois at Chicago.
In the same press release, Dr. Zee commented that “The CPAP device targets the physical problem but not the cause. The drug targets the brain and nerves that regulate the upper airway muscles. It alters the neurotransmitters from the brain that communicate with the muscles.”
This document summarizes four studies that examined the effects of light therapy on non-seasonal depression. The studies found that exposure to bright light therapy for periods ranging from one hour to several hours per day showed improvements in depressive symptoms, as measured by scales like the Hamilton Rating Scale for Depression. However, the degree of improvement was not always statistically significant or sufficient to recommend light therapy as a standalone clinical treatment for non-seasonal depression. Future research could explore combining light therapy with antidepressant medication.
1) Quetiapine was initially approved to treat schizophrenia but is now also approved to treat manic and depressive episodes associated with bipolar I and II disorder.
2) Quetiapine's mechanism of action involves antagonism of dopamine D2 and serotonin 5-HT2 receptors. It also has partial agonist effects on 5-HT1A receptors.
3) Studies have shown quetiapine to be effective in reducing manic and depressive symptoms in bipolar disorder as monotherapy or adjunctive therapy, and as maintenance therapy to delay relapse of mood episodes.
This editorial discusses advances in the treatment of depression, focusing on new drugs that target the opioid receptor system. Specifically, it describes how researchers have found that developing antagonists of the kappa opioid receptor (OPKR) may effectively treat major depression without significantly increasing pleasure responses. Two such drugs currently in clinical trials are highlighted - ALKS-5461, which combines buprenorphine and samidorphan, and LY-2456302/CERC-501 being developed by Eli Lily. The editorial concludes by noting that targeting the endogenous opioid system through OPKR antagonism offers hope for treating treatment-resistant depression and suicidal patients.
Polypharmacy in psychiatry practice, volume iiSpringer
This document discusses evidence for combination therapies in treating bipolar disorder. It finds that while some agents are effective alone, overall outcomes are unsatisfactory. Only specific combinations have solid evidence of efficacy. The combination with the best data for acute bipolar depression is lithium plus lamotrigine. For partial responders to initial treatment, adding an antipsychotic, valproate, antidepressant or lamotrigine can provide benefit depending on the acute phase. Combination therapy may improve outcomes but also increases side effects. Further research is still needed.
Clozapine is a second-generation antipsychotic drug known as an atypical antipsychotic. It was the first discovered to be effective for treatment-resistant schizophrenia without causing extrapyramidal symptoms. However, it was withdrawn from the market briefly in the 1970s due to cases of agranulocytosis. Three studies summarized found clozapine to be superior to typical antipsychotics like risperidone and haloperidol in improving positive symptoms. While it improved positive symptoms, clozapine did not significantly impact negative symptoms. The mechanism of action is believed to involve antagonizing dopamine D1, D4, and serotonin 5-HT2 receptors.
Introduction true vertigo is a type of vertigo identifieniraj57
This study compared the effectiveness of hyoscine and diazepam in treating true vertigo in 69 patients in an emergency department. Patients were randomly assigned to receive either 5 mg of hyoscine or 10 mg of diazepam. Vertigo severity was assessed before and 1 and 2 hours after drug administration in different positions. Diazepam was significantly more effective at relieving vertigo in all positions compared to hyoscine based on treatment success rates. Complete relief of vertigo occurred in 40-63% of patients given diazepam but only 2.6-12.5% of those given hyoscine. The study suggests that diazepam is a better option than hyoscine for
The Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) published updated guidelines for managing bipolar disorder. This third update reviews new evidence from 2009 to 2012 and is intended to be used along with previous guideline publications from 2005, 2007, and 2009. The recommendations for treating acute mania remain largely unchanged, while new options have been added for treating bipolar depression and for maintenance treatment.
This document summarizes the results of a pooled analysis of two placebo-controlled clinical trials that evaluated the efficacy, safety, and tolerability of desvenlafaxine for the treatment of major depressive disorder. The pooled analysis found that after 8 weeks of treatment, desvenlafaxine was significantly more effective than placebo in reducing depression symptoms as measured by the Hamilton Rating Scale for Depression and the Clinical Global Impressions-Improvement scale. Adverse events reported with desvenlafaxine were consistent with other drugs in its class. The pooled analysis provides support for the use of desvenlafaxine in treating major depressive disorder.
Treatment resistant schizophrenia is defined as lack of satisfactory improvement despite trials of two antipsychotics for adequate duration and dose. Around 20-30% of schizophrenia patients are considered treatment resistant. Clozapine is currently the treatment of choice for such patients, though combination and augmentation strategies with other agents have limited evidence. Definitive treatment guidelines recommend establishing treatment resistance before trials of clozapine or other strategies for treatment resistant schizophrenia.
Resultados del tratmiento farmacológico en pacientes latinoamericanos con tra...vitriolum
This study evaluated treatment outcomes of 516 Latin American patients with bipolar I disorder who received olanzapine compared to 246 patients who did not. The time to remission of manic symptoms was similar between groups. However, the time to hospitalization and relapse with a manic episode, but not a depressive episode, was significantly longer for those treated with olanzapine. Both groups also experienced similar rates of adverse effects and statistically significant improvements in quality of life. The study concludes that inclusion of olanzapine in treatment may allow Latin American patients to maintain clinically effective responses long-term.
Treating Insomnia in Depression Insomnia Related Factors Pred.docxturveycharlyn
Treating Insomnia in Depression: Insomnia Related Factors Predict
Long-Term Depression Trajectories
Bei Bei
Monash University and Royal Women’s Hospital, University of
Melbourne
Lauren D. Asarnow
Stanford University
Andrew Krystal
University of California, San Francisco
Jack D. Edinger
National Jewish Health, Denver, Colorado, and Duke University
Medical Center
Daniel J. Buysse
University of Pittsburgh
Rachel Manber
Stanford University
Objective: Insomnia and major depressive disorders (MDD) often co-occur, and such comorbidity has
been associated with poorer outcomes for both conditions. However, individual differences in depressive
symptom trajectories during and after treatment are poorly understood in comorbid insomnia and
depression. This study explored the heterogeneity in long-term depression change trajectories, and
examined their correlates, particularly insomnia-related characteristics. Method: Participants were 148
adults (age M � SD � 46.6 � 12.6, 73.0% female) with insomnia and MDD who received antidepressant
pharmacotherapy, and were randomized to 7-session Cognitive Behavioral Therapy for Insomnia or
control conditions over 16 weeks with 2-year follow-ups. Depression and insomnia severity were
assessed at baseline, biweekly during treatment, and every 4 months thereafter. Sleep effort and beliefs
about sleep were also assessed. Results: Growth mixture modeling revealed three trajectories: (a)
Partial-Responders (68.9%) had moderate symptom reduction during early treatment (p value � .001)
and maintained mild depression during follow-ups. (b) Initial-Responders (17.6%) had marked symptom
reduction during treatment (p values � .001) and low depression severity at posttreatment, but increased
severity over follow-up (p value � .001). (c) Optimal-Responders (13.5%) achieved most gains during
early treatment (p value � .001), continued to improve (p value � .01) and maintained minimal
depression during follow-ups. The classes did not differ significantly on baseline measures or treatment
received, but differed on insomnia-related measures after treatment began (p values � .05): Optimal-
Responders consistently endorsed the lowest insomnia severity, sleep effort, and unhelpful beliefs about
sleep. Conclusions: Three depression symptom trajectories were observed among patients with comorbid
insomnia and MDD. These trajectories were associated with insomnia-related constructs after commenc-
ing treatment. Early changes in insomnia characteristics may predict long-term depression outcomes.
What is the public health significance of this article?
This study identified three distinct depression trajectories in patients with comorbid major depression
and insomnia disorders during treatment and 2-year follow-up. Those with the largest and most
sustained improvements in depression consistently scored the lowest on postbaseline insomnia and
insomnia-related cognitions. Early changes in insomnia symptoms and insomnia-related character ...
Major depression is a common mental disorder in the United States, affecting around 15.7 million adults annually. Up to 50% of patients treated with a single antidepressant do not achieve full remission. The STAR*D study evaluated treatment strategies for patients with treatment-resistant depression, defined as lack of response to at least two antidepressant trials. STAR*D involved four levels of treatment including medication changes or augmentations. The cumulative remission rate after four treatment steps was 67%, with higher remission rates occurring earlier in treatment. STAR*D provides guidance for treating treatment-resistant depression, with the goal of achieving remission through persistent, adequately dosed interventions.
This document provides an overview of treatment resistant schizophrenia, including definitions, prevalence, factors leading to treatment resistance, and management approaches. It notes that approximately 30% of schizophrenia patients do not adequately respond to initial treatment. Clozapine is identified as the gold standard treatment for resistant cases, though some patients remain resistant even to clozapine. The document discusses criteria for defining treatment resistance and response, as well as strategies for managing patients who are clozapine-resistant, including augmentation with other pharmacological or psychosocial approaches.
Vilazodone is a serotonin partial agonist and reuptake inhibitor (SPARI) antidepressant approved for treatment of major depressive disorder. It has a dual mechanism of action - selective serotonin reuptake inhibition and high-affinity partial agonism of serotonin 5-HT1A receptors. This dual action provides faster onset of antidepressant effects within 1-2 weeks. Studies have shown vilazodone to be effective and well-tolerated for short-term and long-term treatment of MDD, with comparable efficacy to SSRIs like escitalopram. It has fewer sexual side effects than SSRIs. The recommended dosage range is 40 mg per day.
You will present information on the AAC Tobii Dynavox I Seri.docxlillie234567
You will present information on the AAC Tobii Dynavox I
Series device and SNAP Core First Software.
The following objectives should be met:
1. Identify the AAC Device and communication APP
2. Discuss/demonstrate its function, use specs, and the
population it is best suited for
3. Identify research, evidence of efficacy, list pros and
cons of the device/app
4. Use 3D visuals and video of demonstrating how it is
used
5. Steps the individual that it is best suited for needs to
take for improvement.
6. Roles of the speech pathologist and who they would
collaborate with.
7. Resources
8. At least 8-10 slides with slide transcript
.
The document outlines an implementation plan for adding blood pressure monitoring capabilities to Fitbit's existing apps and website. Key elements of the plan include:
1) Developing extensions to Fitbit's existing apps for iOS, Android, and the website to display and track blood pressure readings over time.
2) Validating the functionality and data integration across all platforms through individual testing, regression testing, and end-to-end cross-platform testing.
3) Conducting ongoing evaluation of customer feedback, bug reports, and usage metrics to continuously improve the new blood pressure feature.
More Related Content
Similar to Running head GUIDED IMAGERY AND PROGRESSIVE MUSCLE RELAXATION (5).docx
This document provides an overview of aripiprazole for the treatment of schizophrenia. It discusses:
1. The history of antipsychotic medications and the limitations of typical antipsychotics that led to the development of atypical antipsychotics like aripiprazole.
2. Aripiprazole's unique receptor binding profile as a partial agonist at dopamine D2 and serotonin 5-HT1A receptors, which allows it to control positive and negative symptoms with a low risk of extrapyramidal side effects.
3. Clinical trial evidence demonstrating aripiprazole's efficacy in treating schizophrenia, including improvements in symptoms and functioning, and a better side effect and tolerability profile compared to
Hanipsych, aripiprazole as antidepressantHani Hamed
This document discusses the use of aripiprazole as an adjunctive treatment for major depressive disorder.
1) A study found that adjunctive aripiprazole resulted in significantly greater improvement in depressive symptoms compared to placebo, as measured by the MADRS scale. Remission rates were also higher with aripiprazole.
2) Adjunctive aripiprazole was well tolerated with completion rates similar to placebo and lower discontinuation due to adverse events.
3) Aripiprazole's mechanism of action as a partial agonist at dopamine and serotonin receptors provides a unique pharmacological profile that may improve outcomes for patients with treatment resistant depression when used as an adjunct
My Role Salesforce DeveloperMy Working Client Truck Rental Com.docxroushhsiu
My Role: Salesforce Developer
My Working Client: Truck Rental Company
Purpose:
This assignment is a written assignment where students will demonstrate how this course research has connected and put into practice within their own career.
Description:
Provide a reflection of at least 500 words (2 pages double spaced) of how the knowledge, skills, or theories of this course have been applied, or could be applied, in a practical manner to your current work environment.
Deliverable:Prepare a 2 page (excluding title and reference page) APA styled Microsoft Word document that shares a personal connection that identifies specific knowledge and theories from this course as well as demonstrates a connection to your current work environment.
Critique the decision making of two of your peers in your response posts.
1. Do you agree/disagree with their medication choice? Why?
2. Is there anything else you recommend including?
3. Compare peer's decision making to yours—what are the advantages and disadvantages of each?
Your response should include evidence of review of the course material through proper citations using APA format.
Reply one:
1)Psychosis: Again, the diagnosis of schizophrenia is best made over time because repeated observations increase the reliability of the diagnosis. A diagnosis of schizophrenia is reached through an assessment of patient-specific signs and symptoms, as described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Schizophrenia presents with four symptom clusters: positive, negative, cognitive, and affective disturbances. Positive symptoms can include hallucinations, delusions, thought disorders/behaviors, and movement disorders. Negative symptoms include a flat affect, alogia, anhedonia, lack of self-motivation, social withdrawal. Cognitive symptoms include poor executive function, difficulty focusing, memory deficits. And finally, affective disturbances include odd expressions or actions, poor self-esteem, depression with an increased risk of suicide (Dunphy, Winland-Brown, Porter, & Thomas, 2011).
The diagnostic criteria for schizophrenia include the persistence of two or more of the following active-phase symptoms, each lasting for a significant portion of at least a one-month period: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms. At least one of the qualifying symptoms must be delusions, hallucinations, or disorganized speech (DSM-5, 2013). Patient Andy presents with delusions, auditory/cenesthetic hallucinations, and increasing social withdrawal extending upon two months. As well, an estimated 80% of clients affected by a psychotic disorder experience their first episode between the ages of 16-30. In men, the symptoms tend to present between 18 and 25 years of age. In women, the onset of symptoms has two peaks, the first between 25 years of age and the mid-30s, and the second after 40 years of age (Hol ...
RespireRx Pharmaceuticals Inc. Announces Publication of Phase 2B PACE Study: ...RespireRX
Subjects receiving 10mg/day of dronabinol expressed the highest overall satisfaction with treatment (p=0.04). In comparison to placebo, dronabinol dose-dependently reduced AHI by 10.7±4.4 (p=0.02) and 12.9±4.3 (p=0.003) events/hour at doses of 2.5 and 10 mg/day, respectively. Dronabinol at 10 mg/day reduced ESS score by -3.8±0.8 points from baseline (p<0.0001) and by -2.3±1.2 points in comparison to placebo (p=0.05). Body weights, MWT sleep latencies, gross sleep architecture and overnight oxygenation parameters were unchanged from baseline in any treatment group. The number and severity of adverse events and treatment adherence (0.3±0.6 missed doses/week) were equivalent among all treatment groups.
OSA affects approximately 30 million Americans, according to the American Academy of Sleep Medicine. Besides causing next day sleepiness, a major cause of motor vehicle and industrial accidents, OSA is co-morbid with cardiovascular disease, type 2 diabetes, and other conditions. Treatment options are limited and the most effective treatment, the CPAP device, has an extremely high non-compliance rate. “There is a tremendous need for effective, new treatments in obstructive sleep apnea,” said Dr. Carley in a press release by the University of Illinois at Chicago.
In the same press release, Dr. Zee commented that “The CPAP device targets the physical problem but not the cause. The drug targets the brain and nerves that regulate the upper airway muscles. It alters the neurotransmitters from the brain that communicate with the muscles.”
This document summarizes four studies that examined the effects of light therapy on non-seasonal depression. The studies found that exposure to bright light therapy for periods ranging from one hour to several hours per day showed improvements in depressive symptoms, as measured by scales like the Hamilton Rating Scale for Depression. However, the degree of improvement was not always statistically significant or sufficient to recommend light therapy as a standalone clinical treatment for non-seasonal depression. Future research could explore combining light therapy with antidepressant medication.
1) Quetiapine was initially approved to treat schizophrenia but is now also approved to treat manic and depressive episodes associated with bipolar I and II disorder.
2) Quetiapine's mechanism of action involves antagonism of dopamine D2 and serotonin 5-HT2 receptors. It also has partial agonist effects on 5-HT1A receptors.
3) Studies have shown quetiapine to be effective in reducing manic and depressive symptoms in bipolar disorder as monotherapy or adjunctive therapy, and as maintenance therapy to delay relapse of mood episodes.
This editorial discusses advances in the treatment of depression, focusing on new drugs that target the opioid receptor system. Specifically, it describes how researchers have found that developing antagonists of the kappa opioid receptor (OPKR) may effectively treat major depression without significantly increasing pleasure responses. Two such drugs currently in clinical trials are highlighted - ALKS-5461, which combines buprenorphine and samidorphan, and LY-2456302/CERC-501 being developed by Eli Lily. The editorial concludes by noting that targeting the endogenous opioid system through OPKR antagonism offers hope for treating treatment-resistant depression and suicidal patients.
Polypharmacy in psychiatry practice, volume iiSpringer
This document discusses evidence for combination therapies in treating bipolar disorder. It finds that while some agents are effective alone, overall outcomes are unsatisfactory. Only specific combinations have solid evidence of efficacy. The combination with the best data for acute bipolar depression is lithium plus lamotrigine. For partial responders to initial treatment, adding an antipsychotic, valproate, antidepressant or lamotrigine can provide benefit depending on the acute phase. Combination therapy may improve outcomes but also increases side effects. Further research is still needed.
Clozapine is a second-generation antipsychotic drug known as an atypical antipsychotic. It was the first discovered to be effective for treatment-resistant schizophrenia without causing extrapyramidal symptoms. However, it was withdrawn from the market briefly in the 1970s due to cases of agranulocytosis. Three studies summarized found clozapine to be superior to typical antipsychotics like risperidone and haloperidol in improving positive symptoms. While it improved positive symptoms, clozapine did not significantly impact negative symptoms. The mechanism of action is believed to involve antagonizing dopamine D1, D4, and serotonin 5-HT2 receptors.
Introduction true vertigo is a type of vertigo identifieniraj57
This study compared the effectiveness of hyoscine and diazepam in treating true vertigo in 69 patients in an emergency department. Patients were randomly assigned to receive either 5 mg of hyoscine or 10 mg of diazepam. Vertigo severity was assessed before and 1 and 2 hours after drug administration in different positions. Diazepam was significantly more effective at relieving vertigo in all positions compared to hyoscine based on treatment success rates. Complete relief of vertigo occurred in 40-63% of patients given diazepam but only 2.6-12.5% of those given hyoscine. The study suggests that diazepam is a better option than hyoscine for
The Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) published updated guidelines for managing bipolar disorder. This third update reviews new evidence from 2009 to 2012 and is intended to be used along with previous guideline publications from 2005, 2007, and 2009. The recommendations for treating acute mania remain largely unchanged, while new options have been added for treating bipolar depression and for maintenance treatment.
This document summarizes the results of a pooled analysis of two placebo-controlled clinical trials that evaluated the efficacy, safety, and tolerability of desvenlafaxine for the treatment of major depressive disorder. The pooled analysis found that after 8 weeks of treatment, desvenlafaxine was significantly more effective than placebo in reducing depression symptoms as measured by the Hamilton Rating Scale for Depression and the Clinical Global Impressions-Improvement scale. Adverse events reported with desvenlafaxine were consistent with other drugs in its class. The pooled analysis provides support for the use of desvenlafaxine in treating major depressive disorder.
Treatment resistant schizophrenia is defined as lack of satisfactory improvement despite trials of two antipsychotics for adequate duration and dose. Around 20-30% of schizophrenia patients are considered treatment resistant. Clozapine is currently the treatment of choice for such patients, though combination and augmentation strategies with other agents have limited evidence. Definitive treatment guidelines recommend establishing treatment resistance before trials of clozapine or other strategies for treatment resistant schizophrenia.
Resultados del tratmiento farmacológico en pacientes latinoamericanos con tra...vitriolum
This study evaluated treatment outcomes of 516 Latin American patients with bipolar I disorder who received olanzapine compared to 246 patients who did not. The time to remission of manic symptoms was similar between groups. However, the time to hospitalization and relapse with a manic episode, but not a depressive episode, was significantly longer for those treated with olanzapine. Both groups also experienced similar rates of adverse effects and statistically significant improvements in quality of life. The study concludes that inclusion of olanzapine in treatment may allow Latin American patients to maintain clinically effective responses long-term.
Treating Insomnia in Depression Insomnia Related Factors Pred.docxturveycharlyn
Treating Insomnia in Depression: Insomnia Related Factors Predict
Long-Term Depression Trajectories
Bei Bei
Monash University and Royal Women’s Hospital, University of
Melbourne
Lauren D. Asarnow
Stanford University
Andrew Krystal
University of California, San Francisco
Jack D. Edinger
National Jewish Health, Denver, Colorado, and Duke University
Medical Center
Daniel J. Buysse
University of Pittsburgh
Rachel Manber
Stanford University
Objective: Insomnia and major depressive disorders (MDD) often co-occur, and such comorbidity has
been associated with poorer outcomes for both conditions. However, individual differences in depressive
symptom trajectories during and after treatment are poorly understood in comorbid insomnia and
depression. This study explored the heterogeneity in long-term depression change trajectories, and
examined their correlates, particularly insomnia-related characteristics. Method: Participants were 148
adults (age M � SD � 46.6 � 12.6, 73.0% female) with insomnia and MDD who received antidepressant
pharmacotherapy, and were randomized to 7-session Cognitive Behavioral Therapy for Insomnia or
control conditions over 16 weeks with 2-year follow-ups. Depression and insomnia severity were
assessed at baseline, biweekly during treatment, and every 4 months thereafter. Sleep effort and beliefs
about sleep were also assessed. Results: Growth mixture modeling revealed three trajectories: (a)
Partial-Responders (68.9%) had moderate symptom reduction during early treatment (p value � .001)
and maintained mild depression during follow-ups. (b) Initial-Responders (17.6%) had marked symptom
reduction during treatment (p values � .001) and low depression severity at posttreatment, but increased
severity over follow-up (p value � .001). (c) Optimal-Responders (13.5%) achieved most gains during
early treatment (p value � .001), continued to improve (p value � .01) and maintained minimal
depression during follow-ups. The classes did not differ significantly on baseline measures or treatment
received, but differed on insomnia-related measures after treatment began (p values � .05): Optimal-
Responders consistently endorsed the lowest insomnia severity, sleep effort, and unhelpful beliefs about
sleep. Conclusions: Three depression symptom trajectories were observed among patients with comorbid
insomnia and MDD. These trajectories were associated with insomnia-related constructs after commenc-
ing treatment. Early changes in insomnia characteristics may predict long-term depression outcomes.
What is the public health significance of this article?
This study identified three distinct depression trajectories in patients with comorbid major depression
and insomnia disorders during treatment and 2-year follow-up. Those with the largest and most
sustained improvements in depression consistently scored the lowest on postbaseline insomnia and
insomnia-related cognitions. Early changes in insomnia symptoms and insomnia-related character ...
Major depression is a common mental disorder in the United States, affecting around 15.7 million adults annually. Up to 50% of patients treated with a single antidepressant do not achieve full remission. The STAR*D study evaluated treatment strategies for patients with treatment-resistant depression, defined as lack of response to at least two antidepressant trials. STAR*D involved four levels of treatment including medication changes or augmentations. The cumulative remission rate after four treatment steps was 67%, with higher remission rates occurring earlier in treatment. STAR*D provides guidance for treating treatment-resistant depression, with the goal of achieving remission through persistent, adequately dosed interventions.
This document provides an overview of treatment resistant schizophrenia, including definitions, prevalence, factors leading to treatment resistance, and management approaches. It notes that approximately 30% of schizophrenia patients do not adequately respond to initial treatment. Clozapine is identified as the gold standard treatment for resistant cases, though some patients remain resistant even to clozapine. The document discusses criteria for defining treatment resistance and response, as well as strategies for managing patients who are clozapine-resistant, including augmentation with other pharmacological or psychosocial approaches.
Vilazodone is a serotonin partial agonist and reuptake inhibitor (SPARI) antidepressant approved for treatment of major depressive disorder. It has a dual mechanism of action - selective serotonin reuptake inhibition and high-affinity partial agonism of serotonin 5-HT1A receptors. This dual action provides faster onset of antidepressant effects within 1-2 weeks. Studies have shown vilazodone to be effective and well-tolerated for short-term and long-term treatment of MDD, with comparable efficacy to SSRIs like escitalopram. It has fewer sexual side effects than SSRIs. The recommended dosage range is 40 mg per day.
Similar to Running head GUIDED IMAGERY AND PROGRESSIVE MUSCLE RELAXATION (5).docx (20)
You will present information on the AAC Tobii Dynavox I Seri.docxlillie234567
You will present information on the AAC Tobii Dynavox I
Series device and SNAP Core First Software.
The following objectives should be met:
1. Identify the AAC Device and communication APP
2. Discuss/demonstrate its function, use specs, and the
population it is best suited for
3. Identify research, evidence of efficacy, list pros and
cons of the device/app
4. Use 3D visuals and video of demonstrating how it is
used
5. Steps the individual that it is best suited for needs to
take for improvement.
6. Roles of the speech pathologist and who they would
collaborate with.
7. Resources
8. At least 8-10 slides with slide transcript
.
The document outlines an implementation plan for adding blood pressure monitoring capabilities to Fitbit's existing apps and website. Key elements of the plan include:
1) Developing extensions to Fitbit's existing apps for iOS, Android, and the website to display and track blood pressure readings over time.
2) Validating the functionality and data integration across all platforms through individual testing, regression testing, and end-to-end cross-platform testing.
3) Conducting ongoing evaluation of customer feedback, bug reports, and usage metrics to continuously improve the new blood pressure feature.
Task· This is an individual task. · The task focuses on areas .docxlillie234567
Task
· This is an individual task.
· The task focuses on areas studied to date, requiring you to show knowledge and application in the parts stated.
· You should upload a single, correctly formatted document which may also include any relevant tables and diagrams
Continuing with the marketing plan you developed for the Midterm Assessment, complete it with according with the topics discussed in class during the 2nd part of the course with following points (but not exclusively)
1. Distribution Channels:
· Markets with direct sales (if any)
· Markets with distributors (if any)
· Markets with agents (if any)
2. Pricing Strategy:
· Pricing strategies per channel
· Take a product and show how should you fix the price according the channel
3. Communication Strategy
· Business Magazines
· Trade Shows
· Digital Tools
4. Any other factor you consider key for your marketing plan
Formalities:
· Wordcount: 2.000 words
· Cover, Table of Contents, References and Appendix are excluded from the total wordcount.
· Font: Arial 12,5 pts.
· Text alignment: Justified.
· Harvard style in-text citations and bibliography
It assesses the following learning outcomes:
1. Have an in-depth understanding of B2B market opportunities.
2. Identify and differentiate between the different and unique challenges of business markets
3. Apply and analyze the different B2Bsystems and processes
4. Have a systematic understanding of how theoretical concepts can be applied in business markets.
5. Critically appreciate B2B marketing strategy assessments and developments.
6. Apply and assess the tools for B2Bmarketing strategy development and implementation
Rubrics
Learning Descriptors
Fail Below 60%
Marginal Fail 60-69%
Fair 70-79 %
Good 80-89%
Exceptional 90-100%
Purpose & Understanding
KNOWLEDGE & UNDERSTANDING
15%
Very poor coverage of central purpose, goals, research questions or arguments with little relevant information evident. Virtually no evidence of understanding or focus.
Minimal understanding of purpose of the study; factual errors evident. Gaps in knowledge and superficial understanding. A few lines of relevant material.
Reasonable understanding and clearly identifies the purpose, goals, research questions or argument.
Reflect partial achievement of learning outcomes.
A sound grasp of, and clearly identifies, the purpose, goals, research questions or argument. Some wider study beyond the classroom content shown.
Effectively describes and explains the central purpose, arguments, research questions, or goals of the project; explanation is focused, detailed and compelling. Recognition of alternative forms of evidence beyond that supplied in the classroom.
Content
KNOWLEDGE & UNDERSTANDING
15%
Content is unclear, inaccurate and/or incomplete. Brief and irrelevant. Descriptive. Only personal views offered.
Unsubstantiated and does not support the purpose, argument or goals of the project. Reader gains no insight through the content of the project.
Limi.
Team ProjectMBA687What it is…The team project in MBA68.docxlillie234567
Team Project
MBA687
What it is…
The team project in MBA687 gives you, the learner and person who is one course away from an MBA:
The opportunity to demonstrate that you can work as a member of a high-functioning team to complete a complex analysis, synthesis and presentation task.
The opportunity to demonstrate mastery of the knowledge and skills that you have acquired through the MBA program.
Where to find information in the syllabus, 1
Page 6
Group Case Study
Prior to the start of Unit 7, students will be assigned into groups of no more than 4 students per group. Each group will be assigned to complete a case study chosen by the instructor from 20 cases located in Appendix C. The 20 case materials can be found in the required textbook (see Appendix C for relevant page numbers). Group case studies should follow the same requirements as the writing assignments stated above. Group case studies are due in Unit 7. Earlier submissions are encouraged.
Also from Page 6
Writing Assignments
Writing assignments must be APA compliant and include a title page, appropriate citations, and references.
Where to find information in the syllabus, 2
Appendix C (Page 24)
This was the list from which your team selected its case
Pages 43-45
This is the rubric (grading guide) that the instructor will use to evaluate and grade the team’s submission.
General outline for the submission
This submission is much like one that you would present in a workplace situation. Imagine that you are presenting your findings on the case to senior management of your company, or to the board of directors.
For your paper, use the outline found in Table 2, page C-6 of your text.
Strategic Profile and Case Analysis Purpose
Situation Analysis
A. General environmental analysis
B. Industry analysis
C. Competitor analysis
D. Internal analysis
III. Identification of Environmental Opportunities and Threats and Firm Strengths and Weaknesses (SWOT Analysis)
Strategy Formulation
A. Strategic alternatives
B. Alternative evaluation
C. Alternative choice
Strategic Alternative Implementation
A. Action items
B. Action plan
Parts I, II and II
Parts I, II and III are much like the introduction, external analysis and internal analysis that you did for your individual project.
The author provides a list of things that you can consider about the external analysis of the industry in Table 3 (C-7)
The author discusses industry analysis (C-6), competitor analysis (C-7) and industry analysis (C-8). It will be helpful to review these areas, even though you have done your individual projects.
In the following pages, the author suggests many tools that you can use to analyze the company and its industry.
Strategy in the paper, 1
Strategy formulation
This is your team’s recommendations for the company
Recommendations should be either business level strategy alternatives or corporate level strategy alternatives.
Recommendations should be based on and sup.
T he fifteen year-old patient was scheduled for surgery on t.docxlillie234567
T he fifteen year-old patient was
scheduled for surgery on the right
side of his brain to remove a right tem-
poral lobe lesion that was believed to be
causing his epileptic seizures.
The surgery began with the sur-
geon making an incision on the left
side, opening the skull, penetrating the
dura and removing significant portions
of the left amygdala, hippocampus and
other left-side brain tissue before it was
discovered that they were working on
the wrong side.
The left-side wound was closed,
the right side was opened and the pro-
cedure went ahead on the right, correct
side.
The error in the O.R. was revealed
to the parents shortly after the surgery,
but only as if it was a minor and incon-
sequential gaffe.
The patient recuperated, left the
hospital, returned to his regular activi-
ties and graduated from high school
before his parents could no longer deny
he was not all right. After a thorough
neurological assessment he had to be
placed in an assisted living facility for
brain damaged individuals.
When the full magnitude of the
consequences came to light a lawsuit
was filed which resulted in a $11 mil-
lion judgment which was affirmed by
the Supreme Court of Arkansas.
A circulating nurse has a le-
gal duty to see that surgery
does not take place on the
wrong side of the body.
The preoperative documents
failed to identify on which side
the surgery was to be done.
It was below the standard of
care for the circulating nurse
not to notice that fact and not
to seek out the correct infor-
mation.
SUPREME COURT OF ARKANSAS
December 13, 2012
Operating Room: Surgical Error Blamed, In
Part, On Circulating Nurse’s Negligence.
Surgical Error Blamed, In Part, On
Circulating Nurse’s Negligence
The Court accepted the testimony
of the family’s nursing expert that a
circulating nurse has a fundamental
responsibility as a member of the surgi-
cal team to make sure that surgery is
done on the correct anatomical site,
especially when it is brain surgery.
The circulating nurse is supposed
to understand imposing terms like se-
lective amygdala hippocampectomy
and know the basics of how it is sup-
posed to be done.
Hospital policy called for the sur-
geon, the anesthesiologist, the circulat-
ing nurse and the scrub nurse or tech to
take a “timeout” prior to starting a sur-
gical case for final verification of the
correct anatomical site.
The circulating nurse should have
available three essential documents, the
surgical consent form, the preoperative
history and the O.R. schedule.
The full extent of the error, that is,
a full list of the parts of the brain that
were removed from the healthy side,
should have been documented by the
circulating nurse, and failure to do so
was a factor that adversely affected the
patient’s later medical course, the pa-
tient’s nursing expert said. Proassur-
ance v. Metheny, __ S.W. 3d __, 2012 WL
6204231 (Ark.
Study Participants Answers to Interview QuestionsParticipant #1.docxlillie234567
Study Participants Answers to Interview Questions
Participant #1:
1. What are the disparities between jail and youth rehabilitation for African American offenders?
a. African Americans will be imprisoned more than their white counterparts who will be given rehabilitation, institutional racism exists, and the system will spend more man hours and time dealing with white offenders than black offenders.
2. What are some social issues that African American juveniles are faced with?
a. Sociocultural stigmas, single-parent households, inadequate educational systems, poor role models, and single-parent households
3. Why are African American male juveniles not offered other means of rehabilitative punishments?
a. The New Jim Crow is our correctional system, which seeks to fill jail cells by incarcerating more black and Latino people who are then utilized as enslaved people in the system for huge corporations and the US Government. The system indicates they are not receptive and will not change.
4. What effects does the existing jail and punishment system have on this population?
a. Demeaning and discouraging—we should fund educational aid, mental health services, and instruction. Providing people with helpful tools, role models, and direction will also help them become contributing members of society
Participant #2:
1. Youth rehabilitation centers should provide mechanisms to prevent offenders from committing crimes but in order to effectively do that the differences amongst AA juveniles and other races must be addressed, while jail just allows for a separation from society to think about the crime.
2. African American male juveniles are faced with a predetermined
perception of being criminals as well as a lack of resources in their communities to educate them on the different career paths & trades that exist.
3. The funding doesn’t exist to provide other rehabilitative opportunities in AA communities.
4. The existing punishment system allows offenders to be separated from the public but it doesn’t provide them with any resources to be successful once their time is complete. Not addressing the underlying issues of how they entered the system as well as how to they can live a successful life after now being labeled as a criminal normally results in repeat offenders.
Participant #3:
1. The youth aren’t getting the proper guidance, mental healthcare and attentiveness in jail. They’re already “written off” which leads to them believing what they’re being taught and increasing the likelihood of them becoming repeat offenders. In youth rehab, you’re given a second chance, you’re being taught how to manage your mental and emotional state. You are being prepared for the world.
2. Prejudice. Are seen as thugs, no good. Etc. don’t have proper resources to get them back on their feet. Difficulty getting jobs, getting into school once released.
3. Unsure, but I’m sure it’s race.
4. You can become in.
STUDENT REPLIES
STUDENT REPLY #1 Vanessa Deleon Guerrero
When conducting surveillance, you are closely monitoring a person’s activities. Investigators or detectives watch their every move, at home, work, where they eat, shop all while being unnoticeable. When detectives conduct surveillance, they still need to ensure that they are respecting the person’s privacy. For example, detectives will not take photos of the person while they are in the shower. If the person is outside or in an area that has public view, then they can take photos of that person. They must conduct their surveillance in an orderly manner, without causing panic to the public in order to ensure public safety.
Private companies such as Facebook, Instagram or twitter are used for people to express themselves. However, what is posted on their social media becomes public and they make their lives public for everyone to see. If someone posted that they were just at a park where a shooting happened, law enforcement can use that to interview them because it puts them at the scene of the crime. However, private companies, for example like phone companies should not use data like text messaging for their benefit. They should not be allowed to read their customers’ messages or listen in on their phone calls. That is a true invasion of privacy.
Reference
Brandl, S. (2018). Criminal investigation (4th ed.). Thousand Oaks, CA: SAGE Publications.
Bedi, M. (2016). The curious case of cell phone location data: Fourth Amendment doctrine mash-up Links to an external site... Northwestern University Law Review, 110(2), 507–524
STUDENT REPLY #2 Danielle Berlus
Hello everyone, when I think of surveillance, I think of all the places that they put cameras like the ones at streetlights that catch you speeding or when they are looking for a suspect and they look to facial recognition devices. I think it is hard to balance what is expected to be private. I don't think anything is private anymore except possibly the bathrooms and even then, someone maybe recording you. Our cell phones I think are being monitored by so many companies and even those who want to steal our personal data as well.
"The government tracks movements through the acquisition of cell phone location data: historical cell phone location data, real-time cell phone location data, and actively "pinging" a cell phone for location data. Cell phone providers store location data as the normal part of their business of providing service. Police, in turn, can request that cell phone providers hand over this location data for a suspect over a set period of time. This information is classified as historical cell phone location data. This data stands in contrast to real-time location data. Whereas the former focuses on past locations, real-time data provides locations as they actually occur. Here, cell phone providers, upon request, give police contemporaneous data on the location of the nearest cell tower for tracking p.
Student Name
BUS 300 Public Relations
[Insert Instructor’s Name]
Month Date Year
BUS300 PR Plan Part 2 Outline
This paper will be a revised and expanded version of Developing a Public Relations Plan, Part 1 assignment in Week 4. Your paper should have a section with the bolded headers below. Ensure you have a section that discusses each of these:
Mix Media
In this section, you will describe the mix of media you would use to implement your public relations campaign and explain in detail your objectives for each media form. Include traditional and twenty-first- century integrated marketing communication strategies in your discussion. (This section should be at least three paragraphs).
Government Relations
In this section you will describe the government relations tactics you would use as part of your public relations campaign, and explain in detail how these tactics will help you achieve your objectives. In great detail explain how these tactics will help you achieve your objectives. (This section should be at least two paragraphs).
Community Relations
In this section please explain in detail how you can take advantage of community relations to generate positive publicity for your organization. (This section should be at least two paragraphs).
News Release
Draft a news release that you will use in your public relations campaign (Chapter 15). Explain in detail how the content, style, and essentials of your news release will help you persuade the public to your point of view. Use information from Chapter 15 as support. Describe the key elements of writing to consider when responding to a public relations crisis or scandal. (Your news release should be similar to the example provided in the book).
Crisis Management
In this section you will explain the five planning issues related to crisis management that can be employed to mitigate the scandal or risks (Chapter 17). (This section should be at least four to five paragraphs).
Additional Requirements
Remember to Include in-text citations when presenting information from other sources. You should begin your search for sources in the Strayer Library. Use a minimum of three credible, relevant, and appropriate sources. After you conclude the paper, you will need a separate page that includes your references. Include a sources page at the end of your paper.
Please ensure you proofread your paper and summarize when providing in-text citations.
1. Enter your first source entry here.
2. Enter your second source entry here.
3. Enter your third source entry here.
image1.png
BUS 300 Public Relations
Dr. Tenielle Buchanan
October 30, 2022BUS300 PR Plan Part 1 Outline
Your paper should have a section with the bolded headers below. Ensure you have a section that discusses each of these:
Name of organization
The United States-based publication Rolling Stone magazine is a news magazine that covers articles on current events relating to music, contempo.
Statistical Process Control 1 STATISTICAL PROCESS .docxlillie234567
Statistical Process Control 1
STATISTICAL PROCESS CONTROL
by XXXXXXXX
Student ID: 2XXXXXXX
University of Northampton
(Amity Global Institute Pte Ltd, Singapore)
Managing Operations and The Supply Chain
Dr. Melvin Goh
BSOM046
BSOM046-SUM-1920-ES1-Statistical Process Control
18 Oct XXXX
Word Count: 1600 (± 50)
Statistical Process Control 2
Table of Content
1. Introduction………………………………………………………………….3
2. Literature Review……………………………………………………………3
3. Methodology…………………………………………………………………5
4. Case Study Analysis…………………………………………………………9
5. Recommendation…………………………………………………………….15
6. Conclusion…………………………………………………………………...17
7. References……………………………………………………………………18
8. Appendix……………………………………………………………………..22
Statistical Process Control 3
STATISTICAL PROCESS CONTROL
INTRODUCTION
This report will provide a literature review of the concept and relevance of statistical process
control (SPC) from its inception until the present day. A case study of Waterside’s Leather
Limited (WLL) using the temperature data of its combined effluent discharge over one hundred
and twenty days will be conducted, and a recommendation will also be proposed.
LITERATURE REVIEW
Man has always tried to imitate and better his competitors to develop a better and cheaper
product or service. This idea was as crucial for the hunter-gatherer as it is for the manufacturing
industry after many millennia. This awareness led to the requirement of apprentices having to
follow in the footsteps of the master craftsmen for many years until they could become masters
in their craft. However, this was not a scientifically tabulated and monitored process.
Bradford and Miranti (2019) state that “it was in 1924 that Walter A. Shewhart introduced the
use of control charts to evaluate data distribution patterns to determine whether manufacturing
processes remain under control at Bell Telephone Laboratories”. He also introduced the terms
of variation in the process which comprises of common cause and special cause variation
(Subhabrata and Marien, 2019).
SPC is a technique for controlling processes to distinguish causes of variation and signal for
corrective action (Chen 2005 cited in Avakh and Nasari 2016). While some say that “SPC is
the use of statistically based tools and techniques principally for the management and
Statistical Process Control 4
improvement of processes” (Stapenhurrst, 2005), others say that “SPC is not really about
statistics or control, it is about competitiveness” (Oakland and Oakland, 2018).
Figure 1: A typical Control Chart
(Graph from https://learning.oreilly.com/library/view/nonparametric-statistical-process/9781118456033/c02.xhtml#head-2-
18)
The USA War Department used these methods to enhance the quality of products during World
War II. W.E Deming used Shewhart’s cycle in his quality training in Japan in 1950 but made
a new version stress.
Student 1 Student Mr. Randy Martin Eng 102 MW .docxlillie234567
Student 1
Student
Mr. Randy Martin
Eng 102 MW
6 December 2010
The Tragedy of Othello
The “Devil” throughout the ages has been referred to by many names; accuser, adversary,
enemy, and thief among others, no matter what title is given he is universally accepted as the
purest and ultimate form of evil. In William Shakespeare’s play, The Tragedy of Othello,
Shakespeare uses the element of drama of character to create a villain that embodies absolute
wickedness, a human form of the author of evil. The character Shakespeare creates to serve as
the ultimate antagonist is none other than “honest Iago.” Iago’s character is the best
representation of an elusive villain whose clever abilities to deceive and persuade bring
catastrophic destruction like that of an unexpected, nearly invisible black ice. Shakespeare uses
the character to advance the theme that mankind has the ability to be influenced and even driven
to engage in repulsive and devastatingly horrendous acts towards to each other. Iago himself is
driven and influences the actions Casio, Othello, and Rodrigo.
Spurred by jealousy and the pain of an injured pride Iago observes the man who was
granted/appointed the position he believed to have deserved and conceives a plan for taking
Cassio(this man) out. The character Cassio is deceived and manipulated by Iago in two manners.
First Iago sets up Cassio to betray himself and be demoted and then later uses Cassio as a pawn
to play into an even greater and more elaborate act of revenge against Othello.
Giving into anger and jealousy, Iago devises a plan to crush Cassio and satiate the pain of
Student 2
being passed over, Shakespeare writes:
I: With as little
a web as this will I ensnare as great a fly as Cassio. Ay, smile upon her, do!
I will gyve thee in thine own courtship…
If such tricks as these strip you out of your lieutenantry, (2.1.162-4)
Critic August Schlegel notes, “…he spreads his nets with a skill which nothing can escape.” The
devastation of being passed over for the position drove Iago to exact revenge on the unknowing
bystander, Cassio. Pride is a powerful internal motivator that takes a tremendous toll on those
who allow it contribute to their actions or control their thoughts. It is easy to give into the
feelings of being wronged and turn an evil eye rather than applauding another in their success.
More commonly found in relationships is the mentality of if I can’t have him nobody will.
With ease and grace Iago is able to show Cassio false sympathy and gain trust that allows
him to direct Cassio’s actions, by creating false hope. Shakespeare writes:
I: …, I could heartily wish this had not
befall’n; but since it is as it is, mend it for your own good.(2.3.270-1)
I: I tell you what you
shall do. Our general’s wife is now the general...
confess yourself freely to her; importune her help
to put you in your place again. She is of so free, .
Sophia Pathways for College Credit – English Composition II
SAMPLE TOUCHSTONE AND SCORING
Logan Stevens
English Composition II
December 20, 2019
Where’s the Beef?: Ethics and the Beef Industry
Americans love their beef. Despite the high rate of its consumption, in recent years
people in the United States have grown increasingly concerned about where their food comes
from, how it is produced, and what environmental and health impacts result from its production.
These concerns can be distilled into two ethical questions: is the treatment of cattle humane and
is there a negative environmental impact of beef production? For many, the current methods of
industrial beef production and consumption do not meet personal ethical or environmental
standards. Therefore, for ethical and environmental reasons, people should limit their beef
consumption.
The first ethical question to consider is the humane treatment of domesticated cattle. It
has been demonstrated in multiple scientific studies that animals feel physical pain as well as
emotional states such as fear (Grandin & Smith, 2004, para. 2). In Concentrated Animal Feeding
Operations (CAFOs), better known as “factory farms” due to their industrialized attitude toward
cattle production, cattle are often confined to unnaturally small areas; fed a fattening, grain-based
diet; and given a constant stream of antibiotics to help combat disease and infection. In his essay,
“An Animal’s Place,” Michael Pollan (2002) states that beef cattle often live “standing ankle
Comment [SL1]: Hi Logan! This is a great title.
Comment [SL2]: It will help strengthen your opening
sentence to include some sort of facts or statistics about
beef consumption in America.
Comment [SL3]: Throughout your essay, you talk about
more than just limiting the consumption of beef. How could
you strengthen your Thesis Statement to connect all of
those points?
Sophia Pathways for College Credit – English Composition II
SAMPLE TOUCHSTONE AND SCORING
deep in their own waste eating a diet that makes them sick” (para. 40). Pollan describes
Americans’ discomfort with this aspect of meat production and notes that they are removed from
and uncomfortable with the physical and psychological aspects of killing animals for food. He
simplifies the actions chosen by many Americans: “we either look away—or stop eating
animals” (para. 32). This decision to look away has enabled companies to treat and slaughter
their animals in ways that cause true suffering for the animals. If Americans want to continue to
eat beef, alternative, ethical methods of cattle production must be considered.
The emphasis on a grain-based diet, and therefore a reliance on mono-cropping, also
contributes to the inefficient use of available land. The vast majority of grain production (75-
90% depending on whether corn or soy) goes to feeding animals rather than humans, and cattle
alone .
STORY TELLING IN MARKETING AND SALES – AssignmentThe Ethic.docxlillie234567
STORY TELLING IN MARKETING AND SALES – Assignment
The Ethics of Storytelling
Assignment Description:
During the past week in class, we learned that all brand stories need to have a strong ethical foundation. Brands need to create and distribute messages that are honest and convey their corporate values.
FOR THIS ASSIGNMENT, “CHOOSE ANY 1” OF THE FOLLOWING SHORT VIDEOS TO WRITE ABOUT:
· “Apple 2013 Christmas commercial”
https://www.youtube.com/watch?v=03KQTCEM08k
· “WestJet Christmas Miracle”
https://www.youtube.com/watch?v=zIEIvi2MuEk&t=9s
For the video you choose, answer the following questions about the story that is being told:
(minimum 350 words, combine 1 to 5)
1. Does this story affirm the company’s core values? Why or why not?
2. Does this story foster trust with each and every stakeholder? Why or why not?
3. Does this story help build relationships? Why or why not?
4. Does this story showcase diverse and inclusive behaviors?
5. Does this story honor the company’s commitments and promises to its customers? Why or why not?
Note: Write a minimum of 350 words for above 5 questions, conveying your own thoughts and views.
image1.png
CHCCCS023 Learner Guide Version 1.1 Page 1 of 59
CHCCCS023
Support independence and
wellbeing
Learner Guide
CHCCCS023 Learner Guide Version 1.1 Page 2 of 59
Table of Contents
Unit of Competency ..................................................................................................................... 5
Application ...................................................................................................................................... 5
Unit Sector ...................................................................................................................................... 5
Performance Criteria ....................................................................................................................... 6
Foundation Skills ............................................................................................................................. 8
Assessment Requirements .............................................................................................................. 9
1. Recognise and support individual differences.......................................................................... 12
1.1 – Recognise and respect the person’s social, cultural and spiritual differences ........................ 13
Individual differences .................................................................................................................... 13
Social differences .......................................................................................................................... 13
Cultural differences ....................................................
STEP IV CASE STUDY & FINAL PAPERA. Based on the analysis in Ste.docxlillie234567
STEP IV: CASE STUDY & FINAL PAPER
A. Based on the analysis in Step III, choose which theory best applies to this situation. Add any arguments justifying your choice of these ethical principles to support your decision.
Consequentialism (Utilitarian) Theory
Deontology Theory
Kant’s Categorical Imperative Principle
Social Contract Theory
Virtue Ethics Theory
NAME THE THEORY HERE: Deontology Theory
B. Explain your choice above: THIS AREA SHOULD BE 4-7 sentences or roughly 100-200 words.
Deontology is an approach to Ethics that focuses on the rightness or wrongness of actions themselves I choose this because ethical actions based on normative theories can be effective in developing better privacy practices for organizations. A business should be able to admit to making a mistake. This is especially important to shareholders, employees, and other stakeholders.It is important for businesses to operate with transparency. Consumers need to be able to trust what businesses present to them.
C. Your decision: What would you do? Why? List the specific steps needed to implement your defensible ethical decision. THIS AREA SHOULD BE 2 OR MORE PARAGRAPHS (250-350 words).
Deontology is a theory of ethics that suggests that actions can either be bad or good when judged based on a clear set of rules. So what I would do is set these rules in place. Businesses/companies should uphold the ethical standard of respect. People personal data shouldn’t be treated as ends rather than means. Companies should keep personal data about their customers/users and should be expected to keep this information private out of respect for these individual’s privacy.
Another rule, Businesses/companies should uphold complete transparency. This builds not only trust, but help builds a relationship with the users/customers. And if they don’t enclosed information the company’s actions would be considered unethical and wrong. Another rule is that there should always be accountability. A business/company should always be able to admit to making a mistake. This is especially important to shareholders, and stakeholders. They should be able to own up to missteps even when this could have serious consequences. With these rules emplaced it would be more ethical.
D. What longer-term changes (i.e., political, legal, societal, organizational) would help prevent your defined dilemma in the future? THIS AREA SHOULD BE 2 OR MORE PARAGRAPHS (250-350 words).
My dilemma is the misuse of personal information and data. Not just in social media but, also companies and business. One of the obvious ways to stop this dilemma is to make it that companies aren’t allowed to collect and store our personal data. User data can legally be sold as long as legal conditions for its collection and sale have been met and there isn’t any regulation against it. Our data is being sold for profit. This shouldn’t be allowed. There should be laws and regulations against that. They are the only ones benefiting.
Step 1Familiarize yourself with the video found here .docxlillie234567
Step 1:
Familiarize yourself with the video found here:
Link to Who Leads Us? video
AND the website associated with the video, located here:
Who Leads Us?
AND the website of your Representative in the United States House:
The US House of Representatives
Step 2:
After learning about Reflective Democracy across the United States it is time to learn about how it affects you. Begin by examining yourself and your surrounding community. How would you describe your cultural background? How would you describe the cultural background of your US Representative? How would you describe the cultural background of the district that he or she represents (and that you are a part of)? Compare and contrast the culture of the district to the culture of your Representative. Compare and contrast the culture of your Representative and your culture. Compare and contrast your culture with the culture of the district that you live. Where do you see the greatest differences between cultures? What are some advantages and disadvantages of these cultural differences? How would you work to bridge the divide between cultures? (SR 1)Step 3:
Find a policy issue that your Representative has taken a stand on. Explain that issue in detail. Once you have explained the issue, provide information on where your representative stands on the issue. Where do you stand on the issue? What do you believe should be done? What might be another alternative solution? Thinking about your ideas on the issue who might object to your viewpoint and what might their objections be? Once you’ve laid out their objections, respond to them, and explain, with logic, why your perspective is correct and your opponents’ objections are mistaken. (PR 1 and PR 2)Step 4:
Now that you have officially staked out a policy position, you need to think about how to get it put into action. Who in the government, and who in your community. do you believe should be involved? What specific actions should you (and those in the community) take? Why is it important to get your community involved and what will be the benefits of activating people to the cause? (SR 2)Step 5:
Let’s assume that you are successful in your efforts, and you achieve your policy goal. What do you believe will be the consequences of putting this policy into practice? How far reaching do you think the consequences will be for your community? Your state? Your country? What do you think will be the effects over the short term? Over the long term? Be sure to mention both positive and negative consequences that might result? (PR 3)
.
Statistical application and the interpretation of data is importan.docxlillie234567
Statistical application and the interpretation of data is important in health care. Review the statistical concepts covered in this topic. In a 800-1,000 words paper, discuss the significance of statistical application in health care. Include the following:
1. Describe the application of statistics in health care. Specifically discuss its significance to quality, safety, health promotion, and leadership.
2. Consider your organization or specialty area and how you utilize statistical knowledge. Discuss how you obtain statistical data, how statistical knowledge is used in day-to-day operations and how you apply it or use it in decision making.
Three peer-reviewed, scholarly or professional references are required.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
RUBRICS:
1, Application of statistics in health care is described in detail. The significance to quality, safety, health promotion, and leadership is described thoroughly for all criteria. Strong information and rationale is provided to fully illustrate the application of statistics, and its significance, to health care and the specific areas.
2, Application of statistical knowledge to organization or specialty area is thoroughly discussed. How statistical data are obtained, used in day-to-day operations, or applied in decision making is described in detail. The ability to understand and apply statistical data is clearly demonstrated.
3, Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.
4, Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.
5, Writer is clearly in command of standard, written, academic English
6, Paper Format (use of appropriate style for the major and assignment)
Compañías utilizando la Inteligencia Artificial
La Inteligencia Artificial es un campo donde se combina las ciencias de las computadoras y bases de datos para ayudar a resolver problemas o para simular Inteligencia Humana. Comprende varios subcampos donde se utilizan varios métodos en los cuales se pueden mencionar los más comunes que son: las maquinas aprendiendo o Machine Learning y el aprendizaje profundo o Deep Learning. Estos métodos o disciplinas están comprometidas con los Algoritmos de la Inteligencia Artificial que buscan crear sistemas expertos que pueden hacer predicciones o clasificaciones basadas en una data introducida por un usuario. Algunas de las funciones primarias de la Inteligencia Artificial varían entre razonar, aprender, resolver problemas, toma de decisiones y principalmente entender el comportamiento humano. Este concepto esta formado por dos tipos de acercamientos, el primero es el acercamiento humano y el acercamiento ideal. Cuando hablamos del acercamiento humano, estamos emprendiendo sistemas que piensan y actúan como humanos. El acercami.
SOURCE: http://eyeonhousing.org/2013/09/24/property-tax-remains-largest-revenue-source/
Property tax comes from housing. More new construction means more property taxes collected. The
better (so more expensive the home) the more property taxes collected. Defaults, foreclosures can
drive down house values and reduce property taxes. You are simply trying to understand some
forecasting regarding the future (maybe near-term future) of property taxes to be collected. CERNIK
Property Tax Remains Largest Revenue Source
According to the latest data from the Census Bureau, taxes paid by homeowners and other real
estate owners remain the largest single source of revenue for state and local governments. At
34%, property taxes represent a significantly larger share than the next largest sources: individual
income taxes (24%) and sales taxes (21%).
State and local government property tax collections continue to increase on a nominal basis.
From the third quarter of 2012 through the end of the second quarter of 2013, approximately
$479 billion in taxes were paid by property owners. This was a small increase from the
previous trailing four-quarter record of $477 billion, set last quarter.
The modest changes throughout the Great Recession in nominal state and local government
property tax collections are due in large part to lagging property assessments and the ability of
local jurisdiction to make annual adjustments to tax rates. In general, declining property values
are not reflected in the system until a few years after the decline occurs. Once assessments are
updated, property tax authorities can adjust rates thus maintaining a desired level of collection.
http://eyeonhousing.org/2013/09/24/property-tax-remains-largest-revenue-source/
http://www.census.gov/govs/qtax/
http://eyeonhousing.files.wordpress.com/2013/09/piechart.png
As state and local government property tax collections increased in recent years, the share of
local tax collections due to property taxes fell from a high of 37.4% in the second quarter of
2010 to the current share of 33.5%. The average share for property taxes since 2000 is 32.4%.
The changing share of local collections is due predominantly to fluctuations in all other tax
receipts. State and local individual income tax, corporate income tax, and sales tax collections
are very responsive to changing economic conditions. For example, in the second quarter of 2009
state and local governments collected $76 billion in individual income tax. In the second quarter
of 2013, the most recent, state and local governments collected $114 billion in individual income
tax. The dramatic 50% increase in state and local individual income tax receipts is due to
improving economic conditions, rising incomes, and higher rates in several states.
http://eyeonhousing.files.wordpress.com/2013/09/chart_13.png
The S&P/Case-Shiller House Price Index – National Index grew by 7.1% on a n.
Sophia Pathways for College Credit – English Composition I
Are you ready to write Touchstone 4?
The essay below provides an example of an advanced level argumentative essay. As you read through
the essay, notice how the author effectively incorporates elements of argument, has a strong thesis
statement which takes a stand on one side of a debatable topic, and utilizes the classical model of
argumentation with effective incorporation and utilization of support.
______________________________________________________________________
Marcus Bishop
English Composition I
March 15, 2018
Teenage Sleep and School Start Times
John, an average teenager, tries to get to school on time in the mornings. He sets two
alarms on his phone and often skips a shower or breakfast, or both, so that he doesn’t miss the
school bus that stops at his corner at 7:00 AM. Once at school, John joins his sleep-deprived
peers in mad dashes to their first classes. School is on, whether students are prepared to learn
or not. According to numerous studies, the average U.S. teenager gets between 7 and 7.25
hours of sleep a night, while his body needs between 9 and 9.5 hours. With the average start
time for high school in the U.S. 8:03 AM (Croft, Ferro, and Wheaton, 2015), it’s not a great leap
to conclude many high school students are sleep-deprived. High schools should implement later
start times to maintain healthy biological functions and to maximize learning for teenagers.
Comment [SL1]: While the sentence structure is a bit
repetitive, this introduction does a good job of engaging the
reader with the average teenager and providing the
necessary background information for the reader to fully
understand the importance of the thesis.
Comment [SL2]: This is a well written thesis statement. It
takes a clear position on one side of a debatable topic. It is
concise, yet provides adequate detail so that the reader
knows what your key points within the essay will likely be.
Sophia Pathways for College Credit – English Composition I
Sleep deprivation in teens affects their health, including issues like mood and behavior,
increased anxiety or depression, use of caffeine, tobacco, or alcohol, and even weight gain. Lack
of sleep increases the likelihood that teens across all socio-economic spectrums will be unable
to concentrate and will suffer poor grades in school as a result. In addition, teens, already in a
high risk category as new drivers, are more susceptible to “drowsy-driving incidents.” (Richter,
2015). These are all compelling reasons to consider changes in school start times for teenagers.
Our internal body clocks – what scientists call circadian rhythm - regulate biological
processes according to light and dark. When our eyes tell us it’s dark, we begin to tire, and
when our eyes tell us it’s light, we begin to waken. Adults often refer to themselves as a
“morning person” or a “night person” because t.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
Thinking of getting a dog? Be aware that breeds like Pit Bulls, Rottweilers, and German Shepherds can be loyal and dangerous. Proper training and socialization are crucial to preventing aggressive behaviors. Ensure safety by understanding their needs and always supervising interactions. Stay safe, and enjoy your furry friends!
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
MATATAG CURRICULUM: ASSESSING THE READINESS OF ELEM. PUBLIC SCHOOL TEACHERS I...NelTorrente
In this research, it concludes that while the readiness of teachers in Caloocan City to implement the MATATAG Curriculum is generally positive, targeted efforts in professional development, resource distribution, support networks, and comprehensive preparation can address the existing gaps and ensure successful curriculum implementation.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
Azure Interview Questions and Answers PDF By ScholarHat
Running head GUIDED IMAGERY AND PROGRESSIVE MUSCLE RELAXATION (5).docx
1. Running head: GUIDED IMAGERY AND PROGRESSIVE
MUSCLE RELAXATION
2
2
Title of Paper in Bold Centered
Student Name
American Public University
COURSE####: Course Title
Instructor Name
Due Date
Repeat the Title – Level 1 Header
Hit the tab key one time to begin the main body of the paper.
The paragraphs of the main document are indented. The
computer will wrap your text for you based upon the margin
settings established by this document template. It is not
necessary for you to hit the Enter or return key at the end of a
line of text. Only hit the enter key (one time) when you reach
the end of a paragraph.
Then hit the tab key to indent and then continue typing the
paper. In APA any source that you use in your paper must have
an in-text citation. In APA these citations include the author’s
last name and the year of the publication in parentheses (Name,
Year).
Level 2 Header use: Flush Left, Bold, Title Case Heading
Sub-section your essay using sub-headers in the same
sequence you introduced your topic in your lead paragraph, your
2. thesis.
Level 3 Header use: Flush Left, Bold Italic, Title Case Heading
The more lengthy or complex your essay, the potential for using
additional Level Headers; notice the subtle difference. One tip
for any submission, always double-check the font choice is
consistent throughout the essay.
Conclusion
Begin to summarize the main points of your topic in three to
five sentences. The conclusion of your paper should re-phrase
the points of what your reader should be left remembering,
nothing new, concise and to the point.
References
Lastname, C. (2008). Title of the source without caps except
Proper Nouns or: First word after colon.
The Journal or Publication Italicized and Capped,
Vol#(Issue#), Page numbers.
Guideline Watch for the Practice Guideline for the Treatment of
Patients With Bipolar Disorder 1
GUIDELINE WATCH:
PRACTICE GUIDELINE FOR THE TREATMENT
OF PATIENTS WITH BIPOLAR DISORDER,
2ND EDITION
Robert M. A. Hirschfeld, M.D.
APA’s Practice Guideline for the Treatment of Patients With
Bipolar Disorder, 2nd Edition, was
published in April 2002 (1). Since that time, a number of
3. controlled treatment studies on as-
pects of bipolar disorder have been completed and published or
are in press, including studies
of second-generation (atypical) antipsychotics as monotherapy
and as adjunctive treatment
(with more traditional mood stabilizers) for the acute treatment
of mania, studies of antiepileptic
agents for the acute treatment of mania, trials for three
medications for the acute treatment of
bipolar depression, four monotherapy and one combination
therapy relapse prevention studies,
and studies of psychosocial interventions for maintenance. The
evidence from these studies
supports a substantially expanded set of options for clinicians
who treat patients with bipolar
disorder. This guideline watch briefly reviews the most
important of the studies. The majority
of the studies were industry supported.
� PSYCHIATRIC MANAGEMENT
Recently completed epidemiological studies have estimated the
lifetime prevalence of bipolar I
and II disorders in the general population to be 3.7%–3.9% (2,
3). The prevalence in samples of
patients presenting with depression is much higher, ranging
from 21% (4) to 26% (5) in primary
care settings and from 28% (6) to 49% (7) in psychiatric clinics.
Use of a screening instrument,
such as the Mood Disorder Questionnaire, can substantially
improve recognition of patients with
bipolar disorder, particularly among depressed patients (8).
The American Psychiatric Association (APA) practice
guidelines are developed by expert work groups us-
ing an explicit methodology that includes rigorous review of
available evidence, broad peer review of it-
5. sodes, with initial dosing of either 10 mg/day or 15 mg/day (9,
10). Somnolence, dry mouth,
dizziness, and weight gain occurred significantly more
frequently in the olanzapine group than
in the placebo group. In another randomized, double-blind
study, olanzapine was equivalent
to haloperidol for patients with acute mania and was superior to
haloperidol for patients whose
index episode did not include psychotic features (11).
Olanzapine monotherapy has also been
compared with divalproex monotherapy in two randomized,
double-blind, controlled studies.
In one there was equivalent efficacy (12), and in the other
olanzapine had superior efficacy
(13). However, the side-effect profile for divalproex was more
benign.
Olanzapine has also been studied as an adjunctive agent to
traditional mood stabilizers. In
a double-blind, randomized, controlled trial, olanzapine added
to divalproex or lithium was
superior to divalproex or lithium alone in patients who had had
an inadequate response to at
least 2 weeks of lithium or valproate monotherapy (14). Side
effects included somnolence, hyper-
kinesia, and nausea.
The efficacy of risperidone monotherapy for the acute treatment
of mania has been demon-
strated in three randomized, double-blind, placebo-controlled
trials. Risperidone monotherapy
was superior to placebo in all three studies. In the three studies
patients were started on 3 mg/day
of risperidone, with titration to a maximum of 6 mg/day. Onset
of action in one study was seen at
day 3 (15), and in another at 1 week (16). In the third study,
6. risperidone was equivalent to halo-
peridol and superior to placebo (17). Side effects included
somnolence, hyperkinesia, and nausea.
Two randomized, double-blind, placebo-controlled studies
examined the adjunctive use of
risperidone with traditional mood stabilizers (i.e., lithium or
divalproex) (18, 19). In both stud-
ies the combination of risperidone with mood stabilizer
outperformed mood stabilizer alone.
The addition of risperidone substantially increased the
prevalence of extrapyramidal symptoms.
The efficacy of ziprasidone as monotherapy in the acute
treatment of patients with manic
or mixed episodes was tested in two randomized, double-blind,
placebo-controlled studies,
with initial dosing of 40 mg twice a day (20, 21). Ziprasidone
had an onset of action at day 2 in
both trials and was superior to placebo at endpoint. The mean
dosage in the two studies was
130 mg/day and 112 mg/day, respectively. Side effects included
somnolence, dizziness, extra-
pyramidal syndrome, nausea, akathisia, and tremor.
Two studies of aripiprazole monotherapy in the acute treatment
of mania have been pub-
lished (22, 23). In a randomized, double-blind, controlled study,
aripiprazole at a starting dos-
age of 30 mg/day was compared with placebo in patients with
manic or mixed episodes (22).
Aripiprazole was superior to placebo in efficacy, beginning at
day 4. Side effects included nausea,
dyspepsia, somnolence, vomiting, insomnia, and akathisia. A
second study compared aripipra-
zole and haloperidol over 12 weeks (23). The drugs performed
7. similarly regarding improve-
ment in manic symptoms, but substantially more aripiprazole
patients completed the study.
Extrapyramidal symptoms were much higher for haloperidol.
The efficacy of quetiapine in patients with manic episodes has
been studied in two different
12-week randomized, double-blind, placebo-controlled trials—
one against lithium and the
other against haloperidol (24, 25). Quetiapine was initiated at
100 mg on day 1, with an up-
ward titration to 800 mg/day or higher. Quetiapine was
equivalent in efficacy to the two active
comparators, and both were superior to placebo at day 21. Side
effects included dry mouth,
somnolence, weight gain, and dizziness.
In another study, adjunctive quetiapine or placebo was given to
acutely manic patients who
were still manic after at least 7 days of treatment with lithium
or divalproex. Quetiapine was ini-
tiated at 100 mg and titrated to 400 mg/day by day 4, with a
target dose of 200–800 mg/day (26).
Guideline Watch for the Practice Guideline for the Treatment of
Patients With Bipolar Disorder 3
The quetiapine treatment group had a significantly higher
response rate and reduction in manic
symptoms. The mean last-week dosage in all patients receiving
quetiapine was 504 mg/day.
There have been two recently published randomized, double-
blind, placebo-controlled
8. studies of the extended-release formulation of the
anticonvulsant carbamazepine for the acute
treatment of manic or mixed episodes (27, 28). In both studies,
carbamazepine extended-
release was initiated at 400 mg in divided doses on day 1 and
increased as tolerated up to 1,600
mg/day. The mean final dosages were 756 mg/day (27) and 643
mg/day (28), respectively. An
onset of action was seen at day 14 in the first trial and at day 7
in the second trial, and both
trials found carbamazepine extended-release to be superior to
placebo at endpoint. Side effects
included dizziness, somnolence, nausea, vomiting, ataxia,
blurred vision, dyspepsia, dry mouth,
pruritus, and speech disorder.
The many monotherapy and adjunctive therapy studies of mania
since 2002 provide a num-
ber of new options for clinicians in the acute treatment of
patients with mania.
A significant clinical concern is metabolic effects associated
with second-generation anti-
psychotics (29). Clozapine and olanzapine are associated with
increased risks of developing di-
abetes mellitus and dyslipidemia. A recent comparative
antipsychotic trial in schizophrenia
suggested significantly greater weight gain for olanzapine than
for the other antipsychotics
studied (i.e., perphenazine, quetiapine, risperidone, and
ziprasidone) (30). Clozapine and olan-
zapine are associated with the most weight gain, risperidone and
quetiapine with moderate
weight gain, and ziprasidone and aripiprazole with minimal
weight change. Because of these
risks, clinicians have been advised to monitor weight, waist
9. circumference, blood pressure, glu-
cose, and lipids at baseline and at monthly intervals in patients
on these medications (31).
Depressive episodes
The impact (in terms of duration of episodes and quality of life)
of depressive episodes in bi-
polar patients is substantially worse than the impact of manic
episodes (32, 33). Unfortunately,
far less research attention has been paid to the treatment of
bipolar depression (34, 35). This sec-
tion reviews three studies published since the 2002 publication
of the second edition practice
guideline.
In an 8-week placebo-controlled, double-blind study, olanzapine
monotherapy and the
combination of olanzapine and fluoxetine were examined in the
acute treatment of bipolar I
depression (36). Although both olanzapine and the combination
of olanzapine and fluoxetine
were superior to placebo in efficacy, the response in the
combination group was much greater,
and only the combination of olanzapine and fluoxetine received
an indication from the Food
and Drug Administration for the acute treatment of bipolar
depression. The first separation
from placebo occurred at week 1 and continued throughout the
trial. The mean dosage in the
combination group was 7.4 mg/day of olanzapine and 39.3
mg/day of fluoxetine. By the end
of the study, 8 of 10 core symptoms of depression had improved
relative to placebo. Side effects
included somnolence, weight gain, increased appetite, dry
mouth, asthenia, and diarrhea. Nei-
ther olanzapine monotherapy nor the combination of olanzapine
10. and fluoxetine caused switch-
ing into mania or hypomania.
A large randomized, double-blind, placebo-controlled trial
supported the efficacy of que-
tiapine monotherapy for the treatment of bipolar I or II
depression (37). Quetiapine initiated
at 50 mg/day and titrated to either 300 mg/day or 600 mg/day
within 1 week was found to be
effective compared with placebo at both doses, with no
significant difference in efficacy be-
tween the two dosage groups. Onset of action occurred by 1
week and continued throughout
the trial. Statistical significance was achieved at endpoint in 9
of 10 core features of depression.
Side effects included dry mouth, sedation, somnolence,
dizziness, and constipation and were
substantially greater in the 600 mg/day group compared with the
300 mg/day group. Incidence
of treatment-emergent mania did not differ from that of placebo.
4 APA Practice Guidelines
A single-blind, randomized, nonplacebo-controlled comparison
of venlafaxine and paroxe-
tine was conducted with patients with bipolar disorder who were
currently presenting with a
major depressive episode and who were currently taking a mood
stabilizer (38). Both medica-
tions yielded significant improvements in depressive
symptomatology with no significant dif-
ferences in safety measures. Among the patients treated with
paroxetine, 3% switched to
hypomania or mania, compared with 13% in the venlafaxine
11. group.
Two small, controlled studies of the adjunctive use of the
dopamine agonist pramipexole in the
treatment of bipolar depression suggest efficacy (39, 40). Both
studies were 6-week placebo-con-
trolled studies of pramipexole (mean peak dosage = 1.7 mg/day)
added to the therapeutic levels of
traditional mood stabilizers. Results were strongly positive in
both studies, with few adverse events.
In conclusion, medications having the strongest evidence for
efficacy for acute treatment of
depression in patients with bipolar I disorder are the
olanzapine-fluoxetine combination, que-
tiapine, and lamotrigine. There is suggestive evidence that the
adjunctive use of pramipexole
may be helpful. Evidence for the efficacy of an antidepressant
with adjunctive mood stabilizer
is modest. Prescription of antidepressants in the absence of a
mood stabilizer is not recom-
mended for bipolar I patients.
Maintenance treatment
Since publication of the second edition practice guideline, new
studies have been published on
the long-term treatment of patients with bipolar disorder.
Pharmacological interventions
Two large randomized, double-blind studies examined the
utility of lamotrigine in the main-
tenance treatment of patients with bipolar I disorder (41, 42).
Both studies were placebo con-
trolled and included lithium monotherapy as an active
comparator. In one study, patients had
most recently suffered a depressive episode (41) and, in the
12. other, a manic or hypomanic episode
(42). Both studies involved an open-label stabilization period of
8–16 weeks followed by an
18-month trial of lamotrigine monotherapy, lithium
monotherapy, or placebo in patients who
had recovered and were stable.
In the study of recently depressed patients (41), both
lamotrigine (200 mg/day or 400 mg/
day) and lithium (0.8–1.1 meq/liter) were superior to placebo in
preventing any mood episode.
Lamotrigine, but not lithium, was superior to placebo in
preventing a depressive episode. Lith-
ium, but not lamotrigine, was superior to placebo in preventing
a manic, hypomanic, or mixed
episode. With the exception of rash, there were no side effects
of lamotrigine that exceeded pla-
cebo. There were no serious rashes. For the lithium group, the
incidence of somnolence and
tremor exceeded that of placebo.
In the study of recently manic or hypomanic patients (42), both
lamotrigine (target dosage
of 200 mg/day) and lithium (0.8–1.1 meq/liter) were superior to
placebo in delaying onset of
any mood episode. Lithium, but not lamotrigine, was superior to
placebo in prevention of a
manic episode, but neither agent was superior to placebo in
preventing depressive episodes. There
were no adverse events for which lamotrigine statistically
exceeded placebo. Lithium exceeded
placebo for diarrhea only.
When the data from both studies were pooled, lamotrigine was
superior to placebo in time
to intervention for any mood episode, as well as for prevention
13. of depressive episodes and manic,
hypomanic, or mixed episodes (43). Similarly, lithium was
superior to placebo in time to in-
tervention for a mood episode and for prevention of a manic,
hypomanic, or mixed episode.
Lithium was not superior to placebo in prevention of a
depressed episode.
Given the results from these studies, both lamotrigine and
lithium appear to have substantial
utility in the maintenance treatment of patients with bipolar
disorder. The utility of lamotrigine
was somewhat greater for the prevention of depressive
compared with manic episodes, and the
opposite is true for lithium.
Guideline Watch for the Practice Guideline for the Treatment of
Patients With Bipolar Disorder 5
A 47-week, randomized, double-blind study of olanzapine
versus divalproex for manic or
mixed episodes was completed (44). The median time to
remission was shorter for olanzapine
than for divalproex, although the remission rates at the end of
the study did not differ between
agents. Adverse events for olanzapine included somnolence, dry
mouth, increased appetite,
weight gain, akathisia, and high alanine aminotransferase
levels, while adverse events for dival-
proex were nausea and nervousness.
A randomized, double-blind, controlled trial compared the
efficacy of olanzapine and lithium
for the prevention of relapse or recurrence of a manic or mixed
14. episode (45). In this study patients
currently experiencing a manic or mixed episode were treated
acutely with olanzapine and lithium
for 6–12 weeks. Patients who achieved remission were
randomly assigned to 52 weeks of olanza-
pine or lithium monotherapy. A relapse into mania or depression
occurred in 30% of the olanza-
pine-treated patients and in 39% of the lithium-treated
patients—an insignificant difference.
Olanzapine was superior to lithium in rates of symptomatic
recurrence of mania or mixed episodes
(14% vs. 28%), but rates of depression recurrence did not differ.
Treatment-emergent insomnia
was higher in the lithium group than in the olanzapine group.
Among the lithium group, 26%
discontinued treatment because of side effects, compared with
19% of the olanzapine group.
A randomized, double-blind, controlled study examined the
utility of continued combina-
tion treatment with a mood stabilizer (lithium, carbamazepine,
or valproate) and a first-gener-
ation (typical) antipsychotic (perphenazine) (46). Immediately
following remission from a
manic episode, patients were randomly assigned to remain on
the combination therapy or to re-
ceive the mood stabilizer plus placebo. Among those on
continued combination therapy, there
was shorter time to depressive relapse, a higher rate of
discontinuation, and higher rates of dys-
phoria, depressive symptoms, and extrapyramidal symptoms.
The study concluded that there
were no short-term benefits with the continuation of the first-
generation antipsychotic with a
mood stabilizer; in fact, its continued use was associated with
the aforementioned detrimental
15. effects.
However, a similar study of the second-generation antipsychotic
olanzapine plus mood
stabilizer versus mood stabilizer plus placebo had somewhat
different results (47). In this ran-
domized, double-blind, controlled study, patients who achieved
remission after 6 weeks of
treatment with olanzapine plus either lithium or valproate
received continued lithium or
valproate plus olanzapine or plus placebo for 18 months. There
were no differences in time to
relapse into mania or depression between the monotherapy and
combination therapy groups,
but combination therapy was significantly better for prevention
of symptomatic relapse. Com-
bination therapy was associated with increased somnolence,
weight gain, and tremor.
Psychosocial interventions
Knowledge of the utility of psychosocial interventions has
expanded recently. Family-focused
therapy is a manualized psychosocial program involving all
available family members in which
weekly psychoeducation, communication enhancement training,
and problem-solving skills
training occur adjunctively with pharmacotherapy. A 2-year
randomized, controlled study of
family-focused therapy plus pharmacotherapy versus a crisis
management intervention and
pharmacotherapy (supported by grants from the National
Institute of Mental Health, the Na-
tional Alliance for Research on Schizophrenia, and the
MacArthur Foundation) found that
postepisode symptomatic adjustment and drug adherence were
enhanced with the family-
16. focused therapy and pharmacotherapy combination compared
with the other (48). Patients in
the group receiving family-focused therapy had fewer relapses
and longer survival intervals.
Another randomized, controlled study examined the utility of
cognitive therapy in conjunc-
tion with pharmacotherapy over a 12-month period (49). Those
treated with cognitive therapy
and pharmacotherapy had significantly fewer bipolar episodes,
days in an episode, and number
of admissions.
6 APA Practice Guidelines
Two controlled studies (supported by grants from the Stanley
Medical Research Institute,
the Instituto de Salud Carlos III, the Fundació Marató de TV3,
and the Fundació María Fran-
cisca Roviralta) of a longitudinal (21-session)
psychoeducational program were conducted in
Spain (50, 51). In both studies psychoeducation reduced
recurrences over 2 years. Psychoedu-
cation enhanced lifestyle regularity and early syndrome
detection.
A recent study (supported by grants from the National Institute
of Mental Health) found
that a psychosocial intervention focused on addressing
interpersonal problems and regulating
social rhythms during acute treatment in bipolar I patients
extended the time to new episode
and reduced the likelihood of recurrence (52).
17. � CONCLUSION
Since the publication in 2002 of the Practice Guideline for the
Treatment of Patients With Bipolar
Disorder, 2nd Edition, new options for the acute treatment of
manic, mixed, or depressive epi-
sodes have emerged. Knowledge of pharmacological and
psychosocial interventions for main-
tenance has also increased.
� ACKNOWLEDGMENT
The author thanks Colleen M. Sonora, M.A., for help in
preparing this guideline watch.
� REFERENCES
1. American Psychiatric Association: Practice guideline for the
treatment of patients with
bipolar disorder (revision). Am J Psychiatry 2002; 159:1–50
2. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR,
Walters EE: Lifetime prevalence
and age-of-onset distributions of DSM-IV disorders in the
National Comorbidity Survey
Replication. Arch Gen Psychiatry 2005; 62:593–602
3. Hirschfeld RM, Calabrese JR, Weissman MM, Reed M,
Davies MA, Frye MA, Keck PE
Jr, Lewis L, McElroy SL, McNulty JP, Wagner KD: Screening
for bipolar disorder in the
community. J Clin Psychiatry 2003; 64:53–59
4. Hirschfeld RM, Cass AR, Holt DC, Carlson CA: Screening
for bipolar disorder in
patients treated for depression in a family medicine clinic. J Am
Board Fam Pract 2005;
18:233–239
18. 5. Manning JS, Haykal RF, Connor PD, Akiskal HS: On the
nature of depressive and anxious
states in a family practice setting: the high prevalence of
bipolar II and related disorders in
a cohort followed longitudinally. Compr Psychiatry 1997;
38:102–108
6. Hantouche EG, Akiskal HS, Lancrenon S, Allilaire JF,
Sechter D, Azorin JM, Bourgeois M,
Fraud JP, Chatenet-Duchene L: Systematic clinical methodology
for validating bipolar II
disorder: data in mid-stream from a French national multi-site
study (EPIDEP). J Affect
Disord 1998; 50:163–173
7. Benazzi F: Prevalence of bipolar II disorder in outpatient
depression: a 203-case study in
private practice. J Affect Disord 1997; 43:163–166
8. Hirschfeld RM, Williams JB, Spitzer RL, Calabrese JR, Flynn
L, Keck PE Jr, Lewis L,
McElroy SL, Post RM, Rapport DJ, Russell JM, Sachs GS,
Zajecka J: Development and
validation of a screening instrument for bipolar spectrum
disorder: the Mood Disorder
Questionnaire. Am J Psychiatry 2000; 157:1873–1875
9. Tohen M, Sanger TM, McElroy SL, Tollefson GD, Chengappa
KN, Daniel DG, Petty F,
Centorrino F, Wang R, Grundy SL, Greaney MG, Jacobs TG,
David SR, Toma V:
Guideline Watch for the Practice Guideline for the Treatment of
19. Patients With Bipolar Disorder 7
Olanzapine versus placebo in the treatment of acute mania.
Olanzapine HGEH Study
Group. Am J Psychiatry 1999; 156:702–709
10. Tohen M, Jacobs TG, Grundy SL, McElroy SL, Banov MC,
Janicak PG, Sanger T, Risser R,
Zhang F, Toma V, Francis J, Tollefson GD, Breier A : Efficacy
of olanzapine in acute bipolar
mania: a double-blind, placebo-controlled study. The
Olanzapine HGGW Study Group.
Arch Gen Psychiatry 2000; 57:841–849
11. Tohen M, Goldberg JF, Gonzalez-Pinto Arrillaga AM,
Azorin JM, Vieta E, Hardy-Bayle
MC, Lawson WB, Emsley RA, Zhang F, Baker RW, Risser RC,
Namjoshi MA, Evans AR,
Breier A: A 12-week, double-blind comparison of olanzapine vs
haloperidol in the treatment
of acute mania. Arch Gen Psychiatry 2003; 60:1218–1226
12. Zajecka JM, Weisler R, Sachs G, Swann AC, Wozniak P,
Sommerville KW: A comparison
of the efficacy, safety, and tolerability of divalproex sodium
and olanzapine in the treatment
of bipolar disorder. J Clin Psychiatry 2002; 63:1148–1155
13. Tohen M, Baker RW, Altshuler LL, Zarate CA, Suppes T,
Ketter TA, Milton DR, Risser R,
Gilmore JA, Breier A, Tollefson GA: Olanzapine versus
divalproex in the treatment of acute
mania. Am J Psychiatry 2002; 159:1011–1017
14. Tohen M, Chengappa KN, Suppes T, Zarate CA Jr,
Calabrese JR, Bowden CL, Sachs GS,
20. Kupfer DJ, Baker RW, Risser RC, Keeter EL, Feldman PD,
Tollefson GD, Breier A: Efficacy
of olanzapine in combination with valproate or lithium in the
treatment of mania in patients
partially nonresponsive to valproate or lithium monotherapy.
Arch Gen Psychiatry 2002;
59:62–69
15. Hirschfeld RM, Keck PE Jr, Kramer M, Karcher K, Canuso
C, Eerdekens M, Grossman F:
Rapid antimanic effect of risperidone monotherapy: a 3-week
multicenter, double-blind,
placebo-controlled trial. Am J Psychiatry 2004; 161:1057–1065
16. Khanna S, Vieta E, Lyons B, Grossman F, Eerdekens M,
Kramer M: Risperidone in the
treatment of acute bipolar mania: double-blind, placebo-
controlled study. Br J Psychiatry
2005; 187:229–234
17. Smulevich AB, Khanna S, Eerdekens M, Karcher K, Kramer
M, Grossman F: Acute and
continuation risperidone monotherapy in bipolar mania: a 3-
week placebo-controlled trial
followed by a 9-week double-blind trial of risperidone and
haloperidol. Eur Neuropsycho-
pharmacol 2005; 15:75–84
18. Sachs GS, Grossman F, Ghaemi SN, Okamoto A, Bowden
CL: Combination of a mood
stabilizer with risperidone or haloperidol for treatment of acute
mania: a double-blind, placebo-
controlled comparison of efficacy and safety. Am J Psychiatry
2002; 159:1146–1154
19. Yatham LN, Grossman F, Augustyns I, Vieta E, Ravindran
21. A: Mood stabilisers plus
risperidone or placebo in the treatment of acute mania:
international, double-blind, ran-
domised controlled trial. Br J Psychiatry 2003; 182:141–147
20. Keck PE Jr, Versiani M, Potkin S, West SA, Giller E, Ice K:
Ziprasidone in the treatment
of acute bipolar mania: a three-week, placebo-controlled,
double-blind, randomized trial.
Am J Psychiatry 2003; 160:741–748
21. Potkin SG, Keck PE Jr, Segal S, Ice K, English P:
Ziprasidone in acute bipolar mania: a 21-
day randomized, double-blind, placebo-controlled replication
trial. J Clin Psychopharma-
col 2005; 25:301–310
22. Keck PE Jr, Marcus R, Tourkodimitris S, Ali M, Liebeskind
A, Saha A, Ingenito G: A
placebo-controlled, double-blind study of the efficacy and
safety of aripiprazole in patients
with acute bipolar mania. Am J Psychiatry 2003; 160:1651–
1658
23. Vieta E, Bourin M, Sanchez R, Marcus R, Stock E,
McQuade R, Carson W, Abou-Gharbia
N, Swanink R, Iwamoto T: Effectiveness of aripiprazole vs
haloperidol in acute bipolar
mania: double-blind, randomised, comparative 12-week trial. Br
J Psychiatry 2005; 187:235–
242
8 APA Practice Guidelines
22. 24. McIntyre RS, Brecher M, Paulsson B, Huziar K, Mullen J:
Quetiapine or haloperidol as
monotherapy for bipolar mania: a 12-week, double-blind,
randomised, parallel-group,
placebo-controlled trial. Eur Neuropsychopharmacol 2005;
15:573–585
25. Bowden CL, Grunze H, Mullen J, Brecher M, Paulsson B,
Jones M, Vagero M, Svensson K:
A randomized, double-blind, placebo-controlled efficacy and
safety study of quetiapine or
lithium as monotherapy for mania in bipolar disorder. J Clin
Psychiatry 2005; 66:111–121
26. Sachs G, Chengappa KN, Suppes T, Mullen JA, Brecher M,
Devine NA, Sweitzer DE:
Quetiapine with lithium or divalproex for the treatment of
bipolar mania: a randomized,
double-blind, placebo-controlled study. Bipolar Disord 2004;
6:213–223
27. Weisler RH, Kalali AH, Ketter TA: A multicenter,
randomized, double-blind, placebo-
controlled trial of extended-release carbamazepine capsules as
monotherapy for bipolar
disorder patients with manic or mixed episodes. J Clin
Psychiatry 2004; 65:478–484
28. Weisler RH, Keck PE Jr, Swann AC, Cutler AJ, Ketter TA,
Kalali AH: Extended-release
carbamazepine capsules as monotherapy for acute mania in
bipolar disorder: a multicenter,
randomized, double-blind, placebo-controlled trial. J Clin
Psychiatry 2005; 66:323–330
29. Newcomer JW: Second-generation (atypical) antipsychotics
23. and metabolic effects: a com-
prehensive literature review. CNS Drugs 2005; 19(suppl 1):1–93
30. Lieberman JA, Stroup TS, McEvoy JP, Swartz MS,
Rosenheck RA, Perkins DO, Keefe RS,
Davis SM, Davis CE, Lebowitz BD, Severe J, Hsiao JK:
Effectiveness of antipsychotic drugs
in patients with chronic schizophrenia. N Engl J Med 2005;
353:1209–1223
31. American Diabetes Association, American Psychiatry
Association, American Association of
Clinical Endocrinologists: Consensus development conference
on antipsychotic drugs and
obesity and diabetes. J Clin Psychiatry 2004; 65:267–272
32. Judd LL, Akiskal HS, Schettler PJ, Endicott J, Maser J,
Solomon DA, Leon AC, Rice JA,
Keller MB: The long-term natural history of the weekly
symptomatic status of bipolar I
disorder. Arch Gen Psychiatry 2002; 59:530–537
33. Calabrese JR, Hirschfeld RM, Frye MA, Reed ML: Impact
of depressive symptoms
compared with manic symptoms in bipolar disorder: results of a
U.S. community-based
sample. J Clin Psychiatry 2004; 65:1499–1504
34. Gijsman HJ, Geddes JR, Rendell JM, Nolen WA, Goodwin
GM: Antidepressants for bipolar
depression: a systematic review of randomized, controlled
trials. Am J Psychiatry 2004;
161:1537–1547
35. Hirschfeld RM, Fochtmann LJ, McIntyre JS:
Antidepressants for bipolar depression. Am
24. J Psychiatry 2005; 162:1546–1547
36. Tohen M, Vieta E, Calabrese J, Ketter TA, Sachs G,
Bowden C, Mitchell PB, Centorrino
F, Risser R, Baker RW, Evans AR, Beymer K, Dube S,
Tollefson GD, Breier A: Efficacy of
olanzapine and olanzapine-fluoxetine combination in the
treatment of bipolar I depression.
Arch Gen Psychiatry 2003; 60:1079–1088
37. Calabrese JR, Keck PE Jr, Macfadden W, Minkwitz M,
Ketter TA, Weisler RH, Cutler AJ,
McCoy R, Wilson E, Mullen J: A randomized, double-blind,
placebo-controlled trial of
quetiapine in the treatment of bipolar I or II depression. Am J
Psychiatry 2005; 162:1351–1360
38. Vieta E, Martinez-Aran A, Goikolea JM, Torrent C, Colom
F, Benabarre A, Reinares M: A
randomized trial comparing paroxetine and venlafaxine in the
treatment of bipolar de-
pressed patients taking mood stabilizers. J Clin Psychiatry
2002; 63:508–512
39. Goldberg JF, Burdick KE, Endick CJ: Preliminary
randomized, double-blind, placebo-
controlled trial of pramipexole added to mood stabilizers for
treatment-resistant bipolar
depression. Am J Psychiatry 2004; 161:564–566
40. Zarate CA Jr, Payne JL, Singh J, Quiroz JA, Luckenbaugh
DA, Denicoff KD, Charney DS,
Manji HK: Pramipexole for bipolar II depression: a placebo-
controlled proof of concept
study. Biol Psychiatry 2004; 56:54–60
25. Guideline Watch for the Practice Guideline for the Treatment of
Patients With Bipolar Disorder 9
41. Calabrese JR, Bowden CL, Sachs G, Yatham LN, Behnke K,
Mehtonen OP, Montgomery
P, Ascher J, Paska W, Earl N, DeVeaugh-Geiss J: A placebo-
controlled 18-month trial of
lamotrigine and lithium maintenance treatment in recently
depressed patients with bipolar
I disorder. J Clin Psychiatry 2003; 64:1013–1024
42. Bowden CL, Calabrese JR, Sachs G, Yatham LN, Asghar
SA, Hompland M, Montgomery P,
Earl N, Smoot TM, DeVeaugh-Geiss J: A placebo-controlled 18-
month trial of lamotrigine
and lithium maintenance treatment in recently manic or
hypomanic patients with bipolar I
disorder. Arch Gen Psychiatry 2003; 60:392–400
43. Goodwin GM, Bowden CL, Calabrese JR, Grunze H, Kasper
S, White R, Greene P,
Leadbetter R: A pooled analysis of 2 placebo-controlled 18-
month trials of lamotrigine and
lithium maintenance in bipolar I disorder. J Clin Psychiatry
2004; 65:432–441
44. Tohen M, Ketter TA, Zarate CA, Suppes T, Frye M,
Altshuler L, Zajecka J, Schuh LM,
Risser RC, Brown E, Baker RW: Olanzapine versus divalproex
sodium for the treatment of
acute mania and maintenance of remission: a 47-week study.
Am J Psychiatry 2003; 160:1263–
1271
26. 45. Tohen M, Greil W, Calabrese JR, Sachs GS, Yatham LN,
Oerlinghausen BM, Koukopoulos
A, Cassano GB, Grunze H, Licht RW, Dell’Osso L, Evans AR,
Risser R, Baker RW, Crane
H, Dossenbach MR, Bowden CL: Olanzapine versus lithium in
the maintenance treatment
of bipolar disorder: a 12-month, randomized, double-blind,
controlled clinical trial. Am J
Psychiatry 2005; 162:1281–1290
46. Zarate CA Jr, Tohen M: Double-blind comparison of the
continued use of antipsychotic
treatment versus its discontinuation in remitted manic patients.
Am J Psychiatry 2004; 161:169–
171
47. Tohen M, Chengappa KN, Suppes T, Baker RW, Zarate CA,
Bowden CL, Sachs GS, Kupfer
DJ, Ghaemi SN, Feldman PD, Risser RC, Evans AR, Calabrese
JR: Relapse prevention in
bipolar I disorder: 18-month comparison of olanzapine plus
mood stabiliser vs mood
stabiliser alone. Br J Psychiatry 2004; 184:337–345
48. Miklowitz DJ, George EL, Richards JA, Simoneau TL,
Suddath RL: A randomized study
of family-focused psychoeducation and pharmacotherapy in the
outpatient management
of bipolar disorder. Arch Gen Psychiatry 2003; 60:904–912
49. Lam DH, Watkins ER, Hayward P, Bright J, Wright K, Kerr
N, Parr-Davis G, Sham P:
A randomized controlled study of cognitive therapy for relapse
prevention for bipolar
affective disorder: outcome of the first year. Arch Gen
Psychiatry 2003; 60:145–152
27. 50. Colom F, Vieta E, Reinares M, Martinez-Aran A, Torrent C,
Goikolea JM, Gasto C:
Psychoeducation efficacy in bipolar disorders: beyond
compliance enhancement. J Clin
Psychiatry 2003; 64:1101–1105
51. Colom F, Vieta E, Martinez-Aran A, Reinares M, Goikolea
JM, Benabarre A, Torrent C,
Comes M, Corbella B, Parramon G, Corominas J: A randomized
trial on the efficacy of
group psychoeducation in the prophylaxis of recurrences in
bipolar patients whose disease
is in remission. Arch Gen Psychiatry 2003; 60:402–407
52. Frank E, Kupfer DJ, Thase ME, Mallinger AG, Swartz HA,
Fagiolini AM, Grochocinski
V, Houck P, Scott J, Thompson W, Monk T: Two-year outcomes
for interpersonal and
social rhythm therapy in individuals with bipolar I disorder.
Arch Gen Psychiatry 2005;
62:996–1004
APA format with intext citation
3 scholarly references with in the last 5 years
Plagiarism free with Turnitin report
6 pages
Week 5 - Assessing and Treating Patients with Bipolar Disorder
Bipolar disorder is a unique disorder that causes shifts in mood
and energy, which results in depression and mania for patients.
Proper diagnosis of this disorder is often a challenge for two
reasons: 1) patients often present as depressive or manic but
may have both; and 2) many symptoms of bipolar disorder are
similar to other disorders. Misdiagnosis is common, making it
28. essential for you to have a deep understanding of the disorder’s
pathophysiology.
Assignment
For this assignment, you will write a 5–6-page paper on the
topic of bipolar and bipolar and related disorders. You will
create this guide as an assignment; therefore, a title page,
introduction, conclusion, and reference page are required. You
must include a minimum of 3 scholarly supporting resources
outside of your course provided resources.
In your paper, you will choose one of the following diagnoses:
Bipolar I, Bipolar II, Cyclothymic Disorder,
Substance/Medication-Induced Bipolar and Related Disorder,
Bipolar and Related Disorder Due to Another Medical
Condition. Your paper will include discussion for your chosen
diagnosis of bipolar and related disorder on the following:
·
Prevalence and Neurobiology of your chosen disorder
·
Discuss the differences between your chosen disorder
and one other bipolar and related disorders in relation to the
diagnostic criteria including presentation of symptoms
according to DSM 5 TR criteria
·
Discuss special populations and considerations
(children, adolescents, pregnancy/post-partum, older adult,
emergency care) for your chosen bipolar and related disorder;
demonstrating critical thinking beyond basics of HIPPA and
informed consent with discussion of at least one for EACH
category: legal considerations, ethical considerations, cultural
considerations, social determinants of health
·
Discuss FDA and/or clinical practice guidelines
approved pharmacological treatment options in relation to acute
and mixed episodes vs maintenance pharmacological treatment
for your chosen bipolar and related disorder
·
29. Of the medication treatment options for your chosen
disorder discuss side effects, FDA approvals and warnings.
What is important to monitor in terms of labs, comorbid medical
issues with why important for monitoring
·
Provide 3 examples of how to write a proper
prescription that you would provide to the patient or transmit to
the pharmacy. please be detailed in your description of the
medications, including uses, potential adverse effects,
monitoring and potential drug interactions.
Assignment: Conceptual Learning Summary
GOAL: Create a concise expose of two strategic planning
concepts that may be utilized in your own organization.
Instructions: Do some research and write a 500-600-word
summary (body content length) that discusses two different
strategic planning concepts. Locate a minimum of two scholarly
journal articles for each concept—a minimum of four articles
for the paper altogether (these articles must be new to this
assignment for this course). You want to select research that
presents each concept and its usefulness in strategic planning
within organizations. If you elect to write the paper, then keep
your writing in third person if you discuss how these concepts
work in your sector.