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The idea is that the various operational definitions are “converging” on the same construct buy cheap zanaflex 2 mg on line muscle relaxant 551. When scores based on several different operational definitions are closely related to discount zanaflex 4 mg mastercard muscle relaxant non-prescription each other and produce similar patterns of results discount 2mg zanaflex with amex spasms constipation, this constitutes good evidence that the construct is being measured effectively and that it is useful generic zanaflex 4mg on-line muscle relaxant intravenous. The various measures of stress, for example, are all correlated with each other and have all been shown to be correlated with other variables such as immune system functioning (also measured in a variety of ways) 5 (Segerstrom & Miller, 2004). This is what allows researchers eventually to draw useful general conclusions, such as “stress is negatively correlated with immune system functioning,” as opposed to more specific and less useful ones, such as “people’s scores on the Perceived Stress Scale are negatively correlated with their white blood counts. Stevens suggested that scores can be assigned to individuals so that they communicate more or less quantitative information about the variable of interest (Stevens, 1946). In either case, they would be measuring the runners’ times by systematically assigning scores to represent those times. But while the rank ordering procedure communicates the fact that the second-place runner took longer to fnish than the frst-place fnisher, the stopwatch procedure also communicates how much longer the second-place fnisher took. Stevens actually suggested four diferent levels of measurement (which he called “scales of measurement”) that correspond to four diferent levels of quantitative information that can be communicated by a set of scores. The nominal level of measurement is used for categorical variables and involves assigning scores that are category labels. Category labels communicate whether any two individuals are the same or diferent in terms of the variable being measured. For example, if you look at your research participants as they enter the room, decide whether each one is male or female, and type this information into a spreadsheet, you are engaged in nominal-level measurement. Or if you ask your participants to indicate which of several ethnicities they identify themselves with, you are again engaged in nominal-level measurement. Chapter 5 91 the remaining three levels of measurement are used for quantitative variables. The ordinal level of measurement involves assigning scores so that they represent the rank order of the individuals. Ranks communicate not only whether any two individuals are the same or diferent in terms of the variable being measured but also whether one individual is higher or lower on that variable. The interval level of measurement involves assigning scores so that they represent the precise magnitude of the diference between individuals, but a score of zero does not actually represent the complete absence of the characteristic. A classic example is the measurement of heat using the Celsius or Fahrenheit scale. The diference between temperatures of 20°C and 25°C is precisely 5°, but a temperature of 0°C does not mean that there is a complete absence of heat. Finally, the ratio level of measurement involves assigning scores in such a way that there is a true zero point that represents the complete absence of the quantity. So are counts of discrete objects or events such as the number of siblings one has or the number of questions a student answers correctly on an exam. Although people do not normally think of categorizing or ranking individuals as measurement, in fact they are as long as they are done so that they represent some characteristic of the individuals. Second, the levels of measurement can serve as a rough guide to the statistical procedures that can be used with the data and the conclusions that can be drawn from them. With nominal-level measurement, for example, the only available measure of central tendency is the mode. Also, ratio-level measurement is the only level that allows meaningful statements about ratios of scores. Psychological measurement can be achieved in a wide variety of ways, including self-report, behavioral, and physiological measures. An important goal of scientific research is to conceptually define psychological constructs in ways that accurately describe them. The use of multiple operational definitions, or converging operations, is a common strategy in psychological research. The level of measurement affects the kinds of statistics you can use and conclusions you can draw from your data. Practice: Complete the Rosenberg Self-Esteem Scale and compute your overall score. Practice: Think of three operational definitions for sexual jealousy, decisiveness, and social anxiety. Practice: For each of the following variables, decide which level of measurement is being used. A college instructor measures the time it takes his students to finish an exam by looking through the stack of exams at the end. He assigns the one on the bottom a score of 1, the one on top of that a 2, and so on. A researcher accesses her participants’ medical records and counts the number of times they have seen a doctor in the past year. Participants in a research study are asked whether they are right-handed or left-handed. Describe the kinds of evidence that would be relevant to assessing the reliability and validity of a particular measure. Again, measurement involves assigning scores to individuals so that they represent some characteristic of the individuals. But how do researchers know that the scores actually represent the characteristic, especially when it is a construct like intelligence, self-esteem, depression, or working memory capacity? The answer is that they conduct research using the measure to confrm that the scores make sense based on their understanding of the construct being measured. Your clothes seem to be ftting more loosely, and several friends have asked if you have lost weight. If at this point your bathroom scale indicated that you had lost 10 pounds, this would make sense and you would continue to use the scale. But if it indicated that you had gained 10 pounds, you would rightly conclude that it was broken and either fx it or get rid of it.

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He was part of a group imbued with the hacker spirit cheap zanaflex 4mg on line muscle relaxant 8667, ready to purchase 2mg zanaflex amex zanaflex muscle relaxant do something with computers purchase zanaflex 4 mg fast delivery muscle relaxant vs pain killer, all charged up with the idea that access to order 2mg zanaflex visa spasms below middle rib cage terminals was going to link people together with unheard-of efficiency, and ultimately change the world. Community Memory was not the only ongoing attempt to bring computers to the people. All over the Bay Area, the engineers and programmers who loved computers and had become politicized during the anti-war movement were thinking of combining their two activities. One place in particular seemed to combine an easygoing counterculture irreverence with an evangelical drive to expose people, especially kids, to computers. The organization, a misnomer if one ever existed, did publish a periodical by that name, but the only thing actually manufactured was an intense feeling for computing for its own sake. He was a man, Lee Felsenstein would later say, to whom "bringing a kid up to a computer was like child molesting. In the spring of 1962, Bob Albrecht had walked into a classroom and had an experience which was to change his life. Albrecht, a large man with a clip-on tie, a beefy nose, and sea-blue eyes which could gleam with creative force or sag basset-like behind his square-rimmed lenses, gave his little talk on computers and casually asked if any of the thirty-two students might want to learn how to program a computer. Through a succession of jobs, he had been constantly frustrated with bureaucracies. Bob Albrecht preferred a flexible environment; he was a student of serendipity in life-style and outlook. His hair was short, his shirt button-down, and his family profile wife, three kids, dog was unexceptional. Underneath it all, though, Bob Albrecht was a Greek dancer, eager to break out the ouzo and the bouzouki. And he was startled to find how eager the high school students were to indulge in the latter pleasure, the most seductive of the three. He began to envision a world where computers would lead the way to a new, liberating life-style. Albrecht hired four of his top students to do programming for around a buck an hour. They would sit there at desks, happily typing in programs to solve quadratic functions. The machine would accept their cards and crunch away while they watched blissfully. Twenty math classes were involved in the program, for which Albrecht had convinced his employers to part with the 160A and a Flexowriter for a week. Sixty students were motivated by the medicine show to sign up for computer classes; and when Albrecht took the medicine show to other high schools, the response was just as enthusiastic. And it had a built-in random number generator, so kids could use it to write games quickly. Albrecht knew even then that games would provide the seductive scent that would lure kids to programming and hackerism. As he became more involved in the missionary aspects of his work, the Bob Albrecht simmering under the button-down exterior finally surfaced. As the sixties hit full swing, Albrecht swung into California divorced, with long hair, blazing eyes, and a head full of radical ideas about exposing kids to computers. On Tuesday nights he opened his apartment up for sessions that combined wine tasting, Greek dancing, and computer programming. Albrecht was involved in starting the loosely run "computer education division" of the nonprofit foundation called the Portola Institute, which later spawned the Whole Earth Catalog. To house this marvelous machine, they moved the company to a new headquarters in Memo Park. More equipment came, and in 1971 Dymax became a popular hangout for young computerists, budding hackers, would-be gurus of computer education, and techno-social malcontents. Bob, meanwhile, had moved to a forty-foot ketch docked off Beach Harbor, about thirty miles south of the City. Albrecht was often criticized by the hip, technology-is-evil Palo Alto crowd for pushing computers. So his method of indoctrinating people into the computer world became subtle, a sly dope-dealer approach: "Just take a hit of this game. Unintentionally, we were taking the long-term view, encouraging anyone who wanted to to use computers, writing books that people could leam to program from, setting up places where people could play with computers and have fun. The place was full of long-haired, populist computer freaks, many of them of high school age. Bob Albrecht acted the role of bearded guru, spewing ideas and concepts faster than anyone could possibly carry them out. Some of his ideas were brilliant, others garbage, but all of them were infused with the charisma of his personality, which was often charming but could also be overbearing. Albrecht would take the crew on excursions to local piano bars where he would wind up with the microphone in hand, leading the group in songfests. Albrecht thought that some sort of publication should chronicle this movement, be a lightning rod for new developments. There could be four or five different type fonts on a page, and often messages were scribbled directly onto the boards, too urgent to wait for the typesetter. Readers got the impression that there was hardly any time to waste in the mission of spreading computing to the people and certainly no time to waste doing random tasks like straightening margins or laying out stories neatly or planning too far ahead-Each issue was loaded with news of people infused with the computer religion, some of them starting similar operations in different parts of the country. There was little response from the ivory towers of academia or the blue-sky institutions of research. But the new breed of hardware hackers, the Lee Felsenstein types who were trying to figure out ways for more computer access for themselves and perhaps others, discovered the tabloid and would write in, offering program listings, suggestions on buying computer parts, or just plain encouragement. Most of the furniture, save for some chairs in front of the gray teletype-style terminals, consisted of large pillows which people variously used as seat cushions, beds, or playful weapons. A faded green rug covered the area, and against a wall was a battered bookshelf loaded with one of the best, and most active, paperback science-fiction collections in the area.

At delivery order 4mg zanaflex visa spasms during mri, the rapid fluid shifts in the mother will markedly increase lithium levels unless care is taken to purchase zanaflex 4mg without a prescription muscle relaxant indications either lower the lithium dose quality zanaflex 4 mg muscle relaxant jaw, ensure hydration generic 2mg zanaflex spasms 1st trimester, or both (112). Discontinuing lithium on the day of delivery is probably not necessary and may be un wise given the high risk for postpartum mood episodes and the greater risk of recurrence if lith ium is discontinued in women with bipolar disorder (94, 112). For women with bipolar disorder, the rate of postpartum relapse is as high as 50% (86, 94). Women who have had severe postpartum affective episodes in the past are at highest risk to have another episode of illness after subsequent pregnancies. Despite a paucity of studies, it is generally considered that prophylactic medications such as lithium or valproate may prevent postpartum mood episodes in women with bipolar disorder (113). Also, since changes in sleep are common in the postpartum period, women should be educated about the need to maintain normal sleep patterns to avoid precipitating episodes of mania. However, as with the risks of medications during pregnancy, risks of breast-feeding with psychotropic med ications must be weighed against the benefits of breast-feeding (115, 116). Because lithium is secreted in breast milk at 40% of maternal serum concentration, most experts have recommend ed against its use in mothers who choose to breast-feed (105). Fewer data on breast-feeding are Treatment of Patients With Bipolar Disorder 23 Copyright 2010, American Psychiatric Association. Although it is generally considered safe, potential risks should always be considered. Little is known about lamotrigine exposure in breast-fed neonates; however, levels in the infant may reach 25% of maternal serum levels (117). Conse quently, the potential for pharmacological effects, including a risk for life-threatening rash, should be taken into consideration (118). With other psychotropic medications (including anti psychotics, antidepressants, and benzodiazepines), there are few reports of specific adverse effects in breast-feeding infants. Nonetheless, these drugs are found in measurable quantities in breast milk and could conceivably affect central nervous system functioning in the infant (118). Cross-cultural issues Culture can influence the experience and communication of symptoms of depression and ma nia. Underdiagnosis or misdiagnosis, as well as delayed detection of early signs of recurrence, can be reduced by being alert to specific ethnic and cultural differences in reporting complaints of a major mood episode. Specifically, minority patients (particularly African and Hispanic Americans) with bipolar disorder are at greater risk for being misdiagnosed with schizophrenia (119, 120). This greater risk appears to result from clinicians failing to elicit affective symptoms in minority patients with affective psychoses (121). Ethnicity and race must also be taken into consideration when prescribing medications, since ethnic and racial groups may differ in their metabolism of some medications (122, 123). For example, relative to Caucasian patients, Chinese patients have a lower average activity of the cytochrome P-450 isoenzyme 2D6 (123). As a result, they typically require lower doses of antidepressants and antipsychotics that are metabolized by this enzyme (122). Similar deficits in average activity of the cytochrome P-450 isoenzyme 2C19 have been found in Chinese, Jap anese, and Korean patients compared with Caucasians (123). Children and adolescents the prevalence of bipolar disorder in a community sample of children and adolescents was 1%; an additional 5. Children with bipolar disorder often have mixed mania, rapid cycling, and psychosis (125). Child and adolescent bipolar disorder is often comorbid with attention deficit and conduct disorders (126–128). For children and adolescents in a current manic episode, 1 year recovery rates of 37. In a 5-year prospective follow-up of adolescents experiencing bipolar disorder, relapse rates of 44% were found (130). Despite the severity and chronicity of this disorder in children and adolescents and its devastating impact on social, emotional, and academic development, treatment research has lagged far behind that of adult bipolar disorder. Although there is more information available about the use of lithium and divalproex in children and adolescents with bipolar disorder, other medication treatment options include atypical antipsychotics, carbamazepine, and combinations of these medications. Treatment with a maintenance agent should continue for a minimum of 18 months after sta bilization of a manic episode. In addition, lithium discontinuation has been shown to increase relapse rates in adolescents with bipolar disorder: relapse occurred within 18 months in 92% of those who discontinued lith ium versus 37% of those who continued lithium (132). Consequently, medication discontinua tion should be done gradually at a time when there are no major anticipated stressors. Psychiatric comorbidity may complicate the diagnosis and treatment of bipolar disorder in children and adolescents. Youths with bipolar disorder are at greater risk for substance use disorders (133, 134). Co morbid substance use has been shown to complicate the course of bipolar disorder and its treat ment (135). Short-term treatment with lithium (136) and divalproex (137) may be useful in these conditions. However, in a 2-year follow-up of hospitalized manic adolescents, the bipolar disorder patients who continued to abuse substances had more manic episodes and poorer functioning than early-onset bipolar disorder patients who did not exhibit comorbid substance abuse. In contrast, cessation of substance use was associated with fewer episodes and greater functional improvement at the 4-year follow-up point (135). Geriatric patients In patients over 65 years of age, prevalence rates of bipolar disorder range from 0. In addition, 5%–12% of geriatric psychiatry admissions are for bipolar disorder (138).

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Joe says that with people he knows order zanaflex 4 mg overnight delivery muscle relaxant and nsaid, he is able to buy zanaflex 2mg free shipping muscle spasms zyprexa be honest without worrying what they may think of him zanaflex 2 mg otc muscle spasms 8 weeks pregnant. This kind of acceptance helps to discount 2mg zanaflex with mastercard spasmus nutans relieve his anxiety and other symptoms related to his disorder. Acceptance from others makes it easier for him to accept himself and the illness he manages. Then one of her friends introduced her to painting, which has now become a huge part of who she is. She considers this interaction to have altered her reality, bringing fresh energy and ideas into her daily life. Janet tells me that human interaction is so important to all of us, especially those of us with mental illness, because our number one way to cope when things are tough is to retreat. Her experience with friends has helped her change this, and she says that she no longer feels as alone as she had felt in the past. Specifically, he enjoys getting to spend time with friends, staying up late talking and making jokes. Scott expressed that one of the best things about it was not just the fun he had at the time but that it improved his mood for several days afterwards. He followed up this statement by saying that it made him feel like he is more than his illness and that he belongs somewhere. This was the case for Christine, one of my friends with bipolar It is empowering to disorder. In the last year she made friends with some people by joining a hiking group so that she would have support outside of have something fun to do on the weekends. She was the structure of a support recently admitted to the hospital due to an increase group. Having a friend that in the severity of her symptoms and a concern about is supportive can help you her safety. When Christine’s new friends found out in your recovery process about her being in the hospital, many of them came and can boost your to visit. She self esteem said it helped her tremendously to talk about what was going on for her and know that she was understood. Christine went on to say that she had experienced this once before on a previous hospital stay when a group of her friends got together and signed a get-well card. She said it made a big difference because it felt really supportive and ended up improving her mood. Having a friend that is supportive can help you in your recovery process and can boost your self-esteem. In my personal experience, as well as my experience leading a social activity program for young adults with mental illness, the need is clear, and the benefits of socialization are endless. Read on to find ways to come to terms with the challenges that can keep you isolated. Challenges In Socialization For People With Bipolar Disorder Despite how simple it may seem to some, finding a way to create meaningful connections can be difficult for those with bipolar disorder. This is particularly true in the beginning stages of restoring a sense of balance in your life. You may be managing difficult symptoms or stress, your lifestyle may not bring you into contact with others you can relate to, and there is a stigma associated with this illness. Further, low self esteem can take so much of your attention that trying to add anything else in your life seems impossible. I will outline these challenges in the following section not to discourage you, but in hopes of acknowledging what you may be going through. Depression For me, like many other people, depression involves feelings of insecurity and uncertainty about the future. These feelings can be extremely overwhelming, and it is easy to get caught in the revolving door of negative thoughts. The longer I listen to the negative thoughts, the harder it is to get out of the trap they put me in. Added to this, one of depression’s “closest friends” is isolation, and unfortunately this, along with the negative thoughts, make it even more difficult to get out of the house and socialize. Other symptoms of depression include: lack of energy and motivation, dietary issues, and cognitive impairments like poor concentration or inability to think clearly. If any of this has stopped you in the past, a few of the ideas listed in the How-to section at the end of the chapter may be helpful. You can also try setting small goals for yourself so that you won’t feel intimidated or overwhelmed. For example, if you want to go to a support group, tell yourself that you don’t have to stay the entire time. The important thing to remember is to make it as comfortable as you can for yourself as you work to try something new. Mania the affects of mania on relationships can appear different depending on whom you talk to – the person with bipolar disorder or the person without it. Manic behaviors are easily misunderstood, often leaving people wondering if they can trust your behavior, and your relationships can become strained or even dissolve. Additional symptoms that can make socializing difficult are restlessness, irritability, paranoia, incoherent speech, and grandiose thoughts. My experience with these symptoms is that it is best to get them under control by working with your treatment provider before taking on anything more. Once things have settled down, you can try other ideas listed in the How-to section.

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