Dr Phil Dellinger

• Critical Care Division
• Cooper University Hospital
• Robert Wood Johnson Medical School
• 393 Dorrance
• Camden USA

For patients with a his to ry of non-type I allergic reaction to penicillin medicine information buy generic trazodone 100mg on line, agents such as cefdinir medicine lodge treaty generic trazodone 100mg online, cefuroxime medications zoloft buy discount trazodone 100mg, or cefpodoxime can be used orally treatment questionnaire discount trazodone american express. Myringo to my or tympanocentesis should be considered for children failing to respond to second-line therapy and for severe cases to obtain cultures to guide therapy. For multi drug-resistant strains of S pneumoniae, use of clindamycin, rifampin, or other agents should be considered in consultation with an expert in infectious diseases. Infants of very low birth weight (1500 g or less) should be immunized when they attain a chronologic age of 6 to 8 weeks, regardless of their gesta tional age at birth. For fully immu nized children 14 through 71 months of age who have an underlying medical condition (Table 3. Control of Transmission of Pneumococcal Infection and Invasive Disease Among Children Attending Out-of-Home Child Care. Available data are insuffcient to recommend any antimicrobial regimen for preventing or interrupting the carriage or transmission of pneumococcal infection in out-of-home child care settings. Antimicrobial chemoprophy laxis is not recommended for contacts of children with invasive pneumococcal disease, regardless of their immunization status. Pneumo coccal vaccine should be injected with a separate syringe in a sepa rate injection site. Immunization also should precede initiation of immune-compromising therapy or placement of a cochlear implant by at least 2 weeks. However, inactivated or killed vaccines, including licensed polysac charide vaccines, have been administered safely during pregnancy. Cases of invasive pneumococcal disease in children younger than 5 years of age and drug-resistant infection in all ages should be reported according to state standards. Therefore, the overwhelming majority of invasive pneumococcal disease cases occurring among unimmunized children have not represented vaccine failures. Adverse reactions after administration of polysaccharide or conjugate vaccines generally are mild and limited to local reactions of redness or swelling. Fever may occur within the frst 1 to 2 days after injections, particu larly after use of conjugate vaccine. Daily antimicrobial prophylaxis is recommended for children with functional or ana to mic asplenia, regardless of their immunization status, for preven tion of pneumococcal disease on the basis of results of a large, multicenter study (see Children With Asplenia, p 88). Oral penicillin V (125 mg, twice a day, for children younger than 5 years of age; 250 mg, twice a day, for children 5 years of age and older) is recom mended. Parents should be informed that penicillin prophy laxis may not be effective in preventing all cases of invasive pneumococcal infections. In children with suspected or proven penicillin allergy, erythromycin is an alternative agent for prophylaxis. Most children with sickle cell disease who have received all recommended pneumococcal vaccines for age and who had received penicillin prophylaxis for prolonged periods, who are receiving regular medical attention, and who have not had a previous severe pneumococcal infec tion or a surgical splenec to my safely may discontinue prophylactic penicillin at 5 years of age. The duration of prophylaxis for children with asplenia attributable to other causes is unknown. However, the intensity of these signs and symp to ms can vary, and in some immunocompromised children and adults, onset can be acute and fulmi nant. Chest radiographs often show bilateral diffuse interstitial or alveolar disease; rarely, lobar, miliary, cavitary, and nodular lesions or even no lesions are seen. Most children with Pneumocystis pneumonia are hypoxic with low arterial oxygen pressure. The mortal ity rate in immunocompromised patients ranges from 5% to 40% in patients treated and approaches 100% without therapy. Because of this, human Pneumocystis now is called Pneumocystis jirovecii, refecting the fact that Pneumocystis carinii only infects rats. P carinii or P carinii f sp hominis sometimes still are used to refer to human Pneumocystis. P jirovecii is an atypical fungus, with several morphologic and biologic similarities to pro to zoa, including susceptibility to a number of anti pro to zoal agents but resistance to most antifungal agents. In addition, the organism exists as 2 distinct morphologic forms: the 5 to 7-fim-diameter cysts, which contain up to 8 intracystic bodies, and the smaller, 1 to 5-fim-diameter trophozoite or trophic form. Pneumocystis isolates recovered from mice, rats, and ferrets differ genetically from each other and from human P jirovecii. Infections are species-specifc, and cross-species infections are not known to occur. Asymp to matic human infection occurs early in life, with more than 85% of healthy children acquiring antibody by 20 months of age. Animal studies have demonstrated animal- to -animal transmission by the air borne route; evidence suggests airborne transmission among humans. The most sensitive and specifc diag nostic procedures involve specimen collection from open lung biopsy and, in older children, transbronchial biopsy. Methenamine silver, to luidine blue O, calcofuor white, and fuorescein-conjugated monoclonal antibody are the most useful stains for identifying the thick-walled cysts of P jirovecii. Extracystic trophozoite forms are identifed with Giemsa stain, modifed Wright-Giemsa stain, and fuorescein-conjugated monoclonal antibody stain. The sensitivity of all microscopy-based methods depends on the skill of the labora to ry technician. Polymerase chain reaction assays for detecting P jirovecii infection have been shown to be sensitive even with noninvasive iso lates, such as oral wash or expec to rated sputum, but are not yet available commercially. Oral therapy should be reserved for patients with mild disease who do not have malabsorption or diarrhea or for patients with a favorable clinical response to initial intravenous therapy. Pentamidine is associated with a high incidence of adverse reactions, including pancreatitis, diabetes mellitus, renal to xicity, electrolyte abnormalities, hypoglycemia, hyperglycemia, hypotension, cardiac arrhythmias, fever, and neutropenia. If a recipient of didanosine requires pentamidine, didanosine should not be administered until 1 week after pentamidine therapy has been completed because of overlapping to xicities. Other poten tially useful drugs in adults include clindamycin with primaquine (adverse reactions are rash, nausea, and diarrhea), dapsone with trimethoprim (associated with neutropenia, anemia, thrombocy to penia, methemoglobinemia, rash, and transaminase elevation), and trimetrexate with leucovorin. For adolescents older than 13 years of age and adults, the recommended dose of oral pred nisone is 80 mg/day in 2 divided doses for the frst 5 days of therapy; 40 mg, once daily, on days 6 through 10; and 20 mg, once daily, on days 11 through 21. On the basis of limited available data, a recommended regimen of oral prednisone for children younger than 13 years of age is 1 mg/kg/dose, twice daily for the frst 5 days of therapy; 0. It should be continued for more than 6 months in all children receiving ongoing or intensifed immunosuppressive therapy (eg, prednisone or cyclosporin) or in children with chronic graft-versus-host disease. Dapsone is effective and inexpensive but associated with more serious adverse effects than a to vaquone. Intravenous pentamidine has been used but is more to xic than other regimens and is not recommended for prophylaxis. Other drugs with potential for prophylaxis include pyrimethamine plus dapsone plus leucovorin or pyrimethamine-sulfadoxine. Experience with these drugs in adults and children for this indication is limited. These agents should be considered only in situations in which rec ommended regimens are not to lerated or cannot be used for other reasons. Guidelines for preventing opportunistic infections among hema to poietic stem cell transplant recipients. Nonspecifc illness with low-grade fever and sore throat (minor illness) occurs in 24% of people who become infected. Aseptic meningitis, some times with paresthesias, occurs in 1% to 5% of patients a few days after the minor illness has resolved. Rapid onset of asymmetric acute faccid paralysis with arefexia of the involved limb occurs in fewer than 1% of infections, and residual paralytic disease involv ing the mo to r neurons (paralytic poliomyelitis) occurs in approximately two thirds of people with acute mo to r neuron disease. Cranial nerve involvement (bulbar poliomyelitis, often showing a tripod sign) and paralysis of respira to ry tract muscles can occur. Adults who contracted paralytic poliomyelitis during childhood may develop the non infectious postpolio syndrome 15 to 40 years later. Postpolio syndrome is characterized by slow and irreversible exacerbation of weakness most likely occurring in those muscle groups involved during the original infection. Studies estimate the range of postpolio syndrome in poliomyelitis survivors is from 25% to 40%.

Radiofrequency exposure in young and old: different sensitivities in light of age-relevant natural differences medicine ball exercises purchase trazodone 100 mg free shipping. Review of extensive workups of 34 patients overexposed to radiofrequency radiation treatment cervical cancer generic trazodone 100mg overnight delivery. Cognitive performance measures in bioelectromagnetic research-critical evaluation and recommendations medicine 8 discogs generic trazodone 100mg without a prescription. Risk of childhood acute lymphoblastic leukaemia following parental occupational exposure to extremely low frequency electromagnetic fields symptoms exhaustion cheap trazodone 100mg mastercard. Neuroelectric mechanisms applied to low frequency electric and magnetic field exposure guidelines-part I: sinusoidal waveforms. Safety considerations concerning the minimum threshold for magnetic excitation of the heart. Apop to sis in haemopoietic progeni to r cells exposed to extremely low-frequency magnetic fields. High-voltage overhead power lines in epidemiology: patterns of time variations in current load and magnetic fields. Effects of atmospheric and extra-terrestrial electromagnetic and corpuscular radiations on living organisms. A review of neuroendocrine and neurochemical changes associated with static and extremely low frequency electromagnetic field exposure. Integrative physiological and behavioral science; the official journal of the Pavlovian Society. Mela to nin suppression by static and extremely low frequency electromagnetic fields: relationship to the reported increased incidence of cancer. Reported biological consequences related to the suppression of mela to nin by electric and magnetic field exposure. Cognitive functioning after repetitive transcranial magnetic stimulation in patients with cerebrovascular disease without dementia: a pilot study of seven patients. Effect of 50-Hz electromagnetic field on the retention of to xic radionuclides in rat tissues. Repacholi M, Buschmann J, Pioli C, Sypniewska R, International Oversight Committee members for the Franco-Russian P. Scientific basis for the Soviet and Russian radiofrequency standards for the general public. Interaction of static and extremely low frequency electric and magnetic fields with living systems: health effects and research needs. Cancer from exposure to 50/60 Hz electric and magnetic fields-a major scientific debate. Low-level exposure to radiofrequency electromagnetic fields: health effects and research needs. A case-control pilot study of traffic exposures and early childhood leukemia using a geographic information system. Pathological effects of exposure to magnetic fields: morphological aspects of injury at the testicular level. Richardson S, Zit to un R, Bastuji-Garin S, Lasserre V, Guihenneuc C, Cadiou M, et al. Cancer in radar technicians exposed to radiofrequency/microwave radiation: sentinel episodes. Numerical calculations of switched magnetic field gradients during magnetic resonance imaging. Induction ovens and electromagnetic interference: what is the risk for patients with implanted pacemakersfi Structural evaluation of porcine heart valve prostheses with radiofrequency ultrasound. Cardiovascular pathology; the official journal of the Society for Cardiovascular Pathology. Cerebrovascular accident after percutaneous rf thermocoagulation of the trigeminal ganglion. Percutaneous Selective Neuromodulation via Monopolar Radiofrequency for Glabellar Lines: A Case Study. Case-control study on maternal residential proximity to high voltage power lines and congenital anomalies in France. Birth defects and high voltage power lines: an explora to ry study based on registry data. The biological effects of radiofrequency radiation: a critical review and recommendations. Evaluation of potential health effects of 10 kHz magnetic fields: a short-term mouse to xicology study. Low frequency pulsed electromagnetic field exposure can alter neuroprocessing in humans. Electromagnetic re-warming of cryopreserved tissues: effect of choice of cryoprotectant and sample shape on uniformity of heating. The effect of electromagnetic fields on living organisms: plants, birds and animals. Responses of the estrous cycle in dairy cows exposed to electric and magnetic fields (60 Hz) during 8-h pho to periods. Usefulness of High-Frequency Ultrasound in the Diagnosis of Piezogenic Pedal Papules. High incidence of acute leukemia in the proximity of some industrial facilities in El Bierzo, northwestern Spain. A 60 Hz electric and magnetic field exposure facility for nonhuman primates: design and operational data during experiments. Chronically indwelling venous cannula and au to matic blood sampling system for use with nonhuman primates exposed to 60 Hz electric and magnetic fields. Initial exposure to 30 kV/m or 60 kV/m 60 Hz electric fields produces temporary cessation of operant behavior of nonhuman primates. Regularly scheduled, day-time, slow-onset 60 Hz electric and magnetic field exposure does not depress serum mela to nin concentration in nonhuman primates. Rapid-onset/offset, variably scheduled 60 Hz electric and magnetic field exposure reduces nocturnal serum mela to nin concentration in nonhuman primates. Intensity of extremely low-frequency electromagnetic fields produced in operating rooms during surgery at the standing position of anesthesiologists. Mo to r evoked potentials during embolization of arteriovenous malformations for the detection of ischemic complications. The interaction between electromagnetic fields at megahertz, gigahertz and terahertz frequencies with cells, tissues and organisms: risks and potential. Strategies in approaches to requirements in the control of electromagnetic irradiation levels. Colorectal disease; the official journal of the Association of Coloproc to logy of Great Britain and Ireland. Mortality and cancer morbidity in workers from an aluminium smelter with prebaked carbon anodes-Part I: Exposure assessment. Cardiovascular mortality and exposure to extremely low frequency magnetic fields: a cohort study of Swiss railway workers. Conduct of a personal radiofrequency electromagnetic field measurement study: proposed study pro to col. Systematic review on the health effects of exposure to radiofrequency electromagnetic fields from mobile phone base stations. Wireless communication fields and non-specific symp to ms of ill health: a literature review. Commentary: magnetic field exposure and childhood leukaemia-moving the research agenda forward. Leukaemia, brain tumours and exposure to extremely low frequency magnetic fields: cohort study of Swiss railway employees. Mortality from neurodegenerative disease and exposure to extremely low frequency magnetic fields: 31 years of observations on Swiss railway employees. Symp to ms of ill health ascribed to electromagnetic field exposure-a questionnaire survey. Radio and microwave frequency radiation and health-an analysis of the literature. Radiofrequency electromagnetic field exposure and non-specific symp to ms of ill health: a systematic review. Annales de readaptation et de medecine physique; revue scientifique de la Societe francaise de reeducation fonctionnelle de readaptation et de medecine physique.

100 mg trazodone fast delivery. Atrial fibrillation: improving symptoms.

High doses of cocaine can cocaine misuse appears to be recently a growing often lead to seizures medicine to help you sleep purchase cheap trazodone, respira to ry depression in treatment 1 purchase trazodone 100mg fast delivery, cardiac problem in the metros of India medicine 4h2 pill discount 100 mg trazodone amex. Acute cocaine in to xication is characterised by pupil Treatment lary dilatation treatment 7th march generic trazodone 100mg without prescription, tachycardia, hypertension, sweating, and nausea or vomiting. A hypomanic picture with Before starting treatment, it is essential to diagnose increased psychomo to r activity, grandiosity, ela (or rule out) co-existent psychiatric and/or physical tion of mood, hypervigilance and increased speech disorder, and assess the motivation for treatment. Haloperidol (or pimoz depression, and even to heighten energy and capac ide) can be used for the treatment of psychosis, as ity to work. These must be administered very carefully is basically phenyl-iso-propylamine or methyl by an expert specialist. The Treatment of Chronic Cocaine Use dextro-amphetamine isomer is nearly 3-4 times more the management of underlying (or co-existent) psy potent than the levo-isomer. It acts primarily on nore chopathology is probably the most important step in pinephrine release in brain, along with an action on the management of chronic cocaine use. The pharmacological treatment includes the Although still clinically indicated for narcolepsy use of bromocriptine (a dopaminergic agonist) and and attention deficit hyperactivity disorder (and very amantadine (an antiparkinsonian) in reducing cocaine rarely for obesity and mild depression), one of the craving. The goal of the treatment is central as well as cardiovascular effects of ampheta to tal abstinence from cocaine use. Acute in to xication is treated by symp to matic meas In to xication and Complications ures. The neuropsychiatric manifestations Treatment of Withdrawal Symp to ms include anxiety, panic, insomnia, restlessness, irrita bility, hostility and bruxism. The presence of severe suicidal depression may necessitate Acute in to xication may present as a paranoid hal hospitalisation. The treatment includes symp to matic lucina to ry syndrome which closely mimics paranoid management, use of antidepressants and supportive schizophrenia. The management of withdrawal syndrome rapidity of onset, prominence of visual hallucinations, is usually the first step to wards successful management absence of thought disorder, appropriateness of affect, of amphetamine dependence. Ampheta mine-induced psychosis usually resolves within seven Lysergic acid diethylamide, first synthesised by Albert days of urinary clearance of amphetamines. These perceptual changes include deperson depression (may present with suicidal ideation), alisation, derealisation, intensification of perceptions, marked asthenia, apathy, fatigue, hypersomnia alterna synaesthesias (for example, colours are heard, and ting with insomnia, agitation and hyperphagia. The commonly abused these changes are usually associated with marked barbiturates are secobarbital, pen to barbital and amo anxiety and/or depression, though euphoria is more barbital. Persecu to ry and referential as benzodiazepines have replaced barbiturates in the ideation may also occur. Tolerance (both central and the individual experiences a loss of control over his metabolic) develops rapidly and is usually marked. The recovery usually occurs within 8-12 hours of There is also a cross to lerance with alcohol. Rarely, the in to xication is severe enough In to xication and Complications to produce an acute psychotic episode resembling a schizophreniform psychosis. Drug au to matism may sometimes often induced by stress, fatigue, alcohol intake, severe lead to lethal accidents. Intravenous use can lead to skin abscesses, cel lulitis, infections, embolism and hypersensitivity Complications reactions. The with depressant or antipsychotic medication, along with drawal syndrome is at its worst about 72 hours after supportive psychotherapy. If patient is conscious induction of vomiting Psychoactive Substance Use Disorders 51 and use of activated charcoal can reduce drug absorp to heavy doses (more than 60-80 mg per day of dia tion. If coma ensues, intensive care measures should zepam), is characterised by marked anxiety, irritability, be employed on an emergency basis. However, pen to barbital substitution Depression, transient psychotic episodes, suicidal therapy has been suggested for treatment of withdrawal ideation, perceptual disturbances and rarely delirium from short-acting barbiturates. Since the discovery of chlordiazepoxide in 1957 the treatment of low dose dependence syndrome by Sternbach, benzodiazepines have replaced other (~15 mg/day of diazepam) is abrupt withdrawal and sedative-hypnotics in treatment of insomnia and symp to matic management of withdrawal symp to ms. These are currently one of the most often pre However, moderate to high dose dependence is best scribed drugs. The best treatment is probably prevention by limit Benzodiazepine (or sedative-hypnotic) use disor ing benzodiazepine use to no more than 2-4 weeks of der can be either iatrogenic or originating with illicit prescription at most. Dependence, both physical and psychologi After the de to xification phase, an adequate follow-up cal, can occur and to lerance is usually moderate. Excessive doses can lead to respira line (petrol), glues, aerosols (spray paints), thinners, to ry depression, coma and death while chronic use has varnish remover and industrial solvents. Withdrawal Syndrome In to xication and Complications A typical withdrawal syndrome, after cessation of Inhalation of a volatile solvent leads to euphoria, ex prolonged use (more than 4-6 weeks) of moderate citement, belligerence, dizziness, slurring of speech, 52 A Short Textbook of Psychiatry apathy, impaired judgement, and neurological signs depression and impairment in cognitive functions (such as decreased refiexes, ataxia, nystagmus, incoor have been reported. Death can occur due to respira to ry Treatment depression, cardiac arrhythmias, or asphyxia. There is often an associated psy There is no specific treatment for phencyclidine chiatric disorder (usually schizophrenia or personality withdrawal syndrome. Nicotine use (often in the form of smoking) is more However, its use was soon restricted to veterinary common in schizophrenia and depression. Smoking anaesthesia as some human subjects developed predisposes to increased risk of cardiovascular dis delirium while emerging from anaesthesia. Classified ease, respira to ry disease and cancer, and can affect as an atypical hallucinogen (street names: Peace pill; metabolism of several psychotropic drugs. Other features last smoke and can present with anxiety, restless may include impulsiveness, agitation, impaired social ness, poor concentration, decreased sleep, increased judgement, assaultativeness, feeling of numbness appetite and exacerbation of psychiatric symp to ms in and inability to move. These clinically significant distress or impairment in social, should only be initiated after a discussion of possible occupational or other areas of functioning, and the adverse effects with the patient. Caffeine is also or more of the following: restlessness, nervousness, present in chocolate. Schizophrenia 5 Schizophrenia has puzzled physicians, philosophers, outcome (dementia: deterioration; praecox: early and general public for centuries. To understand what schizophrenia is, it is impor Eugen Bleuler (1911), while renaming dementia tant to have a brief look at the his to ry of evolution of praecox as schizophrenia (meaning mental splitting), the concept of schizophrenia. Therefore, Although earlier descriptions of schizophrenia-like he used the term, a group of schizophrenias. He hebephrenia), the scientific study of the disorder also described accessory symp to ms of schizophrenia began with the description of dementia praecox by (thought to be secondary to fundamental symp to ms). Emil Kraepelin Kurt Schneider In 1896, Emil Kraepelin differentiated the major psychiatric illnesses in to two clinical types: Dementia Kurt Schneider (1959) described symp to ms which, praecox, and Manic depressive illness. The emphasis in diagnosis of He also described the second rank symp to ms of dementia praecox was on an early onset and a poor schizophrenia (which were considered by him as less Schizophrenia 55 Table 5. Voices heard arguing: Two or more hallucina to ry few exceptions in the prevalence rates in some isolated voices discussing the subject in third person. The onset of schizophrenia occurs experiences them as removed by an external force. Thought insertion: Experience of thoughts imposed benign course, as compared to men. The diagnosis is entirely clinical and is based ses or acts which are imposed by some external on the following clinical features, none of which are force. Somatic passivity: Bodily sensations, especially Autistic thinking is one of the most classical features sensory symp to ms, are experienced as imposed on of schizophrenia. Delusional perception: Normal perception has a things identical because they have identical predicates private and illogical meaning. If 56 A Short Textbook of Psychiatry the loosening becomes very severe, speech becomes the commonly seen delusions in schizophrenia virtually incomprehensible. Delusions of persecution (being persecuted Thought blocking is a characteristic feature of against. Delusions of reference (being referred to by others; plex partial seizures (temporal lobe epilepsy).

Asneezia: It signifies absence of sneezing or inability to sneeze medicine 94 trazodone 100mg online, was described as a hither to unrecognized psychiatric symp to m (Shukla treatment vertigo buy discount trazodone 100mg on-line, G treatment dynamics florham park discount trazodone 100 mg with amex. The common psychiatric causes may be schizophrenia medications known to cause pancreatitis buy trazodone 100mg mastercard, endogenous depression, neurotic depression, hypochondriasis etc. Asociality: An indifference to social values or cus to ms, withdrawal from society, as seen in a recluse or a regressed schizophrenic. Aspiration level: In a brilliant series of studies inspired by Lewin, Dembo and Hoppe conducted some of 32 Dictionary of Psychology & Allied Sciences the first experimental studies in human motivation. Assertivenes training: A procedure in which subjects are taught appropriate interpersonal responses involving frank, honest, and direct expression of feelings, both positive and negative. Assimilation: One of two processes by which a schema in Piagetian theory is considered to develop. New information is said to have been assimilated when it fitted in to existing schema and so can be under s to od in relation to earlier learning. Assimilation and accommodation are considered to be conti nuous cognitive processes, contributing to the generalized process of adaptation. Associative learning which has been acquired as a result of the connection of a stimulus with a response. Assortive mating: the tendency for organisms (including humans) to select as sexual partners those with characteristic similar to their own. Assumption: An idea or set of ideas which is taken for granted in the formulation of an argument or theory. Astasia-abasia: Incoordination in the erect position, and a resulting inability to stand or walk, with intact capacity for leg movements while sitting or lying down. In the absence of an organic lesion to the central nervous system, astesia-abasia is usually a manifestation of hysteria. Astasia, however can be a sign of organic cerebral pathology, especially involving the frontal lobes or corpus callosum. Asthenic personality: A disorder characterized by lack of enthusiasm, fatigability, lack of capacity for enjoyment, and low to lerance for stress. Dictionary of Psychology & Allied Sciences 33 Asyndesis: A disorder of language commonly seen in schizophrenia in which the patient combines unconnected ideas and images. Ataque or Puer to Rican syndrome: Often characterized by anxiety, hyperventilation, and pseudoepileptic movements. There may also be hallucinations, screaming, some violence to others or the self, and mutism. At other times, it is severe and extends to a few days, thereby causing difficulty in differentiating from acute schizophr enic episode or atypical psychosis. Attachment: A close, emotionally meaningful relation ship between two people in which each seeks closeness with the other and feels more secure in their presence. The attachment between mother and infant has been extensively studied and some writers apply the term only to the relationship of the infant to the mother. There is now much evidence that the quality of attach ments in infancy affects exploration and play in the short term, and a wide range cognitive and social functions throughout childhood. However, it is no longer believed that infant always forms a major attachment exclusively to the mother. Attachment learning: the theory that the presence of whom we are emotionally attached has a special effect on how we learn, especially in infancy. Attainment test: A test designed to assess the know ledge and skills which an individual has obtained, either through experience or through following a prescribed course of training. The category subsumes abnormal behaviour patterns that had been referred to be a variety of name including hyperactive child syndrome, strauss syndrome, and minimal brain dysfunction. Attenuation: (1) the shortening or limiting of an object or event (2) A term used by Triesman to refer to the weakening of a signal being processed, as an essential part of a model of selective attention. Attitudes are commonly held to have three essential components or dimensions: a cognitive dimension, involving the beliefs and rationalizations which explains the holding of the attitude; an affective dimension, involving the emotional aspects of the attitude; such as likes dislikes, feelings of distaste, or affection and a conative, or behavioural dimension which involves the extent to which the individual is prepared to act on the attitude that he hold. Attribution: the process by which an event or the behaviour of a person is unders to od in terms of suggested motives or influences. The judgement that a person or an event has a particular character istic or quality. Attributional style: the theory that individuals tend to believe in particular kinds of causes for a wide range of effects. Styles may vary in the extent to which they incline to wards stable causes (ones which are unlikely to change in the future), global causes (affecting lots of things) and internal external causes (such as character situation). So of two people who have failed an exam, one may attribute the cause to the room being noisy (unstable, specific and external), while the other may believe it is due to their being stupid (stable, global and internal). Martin Seligman believes that individuals who incline to wards using a stable, global and internal pattern of attributions may become vulnerable to depression. It is most concerned with the kinds of causes by which people come to account for their experiences-attributions about negative life events are considered to be particularly 36 Dictionary of Psychology & Allied Sciences important. Although attribution theory has been used to improve and extend helplessness theory and is extensively used in cognition therapy strictly, attribution theory deals with how people come to have their beliefs about the causes of events and behaviour, while attributional theory deals with the different forms (or attributional styles) that such beliefs may take. Included are atypical organic mental disorder, atypical psychosis, atypical anxiety disorder, atypical soma to form disorder, atypical dissociative disorder, atypical gender iden tity disorder, atypical paraphilia, atypical para noid disorder, atypical psychosexual dysfunction, atypical fictitious disorder with physical symp to ms, atypical impulse control disorder, adjustment dis order with atypical features, atypical personality disorder, atypical conduct disorder, atypical eating disorder, atypical tic disorder, atypical stereotyped movements disorder and atypical developmental disorder. Atypical child: A term describing a child with dis to rted personality development; often used in connection with brain-damaged or autistic children. Authenticity: Quality of being authentic, real and valid in psychological functioning and personality, it applies to the conscious feelings, perceptions and thoughts that a person expresses and communi cates. Authoritarian personality: A specific, rigid pattern of personality characterized by punitive approaches to social sanctions and high levels of prejudice Dictionary of Psychology & Allied Sciences 37 to wards outgroup members. Adorono concluded that this was due to defense mechanisms; highly prejudiced individuals had to protect themselves against ambiguities which might challenge their ideas. Also, they had often been brought up by cold and highly authoritarian parents producing a reaction for mation; the child would displace its aggression to wards authority figures on to minority groups in society. Adorno developed the F-scale (F for fascism), which measured authoritarianism through nine sub-traits. These were (1) Conventionalism (2) Authoritarian submissiveness (3) Authoritarian aggression (hostility to wards those who challenge authority. This was in contrast with an authoritarian approach, in which the child is not encouraged to express an opinion; or a laissez faire approach in which the parent has little involvement in the process of decision-making. Authority figure: A real or projected person in a position of power transferentially a projected parent. Authority principle: the idea that each member of an organizational hierarchy tries to comply with the presumed or fantasized wishes of those above him while those below him try to comply with his wishes. Autistic thinking: A form of thinking in which the thoughts are largely narcissistic and egocentric, with emphasis on subjectivity, rather than objecti 38 Dictionary of Psychology & Allied Sciences vity and without regard for reality the term is used interchangeably with autism and derelism. Daydreams are autistic, but the term is usually reserved for the more extreme and permanent removal from reality of schizophrenic thoughts. Activity is directed to wards inanimate objects and may give evidence of quite high intelligence, but speech is usually minimal. There is little agree ment about cause, although a majority of those who work in the area probably believe in an organic predisposition and even less agreement about treatment.

References

• Ozturk A, Deymeer F, Serdarogly P, et al. Distribution of muscle weakness in myasthenia gravis [abstract]. Neuromuscul Disord. 1999;9:6-7.
• Feste, J.R., Bojahr, B., Turner, D.J. Randomized trial comparing a radial expandable needle system with cutting trocars. J Soc Laparoendosc Surg 2000;4:11-15.
• Ackroyd R, Kelty CJ, Brown NJ, et al. Eradication of dysplastic Barrett's oesophagus using photodynamic therapy: long-term follow-up. Endoscopy 2003;35:496-501.
• Wang QX, Ohtani O, Saitoh M, Ohtani Y. Distribution and ultrastructure of the stomata connecting the pleural cavity with lymphatics in the rat costal pleura. Acta Anat (Basel) 1997; 158:255-65.
• Jenkins MA, Hayashi S, O'Shea AM, et al. Pathology features in Bethesda guidelines predict colorectal cancer microsatellite instability: a population-based study. Gastroenterology. 2007;133(1):48-56.
• Vanuytsel LJ, Bessell EM, Ashley SE, et al. Intracranial ependymoma: longterm results of a policy of surgery and radiotherapy. Int J Radiat Oncol Biol Phys 1992; 23(2):313-319.