Cornelia R. Graves MD

• Medical Director, Tennessee Maternal Fetal Medicine
• Director, Perinatal Services, Baptist Hospital
• Clinical Professor, Vanderbilt University
• Nashville, Tennessee

The Resource Guide helps the administrator shape a planning process that engages key operational staff in executing strate gies that prevent sexual assault impotence with blood pressure medication viagra soft 50mg lowest price. With an emphasis on operational issues facilities that apply to both prison and jails impotence at 55 discount 100 mg viagra soft visa, the Resource >>> Guide for Jail Administrators may provide the more No Refuge Here: A First Look at Sexual Abuse in useful tool for both jail and prison administrators erectile dysfunction only at night viagra soft 50 mg low price. The report includes an executive trators offers administrators a structured planning summary and the following sections: approach erectile dysfunction natural remedies buy 100mg viagra soft mastercard. Responses to thirteen questions regarding curriculum related to staff sexual misconduct with youth and youth-on-youth sexual assault are provided. This 3-hour program, originally broadcast June 28, 2006, addresses this serious >>> issue and introduces administrators, managers, advocates, Meeting the Challenge of Housing Juveniles in and practitioners working with juvenile offenders to the Adult Facilities. The article also discusses bedspace and address the sexual abuse of children and youth in management, control measures, and inmate behavior. The use of direct supervision as a method for improving the safety of incarceration facilities >>> is a central strategy for moving the corrections Recognizing and Addressing Sexual Abuse, Assault profession forward and prioritizing the humane Prevention and Intervention Issues in Your Juve treatment of inmates. Addresses architectural design as it relates to functional components of the jail, discusses overall design consid Facility design: Protecting erations, and reviews pre-design planning, renovation, inmates through direct construction costs, and facility transition. A directory of facilities that utilize the direct supervi sure the state of the art in podular direct-supervision jails, sion concept of jail design and management is provided. Staff and inmates in mation: facility name, address, description and status, facilities in Minnesota, Florida, and Massachusetts were year opened, contact person, facility capacity, direct surveyed on issues such as safety and security, effective supervision pods, direct supervision beds, largest direct supervision of inmates, classifcation, staffng and train supervision pod size, maximum inmates per offcer, direct ing, and design and environment. Findings are presented supervision dormitories, non-direct pods, disciplinary or in detail by facility. Designed to give the reader Jails in America: A Report on Podular Direct an introduction to the concept, this collection of articles Supervision, Version 2 [videorecording] 2005. Includes bibliography and attachments Correctional Internal Affairs Investigators Job to fnal report. A job profle for an Internal Affairs >>> Investigator in state operated adult correctional facilities Direct Supervision Jails: Interviews with Admin is provided. Details of the experiences of eleven jurisdictions and veteran Internal Affairs Investigators in the Kentucky in developing and operating direct supervision jails are Department of Corrections; comparing Correctional Inves presented in this report. Sections of this Annotated Bibliography on Prison Rape/Inmate report are: summary of fndings and recommendations; Sexual Assault. Will the proposed (existing) layout allow staff a clear view of all inmate areas without >>> having to move or turn around so much they Sexual Violence Reported by Correctional Authori get dizzy or tired However, >>> working through the issues can help staff answer Still In Danger: the Ongoing Threat of Sexual those questions and determine whether changes Violence Against Transgender Prisoners. Sections following an executive summary trained to operate them effciently are: introduction; Farmer v. This Bureau of Justice Statistics report pres ents the frst national survey of administrative records on At the end of the review, administrative, custody, sexual violence in adult and juvenile correctional facilities. The planning in custody were surveyed; 8,210 allegations of sexual process engages correctional staff in a planning violence were reported in the U. This guide is care, discharge and follow-up, and examiner court designed to enhance the leadership skills, knowledge, appearances. Sixteen checklists allow admin ment: A Ten Point Plan [and] Ohio Prisons Chief istrators to assess performance and effectiveness of jail Release [sic] 10 Point Plan on Sexual Assault operations. Zero tolerance is refected >>> in ten areas of focus: staff training; inmate education; A National Protocol for Sexual Assault Medical sanctions; victim support persons; investigation proce Forensic Examinations: Adults/Adolescents. It is also important to stress that the implementation of promising practices does not ensure that all forms of violence have been effectively eliminated. Opinions or points of view expressed are those of the authors and do not necessarily refect the of Resources offcial position or policies of U. The contents of this publicaton may be freely used and copied for educatonal and other non-commercial purposes, provided that a reproducton is accompanied by an acknowledgement of the authors of the artcles. It addresses and beter informs policy and decision makers at all levels, actors from the criminal justce system, practtoners, civil society actvists, academics, and individuals concerned with this horrible phenomenon. This publicaton was made possible by contributons from individuals, non-governmental organisatons, and government agencies who have researched femicide and vio lence against women, gathered data on gender motvated killings and crimes against women, and set up units to inves tgate and prosecute these murders and aggravated assaults. We express our appreciaton to all volunteers, who have remained with the ant-femicide campaign and dedicated their tme to the cause. Printed copies of all previous issues are available for perusal at the Natonal Library of Austria. The heart of a mother, victm of femicide, that leaves the side of her child forever. The loneliness that the living victms of femicide sufer once their loved ones are gone. Despite these big changes, what has remained the same is our commitment to bring about change, to atract atenton to and promote the fght against a societal phenomenon that, sadly, is worsening. Regretably, our contributon to end violence against women seems to be more important than ever!

Although both oring erectile dysfunction myths and facts buy generic viagra soft 50mg online, their professional responsibilities to clients ethical principles and law guide and regulate behavior kidney transplant and erectile dysfunction treatment purchase generic viagra soft on-line, and community erectile dysfunction medication reviews purchase viagra soft in united states online. The principle of prohibited by law reasons erectile dysfunction young age purchase viagra soft 100mg visa, as the law does not simply codify Integrity obligates school psychologists to be ethical norms. If the ethical responsibili strive for fairness and nondiscrimination in the ties of psychologists conflict with a law, psychologists provision of services. It encourages school psychologists solvable via such means, psychologists may adhere to respect the worth of all people, and their rights to the requirements of the law as long as doing so is to privacy, confidentiality, autonomy, and self in keeping with basic principles of human rights determination. These are followed by sections on supervised discussion of ethical issues in practicum and Education and Training, Research and Publication, internship settings. Most ethically challenging situations encountered by practitioners concern difficult situations rather than 7. Present any evidence that the various con clear-cut violations of the specific rules outlined in sequences or benefits resulting from each professional codes of ethics. Consistent with codes of inherent in the dual roles of employee and pupil advo ethics, school psychologists accept responsibil cate, conflicting interests of multiple clients. All of these situations are potentially harmful to students (Jacob & Hartshorne, 2003). In addition, there are a number of decision-making model or procedure may not only more specific ethical issues that cut across their many help the practitioner make informed, well-reasoned, job roles. In all roles, school psychologists practice choices when dilemmas arise in professional practice, within the boundaries of their competence and accept but also will allow the practitioner to describe how a responsibility for their actions. This may afford some protection to and respectful of cultural, individual, and role when difficult decisions come under the scrutiny of differences, and knowledgeable of the ways in which others. The following eight-step problem individuals to choose for themselves the time and the solving model is adapted from Koocher and Keith circumstances under which and the extent to which Spiegel (1998, pp. Define the potential ethical-legal issues need to balance the interest of the state (school) in ful involved. Consult ethical and legal guidelines and district and educate children, with the personal freedoms and policies that might apply to the resolution of rights generally afforded citizens. A school child has situations in which failure to release information privacy rights with regard to his or her person (body) would result in clear danger to the client or others. School psycho Respect for client privacy is also an ethical man logists define the parameters of confidentiality at date. The parameters of the for the dignity of persons and the valuing of auto promise of confidentiality will vary depending on nomy, school psychologists are obligated to respect the nature of the services offered. When the student requests it sent of an adult student) for school actions that may 2. When there is a situation involving danger to result in a significant intrusion on personal or family the student or others. Conse danger to others) quently, with the exception of unusual situations, informed consent is obtained prior to the provision of 3. In the delivery of psychologi court of law cal services in the schools, as elsewhere, the three key elements of informed consent are that it must be Thus, for school practitioners, concern for the knowing, competent, and voluntary. Knowing means welfare of schoolchildren is the top priority in-service the individual giving consent has a clear understand delivery. In addition, there are also special ethical ing of what it is they are consenting to . The third element test in English to a student with limited English profi of informed consent is that it must be voluntary; that ciency and then to interpret the score as a measure of is, consent is obtained without coercion or undue intellectual ability. Federal education law outlines specific When psychologists assist in planning inter requirements for informed consent for psychological ventions for students with learning difficulties or evaluation of students with suspected disabilities and behavior problems, they are ethically obligated to rec for the release of information from school records. For example, it would by association members, and impose sanctions on be unethical for a psychologist to recommend use of violators. Ethics committees only investigate com time-out procedures to reduce an undesired student plaints regarding violation of specific ethical stan behavior unless differential reinforcement (positive dards. While the general ethical principles outlined in reinforcement for appropriate behavior) had first been ethics codes provide guidance in decision making, tried and found ineffective. For example, when providing consul issuing an educative letter, censuring or reprimanding tation to a team meeting to determine the placement the violator, requiring restitution or an apology, of a pupil with special education needs, the parents imposing a period of probation, or evicting the viola might request full-time placement in regular educa tor from the organization. The regular class room teacher might believe part-time placement in See also Confidentiality; Informed Consent a special education classroom is justified on the basis of greater academic benefit. Ethical princi There also are special ethical issues associated ples of psychologists and code of conduct. The crisis in ethics, anno domini sional practices of the persons being supervised. The relation between learn new skills, the supervisor must assign new and ethical codes and moral principles. Ethical decision welfare is not compromised because of the super making models: A review of the literature. Introducing ethics to beginning psycho itoring the supervisee closely enough to ensure the logists: A problem-solving approach. An evaluation of the evidence cents, the range of potential single or multiple causes base to support an intervention requires examining to explain the difficulties these individuals encounter whether reliable and valid methods were applied in is often extensive (Kamphaus & Frick, 2002). For documenting the effectiveness of prevention and inter example, a host of etiologies have been suggested to vention programs. In addition, there are research psychology to identify interventions that are of value supported effective intervention approaches that tend to clients and eligible for reimbursement by insurance not to be frequently used in typical educational set or other third-party payers. School psychology practitioners and researchers Although the issues surrounding managed health need valid information to guide the application of care and third-party reimbursement in psychology are prevention and intervention methods to the range of important to understand, school psychologists typically school contexts and populations they serve. When moving approaches to diverse settings and problems as well as research to practice in educational settings, the day-to to specific field-based contexts). Thus, school psychologists do not Eysenck (1952) provocatively questioned the effective provide treatments to students under the same condi ness of psychotherapy, the notion of whether and how tions that characterize clinical practice. Whereas in psychologists make clinical decisions based on science clinical psychology it may prove most useful to pre has remained a hotly debated issue. Rather, the level of evidence is skills in a training program) has been widely embraced. A major task undertaken in school psychology Perhaps one of the most noteworthy developments has been the construction of a manual titled the to occur within psychology and mental health fields Procedural and Coding Manual for Review of Evidence has been the attempt to formalize criteria for evaluat Based Interventions (hereafter called the Procedural ing the effectiveness of interventions and to document and Coding Manual).

The high rate of hemodynamic stability and better control of uid balance erectile dysfunction kolkata buy cheap viagra soft line, crossover between the treatment modalities also complicates the slower control of solute concentration erectile dysfunction pump review viagra soft 50 mg online, avoiding large the interpretation of the results impotence quitting smoking buy cheap viagra soft 100mg online. However best erectile dysfunction pills at gnc purchase viagra soft 50mg mastercard, an analysis of immobilization, the use of continuous anticoagulation, the cost ranges from a multicenter, multinational observational risk of hypothermia and, in some settings, higher costs. In general, the number of patients included in tive trials will be required to address this issue. The clinical practice algorithm included priming Signicant session interruptions occurred in 16 (16. This may be the result of a decrease of mean cost, and minimal requirements on infrastructure. Other arterial pressure (dialysis-induced hypotension) or an advantages include the lack of a need for vascular access and increase of cerebral edema and intracranial pressure (dialysis anticoagulation, the absence of a disequilibrium syndrome disequilibrium), and may jeopardize the potential for and the relatively good hemodynamic tolerance compared to neurologic recovery. Disadvantages are the overall lower effectiveness the rapid removal of solutes, resulting in intracellular uid (especially in patients with splanchnic hypoperfusion or shifts. Small observational trials and case intact peritoneal cavity, risk of peritonitis, diaphragmatic reports in patients with intracranial pressure monitoring splinting leading to ventilatory compromise and uctuating indeed reported increases in intracranial pressure with blood glucose levels. These trials should be varying size range of pediatric patients imparts technical standardized for treatment dose, buffer, membrane, considerations in selection of a modality. However, technological advances aimed at provid should be evaluated in prospective randomized trials. Since lactate is a strong anion, acidosis on cardiovascular performance and hormonal insufcient lactate conversion will result in worsening response. Options for correction of metabolic acidosis acidosis, especially since bicarbonate losses are ongoing in include the use of acetate-, lactate-, and bicarbonate the extracorporeal circuit. Some centers linked to impaired cellular function and catabolism due to use citrate anticoagulation, and the citrate load provides an lowering of the cellular redox state and phosphorylation 750 adequate supply of anionic base to control metabolic potential. Differences in the case-mix may explain of acetate has been largely abandoned in view of the these different results. Under patients with coincidental liver disease, those on inotropic normal circumstances, this lactate is metabolized, resulting in support, and in patients with initial blood lactate measure adequate correction of acidosis in most patients. However, in recent patients with circulatory problems and in those with liver years, bicarbonate has gained popularity because of concerns dysfunction. Two studies Supplementary material is linked to the online version of the paper at conrmed microbial contamination of (locally prepared and. This will therapeutic procedure should be, and actually it is, delivered usually require a higher prescription of efuent is essential for a good medical practice. Neither study showed improvement in mortality or renal and university-afliated North-American centers. Within recovery when the dialysis dose was increased, either by each randomization arm patients were switched between increasing Kt/V above 3. The comparators might be different efficiency another modality or the combination of different modalities targets. Mean norepinephrine dose decreased more Transwestern Commercial Services, and Wyeth. Some possible methods to clear that the data and opinions appearing in the articles and explore are on-line Kt/V urea, urea reduction ratios, or advertisements herein are the responsibility of the contri application of the concept of corrected equivalent renal butor, copyright holder, or advertiser concerned. The every effort is made to ensure that drug doses and other comparators might be the standard ways to measure dose quantities are presented accurately, readers are advised that as Kt/Vor prescribed effluent volume. Chair for Research within the Department of Critical Care Dr Lameire reported no relevant nancial relationships. Professor Aspelin was Vice Dean of the Medical of critical-care medicine, but center in critical-care nephro School at Karolinska Institutet from 1993 to 1995 and served logy, sepsis, multiorgan failure, and clinical epidemiology, as Vice President at the institution from 1995 to 2001. Other Renal Replacement Therapy, Critical Care Nephrology, and notable accomplishments also include his roles as President Management of Acute Kidney Problems. Vice Chairman and current Chairman of the Swedish Advisor/Consultant: Abbott; Alere; Astute Medical; Baxter; Medical Association. He has also authored more than 200 journal articles of the Renal Disaster Relief Task Force, he was awarded and book chapters and currently serves as Associate Editor Doctor Honoris Causa at the Kaunas Medical Academy in for Nephron Clinical Practice and editorial board member for Lithuania and an honorary membership of the International American Journal of Kidney Diseases. He Unit and Associate Professor, Division of Nephrology at founded the program in interventional cardiology and served University of Sao Paulo Medical School. Latin American Society of Nephrology and Hypertension and He participated in the development of the National Kidney current President of Brazilian Society of Nephrology. He is also a member Dr Herzog has served on the Editorial Board for the American of numerous professional societies and has served on the Heart Journal since 2005 and as liaison editor (cardiology) for Council of the International Society of Nephrology and Nephrology Dialysis Transplantation since 2007. International Society of Nephrology Commission of Acute Dr Joannidis currently serves as chair of the section Acute Renal Failure, and has been elected to the Council of the Kidney Injury of the European Society of Intensive Care American Society of Pediatric Nephrology. He received his Evidence-Based Nephrology, Handbook of Dialysis Therapy, medical degree at the Johann-Wolfgang Goethe University Management of Acute Kidney Problems, Pediatric Critical Care, Frankfurt, Germany in 1983. Internal Medicine and Nephrology at the Department of Advisor/Consultant: Baxter; Gambro Nephrology of the University Hospital Klinikum Steglitz, Speaker: Gambro Free University of Berlin, Germany and at the University Grant/Research Support: Amgen; Baxter; Gambro Hospital Essen, University Duisburg-Essen, Germany. In addition, she is Chairman the American Society of Nephrology, the European Dialysis of the Scottish Intercollegiate Guidelines Network, Diagnosis and Transplantation Association, and he is a member of the and Management of Chronic Renal Failure and was a Board of Directors of the German Society of Nephrology. He is an editorial member of Clinical Nephrology and served Dr MacLeod reported no relevant nancial relationships. Friedman Professor of Medicine at Tufts University School He subsequently completed a nephrology fellowship at of Medicine, Chief of the William B. Clinical Research at the Sackler School of Graduate Dr Mehta is an internationally recognized expert in the Biomedical Sciences at Tufts University. He has authored over 150 scientic articles, Grant/Research Support: Amgen; National Institutes of papers and book chapters, and has been actively involved in Health; National Kidney Foundation resident and scholar teaching. She completed her fellowship at the Royal Nephrologists of Indian Origin for his achievements in Colleges of Physicians of London and Edinburgh, and has nephrology. Infectious Disease Division, Memorial Hospital of Rhode Dr Murray is board-certied in internal medicine, Island. Dr Opal is a member of 1996 to 2008, serving as the fellowship training program numerous national and international committees including, director in nephrology and also directing the Acute Dialysis International Steering Committee for Sepsis Clinical Trials; Service. Dr Murray has published publications and has given more than 100 invited presenta extensively with contributions in numerous books inclu tions. Dr Opal currently serves on the editorial boards of ding, Critical Care Nephrology, Evidence-Based Nephrology, Advances in Sepsis, Critical Care Forum, Current Opinion in Evidence-Based Practice of Critical Care, and Intensive Care in Critical Care, and Shock. Advisor/Consultant: Affymax; Amgen; Hexal Sandoz; Dr Schaefer reported no relevant nancial relationships. He received his medical the department of Intensive Care Medicine at the University degree from the University of Iowa and completed his Hospital Leuven (Chair: Greet Van den Berghe) and has Internal Medicine residency and fellowship training in been Associate Professor at the Catholic University Leuven Nephrology at Hennepin County Medical Center where he since 2000. He received currently serving on the Board of Councilors of the his medical degree from Tokyo Medical and Dental International Society of Nephrology. He is the Principal University and his PhD from Jikei University School of Investigator for a National Institutes of Health-sponsored, Medicine. Dr Uchino is a member of the Japanese Society of multi-center study of long term outcomes after kidney Intensive Care Medicine, Japanese Association for Acute donation. He is the Director of the Scientic Registry of Medicine, Society of Critical Care Medicine, and the Transplant Recipients. He has over 160 scientic publications European Society of Intensive Care Medicine. In addition in major peer reviewed journals, and 230 review articles, to serving as a reviewer for numerous journals, he has written editorials and textbook chapters. Evidence-Based Practice of Critical Care, and Intensive Care Advisor/Consultant: Litholink in Nephrology. Subsequently, he continued his training in internal University Medical Center and Tufts Medical Center).

Syndromes

• Blood tests, ultrasound of your gallbladder, and other tests to make sure you are healthy enough to have surgery
• Some types of abnormal heart rhythms (arrhythmias)
• Blood culture (if an infection is suspected)
• Wearing good quality sunglasses
• National Kidney and Urologic Diseases Information Clearinghouse - http://kidney.niddk.nih.gov/kudiseases/topics/incontinence.asp
• If there is grimacing and a cough, sneeze, or vigorous cry, the infant scores 2 for reflex irritability.
• Blindness (rare)

Flight of ideas is characterised by an increased fow of thought with a loss of goal erectile dysfunction doctors san antonio order viagra soft uk. In contrast to the formal thought disorder of schizophrenia erectile dysfunction zinc supplements 50 mg viagra soft for sale, the logical connections between thoughts are maintained in fight of ideas erectile dysfunction treatment viagra buy generic viagra soft pills. People with bipolar disorder are prone to sufering major depressive as well as manic episodes causes to erectile dysfunction purchase viagra soft online. As a consequence of their impaired judgement and disinhibited behaviour during manic episodes, people with bipolar disorder are at risk of sufering damage to their reputations, fnancial losses and legal problems. They tend to lose insight early in the course of the illness and so usually require hospitalisation, often against their will. Manic episodes range in severity from hypomania, in which the person does not sufer any marked disruption of social or occupational functioning, to mania with or without psychotic features. During some episodes, there may be a mixture of both manic and depressive features. Psychotic depression the features of major depression were discussed in Chapter 14. They include persistently depressed mood, anhedonia, neurovegetative function disturbance, psychomotor retardation or agitation, feelings of worthlessness and guilt, poor concentration, helplessness, hopelessness, recurrent thoughts of death and suicidality. Delusional disorder Delusional disorder is characterised by non-bizarre delusions occurring in the absence of other symptoms of schizophrenia. Delusional disorder is distinguished from schizophrenia by an absence of the following: prominent auditory or visual hallucinations, passivity experiences, formal thought disorder, catatonia or prominent negative symptoms. There may be kinaesthetic or olfactory hallucinations that are related to the delusional theme. The onset is often later than for schizophrenia, with most beginning in middle to later life. Box 22-1: A woman with delusional disorder (persecutory type) A 75-year-old woman is brought to see you by her daughter. Over the past year, she has become increasingly suspicious of her neighbours, whom she accuses of watching and listening to her when she is in the bathroom, and of trying to poison her. The neighbours called her daughter after she cut up their hose, accusing them of trying to poison her. Her daughter describes her as always having been an orderly, rather anxious person who would avoid social engagements unless accompanied by her husband. A Manual of Mental Health Care in General Practice 213 Diferential diagnosis the diferential diagnosis of the functional psychoses includes substance abuse and physical disorders (see Table 22-3). It is particularly important to consider a medical condition as the cause of psychosis in people over the age of 40 who present for the frst time with psychotic symptoms. Schizoid, schizotypal and paranoid personality disorders can precede the onset of schizophrenia and share some symptoms (paranoid ideation, woolly speech, interpersonal withdrawal, odd beliefs and magical thinking). Refer to Chapter 3 for a detailed discussion of the assessment of suicidality and dangerousness. People with command hallucinations (to self-harm or to harm others) and ideas of retaliation in response to persecutory delusions are at particular risk. Individuals may be unable to care for themselves or their dependents during acute psychotic episodes. The treatment setting People with schizophrenia usually require admission during their frst psychotic episode. However, with adequate social supports, subsequent admissions are usually brief or may be avoided altogether. Community mental health teams with an extended hours capacity facilitate care in the community. If the person presents a danger to himself or herself, or others, involuntary hospitalisation may be required under the provisions of the State Mental Health Act. People may place themselves at risk through reckless behaviour, substance abuse or unsafe sex. They may cause themselves serious fnancial harm through extravagant spending or poorly judged business dealings. They may cause damage to their reputations through disinhibited, sexually promiscuous, aggressive or other ill-judged behaviours. Medication Schizophrenia Antipsychotic drugs are the mainstay in the treatment of acute schizophrenia and in relapse prevention. Over the past few years three new antipsychotics have become available: clozapine, risperidone and olanzapine (see Table 13-1). All have a lower propensity to cause acute extra pyramidal side efects than traditional antipsychotics and are associated with fewer negative symptoms. Clozapine is efective in cases that are resistant to treatment with traditional antipsychotics. However, it is only available through registered centres and requires close monitoring because of the risk of agranulocytosis. Parenteral preparations are useful in the treatment of people who fail to adhere to oral medication. A Manual of Mental Health Care in General Practice 215 the newer antipsychotics have fewer extra-pyramidal side effects than traditional antipsychotics and are associated with fewer negative symptoms. The very young, older and frst episode patients may only require small doses to control symptoms. In general, doses above 15mg equivalent of haloperidol have no greater antipsychotic efect. Doses above 15mg equivalent of haloperidol have no greater antipsychotic effect, only more side effects. However, the positive symptoms generally take between two and eight weeks to settle. While agitation can settle within hours to days, the positive symptoms generally take between two and eight weeks to be alleviated. Anticholinergics can usually be withdrawn once a steady dose of the antipsychotic has been attained. For those who have had two or more acute episodes, treatment should be continued for at least fve years. Reduce the dose of the frst medication (or cease depot preparations) and gradually increase the dose of the second medication over several weeks. When changing from a traditional antipsychotic to risperidone, a crossover phase is required to avoid a cholinergic rebound syndrome. It is important to remember that traditional antipsychotics may suppress the signs of tardive dyskinesia, while at the same time causing it. Mood stabilisers are prescribed for relapse prevention (see Chapter 13 for a discussion of the use of these drugs). Contraindications to the use of lithium include pregnancy, renal failure and recent myocardial infarction. The decision whether or not to embark on maintenance treatment depends on the number, severity and frequency of previous episodes; the ability of the person to recognise early signs of relapse; the presence of suicidality or dangerousness during acute episodes; and the strength of social supports. Following a frst episode of mania, it is generally recommended that mood stabilisers be continued for a minimum of six months to prevent early relapse. It is essential to inform patients and their carers about the early signs of lithium toxicity and the circumstances under which it can occur. Women of childbearing age must be warned of the potential teratogenic efects of lithium. Treatment adherence Non-adherence to prescribed antipsychotic medication is common with a reported incidence of between 11 and 80 per cent. Explain the reasons for your recommendations rather than trying to direct the patient to comply.

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