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Last modified: November buy cheap colospa 135mg on line spasms prostate, 2017 1 CHAPTER 8 SADNESS AND DEPRESSION [Please note: Two depression scales are available order colospa 135mg with mastercard muscle relaxant juice, after the references purchase tricor 160mg with visa. Readers may choose to print the text only, without these additional pages. By this is meant, certain aspects of “normal” human behaviour and experience get “re-badged” as medical conditions. An example: what was formerly described as promiscuous or self indulgent sexual behaviour is being “diagnosed” in pop-psychology as “sexual addiction”. Chapter 32 deals in detail with “medicalization” in detail. It is profoundly important that we understand that sadness (low/depressed mood) is a part of the human experience – when people are sad for good reason we should give them support, but we must not call them “sick” until they have sufficient symptoms to justify the diagnosis. Some very clever people make the point that we must not consider every person who is experiencing an unpleasant emotions to be a “patient”. Sociologists Horwitz & Wakefield (2007) wrote the important book, “The Loss of Sadness: How psychiatry transformed normal sorrow into depressive disorder”. More recently, distinguished psychiatrist Allen Frances (2013) wrote the book “Saving Normal” – in which he demonstrates that many normal reactions are being called illness/sickness. At times when it is generally considered that medicine should be limited to the abnormal, yes, it does. An example: Medicare covers the cost of only certain cosmetic surgery procedures - it will cover the cost of repairing a face damaged by an accident, but not the passage of time (a face-lift for loss of skin elasticity). But the contrary view, that the distinction between normal and abnormal is unimportant, can be argued. The modern practitioner is expected to provide comfort and assistance to those in need, and the prevention of disease is regarded as a greater good than its treatment. Example: the management of obesity and mild elevation of the blood pressure, neither of which are diseases, are legitimate activities for medical practitioners. We will look briefly at the experiences of sadness, grief and demoralization, but will, of course, spend the majority of our energy on the pathological conditions which have sadness as a prominent feature. As we know, the current diagnostic systems (DSM-5, ICD-10) are descriptive (providing lists of diagnostic points). McHugh (2005) states the time has come to Pridmore S. Last modified: November, 2017 2 classify psychiatric disorders using an etiological perspective. His proposed etiological approach involves 4 clusters: 1) “brain disease”, in which there is disruption of neural underpinnings, 2) “vulnerability because of psychological make- up”, 3) the adoption of behaviour “that has become a relatively fixed and warped way of life”, and 4) “conditions provoked by events that thwart or threaten”. Using the McHugh (2005) system, with respect to “depression”, Cluster 1 would include severe depressive disorder (such as psychotic, for example), Cluster 2 would incorporate the low mood associated with some personality types, Cluster 3 would incorporate the depression which is secondary to, or associated with, conditions including alcoholism, pathological gambling and anorexia nervosa, and Cluster 4 would incorporate the low mood of grief, situational anxiety and posttraumatic disorder. Such a system of classification would assist in indicating the most appropriate professional response.

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Syndromes

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This paired structure derives its name because it lies just above The Pineal Gland the optic chiasm cheap colospa 135 mg free shipping spasms detoxification. There is also a great deal of interest in clock genes Postganglionic sympathetic nerves (called the nervi conarii) and clock components of cells in general 135 mg colospa amex muscle relaxant reversal, not just in the from the superior cervical ganglion innervate the pineal (4) buy genuine effexor xr on-line. The journal Science designated clock genes as the The preganglionic neurons originate in the spinal cord, spe- second most important breakthrough for the recent year; cifically in the thoracic intermediolateral column. The path- the year before it was also on the runner-up list. That is, darkness during the day cannot increase melatonin production. These two effects of light combine to restrict the duration of melatonin production to about 12 hours or less during Alfred J. Lewy: Department of Psychiatry, School of Medicine, Oregon the night. In many animals, the changing duration of the Health Science University, Portland, Oregon. Changes a seasonal time cue for regulating hibernation, migration, in melatonin duration probably are not as important in and estrous (6). Drugs that affect mela- Sympathetic stimulation of the pineal results in the syn- tonin production generally lower or raise the entire night- thesis and secretion of melatonin into the venous circula- time profile symmetrically; therefore, a circadian phase shift tion, as well as into the cerebrospinal fluid. After conversion of serotonin to N-acetylsero- tonin, hydroxyindole-O-methyltransferase synthesizes mel- atonin (8). Perhaps unique in the autonomic nervous system, sity room light was used. These negative findings caused there is no dual parasympathetic innervation opposing sym- some scientists to speculate that humans lacked the neural pathetic control of pineal melatonin production; however, pathways for mediating chronobiologic effects of light. Nevertheless, melatonin production is a perturbed by ordinary-intensity indoor light. A second im- reliable measure of sympathetic and noradrenergic activity plication was that bright artificial light might be substituted in the pineal gland. Consistent with the catecholamine hy- for sunlight, in order to experimentally, and perhaps thera- pothesis of affective disorders, melatonin production is peutically manipulate biological rhythms in humans. Winter Depression Following our discovery of bright light suppression of mela- tonin production in humans (23), researchers began to treat Pineal Pharmacology depressed patients with bright light (24). Drugs that a diary he had kept over for over 13 years (25). Since 2,000- stimulate and block 2-adrenergic receptors also have the light was effective in suppressing melatonin production, we predictable effects on melatonin production.