In what way do Macbeth's strengths contribute to his downfall?

Macbeth’s strengths include initiative and strength. He has courage on the battlefield, but since he wavers in his indecision on how much control he should have over his destiny in becoming king, this might not be seen as a strength off the battlefield, at least in the beginning. He is easily swayed by his wife. Yet in battle, he shows his courage and his loyalty to the king.

In the battle against the king of...

Macbeth’s strengths include initiative and strength. He has courage on the battlefield, but since he wavers in his indecision on how much control he should have over his destiny in becoming king, this might not be seen as a strength off the battlefield, at least in the beginning. He is easily swayed by his wife. Yet in battle, he shows his courage and his loyalty to the king.

In the battle against the king of Norway, Macbeth’s strength makes him a hero. He carves his way through opposing forces. Malcom, Duncan’s son, reports of his valor and says he well deserves the name of “brave Macbeth.” He takes the initiative in leading the charge, rather than looking to someone else’s leadership. His confidence in his abilities aids him in not backing down.

Each of these strengths, however, is turned toward evil once the ugly head of ambition arises. He is confronted with his destiny to be king. His initiative makes him decide to murder Duncan, rather than letting fate take its course. His loyalty to his king is quickly cast aside, replacing it with loyalty toward himself. Though he is called weak by his wife, he commands his strength to do the terrible deed. It is the first murder only that is difficult. His conscience is cauterized, making each succeeding murder easy. His confidence in his abilities as well as in the truth of the prophecy, helps him to justify his actions.  His bravery is thus returned, seeing these murders as part of the "battlefield" in his war to gain the crown. These strengths lead to his downfall, as the acceptance of evil turns them into flaws.

`theta = 1.27 radians` Find the slope of the line with inclination 'theta'.

slope of a line in X-Y plane 

 = (change in Y coordinates)/(change in X-coordinates)

If the angle with line and X-axis is `theta`  then the slope can be given as `tantheta` . This angle is also called inclination angle.

`slope = tantheta`

`slope = tantheta`

`slope = tan1.27`

`slope = 3.224`

So the slope of the line that has inclination angle `theta = 1.27rad`  is 3.224

 

slope of a line in X-Y plane 

 = (change in Y coordinates)/(change in X-coordinates)

If the angle with line and X-axis is `theta`  then the slope can be given as `tantheta` . This angle is also called inclination angle.

`slope = tantheta`

`slope = tantheta`

`slope = tan1.27`

`slope = 3.224`

So the slope of the line that has inclination angle `theta = 1.27rad`  is 3.224

 

What is the concept of teen privacy?

Privacy is a difficult issue for both teenagers and their parents. On one hand, teens need privacy to mature and become independent people. But on the other hand, too much privacy can be harmful. Parents of teens should therefore strive to find a balance. This means that parents should respect their child’s space and possessions, while still regularly checking up on the teen.

One example of finding a balance is with suspected alcohol or drug use. If parents suspect such activities, they should not overreact and invade the teen’s privacy, such as by rummaging through his or her possessions. But parents should not avoid the situation either. An ongoing conversation between the parents and teen is a more effective approach.

Social media has changed the way teens deal with privacy. Because social networks are public, many teens have lost their privacy. Certain posts on Facebook, for example, could damage a teen’s standing with his or her peers. Furthermore, many parents join the same social networks as their children do as a way to spy on them. Social media is a way of life and may teach teens valuable lessons about responsibility and good behavior.

Overview

Privacy is important for teens because it allows them to develop independence. It also helps them to mature and build self-esteem. Parents who give their teens enough privacy display trust. This trust becomes increasingly important as teens desire to do more things independently. Parents who afford their children privacy also show that they respect their children’s space and possessions.

A good example is when parents let their teens maintain their own bedrooms, such as keeping the space clean. This shows teens that parents respect them and their privacy and also trust them with the responsibility. However, parents should still regularly check up on the teens and their rooms. Teens may in fact fail to properly look after their rooms. In this sense, parents should be careful not to give teen children too much privacy.

Another good way for parents to check up on their teen children is to ask questions. If a teen is going out somewhere, his or her parents should ask where the teen is going; with whom; and for how long. Asking questions such as these builds trust between parents and teens and also helps teens develop a sense of responsibility. However, teens may resent being asked too many questions. Parents should therefore find a balance, seeking information occasionally or whenever they believe a teen may be in danger.

Harmful Activities and Teen Privacy

Teen privacy is especially important when it comes to harmful activities, such as alcohol use and drug use. Parents who suspect such activities may overreact and invade a child’s privacy. For example, parents may secretly go through the teen’s personal possessions. This may lead to more defiant behavior from the teen. Other parents who suspect alcohol or drug use may refrain from taking any action. These parents may choose to avoid conflict, often because they fear a negative reaction from the teen for being questioned. Parents should therefore talk to teens about drugs and alcohol while still respecting the privacy boundary. This can be an ongoing conversation that lets teen know parents are concerned. Children whose parents teach them about the risks of drugs are about 50 percent less likely to use drugs.

Social Media and Teen Privacy

With the advent of social media, including Facebook and Twitter, privacy has diminished. Social networks generally have public forums and traceable activities. In fact, given Facebook’s privacy rules, anyone can see another user’s status updates, images, and videos, unless that user opts out. This makes teens susceptible to harmful online behavior. For example, posting a provocative photo on Facebook may stigmatize a teen because of the public nature of the social network.

Social media also allows parents to spy on their children. For example, many parents join Facebook to be able to see what their children post and with whom they communicate. In fact, a study by the Education Database Online revealed that the main reason for joining Facebook for about half of all parents on the social network was so they could spy on their children and their children's friends. The study also found that nearly all of these parents monitor their child’s profile on a daily basis. Parents typically check their child’s status updates, photos they post or are tagged in, and location check-ins. These monitoring activities may be detrimental to teens. Social media has become a way of life, and parents should not try to protect their teen children from that fact.

In the end, social media teaches many teens a lesson about online privacy and being responsible on the Internet. Many teens learn—perhaps through their mistakes—that social media is public, and some mistakes cannot be erased. Teens may come to realize the things they should not share on social networks and how not to behave.

Bibliography

Barker, Joanne. “Teen Privacy: When to Cross the Line.” WebMD. WebMD, LLC. Web. 2 Dec. 2014. <http://www.webmd.com/parenting/teen-abuse-cough-medicine-9/teen-privacy, http://www.webmd.com/parenting/teen-abuse-cough-medicine-9/teen-privacy?page=2, http://www.webmd.com/parenting/teen-abuse-cough-medicine-9/teen-privacy?page=3>

Blackwell, Rachel. “Invading Your Teen’s Privacy—Nosey or Caring?” Parentdish. AOL (UK). Web. 2 Dec. 2014. <http://www.parentdish.co.uk/teen/invading-your-teenagers-privacy-nosey-or-caring/>

Drexler, Peggy. “Why Teens Need Privacy Online.” Psychology Today. Sussex Publishers, LLC. 6 Dec. 2013. Web. 2 Dec. 2014. <http://www.psychologytoday.com/blog/our-gender-ourselves/201312/why-teens-need-privacy-online>

Witmer, Denise. “How Much Privacy Does My Teen Need?” About Parenting. About.com. Web. 2 Dec. 2014. <http://parentingteens.about.com/od/familylife/f/teenprivacy1.htm>

Witmer, Denise. “Should Parents Check Up on Their Teen?” About Parenting. About.com. Web. 2 Dec. 2014. <http://parentingteens.about.com/od/familylife/f/teenprivacy5.htm>

Witmer, Denise. “Why Does My Teen Need Privacy?” About Parenting. About.com. Web. 2 Dec. 2014. <http://parentingteens.about.com/od/familylife/f/teenprivacy3.htm>

What is endometrial cancer? |

Related conditions:
Obesity, hypertension, polycystic ovary syndrome, endometrial hyperplasia

Definition:

Endometrial cancer is cancer of the endometrial cells that line the uterus, which is the female organ in which the fetus develops. Estrogen, a female hormone, is a primary growth signal for the endometrium (lining of the uterus). When endometrial cells are exposed to increased levels of estrogen for long periods of time and when they acquire certain genetic mutations, they can become cancerous.

Risk factors: Certain demographic characteristics including being over the age of fifty, being white, and never having been pregnant can contribute to the risk of endometrial cancer. Long-term exposure to estrogen may also affect the incidence of endometrial cancer. Estrogen exposure can be in the form of hormone replacement therapy (commonly used to control menopause-related symptoms) or tamoxifen (an estrogen-like drug used to prevent or treat breast cancer). Increased exposure to estrogen can also occur in women who began menstruation early (before the age of twelve) or reached menopause late (after the age of fifty). Because estrogen can be produced in fatty tissue, being overweight can increase the risk of endometrial cancer. Furthermore, obesity-related conditions, such as type 2 diabetes and high blood pressure, may increase the risk. Finally, many diseases may also be associated with an elevated risk of endometrial cancer, including endometrial hyperplasia (a noncancerous condition characterized by overgrowth of the endometrium), a history of breast or ovarian cancer, and hereditary nonpolyposis colorectal cancer (a disease caused by mutations in deoxyribonucleic acid, or DNA, repair genes).

Etiology and the disease process: Within the female reproductive system, the ovaries are responsible for producing the hormones estrogen and progesterone. The levels of these hormones fluctuate each month, allowing the endometrium to thicken (because of endometrial cell growth) at the beginning of the monthly menstruation cycle in preparation for an egg to be fertilized and implanted within the uterus. At the end of the monthly cycle, the endometrium is shed if pregnancy does not occur. Because estrogen is responsible for stimulating the growth of endometrial cells, too much estrogen may lead to too much cell growth.

Genetic changes may also contribute to the transformation of normal cells into cancerous cells. Endometrial cancer can be divided into type 1 and type 2 carcinomas based on their relationship with estrogen and how the cells look under a microscope. Type 1 carcinoma, which accounts for 70 to 80 percent of all endometrial cancer cases, is estrogen dependent and associated with the inactivation of PTEN (a tumor-suppressor gene) and mutations in DNA repair genes, KRAS (a gene that encodes a proto-oncogene), and beta-catenin (a protein). In the less prevalent (but more aggressive) type 2 carcinoma, which follows an estrogen-independent pathway, major genetic changes within endometrial cells include mutations in TP53 (another tumor-suppressor gene) and overexpression of human epidermal growth factor receptor 2/neu (HER2/neu). When cells have tumor-suppressor genes and DNA repair genes that are not functional, they lose the ability to regulate growth and cell division, as well as the ability to fix additional mutations that may arise. Expressing excess growth factor receptors also means that cells may grow and divide more quickly and may not respond when cellular signals try to stop proliferation.

Incidence: In women, endometrial cancer is the fourth most common cancer (after breast, lung, and colon cancers). Some 95 percent of uterine cancers are endometrial; the other 5 percent are due to cancerous muscle or myometrial cells within the uterus. The American Cancer Society estimated that there were 52,630 new cases of uterine cancer and 8590 deaths from the disease in the United States, though approximately 2 percent of these cases are other forms of uterine cancer.

Symptoms: The most common symptoms in endometrial cancer are pelvic pain and vaginal bleeding between menstrual periods or after menopause.

Screening and diagnosis: Screening tests such as a pelvic exam, a Pap smear (to check for cervical cancer), and a transvaginal ultrasound (to determine if the endometrium is too thick) may be performed. Blood tests can look for lower red blood cell counts (possibly indicating loss of blood from the uterus) and for raised levels of cancer antigen 125 (CA 125, a protein that is associated with tumors of the endometrium and ovaries).

To make a diagnosis, a tissue sample from the uterine lining should be removed and analyzed under the microscope. Tissue samples can be obtained either by a biopsy or by dilation and curettage (D&C). A D&C is a more invasive procedure for obtaining endometrial tissue and may be done if the biopsy did not obtain a large enough sample or if the biopsy was positive for cancer and a confirmation is needed.

Endometrial cancer is staged using the International Federation of Gynecology and Obstetrics (FIGO) cancer staging system, as follows:

• Stage I: The tumor is only in the uterus.





• Stage II: The cancer has spread from the body of the uterus to the cervix.





• Stage III: The cancer has spread outside the uterus but not outside the pelvis (and not to the bladder or rectum). Lymph nodes in the pelvis may contain cancer cells.





• Stage IV: The cancer has spread into the bladder or rectum, or it has spread beyond the pelvis to other parts of the body.

Treatment and therapy: Women with endometrial cancer may undergo surgical removal of the uterus, in a procedure known as a hysterectomy. Often, the uterus is removed along with the Fallopian tubes and ovaries as well as neighboring lymph nodes to ensure that all of the cancerous cells have been removed. Although this is the standard treatment for women already in menopause and no longer fertile, women of childbearing age need to consider the outcome of this surgery as they will lose the ability to have a child. For Stage I endometrial cancer, surgery to remove the uterus has been shown to be 90 percent effective.

Radiation therapy, where high-dose X rays are used to kill cancer cells, may be used after surgery to prevent the formation of or treat existing cancer cells outside the uterus. Radiation may also be used in place of surgery if women refuse a hysterectomy or if a tumor is growing rapidly, associated closely with muscle cells in the uterus, or is highly vascularized (with lots of blood vessels infiltrating the tumor). Radiation therapy can be delivered either conventionally (the standard external X ray) or as brachytherapy (internal radiation to target only the inner lining of the uterus). Although brachytherapy has fewer side effects than conventional radiation therapy, its effects are only local, so it cannot be used if the cancer has spread outside the uterus.

Hormone therapy is often used when cancer has spread outside the uterus. Synthetic progestin, which is a form of progesterone, is used to inhibit the growth of cancerous endometrial cells. Although this therapy may be associated with higher risks of recurrence than surgical removal of the uterus, this option is attractive to women who still want to have children or who were diagnosed in a very early stage. Chemotherapy may also be used to kill cancer cells that have spread beyond the uterus.

Prognosis, prevention, and outcomes: To prevent endometrial cancer (both initial and recurrent cases), taking hormones with progesterone may help slow or inhibit the growth of endometrial cells. Women may undergo hormone therapy with progestin or take birth control pills. Women who take birth control pills have a reduced risk of endometrial cancer for up to ten years after discontinuing oral contraceptives. As with other cancers, living a healthy lifestyle is important in reducing the risk of cancer. This includes maintaining a healthy weight (as obesity is a risk factor for developing endometrial cancer) and exercising regularly.

For endometrial cancer, the five-year survival rates for women receiving the proper treatment are approximately 75 to 95 percent for women diagnosed at Stage I, 50 percent for Stage II, 30 percent for Stage III, and less than 5 percent for Stage IV.

In a study analyzing recurrence rates across sixteen studies, the overall risk of recurrence was 13 percent, and this was even less in low-risk patients who were diagnosed with Stage I or II cancers or who did not have associated diseases known to increase the risk of endometrial cancer. This study also showed that about 70 percent of recurrences were accompanied by symptoms, and 68 to 100 percent of these recurrences occurred within about a three-year span after the follow-up visit.

Canavan, T. P., and N. R. Doshi. “Endometrial Cancer.” American Family Physician 59.11 (1999): 3069–077. Print.

Clarke-Pearson, Daniel L, and John Soper. Gynecological Cancer Management: Identification, Diagnosis, and Treatment. Chichester: Wiley, 2010. Print.

Fung-Kee-Fung, M., et al. “Follow-Up After Primary Therapy for Endometrial Cancer: A Systematic Review.” Gynecologic Oncology 101.3 (2006): 520–29. Print.

Liu, F. S. “Molecular Carcinogenesis of Endometrial Cancer.” Taiwanese Journal of Obstetrics and Gynecology 46.1 (2007): 26–32. Print.

Mundt, Arno J., Catheryn M. Yashar, and Loren K. Mell. Gynecologic Cancer. New York: Demos Medical, 2011. Print.

Robertson G. “Screening for Endometrial Cancer.” Medical Journal of Australia 178.12 (2003): 657–59. Print.

Sherman, M. E. “Theories of Endometrial Carcinogenesis: A Multidisciplinary Approach.” Modern Pathology 13.3 (2000): 295–308. Print.

Van Look, Paul, Kris Heggenhougen, and Stella R. Quah. Sexual and Reproductive Health: A Public Health Perspective. San Diego: Academic, 2011. Print.

What is the central idea of the poem "The River" from The Water-Babies by Charles Kingsley?

Charles Kingsley's novel The Water-Babies is peppered with songs and poems, some of which are original to the novel. The poem about the river is original (written by Kingsley himself) and actually appears untitled within the story. You can find it near the beginning, as Tom is starting his journey. Outside of the novel, the poem appears under the title "Inland Waters: Highlands Song of the River."

It's a short poem, just three stanzas long. ...

Charles Kingsley's novel The Water-Babies is peppered with songs and poems, some of which are original to the novel. The poem about the river is original (written by Kingsley himself) and actually appears untitled within the story. You can find it near the beginning, as Tom is starting his journey. Outside of the novel, the poem appears under the title "Inland Waters: Highlands Song of the River."

It's a short poem, just three stanzas long. Its central idea is that a river can be symbolic of both cleanliness and filth, and both sin and purity of the soul. 

More specifically, a river can be a place for playing, laughing, dreaming, and bathing: a pure place where a mother and child can belong. It can reflect the cleanest, most admirable aspects of the human spirit.

At the same time, a river can be dark, dank, foul, and slimy: a place where a mother and child should naturally feel repulsed. These portions of the river reflect the sinful, unclean aspects of humanity.

The point is that the river is defiled in some places and undefiled in others. It's complex and changing. The same is true of humanity. We're debauched at times, pure at other times.

The author seems to hint that sin and filth are related to greed and the accumulation of money. "Baser and baser the richer I grow," the river says, meaning that it gets more disgusting and unclean as it gets "richer." However, the poem seems to have a hopeful message overall: the first and last stanza are about the purity of the river, while the second stanza is about its filth. This structure allows the poem to end on a pure note. Toward the end of the final stanza, the river cries out this description of itself: "Like a soul that has sinned and is pardoned again."

What are psychotic disorders? |

Introduction

Psychotic disorders are a group of mental illnesses that share psychosis as one of their clinical features. Psychosis involves a gross impairment in one’s sense of reality, as evidenced by symptoms such as delusions, hallucinations, thought disorder, and bizarre behavior. These psychotic symptoms may be a primary component of illness or may be secondary to a mental or physical condition.

Types of Psychotic Symptoms

Delusions
are false beliefs that are associated with misinterpretations of perceptions or experiences. There are different types of delusions. The most common are persecutory delusions and grandiose delusions. Persecutory delusions are delusions in which the person believes that he or she is being spied on or plotted against. Grandiose delusions are delusions in which the person believes that he or she possesses special abilities or is related to a famous person or deity.

Hallucinations
are false perceptions in the absence of any real stimulus. Hallucinations may involve any of the five senses. There are auditory hallucinations, such as hearing voices; visual hallucinations, such as seeing faces or flashes of light; tactile hallucinations, such as feeling a tingling, electrical, crawling, or burning sensation; and olfactory hallucinations, such as smelling something not perceived by others. Gustatory hallucinations, or false tastes, are very rare. Most hallucinations are auditory hallucinations.

Thought disorder is defined as a disturbance in the form or content of thought and speech. In psychosis, the person’s speech may be incomprehensible or remotely related to the topic of conversation. Examples of formal thought disorder are neologisms, which are made-up words whose meaning is only known to the psychotic person, and loose associations, in which the person’s ideas shift from one subject to another, loosely related topic, without the person seeming aware of the shift. Delusions are examples of disorders of thought content. Psychotic behavior is typically bizarre or grossly disorganized.

Psychotic symptoms can appear at any point during the life course, though it is difficult to diagnose psychotic symptoms in preverbal children (prior to age five or six). Psychotic disorders can appear for the first time in individuals over age sixty-five.

Conceptualizations of Psychotic Disorders

In 1896, the German clinical psychiatrist Emil Kraepelin
proposed that there were two broad yet fundamental categories of psychotic disorder: manic-depressive illness, which is now referred to as bipolar disorder; and dementia praecox, which was labeled schizophrenia
by the Swiss psychiatrist Eugen Bleuler in 1908. Kraepelin delineated dementia praecox on the basis of course and outcome, noting that it was associated with a deteriorating course and poor outcome. According to Kraepelin, manic-depressive illness was associated with a more episodic and less deteriorating course relative to dementia praecox.

Psychotic disorders are currently classified on the basis of presenting symptoms rather than on the basis of underlying etiological processes. Episodes of psychosis can be brief or chronic in duration, lasting from a few days to many years, and psychotic symptoms may be mild, moderate, or severe in form. Although the various types of psychotic disorders have some common symptoms, their onset, course, and development are often substantially different.

Ongoing research efforts to clarify the cognitive and physiological mechanisms associated with different psychotic illness will hopefully help to aid in future diagnosis. According to the Diagnostic and Statistical Manual of Mental Disorders: DSM-5 (5th ed., 2013), published by the American Psychiatric Association, psychotic symptoms are a central feature of schizophrenia and other psychotic disorders. Schizophrenia, which is often a severe and debilitating mental illness, is found in approximately 1 percent of the general population and affects more than 2.5 million Americans. Onset of the disorder is most likely to occur between the ages of fifteen and thirty-five; the average age of onset is eighteen for men and twenty-five for women. Schizophrenia can occur in childhood, although this is rare, and can also have a late onset after the age of forty-five. Rates of schizophrenia do not vary substantially in terms of gender, race, or ethnicity, but the disorder is more prevalent in urban than in rural areas.

The DSM-5 outlines other psychotic disorders, known as schizophrenia spectrum disorders, that differ from schizophrenia primarily in terms of illness duration and severity. Schizophreniform disorder is diagnosed when the individual shows symptoms of schizophrenia that last less than six months. As the term implies, the psychotic symptoms in schizophreniform disorder are identical in form to schizophrenia but they have a briefer duration. Some individuals with schizophreniform disorder will eventually develop schizophrenia. Schizoaffective disorder contains features of a mood disturbance, with manic or depressive episodes, as well as the symptoms of schizophrenia. For a diagnosis of schizoaffective disorder, rather than schizophrenia or a mood disorder with psychotic features, both schizophrenia and mood disorder symptoms must be present the majority of the time. Schizoaffective disorder is less common than schizophrenia and may be associated with better functional outcome. Brief psychotic disorder, which is diagnosed if psychotic symptoms last for more than one day but no longer than four weeks, may develop in response to severe environmental stress or psychological trauma. Delusional disorder (paranoia) is less common and less severe than schizophrenia. In delusional disorder, the person has one or more delusions for at least one month. Other than the delusions, the person does not share any of the other psychotic symptoms typically observed in people with schizophrenia.

As of the DSM-5, schizotypal personality disorder is listed under this category as well as under its original category of personality disorders. Schizotypal personality disorder is characterized by eccentric behavior, odd beliefs, and difficulty or lack of interest in forming social relationships.

Psychotic symptoms may also be present in bipolar disorder and major depression, though they are not typically categorized as psychotic disorders. Bipolar disorder is characterized by periods of elevated, expansive, or irritable mood that may alternate with periods of depressed mood. In 1990, Frederick K. Goodwin and Kay R. Jamison reported that approximately 58 percent of individuals with bipolar disorder have at least one psychotic symptom during their lifetimes, which is most likely to occur during a manic episode. Psychotic symptoms may also accompany major depression. Psychotic symptoms are most likely to be associated with severe episodes of affective disturbance and could be either mood congruent or mood incongruent. Mood congruent psychotic symptoms contain themes that are consistent with the current affective state, such as a depressed individual with delusional thoughts about death. Mood incongruent psychotic symptoms involve content that is inconsistent with the current mood state, such as a depressed individual with delusional ideas about possessing special powers.

Some psychotic disorders are the direct result of external or environmental factors. Psychotic symptoms that result from psychoactive substance use or toxin exposure are classified as a substance-induced psychotic disorder. For example, some people may appear at hospital emergency rooms because of amphetamine-induced psychosis or cocaine-induced psychosis. In these cases, psychotic symptoms appear to arise because of the ingestion of a psychoactive (psychomimetic) substance. However, it is not known whether the people who experience psychotic symptoms while using a drug were already prone to psychosis (diathesis) and the drug was the additional stressor, or whether the drug was the proximal causal agent in the development of the psychosis.

Psychotic symptoms can be present in other disorders but are not considered to be defining features of the illness. Psychotic symptoms, especially paranoid delusions, are observed in people with dementia. Dementia is any condition in which there is a progressive deterioration of one’s memory, abstract thinking, and judgment and decision-making abilities. The most common types of dementia are Alzheimer’s disease and vascular dementia. Psychotic symptoms may also accompany a disorder known as dissociative identity disorder. Dissociative identity disorder (formerly known as multiple personality disorder) is associated with a failure to integrate various aspects of identity, memory, and consciousness.

Differential Diagnosis

Because the symptoms found across psychotic disorders greatly overlap, differential diagnosis of these conditions is often challenging. If a patient presents with psychotic symptoms, each of the psychotic disorders is considered when making a differential diagnosis. When diagnosing a psychotic disorder, it is important for mental health professionals to first obtain a thorough personal and family history of the patient. Information about the onset and course of presenting symptoms should also be obtained. If necessary, a physical examination or laboratory tests may be required to rule out other causes of the symptoms, such as brain injury.

Often, other psychotic disorders, such as schizoaffective disorder or schizophreniform disorder, must be ruled out from schizophrenia. The duration of psychotic symptoms will help differentiate whether the disorder is schizophrenia, schizophreniform disorder, or brief psychotic disorder. The length of affective impairment as well as the overlap between mood and psychotic symptoms is often helpful when distinguishing between schizoaffective disorder and psychotic mood disorder. The presence of other conditions, such as dementia or amnesic episodes, along with psychotic symptoms may aid in differential diagnosis as well.

Etiological Factors

Diathesis-stress models have been proposed as a way to explain the onset and development of many of the psychotic disorders. In this view, the diathesis, or underlying predisposition to illness, remains latent and unexpressed until it interacts with a sufficient amount of environmental stress. Individuals may vary in terms of the amount of their underlying diathesis and the stress required to bring about disorder. If an individual has a large diathesis, less stress is required to bring about illness onset. Conversely, if an individual with a substantial genetic diathesis is in a relatively low-stress environment, he or she may be protected from developing the illness. Diathesis-stress models have formed the basis for research on the role of genetic and environmental factors in the development of schizophrenia and related psychotic disorders.

Treatment Approaches

Antipsychotic
medications are considered an effective means of alleviating psychotic symptoms. Conventional (typical) antipsychotics were used to treat psychotic symptoms beginning in the 1950s. More recently, novel (atypical) antipsychotics, such as clozapine, risperidone, and olanzapine, have been introduced, which greatly reduce the severity of extrapyramidal side effects and are more effective at reducing negative or deficit symptoms relative to the typical antipsychotics. The optimal medication dose required is often obtained through a series of judgments made by the psychiatrist, who gradually increases or tapers the dosage based on observed treatment response. Psychopharmacological treatment has been found to be very effective in reducing symptoms during acute psychotic episodes and in preventing future relapses.

Typically, the treatment of choice for individuals with mood disorders, such as bipolar disorder or major depression, is a mood stabilizer or antidepressant. If psychotic features are present, an antipsychotic medication may be added to the treatment regimen.

Psychotherapy may also be helpful to individuals with psychotic disorders to assist them in medication compliance and other aspects of having a chronic mental illness. Psychosocial treatments, such as social skills training and family psychoeducation, can enhance the daily functioning and quality of life of individuals with psychotic disorders. By strengthening social support networks and teaching life skills, such interventions could improve social and vocational functioning, enhance one’s ability to cope with life stressors, and potentially protect against illness exacerbation.

Bibliography

Cardinal, Rudolf N., and Edward T. Bullmore. The Diagnosis of Psychosis. Cambridge: Cambridge UP, 2011. Print.

Goodwin, Frederick K., and Kay R. Jamison. Manic Depressive Illness. 2d ed. New York: Oxford UP, 2007. Print.

Gottesman, Irving I. Schizophrenia Genesis: The Origins of Madness. New York: Freeman, 1991. Print.

Lucas, Richard. The Psychotic Wavelength: A Psychoanalytic Perspective for Psychiatry. London: Routledge, 2009. Print.

Moskowitz, Andrew, Ingo Schafer, and Martin J. Dorahy. Psychosis, Trauma, and Dissociation: Emerging Perspectives on Severe Psychopathology. Chichester: Wiley, 2009. Print.

Oltmanns, Thomas F., and Richard E. Emery. Abnormal Psychology. 5th ed. Upper Saddle River: Pearson, 2009. Print.

Weiden, Peter J., Patricia L. Scheifler, Ronald J. Diamond, and Ruth Ross. Breakthroughs in Antipsychotic Medications. New York: Norton, 1999. Print.

What is heartburn? |

Causes and Symptoms

Heartburn occurs when acid travels backward from the stomach to the esophagus. Acid is normally present at very high concentrations in the stomach, where it aids digestion. Contrary to popular belief, most people who suffer from heartburn do not produce too much acid. Rather, they have a malfunction of the lower esophageal sphincter (LES), a ring of muscle between the stomach and the esophagus. Normally, unless food is being swallowed, the LES stays closed. This keeps acid confined to the stomach. If the LES remains open, or if it is weakened, then stomach acid can travel freely to the esophagus and irritate its inner lining, resulting in heartburn.

Heartburn is described as a hot, burning feeling in the chest. It usually occurs thirty minutes to one hour after eating and lasts for several minutes. It is often worsened by lying down or bending over and is improved by standing up. Other associated symptoms may include a sour taste in the mouth, sore throat, or hoarseness. Some patients develop a dry cough as a result of acid irritating the throat. Heartburn must be distinguished from more ominous causes of chest pain, including a heart attack or other heart-related chest pain. Usually, chest pain attributable to such causes becomes worse with exertion, while heartburn should not. Some cases of heartburn may also be caused by the condition known as Barrett esophagus.

Treatment and Therapy

The initial therapy for heartburn includes elimination of dietary and lifestyle factors that weaken the LES: tobacco, excessive alcohol, fatty foods, chocolate, and caffeine. Medications such as calcium-channel blockers and nitrates can also worsen heartburn, but they should not be discontinued without consulting a physician. It has been suggested that avoiding late-night meals and elevating the head of the bed with blocks underneath the headboard can improve heartburn, especially if symptoms occur mostly at nighttime. Occasional heartburn can be treated with over-the-counter antacids or medications such as ranitidine, which reduces acid production. If symptoms do not improve, then prescription medications are also available.

Surgery to reinforce the LES, called a Nissen fundoplication, is another option. Although results are excellent, patients often must take acid-suppressive medications after the procedure. Heartburn that is persistent or accompanied by trouble swallowing, weight loss, or bleeding requires more thorough investigation, as with endoscopy, to exclude the possibility of cancer or another serious medical condition.

Bibliography

Alan, Rick, Daus Mahnke, and Brian Randall. "Conditions InDepth: Gastroesophageal Reflux Disease (GERD)/Heartburn." Health Library, March 18, 2013.

Cheskin, Lawrence J., and Brian E. Lacy. Healing Heartburn. Baltimore: Johns Hopkins U P, 2002. Print.

"Heartburn." Mayo Clinic. Mayo Foundation for Medical Education and Research. 7 Aug. 2014. Web. 16 Feb. 2015.

"Heartburn." MedlinePlus. Natl. Lib. of Medicine, Natl. Institutes of Health, 3 Dec. 2014. Web. 16 Feb. 2015.

Longo, Dan, et al., eds. Harrison’s Principles of Internal Medicine. 18th ed. New York: McGraw-Hill, 2012. Print.

Minocha, Anil, and Christine Adamec. How to Stop Heartburn: Simple Ways to Heal Heartburn and Acid Reflux. New York: Wiley, 2001. Print.

Shimberg, Elaine Fantle. Coping with Chronic Heartburn: What You Need to Know About Acid Reflux and GERD. New York: St. Martin’s Griffin, 2002. Print.

At what time of year does Gene return to Devon to visit? What atmosphere or mood is created by setting the story during this season? What do Gene's...

Gene returns to Devon in the fall fifteen years after he graduated. Autumn usually signifies age, or the process of aging, which also connects to the time since he's been at the school. As people generally do when they have aged, Gene reminisces about his teenage years, the people he knew and the things he did or accomplished.

Gene says that the weather is "raw" and the day is "the kind of wet, self-pitying November...

Gene returns to Devon in the fall fifteen years after he graduated. Autumn usually signifies age, or the process of aging, which also connects to the time since he's been at the school. As people generally do when they have aged, Gene reminisces about his teenage years, the people he knew and the things he did or accomplished.

Gene says that the weather is "raw" and the day is "the kind of wet, self-pitying November day when every speck of dirt stands out clearly. . . but this day it blew wet, moody gusts all around me" (10). There is a lot of symbolism in what he says here. First, the word "raw" suggests that his memories are fresh in his mind. Next, Gene might also be in a state of self-pity since he applies that feeling to the weather. Then, he says the wind is moody, which is just how Gene feels—he also says that he is feeling fear and joy at the same time.

When Gene gets to the tree that he and Phineas had jumped from while in high school, he describes the scene as follows:

"A little fog hung over the river so that as I neared it I felt myself becoming isolated from everything except the river and the few trees beside it. The wind was blowing more steadily here, and I was beginning to feel cold" (13).

The fog seems to create an atmosphere of loneliness or isolation for Gene. He is strolling down memory lane by visiting places where tragic events happened in his young life. This is bound to bring out sorrow, as well as joy. The rain and wind seem to carry with them a mood linked to grieving and loss, along with many other emotions that have come and gone throughout the years.

What are theories on aging?

Introduction

The aging process occurs in all living organisms, although it is most pronounced in vertebrate animals, animals having a cartilaginous, bony endoskeleton, an efficient heart, and a highly developed nervous system. It is part of the basic sequence of animal development from conception to reproductive maturity to death. It follows the second law of thermodynamics, a physical principle of the entire universe that maintains that the disorder (entropy) of the universe is constantly increasing because of the dissipation of energy and the gradual transfer of energy from system to system. Living organisms age because of the inefficiency of the chemical reactions within their cells, thereby creating disorder as is evidenced by breakdowns in physiological rhythms (for example, nerve cell functioning, blood pressure changes, and reduced kidney filtration) and physical structure (for example, bone deformations, muscle weakness, and hair loss). The second law of thermodynamics maintains that no machine is 100 percent efficient; therefore, energy will be lost continuously with accompanying decay of the system, or body.

Physiological Aging

In humans and other mammalian species, the process of aging follows a very predictable pattern. An individual is conceived by the union of genetic information from the mother via an egg and the father via sperm, thereby producing a single-celled zygote. By the connected processes of mitosis (chromosome duplication followed by separation) and cytokinesis (cell division), the zygote divides into two cells, which later divide to make four cells, then eight cells, and so on until an individual composed of approximately 100 trillion cells is produced. Very early in development (for example, a few hundred cells), different cells in various locations begin to specialize, or differentiate, by hormonally initiated changes in gene expression within these cells, thereby giving rise to specialized structures such as nerves, muscle, skin, bone, eyes, and fingers.

After the individual organism is fully developed and can survive in the environment on its own, it will either exit the mother’s body or hatch from a protective egg case, or shell. Subsequent juvenile development will include brain neuronal changes (plasticity) as a result of learning and social interactions, and physiological changes, leading to sexual maturity, or adulthood. Development up to adulthood does technically constitute aging, although there is little evidence of physiological decay. Various hormones, particularly steroid hormones, are prominent during a person’s sexual stage, when the individual is capable of sexual reproduction. Individuals are at their physical peak during the reproductive period. At the end of the critical reproductive period (menopause in women), the degenerative physical effects of true aging become very evident and accelerate with time as the individual becomes older. In a biological sense, the purpose of an organism is to reproduce and continue the transfer of genetic information. By age fifty or so, both men and women should have achieved this objective, and estrogen (in women) and testosterone (in men) begin a more rapid decline. Consequently, the individual organism begins a progressive deterioration after age fifty or so toward death, thereby making room in the environment for its descendants. This is a harsh, but real, view of an organism’s life. The key to understanding why deteriorative aging occurs lies in the hormones, chemicals, and cellular changes that are present in the organism just before this stage.

Among the physical changes of aging that are evident very early are heart and respiratory changes. On birth, the average human newborn has a pulse of 120 heartbeats per minute, a breathing rate of forty to forty-five breaths per minute, and a blood pressure of 60/30. These data indicate a very high metabolic rate in individuals during early development. As humans age, both pulse and breathing rates decrease, whereas blood pressure increases. The average healthy adult has a pulse of approximately 60 to 80 heartbeats per minute, a breathing rate of approximately eight to twelve breaths per minute, and a blood pressure somewhere around 120/70. Neuronal plasticity of the brain and, therefore, learning peak during the early reproductive years and decline around the age of forty-five to fifty. Most physiological processes undergo a steady decline from age twenty or so, with steeper declines occurring near age fifty, although large individual variation exists.

Theories of Aging

When an organism dies, the electrical activity of billions of brain neurons ceases, along with cessation of heart and respiratory muscle contractions. In more than 80 percent of human deaths by “natural causes,” however, the exact cause of death cannot be determined. The physiological causes of aging and death remain poorly understood, although more than three hundred theories have been proposed to explain the process. Of all the theories proposed, two—the free radical theory and the genetic programming theory—have withstood vigorous testing and continue to be widely studied. Although each theory emphasizes different aspects of cellular aging, they are complementary and both may be correct in their combined interpretations.

Free Radical Theory

The role of free radicals
in cell damage and aging was first proposed by Denham Harman in 1972. The free radical theory of aging maintains that the degenerative events that occur within the cell and the entire organism during aging are caused by the toxic effects of oxidizing free radical molecules. Free radicals are molecules that have a free extra electron per molecule that can be donated to another molecule. As a result, free radicals are highly reactive with most substances that they encounter. Their chemical reaction with a recipient molecule may affect the structure and function of that molecule so that it does not function properly. In a living cell, such an event could have disastrous consequences. The deoxyribonucleic acid (DNA) nucleotide sequence of any gene could be mutated, or altered, by a free radical, thereby altering the structure or function of the protein encoded by that gene and affecting all cellular functions controlled by that specific protein. If the protein is essential for the cell’s survival, the result could be cellular death or cellular transformation to the cancerous state.

Free radicals such as superoxide, hydroxyl radical, and hydrogen peroxide are naturally produced as by-products of the cell’s metabolic activities. The cells of most living organisms produce antioxidant enzymes such as catalase, glutathione peroxidase, and superoxide dismutase to scavenge and inactivate free radicals wherever they occur. No such capture operation is 100 percent efficient, however. Some free radicals react with cellular molecules; the accumulated effects of these reactions over time may be responsible for cellular aging. Antioxidants, such as vitamins C and E, block free radicals and are suggested for prolonging life. These antioxidant chemicals are frequently cited as the basis of claims for the benefits of consuming a diet rich in fruit and vegetables. However, antioxidant supplementation has not yet been proven to extend life. Although phenybutylnitrone was shown to produce about a 10 percent extension of the life span in animals, the results of this experiment have not been reproduced. Of all the theories of aging, Harman’s free-radical theory has the most consistent experimental support. However some models demonstrate that increased oxidative stress has no effect on life span. Thus, more data are needed to decisively determine the role of free radicals in aging.

Genetic Programming Theory

The genetic programming theory of aging maintains that the cells of all living organisms contain genes that encode signaling protein hormones. These hormones, when produced, elicit aging-related changes within the cells at specific times during the organism’s development, including death. Another viewpoint within this theory is that the cells of various tissues within living organisms are programmed to die after undergoing a specified number of genetically encoded divisions. Some studies in gene theory suggest it is the altering of genes over time that causes aging. In addition, because observations of older people demonstrate an increase of mutated genes, it is also theorized that gene mutations over time cause aging. Indeed, cancer is often the result of mutations. Molecular biology underlies the more recent theories on aging. Cells keep dividing until they can no longer divide and then they simply die. Embryonic cells divide much more than cells from adults. Hence, this theory proposes that cell division holds the key to the mechanics of human aging. Other nonbiological theories of aging include disengagement, activity, selectivity, and continuity theories. Additional biological theories include telomere, reproductive-cell cycle, wear-and-tear, evolutionary, accumulative-waste, autoimmune, aging-clock, and cross-linkage theories.

Applying Theories to Health and Disease

By the start of the twenty-first century, researchers in laboratories throughout the world had begun actively investigating the mechanisms of the aging process. The problem was being tackled from many different perspectives, including biochemical, genetic, physiological, gerontological, psychological, and sociological approaches. The topic is of particular interest in countries such as the United States, where the overall population is becoming progressively older. Although much of the research has been devoted to medical care for the elderly, many scientists have begun exploring the biochemistry of aging with hopes of understanding the process and possibly slowing or reversing it.

The two principal theories of aging (senescence), when combined, provide a very good working model for attacking the aging problem. The free radical theory of aging provides the cause, and the genetic programming theory provides an overall developmental view of the phenomenon. There can be no question that there are certain genes within all living cells that in a step-by-step manner control the sequential development of the entire organism. At the same time, free radical molecules are constantly being produced within body cells, and these same cells are being exposed to mutagenic (mutation-causing) radiation and chemicals. These substances will cause accumulated cellular damage over time, even with the body’s combined defenses of antioxidant enzymes, immune system cells, and kidney filtration of impurities from blood. These defenses work extremely well up to the end of the individual’s reproductive period; then, they decline rapidly, almost as if they were programmed to do so.

Recent studies have shown that calorie restriction, which limits the intake of energy, reduces free radicals and increases the life span of rodents. Severely reducing calories by restricting the number of meals and fasting has been shown to suppress the development of various diseases and to increase the longevity of life in rodents by 30 to 40 percent. However, severely reducing calories by 50 percent or more resulted in death. In addition, for caloric restriction, which lengthens the time between cell divisions, to be beneficial, it must be started early in life because age, at the molecular level, is counted as the number of cell doublings. Drug companies have begun searching for methods to mimic the beneficial effects of caloric restriction without severely limiting food intake.

Among humans, several unusual pathologies are of interest to scientists who research aging. Among these is the disease called progeria, a condition in which the aging process is greatly accelerated. The aging process is also emphasized in acquired immunodeficiency syndrome (AIDS) and the genetic disorder called autoimmune deficiency syndrome. In both situations, an individual’s entire immune system
is rendered useless, thereby leaving the individual’s body defenseless against the continuous onslaught of usually harmless bacteria, viruses, and mutations.

Cancer
is one of the leading causes of death, and the incidence of cancer increases as people age. Cancer is essentially a disease of uncontrolled cell growth, which interferes with the normal functions of the body. There are several dozen types of cancer, based on the affected tissues, site of the cancer in the tissue, and cell type that is affected. Causes of cancers are believed to be both genetically and environmentally defined; that is, some people are genetically more susceptible to environmental insults than others. Scientists believe that all cancers begin with one cell that becomes damaged and is not stopped from dividing and creating new damaged cells. An important scientific discovery has been the identification of certain genes involved in the development of cancerous cells: the proto-oncogenes and the tumor-suppressor genes. How cancer relates to death is complex and continues to be debated. Until more research is completed, it will not be known with certainty whether aging-related changes in cells and their systems make them more susceptible to cancer, or whether advancing time just allows more genetic hits to accumulate and produce cancerous cells.

The process of aging is difficult to measure, describe, or quantify, although it is a process that every organism experiences. Aging is a focus of many sciences, including physiology, chemistry, biochemistry, and genetics. As a scientific process, aging must have a beginning and an end, a substrate and a product, and a reason for the metabolic change; however, the scientific process of aging is not yet understood.

Psychological Perspective

The process of aging occurs within all living organisms. Theories describing the mechanisms of aging are of relevance to psychology because the aging process is a developmental process that encompasses all bodily systems, including the brain and central nervous system. Aging is a fundamental focal point of consciousness, religious beliefs, and social structure. Simply, people are afraid of dying. As a result, aging is incorporated into human religions, behavior, and culture. Society stresses youthfulness, so humans go to great lengths and expense to reverse the effects of aging with skin creams, baldness cures or coverups, clothing, bodybuilding, cosmetic injections, and plastic surgery. Psychologists have found that negative stereotypes about aging can actually shorten life and that people who have a positive perception of aging live seven and a half years longer than those who have a negative view.

Psychology is a phenomenon of intelligent living organisms, and living organisms are complex entities consisting of intricate chemical reactions. These biochemical reactions, which are responsible for all aspects of life, follow the fundamental physical and chemical properties of the universe. One of these physical processes is the second law of thermodynamics, which maintains that any system loses energy because of inefficiency and therefore becomes more disordered, or entropic. Therefore, aging is an entropic process for the entire universe. Living organisms do undergo a building process during early development that is antientropic; however, after a certain time, specifically the end of the reproductive period, entropy takes over and accelerates. All aspects of the living animal, including the brain, deteriorate.

The free radical and the genetic programming theories of aging have provided scientists with greater insights into the mechanisms of the aging process. These theories also give researchers ideas for attacking aging as a disease that can be treated. Although the so-called fountain of youth represents wishful thinking, research on aging realistically can lead to the prolongation of human life and improvement of the quality of human life. Aging research may help eliminate or treat maladies such as heart disease, Alzheimer’s disease, cancer, and general aging-related declines in most bodily functions.

One factor that permeates human biology in terms of aging, disease, and abnormal psychological behavior is stress. Research has repeatedly linked stress with accelerated aging, increased susceptibility to many diseases (including cancer), decreased mental agility and memory, and insanity. Indeed, scientific research demonstrates that stress speeds the aging process by harming DNA. The rise in the human population and continuing technological growth have been paralleled by a rapid increase in individual stress levels; stress-related diseases such as heart disease, stroke, and cancer; acts of violence, devastating wars, torture, exploitation, and destruction of human life; and the use of alcohol and illegal drugs in an attempt to relieve stress. Reevaluation of the way that one treats fellow humans, a slowing of the fast-paced society, major social reforms, and medical advances in the treatment of stress all will be needed for decreasing stress, a major killer and contributor to the aging process.

Advances in biochemical and genetic medical research probably will produce the means for extending life within the twenty-first century. Regardless of whether human longevity is extended, aging will continue. As it does, researchers will continue to study how and why people age and the consequences of aging for both the individual and the community.

Bibliography

Arking, Robert. Biology of Aging: Observations and Principles. New York: Oxford UP, 2006. Print.

Baudisch, Annette. Inevitable Aging? Contributions to Evolutionary-Demographic Theory. New York: Springer, 2008. Print.

Bergtson, Vern L., and K. Warner Schaie, eds. Handbook of Theories of Aging. 2nd ed. New York: Springer, 2008. Print.

Birren, James E., and K. Warner Schaie, eds. Handbook of the Psychology of Aging. Burlington: Elsevier, 2011. Digital file.

Erber, Joan T. Aging and Older Adulthood. 3rd ed. Malden: Wiley, 2013. Print.

Lewin, Benjamin. Genes. 9th ed. New York: Oxford UP, 2007. Print.

Masoro, Edward J., and Steven N. Austad, eds. Handbook of the Biology of Aging. 6th ed. San Diego: Academic, 2005. Print.

Morgan, Leslie A., and Suzanne R. Kunkel. Aging, Society, and the Life Course. 4th ed. New York: Springer, 2011. Print.

What is cancer of the mouth and throat?

Causes and Symptoms

Often, dentists detect cancers of the mouth and throat during routine dental examinations. People who visit their dentists regularly, preferably twice a year, will likely have such cancers detected and diagnosed in their earliest stages when treatment is effective and the cure rate high.

Valid generalizations can be made about the causes of mouth and throat cancers. The most significant cause is the regular use of tobacco products. Cigarette smoking over long periods often results in these cancers or in lung cancer. Males, especially those over forty, have a higher rate of mouth and throat cancer than do females. Pipe and cigar smokers are at greater risk of cancer than are cigarette smokers, and a correlation also exists between the use of chewing tobacco and snuff and the development of mouth cancer. About 90 percent of people suffering from mouth and/or throat cancer have been consistent users of tobacco.

A second causal factor is the regular consumption of substantial quantities of alcoholic beverages, usually over four drinks a day. Some 80 percent of people suffering from mouth and/or throat cancer have used alcohol regularly and in substantial quantities. They are particularly subject to cancers on the floor of the mouth, the tonsils, the lower pharynx, and the tongue.

People who smoke two packs of cigarettes a day and consume over four drinks a day increase the likelihood that they will develop mouth and/or throat cancers by forty times. Other factors in such cancers are poor dental hygiene, ill-fitting dentures, or irregular teeth that cause irritations in the mouth. Those whose work brings them into direct contact with certain toxic chemicals are also at risk.

The most common symptom of lip cancer is the formation of a small, whitish patch (leukoplakia), usually painless, on the lip. It frequently consists of squamous cells. As it develops, it may become ulcerous, causing bleeding and compromising surrounding tissue. If the tongue becomes involved, then it may stiffen. As the malignancy advances, the tongue often becomes painful. Speech, chewing, and swallowing become progressively difficult.

Cancer of the oropharynx, the mid-section of the pharynx, is often accompanied by difficulty in swallowing and hoarseness. Such cancers may also cause patients to expectorate blood-stained sputum. A sore throat frequently accompanies this form of cancer, and earache may also occur, although both of these symptoms frequently result from other causes. People with severe and consistent stomach acid reflux are vulnerable to throat cancer.

Treatment and Therapy

The usual treatment of mouth and throat cancer is surgery to remove the affected tissue. Such surgery is almost always followed by a course of radiation, which may also precede such surgery to shrink any tumors that might be present. Sometimes, removal of the tongue is indicated, although this is a very drastic treatment because of the problems that it causes for the patient, whose ability to speak and to chew and swallow food will be drastically compromised. Cancer of the tongue is the most aggressive form of mouth cancer, which is justification for using drastic measures to deal with it. Facial disfiguration may also be involved in treating cancers of this sort, so extensive plastic surgery may be necessary following it.

Throat cancers usually require the surgical removal of cancerous tissue followed by radiation, but treatment with anticancer medications may also be involved in the management of such cancers. Often, a biopsy is performed in the operating room prior to surgery, usually in conjunction with invasive procedures that permit surgeons and oncologists to view the pharynx, the lungs, and the esophagus using laryngoscopes, bronchoscopes, or esophagoscopes.

Perspective and Prospects

Cancer of the mouth and throat constitute about 8 percent of all the cancers diagnosed in the United States annually. The American Cancer Society estimates that, in 2013, approximately 36,000 people in the United States will develop oral cavity or oropharyngeal cancer and that about 6,850 people will die of these cancers. When an early diagnosis is made and is followed by prompt treatment, a cure results in 75 percent of cases. More than half the people diagnosed with mouth cancer, even those for whom late diagnoses are made, survive for at least five years following treatment. As in all cancers, early detection is the key to effective management and desirable outcomes.

Perhaps the most important factor in reducing the incidence of mouth and throat cancer is to convince young people not to develop the habit of using tobacco products and not to abuse alcohol. People who are already smokers and drinkers are well advised to stop smoking and to limit their alcohol intake to two drinks a day or less.

No conclusive correlation has been made between mouth and throat cancer and secondhand smoke. As an increasing number of public venues and workplaces have become smoke-free, however, people who patronize or work in such places have been smoking less.

Most inveterate smokers want to overcome the habit, but nicotine
addiction is so powerful that giving it up is difficult. Various methods have proved helpful in enabling people to control their habits, among them hypnosis, acupuncture, laser treatment, psychotherapy, and nicotine replacement through patches or nicotine chewing gum.

In 2013, researchers from Penn State reported the results of their study of about two thousand smokers who took part in the US National Health and Nutrition Examination Survey. They found that people who smoked a cigarette within five minutes of waking up in the morning were more likely to develop lung and oral cancer than other smokers. The research team published their findings in the March 29, 2013, issue of Cancer Epidemiology, Biomarkers and Prevention.

Bibliography

American Cancer Society. "Oral Cavity and Oropharyngeal Cancer." American Cancer Society, February 26, 2013.

DeConno, Franco, et al. “Mouth Care.” In Oxford Textbook of Palliative Medicine, edited by Derek Doyle et al. 3d ed. New York: Oxford University Press, 2006.

Dougherty, Lisa, and Sara E. Lister, eds. The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 8th ed. Oxford: Wiley-Blackwell, 2011.

Hahn, Michael J., and Anne Jones. Head and Neck Nursing. Edinburgh, N.Y.: Churchill Livingstone, 2000.

Hellwig, Jennifer. "Throat Cancer." Health Library, May 1, 2013.

Lydiatt, William M., and Perry J. Johnson. Cancers of the Mouth and Throat: A Patient’s Guide to Treatment. Omaha, Nebr.: Addicus Books, 2012.

MedlinePlus. "Oral Cancer." MedlinePlus, April 12, 2013.

Preidt, Robert. "HealthDay: 'Wake-Up Cigarette May Raise Risk for Lung, Mouth Cancers." MedlinePlus, April 5, 2013.

What are moles? How can moles become cancerous?

Related conditions:
Common acquired nevi (acquired in early decades of life), congenital nevi
(acquired at birth), freckles, seborrheic keratoses, lentigos (age spots),
dysplastic nevi, melanoma, basal cell carcinoma, squamous cell
carcinoma

Definition:
Moles, or nevi, are clustered melanocytes
or nevus cells that appear on the skin, usually brown in color. Melanocytes are
cells in the skin that produce the pigment called melanin that
protects human skin from the damage of ultraviolet (UV) rays in sunlight.

Risk factors: Although almost everyone has moles, some factors may
increase the risk of moles. People with lighter skin and with freckles have a
slightly greater risk of developing melanoma. Exposure to ultraviolet
rays from the sun can increase the number of moles, and the
more moles a person has, the greater the risk of developing melanoma. Damage to
the melanocyte deoxyribonucleic acid (DNA) can cause a mole to become cancerous.
Lowered immune systems such as those in persons with the human immunodeficiency
virus (HIV) or who have had an organ transplant can increase development of
moles.

Etiology and the disease process: Nevus cells (melanocytes) are normally localized in the basal layer of the skin (epidermis). A mole of itself is not dangerous and remains a stable part of the skin unless it becomes damaged and then can change into cancer.

Within sunlight are two types of invisible rays: infrared radiation (the sun’s
heat) and ultraviolet radiation (ultraviolet light). Ultraviolet (UV) light is
necessary for plants to live and generate energy. However, UV light can also cause
sunburn, aging of the skin, and, under the right conditions,
skin
cancer. UV rays are further differentiated into UVA, UVB, and
UVC. Studies are investigating UVA, once thought to be harmless, as a possible
cause of skin cancer. Researchers believe that damaged melanocytes may reproduce
in an uncontrolled and abnormal way, possibly causing melanoma, one dangerous form
of skin cancer. The exact mechanisms by which skin cancer or malignant moles occur
is still unclear.

Incidence: Most people have some form of moles, depending on their
age, sun exposure, and genetic makeup. Usually people have few moles as an infant
or child but may develop moles from puberty to the age of thirty. Often after that
time, moles begin to disappear so that older adults may have fewer moles. White
adults have an average of twenty or fewer moles, but an average person can have
ten to forty moles over a lifetime, with a risk of 1:100 turning into a malignant
melanoma. With lifestyle changes and more exposure to sunlight, this number can
increase.

The number of moles a person has is determined by genetics and exposure to sunlight. Moles are more common on parts of the body that are exposed to sunlight. Some evidence points to a role by the immune system in developing moles because they tend to develop in people with depressed immune systems such those infected with HIV and those who have had organ transplants.

Studies suggest that malignant nevi such as melanoma arise from preexisting
moles. If this proves true, the more moles a person has, the higher the incidence
of malignant nevi. The incidence of melanoma has been increasing worldwide.
Australia has the highest incidence of melanoma.

Symptoms: Moles come in various colors and shapes. Some are brown and others are pink. Some are yellow, dark blue, or black. Moles can be flat or raised.

Most moles are harmless but people should monitor their moles for changes in
color, size, and texture, and for the development of asymmetrical or irregular
borders. A benign or noncancerous mole will remain stable in size, color, and
shape for years. During pregnancy or puberty, moles may naturally change in color
and size, becoming darker and larger.

When a mole bleeds, itches, enlarges, turns multipigmented, or evolves with irregular edges, the patient should see a dermatologist, as this mole may need testing for cancer.

Screening and diagnosis: Health care providers can check their
patients’ moles during routine physicals or checkups. Also, people can check their
own moles periodically. One way to check moles for signs of melanoma is called the
ABCDEs of melanomas. “A” stands for asymmetry and indicates that the halves of a
single mole should be checked to see if they are different or asymmetrical; a
normal mole has identical halves. “B” means to look at the borders or edges of the
mole to see if they are irregular; usually a noncancerous mole has regular
distinct edges. “C” means that moles should be examined for color that varies
within a single mole; ordinary moles are one color, not multipigmented. “D” is a
reminder that the diameter of malignant mole is usually larger than the size of a
pencil eraser. "E" reminds patients to check for any moles that are evolving and
to make note of any moles that are changing in size, shape, color, or
elevation.

If changes appear in the mole, the patient should see a dermatologist who can
provide more in-depth testing or removal of the mole. Some symptoms that may need
evaluation are bleeding, itching, crusting, or an unusual change. The eyes alone
cannot diagnosis a malignant mole. The dermatologist will biopsy or excise the
mole for the pathologist to inspect. If the mole is malignant, the pathologist can
provide a series of tests called staging. These tests may indicate whether the
cancer has spread beyond the original site.

Treatment and therapy: Generally nevi require no treatment unless they change into a cancerous mole. However, sometimes they occur in an uncomfortable place and may be surgically removed. Failure to remove such a mole may result in bleeding from irritation.

When a mole is found to be cancerous, the mole, along with some surrounding tissue, is surgically removed.

Prognosis, prevention, and outcomes: Most moles are harmless.
However, there are known risk factors that increase the incidence of moles, and
some can cause adverse changes in the structure of the moles, leading to
malignancies. People at high risk for melanoma should be vigilant for changes in
their moles.

Although some exposure to sunlight is healthful because it supplies the body
with vitamin D, intense exposure to UV rays such as tanning puts people at risk.
Sunburn experienced years earlier can still bring about changes in the skin that
can precipitate a malignant mole. Young people often will not see the effects of
overexposure to the sun’s rays until years later, so they may not feel motivated
to change their behavior. To decrease the risk of moles as well as the conversion
of moles to cancer, people should use sun protection such as sunglasses,
sunscreen, long-sleeved garments, and hats.

Barnhill, Raymond
L., Michael W. Piepkorn, and J. Klaus Busam. Pathology of
Melanocytic Nevi and Malignant Melanoma. 3rd ed. New York:
Springer, 2014. Print.

Hearing, Vincent
J., and Stanley P. L. Leong, eds. From Melanocytes to Melanoma: The
Progression to Malignancy. Totowa: Humana, 2006.
Print.

Massi, Guido, and Philip E. LeBoit.
Histological Diagnosis of Nevi and Melanoma. 2nd ed. New
York: Springer, 2013. Print.

Niederhuber, John E., et al.
Abeloff's Clinical Oncology. 5th ed. Philadelphia:
Elsevier, 2014. Print.

Poole, Catherine
M., and Dupont Guerry IV. Melanoma: Prevention, Detection, and
Treatment. 2nd ed. New Haven: Yale UP, 2005. Print.

Schofield, Jill R.,
and William A. Robinson. What You Really Need to Know About Moles
and Melanoma. Baltimore: Johns Hopkins UP, 2000.
Print.

What is internet addiction? |

Causes

Some researchers have suggested that problematic Internet use stems from introversion, inability to communicate directly with others, and social isolation. Other experts have developed models to explain the etiology of this puzzling disorder.

One cognitive-behavioral model states that Internet use provides a way to escape
real or perceived problems, often for persons who tend to overgeneralize and hold
catastrophic and negative views of reality. The anonymous character of the
Internet appeals to persons with low self-esteem and with negative thinking.
The Internet offers a nonjudgmental environment and induces an artificial feeling
of self-worth and belonging.

The compensation theory, promoted by Chinese researchers, maintains that the
Internet serves a spiritual compensatory function and represents an avenue for
forming social networks in an increasingly demanding and threatening society.
Another explanation centers on the neurophysiology of Internet use and the
pleasurable, euphoric effect it induces. This effect leads to a host of phenomena,
such as reinforcement (in mitigating loneliness or social
awkwardness), repeated use, tolerance, and withdrawal,
all of which are analogous to other addictions. Finally, some research
indicates that situational factors, including the loss of a loved one,
unemployment, and relocation, might prompt a person to seek solace on the
Internet, thereby precipitating the development of IA.

Risk Factors

Internet access occurs anywhere, anytime. Although fraught with issues of sampling and standardization, a large body of research confirms the existence of problematic Internet use across cultures and age groups. IA, a newer disorder, is more prevalent in young and middle-aged people, especially males and college students. Homemakers also appear to be at risk for the disorder.

The status of the Internet in modern culture ensures that all susceptible persons
(that is, persons with a genetic predisposition to addiction or those with
psychological disturbances) spend time on the Internet and can develop IA. Persons
undergoing life-changing events (such as bereavement, divorce, or job loss) are
more vulnerable to developing problematic Internet use. In some young persons,
studies show, the pressure to succeed can lead to Internet overuse as a means to
relieve the stress.

Socially isolated persons and persons with attention
deficit hyperactivity disorder (ADHD), depression,
and other psychological disorders are at an increased risk for developing IA.
Depression, ADHD, social phobia, and hostility predicted the occurrence of IA in
follow-up studies. Hostility and ADHD were the most important predictors of IA in
male and female adolescents, respectively. Persons with multiple addictions have a
high risk of becoming addicted to the Internet and to subsequently relapsing.

Symptoms

IA lacks formal diagnosis criteria. Many researchers still consider excessive
Internet use a compulsive, rather than addictive, behavior. In addition, some
think of it as a coping mechanism, a symptom of underlying psychological
abnormalities, or even a lifestyle change inherent to technological advances.
Significant progress has been made, however, in diagnosing IA since it was first
described in the mid-1990s. The fifth edition of the American Psychiatric
Association's Diagnostic and Statistical Manual of Mental
Disorders (DSM-5), published in 2013, included Internet gaming
disorder in Section III as a disorder that warrants more clinical research before
it can be considered for inclusion as a formal diagnosis, signaling increased
acceptance in the psychiatric community for the existence of Internet addiction;
however, the DSM's criteria for the condition are limited to Internet gaming and
do not include problematic use of the Internet in general or of social media.

Overall, the fundamental components of the addictive process, in some ways similar
to gambling addiction, are the following:
preoccupation with Internet use, greater usage than desired, numerous unsuccessful
attempts to reduce usage, withdrawal (with anger and tension when not online),
tolerance (including the need for more hours and better equipment), and lying
about Internet usage. The DSM criteria for Internet gaming disorder include
playing Internet games compulsively, to the exclusion of other interests; causing
clinically significant impairment or distress due to Internet gaming; experiencing
withdrawal; and incurring negative consequences at school or work.

Several subtypes of problematic online behavior exist, as the criteria for
Internet gaming disorder indicate. These subtypes include addictions to
gaming , gambling, sexual activities such
as viewing pornography, shopping, social media
use, and email or text message exchange. Affected persons
also may overuse digital devices such as smartphones and tablets. Some of these
behaviors likely indicate underlying psychological disorders (such as gambling and
compulsive shopping), while others represent Internet-specific behaviors (such as
gaming, texting, and browsing). The affected person might turn to the Internet
when feeling lonely and might establish online relationships.

Ultimately, the computer or other digital device becomes the person’s primary relationship. The affected person undergoes a cycle that rationalizes online behavior and that progresses through regret, abstinence, and relapse. These behaviors can damage relationships with family members and friends, further deepening social isolation. In addition, affected persons may experience difficulty setting and achieving goals, and may display poor attention skills, an inability to delay gratification, and poor school or job performance. One study suggested that young people who are initially free of mental health problems, but who use the Internet pathologically, could develop depression as a consequence. Some people who present with depression, anxiety, or obsessive-compulsive manifestations later show signs of IA upon further examination.

In addition to mental problems, excessive Internet use can lead to physical
conditions. Using a computer for extended periods of time leads to weight gain,
sleep deprivation, back pain, carpal tunnel syndrome, and vision
impairment.

Screening and Diagnosis

Unlike illegal drugs or gambling, for example, the Internet has widespread
legitimate uses in fields such as education, research, business, industry, and
communications. In this context, IA can be easily masked. Therapists may not
detect the disorder unless they look for it. To this end, they obtain a history of
symptoms and previous treatment attempts, and information about other potential
addictions.

Screening tests used include Internet addiction expert Kimberly Young’s Internet
Addiction Test (IAT) and multiple clinical interactions. Even so, diagnosing IA
can prove difficult because of the lack of rigorous diagnostic criteria. Experts
agree, however, that Internet activities become problematic when the person loses
his or her ability to control the use and when time spent online impairs daily
functions and jeopardizes relationships, employment, education, and personal
health. Studies generally indicate significant distress if Internet usage exceeds
twenty to twenty-five hours per week.

The first validated instrument to assess the disorder is the IA Test (IAT). This
questionnaire addresses the duration and frequency of online activities, job
productivity, ability to form new offline and online relationships, fear of life
offline, attempts to reduce Internet use, and many other behaviors. The person
answers each IAT question using a scale of 0 to 5. The higher the final score, the
greater the level of addiction. In addition to the severity of the addiction, the
therapist identifies the applications (such as gaming, pornography, and chat
rooms) that are most problematic for a particular person. The assessment is
completed by obtaining a history of earlier treatment attempts, identifying the
most detrimental types of usage, analyzing the family environment, and conducting
a motivational interview.

Treatment and Therapy

While China was one of the first countries to label IA as a clinical disorder,
hospitals and clinics all over the world have established treatment centers and
“detox” facilities for Internet addiction. The programs aim to reconnect
Internet-dependent youth and adults to the offline world by temporarily
eliminating all avenues for electronic communication or by gradually reducing
online time. In the United States, Young founded and opened the country's first
inpatient treatment program for IA in a hospital in 2013 at Bradford Regional
Medical Center in Pennsylvania. A ten-day program, the treatment includes
evaluation, therapy sessions, and seminars. A 2014 documentary titled Web
Junkie, screened at the Sundance Film Festival, examined problematic
Internet use in Chinese culture and offered a glimpse into one of the treatment
centers for IA.

Given society’s increasingly online nature, many therapists argue that traditional
abstinence treatment models may not yield
good outcomes, at least for some types of IA. Reorganization of the time periods
usually spent online, using timers and reminder cards, and setting goals may help
to limit the extent of online activities. Cognitive-behavioral therapy is often recommended as a first
therapeutic approach, in addition to couples therapy (especially for networking
and “Internet infidelity” addictions), cultivating hobbies, home maintenance
skill-building, and socializing opportunities.

The majority of individuals with Internet addiction have an additional psychiatric
diagnosis. In these persons, IA remains highly resistant to treatment and, in
turn, can render the coexisting psychiatric disorder more difficult to treat.
Consequently, any therapeutic attempt should consider the addict’s
comorbid conditions and address them
promptly.

Prevention

Despite providing undeniable benefits, the Internet can be detrimental when used inappropriately or obsessively. An expanding body of research aims to clarify the causes, evaluation methods, and treatment outcomes for this phenomenon, which threatens to reach epidemic proportions. Meanwhile, persons at risk of IA, especially youth, can benefit from safeguards that ensure appropriate Internet usage in schools and colleges. Setting limits for usage time is necessary for children and adolescents at home. Guardians and teachers should monitor and limit online time, especially among at-risk children with preexisting psychosocial difficulties.

South Korea has seen at least ten cardiopulmonary-related deaths in Internet cafés and one murder related to online gaming. Also, because hundreds of thousands of South Korean youths age six to nineteen years are affected by and require treatment for IA, that country has identified IA as a prominent public health issue and started training counselors to address the problem. Competent, aware, technology-savvy professionals now help to identify populations at risk and provide correct diagnoses and therapeutic strategies.

Bibliography

Aboujaoude, Elias, et al. “Potential Markers for Problematic Internet Use: A Telephone Survey of 2,513 Adults.” CNS Spectrums 11 (2006): 750–55. Print.

Braunstein, Danya. "Internet Use Disorder:
What Do Parents Need to Know?" Huffington Post.
TheHuffingtonPost.com, 12 Mar. 2013. Web. 30 Oct. 2015.

Cash, Hilarie, et al. "Internet Addiction:
A Brief Summary of Research and Practice." Current Psychiatry
Reviews 8.4 (2012): 292–98. Print.

Christakis, Dimitri A.
“Internet Addiction: A 21st Century Epidemic?” BioMed Central
Medicine 8 (2010): 61. Print.

Davidow, Bill. "Exploiting the Neuroscience of Internet Addiction." Atlantic. Atlantic Monthly, 18 July 2012. Web. 1 Dec. 2014.

Doan, Andrew P. Hooked on Games: The Lure and Cost of Video Games and Internet Addiction. Coralville: FEP Intl., 2012. Print.

Konnikova, Maria. "Is Internet Addiction a Real Thing?" New Yorker. Condé Nast, 26 Nov. 2014. Web. 1 Dec. 2014.

Young, Kimberly S. Caught in the Net. Hoboken: Wiley, 1998. Print.

Young, Kimberly S., and Cristiano Nabuco de Abreu, eds. Internet Addiction: A Handbook and Guide to Evaluation and Treatment. Hoboken: Wiley, 2011. Print.