By J. Garik. The Johns Hopkins University.
Fearful of displeasing their partner and feeling inadequate as a function of it buy 15 mcg mircette with mastercard, men often would rather avoid sex rather than experience the humiliation and discomfort discount mircette 15mcg line. Ejaculatory incompetence is the opposite of premature ejaculation and refers to the inability to ejaculate inside the vagina. Men with this difficulty may be able to maintain an erection for 30 minutes to an hour, but because of psychological concerns about ejaculating inside a woman, they are not able to achieve orgasm. Usually they do not experience sexual intercourse as satisfying. Most of the men who suffer from retarded ejaculation can readily achieve orgasm through masturbation or in some cases through felatio. Many factors contribute to this condition, some of which are religious restrictions, fear of impregnating, and lack of physical interest or active dislike for the female partner. Primary erectile dysfunction refers to a man who has never been able to maintain an erection for purposes of intercourse either with a female or a male, vaginally or rectally. In secondary impotence a man cannot maintain or perhaps even get an erection, but has succeeded at having either vaginal or rectal intercourse at least one time in his life. The occasional failure to get an erection is not to be confused with secondary impotence. Familial, societal, and intrapsychic factors contribute to primary impotence. Some of the more common influences are (1) performance anxiety, (2) a seductive relationship with a mother, (3) religious beliefs in sex as a sin, (4) traumatic initial failure, (5) anger toward women, and (6) fear of impregnating a woman. These dysfunctions, according to noted sexologist, Dr. Helen Singer Kaplan, "are characterized by an inhibition in the general arousal aspect of the sexual response. On a psychological level there is a lack of erotic feelings. In other words, these women manifest a universal sexual inhibition which varies in intensity. The most common sexual complaint of women involves the specific inhibition of orgasm. Orgastic dysfunction refers solely to the impairment of the orgastic component of the female sexual response and not arousal in general. Nonorgastic women can become sexually aroused and in fact enjoy most other aspects of sexual arousal. With a combination of education and practice, most women can be taught to achieve orgasm. This relatively rare sexual disorder is characterized by a conditioned spasm of the vaginal entrance. The vagina involuntarily closes down tight whenever entry is attempted, precluding sexual intercourse. Otherwise, vaginismic women are often sexually responsive and orgastic with clitoral stimulation. Similar attitudes to those found in impotent males are often found in these women. Religious taboos, physical assault, repressed or controlled anger, and a history of painful intercourse all contribute to this dysfunction. Some women complain that they have no feelings on sexual stimulation, although they can enjoy the closeness and comfort of physical contact.
Psychiatric Confusional states (especially the elderly) with hallucinations mircette 15 mcg overnight delivery, disorientation order mircette 15 mcg mastercard, delusions; anxiety, restlessness, agitation; insomnia and nightmares; hypomania; exacerbation of psychosis. Neurological Numbness, tingling, paresthesias of extremities; incoordination, ataxia, tremors; peripheral neuropathy; extrapyramidal symptoms; seizures, alterations in EEG patterns; tinnitus; syndrome of inappropriate ADH (antidiuretic hormone) secretion. Anticholinergic Dry mouth and, rarely, associated sublingual adenitis; blurred vision, disturbances of accommodation, mydriasis, constipation, paralytic ileus; urinary retention, delayed micturition, dilation of the urinary tract. Allergic Skin rash, petechiae, urticaria, itching, photosensitization, edema of face and tongue. Hematologic Bone-marrow depression including agranulocytosis, eosinophilia; purpura; thrombo-cytopenia. Leukocyte and differential counts should be performed in any patient who develops fever and sore throat during therapy; the drug should be discontinued if there is evidence of pathological neutrophil depression. Gastrointestinal Nausea and vomiting, anorexia, epigastric distress, diarrhea, peculiar taste, stomatitis, abdominal cramps, black tongue. Endocrine Gynecomastia in the male; breast enlargement and galactorrhea in the female; increased or decreased libido, impotence; testicular swelling; elevation or depression of blood-sugar levels. Other Jaundice (simulating obstructive); altered liver function; weight gain or loss; perspiration; flushing; urinary frequency; drowsiness, dizziness, weakness, and fatigue; headache; parotid swelling; alopecia. Withdrawal Symptoms Though not indicative of addiction, abrupt cessation of treatment after prolonged therapy may produce nausea, headache, and malaise. Dosage should be initiated at a low level and increased gradually, noting carefully the clinical response and any evidence of intolerance. Lower dosages are recommended for elderly patients and adolescents. Lower dosages are also recommended for outpatients as compared to hospitalized patients who will be under close supervision. It is not possible to prescribe a single dosage schedule of Surmontil that will be therapeutically effective in all patients. The physical psychodynamic factors contributing to depressive symptomatology are very complex; spontaneous remissions or exacerbations of depressive symptoms may occur with or without drug therapy. Consequently, the recommended dosage regimens are furnished as a guide which may be modified by factors such as the age of the patient, chronicity and severity of the disease, medical condition of the patient, and degree of psychotherapeutic support. Most antidepressant drugs have a lag period of ten days to four weeks before a therapeutic response is noted. Increasing the dose will not shorten this period but rather increase the incidence of adverse reactions. Usual Adult Dose Outpatients and Office Patients -Initially, 75 mg/day in divided doses, increased to 150 mg/day. Maintenance therapy is in the range of 50 to 150 mg/day. For convenient therapy and to facilitate patient compliance, the total dosage requirement may be given at bedtime. Hospitalized Patients-Initially, 100 mg/day in divided doses. This may be increased gradually in a few days to 200 mg/day, depending upon individual response and tolerance. If improvement does not occur in 2 to 3 weeks, the dose may be increased to the maximum recommended dose of 250 to 300 mg/day. Adolescent and Geriatric Patients-Initially, a dose of 50 mg/day is recommended, with gradual increments up to 100 mg/day, depending upon patient response and tolerance.
Most therapists feel rather changed by the experience and believe their overall skills have been improved by meeting the challenge of working with this complex psychopathology order 15 mcg mircette fast delivery. Certain initial reactions are normative: excitement mircette 15mcg overnight delivery, fascination, over investment, and interest in documenting the panoply of pathology. These reactions are often followed by bewilderment, exasperation, and a sense of being drained. Many feel overwhelmed by the painful material, the high incidence of crises, the need to bring to bear a variety of clinical skills in rapid succession and/or novel combinations, and the skepticism of usually supportive colleagues. Many psychiatrists, sensitive to their patients isolation and the rigors of therapy, find it difficult both to be accessible and to remain able to set reasonable and non-punitive limits. They discover that patients consume substantial amounts of their professional and personal time. Often the therapist is distressed to find his preferred techniques ineffective and his cherished theories disconfirmed. It is difficult to feel along with the separate personalities, and to remain in touch with the "red thread" of a session across dissociative defenses and personality switches. Furthermore, the material of therapy is often painful, and difficult to accept on an empathic level. In the first, the psychiatrist retreats from painful affect and material into a cognitive stance and undertakes an intellectualized therapy in which he plays detective, becoming a defensive skeptic or an obsessional worrier over "what is real. Therapists who work smoothly with MPD patients set firm but non-rejecting boundaries and sensible but non-punitive limits. They know therapy may be prolonged, thus they avoid placing unreasonable pressures upon themselves, the patients, or the treatment. They are wary of accepting an MPD patient whom they do not find likable, because they are aware that their relationship with the patient may become quite intense and complex and go on for many years. As a group, successful MPD therapists are flexible and ready to learn from their patients and colleagues. They are comfortable in seeking rather than allowing difficult situations to escalate. They neither relish nor fear crises and understand them to be characteristic of work with MPD patients. Sometimes a structured environment is advisable for difficult phases of treatment; an occasional patient must seek treatment far from home. Such patients can be quite challenging, but if the hospital staff accepts the diagnosis and is supportive of the treatment, most can be managed adequately. An MPD patient rarely splits a staff splits itself by allowing individual divergent views about this controversial condition to influence professional behavior. MPD patients, experienced as so overwhelming as to threaten the sense of competence of that particular milieu. It is optimal for the psychiatrist to help the staff in matter-of-fact problem-solving, explain his therapeutic approach, and be available by telephone. The following guidelines emerge from clinical experience:A private room offers the patient a place of refuge and diminishes crises. Treat all alters with equal respect and address the patient as he or she wishes to be addressed. Insisting on a uniformity of name or personality presence on a uniformity of name or personality presence provokes crises or suppresses necessary data.
Comprehensive Information on Suicide After the suicide of a loved one or friend 15mcg mircette, you may feel shock discount mircette 15 mcg on line, disbelief and, yes, anger. They made a devastating choice that will impact the rest of your life, leaving you to pick up the pieces and deal with the aftermath. As yourself whether you love or hate the person you lost. Do you feel guilty about loving and missing your loved one? The question is, are you angry at the person who committed suicide or are you angry about the choice he/she made to end his/her life, leaving you behind with the legacy of pain and hurt? Chances are, you are angry at the choice, not the person - and it was your loved one who made that choice, not you. Had you known that he/she was going to commit suicide and known when/where, you would have done what you could to stop it. If you are burdening yourself with misplaced guilt, you are in effect confining yourself to an emotional prison. The bars of an emotional prison are made out of guilt, anger, bitterness and resentment. Learn about coping with loss, bereavement and grief after the death of a loved one. In our hearts, we all know that death is a part of life. In fact, death gives meaning to our existence because it reminds us how precious life is. After the death of someone you love, you experience bereavement, which literally means "to be deprived by death. Many people report feeling an initial stage of numbness after first learning of a death, but there is no real order to the grieving process. Some emotions you may experience include:These feelings are normal and common reactions to loss. You may not be prepared for the intensity and duration of your emotions or how swiftly your moods may change. You may even begin to doubt the stability of your mental health. But be assured that these feelings are healthy and appropriate and will help you come to terms with your loss. Remember: It takes time to fully absorb the impact of a major loss. You never stop missing your loved one, but the pain eases after time and allows you to go on with your life. Mourning is the natural process you go through to accept a major loss. Mourning may include religious traditions honoring the dead or gathering with friends and family to share your loss. Your grief is likely to be expressed physically, emotionally, and psychologically. For instance, crying is a physical expression, while depression is a psychological expression. It is very important to allow yourself to express these feelings. Often, death is a subject that is avoided, ignored or denied.
Institutions can make intimidation less likely by instituting policies discouraging bullying behavior generic mircette 15 mcg amex. Supervisors need help with learning sensitive ways to interact with employees buy generic mircette 15 mcg. Sometimes it may be as simple as cultural sensitivity and remembering to ask employees for feedback. Other times, particular individuals may need ongoing supervision or removal. Managers need to understand their management style and how subordinates perceive it. It is important to understand the line between tough but fair and imperious and capricious. One might look at adult bullying as a mechanism of social control. Employers, government officials, and others in authority wish to retain and increase their control and authority. If power and control are central to the existence of an organization, bullying and denial about the existence of bullying may be central to the stability of the organization. Rules, regulations and clear lines of authority are not the same as institutional bullying. His parents might single him out for harsher treatment than his siblings but make him feel too guilty to speak out. Paradoxically enough, such an individual might experience a strong sense of relief after joining the military. He would experience more overt yelling and more minute-to-minute control of his activities. In the armed forces he would report that he received fair and consistent treatment. The expectations were rigorous but clear and predictable. His superiors shouted at him, but they shouted at everyone else. Some superiors might be excessively harsh, but everyone knew who they were and knew what to expect. Intense, highly authoritarian situations sometimes lend themselves to bullying situations. If there are consistent predictable rules and no one is unfairly singled out, hierarchy does not necessarily mean bullying. In strict hierarchical situations, there should always be an avenue for individuals who feel that they are being treated unfairly or being asked to do unethical things. While there is no direct cause of physical abuse, there are factors that are known to increase the risk for physical abuse - both on the side of the perpetrator and on the side of the victim. It is worth noting that women abused in marriages suffer greater severity of abuse than those in other types of relationships. While no one type of man abuses women, in studies abusive men share certain characteristics. A Harvard University study showed convicted physically abusive men were found to, when compared to the average American man, commit more crimes as well as: Have lower levels of education and IQ; be less clear-thinkingBe more neurotic, anxious, nervous and defensiveBe less agreeable, optimistic, content and more irritableBe less extraverted, conscientious and openBe more excitable, moody, hasty and self-centeredThese characteristics of men who abuse women alone show that they are more likely to lash out when provoked. Commented the author of the Harvard study:"Instead of being ashamed, they seemed proud when they talked about kicking, biting, or slapping their wives and girlfriends 20 or more times in the past year.