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The published literature on couples therapy with patients with borderline personality dis- order consists only of reported clinical experience and case reports order decadron 1 mg on line. This clinical literature sug- gests that couples therapy may be a useful and at times essential adjunctive treatment modality 0.5 mg decadron amex, since inherent in the very nature of the illness is the potential for chaotic interpersonal relation- ships purchase 0.5 mg decadron. However, couples therapy is not recommended as the only form of treatment for patients with borderline personality disorder. Clinical experience suggests that it is relatively contrain- dicated when either partner is unable to listen to the other’s criticisms or complaints without becoming too enraged, terrified, or despairing (41). There is only one published study of family therapy for patients with borderline personality disorder (12), which found that a psychoeducational approach could greatly enhance commu- nication and diminish conflict about independence. Published clinical reports differ in their recommendations about the appropriateness of family therapy and family involvement in the treatment. Whereas some clinicians recommend removing the patient’s treatment from the family setting and not attempting family therapy (12), others recommend working with the patient and family together (42). Treatment of Patients With Borderline Personality Disorder 23 Copyright 2010, American Psychiatric Association. Clinical experience suggests that family work is most apt to be helpful and can be of critical importance when patients with borderline personality disorder have significant involvement with, or are financially dependent on, the family. The decision about whether to work with the family should de- pend on the degree of pathology within the family and strengths and weaknesses of the family members. Clinical experience suggests that a psychoeducational approach may lay the ground- work for the small subset of families for whom subsequent dynamic family therapy may be ef- fective. Family therapy is not recommended as the only form of treatment for patients with borderline personality disorder. Pharmacotherapy and other somatic treatments A pharmacological approach to the treatment of borderline personality disorder is based upon evidence that some personality dimensions of patients appear to be mediated by dysregulation of neurotransmitter physiology and are responsive to medication (43). Pharmacotherapy is used to treat state symptoms during periods of acute decompensation as well as trait vulnera- bilities. Although medications are widely used to treat patients who have borderline personality disorder, the Food and Drug Administration has not approved any medications specifically for the treatment of this disorder. Pharmacotherapy may be guided by a set of basic assumptions that provide the theoretical rationale and empirical basis for choosing specific treatments. Pharmacotherapy has demonstrated significant efficacy in many studies in diminishing symptom severity and optimizing functioning. Second, borderline personality disorder is characterized by a number of dimensions; treatment is symptom-specific, directed at particular behavioral dimensions, rather than the disorder as a whole. Third, affective dysregulation and impulsive aggression are dimensions that require particular attention because they are risk fac- tors for suicidal behavior, self-injury, and assaultiveness and are thus given high priority in se- lecting pharmacological agents. Fourth, pharmacotherapy targets the neurotransmitter basis of behavioral dimensions, affecting both acute symptomatic expression (e. Symptoms exhibited within three behavioral dimensions seen in patients with borderline personality disorder are targeted for pharmacotherapy: affective dysregulation, impulsive- behavioral dyscontrol, and cognitive-perceptual difficulties. For example, fluoxetine has been found to improve depressed mood, mood lability, rejection sensitivity, impulsive behavior, self-mutilation, hos- tility, and even psychotic features. Studies have been reported with fluoxetine (in doses of 20–80 mg/day), sertraline (in doses of 100–200 mg/day), and the mixed norepinephrine/sero- tonin reuptake blocker venlafaxine (in doses of up to 400 mg/day) (45). Empirical trials of tricyclic antidepressants have produced inconsistent results (50, 51). Pa- tients with comorbid major depression and borderline personality disorder have shown im- provement following treatment with tricyclic antidepressants. However, in one placebo- controlled study, amitriptyline had a paradoxical effect in patients with borderline personality disorder, increasing suicidal ideation, paranoid thinking, and assaultiveness (50). Since affective dysregulation is a dimension of temperament in patients with borderline per- sonality disorder and not an acute illness, the duration of continuation and maintenance phases of pharmacotherapy cannot presently be defined. Significant improvement in the quality of the patient’s coping skills and interpersonal relationships may be required before medication can be discontinued. Clinical experience suggests caution in discontinuing a successful antidepressant trial, especially if prior medication trials have failed. In one study of patients with borderline personality disorder (45), one-half of the patients who failed to respond to fluoxetine subsequently responded to sertraline. At this point, the use of a benzodiazepine should be considered, although there is little systematic research on the use of these medications in patients with borderline personality disorder. Use of benzo- diazepines may be problematic, given the risk of abuse, tolerance, and even behavioral toxicity.

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Read carefully buy discount decadron 1mg, and save all materials from your employer or union to know your options purchase decadron 0.5mg free shipping. You may have to make choices about your employer/union drug coverage and Medicare drug coverage: During your 7-month Initial Enrollment Period discount decadron 1 mg with amex, when you frst become eligible for Medicare (see page 18 for details) During Open Enrollment, between October 15–December 7 each year When your employer/union coverage changes or ends 53 Your Coverage Choices 4 I have Medicare and get drug coverage from a current or former employer or union (continued) Some important questions to answer before making a decision: Is your employer or union drug coverage creditable (on average, does it expect to pay at least as much as standard Medicare drug coverage)? If not, in most cases, you’ll have to pay a late enrollment penalty if you don’t join a Medicare drug plan when you’re frst eligible. Note: Keep materials your employer or union sends you that tell you your drug coverage is creditable. You may need to show it to your Medicare drug plan as proof of creditable prescription drug coverage if you decide to join a Medicare drug plan later. If you don’t enroll when you’re frst eligible, you may have to wait to join a Medicare drug plan until Open Enrollment, which is October 15–December 7. You may be able to do one of these: Keep your current employer or union drug coverage, and join a Medicare drug plan to get more complete drug coverage. If you join a Medicare drug plan later, you may have to pay a late enrollment penalty if your current drug coverage isn’t creditable. Words in Drop your current coverage and join a Medicare drug plan, or red are join a Medicare health plan that covers prescription drugs. You also may not be able to drop your employer or union drug coverage without also dropping your employer or union health coverage. If you drop coverage for yourself, you may also have to drop coverage for your spouse and dependents. Medicare doesn’t have information about how your current employer or union drug coverage will be afected by your enrollment in a Medicare drug plan, so talk to your employer or union’s benefts administrator before you make any decisions about your drug coverage. It’ll almost always be to your advantage to keep your current coverage without any changes. It’s almost always on pages to your advantage to keep your current coverage without any changes. Words in Because you have Medicaid, Medicare automatically gives you Extra Help red are with your Medicare drug plan costs. If you live in an institution (like a nursing home), in most on pages cases, you pay nothing for your covered drugs. If you haven’t joined a Medicare drug plan, Medicare will enroll you in a drug plan to make sure you have drug coverage (unless you already have certain retiree drug coverage). Medicare sends you a yellow notice telling you what drug plan you’re in and when your coverage starts. Check to see if the plan covers the drugs you take and includes the pharmacies you use. If you flled any covered prescriptions before your Medicare drug plan coverage started, you may be able to get back some of the money you spent. In limited cases, some state Medicaid programs may pay for drugs Medicare doesn’t cover. If you continue to qualify for Medicaid, Medicaid will still cover the other health care costs that Medicare doesn’t cover. If you aren’t sure whether you still qualify for Medicaid, call your State Medical Assistance (Medicaid) ofce. If you don’t join a Medicare drug plan on your own, Medicare will enroll you in a Medicare Prescription Drug Plan, to make sure you have coverage, unless you already have certain retiree drug coverage. Medicare sends you a yellow or a green notice letting you know when your coverage begins. You can switch to a diferent Medicare drug plan at any time as long as you continue to qualify for Extra Help. You can change your mind and join a Medicare drug plan at any time without paying a late enrollment penalty as long as you continue to qualify for Extra Help. Tis long-term care pharmacy usually contracts with (or is owned and operated by) your institution. Medicaid coverage, you pay nothing for your covered drugs afer Medicaid has paid for your stay for at least one full calendar month. Note: Institutions don’t include assisted living, adult living facilities, residential homes, or any kind of nursing home not certifed by Medicare or Medicaid.

Withdrawal Symptoms Nausea discount decadron 0.5 mg online, loss of appetite discount 0.5mg decadron visa, sweating generic 0.5mg decadron overnight delivery, tics, problems sleeping, and mood changes. Long-term Consequences of Ulcers and pain in the bladder; kidney problems; stomach pain; depression; fashbacks; Use and Health and poor memory. More research is needed to determine if behavioral therapies can be used to treat Behavioral Therapies addiction to dissociative drugs. Long-term Mental health problems, chronic cough, frequent respiratory infections, increased risk Consequences of Use for cancer, and suppression of the immune system. Pregnancy-related: Babies born with problems with attention, memory, and problem solving. In Combination with Increased heart rate, blood pressure; further slowing of mental processing and reaction time. Alcohol Withdrawal Symptoms Irritability, trouble sleeping, decreased appetite, anxiety. As of this writing, 25 states and the District of Columbia have legalized medical marijuana use, four states have legalized retail marijuana sales, and the District of Columbia has legalized personal use and home cultivation (both medical and recreational). Long-term Long-lasting confusion; depression; damage to the serotonin system; problems with Consequences of Use attention, memory, and sleep; increased anxiety, impulsiveness, and aggression; loss of and Health Effects appetite; and less interest in sex. Alcohol Withdrawal Symptoms Fatigue, loss of appetite, depression, and trouble concentrating. More research is needed to determine if behavioral therapies can be used to treat Behavioral Therapies addiction to hallucinogens. Anxiety, confusion, insomnia, mood problems, violent behavior, paranoia, Long-term hallucinations, delusions, weight loss, severe dental problems (“meth mouth”), Consequences of Use memory loss, intense itching leading to skin sores from scratching and high-risk for and Health Effects addiction. Issues Pregnancy-related: premature delivery; separation of the placenta from the uterus; low birth weight; lethargy; heart and brain problems. In Combination with Masks the depressant effect of alcohol, increasing risk of alcohol overdose; may Alcohol increase blood pressure and jitters. More research is needed to determine if behavioral therapies can be used to treat Behavioral Therapies addiction to over-the-counter cough/cold medicines. Dissociative drugs are hallucinogens that cause the user to feel detached from reality. Low doses: slight increase in pulse and breathing rate; increased blood pressure and Short-term Symptoms heart rate; shallow breathing; face redness and sweating; numbness of the hands or of Use feet; and loss of coordination. High doses: lowered blood pressure, heart rate, and breathing; nausea; vomiting; blurred vision; ficking up and down of the eyes; drooling; loss of balance; dizziness; violence; suicidal thoughts; seizures, coma, and death. Long-term Memory loss, problems with speech and thinking, depression, psychosis, weight loss, Consequences of Use anxiety. Opioids can cause euphoria and are sometimes used nonmedically, leading to overdose deaths. Short-term Symptoms For oxycodone specifcally: Pain relief, sedation, respiratory depression, constipation, of Use papillary constriction, and cough suppression. For fentanyl specifcally: Fentanyl is about 100 times more potent than morphine as an analgesic and results in frequent overdoses. Extended or chronic use of oxycodone containing Consequences of Use acetaminophen may cause severe liver damage. Abuse of opioid medications can lead and Health Effects to psychological dependence. Older adults: higher risk of accidental misuse or abuse because many older adults have Other Health-related multiple prescriptions, increasing the risk of drug-drug interactions, and breakdown of Issues drugs slows with age; also, many older adults are treated with prescription medications for pain. In Combination with Dangerous slowing of heart rate and breathing leading to coma or death. Alcohol Withdrawal Restlessness, anxiety, muscle and bone pain, insomnia, diarrhea, vomiting, cold fashes Symptoms with goose bumps, and muscle tremors. Treatment Optionsiv • Methadone Medications • Buprenorphine • Naltrexone (oral and extended-release injectable) Behavioral therapies that have helped treat addiction to heroin may be useful in Behavioral Therapies treating prescription opioid addiction. In Combination with Dangerous slowdown of heart rate and breathing, coma, and death. Alcohol Must be discussed with a health care professional; barbiturate withdrawal can Withdrawal Symptoms cause a serious abstinence syndrome that may even include seizures.

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Such transport may also be used to convey: a) correspondence buy decadron 0.5mg on-line, lists and reports exchanged between the Central Information Agency referred to in Article 123 and the National Bureaux referred to in Article 122 generic 1mg decadron visa; b) correspondence and reports relating to prisoners of war which the Protecting Power generic 0.5 mg decadron otc, the International Committee of the Red Cross or any other body assisting the prisoners, exchange either with their own delegates or with the Parties to the conflict. These provisions in no way detract from the right of any Party to the conflict to arrange other means of transport, if it should so prefer, nor preclude the granting of safe-conducts, under mutually agreed conditions, to such means of transport. In the absence of special agreements, the costs occasioned by the use of such means of transport shall be borne proportionally by the Parties to the conflict whose nationals are benefited thereby. Mail shall be censored only by the despatching State and the receiving State, and once only by each. The examination of consignments intended for prisoners of war shall not be carried out under conditions that will expose the goods contained in them to deterioration; except in the case of written or printed matter, it shall be done in the presence of the addressee, or of a fellow-prisoner duly delegated by him. The delivery to prisoners of individual or collective consignments shall not be delayed under the pretext of difficulties of censorship. Any prohibition of correspondence ordered by Parties to the conflict, either for military or political reasons, shall be only temporary and its duration shall be as short as possible. Theses requests and complaints shall not be limited nor considered to be a part of the correspondence quota referred to in Article 71. Even if they are recognized to be unfounded, they may not give rise to any punishment. Prisoners’ representative may send periodic reports on the situation in the camps and the needs of the prisoners of war to the representatives of the Protecting Powers. In camps for officers and persons of equivalent status or in mixed camps, the senior officer among the prisoners of war shall be recognized as the camp prisoners’ representative. In camps for officers, he shall be assisted by one or more advisers chosen by the officers; in mixed camps, his assistants shall be chosen from among the prisoners of war who are not officers and shall be elected by them. Officer prisoners of war of the same nationality shall be stationed in labour camps for prisoners of war, for the purpose of carrying out the camp administration duties for which the prisoners of war are responsible. These officers may be elected as prisoners’ representatives under the first paragraph of this Article. In such a case the assistants to the prisoners’ representatives shall be chosen from among those prisoners of war who are not officers. Every representative elected must be approved by the Detaining Power before he has the right to commence his duties. In all cases the prisoners’ representative must have the same nationality, language and customs as the prisoners of war whom he represents. Thus,prisoners of war distributed in different sections of a camp, according to their nationality, language or customs, shall have for each section their own prisoners’ representative, in accordance with the foregoing paragraphs. In particular, where the prisoners decide to organize amongst themselves a system of mutual assistance, this organization will be within the province of the prisoners’ representative, in addition to the special duties entrusted to him by other provisions of the present Convention. Prisoners’ representatives shall not be held responsible, simply by reason of their duties, for any offences committed by prisoners of war. Prisoners’ representatives may appoint from amongst the prisoners such assistants as they may require. All material facilities shall be granted them, particularly a certain freedom of movement necessary for the accomplishment of their duties (inspection of labour detachments, receipt of supplies, etc. Prisoners’ representatives shall be permitted to visit premises where prisoners of war are detained, and every prisoner of war shall have the right to consult freely his prisoners’ representative. All facilities shall likewise be accorded to the prisoners’ representatives for communication by post and telegraph with the detaining authorities, the Protecting Powers, the International Committee of the Red Cross and their delegates, the Mixed Medical Commissions and with the bodies which give assistance to prisoners of war. Prisoners’ representatives of labour detachments shall enjoy the same facilities for communication with the prisoners’ representatives of the principal camp. Such communications shall not be restricted, nor considered as forming a part of the quota mentioned in Article 71. Prisoners’ representatives who are transferred shall be allowed a reasonable time to acquaint their successors with current affairs. In case of dismissal, the reasons therefor shall be communicated to the Protecting Power. However, no proceedings or punishments contrary to the provisions of this Chapter shall be allowed. If any law, regulation or order of the Detaining Power shall declare acts committed by a prisoner of war to be punishable, whereas the same acts would not be punishable if committed by a member of the forces of the Detaining Power, such acts shall entail disciplinary punishments only. In no circumstances whatever shall a prisoner of war be tried by a court of any kind which does not offer the essential guarantees of independence and impartiality as generally recognized, and, in particular, the procedure of which does not afford the accused the rights and means of defence provided for in Article 105.

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