Thursday, January 30, 2020
Childhood and Adolescent Depression and the Risks of Suicide Essay Example for Free
Childhood and Adolescent Depression and the Risks of Suicide Essay Introduction Problem and its Background            One of the most common reasons for referral of children and adolescents to mental health professionals is suspected depression. There are continues debate as to whether childhood and adolescent depression are a reflection of normal variation in mood. It is reasonable for the primary care physician to view childhood depression as a constellation of factors that forms a syndrome. This constellation consists of a persistent mood disorder and dysfunctional behavior that intrudes and distorts the child’s day-to-day activities (Gottlieb Williams, 1991 p. 1). A firm denial gave way into a general and strong conviction about significance of depressive syndromes in childhood and adolescents, and of the implications throughout the life course. The realization of the problem occurrence made it possible for the therapeutic interventions and prevention programs to be developed and set up for depressive children, and to have these programs sponsored and evaluated on a scientific perspective. Various factors have facilitated the progression of this study concerning the recognition of childhood depression. Society is approached with enormous cost of untreated childhood depression later on in life (Corveleyn etal, 2005 p.165).            The concept of a depressive syndrome that is distinct from the broad class of childhood onset emotional disorders has been linked to incidence of suicidal rates worldwide. The condition of such incidence is becoming evidently alarming as the number of suicidal rate continue.            The treatment of such depressive states range from pharmacologic drugs up to psychological modifications and therapies, such as behavioral, peer and group focused groups, etc. With the serious nature of childhood / adolescent depression, it is crucial that treatments with known efficacy and more than transitory effects be provided promptly and skillfully (Maj Sartorius, 2002 p.292). Scope and Limitations            The treatment procedures and the condition of health care management for the case of childhood and adolescent depression are the primary subjects of the study. The concept on treatment procedure involves the pharmacologic, medical and psychological interventions that are absolutely necessary in the health care management of such condition. The study shall cover the discussion of depressive condition of the childhood and adolescent age group. Diagnostic procedures and issues shall be tackled in this research in order to portray possible conflicts and difficulties that occur in diagnosing the condition. The neurobiology of the depressive state shall be elaborated utilizing psychophysiology of the disorder, and linked to probable external physiological occurrences. Lastly, since the study focuses on therapy and medication as treatment modalities, the following methods and means of treatment shall be involved in the study. The following shall be the objectives of the over-all study. To be able to define, discuss and elaborate the conditions involved in the occurrence of depression in adolescent and childhood stages To be able to provide and tackle the treatment procedure as the center scope of study, accompanied by the issues, physiology and specific drugs involved in depression health care management. Discussion            Cases of despondency and depression in children and adolescents were reported as early as the seventeenth century. Prior to the 1970s, however, little attention was paid to depression in youth (Hersen Hasselt, 2001 p.243). The study on depression had been more inclined to adulthood depression and not on childhood and adolescence.            Depression among children and adolescents is relatively common, enduring, and recurrent disorder that has an adverse impact on a youngster’s psychosocial development and in some cases is associated with self-destructive and life-threatening behaviors. Depressive disorders during childhood and adolescence may be more virulent and of longer duration than depressive disorders in adults. Depressive disorders during childhood are a risk factor for the development of additional psychological disturbances and for the development of depressive disorders later in life. The number of youths who are experiencing depressive disorders is increasing at the same time that the age of onset is decreasing (Mash Barkley, 2006 p.336).            Depression can be conceptualized both as a dimension and as a category. Epidemiological studies suggest that juvenile depression is a continuum that is associated with problems at most levels of severity. According to Oregon Adolescent Depression Project, the level of psychosocial impairment increased as a direct function of the number of depressive symptoms. Moreover, in line with studies of adults, much of the morbidity associated with depression occurred in the â€Å"milder†but more numerous cases of minor depression. Such results suggest that even mild forms of adolescent depression are a risk factor for depression in early adulthood (Rutter Taylor, 2002 p.463).            In recent years, increased attention has been given to evidence-based psychosocial and pharmacological interventions for depressed youth. The need to highlight what we know about treatment is underscored by the fact that most depressed youth do not receive treatment. However, as knowledge about treatments for youth depression has increased, the rate of treatment appears to have developed. Although depression among youth is treated more often, it is not clear that standard practice is effective at alleviating depressive symptoms or preventing recurrence. Moreover, there is a bias toward the utilization of pharmacologic drugs and extremely brief psychosocial interventions (Gotlib Hammen, 2002 p.441). Diagnostic Issues involved in Depression            The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision groups mood disorders into two categories: depressive disorders and bipolar disorders. Both types of disorders are characterized by depressive episodes. For a diagnosis of depressive disorder, the child must be experiencing a mood disturbance for a period of at least 2 weeks, and the symptoms must be present more often than not. At least four of the following symptoms must be present during the same period (Mash Barkley, 2006 p.337): Significant, unintentional weight gain or loss Insomnia or hypersomnia Psychomotor retardation or agitation fatigue or loss or energy feelings of worthlessness or extreme guilt Diminished concentration pr ability to make decisions Recurring thoughts of death, suicidality, or suicide attempts In depressed preadolescents and adolescents, a lack of perceived personal competence was associated with depression; however, in adolescents, the more abstract concept of contingencies is also related to depression (Mash Barkley, 2006 p.338). Confusion sometimes arises in the childhood depression field, as it does with adult depression, because of different usages of the term â€Å"depression†and associated differences in methods of assessment. Moreover, the Diagnostic and Statistical Manual of Mental Disorders, which is the primary reference of psychiatric diagnosis, frequently changes. One example is in studies of childhood and adolescent depression, the term is variously used to identify depressed mood, a constellation of mood and other symptoms forming a syndrome, or a set of symptoms meeting official diagnostic criteria for depressive disorder. The usage of such term connotes various meaning, such as depression as a symptoms (lonely, fear impulses, guilt, etc.) and depression as a syndrome (comprises clusters of various signs and symptoms) (Mash Barkley, 2003 p.336). Neurobiology of Childhood Adolescent Depression            Biologic studies in children are difficult to implement since they often require several blood draws, subjects remaining still more long periods of time, and the overall cooperation of the children and adolescents. Three types of investigation have provided information on possible developmental differences in the neurobiology of depression. The first is the study of Cortisol secretion, measured by investigations such as the dexamethasone suppression test (Rapoport, 2000 p.230).            Studies of neurotransmitters in depressed adults have focused on norepinephrine, serotonin, and acetylcholine. Serotonin regulation studied in adults with depression reported that in response to L-5hyroxytrytophan in 37 pre-pubertal depressed children secreted less Cortisol and more prolactin than age-matched and gender-matched normal controls, suggesting a deregulation of central serotonergic systems in childhood depression.            Abnormalities of the hypothalamic pituitary-thyroid axis and the hypothalamic pituitary-growth hormone axis have been reported in depression in adults. However, Cortisol hypersecretion, as measured by repeated samples over a 24-hour period or by nocturnal sampling, has not been identified in depressed children and adolescents although adolescent showed a Cortisol elevation at the approximate time of sleep onset (Coffey, 2006 p.266).            The second type of developmentally informative investigation is the study of sleep. Polysomnographic studies of depressed children and adolescent have tended to demonstrate abnormalities of sleep, including shortened rapid eye movement (REM) latency and reduced slow wave sleep. These generally positive results of polysomnographic studies with children have shown few differences (Rapoport, 2000 p.231).            The third type of developmentally informative investigation is the study of growth hormone. A variety of pharmacological challenge agents that stimulate release of growth hormone have been studied in depressed adolescents and children. Interestingly, the results with adolescents have been negative in terms of slow blunted growth hormone response to provocative stimuli. However, some studies have reported high levels of growth hormone in adolescents with major depression. Moreover, pubertal children both during depressive episode and after recovery have demonstrated blunted growth hormone response to provocative stimuli (Rapoport, 2000 p.231). Psychopharmacology: Antidepressants (SSRIs)            Special considerations arise in treating children and adolescents with antidepressants. Empirical data on antidepressants in young patients are quite limited. Psychiatrists, faced with depriving children of potentially effective medication or prescribing medication or prescribing medications â€Å"Off Label,†need information on which to base treatment decisions, and efforts are underway to promote research in this area. Clinically significant differences in pharmacokinetics and possibly pharmacodynamics between adults and younger patients can also complicate treatment. Moreover, younger patients may also be more sensitive to adverse effects of medications (Preskorn, 2004 p.356).            The antidepressant drugs are a heterogeneous group of compounds that, in adults, have bee found to be effective in the treatment of major depressive disorder. This particular pharmacologic intervention is also utilized in adolescent and children with major depression; although, there have been no studies that validate the appropriateness of such medications. The following are considered as the major treatment of adolescent depression, specifically Tricyclic Antidepressants and (SSRI) Selective-serotonin reuptake inhibitors (Rossenberg Ryan, 1998 p.28).            Tricyclic antidepressants (TCAs) have long been the first-line antidepressants used by most clinicians for adults because of their established efficacy, safety, and ease of administration, but they have been less successful in the treatment of child and adolescent conditions. The mechanism by which TCAs are effective in the treatment of adult depression and other disorders has not been clearly established. There is, however, evidence that these agents affect monoamine neurotransmitter systems in the central; nervous system, such as serotonin and norepinephrine (Rossenberg Ryan, 1998 p.28-29). The TCAs inhibit the reuptake of norepinephrine and serotonin, potentiating their action. It has been suggested that antidepressants work by increasing noradrenergic and/or serotonergic transmission, compensating for a presumed deficiency. Controlled studies failed to demonstrate that TCAs are superior to placebo in the treatment of childhood and adolescent depression (Rossenberg Ryan, 1998 p.28-29).            Since serotonin is also implicated in the etiology and maintenance of affective disorders, particularly depression; hence, the use selective serotonin reuptake inhibitor (SSRIs) is possible. SSRIs prevent the re-uptake of serotonin, which poses significant therapeutic value although has been shown to be less effective in therapeutic trials in children (Mash Barkley, 2006 p.384). The SSRIs are now first-line agents for treating child and adolescent depression. The newer antidepressants, such as bupropion and mirtazapine, do not have an adequate empirical base with children; however, they are sometimes used as second-line treatments for those youths who do not respond to SSRIs. Thus far, none of the SSRIs has produced irreversible damage in children and adolescents. However, as the SSRIs gained wide use with depressed adolescents, concerns emerged about the safety of this class of medications. Reports suggested that they were responsible for increased suicidal ideation and behavior among youths (Mash Barkley, 2006 p.384). In 2003, the British Medicines and Healthcare products Regulatory Agency (MHRA) concluded that most of the SSRIs do not show benefits exceeding their risks of suicidal ideation, and thus should not be prescribed in the child and adolescent population (Mash Barkley, 2006 p.384).            If the adolescent fails to respond to any SSRI, then switching to a different class of antidepressant is recommended. At present, no data support the use of one agent over another. Therefore, whether the clinician chooses a TCA, nefazodone, or venlafaxine should be based on clinical experience. Other factors to consider for a given adolescent are medication side effects, medical conditions, previous medication trials, comorbid psychiatric conditions, and familial history of a positive response to particular antidepressants (Esman, 1999 p.222). Other classes of antidepressants are fluoxetine, setraline, paroxetine, fluvoxamine, venlafaxine, bupropion, trazodone, and nefazadone. As major depression has a high recurrence rate, it is recommended that pharmacologic treatment continue for a minimum of six months achieving resolution of symptoms. Medication discontinuation should be accomplished gradually, with a slow, stepwise reduction in dosage over a two- or three-month period. The health care providers should carefully monitor the adolescent for withdrawal syndromes and reemergence of depressive symptoms (Esman, 1999 p.222). Relationship to Suicide Rates            Suicidal thoughts and attempts are among the diagnostic criteria for major depression. Suicidal ideation is quite common, and has been reported in more than 60% of depressed preschoolers, preadolescents, and adolescents. Actual suicidal attempts also may occur, at rates that appear to be higher among depressed adolescents than among depressed adults (Mash Barkley, 2003 p.336).            Studies have shown consistently high rates of comorbid psychiatric disorders in depressed children and adolescents. The comorbidity rate in children and adolescents with depression has been reported to be 80% to 95%. The most common comorbid disorders in adolescents with depression are anxiety disorders, with rates ranging from 40% to 50%. Moreover, substance abuse frequently co-occurs with depression. Adolescents with major depression are at risk for impairment in school performance and interpersonal relationships, which may interfere with achievement of appropriate developmental tasks. Suicidal behavior is a common sequela. A 10-yar follow-up of depressed child and adolescent outpatients found that 4.4% committed suicide. Mood disorder, prior to suicide attempt, and substance abuse are major risk factors for adolescent suicide (Esman, 1999 p.216).            Depressed and suicidal children and adolescents are often not identified. Identification of children and adolescents who express suicidal ideation or suicidal acts is crucial since such symptoms are recurrent and strong predictors of youth suicide. Other risk factors for youth suicide behavior have been described including family, other environmental and biological factors. Notably, family history of suicidal behavior increases risk for youth suicide (Rapoport, 2000 p.231). Reference Coffey, E. C. (2006). Pediatric Neuropsychiatry. Lippincott Williams Wilkins. Corveleyn etal, J. (2005). The Theory and Treatment of Depression: Towards a Dynamic Interactionism Model. Routledge. Esman, A. H. (1999). Adolescent Psychiatry: Developmental and Clinical Studies. Routledge. Gotlib, I., Hammen, C. L. (2002). Handbook of Depression. Guilford Press. Gottlieb, M. I., Williams, J. (1991). Developmental-behavioral Disorders: Selected Topics. Springer. Hersen, M., Hasselt, V. B. (2001). Advanced Abnormal Psychology. Springer. Maj, M., Sartorius, N. (2002). Depressive Disorders. John Wiley and Sons. Mash, E. J., Barkley, R. A. (2006). Child Psychopathology. Guilford Press. Mash, E. J., Barkley, R. A. (2006). Treatment of Childhood Disorders. Guilford Press. Preskorn, S. (2004). Antidepressants: Past, Present, and Future. Springer. Rapoport, J. L. (2000). Childhood Onset of Adult Psychopathology: Clinical and Research Advances. American Psychiatric Pub., Inc. Rossenber, D., Ryan, N. (1998). Pocket Guide for the Textbook of Pharmacotherapy for Child and Adolescent Psychiatric Disorders. Psychology Press. Rutter, M., Taylor, E. A. (2002). Child and Adolescent Psychiatry. Blackwell Publishing.
Wednesday, January 22, 2020
The Battle Between Heart and Conscience in Mark Twains Huckleberry Fin
The Battle Between Heart and Conscience in Mark Twain's Huckleberry Finn     Society can have a huge impact on an individual's moral growth. Sometimes the impact is positive but other times the learned habits and set morals of society have a negative effect. In Mark Twain's novel, The Adventures of Huckleberry Finn, the main character, Huck, struggles with what society teaches him and with what he knows to be good and true. During different conflicts concerning either the king and duke, various women or Jim, Huck's sound heart wins the battle over his conscience, which the reader knows to be ill-formed. Right from the first time Huck hears the story of the king and duke's amazing pasts Huck knows, "these liars warn't no kings nor dukes at all" (Twain 166). However, Huck also does not want to make any trouble so he goes along with the lie. Society may have taught Huck's conscience that lying is wrong but in this case the truth would have caused unnecessary danger and havoc. Another time that Huck sees right through the king and duke, is during the Wilks' inheritance situa...
Tuesday, January 14, 2020
Reinvest in R&D
To what extent is it necessary for companies to reinvest profits in research and development? In the past 20 years, intellectual property has been highly respected in the world. In other words, there has been a majority of companies that paid more and more attention with regard to the performance of department of research and development (R&D), and especially for technologic corporations that own the fast product-life-cycle. Despite the fact that some people will argue whether reinvesting more source in research and development is successful strategy or not, an important issue for management studies would be normally discussed to be to what extent companies have to reinvest in research and development. This essay will seek to discuss some solutions of a number of large technologic companies form different views and also try to find the optimum one. Firstly, there are two solutions will be discussed. Secondly , They will be compared each other. In the end, the essay could summarize that which solution is the best. One way of solving the problem would be to undoubtedly reinvest a significant amount of profits in R&D, even if it may occupy more 15% of the revenue. In fact, John Madden (2010) emphasized that â€Å"Most successful companies reinvest 3-6% of net sales into research and development†and some companies in the specific industries would arrive at 15% of revenue into R&D. In addition, according to Chesbrough, H. W. (2006: xix), â€Å"Internal R&D was viewed as a strategic asset and even barrier to competitive entry in many industries†. In particular, those enormous technologic corporations with considerable capitals and extended schemes of R&D could compete, such APPLE, IBM and HTC. Therefore, it could be said that the solution entirely agree R&D is a vital cycle and asset in developing company. Evidence indicates that most products of technologic corporations be probably own shorter product-life-cycle. As a result, R&D will allow the company to create new products continually. Following that, company makes a majority of profit form these new products. For example, ADES stated that more than 60% of revenue of Xerox earn from the new products that launched in the past two years. Moreover, investing R&D oneself will control the main techniques and put up the higher barriers to control competitor’s entrance. For instance, Apple enterprise continually devotes to discover new technology to take out enormous intellectual patents and then raise their competitiveness. On the other hand, firms need to spend huge time money and manpower to participate in the process of R&D and some companies that want to reinvest in R&D must ante up bigger risk. Unfortunately, this investment may be frequently sunk costs. A number of businesses fail and go bankrupt in the bad condition. On balance, it is not only unsuitable methods for all enterprise, but it is not unique answer. Another way to solving the problem would be to stop any investment of R&D. This is to say, the corporations do not have to reinvest any resource into R&D and also do not need to organize the department of R&D oneself. However, it does not mean that they must not acquire any new techniques and products of next generation. They just utilize some methods or strategies to gain a number of technology what they want, such as technical authorization, technical transfer, outsource R&D, hire consultants and enterprise merger and acquisition. To a certain extent, there are probably noticeable advantages in this solution. Firstly, the firms just spend lower cost to gain new technical knowledge and then finish the mission of R&D. Secondly, this should be able to compress the time of researching new technical knowledge and also shorten in the procedure of developing the coming products. Furthermore, the brilliant product could be successfully launched at the good timing. In contrast, evidence indicates that the strategy of utilizing outsource seem to be marked difficult for how to execute deeply it. There is one instance of enterprise merger and acquisition of exploring the post-acquisition integration risks. According to Chen, C. H. and Shih, H. T. (2008), Whether the mission or vision of the both company is the same or not will be a vital factor. The reason totally affects the success of an acquisition. In addition, how to find out and to purchase the primary techniques is also an obvious problem. Clearly, this method has some strengths and weaknesses, thus below two will be evaluated as follows. Both methods have probably offered most corporations to solve the R&D problem. Similarly, all of them agree that the importance of R&D and utilizing new techniques in the company. Moreover, there are also the similar risks in both ways. Tassey (1997) stated that uncertainty of R&D is â€Å" the inability to estimate the reward and risk. †On the other hand, one of their different points is the speed of exploiting new product. This would seem to be the way of cooperating other R&D institutions. The other one could be whether they can control the key techniques to persistently maintain core competitiveness of the enterprise or not. According to Porter (2004:164), â€Å"Technological change is one of the principal driver of competition. It plays a major role in industry structural. †technological As for that, organizing own R&D might be an appropriate way. Overall, how to keep the main technical knowledge is a very vital around growing energy and supporting stable profit of most firms. Despite the fact that outsourcing can help corporations acquire rapidly knowledge, reinvesting income in R&D by themselves is apparently better. Obviously, every method has different characters to solve the R&D problem. So people should understand the situation of the companies themselves before choosing the solution. All in all, it is difficult to clearly identify what extent is suitable to plow revenue in R&D related to the large technologic companies to and decide the best way to solve this problem. However, Here there are two methods to solve the problem in this essay. The best way seems to be the first one. It could be said that should do their own individual R&D seem to be one of competitive capabilities in a firm, and then it may affect the growth of a company in the future, such as launching latest production and recognizing new marking. Nevertheless, they should estimate the overall risk before deciding that. References: ADES (2008) Invest in R&D, It’s vital for your business’ survival. (school practitioner). ADESBLOG Weblog [online] 5th March. Available from: http://www. adesblog. com/2008/03/05/invest-in-research-and-development/. [Accessed 22/8/11]. CHEN, C. H. and SHIH, H. T. 2008) Mergers and Acquisitions in China: Impacts of WTO Accession. United Kingdom: Edward Elgar Publishing Limited. CHESBROUGH, H. W. (2006) Open Innovation: The New Imperative for Creating And Profiting from Technology. United States of America: Harvard Business School Publishing Corporation. MADDEN, J. (2010) Research and Development- reinvestment in innovation [www] Airborn Electronics. Ava ilable from: http://www. airborn. com. au/spec/econ. html [Accessed 22/08/11]. PORTER, M. E. (2004) Competitive Advantage. New York: Free press. TASSEY, G. (1997) The Economics of R&D Policy. United States of America: Quorum books.
Sunday, January 5, 2020
Do Bugs Crawl in Peoples Ears
Ever have a persistent itch in your ear and wonder if something is in there? Is it possible theres a bug in your ear? This is a topic of considerable concern for some people (just slightly less concerning than whether we swallow spiders in our sleep). Yes, bugs do crawl in peoples ears, but before you launch into a full-scale panic attack, you should know that it doesnt occur very often. Although a bug crawling around inside your ear canal can be very uncomfortable, it isnt usually life-threatening. Cockroaches Crawl into Peoples Ears Most Often If you have cockroaches in your home, you might want to sleep with earplugs in, just to be on the safe side. Cockroaches crawl into peoples ears more often than any other bug. They arent crawling in ears with ill intent, though; theyre simply looking for a cozy place to retreat. Cockroaches exhibit positive thigmotaxis, meaning they like to squeeze into small spaces. Since they also prefer to explore in the dark of night, they can and do find their way into the ears of sleeping humans from time to time. Flies and Maggots in Peoples Ears Coming in a close second to cockroaches were flies. Almost everyone has swatted away an annoying, buzzing fly at some point in their lives, and thought nothing of it. While gross and annoying, most flies arent going to cause any harm if they get in your ear. However, there are some that can cause health problems, most notably the screwworm maggot. These parasitic larvae feed on the flesh of their animal (or human) hosts. Oddly, one bug that tends not to crawl into peoples ears is the earwig, which was so nicknamed because people thought it did. What to Do If You Think Theres a Bug in Your Ear Any arthropod in your ear is a potential medical concern because it can scratch or puncture your eardrum or in extreme cases, may cause an infection. Even if you succeed in removing the critter, its wise to follow-up with a visit to the doctor to be sure your ear canal is free from any bug bits or damage that might cause problems later. The National Institutes of Health offers the following advice for treating insects in the ear: Do not put a finger in the ear, since this may make the insect sting.Turn your head so that the affected side is up, and wait to see if the insect flies or crawls out.If this doesnt work, try pouring mineral oil, olive oil, or baby oil into the ear. As you pour the oil, pull the ear lobe gently backward and upward for an adult, or backward and downward for a child. The insect should suffocate and may float out in the oil. AVOID using oil to remove any object other than an insect, since oil can cause other kinds of objects to swell.Even if an insect appears to come out, get medical attention. Small insect parts can irritate the sensitive skin of the ear canal.
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