Special Populations and Situations

PATIENTS TAKING MEDICATIONS FOR GENERAL MEDICAL CONDITIONS 

The focus of our text is the collaboration between therapist and physician and the use of medication to treat psychiatric symptoms. Although we use medications to treat mental illness, it is critical for the therapist to know that the use of certain medications for general medical conditions can cause psychiatric symptoms. The therapist must take a careful history, including knowledge of all of the medications that a person takes for any reason if it is possible that a medication is causing the mental health problem, the patient must be promptly referred to his or her physician for medication adjustment. 

One of the early modern medications seen to have psychiatric side effects is the antibiotic isoniazid (also known as INH). Tuberculosis (TB) is usu- 

Many other commonly used antibiotics can cause psychiatric symptoms, for example, clarithromycin (trade name, Biaxin)—which is frequently used to treat respiratory illness, ear infections, and skin infections—has been reported to cause mania in some patients. Metronidazole (trade name Flagyl), which is used to treat many types of infections—from parasites to vaginal infections and abscesses—has been reported to cause depression, agitation, confusion, hallucinations, and mania. Trimethoprim-sulfamethoxazole (trade names Bactrim and Septra)—which is used, for example, for bladder infections and sinus and ear infections—has been reported to cause delirium, psychosis, depression, and hallucinations in rare cases. The fluoroquinolone antibiotics—such as ciprofloxacin (trade name Cipro), levofloxacin (trade name Levaquin), ofloxacin (trade name Floxin), trovafloxacin (trade name Trovan), and others of this class—can cause psychiatric symptoms fairly often, including confusion, agitation, depression, insomnia, mania, paranoia, and psychosis. 

The benzodiazepines are used to treat anxiety and insomnia, but they can have the unintended effects of disinhibition, rage, hostility, depression, mania, paranoia, hallucinations, nightmares, and amnesia. 

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The above discussions about octant and antioctant behavior of cyclopropyl ketones has revealed that often there exists ambiguities in the interpretation of the CD spectra of these compounds. Therefore, sometimes the discussions of CD spectra of cyclopropyl ketones are a posteriori explanations of the experimental findings rather than a priori predictions of the outcomes of the experiments. This means that, in particular, the antioctant rule is viewed as a regularity and discrepancies have to be explained in terms of deviations from the foundations of that rule (such as conformer populations and/or special electronic situations of the chromophore). 

In pinacolic deamination we have a rather special situation, where reaction and rotation are of roughly comparable speeds, and hence both the populations and the reactivities of conformers affect the product ratio. Most interesting of all, perhaps, is the ingenuity that Collins used to show that this is so. 

In estuaries trace metal chemistry intensive studies have been devoted to the distribution of heavy metals between dissolved and suspended matter phase, the special influence of phytoplankton population and the complicated heavy metal concentration regulation in the estuarine water column affected by the salinity gradient and resuspension and solubilization phenomena. Detailed long-term studies are investigating the situation and its seasonal dependence in various parts of the Oosterscheldt in connection with effects exerted by the completion of the Dutch Delta Plan[42,43,44]. The influence of the dry and wet season have been studied in an African tropical estuary[44]. 

Hrupkin VI (2000) The organization of the urgent specialized surgical help to the population in extreme situations. In Medicine of accidents, the urgent and extreme medicine (in Russian), Moscow, pp 162-165... 

Phenolic and etherified softwood lignin model compounds were also successfully crosslinked at the meta positions. Special care was taken to assign the structure of the dimer (22) (Fig. 4C). With NMR-SPI (selective population inversion) techniques it was unevocably proved that the methylene linkage was situated at the 6-positions (13). 

The specimen should be properly dried, labeled, and identified by competent systematists or even specialists. Photographic records are helpful and sometimes must take the place of a plant specimen in situations when endangered or threatened species are involved and populations have already been vouchered (e.g., Hawaiian Lobeliaceae). Special arrangements must be made if the voucher for the molecular systematic study is unicate and will be carried out of the country, because most foreign countries require that the first set of plant specimens be deposited at the national or a local herbarium. The herbarium in which the vouchers are deposited (see Holmgren et a/.24) should be cited in subsequent publications. 

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