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By B. Phil. Huston-Tillotson College. 2018.

Early data shows that lamotrigine (Lamictal) may be safe for treating bipolar women who are pregnant generic 20mg atorlip-20 overnight delivery. As the use of anticonvulsants to treat bipolar illness has grown over the past decade generic atorlip-20 20mg free shipping, so has the number of women successfully treated with these medications who have questions about whether they should discontinue these drugs before they attempt to conceive buy atorlip-20 20 mg without a prescription, or what to do if they are already pregnant discount 20mg atorlip-20 fast delivery. The anticonvulsants that have been most widely used for bipolar illness are sodium valproate and carbamazepine, and more recently, gabapentin (Neurontin), lamotrigine (Lamictal), oxcarbazepine (Trileptal), and tiagabine (Gabitril). Until recently, there have been few reproductive safety data available on the newer anticonvulsants. Many women and their physicians are caught in a particularly vexing bind because two of the mainstays of bipolar therapy, lithium and sodium valproate (Depakote), are known teratogens, though the teratogenicity of these two compounds is particularly different. The risk associated with first-trimester exposure ranges from a relatively modest 0. The latter is based on recent findings from the Antiepileptic Drug Registry at Massachusetts General Hospital (Am. But the data that are accumulating on lamotrigine, approved in June for maintenance treatment of bipolar disorder, provide some welcome news for reproductive-aged women with bipolar disorder. An interim report on cases collected by the lamotrigine pregnancy registry maintained by the manufacturer, GlaxoSmithKline, since September 1992 indicates that the drug does not appear to be teratogenic. The report does note, however, that the sample size is not large enough to make definitive conclusions. As of March, the pregnancy registry had collected information on more than 500 first-trimester exposures in women treated with Lamictal for bipolar illness and for epilepsy, which did not demonstrate an increase in major birth defects associated with first-trimester exposure, supporting earlier reports. The risk of teratogenicity was significantly increased with first-trimester exposure to the combination of lamotrigine and sodium valproate (more commonly used for epilepsy), but not with lamotrigine monotherapy: Among the 302 pregnancies exposed to monotherapy in the first trimester, there were 9 (3%) major birth defects, compared with 7 (10. The clinical implications of these long-awaited data on lamotrigine are relatively clear and present an opportunity to navigate the tricky course of maintaining euthymia across pregnancy and minimizing exposure to drugs that might be harmful to the fetus. For example, sodium valproate can be deferred for a medicine such as lamotrigine in some patients, particularly those who do not respond to or who have not tolerated lithium. Although lamotrigine has not demonstrated efficacy for the treatment of acute mania, the anticonvulsant can be combined with medicines that are helpful in treating this phase of bipolar disorder. Such adjunctive medicines include high-potency typical antipsychotics like haloperidol or trifluoperazine. Unfortunately, the reproductive safety data available for the newer atypical antipsychotic olanzapine (Zyprexa)--efficacious for both acute mania and for prophylaxis against recurrent mania--are exceedingly sparse. Clinicians are left with the task of trying to minimize exposure to medicines we know very little about, such as olanzapine, and to medicines we know a lot about that appear to be particularly harmful to the fetus, such as sodium valproate (Depakote). Lamotrigine is the only one of the newer anticonvulsants for which there are enough exposed cases to allow for some reliable quantification of teratogenic risk. Manufacturers of the other anticonvulsants have not established independent registries. The Antiepileptic Drug Registry at Massachusetts General Hospital is collecting data on a spectrum of newer anticonvulsants, but to date the numbers are too small for any conclusions, except on lamotrigine (Lamictal). One caveat with respect to use of lamotrigine lies in the very small but quantifiable risk of Stevens-Johnson syndrome associated with lamotrigine therapy. To reduce risk, the manufacturer recommends titrating patients gingerly, by no more than 25 mg weekly. More safety data on older antipsychotics make them first choice for use during pregnancy. Women typically have been counseled to avoid using psychiatric medications during pregnancy because of known or unknown risks of prenatal exposure to these medications. But data suggest that pregnancy does not protect women from new onset or relapse of psychiatric disorders. This is particularly true for women who have disorders such as schizophrenia or bipolar illness, which is also now treated with antipsychotics, according to Dr. Lee Cohen, director of the perinatal psychiatry program at Massachusetts General Hospital, Boston.

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There is also some evidence that receiving more information from independent reading as opposed to other sources may be associated with more sexual experience (Andre et al order atorlip-20 20 mg line. In addition order atorlip-20 20mg with visa, in one study buy atorlip-20 20mg low cost, reading sex manuals and reading Playboy were each associated with beliefs about greater frequency of behaviors including sexual intercourse atorlip-20 20mg fast delivery, oral sex, and erotic dreams, and reading Playboy was associated with beliefs that sex without love, the use of stimulants for sex, and the exchange of sex for favors were relatively more common (Buerkel-Rothfuss & Strouse, 1993). Limited experimental evidence also indicates that viewing nonpornographic sexual images from magazines can lead to greater endorsement of rape-supportive attitudes (Lanis & Covell, 1995; MacKay & Covell, 1997). Given the apparent influence of magazine content and the importance of independent reading in general, and magazines in particular, as sources of sexual information for young people, it is important to understand what messages about sex are contained in the magazines read by young people. Relatively little research is available on this topic, and what is available is largely concerned with magazines targeted at young women. Magazines targeted at adolescent girls, such as Seventeen and YM, have been found to contain conflicting messages about sex; they encourage girls to be sexy, emphasize the importance of romantic relationships, instruct young women on how to please young men, and simultaneously emphasize patience and control (Carpenter, 1998; Durham, 1998; Garner et al. Studies of magazines targeted at adult audiences, both male and female, such as Cosmopolitan, Self, GQ, and Playboy, have demonstrated that their contents treat women as sex objects, both through use of objectifying images (Krassas, Blauwkamp, & Wesselink, 2001) and the written content of articles about relationships (Duran & Prusank, 1997). Further, magazines such as Playboy, despite their ostensible status as "lifestyle magazines," seem to be in a very different category than lifestyle magazines such as Cosmopolitan that are oriented toward women. That includes enjoying sex and intimate relationships. Like adults of all ages, you probably want to continue sharing your life in a fulfilling relationship. A healthy sexual relationship can positively affect all aspects of your life, including your physical health and self-esteem. Most people still have sexual fantasies and desires well into their 80s and 90s. As you know, your body changes as you age, and these changes can affect your sexual relationships. Jokes abound about the rapaciousness of senior females in quest of a male functional enough to engage in it. And my teenage son wrinkles up his nose and says "Eewww! Media coverage of aging baby-boomers and their older cousins would have us believe that seniors are a homogeneous group jumping into bed and "hooking up - with great regularity. In fact, the level of sexual interest and activity among people over the age of 65 is as diverse as the individuals who make up that population. A recent survey of married men and women showed that 87% of married men and 89% of married women in the 60-64 age range are sexually active. Those numbers drop with advancing years, but 29% of men and 25% of women over the age of 80 are still sexually active. So clearly, the older years can be a time of relief that children are no longer lurking in nearby bedrooms, and there is no longer a need to jump up early in the morning for work. For some, older age is a time of freedom to explore sexual expression in ways never before realized. A time to cast away the "shoulds" of earlier years, the societal expectations. For others, they are more than happy to forget about sexual performance, and to seek other forms of companionship and interpersonal sharing. One of the most significant losses with advancing age is the loss of intimacy. Many seniors have no opportunity for physical contact, affectionate dialogue, snuggling, or shared secrets. The actual act of intercourse is only one possible form of sexual expression. The continuing development of your sexual identity and the evolution of your own form of sexual expression with advancing years represents, in many ways, the most basic expression of your self. One fascinating recent study showed that men who have more than two orgasms per week have lower mortality statistics.

However buy cheap atorlip-20 20mg, most resolve with normal eating behavior and weight gain atorlip-20 20mg generic. If you are having any symptoms such as shortness of breath cheap atorlip-20 20 mg with amex, fatigue atorlip-20 20 mg line, palpitations, irregular heart beat, chest pain, etc. Our topic tonight is: What does the word "recovered" really mean when it comes to an eating disorder. And coping strategies for families and friends and how they can best help the eating disorder sufferer. Crawford: The first step is acknowledging that there is a problem. Then they must be willing to accept help from friends, family, and professionals. Bob M: I get emails everyday from family and friends of those with eating disorders asking what can they do to help and how difficult it is for them to cope. The second half of this conference will concentrate on that. I can only imagine how difficult it must be for parents, siblings, husbands, wives, and children who are in the same house as someone with an eating disorder. As I mentioned, I get letters from these people everyday talking about how their lives have been impacted. Crawford: First, and most importantly, family and friends need to be patient. They need to recognize how powerful an eating disorder can be. They need to remember it is an illness and that the individual needs compassion. Family and friends can support the individual in getting treatment and may consider getting help themselves, if needed. Finally, asking the individual how one can best be helpful is an important step. Crawford: We generally suggest to the person that they tell the patient that nothing can be lost from getting some professional input. But how are those close to the person with anorexia, bulimia, or a compulsive overeater, supposed to cope. Crawford: First, it is important for friends and family to recognize that while they can provide access to treatment, and support treatment, they cannot recover FOR the individual. We recommend that family members and friends develop their own coping mechanisms and support structure. In our area, many family members benefit from our open support groups, where they do not feel as alone. Crawford: I would tell the individual that there is no good answer to this common question. If they were to say "no," the individual will likely discount the response. In general, it is best to avoid conversations related to these topics. Crawford: Perhaps he withdraws because he is concerned about your health. If you avoid eating because of fear of weight gain, you have a problem that warrants your serious attention. Crawford, I believe this person is the is speaking about his wife-who is a long-time bulimic patient. First, the husband should try as best he can to recognize the signs of depression in his wife and he should try to be as compassionate and understanding as he can. He should try not to be judgmental, although this can be quite difficult at times. He should encourage her to follow the treatment program that has been developed by her care providers and he should try to avoid power struggles and conflicts related to food and eating. Most importantly, he should constantly remind himself that his wife has a serious illness and she lacks certain controls at times. In terms of his own depression, he should recognize that the chronic stress of a serious illness in the family can take its toll, and no one is immune from depression.

Those two things keep you from being free"Patterson buy generic atorlip-20 20mg, who founded The Love Clinic nine years ago and authored a book by the same title buy atorlip-20 20 mg, is encouraging people to move toward marriage through her "Mission Get Married" project buy discount atorlip-20 20 mg. Married for 20 years herself cheap 20 mg atorlip-20 with amex, Patterson believes that couples who marry feel a burden lifted in the bedroom. The Bible teaches that sex outside of marriage is sin. Wendell Cotton, 82, and Lurline Cotton, 83, of Garland, TX, have gotten to know each other well after 61 years of marriage. The parents of two know firsthand and wholeheartedly agree that committed couples have better sex. The "honesty of the situation" makes committed couples have better sex than singles, believes Dr. You should innately know what the other desires and what is good for each other. Tiy-E says that committed and married couples will have better sex because you perform at your best if you are in your comfort zone. You give a woman a commitment and you have great sex for as long as the man does right by his beloved woman"Some may believe that single people have better sex, because there is no commitment and there can be variety. And loneliness is exactly what you get when your sex partner leaves you in the bed after a sexual session... Even if a man claims to be a big-time ladies man, he still goes to bed at the end of the night feeling lonely. Every man and woman wants someone whom they can trust, respect and please every day, not just for an occasional booty call. At that time, virtually nothing was known about the virus that causes the disease, and there was little that clinicians could do to slow its inevitable progression to AIDS, then death. A lot has changed since then, and though there is still no cure for HIV, the HIV virus can often be controlled now with medications. But adhering to an HIV drug regimen can pose tremendous challenges. Missing just two drug doses can result in increased levels of virus in the body, or resistance to the drug, derailing their effectiveness. Maintaining HIV control requires a near perfect score in drug adherence. But, some drug regimens for HIV are hard to stick to, to say the least. Some require upwards of 20 pills per day, pills that must be refrigerated or taken at particular times during the day or pills that must be taken with or without food. For patients looking for that "perfect score", the level of difficulty is high. Susan Ball, Associate Professor at the Weill Cornell College of Medicine, talks about the importance of drug compliance in HIV treatment, and some of the issues HIV patients struggle with on a daily basis. How do drug manufacturers determine the timing and dosing of HIV medications? Drug companies arrive at drug dosing by trying to inhibit the virus for the longest amount of time in the body, with the lowest drug levels in the blood. As a result, the drug needs to be given more frequently. They work to reduce the concentration of the drug needed so that they can minimize side effects. Often when a drug first comes to market, it will be in a form that is difficult to take: either multiple pills per day, or by injection only, or it will have side effects that make it unpleasant, if not intolerable. AZT, for instance, was one of the earlier HIV drugs, and had to be taken every four hours. Norvir, a protease inhibitor, used to be offered in doses that made most patients too nauseated to tolerate it. Manufacturers try to make the drugs more and more palatable in terms of reducing the number of pills, the side effect profile, and the number of times a day that you have to take a medication. The drugs are carefully dosed to maintain blood levels that will suppress the virus. But if a person does not take the prescribed dosage, the drug level can fall and there will not be enough concentration of the drug to inhibit the virus.

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