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Geoffrey L. Robb, MD, FACS

• Professor and Chairman
• Department of Plastic Surgery
• The University of Texas
• MD Anderson Cancer Center
• Houston, Texas

Ten students will explore possible answers to those questions by applying more sophisticated computer models mental illness uk cheap 150 mg lyrica mastercard. This investigation also provides an opportunity for students to review concepts they might have studied previously mental therapy methods order 150 mg lyrica visa, including natural selection as the major mechanism of evolution; the relationship among genotype mental health 265 buy lyrica 150mg low price, phenotype mental health of america lyrica 150mg low cost, and natural selection; and fundamentals of classic Mendelian genetics. Without an opportunity to build these skills, students, when faced with more sophisticated, prebuilt models, tend to click randomly, with no particular plan in mind, rather than use a systematic exploration of the model’s parameters and output. Likewise, without taking the time to develop modeling skills, students cannot fully appreciate the limitations and the strengths of modeling natural phenomena. Afer completing the model exploration, the class should consider exploring applications of the null Hardy-Weinberg model in the real world by following up with the supertasters lab suggested in the section Where Can Students Go from Here? However, there are some important things to consider when managing such work in the classroom. To avoid frustration, develop a system whereby the students periodically save their work. When developing and working out models, it is ofen a good idea to save each new version of the model with a diferent fle name. Tat way, if a particular strategy doesn’t work, a student will not necessarily have to start over completely but can bring up a fle that had the beginnings of a working model. Students should generate their own work to get the maximal beneft from this exercise. Finally, your students may be able to produce a rudimentary spreadsheet but have difculty refning the sheet. Consider having these students rely on a hybrid approach — use the spreadsheet to generate the random samples, but use reliable pencil and paper to archive and graph the results. Without a doubt, the students will be able fnd a Hardy-Weinberg spreadsheet model on the Internet. Keep this in mind as you make the assignment, and consider having most of the work done in class if you have access to computers. K: Describe the conditions under which allele and genotype frequencies will change in populations. Students will be challenged to think about an idealized life cycle of a population of hypothetical organisms that serves as the basis for the modeling exercise. You might wish to review life cycles, even though this topic is generally taught in elementary grades. It is not unusual for students to have an incomplete understanding of an organism’s life cycle. Try working through an idealized life cycle and population as a class before the students view the investigation. Specifcally, use the modeling guidelines and assumptions described in the student investigation as a road map for your instruction as you and your students try to conceptualize this idealized population. Generally, most students have been exposed to spreadsheets by the time they are in high school, but they typically have memorized the steps of their operations. While this may be more intuitive for some students, it does introduce a new, unique spreadsheet function. One of the distinct advantages of using online spreadsheet applications is the ability to adjust the language of the spreadsheet to many diferent languages. The calculations are the same, but teachers and students can choose the language in which the instructions and navigation are displayed by changing the account settings. The skills that are reinforced and introduced vary across the laboratories in this manual. The skills emphasized in a laboratory dictate whether a prelab assessment is appropriate. This particular investigation provides a lab environment, guidance, and a problem designed to help students understand and develop the skill of modeling biological phenomena with computers. The idea of this laboratory is for students to experience the benefts of building their own model from scratch. To gain the maximum beneft from this exercise, students should not do too much background preparation. By building and exploring their own models, students should develop a more thorough understanding of how genes behave in populations. Many classroom investigations of the Hardy-Weinberg equilibrium involve simulated populations, such as M&M candies or beans. Students can model gene inheritance in a simulated population and apply the H-W equation. While all models are simplifcations and approximations, these particular models are generally based on such small populations that students ofen develop misconceptions regarding H-W equilibrium. However, for students who are simply stuck on how to get started, these pencil-and­ paper simulations can provide good preparation for the computer modeling featured here. The author of this investigation has made this model dozens of times from scratch and usually learns something new, thinks of a diferent way to accomplish a task, or simply improves the model with every new build. Each time you work out this model with students you develop a richer repertoire of methods to apply to modeling. It is that rich environment that produces an authentic learning experience for students — a learning experience that transfers generally to a deeper understanding of the Hardy-Weinberg equilibrium and its application in population genetics. You can have the students build their models to explore other aspects of H-W equilibrium. Have the students build models that explore selection and multigenerations, mutation, or migration. However, because students will have a limited skill set for working in the spreadsheet environment even at this point, this option might not be time efective. The alternative is to have students move from their spreadsheet models to more sophisticated models available on the Internet to answer their own questions; see the suggested online options that follow. In this option, while the students are not building the model, they are applying their knowledge of models to explore questions about population genetics. Options for More Advanced Modeling Experiences Have students generate their own questions regarding the evolution of allele frequencies in a population. Encourage them to experiment a bit with one of these more sophisticated and powerful models, trying out various combinations of changes to parameters or various extremes of one parameter at time. This is exploration, and it should allow the students to generate questions that have direct implications to the real world. Encourage them to systematically investigate the consequences of changing variables (parameters) on the system they are studying — in this case, population genetics. From these questions have the students develop hypotheses that can be tested with the use of more sophisticated models — those that allow more easily manipulated parameters of population size, number of generations, selection (ftness), mutation, migration, and genetic drif. Any number of computer-based Hardy-Weinberg simulations can be found with a Google search. Population genetics simulation program: Bob Sheely from Radford University has created a simulation and documentation in the form of a Web application. Be sure that all students/student teams treat their model spaces as experimental spaces. Have them propose, test, and analyze specifc hypotheses and report these in a miniposter presentation that is designed to generate a rigorous peer review before the teacher evaluation. The ultimate laboratory learning experience would be to develop a model and then try out that model in the real world. The supertaster trait described in this laboratory does express an intermediate phenotype; therefore, it creates an exemplary investigative population genetics laboratory. One way to study evolution is to study how the frequency of alleles in a population changes from generation to generation. In other words, you can ask What are the inheritance patterns of alleles, not just from two parental organisms, but also in a population? You can then explore how allele frequencies change in populations and how these changes might predict what will happen to a population in the future. Mathematical models and computer simulations are tools used to explore the complexity of biological systems that might otherwise be difcult or impossible to study. In this investigation, you will build a spreadsheet that models how a hypothetical gene pool changes from one generation to the next. This model will let you explore parameters that afect allele frequencies, such as selection, mutation, and migration.

I’m a figure that has an obvious defect or deformity– has strange clothes or a strange growth (laughs) — which others can see … but to which I’m oblivious mental disorders ppt order lyrica with visa. I’ve psychologically drugged myself and disappeared before alcohol comes into the picture mental health policy order 150 mg lyrica with amex. Others have told me this— they’re not surprised…” “You’re wondering what I say to myself while I’m drinking— Well mental treatment junctional rhythm buy discount lyrica 150 mg on line, let me tell you…I have a fantasy picture mental illness young children order lyrica without a prescription, from my childhood, that soothes me right before I go to sleep at night. I have water and communication but no one knows that I’m there— no one requires anything from me… this gives me a calm and peaceful feeling. I get to go into that little box …where I’m extremely isolated…problems or threats don’t exist (for at least a while)…and drink. It seems that Simon seeks a safe haven where he can be free from anxiety and responsibility, at least temporarily. Now, listen to this…It’s a science fiction based dialog between the drunk ‘Kirk’ who has so much fun in his space station, where the colors are vibrant, birds sing and the air smells sweet and “Sober Harry” who’s so damn logical and lives on the dull, arid, boring planet earth. Sometimes Harry takes over and tries to convince ‘Kirk’ that it might be necessary to come back to earth. I’m just writing about a method of transportation… that’s all… But that’s what alcohol does for me— takes me away to that wonderful planet. I’ve tried many different anti-depressants to help me to feel better while sober but they don’t help. Hmmm…maybe it’s ‘Kirk’ who’s telling me that they don’t help because then I won’t be able to visit the ‘space station’ anymore…” Harry Harry too, wishes to escape his anxiety and reality for a while, to be able to feel relaxed, living in the moment. But he struggles with two personas and forces living within—the socially accepted role of “Sober Harry” versus “Drunk Kirk”. They are not only in touch with the changes in their emotional state in the days or weeks preceding the drinking period, but also aware of the possibility they have then, to divert it. Despite forewarnings, they proceed to actively plan a course of action which involves not only deceiving others, but themselves as well. Subjects act, in their stories, as if their behavior, at times, was rather rational. They emphasize that drinking, in its initial phases, gives them a sense of relaxation, euphoria and creativity. Here, relapse doesn’t just mean a return to drinking but involves a full blown drinking binge that lasts for weeks on end. Drinking partners aren’t friends, but rather, allies in that they help the misuser rationalize his behavior. It is only when they have pushed their bodies to the limit, jeopardized their health, and become physically unable to continue drinking that they break away from this state and seek help. The period spent at de-tox, is felt as a very good one— being taken care of, safe and secure, and without any desire for alcohol. After a week or so, they emerge, feeling renewed, if a bit shameful over their recent behavior. And they continue this behavior in the very face of the fact that it is destroying their lives. Relapse provides a short-lived respite from the real world but in the end, it is counterproductive and leads nowhere. Psychoanalytic theories of addiction address psychic conflict and affect management where alcohol serves to relieve psychic pain. Abused substances may be used to push painful thoughts from ones consciousness and to numb painful feelings. Negative affect states or psychological “inner triggers” play a large role in triggering relapse. Subjects have been raised in environments where there has been traumatic loss, neglect, and violations of autonomy, through physical or sexual abuse, from early on. When this happens within the context of a child’s primary caregivers, it severely impacts an individual’s 52 ability to develop trusting and supportive relationships. Many recreate or “act-out” their trauma through their substance misuse, dysfunctional relationships and related behaviours and consequences. It seems that these victims of childhood trauma have spent much of their lives feeling responsible for the terrible things that happened to them. It seems that guilt feelings are an important part of the relapse story and serve as an important “inner trigger”. Normal guilt serves a highly useful adaptive function and acts as a feedback signal to the person that his actions are no longer in harmony with his central core beliefs and values. For example, the realization for the alcohol misuser, that he neglects or lies to his family. Moreover, it often leads to paradoxical effects, serving to maintain the actions that produced it. In the alcohol misuser, irrational guilt may trigger drinking, leading to more drinking, and so on. As dysfunctional family backgrounds and difficult childhood experiences show up in the results, socio-cultural theories may also be applied. Family systems have most certainly played, and still do play, an important role here. Most of the subjects embrace the disease model of addiction where they view their alcohol misuse as an illness. This disease concept both attempts to reduce social stigma and free them from guilt about their drinking. Furthermore, with this view, recovery can only be sustained through total abstinence. Subjects describe their difficulty with social drinking and its “trigger” effect on them. The disease theory of addiction takes up the concept of “craving” or strong mental and emotional need to drink. The subjects clearly describe this with their perceived loss of control and their ability, through strong psychological defenses, to shut out the real world. While in their sober period, they play many of the same roles that one would expect from any upstanding member of society attentive spouse/partner, loving grandparent, trusted friend, helpful colleague, supportive parent, etc. Normally, these societal roles, norms, and appropriate social behaviors are upheld without too much difficulty despite there always being a certain pressure to conform. But, as the subjects have contradictory and even negative views of themselves, cognitive inconsistencies may develop. They may feel strong pressure to live up to these positive images or performances. Also, as they also show one side of themselves publicly and one side privately, they lead a sort of double-life. These conflicts may contribute to anxiety and the “inner trigger” which eventually results in relapse. They drink in an effort to reduce conflict and dissonance between who they are and what they do. They may have difficulty integrating these contradictory qualities into a coherent sense of self. They long for to be free from anxiety, to feel safe, and to be released from burdens and responsibility—if only for a while. They spend some days and even weeks existing in a “bubble” where they move between fantasy and reality. In the inner sanctum of ritual, time stands still and the day-to day world is far away. Ritual is carried out in a special context, segregated from everyday existence, and in these cases, experienced alone. In this “in-between” state of liminality, status roles and ordinary social structures, and obligations are momentarily relieved. Initially, there is a sense of excitement which involves the entire body—there is a longing for change and liberation. They attempt to gain control over feelings by shutting off all contact with their inner world by drinking and using strong primitive defenses, only to act out those feelings through ritual. Relapse behavior becomes automatic and according to the subjects, rarely deviates.

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An individual with bipolar disorder may have manic episodes mental health 5 a day proven 150 mg lyrica, depressive episodes mental health therapist salary order cheap lyrica on-line, or “mixed” episodes mental health treatment now order lyrica online pills. The feelings are intense and happen along with changes in behavior mental health yakima order 75mg lyrica with amex, energy levels, or activity levels that are noticeable to others. For example, hypomanic episodes may make the individual feel very good and be very productive; they may not feel like anything is wrong. However, family and friends may notice the mood swings and changes in activity levels as behavior that is diferent from usual, and severe depression may follow mild hypomanic episodes. Types of Bipolar Disorder There are three basic types of bipolar disorder; all of them involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, and energized behavior or increased activity levels (manic episodes) to very sad, “down,” hopeless, or low activity level periods (depressive episodes). People with bipolar disorder also may have a normal (euthymic) mood alternating with depression. Usually, separate depressive episodes occur as well, typically lasting at least two weeks. Episodes of mood disturbance with mixed features (having depression and manic symptoms at the same time) are also possible. The symptoms usually occur for at least two years in adults and for one year in children and teenagers. Conditions That Can Co-Occur With Bipolar Disorder Many people with bipolar disorder also may have other mental health disorders or conditions such as: Psychosis. Sometimes people who have severe episodes of mania or depression also have psychotic symptoms, such as hallucinations or delusions. For example: ● Someone having psychotic symptoms during a manic episode may falsely believe that he or she is famous, has a lot of money, or has special powers. People with bipolar disorder occasionally may have an eating disorder, such as binge eating or bulimia. Some bipolar disorder symptoms are like those of other illnesses, which can lead to misdiagnosis. For example, some people with bipolar disorder who also have psychotic symptoms can be misdiagnosed with schizophrenia. Some physical health conditions, such as thyroid disease, can mimic the moods and other symptoms of bipolar disorder. Looking at symptoms over the course of the illness (longitudinal follow-up) and the person’s family history can play a key role in determining whether the person has bipolar disorder with psychosis or schizophrenia. Genes Bipolar disorder often runs in families, and research suggests that this is mostly explained by heredity—people with certain genes are more likely to develop bipolar disorder than others. Some studies of identical twins have found that even when one twin develops bipolar disorder, the other twin may not. Although people with a parent or sibling with bipolar disorder are more likely to develop the disorder themselves, most people with a family history of bipolar disorder will not develop the illness. Brain Structure and Function Researchers are learning that the brain structure and function of people with bipolar disorder may be diferent from the brain structure and function of people who do not have bipolar disorder or other psychiatric disorders. Learning about the nature of these brain changes helps doctors better understand bipolar disorder and may in the future help predict which types of treatment will work best for a person with bipolar disorder. At this time, diagnosis is based on symptoms rather than brain imaging or other diagnostic tests. To diagnose bipolar disorder, a doctor or other health care provider may: Complete a full physical exam. A psychiatrist or other mental health professional diagnoses bipolar disorder based on the symptoms, lifetime course, and experiences of the individual. This may be because: Bipolar disorder has symptoms in common with several other mental health disorders. A doctor may think the person has a diferent disorder, such as schizophrenia or (unipolar) depression. Treatment helps many people, even those with the most severe forms of bipolar disorder. Doctors treat bipolar disorder with medications, psychotherapy, or a combination of treatments. Medications Certain medications can help control the symptoms of bipolar disorder. Some people may need to try several diferent medications and work with their doctor before fnding the ones that work best. The most common types of medications that doctors prescribe include mood stabilizers and atypical antipsychotics. Mood stabilizers such as lithium can help prevent mood episodes or reduce their severity when they occur. Additional medications that target sleep or anxiety are sometimes added to mood stabilizers as part of a treatment plan. Talk with your doctor or a pharmacist to understand the risks and benefts of each medication. Psychotherapy Psychotherapy (sometimes called “talk therapy”) is a term for a variety of treatment techniques that aim to help a person identify and change troubling emotions, thoughts, and behaviors. Psychotherapy can ofer support, education, skills, and strategies to people with bipolar disorder and their families. Psychotherapy often is used in combination with medications; some types of psychotherapy. Other Treatments Some people may fnd other treatments helpful in managing their bipolar symptoms, including: Electroconvulsive therapy is a brain stimulation procedure that can help people get relief from severe symptoms of bipolar disorder. This type of therapy is usually considered only if a patient’s illness has not improved after other treatments (such as medication or psychotherapy) are tried, or in cases where rapid response is needed, as in the case of suicide risk and catatonia (a state of unresponsiveness), for example. Not much research has been conducted on herbal or natural supplements and how they may afect bipolar disorder. Certain medications and supplements taken together can cause serious side efects or life-threatening drug reactions. Visit the National Center for Complementary and Integrative Health for more information: Contact social media outlets directly if you are concerned about a friend’s social media updates, or dial 911 in an emergency. Coping With Bipolar Disorder Living with bipolar disorder can be challenging, but there are ways to help make it easier for yourself, a friend, or a loved one. Remember, bipolar disorder is a lifelong illness, but long-term, ongoing treatment can help control symptoms and enable you to live a healthy life. Researchers continue to study genetics and bipolar disorder, brain function, and symptoms in children and teens who have bipolar disorder, as well as family history in health and behavior. Participating in Clinical Research Clinical research is medical research that involves people like you. People volunteer to participate in carefully conducted investigations that ultimately uncover better ways to treat, prevent, diagnose, and understand human disease. Clinical research includes trials that test new treatments and therapies as well as long-term natural history studies, which provide valuable information about how disease and health progress. Please Note: Decisions about participating in a clinical trial and determining which ones are best suited for you are best made in collaboration with your licensed health professional. After the initial phone interview, you will come to an appointment at the clinic and meet with a clinician. This website is a searchable registry and results database of federally and privately supported clinical trials conducted in the United States and around the world. This information should be used in conjunction with advice from health professionals. Talk to your doctor about clinical trials, their benefts and risks, and whether one is right for you. Finding Help Mental Health Treatment Locator the Substance Abuse and Mental Health Services Administration provides this online resource for locating mental health treatment facilities and programs. The Mental Health Treatment Locator section of the Behavioral Health Treatment Services Locator lists facilities providing mental health services to persons with mental illness.

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