Risperdal

By T. Ayitos. Waynesburg College.

Of course people with MS purchase risperdal 2 mg with mastercard, just like anyone else of a similar age and sex, can suffer mental illness or dementia but, clinically, people with MS do appear to have more depression (see next section) compared to other people, and perhaps have what might be called mood swings rather more often. More recently, studies have shown that many people with MS have some problems with memory and with what are called their cognitive abilities, and these seem to be associated with the effects of the disease. It is thought that MS could lead to a subcortical dementia but this is not inevitable. How to recognize the problem We can all change without necessarily realizing the nature or extent of that change – until someone tells us. Sometimes people with MS may be so depressed or anxious that they think their cognitive problems are worse than in fact they are; on the other hand, they may not want to acknowledge them at all, for they do not want to think that MS may affect their cognitive as well as their physical functions. In addition to the general variability of symptoms, an issue that we have indicated is characteristic of MS, we have also noted that previously it has been very difficult to link cognitive performance to any other aspect of MS. However, more recently, studies using MRI (magnetic resonance imaging) have shown that the more general the demyelination the more likely it is that significant cognitive problems will also exist. Moreover, MS lesions in certain areas of the brain seem to be associated with cognitive difficulties. Further work will, it is hoped, be able to identify more precisely the relationship between certain kinds of cognitive problems and areas of the brain affected by MS. In addition, during acute attacks of MS, it has been observed that cognitive performance – memory and concentration, for example – may get significantly worse and then improve again; on the other hand, if the cognitive problems have arisen gradually and have been present for some time, then it is unlikely that they will improve substantially. To avoid possible uncertainties, concerns or perhaps even recriminations, you should seek an objective assessment of any cognitive problems, if possible with a referral to a clinical psychologist, or more specifically to a neuropsychologist – usually from your neurologist. Professional opinions Until the results of recent research, many GPs and neurologists did not consider cognitive symptoms to be a major issue in relation to MS. Because the understanding and use of language is quite good in people with MS, in a single or occasional interview or consultation, it may be hard for a doctor to pick up more subtle but still important cognitive prob- lems. As we have suggested, it is far more likely that those who are with you, and see you everyday, will notice these things first. People with MS have found that cognitive problems can be one of the main reasons why they have to go into residential care or why they become unemployed.

W e then com pared our decisions and argued (som etim es heatedly) about our disagreem ents cheap risperdal 3 mg fast delivery. Our analysis revealed differences in the interpretation of certain statem ents which we were unable to fully resolve; in other words, our inability to "wrap up" all aspects of the interpretation was itself an im portant 174 PAPERS TH AT G O BEYON D N U M BERS item of data. W hat is not legitim ate is to assum e that there is a single "right" way to interpret the data. H aving said that, there are som e researchers who feel strongly that only the person m ost im m ersed in the fieldwork has genuine insight into the m eaning of the data; in other words, interpretation should not be "triangulated" by all and sundry sim ply to give a show of im proving validity. W e obviously cannot assess the credibility of qualitative results via the precision and accuracy of m easuring devices, nor their significance via confidence intervals and num bers needed to treat. It takes little m ore than plain com m on sense to determ ine whether the results are sensible and believable and whether they m atter in practice. One im portant aspect of the results section to check is whether the authors cite actual data. Claim s such as "G eneral practitioners did not usually recognise the value of audit" would be infinitely m ore credible if one or two verbatim quotes from the interviewees were reproduced to illustrate them. The results should be independently and objectively verifiable – after all, a subject either m ade a particular statem ent or (s)he did not – and all quotes and exam ples should be indexed so that they can be traced back to an identifiable subject and setting. A quantitative research paper, presented in standard IM RAD form at (see section 3. The reader should have no difficulty separating what the researchers found from what they think it means. In qualitative research, however, such a distinction is rarely possible since the results are by definition an interpretation of the data. It is therefore necessary, when assessing the validity of qualitative research, to ask whether the interpretation placed on the data accords with com m on sense and is relatively untainted with personal or cultural perspective. This can be a difficult exercise, because the language we use to describe things tends to im ply 175 H OW TO READ A PAPER m eanings and m otives which the subjects them selves m ay not share. Com pare, for exam ple, the two statem ents, "Three wom en went to the well to get water" and "Three wom en m et at the well and each was carrying a pitcher".

The spouses usually are very eager to do so buy 2mg risperdal visa, as attention to their presenting problems may have been delayed for the few weeks of anger management training. At this point, we gener- ally use techniques derived from behavioral marital therapy (BMT; e. Given that such methods are well outlined in other publications, and are probably familiar to most couples therapists, we do not present them here. Michael and Joan were very excited to begin the sessions on communi- cation training and problem solving. They then applied them to each of their major presenting problems, usually solving one major problem per week. They used problem solving to write contracts for several financial problems, the issue of how to handle household tasks, and the problem of how much time to spend with each of their families. One particularly sensitive issue (how to say no to Joan’s families frequent invitations) took several sessions and had to be revised twice, following their discovery of problems with their initial contract on its implementation. They found that as they began implementing these contracts, the frequency of their arguments declined, lowering the risk of aggression. OVERVIEW OF THE CHAPTER 320 SPECIAL ISSUES FACED BY COUPLES had been difficult for her. I asked him if there were other reasons he thought his substance use was a problem, and he discussed some problems at work and his DUI incident. To avoid conflict at home about prior sub- stance use, I asked Rick and Liz to use therapy sessions as a controlled envi- ronment for any further discussion of past use. When partners participate in treatment, they can be a helpful source of in- formation about the amount of substance consumed, the topographical char- acteristics of consumption (rapidity, frequency, presentation of the drug for consumption), the social context, and typical locations of use. For reports to be accurate, it is necessary that the partner have regular contact with the addict for the period reported (typically they are living together and the partner regularly ob- serves the behavior of the addict). If the couple is separated and does not have consistent contact, reports may not reflect actual behavior (Miller, Meyers, & Tonigan, 1999).