Renee J. G. Arnold, RPh, PharmD
- Department of Preventive Medicine
- Mount Sinai School of Medicine
- New York, NY
- Division of Social and Administrative Sciences
- Arnold and Marie Schwartz College of Pharmacy
- Long Island University
- Brooklyn, NY
Clinicians medicine 377 buy discount glucophage sr on-line, therefore medications used for bipolar disorder buy discount glucophage sr 500mg, are faced with a difficult dilemma: do we withhold potentially beneficial medications from young patients because they are not labeled for that age group Or do we give the drugs based on extrapolation from adult studies (with some dosage modifications for body mass or surface area) without direct data on safety and effectiveness No analgesic medications have been labeled for children less than 6 months of age and only ibuprofen has been labeled for those 6 to 24 months symptoms zinc deficiency adults discount 500mg glucophage sr fast delivery. Although the benefits have been deemed to outweigh the risks for using opioids for acute pain in children medicine joji glucophage sr 500 mg, such is not the case for chronic pain and, thus, opioid treatment in this context is generally 271 discouraged. For example, the American Pain Society (2012) states, Opioids are rarely indicated in the long-term treatment of chronic non-cancer pain in children, although they may be beneficial in certain painful conditions with clearly defined etiologies. The use of 272 opiates is not recommended for the types of chronic pain described in the present guidelines. The most common pain problems in adults are rarely seen in pediatric populations, as they are frequently neuropathic in nature and often are related to 274 degenerative aging processes. Multiple studies have shown that children with functional abdominal pain are at risk for difficulties as adults that include anxiety or depressive disorders, functional gastrointestinal disorders, and other non-abdominal 276-280 281,282 283-285 chronic pain. Similar data have been generated for headaches and back pain Although no specific studies on prevention have been reported, it seems clear that by addressing pain complaints in the young, morbidity in the subsequent years will be reduced. As in all age groups, evidence of long-term effectiveness of opioid therapy is lacking. However, in carefully selected and monitored patients, opioids may provide effective pain relief 286 if used as part of a comprehensive multimodal pain management strategy. Prophylaxis and/or treatment can include hydration, bulk fiber (only if hydration is maintained), activity, senna, and sorbitol (20 ml of 70% taken twice daily for 3 days per week). Recognize and manage all potential causes of side effects, taking into consideration medications that potentiate opioid side effects: Interagency Guideline on Prescribing Opioids for Pain [06-2015] 47 a. Antihistamines, phenothiazines, tricyclics, and anticholinergics can cause confusion and urinary retention. The incidence of delirium and other adverse reactions increases with the number of prescription drugs taken. In addition, methadone is difficult to titrate because of its large inter-individual variability in pharmacokinetics, particularly in the frail elderly. Due to the frequency of chronic disease and potential for polypharmacy among older adults, drug disease and drug-drug interactions should also be considered when prescribing. These age-related changes all make older adults especially vulnerable to opioid side effects and reduce the therapeutic window between beneficial doses and doses that are toxic or lethal. However, one large longitudinal nursing home study showed that extended-release opioids 293 improved functional status and social engagement when compared to short acting opioids. Opioids have also been 294,295 linked to an increased risk for falls and non-spine fractures in community living older adults. Although the term cancer survivor has a variety of definitions, for this guideline, a survivor is someone who has completed cancer treatment, is cured or in full clinical 8,300,301 remission with no current evidence of disease, and is under cancer surveillance only. Interagency Guideline on Prescribing Opioids for Pain [06-2015] 49 8,302 Cancer survivors tend to be older, 45% are over the age of 70, and only 5% younger than age 40. With this survival benefit comes the burden of long-term and late effects of cancer and cancer therapy. Primary care providers will see more patients who are cancer survivors, as their numbers are increasing significantly due to earlier detection and improved cancer 8 therapies. Make a medical diagnosis for the cause of pain and accurately define its location. Always consider cancer recurrence or secondary malignancy in the differential diagnosis. Use an individualized approach to pain management, paying special attention to those who are hypervigilant about their body sensations and may present with frequent reports of new symptoms. Reassure and redirect them after a thorough evaluation of the pain complaint, and consultation with the oncologist as appropriate. Encourage survivors to actively engage in their pain management plan and to explore options to participate in support groups. The Childhood Cancer Survivor Study reported 11% of adult survivors (mean interval from diagnosis 17 years) 310 experienced medium or higher pain intensity; and 6% of Australian adult cancer survivors at 5-6 years 311 post treatment reported moderate to severe pain. Pain treatments in the survivor should be modeled after chronic non-cancer pain strategies, rather than palliative therapies. However, it should be noted that efficacy of these agents has not been established in cancer survivors. Specialized therapy such as manual lymphatic drainage for lymphedema will improve discomfort from swelling. Counseling for anxiety, depression, and pervasive fear of cancer recurrence is beneficial; as is mindfulness training and other cognitive behavioral strategies to reduce pain. Sleep hygiene education is essential for pain management, as sleep 313 disruption is common in this population. All new or worsening pain in the cancer survivor must be promptly evaluated to eliminate the possibility of cancer recurrence as the source of pain. The clinician should provide reassurance that all new or worsening pain problems will be assessed and appropriately investigated to eliminate cancer as the cause. Extensive emotional support may be needed, and formal counseling with supportive services may be required to assist with anxiety 300,318 related to the potential for cancer recurrence. The oncologist will direct surveillance screening, either through his/her office, or guide the primary care 319-321 provider through the Cancer Treatment Summary and Survivorship Care Plan. However, it is Interagency Guideline on Prescribing Opioids for Pain [06-2015] 52 essential that all providers involved in the care of cancer survivors know the signs and symptoms associated with cancer, whether from recurrence or secondary malignancy (Table 12). In many situations, pain may be the only presenting symptom of recurrence, and it is essential that clinicians closely monitor and assess this complaint. Signs and Symptoms Associated with Recurrence of Malignancy New or worsening pain Unexplained and unintentional weight loss of 10 pounds (4. Immediate Release See individual product labeling for maximum 5-10 mg q dosing of combination products. Use caution when combining with other medications that affect serotonin as it 300 mg per 24 Tapentadol may increase risk of seizures and serotonin hours syndrome. Sustained Release Do not exceed 600 mg/day for immediate 50 mg q 12 hours release and 500 mg/day for sustained release formulation. Dual mechanism of action binds to mu-opioid Immediate Release receptors and inhibits reuptake of serotonin and 50 mg q 4-6 hours norepinephrine. Patient variability in response to different opioids can be large, due primarily to genetic factors and incomplete cross tolerance. Methadone exhibits a non-linear relationship due to the long half-life and accumulation with chronic dosing. Table 17 below shows samples of morphine equivalents that can be computed using the calculator. Morphine Equivalent Dose Calculation For patients taking more than one opioid, the morphine equivalent doses of the different opioids must be added together to determine the cumulative dose (Table 15). Per Equianalgesic Dose table, 20 mg oxycodone = 30 mg morphine so 40 mg oxycodone = 60 mg morphine equivalents. Interagency Guideline on Prescribing Opioids for Pain [06-2015] 61 Appendix D: Urine Drug Testing for Monitoring Opioid Therapy i. There are several validated screening tools available to assess risk of aberrant behavior. This gives the patient an opportunity to disclose drug use and allows the prescriber to modify the drug screen for the individual circumstances and more accurately interpret the results. Likewise, oxycodone is metabolized to oxymorphone, so these may both be present in the urine of oxycodone users. Thus, the presence of an days w/long acting intermediated-acting barbiturate indicates exposure within 5-7 days.
This may represent differences related to the brain areas After a seizure episode is a postictal phase in which responsible and the extent of cortical involvement medicine 0552 purchase glucophage sr toronto. Less common treatment non hodgkins lymphoma cheap glucophage sr 500 mg overnight delivery, the person ized absence seizures is not present and is replaced by may bite his or her tongue or lose bladder control harrison internal medicine order glucophage sr now. Because the girl seemed so attentive symptoms ketoacidosis discount 500 mg glucophage sr overnight delivery, intelli the following sections discuss seizure types according gent, and well-behaved, it was hard for me to believe that she to the epilepsy classi cation scheme of Table 16. Her teacher reported that cal descriptions correlate with what is known of their neu she made frequent mistakes on the blackboard and was often rologic counterparts. In my office, I asked her to brain mechanisms responsible for seizure activity follows. I had witnessed a classic absence Generalized seizures, formally known as grand mal seizures, seizure. The brain origin of these seizures has traditionally been considered unknown or generalized. In the above case, the doctor precipitated a seizure by Behaviorally, they typically have a motor component that having the girl hyperventilate. Less typical for this type of seizure is a the clonic component, and a number of seizures involve sudden myoclonic jerk or atonic loss of muscle tone. In these tonic-clonic seizures, the behavior that the approach of an attack, some individuals may just stop alerts others to a seizure onset is the tonic stage. Interestingly, many chil ratory arrest, but during a seizure this actually occurs be dren with absence attacks outgrow them, suggesting that cause peripheral blood vessel constriction allows more a delay or anomaly in brain development plays an impor blood to ow to the brain. After seconds to minutes, the second clonic seizure or trauma history to develop absence attacks. This is followed by abrupt Partial Seizures limpness (or atonia) and a gradual regaining of conscious Partial or focal seizures may take several forms, but they awareness. Generalized seizures may take several forms, but always begin as a local neuronal discharge that may gen usually include components of irregular motor discharge in eralize across the corpus callosum, eventually involving the form of tonic and/or clonic movement. This Other types of generalized seizures resulting in abnor seizure category represents the most common type, affect mal muscular symptoms are myoclonic and atonic ing about 800,000 people in the United States (Cascino, seizures. These seizures can be more frequently localized bursts of jerky motor movements that usually do not last than generalized seizures, but still only a third of those af more than a second and tend to occur in clusters over a icted have identi able causes. People who experience them sometimes de viral brain diseases such as meningitis and encephalitis are scribe them as jumps. They last no longer than 15 seconds while ple seizures are focal events that may involve sensorimo the person remains conscious. For example, difficult to localize, because they quickly disrupt the entire discharges from the motor strip can cause sudden or range of behavior involving all cortical neurons and may arise stereotypic movement, such as jerking or twitching. Peo from a central mechanism capable of having a global effect ple have reported that their eyes may move to a certain on the brain. Memory and personality alterations can be a result Seizures are a symptom, similar to the concept of fever, of temporal lobe foci, and intensive mood experiences can that something is going on in the brain. The behavioral results vary localized to a particular anatomic area of the brain, and widely from person to person but are closely tied to the site technicians may be able to image a corresponding struc of seizure focus. Because there is no further involvement, tural pathology such as a lesion, a tumor, a vascular disease, the person can also experience these events as an aura. For example, the cause of some child the second type of partial seizure is complex partial hood seizures may be malformed brain tissue (Figure 16. These are more complex than and infections that affect the delicate physiological balance simple partial seizures in that they have an element of al of the brain, neurologists cannot always nd a structural tered psyche or awareness in addition to sensory or motor location of injury or neuronal destruction in the brain. About half of those with complex partial though many normal people may experience a seizure, the seizures experience an aura (Cascino, 1992). Complex occurrence may indicate signi cant brain pathology and partial seizures typically emanate from the temporal lobes medical consultation should always be sought. The al Normally, the brain maintains a balance of neuronal teration of consciousness can take several forms. It may ring between excitatory discharges and inhibitory con include a sense of deja vu (already seen) in new environ trol of excessive ring. Single neurons and neuronal cir ments or jamais vu (never seen) in a familiar place. The cuits re according to their own direction and processing person may experience a sense of forced thinking, illusions, in what appear to be random patterns. The shift into the ictal phase is abrupt, usu Seizures occur due to excessive excitatory synchronous ally commencing with a motionless stare. If you have ever been caught up in a riod of confusion and drowsiness can be quite long with wave in a packed football stadium, the analogy to the complex partial seizures. All the people represent individual neu a good example of what may happen with complex partial rons and are initially involved in their own behaviors. If a sim behavior appears random, with occasional synchronous ple seizure spreads, this spreading can generalize throughout bursts of cheering from one side or the other. Jack small group of people successfully initiate a wave, before sonian seizures involve motor areas and have been called long the entire stadium of 50,000 people synchronizes in marching seizures, because they begin with jerking or tin a rhythm that sweeps through the crowd. The Absence seizures provide a good example of a general symptoms re ect their corresponding brain regions; thus, ized seizure that arises from a central mechanism. The environment, failing to respond to questions currently affecting more than 2 million most common emotion is fear, but the by others. The person may be vaguely aware people in the United States (for a detailed person may also report pleasure, sadness, of what is going on but unable to control it. These other room, wander through a public place, or abnormality in the interictal (between sensations may range throughout the spec leave a store and wander down the street. The trum of visual, gustatory, olfactory, auditory, Imagine how upset you would be to find interictal spike is a marker for this disorder or somatic perceptions. Olfactory sensations yourself in a different place from where you (McIntosh, 1992). These are typically quite displeas or even hours of time, not knowing what you seizures are called complex partial seizures. This is illustrated by For neuropsychologists, these are the most flesh), but may on occasion be pleasant the case of the sweeping lady. They may be associated with motor In the course of a complex partial seizure, been a client of mine for almost 15 years. Complex motor responses may deal with the impact of her epilepsy on her blinking, lip smacking, pointing, or picking at also occur, including compulsive, purpose life. During a pletely controlled by antiepileptic drugs, a far because of their frequent temporal lobe and complex partial seizure, a person may be too common experience for those with com limbic system focus, may have an emotional unaware of or unresponsive to her or his plex partial seizures. She has had to alter her Both animal and human studies point to the thalamo One of their main functions is in controlling cerebral ex cortical circuitry as the source for the primary aberrant citability. External transmission to the absence seizures in children may result from an error in cortex dampens when neurons begin ring according to an development, resulting in a temporary overabundance of internally generated oscillating rhythm. She has worked in a stare preceded her motor automatisms, and seizure occurred several years ago. I have couple of settings, but overstimulation and she lost clear awareness of her surroundings thought of this as the great fugue, or the fatigue can increase seizure frequency, and at this point. Apparently, she swept across the because it typically contains many of the ing contorted her face. She laughed uncon kitchen, down the hall, through the entryway, phenomena I have discussed. The sequence ended when first, she did not know who she was or where a fairly long interictal interval, Alice typically the spread of epileptic activity caused a she was. Over the next few minutes, she experienced epigastric sensations (butter generalized tonic contraction and she lost became reoriented and realized she was on flies in the stomach) and nausea during the consciousness. This phenomenon, wealth of events that can occur during a down the sidewalk into the street, and which was a seizure event, actually led her to complex partial seizure episode. That enabled her to reorient to where specialist before complex partial seizures what she had done for several hours. During this interval, her time happened when she went into a grocery several blocks from her home, crossing perception was distorted so that everything store or large department store during the several intersections, without awareness, seemed to slow down around her. She felt day when things were busy, noisy, and while in an extended complex partial seizure detached from her surroundings. For example, if a person shows impaired radrenergic, dopaminergic, and serotonergic neurons.
Code the absence (code 0) or presence (code 1) of fibrosis as documented in the pathology report symptoms 5-6 weeks pregnant discount glucophage sr 500mg overnight delivery. Note 6: Use code 7 if there is a clinical diagnosis (no microscopic confirmation) of severe fibrosis or cirrhosis medicine syringe 500mg glucophage sr free shipping. Definition Primary sclerosing cholangitis is an idiopathic liver disease characterized by inflammation and fibrosis of the entire biliary tree treatment glaucoma purchase cheap glucophage sr online. There must be a statement that primary sclerosing cholangitis is not present to code 0 medicine 44175 order glucophage sr 500 mg visa. The tumor growth patterns of intrahepatic cholangiocarcinoma include the mass forming type, the periductal infiltrating type, and a mixed type. The periductal infiltrating type of cholangiocarcinoma demonstrates a diffuse longitudinal growth pattern along the bile duct. Limited analyses suggest that the diffuse periductal infiltrating type is associated with a poor prognosis. The presence of metastases to extrathoracic sites does not change this distinction. Histology may be determined clinically (presumed to be the same based on imaging or physician judgement) or microscopically confirmed. Note 2: Code the presence and location of separate tumor nodules, also known as intrapulmonary metastasis, at the time of diagnosis in this item. Separate tumor nodules can be defined clinically (by imaging) and/or pathologically. Note 3: For this item, only code separate tumor nodules of the same histologic type as the primary tumor, also referred to as intrapulmonary metastases. If separate nodules are described as metachronous, the nodules may be evidence of progression of disease in which case they would not be coded here. Note 6: If there are multiple tumor nodules or foci and the terminology used is not readily identifiable as one of the situations described in Note 4, consult with the pathologist or clinician. The elastic layer may be identified on hematoxylin and eosin (H&E) stains or by special stains looking for the elastic fibers. Coding guidelines Record results of visceral pleural invasion as stated on pathology report. Do not code separate pleural tumor foci or nodules in this field (discontinuous pleural metastasis). When pathologists have difficulty assessing the relationship of the tumor to the elastic layer on routine hematoxylin and eosin (H and E) stains, they may perform a special elastic stain to make the determination. Rationale Pleural Effusion can be collected by the surveillance community for pleura cancers. Definition Pleural effusion is the accumulation of fluid between the two layers of pleura: visceral (covering the lungs) and parietal (lining the chest wall and covering the diaphragm). Pleural effusion is a symptom of mesothelioma that increases the Summary Stage from local or regional direct extension to distant involvement. Note 2: One of the most common symptoms of mesothelioma is a pleural effusion, or an accumulation of fluid between the parietal pleura (the pleura covering the chest wall and diaphragm) and the visceral pleura (the pleura covering the lungs). This field does not include distant or discontinuous metastases to the skeletal system. Do not record secondary or acquired mutations that may have developed because of long-term imatinib treatment. Definition Profound immune suppression may greatly increase the risk of developing Merkel cell carcinoma. Immune suppression may be deliberately induced with drugs, as in preparation for bone marrow or other organ transplantation, to prevent rejection of the donor tissue. In the absence of this label, a measurement described as taken from the cut surface of the specimen may be coded. Code the greatest measured thickness from any procedure performed on the lesion, whether it is described as a biopsy or an excision. If the tumor is excised post-neoadjuvant treatment, tumor measurements cannot be compared before and after treatment to determine which would indicate the greater involvement. Definition Ulceration is the formation of a break on the skin or on the surface of an organ. The presence or absence of ulceration must be confirmed on microscopic examination. The Allred score combines the percentage of positive cells (proportion score) and the intensity score of the reaction product in most of the carcinoma. If there are no results prior to neoadjuvant treatment, code the results from a post-treatment specimen. The higher the score, the more receptors were found and the easier they were to see in the sample. If assays are performed on more than one specimen and any result is interpreted as positive, code as 1 Positive/elevated. Exception: If results from both an in situ specimen and an invasive component are given, record the results from the invasive specimen, even if the in situ is positive and the invasive specimen is negative. Note 7: If the test results are presented to the hundredth decimal, ignore the hundredth decimal. It tests a sample of the tumor (removed during a biopsy or surgery) for a group of 50 genes. The test can help women and their doctors decide if extending hormonal therapy 5 more years (for a total of 10 years of hormonal therapy) would be beneficial. The EndoPredict test provides a risk score that is either low-risk or high-risk of breast cancer recurring as distant metastasis. Coding Instructions and Codes Note 1: Physician statement of the Multigene Signature Method can be used to code this data item. Note 2: Multigene signatures or classifiers are assays of a panel of genes from a tumor specimen, intended to provide a quantitative assessment of the likelihood of response to chemotherapy and to evaluate prognosis or the likelihood of future metastasis. Coding Instructions and Codes Note 1: Physician statement of the Multigene Signature Results can be used to code this data item. The likelihood of distant recurrence and benefit from chemotherapy increases with an increase in the Recurrence Score result. Coding Instructions and Codes Note 1: Physician statement of Oncotype Dx Recurrence Score-Invasive score can be used to code this data item. Note 2: the Oncotype Dx-Invasive recurrence score is reported as a whole number between 0 and 100. Note 3: Record only the results of an Oncotype Dx-Invasive recurrence score in this data item. Note 5: Staging for Breast cancer now depends on the Oncotype-Dx-Invasive recurrence score. Coding Instructions and Codes Note 1: Physician statement of Oncotype Dx Risk Level-Invasive can be used to code this data item. Note 2: the Oncotype Dx Risk Level-Invasive test stratifies scores into low, intermediate, and high risk of distant recurrence. As of early 2017 there are no established standards for interpretation of results or for cutoffs for positive and negative. Do not confuse intramammary nodes, which are within breast tissue and are included in level I, with internal mammary nodes, which are along the sternum.
Marijuana also acts as a stimulant medications list order genuine glucophage sr on line, producing giggling medicine 831 safe 500 mg glucophage sr, laughing symptoms after flu shot buy glucophage sr 500mg online, and mild intoxication medications not to mix purchase glucophage sr 500 mg with amex. It acts to enhance perception of sights, sounds, and smells, and may produce a sensation of time slowing down. It is much less likely to lead to antisocial acts than that other popular intoxicant, alcohol, and it is also the one psychedelic drug whose use has not declined in [15] recent years (National Institute on Drug Abuse, 2009). Although the hallucinogens are powerful drugs that produce striking mind-altering effects, they do not produce physiological or psychological tolerance or dependence. While they are not addictive and pose little physical threat to the body, their use is not advisable in any situation in which the user needs to be alert and attentive, exercise focused awareness or good judgment, or demonstrate normal mental functioning, such as driving a car, studying, or operating machinery. Why We Use Psychoactive Drugs People have used, and often abused, psychoactive drugs for thousands of years. Perhaps this should not be surprising, because many people find using drugs to be fun and enjoyable. Even when we know the potential costs of using drugs, we may engage in them anyway because the pleasures of using the drugs are occurring right now, whereas the potential costs are abstract and occur in the future. Carl Lejuez and his colleagues (Lejuez, Aklin, [16] Bornovalova, & Moolchan, 2005) tested the hypothesis that cigarette smoking was related to a desire to take risks. In their research they compared risk-taking behavior in adolescents who reported having tried a cigarette at least once with those who reported that they had never tried smoking. Eighty percent of the adolescents indicated that they had never tried even a puff of a cigarette, and 20% indicated that they had had at least one puff of a cigarette. With each pump the balloon appears bigger on the screen, and more money accumulates in a temporary bank account. At any point during each balloon trial, the participant can stop pumping up the balloon, click on a button, transfer all money from the temporary bank to the permanent bank, and begin with a new balloon. Because the participants do not have precise information about the probability of each balloon exploding, and because each balloon is programmed to explode after a different number of pumps, the participants have to determine how much to pump up the balloon. The number of pumps that participants take is used as a measure of their tolerance for risk. Low-tolerance people tend to make a few pumps and then collect the money, whereas more risky people pump more times into each balloon. Supporting the hypothesis that risk tolerance is related to smoking, Lejuez et al. Children try drugs when their friends convince them to do it, and these decisions are based on social norms about the risks and benefits of various drugs. In the period 1991 to 1997, the percentage of 12th-graders who responded that they perceived great harm in regular marijuana use declined from 79% to 58%, while annual [20] use of marijuana in this group rose from 24% to 39% (Johnston et al. And students binge drink in part when they see that many other people around them are also binging (Clapp, [21] Reed, Holmes, Lange, & Voas, 2006). All recreational drug use is associated with at least some risks, and those who begin using drugs earlier are also more [22] likely to use more dangerous drugs later (Lynskey et al. Furthermore, as we will see in the next section, there are many other enjoyable ways to alter consciousness that are safer. Based on what you have learned in this section, why do you think that they are used, and do you think that their side effects are harmful Consider the research reported in the research focus on risk and cigarette smoking. Can you see any weaknesses in the study caused by the fact that the results are based on correlational analyses From first drug use to drug dependence: Developmental periods of risk for dependence upon marijuana, cocaine, and alcohol. Human aggression while under the influence of alcohol and other drugs: An integrative research review. Differences in risk-taking propensity across inner city adolescent ever and never-smokers. Drunk in public, drunk in private: the relationship between college students, drinking environments and alcohol consumption. These altered states of consciousness are sometimes the result of simple and safe activities, such as sleeping, watching television, exercising, or working on a task that intrigues us. In this section we consider the changes in consciousness that occur through hypnosis, sensory deprivation, and meditation, as well as through other non-drug-induced mechanisms. In his practice, Mesmer passed magnets over the bodies of his patients while telling them their physical and psychological problems would disappear. The patients frequently lapsed into a trancelike state (they were said to be mesmerized) and [1] reported feeling better when they awoke (Hammond, 2008). James Braid, a Scottish physician, coined the term hypnosis in 1843, basing it on the Greek word [2] for sleep(Callahan, 1997). Hypnosis is a trance-like state of consciousness, usually induced by a procedure known as hypnotic induction, which consists of heightened suggestibility, deep relaxation, and intense [3] focus(Nash & Barnier, 2008). Hypnosis became famous in part through its use by Sigmund Freud in an attempt to make unconscious desires and emotions conscious and thus able to be [4] considered and confronted (Baker & Nash, 2008). Because hypnosis is based on the power of suggestion, and because some people are more [5] suggestible than others, these people are more easily hypnotized. Hilgard (1965) found that about 20% of the participants he tested were entirely unsusceptible to hypnosis, whereas about 15% were highly responsive to it. The best participants for hypnosis are people who are willing or eager to be hypnotized, who are able to focus their attention and block out peripheral awareness, who are open to new experiences, and who are capable of fantasy (Spiegel, [6] Greenleaf, & Spiegel, 2005). People who want to become hypnotized are motivated to be good subjects, to be open to suggestions by the hypnotist, and to fulfill the role of a hypnotized person as they perceive it [7] (Spanos, 1991). The hypnotized state results from a combination of conformity, relaxation, [8] obedience, and suggestion (Fassler, Lynn, & Knox, 2008). This does not necessarily indicate that hypnotized people are faking or lying about being hypnotized. Their results suggested that almost 90% of their supposedly hypnotized subjects truly believed that they had been hypnotized. One common misconception about hypnosis is that the hypnotist is able to take control of hypnotized patients and thus can command them to engage in behaviors against their will. In fact, people who have not been hypnotized are often just as suggestible as those who have been (Orne & Evans, [12] 1965). Another common belief is that hypnotists can lead people to forget the things that happened to [13] them while they were hypnotized. Hilgard and Cooper (1965) investigated this question and found that they could lead people who were very highly susceptible through hypnosis to show at least some signs of posthypnotic amnesia. Some hypnotists have tried to use hypnosis to help people remember events, such as childhood experiences or details of crime scenes, that they have forgotten or repressed. The idea is that some memories have been stored but can no longer be retrieved, and that hypnosis can aid in the retrieval process. But research finds that this is not successful: People who are hypnotized and then asked to relive their childhood act like children, but they do not accurately recall the things [14] that occurred to them in their own childhood (Silverman & Retzlaff, 1986). Furthermore, the suggestibility produced through hypnosis may lead people to erroneously recall experiences that [15] they did not have (Newman & Baumeister, 1996). Many states and jurisdictions have therefore banned the use of hypnosis in criminal trials because the evidence recovered through hypnosis is likely to be fabricated and inaccurate. The effectiveness of hypnosis in these areas is controversial, although at least some successes have been reported. Kirsch, Montgomery, and [16] Sapirstein (1995) found that that adding hypnosis to other forms of therapies increased the [17] effectiveness of the treatment, and Elkins and Perfect (2008) reported that hypnosis was useful in helping people stop smoking. Reducing Sensation to Alter Consciousness: Sensory Deprivation Sensory deprivation is the intentional reduction of stimuli affecting one or more of the five senses, with the possibility of resulting changes in consciousness. Sensory deprivation is used for relaxation or meditation purposes, and in physical and mental health-care programs to produce enjoyable changes in consciousness.
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