Brahmi

David P. Faxon, MD

• Director of Strategic Planning
• Department of Medicine
• Brigham and Women? Hospital
• Professor of Medicine
• Department of Medicine
• Harvard Medical School
• Boston, Massachusetts

Following the Inevitable Event treatment centers for drug addiction buy discount brahmi line, the whole technospheric system will be coming down slowly over the next few years everlast my medicine buy generic brahmi 60 caps line, like a giant circus tent that has lost its central prop treatment that works order cheap brahmi online. How gracefully or gracelessly this happens is dependent on the response of the Pentagon-or the will of humanity to rouse itself in the face of even worse barbarisms acute treatment cheap 60caps brahmi mastercard. Because it consists of five interactive components, the techno sphere can be graphi cally depicted as a pentagon, a five-sided figure. At the center of this pentagon of the technosphere are the World Trade Center Twin Towers. The actual Pentagon, which was attacked along with the Twin Towers, was designed in the late 1930s to house the U. The structure of the Pentagon is the prototypical morphology the Climax of History. The Pentagon was the impregnable fortress of the American war machine, protecting American in terests and globalization around the world. If there were two central points-actual and symbolic-to what is known as the military-industrial complex, it was the Pen tagon and the World Trade Center, and this is undoubtedly the reason why they were both targets of the Inevitable Event. What is architecturally noteworthy about the Pentagon is that it is designed with five inner pentagonal corridors and office slabs, and that it is constructed with its odd point to the south. Since a pentagon is actually a pentagram, a five-pointed star with its points connected, the Pentagon represents an inverted pentagram, as its odd point faces south rather than north. In the traditional Tarot deck it is interesting that the Fifteenth Major Arcana, the Devil, contains an inverted pentagram between the horns of the Beast. Paul Foster Case writes, "This is a key to the whole meaning of the figure [of the devil]. No matter how much America and its allies, many of them bought for a price, may strike back, the deed has been done. While it will take several years for the full realization of the absolute magnitude of this archetypal event to sink into the 88. The Climax of History collective mind, it is important to demonstrate the actual structure in time of the techno sphere so that the finality of its end may be seriously considered, and the gate to the future, which has thereby been opened, can be made clearly visible. As we have shown, the technosphere is a structure totally brought about by the 12:60 timing frequency, and thus is purely a function of the latter. As such, the technosphere is embedded in the global macro-organizing principle of the 12:60 fre quency, the Gregorian calendar. Two 28-year cycles, each one divided into four 7-year subcycles, define the duration of the technosphere. As we have pointed out, the 56-year cycle of the technosphere, 1945-2001, is preceded by the 44-year cycle of the proto technosphere. The fifty-six years between Hiroshima and the Inevitable Event were the age of terror, for it was atomic terror that initiated the technosphere in a baptism of nuclear fire, and in the end, it was an unimaginable suicidal terror that brought down not just one, but both of the Twin Towers of Babel. The final collapse of the technosphere is also the final war between blood and money. Only a new time will be able to regenerate the biosphere and spiritually revive mankind. What follows is a chronological description of the eight 7-year stages of the fifty-six years of the technosphere. During the first dynamic 7-year cycle, with the triple event of the first test of the atomic bomb and its two detonations at Hiroshima and Nagasaki, the biosphere becomes irrevocably altered by the introduction of a constant, steady state back ground radiation into the atmosphere, the actual inception of the biogeochemical combustion. The reality is that the humans also created their first weapon of mass destruction. It is this act that also immediately sets in motion a destabilization of the human consciousness in the noosphere. In the same year, 1947, the iron curtain between communist Eastern Europe and the West, epitomized by the Berlin Wall, turns the enmity between the two major powers, the Soviet Union and capitalist America, into the Cold War. Nonetheless, the terror of the Bomb as the ultimate deterrent engenders the arms race. War in Indochina, the establishment of the Israeli state in Palestine (1948) at the expense of the sover eignty of the Palestinian people, and the completion of the Chinese Marxist Revolu tion under Chairman Mao are the highlights of 1949, followed by the Korean War in 1950. At the same time, 1949, commercial television production begins in the United States; the age of radio is replaced by the "tube. In the summer of 1952 a Cuban archaeologist discovers the tomb of the Mayan sage, Pacal Votan. This unprecedented archaeological event marks the beginning of the final sixty years-three katun cycles-of the Mayan thirteen baktun cycle of history. The United States and Russia conduct numerous nuclear weapons tests in Nevada, Siberia, and the Pacific Ocean. Wars for independence occur in various African states, and in general the era of European imperialism is at an end, followed by the neo-colonialist (Third World) era of guer rilla warfare, poverty, and social instability. In 1956, the year the Russians launch the first sputnik and begin the space age, the United Nations tables the issue of calendar reform indefinitely, thus closing the chapter begun when the League of Nations proposed global calendar reform in 1931. The year 1956 also marks the beginning of the electronic pop culture of the technosphere, rock and roll. By the end of this cycle, the "space race" joins the arms race as a force in promoting the advance of the technosphere. The Climax of History travel begins, with the airport to become the centerpiece of globalization. The July 26 Cuban Revolution of Fidel Castro, triumphant in 1959, establishes a communist state in the Americas and heightens the Cold War. That same year the Chinese communists bring to a definitive end the rule of the Dalai Lama in Tibet. In the Congo, the popular hero Patrice Lumumba is assassinated after only two months in office. Also in 1960, the human population hits three billion, an increase of one billion since 1930. In 1961 the Institute of Mathematics of the Siberian Branch of the Soviet Academy of Sciences begins the monumental mathematical analysis of Mayan hieroglyphic texts. The attempted 1961 Bay of Pigs invasion of Cuba is fol lowed in 1963 with the assassination ofJohn F. Kennedy, an act that reflects a rising level of cultural turmoil in the United States. This act seals the technosphere within the unquestioned confines of Gregorian time, ultimately turn ing the atomic mind explosion in on itself. In 1966 construction begins on the World Trade Center Twin Towers, while in 1968 World Trade Centers are independently established in Houston, New Orleans, and Tokyo. This ferment includes: race riots, antiwar riots, a march on the Pentagon, the assassinations of Martin Luther King Jr. Also in 1969, the Woodstock concert marks the apex of the early rock-and-roll culture and the visionary climax of the cultural revolution. In 1970 the vision of the whole Earth is translated into the first Earth Day and the birth of the ecology movement. The United Nations follows two years later with the Stockholm Conference on the Environment. The revolutionary fervor of the previ ous years turns more violent, and repressive governmental police powers win the day. The first 28-year cycle ends with a whimper, the dynamic destabilization of consciousness reaches a plateau of normalcy-a normalcy to be increasingly punctu ated by terrorist activity, as in the Palestinian takeover of the Olympic Village in September 1972. Both apart from as well as in reaction to such activity, the technosphere has now become all-dominant and all-powerful in human affairs. This normalization of human consciousness allows the diverse and rapidly evolving tech nological components of the technosphere to reach a point of consolidation. This stabilization of the World Market fosters its next and concluding phase: globalization and the triumph of marketing over human culture. It should be kept in mind that the instruments and weapons of mass destruction, of which there were none on January 1, 1945, have now proliferated to five different countries and provide the ultimate backdrop to these first twenty-eight years. The dedication of the World Trade Center Twin Towers on April 4, 1973 (a repeat of the calendar year of the Bomb, 1945) is the counterpart to the construction of the Pentagon (1940-1941), which sponsored the bombing of Hiroshima and Nagasaki. The tallest buildings in the world when they opened, the 11O-story Twin Towers seal the Climax of History. Also in 1973, after five years of study the Club of Rome issues the Limits of Growth, which in its analysis of trends foresees a major environmental (biospheric) crisis within one hundred years, yet nonetheless establishes and promotes the standard world model, a setting of production quotas at the 1973 level, to foster sustainable growth at least until 2020. The third war (previous ones having occurred in 1967 and 1949) between Israel and its neighbors occurs this year. With Gregorian civilization triumphant, Mexico, home of the Maya, is the first country visited by the new Pope.

Both multiple motor and one or more vocal tics have been present at some time during the illness medications are administered to effective 60 caps brahmi, although not necessarily concurrently medications via g tube cheap brahmi 60caps with amex. The tics may wax and wane in frequency but have persisted for more than 1year since first tic onset symptoms zinc deficiency cheap brahmi american express. Single or multiple motor or vocal tics have been present during the illness symptoms 4dp5dt fet buy cheap brahmi 60 caps, but not both motor and vocal. Specify if: With motor tics only With vocal tics only Provisional Tic Disorder 307. The disturbance is not attributable to the physiological effects of a substance. Diagnosis for any tic disorder is based on the presence of motor and/or vocal tics (Criterion A), duration of tic symptoms (Criterion B), age at onset (Criterion C), and ab? sence of any known cause such as another medical condition or substance use (Criterion D). An individual may have various tic symptoms over time, but at any point in time, the tic rep? ertoire recurs in a characteristic fashion. Although tics can include almost any muscle group or vocalization, certain tic symptoms, such as eye blinking or throat clearing, are common across patient populations. Tics are generally experienced as involuntary but can be vol? untarily suppressed for varying lengths of time. Simple vocal tics include throat clearing, sniffing, and grunting often caused by contraction of the diaphragm or muscles of the oropharynx. Importantly, coprolalia is an abrupt, sharp bark or grunt utterance and lacks the prosody of similar inappropriate speech observed in human interactions. The presence of motor and/or vocal tics varies across the four tic disorders (Criterion A). For other specified or un? specified tic disorders, the movement disorder symptoms are best characterized as tics but are atypical in presentation or age at onset, or have a known etiology. For an individual with motor and/or vocal tics of less than 1 year since first tic onset, a provisional tic disorder diagnosis can be considered. There is no duration specification for other specified and unspecified tic disorders. Tic disorders typically begin in the prepubertal period, with an average age at onset between 4 and 6 years, and with the incidence of new-onset tic disorders decreasing in the teen years. New onset of tic symptoms in adulthood is exceedingly rare and is often associated with expo? sures to drugs. Although tic onset is uncommon in teenagers and adults, it is not uncommon for adolescents and adults to present for an initial diagnostic assessment and, when carefully evaluated, provide a history of milder symptoms dating back to child? hood. New-onset abnormal movements suggestive of tics outside of the usual age range should result in evaluation for other movement disorders or for specific etiologies. Tic symptoms cannot be attributable to the physiological effects of a substance or an? other medical condition (Criterion D). When there is strong evidence from the history, physical examination, and/or laboratory results to suggest a plausible, proximal, and probable cause for a tic disorder, a diagnosis of other specified tic disorder should be used. Similarly, a previ? ous diagnosis of persistent (chronic) motor or vocal tic disorder negates a diagnosis of provisional tic disorder or other specified or unspecified tic disorder (Criterion E). Males are more commonly affected than females, with the ratio varying from 2:1 to 4:1. A national survey in the United States estimated 3 per 1,000 for the prevalence of clinically identified cases. The frequency of identified cases was lower among African Americans and Hispanic Americans, which may be related to differences in access to care. Peak severity occurs between ages 10 and 12 years, with a decline in severity during adolescence. A small percentage of individuals will have persis? tently severe or worsening symptoms in adulthood. Tics wax and wane in severity and change in affected muscle groups and vocalizations over time. As children get older, they begin to report their tics being associated with a premonitory urge?a somatic sensation that precedes the tic?and a feeling of tension reduction follow? ing the expression of the tic. Tics associated with a premonitory urge may be experienced as not completely 'involuntary" in that the urge and the tic can be resisted. Tics are worsened by anxiety, excitement, and exhaustion and are better during calm, focused activities. Individuals may have fewer tics when engaged in schoolwork or tasks at work than when relaxing at home after school or in the evening. Observing a gesture or sound in another person may result in an indi? vidual with a tic disorder making a similar gesture or sound, which may be incorrectly perceived by others as purposeful. This can be a particular problem when the individual is interacting with authority figures. Obstetrical complications, older paternal age, lower birth weight, and maternal smoking during pregnancy are as? sociated with worse tic severity. Culture-Related Diagnostic Issues Tic disorders do not appear to vary in clinical characteristics, course, or etiology by race, ethnicity, and culture. However, race, ethnicity, and culture may impact how tic disorders are perceived and managed in the family and community, as well as influencing patterns of help seeking, and choices of treatment. G ender-Related Diagnostic Issues Males are more commonly affected than females, but there are no gender differences in the kinds of tics, age at onset, or course. Women with persistent tic disorders may be more likely to experience anxiety and depression. Functional Consequences of Tic Disorders Many individuals with mild to moderate tic severity experience no distress or impairment in functioning and may even be unaware of their tics. Individuals with more severe symp? toms generally have more impairment in daily living, but even individuals with moderate or even severe tic disorders may function well. Less commonly, tics dis? rupt functioning in daily activities and result in social isolation, interpersonal conflict, peer victimization, inability to work or to go to school, and lower quality of life. D ifferential Diagnosis Abnormal movements that may accompany other medical conditions and stereotypic movement disorder. Motor stereotypies are defined as involuntary rhythmic, repetitive, predictable movements that appear purposeful but serve no obvious adaptive function or purpose and stop with distraction. Examples include repetitive hand waving/rotating, arm flapping, and finger wiggling. Chorea represents rapid, random, continual, abrupt, irregular, unpredictable, nonstereotyped actions that are usually bilateral and affect all parts of the body. The timing, direction, and distribution of movements vary from mo? ment to moment, and movements usually worsen during attempted voluntary action. Dys? tonia is the simultaneous sustained contracture of both agonist and antagonist muscles, resulting in a distorted posture or movement of parts of the body. Dystonie postures are of? ten triggered by attempts at voluntary movements and are not seen during sleep. Paroxysmal dyskinesias usually oc? cur as dystonie or choreoathetoid movements that are precipitated by voluntary move? ment or exertion and less commonly arise from normal background activity. Myoclonus is characterized by a sudden unidirectional movement that is often nonrhythmic. Myoclonus is differentiated from tics by its rapidity, lack of suppressibility, and absence of a premon? itory urge. Clues favoring an obsessive-compulsive behavior in? clude a cognitive-based drive. Impulse-control problems and other repetitive be? haviors, including persistent hair pulling, skin picking, and nail biting, appear more goal directed and complex than tics. The obsessive-compulsive symptoms observed in tic disorder tend to be characterized by more aggressive symmetry and order symptoms and poorer response to pharmacotherapy with selective serotonin reuptake inhibitors. Individuals with tic disorders can also have other movement disorders and other mental disorders, such as depressive, bipolar, or substance use disorders. The other specified tic disorder category is used in situations in which the clinician chooses to com? municate the specific reason that the presentation does not meet the criteria for a tic disor? der or any specific neurodevelopmental disorder. This is done by recording other specified tic disorder?followed by the specific reason. The un? specified tic disorder category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a tic disorder or for a specific neurode? velopmental disorder, and includes presentations in which there is insufficient information to make a more specific diagnosis.

Delusions may have a variety of themes treatment xerostomia purchase brahmi now, including somatic treatment vitiligo buy generic brahmi 60 caps online, grandiose symptoms 8 days post 5 day transfer buy cheap brahmi on-line, religious symptoms 5 days before missed period generic brahmi 60 caps overnight delivery, and, most commonly, perse? cutory. On the whole, however, associations between delusions and particular medical conditions appear to be less specific than is the case for hallucinations. In determining whether the psychotic disturbance is attributable to another medical condition, the presence of a medical condition must be identified and considered to be the etiology of the psychosis through a physiological mechanism. Although there are no infallible guidelines for determining whether the relationship between the psychotic distur? bance and the medical condition is etiological, several considerations provide some guidance. One consideration is the presence of a temporal association between the onset, exacerba? tion, or remission of the medical condition and that of the psychotic disturbance. A second consideration is the presence of features that are atypical for a psychotic disorder. The disturbance must also be distinguished from a substance/medication-induced psychotic disorder or an? other mental disorder. Associated Features Supporting Diagnosis the temporal association of the onset or exacerbation of the medical condition offers the greatest diagnostic certainty that the delusions or hallucinations are attributable to a med? ical condition. Additional factors may include concomitant treatments for the underlying medical condition that confer a risk for psychosis independently, such as steroid treatment for autoimmune disorders. Prevalence Prevalence rates for psychotic disorder due to another medical condition are difficult to es? timate given the wide variety of underlying medical etiologies. When the prevalence findings are stratified by age group, individuals older than 65 years have a significantly greater prevalence of 0. Rates of psychosis also vary according to the underlying medical condition; conditions most commonly associated with psy? chosis include untreated endocrine and metabolic disorders, autoimmune disorders. Psychosis due to epilepsy has been further differ? entiated into ictal, postictal, and interictal psychosis. Among older individuals, there may be a higher prevalence of the disorder in females, although additional gender-related fea? tures are not clear and vary considerably with the gender distributions of the underlying medical conditions. Development and Course Psychotic disorder due to another medical condition may be a single transient state or it may be recurrent, cycling with exacerbations and remissions of the underlying medical condition. Although treatment of the underlying medical condition often results in a res? olution of the psychosis, this is not always the case, and psychotic symptoms may persist long after the medical event. In the con? text of chronic conditions such as multiple sclerosis or chronic interictal psychosis of epi? lepsy, the psychosis may assume a long-term course. The expression of psychotic disorder due to another medical condition does not differ substantially in phenomenology depending on age at occurrence. However, older age groups have a higher prevalence of the disorder, which is most likely due to the increasing medical burden associated with advanced age and the cumulative effects of deleterious exposures and age-related processes. The nature of the underlying medical conditions is likely to change across the lifespan, with younger age groups more affected by epilepsy, head trauma, autoimmune, and neoplastic diseases of early to mid? life, and older age groups more affected by stroke disease, anoxic events, and multiple sys? tem comorbidities. Underlying factors with increasing age, such as preexisting cognitive impairment as well as vision and hearing impairments, may incur a greater risk for psy? chosis, possibly by serving to lower the threshold for experiencing psychosis. Identification and treatment of the underlying medical condition has the greatest impact on course, although preexisting central nervous system injury may confer a worse course outcome. Diagnostic iVlarlcers the diagnosis of psychotic disorder due to another medical condition depends on the clin? ical condition of each individual, and the diagnostic tests will vary according to that con? dition. The associated physical examination findings, laboratory findings, and patterns of prevalence or onset reflect the etiological medical condition. Suicide Risl(Suicide risk in the context of psychotic disorder due to another medical condition is not clearly delineated, although certain conditions such as epilepsy and multiple sclerosis are associated with increased rates of suicide, which may be further increased in the presence of psychosis. Hallucinations and delusions commonly occur in the context of a delirium; however, a separate diagnosis of psychotic disorder due to another medical condition is not given if the disturbance occurs exclusively during the course of a delirium. Delusions in the context of a major or mild neurocognitive disorder would be diagnosed as major or mild neurocognitive disorder, with behavioral disturbance. If there is evidence of recent or prolonged substance use (including medications with psychoactive effects), withdrawal from a substance, or exposure to a toxin. If the clinician has ascertained that the disturbance is due to both a medical condition and substance use, both diagnoses. Psychotic disorder due to another medical condition must be distin? guished from a psychotic disorder. In psychotic disor? ders and in depressive or bipolar disorders, with psychotic features, no specific and direct causative physiological mechanisms associated with a medical condition can be demon? strated. Late age at onset and the absence of a personal or family history of schizophrenia or delusional disorder suggest the need for a thorough assessment to rule out the diagno? sis of psychotic disorder due to another medical condition. Auditory hallucinations that involve voices speaking complex sentences are more characteristic of schizophrenia than of psychotic disorder due to a medical condition. Comorbidity Psychotic disorder due to another medical condition in individuals older than 80 years is associated with concurrent major neurocognitive disorder (dementia). Catatonia Catatonia can occur in the context of several disorders, including neurodevelopmental, psychotic, bipolar, depressive disorders, and other medical conditions. The manual does not treat catatonia as an independent class but recognizes a) catatonia associated with another men? tal disorder. Catatonia is defined by the presence of three or more of 12 psychomotor features in the diagnostic criteria for catatonia associated with another mental disorder and catatonic dis? order due to another medical condition. The essential feature of catatonia is a marked psy? chomotor disturbance that may involve decreased motor activity, decreased engagement during interview or physical examination, or excessive and peculiar motor activity. The clinical presentation of catatonia can be puzzling, as the psychomotor disturbance may range from marked unresponsiveness to marked agitation. Motoric immobility may be se? vere (stupor) or moderate (catalepsy and waxy flexibility). Similarly, decreased engage? ment may be severe (mutism) or moderate (negativism). In extreme cases, the same individual may wax and wane between de? creased and excessive motor activity. The seemingly opposing clinical features and variable manifestations of the diagnosis contribute to a lack of awareness and decreased recognition of catatonia. During severe stages of catatonia, the individual may need care? ful supervision to avoid self-harm or harming others. There are potential risks from mal? nutrition, exhaustion, hyperpyrexia and self-inflicted injury. The clinical picture is dominated by three (or more) of the following symptoms: 1. Coding note: Indicate the name of the associated mental disorder when recording the name of the condition. Diagnostic Features Catatonia associated with another mental disorder (catatonia specifier) may be used when criteria are met for catatonia during the course of a neurodevelopmental, psychotic, bipo? lar, depressive, or other mental disorder. The catatonia specifier is appropriate when the clinical picture is characterized by marked psychomotor disturbance and involves at least three of the 12 diagnostic features listed in Criterion A. Catatonia is typically diagnosed in an inpatient setting and occurs in up to 35% of individuals with schizophrenia, but the ma? jority of catatonia cases involve individuals with depressive or bipolar disorders. Catatonia can also be a side effect of a medication (see the chapter "Medication Induced Movement Disorders and Other Adverse Effects of Medication"). Because of the seriousness of the complications, particular attention should be paid to the possibility that the catatonia is attributable to 333. Coding note: Include the name of the medical condition in the name of the mental disor? der. The other medical condition should be coded and listed separately immediately before the cata? tonic disorder due to the medical condition. Diagnostic Features the essential feature of catatonic disorder due to another medical condition is the presence of catatonia that is judged to be attributed to the physiological effects of another medical condition. Catatonia can be diagnosed by the presence of at least three of the 12 clinical fea? tures in Criterion A. There must be evidence from the history, physical examination, or laboratory findings that the catatonia is attributable to another medical condition (Crite? rion B). The diagnosis is not given if the catatonia is better explained by another mental disorder. Associated Features Supporting Diagnosis A variety of medical conditions may cause catatonia, especially neurological conditions. The associated physical examination findings, laboratory findings, and patterns of prevalence and onset reflect those of the etiological medical condition. D ifferential Diagnosis A separate diagnosis of catatonic disorder due to another medical condition is not given if the catatonia occurs exclusively during the course of a delirium or neuroleptic malignant syndrome. If the individual is currently taking neuroleptic medication, consideration should be given to medication-induced movement disorders.

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