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By: N. Masil, M.A.S., M.D.
Clinical Director, University of Minnesota Medical School
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Some individuals may acquire extensive collections of highly desired fetish objects. Cuiture-R eiated Diagnostic issues Knowledge of and appropriate consideration for normative aspects of sexual behavior are important fac to rs to explore to establish a clinical diagnosis of fetishistic disorder and to distinguish a clinical diagnosis from a socially acceptable sexual behavior. Gender-Reiated Diagnostic issues Fetishistic disorder has not been systematically reported to occur in females. In clinical samples, fetishistic disorder is nearly exclusively reported in males. Functionai Consequences of Fetishistic Disorder Typical impairments associated with fetishistic disorder include sexual dysfunction during romantic reciprocal relationships when the preferred fetish object or body part is unavailable during foreplay or coitus. Such individuals have been arrested and charged for nonsexual antisocial behaviors. The nearest diagnostic neighbor of fetishistic disorder is transves tic disorder. Fetishes can co-occur with other paraphilic disorders, especially "sadomasochism" and transvestic disorder. Specify if: With fetishism: If sexually aroused by fabrics, materials, or garments. Specify if: in a controiied environment: this specifier is primarily applicable to individuals living in institutional or other settings where opportunities to cross-dress are restricted, in fuii remission: There has been no distress or impairment in social, occupational, or other areas of functioning for at least 5 years while in an uncontrolled environment. Sexual arousal, in its most obvious form of penile erection, may co-occur with cross-dressing in various ways. In younger males, cross-dressing often leads to masturbation, following which any female clothing is removed. Older males often leam to avoid masturbating or doing anything to stimulate the penis so that the avoidance of ejaculation allows them to prolong their cross-dressing session.
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The following reactions were reported by at least 2% of patients treated with a to moxetine, and equal to or less than placebo: pharyngolaryngeal pain, insomnia (insomnia includes the terms, insomnia, initial insomnia, middle insomnia). The following reaction did not meet this criterion but shows a statistically significant dose relationship: pruritus. In these clinical trials, no poor metabolizers (0/43) reported seizures compared to 0. The following reactions did not meet this criterion but were reported by more a to moxetine-treated patients than placebo-treated patients and are possibly related to a to moxetine treatment: peripheral coldness, tachycardia, prostatitis, testicular pain, orgasm abnormal, flatulence, asthenia, feeling cold, muscle spasm, dysgeusia, agitation, restlessness, micturition urgency, pollakiuria, pruritus, urticaria, flushing, tremor, menstruation irregular, rash, and urinary retention. Changes in sexual desire, sexual performance, and sexual satisfaction are not well assessed in most clinical trials because they need special attention and because patients and physicians may be reluctant to discuss them. Accordingly, estimates of the incidence of un to ward sexual experience and performance cited in product labeling are likely to underestimate the actual incidence. Unless otherwise specified, these adverse reactions have occurred in adults and children and adolescents. The postmarketing seizure cases include patients with pre-existing seizure disorders and those with identified risk fac to rs for seizures, as well as patients with neither a his to ry of nor identified risk fac to rs for seizures. Such reactions may occur when these drugs are given concurrently or in close proximity [see Contraindications (4. Albuterol (600 mcg iv over 2 hours) induced increases in heart rate and blood pressure. A to moxetine did not affect the binding of warfarin, acetylsalicylic acid, pheny to in, or diazepam to human albumin. Similarly, these compounds did not affect the binding of a to moxetine to human albumin. Risk Summary Available published studies with a to moxetine use in pregnant women are insufficient to establish a drug associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. Some animal reproduction studies of a to moxetine had adverse developmental outcomes. One of 3 studies in pregnant rabbits dosed during organogenesis resulted in decreased live fetuses and an increase in early resorptions, as well as slight increases in the incidences of atypical origin of carotid artery and absent subclavian artery. No adverse fetal effects were seen in pregnant rats dosed during the organogenesis period (see Data). Data Animal Data 14 Pregnant rabbits were treated with up to 100 mg/kg/day of a to moxetine by gavage throughout the period of organogenesis. At this dose, in 1 of 3 studies, a decrease in live fetuses and an increase in early resorptions was observed. Slight increases in the incidences of atypical origin of carotid artery and absent subclavian artery were observed. When a drug is present in animal milk, it is likely that the drug will be present in human milk. The pharmacokinetics of a to moxetine in children and adolescents are similar to those in adults. A study was conducted in young rats to evaluate the effects of a to moxetine on growth and neurobehavioral and sexual development. Slight delays in onset of vaginal patency (all doses) and preputial separation (10 and 50 mg/kg), slight decreases in epididymal weight and sperm number (10 and 50 mg/kg), and a slight decrease in corpora lutea (50 mg/kg) were seen, but there were no effects on fertility or reproductive performance. A slight increase in mo to r activity was seen on Day 15 (males at 10 and 50 mg/kg and females at 50 mg/kg) and on Day 30 (females at 50 mg/kg) but not on Day 60 of age. Dosage adjustment is recommended for patients with moderate or severe hepatic insufficiency [see Dosage and Administration (2. The primary reason for discontinuation in both the a to moxetine (38 of 76 patients, 50.
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Lower estimates have been reported for Asian, African, and Latin American countries, ranging from 0. The gender differentiation occurs in adolescence and is already observable before age 14 years. Although panic attacks occur in children, the overall prevalence of panic disorder is low before age 14 years (<0. Development and Course the median age at onset for panic disorder in the United States is 20-24 years. A small number of cases begin in childhood, and onset after age 45 years is unusual but can occur. Only a minority of individuals have full remission without subsequent relapse within a few years. Although panic disorder is very rare in childhood, first occurrence of "fearful spells" is often dated retrospectively back to childhood. As in adults, panic disorder in adolescents tends to have a chronic course and is frequently comorbid with other anxiety, depressive, and bipolar disorders. Lower prevalence of panic disorder in older adults appears to be attributable to age-related "dampening" of the au to nomic nervous system response. Many older individuals with "panicky feelings" are observed to have a "hybrid" of limited-symp to m panic attacks and generalized anxiety. Older individuals may retrospectively endorse explanations for the panic attack^which would preclude the diagnosis of panic disorder), even if an attack might actually have been unexpected in the moment (and thus qualify as the basis for a panic disorder diagnosis). Thus, careful questioning of older adults is required to assess whether panic attacks were expected before entering the situation, so that unexpected panic attacks and the diagnosis of panic disorder are not overlooked. While the low rate of panic disorder in children could relate to difficulties in symp to m reporting, this seems unlikely given that children are capable of reporting intense fear or panic in relation to separation and to phobic objects or phobic situations. Therefore, clinicians should be aware that unexpected panic attacks do occur in adolescents, much as they do in adults, and be attuned to this possibility when encountering adolescents presenting with episodes of intense fear or distress. Although separation anxiety in childhood, especially when severe, may precede the later development of panic disorder, it is not a consistent risk fac to r. Reports of childhood experiences of sexual and physical abuse are more common in panic disorder than in certain other anxiety disorders. Most individuals report identifiable stressors in the months before their first panic attack. There is an increased risk for panic disorder among offspring of parents with anxiety, depressive, and bipolar disorders. Respira to ry disturbance, such as asthma, is associated with panic disorder, in terms of past his to ry, comorbidity, and family his to ry. Culture-Related Diagnostic issues the rate of fears about mental and somatic symp to ms of anxiety appears to vary across cultures and may influence the rate of panic attacks and panic disorder.
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If the medical records of the insured person are not in French or English, you must provide the original records along with a translation of the records in to either French or English. Based on the medical records we receive, we must be satisfied that the same diagnosis or treatment would have been made if the illness developed or was diagnosed in Canada. The policy includes other terms and conditions not covered in this guide this guide is a general reference only and does not form part of your policy. Each policy is unique, and includes additional exclusions and limitations that define when a benefit is not payable. Illnesses not specifically mentioned or not meeting the stated criteria are not covered. Acquired brain injury Aortic surgery Acquired brain injury means a definite diagnosis of new Aortic surgery means the undergoing of surgery for disease damage to brain tissue caused by traumatic injury, anoxia of the aorta requiring excision and surgical replacement of or encephalitis, resulting in signs and symp to ms of any part of the diseased aorta with a graft. Aorta means neurological impairment that: the thoracic and abdominal aorta but not its branches. No benefit will be payable under this condition for angioplasty, intra arterial procedures, percutaneous trans the diagnosis of acquired brain injury must be made catheter procedures or non surgical procedures. The tumour must require surgical or radiation treatment or cause irreversible objective neurological deficit(s). An example of an excluded cancer is cancer-in-situ of the cervix, which is No benefit will be payable for cancer if, within the first usually identified and treated before the malignant cells 90 days following the later of: have invaded adjacent tissues. However, if one of these > the date the application for the policy was signed excluded cancers is not cured and then worsens, benefits > the policy date may become payable providing the policy remains in force. You have a responsibility to notify us about cancer, regardless of when a diagnosis is made: the surgery must be determined to be medically necessary by a specialist. Coma Deafness Coma means a definite diagnosis of a state of Deafness is defined as a definite diagnosis of the to tal unconsciousness with no reaction to external stimuli or and irreversible loss of hearing in both ears, with an response to internal needs for a continuous period of at audi to ry threshold of 90 decibels or greater within the least 96 hours, and for which period the Glasgow coma speech threshold of 500 to 3,000 hertz. The diagnosis of a recent heart attack therefore, is confirmed by the detection of > agnosia (difficulty recognizing objects), or abnormal electrical activity over the surface of the heart, > disturbance in executive functioning. No benefit will be payable under this condition for affective or schizophrenic disorders, or delirium. The diagnosis of loss of independent existence must be the surgery must be determined to be medically made by a specialist. If the insured person has a loss of independent existence before the policy anniversary nearest their 18th birthday, you must wait to send us a claim for this illness. To qualify under major organ transplant, the insured person must undergo a transplantation procedure as the recipient of a heart, lung, liver, kidney or bone marrow, and limited to these entities. Depending on which part of the brain is damaged, disease or specified atypical parkinsonian disorders, this can result in paralysis to one side of the body and regardless of when a diagnosis is made: impairment of speech or vision. Tiny mini-strokes that do not produce symp to ms or persisting neurologic > If we are notified within 6 months of the date of the impairment are not covered. These new symp to ms and deficits must be Severe burns corroborated by diagnostic imaging testing. Severe burns means a definite diagnosis of third degree burns over at least 20% of the body surface. The partial lump sum payment will be equal to 15% of the critical illness insurance benefit amount to a maximum of $50,000 per condition. You can make one claim per partial payout illness, to a maximum of four partial payments.
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