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Reduction in dosage or, if possible, discontinuation of chlorprothixene therapy is recommended. Frequencies are defined as: very common (1/10), common (1/100 to <1/10), uncommon (1/1000 to <1/100), rare (1/10000 to <1/1000), very rare (<1/10000), or not known (cannot be estimated from the available data). Blood and lymphatic system Rare Thrombocy to penia, neutropenia, disorders leukopenia, agranulocy to sis. Nervous system disorders Very Somnolence, dizziness common Common Dys to nia, headache. Uncommon Tardive dyskinesia, parkinsonism, convulsion, akathisia Very rare Neuroleptic malignant syndrome. Reproductive system and Uncommon Ejaculation failure, erectile breast disorders dysfunction. Abrupt discontinuation of chlorprothixene may be accompanied by withdrawal symp to ms. The most common symp to ms are nausea, vomiting, anorexia, diarrhoea, rhinorrhoea, sweating, myalgias, paraesthesias, insomnia, restlessness, anxiety, and agitation. Patients may also experience vertigo, alternate feelings of warmth and coldness, and tremor. Symp to ms generally begin within 1 to 4 days of withdrawal and abate within 7 to 14 days. Gastric lavage should be carried out as soon as possible after oral ingestion and activated charcoal may be administered. Measures to support the respira to ry and cardiovascular systems should be instituted. Epinephrine (adrenaline) should not be used as further lowering of blood pressure may result. Convulsions may be treated with diazepam and extrapyramidal disorders with biperiden. In order to wide advancement in development of pharmaceutical and cosmetic industries we preferred to work in this field as well as for improvement of safety and efficacy of traditionally used natural products. The aim of the present study was to formulate deodorant potash alum as lotion dosage form and astringent as cream and gel dosage forms. The activity of potash alum against axillaries normal microbiota was tested in vitro using wells diffusion agar method for different concentrations (0. Alum powder has wide traditional usage as astringent to prevent bleeding from minor cuts and for its accelerated healing. Therefore, a more appropriate dosage form was designed in a suitable concentration (2% gel) to elongate its astringent activity by its higher retention time due to highly viscous nature of gel. Using suitable excipients, 2% lotion and gel were prepared by dispersion method while emulsification was used for preparation of the potash alum cream of same strength. The above formulations were evaluated by comparing their pH, viscosity, spreadability, contents uniformity and in vitro diffusion. The results indicated no change in the formulations demonstrating their stable nature as a dosage form and suitability as a commercial product line. It was used as a base in skin whiteners and treatments during the late 16th century. Natural and can also be affected by food or medication (Kanal products have been used for centuries in treating human yavattanakul, 2011; Bhutta, 2007). Although sweating diseases and they contain components of therapeutic plays an important role, the classic association of sweat value. Natural products are environmentally safer, easily and body odour is only part of the explanation. Alum (Aluminum potassium sulfate), the living on the skin which find ideal conditions for growth crystallized double sulfate with the formula in the warm areas of the body that tend to stay moist. The three most processes such as pickling and fermentation and as a commonly used methods to deodorise (combat body flocculants for water purification (Bes to on, 2012). Alum Quantities of sweat can be reduced by using what is used medicinally in many subunit vaccines as an are known as antiperspirants. Alum is also widely used in rural areas of Nigeria are aluminium salts such as aluminium hydroxychloride, for the treatment of pediatric cough (Betsoon, 2012). Antiperspirants form complexes with water, *Corresponding Author: small scales of skin and lipids to create a protein mass Abdulkarim K.
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Rozita Mat Zin Professor Emeritus of Psychiatry Patient Advocate University of Pittsburgh Selangor United States of America Professor Dr. Sarfraz Manzoor Hussain Head of Department & Clinical Psychologist Consultant Psychiatrist Universiti Putra Malaysia, Selangor Nilai Medical Centre, Negeri Sembilan Professor Dr. Syahrir Zaini Senior Lecturer & Senior Consultant Lecturer & Pharmacist Psychiatrist International Islamic University, Pahang Pusat Perubatan Universiti Kebangsaan Malaysia, Kuala Lumpur Dr. This disorder is characterised by persistent low mood, loss of interest, difficulty in concentrating, sleep disturbances, fatigue and in more severe form, functional impairment and suicidal ideations. There is higher risk of early mortality resulting from physical disorders and suicide. It should be implemented when there are adequate systems in place to ensure accurate diagnosis, effective treatment and appropriate follow up. The assessment is determined by to tal number of symp to ms criteria, severity of symp to ms and extent of functional disability. For mild depression, five or more symp to ms are present which cause distress but they are manageable and result in minor impairment in social or occupational functioning. For severe depression, most of the symp to ms are present with marked impairment in functioning. For moderate depression, both symp to ms presentation and functional impairment are between mild and severe. Recommendation 2 fi Severity of major depressive disorder should be made to determine the mode of treatment. Locally, the Malaysian Guidelines on Suicide Prevention & Management and Guidelines on Suicide Risk Management in Hospitals were developed to assist practitioners in suicide preventive measures. A systematic review of 21 studies evaluating 15 suicide risk assessment instruments on a group of suicide attempters, showed that none fulfilled requirements for diagnostic accuracy and there was insufficient evidence to support its use in predicting suicidal acts. Assessment of suicidal intent at the time of self-harm has been associated with risk of subsequent suicide. Communication between healthcare personnel and patients has to be clear in explaining the needs and benefits of psychiatric interventions. Locally, admission to the Psychiatry Ward can be voluntary or involuntary according to Mental Health Act (2001). MoH Singapore, 2012 fi Recovery is when an individual is fully functional and has returned to premorbid functioning. The general aim of these interventions is to alleviate core depressive symp to ms or prevent symp to ms recurring. There are psychological and psychosocial interventions of lower intensity that are less dependent on trained professionals and can be self-guided. Psychoeducation Psychoeducation is given by delivering information on pharmacotherapy and psychological measures which consists of to pics on: fi Symp to ms and course of depression fi biopsychosocial model of aetiology fi pharmacotherapy for acute phase and maintenance fi drug side effects and complications fi importance of medication adherence fi early signs of recurrence fi management of relapse and recurrence Psychoeducation is an important component in the treatment of depression. However, in those with fi5 previous major depressive episodes, manualised psychoeducation is significantly less effective in similar comparison. Peer Intervention Peer intervention, which includes peer support and self-help groups, is often used as a complement to clinical care. Relaxation Relaxation technique is a method to help a person attain a state of calmness. Psychospiritual intervention It is crucial to be culturally sensitive in providing mental health care. The World Health Organization has declared that spirituality is an important dimension of quality of life.
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Successive progress reports on the New Zealand strategy have shown that Drug Treatment Units have been successful at reducing re-imprisonment rates by up to 20 per cent. Given the higher rates of methamphetamine use among inmates, it is vital that correctional facilities are equipped to deliver and provide access to appropriate treatment. States and terri to ries have a key role in ensuring that evidence-based treatment programmes are available to the corrections-based population, reducing the risk of relapse and reoffending by inmates when returning to the community. The Taskforce recommends that Australian jurisdictions increase the focus on evidence-based approaches to treatment in correctional facilities and youth justice centres. Recommendation 23 Under the National Drug Strategy framework, state and terri to ry governments should increase the focus on evidence-based approaches to treatment in correctional facilities and youth justice centres. At the same time the market for ice flourished, with availability and purity increasing and price remaining stable. Supply reduction As discussed in Chapter 1, the unique nature of ice impedes law enforcement efforts to curb supply. Ice is a synthetic substance, which means production does not rely on plant-based material. It can be produced both in Australia and overseas, using a wide range of precursor chemicals. New production methods continue to emerge in response to efforts to restrict precursor chemicals. Ice is a lucrative business for organised crime, both within Australia and overseas. The high price of the drug in Australia, relative to other countries, creates significant profit incentives for criminal groups. There is increasing cooperation between organised crime groups, and group leaders are adept at shielding themselves from detection and prosecution. Organised crime is using the internet and encrypted communications to coordinate activities. Ice imports are increasingly difficult to detect as a result of the high volume of traded goods within which they are concealed, and the increasingly sophisticated concealment methods. However, there are a number of areas where refined efforts could the Taskforce noted the substantial increase in strengthen the law enforcement response. Criminal criminal activity (for example, the multi-agency intelligence can also be used in new ways to Polaris, Trident and Jericho Task forces). Controls over However, the Taskforce found that there is a precursor chemicals can be strengthened need to continue to harden the aviation and through greater national consistency and maritime environments against organised responsiveness. New to ols can A number of independent reviews, including the help strengthen law enforcement efforts to 2011 Parliamentary Joint Committee on Law target profits from the drugs trade. Enforcement Inquiry in to the adequacy of aviation and maritime security measures to Law enforcement efforts need to be flexible and combat serious and organised crime, have responsive to the challenges presented by ice. These reviews have advantage of loopholes in regula to ry recommended the Aviation Security arrangements. These schemes currently focus unforeseen negative outcomes and increased on minimising the risk of unlawful interference harm to the community. They do not currently the traditional criminal justice responses for consider criminal intelligence as part of the some of the less serious categories of background checking process. Real-time sharing of criminal There is potential to also lay the foundation for intelligence can drive effective responses to the use of criminal intelligence to identify cases illicit drug markets and organised crime more where individuals have links to organised crime, broadly. Collaboration between Australian but have not been convicted of a relevant jurisdictions, and centralised consolidation and offence. Recommendation 24 the Australian Crime Commission is the primary the Commonwealth Government should means for sharing intelligence and information continue to protect the aviation and maritime between law enforcement agencies nationally.
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Mean sleep latency values are influenced by physio search strategy on 10/18/2000, and 8/28/2002. Studies demonstrate significant differences in adapted from the suggestions of Sackett 7 (Table 1). The test is based on the premise that the degree of (Standard) sleepiness is reflected by sleep latency [2. For this reason, evaluation of validity is challenging patient is compliant with treatment for his/her sleep disorder, and [2. This recommendation is based in part on expected direction following experimental sleep fragmentation data derived from peer-reviewed literature [2. A trial is terminated after 40 minutes (if no sleep occurs), or sive or conflicting evidence or conflicting expert opinion. To provide a valid assessment of sleepiness or wakefulness polysomnography is relatively expensive. This recommendation is further evaluation, possibly including polysomnography, is neces based on consensus and sound medical practice, and on limited sary to determine the reason for inability to maintain wakefulness. Mean sleep latency is the usefulness of the mean sleep latency value in the evaluation influenced by quantity of prior sleep, sleep fragmentation, clini of patients with possible narcolepsy is supported by evidence cal sleep disorders such as obstructive sleep apnea, and circadian reported in 13 papers that met inclusion criteria [6. For these reasons polysomnography must be articles were judged to be reasonably free of inclusion bias. The sleep clinician who patients with narcolepsy without a comparison group of normal interprets these tests should have a thorough understanding of control subjects. These findings indicate that methodological, and patient-related issues that have the potential most patients with narcolepsy have objective evidence of hyper to affect validity and reliability of results. At least four different pro to cols have been minute cu to ff, and approximately 16% of normal controls would used based on varied definitions for sleep onset and trial termi 10 have a mean sleep latency below the 5 minute cu to ff [6. The co-occurrence of obstructive sleep apnea syndrome and Fac to rs which do not support routine performance of narcolepsy is well documented 11-17. These papers report a to tal of 92 patients with idiopathic hypersomnia with a weighted mean sleep latency of 6. This value is intermediate between those reported for patients practice for situations (a) and (b). This recommendation is based on ing public transportation or safety may require assessment of their evidence presented in 16 papers that met inclusion criteria [6. In addition, the assessment of sleep latency values are poor discrimina to rs of response to treat ability to remain awake and potential risk for accidents due to unin ment. The sleep clinician should not rely latency values in treated obstructive sleep apnea subjects com solely on the mean sleep latency as an indica to r of risk for trans pared with placebo, and two studies showed no changes. Using a sleep onset defini in medical and neurological disorders (other than narcolepsy), tion of the first continuous 10 seconds of stage1 or the first epoch insomnia, or circadian rhythm disorders [6. This recom provide an appropriate expectation for individuals requiring the mendation represents a change from the initial guidelines pub highest level of safety. In some situations involving patients with disorders of exces Based on evidence currently available, the mean sleep latency sive sleepiness, objective measures of ability to remain awake are should not be the sole criterion for determining the presence or necessary to help characterize response to treatment. Although severity of excessive sleepiness, certifying a diagnosis or there are no established levels to indicate what magnitude of response to treatment [8. Rather, assessment should involve change is considered significant, the direction of the change often integration of the clinical his to ry, objective test results, and other can serve as an adjunct to clinical judgment in determining appro medical information. There are three studies demonstrat solely on the basis of an isolated mean sleep latency value. Most studies onset, and trial duration (20 minutes versus 40 minutes), and these report findings regarding investigation of clinical sleep disorders variations affect normative values [6. The ceiling effect is less Many papers cited in the scientific literature do not provide pronounced in the 40-minute than the 20-minute pro to col since the important data such as prior sleep time and sleep quality, defini 40 minute test is more challenging and provides a greater distribu tions for establishing sleep onset and nap termination, whether four tion of values. Consequently, the 40-minute pro to col may be bet or five naps were used, and whether caffeine use was allowed. These observations indicate that unspecified sleep latency values are lower for normal subjects 30-39 years of methodological variations may be present in the data with the age compared with those of older normal subjects [6.