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A PRIMEIRA GUERRA MUNDIAL 1914 - 1918 (Resumo) Entre 1871 e 1914, durante a chamada Belle Époque, a sociedade europeia, liberal e capitalista, passou por uma das fases de maior prosperidade. Assignment Helper? O desenvolvimento industrial trouxe para boa parte da população um conforto nunca antes experimentado, enquanto a ciência e a técnica abriam possibilidades inimagináveis de comunicação e transporte, com a invenção do telégrafo, do telefone e do automóvel. Sample? Entretanto, as disputas territoriais entre as potências e a má distribuição dos benefícios do progresso entre a população criavam um clima de instabilidade constante. Helper? O risco de um confronto iminente pairava no ar. Até que, em 1914, as previsões se confirmaram, com o início da guerra que ia acabar com todas as guerras, como se costumava dizer na época.
Na prática, não foi isso que o mundo assistiu. Thesis Essay? Outro conflito, maior e ainda mais devastador, iria eclodir 25 anos depois. Online Helper? A expressão Grande Guerra, cunhada para o conflito que pela primeira vez na história envolveu todo o planeta, se justifica pelas proporções que o confronto alcançou, pelo aparato bélico que foi mobilizado e pela devastação que provocou. How To Write? As novas armas, fruto do desenvolvimento industrial, e os métodos inéditos empregados nos combates deram aos países capitalistas o poder quase absoluto de matar e destruir. Helper? Por volta de 1914, havia motivos de sobra para o acirramento das divergências entre os países europeus. Sample Search? Era grande, por exemplo, a insatisfação entre as nações que tinham chegado tarde à partilha da África e da Ásia; a disputa ostensiva por novos mercados e fontes de matérias-primas envolvia muitos governos imperialistas; e as tensões nacionalistas, acumuladas durante décadas, pareciam prestes a explodir.
O que estava em jogo eram interesses estratégicos para vencer a eterna competição pela hegemonia na Europa e no mundo. Assignment Helper? A disputa colonial: buscando novos mercados para a venda de seus produtos, os países industrializados entravam em choque pela conquista de colônias na África e na Ásia. A concorrência econômica: cada um dos grandes países industrializados dificultara a expansão econômica do país concorrente. How To? Essa briga econômica foi especialmente intensa entre Inglaterra e Alemanha. Online Helper? A disputa nacionalista: em diversas regiões da Europa surgiram movimentos nacionalistas que pretendiam agrupar sob um mesmo Estado os povos de raízes culturais semelhantes. Nursing? O nacionalismo exaltado provocava um desejo de expansão territorial. Online Assignment Helper? Movimentos nacionalistas: os interesses da Alemanha, Rússia e França.
Entre os principais movimentos nacionalistas que se desenvolveram na Europa no início do século XX, podemos destacar os seguintes: Pan-eslavismo: buscava a união de todos os povos eslavos da Europa oriental. Top 10? Era liderado pela Rússia. Assignment Helper? Pangermanismo: buscava a expansão da Alemanha através dos territórios ocupados por povos germânicos da Europa central. Stress? Era liderado pela Alemanha. Online? Revanchismo francês: visava desforrar a derrota francesa para a Alemanha em 1870 (Guerra Franco-prussiana) e recuperar os territórios da Alsácia-Lorena, cedidos aos alemães. A situação conflituosa deu origem à chamada paz armada.
Como o risco de guerra era bastante grande, as principais potências trataram de estimular a produção de armas e de fortalecer seus exércitos. Top 10 Book Reviews? O clima de tensão internacional levou as grandes potências a firmar tratados de alianças com certos países. Assignment? O objetivo desses tratados era somar forças para enfrentar a potência rival. Georgia? O assassinato de Francisco Ferdinando (Sarajevo, Bósnia, 28/06/1914) foi o estopim que detonou a Primeira Guerra Mundial, quando as tensões entre os dois blocos de países haviam crescido a um nível insuportável. Online Assignment? Principais fases: primeira fase (1914/1915) movimentação de tropas e equilíbrio entre as forças rivais; segunda fase (1915/1917) guerra de trincheiras; terceira fase (1917-1918) entrada dos Estados Unidos, ao lado da França e da Inglaterra, e derrota da Alemanha. Resume? Entrada da Itália A Itália, membro da Tríplice Aliança, manteve-se neutra até que, em 1915, sob promessa de receber territórios austríacos, entrou na guerra ao lado de franceses e ingleses. Online Assignment? Saída da Rússia Com o triunfo da Revolução Russa de 1917, na qual os bolcheviques estabeleceram-se no poder, foi assinado um acordo com a Alemanha para oficializar sua retirada do grande conflito. Resume? Este acordo chamou-se Tratado de Brest-Litovsk, que impôs duras condições para a Rússia. Helper? Entrada dos Estados Unidos Os norte-americanos tinham muitos investimentos nesta guerra com seus amigos aliados (Inglaterra e França).
Era preciso garantir o recebimento de tais investimentos. Top 10 Book Reviews? Utilizou-se como pretexto o afundamento do navio “Lusitânia”, que conduzia passageiros norte-americanos. Assignment? Participação do Brasil Os alemães, diante da superioridade naval da Inglaterra, resolveram empreender uma guerra submarina sem restrições. Ap Bio Essays Georgia? Na noite de 3 de abril de 1917, o navio brasileiro “Paraná” foi atacado pelos submarinos alemães perto de Barfleur, na França. Assignment? O Brasil, presidido por Wenceslau Brás, rompeu as relações com Berlim e revogou sua neutralidade na guerra. Search? Novos navios brasileiros foram afundados. Online Assignment? No dia 25 de outubro, quando recebeu a noticia do afundamento do navio “Macau”, o Brasil declarou guerra à Alemanha. Write? Enviou auxilio à esquadra inglesa no policiamento do Atlântico e uma missão médica. Online Helper? Consequências da guerra: a) O aparecimento de novas nações; b) Desmembramento do império Austro- Húngaro; c) A hegemonia do militarismo francês, em decorrência do desarmamento alemão; d) A Inglaterra dividiu sua hegemonia marítima com os Estados Unidos; e) O enriquecimento dos Estados Unidos; f) A depreciação do marco alemão, que baixou à milionésima parte do valor, e a baixa do franco e do dólar; g) O surgimento do fascismo na Itália e do Nazismo na Alemanha. Os 14 Pontos do Presidente Wilson Em mensagem enviada ao Congresso americano em 8 de janeiro de 1918, o Presidente Wilson sumariou sua plataforma para a Paz que concebia: 1) acordos públicos, negociados publicamente, ou seja a abolição da diplomacia secreta; 2) liberdade dos mares; 3) eliminação das barreiras econômicas entre as nações; 4) limitação dos armamentos nacionais ao nível mínimo compatível com a segurança; 5) ajuste imparcial das pretensões coloniais, tendo em vista os interesses dos povos atingidos por elas; 9) reajustamento das fronteiras italianas, seguindo linhas divisórias de nacionalidade claramente reconhecíveis; 10) desenvolvimento autônomo dos povos da Áutria-Hungria; 11) restauração da Romênia, da Sérvia e do Montenegro, com acesso ao mar para Sérvia; 12) desenvolvimento autônomo dos povos da Turquia, sendo os estreitos que ligam o Mar Negro ao Mediterrâneo abertos permanentemente;
13) uma Polônia independente, habitada por populações indiscutivelmente polonesas e com acesso para o mar; e. Ap Bio Georgia? 14) uma Liga das Nações, órgão internacional que evitaria novos conflitos atuando como árbitro nas contendas entre os países. Online Assignment Helper? Os 14 pontos não previam nenhuma séria sanção para com os derrotados, abraçando a ideia de uma Paz sem vencedores nem vencidos. Resume Search? No terreno prático, poucas propostas de Wilson foram aplicadas, pois o desejo de uma vendetta por parte da Inglaterra e principalmente da França prevaleceram sobre as intenções americanas. Online Assignment? O Tratado de Versalhes: conjunto de decisões tomadas no palácio de Versalhes no período de 1919 a 1920. Stress? As nações vencedoras da guerra, lideradas por Estados Unidos, França e Inglaterra, impuseram duras condições à Alemanha derrotada. Online Assignment Helper? O desejo dos alemães de superar as condições humilhantes desse tratado desempenhou papel importante entre as causas da Segunda Guerra Mundial: Restituir a região da Alsácia-Lorena à França.
Ceder outras regiões à Bélgica, à Dinamarca e à Polônia ( corredor polonês). How To Write Chinse? Ceder todas as colônias. Online? Entregar quase todos seu navios mercantes à França, à Inglaterra e à Bélgica. Essay? Pagar uma enorme indenização em dinheiro aos paises vencedores. Helper? Reduzir o poderio militar de seus exércitos limitados a 100 mil voluntários, sendo proibida de possuir aviação militar, submarinos, artilharia pesada e tanques, e o recrutamento militar foi proibido. Resume? Considerada a grande culpada pela guerra. A formação da Liga das Nações: em 28 de abril de 1919, a Conferência de Pás de Versalhes aprovou a criação da Liga das Nações, com a missão de agir como mediadora nos casos de conflito internacional, preservando a paz mundial. Online Assignment Helper? Entretanto, sem a participação de países importantes como os Estados Unidos, União Soviética e Alemanha, a liga revelou-se um organismo impotente. Stress Essay? A ascensão econômica dos Estados Unidos no pós-guerra: os Estados unidos alcançaram significativo desenvolvimento econômico através da exportação de produtos industrializados. Assignment Helper? A Europa tornou-se dependente dos produtos americanos.
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resume withdrawal Protracted Withdrawal Syndromes. Journal of Substance Abuse Treatment. Vol. 8 pp. 19-28 · 1991. Professor C Heather Ashton DM, FRCP. School of online assignment helper Neurosciences. Division of Psychiatry. The Royal Victoria Infirmary. Queen Victoria Road.
Newcastle upon Tyne NE1 4LP. Abstract: The benzodiazepine withdrawal syndrome is essay, a complex phenomenon which presents serious difficulties in helper, definition and measurement. It is particularly difficult to set out resume sample, precise limits on assignment its duration. Many withdrawal symptoms are a result of pharmacodynamic tolerance to benzodiazepines, some mechanisms for which are discussed. Such tolerance develops unevenly in different brain systems and may be slow to reverse. Withdrawal symptoms occurring in the first weeks after cessation of sample drug use tend to online assignment helper merge with more persistent symptoms that may last for many months.
These prolonged symptoms do not necessarily constitute true pharmacological withdrawal symptoms, but are nevertheless related to long-term benzodiazepine use. Such symptoms can include anxiety, which may partly result from a learning deficit imposed by the drugs, and a variety of sensory and motor neurological symptoms. The protracted nature of some of these symptoms raises the possibility that benzodiazepines can give rise not only to slowly reversible functional changes in the central nervous system, but may also occasionally cause structural neuronal damage. Keywords: benzodiazepines; withdrawal syndrome; tolerance; protracted symptoms; tinnitus; brain mechanisms. Drug withdrawal syndromes, in general, tend to consist of mirror images of the drugs' initial effects. Thus, abrupt withdrawal from stress chronic usage of beta adrenoceptor antagonists such as propranolol may give rise to online helper tachycardia and search, palpitations; abrupt withdrawal from antihypertensive doses of clonidine may be followed by hypertension, anxiety, and other signs of increased sympathetic activity.
Benzodiazepines are no exception: On sudden cessation after chronic use, anticonvulsant effects may be replaced by assignment helper epileptic seizures, muscle relaxation by increased muscle tension, hypnotic effects by increased anxiety. The same symptoms can occur in attenuated form when the drugs are withdrawn slowly. However, all of these symptoms are not inevitable in stress essay, any individual patient. The particular features of the assignment helper, withdrawal syndrome and their time of onset, duration, and severity are greatly modified by many other factors. Essay On Sensitivity? Such factors include pharmacokinetic variables, dosage and duration of assignment drug use, rate of resume withdrawal, the assignment helper, presence or absence of the original disorder (such as anxiety) for which the drug was prescribed, personality characteristics, physical makeup and susceptibility, and the use of concomitant treatments. These variables alone make it difficult to grad resume characterise specific features of the withdrawal syndrome. This difficulty is compounded by the fact that, as long-term medication, benzodiazepines have mainly been prescribed for anxiety and insomnia, disorders which themselves include most features of the drug withdrawal syndrome. Online Helper? When such patients undergo reduction of benzodiazepine dosage, especially slow reduction, how can one specify which emergent symptoms are true, drug-related withdrawal symptoms, which are pseudowithdrawal symptoms (Tyrer, Owen, Dawling, 1983), which represent a return of the ap bio georgia, original anxiety state, and assignment helper, which are the natural reactions of an how to chinse anxious personality undergoing the stress of helper withdrawal? In circumstances such as these, the benzodiazepine withdrawal syndrome becomes largely a matter of definition.
Nevertheless, the existence of a benzodiazepine withdrawal reaction, from book both high and low (therapeutic) doses of online assignment helper benzodiazepines, is no longer in on sensitivity, dispute, and many attempts have been made to define and measure it and to online assignment helper estimate its incidence and duration. Definitions and Measurements. Symptoms occurring during benzodiazepine withdrawal have been described by essays many authors (Ashton, 1984, 1987; Busto, Sellers, Naranjo, Cappell, Sanchez, Sykora, 1986; Hallström Lader, 1981; Murphy, Owen Tyrer, 1983, 1984; Petursson Lader, 1981a, 1981b; Smith Wesson, 1983; Tyrer et al ., 1983; Tyrer, Rutherford, Higgett, 1981; Winokur, Rickels, Greenblatt, Snyder, Schatz, 1980; among others). Commonly described symptoms are shown in online helper, Figure 1. None of these symptoms are specific to benzodiazepine withdrawal: They include all of the psychological and somatic symptoms of anxiety, although certain symptom clusters are characteristic. Owen and Tyrer (1983) and Petursson and essays georgia, Lader (1981a b) emphasised the appearance of new symptoms, not experienced before withdrawal and uncommon in anxiety states. These new symptoms include hypersensitivity to sensory stimuli (sound, light, touch, taste, and smell) and perceptual distortions (e.g., sensation of the floor undulating, feeling of motion, impression of walls or floor tilting). There also appears to be a higher incidence than usually seen in anxiety of depersonalisation, derealisation, paraesthesiae, and extreme dysphoria, an online amalgam of anxiety, depression, nausea, malaise, and depersonalisation (Petursson Lader, 1981a, 1981b). Visual hallucinations, distortion of body image, psychotic reactions, formication, muscle fasciculation and twitching (occasionally resembling myoclonus), and thesis, considerable loss of weight are also described during benzodiazepine withdrawal and are unusual in anxiety states. Smith and Wesson (1983) and online assignment helper, Ashton (1984) drew attention to the characteristic fluctuation of book symptoms, which may wax and helper, wane without obvious psychological provocation.
Smith and Wesson (1983) suggest that this wavelike symptomatology is an important marker for distinguishing the low-dose benzodiazepine withdrawal syndrome from symptom re-emergence. However, since symptoms may fluctuate in reviews, the course of the day or over periods of days or weeks, accurate recording is difficult. Since no particular symptom is online helper, exclusive to benzodiazepine withdrawal, how can one define the top 10 reviews, syndrome? Tyrer et al . Online Assignment? (1981, 1983) have attempted various methods in placebo controlled studies: The appearance of on sensitivity two or more new symptoms during the withdrawal period. New symptoms in one study included perceptual disturbances, sensory hypersensitivity, and assignment helper, fear of imminent death (1981), and in another study (1983), psychotic symptoms, depression and dysphoria, muscle twitching, and abnormal sensations of movement. The choice of two new symptoms as the minimum number necessary to qualify as withdrawal is clearly arbitrary. An increase in self-rated symptoms (Comprehensive Psychiatric Rating Scale) to greater than 50% of essay baseline levels, followed by a return to lower values. Symptom resolution is clearly an important feature in differentiating between symptoms due to withdrawal and symptom re-emergence, emergence, or overinterpretation. As Smith and Wesson (1983, p. 88) point out: Withdrawal symptoms subside with continued abstinence, whereas symptoms of other aetiology persist. However, a measure of online assignment helper symptom resolution is not applicable to patients who drop out of withdrawal studies, perhaps because of intolerable true withdrawal symptoms.
It is noteworthy that 45% of patients dropped out of one study (Tyrer et al ., 1981). A combination of methods (1) and (2) so that a withdrawal reaction is defined as the appearance of new symptoms that resolved before the end of the ap bio essays, study (20 and 14 weeks after the end of withdrawal [Tyrer et al ., 1983]). More recently Tyrer, Murphy, Riley (1989) have produced a questionnaire of symptoms that are relatively specific to benzodiazepine withdrawal in that they mainly occur during periods of drug withdrawal and return towards baseline levels after withdrawal. Pseudowithdrawal symptoms were defined as symptoms occurring when patients thought they were reducing but their drug consumption and blood concentrations of benzodiazepines were unchanged. Such definitions, derived from double-blind, placebo-controlled studies, have been extremely helpful in the recognition of benzodiazepine dependence, especially low-dose dependence. However, they are of necessity arbitrary and can only be approximate, since the appearance or severity of any particular symptom or symptom cluster may actually represent a variable combination of true withdrawal, pseudowithdrawal, and re-emergence of online assignment helper anxiety, and the same patients liable to essays georgia pseudowithdrawal reactions are also likely to be most vulnerable to true withdrawal effects. Furthermore, definitions based on differences from prewithdrawal symptoms do not take into account the possibility that, due to the development of online assignment tolerance, withdrawal symptoms may already be present while patients are still taking benzodiazepines. Such a situation is most clearly seen with relatively short-acting benzodiazepines.
For example, patients taking triazolam as a hypnotic commonly develop daytime anxiety (Oswald, 1989) and even hallucinations or psychotic reactions. These are almost certainly withdrawal effects since they are immediately relieved by taking the drug but eventually disappear after the drug is grad resume, stopped (Ashton, 1987). Similarly, with lorazepam and alprazolam (Hermann, Brotman, Rosenbaum, 1987) patients often develop increasing anxiety and panic as well as craving between doses (Ashton, 1984). They appear to undergo a miniwithdrawal between each dose, which is temporarily relieved by the next tablet, but disappears after total cessation. An analagous condition is seen with alcohol: alcoholics commonly complain of tremor and insomnia, symptoms which are temporarily relieved by alcohol but which only disappear after a period of abstinence. Even with long-acting benzodiazepines such as diazepam, there is usually a history in online helper, long-term users of resume search steadily increasing anxiety, with the helper, development over the years of new symptoms such as agoraphobia, often with perceptual distortions and depersonalisation, despite continued usage of these supposedly anxiolytic drugs. These symptoms have often been temporarily alleviated by a moderate increase in dosage or the addition of another benzodiazepine, but eventually re-emerge during further chronic use and only disappear after the benzodiazepine is stopped (Ashton, 1984, 1987).
Mechanisms of tolerance and withdrawal symptoms are discussed below, but tolerance is difficult to demonstrate in clinical practice. Because of how to these many immeasurable factors, it is doubtful whether the boundaries of a true benzodiazepine withdrawal syndrome can ever be clearly demarcated. The overall incidence of the benzodiazepine withdrawal syndrome is unknown. Assignment Helper? As with cigarette smokers (Ashton Stepney, 1982), there may be a large, uncounted population who quit regular benzodiazepine usage after months or years without ever coming to nursing medical attention. Assignment? Tyrer (1990) notes that it is surprising how many patients in ordinary practice have no difficulties whatsoever in reducing their benzodiazepines, and the incidence of a benzodiazepine withdrawal syndrome in general practice appears to be around 30% (Tyrer et al ., 1981, 1983; Tyrer, 1989; Tyrer, Murphy, Riley, in press; Tyrer, 1990). On the other hand, in selected patients referred for specialist treatment, the incidence may be 100% (Ashton, 1987; Lader Olajide, 1987; Petursson Lader, 1981a). It is also worth noting that withdrawal syndromes in the form of rebound insomnia (Kales, Scharf, Kales, 1978) or more general symptoms can occur in experimental subjects and in nonanxious patients prescribed benzodiazepines for how to, sports injuries (Lader, 1988). In addition, a benzodiazepine withdrawal syndrome has been described in neonates whose mothers took therapeutic doses of benzodiazepines during pregnancy (Rementeria Bhatt, 1977). Not surprisingly, the observed incidence of benzodiazepine withdrawal reactions depends not only on patient selection but also on the criteria used for measurement.
In the study of Tyrer et al . (1983), when definitions of withdrawal (1) and (2) (see above) were used singly, the incidence of pseudowithdrawal reactions was around 20%. Helper? With the combined definition (3) (see above) the top 10 book reviews, incidence of true withdrawal symptoms was 44% and assignment, there were no pseudowithdrawal reactions. This incidence of course only applies to those consenting to nursing take part in assignment helper, the study and managing to finish it. It cannot account for dropouts during withdrawal or for individuals declining to undergo withdrawal (45.5% of eligible patients in grad resume, the study of Tyrer et al ., 1981). Thus the online assignment, incidence of benzodiazepine withdrawal, like its diagnosis, becomes largely a matter of definition. The identification of the benzodiazepine withdrawal syndrome is difficult enough; its duration is how to chinse, even more difficult to online helper delineate. Most estimates suggest a duration of georgia approximately 5-28 days, with a peak in online assignment helper, severity around 2 weeks post withdrawal, after which most symptoms return to essays georgia prewithdrawal levels (Busto et al ., 1986; Murphy et al ., 1984; Owen Tyrer, 1983; Petursson Lader, 1981a, 1981b; Tyrer et al ., 1981, 1983).
To a large extent the online assignment, apparent duration depends upon nursing grad, how long the patients are followed up, and several authors have drawn attention to the prolonged nature of postwithdrawal symptoms in some cases. For example, Smith and Wesson (1983) observed that symptoms after withdrawal from low-dose benzodiazepine typically take 6-12 months to subside completely. Assignment? Prolonged symptoms included anxiety, insomnia, paraesthesiae, altered sensation, muscle spasms, and thesis stress, psychosis. Ashton (1984, 1987) reported a similar protracted time-course. Tyrer (1990) refers to a post-withdrawal syndrome in the 6 months after withdrawal. Hallström and Lader (1981) found the Hamilton Anxiety Score still raised above baseline levels by online follow-up several months later when successfully withdrawn patients had resumed their normal life (Hallström Lader, 1981 p. 237). Olajide and Lader (1984) suggested that depression may be an integral part of the benzodiazepine withdrawal syndrome and may last several months after withdrawal in susceptible individuals; this phenomenon was also observed by Ashton (1987). Busto, Fornazzari, and Naranjo (1988) described two cases in whom severe tinnitus first appeared during benzodiazepine withdrawal and persisted for top 10, 6 and 12 months after discontinuation before finally diminishing or disappearing. In one of these cases the tinnitus was immediately alleviated by diazepam in a double-blind placebo-controlled trial conducted over online assignment, 1 week, 6 months after withdrawal; after a further 6 months of abstinence the tinnitus had became tolerable. In a recent study of 68 patients who were withdrawn from benzodiazepines over a 6-week period and followed for on sensitivity, a further 4 weeks, Tyrer et al . (1989), using a self-report scale, found a wide variation in the time at which individual symptoms peaked.
Mean scores for some symptoms (depression, dizziness, paraesthesiae, feeling of unreality) peaked early, while mean scores for others (nausea, memory impairment, faintness, touch sensitivity, and online assignment helper, motor impairment) were maximal 8 weeks after the start of nursing resume withdrawal. Although individual patient's scores were not reported, and 30% withdrew from the study, these findings suggest that symptoms can persist beyond the 5-28 days usually regarded as the duration of the withdrawal syndrome. Ashton, Rawlins and Tyrer (1990) used the rating scale shown in Figure 1 to record the symptoms of patients undergoing diazepam withdrawal under double-blind placebo controlled conditions. Withdrawal took place over 4 weeks, and patients were followed for 8 weeks after the end of withdrawal. Half the patients received placebo and the other half withdrawal. Analysis of the time-course of selected symptoms in the 11 out of 12 patients in the placebo group who successfully completed withdrawal is shown in Table 1. Eight weeks after the end of online assignment helper withdrawal, mean scores for headache, dizziness, depression, tinnitus, paraesthesiae, and motor symptoms remained higher than prewithdrawal scores; other symptoms had declined although few had disappeared. Thesis Stress Essay? These findings again show that duration of symptoms after benzodiazepine withdrawal is often a matter of online helper months rather than weeks. Different symptoms persisted in the Tyrer et al . (1989) and Ashton et al . (1990) studies, which differed also in size of sample, patient selection, and rate of withdrawal.
To what extent such persistent symptoms are true withdrawal symptoms is unknown. A further problem in assessing the duration of the withdrawal syndrome is the interpretation of the baseline (prewithdrawal) symptoms and resume search, anxiety scores. Patients presenting for benzodiazepine withdrawal often have high levels of anxiety and many psychological and somatic symptoms. Online Assignment? Figures 2 and 3 show Hospital Anxiety Depression (anxiety) (Zigmond Snaith, 1983) and symptom rating scores for thesis, 12 patients on benzodiazepines compared with the scores of 18 healthy university students approaching their exams. Online? Both groups took placebo tablets and were followed for 20 weeks. The benzodiazepine group withdrew from the search, benzodiazepines between weeks 8 and 12. Assignment Helper? It is how to write, clear that the patients had considerably higher scores than the online assignment helper, normal subjects on both scales, even at the beginning of the study while they were still taking benzodiazepines. Certainly in book reviews, these patients the benzodiazepines were not effectively controlling anxiety and, as argued above, it is possible that at least some of the presenting symptoms were due to withdrawal symptoms even in the presence of the online, drug, as a result of the development of drug tolerance.
Such symptoms would be expected to disappear after withdrawal, but they could be slow to resolve. There was no evidence of resolution below baseline levels 8 weeks after withdrawal, but unfortunately (as in most studies) formal assessment stopped at this point. However, continued clinical contact with most of these patients has shown that anxiety symptoms have declined over time. This slow improvement bears out the observations quoted above (Ashton, 1984, 1987; Busto et al ., 1988; Hallström Lader, 1981; Olajide and Lader, 1984; Smith Wesson, 1983) that symptoms improve gradually for many months after withdrawal, and some patients are able to resume normal lives after years of incapacity before withdrawal. Which of these long-lasting symptoms can one attribute to true drug withdrawal effects? Is it possible to pinpoint a time at book reviews which the benzodiazepine withdrawal syndrome ends and to assignment say with certainty that any residual symptoms must be due to other factors? The problem is similar to essays that of designating which effects of a bout of influenza or infectious mononucleosis can be attributed to the specific virus. Online Helper? Do such effects include only those of the viral toxaemia? Do they include secondary bacterial infection consequent upon the impact of the essay, virus? Do they include the period of postviral lethargy and depression which, like benzodiazepine withdrawal symptoms, tends to recur in wave-like fashion for online helper, several months? Once again, the benzodiazepine withdrawal syndrome appears to slip through the fingers and one is led back to essay a question of definition.
Probably a clear definition of duration is impossible because drug-induced perturbations of online assignment central neurotransmission merge imperceptibly into the background of individual, genetically determined, and learned patterns of brain activity. Protracted Symptoms After Benzodiazepine Withdrawal. All the problems of definition discussed above are multiplied in any attempt to describe protracted benzodiazepine withdrawal syndromes. Yet anyone observing patients for long periods after withdrawal cannot fail to be struck by the persistence of certain symptoms in some patients. These may not be true benzodiazepine withdrawal symptoms; nevertheless they are possibly related to benzodiazepine use and how to chinse, often present a clinical problem.
Listed below are examples of some protracted symptoms that from personal observations and other reports appear to online assignment helper be relatively common after benzodiazepine withdrawal. Unfortunately, there are no data available on the incidence and sample, duration of such symptoms in comparable patients not treated with benzodiazepines, nor of their relative incidence in helper, patients undergoing benzodiazepine withdrawal. Nor are there any known predictive factors to indicate which patients might be especially vulnerable. Anxiety: As discussed above, anxiety may persist for many months after benzodiazepine withdrawal, yet slowly decline below prewithdrawal levels after 1-2 years (Ashton, 1987). One reason for the slow resolution may be that benzodiazepines inhibit the learning of stress-coping strategies. On Sensitivity? Such effects have been demonstrated in animals and man (Gray, 1987). Consequently there is a long period after benzodiazepine withdrawal when patients have a decreased ability to cope with stressful situations (Ashton, 1989; Murphy Tyrer, 1988; Owen Tyrer, 1983).
Recovery may require many months of learning new strategies of stress control to replace the helper, years of coping with stress by means of exogenous drugs. Hence persisting anxiety after benzodiazepine withdrawal does not necessarily imply the re-emergence of an anxiety state existing before benzodiazepine treatment; it may represent the uncovering of how to write chinse a type of online assignment helper learning deficiency induced by long-term benzodiazepine use. People who take benzodiazepines tend to have high ratings for trait anxiety (Ashton and Golding, 1989; Golding Cornish, 1987; Golding, Harper, Brent-Smith, 1983) which may confer a particular vulnerability to nursing resume the stress of online assignment helper withdrawal. Reviews? Nevertheless, even without formal treatment, protracted anxiety symptoms, including agoraphobia and assignment, panic, may gradually resolve after benzodiazepine withdrawal (Ashton, 1987) although the process may be hastened by nursing behavioural treatments. Depression: Depression can be caused or aggravated by chronic benzodiazepine use (Lader Petursson, 1981), yet it also appears to be a feature of the withdrawal syndrome (Olajide Lader, 1984). It may be severe enough to qualify as a major depressive disorder (Ashton, 1987) and may persist for some months. Olajide and assignment helper, Lader (1984) suggest that the mechanisms for postwithdrawal depression may be central serotonin depletion, but there is no direct evidence for this.
Clinically, the depression is not different from depressive illness in general, and write chinse, it responds to antidepressant drugs. It is online assignment, not clear whether protracted depressive symptoms are more common in essay, patients with a previous history of depression or whether it recurs in subsequent years after withdrawal. Tinnitus: Tinnitus is a common symptom of benzodiazepine withdrawal and may initially result from the characteristic general hypersensitivity to sensory stimuli. It usually resolves in a few weeks, but occasionally qualifies as a protracted symptom. Busto et al . (1988) describe two cases in which tinnitus persisted for 6 and 12 months after withdrawal and mention a third patient who was unable to withdraw from benzodiazepines because of severe tinnitus at each attempt. Helper? Further cases of essay on sensitivity protracted tinnitus personally observed are described below. Case 1: Female, aged 54. Duration of benzodiazepine usage: 8 years. Online? Withdrawal slowly from oxazepam 45mg daily in 1986. Right-sided tinnitus first noticed during previous attempts at withdrawal; became severe after final withdrawal and is still constantly present and severe 2 years later, remaining mainly unilateral.
No abnormality detected on skull x-ray, CAT scan, EEG, or ENT examination, apart from slight bilateral (symmetrical) high-tone deafness. Not clinically anxious or depressed; all other withdrawal symptoms resolved quickly. Taking no medication. Case 2: Female, aged 62. Duration of benzodiazepine usage: 18 years. Withdrawn slowly from on sensitivity diazepam 15mg daily in 1988. Online? Bilateral tinnitus first noticed during previous attempts at withdrawal, becoming severe after final withdrawal, and still present, severe, and resume sample, continuous 1 year later.
ENT investigation: moderate bilateral high-tone deafness; wears hearing aid. No clinical anxiety or depression; no other withdrawal symptoms; no medication. Case 3: Female, aged 58. Helper? Duration of benzodiazepine usage: 20 years. Withdrew from ap bio diazepam 20mg daily over 4 weeks in 1988. Developed acute psychotic reaction, which resolved in one week. First noticed left-sided tinnitus 1 month after withdrawal. Online Assignment Helper? Three months later restarted diazepam 20mg daily because of unremitting tinnitus, but experienced only slight improvement. Top 10 Book Reviews? Second withdrawal over helper, one year 1988-9. Left-sided tinnitus severe throughout withdrawal and still persisting though becoming intermittent.
ENT examination negative except for slight bilateral (symmetrical) high-tone deafness. Medication: mianserin 30mg daily, started after onset of tinnitus; carbamazepine recently added with no effect on tinnitus. Case 4: Female, aged 70. Duration of nursing benzodiazepine usage: 20 years. First noticed tinnitus, mainly right-sided, on online helper withdrawal from flurazepam 30mg daily in 1985. Tinnitus continuous ever since, not relieved by a course of diazepam. ENT examination normal. Drugs: no psychotropics; inhalers for asthma. Tinnitus is fairly common in the general population and the apparent relation to benzodiazepine use may be incidental, but these cases raise the suspicion that benzodiazepines may occasionally cause permanent or only slowly reversible brain damage. Such damage may not be detectable on CAT scans; one study (Lader Petursson, 1984) suggested a mild degree of cortical shrinkage in chronic benzodiazepine users, but this finding was not confirmed in a later study (Perera, Powell, Jenner, 1987).
Two of the above patients also complained of unilateral headaches. Paraesthesiae: Paraesthesiae, in the form of tingling, pins and needles or numbness of the extremities or circumoral region, is another common symptom of thesis benzodiazepine withdrawal. Online Assignment Helper? The symptom also occurs in write chinse, anxiety and possibly results from hyperventilation. Benzodiazepines depress the helper, sensitivity of the resume search, respiratory centre to online assignment carbon dioxide (Gilmartin, Corris, Stone, Veale, Gibson, 1988) and it is possible that the respiratory centre becomes hypersensitive during withdrawal, triggering hyperventilation. Resume? Resolution of paraesthesiae usually occurs within a few weeks of withdrawal.
Occasionally, however, patients complain of helper numbness or of a burning sensation affecting the fingers, feet, and legs that may be protracted for months or years. The symptoms suggest a peripheral sensory neuropathy and there may be demonstrable sensory impairment to essay on sensitivity light touch. Two patients summarised below typify several similar cases personally observed at a benzodiazepine withdrawal clinic. Case 1: Female, aged 56. Duration of benzodiazepine usage: 15 years. Severe continuous burning pain of feet first noticed in online, 1984 during slow reduction of lorazepam 7.5mg to resume sample 1.5mg daily. Changed to diazepam and online helper, slowly withdrawn over 1 year 1987-8. Burning feet persisted for top 10, a further year, gradually decreasing in intensity and now almost disappeared.
No abnormal signs; good peripheral pulses. Medication; promethazine 50mg nocte since 1988. Case 2: Female, aged 67. Duration of online assignment benzodiazepine usage: 12 years. First noticed severe burning pain in feet and thesis, legs in 1981 during reduction of medazepam 15mg to 5mg daily. Pain persisted during diazepam substitution and slow withdrawal in 1985. 1986: still severe burning pain in legs not relieved by chlordiazepoxide. 1989: pain still present. Neurological examination, nerve conduction studies, serum foliate and B 12 levels normal; peripheral pulses present and normal. Formication is also common during benzodiazepine withdrawal, and many patients temporarily complain of helper a feeling of insects crawling on the skin or of lice or nits in the hair. Occasionally, more bizarre sensations are reported, such as a feeling of slime or water running over the body, a sense of inner vibration, or a feeling of trembling inside, and on sensitivity, these symptoms may be protracted.
Such symptoms may be variants of the burning sensations described above or may possibly be psychotic, but have a temporal relationship to assignment benzodiazepine withdrawal. Motor Symptoms: Increased muscle tension, hyperreflexia, tremor, fasciculation, and ap bio georgia, muscle jerking are common features of benzodiazepine withdrawal but usually resolve within weeks. Occasionally muscle jerking persists for a year or more after withdrawal, and the clinical picture may suggest myoclonus, tics, or exaggerated startle reactions. Shoulder girdle and limb muscles are usually affected, but blepharospasm can occur. Online Assignment Helper? Some patients complain of violent jerking of the whole body at georgia the onset of assignment helper sleep, which may occur 20 or more times a night. Restless legs syndrome may also be protracted. Some of these symptoms may result from increased peripheral sympathetic tone since they are often improved by propranolol. Thesis Essay? Others may be centrally generated and at least partially respond to online carbamazepine. Nursing Grad? Blepharospasm can be controlled by local injection of botulinum toxin at 3 monthly intervals.
Protracted motor symptoms such as these raise the possibility that benzodiazepines are capable of causing long-term hyperexcitability of assignment motoneurons or central motor pathways. Gastrointestinal Symptoms: Gastrointestinal symptoms are extremely common during chronic benzodiazepine use and in withdrawal. Many chronic benzodiazepine users have been investigated by ap bio gastroenterologists and found to have irritable bowel syndrome (Ashton, 1987). Gastrointestinal symptoms may be aggravated by hyperventilation (Lum, 1987) and may disappear completely after benzodiazepine withdrawal, even in assignment, patients who have had irritable bowel syndrome for years. Nevertheless, there remains a sizeable core of patients who complain of food intolerance and gaseous abdominal distension which first appears during withdrawal and resume sample, is protracted for helper, many months. Tests for specific food allergies almost always prove negative, and the condition is unresponsive to conventional treatment. Patients often turn to alternative or fringe medicine, undergo various forms of diet, and become convinced that they have intestinal candidiasis or damage to the immune system. None of these claims have scientific support, although Lum (1987) reports that hyperventilation provokes histamine release and resume sample search, that the incidence of food intolerance and pseudo-allergic reactions is high in chronic hyperventilators. The effect of benzodiazepine withdrawal on gastrointestinal function and on coriocosteroid and online assignment, immune responses (known to be affected by stress) perhaps merits further attention. Brain Mechanisms of Benzodiazepine Withdrawal Symptoms. The primary effect of resume sample benzodiazepines is enhancement of gamma-aminobutyric acid (GABA) activity on postsynaptic GABA-A receptors in the brain.
The effect results from an interaction with specific benzodiazepine binding sites on the GABA-receptor complex (Möhler Okada, 1977; Squires Braestrup, 1977), which increases the affinity of the receptors for GABA (Costa, 1981). GABA neurons consist of small interneurons forming local circuits which exert a powerful influence on assignment helper the excitability of other neurons passing through their spatial domain (Bloom, 1985). Such local GABA circuits are widely distributed throughout the thesis stress essay, brain, including the reticular formation, limbic system structures, cerebral and online assignment helper, cerebellar cortex (Young Kuhar, 1980). GABA is a universal inhibitor of nervous activity and also inhibits the release of excitatory neurotransmitters (Benton Rick, 1976). Thus the actions of benzodiazepines include not only enhancement of GABA activity at many brain sites but also decreased release of acetylcholine, noradrenaline, dopamine and serotonin (Faefely, Pieri, Pole, Schaffer, 1981). The clinical effects of benzodiazepines probably result from a combination of nursing grad these primary and secondary effects at critical sites. For example, the anxiolytic effects may be due to decreased serotonergic and noradrenergic activity in septo-hippocampal pathways (Gray, 1981).
Thus benzodiazepine actions are by no means confined to a particular neurotransmitter or brain pathway. Any chronically used drug gradually engenders a series of homeostatic responses which tend to restore normal function despite the presence of the drug. With chronic benzodiazepine use, compensatory changes occur in GABA receptors. Online? Such changes consist of top 10 book reviews decreased sensitivity of these receptors to GABA, probably as a result of online helper alterations in affinity state and decreased density (Cowan Nutt, 1982; Nutt, 1986). In addition, there are changes in the secondary systems controlled by GABA, so that the output of excitatory neurotransmitters tends to be restored, and/or the sensitivity of their receptors increases.
The whole complex of primary and stress essay, secondary changes eventually results in benzodiazepine tolerance. This pharmacodynamic tolerance develops unevenly to different benzodiazepine effects. Online Helper? For example, tolerance appears more rapidly to hypnotic and anticonvulsant than to anxiolytic effects (Sepinwall Cook, 1979). Resume? Tolerance to online assignment different effects may also vary between individuals, possibly due to variations in intrinsic GABA activity in different parts of the brain, which are in turn reflected in personality characteristics and susceptibility to stress. Essay On Sensitivity? Tolerance is never complete and probably never reaches a perfect equilibrium in all brain systems, which may be one reason for the high morbidity amongst chronic benzodiazepine users (Ashton, 1987).
Acute tolerance, especially to hypnotic effects, can be manifested rapidly, but chronic tolerance develops over a time-course of several weeks. Once established, chronic tolerance can last for months or even years after cessation of some central nervous system depressants such as alcohol (Cicero, 1979) and probably also benzodiazepines. The development of assignment pharmacodynamic tolerance sets the scene for the withdrawal syndrome. Cessation of the drug exposes all the adaptations which have accrued to counteract its presence, releasing a rebound of unopposed activity involving many neurotransmitters and their receptors and many brain systems. Nursing Grad Resume? Clinically this state is manifested as the withdrawal syndrome, consisting of online assignment effects that are largely the opposite of those originally induced by book reviews the drug. The distribution, duration, and severity of symptoms depend on the particular systems that have undergone adaptive modulations and helper, the degree of the adaptive changes induced, as well as on the rate of drug withdrawal.
Some authors distinguish between rebound and withdrawal effects, but the mechanism is the same for both (Lader, 1988) Acute withdrawal effects are reversed by an appropriate dose of the drug, which restores the status quo . As the homeostatic changes slowly reverse, withdrawal symptoms decline. Essay On Sensitivity? The process of reversal, like that of tolerance acquisition, does not necessarily proceed evenly in all systems. The variable time of emergence and duration of individual symptoms during benzodiazepine withdrawal noted by assignment Tyrer (1989) and Ashton et al . Stress Essay? (1990) (Table 1) may reflect this uneven course. The perturbations of brain function induced by online helper benzodiazepines are exceedingly complex, and it is not surprising that withdrawal symptoms are many and variable. Different symptoms may reflect disturbance of the write chinse, balance between different neurotransmitter systems as suggested by Ashton (1984) and are likely to show large interindividual differences depending on personal characteristics and susceptibilities. Online? As discussed above, it is difficult to how to chinse set a definite time limit on the reversal of tolerance and, therefore, the end of the withdrawal syndrome.
In general, tolerance declines over a matter of weeks, but in some cases it may endure for a year or more (Cicero, 1979). Delayed or slow reversal of tolerance may account for some protracted withdrawal symptoms. However, some changes induced by benzodiazepines may be permanent or only very slowly reversible. Online Helper? Since benzodiazepines apparently inhibit learning, especially for coping with stress strategies (Gray, 1987), cessation after many years of essay use may expose a learning deficit, especially in the ability to cope with stress. This may persist as protracted anxiety, and may possibly be related to protracted depression. Anxiety symptoms are likely to endure until new learning has induced the appropriate synaptic changes, which probably involve modification of endogenous GABA activity. Finally, there remains the question of whether benzodiazepines can cause structural neurological damage.
Like alcohol, benzodiazepines are lipid soluble, are highly concentrated in the brain, and online helper, impair cerebral cortical, cerebellar, and essays georgia, limbic system function. Online Assignment? It is possible that use over many years could cause physical changes such as cortical shrinkage, which may be only stress essay partially reversible. Such changes have been demonstrated by CAT-scan studies in young alcoholics (Lee, Möller, Hardt, Haubek, Jenson, 1979; staff, British Medical Journal, 1981) although not conclusively in assignment, chronic benzodiazepine users (Lader Petursson, 1984; Perera, Powell, Jenner, 1987). However, such techniques may not be sensitive enough to detect subtle changes. Thesis Essay? Nor are standard tests of intellectual function sensitive enough to detect minor degrees of cognitive impairment that may persist after withdrawal in some long-term users. Online Assignment? It remains possible that some protracted benzodiazepine withdrawal symptoms (including tinnitus and other neurological and psychological symptoms) could result from physicochemical neuronal damage. These symptoms would not be fully relieved by restarting benzodiazepines. There are still many puzzling features of benzodiazepine withdrawal, and the benzodiazepine story remains unfinished (Ashton, 1984). Ashton, H. (1989). Risks of dependence on nursing resume benzodiazepine drugs: A major problem of long-term treatment.
British Medical Journal , 298, 103-104. Ashton, H., Golding. Online Assignment Helper? J.F. (1989). Tranquillisers: Prevalence, predictors and essay, possible consequences. Data from a large United Kingdom Survey. British Journal of Addiction , 84,541-546. Ashton, H., Rawlins, M.D. Tyrer, S.P. (1990). A double blind placebo controlled study of buspirone in diazepam withdrawal in chronic benzodiazepine users.
British Journal of Addiction, 157, 232-238. Ashton, H., Stepney, R. (1982) Smoking: Psychology and pharmacology , London: Tavistock Publications. Benton, D., Rick, J.T. (1976). The effect of online assignment helper increased brain GABA produced by amino-oxyacetic acid on arousal in top 10 book, rats. Online Assignment Helper? Psychopharmacology , 49, 85-89. Bloom, F.E. (1985). Neurohumoral transmission in the central nervous system. In A.G.
Gilman, L.S. Goodman, T.W. Rall, F. Muland (Eds.), The pharmacological basis of therapeutics (pp. 236-259). How To Write? New York: Macmillan. Busto, U., Fornazzari, L., Naranjo, C.A. (1988). Protracted tinnitus after discontinuation of long-term therapeutic use of benzodiazepines. Journal of Clinical Psychopharmacology , 8, 359-362.
Busto, U., Sellers, E.M., Naranjo, C.A. Cappell, H.P., Sanchez, C.M., Sykora, K. (1986). Withdrawal reaction after long-term therapeutic use of benzodiazepines. New England Journal of Medicine , 315, 654-659. Cicero, T.J. (1979). Assignment Helper? Tolerance to and physical dependence on resume sample alcohol: Behavioural and neurobiological mechanisms. in Brain and pituitary peptides (pp.1603-1617). Munich: Ferring Symposium 1979.
Costa, E. Online? (1981). The role of gamma-aminobutyric acid in the action of 1,4 benzodiazepines. In J.W. Lamble (Ed), Towards understanding receptors (pp. 176-183). Amsterdam: Elsevier/North Holland. Cowen, P.J., Nutt, D.J. Resume Sample? (1982).
Abstinence symptoms after withdrawal from assignment tranquillising drugs: Is there a common neurochemical mechanism? Lancet ,2,360-362. Gilmartin, J.J., Corris, P.A., Stone, T.N., Veale, D., Gibson, G.J. Write Chinse? (1988). Effects of diazepam and chlormethiazole on ventilatory control in normal subject. British Journal of Clinical Pharmacology , 25, 766-770. Golding, J.F., Cornish, A.M. (1987).
Personality and life-style in online, medical students: Psychopharmacological aspects. Psychology and Health , 1, 287-301. Golding, J.F., Harper, T., Brent-Smith, H. (1983). Personality, drinking and drug-taking correlates of cigarette smoking. Personality and Individual Differences , 4, 703-706. Gray, J.A. (1981). Anxiety as a paradigm case of emotion.
British Medical Bulletin , 37, 193-197. Gray, J. A. (1987). The neuropsychology of emotion and top 10 book, personality. In S.M. Stahl, S.D. Iverson, E.C. Goodman (Eds.), Cognitive neurochemistry (pp.171-190). Oxford: Oxford University Press. Haefley, W., Pieri, L., Pole, P., Schaffer, R. (1981). Online Assignment Helper? General pharmacology and nursing grad, neuropharmacology of benzodiazepine derivatives. In H. Hoffmeister, and G. Stille (Eds.), Handbook of experimental pharmacology (Vol.
55, 11, pp. 13-262). Berlin: Springer-Verlag. Hallström, C., Lader, M. (1981). Benzodiazepine withdrawal phenomena. International Pharmacopsychiatry , 16, 235-244. Hermann, J.B., Brotman, A.W., Rosenbaum, J.F. (1987). Rebound anxiety in panic disorder patients treated with shorter-acting benzodiazepines.
Journal of Clinical Psychiatry , 48 (suppl. 10), 22-28. Kales, A., Scharf, M.B., Kales, J.D. (1978). Rebound insomnia: A new clinical syndrome. Assignment? Science , 201, 1039-1041. Lader, M. (1988). Sample Search? The psychopharmacology of addiction - Benzodiazepine tolerance and dependence.
In M. Online Assignment? Lader (Ed.), T he psychopharmacology of nursing addiction (pp. 1-14). Oxford: Oxford University Press. Lader, M.H., Olajide, D. (1987). A comparison of buspirone and placebo in relieving benzodiazepine withdrawal symptoms. Journal of helper Clinical Psychopharmacology , 7, 11-15. Lader, M.H., Petursson, H. (1981). Benzodiazepine derivatives - Side effects and dangers. Biological Psychiatry , 16, 1195-1212.
Lader, M.H., Ron, M., Petursson, R.H. (1984). Computed axial brain tomography in long-term benzodiazepine users. Psychological Medicine , 14, 203-206. Lee, K., Moller, L., Hardt, F., Haubek, A., Jenson, E. (1979). Alcohol-injured brain damage and top 10 reviews, liver damage in assignment helper, young males. Thesis? Lancet 2, 759-761.
Lum, L.C., (1987). Hyperventilation syndromes in medicine and psychiatry: A review. Helper? Journal of the Royal Society of Medicine , 80, 229-231. Möhler, H., Okada, T. (1977). Benzodiazepine receptors: Demonstration in the central nervous system. Science 198, 849-851.
Murphy, S.M., Owen, R.T., Tyrer, P.J., (1984). Withdrawal symptoms after six week’s treatment with diazepam. Lancet , 1389. Murphy, S.M., Tyrer, P. (1988). The essence of benzodiazepine dependence. (pp. 157-167). How To Chinse? Oxford: Oxford University Press.
Nutt, D. (1986). Benzodiazepine dependence in the clinic: Reason for anxiety? Trends in Pharmacological Sciences 7, 457-460. Olijade, D., Lader, M. Assignment Helper? (1984). Depression following withdrawal from long-term benzodiazepine use: A report of four cases.
Psychological Medicine , 14, 937-940. Oswald, I. (1989) Triazolam syndrome 10 years on. Lancet 1, 451-452. Owen, R.T., Tyrer, P. Thesis? (1983) Benzodiazepine dependence: A review of the assignment, evidence. Top 10 Book? Drugs , 25, 385-398. Perera, K.M.H., Powell, T., Jenner, F.A. (1987). Computerised axial tomographic studies following long-term use of benzodiazepines. Psychological Medicine , 17, 775-777.
Petursson, H., Lader, M.H. (1981a) Withdrawal from long-term benzodiazepine treatment. Online Assignment Helper? British Medical Journal , 283, 634-635. Petursson, H., Lader, M.H. (1981b). Benzodiazepine dependence. Chinse? British Journal of Addiction , 76, 133-145. Rementeria, J.L., Bhatt, K. (1977).
Withdrawal symptoms in online, neonates from intrauterine exposure to diazepam. Journal of ap bio Paediatrics , 90, 123-125. Sepinwall, J., Cook, L. (1979). Mechanisms of action of the helper, benzodiazepines: Behavioural aspects. Federation Proceedings 39, 3024-3031. Smith, D.E., Wesson, D.R. (1983). Benzodiazepine dependency syndromes.
Journal of Psychoactive Drugs , 15, 85-95. Squires, R.F., Braestrup, C. (1977). Benzodiazepine receptors in the rat brain. Nature , 266,732-734. Staff. (1981). Minor brain damage and alcoholism. British Medical Journal , 2, 455-456. Tyrer, P. (1990) Diagnosis of benzodiazepine dependence . Unpublished manuscript. Tyrer, P., Murphy, S., Riley, P. (1989). The benzodiazepine withdrawal symptom questionnaire.
Journal of how to write Affective Disorders , 19, 53-61. Tyrer, P., Owen, R., Dawling, S. (1983). Online? Gradual withdrawal of resume diazepam after long-term therapy. Online Assignment Helper? Lancet 1, 1402-1406. Tyrer, P., Rutherford, D., Higgett, T. Top 10 Reviews? (1981). Benzodiazepine withdrawal symptoms and propranolol. Assignment? Lancet , 1, 520-522. Winokur, A., Rickels, K., Greenblatt, D.J., Schatz, N.J. On Sensitivity? (1980). Assignment Helper? Withdrawal reaction from long-term low dosage administration of diazepam.
Archives of General Psychiatry , 37, 101-105. Young, W.S., Kuhar, M.J. (1980). Radiohistochemical localisation of benzodiazepine receptors in top 10 book, rat brain. Journal of Pharmacology and Experimental Therapeutics , 212, 337-346. Zigmond, A.S., Snaith, R.P. (1983). The hospital anxiety and depression (HAD) scale. Acta Psychiatrica Scandinavica , 67, 361-370. FIGURE 1. WITHDRAWAL SYMPTOMS RATING SCALE. Ratings: 0=none 1=mild 2=moderate 3=severe.
FIGURE 1. Withdrawal Symptoms Rating Scale. FIGURE 2. Hospital Anxiety Depression (HAD) Scale scores for anxiety over 20 weeks in 18 healthy students and 12 patients taking diazepam (7.5 SD 4.6 daily). Assignment Helper? Patients and students took placebo tablets until week 20. Patients withdrew from diazepam during weeks 8-12. One patient dropped out after 12 weeks for domestic reasons. Circles represent placebo group; triangles represent students. FIGURE 3. Withdrawal symptoms scores over essay, 20 weeks in online, 18 healthy students and 12 patients taking diazepam (7.5mg SD 4.6 daily).
Patients and procedures as in Figure 2. Symptom rating shown in Figure 1. Circles represent placebo group; triangles represent students. TABLE 1. Thesis Stress? Scores for selected symptoms before, during, and assignment helper, after diazepam withdrawal. ( n = 11; mean total scores on withdrawal symptoms scale shown in Figure 1. (postwithdrawal score equal. to or less than prewithdrawal. greater than prewithdrawal. Sensory hypersensitivity: to light, sound, taste, smell. Anxiety: Hospital Anxiety Depression (HAD) Scale (anxiety) scores. Paraesthesiae: tingling, numbness, altered sensitivity in limbs, face, trunk.
Motor symptoms: total score for stiffness, weakness, tremor, muscle twitches, ataxia.
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According to CEO Cynthia McCahon, the goal of the company is to help entrepreneurs make better-informed decisions. Users can get started on Enloop for free; more advanced paid options are also available. LivePlan is online a relatively new entrant to the online business-tools market that helps you every step of the way, from the planning stages through your launch. Like other services, LivePlan allows business owners to craft perfectly formatted plans. From there, users can create the presentation necessary to pitch their business ideas to would-be investors. Once off the ground, businesses can track revenue and expenses against forecasts, and how to write chinse, multiple users within a company can work through the LivePlan interface. Online Helper. Pricing starts at essay less than $12 a month. The One Page Business Plan Company. Created by online The One Page Business Plan Company, this simple business template covers only the key areas entrepreneurs need to essay, address to start a business: their vision for the company, mission for why the business exists, objectives for setting out goals, strategies to make the business successful and online assignment, action plans indicating what work needs to be done.
Unlike complicated business plans, boring blocks of text are not required bullet points will do. Are you the visual type? Look no further than Angela Bowman#39;s One-Page Visual Business Plan. Based on on sensitivity, the principles of the Business Generation Model Strategyzer app, Bowman#39;s One-Page Visual Business Plan uses sticky notes to help you creatively craft an out-of-the-box business plan. To create a One-Page Visual Business Plan, start by assignment separating a single page into different sections or columns, such as company information and customer segments. Write down your ideas or responses on a sticky note, and then stick it on the corresponding section. You can also color-code the sticky notes for better organization.
Then, if your plans change, you can easily remove a note, move it around or add new ones to ap bio essays georgia, better fit the direction in assignment, which your business is headed. SBA Build Your Business Plan Tool. The fact that the essay on sensitivity U.S. Small Business Administration (SBA) has an online tool to help users craft business plans will come as no surprise to helper, anyone who has investigated the SBA#39;s offerings before. The agency has a wealth of free planning, financing and consulting tools and resources, both online and through available consultants. The SBA#39;s online tool for business-plan creation allows a user to enter information on a Web interface that is tied to ap bio georgia, that user#39;s account.
The administration says this is intended to be a live plan that can be referred to assignment helper, and changed as the company#39;s plans progress. The SBA encourages entrepreneurs to use their generated plans to discuss their company#39;s prospects with SBA advisers like those available through SCORE and how to chinse, the Small Business Development Center. The SBA#39;s tool is available online at no cost. Greg Go, co-founder of online finance community Wise Bread, is a big believer that entrepreneurs who are just starting out don#39;t need lengthy business plans. What they actually need, he said, is an internal working plan to get started.
The internal working plan consists of assignment helper four simple questions that make up the ap bio georgia simple business plan: What is your product or service? Who are your customers? When will things get done? When are bills due, and online assignment helper, when do you get paid? To guide entrepreneurs in completing their four-question business plan, Go provides a simplified way of answering each question in his blog post on the subject. Ap Bio Essays. Editor#39;s note: If you#39;re looking for information to help you with writing a complete business plan, use the helper questionnaire below to have our sister site provide you with information from a variety of top 10 book reviews vendors for free. Updated on May 1, 2015.
Additional reporting by Business News Daily staff writer Sara Angeles.
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