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By J. Bozep. George Mason University.

The medullar cells secrete epinephrine (you may know it as adrenaline) and norepinephrine (also known as noradrenaline) buy citalopram 10 mg with amex symptoms 7 days before period. Made up of closely packed epithelial cells order citalopram 10mg free shipping medicine 0031, the adrenal cortex is loaded with blood ves- sels. Each zone is com- posed of a different cellular arrangement and secretes different steroid hormones. The zona reticularis (inner zone) secretes small amounts of gonadocorticoids or sex hormones. The following are among the hormones produced by the cortex: Aldosterone, or mineralocorticoid, regulates electrolytes (sodium and potassium mineral salts) retained in the body. Cortisone, or cortisol, acts as an antagonist to insulin, causing more glucose to form and increasing blood sugar to maintain normal levels. Elevated levels of cortisone speed up protein breakdown and inhibit amino acid absorption. Androgens generally convey antifeminine effects, thus accelerating maleness, although in women adrenal androgens maintain the sexual drive. Too much androgen in females can cause virilism (male secondary sexual characteristics). The adrenal medulla is made of irregularly shaped chromaffin cells arranged in groups around blood vessels. The sympathetic division of the autonomic nervous system con- trols these cells as they secrete adrenaline and noradrenaline. The adrenal cortex produces approximately 80 percent adrenaline and 20 percent noradrenaline.

Likely (but unproven) physiological benefits include improved lymphatic drainage cheap 40 mg citalopram mastercard symptoms migraine, returning plasma proteins to the circulation cheap 20 mg citalopram with visa symptoms hiatal hernia. Reflexology Although there are ancient precedents, modern Western reflexology derives from the work of William Fitzgerald, a nineteenth-century doctor who accidentally found that the Intensive care nursing 442 use of pressure could replace anaesthesia during minor operations (Griffiths 1995). Fitzgerald believed that organ malfunction resulted in tiny crystalline deposits of calcium and uric acid on the nerve endings of the feet, and that breaking down these deposits with massage would heal the organ (Griffiths 1995). Fitzgerald identified ten energy zones of life-force running longitudinally through the body (not too dissimilar to the twelve meridians of Ki), reflecting the organs in specific parts of the feet (and hands). Reflexologists can therefore treat any part of the body using specialised foot massage that breaks down the crystalline deposits. If reflexology’s assumptions are correct, it is possible that nurses manipulating feet and hands (e. Griffiths (1995) warns that reflexology initiates a ‘healing crisis’ which can last up to 24 hours, although this is less likely to occur with the gentler Western approaches than the more vigorous approaches used in the East. The absence of any reported complications suggests this may not be an actual problem, but it leaves a (currently) unanswered question. Shiatsu Although derived from the Japanese for ‘finger pressure’, Shiatsu practice has gained wider connotations; it usually treats the whole meridian system (of vital energy/life force) in order to harmonise Ki (Stevensen 1995). Like other variants of massage, shiatsu is best left to those with specialist knowledge. Aromatherapy Aromatherapy implies the use of essential oils with direct chemical effects, not just burning something which emits pleasant smells (although boundaries between pleasure and therapy can become blurred when evaluating psychological benefit): burning neroli (see Massage above) can reduce anxiety. As active chemicals, essential oils can be considered to be drugs, albeit not restricted by regulations governing traditional medicines. Because of the nature of this therapy, the effects of aromatherapy may affect anyone (staff, other patients) in the immediate environment, so although relaxation may help some patients, it could be harmful to others, while possibly reducing staff efficiency. Complementary therapies 443 Placebo effect Throughout history significant minorities of people have benefited from inactive medicines (placebos); Hippocrates was familiar with the problems of patients who had been given unhelpful (and often harmful) treatments.

Even if a group exerts posi- tive peer pressure order 40mg citalopram fast delivery medicine 029, it may also be exerting negative peer pressure by being exclusive on the basis of race effective 40mg citalopram treatment vitamin d deficiency, class, religion, sexual orientation, or ethnicity. Cliques A group of people who identify with each other Further Reading and interact frequently. Lockers, Lunch Lines, Chemistry, and people who interact with each other more intensively Cliques. It is used to describe an adolescent social group that excludes others on the basis of superficial differences, exercising greater than average amount of peer pressure upon its mem- Cocaine bers. The numerous terms teenagers use to describe themselves and others—such as jocks, druggies, popu- See Drugs/Drug abuse lars, brains, nerds, normals, rappers, preps, stoners, rock- ers, punks (punx), freaks (phreaks), and skaters—exem- plify both levels of meaning in the word “clique. A term used to describe a person who is intimately A clique consists of a particular group of people involved with a person who is abusing or addicted within a particular location. Joining cliques, having the desire to person involved with the dependent person in any inti- join a particular clique, and being excluded from cliques mate way (spouse, lover, child, sibling, etc. The definition of the term has been expand- Joining cliques helps children to develop, identify, and ed to include anyone showing an extreme degree of cer- regulate social interaction. Generally children begin to tain personality traits: denial, silent or even cheerful tol- be more aware of differences and form cliques in late el- erance of unreasonable behavior from others, rigid loyal- ementary school, between the ages of 8 and 10 years old. Some consider it a pro- greatly exaggerated between ages 10 and 12 years old, gressive disease, one which gets worse without treatment when a child’s clique may change on a daily basis. Progressive codependence can ing middle school and high school, and membership in lead to depression, isolation, self-destructive behavior cliques can have a strong effect on the adolescent’s sense (such as bulimia, anorexia, self-mutilation) or even sui- of self-worth. There is a large self-help movement to help code- consistent, though their composition may change.