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Articles 781 - 810 of 1392

Full-Text Articles in Psychiatry and Psychology

Social Isolation Among Families Caring For Children With Disabilities, Dennis J. Baumgardner Oct 2019

Social Isolation Among Families Caring For Children With Disabilities, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

In this issue introduction, the editor-in-chief of Journal of Patient-Centered Research and Reviews comments on the social isolation experienced by families that include children with significant disabilities.


Treatment Of Attention-Deficit Hyperactivity Disorder In Children And Adolescents: Benefits And Challenges, Kaila Bollinger, Albert Bui, Adam Smith, Kelsey Fink, Manoranjan D'Souza Oct 2019

Treatment Of Attention-Deficit Hyperactivity Disorder In Children And Adolescents: Benefits And Challenges, Kaila Bollinger, Albert Bui, Adam Smith, Kelsey Fink, Manoranjan D'Souza

Pharmacy and Wellness Review

Attention-deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder affecting approximately 11 percent of the country's children and adolescents, between the ages four to seventeen years. Stimulant medications such as methylphenidate and amphetamines are the first-line of treatment for ADHD. The increasing use of these stimulant medications has resulted in increased media attention and raised questions about their efficacy and safety. This review focuses on the history of stimulant use in ADHD, the disease's pathophysiology, the long-term benefits of pharmacotherapy, and the possible subsequent adverse effects associated with prolonged stimulant use in children and adolescents suffering from ADHD. Furthermore, we will …


Antidepressant Therapy: A Review Of Current Treatment Options And A Glance At The Future, Brittany Dye, Stacy Henthorne, Molly Kulp, Tristan Maiers, Zachary Crawford, Erin Petersen Oct 2019

Antidepressant Therapy: A Review Of Current Treatment Options And A Glance At The Future, Brittany Dye, Stacy Henthorne, Molly Kulp, Tristan Maiers, Zachary Crawford, Erin Petersen

Pharmacy and Wellness Review

Depression and anxiety disorders are two of the most common mental illnesses experienced by people within the United States, affecting 6.7 percent of the adult population per year. This article will focus on one specific type of depression, major depressive disorder (MDD), characterized by two or more weeks of depressed mood and/or decreased interest in normally enjoyed activities. Depression complicates treatment of other disease state(s), making successful treatment of depression essential in the management of a patient's overall health. This review will evaluate the pathophysiology, antidepressant treatment, and new approaches to treatment, specifically vortioxetine, for MDD.


Somatic Symptom And Related Disorders: A Case Of Illness Anxiety Disorder In A Young Relatively Treatment Naive African American Male, Linda Zhang, Richard P. Leggett, Harrison Ross Galicki, William B. Dehart Oct 2019

Somatic Symptom And Related Disorders: A Case Of Illness Anxiety Disorder In A Young Relatively Treatment Naive African American Male, Linda Zhang, Richard P. Leggett, Harrison Ross Galicki, William B. Dehart

Psychiatry

Somatic symptom and related disorders (including illness anxiety disorder and somatic symptom disorder) is a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) replacing somatoform and related disorders in the DSM-4 Text Revision. This classification eliminated the requirement that somatic symptoms must be nonorganic in nature, in an effort to reliably detect more cases of significant health anxiety than previously with DSM-4 criteria. Illness anxiety disorder is a primary anxiety disorder characterized by persistent preoccupation or excessive concern about having or developing an undiagnosed disease despite medical evaluation and reassurance. It is considered a …


Texas, The Death Penalty, And Intellectual Disability, Megan Green Oct 2019

Texas, The Death Penalty, And Intellectual Disability, Megan Green

St. Mary's Law Journal

Abstract forthcoming


An Animal-Assisted Intervention Study In The Nursing Home: Lessons Learned, Lonneke G. J. A. Schuurmans, Inge Noback, Jos M. G. A. Schols, Marie-Jose Enders-Slegers Sep 2019

An Animal-Assisted Intervention Study In The Nursing Home: Lessons Learned, Lonneke G. J. A. Schuurmans, Inge Noback, Jos M. G. A. Schols, Marie-Jose Enders-Slegers

People and Animals: The International Journal of Research and Practice

AAI studies in the nursing home pose a specific set of challenges. In this article the practical and ethical issues encountered during a Dutch psychogeriatric nursing home AAI study are addressed with the aim of sharing our experiences for future researchers as well as AAI practitioners in general.

In our study we compared three groups of clients with dementia who participated in group sessions of either visiting dog teams, visiting FurReal Friend robot animals, or visiting students (control group) and monitored the effect on social interaction and neuropsychiatric symptoms through video analysis and questionnaires. We encountered the following four categories …


Anxiety Induced Pulmonary Edema: A Rare Occurrence, Anum Akhlaq Md, Neda Shahoori, Alexandra Mary Kelada, Aftab Ahmad Sep 2019

Anxiety Induced Pulmonary Edema: A Rare Occurrence, Anum Akhlaq Md, Neda Shahoori, Alexandra Mary Kelada, Aftab Ahmad

Internal Medicine

No abstract provided.


Trait Emotional Experience In Individuals With Schizophrenia And Youth At Clinical High Risk For Psychosis, Claire I. Yee, Gregory P. Strauss, Daniel N. Allen, Claudia M. Haase, David Kimhy, Vijay A. Mittal Sep 2019

Trait Emotional Experience In Individuals With Schizophrenia And Youth At Clinical High Risk For Psychosis, Claire I. Yee, Gregory P. Strauss, Daniel N. Allen, Claudia M. Haase, David Kimhy, Vijay A. Mittal

Psychology Faculty Research

Background: Disturbances in trait emotions are a predominant feature in schizophrenia. However, less is known about (a) differences in trait emotion across phases of the illness such as the clinical high-risk (CHR) phase and (b) whether abnormalities in trait emotion that are associated with negative symptoms are driven by primary (i.e. idiopathic) or secondary (e.g. depression, anxiety) factors. Aims: To examine profiles of trait affective disturbance and their clinical correlates in individuals with schizophrenia and individuals at CHR for psychosis. Method: In two studies (sample 1: 56 out-patients diagnosed with schizophrenia and 34 demographically matched individuals without schizophrenia (controls); sample …


A Polygenic Resilience Score Moderates The Genetic Risk For Schizophrenia, Jonathan L. Hess, Et Al, Schizophrenia Working Group Of The Psychiatric Genomics Consortium, Nancy G. Buccola Sep 2019

A Polygenic Resilience Score Moderates The Genetic Risk For Schizophrenia, Jonathan L. Hess, Et Al, Schizophrenia Working Group Of The Psychiatric Genomics Consortium, Nancy G. Buccola

School of Nursing Faculty Publications

Based on the discovery by the Resilience Project (Chen R. et al. Nat Biotechnol 34:531–538, 2016) of rare variants that confer resistance to Mendelian disease, and protective alleles for some complex diseases, we posited the existence of genetic variants that promote resilience to highly heritable polygenic disorders1,0 such as schizophrenia. Resilience has been traditionally viewed as a psychological construct, although our use of the term resilience refers to a different construct that directly relates to the Resilience Project, namely: heritable variation that promotes resistance to disease by reducing the penetrance of risk loci, wherein resilience and risk loci operate orthogonal …


The Development Of Face Morphing Task To Assess Self Other Differentiation, Esen Karan Sep 2019

The Development Of Face Morphing Task To Assess Self Other Differentiation, Esen Karan

Dissertations, Theses, and Capstone Projects

Self-Other Differentiation (SOD) refers to a developmental process of acquiring a consolidated, integrated, and individuated sense of self. SOD develops at a) perceptual (e.g., facial perception) and b) representational (e.g., traits, mental states, and beliefs) levels. Impairments in representational SOD (R-SOD) are associated with many forms of psychopathology, particularly borderline personality disorder (BPD) and narcissistic personality disorder (NPD). Few studies to date have examined the perceptual aspects of SOD (P-SOD), which are hypothesized to develop from infancy onwards in tandem and in interaction with R-SOD. Given that the human face is one of the key characteristics that humans use to …


Does Ethnic Identity, In-Group Preference, And Acculturation Protect Latinas With A History Of Interpersonal Trauma From Developing Symptoms Of Ptsd?, Evelyn M. Ramirez Sep 2019

Does Ethnic Identity, In-Group Preference, And Acculturation Protect Latinas With A History Of Interpersonal Trauma From Developing Symptoms Of Ptsd?, Evelyn M. Ramirez

Dissertations, Theses, and Capstone Projects

Previous research suggests ethnic identity, a sense of belonging to a particular cultural group, may be protective against symptoms of post-traumatic stress disorder (PTSD). However, the role of ethnic identity, in-group preference (i.e., an individual’s preference for interactions with members of their own ethnic group) and acculturation (i.e., the level of comfort with the mainstream culture) have not been investigated as protective factors for Latinas with a history of interpersonal and sexual trauma. In this study, ethnic identity, in-group preference and acculturation were assessed via self-report on the Scale of Ethnic Experience in two samples of undergraduate Latina and non-Latina …


Language Nutrition For Language Health In Children With Disorders: A Scoping Review, Janet Y. Bang, Aubrey S. Adiao, Virginia A. Marchman, Heidi M. Feldman Aug 2019

Language Nutrition For Language Health In Children With Disorders: A Scoping Review, Janet Y. Bang, Aubrey S. Adiao, Virginia A. Marchman, Heidi M. Feldman

Faculty Research, Scholarly, and Creative Activity

The quantity and quality of child-directed speech—language nutrition—provided to typically-developing children is associated with language outcomes—language health. Limited information is available about child-directed speech to children at biological risk of language impairments. We conducted a scoping review on caregiver child-directed speech for children with three clinical conditions associated with language impairments—preterm birth, intellectual disability, and autism—addressing three questions: (1) How does child-directed speech to these children differ from speech to typically-developing children? (2) What are the associations between child-directed speech and child language outcomes? (3) How convincing are intervention studies that aim to improve child-directed speech and thereby facilitate children’s …


Recent Trends, Current Research In Cyberpsychology: A Literature Review, Amarjit Kumar Singh, Pawan Kumar Singh Aug 2019

Recent Trends, Current Research In Cyberpsychology: A Literature Review, Amarjit Kumar Singh, Pawan Kumar Singh

Library Philosophy and Practice (e-journal)

Cyberpsychology refers to the study of the mind and behavior in the context of interactions with technology. It is an emerging branch, which has focused on the psychological aspects connected to the increasing presence and usages of technology in modern lives. This paper traces recent advancement and trends of Cyberpsychology is an emerging domain of knowledge and goes on the give a literature review of the same. An analysis of the recent research and literature covering 300 most relevant research papers from the period of 2012 to 15, August 2019 was conducted to determine and shape the research pattern based …


Feasibility Pilot Outcomes Of A Mammography Decision Support And Navigation Intervention For Women With Serious Mental Illness Living In Supportive Housing Settings., Lara Weinstein, Marianna Lanoue, Katelyn Hurley, Colleen Payton, Randa Sifri, Ronald Myers Aug 2019

Feasibility Pilot Outcomes Of A Mammography Decision Support And Navigation Intervention For Women With Serious Mental Illness Living In Supportive Housing Settings., Lara Weinstein, Marianna Lanoue, Katelyn Hurley, Colleen Payton, Randa Sifri, Ronald Myers

Department of Family & Community Medicine Faculty Papers

Objective: People with serious mental illness (SMI) experience significant disparities in morbidity and mortality from preventable and treatable medical conditions. Women with SMI have low mammography screening rates. SMI, poverty, and poor access to care can have a significant effect on a woman’s opportunity to learn about and discuss breast cancer screening with health care providers. This study examines the feasibility pilot outcomes of mammography decision support and patient navigation intervention (DSNI) for women with SMI living in supportive housing settings. The primary research question was: Does the DSNI increase knowledge, promote favorable attitudes, and decrease decisional conflict relating to …


Comorbidity Profile Of Head And Neck Cancer Patients With And Without Depression, Michaela Frenzel Aug 2019

Comorbidity Profile Of Head And Neck Cancer Patients With And Without Depression, Michaela Frenzel

Capstone Experience: Master of Public Health

This population-based retrospective study used SEER-Medicare data from 2002-2010 to assess depression, comorbidity, and substance use in the elderly head and neck cancer population. Out of 3,533 head and neck cancer patients, 10.6% had depression diagnoses two years prior to cancer diagnosis, 8.9% were newly diagnosed with depression within one year after cancer diagnosis, and 44.5% of those with preexisting depression had an additional depression diagnosis within one year following cancer diagnosis. Comorbid conditions (p<0.0001) and substance use (p=0.0017) showed associations with depression prior to cancer diagnosis yet, no significant associations with incidence of depression in this head and neck cancer population. This study affirms the need for continual depression screenings in head and neck cancer patients and suggests the need for increased research into the burden of comorbid conditions and substance use within the head and neck cancer population.


A Letter To My Departed Niece, * Anonymous * Jul 2019

A Letter To My Departed Niece, * Anonymous *

Journal of Patient-Centered Research and Reviews

The following piece was written in the weeks following the death of the author’s niece. It is an attempt to explore how we as a society handle health crises differently for medical versus mental health diagnoses.


Associations Between Comorbid Tdp-43, Lewy Body Pathology And Neuropsychiatric Symptoms In Alzheimer's Disease, Ece Bayram, Guogen Shan, Jeffrey L. Cummings Jun 2019

Associations Between Comorbid Tdp-43, Lewy Body Pathology And Neuropsychiatric Symptoms In Alzheimer's Disease, Ece Bayram, Guogen Shan, Jeffrey L. Cummings

School of Public Health Faculty Research

More than half of the patients with Alzheimer’s disease (AD) have comorbidities including TDP-43 and Lewy bodies, which are also associated with frontotemporal lobar degeneration and dementia with Lewy bodies, respectively. These comorbidities may help explain the overlapping neuropsychiatric symptoms between AD and other dementias. Data on 221 AD patients with Neuropsychiatric Inventory-Questionnaire were obtained from the National Alzheimer’s Coordinating Center. TDP-43 was associated with aberrant motor activity, whereas Lewy bodies were associated with anxiety, irritability, sleep behavior, and appetite problems. The associations between these comorbidities and neuropsychiatric symptoms were more significant for patients with sparse diffuse plaques.


Mental Health Profiles Of Adolescents With Co-Occurring Gambling Behaviours And Benzodiazepine Misuse, Emilie Fletcher, Jeremie Richard, Jeffrey Derevensky Dr, William Ivoska Dr, Caroline Temcheff Dr May 2019

Mental Health Profiles Of Adolescents With Co-Occurring Gambling Behaviours And Benzodiazepine Misuse, Emilie Fletcher, Jeremie Richard, Jeffrey Derevensky Dr, William Ivoska Dr, Caroline Temcheff Dr

International Conference on Gambling & Risk Taking

No abstract provided.


Do Not Miss Your Shot: Improving Follow-Up In Patients Receiving Long-Acting Injectable Medications, Mary O'Hara May 2019

Do Not Miss Your Shot: Improving Follow-Up In Patients Receiving Long-Acting Injectable Medications, Mary O'Hara

Doctor of Nursing Practice Final Manuscripts

Background: Serious mental illness including schizophrenia and bipolar disorder affects 1 in 24 adults in California. These chronic disorders are difficult to treat and often sabotaged by medication nonadherence. Long-acting injectable (LAI) medications are one strategy to combat medication nonadherence. Effectively providing treatment with LAI medications can be challenging at the clinic level.

Objectives: Reduce the number of days without medication by reducing the number of days between injection due date and injection administration for patients receiving LAI medications.

Design: Establish appointments for all injection visits. Standardize visit protocol for injection encounters to optimize provider time. Arrange immediate follow-up and …


Understanding The Impact Of A Perinatal Mood And Anxiety Disorders Phone Support Line, Diana Nguyen, Semira Semino-Asaro May 2019

Understanding The Impact Of A Perinatal Mood And Anxiety Disorders Phone Support Line, Diana Nguyen, Semira Semino-Asaro

Doctor of Nursing Practice Final Manuscripts

Postpartum depression affects one in every seven women and anxiety is estimated to range from 13-21% in new mothers. Risk factors include prior diagnosis of depression, family history of depression, having medical complications during childbirth including a premature baby and a lack of social, emotional support. The purpose of this evidence-based practice project was to increase the amount of data gathered by a local perinatal support organization by analyzing the callers’ demographics through phoneline surveys and use the information to expand resources and access to care for mothers with perinatal mood and anxiety disorders (PMADs). The project was guided by …


Analysis Of A Universal Depression Screening Workflow At An Integrated Healthcare Center, Arthur Roehr May 2019

Analysis Of A Universal Depression Screening Workflow At An Integrated Healthcare Center, Arthur Roehr

Doctor of Nursing Practice Final Manuscripts

Purpose: Evaluation of an evidence-based protocol that measures the effectiveness of universal depression screening at an integrated healthcare center. At risk patients are those who complete a patient health questionnaire (phq-9) and score ≥ 10 when presenting for a primary care visit. A score of ≥ 10 prompts further evaluation by the primary care provider (PCP) prior to behavioral health care management (BHCM) referral.

Background: In 2016, 16.2 million adults aged 18 or older in the U.S. experienced a major depressive episode (MDE). 65.3% of those received some form of treatment from a healthcare professional (therapy and/or medication). Early identification …


Dance/Movement Therapy As A Tool To Improve Social Skills In Children And Adolescents With Autism Spectrum Disorder: A Literature Review, Holly Berlandy May 2019

Dance/Movement Therapy As A Tool To Improve Social Skills In Children And Adolescents With Autism Spectrum Disorder: A Literature Review, Holly Berlandy

Expressive Therapies Capstone Theses

Abstract

Autism spectrum disorder is a neurodevelopmental disorder diagnosed by the presence of social communication and interaction deficits present in their day to day. The deficits present in this disorder appear within the first three years of life and lead to problems with connecting and interacting with other individuals including their own family members. As a result, children and adolescents with Autism spectrum disorder often experience negative self-image and lack the proper skills to interact with others. Autism spectrum disorder is becoming more commonly diagnosed and yet there remains a gap in interventions and treatment due to the individualized appearance …


“There Was Something Magical About This Group”: Building Cohesion In A Psychiatric Hospital, Mariah L. Logan May 2019

“There Was Something Magical About This Group”: Building Cohesion In A Psychiatric Hospital, Mariah L. Logan

Expressive Therapies Capstone Theses

This capstone details the development and implementation of Hope Notes, an expressive arts therapy intervention used in a private psychiatric hospital setting. Hope Notes was carried out in the group setting with adolescent and adult clients in a partial-hospitalization or inpatient hospitalization with a range of diagnoses and symptoms including, but not limited to, depression, anxiety, bipolar disorder, schizophrenia, trauma disorders including post-traumatic stress, and obsessive-compulsive disorder with symptoms of delusions, hallucinations, suicidality and homicidally. Using expressive arts therapy the clients worked together to collaboratively discuss, create, design, and build an art piece intended to increase group cohesion and connection …


Expressive Mindfulness: A Trauma-Sensitive Expressive Arts Therapy Group Method, Meghan Daly May 2019

Expressive Mindfulness: A Trauma-Sensitive Expressive Arts Therapy Group Method, Meghan Daly

Expressive Therapies Capstone Theses

Mindfulness and expressive arts therapy are both supportive of directing attention in a manner that promotes integration and function of a person. In this paper, a trauma-sensitive method was created for use in a day treatment setting for adults with severe and persistent mental illness (SPMI). This method utilized expressive movement, visual art making with three different materials, and creative writing to encourage mindful, non-judgmental acceptance of the present moment; a sense of relaxation; and an overall increase in quality of life. During development of the method arts-based research informed the choice of materials, music, and structure of the group. …


School-Based Mental Health Screening: Improving Outcomes Through Interprofessional Communication And Collaboration, Tiffany Gishizky May 2019

School-Based Mental Health Screening: Improving Outcomes Through Interprofessional Communication And Collaboration, Tiffany Gishizky

Doctor of Nursing Practice (DNP) Projects

For the adolescent population, the immediate impact a mental health disorder has on academics,relationships, and even suicide risk cannot be understated. Access to mental health care in low socioeconomic communities for adolescents is fraught with barriers. These include lack of transportation, lack of insurance coverage, fear of stigma, and a fundamental lack of knowledge regarding available resources. It is therefore a two-fold problem that exists for those in the care and observation of these adolescents; underutilization of appropriate routine screening and navigation to access care. This project aimed to remediate both of these issues at a high school located in …


Orthorexia Nervosa Among Collegiate Female Student-Athletes, Maryse Bard-Martel May 2019

Orthorexia Nervosa Among Collegiate Female Student-Athletes, Maryse Bard-Martel

Graduate Theses/Dissertations

Orthorexia nervosa (ON) is a specific style of disordered eating defined as an unhealthy obsession with eating healthy food, or going to extremes in the pursuit of a diet that is supposed to be good for you. The purpose of this study was to explore the prevalence of orthorexia nervosa tendencies in college female soccer players in the NCAA Division 1. Purposive sampling was used, and participants were current student-athletes from the Missouri State women’s soccer team (n=18). Survey research was utilized to assess athletes’ attitudes and behaviors related to various aspects of diet and training, and the control it …


A Meta-Analytic Review Of Cognitive Functioning In Negative And Positive Symptoms Of Schizophrenia, Tiffany Forsythe May 2019

A Meta-Analytic Review Of Cognitive Functioning In Negative And Positive Symptoms Of Schizophrenia, Tiffany Forsythe

Electronic Theses and Dissertations

The purpose of the study was to conduct two meta-analytic reviews examining cognitive functioning and schizophrenia. The first review examined the literature comparing the cognitive functioning of schizophrenic patients to healthy controls. A second review examined the cognitive functioning within schizophrenic patients, examining the differences between individuals with primarily positive symptomatology and those with primarily negative symptomatology. The first meta-analysis included 19 studies which assessed 861 schizophrenic patients and 858 healthy volunteers overall. The second meta-analysis included 10 studies comparing the cognitive functioning of 1,263 schizophrenics across positive and negative symptoms. Results of the first review indicated that healthy controls …


Affective Disturbance In Mild Cognitive Impairment, Jason Greenhagen, Emily Matusz, Sheina Emrani, David Libon, Sherry Pomerantz May 2019

Affective Disturbance In Mild Cognitive Impairment, Jason Greenhagen, Emily Matusz, Sheina Emrani, David Libon, Sherry Pomerantz

Rowan-Virtua Research Day

Mild cognitive impairment (MCI) is an identifiable, prodromal stage of cognitive impairment and has been further defined into subtypes: amnestic, language, executive functioning, and multi domain/mixed MCI (Jak et al. 2009 ). The purpose of this study is to (1) examine the differences in depression, anxiety, and apathy between MCI subtypes; and (2) assess the relationship between the neurocognitive domains (executive functioning, language, and memory and affective symptoms. We hypothesize that apathy will be greater in dysexecutive/mixed MCI (dys/mixed MCI) and be more highly correlated to neurocognitive deficits compared to depression or anxiety. This is a retrospective study of 113 …


The Effects Of A Dementia Simulation Experience On Attitudes Towards People With Dementia, Micah Huckabee May 2019

The Effects Of A Dementia Simulation Experience On Attitudes Towards People With Dementia, Micah Huckabee

Health, Human Performance and Recreation Undergraduate Honors Theses

Introduction: The neurodegenerative effects of dementia resulting in cognitive and behavioral impairments is plausibly one of the reasons for a societal stigma towards individuals with dementia. Societal stigmas are associated with decreased life satisfaction, depressive symptoms, and decreased psychological well-being for stigmatized individuals. In an effort to improve attitudes towards individuals with dementia, this study utilized a dementia simulation to measure attitudinal changes after a dementia simulation. Methods: There were 33 participants in this study (13 male and 20 female) between the ages of 18 and 25. Participants completed a Dementia Attitudes Scale (DAS) survey, and then they dressed in …


Weight Status, Bullying Involvement, And Internalizing Symptomology In Adolescents: Examining A Diathesis-Stress Model, Ana Damme May 2019

Weight Status, Bullying Involvement, And Internalizing Symptomology In Adolescents: Examining A Diathesis-Stress Model, Ana Damme

College of Education and Human Sciences: Dissertations, Theses, and Student Research

Bullying is a pervasive societal issue that is consistently linked to negative outcomes that are emotionally, socially, behaviorally, and medically related. Most youth will encounter this negative life event in their childhood. The purpose of this dissertation was to use a diathesis-stress model perspective to assess the relations between the negative life event of bullying involvement, youths’ mental health, and youth weight status. Youth who have an unhealthy weight status are more likely to be involved in bullying than those with a healthy weight status (Browne, 2012; Puhl). Additionally, bullying and having an unhealthy weight status are related internalizing symptomology …