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Articles 1891 - 1920 of 2053

Full-Text Articles in Psychiatry and Psychology

Psychosis In Indigenous Populations Of Cape York And The Torres Strait, Ernest M. Hunter, Bruce D. Gynther, Carrick J. Anderson, Leigh-Ann L. Onnis, Jeffrey R. Nelson, Wayne Hall, Bernhard T. Baune, Aaron R. Groves Feb 2012

Psychosis In Indigenous Populations Of Cape York And The Torres Strait, Ernest M. Hunter, Bruce D. Gynther, Carrick J. Anderson, Leigh-Ann L. Onnis, Jeffrey R. Nelson, Wayne Hall, Bernhard T. Baune, Aaron R. Groves

Aboriginal Policy Research Consortium International (APRCi)

Objective: To describe and characterise treated psychotic disorders in the Indigenous populations of Cape York and the Torres Strait.

Design: Cross-sectional analysis of patients with a psychotic disorder identified by treating psychiatrists.

Setting and participants: Indigenous patients aged 􏰀 15 years in Cape York and Torres Strait communities receiving treatment for a psychotic disorder over 3 months in 2010.

Main outcome measures: Prevalence of psychosis diagnoses, intellectual disability, and substance use comorbidities.

Results: 171 patients were included. The prevalence rate in this population was 1.68%, higher for males (2.60%) than females (0.89%), and twice as high in the Aboriginal (2.05%) …


Medical Evaluation And Triage Of The Agitated Patient: Consensus Statement Of The American Association For Emergency Psychiatry Project Beta Medical Evaluation Workgroup, Kimberly Nordstrom, Leslie S. Zun, Michael P. Wilson, Victor Stiebel, Anthony T. Ng, Benjamin Bregman, Eric L. Anderson Feb 2012

Medical Evaluation And Triage Of The Agitated Patient: Consensus Statement Of The American Association For Emergency Psychiatry Project Beta Medical Evaluation Workgroup, Kimberly Nordstrom, Leslie S. Zun, Michael P. Wilson, Victor Stiebel, Anthony T. Ng, Benjamin Bregman, Eric L. Anderson

Psychiatry and Behavioral Sciences Faculty Publications

Numerous medical and psychiatric conditions can cause agitation, some of these causes are life threatening. It is important to be able to differentiate between medical and non-medical causes of agitation so that patients can receive appropriate and timely treatment. This article aims to educate all clinicians in non-medical settings, such as mental health clinics, and medical settings on the differing levels of severity in agitation, basic triage, use of de-escalation, and factors, symptoms, and signs in determining whether a medical etiology is likely. Lastly, this article focuses on the medical workup of agitation when a medical etiology is suspected or …


Vitamin D: Does It Play A Role In Psychiatry, Mukesh Mohan Bhimani Feb 2012

Vitamin D: Does It Play A Role In Psychiatry, Mukesh Mohan Bhimani

Department of Psychiatry

No abstract provided.


The Social Production Of Substance Abuse And Hiv/Hcv Risk: An Exploratory Study Of Opioid-Using Immigrants From The Former Soviet Union Living In New York City, Honoria Guarino, Sarah K. Moore, Lisa A. Marsch, Sal Florio Jan 2012

The Social Production Of Substance Abuse And Hiv/Hcv Risk: An Exploratory Study Of Opioid-Using Immigrants From The Former Soviet Union Living In New York City, Honoria Guarino, Sarah K. Moore, Lisa A. Marsch, Sal Florio

Dartmouth Scholarship

Several former Soviet countries have witnessed the rapid emergence of major epidemics of injection drug use (IDU) and associated HIV/HCV, suggesting that immigrants from the former Soviet Union (FSU) may be at heightened risk for similar problems. This exploratory study examines substance use patterns among the understudied population of opioid-using FSU immigrants in the U.S., as well as social contextual factors that may increase these immigrants' susceptibility to opioid abuse and HIV/HCV infection. In-depth interviews were conducted with 10 FSU immigrants living in New York City who initiated opioid use in adolescence or young adulthood, and with 6 drug treatment …


Reintegration Of Child Soldiers In Burundi: A Tracer Study, Mark J.D. Jordans, Ivan H. Komproe, Wietse A. Tol, Aline Ndayisaba, Theodora Nisabwe, Brandon A. Kohrt Jan 2012

Reintegration Of Child Soldiers In Burundi: A Tracer Study, Mark J.D. Jordans, Ivan H. Komproe, Wietse A. Tol, Aline Ndayisaba, Theodora Nisabwe, Brandon A. Kohrt

Psychiatry and Behavioral Sciences Faculty Publications

No abstract provided.


Concurrent And Predictive Relationships Between Compulsive Internet Use And Substance Use: Findings From Vocational High School Students In China And The Usa, C. Anderson Johnson, Ping Sun, Paula Palmer, Thalida E. Arpawong, Jennifer B. Unger, Bin Xie, Louise Ann Rohrbach, Donna Spruijt-Metz, Steve Sussman Jan 2012

Concurrent And Predictive Relationships Between Compulsive Internet Use And Substance Use: Findings From Vocational High School Students In China And The Usa, C. Anderson Johnson, Ping Sun, Paula Palmer, Thalida E. Arpawong, Jennifer B. Unger, Bin Xie, Louise Ann Rohrbach, Donna Spruijt-Metz, Steve Sussman

CGU Faculty Publications and Research

Purpose: Compulsive Internet Use (CIU) has increasingly become an area of research among process addictions. Largely based on data from cross-sectional studies, a positive association between CIU and substance use has previously been reported. This study presents gender and country-specific longitudinal findings on the relationships between CIU and substance use. Methods: Data were drawn from youth attending non-conventional high schools, recruited into two similarly implemented trials conducted in China and the USA. The Chinese sample included 1,761 students (49% male); the US sample included 1,182 students (57% male) with over half (65%) of the US youth being of Hispanic ethnicity. …


Culture Ontogeny: Lifespan Development Of Religion And The Ethics Of Spiritual Counselling, Glen Milstein, Amy Manierre Jan 2012

Culture Ontogeny: Lifespan Development Of Religion And The Ethics Of Spiritual Counselling, Glen Milstein, Amy Manierre

Publications and Research

The counsellor has an ethical obligation to treat the whole person. Humans are cultural beings and the foundation of most cultures is religion. Religion and culture are received from our early relation~ ships and modified through later relationships across the lifespan. The paper introduces the term "culture ontogeny" to emphasize that this is a biological process wherein abstract ideas of culture and religion become material in the developing neurophysiology of each brain. A framework and methods are offered to examine the changing roles of religion in clients' emotional self~ structure, inclusive of those who describe themselves as spiritual, not religious. …


The Relationship Of Rehabilitation Counselors' Knowledge Of The Americans With Disabilities Act 1990, Attitudes Toward Reasonable Accommodation, And Job Development Efficacy, Joy Elizabeth Inniss-Johnson Jan 2012

The Relationship Of Rehabilitation Counselors' Knowledge Of The Americans With Disabilities Act 1990, Attitudes Toward Reasonable Accommodation, And Job Development Efficacy, Joy Elizabeth Inniss-Johnson

Wayne State University Dissertations

The purpose of this research was to evaluate the relationship between the rehabilitation counselors' level of knowledge, attitudes towards reasonable accommodations and job development efficacy. The more knowledgeable rehabilitation counselors are about ADA, reasonable accommodations, and their attitude toward job development, the less likely their attitudes will be expected to fluctuate. In addition, there has been very little research in terms of evaluating rehabilitation counselor's level of job placement efficacy. A survey-based design was utilized to create both a quantitative description of knowledge of the ADA, beliefs about reasonable accommodations and job placement efficacy and qualitative information concerning the barriers …


Hemicrania Continua Headache In A Veteran With Post Traumatic Stress Disorder And Major Depressive Disorder Without Traumatic Brain Injury, Brandon A. Kohrt, Erica Duncan Jan 2012

Hemicrania Continua Headache In A Veteran With Post Traumatic Stress Disorder And Major Depressive Disorder Without Traumatic Brain Injury, Brandon A. Kohrt, Erica Duncan

Psychiatry and Behavioral Sciences Faculty Publications

Hemicrania continua is a headache characterized by chronic unremitting unilateral pain associated with ipsilateral autonomic findings. This type of headache responds to high-flow oxygen and indomethacin. This case report describes a male veteran with posttraumatic stress disorder (PTSD) and major depressive disorder who suffers from comorbid hemicrania continua. The psychiatric symptoms were recalcitrant to psychopharmacological intervention. However, when the patient's hemicrania continua was treated appropriately, the patient's psychiatric symptoms also abated. This case demonstrates the need to address physical comorbidities that may exacerbate psychiatric disorders, such as PTSD.


Differential Effects Of Acute Amphetamine And Phencyclidine Treatment And Withdrawal From Repeated Amphetamine Or Phencyclidine Treatment On Social Interaction And Social Memory In Rats, Ming Li, Wei He, Rebecca Munro Jan 2012

Differential Effects Of Acute Amphetamine And Phencyclidine Treatment And Withdrawal From Repeated Amphetamine Or Phencyclidine Treatment On Social Interaction And Social Memory In Rats, Ming Li, Wei He, Rebecca Munro

Department of Psychology: Faculty Publications

Although animal models based on amphetamine (AMPH) or phencyclidine (PCP) treatment have been used extensively to study the neurobiological and behavioral characteristics of schizophrenia, there are conflicting reports regarding their validity in modeling the negative symptoms and cognitive deficits of schizophrenia. The present study examined how acute AMPH or PCP treatment (Experiment 1) and withdrawal from repeated AMPH treatment (Experiment 2) or PCP treatment (Experiment 3) affects social behavior and social recognition memory in male Sprague-Dawley rats. Each subject was tested on two consecutive days. On the first day, the rats were tested four times (5 min/each) at 10-min intervals …


Examining Multicultural Competency Education In The Creative Arts Therapies, Donna C. Owens Jan 2012

Examining Multicultural Competency Education In The Creative Arts Therapies, Donna C. Owens

Expressive Therapies Dissertations

In the changing landscape of the United States, the skills and competencies of helping professionals must continue to address the unique needs of its various populations. As a growing field, the creative arts therapies must adopt multicultural values and standards necessary to remain competitive and relevant.

This study addressed the issue of multicultural counseling competency training in the creative arts therapies from three perspectives: the governing association, the training institution, and the student/trainee. Throughout this study the term creative arts therapies includes art, dance/movement, drama, expressive arts, music, poetry, and psychodrama.

Information concerning the associations for each of the seven …


Hospital Loneliness And The Patient-Physician Relationship: A Preliminary Analysis Of Associations With Recovery In Bone Marrow Transplant Patients, Lindsay E. Balfour Jan 2012

Hospital Loneliness And The Patient-Physician Relationship: A Preliminary Analysis Of Associations With Recovery In Bone Marrow Transplant Patients, Lindsay E. Balfour

UNF Graduate Theses and Dissertations

The purpose of the present study was to examine general loneliness, hospital loneliness, and the patient-physician relationship in regards to their associations with Bone Marrow Transplant (BMT) recovery outcome variables (days until engraftment and quality of life). Fifteen (66.7% female, 33.3% male; 93.3% white, 6.7% Black/African American; average age 61.73) individuals who had an allogeneic or autologous BMT at The Mayo Clinic of Jacksonville completed the FACT-BMT, UCLA-Loneliness Scale Version 3, the CARE Measure, and provided disease and treatment information at the 6 month posttransplant date (+/- 30 days). Patients recovering from BMT indicated significantly higher scores of hospital loneliness …


An Overview Of Avoidant Personality Disorder, Kristin Dehrkoop Jan 2012

An Overview Of Avoidant Personality Disorder, Kristin Dehrkoop

All Graduate Theses, Dissertations, and Other Capstone Projects

Avoidant Personality Disorder presents very similarly to other disorders in the Diagnostic and Statistical Manual (DSM-IV). What separates Avoidant Personality Disorder (APD) to other disorders that present similarly?


Exploring Support Network Structure, Content, And Stability As Youth Transition From Foster Care, Jennifer E. Blakeslee Jan 2012

Exploring Support Network Structure, Content, And Stability As Youth Transition From Foster Care, Jennifer E. Blakeslee

Dissertations and Theses

Many older youth in foster care lack adequate resources and ongoing support in their social networks as they transition into young adulthood, while other youth in these circumstances experience stable social networks providing comprehensive support. Systematically measuring the supportive personal and service-oriented relationships in youth networks expands the scope of inquiry in this area by identifying patterns of social network structure, member composition, and relational qualities that are associated with more or less support provision through formal and informal relationships. These can also be measured over time to observe changes in network form and content and assess network stability. This …


The Effect Of Gender Role And Males' Attitudes Toward Receiving Mental Health Therapy, Christina H. Thomas Dec 2011

The Effect Of Gender Role And Males' Attitudes Toward Receiving Mental Health Therapy, Christina H. Thomas

Graduate Theses

The purpose of this research study was to build upon previous research pertaining to gender role and young adult male attitudes towards receiving mental health therapy. An additional purpose of the study was to explore the relationship between media exposure and attitude toward mental health therapy. The first hypothesis was that there would be a positive correlation between gender role scores and attitudes with the BEM Sex- Role Inventory (BSRI) and with scores on attitudes with the Attitudes Towards Seeking Professional Psychological Help Scale (ATSPPHS) in young adult males. The second hypothesis was that young adult males who watched a …


An Automated Internet Application To Help Patients With Bipolar Disorder Track Social Rhythm Stabilization., Daniel Z Lieberman, Susan Swayze, Frederick K Goodwin Nov 2011

An Automated Internet Application To Help Patients With Bipolar Disorder Track Social Rhythm Stabilization., Daniel Z Lieberman, Susan Swayze, Frederick K Goodwin

Psychiatry and Behavioral Sciences Faculty Publications

This column describes a pilot study of a fully automated, Internet-based program that provides a key element of interpersonal and social rhythm therapy, a form of psychotherapy shown to be effective in the treatment of bipolar disorder when combined with mood-stabilizing medication. Participants (N=64) recorded the time they completed activities of daily living and their mood at the time of each entry. After 90 days they demonstrated a 31% increase in social rhythm stability and a small, though statistically significant, decrease in symptoms of abnormal mood. Internet-based programs can enhance access to a best practice in the management of bipolar …


Smoking Cessation Outcomes Among Individuals With Substance Use And/Or Psychiatric Disorders, Milan Khara, Chizimuzo T.C. Okoli Oct 2011

Smoking Cessation Outcomes Among Individuals With Substance Use And/Or Psychiatric Disorders, Milan Khara, Chizimuzo T.C. Okoli

Nursing Faculty Publications

Objectives: The population of individuals with substance use (SUD) and/or psychiatric disorders (PD) has a high prevalence of smoking and a consequent increase in tobacco-related morbidity and mortality when compared to the general population. The aim of this study is to examine the outcomes of a program in a real-life setting which takes a tailored approach to smoking cessation among individuals with SUD and/or PD.

Methods: A retrospective chart review of tailored tobacco dependence treatment was performed on individuals with histories of SUD and/or PD attending a Tobacco Dependence Clinic (TDC) program in Vancouver, British Columbia, Canada. Participants of the …


Perceived Self-Efficacy Of Licensed Counselors To Provide Substance Abuse Counseling, Nichelle Chandler, Michelle Perepiczka, Richard S. Balken Oct 2011

Perceived Self-Efficacy Of Licensed Counselors To Provide Substance Abuse Counseling, Nichelle Chandler, Michelle Perepiczka, Richard S. Balken

Walden Faculty and Staff Publications

This nationwide, quantitative study documented licensed counselors' perceived self-efficacy of adequately providing substance abuse services. Despite their lack of substance abuse training, counselors were highly confident in their ability to provide quality substance abuse services. Counselor training implications are discussed.


The Social Nature Of Male Suicide: A New Analytic Model, Daniel Coleman, John T. Casey Oct 2011

The Social Nature Of Male Suicide: A New Analytic Model, Daniel Coleman, John T. Casey

School of Social Work Faculty Publications and Presentations

Suicide is one of the leading causes of male mortality. In nearly every country in the world, more males than females end their life by suicide. Previous research indicates male-specific risk factors include social factors such as being unmarried, low income, and unemployment. An analytic model of male suicide is developed, proposing that the traditional male gender role creates a culturally-conditioned narrowing of perceived options and cognitive rigidity when under stress that increases male suicide risk. Suicide prevention and intervention require recognition of the role of high traditional masculinity, situating individual explanations within a broader social context. Based on this …


The Structure Of Client Language And Drinking Outcomes In Project Match, Tim Martin, Paulette J. Christopher, Jon M. Houck, Theresa B. Moyers Sep 2011

The Structure Of Client Language And Drinking Outcomes In Project Match, Tim Martin, Paulette J. Christopher, Jon M. Houck, Theresa B. Moyers

Faculty Articles

Client language during Motivational Interviewing interventions is an important predictor of drinking outcomes, but there are inconsistencies in the literature regarding what aspects of client language are most predictive. We characterized the structure of client language by factor analyzing frequency counts of several categories of client speech. The results provide limited support for a model proposed by Miller et al. (2006) and Amrhein et al. (2003) but with some important differences. While Amrhein et al. (2003) found that only increasing strength in client commitment language predicted behavior change, the current study revealed that client language preparatory to commitment predicted drinking …


Evidence Based Treatment Of Schizophrenia: Do We Know Enough, Faheem Khan, Haider A Naqvi May 2011

Evidence Based Treatment Of Schizophrenia: Do We Know Enough, Faheem Khan, Haider A Naqvi

Department of Psychiatry

No abstract provided.


Impact Of Exercise Partner Attractiveness On Mood, Enjoyment, And Exertion, Thomas G. Plante, Sarah Gregg, Jaclyn Rubbo, Thomas Favero, Ashley Morisako, Jessica Cuadra Jan 2011

Impact Of Exercise Partner Attractiveness On Mood, Enjoyment, And Exertion, Thomas G. Plante, Sarah Gregg, Jaclyn Rubbo, Thomas Favero, Ashley Morisako, Jessica Cuadra

Psychology

Social comparison theory was used to examine if males exercising with a female research confederate posing as either attractive or unattractive would alter their exercise mood, exertion, and enjoyment. A total of 101 college students (51 males and 51 females) were randomly assigned to one of three conditions: biking alone, biking with an attractive female confederate, or biking with the same female confederate appearing unattractive. All participants were instructed to complete 20 minutes of exercise at 60%-70% of their maximum target heart rate. Standard exercise mood measures (e.g., Activation-Deactivation Adjective Check List) were administered immediately prior to and immediately following …


Conflicts Of Interest In Clinical Practice Guidelines, Lisa Cosgrove, Allen F. Shaughnessy Jan 2011

Conflicts Of Interest In Clinical Practice Guidelines, Lisa Cosgrove, Allen F. Shaughnessy

Counseling, School Psychology & Sport Faculty Publication Series

Clinical practice guidelines are used increasingly across medical specialties and settings, making evaluation of their utility and validity a critical public health issue. In this paper, we describe some of the challenges that specialty organizations face as they try to ensure that their guidelines are trustworthy and useful. We examine the practice guidelines for Major Depressive Disorder recently published by the American Psychiatric Association (APA), identify five sources of potential bias that may affect the guideline development process and offer suggestions based on our review. For example, even for mild depression, this guideline privileges pharmacotherapy over other interventions, despite questions …


Creative Arts Therapies Students' Professional Development: Mixed Methods Longitudinal Research, Hod Orkibi Jan 2011

Creative Arts Therapies Students' Professional Development: Mixed Methods Longitudinal Research, Hod Orkibi

Expressive Therapies Dissertations

This mixed-methods longitudinal study sought to describe, understand, and explain the professional development (PD) of graduate students during art therapy (AT), dance movement therapy (DMT), and drama therapy (DT) training (N = 51).

Repeated measures of students’ scores in profession-related variables were performed. Quantitative theory testing probed the extent to which students confirm Rønnestad and Skovholt’s (2003) theory of counselors and therapists’ PD as representative of their pre-training and in-training experiences. Qualitative theory derivation generated data-driven concepts to modify and refine the extant theory. Data were collected using My Vocational Situation, Career Commitment Measurement, and questionnaires for each developmental phase. …


Effectiveness Of A Motivational Enhancement Group Treatment In A Community Treatment Program With A Substance Abusing Population, Matthew S. Willerick Jan 2011

Effectiveness Of A Motivational Enhancement Group Treatment In A Community Treatment Program With A Substance Abusing Population, Matthew S. Willerick

Dissertations

Motivational interviewing (MI) is a directive, client-centered intervention to elicit behavior change by assisting clients in the exploration and resolution of ambivalence toward change. MI-inspired approaches have been used in an attempt to facilitate change in a wide variety of domains including alcohol and drug abuse, safe water handling practices, dual diagnoses, gambling, spousal abuse, health related areas, mood and anxiety disorders, and parental engagement. MI seeks to resolve ambivalence in the direction of change by increasing the client's self-efficacy. This is accomplished by combining clientcentered (e.g., reflective listening) and directive strategies (e.g., attending selectively to change statements). The origins …


Orbitofrontal Cortex Provides Cross-Modal Valuation Of Self-Generated Stimuli, William A. Cunningham, Ingrid J. Haas, Ashley S. Waggoner Jan 2011

Orbitofrontal Cortex Provides Cross-Modal Valuation Of Self-Generated Stimuli, William A. Cunningham, Ingrid J. Haas, Ashley S. Waggoner

Department of Political Science: Faculty Publications

Prior research has shown that the orbitofrontal cortex (OFC) plays an important role in the representation of the evaluation of stimuli, regardless of stimulus modality. Based on these findings, researchers have proposed that the OFC serves a common currency function, allowing for the direct comparison of different types of perceptual stimuli (e.g. food, drink, money). The present study was designed to extend this research and investigate whether these same regions of OFC that have been identified in previous research are involved in evaluating imagined stimuli. Specifically, we asked participants to draw on prior attitudinal knowledge to generate internal representations of …


Children's Emotional State And False Memory In The Drm Paradigm, Pamela Cornejo Jan 2011

Children's Emotional State And False Memory In The Drm Paradigm, Pamela Cornejo

McNair Poster Presentations

Children are called to give testimony for highly emotional during court cases. Research indicates that children in a negative emotional state recall with lesser vividness (Berliner et al. 2003) and are more likely to incorporate false information (Levine, Burgess & Laney, 2008). The present study will examine this further by examining the influence of negative and positive emotional states on recall and recognition in child-normed lists within the Deese-Roediger-McDermott (DRM) paradigm. The DRM paradigm is a cognitive task that relies on gist memory for remembrance of the critical lure in semantically associated word lists. It is expected that the eight …


David Grove's Metaphors For Healing, David Pincus, Anees A. Sheikh Jan 2011

David Grove's Metaphors For Healing, David Pincus, Anees A. Sheikh

Psychology Faculty Articles and Research

Within the ever-expanding list of approaches to psychotherapy, there is a tendency to overlook deep imagery approaches. The current article reports on one such metaphor-based therapy developed by David Grove (Grove & Panzer, 1989). The approach is analyzed within the context of mainstream contemporary psychotherapy in general, the state of empirical understanding of common processes to psychotherapy, and in relation to other deep imagery-based approaches to therapy. Next, a step-by-step description of the techniques used within metaphor therapy are presented, along with a case example demonstrating the use of these techniques on a case involving pain symptoms. Finally, it is …


A Concept Mapping Needs Assessment Of Young Families With Parental Cancer, Richard P. Durant Jan 2011

A Concept Mapping Needs Assessment Of Young Families With Parental Cancer, Richard P. Durant

Antioch University Dissertations & Theses

The purpose of this research is to investigate the support needs of young families living with and beyond a parental diagnosis of cancer. The sample includes 56 participants comprised of 31 professional stakeholders and 25 patient stakeholders affiliated with the Charles R. Wood Cancer Center. It was hypothesized there would be differences in how the groups of stakeholders rated needs in terms of importance, satisfaction, and utilization. Differences in ratings are thought to be barriers to effective program development. While not a formal research hypothesis, it was anticipated other program development barriers germane to naturalistic clinical settings would emerge from …


Psychiatric Taxonomy, Psychopharmacology And Big Pharma, Lisa Cosgrove Nov 2010

Psychiatric Taxonomy, Psychopharmacology And Big Pharma, Lisa Cosgrove

Counseling, School Psychology & Sport Faculty Publication Series

Clinicians practicing today need to be aware of the ways in which the current industry-dominated climate may undermine the integrity of the scientific process and, thus, may compromise patient care. In the mental health field, corporate sponsorship bias can affect psychiatric taxonomy and clinical Practice Guidelines (CPG). Financial conflicts of interest (FCOI) can occur when there are financial associations between researchers, authors, or panel members developing psychiatric diagnostic and treatment guidelines, and the pharmaceutical industry, or when randomized clinical trials (RCTs) are industry funded. Therefore, clinicians need to be especially vigilant about the informed consent process when patients are prescribed …