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Power is globally reduced in the left hand cheap malegra fxt plus 160mg with amex erectile dysfunction drugs buy, and also slightly reduced in the right hand order malegra fxt plus 160mg overnight delivery impotence at 18. This is a degenerative disease of unknown cause that affects the motor neurones of the spinal cord discount malegra fxt plus 160mg amex erectile dysfunction tips, the cranial nerve nuclei, and the motor cortex. Weakness and wasting of the muscles of one hand or arm is the commonest presentation. Painful cramps of the forearm muscles are com- mon in the early phases of the disease. The characteristic physical sign of this condition is fascicu- lation, which is an irregular rapid contraction of segments of muscle, caused by denerva- tion of the muscle from a lower motor neurone lesion. Dysphagia and dysarthria in the elderly are much more commonly due to the pseudobulbar palsy of cerebrovascular disease. Cervical myelopathy is another common cause of wasting and fasciculation of the upper limbs without sensory loss. Brachial plexus lesions from trauma or invasion by an apical lung tumour (Pancoast tumour) may affect one arm. A predominant motor periph- eral neuropathy causes a symmetrical pattern of weakness and reflexes are reduced. As the disease progresses and speech deteriorates communication may be helped by using com- puters. Non- invasive ventilation can be used to help respiratory failure, but death usually occurs from bronchopneumonia. Examination She looks well, and examination of the cardiovascular, respiratory and abdominal systems is normal. Power in all muscle groups is grossly normal but seems to decrease after testing a movement repetitively. Myasthenia gravis is due to the presence of acetylcholine receptor antibodies causing impaired neuromuscular transmission. It characteristically affects the external ocular, bulbar, neck and shoulder girdle muscles. Weakness is worse after repetitive movements which cause acetylcholine depletion from the presynaptic terminals. Ptosis of the upper lids is often associated with diplopia due to weakness of the external ocular muscles. Differential diagnoses of generalized muscle weakness • Motor neurone disease: suggested clinically by muscle fasciculation and later by marked muscle weakness. There is a characteristic facial appearance with frontal baldness, expressionless facies and sunken cheeks. Intravenous injection of edrophonium (Tensilon) will increase muscular power for a few minutes. Blood should be assayed for acetylcholine receptor antibodies (present in 90 per cent). Examination of cardiovascular, respiratory, abdominal and neurological systems is normal. The diagnosis in this man was postinfective inflammatory mucositis and arthritis, often shortened to reactive arthritis, and also known as Reiter’s syndrome. However there is now a move to disassociate the name of Reiter (1881–1969) from this disease in view of his crimes committed, as a doctor, by experimenting on pris- oners in the concentration camps of Nazi Germany. This disease classically presents with a triad of symptoms (although all three may not always be present): • seronegative arthritis affecting mainly lower limb joints • conjunctivitis • non-specific urethritis. The acute arthritis is typically a monoarthritis but can develop into a chronic relapsing destructive arthritis affecting the knees and feet, and causing a sacroiliitis and spondylitis. The red eyes are due to conjunctivitis and anterior uveitis, and can recur with flares of the arthritis. The rash on the patient’s palmar surfaces is the characteristic brown macu- lar rash of this condition – keratoderma blenorrhagica. Other features of this condition that are sometimes seen include nail dystrophy and a circinate balanitis. Systemic manifestations such as pericarditis, pleuritis, fever and lymphadenopathy may occur in this disease. Differential diagnoses of an acute monoarthritis • Gonococcal arthritis: occasionally a polyarthritis affecting the small joints of the hands and wrists, with a pustular rash. This patient should have urethral swabs taken to exclude chlamydial/gonococcal infections, and the appropriate antibiotics given. A Gram stain will exclude a pyogenic infection and birefringent microscopy can be used to detect uric acid or pyrophosphate crystals. The pain began 2 days previously and she says that the knee is now hot, swollen and painful on movement. She had a health check 6 months previously and was told that everything was fine except for some elevation of her blood pressure which was 172/102 mmHg and her creatinine level, which was around the upper limit of normal. The blood pressure was checked several times over the next 4 weeks and found to be persistently elevated and she was started on treatment with 2. The left knee is hot and swollen with evidence of effusion in the joint with a positive patellar tap. The patient has a history of some hip pains but this and the Heberden’s nodes are common findings in an 80-year-old woman, related to osteoarthritis. Differential diagnoses of pain in the knee The differential diagnosis includes trauma, septic arthritis, gout and pseudogout. The recent introduction of a thiazide diuretic for treatment of the hypertension increases the suspicion of gout. Pseudogout is caused by deposition of calcium pyrophosphate crys- tals and would be expected to show calcification in the articular cartilage in the knee joint. The X-rays here show some joint space narrowing but no calcification in the articu- lar cartilage. If this remains after the acute arthritis has subsided then it may need further treatment. Precipitation of gout by thi- azides is more likely in older women, particularly in the presence of renal impairment and diabetes. It may involve the hands, be polyarticular and can affect existing Heberden’s nodes. The serum uric acid level is likely to be raised, but this occurs commonly without evidence of acute gout. The diagnosis is made from the needle-like crystals of uric acid which are negatively birefringent under polarized light, unlike the positively birefringent crystals of calcium pyrophosphate. Treatment with a non-steroidal anti-inflammatory drug should be covered by a proton pump inhibitor in view of her history of heartburn and indigestion. The thiazide diuretic was changed to an angiotensin-converting enzyme inhibitor as treatment for her hypertension, and the blood glucose settled. In addition her last two menstrual periods have been abnormally heavy, and she has suffered a major nosebleed. Examination On examination there are multiple areas of purpura on her legs and to a lesser extent on her abdomen and arms.
However purchase 160mg malegra fxt plus with visa impotence yahoo answers, the authors 160 mg malegra fxt plus otc lipitor erectile dysfunction treatment, editors discount malegra fxt plus 160 mg otc erectile dysfunction treatment stents, and Sixth Edition, 2006 publisher are not responsible for errors or omissions or for any consequences Seventh Edition, 2011 by from application of the information in this book and make no warranty, Schattauer GmbH, expressed or implied, with respect to the currency, completeness, or accuracy Hölderlinstraße 3, 70174 Stuttgart, Germany; http://www. Application of this information in a Lippincott Williams & Wilkins, a Wolters Kluwer business particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered 351 West Camden Street 530 Walnut Street absolute and universal recommendations. No part of this book current recommendations and practice at the time of publication. However, may be reproduced or transmitted in any form or by any means, including as in view of ongoing research, changes in government regulations, and the photocopies or scanned-in or other electronic copies, or utilized by any constant flow of information relating to drug therapy and drug reactions, the information storage and retrieval system without written permission from reader is urged to check the package insert for each drug for any change in the copyright owner, except for brief quotations embodied in critical articles indications and dosage and for added warnings and precautions. Materials appearing in this book prepared by individuals as particularly important when the recommended agent is a new or infrequently part of their official duties as U. It is the responsibility of the health care provider to ascertain the and services). Library of Congress Cataloging-in-Publication data has been applied for and is available upon request. Each chapter is provided with an introductory front page anatomy of the human body were included again. We omitted to give an overview of the topics of the chapter and short marks and indications in order not to affect the quality of the descriptions. The large chapter 2 “Head and Neck” clinics are offered an atlas easy to handle and cope with. While preparing this new edition, the authors were reminded of Furthermore, the drawings were revised and improved in many how precisely, beautifully, and admirably the human body is chapters and depicted more consistently. If this book helps the student or medial doctor to new photographs taken from newly dissected specimens were appreciate the overwhelming beauty of the anatomical architecture incorporated. The general structure and arrangement of the Atlas were main- Deep interest and admiration of the anatomical structures may tained. The chapters of regional anatomy are consequently create the “love for man”, which alone can be considered of placed behind the systematic descriptions of the anatomical primary importance for daily medical work. For studying the photographs of the specimens the Color Atlas of Anatomy would not have been possible. The enormous plasticity of would also like to express our sincere thanks to those at the photos is surprising, especially at higher magnifications. Acknowledgements We would like to express our great gratitude to all coworkers We would also like to express our many thanks to Prof. We (Radiologisches Institut, University Erlangen-Nürnberg, Germany) are particularly indebted to those who dissected new specimens and Prof. Okamoto Coburg, Germany), who kindly provided a number of excellent (now Nagasaki, Japan), who dissected many excellent specimens of bone specimens. Furthermore, Finally, we would like to express our great gratitude to our we are greatly indebted to Prof. Marco Gößwein, who contributed the very for their great efforts in supporting our work. Excellent and untiring work was done by The specimens of the previous editions also depicted in this our secretaries, Mrs. Lisa Köhler and Elisabeth Wascher, and as volume were dissected with great skill and enthusiasm by Prof. Mutsuko Takahashi not only performed excellent new drawings but revised effectively (now Tokyo, Japan), Dr. Conse- skull bones, for example, was not presented in a descriptive way, quently, the advent of a new work requires justification. We but rather through a series of figures revealing the mosaic of found three main reasons to undertake the publication of such a bones by adding one bone to another, so that ultimately the book. First of all, most of the previous atlases contain mainly schematic Finally, the authors also considered the present situation in or semischematic drawings which often reflect reality only in a medical education. As a consequence, students do not tions and spatial dimensions in a more exact and realistic manner have access to sufficient illustrative material for their anatomic than the “idealized”, colored “nice” drawings of most previous studies. Furthermore, the photo of the human specimen corre- observation, but we think the use of a macroscopic photo instead sponds to the student’s observations and needs in the dissection of a painted, mostly idealized picture is more appropriate and is courses. Thus he has the advantage of immediate orientation by an improvement in anatomic study over drawings alone. The majority of the specimens depicted in the atlas were prepared Secondly, some of the existing atlases are classified by systemic by the authors either in the Dept. The present atlas, however, tries to portray macroscopic the spinal cord demonstrating the dorsal branches of the spinal anatomy with regard to the regional and stratigraphic aspects of nerves were prepared by Dr. The specimens of the ligaments of the vertebral diate help during the dissection courses in the study of medical column were prepared by Dr. To all regions of the body we added schematic drawings for their unselfish, devoted and highly qualified work. This will enhance the understanding of the details Erlangen, Germany; Spring 1983 J. The principle of polarity: Polarity is reflected mainly in the formal and functional contrast between the head (predominantly spherical form) and the extremities (radially arranged skeletal elements). In the phylogenetic development of the upright position of the human body, polarity developed also among the extremities: The lower extremities provide the basis for locomotion whereas the upper extremities are not needed anymore for locomotion, so they can be used for gesture, manual and artistic activities. The anatomical structures (vertebrae, pairs of ribs, muscles, and nerves) are arranged segmentally and replicate rhythmically in a similar way. The principle of bilateral symmetry: Both sides of the body are separated by a midsagittal plane and resemble each other like image and mirror-image. There are also different principles in the architecture and function of the inner organs: The skull contains the brain and the sensory organs. They are arranged like mirror and mirror-image and are the basis of our consciousness. The thorax contains the organs of the rhythmic system (heart, lung), which are only to some extent bilaterally organized. In the abdominal cavity, the most important abdominal organs (intesti- nal tract, liver, pancreas) are arranged unpaired. Regional lines A = parasternal line B = midclavicular line C = anterior axillary line D = umbilical-pelvic line The bones of the skeletal system are palpable through the localized. On the ventral side, the clavicle, line, the anterior axillary line, the umbilical-pelvic line. Further- By means of these lines, the heart and the position of the more, the anterior iliac spine and the symphysis can be vermiform process can be localized. Position of the lnner Organs, Palpable Points, and Regional Lines 3 E F F 3 G 19 G 10 20 7 8 11 H H 21 22 12 Position of the inner organs of the human body Regional lines and palpable points at the dorsal side of the (posterior aspect). Regional lines E = paravertebral line F = scapular line G = posterior axillary line H = iliac crest 1 Brain 2 Lung 3 Diaphragm 4 Heart 5 Liver 6 Stomach 7 Colon 8 Small intestine 9 Testis 10 Kidney 11 Ureter 12 Anal canal 13 Clavicle 14 Manubrium sterni 15 Costal arch 16 Umbilicus 17 Anterior superior iliac spine At the dorsal side of the body, the posterior spines of the 18 Inguinal ligament vertebral column, the ribs, the scapula, the sacrum, and 19 Scapular spine the iliac crest are palpable. Lines of orientation are the 20 Spinous processes 21 Iliac crest paravertebral line, the scapular line, the posterior axillary 22 Coccyx and sacrum line, and the iliac crest. Osteology: Skeleton of the Human Body 7 Axial skeleton Head 1 Frontal bone 1 2 Occipital bone 3 Parietal bone 4 4 Orbit 6 5 Nasal cavity 6 Maxilla 7 Zygomatic bone 8 8 Mandible 9 Trunk and thorax Vertebral column 15 9 Cervical vertebrae 10 Thoracic vertebrae 17 11 Lumbar vertebrae 12 Sacrum 21 13 Coccyx 14 Intervertebral discs Thorax 15 Sternum 11 16 Ribs 17 Costal cartilage 18 Infrasternal angle 22 23 Appendicular skeleton Upper limb and shoulder girdle 19 Clavicle 24 20 Scapula 25 21 Humerus 22 Radius 26 23 Ulna 24 Carpal bones 25 Metacarpal bones 31 26 Phalanges of the hand Lower limb and pelvis 27 Ilium 28 Pubis 34 29 Ischium 30 Symphysis pubis 31 Femur 32 32 Tibia 33 33 Fibula 34 Patella 35 Tarsal bones 36 Metatarsal bones 37 Phalanges of the foot 38 Calcaneus 35 36 37 Skeleton of a 5-year-old child (anterior aspect). Coronal section of the 3 Diaphysis of the femur proximal and distal epiphyses displaying the 4 Compact bone spongy bone and the medullary cavity. Osteology: Ossification of the Bones 9 The ossification of the bones of the limbs starts within 3 the ossification centers of the primary cartilagenous 2 bones.
Prayer is naturally a familiar source for achieving a cure and purchase malegra fxt plus 160 mg on-line erectile dysfunction medications injection, even in modern times purchase 160mg malegra fxt plus fast delivery erectile dysfunction treatment in kerala, despite studies of prayer effectiveness producing negative results generic 160mg malegra fxt plus with visa hot rod erectile dysfunction pills, it retains its popularity as evidenced by the existence of websites such as www. Many believe that prayer can aid in recovery, due not just to divine influence but also to the psychological and physical benefits to a person who knows that he or she is being prayed for. Many studies have suggested that prayer can reduce physical stress and that ‘the psychological benefits of prayer may help reduce stress and anxiety, promote a more positive outlook, and strengthen the will to live’. The rise of the pietistic Hasidic movement in eastern Europe in the eighteenth century, with its veneration of leaders, known as Zaddikim, led to a belief in the power of the Zaddik to cure the sick. It should not be thought that traditional Jewish medicine has disap- peared in the modern period with its emphasis on scientific progress and evidence-based procedures. Customs common in eastern Europe a century ago, such as placing pigeons on the abdomen of a jaundiced patient, have become common practice in Israel among all sectors of the population. These amulets are often made of stone or metal to be worn by the patient and, over the past few years, it has been observed that there has been an increasing tendency for the use of amulets in Israeli hospitals. A study of parents of children admitted to a paediatric intensive care unit in Zerifin (Sarafand), Israel showed that around a third of Jewish families used such amulets, claiming that it reduced parental anxiety and warned medical staff to respect the emotional and psychological value that they represent. Moslem patients in Israel also made use of healing charms, many of Jewish origin with Hebrew lettering, reflecting a tradition dating back to mediaeval times. Amulets have persisted despite almost universal opposition through the ages by rabbis and Jewish physicians who consistently described their use as irrational and superstitious. Of course, religious Jews have long regarded positively the value of prayer, whether by the reciting of Psalms or the direct blessing of the patient, and as we have seen there remained a strand within the rabbinic leadership Traditional Jewish medicine | 311 that preferred to see healing in divine hands without negating the value of medical interventions. In extreme cases, which I have witnessed myself on a couple of occasions, the name of a seriously sick person was changed in an attempt to thwart the evil designs of the Angel of Death. Given the survival of these customs, and an increasingly pervasive concern about the direction of modern medicine, it is not surprising to record the continuing use of traditional practices. In recent years studies have indicated the use of medicinal plants among the rural population of Israel and within the country’s ethnic groups, especially those from such countries as Iraq, Iran and Yemen. These substances, usually obtained from local rather than imported products, are considered to be based on the Galenic tradition and adapted to an Arabic and Moslem form during the Middle Ages. The contemporary emphasis on modern therapeutics has modified this tradition but not eliminated it. Lev and Amar have identified animal, mineral and especially plant prod- ucts used in the modern Israeli popular medicine market. While enumeration of all the products is beyond the scope of this article many will be familiar to those who would keep a supply of simple herbal home remedies for minor ailments not thought sufficiently important to call on the services of a physi- cian. Thus, there are such common vegetables as onion, cauliflower and garlic, cereals such as oats, and herbs and spices such as tarragon, worm- wood, cumin, cloves and dill. Hyssop oil is used for backache, clove oil for toothache and rosemary remains a popular remedy for kidney stones, while the use of the seed of the emetic nut Strychnos nux vomica, substantially having the properties of the poison strychnine, is used for its stimulant action on the gastrointestinal tract, for itch and for inflammations of the external ear. In chronic constipation it is often combined with cascara and other laxatives to good effect. Wild plants are still gathered by healers and patients but they are not commonly sold in the traditional shops. The 20 animal products include such substances as beeswax and honey used for burns, eye inflammation and coughs, but also deer horn employed as a general tonic and for drug addiction. Musk oil and grain is used for high blood sugar while snail operculum, from the shell lid, deals with the evil eye. There were fewer than 20 mineral products available, many, such as clay, earth, sulphur and ferrous citrate, known also as green vitriol, used to treat skin problems. Galena, otherwise known as lead sulphide but often containing silver admixtures, antimony and zinc products, is used for eye problems. Apart from sulphur the most frequent mineral prescribed was alum, long known to have antibacterial properties and used in modern deodorants, is not only used as a disinfectant but also to reduce liver size and as a general tonic. Nevertheless, Lev and Amar relate that the commercial 312 | Traditional medicine field for the sale of traditional medicines in Israel is declining and businesses have closed and the inventory of medicines has diminished. If commercial popular medicine is fighting for survival against the current fads for modern alternative medicines, one Jewish folk remedy still seems to hold sway. From Talmudic times rabbis such as Rabbi Abba used chicken soup as a remedy (Figure 11. The practice reflects the Biblical and Talmudic period with additions reflecting the encounter between Jews and their Christian and Moslem neighbours over 1500 years of the diaspora. The resurgence of interest in medical botany and herbalism in recent years has encouraged further study of the content and practice of popular medi- cine in its widest context and has emphasised its cross-cultural nature. Even the spells, charms and incantations of an earlier era still find their echo today and might claim a place in the search for cure as long as patients are given recourse to the evidence-based medicine that they require for recovery. The problem can be identiﬁed as the human response to actual or potential health problems as assessed by the nurse. The etiology may be represented by past experiences of the individ- ual, genetic inﬂuences, current environmental factors, or patho- physiological changes. The deﬁning characteristics describe what the client says and what the nurse observes that indicate the existence of a particular problem. This book may be used as a guide in the construction of care plans for various psychiatric clients. The use of this format is not to imply that nursing diagnoses are based on, or ﬂow from, medical diagnoses; it is meant only to enhance the usability of the book. In addition, I am not suggest- ing that those nursing diagnoses presented with each psychiatric category are all-inclusive. It is valid, however, to state that certain nursing diagnoses are indeed common to individuals with speciﬁc psychiatric dis- orders. The diagnoses presented in this book are intended to be used as guidelines for construction of care plans that must be individualized for each client, based on the nursing assessment. The interventions can also be used in areas in which interdisci- plinary treatment plans take the place of the nursing care plan. The Disorder: A deﬁnition and common types or categories that have been identiﬁed. Predisposing Factors: Information regarding theories of etiology, which the nurse may use in formulating the “re- lated to” portion of the nursing diagnosis, as it applies to the client. Symptomatology: Subjective and objective data identifying behaviors common to the disorder. These behaviors, as they apply to the individual client, may be pertinent to the “evi- denced by” portion of the nursing diagnosis. Possible Etiologies (“related to”): This section suggests possible causes for the problem identiﬁed. Note: Deﬁning characteristics are replaced by “related/risk factors” for the “Risk for” diagnoses. Deﬁning Characteristics (“evidenced by”): This section in- cludes signs and symptoms that may be evident to indicate that the problem exists. Goals/Objectives: These statements are made in client behav- ioral objective terminology. They are measurable, short- and long-term goals, to be used in evaluating the effectiveness of the nursing interventions in alleviating the identiﬁed problem.
Chapter 1: Sorting Out Signs of Anxiety and Depression 15 In addition purchase 160 mg malegra fxt plus with visa impotence journal, put an A by the symptoms that are most indicative of anxiety (even-numbered items in the preceding quizzes) and a D by symptoms that are most consistent with depres- sion (odd-numbered items) best malegra fxt plus 160 mg erectile dysfunction diabetes medication. And do they seem to mostly affect your thoughts cheap 160mg malegra fxt plus overnight delivery valsartan causes erectile dysfunction, feelings, behaviors, or relationships? Worksheet 1-8 My Reﬂections Choosing Your Challenge The next four parts of this workbook cover the areas of thoughts, feelings, behaviors, and relationships. One obvious way of deciding which area to begin in is to choose the one that causes you the most problems. Wherever you choose to start, you should know that all these areas interact with each other. For example, if you have anxious thoughts about being judged, you’re likely to avoid (behavior) the spot- light. Furthermore, you may be overly sensitive to criticism from others (relationships). Part I: Analyzing Angst and Preparing a Plan 16 Nevertheless, we ﬁnd that many people like to start out by tackling the problem area that best ﬁts their personal styles. In other words, some folks are doers and others are thinkers; still others are feelers, and some are relaters. Use the Personal Style Questionnaire in Worksheet 1-9 to pinpoint and understand your preferred style. Many people ﬁnd they can overcome minor to moderate emotional problems by working with books like this one. Nevertheless, some difﬁculties require professional help, perhaps because your anxiety or depression is especially serious or because your problems are simply too complex to be addressed by self-help methods. Work through The Serious Symptom Checklist in Worksheet 1-10 to ﬁnd out if you should seriously consider seeking treatment from a mental health professional. Checking off any one item from the list means that you should strongly consider a profes- sional consultation. If you’re really not sure if you need help, see a mental health professional for an assessment. Worksheet 1-10 The Serious Symptom Checklist ❏ I have thoughts about killing myself. If you checked one or more of the statements above and you’re beginning to think that per- haps you need help, where should you go? Many people start with their family physicians, which is a pretty good idea because your doctor can also determine if your problems have a physical cause. If physical problems have been ruled out or treated and you still need help, you can: Part I: Analyzing Angst and Preparing a Plan 18 Check with your state’s psychology, counseling, social work, or psychiatric association. Contact your local university department of psychology, social work, counseling, or psychiatry for a referral. Either before or during your ﬁrst session, talk to the mental health professional and ask if you’ll receive a scientiﬁcally validated treatment for anxiety or depression. Unfortunately, some practitioners lack necessary training in therapies that have shown effectiveness in sci- entiﬁc studies. Chapter 2 Discovering the Beginnings In This Chapter Burrowing through biology Studying your history Reviewing what’s happening now Finding fault (or not) f you’re reading this book, you probably feel a little anxious or depressed. It’s valuable to understand the origins of your feelings, whether its biology and genetics, personal history, or stress. This chapter helps you gain insight into the source of your problem and connect the dots, because knowing the origins of your emotions allows you to discard the baggage of guilt and self-blame. In this chapter, we review the major causes of depression and anxiety: biology, personal his- tory, and stress. Many of our clients come to us believing that they’re to blame for having succumbed to emotional distress. When they discover the factors that contributed to the origins of their problems, they usually feel less guilty, and getting rid of that guilt frees up energy that can be used for making important changes. If you have access to family members, ask if they’d be willing to talk with you about your family’s history. Ask them if any relatives, from either side of the family, suffered from any symptoms of anxiety or depression. There’s no exact number of relatives required for determining if genetics are responsible for your symptoms. However, the more family members with similar problems, the more likely you’ve inherited a tendency for depression or anxiety. Part I: Analyzing Angst and Preparing a Plan 20 Members of my family with anxiety or depression (brothers, sisters, cousins, parents, uncles, aunts, and grandparents): ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ In addition to genetics, depression and anxiety can have biological underpinnings in the drugs you take (legal or illegal) or as the result of physical illness. Drugs — whether over- the-counter, prescription, or illegal — have many side effects. Sometimes solving your problem is as simple as checking your medicine cabinet for possible culprits. Check with your pharmacist or primary care physician to see if your medication may be causing part of your problem. In addition, alcohol is widely known to contribute to depression or anxiety when it’s abused. Some people ﬁnd that even moderate amounts of alcohol exacerbate their problems with mood. Alcohol also interacts with a wide variety of prescribed and over-the-counter drugs to produce harmful and even deadly results. Finally, illegal drugs such as marijuana, cocaine, heroin, methamphetamine, ecstasy, and so on are taken to alter moods. In the short run, they accomplish that goal; but in the long run, they almost inevitably worsen mood problems. Not only can the ill- ness itself cause mood problems, but worry and grief about illness can contribute to your distress. If you’ve been diagnosed with a medical condition, check with your doctor to see if your depression or anxiety is related to that condition. Laying Out a Lifeline The sadness and angst you feel today often sprout from seeds planted in your past. There- fore, exploring your personal history provides clues about the origins of your problems. The exercise in this section, called the Emotional Origins form, takes a little time. The Emotional Origins exercise makes you revisit your childhood by asking questions about your parents and your childhood experiences. Some of the memories involved may evoke powerful emotions; if you become overwhelmed, you may wish to stop the exercise and consult a mental health professional for guidance and support.