His uncle also has this condition asthma 50 lung capacity buy 250 mcg fluticasone visa, but his symptoms did not appear until he was 12 years of age asthma questions buy generic fluticasone 250mcg. On examination asthma definition zoology generic fluticasone 250 mcg on line, the physician notices that he has a social smile asthma bronchitis in babies order 500mcg fluticasone with visa, but does not hold his head up on his own or make noises. What is the most appropriate treatment for the condition the infant most likely has? A 63-year-old man who is an alcoholic is brought into the emergency department by his daughter. Wernicke-Korsakoff syndrome, caused by a water-soluble vitamin deficiency, is suspected. Which of the following conditions is also a result of a water-soluble vitamin deficiency? Upon physical examination the child has bilateral hip dislocations, restricted movement in shoulder and elbow joints, and coarse facial features. The primary abnormality in this disorder is associated with which of the following organelles? Patients with albinism appear white-pink (skin color), have white hair, and have nonpigmented or blue irises. In many cases, these individuals may have melanocytes, but lack melanin in their skin. What is the most useful advice to give to a guardian of a child diagnosed with albinism? He says that in the past few months he has not had much of an appetite and has lost 13. Biochemistry HigH-Yield PrinciPles Chapter 2: Biochemistry · Questions 27 Choice Type of hyperbilirubinemia conjugated conjugated unconjugated unconjugated unconjugated Urine bilirubin Urine urobilinogen normal A B C D E Na+: 135 mEq/L K+: 4. A 78-year-old man with asthma presents to his primary care physician for an annual checkup. The physician performs a physical examination and orders routine blood work, which reveals a macrocytic anemia. A 3-year-old boy recently developed weakness of his lower extremity and uses his arms to stand up even though his lower legs appear quite muscular. She stated that she was concerned after he told her on the phone that he was "drowning his sorrows," having been fired from his job earlier that day. He has no significant medical history other than moderate hypertension, for which he takes a b-blocker. The resident on call immediately places her on supplemental oxygen and draws blood for arterial blood gas analysis. What enzyme is primarily responsible for preventing this condition in the normal adult? In this syndrome, androgens are produced but cells fail to respond to the steroid hormones because they lack appropriate intracellular receptors. After binding intracellular receptors, steroids regulate the rate of which of the following? The wife in an Ashkenazi Jewish family brings her 1-year-old daughter to the pediatrician. Her previous pregnancy was uneventful and resulted in a full-term healthy girl who is now 4 years old. Her younger daughter, however, has demonstrated a progressive series of behaviors over the first year of life. Her motor skills have diminished and she demonstrates an increased startle reaction. Upon administration of a fructose bolus, the child becomes symptomatic and blood glucose levels begin to decrease. Which of the following will also occur after the administration of a fructose bolus in this patient? A 28-year-old African-American man is receiving primaquine therapy for treatment of malaria, which he contracted while visiting Asia. Physical examination is significant for scleral icterus, and urinalysis shows hemoglobinuria. A group of scientists at a pharmaceutical company are conducting in vitro experiments to investigate the effects of an antineoplastic drug. Under the microscope, it appears that with treatment, the majority of the cells are arrested at a stage in which their chromosomes are aligned in the vertical axis of the cells. Which antineoplastic agent has a mechanism of action similar to the one described? She has a nephew with fragile X syndrome (a genetic disorder characterized by trinucleotide repeat expansion) and she would like to assess her risk as a carrier for the disease. This patient has xeroderma pigmentosa, an autosomal recessive disease characterized by a defect in excision repair. This disease results in an inability to repair thymidine dimers that can form in the presence of ultraviolet light. Citrate, formed from oxaloacetate and acetyl CoA by the enzyme citrate synthase, inhibits phosphofructokinase and allosterically activates acetyl CoA carboxylase. Citrate synthase regenerates a molecule of CoA and is an important regulator of the tricarboxylic acid cycle. Malate is not an important regulator of the tricarboxylic acid cycle, but it is important in the malate shuttle. Oxaloacetate is not an important regulator of the tricarboxylic acid cycle, but it is important in glyconeogenesis. Succinyl-CoA downregulates its own synthesis by inhibiting the enzyme responsible for dehydrogenation of a-ketoglutarate. Characteristic symptoms of hyperthyroidism include tachycardia, heat intolerance, weight loss, weakness, tremulousness, and diarrhea. This patient also displays another symptom of elevated thyroid hormone levels, exophthalmos. Thyroid hormone enters target cells through carrier-mediated transport or possibly diffusion, and binds to nuclear receptors. Carbohydrate is produced by the joining of sugar molecules during cellular metabolism; for example, glycogen is produced from the linkage of glucose molecules by glycogen synthase. Fatty acid is synthesized from acetyl-coenzyme A (CoA) in the cell cytoplasm via the action of acetyl-CoA carboxylase and other enzymes. The patient has alkaptonuria, a condition corresponding to the one described in the stem. A deficiency of the enzyme homogentisic acid oxidase leads to deposition of homogentisic acid in the joints and cartilage, giving them a dark color (ochronosis) and resulting in degenerative changes. Clas- Biochemistry HigH-Yield PrinciPles Chapter 2: Biochemistry · Answers 31 sically, the urine of these patients turns black on contact with air or when the urine is made alkaline. A deficiency in a-ketoacid dehydrogenase causes maple syrup urine disease, a metabolic disorder of autosomal recessive inheritance that affects the metabolism of branched-chain amino acids (leucine, isoleucine, and valine) and causes the urine of affected patients to smell like maple syrup. The disease is not classically associated with arthritis in middle-aged individuals. A deficiency in galactokinase causes galactosemia and galactosuria, but is otherwise a fairly benign condition and would not present with any of the symptoms seen in this patient. Other symptoms would be cataracts in affected children, owing to the accumulation of galactitol, a by-product of galactose metabolism when galactokinase is not present. Deficiencies in this enzyme or in orotidine 5-monophosphate decarboxylase (an enzyme involved in the same pathway and located on the same chromosome) cause a very rare disorder called hereditary orotic aciduria. Treatment involves cystidine or uridine to bypass this step in pyrimidine synthesis and also to negatively downregulate orotic acid production. This enzyme converts phenylalanine to tyrosine, and a deficit of this enzyme leads to a deficiency of tyrosine and a build-up of phenylketones in the urine. It is associated with mental retardation and with the presence of phenylketones in the urine (which do not classically turn black upon standing). Lane B represents the Southern blot of a heterozygous carrier of sickle cell anemia. The band in lane A is from a sickle cell anemia patient with two copies of the b-S-globin gene. The band in lane C is from an unaffected patient with two copies of the b-A-globin gene.
Osteomyelitis caused by enteric organisms is sufficiently common in neonates to justify adding an aminoglycoside to the initial regimen asthma classification safe fluticasone 250 mcg. If the organism is identified and antibiotic sensitivities have been determined asthmatic bronchitis drugs discount 250 mcg fluticasone visa, treatment should be changed to the safest and most effective drug asthmatic bronchitis symptoms fluticasone 250 mcg for sale. In the neonatal age group asthma x ray signs cheap 500mcg fluticasone overnight delivery, orally administered antibiotics are not used because there are insufficient data regarding their absorption and efficacy. With the higher-resolution gamma cameras used today, multiple sites of infection are often noted. Most useful as a tool for guiding needle aspiration of fluid collections in joints or adjacent to bone. Can detect inflammatory intramedullary diseases and gives excellent anatomic details in the early stages. Provides good definition of cortical bone and is sensitive for foe early detection of bone destruction, periosteal reaction and sequestra. Conventional radiographs are insensitive to the destruction of <30% of the bone matrix. A 10-day-old male infant presents with a 2-day history of fever, vomiting, lethargy, and jaundice. Examination reveals a temperature of 39° C, a blood pressure measurement of 65/40, and a pulse of 170 bpm; there are no focal abnormal physical findings. Laboratory data include the following levels: bilirubin, 7 mg/dL (direct, 2 mg/dL); creatinine, 0. The urinalysis is consistent with a diagnosis of acute pyelonephritis (assuming that the specimen has been properly obtained). Unlike the distinction of cystitis and pyelonephritis in older infants and children, infection of the urinary tract in the neonate often involves the kidney. Asymptomatic bacteriuria occurs in 2% of healthy term neonates and up to 10% of premature infants. Males are affected more often than females in the neonatal period, and uncircumcised males are even more susceptible, with a threefold to sevenfold increased risk. Unlike in older infants, hematogenous spread of infection is more common in neonates than ascending infection. Anatomic or physiologic abnormalities of the urinary tract, such as obstructive uropathy, are also common underlying factors. The definitive diagnosis is made by positive culture of urine that is obtained by percutaneus aspiration or urethral catheterization of the bladder. Urine from bags and other nonsterile materials should not be used because false-positive results are very common. Other organisms include Proteus, Pseudomonas, Klebsiella, and Enterococcus species or S. Candidiasis can be associated with fungal balls in the kidney and renal pelvis, which can lead to obstruction. Parenteral antibiotics are used to treat pyelonephritis, usually a combination of a penicillin and an aminoglycoside. The clinician should try to obtain a urine culture before initiating antibiotic treatment and then modify the treatment once culture results and sensitivities are known. For suspected staphylococcal infection, a penicillinase-resistant penicillin or vancomycin should be considered. The transition to an oral regimen depends on the clinical and microbiological response and the presence of bacteremia or anatomic abnormalities. A second urine sample is often obtained after 48 hours to ensure clearance of the organisms from the urinary tract. In the past, prophylactic antibiotics were often used for structural anomalies of the urinary tract or vesicoureteral reflux. Principles and practice of pediatric infectious diseases: expert consult-online and print. Abdominal ultrasound is a safe and noninvasive method of evaluating structural abnormalities of the urinary tract and is the initial imaging test of choice. Serosanguinous drainage may be seen with a patent urachus or omphalomesenteric duct. First-line treatment includes a penicillinase-resistant penicillin and an aminoglycoside antibiotic. What syndrome can be associated with chronic omphalitis or delayed separation of the umbilical cord? Leukocyte adhesion deficiency is a life-threatening, autosomal-recessive inherited deficiency of cell adhesion molecules associated with chronic omphalitis or delayed separation of the umbilical cord. The hallmark of leukocyte adhesion deficiency is the absence of granulocytes at the site of infection. Funisitis is a mild inflammation of the umbilical stump with minimal drainage and erythema in the surrounding tissue. It is a local noninvasive infection that may become invasive and lead to a severe abdominal wall inflammation associated with necrotizing fasciitis. Listeriosis causes an estimated 2500 serious illness and 500 deaths annually in the United States. The incidence is highest among newborns: 2 to 13 cases per 100,000 live births, representing 30% to 40% of the total cases in humans. Pregnant women along with elderly adults and those with immunodeficiencies are also at-risk groups. Pregnant women account for about 27% of cases, with the highest incidence in the third trimester. Fecal carriage in pregnant women may lead to vaginal colonization and can be responsible for late-onset infections in infants born of healthy mothers. The frequent presence of chorioamnionitis in the absence of ruptured membranes supports the hypothesis that Listeria infection can occur through a transplacental route. Although direct transmission to humans from infected animals has been reported, most human infections are acquired through ingestion of contaminated food. The relative resistance of Listeria organisms to high temperatures and their ability to multiply at low temperatures provide opportunities for heavy colonization of dairy products if pasteurization has been improperly carried out. Outbreaks are commonly associated with prepared meat products and seafood products. This is supported by the large inoculum required to cause infection in normal hosts. Nevertheless, listeriosis represents the leading cause of death from foodborne diseases in the United States. Invasion of the intestinal mucosal barrier leads to bacteremia, resulting in a flulike illness with fever, chills, myalgia, arthralgia, headache, and backache. Premature labor in pregnant women with listeriosis is common in approximately 70% of cases. Often the placenta becomes a reservoir for bacterial proliferation, resulting in amnionitis with persistence of maternal symptoms until abortion or delivery occurs. Symptoms in the mother usually subside with or without antibiotic treatment soon after delivery. If the infection is recognized promptly, the mother may be treated effectively, preserving the pregnancy. Evidence of preceding maternal illness is often described in infants with early-onset disease, and most cases are clinically apparent at delivery with meconium-stained fluid, septicemia, and pneumonia. In severe infections a granulomatous rash-called granulomatosis infantiseptica-has been described with microabscesses throughout the body but particularly on the the liver and spleen. Blood cultures are positive in 75% of cases, and death might occur within a few hours in up to 25% of infected newborns, particularly if premature. Affected infants may not appear particularly ill and might elude diagnosis for several days. Other clinical forms of diseases at this age include colitis with associated diarrhea and sepsis without meningitis. The mortality risk of late-onset disease is generally low if treatment is started promptly. T-lymphocytes therefore provide the only natural recognition and immunity toward L. Because cellular immunity is suppressed during pregnancy and is naturally deficient during early neonatal life, L. In hosts with adequate cellular responses, symptomatic infection is rare and self-limited.
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She begins a nine-month prophylaxis regimen asthma symptoms mayo quality fluticasone 250 mcg, but two months into treatment she complains of the sudden onset of fever asthma humidifier 250mcg fluticasone free shipping, rash asthma treatment xolair trusted 500 mcg fluticasone, and swelling of her joints asthma what is it buy 500mcg fluticasone free shipping. A 12-year-old African-American girl is brought to the physician with complaints of fever, malaise, and pain in her left forearm for the past four days. Her mother reports no history of trauma or fracture, but recounts an upper respiratory infection a few days ago. The patient has been hospitalized three times for abdominal pain, for which she takes hydroxyurea. His neurologic examination reveals a symmetric smile, symmetric palate elevation, midline tongue, as well as good shoulder shrug and head turning strength. A 32-year-old woman is incidentally found to have a mediastinal mass (see image) while having a plain film x-ray of the chest performed. She subsequently reports that lately she has been "feeling more fatigued, especially at the end of the day. A 9-month-old girl presents to her pediatrician because of abnormal stature and growth. The child displays short stature, shortening of the proximal limbs, short fingers, and frontal bossing. A 64-year-old woman with no prior medical history has had increasing back pain and right hip pain for the past decade. On physical examination, she has bony enlargement of the distal interphalangeal joints (see image). She states that for the past three weeks her eyes have been very dry and itchy, and she is unable to make tears. She also states that she has had a very dry mouth despite drinking adequate fluids. Physical examination reveals bilateral dry, ulcerated corneas and fissures on the sides of her lips. When asked about her knees, she says, "Yes, my knees and wrists tend to be swollen and stiff in the morning, but my mom had arthritis. An 18-year-old man is injured during a soccer game when the goalie dives for the ball but tackles the player on the lateral aspect of his leg. He is helped off the field and brought to the emergency department, where he tells the physician that he heard a pop when he was tackled. The pain is located at the distal right tibia and has persisted over the past two weeks. The mother also notes that the child has had intermittent fevers during this time. Biopsy of the site shows sheets of many uniform cells with scant, clear cytoplasm and no evidence of normal bony matrix. A 45-year-old woman who recently underwent a left mastectomy and axillary dissection for breast cancer now presents to her physician with a chief complaint that she feels like her shoulder blade sticks out sometimes. A 42-year-old woman has had increasing pain and swelling of the joints of her hands and feet for several months. A microscopic image of the synovium of a proximal interphalangeal joint in her hand is shown in the image. Which of the following laboratory serologic findings would most likely be positive in this patient? A 1-year-old adopted, darkly pigmented boy is brought to the pediatrician for his first wellchild check-up. What is a characteristic laboratory finding used to support the most likely diagnosis? A 6-year-old child is brought to the emergency department by his parents after they all returned from a trip to East Africa. His parents report that approximately two weeks ago he had a fever and diarrhea that resolved. On further questioning, his parents state that he is home-schooled and that he has never received vaccinations. A 15-year-old boy presents to the emergency department after falling off his skateboard. In addition, the patient reports pain and numbness in the lateral leg and dorsum of the foot. When asked to walk, he raises his affected leg high off the ground and his foot slaps the ground when walking. Which of the following structures is most likely to be compromised by this fracture? A 27-year-old homeless man presents to the clinic because of a five-day history of pain and swelling in his right upper arm. Which of the following would a complete history of this patient most likely reveal? A 22-year-old woman who is a professional tennis player presents to her physician because of pain on the lateral aspect of her elbow radiating down her forearm. A 50-year-old man who recently returned from visiting family in northern New Mexico comes to the physician with exquisitely tender and enlarged lymph nodes. On physical examination, the physician notes a painful ulcer surrounded by dark, hemorrhagic purpura on the right arm in the area where, according to the patient, a flea had bitten him five days ago. After being admitted to the hospital, the patient soon develops abnormal coagulation times and is quickly started on a regimen of streptomycin and tetracycline. He now presents with hypertension and profuse sweating, and is agitated because he believes that insects are crawling all over his skin. During the examination, he loses consciousness and begins to seize on the stretcher. The seizure-induced muscle contractions result in which of the following changes in length within each sarcomere? Sarcomere I band (A) Lengthening of A band; no change in H band; shortening of I band (B) No change in A band; lengthening of H band; lengthening of I band (C) No change in A band; shortening of H band; shortening of I band (D) Shortening of A band; no change in H band; shortening of I band (E) Shortening of A band; shortening of H band; no change in I band 37. A 38-year-old man comes to the clinic with a swollen, sausage-like left middle finger along with diffuse joint swelling of his left hand and right foot over the past three days. The patient also has scaly plaques with well-defined borders along the skin just distal to both elbows. A 20-year-old man presents to the physician with a nontender indurated mass over his mandible. He has had this mass for four months after undergoing oral surgery and decided to come to the physician because the mass started to ooze a thick yellow exudate. Yellow granules are seen on microscopic examination of the discharge and an antibiotic is prescribed. Which of the following best describes the mechanism of action of the antibiotic most likely prescribed? He is diagnosed with an inguinal hernia on his left side, and undergoes surgery two days later to repair the hernia. Pemphigus vulgaris patients suffer from production of autoantibodies against which of the following labeled layers in this image? A 25-year-old man develops acute onset of fever, malaise, muscle pain, hypertension, abdominal pain, bloody stool, and prerenal failure six months after recovering from an acute hepatitis B infection. She also reports stiffness in both hands that is worse in the morning and decreases after soaking them in her warm morning bath each day. The patient was diagnosed with bilateral sacroiliitis four months ago because of his tenderness to percussion of the sacroiliac joints and pain on springing the pelvis up. A visibly upset 15-year-old boy is brought to the emergency department because he punched a wall and now has pain in his hand. A 38-year-old woman presents to the emergency department complaining of increasing muscle weakness and pain. She first noticed the muscle weakness approximately one month ago, and it has gradually worsened since then. The image demonstrates osteoblastic lesions of the pelvis secondary to metastatic cancer.
The focus of psychotherapy is how individuals feel (affect) qge031 asthma generic fluticasone 500mcg on-line, think (cognitions) asthma treatment cost cheap fluticasone 500 mcg online, and act (behaviors) asthmatic bronchitis juicing generic fluticasone 250mcg on line. Psychological and biologically based interventions are not in competition; they are often combined asthma definition url fluticasone 250 mcg mastercard. The key is not so much whether the treatment is based on a particular domain or derives from a psychological, biological, or other approach. Rather, the issue is whether a viable treatment can be provided that has evidence to suggest it will have an impact on the clinical problem. In this context, we as mental health professionals are not too concerned whether an effective treatment comes from one approach or discipline rather than another. As an example, I work at a clinic for the treatment of aggressive and antisocial children. Problems That Warrant Treatment in Childhood and Adolescence the need for effective treatments stems in part from the range of conditions that children and adolescents experience. This section has an overview of the range of problems to convey the scope of the challenges of identifying and developing treatments. For the purpose of presentation, the dysfunctions are grouped into three categories: social, emotional, and behavioral problems; problem and at-risk behaviors; and delinquency. Social, Emotional, and Behavioral Problems By social, emotional, and behavioral problems, I refer to a range of dysfunctions within the domain of mental health. These are delineated as "problems" because they are associated with impairment in functioning and often serve as the basis for treatment. Within this category are dysfunctions that are referred to as psychiatric or mental disorders, patterns of behavior that are associated with distress, impairment, or significantly increased risk of suffering, death, pain, disability, or an important loss of freedom. Critical to meeting criteria for a diagnosis is impaired functioning in everyday life. Thus, a few symptoms here or odd social behaviors are not enough to count as a disorder unless these also are reflected in difficulties in functioning at home, at work, at school, or in other contexts in which demands are made. Psychological dysfunctions or disorders are enumerated in various diagnostic systems. Oppositional Defiant Disorder: A pattern of negativistic, defiant, and hostile behavior, including frequent arguing, temper tantrums, and noncompliance with adults. Stubbornness, resistance to directions, and seemingly intentional annoying of others are key characteristics. Conduct Disorder: Aggressive or antisocial behavior in which the basic rights of others or social norms are violated. A pattern includes such behaviors as frequent fighting, lying, stealing, firesetting, cruelty to others (or to animals), and destroying property. Major Depressive Disorder: the appearance of depressed mood or loss of interest in activities. Symptoms may include change in appetite or weight, sleep, and psychomotor activity; feelings of worthlessness or guilt; diminished energy; difficulty in thinking, concentrating, or making decisions; and recurrent thoughts of death or suicidal ideation, plans, or attempts. Social Phobia: Symptoms of fear that emerge in social situations in which the person is exposed to unfamiliar people. Also, there may be performance demands in which the individual fears acting in ways that will be embarrassing or humiliating. Posttraumatic Stress Disorder: Development of symptoms of anxiety after exposure to an extreme traumatic event involving actual or threatened injury or witnessing an event that involves death, injury, or a threat to the physical integrity of another person. Key symptoms are intense fear, helplessness, horror, reexperience of the event. There are hundreds of clinical problems that have been identified in contemporary diagnosis, and children and adolescents can experience most of these. From the hundreds of recognized psychiatric disorders, I have summarized several that are more common and more familiar among children and 6 Parent Management Training Eating Disorders: the individual does not maintain minimal normal body weight (85% of normal body weight), is intensely afraid of gaining weight, and exhibits a significant disturbance in the perception of his or her body. Many methods of weight loss may be adopted, such as self-induced vomiting, misuse of laxatives, and increased or excessive exercise. Substance-Abuse Disorder: A set of disorders (depending on the substance) characterized by a maladaptive use of the substance as evident in recurrent and significant adverse consequences. The diagnosis is made on the basis of continued use after untoward consequences. Schizophrenia: Symptoms include delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms such as flat affect, poverty of speech (brief, empty replies), and inability to initiate or persist in goal-directed behavior. Significant dysfunction occurs in one or more areas of functioning, including interpersonal relations, work, school, or self-care. Adjustment Disorder: Clinically significant emotional or behavioral symptoms in response to an identifiable psychological stressor or stressors. The symptoms include marked distress or a reaction in excess of what might be expected within the context or culture. Other Conditions: A set of problems that are not mental disorders but may serve as the focus of clinical attention, such as relational problems. In addition, the symptoms must be associated with impairment in everyday functioning. The delineation and investigation of disorders are active areas of research Introduction 7 with many fascinating subtopics. For example, a given disorder can vary over the course of development, there are subtypes of disorders, the criteria for saying that one has or does not have the disorder are not firmly established, and many disorders go together. For example, depression can emerge during childhood, adolescence, and adulthood and can be diagnosed based on symptoms common across the life span. Yet, some rather stark differences in depression are evident over the course of development. As one case in point, suicide attempt and completion, which sometimes accompany major depression, are rarely evident in children. The rates of attempt and completion increase significantly during adolescence and adulthood. Thus, a key feature associated with depression can change considerably over the life span. For present purposes, the developmental changes of various disorders, such as those illustrated here with depression, need not distract us from the broader point; namely, all sorts of clinical problems are recognized to occur in children and adolescents, and these serve as an impetus for seeking treatment. Many of the currently recognized psychiatric disorders are encompassed by these categories. Externalizing disorders refer to problems that are directed toward the environment and others. Primary examples are oppositional, hyperactive, aggressive, and antisocial behaviors. Internalizing disorders refer to problems that are directed toward inner experience. There are hundreds of disorders, as I have mentioned, but how many children actually experience the dysfunctions these disorders reflect? Between 17% and 22% suffer significant developmental, emotional, or behavioral problems. There are approximately 70 million children and adolescents in the United States (Snyder, Poole, & Wan, 2000). Assume for a moment a prevalence rate of 20%; then, 14 million youths in the United States have significant impairments due to an emotional or behavioral problem. Primary examples: oppositional, hyperactive, aggressive, and antisocial behaviors; encompassed by the psychiatric diagnostic categories attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder (see Table 1. Internalizing Disorders: Problems that are directed toward inner experience or problems of "overcontrol" (inhibition, withdrawal, constraint). Substance-Related Disorders: Impairment associated with any of a variety of substances including alcohol, illicit drugs, and tobacco. These disorders, while important in their own right, are also associated with other psychiatric disorders. Learning and Mental Disabilities: A range of problems related to intellectual and academic functioning, including mental retardation and learning disorders. Because of the more salient problems that serve as the basis for referral, such problems are probably underestimated in terms of both prevalence and impact on behavior among children and adolescents referred to treatment. Severe and Pervasive Psychopathology: the more severe forms of psychopathology that have pervasive influences in the areas of functioning they affect and in their longterm course. However, all indications are that this rate significantly underestimates the range of mental disorders and impairment.
