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In the second or current phase purchase genuine super p-force on line erectile dysfunction 30 years old, we recoded the interview data so as to analyze them from both a qualitative and quantitative perspective generic super p-force 160mg without a prescription erectile dysfunction vitamins. The goal of the paper is to develop an understanding of factors that contributed to reported psychological intimacy in recent years, defined as the last 5 to 10 years of these relationships. What does being psychologically intimate mean to individual partners (i. What factors are associated with the quality of psychological intimacy during the recent years of these relationships? The paper is organized as follows: Perspectives on defining psychological intimacy are discussed, which is followed by a review of recent empirical studies of intimacy, and the theoretical framework for the current study. The research methodology of the current study is summarized. A definition of psychological intimacy, the dependent variable, based on the reports of participants is presented, followed by the definitions of the independent variables that contributed to reported psychological intimacy in recent years. The findings are presented, including a chi-square analysis of those variables related significantly to psychological intimacy in recent years, correlations of the independent variable with the dependent variables, a logistic regression analysis of factors that contribute to psychological intimacy in recent years, and an examination of the qualitative data that help to clarify the effects of gender and sexual orientation on psychological intimacy during recent years. Defining Psychological Intimacy Despite the widespread attention in the professional literature to studies of intimate behavior, there has been little agreement about the meaning of intimacy in human relationships. Any attempt to define intimacy in a meaningful way must attend to various perspectives on the subject as well as clarify the potential linkages between differing perspectives. In addition, the meaning of intimacy must be differentiated from related concepts, such as communication, closeness, and attachment (Prager, 1995). If we are to be meaningful, not to mention relevant to human relationships in general, Prager cautions that any definition of intimacy needs to be compatible with everyday notions about the meaning of psychological intimacy. Because of the contextual and dynamic nature of relationships over time, however, a simple and static definition of intimacy is probably "unobtainable" (Prager, 1995). Most frequently, intimacy has been used synonymously with personal disclosure (Jourard, 1971) which involves "putting aside the masks we wear in the rest of our lives" (Rubin, 1983, p. To be intimate is to be open and honest about levels of the self that usually remain hidden in daily life. The extent of personal disclosure is proportionate to how vulnerable one allows oneself to be with a partner in revealing thoughts and feelings which are not usually apparent in social roles and behaviors of everyday life. Intimacy also has been thought of as companionship (Lauer, Lauer & Kerr, 1990) and has been associated with emotional bonding (Johnson, 1987). Others have defined intimacy as a process which changes as relationships mature (White, Speisman, Jackson, Bartos & Costos, 1986). Schaefer and Olson (1981) considered intimacy to be a dynamic process which included emotional, intellectual, social, and cultural dimensions. Helgeson, Shaver, and Dyer (1987) asked individuals to describe instances where they had experienced feelings of intimacy with members of the same and opposite gender. Self-disclosure, physical contact, sexual contact, sharing activities, mutual appreciation of the other, and warmth emerged as the major themes. Monsour (1992) examined conceptions of intimacy in same- and opposite-gender relationships of 164 college students. Self-disclosure was the most salient characteristic of intimacy, followed by emotional expressiveness, unconditional support, shared activities, physical contact, and lastly, sexual contact. It is important to note that the low ranking of sexual contact in this study may have been due to participants describing platonic, rather than romantic, relationships. This study also focused (like others) on short term relationships of young adults. Across same- and opposite-gender couples, participants described intimacy as the verbal sharing of inner thoughts and feelings between partners along with mutual acceptance of those thoughts and feelings. Relatively little is known about nonverbal communication as an aspect of intimacy. Prager (1995) suggested that a glance or a touch may have great meaning between partners because of the mutual recognition of shared, albeit unspoken, experiences. However, "it is less well known how nonverbal factors influence the development of intimacy in ongoing relationships" (Berscheid & Reis, 1998). It appears reasonable to assume, however, that metacommunications in the form of nonverbal messages must be congruent with the exchange of words, if a sense of psychological intimacy is to develop and be sustained between two individuals. At a minimum, metacommunications at a behavioral level cannot undermine or contradict words that may be used to enhance a sense of psychological intimacy between partners in a meaningful relationship. Sexual involvement between partners in a relationship is another aspect of intimacy. The phrase "intimate relationship" has been equated with sexual activity in several studies (Swain, 1989). In a study of the meanings associated with close and intimate relationships among a sample of college students, 50% of the participants referred to sexual involvement as the characteristic that distinguished intimate from close relationships (Parks & Floyd, 1996). As mentioned earlier, Helgeson, Shaver, and Dyer (1987) also found that participants in their research associated intimacy with sexual contact. Although studies tend to support the observations of Berschid and Reis (1998) regarding the components of intimacy, a significant issue in studies of intimacy is the failure to control for relationship type, the effects of gender, and relationship duration. All of these factors impact how intimacy is perceived and manifested by partners. Intimate communication may be experienced differently by men and women. According to Prager (1995), "few contextual variables have been studied more than gender, and few have been found more likely to affect intimate behavior" (p. In part, differences based on gender may be attributed to developmental experiences. What it is to be psychologically intimate in friendships and romantic relationships may be quite different to each gender, since males and females have been socialized to adopt different roles (Julien, Arellano, & Turgeon, 1997). Traditionally, males were prepared for the "breadwinner" role, while females were socialized "in ways that foster their abilities to maintain the emotional aspects of family life" (p. Macoby (1990) catalogued some of the interpersonal behaviors that men may learn through socialization: competitiveness, assertiveness, autonomy, self-confidence, instrumentality, and the tendency to not express intimate feelings. Noller (1993) described some of the behaviors women may learn through socialization: nurturance, emotional expressivity, verbal exploration of emotions, and warmth. As a consequence, men may experience intimacy through shared activities and women experience intimacy through verbal self-disclosure and shared affect (Markman & Kraft, 1989). Changing cultural values toward androgyny in child-rearing and adult relationships are having a significant impact on gender roles today, and may be changing the meaning of intimacy for males and females in heterosexual and same-gender relationships (Levant, 1996). In a self-report survey by Parks and Floyd (1996), 270 college students were asked what made their same- and cross-gender friendships close and how this closeness was expressed. The findings of Parks and Floyd support their argument that "sharp sex (sic) differences in interpersonal behavior has always been scant" (p.

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Adderall may affect growth rate and weight gain in CHILDREN and teenagers in some cases discount 160 mg super p-force mastercard erectile dysfunction tips. They may need regular growth and weight checks while they take Adderall cheap 160 mg super p-force fast delivery erectile dysfunction question. PREGNANCY and BREAST-FEEDING: Adderall may cause harm to the fetus. If you think you may be pregnant, contact your doctor. You will need to discuss the benefits and risks of taking Adderall while you are pregnant. When used for long periods of time or at high doses, Adderall may not work as well and may require higher doses to obtain the same effect as when originally taken. Talk with your doctor if Adderall stops working well. When used for longer than a few weeks or at high doses, some people develop a need to continue taking Adderall. These may include feeling unwell or unhappy, anxious or irritable, dizzy, confused, or sluggish. You may also have nausea, unusual skin sensations, mood swings, headache, trouble sleeping, or sweating. If you need to stop Adderall, your doctor will lower your dose over time. All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:Constipation; diarrhea; dizziness; dry mouth; headache; loss of appetite; nausea; nervousness; restlessness; stomach pain or upset; trouble sleeping; unpleasant taste; vomiting; weakness; weight loss. Seek medical attention right away if any of these SEVERE side effects occur:Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blurred vision or other vision problems; change in sexual ability or desire; chest pain; confusion; fainting; fast or irregular heartbeat; fever, chills, or sore throat; new or worsening mental or mood problems (eg, aggression, agitation, anxiety, delusions, depression, hallucination, hostility); numbness or tingling of an arm or leg; one-sided weakness; painful or frequent urination; red, swollen, peeling, or blistered skin; seizures; severe or persistent headache; severe stomach pain; severe weight loss; shortness of breath; sudden, severe dizziness or vomiting; slurred speech; uncontrolled muscle movement; unusual weakness or tiredness. This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA. Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include confusion; fast breathing; fever; hallucinations; irregular heartbeat; muscle pain or tenderness; seizures; severe mental or mood changes; severe or persistent headache or dizziness; severe restlessness. Proper storage of Adderall:Store Adderall at 77 degrees F (25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Keep Adderall out of the reach of children and away from pets. If you have any questions about Adderall, please talk with your doctor, pharmacist, or other health care provider. Adderall is to be used only by the patient for whom it is prescribed. If your symptoms do not improve or if they become worse, check with your doctor. Check with your pharmacist about how to dispose of unused medicine. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider. Read the Medication Guide that comes with ADDERALL XR before you or your child starts taking it and each time you get a refill. The following have been reported with use of stimulant medicines. Your doctor should check you or your child carefully for heart problems before starting ADDERALL XR. Call your doctor right away if you or your child has any signs of heart problems such as chest pain, shortness of breath, or fainting while taking ADDERALL XR. Call your doctor right away if you or your child have any new or worsening mental symptoms or problems while taking ADDERALL XR, especially seeing or hearing things that are not real, believing things that are not real, or are suspicious. ADDERALL XR is a once daily central nervous system stimulant prescription medicine. It is used for the treatment of Attention Deficit Hyperactivity Disorder(ADHD). ADDERALL XR may help increase attention and decrease impulsiveness and hyperactivity in patients with ADHD. ADDERALL XR should be used as a part of a total treatment program for ADHD that may include counseling or other therapies. ADDERALL XR is a federally controlled substance (CII) because it can be abused or lead to dependence. Keep ADDERALL XR in a safe place to prevent misuse and abuse. Selling or giving away ADDERALL XR may harm others, and is against the law. Tell your doctor if you or your child have (or have a family history of) ever abused or been dependent on alcohol, prescription medicines or street drugs. ADDERALL XR should not be taken if you or your child:have heart disease or hardening of the arterieshave moderate to severe high blood pressurehave an eye problem called glaucomaare very anxious, tense, or agitatedhave a history of drug abuseare taking or have taken within the past 14 days an antidepression medicine called a monoamine oxidase inhibitor or MAOI. Tell your doctor about all of the medicines that you or your child takes including prescription and non-prescription medicines, vitamins, and herbal supplements. ADDERALL XR and some medicines may interact with each other and cause serious side effects. Sometimes the doses of other medicines will need to be adjusted while taking ADDERALL XR. Your doctor will decide whether ADDERALL XR can be taken with other medicines. Especially tell your doctor if you or your child takes:anti-depression medicines including MAOIsanti-psychotic medicinesnarcotic pain medicinesblood thinner medicinesblood pressure medicinescold or allergy medicines that contain decongestantsKnow the medicines that you or your child takes. Keep a list of your medicines with you to show your doctor and pharmacist. Do not start any new medicine while taking ADDERALL XR without talking to your doctor first. Your doctor may adjust the dose until it is right for you or your child. Take ADDERALL XR once a day in the morning when you first wake up.

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People with obsessive-compulsive disorder are aware that their compulsive behaviors are excessive to the point of being bizarre order 160mg super p-force overnight delivery erectile dysfunction dr. hornsby, and they are afraid they will be embarrassed cheap super p-force erectile dysfunction due to diabetes icd 9, shamed or stigmatized. Thus, they often perform their rituals secretly, even though the rituals may occupy several hours each day. There has been a lot of research into the causes of OCD and as with many psychiatric disorders, genetics, brain chemistry, environment and biology probably play a significant role in the development of obsessive-compulsive disorder. Some research suggests that an antibody against strep throat bacteria sometimes mistakenly acts like a brain enzyme. This disrupts communication between neurons in the brain and may trigger OCD. For comprehensive information on obsessive-compulsive and other types of anxiety disorders, visit the Anxiety-Panic Community. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Merck Manual, Home Edition for Patients and Caregivers, last revised 2006. Full description of Obsessive-Compulsive Personality Disorder (OCPD). Definition, signs, symptoms, causes of Obsessive-Compulsive Personality Disorder. About 16 million Americans, or 8-percent of the population have Obsessive-Compulsive Personality Disorder, making it one of the most prevalent personality disorders in the U. Rigid adherence to rules and regulations and an overwhelming need for order and personal control are the primary characteristics of obsessive compulsive personality disorder. People living with OCPD are inflexible, perfectionists and unwilling to yield responsibilities to others. They are reliable, dependable, orderly, and methodical, but their inflexibility makes them unable to adapt to change. Because they are cautious and weigh all aspects of a problem, they have difficulty making decisions. According to the Merck Manual, "people with an obsessive-compulsive personality are often high achievers, especially in the sciences and other intellectually demanding fields that require order and attention to detail. However, their responsibilities make them so anxious that they can rarely enjoy their successes. Many people confuse Obsessive-Compulsive Personality Disorder (OCPD) with Obsessive-Compulsive Disorder (OCD). People with OCD are often aware that their obsessions are abnormal, but are compelled to perform them anyway. People with obsessive compulsive personality disorder, however, believe their need for strict order and rules is perfectly normal. A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lostshows perfectionism that interferes with task completion (e. Parenting styles and family dynamics may also play a role in the development of OCPD. One theory suggests that as children, people with Obsessive-Compulsive Personality Disorder were consistently punished for negative behavior, failure, and rule-breaking, while receiving no praise for success and compliance. To avoid punishment, the child develops a habit of rigidly following rules that lasts into adulthood. For comprehensive information on obsessive-compulsive and other personality disorders, visit the Personality Disorders Community. Full description of Oppositional Defiant Disorder (ODD). Definition, signs, symptoms, causes of Oppositional Defiant Disorder. All kids, especially very young children, are defiant, express anger, or talk back at some time or another. However, when the behavior becomes increasingly hostile, is a serious concern for parents, teachers and other adults, starts affecting family, friends and school performance, and continues for a significant amount of time, the child may be diagnosed with Oppositional Defiance Disorder. Children with Oppositional Defiant Disorder are stubborn, difficult, and disobedient without being physically aggressive or actually violating the rights of others. The Merck Manual reports ODD usually develops by age 8. There are various statistics on the incidence of Oppositional Definance Disorder in the U. Numbers range from 2-16% of children and teens in the U. Typical behaviors of children with Oppositional Defiant Disorder include arguing with adults; losing their temper; actively defying rules and instructions; blaming others for their own mistakes; and being angry, resentful, and easily annoyed. These children do know the difference between right and wrong and feel guilty if they do anything that is seriously wrong. The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder. Criteria are not met for Conduct Disorder, and, if the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder. Several theories about the causes of Oppositional Defiant Disorder are being investigated. Some studies also suggest that having a mother with a depressive disorder can result in a child with ODD. For more on oppositional defiant disorder and extensive information on parenting challenging children, visit the Parenting Community. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Merck Manual, Home Edition for Patients and Caregivers, last revised 2006. Comprehensive information on Panic Disorder, Panic Attacks. Description of panic disorder plus signs, symptoms, causes and treatment of panic disorder. You stand there in the lobby with your heart pounding, barely able to breathe. Other office workers file past you, looking back over their shoulders to see if something is wrong. The crushing fear of the panic attack most often passes after a few minutes, but in its wake it leaves a residue of uneasiness: when might the panic come again? Modern life, with its pace, its pressures to perform and produce, and its difficult relationships, seems at times almost to be a factory for stress. The panic attacks stemming from the illness often strike in familiar places where there is seemingly "nothing to be afraid of.

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Some cases presented with features resembling neuroleptic malignant syndrome order super p-force 160mg without prescription impotence nasal spray. Therefore buy super p-force 160 mg lowest price gonorrhea causes erectile dysfunction, ZOLOFT should not be used in combination with an MAOI, or within 14 days of discontinuing treatment with an MAOI. Similarly, at least 14 days should be allowed after stopping ZOLOFT before starting an MAOI. The concomitant use of Zoloft with MAOIs intended to treat depression is contraindicated (see CONTRAINDICATIONS and WARNINGS - Potential for Interaction with Monoamine Oxidase Inhibitors. Serotonin syndrome symptoms may include mental status changes (e. If concomitant treatment of SNRIs and SSRIs, including Zoloft, with a 5-hydroxytryptamine receptor agonist (triptan) is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases (see PRECAUTIONS - Drug Interactions). The concomitant use of SNRIs and SSRIs, including Zoloft, with serotonin precursors (such as tryptophan) is not recommended (see PRECAUTIONS - Drug Interactions). Activation of Mania/Hypomania -During premarketing testing, hypomania or mania occurred in approximately 0. Weight Loss -Significant weight loss may be an undesirable result of treatment with sertraline for some patients, but on average, patients in controlled trials had minimal, 1 to 2 pound weight loss, versus smaller changes on placebo. Only rarely have sertraline patients been discontinued for weight loss. Seizure -ZOLOFT has not been evaluated in patients with a seizure disorder. No seizures were observed among approximately 3000 patients treated with ZOLOFT in the development program for major depressive disorder. However, 4 patients out of approximately 1800 (220<18 years of age) exposed during the development program for obsessive-compulsive disorder experienced seizures, representing a crude incidence of 0. Three of these patients were adolescents, two with a seizure disorder and one with a family history of seizure disorder, none of whom were receiving anticonvulsant medication. Accordingly, ZOLOFT should be introduced with care in patients with a seizure disorder. Discontinuation of Treatment with ZoloftDuring marketing of Zoloft and other SSRIs and SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors), there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e. While these events are generally self-limiting, there have been reports of serious discontinuation symptoms. Patients should be monitored for these symptoms when discontinuing treatment with Zoloft. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate (see DOSAGE AND ADMINISTRATION ). Published case reports have documented the occurrence of bleeding episodes in patients treated with psychotropic drugs that interfere with serotonin reuptake. Subsequent epidemiological studies, both of the case-control and cohort design, have demonstrated an association between use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding. In two studies, concurrent use of a non-selective nonsteroidal anti-inflammatory drug (i. Although these studies focused on upper gastrointestinal bleeding, there is reason to believe that bleeding at other sites may be similarly potentiated. Patients should be cautioned regarding the risk of bleeding associated with the concomitant use of ZOLOFT with non-selective NSAIDs (i. Weak Uricosuric Effect -ZOLOFT^ (sertraline hydrochloride) is associated with a mean decrease in serum uric acid of approximately 7%. The clinical significance of this weak uricosuric effect is unknown. Use in Patients with Concomitant Illness -Clinical experience with ZOLOFT in patients with certain concomitant systemic illness is limited. Caution is advisable in using ZOLOFT in patients with diseases or conditions that could affect metabolism or hemodynamic responses. However, the electrocardiograms of 774 patients who received ZOLOFT in double-blind trials were evaluated and the data indicate that ZOLOFT is not associated with the development of significant ECG abnormalities. ZOLOFT administered in a flexible dose range of 50 to 200 mg/day (mean dose of 89 mg/day) was evaluated in a post-marketing, placebo-controlled trial of 372 randomized subjects with a DSM-IV diagnosis of major depressive disorder and recent history of myocardial infarction or unstable angina requiring hospitalization. Exclusions from this trial included, among others, patients with uncontrolled hypertension, need for cardiac surgery, history of CABG within 3 months of index event, severe or symptomatic bradycardia, non-atherosclerotic cause of angina, clinically significant renal impairment (creatinine > 2. ZOLOFT treatment initiated during the acute phase of recovery (within 30 days post-MI or post-hospitalization for unstable angina) was indistinguishable from placebo in this study on the following week 16 treatment endpoints: left ventricular ejection fraction, total cardiovascular events (angina, chest pain, edema, palpitations, syncope, postural dizziness, CHF, MI, tachycardia, bradycardia, and changes in BP), and major cardiovascular events involving death or requiring hospitalization (for MI, CHF, stroke, or angina). In patients with chronic mild liver impairment, sertraline clearance was reduced, resulting in increased AUC, Cmax and elimination half-life. The effects of sertraline in patients with moderate and severe hepatic impairment have not been studied. The use of sertraline in patients with liver disease must be approached with caution. If sertraline is administered to patients with liver impairment, a lower or less frequent dose should be used (see CLINICAL PHARMACOLOGY and DOSAGE AND ADMINISTRATION ). Since ZOLOFT is extensively metabolized, excretion of unchanged drug in urine is a minor route of elimination. A clinical study comparing sertraline pharmacokinetics in healthy volunteers to that in patients with renal impairment ranging from mild to severe (requiring dialysis) indicated that the pharmacokinetics and protein binding are unaffected by renal disease. Based on the pharmacokinetic results, there is no need for dosage adjustment in patients with renal impairment (see CLINICAL PHARMACOLOGY ). Interference with Cognitive and Motor Performance -In controlled studies, ZOLOFT did not cause sedation and did not interfere with psychomotor performance. Some cases were possibly due to the syndrome of inappropriate antidiuretic hormone secretion. The majority of these occurrences have been in elderly individuals, some in patients taking diuretics or who were otherwise volume depleted. Platelet Function -There have been rare reports of altered platelet function and/or abnormal results from laboratory studies in patients taking ZOLOFT. While there have been reports of abnormal bleeding or purpura in several patients taking ZOLOFT, it is unclear whether ZOLOFT had a causative role. Prescribers or other health professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with Zoloft and should counsel them in its appropriate use. A patient Medication Guide About Using Antidepressants in Children and Teenagers is available for ZOLOFT. The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have. The complete text of the Medication Guide is reprinted at the end of this document. Patients should be advised of the following issues and asked to alert their prescriber if these occur while taking ZOLOFT.

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