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To that end medicine 4h2 pill buy generic zyloprim 300mg on line, this guide enables clinicians to medicine 8 capital rocka buy discount zyloprim 100 mg online use other quotes from the Bible to medicine zetia order zyloprim 300 mg help encourage change symptoms you may be pregnant zyloprim 100mg fast delivery, closure, and empathy in these offenders. In a respectful but powerful way, Ducking from Angels becomes a mirror for the offender, encouraging him to honestly look at himself and the damage he has done beyond any potential facades that religious titles or clergy collars can provide. This program in New Zealand was established in 1989 and is housed in a sex offender specific unit with 60 self-contained rooms. The structure of the program is entirely group based and utilizes behavioral treatment within a relapse prevention framework, where individual therapy is kept to a minimum. As of November 1996, 335 men successfully completed the program and have been released. The mean period individuals are considered to be “at risk” is three years and two months (range, 0-5 years 9 months). Twelve of these men have been reconvicted of a sexual crime yielding a reconviction rate of 3. International Journal of Offender Therapy and Comparative Criminology, 44 (5), 593-605. The authors contend that the present approaches utilized to treat the pedophile are not as effective as they should be. The recent developments in the application of attachment theory and the treatment of the “difficult client” may lead to improvements in the treatment of such individuals. Attention is drawn to some of the characteristics that pedophiles have in common with personality disordered individuals and with the difficult client. One conclusion is that confrontation during treatment could be counter therapeutic, if not anti-therapeutic, when used in treating the pedophile. It is postulated that other more empathic and supportive approaches are needed, at least at the beginning of the treatment process. The authors discussed the incorporation of the tenets of attachment theory at the initial stages of treatment in order to develop a therapeutic alliance as opposed to a confrontational approach. This article outlined the development of behavioral and cognitive behavioral treatment of sex offenders from the mid-1800s to 1969. It explored the role of Sigmund Freud and noted that a 109 broad scientific interest in deviant sexual behavior was well established by 1900. Watson and Alfred Kinsey were prominent in the development of behavioral approaches in the early to th mid-20 century. A combination of behavioral and cognitive behavioral treatments began to emerge in the late 1960s. Earlier non-behavioral treatment approaches were important in establishing that sexual offenders could be engaged in treatment. It is now evident that the sexual preference hypothesis, underpinning behavioral approaches to deviant sexuality, failed to account for the complexity of such behaviors. This empirically derived classification began a process that recently resulted in the sophisticated systems of Knight and Prentky (1990, 1993). Gebhard et al (1965) were also among the first researchers to demonstrate that some child molesters were violent to ward their victims, an observation subsequently confirmed by Marshall and Christie (1981). The earliest behavioral approaches reflected the view that deviant sexual behavior was a dis to rted manifestation for pedophilia and other paraphilias. Exhibitionists and child molesters were treated with electrical aversion therapy; the modification of sexual fantasies was the target of efforts applied to sadists and voyeurs. However, there was limited evidence on the long-term effects on overt behavior using these techniques. The authors continued their review of the treatment literature by providing an overview of the advances in treatment during the 1970s. The most important developments in the 1970s include: further development of phallometric evaluations in assessment and the associated focus on modifying sexual preferences; introduction of cognitive processes; and the first description of more comprehensive treatment programs. In the early 1970s cognitive psychology began to penetrate the field with particular emphasis upon social skills training, assertiveness, sexual dysfunctions, and gender role behavior. The most significant innovation of the 1980s was the adaptation from the addictions field of the relapse prevention model, as well as the formulation of social learning theories of sexual offending. Further, a wide variety of programs described targets such as sexual preferences, sex education, empathy, social skills, self-esteem, substance abuse, anger management, and relapse prevention. The final important development of the 1980s was the beginnings of the work on classifica to ry (or taxonomic) systems applied to sexual offending. Unlike prior attempts at classification, these models were empirically driven and refined by repeated research. The 1990s were characterized by an explosion of treatment programs and a remarkable increase in the publication of research articles; the emergence of strictly actuarial approaches to risk assessment; the construction of theories describing the cognitions, emotions, and intimacy in sexual offenders; and the introduction of the “self-regulation” model as a revision of the relapse prevention model. The authors discussed a national strategy for the treatment of sex offenders in England. The author discussed how treatment programs have become more empirically based since the advent of cognitive behavioral therapy in the early 1970’s. Marshall described a hypothetical program that includes the assessment of offenders in eight areas – sexual behavior, social functioning, life his to ry, cognitive processes, personality, substance use, physical problems, and relapse-related issues. Assessment, treatment, and theorizing about sex offenders: Developments during the past twenty years and future directions. This article considered developments during the past 20 years in the assessment and treatment of sex offenders and in theoretical interpretations of their behavior. Marshall reviewed research indicating that in the field of assessments there is a move to ward including more cognitive features. One interpretation of the evidence to date suggests that phallometry has been overvalued and that considerable work remains to be done on the psychometric aspects of erectile measurement. Treatment also has moved in a more cognitive direction, but the addition of a relapse prevention approach has been the most significant innovation. Theory development is accelerating, but there needs to be more emphasis on developing and refining our specific constructs rather than elaborating broad explana to ry theories. Matson concluded that effective treatment interventions incorporate a variety of approaches, including cognitive behavioral techniques, relapse prevention strategies, psychopharmacology, group therapy, and treatment planning that addresses both the risks and needs of individual offenders. He suggested that the most comprehensive approach to managing sex offenders involves strategies that emphasize collaboration and information-sharing while employing individualized supervision plans and the use of sex offender specific treatment. International Journal of Offender Therapy and Comparative Criminology, 43 (3), 357 374. An evaluation of 21 sex offender prison and non-prison-based treatment programs was undertaken using the format of the University of Maryland’s 1997 report to the U. Eight of the studies were deemed as being to o low in scientific merit to include in assessing the effectiveness of the treatment. Of the remaining studies, approximately 50% showed statistically significant findings in favor of sex offender treatment programs. Of six studies that showed a positive treatment effect, four incorporated a cognitive-behavioral approach. Non prison-based sex offender treatment programs were deemed as being effective in curtailing future criminal activity. Prison-based treatment programs displayed promise, but the evidence is not strong enough to support a conclusion that such programs are effective. Thus, the researchers were unable to formulate any type of conclusion concerning the effectiveness of programs for different sex offender typologies. The Peterhead Prison Program operates out of a maximum security penitentiary and is owned and operated by basic prison (correctional) staff. Cognitive/ behavioral treatment for sexual offenders: An examination of recidivism. The authors reviewed a cognitive behavioral treatment program in Jackson County, Oregon, that was established in 1982. Offenders were mandated to participate in this community-based program upon conviction of a felony or misdemeanor sexual offense. A group of offenders who participated in the Jackson County program between 1985 and 1995 was identified through archival data from the Oregon Department of Corrections. The data revealed success or non success in treatment, as well as any new convictions for sexual or nonsexual offenses. A control group of nonsexual offenders in Jackson County, and a group of sexual offenders in Linn County who were not in a treatment program were also studied. As hypothesized, those Jackson County offenders who successfully completed treatment had lower recidivism rates than those who were unsuccessful in the program. The observed effect of the program was particularly strong for offenders who remained in treatment for one year or more. When review was restricted solely to those participants, the re-offense rate for Jackson County offenders was reduced by over 40% when compared with Linn County offenders.

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There has not been any material deterioration in Company’s financial condition since the date of the most recent financial statements and projections delivered to symptoms quiz order 100 mg zyloprim free shipping NovaQuest medications emts can administer order 100mg zyloprim. Company has delivered or provided to 92507 treatment code zyloprim 100 mg line NovaQuest and included in the data room described in Section 5 symptoms dizziness nausea buy zyloprim 100mg with mastercard. All written statements and other writings furnished pursuant here to, or in connection with this Agreement or the transactions contemplated hereby, are complete and accurate in all material respects. No representation or warranty by Company contained in this Agreement contains any untrue statement of a material fact or omits to state any material fact necessary in order to make any statement contained herein not misleading. To the knowledge of Company, there is no fact, event, or condition that materially adversely affects the Product that has not been set forth in this Agreement and the Schedules here to. NovaQuest represents, warrants, and covenants to Company as of the Effective Date: (a) Organization. NovaQuest is a Delaware limited partnership duly organized, validly existing and in good standing under the laws of the jurisdiction of its organization. NovaQuest has all necessary power, right, and authority to carry on its business as it is presently carried on by NovaQuest, to enter in to, execute, and deliver this Agreement and perform all of the covenants, agreements, and obligations to be performed by NovaQuest hereunder. This Agreement has been duly executed and delivered by NovaQuest and constitutes, when executed and delivered by Company, NovaQuest’s valid and binding obligation, enforceable against NovaQuest in accordance with its terms, subject to bankruptcy, insolvency, reorganization, or similar laws affecting the rights of credi to rs generally and equitable principles. Neither the execution and delivery of this Agreement nor the performance or consummation of it or the transactions contemplated hereby will (i) conflict with any Applicable Law; (ii) in any material respect, violate, conflict with, result in a material breach or violation of, or constitute a material default under any material contract, agreement, commitment, or instrument to which NovaQuest is a party or by which NovaQuest or any of its assets are bound or committed; or (iii) violate the applicable formation documents for NovaQuest. No consent, approval, license, order, authorization, registration, declaration, or filing with or of any Person is required by NovaQuest in connection with the execution and delivery by NovaQuest of this Agreement, the performance by it of its obligations under this Agreement, or the consummation by it of any of the transactions contemplated hereby or thereby. NovaQuest has, and shall have at all times during the Product Funding Period, the financial ability to timely satisfy its obligations to make Development Payments hereunder. All representations and warranties of the Parties hereunder shall survive the applicable dates referred to in the first sentence of Section 7. Each such notification shall contain a reasonably detailed summary of the event described therein. At the request of NovaQuest, Company shall promptly discuss with NovaQuest, or provide in writing to NovaQuest, full particulars of the applicable matter. Notwithstanding anything to the contrary herein, without NovaQuest’s prior written consent, which shall not be unreasonably withheld or delayed, Company shall not and shall ensure that Responsible Parties do not, sell, transfer, assign, grant any License, otherwise dispose of or grant any Encumbrance in, to or under any Product Assets that are necessary or useful to the Development or Commercialization of the Product in the Terri to ry, provided, however, that the foregoing shall not preclude or limit Company or its Affiliates from, without NovaQuest’s consent, (i) effecting any such sale, transfer, assignment, or other disposition as part of any sale of all or substantially all of the Product Assets to a Permitted Company that assumes all of Company’s obligations under this Agreement pursuant to a written assumption agreement in a form and substance acceptable to NovaQuest in its sole discretion, including by asset sale, merger, combination, sale of securities or otherwise, directly or indirectly, (ii) using, selling, or otherwise disposing of inven to ries of the Product in the ordinary course of business in connection with the Development or Commercialization of the Product, (iii) granting Licenses to Affiliates or Responsible Parties in the Terri to ry or other licenses or sublicenses or other rights outside the Terri to ry under Product Assets. Company shall (and shall cause each Responsible Party to ): (a) prosecute and maintain in full force and effect all Patents Covering the Product owned or controlled by it on or after the Effective Date and all Regula to ry Approvals necessary for the Development, Commercialization or manufacture of the Product in the Terri to ry; (b) maintain, keep in full force and effect, and seek available patent term extensions for any such Patents referred to in Section 8. With respect to the performance of this Agreement and the activities contemplated by this Agreement, Company shall comply, and shall cause each Responsible Party to comply, with all Applicable Laws. During the Term, Company shall not grant any right to any Affiliate or Third Party that would conflict with the rights granted to NovaQuest hereunder or enter in to any agreement that would impair Company’s ability to perform its obligations under this Agreement. Company shall comply with all terms and conditions of, and fulfill all of its obligations under, all of the Material Contracts, except for such noncompliance that could not reasonably be expected to result in a Material Adverse Event. Company shall use commercially reasonable efforts to enforce against the other party(ies) to each Material Contract all material terms and conditions thereunder except where the failure to do so could not reasonably be expected to result in a Material Adverse Effect. Company shall not amend any Material Contract in any material respect or issue any waivers or consents or other approvals under any Material Contract without the prior written consent of NovaQuest (not to be unreasonably withheld or delayed), except where such amendment, waiver, or consent could not reasonably be expected to result in a Material Adverse Event. Company shall ensure that all Licenses granted after the Effective Date contain provisions that require the Licensees to notify Company of any Material Adverse Event and that allow Company to share information pertaining to the Development and Commercialization of the Product to NovaQuest as contemplated by this Agreement. Until the earlier of (i) the date on which Company has paid NovaQuest all payments due and owing under Section 4. Except as otherwise contemplated by this Agreement, including the consummation of the transactions contemplated under the Vical Transaction, between the Effective Date and the Closing Date, unless NovaQuest otherwise provides its prior written consent, Company (a) shall conduct its operations in the ordinary course in all material respects and in a manner that will not impair its ability to perform its obligations under this Agreement; (b) shall not, without NovaQuest’s written consent, not to be unreasonably withheld, conditioned or delayed, by its own action, amend in any material respect, or waive any material right of the Company under, the Vical Merger Agreement. Company shall have repaid in full all outstanding amounts under the Hercules Loan in accordance with the Payoff Letter, no later than three (3) Business Days after the Closing Date. The Parties agree to treat this Agreement (but for clarity, not the Warrant Agreement) for all U. The Parties shall file all tax and information returns consistent with the treatment set forth in this Section 8. The Parties agree to treat [***] of the Development Payments as paid in exchange for the Warrant Agreement. The occurrence of any of the following events, actions, or omissions shall constitute a material breach of this Agreement by Company: (a) Company breaches any material representation or warranty under this Agreement or the Security Agreement between the Parties and, to the extent curable, does not cure such breach within thirty (30) calendar days after the earlier of (i) NovaQuest’s provision of notice to Company of such breach or (ii) Company’s becoming aware of such breach; (b) Company materially breaches any agreement, covenant, or obligation in this Agreement or the Security Agreement between the Parties, or a Responsible Party other than Company materially breaches any agreement, covenant, or obligation in this Agreement applicable to Responsible Parties, and, to the extent curable, does not cure such breach within thirty (30) calendar days after the earlier of (i) NovaQuest’s provision of notice to Company of such breach or (ii) Company’s becoming aware of such breach; (c) a Responsible Party terminates the Program in any material respect for any reason other than Technical Failure; (d) Company or any Affiliate of Company that is materially involved in the Development or Commercialization of the Product in the Terri to ry (i) files a petition seeking to take advantage of any laws relating to bankruptcy, insolvency, reorganization, winding up, or composition for adjustment of debts; (ii) consents to, or fails to contest within sixty (60) calendar days and in appropriate manner, any petition filed against it in an involuntary case under such bankruptcy laws or other laws; (iii) applies for, consents to, or fails to contest within sixty (60) calendar days and in appropriate manner the appointment of, or the taking of possession by, a receiver, cus to dian, trustee, or liquida to r of itself or of a substantial part of its property; (iv) admits in writing its inability to pay its debts as they become due; (v) makes a general assignment for the benefit of credi to rs; or (vi) takes any corporate action for the purpose of authorizing any of the foregoing; or (e) a case or other proceeding is commenced against the Company or any Affiliate of Company that is materially involved in the Development or Commercialization of the Product in the Terri to ry in any court of competent jurisdiction seeking (i) relief under any laws relating to bankruptcy, insolvency, reorganization, winding up, or adjustment of debts or (ii) the appointment of a trustee, receiver, cus to dian, liquida to r, or the like for a Responsible Party for all or any substantial part of its assets; and under either clause (i) or (ii) of this 9. If NovaQuest provides Company such written notice of termination of its remaining payment obligations, all terms of this Agreement shall terminate except as provided in this Section 9. Either Party may terminate this Agreement in its entirety upon written notice to the other Party if the Closing has not occurred on or before the End Date, as defined in Section 9. Company hereby agrees to indemnify, defend, hold harmless, and reimburse NovaQuest and its Affiliates and their respective managers, direc to rs, officers, employees, agents, and its and their respective successors, heirs, and assigns (collectively, the “NovaQuest Indemnitees”) from and against any losses, costs, claims, damages, Liabilities, or expenses (including reasonable at to rneys’ and professional fees and other expenses of litigation) (each, a “Loss” and collectively, “Losses”) actually incurred by NovaQuest Indemnitees arising out of claims, suits, actions, or demands, in each case brought by a Third Party, or settlements or judgments arising therefrom (including personal injury, products liability, and intellectual property infringement or misappropriation claims) (each a “Third Party Claim”) as a result or arising out of: (a) a Responsible Party’s, or its or their respective agent’s or contrac to r’s Development, promotion, marketing, handling, manufacture, Commercialization, packaging, labeling, s to rage, distribution, pricing, reimbursement, transport, use, sale, or other disposition of the Product; (b) any material breach by a Responsible Party of a representation or warranty of a Responsible Party contained in this Agreement or in any other agreement between the Parties or the breach or default in any material respect by a Responsible Party of any covenant, agreement, or obligation of Company contained in this Agreement or in any other agreement between the Parties; (c) a Responsible Party’s failure to comply with Applicable Law; or (d) the negligence or willful misconduct related to this Agreement of a Responsible Party, or contrac to rs or any of their respective direc to rs, employees, or agents. A NovaQuest Indemnitee seeking indemnification (the “Indemnified Party”) under Section 10. Such notice shall include a description of the claim and the nature and amount of the applicable Loss, to the extent known at such time. The failure of an Indemnified Party to notify the Indemnifying Party on a timely basis or provide such information as set forth above will not relieve the Indemnifying Party of any liability that it may have to the Indemnified Party unless the Indemnifying Party demonstrates that the defense of such action is materially prejudiced by the Indemnified Party’s failure to give such notice and then solely to the extent thereof. The Indemnified Party shall provide the Indemnifying Party with complete and correct copies of all papers and official documents received in connection with any Third Party Claims for which indemnity is sought hereunder and such other information with respect there to as the Indemnifying Party may reasonably request. The Parties shall keep each other reasonably informed of any facts or circumstances that may be of material relevance in connection with the Loss for which indemnification is sought. The Indemnifying Party may assume the defense of any Third Party Claim for which indemnity is sought hereunder by giving written notice thereof to the Indemnified Party within thirty (30) calendar days after the Indemnifying Party’s receipt of a notice provided pursuant to Section 10. Upon assuming the defense of a Third Party Claim, the Indemnifying Party may appoint as lead counsel in the defense of the Third Party Claim any legal counsel selected by the Indemnifying Party and reasonably acceptable to the Indemnified Party. If the Indemnifying Party assumes the defense of a Third Party Claim, then the Indemnified Party shall promptly deliver to the Indemnifying Party all original notices and documents (including court papers) received by the Indemnified Party in connection with the Third Party Claim. However, such employment shall be at the Indemnified Party’s own expense unless (i) the employment thereof has been specifically authorized by the Indemnifying Party in writing; (ii) the Indemnifying Party has failed to assume the defense and employ counsel in accordance with Section 10. With respect to any Third Party Claim, the Indemnifying Party shall have the right to consent to the entry of any judgment or enter in to any settlement with respect to such Third Party Claim, only with the prior written consent of the Indemnified Party. Regardless of whether the Indemnifying Party chooses to defend or prosecute any Third Party Claim in respect of which indemnity is sought hereunder, the Indemnified Party shall, and shall cause each of its indemnitees to, reasonably cooperate in the defense or prosecution thereof, and the Indemnifying Party shall reimburse the Indemnified Party for all its reasonable out-of-pocket expenses in connection therewith. If the Indemnifying Party chooses not to defend any Third Party Claim in respect of which indemnity is sought hereunder, then the 37 Indemnifying Party shall cooperate with the Indemnified Party in the defense or prosecution thereof, including by furnishing such records, information, and testimony, providing such witnesses and attending such conferences, discovery proceedings, hearings, trials, and appeals as may be reasonably requested in connection therewith. Such cooperation shall include access during normal business hours afforded to the Indemnified Party to, and reasonable retention by the Indemnifying Party of, records and information that are reasonably relevant to such Third Party Claim, and making Indemnifying Parties and other employees and agents available on a mutually convenient basis to provide additional information and explanation of any material provided hereunder. If the Indemnifying Party fails to timely (and in any event within thirty (30) calendar days) assume and diligently conduct the defense of any such Third Party Claim, then its right to defend that Third Party Claim shall terminate and the Indemnified Party may assume the defense of, and settle, such claim with counsel of its own choice and on such terms as it deems appropriate, without any obligation to obtain the consent of the Indemnifying Party. This Agreement shall be governed by and construed, interpreted, and enforced in accordance with the laws of the State of New York, as applied to agreements executed and performed entirely in the State of New York, without giving effect to the principles of conflicts of law thereof. Either Party shall have the right to refer a Dispute to the Parties’ Senior Officers for attempted resolution by sending a written notice to the other Party requesting the same (the “Dispute Notice”). If either Party provides a Dispute Notice, then the Senior Officer (or his or her designee) from each Party shall, by phone or in-person, discuss the Dispute in good faith, commencing within fourteen (14) calendar days after the delivery of the Dispute Notice and continuing until at least twenty-eight (28) calendar days after the delivery of the Dispute Notice. The Arbitration tribunal shall consist of three (3) arbitra to rs, which shall be selected as follows: (i) one (1) arbitra to r shall be selected by Company; (ii) one (1) arbitra to r shall be selected by NovaQuest; and (iii) one (1) arbitra to r shall be selected by the two (2) foregoing arbitra to rs (each such arbitra to r, an “Arbitra to r”). Each of the Arbitra to rs shall have 38 prior experience in the biopharmaceutical industry. No Arbitra to r shall be a current or former employee, shareholder, officer, or direc to r of, or consultant, or advisor to, or other representative of, either Party. The Arbitration shall be conducted in English, and all foreign language documents shall be submitted in the original language and shall be accompanied by a translation in to English. Upon the written mutual agreement of both Parties, any time period specified in this Section 11. The Arbitra to rs shall take in to account both the desirability of making discovery efficient and cost-effective and the needs of the Parties for an understanding of any legitimate issue raised in the Arbitration. In order to facilitate the comprehensive resolution of related disputes, and upon request of any Party to the Arbitration proceeding, the Arbitra to rs may consolidate the Arbitration proceeding with any other Arbitration proceeding relating to this Agreement. The Arbitra to rs shall not consolidate such Arbitrations unless they determine that (i) there are issues of fact or law common to the proceedings so that a consolidated proceeding would be more efficient than separate proceedings, and (ii) no Party would be prejudiced as a result of such consolidation through undue delay or otherwise. The costs of the Arbitration, including reasonable fees plus expenses to be paid to the Arbitra to r(s) and the reasonable out-of-pocket costs (including the costs incurred for translation of the documents in to English, reasonable at to rneys’ and expert witness fees, and reasonable travel expenses) of the prevailing Party shall be borne by (i) the losing Party, if the Arbitra to r(s) rule in favor of one Party on all disputed issues in the Arbitration and (ii) by the Parties, as allocated in writing by the Arbitra to r(s) in a manner with a reasonable relationship to the outcome of the Arbitration, if the Arbitra to r(s) rule in favor of one Party with respect to some issues and in favor of the other Party with respect to other issues and, in either case ((i) or (ii)), paid within thirty (30) calendar days from the final decision by the Arbitra to r. The decision by the Arbitra to rs shall be final and binding on the Parties, non-reviewable and non-appealable, and judgment upon any arbitral award may be entered and enforced by any court or other judicial authority of competent jurisdiction. In any Arbitration proceeding, the Arbitra to r(s) shall take all measures necessary for the protection of Confidential Information and the Product.

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There is evidence symptoms zoloft zyloprim 300 mg low cost, however symptoms 6dp5dt cheap 100 mg zyloprim with visa, that genetics (specific genes passed from one generation to treatment 4 addiction 300mg zyloprim sale the next) medicine vs medication generic zyloprim 300 mg overnight delivery, contributes to the child’s vulnerability to a Mood Disorder. School aged children and adolescents having family members who are depressed are more likely to experience depression themselves, although this does not appear to be the case for preschoolers (Klein, Torpey & Bufferd, 2008). There is no research which shows whether family his to ry and childhood onset of depression stems from genetic fac to rs or whether depressed parents create an environment that increases the likelihood of a child’s developing a depressive disorder (U. More research has been conducted on adult depression than on depression in children. Research on adults has pointed to a link between depression and sero to nin and norepinephrine neurotransmitters, but this research has not been fully supported in children and adolescents (Klein, Torpey & Bufferd, 2008). Research with adults with and without depression has also revealed differences in production levels of the hormone cortisol, which is often associated with stress. This finding has been only partially supported in children and adolescents (Klein, Torpey & Bufferd). Depressed children and adolescents, however, are similar to depressed adults in that, like adults, they have an abnormal production of growth hormone (Klein, Torpey & Bufferd). Assessment Proper assessment of mood disorders in children and adolescents is essential for accurate diagnosis, effective treatment formulation, and treatment moni to ring(Rudolph & Lambert, 2007). Assessment of depression in children and adolescents should include information obtained directly from the child, as well as from the child’s parents and teachers. Information about symp to m severity, frequency, and resulting impairment can be gathered through the use of structured or semi-structured clinical interviews, self-report questionnaires, observer questionnaires, and behavioral observation (Klein, Torpey & Bufferd, 2008). Regardless of the method of assessment, clinicians should make the diagnosis only after other causes of the child’s condition are ruled out. Research indicates that both are good measures of depressive disorders in very young children (Rudolph & Lambert). Because youth who experience the onset of mood disorders at a younger age typically have a worse prognosis, early intervention is crucial in treatment (Brown, 1996). Early clinical intervention is critical in order to prevent additional functional breakdown, relapse, and suicidal behavior (Burns, Hoagwood & Mrazek). In their review of treatments for youth with depression, David-Ferdon and Kaslow reported that standardized treatments which adhered to a treatment manual and were standardized led to greater gains than treatments that were not standardized. The research also has indicated that treatment gains were realized, regardless where the treatment was provided (school, community clinics, primary care clinics, hospitals, or research settings). It should be noted that the youth reported greater treatment gains than did their parents and clinicians. While each of the studies reviewed by David-Ferdon and Kaslow (2008) used different criteria for including and excluding participants, the vast majority required that the youth have elevated depressive symp to ms. For this review, treatments are divided in to two groups: What Works and What Seems to Work. Table 1 outlines psychosocial interventions for children; Table 2, those for adolescents. Behavioral Therapy Behavioral therapy includes pleasant activity moni to ring, social skills training and relaxation. Accordingly, the potential for suicidal behavior is a grave matter and must be taken in to account by clinicians providing treatment. Depressed adolescents were five times more likely than adolescents without depression to have attempted suicide (U. There has been considerable debate about the use of antidepressants to treat youth with depression, specifically whether their use increases the risk of suicidal behaviors. A more detailed discussion of the use of antidepressants to treat 154 children and adolescents is provided in the “Antidepressants and the Risk of Suicidal Behavior” section of the Collection. Unproven Treatments Several treatments have been found to be ineffective in treating depression. Evidence indicates that cyclic antidepressants are not efficacious (Klein, Dougherty & Olino, 2005). The National Depressive and Manic-Depressive Association (2001) recognizes that various alternative treatments may have a positive effect on mood disorders, but asserts that such treatments ought not to be endorsed. The Association asserts there is no scientific data supporting the use of dietary supplements such as Omega-3, St. Cultural Considerations As indicated by Yaylayan (2002), culture can influence how children communicate symp to ms of mood disorders. Complaints of nervousness and headaches are more common among Latino and Mediterranean cultures. It is important that clinicians be aware of the youth’s cultural background, as well as the norms of their culture. More research is being conducted on the impact of culture on the assessment and treatment of mood disorders but, as noted by Kaslow & Thompson (1998), there is a noticeable deficit of cultural information about treating mood disorders in children and adolescents. Most of the existing studies were conducted using children who were middle-class and Caucasian. Moreover, little attention has been paid to the relevance of the materials and interventions employed in treatment or to the clinician’s education about cultural differences. Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. The use of medication in treating childhood and adolescent depression: Information for physicians. The confluence of mental, physical, social, and academic difficulties in middle childhood. Applying the criteria for empirically supported treatments to studies of psychosocial interventions for child and adolescent depression. Toward guidelines for evidence-based assessment of depression in children and adolescents. The clinical significance of preschool depression Impairment in functioning and clinical markers of the disorder. The preschool feelings checklist: a brief and sensitive screening measure for depression in young children. Journal of the American Academy of Child and Adolescent Psychiatry, 42 (3), 340-348. Psychotherapy for children and adolescents: Evidence-based treatments and case examples. In a depressed episode, the child may have any or all of the symp to ms of a depressive disorder. When in a manic episode, the child may be overactive, over talkative, and have a great deal of energy (Center for Advancement of Children’s Mental Health at Columbia University). The more controversial issues are the core criteria for diagnosis, the need for discrete mood episodes, and the definition of cycling (mood changes that occur during an episode) (Brown, An to nuccio, DuPaul, Fristad, King, Leslie et al. A detailed review of the second category of Mood Disorders is available in the “Depression and Dysthymia” section of the Collection. The lifetime prevalence for mania is approximately one to two percent by late adolescence (Kessler, Avenevoli & Merikangas, 2001). Characteristics of mania include extreme euphoria, grandiosity, and irritability, with associated racing thoughts, increased psychomo to r activity, and mood lability (Cassidy & Carroll, 2001). Many researchers have proposed certain hallmark criteria or “handle” symp to ms to help diagnosis of bipolar disorder in youth (Youngstrom, 2007). Mania in younger children is usually defined by erratic changes in mood, energy levels, and behavior. Irritability, and mixed manic/depressive episodes are usually more common than euphoria (McClellan, Kowatch & Findling, 2007). Misdiagnosis can lead to unnecessary aggressive pharmacotherapy that has not been studied in young children. Depressive episodes are not required, but most youth experience major or minor episodes during their lifetime. Cyclothymic disorder: Requires at least two years of numerous periods of hypomanic symp to ms that do not meet criteria for a manic episode and numerous periods of depressive symp to ms that do not meet criteria for a major depressive episode. However, researchers recognize that the criteria need refinement for children and adolescents. Another diagnostic issue that clinicians should consider is that cyclothymia is rarely diagnosed in youth due to the prolonged duration criteria needed to make a diagnosis (Youngstrom et al. Heritability estimates have been shown to be as high as 85 percent (Roberts, Bishop & Rooney, 2008). Research has revealed a relationship between early age of onset with a greater likelihood of increased rapid cycling and higher rates of comorbidity, suicidality, violent behavior, and substance abuse (Perlis et al. Risk fac to rs posed at home include poor family cohesion and high levels of conflict within the family (Chang, Blaser, Ketter & Steiner, 2001).

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Family drug courts: Conceptual frameworks treatment innovations buy zyloprim 100mg free shipping, empirical evidence symptoms stomach cancer 300mg zyloprim for sale, and implications for social work medicine emoji purchase 100 mg zyloprim otc. Illuminating the black box from within: Stakeholder perspectives on family drug court best practices medications gout zyloprim 300mg overnight delivery. Learning more from evaluation of justice interventions: Further consideration of theoretical mechanisms in juvenile drug courts. Understanding the risk principle: How and why correctional programs can harm low risk offenders. The Seattle Community Court: Start-up, initial implementation, and recommendations concerning future development. The influence of co-occurring mental health and sub stance use problems on the effectiveness of juvenile drug courts. Alternative tracks in adult drug courts: Matching your program to the needs of your clients. Manual for scientific moni to ring and evaluation of drug treatment courts in the Americas. An experimental trial of adaptive programming in drug court: Outcomes at 6, 12 and 18 months. A national research agenda for drug courts: Plotting the course for second-generation scientific inquiry. Olympia: Research and Data Analysis Division, Washing to n State Department of Social and Health Services. System-level effects of integrating a promising treat ment in to juvenile drug courts. Leaving no veteran behind: Policies and perspectives on combat trauma, veterans courts, and the rehabilitative approach to criminal behavior. Staff perspectives on juvenile drug court operations: A multi-site qualitative study. Assessing the effectiveness of drug courts on recidivism: A meta-analytic review of traditional and non-traditional drug courts. Risk fac to rs for overall recidivism and severity of recidivism in seri ous juvenile offenders. 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Predicting treatment noncompliance among criminal justice-man dated clients: A theoretical and empirical exploration. Dispensing justice locally: the impacts, cost and benefits of the Mid to wn Community Court. Adapting multisystemic therapy for co-occurring child maltreatment and parental substance abuse: the Building Stronger Families Project. General responsivity adherence in juvenile drug treatment court: Examining the impact on substance-use outcome. A preliminary outcome evaluation of North Dakota’s Juvenile Drug Court—Recidivism analysis. Perceptions of drug court: How offenders view ease of program com pletion, strengths and weaknesses, and the impact on their lives. Understanding operational dynamics of drug courts (Doc to ral dissertation, University of Washing to n). 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