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Although formal rating scales can be used to measure negative symptoms in research studies, in clinical practice it may be more practical to identify and monitor negative symptoms quickly by observation alone ( Figure 4-2 ) or by some simple questioning ( Figure 4-3 ). Negative symptoms are not just part of the syndrome of schizophrenia – they can also be part of a “prodrome” that begins with subsyndromal symptoms that do not meet the diagnostic criteria of schizophrenia and occur before the onset of the full syndrome of schizophrenia. Prodromal negative symptoms are important to detect and monitor over time in high-risk patients so that treatment can be initiated at the first signs of psychosis. Negative Table 4-5 What are negative symptoms?

Figure 11-1. Arousal spectrum of sleep and wakefulness . One’s state of arousal is more complicated than simply being “awake” or “asleep.” Rather, arousal exists as if on a dimmer switch, with many phases along the spectrum. Where on the spectrum one lies is influenced in large part by five key neurotransmitters: histamine (HA), dopamine (DA), norepinephrine (NE), serotonin (5HT), and acetylcholine (ACh). When there is good balance between too much and too little arousal (depicted by the gray [baseline] color of the brain), one is awake, alert, and able to function well. As the dial shifts to the right there is too much arousal, which may cause hypervigilance and consequently insomnia at night. As arousal further increases this can cause cognitive dysfunction, panic, and in extreme cases perhaps even hallucinations. On the other hand, as arousal diminishes, individuals may experience inattentiveness, cognitive dysfunction, sleepiness, and ultimately sleep.

More than 23 million people in the . age 12 or over need treatment for substance abuse. Unfortunately, only about 10% of this population receives treatment. About 30% of people in substance-abuse treatment facilities are under the age of 30. Successful treatment for addiction often includes a combination of behavioral and pharmacological interventions. Treatment works best when tailored to the individual's unique substance problem and situation. Detoxification ("detox") is the first step in addiction treatment. Certain medications may be used to ease the process and reduce withdrawal symptoms.

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