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By P. Samuel. Winston-Salem State University.

State Medicaid programs help pay medical costs for some people with Medicare who have limited income and resources order 50mg viagra with mastercard. States also have programs called Medicare Savings Programs that pay Medicare premiums and discount generic viagra canada, in some cases generic 25 mg viagra fast delivery, may also pay Medicare Part A and Part B deductibles and coinsurance. The phone number for the State Medical Assistance (Medicaid) office for each state can be obtained by calling Medicare. Medicaid, also called Medical Assistance, is a joint federal and state government program that helps pay medical costs for some people with limited income and resources. Medicaid programs and income limits for Medicaid vary from state to state. The State Medical Assistance (Medicaid) office can help people find out whether they qualify for Medicaid or provide more information about Medicaid programs. To contact a state Medicaid office, people cancheck the government pages of the phone book for the local department of human services or department of social services, which can provide the needed informationSCHIP is a federal and state government partnership to expand health coverage to uninsured children from families with income that is too low to afford private or employer-sponsored health insurance but too high to qualify for Medicaid. The free or low-cost coverage is available to eligible children younger than 19. SCHIP provides an extensive package of benefits including doctor visits, hospital care, and more. People who are not eligible for Medicare or Medicaid may be able to purchase private health insurance. Many insurers consider diabetes that has already been diagnosed a pre-existing condition, so finding coverage may be difficult for people with diabetes. Insurance companies often have a specific waiting period during which they do not cover diabetes-related expenses for new enrollees, although they will cover other medical expenses that arise during this time. Many states now require insurance companies to cover diabetes supplies and education. The Health Insurance Portability and Accountability Act (HIPAA), passed by Congress in 1996, limits insurance companies from denying coverage because of a pre-existing condition. Some state offices may be called the state insurance department or commission. This office can also help identify an insurance company that offers individual coverage. The Georgetown University Health Policy Institute offers consumer guides on health insurance topics, including guides for each state about getting and keeping health insurance. When leaving a job, a person may be able to continue the group health insurance provided by the employer for up to 18 months under a federal law called the Consolidated Omnibus Budget Reconciliation Act, or COBRA. People pay more for group health insurance through COBRA than they did as employees, but group coverage is cheaper than individual coverage. People who have a disability before becoming eligible for COBRA or who are determined by the Social Security Administration to be disabled within the first 60 days of COBRA coverage may be able to extend COBRA coverage an additional 11 months, for up to 29 months of coverage. Department of Labor at 1-866-4-USA-DOL (1-866-487-2365) or visiting www. Some professional and alumni organizations offer group coverage for members. Most states have a high-risk health insurance pool or other means for covering people otherwise unable to get health insurance. Information about high-risk pools is available at www. Some insurance companies also offer stopgap policies designed for people who are between jobs. Each state insurance regulatory office can provide more information about these and other options. Information about consumer health plans is also available at the U. The Bureau of Primary Health Care, a service of the Health Resources and Services Administration, offers primary and preventive health care to medically underserved populations through community health centers. For people with no insurance, fees for care are based on family size and income. The Department of Veterans Affairs (VA) runs hospitals and clinics that serve veterans who have service-related health problems or who simply need financial aid. Veterans who would like to find out more about VA health care can call 1-800-827-1000 or visit www1. Many local governments have public health departments that can help people who need medical care. People who are uninsured and need hospital care may be able to get help from a program known as the Hill-Burton Act. Although the program originally provided hospitals with federal grants for modernization, today it provides free or reduced-fee medical services to people with low incomes. The Department of Health and Human Services administers the program. More information is available by calling 1-800-638-0742 (1-800-492-0359 in Maryland) or visiting www. Kidney failure, also called end-stage renal disease, is a complication of diabetes. People of any age with kidney failure can get Medicare Part A?hospital insurance?if they meet certain criteria. To qualify for Medicare on the basis of kidney failure, a person musthave had a kidney transplanthave worked long enough?or be the dependent child or spouse of someone who has worked long enough?under Social Security, the Railroad Retirement Board, or as a government employeebe receiving?or be the spouse or dependent child of a person who is receiving?Social Security, Railroad Retirement, or Office of Personnel Management benefitsPeople with Medicare Part A can also get Medicare Part B. However, a person needs to have both Part A and Part B for Medicare to cover certain dialysis and kidney transplant services. More information about dialysis and transplantation is available bycalling Social Security at 1-800-772-1213 or visiting www. A free nylon filament?similar to a bristle on a hairbrush?is available to check feet for nerve damage. The filament, with instructions for use, can be obtained by calling 1-888-ASK-HRSA (1-888-275-4772) or by accessing www. More information is available at the Medicare website at www. Drug companies that sell insulin or diabetes medications usually have patient assistance programs. Such programs are available only through a physician. The Pharmaceutical Research and Manufacturers of America and its member companies sponsor an interactive website with information about drug assistance programs at www. Also, because programs for the homeless sometimes provide aid, people can contact a local shelter for more information about how to obtain free medications and medical supplies. The number of the nearest shelter may be listed in the phone book under Human Service Organizations or Social Service Organizations. People who have had an amputation may be concerned about paying their rehabilitation expenses. The following organizations provide financial assistance or information about locating financial resources for people who need prosthetic care:900 East Hill Avenue, Suite 205Phone: 1-888-AMP-KNOW (1-888-267-5669)230 West Monroe Street, Suite 1800Public agencies and other organizations that provide services and assistance, such as providing special equipment, to children with diabetes and other disabilities and to their families are listed on the State Resource Sheets published by the National Dissemination Center for Children with Disabilities (NICHCY). These costs may include special equipment and disability-related medical expenses not covered by insurance.

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The materials and experiences they share may overwhelm the group members order viagra australia. They are prone to dissociate in and/or run from sessions cheapest viagra. So many therapists have reported so many misadventures of MPD patients in heterogeneous groups that their inclusion in such a modality cannot be routinely recommended buy viagra 25mg with mastercard. They work more successfully in task-oriented or project-oriented groups such as that which occupational therapy, music therapy, movement therapy, and art therapy may provide. Some anecdotally describe their successful inclusion in groups with a shared experience, such as those that have been involved in incestuous relationships, rape victims, or adult children of alcoholics. Caul has proposed a model for undertaking an internal group therapy among the alters. A number of workers have described the facilitation of treatment with amobarbital and/or videotaped interviews. Hall, Le Cann, and Schoolar describe treating a patient by retrieving material in amytal in treatment. Caul has described taping hypnotically- facilitated sessions, and offered cautions about the timing of playing back such sessions to the patient. While there are some patients whose personalities tolerate videotaped confrontation with evidence and alters from which they were profoundly dissociated, many are overwhelmed by such data or re-repress it. Such approaches are best considered on a case-by-case basis, and cannot be regarded as uniformly advisable or effective. Caul recognizes this and seems to advocate a version of what hypnotherapists refer to as "permissive amnesia," i. Hypnotherapeutic interventions have an established role in the contemporary treatment of MPD despite the controversy which surrounds their use. On the one hand, a large number of clinicians have helped a good many MPD patients using such interventions. On the other hand, many prominent and eloquent individuals have raised concerns that hypnosis can concretize, exacerbate, or even create MPD (as noted in the first part of this lesson). Often the debate becomes arcane to those unfamiliar with the literature of hypnosis, and the specialized concerns of forensic hypnosis, in which workers struggle to guard against the induction of confabulated or false memories which are perceived as concrete reality, and, if so reported, can impede the judicial process. The thrust of the clinical literature is that judicious hypnotherapeutic interventions thoughtfully integrated into a well-planned psychotherapy, individualized to a particular patient and oriented toward integration, can be extremely productive and helpful, and that ill-advised hypnotic work, like any other inappropriate steps, may well miscarry. The use of hypnosis in exploration, in accessing personalities for therapeutic barriers, in encouraging alters communication, and in encouraging alters communication, and documented by Allison, Bowers et al. A number of clinicians advocate the provision of a very tangible corrective emotional experience, under rubric of reparenting. They undertake to create experiences within the treatment which offer to nurture the patient through a more positive recapitulation of various developmental issues and to provide more positive interjects. Also not available in the literature are papers on the successful approaches involving the coordinated efforts of a team of therapists employing several modalities in conjunction. A number of (3) shaping influences, substrates, and developmental factors determine the form taken by the dissociative defenses (i. Those who remain dissociated are given (4) inadequate stimulus barriers, soothing, and restorative experiences, and are exposed to pressures and further traumatization which reinforce the need for and shape of the dissociative defenses. The elements of the Four-Factor Theory of Etiology have certain implications for treatment. Whether or not a clinician elects to use hypnosis, he ought to be aware of its phenomena, and of how dissociative manifestations may express themselves in clinical settings, especially as psychosomatic and quasi-psychotic presentations. The patient brings his dissociative defenses into the therapy. One must "be gentle, gradual, and avoid imposing upon the patient any overwhelming experience that is not an inevitable concomitant of dealing with painful material. The patient needs to be empathetically understood across and within all personalities; the therapist must deal with all with an "evenhanded gentle respectfulness, but help the patient protect himself from himself. A mutuality of working together and recognition of the difficult nature of the job to be done is essential. These treatments "sink or swim on the quality of the therapeutic alliance established with the personalities. In summary, the therapist must remain within the limits of his competence and not rush to apply incompletely-understood and partially-mastered principles and techniques. The therapist must give integration priority over exploring fascinating phenomena and differences. He should help all alters understand themselves as more or less dissociated sides of a total person. The personalities names are accepted as labels, not as guarantees or individual rights to irresponsible autonomy. All alters must be heard with equal empathy and concern. Often one or more will be especially helpful in advising the therapist about readiness to proceed into painful areas. Psychodynamic psychotherapy is the treatment of choice. Within its context, hypnosis may be valuable for dealing with serious conflicts among alters and, when used synthetically, to help the individual "recognize, consider, and utilize his various past and present experiences, impulses, and purposes for better self-understanding and increased self-direction. Do not dramatize amnesia; assure the patient he will recover his past when he is able. Bowers and two co-authors, Newton and Watkins, in personal communications in a recent source within the rubric of the constructive use of hypnosis. Virtually every aspect of treatment depends on the strength of the therapeutic alliance which must be cultivated globally and with each individual alter. This emphasis is implicit in a general treatment plan outlined by Braun, which has sufficient universality to be applied in most therapy formats. Braun enumerates 12 steps, many of which are overlapping or ongoing rather than sequential. Step 1 involves the development of trust, and is rarely complete until the end of therapy. Operationally, it means "enough trust to continue the work of a difficult therapy. It must be done in a gentle manner, soon after the patient is comfortable in the therapy and the therapist has sufficient data and/or has made sufficient observations to place the issue before the patient in a matter-of-fact and circumspect way. Only after the patient appreciates the nature of his situation can the true therapy of MPD begin. Step 3 involves establishing communication with the accessible alters. In many patients whose alters rarely emerge spontaneously in therapy and who cannot switch voluntarily, hypnosis or hypnotic technique without hypnosis may be useful. Upon gaining access to the alters, Step 4 concerns contracting with them to attend treatment and to agree against harming themselves, others, or the body they share.

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Thank you buy viagra now, Tina cheap viagra 100 mg free shipping, for being our guest purchase viagra 75 mg on-line, for sharing your personal story, providing some excellent information and for answering audience questions. Tina Kotulski: Thank you all for listening and asking such wonderful questions. Croft is a private practice psychiatrist from San Antonio, Texas who is triple board certified in: Adult Psychiatry, Addiction Medicine, and Sex Therapy. His background includes training in both OB-GYN and PSYCHIATRY at the University of Texas Medical Branch in Galveston, Texas. In addition, he trained with the famed sex therapy team of Masters and Johnson. He is also the co-author of the highly acclaimed new book on combat PTSD: "I Always Sit With My Back To The Wall. Army Medical Corps from 1973-1976, when he received the US Army Meritorious Service Medal. He has published papers in The American Journal of OB-GYN, Clinical Therapeutics, Journal of Clinical Psychiatry, Psychiatric Annals The Journal of Sex & Marital Therapy, and others, and has presented at the annual meetings of: The American Medical Association, The American Psychiatric Association, The American College of OB-GYN, The European Congress of Psychopharmacology and others. In addition to lecturing to over 1000 groups of physicians, and mental health professionals in all of the 50 United States, he has also lectured in: Canada, Mexico, France, England, St. He appeared on evening TV newscasts for over 17 years with his national award-winning mental health feature, "The Mind is Powerful Medicine. Branch, Galveston (UTMB), 1968Partial Residency in OB-GYN at UTMB, Completed Psychiatric Residency UTMB, 1972Board Certified in: Adult Psychiatry, Sex Therapy (AASECT), Addiction Medicine (ASAM)In Clinical Practice since 1976 - Principal Investigator in over 3 dozen clinical drug trialsOver 20 publications in medical journalsLast revision: February 2010Private Clinical Psychiatric Practice: 1976 to presentCo-host of the HealthyPlace TV Show: 2007-presentUniversity of Texas Medical Branch, Galveston, Texas1970 - 1973 - Residency, General Psychiatry1969 - 1970 - Partial Residency, Obstetrics & GynecologyBrackenridge Hospital, Austin, Texas1968 - 1969 - Internship, General RotatingSouthern Methodist University, Dallas, Texas1964 - BS Degree in BiologyDISTINGUISHED FELLOW, American Psychiatric Association, 2003FELLOW, American Psychiatric Association, 1993Diplomate in Psychiatry, American Board of Psychiatry & Neurology, 1979Certified Addictionist, American Society of Addiction Medicine, 1990Diplomate in Sex Therapy, American Assoc. Nurnberg, GN, Hensley, PJ, Croft, HA, Debattista, CA, et al "Sildenafil Treatment of Women with Antidepressant-Associated Sexual Dysfunction: A Randomized Clinical Trial," JAMA, July 23/30, 2008 (Vol 300): No 4, 395-404Seagraves, Clayton, Croft, et al "A Multicenter Double Blind Placebo Controlled Study of Bupropion XL in Females with Orgasm Disorders" Poster at Psychiatric Congress 06, New Orleans, 11/06. Croft,HA "Physician Handling of Prescription Stimulants (CME Article)", Pediatric Annals 35:8, 557-562, August, 2006. Clayton, A, Croft HA et al, "Bupropion XL Compared with Escitalopram: Effects on Sexual Functioning and Antidepressant Efficacy in Two Randomized, Double-Blind, Randomized Clinical Studies", Journal of Clinical Psychiatry 67:5 735-746, May, 2006. Croft, HA "Physician Handling of Prescription Stimulants (CME Article)" Psychiatric Annals 35:3 221-226 2005. Wornock JK, Clayton AH, Croft HA, Segraves RT, Biggs CF. Journal of Sex & Marital Therapy (In Print, 06)Seagraves, RT, Clayton, A, Croft, HA et al, "Bupropion Sustained Release for the Treatment of Hypoactive Sexual Desire Disorder in Premenopausal Women," J Clin Psychopharmacology; 2004, 243) 339-342. Labbate, L, Croft,HA, and Oleshansky, MA, "Antidepressant-Related Erectile Dysfunction: Management via Avoidance, Switching Antidepressants, Antidotes, and Adaptation," J Clin Psychiatry, 2003; 64 (10): 11-19. Effects of bupropion sr on weight in the long-term treatment of depression. Effects of bupropion sr on weight in the long term treatment of depression. Thomas, Virgin Islands, February 1999; Society of Biological Psychiatry, Washington, DC, May 1999; The American Psychiatric Association, Washington, DC, May 1999, European College of Neuropsychopharmacology, London, UK, September 1999Kaats, G. Croft has conducted and participated in nearly 50 studies and clinical trials for major pharmaceutical companies for medications primarily focused on depression and anxiety disorders. These pharmaceutical companies include: Forest Laboratories, Sepracor, Bristol-Myers Squibb, Astrazeneca, Sanofi-Aventis, GlaxoSmithKline, Eli Lilly, Merck, Pharmacia & Upjohn, Pfizer, Novartis, and others. Member of Distinguished Faculty for the following CME providers: PsychCME (Duke Psychiatry), Primary Care Network(PCN), Medical World Conferences, Prime MD Net, Texas Association of Family Practice Curriculum Development: Primary Care NetworkManaging Unipolar to Bipolar Depression SpectrumDepression-Long Term Treatment and ChallengesAdvances in Antidepressant TreatmentEvaluation and Treatment of Adult ADHDTreatment of Anxiety DisordersAlcohol and Drug Abuse and Dependence DisordersTreatment of Medication Induced Sexual DysfunctionTreatment of Erectile DysfunctionRESEARCH GRANTS to Croft Group Research CenterHealthyPlace. The funding for the website comes from private individual investors. We do sell advertising to outside companies and organizations. No commercial or non-commercial organizations have contributed funding, services or material for the site (except for paid advertising or sponsorship material which is clearly marked on the specific pages of the website as being "Sponsored By" or an "Advertisement"). Anyone who serves on the content staff must fully disclose any financial or other interests that he or she may have in any drug, biotech, medical device, or other company perceived to have influence in the mental healthcare or healthcare industry. The supervisor will determine whether the interest presents a conflict and, if so, what must be done to eliminate it. No person will serve on both staffs, no content employee will be asked to perform duties on behalf of a sponsor or provide favored treatment to a sponsor or partner. The various sites within each community and extensive information on the issue are listed on the front page of the community or you can click on one of the links below and go directly to that site. These medication patient information pages describe why a particular psychiatric medication is prescribed, important facts about the medication and how you should take it, along with side effects, food and drug interactions, special warnings, taking the medication during pregnancy, recommended dosage and overdose information. Almost all the psychiatric medications such as antidepressants, antipsychotics, and antianxiety medications are covered and presented in plain English. Go here if you are looking for the Psychiatric Medications Pharmacology section which contains more detailed information on each medication. They are also linked from each patient information page. The information in the "Psychiatric Medications Patient Information" section of has been selectively abstracted from various sources. The intended use is as an educational aid and does not cover all possible uses, actions, precautions, side effects, or interactions of any of these medications. This information is not intended as medical advice for individual problems or for making an evaluation as to the risks and benefits of taking a particular drug. The information here should not be used as a substitute for a consultation or visit with your family physician or other health care provider. We bring personal stories of what life is like living with a mental illness. Our goal is to let others facing similar challenges know they are not alone in their feelings and experiences. In the second half of the show, we open it up to you, our viewers. Croft your personal questions about anything you wish concerning mental health. Croft will give you an easy-to-understand straight answer. The show airs live on Tuesday evenings at 8:30p ET, 7:30 CT, 5:30p PT. You can watch the show from the player on the TV Show homepage. If you happen to miss the live show, simply click on the word "on-demand" at the bottom of the player and select the recorded version of the show. 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