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The semi- voluntary nature of tics relates to the fact that they can be Tic Disorders temporarily either suppressed or expressed in an altered or concealed manner (for example, integrating the tic into Motor and/or vocal tics can be transient, episodic, or a series of voluntary movements). Tics are particularly intriguing to neuroscientists voluntary behavior that we all experience is yawning. The insofar as they appear to represent a type of behavior that is urge to yawn can be temporarily suppressed or concealed both voluntary and involuntary with regard to expression. Similarly, the tic is often pre- a number of factors such as chronicity; disturbance to acad- ceded by an urge or sensation (premonitory urge/sensa- emic, social, or work performance; or degree of subjective tion) that can be suppressed, but this produces tension and distress. Simple tics appear more refiexive, Presentation whereas complex tics appear more purposeful and coordi- Gilles de la Tourette was a brilliant neurologist who stud- nated. In extreme cases, motor or speech actions are per- ied with Charcot at the Parisian Hopital de la Saltpetriere formed compulsively. Because Developmentally, tics are evident in healthy developing of his work, the disorder of multiple motor and vocal tics, children, but resolve over time. He suffered gunshot wounds infiicted by a motor or vocal tics for a period greater than 12 months. The average age of onset is 7 years of age, al- 4 though cases are known to occur both earlier and later than this age. Conversely, they tend to diminish when the Age (yrs) child is relaxed, intensely focused on an activity, or emo- tionally calm. Tic severity reaches its highest point between 10 and 12 years of age and begins to decline thereafter. Obsessions are repetitive, intrusive, unwanted, and often Alterations of neurotransmitters intrinsic to the frontos- inappropriate thoughts or images. The cate- contamination, cataclysmic events, symmetry, and exact- cholamines (dopaminergic, serotonergic, and noradrenergic ness. Often, obsessions prompt compulsions that are systems) have received the greatest attention. Compulsive behaviors are many and varied, fre- In part, this is based on the effects of medications that either quently involving checking, counting, ordering, washing, inhibit or facilitate dopamine activity. Dopamine (D2) re- seeking reassurance, and ritualistic behaviors (Bradshaw, ceptor antagonists such as haloperidol (Haldol) reduce motor 2001). Obsessive thoughts/images re- nervous system stimulants (for example, methylphenidate occur and prompt, once again, the compulsive behaviors. A the development of tic disorders as part of an autoimmune number of interpretations have been posed to account for response.
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It is naturally just as unfavourable for a woman if a man approaches her without his full potency as it is if his initial overvaluation of her when he is in love gives place to undervaluation after he has possessed her. In the case of women there is little sign of a need to debase their sexual object. This is no doubt connected with the absence in them as a rule of anything similar to the sexual overvaluation found in men. But their long holding back from sexuality and the lingering of their sensuality in phantasy has another important consequence for them. They are subsequently often unable to undo the connection between sensual activity and the prohibition, and prove to be psychically impotent, that is, frigid, when such activity is at last allowed them. This is the origin of the endeavour made by many women to keep even legitimate relations secret for a while; and of the capacity of other women for normal sensation as soon as the condition of prohibition is re-established by a secret love affair: unfaithful to their husband, they are able to keep a second order of faith with their lover. On the Universal Tendency To Debasement In the Sphere Of Love 2344 the condition of forbiddenness in the erotic life of women is, I think, comparable to the need on the part of men to debase their sexual object. Both are consequences of the long period of delay, which is demanded by education for cultural reasons, between sexual maturity and sexual activity. Both aim at abolishing the psychical impotence that results from the failure of affectionate and sensual impulses to coalesce. That the effect of the same causes should be so different in men and in women may perhaps be traced to another difference in the behaviour of the two sexes. Civilized women do not usually transgress the prohibition on sexual activity in the period during which they have to wait, and thus they acquire the intimate connection between prohibition and sexuality. Men usually break through this prohibition if they can satisfy the condition of debasing the object, and so they carry on this condition into their love in later life. In view of the strenuous efforts being made in the civilized world to-day to reform sexual life, it will not be superfluous to give a reminder that psycho-analytic research is as remote from tendentiousness as any other kind of research. It has no other end in view than to throw light on things by tracing what is manifest back to what is hidden. It is quite satisfied if reforms make use of its findings to replace what is injurious by something more advantageous; but it cannot predict whether other institutions may not result in other, and perhaps graver, sacrifices. The damage caused by the initial frustration of sexual pleasure is seen in the fact that the freedom later given to that pleasure in marriage does not bring full satisfaction. But at the same time, if sexual freedom is unrestricted from the outset the result is no better. It can easily be shown that the psychical value of erotic needs is reduced as soon as their satisfaction becomes easy. An obstacle is required in order to heighten libido; and where natural resistances to satisfaction have not been sufficient men have at all times erected conventional ones so as to be able to enjoy love. In times in which there were no difficulties standing in the way of sexual satisfaction, such as perhaps during the decline of the ancient civilizations, love became worthless and life empty, and strong reaction-formations were required to restore indispensable affective values.
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A boy, who had also heard of the egg, identified it with the testicle, which [in German] is vulgarly called by the same word [Ei]; and he racked his brains to make out how the contents of the scrotum could be constantly renewed. The information given seldom goes far enough to prevent important uncertainties about sexual events. Thus a girl may arrive at an expectation that intercourse occurs on one occasion only, but that it lasts a very long time twenty-four hours and that all the successive babies come from this single occasion. One would suppose that this child had got her knowledge of the reproductive process from certain insects; but it turned out that this was not so and that the theory emerged as a spontaneous creation. Other girls are ignorant of the period of gestation, the life in the womb, and assume that the baby appears immediately after the first night of intercourse. These later sexual researches of children, or of adolescents who have been retarded at the stage of childhood, offer an almost inexhaustible theme and one which is perhaps not uninteresting in general; but it is more remote from my present interest. I must only lay stress on the fact that in this field children produce many incorrect ideas in order to contradict older and better knowledge which has become unconscious and is repressed. The way in which children react to the information they are given also has its significance. In some, sexual repression has gone so far that they will not listen to anything; and these succeed in remaining ignorant even in later life apparently ignorant, at least until, in the psycho-analysis of neurotics, the knowledge that originated in early childhood comes to light. It is true that the phantasies are unconscious; but apart from this they are of the same nature as the phantasies which can be observed directly in day-dreams or which can be elicited by interpretation from dreams at night. Often a dream takes the place of an attack, and still more often it explains it, since the same phantasy finds a different expression in a dream and in an attack. We might expect then that by observing an attack we should be able to get to know the phantasy represented in it; but this is seldom possible. A hysterical attack, therefore, needs to be subjected to the same interpretative revision as we employ for night-dreams. But not only are the forces from which the distortion proceeds and the purpose of the distortion the same as those we have come to know through the interpretation of dreams; the technique employed in the distortion is the same too. Some General Remarks On Hysterical Attacks 1982 (1) the attack becomes unintelligible through the fact that it represents several phantasies in the same material simultaneously that is to say through condensation. The elements common to the two (or more) phantasies constitute the nucleus of the representation, as they do in dreams. The phantasies which are thus made to coincide are often of quite a different nature. They may, for instance, be a recent wish and the re-activation of an infantile impression. The same innervations are in that case made to serve both purposes, often in a most ingenious way.
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Clefts of the palate have substantially more severe effects on speech intelligibility than do isolated clefts of the lip. Pharyngeal flap procedures are considered secondary surgi- cal interventions and involve joining a flap of soft tissue from the posterior pharyngeal wall to the palate, creating a bridge that partially occludes the velopharyngeal space. This pro- cedure is performed primarily for the purpose of facilitating velopharyngeal closure during speech. This results in audible nasal emission of air, hypernasal resonance, and articulation errors. This leakage of air results in reduced oral breath pressure for the production of pressure consonants. The most common types of errors demonstrated by cleft palate speakers are distortions and omissions, with occasional substitutions in the form of glottal stops and pharyngeal fricatives. Therapy focusing solely on oral direction of the breath stream is not usually recom- mended for children who demonstrate clear evidence of vPi. This example has been designed to illustrate the selection of intervention targets as well as specific therapy activities and materials. The five main goals of speech therapy with children with cleft palate are (1) correct articulatory placement, (2) achieve light articulatory con- tacts, (3) attain a greater mouth opening, (4) decrease hypernasal resonance quality, and (5) promote more anterior placement of articulatory production (golding-Kushner, 2000; Kummer, 2008). The /k/, /g/, /t/, and /d/, as well as /p/ and /b/, were selected because pressure consonants are the most effective vehicles for demonstrating light articulatory contact (less forceful move- ments of oral muscles). Compile a set of 20 pictures that are clear demonstrations of the concept of front versus back. Tell the child that this is a memory game in which he and the clinician will take turns selecting pictures, one at a time, to try to match the pairs that represent the front and back of each object. Tell him that some sounds are made at the front of the mouth, like /p/ and /t/, and others are made at the back like /k/ and /g/. The level of response complexity can be increased from imitative to spontaneous and also can be programmed to vary from syllables to lengthy sentences.
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We have already found repeatedly that characteristics which were claimed as being of general validity have turned out to apply only to a particular sort and number of dreams. It is our view that these other dreams have undergone a far-reaching distortion and for that reason cannot be judged at a first glance. These are the dreams which all through life are called up by imperative bodily needs hunger, thirst, sexual need that is, they are wish-fufilments as reactions to internal somatic stimuli. Introductory Lectures On Psycho-Analysis 3228 Observations on prisoners who have been compelled to starve, and on people who have been subjected to privations on travels and explorations, teach us that under these conditions the satisfaction of their needs is regularly dreamt of. Even those of us who otherwise dreamt but rarely had long stories to tell in the morning when we exchanged our latest experiences in this world of the imagination. They were all concerned with the outside world which was now so remote from us, though they were often adapted to our actual circumstances. Eating and drinking, however, were the pivot round which our dreams most often revolved. One of us, who had a special gift for attending large luncheon parties during the night, was proud if he was able to report in the morning that he had "got through a three-course dinner". Another of us dreamt of tobacco, of whole mountains of tobacco; while a third dreamt of a ship in full sail coming in across open water. The postman brought round the mail and gave a long explanation of why we had had to wait so long for it: he had delivered it at the wrong address and had only succeeded in recovering it with great difficulty. But there was a most striking lack of imaginativeness shown by almost all the dreams I dreamt myself or heard described.
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