Sunday, November 10, 2019
Bipolar Disorder
Some people are more prone to either mania or depression, while others alternate equally between the two types of episodes. Some have frequent mood disruptions, while others experience only a few over a lifetime. There are four types of mood occurrences in bipolar disorder: mania, hypomania, depression, and mixed episodes. Each type of bipolar disorder mood episode has a unique set of symptoms. Mania Symptoms In the manic phase of bipolar disorder, feelings of heightened energy, creativity, and euphoria are common. People experiencing a manic episode often talk a recklessly and profligately, scarcely sleep, and are hyperactive.They may also feel like they're omnipotent, impregnable, or destined for prominence. Although mania inaugurates with delightful sensations, it has a tendency to spiral out of control. People often Denave uncontrollaDly aurlng a manic eplsoae: gamDllng away savlngs, engaging In inappropriate sexual activity, or making irrational business investments, for example . They may also become angry, irritable, and aggressiveâ⬠picking fights, lashing out when others don't go along with their plans, and blaming anyone who criticizes their behavior.Some even become delusional or start hearing voices. Depression Symptoms In the past, bipolar depression was amalgamated in with regular depression. But a mounting reservoir of research suggests that there are significant differences between the two, particularly when it comes to recommended treatments. Most people with bipolar depression are not helped by antidepressants. In fact, there is a risk that antidepressants can make bipolar disorder worseâ⬠triggering mania or hypomania, causing rapid cycling between mood states, or interfering with other mood stabilizing drugs.Despite many similarities, certain symptoms are more common in bipolar depression than in regular depression. For example, bipolar epression is more likely to involve irritability, guilt, unpredictable mood swings, and feelings of restlessness. People with bipolar depression also tend to move and speak slowly, sleep a lot, and gain weight. In addition, they are more likely to develop psychotic depressionâ⬠a condition in which theyVe lost contact with realityâ⬠and to experience major disability in work and social functioning.TYPES There are several types of bipolar disorder; all involve episodes of depression and mania to a degree. They include bipolar l, bipolar II, cyclothymic disorder, mixed bipolar, and rapid-cycling bipolar disorder. Bipolar I Raging bipolar (l) is characterized by at least one full-blown manic episode lasting at least one week or any duration if hospitalization is required. This may include inflated self-esteem or grandiosity, decreased need for sleep, being more loquacious than usual, flight of ideas, distractibility, an increase in goal-oriented activity, and excessive involvement in hazardous activities.The symptoms are severe enough to disrupt the patient's ability to work and socialize, and may require hospitalization to prevent harm to themselves or others. The patient may lose touch with reality to the point of being psychotic. The other option for raging bipolar is at least one ââ¬Å"mixedâ⬠episode on the part of the patient. The DSM-IV is uncharacteristically vague as to what constitutes mixed, an accurate reflection of the confusion within the psychiatric profession. More tellingly, a mixed episode is almost impossible to explain to the public. One is literally ââ¬Å"upâ⬠and ââ¬Å"downâ⬠at the same time.Bipolar II Swinging bipolar (II) presumes at least one major depressive episode, plus at least one hypomanic episode over at least four days. The same characteristics as mania are evident, with the disturbance of mood observable by others; but, the episode is ot enough to disrupt normal functioning or necessitate hospitalization and there are no psychotic features. Those in a state of hypomania are typically the life of the party, the salesperson of the month and more often than not the best-selling author or Fortune 500 mover and shaker, which is why so many refuse to seek treatment.But the same condition can also turn on its victim, resulting in bad decision-making, social embarrassments, wrecked relationships and projects left unfinished. Rapid Cycling DSM-IV defines rapid cycling as the occurrence of at least 4 major depressive, manic, ypomanlc, or mlxea eplsoaes aurlng tne prevlous year In a patient wltn a Olagnosls of BP I or BP II. These episodes must be demarcated either by a partial or full remission of at least 2 months' duration or by a switch to an episode of opposite polarity.Duration criteria for episodes are not waived, which means that each major depressive episode must last at least 2 weeks, each manic or mixed episode must last at least 1 week, and each hypomanic episode must last at least 4 days. Mixed Bipolar A mixed episode is not a disorder itself, but rather is a description of a component of a specific type of bipolar disorder. A mixed episode is defined by meeting the diagnostic criteria for both a manic episode as well as a major depressive episode nearly every day for at least a full week.Like most mental disorders, a mixed episode must be severe enough to cause distress or impairment in social, occupational, education or other important functioning and is not better accounted for by the physiological effects of substance use, or abuse, or a general medical condition. Cyclothymia Cyclothymia is a chronic bipolar disorder consisting of short periods of mild depression and short periods of hypomania, lasting a few days to a few weeks, eparated by short periods of normal mood.Individuals with cyclothymia are never liberated of symptoms of either depression or hypomania for more than two months at a time. In 1980 the classification of cyclothymia was changed in the DSM-IV from Personality Disorder to Mood Disorder. Though the above description portrays cycl othymia as a mild disorder, it is so only relative to the severity of Bipolar I and Bipolar II disorders. Cyclothymia can completely disrupt the life of an individual and create personal chaos. In their continual oscillation of mood, they never know from ne day to the next what to expect.TREATMENTS Bipolar disorder is being better understood each day. There is also ongoing research into its treatment. But successfully treating bipolar disorder can involve several medication trials, and it can take years to achieve remission. Even if remission is attained, recurrence is the rule â⬠not the exception. It's not uncommon for all first- line treatments to be exhausted. Common Treatments Lithium and the anticonvulsants lamotrigine and valproate are treatments for bipolar depression. They are mood stabilizers. For severely ill patients, lithium and an ntidepressant are sometimes used.A mood-stabilizing medication works on improving social interactions, mood, and behavior and is recomm ended for both treatment and prevention of bipolar mood states that swing from the lows of depression to the highs of hypomania or mania. According to the American Psychiatric Association (APA), lithium, lamotrigine, valproate, carbamazepine, and most atypical antipsychotic medications are approved by the FDA for treating one, or more, phases of bipolar disorder. Treatment Resistance There is no consensus among clinicians and researchers on one definition of reatment resistance.Generally, patients in an acute state, manic, depressed, or mixed, whose symptoms do not improve after at least two evidence-based medication trlals are conslaerea treatment-reslstant In researcn stu01es. In tne malntenance phase, patients are considered treatment-resistant if they continue cycling despite several adequate medication trials. In some studies additional criteria must be met in order to truly be considered treatment-resistant. These include functional measures of remission. Dr. Prakash Masand, p sychiatrist and founder of Global Bipolar Disorder Bipolar Disorder Heather McLean HCA/240 Maryam Pirnazar 4/14/2013 Introduction Bipolar disorder is a brain disorder it can cause shifts in moods, activity level, energy, and also the ability to due day-to-day tasks. It is also commonly known as manic- depressive illness. This disorder is one of the oldest illnesses that is known. It is one of the first noticed that goes as far back and the second century. The first person that recognized the some of the symptoms is Aretaeus of Cappadocia. What he found went unnoticed until Richard Burton a scientist wrote a book, which the main focus was depression.This is still used in todayââ¬â¢s time. There are many different myths and misconceptions about bipolar disorder. Some myths about bipolar disorder consists of things that people believe like, bipolar disorder can not get better or people with the disorder can not lead a normal life, people with this disorder swing back and forth between depression and mania. Some even believe that dipo lar disorder only affects moods, and some believe that medication is the only way people with this disorder can control it. Only with getting the facts will people be able to understand the truth about bipolar disorder.The causes of bipolar are unknown. There are several factors that do seem to play a role in triggering the bipolar episodes. These causes consist of biological differences, neurotransmitters, hormones, inherited trait, and environment. Theyââ¬â¢re are some that believes that, bipolar disorder is inherited and a family trait. Symptoms Symptoms for bipolar disorder are severe and people do not notice them off the bat. When a patient had bipolar disorder people experience different states. When patients have bipolar disorder, they experience an intense emotional state, which can be called ââ¬Ëmood episodesââ¬â¢.A person that experience overly joy or overly excited times is called manic episodes. When bipolar disorder patients experience extreme hopelessness or s ad states, is considered to be a depressive episodes. There are even times when episodes are mixed, which are considered as mixed states. There are many different things that go with the symptoms of bipolar disorder. Patients can have extreme changes in their activity, energy, sleep patterns, and their changes in their total behavior. It is also possible that people with this disorder can have episodes for a long period of time.Symptoms of mania include mood changes, the patient can feel high or overly happy or a long period of time, and extreme irritable moods. Their behavioral changes consists of talking fast, going from one idea to a different one, easily distracted, an increase in goal-directed activities, being restless, have little sleep, behave impulsively and taking part in high risk behavior. They can also have unrealistic beliefs in ones abilities. Symptoms of depression include a long period of feelings, worry or even empty, a lack of interest and activities, which includ es sex.The behavior changes are felling tired, problems with concentration, and memory and even making decisions. Other symptoms are restlessness, a change in eating habits, and thinking about death and suicide. Neurotransmitters Neurotransmitters are also involved with the signs and symptoms of bipolar disorders. Before knowing how it is involved in bipolar disorder, knowing what neurotransmitters are important. A neurotransmitter is a chemical substance that is released at the very end of the nerve fiber. It transmits signals from the neuron to a target cell across a synapse.With bipolar disorders, neurotransmitters are involved in the aetiology of mood disorder. In earlier theories, suggestions where made that an excess of neurotransmitters occurred during a manic episode, which is not really what happens. It is the effectiveness of the cell functions under the modification and the control of neurotransmitters that underlines the patho-aetiology of mood disorders. Diagnoses Some people wonder how bipolar disorder is diagnosed. The person can do is talk to a doctor that can diagnose and give a physical examination, and mental lab test.It cant be found through a blood test or even a brain scan, although these tests can help make sure that there are not any other contributing factors. The doctor can then conduct a evaluation of mental health. He can also give a patient a referral to a mental health professional, like a psychiatrist, which is more experienced with diagnosing bipolar disorders. When conducting a diagnostic evaluation they discuss all family history and get the patients history of any symptoms. They will also talk about the patients close relatives and spouse.Getting more information about the patient and what they are going through in life will also help determine whether or not they are bipolar. When a person has bipolar disorder, they are more likely to look for help in their most vulnerable state, which is when they are depressed. Making sure that the patient is not mistakenly diagnosed it is important for the doctor to make sure that the patients medical history is done with care. After going thought the process of being diagnosed, the doctor will then find the appropriate treatment for the patient.Treatment Bipolar disorder has no known cure. The best thing for patients is to have proper treatments, to have a better control over their mood swings and other symptoms they may have. Patients with bipolar disorder are in need for a long-term treatment because the disorder is a lifetime disorder. The most affective treatment plan involves medication and psychotherapy, which help the patient from relapsing and helps them reduce the severity of their symptoms. Normally someone that is a doctor of medicine prescribes by a psychiatrist or medications.There are also others that can prescribe medications like psychiatric nurse practitioners, advanced psychiatric nurse specialists and clinical psychologists, but it all depends on the state that you are in, and it is best to check with your states licensing agency to make sure. Some of the types of medications that are used to treat bipolar disorders are, mood-stabilizing medications like Lithium and Valproic, Atypical ant-psychotic medicates like Olanzapine, and Aripiprazole, and antidepressant medications like Fluoxetine. Everyone may not respond to the medications in the same exact way.It may even take different tries with different medications to get the right one that works for the right patient. It may even help to keep a daily chard or the patients mood symptoms, sleep patterns, treatments, and their everyday life to make sure you can tell the doctor about how affective the medication is. With every medication, it is important that you know the side effects and patients should always talk to their doctor about and risks and benefits. Psychotherapy is a part of the treatment with bipolar disorders. It is really when the patient goes in to talk in thera py.It is a way to provide education, guidance, and more important support. Some treatments that can be used in psychotherapy are, cognitive behavioral therapy, family focused therapy, interpersonal and social rhythm therapy, and psycho-education. It is a way to let the patient talk out their feeling and what is going on in their lives, and a way for the doctor to talk to the patient about how they should deal with thing and educate them on the process. Environmental surrounds also could help a person with bipolar disorder, not have an episode or is may cause them to have one. EnvironmentalAn environmental surround of a person that is suffering from bipolar disorder is very important. It is important that the patient understands that doing certain thing or even being around certain people may cause them to have an episode. If the patient is around people and surrounding that does not stressful and not giving the patient a hard time will help them not get over work about things, and b eing around people and place that could upset the patient can cause them to have an episode. Any life event may trigger an episode; alcohol or drug abuse or even hormonal problems can cause an episode.Knowing what is causing the episodes is important, and the patient will be able to have a better control over their episodes. In the Past Things are so much different than when they were before the 20th century. Before the 20th century diagnostic was done a bit different than in todayââ¬â¢s time and so was the treatments. Physical explanations gave way to many theories that believed that mental illness came in the mind. The causes were thought to be a demonic possession or even a moral weakness, and it could be cured by exorcism or a religious zeal. People were even outcast and many was even convicted of consorting with the devil and burned.With ancient treatments, Egyptians believed that depression was caused by a reversal of fortune or even a loss of status. They thought that it c ould have been cured by talking it out or for the person to look to a religious faith. Some people believe that mental illness was a gift from the heavens, and it should have been cherished. The Greeks believed that depression was an overabundance of mania to yellow bile and black bile, that lives in the body, and the only help for it was bleeding or for the person to purge the system to regain their balance.In todayââ¬â¢s time doctors are used to determine what is wrong with the patient, and they are able to treat them with medication and therapy to help them deal with their disorders. Conclusion It is a good thing that in todayââ¬â¢s time we have people to example patients and get appropriate diagnoses for them, and to also make sure they get the help that is needed. Understanding what is going on with a persons mind is important and making sure they know how to deal with a life long situation like bipolar disorder, is necessary. Experience from a Patient with Bipolar Disord er Living with bipolar disorder isnââ¬â¢t easy. You never know when youââ¬â¢re going to have a good or bad day. You just have to be ready for whichever one comes. The medication help a little, but you have to be mentally strong to deal with the things this serious disorder will put you through, that the way I felt was completely natural. I had weeks I was angry, sad, and someday I was happy. It was easy to set me off, I would get mad at simple things and hold on to that anger. School become harder, I didnââ¬â¢t want to be there, everything pushed my buttons.I would hold my anger for so long and it would build up, then someone says something and I would blow the top off the kettle. Finally my build up anger caused me to go to fail, after that I decided I needed some sort of help. I made an appointment with an anger management person and they asked me some very personal questions. They proceeded to a drug test after I told them I did not do drugs, and everything was clean. Th en she said she wanted to try me on a simple mood stabilizer. So for a month I took this medicine called Saphris. It tasted like sulfur, and kept me awake and made me very hyper.I couldnââ¬â¢t sleep and wasnââ¬â¢t really hungry or anything. So I told her on my next visit what I was experiencing. She then changed it to a higher dosage and it did the same things. So my nexts visit, which was a month later, she changed my medicines again, and this time it was a simple anti-depressant call Prozac. Since taking this medicine I have gotten better, I am less angry, sad and hyper. I finally fell semi-normal, its been two months and I am pretty much controlling my moods with the help of Prozac, but I still have my days, that normal just something I live with daily and I am beginning to cop pretty well with everyday life. (Dezarare Walden 4/13/2013). Dezarae is an 18 year old, white, female, which agree to write her experience of bipolar disorder for me. The best way to talk to people a bout it, is to speak to those who are experiences the disorder. Reference: Copyright à © caregiver. com, Inc. 1995 ââ¬â 2013 à ©Helpguide. org Duman et al, 1997; Duman, 2002 U. S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health NIH Publication No. 09-3679 Revised 2008 Reprinted 2009 Bipolar Disorder Bipolar Disorder Heather McLean HCA/240 Maryam Pirnazar 4/14/2013 Introduction Bipolar disorder is a brain disorder it can cause shifts in moods, activity level, energy, and also the ability to due day-to-day tasks. It is also commonly known as manic- depressive illness. This disorder is one of the oldest illnesses that is known. It is one of the first noticed that goes as far back and the second century. The first person that recognized the some of the symptoms is Aretaeus of Cappadocia. What he found went unnoticed until Richard Burton a scientist wrote a book, which the main focus was depression.This is still used in todayââ¬â¢s time. There are many different myths and misconceptions about bipolar disorder. Some myths about bipolar disorder consists of things that people believe like, bipolar disorder can not get better or people with the disorder can not lead a normal life, people with this disorder swing back and forth between depression and mania. Some even believe that dipo lar disorder only affects moods, and some believe that medication is the only way people with this disorder can control it. Only with getting the facts will people be able to understand the truth about bipolar disorder.The causes of bipolar are unknown. There are several factors that do seem to play a role in triggering the bipolar episodes. These causes consist of biological differences, neurotransmitters, hormones, inherited trait, and environment. Theyââ¬â¢re are some that believes that, bipolar disorder is inherited and a family trait. Symptoms Symptoms for bipolar disorder are severe and people do not notice them off the bat. When a patient had bipolar disorder people experience different states. When patients have bipolar disorder, they experience an intense emotional state, which can be called ââ¬Ëmood episodesââ¬â¢.A person that experience overly joy or overly excited times is called manic episodes. When bipolar disorder patients experience extreme hopelessness or s ad states, is considered to be a depressive episodes. There are even times when episodes are mixed, which are considered as mixed states. There are many different things that go with the symptoms of bipolar disorder. Patients can have extreme changes in their activity, energy, sleep patterns, and their changes in their total behavior. It is also possible that people with this disorder can have episodes for a long period of time.Symptoms of mania include mood changes, the patient can feel high or overly happy or a long period of time, and extreme irritable moods. Their behavioral changes consists of talking fast, going from one idea to a different one, easily distracted, an increase in goal-directed activities, being restless, have little sleep, behave impulsively and taking part in high risk behavior. They can also have unrealistic beliefs in ones abilities. Symptoms of depression include a long period of feelings, worry or even empty, a lack of interest and activities, which includ es sex.The behavior changes are felling tired, problems with concentration, and memory and even making decisions. Other symptoms are restlessness, a change in eating habits, and thinking about death and suicide. Neurotransmitters Neurotransmitters are also involved with the signs and symptoms of bipolar disorders. Before knowing how it is involved in bipolar disorder, knowing what neurotransmitters are important. A neurotransmitter is a chemical substance that is released at the very end of the nerve fiber. It transmits signals from the neuron to a target cell across a synapse.With bipolar disorders, neurotransmitters are involved in the aetiology of mood disorder. In earlier theories, suggestions where made that an excess of neurotransmitters occurred during a manic episode, which is not really what happens. It is the effectiveness of the cell functions under the modification and the control of neurotransmitters that underlines the patho-aetiology of mood disorders. Diagnoses Some people wonder how bipolar disorder is diagnosed. The person can do is talk to a doctor that can diagnose and give a physical examination, and mental lab test.It cant be found through a blood test or even a brain scan, although these tests can help make sure that there are not any other contributing factors. The doctor can then conduct a evaluation of mental health. He can also give a patient a referral to a mental health professional, like a psychiatrist, which is more experienced with diagnosing bipolar disorders. When conducting a diagnostic evaluation they discuss all family history and get the patients history of any symptoms. They will also talk about the patients close relatives and spouse.Getting more information about the patient and what they are going through in life will also help determine whether or not they are bipolar. When a person has bipolar disorder, they are more likely to look for help in their most vulnerable state, which is when they are depressed. Making sure that the patient is not mistakenly diagnosed it is important for the doctor to make sure that the patients medical history is done with care. After going thought the process of being diagnosed, the doctor will then find the appropriate treatment for the patient.Treatment Bipolar disorder has no known cure. The best thing for patients is to have proper treatments, to have a better control over their mood swings and other symptoms they may have. Patients with bipolar disorder are in need for a long-term treatment because the disorder is a lifetime disorder. The most affective treatment plan involves medication and psychotherapy, which help the patient from relapsing and helps them reduce the severity of their symptoms. Normally someone that is a doctor of medicine prescribes by a psychiatrist or medications.There are also others that can prescribe medications like psychiatric nurse practitioners, advanced psychiatric nurse specialists and clinical psychologists, but it all depends on the state that you are in, and it is best to check with your states licensing agency to make sure. Some of the types of medications that are used to treat bipolar disorders are, mood-stabilizing medications like Lithium and Valproic, Atypical ant-psychotic medicates like Olanzapine, and Aripiprazole, and antidepressant medications like Fluoxetine. Everyone may not respond to the medications in the same exact way.It may even take different tries with different medications to get the right one that works for the right patient. It may even help to keep a daily chard or the patients mood symptoms, sleep patterns, treatments, and their everyday life to make sure you can tell the doctor about how affective the medication is. With every medication, it is important that you know the side effects and patients should always talk to their doctor about and risks and benefits. Psychotherapy is a part of the treatment with bipolar disorders. It is really when the patient goes in to talk in thera py.It is a way to provide education, guidance, and more important support. Some treatments that can be used in psychotherapy are, cognitive behavioral therapy, family focused therapy, interpersonal and social rhythm therapy, and psycho-education. It is a way to let the patient talk out their feeling and what is going on in their lives, and a way for the doctor to talk to the patient about how they should deal with thing and educate them on the process. Environmental surrounds also could help a person with bipolar disorder, not have an episode or is may cause them to have one. EnvironmentalAn environmental surround of a person that is suffering from bipolar disorder is very important. It is important that the patient understands that doing certain thing or even being around certain people may cause them to have an episode. If the patient is around people and surrounding that does not stressful and not giving the patient a hard time will help them not get over work about things, and b eing around people and place that could upset the patient can cause them to have an episode. Any life event may trigger an episode; alcohol or drug abuse or even hormonal problems can cause an episode.Knowing what is causing the episodes is important, and the patient will be able to have a better control over their episodes. In the Past Things are so much different than when they were before the 20th century. Before the 20th century diagnostic was done a bit different than in todayââ¬â¢s time and so was the treatments. Physical explanations gave way to many theories that believed that mental illness came in the mind. The causes were thought to be a demonic possession or even a moral weakness, and it could be cured by exorcism or a religious zeal. People were even outcast and many was even convicted of consorting with the devil and burned.With ancient treatments, Egyptians believed that depression was caused by a reversal of fortune or even a loss of status. They thought that it c ould have been cured by talking it out or for the person to look to a religious faith. Some people believe that mental illness was a gift from the heavens, and it should have been cherished. The Greeks believed that depression was an overabundance of mania to yellow bile and black bile, that lives in the body, and the only help for it was bleeding or for the person to purge the system to regain their balance.In todayââ¬â¢s time doctors are used to determine what is wrong with the patient, and they are able to treat them with medication and therapy to help them deal with their disorders. Conclusion It is a good thing that in todayââ¬â¢s time we have people to example patients and get appropriate diagnoses for them, and to also make sure they get the help that is needed. Understanding what is going on with a persons mind is important and making sure they know how to deal with a life long situation like bipolar disorder, is necessary. Experience from a Patient with Bipolar Disord er Living with bipolar disorder isnââ¬â¢t easy. You never know when youââ¬â¢re going to have a good or bad day. You just have to be ready for whichever one comes. The medication help a little, but you have to be mentally strong to deal with the things this serious disorder will put you through, that the way I felt was completely natural. I had weeks I was angry, sad, and someday I was happy. It was easy to set me off, I would get mad at simple things and hold on to that anger. School become harder, I didnââ¬â¢t want to be there, everything pushed my buttons.I would hold my anger for so long and it would build up, then someone says something and I would blow the top off the kettle. Finally my build up anger caused me to go to fail, after that I decided I needed some sort of help. I made an appointment with an anger management person and they asked me some very personal questions. They proceeded to a drug test after I told them I did not do drugs, and everything was clean. Th en she said she wanted to try me on a simple mood stabilizer. So for a month I took this medicine called Saphris. It tasted like sulfur, and kept me awake and made me very hyper.I couldnââ¬â¢t sleep and wasnââ¬â¢t really hungry or anything. So I told her on my next visit what I was experiencing. She then changed it to a higher dosage and it did the same things. So my nexts visit, which was a month later, she changed my medicines again, and this time it was a simple anti-depressant call Prozac. Since taking this medicine I have gotten better, I am less angry, sad and hyper. I finally fell semi-normal, its been two months and I am pretty much controlling my moods with the help of Prozac, but I still have my days, that normal just something I live with daily and I am beginning to cop pretty well with everyday life. (Dezarare Walden 4/13/2013). Dezarae is an 18 year old, white, female, which agree to write her experience of bipolar disorder for me. The best way to talk to people a bout it, is to speak to those who are experiences the disorder. Reference: Copyright à © caregiver. com, Inc. 1995 ââ¬â 2013 à ©Helpguide. org Duman et al, 1997; Duman, 2002 U. S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health NIH Publication No. 09-3679 Revised 2008 Reprinted 2009
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