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Evidence exists that the Thirteen Moon/28-Day measure was widely known in prehistory symptoms you need a root canal 50 mg revia amex. We find evidence of its use as a prehistoric synchronic measure in the remote past of China medications related to the lymphatic system cheap 50mg revia otc, in Polynesia symptoms 8 days past ovulation buy revia 50 mg visa, and scattered across late neolithic Europe and the Middle East symptoms of strep discount 50 mg revia otc. Among the Maya it was known as the Tun Uc, literally "moon count" or count of seven, while the living tradition of the Thirteen Moon/28-Day calendar is still continued in South America and in the British Isles, where it is known as the Druid Tree calendar. While the Druid calendar has no year count attached to it that would definitively testify to its prehistoric ancestry, the South American cal endar does. Known as the Pachacuti, the South American Thirteen Moon/28-Day calendar is currently in the year 5509, which places its origins at 3308 B. If we understand that calendars are genuine time-measuring devices meant to synchronize us with the cosmic order within the biosphere, and that calendars are thereby programming devices, we may then say that a calendar of perfect harmony can have no history. In other words, by its harmony such a calendar is always in tune with the cosmos, which is beyond history. History can only be a function of a dishar monic programming, not in sync or even at odds with the laws of natural time. From the point of view of timing devices, there are two factors in the establish ment of history. The first is the 12:60 program established 5,000 years ago with the division of the day into 24 hours, 60 minutes, 60 seconds, based on the 360-degree division of the circle. The other factor is the use of a purely lunar calendar that is difficult to reconcile with the actual measure of the solar year. The purpose of the 12:60 measure was to establish a timing standard that was actually a pseudosolar calendar to assert male intellectual dominance. The Babylonian (and later, Egyp tian) calendar consisted of twelve 30-day cycles = 360 days = 360 degrees, plus an extra 5-day cycle. The 30-day measure is not actually a natural one, being a half day more than the synodic lunar measure, but one that conforms to the hexagisimal (6-based) mathematics of the circle. Its ultimate descendent, as we shall see, is the twelve month Julian/Gregorian system. Its measure, however, is that of eighteen 20-day cycles (18 x 20 = 360) plus the 5-day cycle (uayeb), the 20-day cycle (vinal) being a mathematical function of the 13:20 frequency. In addi tion, the Maya had the measure of the tun, the 360-day count of which is precisely the same as that of the degrees of the circle. It was the tun that the Maya used to measure the thirteen baktun count, which actually consists of5,200 tun (5,125 solar years). The purpose of this measure was to provide an exact harmonic standard for the measure of history that, we may recall, is the duration of artificial time. It is very relevant that the harmonic standard of the thirteen baktun Wave Harmonic of history is the 360-day tun, the actual temporal equivalent of the degrees of a circle in space. The precise measurement of the cycle of artificial time, which turned out to be anything but har monic, could yet be measured with a harmonic unit that reflects both the circle and the mathematical perfection of the Law of Time. How better to coordinate the entire cycle of artificial time than by the tun, a unit of measure that reflects the 360-degree circle, the basis of the original error in artificial time? As we will later observe, the fact that the Law of Time coordinates even the cycles of artificial time is also evident in the analysis of the timing of the fatal flaw of the Twin Towers apocalypse. While the Babylonians began to apply a hexagisimal time-reckoning device based on spatial metrics of the circle, another factor became predominant in the Old World: the rise of the synodical lunar calendar as the exclusive measure of time. The synodi callunar calendar is purely lunar in that it is not evidently or perfectly harmonized with the 365-day measure of the solar cycle-a fact of great consequence for the development of mainstream civilization. The Babylonian calendar, with its abroga tion of the thirteen perfect 28-day months, established the pseudosolar twelve-month measure. This twelve-month measure conformed to the lunar measure of twelve synodic lunations per lunar year. And in reality, although we tend to think of the moon as feminine, the knowledge of the synodic measure, the cycle from new moon to new moon, became the exclusive province of a male priest class that used the lunar calendars to capture and control the feminine principle, and to oppress women in general. Whereas the Babylonian and Egyptian solar calendars fell into disuse over time, the lunar calendar persisted. Since there is only one moon orbiting Earth, it should be kept in mind that all lunar calendars are essentially the same. So when we speak of different lunar calendars most notably the Hebrew, the Islamic, and the Chinese-the measure is basically the 68. It is the program ming of the different holidays and festivals of the calendars, along with the dating of their new year, that makes each lunar calendar tradition distinct and that also dem onstrates how a calendar is a programming device. For instance, if one were to take out the different holidays programmed into the Hebrew lunar calendar, there really would be no such thing asJudaism. This demonstrates that the cultural conditioning of a people is totally dependent on the programming of the calendar they use. This also shows how a calendar is a feedback mechanism that maintains a group of people within the confines of its own self-established belief system. Of the three lunar calendars we have mentioned, the oldest count of years is accorded to the Hebrew calendar. This year Rosh Hashanah, or Jewish New Year, occurred on the new moon, September 17, 2001, and marked the beginning of year 5762. The Hebrew calendar (like the Chinese calendar, which we will discuss below) makes up for the slippage of eleven days per solar year by intercalating a thirteenth lunation cycle approximately every three years, or exactly seven such thirteenth moons every nine teen years. These numbers too-13, 7, and 19-are key harmonic factors of the synchronic order of time. This demonstrates that, at the very least, the synodical lunation calendars are calibrated in their larger cycles by the Law of Time. But the effect of being a purely lunar measure, at variance with the actual 365-day measure of the solar year, creates an interesting and one-sided approach. There is no question that the lunar calendar civilizations are the tool of powerfully patriarchal societies, the tables of the moons and the years being the possession of a dominant male priest class. The Chinese lunar calendar differs from the Hebrew in one important distinc tion: from the most ancient times it has been embedded in a system known as the five elements, and is coordinated with a very elaborate mathematical system that bears some resemblance to the 60-60, 24-360 basis of the SumerianiBabylonian 12:60 frequency. This synchronizing system accounts for the Chinese cycles of years that are counted by the twelve zodiacal animals in combination with the five elements: earth, fire, wood, water, and metal, thus giving rise to 60 (12 x 5) year cycles. We are now (in 2001) in the eighteenth year of the twenty-seventh group, or year 4,698 of the Chinese lunar calendar. So embedded is Chinese culture and civilization in this calendar, with its elaborate system, that to take away this calendar would virtually eliminate the Law of Time in Human Affairs. Perhaps more than any other factor, this highly involved calendar also accounts for the longevity and tenacity of Chinese civilization as one continuous tradition for the duration of its history, which according to the reckon ing of its calendar began in 2697 B. Despite its marvelous system, the Chinese lunar calendar is still just that: a lunar calendar. The problem with this, from the point of view of the Law of Time, is that when it is not regulated by a proper solar count or measure, the lunar calendar leads people into one-sided developments of one kind or another, if only to the extent to which these calendars foster such profoundly patriarchal societies, of which the Chi nese is certainly no exception. The influence and use of the Chinese lunar calendar system extends into southeast Asia, Tibet, Mongolia, Korea, and Japan. As a field of thought within the noosphere, the Chinese system is the equal in power base to the Babylonian and Indian systems, at least up to the time of the dominance of the Gregorian. While the Chinese and Hebrew lunar calendar systems maintain a powerful con servative strain of human society, the intercalation of the thirteenth moon, seven times every nineteen years, creates a kind of circulation within the system. Thirteen is the number of circulation, whereas twelve is that of a static, non-circulating spatial order. The taboo on the number thirteen-epitomized by the superstition about Friday the thirteenth-must certainly be related to the suppression of the solar lunar Thirteen Moon/28-Day calendars in virtually all historical societies. This ir rational repulsion of the number 13 serves psychologically in defense of the "ratio nality" of the number 12, a number that does not circulate time and is at the root of the linear conception of time. The illogical and irrational decisions that are made and then institutionalized into the human social fabric must at one point be dis counted. The Lawof Time in Human Affairs For this reason, this year 2001 saw the beginning oflslamic lunar year A. But if we are to count the solar years since the Hegira, correlated to Gregorian July 26, then it is solar year A.
Both interventions comprised up to treatment 32 order 50 mg revia amex 60 sessions across a 12-month period medicine tablets order revia with visa, consistent with usual treatment practice for bulimia nervosa in Germany symptoms 7 buy 50 mg revia. There was no significant difference between the treatment groups at posttreatment (33% vs 31%) and the outcomes were stable at 12 months symptoms 3 days past ovulation order 50mg revia with visa, follow-up. However, at 12 months? follow-up, the difference between the two interventions was no longer significant (49% vs 32%). Overall, the family-based intervention for bulimia nervosa appears to be the preferred treatment for more rapid and sustained abstinence rates. Participants attended eight core sessions and four optional supplementary sessions on topics of interpersonal relations, behaviour activation, and emotional regulation. Parents attended an initial orientation session and were provided with psychoeducation about eating behaviours. Eleven of these studies targeted interventions for young children (0 to 5 years of age) and three focused on school-aged children and adolescents. The effects were not statistically significant at long term follow-up, although the authors noted that fewer studies incorporated follow-up assessments. For school-aged children (4 to 13 years of age), night waking duration was significantly reduced in the behavioural interventions group compared with pooled controls (small to medium effect size). Furthermore, school-aged children receiving a behavioural intervention achieved substantially higher sleep efficiency than did controls, accompanied by a large effect size. Fifteen participants completed the 6-month follow-up, and the same proportion (87%) no longer qualified for a delayed phase sleep disorder diagnosis. There were no differences detected between the two conditions on measures of total sleep time, waking after sleep onset, or depressive symptoms. Results were analysed separately for recurrent abdominal pain (n = 5), headaches/migraine (n = 2), and fibromyalgia (n = 2). However, in both studies children receiving hypnotherapy reported significantly less pain at posttreatment compared with controls. One study indicated a 67% reduction in pain days per month compared with 21% in controls, and the difference was significant both at posttreatment and 1-month follow-up. The second study indicated that pain intensity during a 1-week period was significantly reduced for the hypnotherapy group compared with controls. In the same study, treatment success at 12-month follow-up was determined to be 85% for hypnotherapy versus 25% for the control group, which was a significant result. These conclusions are consistent with the most recently published guidelines from the National Institute for Clinical Excellence (Obsessive-compulsive disorder and body dysmorphic disorder, 2005). These results were maintained at 2 months? follow-up and were accompanied by a large effect size. At the 12-month follow-up, 50% of the 26 participants were classified as responders and 23% as in remission. However, the authors noted that most patients continued to be symptomatic at 12 months, suggesting additional long-term treatment is warranted. All intervention types included combinations of individual, family, and group components. The intervention was delivered in an outpatient setting over 16 to 24 weeks and comprised one individual session and one family/group session per week. Across the 1-year period, within-group effect sizes for primary outcome measures ranged from medium (aggressive and delinquent behaviours) to large (depression, internalising behaviours, interpersonal sensitivity). Additionally, although two-thirds of participants had attempted suicide at least once prior to treatment, no suicide attempts were recorded during the treatment or follow-up period. Treatment focused on improving control over intense emotions and improving a broad range of coping skills. The intervention was delivered through 17 x 105-minute weekly group sessions as well as two booster sessions in the subsequent 12 weeks. The average treatment period was approximately 30 weeks and consisted of three 30-minute individual sessions and one 45-minute group session per week. Some additional treatment elements, such as occupational therapy and parent counselling, were provided. On a measure of global functioning, there was a large within-group effect size from pre to post-treatment, even controlling for the effect of adjunctive pharmacotherapy. Sessions comprised mainly paper-and-pencil tasks, with scaffolding used to match the skills of each participant. Inclusion required the presence of either delusions or hallucinations before the age of 18. The treatment comprised two phases: initiation (3 individual sessions) and group (12 sessions of 90 minutes each, every 15 days). Adolescents and parents attended separate individual and group sessions which were run in parallel. Furthermore, adolescents receiving the psychoeducational intervention had fewer visits to the emergency department at posttreatment, in comparison with the nonstructured group intervention (medium effect size). The intervention was administered to participants and their parents across 18 x 1-hour family sessions (12 weekly and six biweekly sessions) over a 6-month period. The enhanced care condition consisted of three weekly psychoeducational family sessions. Negative symptom reduction was demonstrated regardless of treatment group, with no significant between-group differences. There is further Level I evidence published guidelines from the National Institute for Clinical supporting family interventions (specifically behavioural parent Excellence (Attention deficit hyperactivity disorder: Diagnosis and management, 2018). Furthermore, within-group analysis for the same period indicated that combined interventions (medium to large effect size) may be more effective than behaviour therapy or community care alone (small to medium effect size). Treatment effects were also found for child social skills (medium effect size), conduct problems, and academic performance (small effect sizes). Behavioural therapies were effective on measures of parenting quality (medium effect size), and parenting self-concept (small to medium effect size). The program consisted of seven 1-hour weekly sessions that were attended by the child, a playmate, and parents. In subsequent weeks, edited video footage of the play sessions was shown to the children and parents, and both positive and negative behaviours were identified and discussed. After the waitlist group received the same treatment, within-group analysis of the combined data indicated that the play-based intervention significantly improved social play skills from to pre to post-treatment, and from pretreatment to follow-up (large effect sizes). Many of the included studies combined psychoeducation with problem-solving strategies or training in communication/assertiveness. Qualitative analysis was conducted on seven articles published between 1980 and 2010. In the current review, there was insufficient evidence interventions (specifically parent training interventions) to treat to indicate that any of the remaining interventions were effective. No studies indicated significant increases in conduct problems during follow-up periods, which was considered a successful outcome for problems of this nature. The intervention consisted of eight modules focusing on the acquisition and use of 17 positive parenting skills such as time out? and descriptive praise. Central to the program was an emphasis on parents? self regulation, agency, and self-efficacy. Family members attended a variety of session types, including parent training, parent-only, and adolescent-only sessions. These reductions continued to be significant at both follow-up time points, with small to medium effect sizes. No treatment effects were found for the equivalent teacher reports of externalising problems. Treatment consisted of three 30-minute sessions of individual therapy and one 45-minute group therapy session per week. Additional elements included parent counselling, occupational therapy, and weekly ward rounds. There was a significant reduction in overall behavioural difficulties for the treatment group in comparison with controls (small effect). However, there was no significant treatment effect for overall psychological distress. There was insufficient evidence to suggest a difference between alarms and behavioural interventions due to the small number of trials. Some studies specifically addressed the diagnostic subtypes of urge incontinence and dysfunctional voiding.
Between 1971 and 1993 I had probably taught some sort of music analysis to symptoms ms women buy revia 50mg otc about 500 students in Sweden (c treatment ind quality revia 50 mg. In short symptoms neck pain order generic revia on-line, extensive testing of analysis procedures in the classroom and repeated exposure to medicine recall generic revia 50 mg fast delivery received wisdom? about music means that I felt confident enough in 2007 to start work on this book so that the back ground, theory and practice of those analysis procedures could be pre sented to a wider public. Under headings like Minor Amen and crisis chords, Sighing sixths and sev enths, Country & Latin clip-clop, Big-country modalism, Ethnic folk lutes, Anaphonic telegraphy, Busy xylophones and comic bustle, the Church of the Flatted Fifth and P. The complete back cover blurb, a more detailed overview of its contents, opinions about it and a link to download it are all at Gtagg. Most of the 600-odd respondents subjected to the this exercise were Swedish, but the tunes were also tested on 44 Latin Americans. Many respondents were stu dents still in, or who had recently left, tertiary education, some were in secondary education, others in adult education. The representation of men and women as well as of musos and non-musos was roughly equal. The basic reception test procedures, including their construction, implementation and result classification are described in Chapter 6. That compari son provoked an enlightening but disturbing discussion of the repre sentation of male and female through music. Terminology To avoid unnecessary confusion I?ve tried as much as possible to stick to established concepts and definitions when writing this book. The only trouble is that established terminology is sometimes the cause of confusion, not its remedy. Much more serious is an embarrassingly illogical and ethnocentric set of key concepts used in conventional mu sic studies in the West to denote musical structures bearing on the or ganisation of pitch. That is indeed one aspect of musical form, but there is an other, equally important? With out the shape and form of those batches of now sound?, the conven tionally diachronic aspect of musical form cannot logically exist. Obviously, if both types of form constitute form?, other words are needed to distinguish between the two. To cut a very long story short, I was unable, after extensive investigation and epistemic agonis ing, to find any adequate conceptual pair of labels to cover the essential distinction between those two types of musical form. The two concepts are explained in a little more detail at the start of Chapter 11. Part 1, Meanings of music? (Chapters 1-5), clears the conceptual and theoretical ground for the bulk of the book in Part 2, Meanings of music? (Chapters 6-14), which focuses on analysing music as if it meant something other than itself? and on the parameters of musical expression. I have yet to write up the process of ter minological elimination, but here are some of the problematic conceptual pairs that passed review: form v. Other potential but unsuitable termi nological candidates for the job were syntax, now-sound, diathesis and synthesis. The prime consideration was to find terms that unequivocally designated each phenom enon and nothing else. Another consideration was the ability of the words to form adjectival and adverbial derivatives (diactactic[al] [-ly], syncritic [-ally]). The chapter finishes with a section on affect, emo tion, feeling and mood, followed by a final word about the use of verbal metaphors of perceived musical meaning. It also helps explain why, in Western institutions of learning, notation was for such a long time considered the only valid musical storage medium. It highlights their contribution, real or potential, to developing a viable sort of semiotic music analysis. It also addresses the problems of music semiotics in dealing with semantics and pragmatics. Six reasons for prioritising the aesthesic rather than poietic pole are followed by a brief presentation of how ethnographic ob servation can help in the semiotic analysis of music. The chapter ends with a short section on the use of library music in systematising reception test responses. The first section summarises paramusical parameters (audience, venue, lyrics, images, etc. It also includes explanations of basic terms essential to subsequent discussion?genre, style, note, pitch, tone, timbre and the extended present. Most of the chapter is devoted to simple explanations of temporal-spatial parameters, including duration, phrase, motif, period, episode, speed, pulse, beat, subbeat, tempo, surface rate, rhythm, accentuation, metre and groove. After reviewing instrumental timbre (vocal timbre is covered in Chapter 10) and how it creates mean ing, an overview of acoustic devices and digital effects units explains eve rything from pizzicato and vibrato to distortion, filtering, phasing, limiting and gating. Then, after a short section dealing with loudness, volume and intensity, the rest of the chapter provides a rudimentary guide to things tonal, including pitch, octave, register, interval, mode, key, tonic, melody, tonal polyphony, heterophony, homophony, counterpoint, harmony, chords and chord progressions. These aes thesic and vernacular characterisations of spoken and singing voices are sorted into a taxonomy including descriptors of vocal costume, as well as those derived from demographics, professions, psychological and narrative archetypes. Practical ways of relating vocal sound to posture and attitude are explained so that its meanings can be more easily grasped and verbal ised as part of the semiotic analysis. The melody-accompaniment dualism is examined as musical parallel to the perceptual grid of figure-ground in other art forms and leads to a discussion of how different types of subjectivity and patterns of social organisation can be heard in contrapuntal poly phony, heavy metal, electronic dance music, unison singing, heterophony, ho mophony, cross rhythm, responsorial practices, bass lines, etc. The chapter ends with examples of the dual figure-ground relationship heard in innumerable pop songs and title themes, and with a brief glimpse into figureless? or bodiless? types of syncrisis. With potentially meaningful musi cal structures (musemes, museme strings and stacks, diataxis and syn crisis) identified and linked to possible fields of paramusical connotation, this chapter presents workable ways of checking the via bility of those links. Or does it, as a style indicator, identify a home style? in relation to other styles of music? Chapter 14 Analysing film music? illustrates how ideas and proce dures presented in the book can be put into practice. After a description of the course Music and the Moving Image and a discussion of conceptual prerequisites to the subject, the bulk of this chapter focuses on the stu dent assignment Cue list and analysis of a feature film, concentrating on underscore and presenting ways of explaining how music contributes to the overall message? of individual scenes and to the film as a whole. Appendices Glossary Terms that I?ve borrowed, adapted or had to coin in order to designate phenomena relevant to the ideas presented in this book are listed al phabetically and defined in the Glossary (p. Other sub stantial reasons for including everything? in one appendix, as well as all the icons used to save space, are explained at the start of the Refer ence Appendix on page 607. Therefore, if there is no text at the bottom of the page on which a footnote flag number occurs in the main body of text, don?t be alarmed. While I sincerely regret causing readers irritation, I persist in my struggle for the right to footnote for the following eight reasons. Many footnotes consist of either references to other work or of extended argumentation about, or exemplification of (see 2), a topic which, for reasons of space and clarity, cannot be included in the main body of text. Readers sceptical about some of the things I try to put across need to know if I have any backing for what I write. Since it would be unfair to lumber all readers with that sort of extra evidence, I try to make it as unobtrusive as possible by con signing it to footnotes. Many footnotes refer to actual pieces of music exemplifying obser vations made in the main text. All those musical references are listed in the RefAppx, together with source details. A substantial proportion of those sources include direct hyperlinks to recordings that can be heard at the click of a mouse. Some readers are simply inquisitive and just want to know a bit more about a topic that I can?t fully cover in the main body of text. Since this book is written with a mainly non-muso readership in mind, I?ve painstakingly tried to reduce both musical notation and musicological jargon to an absolute minimum in the main body of text. On a few occasions, however, additional structural informa tion potentially useful to musos has been consigned to footnotes. The main body of text would be much less readable if it included all those references. As I try to explain in Chapter 2, music is a combinatory and holistic symbolic system involving cross-domain representation and syn aesthesis. That in turn means that talking or writing about music can (and maybe should) go off in almost any direction. Although I make valiant efforts in this book to toe the one-dimensional line of the written word, it would be dishonest to give readers the impres sion that the richness and precision of musical meaning can be real istically explained using the linearity of verbal discourse and nothing else. I therefore take the occasional liberty of putting some of the inevitably lateral thinking that comes with the territory of music into footnotes. Contradictions inside conventional music theory, as well as between musical and verbal discourse, are sometimes downright comical. I?ve included a few such items in the main text, for instance the dubious assumption that music is polysemic and the implication that atonal? music contains no tones.
Gambling disorder is defined as a cluster of four or more of the symptoms listed in Criterion A occurring at any time in the same 12-month period symptoms during pregnancy buy generic revia 50 mg online. The individual may abandon his or her gambling strategy and try to medicine tour buy cheap revia 50mg line win back losses all at once medicine 2016 order 50 mg revia amex. Although many gamblers may "chase" for short periods of time treatment ear infection discount revia 50 mg without prescription, it is the frequent, and often long-term, "chase" that is characteristic of gambling disorder (Criterion A6). Individuals may lie to family members, therapists, or others to conceal the extent of involvement with gambling; these instances of deceit may also include, but are not limited to, covering up illegal behaviors such as forgery, fraud, theft, or embez? zlement to obtain money with which to gamble (Criterion A7). Individuals may also en gage in "bailout" behavior, turning to family or others for help with a desperate financial situation that w,as caused by gambling (Criterion A9). Many individuals with gambling disorder believe that money is both the cause of and the solution to their problems. Some individuals with gambling disorder are im? pulsive, competitive, energetic, restless, and easily bored; they may be overly concerned with the approval of others and may be generous to the point of extravagance when win? ning. Other individuals with gambling disorder are depressed and lonely, and they may gamble when feeling helpless, guilty, or depressed. Up to half of individuals in treatment for gambling disorder have suicidal ideation, and about 17% have attempted suicide. The lifetime prevalence of pathological gambling among African Americans is about 0. Deveiopment and Course the onset of gambling disorder can occur during adolescence or young adulthood, but in other individuals it manifests during middle or even older adulthood. Generally, gam? bling disorder develops over the course of years, although the progression appears to be more rapid in females than in males. Most individuals who develop a gambling disorder evidence a pattern of gambling that gradually increases in both frequency and amount of wagering. Most individuals with gambling disorder report that one or two types of gambling are most problematic for them, although some individuals participate in many forms of gambling. Fre? quency of gambling can be related more to the type of gambling than to the severity of the overall gambling disorder. For example, purchasing a single scratch ticket each day may not be problematic, while less frequent casino, sports, or card gambling may be part of a gambling disorder. Similarly, amounts of money spent wagering are not in themselves in? dicative of gambling disorder. Some individuals can wager thousands of dollars per month and not have a problem with gambling, while others may wager much smaller amounts but experience substantial gambling-related difficulties. Gambling patterns may be regular or episodic, and gambling disorder can be persis? tent or in remission. Gambling can increase during periods of stress or depression and during periods of substance use or abstinence. There may be periods of heavy gambling and severe problems, times of total abstinence, and periods of nonproblematic gambling. Nevertheless, some individuals underestimate their vulnerability to develop gambling disorder or to return to gambling disorder following remission. When in a period of re? mission, they may incorrectly assume that they will have no problem regulating gambling and that they may gamble on some forms nonproblematically, only to experience a return to gambling disorder. Early expression of gambling disorder is more common among males than among fe? males. Individuals who begin gambling in youth often do so with family members or friends. Development of early-life gambling disorder appears to be associated v^ith impul sivity and substance abuse. Many high school and college shidents who develop gambling disorder grow out of the disorder over time, although it remains a lifelong problem for some. Mid and later-life onset of gambling disorder is more common among females than among males. There are age and gender variations in the type of gambling activities and the preva? lence rates of gambling disorder. Gambling disorder is more common among younger and middle-age persons than among older adults. Among adolescents and young adults, the disorder is more prevalent in males than in females. Although the proportions of individuals who seek treatment for gambling disorder are low across all age groups, younger individ? uals are especially unlikely to present for treatment. Males are more likely to begin gambling earlier in life and to have a younger age at on? set of gambling disorder than females, who are more likely to begin gambling later in life and to develop gambling disorder in a shorter time frame. Females with gambling disor? der are more likely than males with gambling disorder to have depressive, bipolar, and anxiety disorders. Females also have a later age at onset of the disorder and seek treatment sooner, although rates of treatment seeking are low (<10%) among individuals with gam? bling disorder regardless of gender. Gambling that begins in childhood or early adolescence is associated with increased rates of gambling disorder. Gambling disorder also appears to aggregate with antisocial personality disorder, depressive and bipolar disorders, and other sub? stance use disorders, particularly with alcohol disorders. Gambling disorder can aggregate in families, and this effect appears to relate to both environmental and genetic factors. Gambling disorder is also more preva? lent among first-degree relatives of individuals with moderate to severe alcohol use dis? order than among the general population. Many individuals, including adolescents and young adults, are likely to resolve their problems with gambling disorder over time, although a strong predictor of future gambling problems is prior gambling problems. Culture-R elated Diagnostic issues Individuals from specific cultures and races/ethnicities are more likely to participate in some types of gambling activities than others. Prevalence rates of gambling disorder are higher among African Americans than among European Americans, with rates for Hispanic Americans similar to those of Euro? pean Americans. Gender-Related Diagnostic issues Males develop gambling disorder at higher rates than females, although this gender gap may be narrowing. Males tend to wager on different forms of gambling than females, with cards, sports, and horse race gambling more prevalent among males, and slot machine and bingo gambling more common among females. Functional Consequences of Gambling Disorder Areas of psychosocial, health, and mental health functioning may be adversely affected by gambling disorder. Specifically, individuals with gambling disorder may, because of their involvement with gambling, jeopardize or lose important relationships with family mem? bers or friends. Such problems may occur from repeatedly lying to others to cover up the extent of gambling or from requesting money that is used for gambling or to pay off gam? bling debts. Employment or educational activities may likewise be adversely impacted by gambling disorder; absenteeism or poor work or school performance can occur with gam? bling disorder, as individuals may gamble during work or school hours or be preoccupied with gambling or its adverse consequence when they should be working or studying. In? dividuals with gambling disorder have poor general health and utilize medical services at high rates. Social gambling typically occurs with friends or colleagues and lasts for a limited period of time, with acceptable losses. An additional diagnosis of gambling disorder should be given only if the gambling behavior is not better explained by manic episodes. Alternatively, an individual with gambling disorder may, during a period of gambling, exhibit behavior that resembles a manic episode, but once the individual is away from the gambling, these manic-like fea? tures dissipate. Problems with gambling may occur in individuals with antisocial personality disorder and other personality disorders. If such symptoms dissipate when dopaminergic medications are reduced in dosage or ceased, then a diagnosis of gambling disorder would not be indicated. In addition, some specific med? ical diagnoses, such as tachycardia and angina, are more common among individuals with gambling disorder than in the general population, even when other substance use disor? ders, including tobacco use disorder, are controlled for. Individuals with gambling disor? der have high rates of comorbidity with other mental disorders, such as substance use disorders, depressive disorders, anxiety disorders, and personality disorders. In some in? dividuals, other mental disorders may precede gambling disorder and be either absent or present during the manifestation of gambling disorder. Gambling disorder may also occur prior to the onset of other mental disorders, especially anxiety disorders and substance use disorders. The various underlying disease entities have all been the subject of extensive re? search, clinical experience, and expert consensus on diagnostic criteria. Dementia is subsumed imder the newly named entity major neurocognitive dis? order, although the term dementia is not precluded from use in the etiological subtypes in which that term is standard.
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