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This is because a given hospital is affiliated with a very small percentage of all sampled physicians diabetes mellitus type 2 risk factors buy cozaar amex. In each specialty blood sugar count order cozaar 50mg free shipping, the sample for the 2018 nonmember physician survey was stratified only by census region (Midwest diabetes x cerveja discount cozaar 50 mg overnight delivery, Northeast diabetes treatments new cheap cozaar online master card, South, and West). The sample size in each specialty was too small to stratify by the demographic characteristics used in the Doximity sample. Weights were constructed and applied to each physician’s survey responses to make nominations representative of Doximity nonmembers nationally. Weights were based on probability of selection within each unique specialty-region combination and on adjustments to account for nonresponders. Reputation scores were tabulated separately for Doximity members and nonmembers and then combined to create 2018 reputation scores. Table 13 shows the reputation weight for Doximity members and nonmembers in each specialty for 2018. The weight is based on the proportion of Doximity members and nonmembers in the population, so the reputation score is representative of all physicians in the nation. Reputation scores for each of the past 3 years were then averaged to create the final weighted reputation values that appear in the methodology report. Log Transformation the online and print rankings display weighted 3-year reputation values. Before incorporating the values into the scoring for the 12 data-driven specialties, however, we implemented a log transformation to adjust for the skewed distribution. By its nature, a survey that solicits recommendations for “bests” will generate data that do not follow a normal distribution. Because outcome and structural data are not similarly skewed, reputation would have a disproportionate impact if the extreme skewness was not addressed. Log transformation in the data-driven rankings reshapes the distribution to match reputation data more closely to those of the other components. Transformed reputation scores are higher than untransformed scores, but the impact is greater on low scores than on high scores, as illustrated by these examples: • An untransformed score of 1% has a transformed value of 4 (4 times greater), • an untransformed score of 10% has a transformed value of 29 (2. Skewness is reduced, and the overall effect of the reputation score on hospitals’ final standing in the rankings is diminished. Reputation Data Before and After Log Transformation 100 90 80 81% 70 60 50 60% 40 30 20 10 0 0 10 20 30 40 50 60 70 80 90 100 Untransformed Reputation Score (%) Normalization and Weighting Starting with the 2014-15 rankings, the weight of reputation in the overall score in the datadriven specialties was reduced from 32. In the 2017-18 rankings, the weight in Cardiology & Heart Surgery was further reduced to 24. As with structural measures, reputation data were normalized before being combined with other metrics. Normalization transforms index values into a distribution between 0 and 1 based on a measure’s range of possible (as opposed to generated) values. The possible values for a hospital’s reputation score range from 0% (no nominations in the latest three years) to 100% (every surveyed physician nominated the hospital). A hospital’s normalized reputation score, after log transformation, determined the number of points the hospital received for reputation. Patient Safety Score Care that harms patients is an important aspect of both outcomes and process. A patient safety score is therefore a critical component in evaluating and determining the best-performing hospitals. For the 2016-17 rankings, the weight of the patient safety score in the total score was reduced from 10% to 5% and one of its constituent measures was removed. For the 2017-18 rankings, two more constituent measures were removed and the scoring was revised. The timeframe used in these analyses is the same that is used for the volume and mortality analyses in the Best Hospitals rankings. For both datasets used, only patients receiving fee-for-service care under Medicare and who were 65 years of age or older were included in the analyses. While death rates are key, hospitalized patients are subject to many adverse outcomes that may not result in 40 death. Hospitals with high rates of adverse events are unlikely to provide patients with high-quality care. As described below, we use a subset of these indicators to identify adverse outcomes likely associated with less-than-desirable quality of care. Hospital stays with patient safety events have been found to be more costly 45-49 and longer in length than stays without patient safety events. Patient safety events have also been associated with higher 90-day readmission rates, compared with rates for patients without safety 45 events. We followed a similar process to develop the Patient Safety Index for the Best Hospitals Project. This latter indicator identifies surgical deaths generally deemed to be avoidable. Additional indicators may be added to the patient safety score as the measures become more refined. Weighting the Index Components An index (or score) is generally a weighted sum or mean of its components. Assuming each “touch” by a hospital staff person has identical quality, the more complex the care, the greater the likelihood of error. It follows that patient safety score values for a hospital with a complex case mix cannot be compared fairly to those for a hospital with a simple case mix. The hospital with a simple case mix might have a better patient safety score but worse underlying quality. Smoothed rates are a weighted average of risk-adjusted and observed rates in the reference population. Starting with the 2016-17 rankings, however, we moved to a risk-adjusted rate out of concern that the smoothed rates overadjust and obscure differences between hospitals. By pooling 3 years of data, some of the potential year-toyear fluctuation that smoothed rates are designed to adjust for is taken into account. Each year, patient safety scores cannot be calculated for a small number of hospitals (< 1%) that lack sufficient data. This process essentially ranks these hospitals as if the patient safety score is not factored into their rankings. This allows more direct comparisons with other hospitals than if they received no points for this measure. The patient safety score used in the rankings reflects the average of the residual values. Lower values of adjusted patient safety scores indicate fewer adverse events than expected (higher quality); higher values indicate more adverse events than expected (lower quality). Hospitals with score values within +/-2 standard deviations are considered to be in the average range and received 2 points; hospitals with patient safety values exceeding this range are considered below average and received 1 point, while those with exceptionally low rates of patient safety events are considered above average and received 3 points. The patient safety scores in Table 15 indicate the cutoffs that determine an individual hospital’s level of patient safety. Public Transparency (Cardiology & Heart Surgery Only) A public transparency component was added to the analysis for Cardiology & Heart Surgery in the 2016-17 rankings. Clinicians initially created these and other clinical registries to foster quality improvement. More recently, public transparency has been identified as an important additional application for registry-based quality measurement. Transparency via clinical registries can facilitate informed decision making by patients, which in turn may boost patient engagement in their healthcare. Transparency also creates opportunities for researchers to externally validate the results of hospital rankings such as Best Hospitals. Moreover, it demonstrates a public commitment on the part of the partcipating hospitals to the process of pursuing quality improvement. Hospitals that voluntarily publicly reported through one group but not the other received 2 points for this measure. Calculation of the Overall Score for the Data-Driven Specialties All Specialties (Excluding Cardiology & Heart Surgery) For 2018-19, the U.
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Aftercare agenesis /efl d enflsfls/ noun the absence of treatment involves changing dressings and an organ diabetes mellitus vs diabetes order cheap cozaar online, resulting from a failure in embryonic helping people to diabetes mellitus quiz discount cozaar 25 mg free shipping look after themselves again diabetes test machine price in bangladesh cheap cozaar 25mg amex. The treatment seems to diabetes signs the honeymoon is over discount 25mg cozaar overnight delivery age /efld / noun the number of years which a person has lived What’s your age on your aggravate the disease. Bones about or twitching nervously because of worry become more brittle and skin becomes less or another psychological state the person elastic. The most important changes affect the became agitated and had to be given a sedablood vessels which are less elastic, making tive. This also reduces the agitation supply of blood to the brain, which in turn reagitation / d fl teflfl(fl)n/ noun a state of beduces the mental faculties. He breathed the polShe suffered the agony of waiting for weeks luted air into his lungs. It is obstruction spread mostly by sexual intercourse and can airway obstruction affect anyone. It is also transmitted through inairway obstruction / eflwefl flb str"kfl(fl)n/ fected blood and plasma transfusions, noun something which blocks the air passages akathisia through using unsterilised needles for injecakathisia / eflkfl flflsifl/ noun restlessness tions, and can be passed from a mother to a akinesia akinesia / eflkfl ni zifl/ noun a lack of volunfetus. It akinetic /eflkfl netflk/ adjective without causes a breakdown of the body’s immune movement system, making the patient susceptible to any alacrima alacrima /efl l krflmfl/ noun same as xerosis infection and often results in the development alactasia of rare skin cancers. Albee’s operation ailurophobia Albee’s operation / fl lbi z flpfl reflfl(fl)n/ ailurophobia /afllflflrfl fflflbifl/ noun a fear noun 1. Alcohol is a dewho takes an intelligent interest in his or her pressant, not a stimulant, and affects the way surroundings the patient is still alert, the brain works. Allergic reaction to serum noun a tube in the body going from the mouth is known as anaphylaxis. Treatment of allerto the anus and including the throat, stomach gies depends on correctly identifying the allerand intestine, through which food passes and gen to which the patient is sensitive. This is is digested done by patch tests in which drops of different alimentary system allergens are placed on scratches in the skin. Note also that live can be used in allergic agent front of a noun: the person was injected with live allergic agent /fl l! Alkaline solutions are used to counteract the effects of acid which cause a physical reaction such as sneezpoisoning and also of bee stings. If strong aling or a rash in someone who comes into conkali, such as ammonia, is swallowed, the patact with them She has an allergy to housetient should drink water and an acid such as hold dust. You have an allergy or you are allergic to alkaloid alkaloid / lkfllflfld/ noun one of many poisomething. Compare lessness, fatigue, nausea and swelling of the homeopathy face, hands and feet. The chemical all or none law /fl l fl n"n lfl / noun the rule that the heart muscle either contracts fully symbol is Al. Compare hypotrichosis alveolar / lvfl flfllfl, l vi fllfl/ adjective realopecia areata ferring to the alveoli alopecia areata / lflfl pi flfl ri efltfl/ noun alveolar bone a condition in which the hair falls out in patchalveolar bone / lvfl flfllfl bflfln/ noun part es of the jawbone to which the teeth are attached alpha alveolar duct alpha / lffl/ noun the first letter of the Greek alveolar duct / lvfl flfllfl d"kt/ noun a duct alphabet in the lung which leads from the respiratory alpha-adrenoceptor antagonist alpha-adrenoceptor antagonist / lffl fl bronchioles to the alveoli. Also called alpha blocker alveolitis alpha cell alveolitis / lvifl lafltfls/ noun inflammation alpha cell / lffl sel/ noun a type of cell of an alveolus in the lungs or the socket of a found in the islets of Langerhans, in the pantooth creas, which produces glucagon, a hormone alveolus that raises the level of glucose in the blood. A high or low concentration is tested for Alzheimer plaque / ltshaflmfl pl k/ noun by amniocentesis in the antenatal diagnosis of a disc-shaped plaque of amyloid found in the spina bifida or Down’s syndrome, respectivebrain in people who have Alzheimer’s disease Alzheimer’s disease ly. Alzheimer’s disease / ltshaflmflz dfl zi z/ alpha rhythm noun a disease where a person experiences alpha rhythm / lffl rflflflm/ noun the pattern of electrical activity in the brain of someprogressive dementia due to nerve cell loss in one who is awake but relaxed or sleepy, regisspecific brain areas, resulting in loss of mental tering on an electroencephalograph at 8–13 faculties including memory [Described 1906. Risk factors include age, genes, makes blood vessels wider, used to treat impohead injury, lifestyle and environment. Compare emmetropia ambidextrous amfetamine ambidextrous / mbfl dekstrfls/ adjective amfetamine / m fetflmi n/ noun an addicreferring to a person who can use both hands tive drug, similar to adrenaline, used to give a equally well and who is not rightor left-handfeeling of wellbeing and wakefulness. Also ed called amphetamine ambiguous genitalia amikacin ambiguous genitalia / m bfl&jufls d enfl amikacin / mfl keflsfln/ noun a type of antitefllifl/ noun a congenital condition in which biotic used to treat infections caused by aerothe outer genitals do not look typical of those bic bacteria of either sex amiloride ambisexual amiloride /fl mfllflrafld/ noun a drug which ambisexual / mbfl sekflufll/ adjective, noun helps to increase the production of urine and same as bisexual preserve the body’s supply of potassium amblyopia amino acid amblyopia / mbli flflpifl/ noun a lack of amino acid /fl mi nflfl sfld/ noun a cheminormal vision without a structural cause. A cal compound which is broken down from procommon example is squint and other forms teins in the digestive system and then used by may be caused by the cyanide in tobacco the body to form its own protein smoke or by drinking methylated spirits. Some amino acids are produced in amblyoscope the body itself, but others have to be absorbed amblyoscope / mbliflflskflflp/ noun an infrom food. The eight essential amino acids strument for measuring the angle of a squint are: isoleucine, leucine, lysine, methionine, and how effectively someone uses both their phenylalanine, threonine, tryptophan and vaeyes together. It is used to treat hyambulatory fever / mbju leflt(fl)ri fi vfl/ noun a mild fever where the patient can walk pertension and angina. Also called amyloid lytica which enters the body through contamidisease nated water or unwashed food amyloid precursor protein amoebicide amyloid precursor protein / mfllflfld pri amoebicide /fl mi bflsafld/ noun a substance k! A mutation of the gene causes earlyamorphous /fl mfl ffls/ adjective with no regular shape onset Alzheimer’s disease in a few families. Also [British Journal of Nursing] anaesthetic induction called floppy baby syndrome anaesthetic induction / nflsfletflk fln amyotrophia d"kflfln/ noun a method of inducing anaestheamyotrophia /efl maflfl trflflfifl/ noun a condition in which a muscle wastes away sia in a patient amyotrophic lateral sclerosis anaesthetic risk amyotrophic lateral sclerosis /efl anaesthetic risk / nflsfletflk rflsk/ noun the risk that an anaesthetic may cause serious maflfltrflfflk l tflr(fl)l sklfl rflflsfls/ noun a unwanted side effects motor neurone disease in which the limbs anaesthetise twitch and the muscles gradually waste away. The symptoms are tiredness and pale col(acetylsalicylic acid), and opioid such as coour, especially pale lips, nails and the inside of deine phosphate. Opioid analgesics are used for severe pain relief such as in terminal care, the eyelids. The condition can be fatal if not as cough suppressants and to reduce gut motreated. The body is assumed to wall of the aorta, ‘aortic aneurysm’, and is ofbe standing, with the feet together, the arms to ten due to atherosclerosis, and sometimes to the side, and the head, eyes and palms facing syphilis. Also called acute glaucoma the organs show up clearly on the film angular stomatitis angiodysplasia angular stomatitis / fl&jfllfl stflflmfl angiodysplasia / nd iflfldfls pleflzifl/ tafltfls/ noun a condition of the lips, mouth and noun a condition where the blood vessels in the cheeks characterised by cracks and fissures colon dilate, resulting in loss of blood and caused by a bacterial infection angiogenesis angular vein angiogenesis / nd iflfl d enflsfls/ noun angular vein / fl&jfllfl vefln/ noun a vein the formation of new blood vessels. Also called prenatal diwhich will not aggravate an allergy agnosis antiarrhythmic antepartum antiarrhythmic / ntiefl rflflmflk/ adjective antepartum / nti pfl tflm/ noun the period referring to a drug which corrects an irregular of three months before childbirth i adjective heartbeat referring to the three months before childbirth antiasthmatic antepartum haemorrhage antiasthmatic / nti s m tflk/ adjective antepartum haemorrhage / ntipfl tflm referring to a drug that is used to treat asthma hemflrfld / noun bleeding from the vagina beantibacterial antibacterial / ntib k tflflrifll/ adjective fore labour. Oppoantibiogram / nti baflfl&r m/ noun a labosite posterior ratory technique which establishes to what deanterior aspect anterior aspect / n tflflrifl spekt/ noun a gree an organism is sensitive to an antibiotic view of the front of the body, or of the front of antibiotic antibiotic / ntibafl fltflk/ adjective stopping part of the body. Antibiwhich is in front of the iris otics have no effect against viral diseases. Alanterior jugular though antibiotics are widely and successfully anterior jugular / n tflflrifl d "&jfllfl/ noun used, new forms of bacteria have developed a small jugular vein in the neck which are resistant to them. Also called external stimulated by the body to produce foreign subnares stances such as bacteria, as part of an immune anterior superior iliac spine anterior superior iliac spine / n tflflrifl reaction Tests showed that he had antibodies sfl pflflrifl flli k spafln/ noun a projection at in his blood. It causes noun a drug which slows down or stops the pustules on the skin or in the lungs, ‘woolsortclotting of blood, used to prevent the formaer’s disease’. Examples are triworm cyclic antidepressants, selective serotonin reantihistamine antihistamine / nti hflstflmi n/ noun a uptake inhibitors and monoamine oxidase indrug used to control the effects of an allergy hibitors. Also called vasopressin acting against microorganisms that cause disantidote ease antidote / ntfldflflt/ noun a substance which antimigraine counteracts the effect of a poison There is no antimigraine / nti mafl&refln/ noun a drug satisfactory antidote to cyanide. Isoniazid or rifampicin body, which sends blood containing oxygen antitussive antitussive / nti t"sflv/ noun a drug used from the heart to other blood vessels around to reduce coughing the body. It leaves the left ventricle, rises where fects of a particular venom from a snake or inthe carotid arteries branch off, then goes sect bite downwards through the abdomen and divides antiviral into the two iliac arteries. The aorta is the antiviral / nti vaflrfll/ adjective referring to blood vessel which carries all arterial blood a drug or treatment which stops or reduces the from the heart. Full form ante apical prandium apical / pflk(fl)l/ adjective situated at the top apathetic or tip of something apathetic / pfl fletflk/ adjective referring to apical abscess a person who takes no interest in anything apical abscess / pflk(fl)l bses/ noun an apathy abscess in the socket around the root of a tooth apathy / pflfli/ noun the condition of not beapicectomy ing interested in anything, or of not wanting to apicectomy / pfl sektflmi/ noun the surgido anything cal removal of the root of a tooth aperient aplasia aperient /fl pflflriflnt/ noun a substance which aplasia /efl pleflzifl/ noun a lack of growth of causes a bowel movement. Compare axial which are linked with increased risk of Alzheskeleton imer’s disease. The blood sample was testfor applying a substance appointment ed in a special piece of apparatus. Acute when carrying out an operation appendicitis usually requires urgent surgery. The symptoms are very oily skin arachnoid /fl r knflfld/ noun the middle of 2 the three membranes covering the brain. Lift your arms up above your arachnoid mater /fl r knflfld mefltfl/, arachnoid membrane /fl r knflfld membrefln/ noun head. Also called axilla arbor vitae arm sling arbor vitae / fl bfl vaflti / noun the structure arm sling / fl m slflfl/ noun a support for an of the cerebellum or of the uterus which looks injured arm that prevents it from moving by tylike a tree ing it against the chest arbovirus Arnold-Chiari malformation arbovirus/ fl bflfl vaflrfls/ noun a virus transArnold-Chiari malformation /fl nflld ki mitted by blood-sucking insects eflri m lffl meflfl(fl)n/ noun a congenital arc arc /fl k/ noun 1. The arterial arrhythmic system begins with the aorta which leaves the arrhythmic /fl rflflmflk/ adjective (of a heartbeat or breathing) rhythmically irregular. It is now recogarticular facet /fl tflkjfllfl f sflt/ noun the nised that asbestos dust can cause many lung point at which a rib articulates with the spine diseases, leading in some cases to forms of articular process cancer. Compare antiseptic aseptic technique hook, so releasing the amniotic fluid aseptic technique /efl septflk tek ni ks/ artificial ventilation noun a method of doing something using sterartificial ventilation /fl tflfflfl(fl)l ventfl leflfl(fl)n/ noun breathing which is assisted or ilised equipment asexual controlled by a machine asexual /efl sekflufll/ adjective not sexual, not arytenoid involving sexual intercourse arytenoid / rfl ti nflfld/ adjective located at asexual reproduction the back of the larynx asexual reproduction /efl sekflflfll ri prfl arytenoid cartilage d"kfl(fl)n/ noun reproduction of a cell by arytenoid cartilage / rfl ti nflfld kfl tfllfld / noun a small cartilage at the back of the larynx cloning arytenoidectomy Asian flu arytenoidectomy / rfl ti nflfld ektflmi/ Asian flu / efl (fl)n flu / noun fl flu -asis noun an operation to remove the arytenoid car-asis /flsfls/ fl -iasis tilage asleep asbestosis asleep /fl sli p/ adjective sleeping the paasbestosis / sbe stflflsfls/ noun a disease tient is asleep and must not be disturbed. Also sleeping deeply called acetylsalicylic acid asparagine assay asparagine /fl sp rfld i n/ noun an amino assay / sefl, fl sefl/ noun the testing of a subacid stance.
Identity: Markedly impoverished diabetes type 2 uncontrolled cheap 25mg cozaar amex, poorly developed diabetes insipidus zdravljenje buy cozaar 50mg, or unstable self-image diabetes symptoms gums purchase cheap cozaar on-line, often associated with excessive self-criticism; chronic feelings of emptiness; dissociative states under stress diabetes type 2 obesity order cozaar on line amex. Empathy: Compromised ability to recognize the feelings and needs of others asso ciated with inteflersonal hypersensitivity. Intimacy: Intense, unstable, and conflicted close relationships, marked by mistrust, neediness, and anxious preoccupation with real or imagined abandonment; close relationships often viewed in extremes of idealization and devaluation and alternat ing between overinvolvement and withdrawal. Four or more of the following seven pathological personality traits, at least one of which must be (5) Impulsivity, (6) Risk taking, or (7) Hostility: 1. Emotional lability (an aspect of Negative Affectivity): Unstable emotional expe riences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances. Anxiousness (an aspect of Negative Affectivity): Intense feelings of nervous ness, tenseness, or panic, often in reaction to interpersonal stresses; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling apart or Ipsing control. Separation insecurity (an aspect of Negative Affectivity): Fears of rejection by— and/or separation from—significant others, associated with fears of excessive de pendency and complete loss of autonomy. Depressivity (an aspect of Negative Affectivity): Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feelings of inferior self-worth; thoughts of sui cide and suicidal behavior. Impulsivity (an aspect of Disiniiibition): Acting on the spur of the moment in re sponse to immediate stimuli; acting on a momentary basis without a plan or consid eration of outcomes; difficulty establishing or following plans; a sense of urgency and self-harming behavior under emotional distress. Hostility (an aspect of Antagonism): Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults. Trait and level of personality functioning specifiers may be used to record ad ditional personality features that may be present in borderline personality disorder but are not required for the diagnosis. Furthermore, although moderate or greater impairment in personality functioning is required for the diagnosis of borderline personality disorder (Criterion A), the level of personality functioning can also be specified. Narcissistic Personaiity Disorder Typical features of narcissistic personality disorder are variable and vulnerable self-esteem, with attempts at regulation through attention and approval seeking, and either overt or covert grandiosity. Characteristic difficulties are apparent in identity, self-direction, em pathy, and/or intimacy, as described below, along with specific maladaptive traits in the domain of Antagonism. Identity: Excessive reference to others for self-definition and self-esteem regula tion; exaggerated self-appraisal inflated or deflated, or vacillating between extremes; emotional regulation mirrors fluctuations in self-esteem. Self-direction: Goal setting based on gaining approval from others; personal stan dards unreasonably high in order to see oneself as exceptional, or too low based on a sense of entitlement; often unaware of own motivations. Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; overor underestimate of own effect on others. Intimacy: Relationships largely superficial and exist to serve self-esteem regula tion; mutuality constrained by little genuine interest in others’ experiences and pre dominance of a need for personal gain. Grandiosity (an aspect of Antagonism); Feelings of entitlement, either overt or co vert; self-centeredness; firmly holding to the belief that one is better than others; condescension toward others. Attention seeldng (an aspect of Antagonism): Excessive attempts to attract and be the focus of the attention of others; admiration seeking. Trait and personality functioning specifiers may be used to record additional personality features that may be present in narcissistic personality disorder but are not re quired for the diagnosis. Furtiiermore, although moderate or greater impairment in personality functioning is required for the diagnosis of narcissistic personality disorder (Criterion A), the level of personality functioning can also be specified. Obsessive-Compulsive Personaiity Disorder Typical features of obsessive-compulsive personality disorder are difficulties in establish ing and sustaining close relationships, associated with rigid perfectionism, inflexibility, and restricted emotional expression. Characteristic difficulties are apparent in identity, self-direction, empathy, and/or intimacy, as described below, along v^ith specific mal adaptive traits in the domains of Negative Affectivity and/or Detachment. Identity: Sense of self derived predominantly from work or productivity; constricted experience and expression of strong emotions. Self-direction: Difficulty completing tasks and realizing goals, associated with rigid and unreasonably high and inflexible internal standards of behavior; overly consci entious and moralistic attitudes. Empathy: Difficulty understanding and appreciating the ideas, feelings, or behav iors of others. Intimacy: Relationships seen as secondary to work and productivity; rigidity and stubbornness negatively affect relationships with others. Three or more of the following four pathological personality traits, one of which must be (1) Rigid perfectionism: 1. Rigid perfectionism (an aspect of extreme Conscientiousness [the opposite pole of Detachment]): Rigid insistence on everything being flawless, perfect, and without errors or faults, including one’s own and others’ performance; sacrificing of timeli ness to ensure correctness in every detail; believing that there is only one right way to do things; difficulty changing ideas and/or viewpoint; preoccupation with details, organization, and order. Perseveration (an aspect of Negative Affectivity): Persistence at tasks long after the behavior has ceased to be functional or effective; continuance of the same be havior despite repeated failures. Restricted affectivity (an aspect of Detachment); Little reaction to emotionally arousing situations; constricted emotional experience and expression; indifference or coldness. Trait and personality functioning specifiers may be used to record additional personality features that may be present in obsessive-compulsive personality disorder but are not required for the diagnosis. Furthermore, although moderate or greater impair ment in personality functioning is required for the diagnosis of obsessive-compulsive person ality disorder (Criterion A), the level of personality functioning can also be specified. Schizotypal Personality Disorder Typical features of schizotypal personality disorder are impairments in the capacity for so cial and close relationships and eccentricities in cognition, perception, and behavior that are associated with distorted self-image and incoherent personal goals and accompanied by suspiciousness and restricted emotional expression. Characteristic difficulties are ap parent in identity, self-direction, empathy, and/or intimacy, along with specific maladap tive traits in the domains of Psychoticism and Detachment. Identity: Confused boundaries between self and others; distorted self-concept; emotional expression often not congruent with context or internal experience. Self-direction: Unrealistic or incoherent goals; no clear set of internal standards. Empathy: Pronounced difficulty understanding impact of own behaviors on others; frequent misinterpretations of others’ motivations and behaviors. Intimacy: Marked impairments in developing close relationships, associated with mistrust and anxiety. Cognitive and perceptual dysregulation (an aspect of Psychoticism): Odd or unusual thought processes; vague, circumstantial, metaphorical, overelaborate, or stereotyped thought or speech; odd sensations in various sensory modalities. Unusual beliefs and experiences (an aspect of Psychoticism): Thought content and views of reality that are viewed by others as bizarre or idiosyncratic; unusual experiences of reality. Eccentricity (an aspect of Psychoticism): Odd, unusual, or bizarre behavior or appearance; saying unusual or inappropriate things. Restricted affectivity (an aspect of Detachment): Little reaction to emotionally arousing situations; constricted emotional experience and expression; indifference or coldness. Withdrawal (an aspect of Detachment): Preference for being alone to being with others; reticence in social situations; avoidance of social contacts and activity; lack of initiation of social contact. Suspiciousness (an aspect of Detachment): Expectations of—and heightened sensitivity to—signs of interpersonal ill-intent or harm; doubts about loyalty and fi delity of others; feelings of persecution. Trait and personality functioning specifiers may be used to record additional personality features that may be present in schizotypal personality disorder but are not re quired for the diagnosis. Furthermore, although moderate or greater im pairment in personality functioning is required for the diagnosis of schizotypal personal ity disorder (Criterion A), the level of personality functioning can also be specified. Moderate or greater impairment in personality functioning, manifested by difficulties in two or more of the following four areas: 1. Emotional Stability): Frequent and intense experiences of high levels of a wide range of negative emotions. Extraversion): Avoidance of socioemotional experience, includ ing both withdrawal from inteflersonal interactions, ranging from casual, daily in teractions to friendships to intimate relationships, as well as restricted affective experience and expression, particularly limited hedonic capacity. Agreeableness): Behaviors that put the individual at odds with other people, including an exaggerated sense of self-importance and a concomi tant expectation of special treatment, as well as a callous antipathy toward others, encompassing both unawareness of others’ needs and feelings, and a readiness to use others in the service of self-enhancement. Conscientiousness): Orientation toward immediate gratification, leading to impulsive behavior driven by current thoughts, feelings, and external stimuli, without regard for past learning or consideration of future consequences. Lucidity): Exhibiting a wide range of culturally incongruent odd, eccentric, or unusual behaviors and cognitions, including both process. Specifiers, the specific personality features of individuals are always recorded in eval uating Criterion C, so the combination of personality features characterizing an individual directly constitutes the specifiers in each case. For example, two individuals who are both characterized by emotional lability, hostility, and depressivity may differ such that the first individual is characterized additionally by callousness, whereas the second is not. Personality Disorder Sooring Algorithms the requirement for any two of the four A criteria for each of the six personality disorders was based on maximizing the relationship of these criteria to their corresponding person ality disorder. The resulting diag nostic criteria sets represent clinically useful personality disorders with high fidelity, in terms of core impairments in personality functioning of varying degrees of severity and constellations of pathological personality traits. Personality Disorder Diagnosis Individuals who have a pattern of impairment in personality functioning and maladaptive traits that matches one of the six defined personality disorders should be diagnosed with that personality disorder. If an individual also has one or even several prominent traits that may have clinical relevance in addition to those required for the diagnosis.
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