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460 Muscular Dystrophies and Other Muscle Diseases Narayanaswami P et al: International consensus guidance for man­ agement of myasthenia gravis: 2020 update. Neurology 96:114, 2021. Ohno K et al: Clinical and pathologic features of congenital myas­ thenic syn...

SECTION 4 Syndromes Associated with Chronic Fatigue Section 4 Syndromes Associated with Chronic Fatigue Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome Elizabeth R. Unger, Jin-Mann S. Lin, Jeanne Bertolli Myalgic encephalomyelitis/chronic fatigue syndrome...

461 Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome Section 4 Syndromes Associated with Chronic Fatigue Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome Elizabeth R. Unger, Jin-Mann S. Lin, Jeanne Bertolli Myalgic encephalomyelitis/chronic fatigue synd...

SECTION 5 Psychiatric and Addiction Disorders Counseling may help patients and their families cope with the long-term consequences of living with a chronic illness. Consulta­ tion with a physical or occupational therapist may identify energysaving strategies f...

462 Biology of Psychiatric Disorders Counseling may help patients and their families cope with the long-term consequences of living with a chronic illness. Consulta­ tion with a physical or occupational therapist may identify energysaving strategies for activi...

463 Psychiatric Disorders Victor I. Reus Psychiatric Disorders Psychiatric disorders are common in medical practice and may present either as a primary disorder or as a comorbid condition. The prevalence of mental or substance use disorders in the United State...

464 Alcohol and Alcohol Use Disorders Marc A. Schuckit Alcohol and Alcohol Use Disorders Most patients drink alcohol, including many who take this drug at levels that can adversely affect their medical conditions or interfere with the effects of prescribed med...

465 Nicotine Addiction as a once-per-month 380-mg injection. By blocking opioid recep­ tors, naltrexone decreases activity in the dopamine-rich ventral tegmental reward system and decreases the feeling of pleasure if alcohol is imbibed. A second medication, ac...

466 Cannabis and Cannabis Use Disorder Hajek P et al: A randomized trial of e-cigarettes versus nicotine- replacement therapy. N Engl J Med 380:629, 2019. Kaplan B et al: Effectiveness of ENDS, NRT and medication for smok­ ing cessation among cigarette-only us...

467 Opioid-Related Disorders cognitive behavioral techniques have also shown clinically significant improvements in abstinence and reduced cannabis use. OTHER ADVERSE EFFECTS ■ ■MENTAL ILLNESS The association between marijuana use and increased risk of mental ...

468 Cocaine, Other Psychostimulants, and Hallucinogens community of fellow drug users. These medication-free programs, as well as the pharmacotherapy programs, also include counseling and behavioral treatments designed to teach interpersonal and cognitive skil...

469 Heavy Metal Poisoning Poisoning, Drug Overdose, and Envenomation PART 14 Howard Hu Heavy Metal Poisoning Toxic metals (hereafter referred to simply as “metals”) pose a significant threat to health through low-level as well as high level environmental and o...

470 Poisoning and Drug Overdose Mark B. Mycyk Poisoning and Drug Overdose Poisoning refers to the development of dose-related adverse effects following exposure to chemicals, drugs, or other xenobiotics. To para­ phrase Paracelsus, the dose makes the poison. A...

472 Ectoparasite Infestations and Arthropod Injuries dysrhythmias, hypotension, and pulmonary edema have also been reported. Postmortem examination of brain tissue has shown neuronal necrosis or cell loss and astrocytosis, most prominently in the hippo­ campus...

473 Health Effects of Climate Change Disorders Associated with Environmental Exposures PART 15 Eugene Richardson, Maxine A. Burkett Health Effects of Climate Change Climate change refers to the effects of accumulated greenhouse gases (GHGs) in the atmosphere o...

474 Climate Change and Infectious Disease Government actions/public policy shifts Effects Impact on human health Establish sustainable dietary guidelines Eliminate subsidies for commodity crops Add cost of environmental degradation to foods with high environme...

475 Altitude Illness Strengthening Public and Political Support Implementing Policies for Mitigation (Primary Prevention) Improving the Public’s Understanding of Climate Change Policymaking Process Energy Policy Building Movements for Addressing Climate Change...

476 Hyperbaric and Diving Medicine Diabetes Mellitus  Well-controlled diabetes is not a contraindi­ cation for travel to high altitude. Most of the high-altitude diabetes advice is based on patients with type 1 diabetes and not type 2 diabetic patients with co...