behavior

JoVE Behavior documents observational and experimental techniques that seek to understand human and animal behavior. Work in this field includes analysis of genetic causes and physiological responses to internal or external stimuli as well as the implicated brain regions.

Behavior

biochemistry

JoVE Biochemistry publishes experiments that investigate the structure, function, and interactions of biological molecules. The video articles in this section demonstrate methods to study nucleic acids, proteins, carbohydrates and lipids as well as enzyme function, protein folding, molecular interactions and biochemical reactions.

Biochemistry

bioengineering

JoVE Bioengineering merges both physical and life sciences to understand and predict biological processes. Applying physical science tools to life science questions allow for the discovery of better technologies to measure, diagnose, and clinically treat disease.

Bioengineering

biology

JoVE Biology welcomes all general biology research methodologies. Content in this section canvases all fields of cell, molecular, and organismal biology, ranging from new applications of standard techniques to novel approaches aimed at understanding the functions of life and living organisms. This diverse section includes, but is not limited to, techniques in physical biology, cellular biochemistry, genetics, physiology, systems biology and a combination of eukaryotic and prokaryotic model systems.

Biology

cancer research

JoVE Cancer Research illustrates experimental approaches in biomedical research and clinical practice aimed at understanding, detecting, treating and preventing cancer. The video articles in this section demonstrate methods to study the cellular and molecular mechanisms of cancer, animal models of cancer research, development of new therapies and diagnostics, tumor imaging, chemical and radiation treatments, surgical procedures and improvements in therapy. These video articles offer researchers and clinical practitioners an efficient way to learn the technologies and experimental methods in cancer research.

Cancer Research

chemistry

JoVE Chemistry surveys a broad scope of chemical disciplines. This collection includes fundamental and applied research that investigates molecular interactions, properties, and structure spanning in the following core divisions: analytical, organic, organometallic, inorganic, bioinorganic, and biochemistry. This section also includes the design and preparation of materials and small molecules for advanced or unique applications.

Chemistry

developmental biology

JoVE Developmental Biology publishes research methodologies in the field of developmental biology. This includes methods that are used to study biological development in vitro and in vivo at the molecular, cellular, tissue, organ and whole organism levels.

Developmental Biology

engineering

JoVE Engineering encompasses a broad range of experimental and instrumental techniques utilized in physics research. Investigations in this area strive to address and answer a broad range of scientific questions, such as device mechanisms and efficiencies, using physical tools. This approach often requires a combination of specialties, and research in this area tends to be interdisciplinary with contributions from mechanical, electrical, and chemical engineers.

Engineering

environment

JoVE Environment is dedicated to research methodologies that address environmental concerns and seek to better understand Earth's ecosystem.  Special consideration is given to experimental methodologies that assess society’s impact on the environment, suggest solutions for protecting Earth’s resources, and develop sustainable fuel sources. Moving towards an environmentally conscious planet is a collaborative effort with contributions from both life and physical scientists.

Environment

genetics

JoVE Genetics publishes video articles demonstrating experimental approaches to investigate gene function and regulation. This includes methods to study gene expression, mutagenesis, epigenetics, genetic determinants of development, genetic disorders, population genetics and evolution.

Genetics

immunology and infection

JoVE Immunology and Infection includes content from a variety of fields working toward a shared initiative of improving global health. Techniques evaluating the biological response to pathogens from the molecular to organismal level are presented as well as therapeutic agents and their efficacy in treating disease.

Immunology and Infection

medicine

JoVE Medicine serves as a connection between basic research and clinical applications. Articles may present medical procedures, case studies or clinical trial methodologies. Included studies are often modeled towards predictive, preventative, personalized, and practical approaches to treatment of disease. The goal of research methodologies in this section is to improve overall patient care and prognosis.

Medicine

neuroscience

JoVE Neuroscience is a multidisciplinary section devoted to investigations of the structure, function, physiology, and pathophysiology of the brain and nervous system. Included methodologies range from molecular and cellular level studies to full central and peripheral neural systems. Potential treatment platforms and surgical techniques for neurological diseases and disorders are also presented in this section.

Neuroscience

jove journal

JoVE Journal

Scientific video journal. Peer reviewed. Multi-disciplinary. Indexed in PubMed and Web of Science.

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Research

Experimental Protocol for Manipulating Plant-induced Soil Heterogeneity

Coexistence theory has often treated environmental heterogeneity as being independent of the community composition; however biotic feedbacks such as plant-soil feedbacks (PSF) have large effects on plant performance, and create environmental heterogeneity that depends on the community composition. Understanding the importance of PSF for plant community assembly necessitates understanding of the role of heterogeneity in PSF, in addition to mean PSF effects. Here, we describe a protocol for manipulating plant-induced soil heterogeneity. Two example experiments are presented: (1) a field experiment with a 6-patch grid of soils to measure plant population responses and (2) a greenhouse experiment with 2-patch soils to measure individual plant responses. Soils can be collected from the zone of root influence (soils from the rhizosphere and directly adjacent to the rhizosphere) of plants in the field from conspecific and heterospecific plant species. Replicate collections are used to avoid pseudoreplicating soil samples. These soils are then placed into separate patches for heterogeneous treatments or mixed for a homogenized treatment. Care should be taken to ensure that heterogeneous and homogenized treatments experience the same degree of soil disturbance. Plants can then be placed in these soil treatments to determine the effect of plant-induced soil heterogeneity on plant performance. We demonstrate that plant-induced heterogeneity results in different outcomes than predicted by traditional coexistence models, perhaps because of the dynamic nature of these feedbacks. Theory that incorporates environmental heterogeneity influenced by the assembling community and additional empirical work is needed to determine when heterogeneity intrinsic to the assembling community will result in different assembly outcomes compared with heterogeneity extrinsic to the community composition.

Understanding the role of environmental heterogeneity in species coexistence has typically focused on types of heterogeneity that are extrinsic to the community&#8217;s species composition. We provide novel detailed methods for creating soil heterogeneity treatments using soils subject to plant-soil feedback conditioning, or heterogeneity intrinsic to the community composition.

Экспериментальный протокол для работы с завод-индуцированной неоднородности почвы

Coexistence theory has often treated environmental heterogeneity as being independent of the community composition; however biotic feedbacks such as ...

Studying Food Reward and Motivation in Humans

A key challenge in studying reward processing in humans is to go beyond subjective self-report measures and quantify different aspects of reward such as hedonics, motivation, and goal value in more objective ways. This is particularly relevant for the understanding of overeating and obesity as well as their potential treatments. In this paper are described a set of measures of food-related motivation using handgrip force as a motivational measure. These methods can be used to examine changes in food related motivation with metabolic (satiety) and pharmacological manipulations and can be used to evaluate interventions targeted at overeating and obesity. However to understand food-related decision making in the complex food environment it is essential to be able to ascertain the reward goal values that guide the decisions and behavioral choices that people make. These values are hidden but it is possible to ascertain them more objectively using metrics such as the willingness to pay and a method for this is described. Both these sets of methods provide quantitative measures of motivation and goal value that can be compared within and between individuals.

This article describes a set of methods for the measurement of food related motivation and food related goal values in humans.

Изучение Продукты наградой и мотивацией у людей

A key challenge in studying reward processing in humans is to go beyond subjective self-report measures and quantify different aspects of reward such as ...

Psychosurgery

Psychosurgery, the surgical alteration or permanent removal of brain tissue to alleviate severe psychological conditions, stands as one of the most radical and controversial treatments in the history of mental health care. Its development and application have evolved significantly, marked by dramatic shifts in scientific understanding and ethical perspectives.
Historical Development of Psychosurgery
In the 1930s, Portuguese neurologist Antonio Egas Moniz introduced a surgical procedure designed to sever neural pathways between the frontal lobe and thalamus. This intervention aimed to mitigate severe mental health disorders, including schizophrenia and severe anxiety. Despite its crude methodology, the surgeries gained recognition, and Moniz was awarded the Nobel Prize in Physiology or Medicine in 1949.
Walter Freeman, an American neurologist, popularized and coined the term prefrontal lobotomy in the United States, introducing a simplified and faster technique that involved accessing the brain through the eye socket using a surgical instrument similar to an ice pick. Freeman performed over 3,000 lobotomies, often in public demonstrations, and fervently advocated for the procedure as a solution to various psychological disorders. However, his approach often overlooked long-term outcomes and ethical considerations.
Decline of Traditional Lobotomies
The widespread adoption of lobotomies from the 1930s to the 1960s resulted in significant and irreversible harm to many patients. Adverse effects included severe cognitive impairments, memory loss, emotional flatness, and personality changes. Coupled with the advent of psychiatric medications in the mid-1950s, which offered non-invasive alternatives, lobotomies fell out of favor. Reports of poor outcomes and heightened ethical scrutiny further discredited the procedure.
Modern Psychosurgical Techniques
Contemporary psychosurgery employs far more precise and controlled methods, targeting specific brain regions such as the amygdala or anterior cingulate cortex. Techniques like cingulotomy and capsulotomy are used to treat intractable psychiatric conditions such as severe obsessive-compulsive disorder (OCD) and major depressive disorder. These procedures are guided by advanced imaging technologies to minimize damage to surrounding tissues.
Stringent regulations, such as institutional review boards, now govern psychosurgery, ensuring thorough patient evaluation, informed consent, and surgeon&#39;s competency. These measures aim to balance the potential benefits of psychosurgery with its inherent risks, emphasizing its use as a last resort when all other treatments have failed.
Ethical and Scientific Considerations
Despite technological advances, psychosurgery remains a contentious field. Critics point to the procedure&#39;s historical misuse and potential for unintended consequences, while proponents argue for its value in treating otherwise untreatable conditions. Ongoing research seeks to refine surgical techniques and deepen understanding of the brain, underscoring the need for a cautious and ethical approach to this powerful intervention.

Psychosurgery involves removing or permanently destroying brain tissue to treat severe psychological conditions, making it a controversial biomedical ...

Self-Help Support Groups

Self-help support groups are voluntary, community-based organizations that provide a platform for individuals with shared concerns to exchange support, insights, and practical strategies for coping with life challenges. Typically led by group members or paraprofessionals, these groups form a cornerstone of mental health care, especially in reaching populations that are underserved by traditional healthcare systems.
Accessibility and Cost-Effectiveness
One of the primary strengths of self-help groups is their accessibility. By leveraging community resources and operating at a low cost, they serve individuals who might otherwise face barriers to mental health services, such as those with limited financial means or lower levels of education. These groups offer an inclusive space where participants can openly share experiences, seek advice, and explore solutions in a non-judgmental environment.
The Power of Shared Experience
The effectiveness of self-help groups is rooted in their emphasis on shared experience. Participants gain unique insights from peers who have faced similar challenges, fostering a sense of credibility and understanding that professionals may not always provide. For instance, a rape survivor might find meaningful support and guidance from another survivor who has successfully navigated a similar recovery process. These interactions not only validate individual experiences but also enhance emotional resilience and promote self-efficacy.
Applications in Mental Health and Beyond
Self-help groups address a wide array of issues, including substance abuse, chronic illnesses such as heart disease or cancer, and psychological trauma. Alcoholics Anonymous (AA) exemplifies the impact of these groups, with research highlighting its role in reducing alcohol consumption through mechanisms such as enhanced social networks, improved self-efficacy, increased spirituality, and alleviation of negative emotions.
The Role of Online Platforms
Advances in technology have expanded the reach of self-help groups through online platforms, offering greater accessibility for individuals unable to attend in-person meetings. However, virtual settings pose unique challenges, including the risk of misinformation. In the absence of guidance from a trained professional, members may lack the expertise and knowledge to provide optimal advice. This increases the potential for harmful group dynamics, as evidenced by certain pro-anorexia communities. Effective moderation by group leaders can mitigate these risks, ensuring a safe and constructive environment for all members.
Self-help groups exemplify the value of peer-led initiatives in mental health care, bridging gaps in accessibility and fostering collective resilience through shared understanding and mutual support.

Self-help support groups are voluntary organizations where individuals with common interests meet regularly to discuss shared concerns and provide mutual ...

Couples Therapy

Couples therapy is a therapeutic approach designed to help individuals in intimate relationships address conflicts, improve communication, and foster healthier dynamics. It is appropriate for couples at various stages, including those who are dating, married, or in long-term partnerships, and aims to support partners in navigating their unique relational challenges.
Core Principles and Techniques
Couples therapy often incorporates cognitive-behavioral principles to identify and modify negative patterns within relationships. Therapists guide partners in understanding how their individual backgrounds, beliefs, past experiences, and behaviors influence their interactions. This insight is crucial in addressing issues such as poor communication, infidelity, jealousy, sexual difficulties, substance abuse, and the complexities of blended families or two-career households.
Therapists use various techniques such as validation, reframing, structural change, and detriangulation to promote relational growth. Validation involves acknowledging each partner&#39;s emotions and beliefs, as well as fostering mutual respect and understanding. Reframing helps couples view their challenges as shared problems rather than assigning blame, encouraging collaboration. The structural change focuses on reorganizing interaction patterns to create a supportive and functional environment, while detriangulation addresses external conflicts that may be diverting attention from the relationship itself.
Navigating High-Conflict Relationships
High-conflict relationships present unique challenges due to heightened emotions and volatility. Therapists act as mediators, helping partners navigate intense disagreements and work toward constructive resolutions. These situations require a nuanced approach to de-escalate tensions and facilitate productive dialogue.
Goals and Outcomes
The primary goal of couples therapy is to equip partners with tools to enhance understanding and foster healthier interactions. For some, this process strengthens the relationship, while for others, therapy may reveal irreconcilable differences, leading to a mutual decision to separate. Regardless of the outcome, therapy emphasizes clarity and informed decision-making, enabling couples to navigate their circumstances with greater insight and confidence.
By addressing relational dynamics and promoting constructive change, couples therapy supports partners in building more harmonious connections or reaching resolutions that align with their well-being.

Couples therapy helps individuals in intimate relationships resolve conflicts and improve dynamics. Couples may be dating, married, or in long-term ...

Family Therapy

Family therapy conceptualizes psychological challenges as arising from dysfunctional interactions within the family unit, rather than as isolated issues within individuals. This approach seeks to address and transform the patterns of communication, roles, and relationships within families to promote healthier dynamics and emotional well-being for all members.
Strategic Family Therapy
Strategic family therapy emphasizes resolving communication barriers and improving problem-solving abilities among family members. Therapists employ carefully planned tasks, known as directives, to alter dysfunctional interaction patterns. One notable technique is the use of paradoxical requests, where problematic behaviors are reframed in unexpected ways to elicit change. For example, a couple prone to frequent arguments might be instructed to argue more intentionally, thereby reframing their conflict as an expression of connection. This paradoxical approach often leads to reduced conflict and an improved relationship dynamic by altering the way family members perceive and engage in their interactions.
Structural Family Therapy
Structural family therapy focuses on reorganizing the family&#39;s hierarchical structure and boundaries to enhance functionality. Therapists actively participate in family activities to observe and modify interactions, fostering healthier dynamics. For instance, helping a teenager who initially sought their family&#39;s attention by refusing to eat to express their needs verbally, ultimately leading them to stop using food refusal as a way to seek affection. This direct engagement strengthens communication, reinforces healthy boundaries, and empowers the family to support each member&#39;s needs effectively.
Effectiveness and Applications
Research demonstrates that family therapy is as effective as individual therapy, offering distinct advantages for families dealing with relational or systemic issues. By addressing problems within their broader context, family therapy promotes growth and healing not just for individuals but for the family as a cohesive unit. Approaches such as strategic and structural therapy exemplify the flexibility and efficacy of this modality, making it a valuable tool in fostering healthier familial relationships and emotional resilience.

Family therapy views psychological problems as rooted in dysfunctional family systems rather than in an individual.
The primary focus of treatment is the ...

Community Based Intervention

Community-based interventions in mental health represent a paradigm shift from institution-centered care to treatments embedded within the fabric of local communities. By prioritizing inclusion and leveraging existing societal structures, this approach fosters a supportive environment conducive to addressing mental health challenges while promoting individual dignity and agency.
Foundations of Community Mental Health Programs
Central to the success of community-based interventions is the training of local stakeholders such as teachers, nurses, and community members. These individuals are equipped with fundamental counseling skills and are often involved in workshops aimed at stress management, substance abuse reduction, and interpersonal skill development. Such initiatives help extend mental health care beyond specialized professionals, making it more accessible and reducing stigma.
The deinstitutionalization movement of the 1960s marked the beginning of this transition. It was driven by concerns over the ethical failings of institutional care, which often subjected individuals to neglect and abuse, and by economic considerations regarding the unsustainable costs of long-term institutionalization. As individuals were reintegrated into communities, the focus shifted to creating support systems that address mental health in a holistic, culturally sensitive manner.
Empowerment and Sustainability
Community-based mental health programs emphasize empowerment, enabling individuals to actively engage in their recovery and integrate fully into familial and societal contexts. This approach, championed by community psychologists, seeks to cultivate long-term well-being by embedding care within the individual&#39;s social and cultural milieu.
However, these programs require robust support in terms of local resources and government funding. Sustainable initiatives are essential to ensure continuity in care and to prevent adverse outcomes, such as homelessness, for individuals with chronic mental health conditions. Investment in community-based interventions not only alleviates the strain on formal healthcare systems but also promotes a more inclusive and equitable approach to mental healthcare.

Community-based intervention provides care within society and family, fostering inclusion and treating mental health in familiar settings like community ...

Interpersonal Psychotherapy

Interpersonal psychotherapy (IPT) is a structured, time-limited therapeutic approach initially developed to treat depression. It integrates key concepts from psychodynamic, humanistic, and cognitive-behavioral therapies, making it a uniquely eclectic framework. The therapy is rooted in the interpersonal theories of Adolph Meyer and Harry Stack Sullivan, as well as John Bowlby&#39;s attachment theory, and focuses on the interplay between interpersonal relationships and emotional well-being.
Foundations of Interpersonal Psychotherapy
The foundational premise of IPT is that interpersonal relationships significantly influence mood and psychological health. Sullivan emphasized the collaborative role of the therapist as a &#34;participant observer,&#34; working to identify and address maladaptive interpersonal patterns in the client&#39;s daily life. This focus on relationship dynamics distinguishes IPT from other therapeutic models. While it draws on psychodynamic concepts, IPT diverges from traditional psychodynamic therapy by explicitly emphasizing practical strategies to improve interpersonal functioning.
Structure and Scope of IPT
IPT is typically delivered in a short-term format, encompassing 12&#8211;16 sessions. The approach aims to enhance clients&#39; social skills, resolve interpersonal conflicts, and assist with life transitions, such as childbirth, retirement, or bereavement. The therapy is structured around specific problem areas identified during the initial assessment, such as role disputes, role transitions, unresolved grief, or interpersonal deficits. By addressing these areas, IPT helps clients develop healthier relationships and coping mechanisms.
Effectiveness Across Conditions
Originally designed to treat depression, IPT has demonstrated efficacy in combination with pharmacological treatments and as a standalone intervention. Clinical studies have shown its effectiveness in treating various conditions, including substance use disorders and eating disorders, with outcomes comparable to those achieved through cognitive-behavioral therapy. IPT&#39;s success lies in its ability to adapt its core principles to address the unique challenges associated with different mental health disorders.
The integration of theoretical insights with practical strategies makes IPT a versatile and evidence-supported approach, offering a collaborative pathway to improved interpersonal functioning and psychological health.

Interpersonal psychotherapy, or IPT, is an insight-based therapy focusing on the relationship between an individual&#39;s mood and their interpersonal ...

Electroconvulsive Therapy

Electroconvulsive therapy (ECT), or shock therapy, remains a critical biomedical intervention for severe, treatment-resistant depression. While its origins can be traced back to Hippocrates&#39; observations that malaria-induced convulsions alleviated mental illness, modern ECT has evolved significantly from its earlier, more primitive applications. First introduced in 1938 by Ugo Cerletti and his colleagues, ECT involves inducing controlled seizures using electrical currents. In its early years, patients were subjected to the procedure without anesthesia, leading to severe bodily convulsions and a barbaric reputation. Today, however, ECT is far more refined and safer due to anesthesia, muscle relaxants, and targeted stimulation.
The current ECT procedure involves administering a brief electric pulse, typically lasting less than a second, through electrodes placed on the patient&#39;s scalp. This electrical current triggers a seizure lasting approximately 60 seconds. Patients are rendered unconscious with anesthesia and muscle relaxants to prevent physical convulsions, ensuring minimal discomfort. Increasingly, the stimulation is applied to the brain&#39;s right hemisphere, reducing the risk of memory loss and cognitive impairments, which are among ECT&#39;s most debated side effects. Patients awaken shortly after the procedure with no memory of the treatment, and recovery occurs within 30 minutes.
ECT is primarily used for individuals with severe depression who do not respond to medication or psychotherapy. It is particularly effective for cases involving acute suicidality, offering rapid mood improvement. Studies report that after two to four weeks of treatments &#8212; typically three sessions per week &#8212; approximately 70% of patients experience significant relief. This success has been attributed to ECT&#39;s ability to reduce overactivity in brain regions associated with depression and potentially stimulate neurogenesis, promoting the growth of new neurons and synaptic connections.
Despite its effectiveness, ECT remains controversial due to its side effects, including memory loss and cognitive impairment. Though modern advancements, such as unilateral stimulation and refined protocols, have reduced these risks, they still warrant careful consideration. Long-term efficacy also remains uncertain, as relapses can occur, necessitating maintenance therapies like antidepressants or exercise. Nonetheless, ECT continues to save lives, especially in severe cases of depression where other treatments fail. For many, its benefits far outweigh the risks.

Electroconvulsive therapy, or ECT, commonly known as shock therapy, originated from Hippocrates&#39; observations in ancient Greece, who noted that ...

Beck's Cognitive Therapy

Cognitive therapy is a psychological approach designed to address distortions in thinking, which can lead to negative emotions and unrealistic beliefs. These cognitive distortions often influence how individuals interpret and respond to situations, exacerbating emotional distress. Below are some prevalent cognitive distortions, their characteristics, and examples of how they manifest in thought processes.
Arbitrary Inference
Arbitrary inference involves making conclusions without sufficient evidence, often based solely on personal assumptions. This type of distortion disregards facts and relies on conjecture. For example, an individual may interpret a canceled lunch appointment as evidence that their friend is seeing someone else, despite having no supporting evidence. This tendency to jump to conclusions can lead to unwarranted anxiety or mistrust.
Selective Thinking
Selective thinking occurs when a person fixates on one aspect of a situation, ignoring other relevant details that might provide balance or perspective. For instance, a student might receive praise for their work but focus entirely on a minor critique, concluding that their performance was poor. This cognitive bias limits the individual&#39;s ability to see the broader context of their achievements or the constructive nature of feedback.
Overgeneralization
Overgeneralization involves drawing broad, often exaggerated conclusions based on a single incident. For example, someone reprimanded at work might irrationally assume that their work relationships are doomed and envision a cascade of negative outcomes. This distortion perpetuates feelings of hopelessness and unwarranted despair.
Magnification and Minimization
In this distortion, individuals amplify the significance of negative events while downplaying positive ones. For example, a student who consistently excels academically might catastrophize a single mediocre grade as a sign of inevitable failure, disregarding their overall success. This imbalance skews self-assessment and fosters unwarranted negative self-perceptions.
Personalization
Personalization involves taking unwarranted responsibility for external events. For example, a person might attribute their partner&#39;s bad mood to their actions, ignoring external factors such as work-related stress. This distortion often results in misplaced guilt or self-blame.
Cognitive therapists aim to address these distortions by encouraging clients to evaluate their beliefs critically. Through structured questioning, such as examining the origin or evidence of a belief, clients are guided to identify and challenge illogical patterns. This process fosters more balanced and realistic thinking, improving emotional well-being and resilience.

Cognitive therapy, developed by Aaron T. Beck, addresses distorted thinking and unrealistic beliefs, particularly in depression.
Some of the common ...

Rational Emotive Behavior Therapy

Cognitive-behavioral therapies (CBTs) are grounded in the belief that our thoughts profoundly influence our emotions and actions. Advocates of CBT emphasize three core assumptions: first, that cognitions are identifiable and measurable; second, that they are central to psychological functioning; and third, that irrational or maladaptive beliefs can be replaced with rational and adaptive ones. This transformative approach to therapy has paved the way for specific models such as Albert Ellis&#39;s Rational Emotive Behavior Therapy (REBT), which integrates both cognitive and behavioral elements to foster mental well-being.
The ABCs of Rational Emotive Behavior Therapy
Ellis introduced REBT in the mid-1950s as a pioneering cognitive-behavioral framework. At its core lies the ABC model, which outlines the interaction between activating events (A), belief systems (B), and emotional and behavioral consequences (C). For instance, two individuals receiving the same test score may exhibit vastly different responses due to disparities in their belief systems. Rational beliefs, characterized by flexibility and self-acceptance, contrast sharply with irrational beliefs, which often involve unrealistic demands and catastrophic thinking.
To address irrational beliefs, Ellis extended the ABC model to include disputation (D), effective new beliefs (E), and fostering desired feelings and behaviors (F). Therapists employing REBT actively challenge clients&#39; maladaptive beliefs and encourage rational rethinking. Assignments or &#8220;homework&#8221; often reinforce this process, such as tasks designed to confront and disprove fears tied to irrational thoughts.
Cognitive-Behavioral Therapy: Expanding on Rationality
CBT builds upon the principles of cognitive psychology and behaviorism, focusing on present cognitive and behavioral interactions rather than past influences. It posits that psychological disorders stem from illogical thought patterns, which, when restructured into logical and rational frameworks, lead to symptom alleviation. The three overarching goals of CBT include symptom relief, equipping clients with coping strategies, and fostering a shift from self-defeating to self-enhancing thoughts.
By blending cognitive interventions with behavioral techniques, CBT offers a robust, action-oriented approach to mental health, emphasizing the transformative power of rational thinking and adaptive behavior.

In the mid-1950s, Albert Ellis developed rational emotive behavior therapy or REBT, a key example of a cognitive-behavioral approach.
He introduced the ...

Cognitive Therapy

Cognitive therapy, pioneered by Aaron T. Beck in the 1960s, is a structured approach to addressing psychological distress by focusing on the influence of thoughts on emotions and behaviors. All cognitive therapies involve the basic assumption that human beings have control over their feelings, and that how individuals feel about something depends on how they think about it. Unlike psychoanalytic methods that delve into unconscious processes or humanistic approaches emphasizing self-actualization, cognitive therapy targets distorted or dysfunctional thought patterns, aiming to restructure these to alleviate maladaptive behaviors and emotional responses.
Principles of Cognitive Therapy
Central to cognitive therapy is the concept of cognitive restructuring, which involves identifying and modifying distorted thinking patterns (cognitive distortions). For example, a client may interpret a single academic failure as indicative of global incompetence, leading to feelings of worthlessness. Through guided questioning, therapists challenge these irrational beliefs and help clients develop more accurate, rational perspectives. This active and structured process distinguishes cognitive therapy as an action-oriented approach rather than one focused on uncovering historical psychological roots.
Application to Depression and Other Disorders
Initially developed to treat depression, cognitive therapy has demonstrated effectiveness across a range of psychological disorders. Beck&#39;s work emphasized the role of self-defeating attitudes and negative automatic thoughts in perpetuating depressive states, even amidst positive life circumstances. By addressing these maladaptive cognitions, clients can reframe their interpretations of situations, reducing distress and promoting healthier emotional responses.

Cognitive therapy is a form of psychotherapy that emphasizes the role of thoughts in causing emotional distress and maladaptive behaviors.
It aims to ...

Group Therapy

Group therapy is a sociocultural approach to psychological treatment, where individuals with shared psychological challenges come together under the guidance of a mental health professional. This therapeutic modality offers unique opportunities for individuals to connect, share, and grow within the context of a supportive group. By fostering mutual understanding and collaboration, group therapy can address a range of psychological concerns effectively, often complementing or surpassing the benefits of individual therapy.
Benefits of Group Therapy
Group therapy promotes universality, helping participants realize that others share similar struggles, which can reduce feelings of isolation and shame. For instance, a child dealing with poor social skills may benefit from observing and practicing interpersonal techniques within a structured group setting. Similarly, a woman with postpartum depression might feel less guilt and more connection in a group of others facing the same challenges.
Altruism is another key feature: participants provide support, advice, and empathy to one another, which can enhance feelings of competence and efficacy. Additionally, the group environment fosters interpersonal learning, where individuals receive feedback from peers, enabling them to refine social behaviors and develop healthier interaction patterns. For those with specific needs, such as sexual abusers, group therapy offers a safe space for practicing social skills, modeling openness, and confronting harmful patterns.
Challenges and Considerations
While group therapy has significant advantages, it is not without challenges. Participants may initially feel reluctant to share personal issues with strangers, and confidentiality concerns can arise if members disclose private information outside the group. Personality conflicts and disagreements within the group can also present obstacles. Despite these challenges, effective facilitation ensures a balanced and inclusive environment where everyone benefits from the group dynamic.
Applications and Formats
Group therapy can adopt various forms, including psychodynamic, humanistic, behavioral, or cognitive approaches. Psycho-educational groups address specific topics, such as coping with a family member&#39;s illness or overcoming bullying, often within school settings. Structured groups have defined goals and activities, while unstructured groups allow members to determine the focus collaboratively. These diverse formats cater to different therapeutic needs, making group therapy an adaptable and powerful tool for psychological growth and healing.

Group therapy is a sociocultural approach to treating psychological disorders, where individuals with similar issues participate in guided sessions led by ...

Behavior Therapy

Behavior therapy incorporates diverse techniques rooted in classical conditioning principles to address maladaptive behaviors and anxiety disorders. These methods aim to reduce avoidance behaviors, foster adaptive coping mechanisms, and alter associations between stimuli and responses, making them effective in a wide range of therapeutic contexts.
Exposure therapy is a cornerstone of behavioral treatment for anxiety disorders. It involves systematic exposure to feared stimuli, either in real life, through visualization, or via virtual reality, to desensitize the individual. Gradual exposure, beginning with the least anxiety-provoking scenarios and progressing to more challenging ones, is designed to help clients build tolerance.
Systematic desensitization builds upon this by pairing exposure with relaxation techniques. For instance, someone with a fear of public speaking may practice relaxation while initially speaking to a single person and then gradually progressing to larger audiences, reducing anxiety through reciprocal inhibition.
Flooding involves directly confronting the most anxiety-inducing stimuli in a controlled setting to extinguish avoidance behaviors. Unlike graded exposure, flooding does not follow a hierarchical approach. For example, an individual with a phobia of dogs might be guided to interact with a calm and friendly dog immediately, enabling them to experience the absence of feared consequences, which helps diminish their fear response.
Aversive conditioning is employed to deter undesirable behaviors by pairing them with unpleasant experiences. For example, to address overeating, therapists may use aversive stimuli, such as a bitter taste, to create a negative association with the behavior. This method conditions the individual to avoid the maladaptive behavior due to its unpleasant consequences.
Relaxation techniques, including deep breathing and progressive muscle relaxation, are integral to these therapies. They work through reciprocal inhibition, whereby a physiological state incompatible with anxiety, such as relaxation, counteracts the anxious response. By combining relaxation with gradual or direct exposure, individuals can recondition their responses to previously feared stimuli, fostering long-term behavioral change.

In behavior therapy, a therapist employs principles of learning, such as classical and operant conditioning, to help clients change undesirable 
...

Modeling in Therapy

Modeling, a key technique in therapy, uses observational learning to help clients acquire and practice new skills by watching therapists demonstrate desired behaviors. This approach, rooted in Albert Bandura&#39;s concept of vicarious learning, plays a significant role in therapeutic interventions for various psychological conditions, including social anxiety, ADHD, and depression.
Participant Modeling
Participant modeling involves therapists demonstrating calm and effective behaviors in situations that clients find challenging. The therapist first models a constructive approach to the feared object or scenario and then guides the client through the same process step-by-step until the client gains the confidence to manage independently. This technique helps clients confront their fears in a controlled and supportive environment.
Assertion Training
Assertion training incorporates modeling to help individuals express their thoughts and feelings assertively while avoiding extremes of submissiveness and aggressiveness. This training teaches clients to advocate for themselves respectfully and effectively, ensuring that their needs and rights are recognized. The focus is on fostering assertiveness as the balance between passivity and hostility, a skill particularly valuable for those with social anxiety or interpersonal challenges.
Behavioral Rehearsal
Behavioral rehearsal, often integrated with assertion training, employs role-playing exercises to enhance the client&#39;s skills. The therapist assumes the role of a significant figure in the client&#39;s life, such as a supervisor or family member, allowing the client to practice responses in a simulated interaction. As a result, role reversal enables the therapist to model ideal verbal and nonverbal communication, illustrating not just what to say but also how to say it effectively. Feedback and coaching refine the client&#39;s performance, helping them build confidence and competence.
Applications Beyond Therapy
These techniques extend beyond therapy sessions by encouraging clients to apply learned skills in real-life situations. By practicing outside the therapeutic setting, clients consolidate their learning and improve their ability to handle social interactions. Modeling and social skills training are instrumental in managing conditions such as schizophrenia, autism spectrum disorders, and ADHD, where improved interpersonal and coping skills can significantly enhance quality of life.
Through structured observation, practice, and application, modeling serves as a powerful tool in helping clients overcome barriers and adopt constructive behaviors.

Modeling allows clients to learn by watching therapists demonstrate positive behaviors, such as maintaining eye contact during conversations.
Similarly, ...

Drug Therapy

The advent of drug therapy has profoundly shaped modern mental health care, providing targeted treatments for a range of psychological disorders. Psychotherapeutic drugs, classified into antianxiety, antidepressant, and antipsychotic medications, address symptoms across anxiety disorders, mood disorders, and schizophrenia. While these medications have transformed patient outcomes, they require careful management due to their potential side effects and limitations.
Antianxiety Medications
Antianxiety drugs, commonly known as tranquilizers, include benzodiazepines such as Xanax, Valium, and Librium. These medications alleviate anxiety by binding to neurotransmitter receptors that are hyperactive during periods of distress. Although benzodiazepines act rapidly and are effective for short-term relief, they pose risks of addiction, drowsiness, impaired coordination, and potentially harmful interactions with alcohol and other drugs. Alternatives like buspirone (BuSpar) offer less addictive solutions but may take longer to provide symptomatic relief. Caution is essential in prescribing these medications, particularly for long-term use, due to their addictive potential.
Antidepressant Drugs
Antidepressants regulate mood by influencing brain neurotransmitters, particularly serotonin and norepinephrine. Types of antidepressants such as tricyclics and tetracyclics, named for their molecular structures, have demonstrated efficacy but come with significant side effects such as dizziness, memory issues, and faintness. Monoamine oxidase (MAO) inhibitors, though effective, are less commonly used due to dietary restrictions and risks of high blood pressure. More commonly prescribed are selective serotonin reuptake inhibitors (SSRIs), which target serotonin reabsorption, offering fewer side effects and broad applications for mood, anxiety, and even chronic pain disorders. However, withdrawal from SSRIs requires careful management to avoid severe symptoms.
Mood Stabilizers Medications
Lithium remains a cornerstone treatment for bipolar disorder, effectively managing manic episodes and stabilizing mood. Its therapeutic benefits are tempered by a narrow safety margin, requiring careful blood monitoring to avoid toxicity. Side effects such as weight gain, thyroid issues, and kidney complications are common, highlighting the need for patient adherence and regular medical supervision.
Antipsychotic Medications
Antipsychotics have revolutionized schizophrenia treatment by reducing symptoms such as hallucinations and agitation. Neuroleptics, the most widely used class, modulate dopamine pathways but are associated with severe side effects, including tardive dyskinesia, a condition characterized by involuntary facial and limb movements. Newer atypical antipsychotics, such as Clozaril and Risperdal, also target serotonin and have fewer side effects, but challenges remain in patient adherence and long-term symptom management. Combining medication with psychotherapy and skill-building therapies improves outcomes, emphasizing the importance of holistic care.
Drug therapies, while pivotal in psychiatric treatment, require personalized and cautious administration. Side effects, risk of dependency, and adherence issues necessitate a balanced approach, often integrating pharmacological interventions with psychotherapy for optimal results.

The development of psychotherapeutic drugs revolutionized mental healthcare, offering effective treatments for anxiety, mood disorders, and 
...

Psychodynamic Therapy

Psychodynamic therapies emphasize the exploration of unconscious processes and early childhood experiences as fundamental contributors to psychological difficulties. These therapies, deeply rooted in Freud&#39;s psychoanalytic theory, aim to uncover and resolve unconscious conflicts, granting individuals insights that promote emotional and behavioral healing. Contemporary psychodynamic approaches have evolved, integrating a broader range of influences and methodologies while still valuing the unconscious mind and the therapeutic relationship.
Freud&#39;s psychoanalysis is the cornerstone of psychodynamic therapies. He proposed that unconscious conflicts, often originating in childhood, manifest as present-day psychological problems. Through techniques such as free association, dream analysis, and interpretation, psychoanalysts endeavor to illuminate these hidden struggles.
Free Association encourages clients to articulate thoughts without censorship, facilitating the emergence of repressed emotions or memories. Freud viewed moments of resistance &#8212; when clients hesitated or avoided certain topics &#8212; as indicators of unresolved conflicts.
Dream Analysis involves interpreting dreams&#39; manifest content (the recalled narrative) to reveal their latent content or hidden unconscious meanings. Freud believed that dreams serve as a disguised outlet for repressed wishes, often rooted in sexual or aggressive instincts.
Interpretation entails uncovering symbolic meanings in clients&#39; words and actions and offering hypotheses about unconscious motivations that drive behaviors.
Freud highlighted the importance of transference, where clients project feelings toward significant figures in their lives onto the therapist. This phenomenon provides a window into relational patterns and unresolved emotions, which therapists can help clients process. Conversely, resistance reflects unconscious defense mechanisms that hinder therapy progress. Psychoanalysts work to address and understand these resistances, aiding clients in confronting difficult truths.
Modern psychodynamic therapies have shifted focus, often prioritizing the conscious mind and current relationships over Freud&#39;s emphasis on sexual conflicts. They explore recurring life patterns, significant past events, and distressing emotions to provide insight. Therapists, influenced by figures like Heinz Kohut, emphasize empathy and healthy therapeutic relationships as a means to foster self-understanding and emotional resilience. Contemporary practices also adapt to practical constraints, favoring weekly sessions over the intensive regimens of Freud&#39;s era.
This evolution reflects an enduring commitment to exploring the depths of the human psyche while embracing contemporary perspectives on mental health.

Psychodynamic therapy explores the unconscious mind, such as repressed memories, conflicts, and early childhood experiences, to understand current ...

Operant Conditioning Intervention

Operant conditioning serves as a foundational principle in therapeutic interventions aimed at modifying maladaptive behaviors. Central to this approach is the notion that behaviors, both adaptive and maladaptive, are learned through reinforcement. By analyzing the environmental factors that reinforce problematic behaviors, clinicians can design interventions to weaken these reinforcements and replace maladaptive behaviors with healthier alternatives.
In operant conditioning, behaviors that are reinforced tend to recur, whereas those that are not reinforced eventually diminish or become extinct. For example, obsessive-compulsive disorder (OCD) behaviors, such as compulsive checking rituals, are maintained through negative reinforcement. A compulsive action, like repeatedly checking if a door is locked, alleviates anxiety and prevents anticipated negative outcomes, reinforcing the behavior. Therapy based on operant conditioning addresses this by extinguishing avoidance learning. The individual is gradually exposed to situations without performing the compulsion, demonstrating that the feared outcomes do not occur. Simultaneously, relaxation training and alternative coping mechanisms are introduced to reduce anxiety, breaking the cycle of compulsive reinforcement.
Behavioral therapies based on operant principles are particularly effective for populations with limited cognitive abilities, such as children or adults with developmental disabilities. In treating autism spectrum disorder (ASD), behavioral therapies have proven highly effective. It is used to address self-injurious behaviors, promote communication, and enhance cognitive and language development. Research indicates that intensive early interventions can significantly improve outcomes for children with ASD.
One widely implemented operant conditioning technique is the token economy. This method is commonly used in controlled environments, such as psychiatric hospitals, to encourage positive behaviors. Tokens, which serve as secondary reinforcers, are awarded for desirable actions and can be exchanged for privileges or rewards. For instance, patients may earn tokens for completing daily tasks or engaging in social interactions, which they can later trade for amenities like extra leisure time or preferred activities. The structured reinforcement system of token economies fosters sustained behavioral improvements across diverse clinical settings.

Operant conditioning suggests that behaviors are shaped by their consequences.
Behaviors followed by positive outcomes are reinforced, such as a child ...

Humanistic Therapy

Humanistic therapies emphasize personal growth, self-understanding, and the fulfillment of human potential. Rooted in the belief that individuals inherently strive toward self-actualization, these approaches encourage clients to explore their feelings and experiences in a supportive, nonjudgmental environment. Humanistic therapies differ from psychodynamic approaches by focusing on conscious experiences, present circumstances, and the potential for self-improvement rather than past conflicts and unconscious drives.
Carl Rogers&#39; client-centered therapy is a cornerstone of humanistic psychotherapy. It aims to foster self-acceptance and unity between the client&#39;s actual self and ideal self. Therapists create a therapeutic environment characterized by three essential elements:
<ol>
	<li>Unconditional Positive Regard: Therapists affirm the inherent worth of clients, offering nonjudgmental acceptance to promote self-acceptance.</li>
	<li>Empathy: By deeply understanding and reflecting on the client&#39;s emotions, therapists help clients feel heard and validated.</li>
	<li>Genuineness: Therapists are authentic and transparent, fostering a genuine connection with the client.</li>
</ol>
Active listening and reflective speech are central techniques that allow clients to identify and articulate their feelings. For example, a therapist might mirror a client&#39;s grief or anger, encouraging deeper emotional exploration.
Gestalt therapy, developed by Fritz Perls, focuses on integrating conflicting aspects of the self to achieve wholeness. Techniques like the two-chair dialogue allow clients to confront and synthesize opposing parts of their personality, fostering authenticity and emotional balance. Gestalt therapy emphasizes the &#34;here and now,&#34; urging clients to take responsibility for their feelings and actions. Techniques such as the two-chair method in Gestalt therapy, where clients alternate speaking from different perspectives to address and resolve internal conflicts, help promote self-awareness and integration.
Existential therapy, exemplified by Viktor Frankl&#39;s logotherapy, explores meaning-making as a response to life&#39;s challenges. Frankl believed that even in dire circumstances, individuals could find purpose and maintain dignity. Existential therapists help clients confront themes like freedom, isolation, and mortality, encouraging personal responsibility and resilience.
Humanistic principles are integral to various contemporary approaches, including motivational interviewing, which leverages empathy and reflective listening to encourage behavior change. Whether addressing mental health conditions or lifestyle modifications, humanistic therapies remain influential in fostering emotional awareness, self-empowerment, and authentic living.

Humanistic therapy focuses on self-healing, conscious thoughts, the present, and self-fulfillment, encouraging individuals to realize their potential and ...

Treatment Strategies for Psychological Disorders

Treatment approaches for psychological disorders fall into three main categories: psychological, biological, and sociocultural. Each approach targets different aspects of mental health, requiring varying levels of education and training.
Psychological therapies focus on modifying emotions, thoughts, and behaviors through talking, interpreting, listening, rewarding, challenging, and modeling. Clinical psychologists, counselors, and social workers commonly practice psychotherapy. Clinical psychologists typically hold a Ph.D. or Psy.D., which involves years of graduate education, supervised clinical practice, and a clinical internship. Licensing and certification are two processes through which society regulates psychotherapy practitioners. Specific laws govern the requirements for obtaining a license or certification, ensuring that professionals meet specific educational and training standards. These regulations outline the necessary qualifications and mandate formal examinations to assess the practitioner&#39;s skills and competency before allowing them to practice.
Biological therapies, or biomedical therapies, aim to treat psychological disorders by altering physical body functions, often through medications. This approach views mental health disorders similarly to physical diseases, requiring medical intervention. Practitioners of biological therapies are generally medical doctors (MDs), with psychiatrists specializing in this field. Psychiatrists undergo medical school, residency, and specialized training in psychiatry. While both psychologists and psychiatrists can administer psychotherapy, only psychiatrists can prescribe medication. If medication is necessary, a psychotherapist may refer clients to a psychiatrist for prescriptions.
Sociocultural therapies emphasize the impact of social and cultural factors on mental health. This approach considers the individual&#39;s relationships, societal roles, and cultural influences in developing and treating psychological issues. Practitioners include psychotherapists, social workers, and psychiatric social workers, who are trained to intervene in the context of these social systems. Social workers typically hold a master&#39;s degree in social work (MSW), and psychiatric social workers receive additional training in mental health. Paraprofessionals, individuals without formal mental health qualifications but trained by professionals, can also assist, often bringing personal experience with specific disorders.

Treatment strategies for psychological disorders fall under three broad approaches - psychological, biological, and sociocultural.
The psychological ...

Psychotherapy

Psychotherapy is a versatile, nonmedical approach aimed at helping individuals address emotional, behavioral, and interpersonal issues to enhance their overall well-being. It can involve one-on-one sessions, couples counseling, or small group discussions with a therapist. The therapeutic process includes various techniques such as open discussion, interpretation of thoughts and behaviors, active listening, positive reinforcement, and role modeling. Psychotherapy aims to support individuals in understanding themselves better, whether or not they have diagnosed mental health conditions.
Insight Therapies
Insight therapies focus on uncovering the psychological motives behind behavior. By exploring unconscious processes, emotions, and past experiences, these therapies aim to help individuals better understand their actions and thought patterns. Psychodynamic therapy, based on Freud&#39;s psychoanalytic principles, delves into unresolved conflicts stemming from childhood. Humanistic therapy, developed by Carl Rogers, emphasizes personal growth and self-actualization, encouraging clients to explore their potential. Existential therapy addresses questions of meaning, freedom, and responsibility, while group therapy fosters interpersonal learning through shared experiences within a group setting.
Action Therapies
Action therapies, on the other hand, focus on modifying harmful thoughts and behaviors without delving deeply into their origins. Cognitive and cognitive-behavioral therapies (CBT) are the most widely used action therapies. Cognitive therapy helps individuals identify and challenge distorted or irrational thought patterns, while CBT combines this cognitive restructuring with behavioral techniques. The aim is to replace negative thought patterns with healthier, more adaptive ones and to encourage positive behavioral changes. These therapies are highly effective in treating conditions such as depression, anxiety disorders, and phobias.

Psychotherapy is a nonmedical approach designed to help individuals recognize and address emotional, behavioral, and interpersonal problems to improve ...

Elements Crucial for Effective Psychotherapy

Research has highlighted several critical factors that influence the effectiveness of psychotherapy, such as the therapeutic alliance, the therapist, and the client.
The Therapeutic Alliance
The therapeutic alliance refers to the relationship between the therapist and the client. The alliance strengthens when the therapist and the client engage in a nurturing, supportive, trusting, empathetic, and respectful relationship, improving therapeutic outcomes. Therapists must monitor this relationship continuously, as studies suggest that clients who rate the alliance poorly are more likely to discontinue therapy or have negative experiences. Conversely, those who share a strong bond with their therapist are more likely to see successful outcomes.
The Therapist
The effectiveness of psychotherapy can depend significantly on the therapist&#39;s skill set and expertise. Experienced therapists deeply understand psychological issues and are committed to adapting their approach based on ongoing progress. Research also suggests that the compatibility between the therapist&#39;s style and the client&#39;s personality plays a crucial role in therapy success. For example, a more flexible and laid-back therapist may succeed with a client who resists change, while a directive approach may work better for others.
The Client
Another major determinant of therapeutic outcomes is the client&#39;s role in the process. Meta-analyses suggest that the client&#39;s participation is one of the most critical factors in determining success. While clients often seek therapy for life challenges, their strengths, skills, and motivation largely contribute to their progress. Research has consistently shown that therapy&#39;s success depends significantly on the client&#39;s engagement, and clients who fail to participate actively are more likely to experience unsatisfactory results.

Effective psychotherapy depends on three crucial elements&#8212; the therapeutic alliance, the therapist, and the client.
The therapeutic alliance refers ...

Conduct Disorder

Conduct disorder is a complex mental health diagnosis characterized by a repetitive and persistent pattern of behavior that violates societal norms, the rights of others, or age-appropriate rules. The diagnostic criteria for conduct disorder require the presence of at least three problematic behaviors within the past 12 months, with at least one occurring in the past six months. These behaviors are grouped into four categories: aggression toward people and animals; destruction of property; deceitfulness or theft; and serious violations of rules. The severity of symptoms, age of onset, and associated features all play crucial roles in understanding the disorder&#39;s impact and prognosis.
Diagnostic Features and Severity
The behaviors defining conduct disorder range from bullying, physical cruelty, and theft, to truancy and property destruction. Severity is categorized as mild, moderate, or severe, based on the number of symptoms and their impact on others. Childhood-onset conduct disorder, marked by symptoms before age 10, is associated with a poorer prognosis compared to adolescent-onset conduct disorder. Those with the specifier &#34;limited prosocial emotions&#34; &#8212; such as lack of remorse, callousness, or shallow affect &#8212; exhibit a more severe and persistent course.
Associated Factors and Risks
A combination of genetic, environmental, and temperamental factors influences conduct disorder. Risk factors include parental neglect, inconsistent discipline, exposure to violence, and association with delinquent peers. Neurobiological findings, such as reduced autonomic fear responses, and structural differences in brain regions associated with emotional regulation, have been observed but are not diagnostic. Co-occurring conditions, including ADHD, substance use disorders, and mood disorders, are common and can exacerbate the symptoms of conduct disorder.
Developmental Trajectory
Conduct disorder typically emerges during middle childhood or adolescence, often following oppositional defiant disorder. Symptoms evolve with age, beginning with less severe behaviors such as lying and escalating to more severe actions like theft and aggression. While the majority of cases remit by adulthood, childhood-onset conduct disorder is strongly predictive of antisocial personality disorder and other psychosocial difficulties later in life.
Sociocultural and Gender Considerations
The expression of conduct disorder behaviors differs by gender, with boys more likely to exhibit physical aggression and girls more often engaging in relational aggression or truancy. Cultural and environmental contexts, such as systemic oppression or high-crime areas, may influence the prevalence and manifestation of conduct disorder, necessitating careful diagnostic evaluation to avoid bias.
Conduct disorder presents significant challenges for affected individuals, families, and communities. Its association with academic failure, legal issues, and health risks underscores the importance of early intervention and comprehensive treatment approaches tailored to the individual&#39;s developmental and social context.

Conduct disorder involves a repetitive pattern of behavior violating others&#39; rights or societal norms, typically emerging in childhood or 
...

Intellectual Disability

Intellectual disability (ID) is a neurodevelopmental condition characterized by deficits in intellectual and adaptive functioning that manifest during the developmental period. This condition encompasses challenges in reasoning, memory, problem-solving, and learning, accompanied by impairments in everyday life skills, such as communication, self-care, and social interactions. Intellectual disability affects approximately 1% of the population in the United States, impacting an estimated 5 million individuals.
Assessment and Diagnosis
Historically, the diagnosis of intellectual disability was heavily reliant on IQ scores, with an IQ below 70 considered a diagnostic threshold. However, recent standards, such as those outlined in the DSM-5, prioritize adaptive functioning over rigid IQ thresholds. Current assessments evaluate impairments across three domains: conceptual, social, and practical skills. Conceptual abilities include literacy, numeracy, and time management, while social skills cover empathy, interpersonal communication, and compliance with social norms. Practical skills pertain to personal care, job responsibilities, and daily routines.
Adaptive functioning is evaluated in the context of the individual&#39;s life circumstances. For example, two individuals with similar IQ scores might differ significantly in functionality &#8212; one might live independently with minimal support, while the other might require institutional care. This shift in diagnostic criteria emphasizes functional capabilities rather than test scores, allowing for a more nuanced understanding of intellectual disability.
Causes and Classifications
The etiology of intellectual disability can be organic or cultural-familial. Organic causes include genetic disorders, such as Down syndrome and Fragile X syndrome, and prenatal exposure to alcohol or toxins,&#160; which result in fetal alcohol syndrome. Fetal alcohol syndrome is a condition that results from exposing a developing embryo to alcohol, and intelligence levels can range from below average to levels associated with intellectual disability. Environmental factors, such as malnutrition, lack of stimulation, and inadequate healthcare, often underlie cultural-familial intellectual disability. This type of intellectual disability, with no identifiable physical damage, typically results in milder impairments.
Classifications range from mild to profound, based on the severity of deficits. Individuals with mild ID may achieve partial independence with support, while those with profound ID often remain fully dependent on caregivers due to severe limitations in all adaptive domains.
Holistic Perspectives
While intellectual disability affects cognitive and adaptive skills, it does not diminish the individual&#39;s capacity for forming meaningful relationships and contributing to their community. Understanding and addressing their diverse needs through tailored support and interventions can significantly enhance their quality of life and social integration.

Intellectual disability, previously termed as mental retardation, has been defined by significant cognitive deficits&#8212;which have been established ...

Eye Exam

Source: Richard Glickman-Simon, MD, Assistant Professor, Department of Public Health and Community Medicine, Tufts University School of Medicine, MA
Proper evaluation of the eyes in a general practice setting involves vision testing, orbit inspection, and ophthalmoscopic examination. Before beginning the exam, it is crucial to be familiar with the anatomy and physiology of the eye. The upper eyelid should be slightly over the iris, but it shouldn&#39;t cover the pupil when open; the lower lid lies below the iris. The sclera normally appears white or slightly buff in color. The appearance of conjunctiva, a transparent membrane covering the anterior sclera and the inner eyelids, is a sensitive indicator of ocular disorders, such as infections and inflammation. The tear-producing lacrimal gland lies above and lateral to the eyeball. Tears spread down and across the eye to drain medially into two lacrimal puncta before passing into the lacrimal sac and nasolacrimal duct to the nose.
The iris divides the anterior from the posterior chamber. Muscles of the iris control the size of the pupil, and muscles of the ciliary body behind it control the focal length of the lens. The ciliary body also produces aqueous humor, which largely determines intraocular pressure (Figure 1). Cranial nerves II and III control pupillary reaction and lens accommodation; cranial nerve III controls upper lid elevation; cranial nerves III, IV, and VI control eye movement. The six cardinal directions of gaze are controlled by six extraocular muscles (Figure 2) innervated by cranial nerves III, IV, and VI.
Visual testing is an essential part of the ophthalmological exam and is also performed as a part of cranial nerve II assessment during the neurological exam. A focused image is projected onto the retina after its light passes through the cornea, pupil, lens, and vitreous body. The projection is upside down and reversed right to left, which means that light entering from the lower temporal field of vision strikes the upper nasal quadrant of the retina. Photosensitive cells of the retina respond by generating electrical impulses, which are relayed to the optic nerve and passed to the visual cortex through the optic tracts. The right and left visual cortices process images entering from the left and right visual fields, respectively.
<img alt="Figure 1" src="/files/ftp_upload/10149/10149fig1.jpg" /> 
Figure 1. Anatomy of the Eye. A diagram showing a sagittal view of the human eye with the structures labeled.
<img alt="Figure 2" src="/files/ftp_upload/10149/10149fig2.jpg" />
Figure 2. Muscles of the Eye. A cartoon showing a frontal view of the human eye and the extraocular muscles (labeled).

Anatomy and Physiology of Eye; Acuity and Vision Testing

Source: Richard Glickman-Simon, MD, Assistant Professor, Department of Public Health and Community Medicine, Tufts University School of Medicine, MA
...

Ophthalmoscopic Examination

Source: Richard Glickman-Simon, MD, Assistant Professor, Department of Public Health and Community Medicine, Tufts University School of Medicine, MA
The simplest ophthalmoscopes consist of an aperture to look through, a diopter indicator, and a disc for selecting lenses. The ophthalmoscope is primarily used to examine the fundus, or the inner wall of the posterior eye, which consists of the choroid, retina, fovea, macula, optic disc, and retinal vessels (Figure 1). The spherical eyeball collects and focuses light on the neurosensory cells of the retina. Light is refracted as it passes sequentially through the cornea, the lens, and the vitreous body.
The first landmark observed during the funduscopic exam is the optic disc, which is where the optic nerve and retinal vessels enter the back of the eye (Figure 2). The disc usually contains a central whitish physiologic cup where the vessels enter; it normally occupies less than half the diameter of the entire disc. Just lateral and slightly inferior is the fovea, a darkened circular area that demarcates the point of central vision. Around this is the macula. A blind spot approximately 15&#176; temporal to the line of gaze results from a lack of photoreceptor cells at the optic disc.
<img alt="Figure 1" src="/files/ftp_upload/10146/10146fig1.jpg" /> 
Figure 1. Anatomy of the eye. A diagram showing a sagittal view of the human eye with the structures labeled.
<img alt="Figure 2" src="/files/ftp_upload/10146/10146fig2.jpg" /> 
Figure 2: Normal retina. A photograph showing an ophthalmoscopic view on the normal retina.

Ophthalmoscopic Functioning and Examination of the Fundus

Source: Richard Glickman-Simon, MD, Assistant Professor, Department of Public Health and Community Medicine, Tufts University School of Medicine, MA
The ...

Ear Exam

Source: Richard Glickman-Simon, MD, Assistant Professor, Department of Public Health and Community Medicine, Tufts University School of Medicine, MA
This video describes the examination of the ear, beginning with a review of its surface and interior anatomy (Figure 1). The cartilaginous auricle consists of the helix, antihelix, earlobe, and tragus. The mastoid process is positioned just behind the earlobe. The slightly curving auditory canal ends at the tympanic membrane, which transmits sound waves collected by the external ear to the air-filled middle ear. The Eustachian tube connects to the middle ear with the nasopharynx. Vibrations of the tympanic membrane transmit to the three connected ossicles of the middle ear (the malleus, incus, and stapes). The vibrations are transformed into electrical signals in the inner ear, and then carried to the brain by the cochlear nerve. Hearing, therefore, comprises a conductive phase that involves the external and middle ear, and a sensorineural phase that involves the inner ear and cochlear nerve.
The auditory canal and the tympanic membrane are examined with the otoscope, a handheld instrument with a light source, a magnifier, and a disposable cone-shaped speculum. It is important to be familiar with the tympanic membrane landmarks (Figure 2). Only two of the three ossicles - the malleus and incus - can normally be seen; the malleus is near the center, and the uncus is just posterior. A cone of light can be seen emanating downward and anteriorly from the umbo, or point of contact between the membrane and the tip of the malleus. The short process roughly demarcates the boundary between the two regions of the tympanic membrane: the pars flaccida, lying superior and posterior, and the far larger pars tensa, lying anterior and inferior. Normally, the tympanic membrane is pink-gray in color and readily reflects the light of the otoscope.
<img alt="Figure 1" src="/files/ftp_upload/10148/10148fig1.jpg" /> 
Figure 1. Anatomy of the Ear. A schematic drawing of the human ear in frontal section with outer, middle, and inner ear structures labeled.

Anatomy of the Ear, External Ear Exam and Hearing Tests

Source: Richard Glickman-Simon, MD, Assistant Professor, Department of Public Health and Community Medicine, Tufts University School of Medicine, MA
This ...

Nose, Sinuses, Oral Cavity and Pharynx Exam

Source: Richard Glickman-Simon, MD, Assistant Professor, Department of Public Health and Community Medicine, Tufts University School of Medicine, MA
This video provides an overview of sinus, nose, and throat examinations. The demonstration begins with a brief overview of the anatomy of the region. The upper third of the nose is bony, and the bottom two-thirds are cartilaginous. Air entering the nares passes through the nasal vestibules and into the narrow passageway between the nasal septum medially and the bony turbinates laterally. Beneath each curving turbinate is a groove or meatus. The nasolacrimal duct and most of the air-filled paranasal sinuses drain into the inferior and middle meatuses, respectively. Of the three sets of paranasal sinuses, only the maxillary and frontal can be readily examined. A continuous, highly vascular mucosa lines the entire nasal cavity and sinuses.
<img alt="Figure 1" src="/files/ftp_upload/10152/10152fig1.jpg" /> 
Figure 1. Anatomy of the Nose. 
<img alt="Figure 2" src="/files/ftp_upload/10152/10152fig2.jpg" /> 
Figure 2. Location of the Major Sinuses.
Muscular folds of the lips mark the entrance to the oral cavity. The pinkish gingiva, or gums, attach firmly to the teeth and adjacent bone into which the teeth embed. The buccal mucosa lines the inner cheeks, where the Stensen duct drains the parotid glands into small papillae near the upper second molars. Small, red papillae cover the dorsal surface of the tongue along with a whitish coat of varying thickness. The midline lingual frenulum connects the undersurface of the tongue to the floor of the mouth, where the Wharton duct drains the submandibular glands into papillae on either side. Arching over the tongue are the anterior and posterior pillars of the soft palate and midline uvula. If present, the tonsils can be seen protruding bilaterally between the pillars. The bony hard palate rises anteriorly above the soft palate. The pharynx lies posteriorly behind the soft palate and tongue.
<img alt="Figure 3" src="/files/ftp_upload/10152/10152fig3.jpg" /> 
Figure 3. Anatomy of the Oral Cavity.
<img alt="Figure 4" src="/files/ftp_upload/10152/10152fig4.jpg" /> 
Figure 4. Pharyngeal Regions.

Thyroid Exam

Source: Richard Glickman-Simon, MD, Assistant Professor, Department of Public Health and Community Medicine, Tufts University School of Medicine, MA
The thyroid gland is located in the neck anterior trachea between the cricoid cartilage (above) and the suprasternal notch (below) (Figure 1). It consists of a right and left lobe connected by an isthmus. The isthmus covers the second, third, and fourth tracheal rings, and the lobes curve posteriorly around the sides of the trachea and esophagus. The normal gland, weighing 10 - 25 g, is usually invisible on inspection and often difficult to palpate. A goiter is an enlarged thyroid from any cause. In addition to assessing its size, it is important to palpate the thyroid for its shape, mobility, consistency, and tenderness. A normal thyroid is soft, smooth, symmetrical, and non-tender, and it slides upward slightly when swallowing. Symmetrical enlargement of a soft, smooth thyroid suggests endemic hypothyroidism due to iodine deficiency or one of two prevalent autoimmune disorders: Graves&#39; disease or Hashimoto&#39;s thyroiditis. Thyroid nodules are common and usually incidental; however, 10% of thyroid nodules turn out to be malignant. They may be single or multiple, and are most often firm and non-tender. A tender, symmetrical goiter typically indicates thyroiditis.
<img alt="Figure 1" src="/files/ftp_upload/10098/10098fig1.jpg" /> 
Figure 1. Anatomy of the thyroid gland. Illustration of the location and anatomy of the thyroid gland with respect to the neck structures.
Thyroid disease rarely manifests as a palpable goiter in isolation. Thyroid hormones serve to maintain homeostasis primarily by stimulating cellular metabolism throughout the body. Thus, hypo and hyperthyroidism are associated with a range of symptoms and physical findings (Table 1). It is important to note that goiters may be euthyroid (normal thyroid hormone levels), hyperthyroid, or hypothyroid. Headaches or visual disturbances may suggest a secondary thyroid disorder due to a pituitary adenoma
<img alt="Table 1" src="/files/ftp_upload/10098/10098table1.jpg" />
Table 1. Symptoms and physical findings for hypo- and hyper-thyroidism.&#160;

Thyroid Anatomy, Physiology and Palpation Examination

Lymph Node Exam

Source: Richard Glickman-Simon, MD, Assistant Professor, Department of Public Health and Community Medicine, Tufts University School of Medicine, MA
The lymphatic system has two main functions: to return extracellular fluid back to the venous circulation and to expose antigenic substances to the immune system. As the collected fluid passes through lymphatic channels on its way back to the systemic circulation, it encounters multiple nodes consisting of highly concentrated clusters of lymphocytes. Most lymph channels and nodes reside deep within the body and, therefore, are not accessible to physical exam (Figure 1). Only nodes near the surface can be inspected or palpated. Lymph nodes are normally invisible, and smaller nodes are also non-palpable. However, larger nodes (&#62;1 cm) in the neck, axillae, and inguinal areas are often detectable as soft, smooth, movable, non-tender, bean-shaped masses imbedded in subcutaneous tissue.
Lymphadenopathy usually indicates an infection or, less commonly, a cancer in the area of lymph drainage. Nodes may become enlarged, fixed, firm, and/or tender depending on the pathology present. For example, a soft, tender lymph node palpable near the angle of the mandible may indicate an infected tonsil, whereas a firm, enlarged, non-tender lymph node palpable in the axilla of a female patient may be a sign of breast cancer.
Regional lymph nodes draining the area of a localized infection typically remain invisible but may become enlarged and tender on palpation. An infected wound or cellulitis may also result in lymphangitis or lymphadenitis, a condition in which the infection spreads along the chain of lymph channels and nodes. This may be accompanied by the appearance of red streaks and systemic symptoms such as fever, chills, and malaise. In rare cases, the intensity of the inflammatory reaction may cause the nodes to adhere to the surrounding soft tissue, fixing them in place.
Many metastatic cancers spread to regional lymph nodes first. Unlike infections, malignant cells invading lymph nodes may cause them to feel irregular and firm (even rock hard) but remain non-tender. If the cancer invades the outer capsules, nodes may become fixed to the surrounding soft tissue or matted together. Lymphoma, a primary cancer intrinsic to the lymphatic system, may be present anywhere in the body as single or multiple enlarged lymph nodes, which may become big enough to see on inspection, and are generally hard and non-tender on palpation. In addition to lymphoma, diffuse lymphadenopathy may be an indication of generalized infectious or inflammatory disorders such as HIV, mononucleosis, or sarcoidosis.
<img alt="Figure 1" src="/files/ftp_upload/10061/10061fig1.jpg" /> 
Figure 1. The Lymphatic System.

Lymph Nodes: Head &amp; Neck, Axillae, Upper &amp; Lower Extremities

Abdominal Exam I: Inspection and Auscultation

Source: Alexander Goldfarb, MD, Assistant Professor of Medicine, Beth Israel Deaconess Medical Center, MA
Gastrointestinal disease accounts for millions of office visits and hospital admissions annually. Physical examination of the abdomen is a crucial tool in diagnosing diseases of the gastrointestinal tract; in addition, it can help identify pathological processes in cardiovascular, urinary, and other systems. As physical examination in general, the examination of the abdominal region is important for establishing physician-patient contact, for reaching the preliminary diagnosis and selecting subsequent laboratory and imaging tests, and determining the urgency of care.
As with the other parts of a physical examination, visual inspection and auscultation of the abdomen are done in a systematic fashion so that no potential findings are missed. Special attention should be paid to potential problems already identified by the patient&#39;s history. Here we assume that the patient has already been identified, and has had history taken, symptoms discussed, and areas of potential concern identified. In this video we will not review the patient&#39;s history; instead, we will go directly to the physical examination.
Before we get to the examination, let&#39;s briefly review surface landmarks of the abdominal region, abdominal anatomy, and topography. Here is a list of useful landmarks: costal margins, xiphoid process, rectus abdominal muscle, linea alba, umbilicus, iliac crest, inguinal ligament, and symphysis pubis. The abdominal exam covers the area down from the xiphoid and costal margins superiorly to the symphysis pubis inferiorly.
For diagnostic and descriptive purposes, the abdomen is subdivided into four quadrants: right upper quadrant (often designated as RUQ), left upper quadrant (LUQ), right lower quadrant (RLQ), and left lower quadrant (LLQ) (Figure 1). The more detailed topography of the abdomen divides it into 9 regions: right and left hypochondriac, right and left lumbar, right and left iliac, and also epigastric, umbilical, and hypogastric regions in the middle (Figure 2).
Remember which organs typically project into each abdominal region (Figure 3). It is essential to know the region&#39;s anatomy and topography well to adequately document and interpret a patient&#39;s complaints and symptoms, as well as physical findings during the examination.
<img alt="Figure 1" src="/files/ftp_upload/10088/10088fig1.jpg" /> 
Figure 1. Four abdominal quadrants. The abdomen can be divided into four regions by two imaginary lines intersecting at the umbilicus: right upper quadrant (often designated as RUQ), left upper quadrant (LUQ), right lower quadrant (RLQ), and left lower quadrant (LLQ) are shown.
<img alt="Figure 2" src="/files/ftp_upload/10088/10088fig2.jpg" /> 
Figure 2. Nine abdominal regions. Midclavicular lines and subcostal and intertubercular planes separate the abdomen into nine regions: epigastric region, right hypochondriac region, left hypochondriac region, umbilical region, right lumbar region, left lumbar region, hypogastric region, right inguinal region, and left inguinal region. Terms for epigastric, umbilical, and hypogastric and suprapubic regions are the most commonly used in clinical practice.
<img alt="Figure 3" src="/files/ftp_upload/10088/10088fig3.jpg" /> 
Figure 3. Location of different organs in the four abdominal regions. Organs in the abdominal cavity and their location with respect to four abdominal quadrants.

Abdominal Exam I: Anatomy, Topography and Auscultation

Source: Alexander Goldfarb, MD, Assistant Professor of Medicine, Beth Israel Deaconess Medical Center, MA
Gastrointestinal disease accounts for millions ...

Abdominal Exam II: Percussion

Source: Alexander Goldfarb, MD, Assistant Professor of Medicine, Beth Israel Deaconess Medical Center, MA
Medical percussion is based on the difference in pitch between the sounds elicited by tapping on the body wall. The auditory response to tapping depends on the ease with which the body wall vibrates, and is influenced by underlying organs, strength of the stroke, and the state of the body wall. There are three main medical percussion sounds: resonance (heard over lungs), tympany (heard over the air-filled bowel loops), and dullness (heard over fluid or solid organs). The contrast between dullness vs. tympany or resonance allows for determination of the size and margins of organs and masses, as well as identification of fluid accumulation and areas of consolidation. Percussion remains an intricate part of the physical diagnosis since it was first introduced more than 200 years ago, and is especially useful in examination of the lungs and abdomen.
As a part of an abdominal examination, percussion follows visual inspection and auscultation. The examiner should first percuss over each of the nine abdominal regions (epigastric region, right hypochondriac region, left hypochondriac region, umbilical region, right lumbar region, left lumbar region, hypogastric region, right inguinal region, and left inguinal region). Tenderness elicited by percussion is abnormal, and peritoneal inflammation should be suspected. As the air-filled bowel loops are positioned in the closest proximity to the abdominal wall, the percussion over most parts of the abdominal cavity elicits a predominantly tympanic sound. The presence of large areas of dullness should prompt evaluation for organomegaly, intra-abdominal masses, or fluid.
In addition to assessing the amount and distribution of abdominal gas, an abdominal exam should include an estimation of liver and spleen size by percussion. As the liver and spleen are covered by the rib cage, the examiner should percuss over the lower anterior chest as well. Normally, one expects to hear dull sound on percussion of the right anterior chest over the liver, and tympanic sound on percussion of left anterior chest over the gastric air bubble and the splenic flexure of the colon (Figure 1).
<img alt="Figure 1" src="/files/ftp_upload/10090/10090fig1.jpg" />
Figure 1. Normal percussion notes over abdominal region. With the exception of an area of dullness over the liver in the right lower anterior chest, tympany is the predominant sound heard over the region.

Abdominal Exam II: Percussion Sounds, Dullness and Tympany

Source: Alexander Goldfarb, MD, Assistant Professor of Medicine, Beth Israel Deaconess Medical Center, MA
Medical percussion is based on the difference in ...

Abdominal Exam III: Palpation

Source: Alexander Goldfarb, MD, Assistant Professor of Medicine, Beth Israel Deaconess Medical Center, MA
Abdominal palpation, if performed correctly, allows for examination of the large and relatively superficial organs; for a skilled examiner, it allows for assessment of the smaller and deeper structures as well. The amount of information that can be obtained by palpation of the abdominal area also depends on the anatomical characteristics of the patient. For example, obesity might make palpation of internal organs difficult and require that additional maneuvers be performed. Abdominal palpation provides valuable information regarding localization of the problem and its severity, as abdominal palpation identifies the areas of tenderness as well as presence of organomegaly and tumors. The specific focus of palpation is driven by the information collected during history taking and other elements of the abdominal exam. Palpation helps to integrate this information and develop the strategy for subsequent diagnostic steps.

Abdominal Exam III: Light and Deep Palpation

Source: Alexander Goldfarb, MD, Assistant Professor of Medicine, Beth Israel Deaconess Medical Center, MA
Abdominal palpation, if performed correctly, ...

Abdominal Exam IV: Acute Abdominal Pain Assessment

Source: Joseph Donroe, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT
Abdominal pain is a frequent presenting concern in both the emergency department and the office setting. Acute abdominal pain is defined as pain lasting less than seven days, while an acute abdomen refers to the abrupt onset of severe abdominal pain with features suggesting a surgically intervenable process. The differential diagnosis of acute abdominal pain is broad; thus, clinicians must have a systematic method of examination guided by a careful history, remembering that pathology outside of the abdomen can also cause abdominal pain, including pulmonary, cardiac, rectal, and genital disorders.
Terminology for describing the location of abdominal tenderness includes the right and left upper and lower quadrants, and the epigastric, umbilical, and hypogastric regions (Figures 1, 2). Thorough examination requires an organized approach involving inspection, auscultation, percussion, and palpation, with each maneuver performed purposefully and with a clear mental representation of the anatomy. Rather than palpating randomly across the abdomen, begin palpating remotely from the site of tenderness, moving systematically toward the tender region, and thinking about what lies below the fingers at each position. A helpful technique is to imagine a clock face with the xiphoid process at 12:00 and the pubic symphysis at 6:00 (Figure 3). When palpating at 8:00, there is skin, muscle, cecum, appendix, and ureters. Performing the exam in this fashion assists in clinical reasoning and minimizes the chance of missing pathology.
<img alt="Figure 1" src="/files/ftp_upload/10120/10120fig1.jpg" /> 
Figure 1. Four abdominal quadrants. Abdomen can be divided into four regions by two imaginary lines intersecting at umbilicus. Right upper quadrant (often designated as RUQ), left upper quadrant (LUQ), right lower quadrant (RLQ), and left lower quadrant (LLQ) are shown.
<img alt="Figure 2" src="/files/ftp_upload/10120/10120fig2.jpg" /> 
Figure 2. Nine abdominal regions. Midclavicular lines and subcostal and intertubercular planes separate abdomen into nine regions: epigastric region, right hypochondriac region, left hypochondriac region, umbilical region, right lumbar region, left lumbar region, hypogastric region, right inguinal region, and left inguinal region.
<img alt="Figure 3" src="/files/ftp_upload/10120/10120fig3.jpg" /> 
Figure 3. Visualizing a clock face over the abdomen for thinking about the underlying anatomy while performing the exam.

Source: Joseph Donroe, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT
Abdominal pain is a frequent presenting concern in ...

Male Rectal Exam

Source: Joseph Donroe, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT
While its usefulness in cancer screening is debated, the male rectal examination remains an important part of the physical exam. The exam is indicated in selected patients with lower urinary tract symptoms, urinary and/or fecal incontinence or retention, back pain, anorectal symptoms, abdominal complaints, trauma patients, unexplained anemia, weight loss, or bone pain. There are no absolute contraindications to the rectal exam; however, relative contraindications include patient unwillingness to undergo the exam, severe rectal pain, recent anorectal surgery or trauma, and neutropenia.
When performing the rectal exam, the examiner should conceptualize the relevant anatomy. The external anal sphincter is the most distal part of the anal canal, which extends three to four centimeters before transitioning into the rectum. The prostate gland lies anterior to the rectum, just beyond the anal canal. The posterior surface of the prostate, including its apex, base, lateral lobes, and median sulcus, can be palpated through the rectal wall (Figure 1). The normal consistency of the prostate is similar to the thenar eminence when the hand is in a tight fist. The thumb knuckle is representative of what a hard nodule may feel like. The normal size of the prostate increases with age and is approximately 4.0 cm by 3.5 cm, or 20-30 g, in a young man.
The steps of the male rectal exam, including preparation, positioning, neurologic assessment, external inspection and palpation, examination of the prostate and rectum, and evaluation of the stool, are detailed in this video.
<img alt="Figure 1" src="/files/ftp_upload/10102/10102fig1.jpg" /> 
Figure 1. Male rectal anatomy (left) and regions of prostate gland posterior surface (right).

Male Rectal Anatomy and Exam Procedure

Source: Joseph Donroe, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT
While its usefulness in cancer screening is debated, ...

Comprehensive Breast Exam

Source: 
Alexandra Duncan, GTA, Praxis Clinical, New Haven, CT 
Tiffany Cook, GTA, Praxis Clinical, New Haven, CT 
Jaideep S. Talwalkar, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT
Breast exams are a key part of an annual gynecological exam and are important for all patients, no matter their sex or gender expression. One out of every 8 women will be diagnosed with breast cancer; male breast cancer, though less common, has a lifetime incidence of 1 in 1000.
Breast exams can feel invasive to patients, so it is important to do everything possible to make the patients feel comfortable and empowered, rather than vulnerable. Examiners should be aware of what they are communicating, both verbally and non-verbally, and give their patients control wherever possible (for instance, always allowing them to remove their own gowns). Examiners may choose to utilize chaperones for the patients&#39; (as well as their own) comfort. Some institutions require the use of chaperones.
While it is always important to avoid overly clinical language, certain colloquial words can cross the line from caring to overly intimate in this exam. It is helpful to avoid the words &#34;touch&#34; and &#34;feel&#34; in this exam, as this language can feel sexualized. Instead, use words like &#34;assess,&#34; &#34;check,&#34; or &#34;examine.&#34;
Additionally, the best practice dictates avoiding assumptions about patients&#39; gender, as patients with female anatomy may identify as another gender (e.g., transgender, genderqueer, etc.). This video depicts the approach to patients whose history has revealed no specific complaints or risk factors related to breast health.
In order to avoid missing potential findings, the breast exam should be performed in a systematic approach and consist of three main components: visual inspection of the breast tissue, palpation of the lymph nodes, and palpation of breast tissue.
The breast tissue extends from directly under the clavicle to around the fifth rib (or bra line). Laterally, it extends from the midaxillary line to the sternal border. The breast is viewed in four quadrants; the upper outer quadrant has the most tissue and is the location of many lymph nodes, and the tail of Spence (or axillary tail) extends to the edge of the axilla, where it attaches to the chest wall (Figure 1).
<img alt="Figure 1" src="/files/ftp_upload/10118/10118fig1.jpg" /> 
Figure 1. Breast anatomical landmarks.

Breast Tissue Anatomy; Tissue and Lymph Node Examination

Source:
Alexandra Duncan, GTA, Praxis Clinical, New Haven, CT
Tiffany Cook, GTA, Praxis Clinical, New Haven, CT
Jaideep S. Talwalkar, MD, Internal ...

Pelvic Exam I: Assessment of the External Genitalia

Source: 
Alexandra Duncan, GTA, Praxis Clinical, New Haven, CT 
Tiffany Cook, GTA, Praxis Clinical, New Haven, CT 
<a href="https://www.jove.com/author/Jaideep+S._Talwalkar">Jaideep S. Talwalkar</a>, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT
The pelvic exam can feel invasive to patients, so it is important to do everything possible to make patients feel comfortable and empowered, rather than vulnerable. Clinicians should be aware of how they are communicating, both verbally and nonverbally, and should give their patients control whenever possible. There are many ways to do this, from how the exam table is positioned to how the patient is engaged throughout the exam. As many as 1 in 5 patients may have experienced sexual trauma; therefore, it is important to avoid triggering those patients, but it&#39;s not always possible to know who they are. The exam in this video demonstrates neutral language and techniques that can be employed with all patients to create the best experience possible.
It&#39;s important to keep the patient covered wherever possible and to minimize extraneous contact. A clinician should be careful to tuck fingers that aren&#39;t being used to examine the patient to avoid accidental contact with the clitoris or anus.
Before performing the pelvic examination, examiners should find out how knowledgeable the patients are about the exam and their own bodies, and establish the expectation that the patients can communicate questions or concerns throughout the exam. While it is always important to avoid extremely clinical language, certain colloquial words can cross the line from caring to overly intimate during this exam. It is helpful to avoid the words &#34;touch&#34; and &#34;feel,&#34; which can feel sexualized in this context; instead, the words &#34;assess,&#34; &#34;check,&#34; &#34;inspect,&#34; or &#34;examine&#34; should be used. The words &#34;bed&#34; and &#34;sheet&#34; should be avoided, and &#34;table&#34; and &#34;drape&#34; should be used instead. Also, a clinician should use the word &#34;footrests&#34; rather than &#34;stirrups&#34; to avoid connoting horses. It&#39;s a good idea to avoid telling patients to &#34;relax,&#34; because it&#39;s a hard order for a patient to follow when anxious. Asking patients to &#34;soften&#34; or &#34;release&#34; specific muscles can be more useful, and having a patient do a Kegel exercise or Valsalva maneuver can serve as a specific relaxation technique.
Best practice dictates avoiding assumptions about patients&#39; gender, as patients with female anatomy may identify as another gender (e.g., transgender or genderqueer). This video depicts the approach to a patient whose history has revealed no specific complaints or risk factors related to gynecological health.
The pelvic exam consists of three parts: the visual and manual exam of the external genitalia, a speculum exam, and a bimanual exam. This video covers the introduction to the pelvic exam and the external genitalia exam. To avoid missing potential findings, the external pelvic exam should be performed in a systematic approach consisting of two main components: a visual inspection of the vulva (Figure 1), and internal palpation and assessment of glands and tone.
<img alt="Figure 1" src="/files/ftp_upload/10144/10144fig1.jpg" /> 
Figure 1. Diagram of the vulva. A diagram showing external genitals with the structures labelled.

Pelvic Exam I: External Genitalia Anatomy and Exam Procedure

Pelvic Exam II: Speculum Exam

Source: 
Alexandra Duncan, GTA, Praxis Clinical, New Haven, CT
Tiffany Cook, GTA, Praxis Clinical, New Haven, CT
Jaideep S. Talwalkar, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT
Providing comfortable speculum placement is an important skill for providers to develop, since the speculum is a necessary tool in many gynecological procedures. Patients and providers are often anxious about the speculum exam, but it is entirely possible to place a speculum without patient discomfort. It&#39;s important for the clinician to be aware of the role language plays in creating a comfortable environment; for instance, a provider should refer to the speculum &#34;bills&#34; rather than &#34;blades&#34; to avoid upsetting the patient.
There are two types of speculums: metal and plastic (Figure 1). This demonstration utilizes plastic, as plastic speculums are most commonly used in clinics for routine testing. When using a metal speculum, it&#39;s recommended to use a Graves speculum if the patient has given birth vaginally, and a Pederson speculum if the patient has not. Pederson and Graves speculums are different shapes, and both come in many different sizes (medium is used most often). Prior to placing a metal speculum, it is helpful to perform a digital cervical exam to assess for the appropriate speculum size. The depth and direction of the cervix is estimated by placing one finger into the vagina. If the patient&#39;s cervix can be located while the patient is seated, it is likely that the patient has a shallow vagina, and therefore should be most comfortable with a short metal speculum.
<img alt="Figure 1" src="/files/ftp_upload/10141/10141fig1.jpg" /> 
Figure 1. A photograph of commercially available speculums in different sizes. 
Plastic speculums are all shaped like Pederson metal speculums and come in different sizes. To assess the appropriate size for a plastic speculum, the examiner places two fingers in the patient&#39;s vagina, palm down, and tries to separate the fingers: if there is no space between the fingers, a small plastic speculum should be used; if there is space between the fingers, a medium one should be used. The exam should never be performed with a large speculum (as it is significantly longer) without first determining the length of the vaginal canal.
The speculum is used to perform the Papanicolaou test as part of cervical cancer screening examinations. Cervical cancer was once the leading cause of cancer deaths for women in the United States, but in recent decades the number of cases and deaths has declined significantly1. This change is credited to the discovery made by Georgios Papanicolaou in 1928 that cervical cancer could be diagnosed by vaginal and cervical smears. The Pap test, as it is now called, detects abnormal cells in the cervix, both cancerous and pre-cancerous. Current guidelines for recommended screening intervals can be found through the U.S. Preventive Services Task Force (USPSTF) website2.
The test can be performed using either 1) a conventional glass slide and fixative with a spatula and endocervical brush (the traditional &#34;Pap smear&#34;) or 2) the more commonly utilized liquid-based cytology with a cervical broom or a spatula and endocervical brush (Figure 2). No matter what tools are used, the samples are collected from just inside the external os and the squamocolumnar junction, or transition zone around the os (Figure 3). This video demonstrates the spatula and endocervical brush with liquid-based cytology, as the liquid preparation is a more effective technique for the detection of cervical lesions, and the spatula and endocervical brush improve specimen collection.
<img alt="Figure 2" src="/files/ftp_upload/10141/10141fig2.jpg" /> 
Figure 2. Pap smear tools. Shown in sequence are: a liquid cytology canister, cervical broom, spatula, and endocervical brush.
<img alt="Figure 3" src="/files/ftp_upload/10141/10141fig3.jpg" /> 
Figure 3. Diagram of the cervix withrelevant structures labeled.

Pelvic Exam II: Speculum Exam and Pap Smear Test

Source: 
Alexandra Duncan, GTA, Praxis Clinical, New Haven, CT
Tiffany Cook, GTA, Praxis Clinical, New Haven, CT
Jaideep S. Talwalkar, MD, Internal ...

Pelvic Exam III:  Bimanual and Rectovaginal Exam

Source:
Alexandra Duncan, GTA, Praxis Clinical, New Haven, CT
Tiffany Cook, GTA, Praxis Clinical, New Haven, CT
<a href="https://www.jove.com/author/Jaideep+S._Talwalkar">Jaideep S. Talwalkar</a>, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT
A bimanual exam is a thorough check of a patient&#39;s cervix, uterus, and ovaries. It can tell an experienced provider a great deal, as it may lead to the discovery of abnormalities, such as cysts, fibroids, or malignancies. However, it&#39;s useful even in the absence of such findings, as it allows the practitioner to establish an understanding of the patient&#39;s anatomy for future reference.
Performing the bimanual exam before the speculum exam can help relax patients, mentally and physically, before what is often perceived as the &#34;most invasive&#34; part of the exam. A practitioner already familiar with the patient&#39;s anatomy can insert a speculum more smoothly and comfortably. However, lubrication used during the bimanual exam may interfere with processing certain samples obtained during the speculum exam. Providers must be familiar with local laboratory processing requirements before committing to a specific order of examination.
This demonstration begins immediately after the end of the speculum exam; therefore, it assumes the patient has provided a history and is in the modified lithotomy position.
A rectovaginal exam is not always necessary, but it may be performed to fully assess a retroverted uterus and ovaries (this may be the only way to accomplish full assessment depending on uterine position) or to assess the rectum.

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