Pharmaceutical ointments based on medicinal plants. Medicinal plants: how to prepare them (infusions, decoctions, powders and extracts from stems, roots, leaves and flowers)

Some older people begin to show restless behavior over the years, as if they cannot find a place for themselves. In some cases this is aimless walking back and forth across the room, in others it is no less aimless shifting of things from place to place. In some cases, anxiety may be accompanied by sighs, groans, shouts and even aggression - verbal or physical. Experts call all these and similar disorders with a special term - agitation (1; 2).

Restless behavior (agitation) is occasionally observed in every second patient with dementia and in more than 20% it is a clinically significant disorder. Agitation does not allow one to concentrate on the actions being performed, including mental and speech ones, so a person suffering from this disorder is increasingly inclined to perform only simple automated operations. Of course, when combined with cognitive impairment, agitation will aggravate them, affect the ability to perform daily activities and reduce the quality of life of the patient and his entire family (3).

Typically, restless behavior is characterized by persistence: in more than a third of patients, it persists for at least 6 months after onset (3; 4).

On early stages development of dementia, patients who are still able to convey their inner experiences to others complain of a certain internal tension that they cannot get rid of. However, there can be many reasons for concern. It may reflect physical or psychological suffering experienced by the patient, and agitation may also be a reaction to delusions or hallucinations. The deeper the decrease/loss of the ability to convey one’s experiences, satisfy one’s needs, and even simply be aware of them, the more likely that the problem that has arisen will find expression in seemingly meaningless (and ineffectively repeated) actions (2; 5; 6).

In this regard, caring for a patient with symptoms of agitation takes, according to scientists, more time and effort from caregivers and is 10-20% more expensive (7).

Where to start?

Now a few comments.

Before considering the option of prescribing severe antipsychotics, reducing activity, you should try to find out the cause from the patient himself, if this is still possible. If he is unable to provide useful information, the following options should be considered:

pain (an ordinary headache, about which the patient cannot complain to others, will be expressed in restless behavior);
physical illness, in particular associated with an infectious or other disease;
uncomfortable air temperature;
thirst or hunger;
depression;
too many external stimuli (crowds of people, cacophony of loud sounds, unusual surroundings with a large number of new objects, etc.);
feeling of fear (for example, against the background of delirium, hallucinations);
a change in the usual environment (this does not necessarily mean moving to a new place, the appearance of a new person or changes in the interior is enough);
the effect of some medications.

If agitation appears in a sudden form or is persistent and has a serious negative impact on the life of the patient and those around him, you should consult a doctor for behavior correction. Properly selected treatment will stabilize the condition or, if the underlying cause cannot be eliminated, will alleviate the symptoms.

Non-medicinal products

Establish communication

The reaction of others to agitation can reduce it or, on the contrary, increase it. A systematic review (8) found, for example, that training staff to communicate appropriately in long-term care homes for people with dementia, as well as training them to identify and respond to their needs in a timely manner (known as personalized care), reduced agitation in their residents.

The modern approach to personalized care is not to ensure the completion of some care task, but to establish personal contact with the patient, understand his needs, and assess his ability to understand what is happening. After all, the patient may not understand or remember what he needs, and when the caregiver sincerely tries to help him, he may perceive this as interference in his life. personal life, which only intensifies the agitation.

Basic principles of communication:

Unobtrusively identify yourself and others to the patient if he does not remember.

Explain to him what is happening, step by step (since the patient may not remember)  

Use a calm, reassuring tone  

Speak so that it can be heard  

Avoid negativity, in words and intonation  

Discuss no more than one topic at a time  

Speak slowly  

Give the patient enough time to respond

If given a choice, then the simplest (of two)

Help the patient find words to express himself, double-check whether you understood correctly  

Light touch for reassurance or attention

Find something you like

Various types of activities may have therapeutic effects and reduce agitation in patients with dementia. A systematic review (8) shows that patient intervention (particularly music therapy) reduces agitation, but unfortunately there is no evidence that it has any effect long lasting effect (9).

Here is a diagram that is designed to help you choose an activity and adapt it to the patient

Social Engagement

Social interaction is essential to well-being throughout life, and a lack of it can cause agitation in people with dementia. It involves physically being near other people, eye contact, touch, speech contact. Some experts suggest increasing social activity in patients with dementia to improve their quality of life, although no supporting evidence exists from qualitative studies (10).

However, there is evidence that a clinically significant reduction in agitation could be achieved with the help of massage (8).

There is also reason to believe that live communication reduces agitation better than organized forms of activity (reading aloud, listening to music, handicrafts...) (11; 12). Scientists have found that visiting children and interacting with pets has a more effective impact than playing with dolls and robotic animals, so it is proposed to equate the use of dolls and robots with activities, and not with social interaction (some experts call games with dolls and robots a simulation of social presence) (13). Patients enjoy interacting with people more than with pets and with pets more than with toys (14).

Other methods of non-drug help for agitation

Neither light therapy, aromatherapy, nor exercise have shown convincing results in the treatment of agitation (8).

In cases where the above measures do not give the desired effect, it is necessary to resort to the help of medications.

Drug therapy

Antidementia therapy

First of all, correction can be considered as part of basic anti-dementia therapy. Numerous studies show the effectiveness of anti-dementia drugs in the correction of neuropsychiatric symptoms. At the same time, AChE inhibitors demonstrate greater effectiveness against anxiety and depression, and memantine – against agitation, hallucinations and aggression (15, 16). The combined use of these drugs may also be considered.

Antipsychotics for agitation

Antipsychotics were the first choice drugs for agitation in dementia until evidence of negative side effects suggested the need for very limited prescribing and close monitoring. The only antipsychotic approved in the United States and Europe for the treatment of neuropsychiatric disorders is risperidone. Risperidone at a dose of less than 1 mg/st demonstrates effectiveness in agitation and psychosis, especially aggression. Haloperidol is also effective for aggression, but not for other symptoms of agitation. Olanzapine and quetiapine are not effective for psychosis, aggression or agitation, but there is some positive evidence for aripiprazole for agitation.

The most convincing evidence from studies of atypical antipsychotics thus comes from risperidone, but it is recommended that its use be limited to 12 weeks, after which discontinuation should begin and then reassess the patient's condition (17).

Other medicines

Citalopram (30 mg) demonstrates good effectiveness against agitation (18).

However, its use is fraught with the negative consequences that are characteristic of selective serotonin reuptake inhibitors: citalopram can cause akathisia (restlessness, the need to constantly change position) and extrapyramidal symptoms (motor disorders), although, according to some data, to a lesser extent than antipsychotics (19).

Citalopram may also be associated with QT prolongation (20), cognitive decline (18), falls, and hyponatremia (21).

According to some data, the effectiveness of citalopram depends on the severity of symptoms: the less severe the symptoms of agitation and cognitive decline, the greater the effect can be achieved (22).

When citalopram was compared with antipsychotics for the treatment of behavioral symptoms, including agitation and psychosis, it showed comparable efficacy but similarly low tolerability: more than half of the participants withdrew from the study due to side effects, lack of effectiveness, and even worsening of symptoms (23, 24).

List of literary figures

1. Cummings J, Mintzer J, Brodaty H, et al, and the International Psychogeriatric Association. Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition. Int Psychogeriatr 2015;27: 7–17.

2. Cohen-Mansfield J. Conceptualization of agitation: results based on the Cohen-Mansfield Agitation Inventory and the Agitation Behavior Mapping Instrument. Int Psychogeriatr 1996; 8 (suppl 3) : 309–15, discussion 351–54.

3. Ryu SH, Katona C, Rive B, Livingston G. Persistence of and changes in neuropsychiatric symptoms in Alzheimer disease over 6 months: the LASER-AD study. Am J Geriatr Psychiatry 2005;  13: 976–83. 

4. van der Linde RM, Dening T, Stephan BC, Prina AM, Evans E, Brayne C. Longitudinal course of behavioral and psychological symptoms of dementia: systematic review. Br J Psychiatry 2016; 209: 366–77. 

5. Livingston G, Kelly L, Lewis-Holmes E, et al. A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioral interventions for managing agitation in older adults with dementia. Health Technol Assess 2014; 18: 1–226.

6. Rosenberg PB, Nowrangi MA, Lyketsos CG.  Neuropsychiatric symptoms in Alzheimer’s disease: what might be associated brain circuits? Mol Aspects Med 2015; 43-44: 25–37.

7. Morris S, Patel N, Baio G, et al. Monetary costs of agitation in older adults with Alzheimer’s disease in the UK: prospective cohort study. BMJ Open 2015; 5: e007382.  

8. Livingston G, Kelly L, Lewis-Holmes E, et al. Non-pharmacological interventions for agitation in dementia: systematic review of randomized controlled trials. Br J Psychiatry 2014; 205: 436–42.  

9. Farina N, Rusted J, Tabet N. The effect of exercise interventions on cognitive outcome in Alzheimer’s disease: a systematic review.  Int Psychogeriatr 2014;26: 9–18.

10. Cooper C, Mukadam N, Katona C, et al, and the World Federation of Biological Psychiatry–Old Age Taskforce. Systematic review of the effectiveness of non-pharmacological interventions to improve the quality of life of people with dementia. Int Psychogeriatr 2012;  24: 856–70.  

11. Cohen-Mansfield J, Marx MS, Dakheel-Ali M, Regier NG, Thein K. Can persons with dementia be engaged with stimuli?  Am J Geriatr Psychiatry 2010;18: 351–62.

12. Ballard C, Brown R, Fossey J, et al. Brief psychosocial therapy for the treatment of agitation in Alzheimer disease (the CALM-AD trial). Am J Geriatr Psychiatry 2009;17: 726–33.

13. Cohen-Mansfield J, Marx MS, Thein K, Dakheel-Ali M. The impact of stimuli on affect in persons with dementia. J Clin Psychiatry 2011;72: 480–86.

14. Cohen-Mansfield J, Marx MS, Dakheel-Ali M, Regier NG, Thein K, Freedman L. Can agitated behavior of nursing home residents with dementia be prevented with the use of standardized stimuli?  J Am Geriatr Soc 2010; 58: 1459–64.  

15. Taylor D, Paton C, Kapur S. Prescribing Guidelines in Psychiatry. 12th ed. West Sussex, UK: John Wiley & Sons; 2015.

16. Tible OP, Riese F, Savaskan E, von Gunten A. Best practice in the management of behavioral and psychological symptoms of dementia. Ther Adv Neurol Discord. 2017; 10: 297–309.  

17. Ballard C, Howard R. Neuroleptic drugs in dementia: benefits and harm. Nat Rev Neurosci 2006; 7: 492–500.

18. Porsteinsson AP, Drye LT, Pollock BG, et al, and the CitAD Research Group. Effect of citalopram on agitation in Alzheimer disease: the CitAD randomized clinical trial. JAMA 2014; 311: 682–91.

19. Hedenmalm K, Güzey C, Dahl ML, Yue QY, Spigset O. Risk factors for extrapyramidal symptoms during treatment with selective serotonin reuptake inhibitors, including cytochrome P-450 enzyme, and serotonin and dopamine transporter and receptor polymorphisms. J Clin Psychopharmacol. 2006;26: 192–97.

20. Drye LT, Spragg D, Devanand DP, et al, for the CitAD Research Group. Changes in QTc interval in the citalopram for agitation in Alzheimer’s disease (CitAD) randomized trial. PLoS One 2014; 9: e98426.

21. Coupland C, Dhiman P, Morriss R, Arthur A, Barton G, Hippisley-Cox J. Antidepressant use and risk of adverse outcomes in older people: population based cohort study. BMJ 2011; 343: d4551.

22. Schneider LS, Frangakis C, Drye LT, et al, for the CitAD Research Group. Heterogeneity of treatment response to citalopram for patients with Alzheimer’s disease with aggression or agitation: the CitAD randomized clinical trial. Am J Psychiatry 2016;173: 465–72. 

23. Pollock BG, Mulsant BH, Rosen J, et al. A double-blind comparison of citalopram and risperidone for the treatment of behavioral and psychotic symptoms associated with dementia.  Am J Geriatr Psychiatry 2007; 15: 942–52.

24. Pollock BG, Mulsant BH, Rosen J, et al. Comparison of citalopram, perphenazine, and placebo for the acute treatment of psychosis and behavioral disturbances in hospitalized, demented patients.  Am J Psychiatry 2002;159: 460–65.

Mental disorders are one of the biggest problems of modern society, as more and more people notice signs of certain diseases. Agitation is a disorder that is associated with increased emotional arousal, accompanied by fear and anxiety, manifested in speech and movement.

You can often come across the expression that a person is “in agitation,” i.e. joyful or restless - in fact, simple emotional arousal has nothing to do with this mental disorder. A person who is in agitation will be extremely fussy, restless, and will also tend to repeat the same movements, etc.

Causes

The reasons for the appearance of agitation, like any mental illness, very blurry. It is difficult to say with certainty what became the basis of this disorder. Usually there is a complex of reasons, ranging from a predisposition to such diseases and ending with overwork or stress.

At the moment, researchers put forward a number of reasons that may trigger agitation:

Severe stress associated with sudden fear.
A job that involves constant risk, exposure to something dangerous, and constant change and change.
The result of drug intoxication, or “delirium tremens.”
Pathological effects of certain medications.
Disorders of the endocrine system (for example, a disease such as hyperthyroidism).

The risk group includes older people - usually due to serious traumatic events, they can be susceptible to this disorder. It can also manifest itself against the background of age-related mental disorders (dementia, Alzheimer’s, etc.).

This disease may be one of the symptoms of other, more serious mental disorders:

Schizophrenia.
Neurosis.
Agitated depression.
Bipolar disorder.

Naturally, the specific treatment will depend on the cause. But it must be said that the cause of this disorder is quite difficult to establish. It is impossible to say unequivocally what exactly – what event or experience – became the main trigger.

Main features

It is necessary to pay attention to how agitated activity will manifest itself, since it will be somewhat different from other disorders. We should also not forget that the patient himself may not notice these signs; it is important for relatives or close people to pay attention to this in order to seek help as early as possible.

The main signs of agitation:

Agitation begins to unfold with the manifestation of fussiness and restlessness in movements.
Trembling appears in the hands, the skin turns pale, sweating increases, breathing and heart rate increase.
Thinking becomes confused, speech becomes confused. It is difficult for a person to complete a sentence; he seems to rush from one thought to another or repeats the same words.
The more serious the disease, the more pronounced the symptoms will appear - moreover, during attacks the patient can harm both himself and others. Therefore, it is important to pay attention to the signs of the disorder as early as possible.
If agitation acts as a symptom of other diseases, then it can be accompanied by visual or auditory illusions, sometimes by attacks of spontaneous shouting of curses, as well as motor tics.

Agitation is a common symptom of a disease called agitated depression. Her symptoms will be somewhat different. It must be said that with this disorder a combination of various symptoms will appear, characteristic of both ordinary depression (depressed mood, apathy, sleep disturbances, etc.) and agitation.

Firstly, such patients experience causeless anxiety. They begin to worry about their loved ones, their health and physical condition. They are captured by a certain premonition that something bad is about to happen.

Secondly, the patient’s speech changes, he repeats the same phrases, usually somehow related to his anxiety. Moreover, this can amount to a couple of words, which he will restlessly repeat and repeat.

Thirdly, there are behavioral changes. It will be difficult for the patient to literally sit still. He will constantly move, move, restlessly walk from corner to corner.

With serious development of this disease, it can be combined with delusional states and obsessions. In some, especially severe cases, suicide attempts may occur, as well as various types of auto-aggression (aggressive behavior directed at oneself, for example, self-torture).

Help and treatment

So, it is important to know that agitation is like independent disease It is currently completely curable. But if it is a sign of another disease, certain difficulties may arise.

First, it is important to establish the cause of the disease. After the specialist determines the factors that led to the development of the disease, treatment is prescribed.

1. Often such patients are offered to undergo a course of individual psychotherapy. Once the patient becomes calmer, he may be referred to a psychotherapy group, where he can practice skills for interacting with other people.

2. It is also important that the psychotherapist be visited by the patient’s relatives, since the need to create a certain atmosphere at home falls on their shoulders.

3. Most often, the treatment of agitation is medicinal, since psychotherapy alone is not capable of returning a person to normal life. Medicines are prescribed depending on the characteristics of the disease; these can be both antidepressants and antipsychotics.

Agitation is a powerful emotional arousal in which a person feels fear and anxiety. This condition is aggravated by movement disorder. The patient makes the same type of fussy movements unconsciously. It is extremely difficult to speak in this state, since consciousness is in a stupor, and the ability to reason and think logically is reduced to zero.

In addition, there is pallor skin, tachycardia, and increased sweating. Experts consider this condition to be prepathological within normal limits, but in particularly stressful situations it can be seriously aggravated.

Agitated depression is a common type of depression that involves alternating states of sadness and anxiety. A person can fall into despair, and after a few minutes succumb to panic and unimaginable fear. This disorder is called agitated, from the word “excitement.”

Plunging into melancholy, the patient thinks with disappointment about the uselessly wasted years of his life, in his opinion, about the lost opportunities. These thoughts are aggravated by self-examination and self-flagellation. In a state of panic and excitement, the patient, on the contrary, worries about his future life.

A bright picture of the future does not take shape, and life seems over, which is why obsessive suicidal thoughts appear. These two opposite states alternate with each other and “compress” the human psyche in a vicious circle. To find the reason and its elimination requires consultation with a psychiatrist.

Given psychological illness is more typical for middle-aged or elderly people. According to statistics, representatives of the stronger sex encounter it more often. If agitation or depression of the same name appeared before the age of 30, the patient usually copes with it on his own.

At this age there is still a strong feeling that “everything is ahead.” Being in middle or pre-retirement age, on the contrary, a person begins to reflect on the past years and states with despair that not all goals have been achieved.

Causes of the disease

Agitation manifests itself during a stressful state. It is also a consequence of many neurological and mental illnesses:

senile decline;
catatonic schizophrenia.

Prolonged alcohol intoxication, alcoholism and any other intoxication can provoke agitation and aggravate it.

Some infectious diseases can cause symptoms of the described illness, but this is not common. In some professions, which involve constant stress, a person may periodically become confused, but this should not be confused with agitation.

In psychiatry, agitation is one of the leading ailments. More than one and a half million people are affected by this disease every year in the United States alone.

Many patients are unable to control themselves while in this state and become dangerous to themselves and others. In view of this, in megacities, closed medical institutions or psychiatric departments are provided for such patients on one of the floors of a regular hospital.

Symptoms and diagnostic methods

Agitation has clear symptoms, but the patient himself usually does not notice them. The first thing that may appear in a person is speech anxiety.

Speaking quickly and indistinctly, he has difficulty formulating his thoughts. Added to this phenomenon is trembling of the fingers or sudden movements of the entire hand. At the same time, there is an increase in heart rate and breathing. The patient is sweating heavily and is in undisguised emotional excitement.

If the disease has passed the initial stage, the patient will complain of a feeling of devastation and difficulty concentrating. The illness does not allow draw up cause-and-effect relationships and think logically. In this case, fear, panic and fussiness arise.

A person has difficulty expressing thoughts, and cannot write at all due to trembling hands. He can perform only the simplest actions and requests, but as the disease worsens, his activity will be reduced to sleep and meals.

Diagnosis and treatment should be carried out by a psychiatrist. In addition, you will need to consult a neurologist and, possibly, a narcologist. Currently, there are accurate and rapid diagnostic methods. In order to determine the diagnosis and correctly plan the treatment, the specialist will need to collect an anamnesis, namely:

visual inspection;
monitoring pulse and blood pressure;
general blood, urine and biochemical analysis;
hormone analysis;

This will allow the doctor to determine the severity of the disease and state that it is agitation, and not, for example, similar symptoms. Based on the information collected, a treatment plan will be developed and specific medications will be selected. The specialist will also decide whether the patient needs hospitalization.

Treatment and preventive measures

It is important for the doctor to discover the cause of the appearance of hydration, and, based on this, then draw up a treatment regimen; usually treatment consists of several methods:

taking medications to relieve symptoms;
psychotherapy for social adaptation;
getting rid of alcoholism (if required);
physical therapy;
diet correction.

Properly selected medications play a leading role. The course will include several drug groups:

Adsorbents(Polifepan, Baktistatin) and absorbents(activated carbon, Polysorb). If the agitation was caused by alcoholism, then first the patient will need to be taken out of this state, to “cleanse” his body of toxins and their breakdown products.
Antipsychotics(Solean, Zeldox). Relieves paranoid attacks and... Their reception is carried out exclusively within the walls of the hospital, under the supervision of medical staff. Take the course for up to 14 days.
Antidepressants sedative effect (Lyudiomil, Fluoxetine). “Softer” drugs for depression and nervous agitation. Course – 14 days.
Tranquilizers(Phenazepam, Diphenhydramine, Lexotan). Required to stabilize the condition, to remove a person from a state of binge drinking. Use for no more than 5-7 days, as they can be addictive.
Prescribed with extreme caution antianxiolytic drugs.

A psychiatrist and narcologist regularly works with the patient, offering certain methods of behavior for optimal recovery from depression. The main thing is for the patient to learn to control their emotions and “work around” stressful situations. Psychotherapy will increase stress resistance and allow you to independently deal with emotional oppression.

To prevent the development of agitation, it is recommended to follow a diet and not overuse alcoholic products. If you often experience stress or simply have a difficult life situation, you should not neglect a visit to a psychoanalyst.

A specialist can prescribe a suitable non-addictive sedative to make it easier for a person to overcome stressful situations. This will prevent the matter from developing into a frightening mental disorder. Agitation can lead to dire and irreversible consequences, so if symptoms appear, you should immediately contact a psychiatrist or neurologist.

If you go to the hospital in a timely manner, the prognosis is favorable. Treatment usually takes at least 20 days, which the patient, in most cases, spends within the walls of the hospital.

An integrated approach will allow a person to be completely cured, but if his initial illness is alcoholism, then the likelihood of relapse is very high. Self-medication in this case is a reckless and counterproductive idea.

ASP.NET profile properties allow your application to track and permanently store user-specific information. For example, users can specify a postal code or a favorite color scheme, and your application can store that information and retrieve it from anywhere in the application. ASP.NET automatically matches the current user - whether the user is anonymous or logged on - with the personal information that is stored for their user account.

This walkthrough shows you how to add profile properties to your application and use the profile properties to create a personalized experience for visitors to the Web site.

During this walkthrough, you will learn how to do the following:

Configure an application to use profile properties.

Define simple and complex profile properties that you want to maintain for users.

Maintain profile properties for both anonymous and logged-on users.

Set and retrieve profile values in your application.

Prerequisites

In order to complete this walkthrough, you will need the following:

Microsoft Visual Studio.

The Microsoft .NET Framework.

Microsoft SQL Server Standard or SQL Server Express.

The profile property information that you create in the walkthrough will be stored in a SQL Server database.

Cookies enabled on your browser.

ASP.NET profile properties can work without cookies, if the application is configured to work without cookies. However, for this walkthrough you will use the default configuration settings for profile properties, which use cookies.

Creating and Configuring the Web Site

If you have already created a Web site in Microsoft Visual Studio by Walkthrough: Creating a Basic Web Page in Visual Studio, you can use that Web site and go to the next section. Otherwise, create a new Web site.

This walkthrough uses a Web site project. You could use a Web application project instead. For information about the difference between these Web project types, see Web Application Projects versus Web Site Projects.

To create a file system Web site

Open Visual Studio.

On the File menu, point to New, and then click Web Site(or on the File menu, click New Web Site).

The New Web Site dialog box appears.

Under Installed templates, click the language that you want to work with.

In the list of templates, select ASP.NET Empty Web Site.

In the left-most Location list, click File System.

In the right-most Location list, enter the name of the folder where you want to keep the pages of the Web site.

For example, type the folder name C:\WebSites.

In the Language list, click the programming language that you prefer to work in.

Click OK.

Visual Studio creates the folder and a new page named Default.aspx.

Configuring Profile Properties

You will begin by configuring your application to enable profile properties. You will then define the first property that you want to track for each user. This property is named PostalCode and will be tracked for both anonymous and logged-on users.

To configure the Web site for the PostalCode property

In Solution Explorer, determine whether the Web site already has a Web.config file.

If the Web site has a Web.config file, open it. If the Web site does not have a Web.config file, follow these steps:

Right-click the name of the Web site.

Click Add New Item.

Web Configuration File.

Click Add.

A new file that is named Web.config is added to the site and is opened in the editor.

Add the following profile element to the Web.config file as a child of the system.web element:

You have added the following elements:

The anonymousIdentification element, which specifies whether profile properties work only with logged-on (authenticated) users or with both logged-on and anonymous users.

In this case, you have set enabled to true. Therefore, profile property information will be tracked for both logged-on and anonymous users.

The properties element, which contains all profile properties that you are defining.

The add element, which defines a new profile element.

In this case, you have defined a single profile property named PostalCode.

When you define a profile property, you specify its data type using a .NET Framework–type class name. You also specify whether the profile property will be tracked for anonymous users. After enabling anonymous identification, you can additionally specify whether to track profile properties individually for anonymous users.

You would create a new add element for each additional profile property that you wanted to define.

By default, user profile information is stored in a SQL Server database in the Application_Data subdirectory of the Web site. This walkthrough uses the default configuration. In production applications that will support a significant number of users, it is better to store profile property data in a server-based (rather than file-based) Microsoft SQL Server database. For more information, see "Next Steps" later in this walkthrough.

Setting and Getting the PostalCode Property

In this section, you will create a page that shows how to set and get the PostalCode value that you defined in the preceding section.

To create a page that sets and gets the PostalCode property

Add a new Web page to your site named Profiles.aspx. Make sure that the Place code in separate file check box is selected.

Open Profiles.aspx and switch to Design view.

From the Standard group in the Toolbox, drag the controls listed in the following table onto the page, and then set their properties as noted.

ID = PostalCodeTextBox

ID = SetPostalCodeButton

Text = Set Postal Code

ID = PostalCodeLabel

Double-click the Set Postal Code

In the SetPostalCodeButton_Click handler, add code that sets the PostalCode profile property, as shown in the following example:
Protected Sub SetPostalCode_Click(ByVal sender As Object, _ ByVal e As System.EventArgs) Profile.PostalCode = Server.HtmlEncode(PostalCodeTextBox.Text) PostalCodeLabel.Text = Profile.PostalCode End Sub protected void SetPostalCode_Click(object sender, System.EventArgs e) ( Profile.PostalCode = Server.HtmlEncode(PostalCodeTextBox.Text); PostalCodeLabel.Text = Profile.PostalCode; )
When user profile properties are enabled, ASP.NET dynamically creates a property named Profile that adds the user profile to the current context. The individual profile properties are then available through Profile.PostalCode.

Add code that displays the Profile.PostalCode to the Page_Load handler, as shown in the following example:
Sub Page_Load(ByVal sender As Object, ByVal e As EventArgs) PostalCodeLabel.Text = Profile.PostalCode End Sub void Page_Load(object sender, System.EventArgs e) ( PostalCodeLabel.Text = Profile.PostalCode; )
This code will display the Profile.PostalCode value every time that the page is requested.

Testing the PostalCode Profile Property

You can now test the PostalCode property that you defined in the preceding section. You will at first work as an anonymous user. Behind the scenes, ASP.NET will assign you a unique, anonymous ID that is stored in a cookie on the computer. ASP.NET can use this anonymous ID to set and get values that are unique to you.

If you are working with an existing Web site that has membership enabled, make sure that you are logged off.

To test the PostalCode property

Right-click Profiles.aspx and click Set as Start Page.

Press CTRL+F5 to run the Profiles.aspx page.

It might take a while for the page to display the first time you make a page request to the site, because ASP.NET is creating the SQL Server database that it uses to store profile information in.

If the browser displays a 502 error or an error indicating that the page cannot be displayed, you might need to configure your browser to bypass proxy servers for local requests. For detailed information, see How to: Bypass a Proxy Server for Local Web Requests.

In the box, type a postal code, and then click Set Postal Code.

The postal code that you entered appears in the Label control.

Close the browser to close your current session.

Press CTRL+F5 to run the Profiles.aspx page again.

The postal code that you entered earlier appears in the Label control.

The last step in the preceding procedure illustrated that ASP.NET stores the PostalCode value. When you visit the page again, ASP.NET reads the PostalCode value based on your unique anonymous ID.

Defining Complex Properties

In "Setting and Getting the PostalCode Property," earlier in this walkthrough, you created a simple property named PostalCode that was stored as a string. In this section, you will define a property named FavoriteURLs that is a collection. ASP.NET can store profile properties of any type, but you must provide additional information when you are defining complex profile properties.

To define the FavoriteURLs property

Open the Web.config file.

Add a new property named "FavoriteURLs" element to the profile element that you created in "Configuring Profile Properties," earlier in this walkthrough, as shown in the following example:

You have added a new profile property named FavoriteURLs. For profile properties that are not simple types (such as string or integer), you must specify the fully qualified type. Here, you are specifying that the profile property will be a collection that will hold strings.

Save and close the Web.config file.

Setting and Getting the FavoriteURLs Property

Working with the FavoriteURLs property, which is a collection, is much like working with a collection in any context. In this part of the walkthrough, you will update the Profiles.aspx page that you created in "Setting and Getting the PostalCode Property," earlier in this walkthrough, by adding a control in which users can type a URL. When the user clicks Add, the URL is added to the FavoriteURLs property. You will display the current list of favorite URLs in a drop-down list box.

To set and get the FavoriteURLs property

On the Profiles.aspx page, add the following controls and set their properties as noted in the following table.

	Property settings
	ID = FavoriteURLTextBox
	ID = AddURLButton
	ID = FavoriteURLsListBox

Double-click the Add URL button to add a handler for the button"s event.

In the AddURLButton_Click handler, add code to add a URL to the list, as shown in the following example:
Protected Sub AddURL_Click(ByVal sender As Object, _ ByVal e As System.EventArgs) Dim urlString As String = _ Server.HtmlEncode(FavoriteURLTextBox.Text) If Profile.FavoriteURLs Is Nothing Then Profile.FavoriteURLs = New _ System.Collections.Specialized. StringCollection End If Profile.FavoriteURLs.Add(urlString) DisplayFavoriteURLs() End Sub protected void AddURL_Click(object sender, System.EventArgs e) ( String urlString = Server.HtmlEncode(FavoriteURLTextBox.Text); if(Profile.FavoriteURLs == null) ( Profile.FavoriteURLs = new System.Collections.Specialized.StringCollection(); ) Profile.FavoriteURLs.Add(urlString); DisplayFavoriteURLs();

In the Page_Load handler, add code to display the URL list, as shown in the following example:
Sub Page_Load(ByVal sender As Object, ByVal e As EventArgs) labelPostalCode.Text = Profile.PostalCode DisplayFavoriteURLs() End Sub void Page_Load(object sender, System.EventArgs e) ( labelPostalCode.Text = Profile.PostalCode; DisplayFavoriteURLs(); )

Add the following subroutine to update the display of the URLs in the ListBox control.
Sub DisplayFavoriteURLs() FavoriteURLsListBox.DataSource = Profile.FavoriteURLs FavoriteURLsListBox.DataBind() End Sub void DisplayFavoriteURLs() ( FavoriteURLsListBox.DataSource = Profile.FavoriteURLs; FavoriteURLsListBox.DataBind(); )

Testing the FavoriteURLs Profile Property

You can now test the FavoriteURLs property.

To test the FavoriteURLs property

To run the Profiles.aspx page, press CTRL+F5.

At first there are no values in the ListBox control.

In the box, type a URL, and then click Add.

The URL is added to the ListBox control.

Repeat the preceding step to add another URL.

Close the browser.

To run the Profiles.aspx page again, press CTRL+F5.

Notice that the ListBox control is populated with the URLs that you entered before closing the browser.

Migrating Profile Properties During Log On

If a user first visits your site as an anonymous user, but then logs on, you might want to preserve the property settings that were established when the user was anonymous. A typical example is a shopping site where the user might browse and add items to a shopping cart as an anonymous user, but then log on to check out. To preserve a user's values when they log on, you migrate the user from the current anonymous user profile to the user profile that they have as a logged-on user (authenticated).

In this section, you will migrate the user"s PostalCode setting. You must have a Web site that is already configured to use user identities and that has a logon page. If the Web site that you are working with has not already been configured for membership, use the following procedure to enable it. If your site already supports membership, you can go to the next section.

To configure the Web site for membership

In Visual Studio, on the Website menu, click ASP.NET Configuration.

The Web Site Administration Tool appears.

Click the Security tab.

Under Users, click Select authentication type.

Select From the internet, and then click Done.

The From the internet option specifies that your application will use Forms authentication, where users will log on to the application by using a logon page.

On the Security tab, under Users, click Create user and then create a user account.

You can use any name and password, but make sure that you remember the name and password. For the e-mail address, use your own. (You will not be sending e-mail messages in this walkthrough.)

After finishing the user account definition, close the Web Site Administration Tool.

Open the Profiles.aspx page.

From the Login group in the Toolbox, drag a Login control and a LoginName control onto the page.

The LoginName control is not required for log on, but will help you see that you are logged on.

Creating a Migrating Handler

To migrate the settings for an anonymous user to the settings for a logged-on user, you must perform the migration when the user"s identity is changing. ASP.NET provides the event for exactly this purpose; in the handler for the event, you can transfer the settings that you want to preserve.

To create a migration handler

In Solution Explorer, right-click the name of the Web site, and then click Add New Item.

In the list of templates, click Global Application Class, and then click Add.

You do not have to enter a name, because the file is always named Global.asax.

Type the following code to create a new handler for the event.

Sub Profile_MigrateAnonymous(ByVal sender As Object, _ ByVal e As ProfileMigrateEventArgs) If Profile.GetProfile(e.AnonymousID).PostalCode<>"" Then Profile.PostalCode = _ Profile.GetProfile(e.AnonymousID).PostalCode End If End Sub void Profile_MigrateAnonymous(Object sender, ProfileMigrateEventArgs e) ( if(Profile.GetProfile(e.AnonymousID).PostalCode != String.Empty) ( Profile.PostalCode = Profile.GetProfile(e.AnonymousID).PostalCode; ) )

The code gets the user profile for the anonymous user and extracts the PostalCode value. Then, it gets the profile for the new user identity and sets the equivalent value for that identity.

Testing Migration

In order to test migration, you will first make some settings as an anonymous user. Then, you will log on and see that the values are preserved.

To test migration

Open the Profiles.aspx page, and then press CTRL+F5 to run it.

The LoginName control does not display anything, because you have not yet logged on.

If a postal code is not displayed on the page, type a new postal code, and then click Set Postal Code.

The postal code for your current anonymous identity is displayed on the page.

Log on, using the user name and password that you created in "Migrating Profile Properties During Log On," earlier in this walkthrough.

The LoginName control displays your user name. The postal code that you entered as an anonymous user is still displayed, because the postal code settings have been migrated to your logged-on user profile.

Next Steps

This walkthrough has illustrated the basic procedures for configuring and using profile properties in Web applications. You can use profile properties for many purposes in your applications. The following list suggests additional areas where you might want to work with profile properties:

Group profile properties together, because it is easier to work with profile properties as a unit.

For example, you can organize profile properties named Street, City, and PostalCode into a group named Address.

This emotional arousal is quite strong, and agitation is accompanied by anxiety, fear, and turns into speech and motor restlessness. A person begins to feel the need for the same type of movements, and often they are unconscious. In a state of agitation, excessive fussiness occurs, and only simple actions are performed, performed automatically, thoughtlessly.

Experts note that this condition appears when there is severe stress, and also if the patient suffers from mental illness. In particular, this refers to agitated depression, anxiety neurosis, and catatonic depression. In addition, agitation can be caused by drug or alcohol intoxication, and sometimes it is a symptom of an infectious disease.

Experts note that in a number of professions that pose a risk to life, for example, in emergency situations, agitation can be mistaken for confusion. The diagnosis is made by a doctor and is based on observation of the patient. Clinical picture has similarities with akathisia. In this regard, a thorough diagnosis is necessary. If treatment for agitation is started, but in reality the patient suffers from akathisia, the influence of the medications prescribed in this case can cause a worsening of symptoms.

Agitation can be identified if a number of signs are present. For example, the patient’s behavior changes, but he himself does not notice it. There is speech anxiety, fussiness in movements, the person’s hands tremble, the face turns pale, sweating increases, and the heart rate increases. In such a state, there are no thoughts, a kind of emptiness is formed, the ability to reason is lost, and causal complex connections are not established. Doctors pay special attention to such a problem as the occurrence of agitation during. In this case, patients also suffer from severe behavioral disorders. In particular, depression occurs, there are various types of complaints, and a person tends to wander.

In this case, the state is characterized as overexcited, excessive agitation is noted. A person begins to use obscene expressions that were previously unusual for him, and clouding of consciousness occurs. With such disorders, normal daily life is disrupted, and problems with sleep arise. In addition, there is a risk that a sick person in a state of agitation will harm himself or those caring for him.

Often environmental changes can provoke agitation, factors such as fatigue and fear have no less pronounced influence on the development of the disease. It has been proven that in some cases, agitation is caused by somatic diseases and infections. You should know that the causes of agitation can be eliminated and cured, which is why it is so important to get help from a qualified specialist. In the event that agitation is not a medical cause, behavioral techniques are used for treatment that can influence the patient’s routine life and distract him from the stress caused by a particular problem.

It is known that, in general, agitation can be cured completely, and that is why a thorough medical diagnosis is required. It would be a big mistake if you leave this process to chance. While in a state of agitation, the patient is capable of harming himself and loved ones, although such actions are unintentional. Treatment for agitation depends on the cause, and if necessary, medications are used. But a significant role is given to psychotherapeutic techniques that help the patient overcome the illness, and also significantly increase his resistance to stress.

Experts believe that agitation is a prepathological condition; it is located in the border region of the psychological norm. At the same time, certain medications may be prescribed to the patient for treatment. For example, these are antipsychotics that are used in cases of clouding of consciousness and if the patient has. Although there are a number of side effects, such as drowsiness, unusual movements, and rigidity. If prescribed, then in this case a feeling of fear, drowsiness, constipation, dry mouth, and a state of depression may occur.

To ensure relapse prevention, a patient in a state of agitation is recommended to undergo special psychotherapeutic courses. They will provide the patient with maximum resistance to emotional stress, which causes new attacks of the disease. If a patient is diagnosed with a mental illness, then the main emphasis in therapy should be placed on this factor. Relatives must ensure that the patient follows all doctor’s instructions and takes prescribed medications.

Reasonable use of drugs

Agitation is common in clinical practice, and many specific studies have been conducted on this subject. As it turned out, at least twenty-five percent of employees of such departments never feel calm at work, or this rarely happens. Additionally, while working with these types of patients, emergency nurses face verbal or physical threats in their workplace. Agitation always affects the patient's condition negatively. There have been deaths due to untreated delirium. If during treatment agitation drug therapy applied too early may interfere with an accurate psychiatric assessment.