In 2008 olanzapine Galunisertib in vivo long-acting injection (OLAI) was licensed for the maintenance treatment of adult patients with schizophrenia sufficiently stabilized during acute treatment with oral olanzapine. During the clinical trial process it was recognized that in 0.07% of injections, a clinical syndrome presented as an adverse event that was consistent with the inadvertent intravenous administration

of olanzapine [Zypadhera, 2011; Detke et al. 2010; McDonnell et al. 2010] and resulting in the symptoms and signs of olanzapine overdose. This has been given the term post-injection delirium/sedation syndrome (PDSS) [Zypadhera, 2011]. The symptoms can be readily identified and have a median onset time of 25 min [Detke Inhibitors,research,lifescience,medical et al. 2010]. In an Inhibitors,research,lifescience,medical effort to minimize the incidence of PDSS, the Committee for Medicinal Products for Human Use mandated in the SPC for OLAI that the depot injection should only be administered in a healthcare facility; other requirements include a 3 h observation period after each injection that would allow any of the

symptoms and signs of PDSS to be detected by appropriately qualified personnel [Zypadhera, 2011]. For the remainder of the day after injection, patients should be advised to be vigilant for signs and symptoms of overdose secondary to postinjection adverse reactions, be able to obtain Inhibitors,research,lifescience,medical assistance if needed, and should not drive or operate machinery. In addition, patients should not travel alone to their destination after the 3 h of observation. Currently, OLAI is the only antipsychotic

treatment that contains such a mandate in its license and thus service providers have been challenged with providing a service whereby OLAI can be administered in accordance with the licence. We present three Inhibitors,research,lifescience,medical clinical cases with details of how this has been managed in a clinical setting, which to our knowledge presents the first case series reported on OLAI usage in clinical practice. Results Case 1 A 24-year-old man who was a former university student with a 4-year history of schizophrenia initially responded well to 20 mg olanzapine but subsequently Inhibitors,research,lifescience,medical became nonadherent to medication with little insight into his illness and need for treatment. OLAI was commenced at 300 mg every 2 weeks in October 2010 and subsequently reduced science to 405 mg every 4 weeks. The man began attending an existing acute day care service to receive his injection and undergo observation, staffed by nurses and occupational therapists taking part in their ongoing programme of activities. During the initial 12 months he has not missed an appointment. His clinical state has improved and he has gained some insight and so is able to do some voluntary work in a shop. He is accompanied to the clinic by a keyworker. Case 2 A 48-year-old man diagnosed with his first episode of schizophrenia in 2008 following a long period of untreated psychosis presented with delusional beliefs about a neighbour. A diagnosis was made of paranoid schizophrenia.

Moreover, we must take into account that, like the pathophysiological mechanisms of complex psychiatric disorders, different genes are interacting and modulating each other in drug response, in addition

to environmental factors. Nevertheless, the field of pharmacogenetics is expanding rapidly, and the elucidation of the disease processes through Inhibitors,research,lifescience,medical genomics, the identification of novel drug targets, and the subtyping of patient populations are all ambitious methods that may help us individualize pharmacological therapy. Conclusion Understanding the biology of major depression is a challenging scientific problem with enormous sociological and clinical relevance. The discovery of antidepressant drugs and the investigation of their mechanism of action has revolutionized our understanding of neuronal functioning and the possible mechanisms underlying depression. There is no doubt that the monoaminergic system is one Inhibitors,research,lifescience,medical of the cornerstones of research, but any hypothesis

for the pathophysiology of depression must take into account the many interactions with other brain systems and the complexity of the regulation of the CNS function. In spite of all the progress that has been achieved in the last Inhibitors,research,lifescience,medical decades, we must be aware that there are still today considerable problems in understanding and treating severe depression, and knowing the cause of treatment-resistant depression. Selected abbreviations

and acronyms BDNF brain-derived neurotrophic factor CRH corticotropin-releasing hormone DA dopamine GABA γ-aminobutyric acid GH growth hormone HPA hypothalamus-pituitary-adrenal Inhibitors,research,lifescience,medical S-HT 5-hydroxy try ptamine (serotonin) MAOI monoamine oxidase inhibitor NE norepinephrine NK natural killer (cell) SSRI selective serotonin-reuptake inhibitor TCA tricyclic antidepressant
Stress-related psychiatric disorders such as anxiety and major depression impair the lives of approximately Inhibitors,research,lifescience,medical 10% to 15% of the population. For many years, the success of the pharmacological treatment of these disorders has been restrained by various factors, including long latency of clinical effect, treatment others CDK phosphorylation resistance, adverse side effects, and, in the case of the anxiolytic benzodiazepines, tolerance and addictive potential. Although stress has continuously been a subject of research since the 1940s, the pharmacological principle of action (ie, the interaction with the classic neurotransmitters such as serotonin, noradrenaline, and γ-aminobutyric acid [GABA]) of the antidepressant and anxiolytic drugs prescribed today still stems from work carried out as early as the 1950s. A new epoch began in 1981 with the discovery of corticotropin-releasing hormone (CRH) as the principal mediator of the effects of stress on the hypothalamicpituitary-adrenocortical (HPA) axis and behavior.

This map indicates the difference in regional cerebral blood flow … Drug side effects and human pharmacokinetics Haloperidol produces significant parkinsonism and akathisia in a large number of subjects even at very low dose levels. In a controlled multicenter trial that evaluated 4 to 16 mg/day dose levels, the motor side effects were evident,

at the lowest, dose, suggesting that motor side effects are inevitable, even at very Inhibitors,research,lifescience,medical low clinical doses. However, other side effects produced by many of the first-generation antipsychotic drugs, like cardiovascular effects, anticholinergic actions, and hematological changes, are no particular problem with haloperidol. The compound fails to alter the QT Epacadostat purchase interval on electrocardiography (ECG), a measure of cardiac repolarization time. Little weight gain has been documented with haloperidol. Haloperidol has only one minor metabolite (reduced haloperidol) and both parent and metabolite are easy to analyze. Halopcridol’s half-life Inhibitors,research,lifescience,medical in humans is 12 to 22 h in a mixed population and 12.2±2.6 Inhibitors,research,lifescience,medical h in “good” metabolizers. In our hands (N=10), the time to maximum concentration (Tmax) is 5±2 h, its distribution half-life is 1.3 ±0.03 h; peak plasma level after 10 mg oral concentrate (Cmax) is 12.3±6.7 ng/mL and elimination half-life

is 21.7 ±20 h (unpublished data). Treatment, studies from multiple laboratories indicate that drug concentrations of 4 to 16 ng/mL form the therapeutic range for the drug.27 Clozapine Clozapine was first, marketed in the early 1960s, but its use was severely restricted due to the acute agranulocytosis seen in Finland and Inhibitors,research,lifescience,medical the associated deaths. However, despite this, the early use of the drug suggested its unique antipsychotic actions; these were demonstrated in the 1988 study by Kane et al.11 Since then, use in persons with psychosis unresponsive to other drugs has been strongly advocated and the clinical outcomes have been broadly positive. In some countries, eg, China, clozapine has been used as a first-line

drug because Inhibitors,research,lifescience,medical of its outstanding clinical actions.28 The clinical actions of the drug have an associated human physiology, which is consistent with its unique actions (see below). Receptor profile and animal pharmacology Clozapine has a broad affinity for many central nervous system (CNS) receptors. It has measurable affinity not Casein kinase 1 only for D1 and D2 dopamine receptor families (D1 D2, D3, and D4), but also for the serotonin (5-HT1A, 5-HT2A, 5-HT2C, 5-HT6, and 5-HT7) receptors. In addition, it has significant, affinity for the α1 and α2 adrenergic, cholinergic, and histamine sites.18 Although the affinity of clozapine for these sites overall is low, clinical doses are relatively high, giving clozapine a broad but low-affinity blockade of many CNS receptors in the clinical situation.

Lundbeck A/S. The sponsor had no role in the study design or in the collection, analysis and interpretation of data. J.S. and K.A. were employed by Takeda Pharmaceuticals at the time of the study. Contributor Information Emna El Hammi, Creativ-Ceutical, Deerfield, IL, USA. Jennifer Samp, Takeda Global Research and Development Center, Deerfield, IL, USA. Cécile Rémuzat, Creativ-Ceutical, Deerfield, IL, USA. Jean-Paul Auray, University of Lyon, University Claude Bernard Inhibitors,research,lifescience,medical Lyon I, Lyon, Cedex, France. Michel Lamure, University of Lyon, University

Claude Bernard Lyon I, Lyon, Cedex, France. Samuel Aballéa, Creativ-Ceutical, Deerfield, IL, USA. Amna Kooli, Creativ-Ceutical, Deerfield, IL, USA. Kasem Akhras, Takeda Global Research and Development Center, Deerfield, IL, USA. Mondher Toumi, University of Lyon, University Claude Bernard Lyon I, UFR d’Odontologie, 11 rue Guillaume Paradin, 69372 Lyon, Cedex 08, France.
Discontinuation of long-term MLN0128 manufacturer lithium treatment leads to early and severe affective recurrences [Baldessarini et al. 1999], and to a bipolar disorder course more severe than that Inhibitors,research,lifescience,medical before lithium treatment with an increased risk of suicide [Post, 2012], which is often resistant not only to other mood stabilizers, but also to the

reinstitution of lithium treatment Inhibitors,research,lifescience,medical at the prior effective serum lithium level [Post, 2012]. Unfortunately, the currently available lithium-alternative mood stabilizers are of limited (anticonvulsants) [Geddes et al. 2010; Kessing et al. 2011; Greil and Kleindiest, 1999], or questionable (atypical neuroleptics) [Goodwin et al. 2011] efficacy. We have recently provided clinical observations strongly suggesting that memantine, a noncompetitive N-methyl D-aspartate receptor antagonist, has a clinically relevant Inhibitors,research,lifescience,medical antimanic and a sustained mood-stabilizing effect in treatment-resistant bipolar disorder with excellent safety and tolerability [Koukopoulos et al. 2010,

2012; Sani et al. 2012; Serra et al. 2013]. More recently we have observed a long-lasting Inhibitors,research,lifescience,medical mood-stabilizing effect of memantine after lithium discontinuation in a bipolar I patient [Serra et al. 2013]. In order to evaluate further the effect of memantine in the prophylaxis of affective recurrences occurring after long-term lithium discontinuation, we administered the drug to three patients who had to discontinue lithium because of severe renal complications Methisazone (two patients) or excessive tremor (one patient). These case histories confirm our previous observations, and suggest that memantine may be considered a useful lithium substitute to prevent the affective recurrences after lithium discontinuation. Case 1 Woman born in 1930, suffering from a bipolar II disorder with rapid cycling course. She has a family history of bipolar disorder. Her first affective episode was a depression in May 1979 (aged 49 years), followed by a hypomania until January 1980. She started lithium prophylaxis and had a very good response to lithium.

12 Moreover, the participants were re-examined for bone and joint pains, hip joint motion limitation, and visual acuity by the investigators six month after the hospitalization. The extent of improvement in both limbs was compared. The nurse, who dealt with the pain scaling, was not aware of the results obtained by the physiotherapist involved in the two-point discrimination tests. The staff

was not informed of the results of pain scaling as well. Moreover, the physicians were not aware of the results they obtained before finishing the hospitalization period. Data are presented Inhibitors,research,lifescience,medical as mean±SD. They were analyzed using Statistical Package for Social Sciences (SPSS). Paired t, unpaired t, or Spearman’s correlation tests were used for statistical analysis. A P value of ≤0.05 was considered statistically significant. Results The values (mean±SD) of two-point discrimination tests obtained from L4, L5 and S1 dermatomes

for the selleck products intact and involved limbs before and after the treatment are shown in table 1. The pretreatment values of two-point discrimination Inhibitors,research,lifescience,medical tests obtained from L4 and L5 in intact and involved limbs were significantly lower than those of after treatment values in the same limb. Inhibitors,research,lifescience,medical Moreover, the two-point discrimination tests values obtained after treatment from involved limb, but not that of intact limb, was significantly lower from that of pretreatment values (table 1). Table 1 The values (means±SD) of two-point discrimination tests (in millimeter) in different dermatomes before and after treatment in intact and involved limbs The difference in the values Inhibitors,research,lifescience,medical of dermatomes from two-point discrimination tests before and after treatment in the intact and involved limbs were compared using unpaired t test. The changes in two-point discrimination tests values were significantly higher in the involved limbs than those in the intact limbs (table 2). Table 2 The mean±SD of differences (mm) of improvement of two-point discrimination tests

in L4, L5 and S1 dermatomes of the intact and the involved limbs before and after the treatment The pain score Inhibitors,research,lifescience,medical for the patients on day 7 of hospitalization was 6.05±2.52, which significantly lower than that on day 1 (8.5±1.72). In 16 out of 20 patients (80%), the results of SLR tests became negative after the treatment, while five out of 20 patients (20%) remained positive. This further indicated that the treatment schedule did manage to improve the patients’ condition. mafosfamide The Spearman’s correlation tests did not reveal a significant correlation between the changes in the outcomes of two-point discrimination tests and changes in the pain scales at L5 level (r=0.017, P=0.94) or S1 level (r=-0.14, P=0.55). Likewise, the correlation between the changes in the results of two-point discrimination tests and changes in the outcomes of SLR changes was not significant. Discussion Admittedly, the improvement in skin sensitivity would lead to increase its ability to discriminate between the two sharp points.

A complete table of instructions would be helpful and will hopefully be available soon. We recommend taking the lowest dose of AZD8055 datasheet melatonin currently available or using a pill cutter. In a few people, even the 0.5 mg dose may cause sleepiness immediately after taking it during the day. Lowering the dose further will reduce the soporific side effect, but then a second dose should be taken a few hours later, particularly when a phase advance is desired, in order to create overlap between the exogenous melatonin

pulse and the endogenous melatonin profile, as described above. Shift work maladaptation Although it is quite clear that very few shift Inhibitors,research,lifescience,medical workers adapt their circadian rhythms to conform to their work schedules, there is no consensus as to how best to help them. This topic has been reviewed elsewhere. The first use of light to treat shift workers was published in 1987.110 The first use of melatonin to treat shift workers was published Inhibitors,research,lifescience,medical in the early 1990s.111,112 When trying to sleep at odd hours, shift workers have a type of jet lag. Night workers have the same problems as someone who has traveled

through 12 time zones, in fact, worse, since air travelers usually adjust at a rate of at least 1 h per day, as mentioned above. Night workers rarely adjust their circadian Inhibitors,research,lifescience,medical rhythms, probably because of the morning sunlight exposure that occurs on the way home from work. Evening workers have it somewhat easier. Chronobiologists uniformly Inhibitors,research,lifescience,medical recommend staying on the same schedule every day, week after week. Neither light nor melatonin would then be necessary. However, workers (certainly those who do so at night) are uniformly against sleeping during the day on their weekends. Because their circadian rhythms do not usually adapt to their work schedules, shift workers feel good only on their days off. After working each night, they force themselves to sleep during the day when their body clocks would have them stay up, and of course their work

suffers as they soldier through the wee hours Inhibitors,research,lifescience,medical of the night when their body clock would have them sleep. A number of medical complaints often accompany shift Isotretinoin work, and the older one gets, the harder it is to adapt. Experts do not agree on how to help shift workers. As mentioned above, part of the problem lies in the fact that some workers would rather feel better on their days off than on their workdays, while managers understandably want workers to be most rested and alert during their hours of employment. Even if this issue is resolved, the next conundrum is that one cannot shift more than 3 to 4 h per day. Compromise schedules that rely on the use of appropriately timed bright light and/or melatonin administration have been proposed that stabilize circadian phase midway between work and off-work schedules. For example, Eastman and associates have proposed such a compromise schedule.

Ambrosio et al. (53) reported an antifibrotic effect of treadmill running in normal mice recovering from muscle damage. Extensive research with healthy humans has shown that adequately calibrated MLN8237 price exercise can increase the release of IGF-1 and decrease myostatin levels (54, 55). As explained earlier, both of these cytokine modifications

would tend to foster antifibrotic effects. Further studies are needed to explore the potential application of exercise in human DMD patients. Concerning the choice and adequate calibration of potential exercise loading, the study by Kern Inhibitors,research,lifescience,medical et al. (56) may be of interest which indicated that vibrational-proprioceptive exercise tends to induce a much stronger increase of IGF-1 and myostatin inhibition when compared with isokinetic exercise. Inhibitors,research,lifescience,medical Another recent study showed that uphill running induced adaptive effects on collagen tissues, consisting mainly of an increase of IGF-1 and decrease of TGF-β1 expression, while avoiding pathological changes often associated with regular or downhill running (57). While this effect was explained by the dominantly concentric muscular contraction mode, treadmill running may not always be appropriate Inhibitors,research,lifescience,medical for moderate and advanced stages of DMD. Use of concentric cycle ergometers, however, could probably achieve similar effects (58,

59). Molecular microdialysis investigations suggest that exercise loading in healthy athletes is accompanied with an increased likelihood Inhibitors,research,lifescience,medical of overuse injury in the affected connective tissues if the same type of loading is repeated on a daily basis. However, if the exercise regimen is performed with two or three ‘recovery days’ in between, healthier collagen remodelling can be observed (60). If a similar response pattern can also be confirmed in Inhibitors,research,lifescience,medical DMD patients, then a helpful model could be provided for the prescription of exercise regimens in these patients. The authors agree with Markert et al. (61) that if exercise is advised for DMD patients,

it should be confirmed that antioxidant activity levels remain elevated afterwards. It would therefore be useful to determine which of the available measurement technologies is most practical and affordable while still sufficiently specific for Histone demethylase this assessment (62-64). Additional mechanostimulatory modalities Massage treatments have long been used in the treatment of hypertrophic scars, however no substantial evidence had been provided about their effectiveness (65). A recent animal study has now convincingly demonstrated that myofascial massage is able to effectively decrease and prevent post-surgical visceral adhesions in rats (66). This finding appears to be in congruence with the cell culture studies from Standley et al. (67), which indicate that a gentle massage-like stimulation of fibroblasts elicits an anti-inflammatory cytokine expression.

Moreover, studies have shown that not only streptococci but also other infectious agents such as Borellia Burgdorferi or Mycoplasma Pneumoniae are associated with tics, ie, the association of tics and infectious agents is not restricted

to streptococci. A broader concept of this association, however, would more fulfill the needs for an infectious concept of TS. Conventional pharmacotherapeutic concepts of TS There is no doubt that dopaminergic neurotransmission is involved in the pathophysiology of TS. Dopamine (D2) receptor Inhibitors,research,lifescience,medical blocking agents such as haloperidol or pimozide have been shown to be effective in TS in several studies.79 Haloperidol showed an efficacy between 78% and 91% in 41 reports over a 14-year period.4 Many patients, however, discontinue haloperidol due to extrapyramidal side effects, while pimozide showed a superior profile regarding side effects. Pimozide was effective in several doubleblind, placebo-controlled studies.80 There are also reports of effective treatment with Inhibitors,research,lifescience,medical drugs such as fluphenazine, penfluridol, trifluoperazine, and flupenthixol.81 In the meantime, atypical antipsychotics such as risperidone, which is not only a D2 receptor antagonist, but also a serotonin (5-HT)2 antagonist, has been shown to be effective in TS.82,83 Clozapine

was observed to be effective against tics,84 although there have also been negative results reported.81 A partial Inhibitors,research,lifescience,medical control of tics during therapy with olanzapine at a dose of 5 to 10 mg/day was reported, as well as a reduction in tics in a controlled study (n=4).85 Ziprasidone, at a dose of 5 to 40 mg/day, was shown to be significantly more effective than placebo in 28 patients (7 to 17 years old) in a double-blind, randomized study, and was well tolerated.86 It should be noted, however, that Inhibitors,research,lifescience,medical the sudden death of a TS patient under therapy with ziprasidone during a clinical trial was reported.87 Aripiprazole, a new atypical antipsychotic that acts as a dopaminergic modulator showing mixed

dopamine antagonistic Inhibitors,research,lifescience,medical and agonistic effects, may take a special position in the therapy of TS. Effective treatment of TS using aripiprazole was reported repeatedly, in contrast to those treated with other antipsychotics, a also number of patients showed complete recovery from tics without significant high throughput screening adverse effects.88-90 The drug of first choice, for therapy of tics, particularly for children in many European countries, is tiapride, a benzamide derivate, which selectively blocks dopamine in the basal ganglia. Although only double-blind, placebo-controlled studies show beneficial effects on movement disorders and tics,91,92 tiapride is widely used in countries such as Germany, France, and others. It is one of the few drugs which is prescribed not only in adults, but also in children. In contrast to several antipsychotics, however, no adverse effects on cognitive performance in children have been observed.

Other activating events include PTEN loss and AKT amplification (59)-(61). Activation of this pathway was associated with poor prognosis

and contributed to chemoresistance in many cancers (62)-(66). Thus, the PI3k/Akt/mTOR pathway is an attractive pathway to target in pancreas cancer. mTOR inhibitors Everolimus 10mg daily was evaluated in 33 metastatic gemcitabine-refractory pancreas Inhibitors,research,lifescience,medical cancer patients (67). No objective responses (complete and partial) were reported and 21% had stable disease at the time of first surveillance CT scan. Median PFS and OS were 1.8 and 4.5 months respectively. In two smaller clinical trials, 4 gemcitabine-refractory patients received temsirolimus (CCI-779) and 16 received a combination of everolimus (30mg once weekly) and erlotinib (150 mg daily) (68). The former study with temsirolimus was halted due to toxicities and no objective response was observed, and the median PFS was 19 days and survival 44 days. The everolimus and erlotinib combination was better tolerated, but no response was observed and median PFS Inhibitors,research,lifescience,medical and survival Inhibitors,research,lifescience,medical was 49 days and 87 days respectively. These trials demonstrate that mTOR inhibition as a single agent is ineffective and combining inhibitors of multiple steps and the role for these inhibitors may lie in combination regimens. Akt inhibitors Akt inhibitors are another class

of agents that abrogate Akt/mTOR signaling. MK-2206, an HIF inhibitor review allosteric Akt1-3 inhibitor, was evaluated in a phase I trial of 70 patients with advanced cancers (69). Interestingly, tumor shrinkage (23%) Inhibitors,research,lifescience,medical was observed in a patient with PTEN-negative pancreas cancer and was associated with a 60% decrease in CA19-9. MK-2206 is being evaluated as weekly (300mg) and every other day (75mg and 90mg) dosing schedules. MK-2206 is also being evaluated in combination with cytotoxic chemo-agents and inhibitors of c-Met and EGFR (70),(71). RX-0201 is an antisense oligonucleotide against Akt1 mRNA, thereby interrupting the pathway’s activation. Inhibitors,research,lifescience,medical The anti-sense oligonucleotide demonstrated activity against pancreas cancer cell lines in low nanomolar range, reducing the expression of Akt1

mRNA and protein. Thymidine kinase In in vivo studies, RX-0201 treatment led to complete response in 2 out of 3 pancreas tumor-bearing mice (72). As such, RX-0201 in combination with gemcitabine is currently being evaluated in a phase II trial for metastatic pancreas cancer patients (73). Given the short half-life typical of anti-sense agents, RX-0201 is being administered by continuous infusion for 14 days of a 21-day cycle and presents a potential obstacle to patient accural. Liposomal formulations are in development (74). PI3K inhibitors XL147 and BKM120 are oral class I PI3k inhibitors that are being evaluated in phase I trials, alone and in combination therapies (75)-(77). These trials have focused on lung, colorectal and breast cancers given the higher frequency of pathway aberrations in these tumor types.

Recommendation Life style modifications, mechanized farming,

and use of alternative means to convey farm produce and traded items with active involvement of males will go a long way to reduce pelvic organ prolapse. Surgical services for affected patients could be provided in hospitals within the various communities if there is an increase in the number of gynecologist in the northern region of Ghana. Acknowledgement Sincere gratitude to Dr. Isaac Aboagye Marfo, Ms. Millicent Kumassey, Hajia Amira Iddrisu and Ms. Amina Abu all of the Department of Obstetrics and Gynaecology, Tamale Teaching Hospital and all others who contributed in putting this paper together.
Trends in ageing have been increasing in all regions of the NLG919 world; Asia,

Europe, Latin America/Caribbean, North America, Oceania and sub-Saharan Africa1. The older adult population has increased steadily since 1950 in all six regions. The highest overall proportion is in Europe; where by 2050 the aged proportion is estimated to be 36.6%. For Asia, Latin America and North America, projections indicate that increases will bring the proportion of the aged to between 22% and 27% by 2050, and in sub-Saharan Africa the projected population of the aged will be 10.2%.1 In Ghana, there is evidence of the ageing of the population, with the proportions aged 60 years and older rising from 4.6 in 1960 to 6.7 percent in 2010. Ageing may appear to be gradual at the moment the but the older population will grow rapidly as the fertility transition advances.2 The later years of life are accompanied by many physical and emotional changes as well as changes Thiazovivin clinical trial in one’s environment. Some of these changes, such as deteriorating health are gradual; whereas others, like the death of a spouse are sudden. However not all the changes associated with ageing are negative. The wisdom of experience, retirement and freedom from familial responsibilities can make later life a very positive part of the life cycle. An individual’s ability to cope with these changes affects their subjective well-being.3

Subjective well-being (SWB) is defined as “a person’s cognitive and affective evaluations of his or her life”3. The cognitive element refers to what one thinks about his or her life satisfaction in global terms (life as a whole) and in domain terms (in specific areas of life such as work, relationships, etc.) The affective element refers to emotions, moods and feelings. Affect is considered positive when the emotions, moods and feelings experienced are pleasant (e.g. joy, elation, affection etc.) Affect is deemed negative, though, when the emotions, moods and feelings experienced are unpleasant (e.g. guilt, anger, shame etc.). The terms subjective well-being, happiness, psychological well-being, positive affect, and morale are often used interchangeably.