How can I buy cocaine online in Khon Kaen

__________________________

📍 Verified store!

📍 Guarantees! Quality! Reviews!

__________________________

▼▼ ▼▼ ▼▼ ▼▼ ▼▼ ▼▼ ▼▼

▲▲ ▲▲ ▲▲ ▲▲ ▲▲ ▲▲ ▲▲

How can I buy cocaine online in Khon Kaen

A total of clubgoers tested positive for drugs after a raid on a pub in Bangkok's Lat Phrao district early on Sunday. The 2. At the time of the raid , customers were inside the pub. They attempted to flee but officers blocked all the exits. One customer was under 20 years of age and seven were not carrying a national ID card. In urine tests, of them - 76 men and 46 women - were found to have used drugs. Sonic Club Bangkok was operating without a permit and drug use was rampant inside, a government spokesperson said. During the raid , the authorities found numerous sachets of various kinds of drugs including ecstasy, ketamine and methamphetamine pills scattered on the floor. Happy water, a new kind of drug, was also available in the pub. The pub owner and those who were involved in its operation were arrested and charged with operating the business without a permit , selling alcoholic drinks to youngsters under 20 years of age, selling alcohol beyond the time limit and allowing use of drugs. The authorities would recommend closing the pub for five years. Sonic Club Bangkok, a pub in Lat Phrao district. A total of pubgoers tested positive for drugs, and the venue faces a five-year closure. Photo: Department of Provincial Administration. Learn from listening. Click play to listen to audio for this story, or download to save the file. Do you like the content of this article? Chinese businessmen abducted for B12m. Governor backs Bangkok congestion charge. Flooding continues in five Thai provinces. Meaning: having a duty to do something.

Narcotics Suppression Bureau vows to crush drug trade

How can I buy cocaine online in Khon Kaen

Official websites use. Share sensitive information only on official, secure websites. This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background: Schizophrenia is a serious mental illness that can relapse after treatments. Risk and protective factors for relapse are dependent on multicultural contexts. Objective: To identify risk and protective factors related to relapse in first-episode schizophrenia FES in northeastern Thailand from perspectives of health professionals. Methods: This qualitative research collected data from 21 health professional staff members psychiatric nurses, psychiatrists, psychologists, social workers, occupational therapists and nutritionist of a tertiary psychiatric hospital of northeastern Thailand who had been involved in mental health care for schizophrenia for at least 5 years by in-depth interviews and group interview using semi-structured interview schedule. Content analyses was used to identify staff perception of factors that put patients at risk of relapse. Results: Data analyses demonstrated that factors related to relapse in FES patients were drug adherence drug discontinuation, limited access to new generation drugs, self-dose reduction and skipping medication, and poor insight , family factors stressful circumstances and family supports , substance abuses narcotics, addictive substances, caffeinated drinks , concurrent medical illness insomnia, thyroid diseases, and pregnancy-related hormonal changes , and natural course of disease. Conclusion: Factors affecting relapse in FES was not only drug adherence. Family factors, drug abuses, and concurrent health status should be also taken into account. A comprehensive mental health care program should be developed for FES patients in the region. Keywords: first-episode schizophrenia, qualitative research, relapse, substance abuse, caregivers. Schizophrenia is a chronic mental health disorder manifested by positive symptoms suspiciousness, hallucinations, delusions, impaired cognitive ability, and disorganized speech or behavior and negative symptoms impairments in attention, loss of volition, social withdrawal, poverty of speech, and affective flattening 1 , 2. The initial treatments of inpatient schizophrenia patients are antipsychotic drugs and other complementary interventions such as psychosocial therapy social skill training and cognitive behavior therapy and medical nutrition therapy 4 — 6. Even though schizophrenic patients with first-episode psychosis FEP can be completely recovered by treatment programs, relapse can still occur. Relapse during the first few years after onset of the FEP is an important determinant for long-term clinical and functional outcome 7. The FEP constitutes a substantial burden for families, society, and health-care systems around the world 9 — Risk and protective factors in symptom severity of schizophrenia are different among countries and cultures Hence, identification of modifiable risk factors that could influence relapse is a crucial for planning treatment strategies. Therefore, the present qualitative study was aimed to investigate risk and protective factors in patients with first-episode schizophrenia in northeastern Thailand from perspectives of health professionals. The study was carried out between January and July The research report complies with consensus-based minimum reporting guidelines for qualitative research COREQ a copy of the checklist can be found in the Reporting guidelines. Pseudonyms were used to protect identity. Written informed consent forms were obtained from all participants and a copy of the form can be found in the Extended data An experienced interviewer J. The interviews consisted of two parts — demographic data and 16 items of interviews on problems and causes of mental health status, severity of problems, perceived impact of problems, and needs for mental health care. The content validity of all the items has been confirmed by index of item-objective congruence IOC. The interviews were undertaken and audio-recorded in Khon Kaen Rajanagarindra Psychiatric Hospital consulting rooms for approximately 90 minutes; and transcribed verbatim by the interviewer. Field notes were also made. Data analysis was ongoing during the data collection. Transcripts were translated to English and coded using an agreed scheme by three independent coders authors J. The data were coded and categorized to conceptualize emerging themes highlighted by the patients. All the answers from the participants were transported to the software, and the relevant sections from each questionnaire were coded and put into different categories. Using concept maps, the coded categories were further grouped to derive a particular theme from each group. Most representative quotations from the patients were used to bolster the themes. The transcripts were returned to the participants for correction proof. Coding tree analysis can be found in the Extended data Twenty-one health professionals four males and seventeen females were psychiatrists 5 , psychiatric nurses 10 , psychologists 2 social workers 2 , a nutritionist, and an occupational therapist with mean age of Fifteen staff work in the outpatient department and six persons serviced in the inpatient department. All details are shown in Table 1. Based on an analysis with the software, risk and protective factors were categorized into five main themes: drug adherence, family factors, substance abuses, concurrent medical illness, and natural course of disease as summarized in Table 2. Failure to follow medical prescription was attribute to various reasons, which could be further subdivided into four subthemes as follows. Patients took antipsychotic drugs until they felt better. They thought that they were fully recovered and hence skipped or discontinued taking drugs. Other reasons were unawareness of importance of the drugs, forgetfulness, and fear of side effects. The symptoms used to be controllable recur. In some cases, the relapse lasts for 1 week, some may last for 6—12 months. Some patients said that they had been completely recovered. No more drugs needed. This is one reason why they had to return to the hospital. High-quality and costly new-generation antipsychotic drugs were not prescribed for patients under basic healthcare coverage scheme. Therefore, these drugs were not accessible for economically poor people. Some drugs have many side effects. For example, intramuscular injection of first-generation long-acting drugs, which are on the list of the drugs for basic healthcare coverage scheme can cause EPS extrapyramidal side effects more easily…rigid and stiff body. Meanwhile, less side effects can be seen in the patients using drugs like Paliperidone palmitate. But this drug is not covered by the scheme, very expensive, and so not accessible by most of the patients. Because of the side effects, patients were lost from follow-up or even from the whole treatment program and finally relapsed. The atypical ones prevent relapse better. So, patients who cannot access atypical drugs lose opportunities for better treatments. Another atypical drug is very expensive and not in the list the National List of Essential Medicines of Thailand , so we cannot prescribe. Only typical drugs are in the list, so we lose control…no other choices. This makes it more complicated and more expensive for treatment cost. In some hospitals, they have just only first-generation antipsychotic drugs for newly diagnosed schizophrenia patients. Patients took drugs until symptoms subsided and thought they fully had recovered. In some patients, they were worried about side effects. Then they arbitrarily decided to reduce drug dosage as stated below. Instead of coming back for dose adjustment, they do it themselves or simply quit it. So, recurrence is so severe that they have to be re-admitted. Some patients lacked ability to recognize psychotic symptoms as illness. Thus, they did not need any treatments as mentioned below. Then we forced them to come for treatment until they recovered. But they discontinued drugs when they were back home. Then, yes, they received drugs, but not taking them. They got home, not taking drugs, becoming relapsed, and coming back here again. In contrast, patients who well cooperated with care team would have better health in long term, being more peaceful or recovered from schizophrenia symptoms. They knew their needs for continuous treatments, managed to take drugs on their own. So, they came to receive medication for continuous treatments. For schizophrenia, drug adherence is important anyway. Continuous use of drugs has a huge effect. We have been seeing some cases routinely come for checkup, years past and still coming to receive new drugs. Meanwhile, medical staff took care of providing drugs, both oral and injection drugs. Community health staff gave mental support. So, we had to motivate his recognition of illness. This would guide him how he should take care for himself. Family factors in schizophrenia patients including stressful circumstances and family supports were addressed as causes of pressure as stated below. Persons with schizophrenia might not be able to appropriately cope with stressful circumstances such as losing their important persons, poor relationships, aggressive expressions, and poor communication. As a consequence, relapse happened despite they were taking drugs. When they lost, they failed to conform to the situation. Even though medications were continued, relapse could still occur. When patients had family problems, they resorted to using alcohol and tobacco. Good friends would support their mind, but bad friends would ask them for drinking to release pressure. The drinking party is a talking panel for pressure. It can be very hostile as a cause of accumulative stress. The high expressed emotion is the variable that worsens psychotic symptoms in most cases. If they failed to control themselves, then the problems resumed. In some cases; on the other hand, if their parents were overly critical, psychotic symptoms might relapse. The patients could feel annoyed and lose self-control. Particularly, poor communication among family members on financial topics can be stressful and aggravate the symptoms. Then they responded with ironic drinking of alcohol and smoking. Most of schizophrenia patients receive family caring and supports These caregivers have been involved from the beginning — observing changed behaviors, bringing them to the hospitals, and supporting their routine cares in accordance with treatment plan until the patients can live their lives in society Therefore, competency of the caregivers is importance for them. In this present study, five subtopics related to family supports were found i. When patients live alone or live with ever-busy family members, they have to confront with absenteeism of a primary caregiver. They lack continuous support, making it difficult to follow treatment plans as stated below. In this case, a patient had to live alone and discontinued medications as he thought he had been fully recovered. Other family members were tied up. In some families, primary caregiver never showed up. Educated caregivers play important roles in supporting and encouraging patients to follow treatment plans until they fully recover, having no relapse, and live their normal lives in society Examples of the statements are presented as follows. Lack of family support and caring can cause relapse. This is the key factor. If they received good family supports, they would have stopped thinking about alcohol, ending a triggering process. In contrast, if their families were unsupportive, they would lose their spiritual anchors. This would eventually worsen their symptoms. Most of caregivers for psychiatric patients are older persons. When she was busy, a neighbor would bring a patient to the hospital and back home. Then the neighbor went back to work. At home, the patient denied taking medicines. We might educate them on mental health issues. At first, it might not be clear for them. When the patient was calm and able to sleep well, symptoms seemed to be improving. The caregivers tended not to strictly instruct the patients. Even they instructed, the patients might not obey. On occasion, they were just powerless to control their mentally ill children. Lack of knowledge on etiology, symptoms, treatments, healthcare, and relapse prevention among family members and caregivers was another important risk factor as mentioned here. If patients drank, the parents dared not dissuade them and had no idea what to do. Sometimes the parents were stress factors themselves — blaming of laziness without understanding the symptoms. So, they were afraid that they might too strictly control the patient and situation would be getting worse. When they realized that the patients were mentally ill, the parents tended to treat them like physically ill persons. They still had to learn how to take care for the patients. Let them do some activities. In contrast, if caregivers were well-informed and adequately knowledgeable about schizophrenia, they would be able to support patients as addressed below. They should understand process of treatments and had emotional maturity. If the family support was good, the patient would stop drinking alcohols and think about the family. Contrarily, if the family was bad, the patient would be without someone to lean on; and in turn the symptoms could be worsened. In the beginning, family members tended to have negative feeling toward mental illness such as disgrace and denial. They considered the patients as the weak persons. This attitude diminished the self-worth of persons. So, we had to support the patients, not only blaming them. They tried to relegate the patients from the community. In the past, some patients were confined and enchained, but not anymore. They are now allowed to live together with other family members and provided with medicines. They are not blamed as troubles, but considered as the ill persons, who need treatments and cares. In the past, psychiatric patients were chained and secretly kept in a storeroom. Lately, people in community accept and collaborate to help prevent them from relapse and let them be parts of the community. In some community, the patients have a chance to participate in charity or work for a little extra money. This reflects societal appreciation of the patients. As members of the community, they can get some money from a village fund to pay for taxi cabs, which bring them here to the hospital. Some of patients and their families were poor, lived in a distance from the city, and lacked facilities, making it difficult for them to come for continuous follow up as shown in the following statements. Some had to wait for monthly subsistence allowance from the government fund to pay for a traveling cost. So, we asked them for an appointment only once. Then our doctors would prescribe drugs they could take at a local primary care center. Most of the cases were poor and ill, having no money to come when the symptoms became worse. Caregivers were worried about work and had no time to bring the patients to the hospital. Some patients used narcotic drugs such as methamphetamines meth pills and crystal meth , alcohols, cigarettes, energy drinks, coffee, and weight loss medications unwarily of their psychotic effects. The health professionals shared their experiences as narrated below. One of these was substance use. It was an important cause of changing psychotic symptoms. The most frequently found were psychoactive substances like energy drinks, alcohols, or narcotics. Rice whisky and beer were mainly used by men. Meanwhile, diet pills were used by women to counteract weight gain, a side effect of antipsychotic drugs. Frequently, they quit the antipsychotic drugs and used diet pills and diet coffee drinks, especially in female teenagers. For example, liquor stores were easily accessed, patients were unaware of their own symptoms, and how they could manage the symptoms. Alcohol is the psychoactive substance. In fact, the one they talked about was an alcoholic energy drink. In some female patients, they believed that herbal liqueurs were good for health, which was not true. Actually, the herbal liqueurs could cause relapse. Other issues were cigarette smoking, and coffee. Then they got back to work for a couple of years, drinking alcohols. Then it became a long story of relapse afterwards. As a result, relapse happened so severely like self-destruction and assaulting others. Some used energy drinks, coffee powder not the drinking one , white whisky, and meth pills. These were considered as triggering factors of relapse. The patients could have relapse due to other health problems, for example, sleeplessness, illness, pregnancy, and other conditions with medications as stated below. If patients did not sleep well for several days in a roll such as going for boy scout camping, it could cause relapse. Even though patients followed all treatment plans and lived their normal lives, there was still a chance of relapse due to a natural pattern of schizophrenia as addressed below. In some cases, relapses just happened even the patients adhered to treatment. Good or poor treatment outcome also depend on several factors. Thailand is a developing country with an upper-middle income level and a population of approximately 70 million in Healthcare for psychiatric patients in Thailand is mainly provided by government-owned hospitals. This qualitative study revealed multiple important factors associated with relapse in FES from perspectives of health professionals working at the Khon Kaen Rajanagarindra Psychiatric Hospital. These factors were grouped into five themes: drug adherence, family factors, substance abuse, concurrent health problems, and natural course of schizophrenia. Drug adherence problems were further categorized into drug discontinuation, limited access to new generation drugs, self-dose reduction and skipping medication, and poor insight. Treatment guidelines for FES recommend at least one-year of antipsychotic drugs must be used following remission The patients who discontinued antipsychotic drugs expressed more positive symptoms, relapses, alcohol and cannabis use, reduced insight; and poorer quality of life These patients were more likely to live alone or live without family members involved in treatments. In this present study, the health professionals reported that their patients discontinued antipsychotic drugs without consultation. A major reason for discontinuation were intolerable side effects including extrapyramidal motor symptoms difficult speaking and walking , drooling, and drowsiness These side effects usually result from first-generation drugs FGAs, typical antipsychotics , which predominantly block dopaminergic neurotransmission by inhibiting dopamine 2 and 3 receptors D2R and D3R in the brain However, Liu-Seifert and colleagues reported different side effects i. Some patients still followed a medication plan, but arbitrarily reduced the dose or skipped some medications. These side effects were reported to cause treatment-related stigma in the patients In worse cases, patients had poor insight from deficits of metacognition ability to think about thinking These patients lack insight into their own mental illness. As a result, they have poor adherence to treatment, subsequent illness relapse and rehospitalization. Verdoux and colleagues reported that over a period of first two years of FES, patients with poor medication adherence presented more frequently with an episodic course of illness and more readmission Therapeutic programs that can improve medication adherence should be implemented early in the course of psychosis to reduce the deleterious consequences of poor medication adherence on clinical outcomes It has been reported that relapse rate in schizophrenia remains considerable even when prescribed medication adherence is well monitored Therefore, it is intriguing to clarify what other factors influence this relapse. Family factors related to FES in the present study were stressful circumstances and family supports. Family is a key supporting unit for schizophrenia patients by encouraging them to find the way of coping with psychotic symptoms In fact, family supports are important determinants for quality of life of schizophrenia patients Loss of family members are related to functional changes in the brain. Previous study demonstrated reduction of rostral anterior cingulate cortex rACC activity in the brain of patients with complicated grief after loss events It is known that the rACC is a region of the limbic system that is hypoactive during emotion processing in schizophrenia This might explain why the loss event-induced stress can trigger relapse in FES. As depicted in the interview summary, high expressed emotion high EE coincides with intense and negative verbal exchanges. This commonly results in oppositional and conflictual consequences It has been revealed that living with family members with high EE doubled relapse risk The high EE consists of five components: critical comments, hostility, emotional overinvolvement EOI , positive remarks, and warmth Critical comments are most common and exemplified by criticizing for being selfish or lazy, which are potential characteristics of negative symptoms Hostility is manifested by general criticisms or attitudes that are rejecting of the patient For example, caregivers state that patients are causes of problems and prefer to living away from them. Verma and colleagues found that applying psychoeducation program on problem-solving and communication skills in caregivers improved treatment outcomes in schizophrenia However, there are still no psychoeducational intervention or other methods applied to enhance their knowledge on mental health. In some countries, caregivers still believed that schizophrenia resulted from supernatural elements From literature, improving the mental health literacy even among primary health care professionals is required in developing countries This present study indicated a positive influence of family supports on adaptation mechanisms of outpatients with schizophrenia. Hence, there is a need for relatives to provide support in order to facilitate adaptability. Substance abuses are the third most frequently reported factors associated with relapse in schizophrenia Alvarez-Jimenez and colleagues showed a three-fold increase in risk of relapse in FES patients with persistent substance uses 8. In this present study, illicit drugs such as amphetamine and methamphetamine; and psychoactive substances such as alcohol, energy drinks, coffee, and weight loss medications were reported as factors of psychotic relapse. Associated with higher frequency of relapse, several studies reported high comorbidity of substance abuse and schizophrenia Most frequently used substances are cannabis or alcohol alone and in combinations with opioids, stimulants, or cocaine In addition, a qualitative study showed that individuals with schizophrenia used caffeine at higher rates than the general population They consumed different types of caffeinated drinks the whole day including: cola, instant coffee, brewed coffee, tea, iced coffee, and energy drinks. In the same study, some participants also reported consumption of three or more different types of caffeinated drinks. In the present study, instant coffee drinks and energy drinks were major sources of caffeine. Most common reasons of substance use were for social recreation, for fun, and imitation of family members Exacerbation of psychotic symptoms in patients with schizophrenia is caused by the multi determinants biology factors, psychological and social factors. Previous studies showed that various concurrent physical health conditions including sleep disturbances, thyroid dysfunctions, and pregnancy can worsen psychotic symptoms. Schizophrenia patients with sleep disturbances were at a greater risk for worsening of positive symptoms after antipsychotic discontinuation 49 , These are linked to various forms of psychopathology of serotonin and dopamine systems Hyperthyroidism usually manifests with different psychiatric disorders such as anxiety, emotional psychosis, or depression Meanwhile, hypothyroidism is associated with negative symptoms of schizophrenia Etiology of the postpartum psychosis is hormonal shift after delivery in women with a history of mental illness Women with broadly defined affective psychoses were more likely to relapse earlier in the postpartum period Some patients experience relapse due to their uncooperativeness, but some patients still manifest relapse in spite of regular drug adherence. In the discontinuation group, frontal dysfunction and dopamine hyperactivity predict relapse occurrence. The proper cognitive control depends on coordination of various parts of the brain e. Altogether, abnormality of the brain per se is another potential cause of relapse in the FES. Health care professionals perceived non-adherence to antipsychotic medication as a major together with family-related problems, substance abuses, concurrent health problems, and nature of schizophrenia. Adherence to antipsychotic medication, family support, and refraining from addictive substances were viewed as protective factors. The results also suggested that strengthening mental health psychoeducation by mental health professionals might help reduce relapse. This study calls for improvement in mental health care service delivery to individuals with schizophrenia. Establishing a program in mental health care that aims to produce competent mental health caregivers and professionals would improve clinical outcomes in mental health care service delivery. OSF: Risk and protective factors of relapse in patients with first-episode schizophrenia from perspectives of health professionals: a qualitative study in northeastern Thailand. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This paper aimed to identify risk and protective factors related to relapse in first-episode schizophrenia FES in northeastern Thailand from the perspectives of health professionals. A qualitative research design has been used. Results indicate multiple factors affect relapse rates. Language needs to be checked throughout the paper for grammatical errors and also use of appropriate terms e. The abstract mentions content analysis whereas the data analysis section seems to describe thematic analysis. Some themes appear to have too many verbatim quotes and this makes the paper too lengthy. Subsequent themes involve substance use and use of the term 'medication' may avoid confusion. There is too much information under the heading currently. Women with mental illness have a chance of relapsing within the first 4 weeks. We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Even though it does not reflect anything new in psychiatry, the paper talks about Thai-specific issues. Understanding a doctor's perspective is more like knowing the clinical acumens instead of knowing the real issues. Such interviews can be replicated with the patients or family itself. The study is pretty easy and nothing much to add from my side. It's a straightforward study to do. I would recommend accepting it for indexing only because it brings area-specific data which might be useful for doctors in Thailand or similar countries. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Risk and protective factors of relapse in patients with first-episode schizophrenia from perspectives of health professionals: a qualitative study in northeastern Thailand Jarunee Intharit Jarunee Intharit 1 Faculty of Public Health, Mahasarakham University, Kantarawichai, Maha Sarakham, , Thailand. Find articles by Jarunee Intharit. Find articles by Khanogwan Kittiwattanagul. Find articles by Wisit Chaveepojnkamjorn. Find articles by Kukiat Tudpor. Accepted Jun 7; Collection date Open in a new tab. Theme Subtheme 1 Drug adherence 1. Find articles by Padmavati Ramachandran. Find articles by Greeshma Mohan. Competing interests: No competing interests were disclosed. Padmavati Ramachandran : Referee. Greeshma Mohan : Co-referee. Find articles by Soumitra Das. Soumitra Das : Referee. Associated Data. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

How can I buy cocaine online in Khon Kaen