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See also: narcolepsy catastrophic reaction A response to symptoms 9 days after iui order 75mg prothiaden with mastercard exceptionally severe physical or mental stress treatment diabetes type 2 prothiaden 75 mg cheap, characterized by a breakdown of coping behaviour symptoms 5 weeks pregnant order prothiaden paypal, intense anxiety medications without a script buy prothiaden 75 mg free shipping, and shock. The term catastrophic reaction has also been applied to the state of agitation and helplessness exhibited by patients with cerebral damage when confronted with tasks beyond their competence (Goldstein, 18 78-I965). See also: acute stress reaction catatonia A range of qualitative psychomotor and volitional disturbances including stereotypies, mannerisms, automatic obedience, catalepsy, echokinesis and echo­ praxia, mutism, negativism, automatisms, and impulsive acts. These phenomena may occur against a background of hyperkinesia, hypokinesia, or ainesia. Catatonia was described as a separate disease by Kahlbaum in 1874, but later subsumed by Kraepelin as one of the subtypes of dementia praecox (schizo­ phrenia). Catatonic phenomena are not limited to schizophrenic psychoses and may occur in organic cerebral disease. Most commonly the corticospinal tracts are involved, producing weakness and spasticity most conspicuous in the lower extremities and leading to contractures and a "scissors gait". There may also be associated athetosis or ataxia, and convulsions and mental retardation are frequent. The brain lesion(s) may be congenital or acquired (prenatal infection, birth injuy, asphyxia, rhesus incompatibility, etc. Both clinical fndings and radiological studies are nonspecifc; presumptive diagnosis can be based on response to empirical therapy with pyrimethamine and sulfadiazine. See also: HlV-associated neuropsychiatric disorders cerebral ventricles, enlarged A increased volume of the ventricular system of the brain, due to cortical atrophy, obstructive hydrocephalus, or communicating hydrocephalus. As air encephalography and ventriculography have largely become superseded by non-invasive techniques, various measurements have been proposed to evaluate ventricular enlargement detectable by computerized tomography. Synonym: stroke character neurosis A psychoanalytical concept, which describes character traits as either derivations of phases of development or the analogues of particular systems. The former would include the oral or anal character; the latter would include the hysterical or obsessional character. Manifestations of character neurosis are viewed as intermediate between normal character traits and neurotic symptoms. The term is unsatisfactory as it may include any of the personality and behavioural disorders. Child abuse may take many forms; in practice, combinations of diferent forms are the rule rather than the exception. Child neglect is the failure of the parent or care-giver to provide the child with adequate care and supervision. Physical abuse, sometimes referred to as the battered child syndrome, may involve physical violence, systematic poisoning, or other non-accidental injuries. Sexual abuse usually involves genital contact and may range in severity from fondling to forcible rape with physical injury. Psychological abuse refers to deliberate and repetitive subjection of a child to fear, rejection, humiliation, loneliness, and other painful psychological states. It is characterized by profound regression and behavioural disintegration over the cot. Prognosis is poor, and in some cases there is evidence of structural brain disease. Synonyms: dementia infantilis; Heiler syndrome choreiform movements Involuntary movements, typically involving upper and lower extremities and the face, which resemble fragments of purposive movements following one another in random or disorderly fashion; the wrists jerk, the toes curl, the tongue protrudes, the lips are pursed or twisted into a bizarre smile, etc. These movements interfere with voluntary movement but usually disappear during sleep. See also: choreoathetoid movements choreoathetoid movements the combined occurrence of choreiform movements ad athetosis (slow, writhing, involuntary movements, usually afecting fngers and extremities, and only rarely speech and respiration). Choreoathetosis is caused by a variety of pathological processes that interrupt the motor circuits linking the cortex, striatum, bran stem, cerebellum, and lower motor neuron. The most common form of chronic intractable pain is back pain, especially of the luwer back. See also: enduring personality change chronic pain personality syndrome See personality change, enduring. See also: biological clock: circadian oscillator circadian oscillator A interal pacemaker responsible for a particular circadian rhythm. The multi-oscillator model postulates the generation of circadian rhythms by multiple interal circadian pacemakers. Speech is erratic and dysrhythmic, with rapid jerky spurts that usually involve faulty phrasing patters. Cocaine is an alkaloid obtained from the coca bush or synthesized from ecgonine or its derivatives. Cocaine ("coke") is often sold as white, translucent, crystalline fakes or powder ("snuf", "snow"), frequently adulterated with various sugars or local anaesthetics. The powder is snifed ("snorting"), producing efects within 1-3 minutes that last for about 30 minutes. Smoking cocaine produces a "rush"-an early feeling of disappearance of anxiety, with exaggerated feelings of competence and self-esteem. Judgement may also be impaired, so that the user may perform irresponsible, illegal, or dangerous activities. With large amounts, especially if taken intravenously, the user experiences a "crash"-elation gives way to apprehension, ideas of reference, ringing in the ears, persecutory delusions, "snow lights" (halluci­ nations or pseudohallucinations resembling the twinkling of sunlight on frozen snow) or other hallucinations. Acute toxic reactions may occur in both the naive experimenter and the chronic abuser of cocaine. They include a panic-like delirium, hyperpyrexia, hypertension (sometimes with subdural or subarachnoidal haemorrhage), car­ diac arrhythmias, myocardial infarct, cardiovascular collapse, seizures, status epilepticus, and death. See also: substance use disorder cognition A general term covering the acquisition ofknowledge by means of any of various mental processes, such as conceptualization, perception, judgement, or imagination. See also: stress reaction, acute command automatism Strict and apparently involuntary response to a command, as if the individual were an automaton. As automatic obedience it is a feature of the catatonic syndrome; command automatisms may also be induced in states of hypersuggestibility. Underlying the overt behaviour is a fear, usually of danger either to or caused by the patient, and the ritual is an inefectual or symbolic attempt to avert that danger. See also: obsessive-compulsive disorder compulsive gambling See gambling, pathological. Such behaviour should amount to major violations of age-appropriate social expectations; it should therefore be more severe than ordinary childish mischief or adolescent rebelliousness and should imply an enduring patter of behaviour (6 months or longer). Features of conduct disorder can also be symptomatic of other psychiatric conditions. Examples of the behaviours on which the diagnosis is based include excessive levels of fghting or bulying, cruelty to other people or animals, severe destructiveness to property, fre-setting, stealing, repeated lying, truancy from school and rng away from home, unusually fequent and severe temper tantrums, and disobedience. The disorder requires that the overall criteria for conduct disorder be met; even severely disturbed parent-child relationships are not of themselves sufcient to qualify for this diagnosis. The false memories are usually loosely held and have to be evoked; less commonly they are spontaneous and sustained, and occasionally tend to grandiosity. It should not be confused with the hallucinations of memory occurring in schizophrenia, or with pseudologia fantastica (Delbruck syndrome). See also: amnesic syndrome, organic confusion A state of impaired consciousness associated with acute or chronic cerebral organic disease. Clinically it is characterized by disorientation, slowness of mental processes with scanty association of ideas, apathy, lack of initiative, fatigue, and poor attention. In mild confusional states, rational responses and behaviour may be provoked by examination but more severe degrees of the disorder render the individual unable to retain contact with the environment. The term is also employed loosely to describe dis­ ordered thinking in the functional psychoses; this latter usage is not recom­ mended. Synonym: confusional state See also: consciousness, clouded confusional state, acute organic See delirium. Disorders of awareness, orientation, and perception are associated with cerebral or other physical organic disease. Although the term has been employed to cover a wider range (including the restricted perceptual field following acute emotional stress), it is best used to designate the early stages of an organically determined confusional state. See also: coping capacity copropraxia Obscene gesturing, such as occurs as a type of echopraxia in tic disorder, combined vocal and multiple motor [Tourette syndrome]. Next the individual typically recoils and withdraws or develops panic, disorganized behaviour. Outcome varies fom spontaneous and rapid resolution with retur to the premorbid level of fnctioning, to personality growth and improvement in problem-solving skills, to chronic disability or illness such as post-traumatic stress disorder. The most prominent symptoms are 25 Lexicon of psychiatric and mental health terms headache, stif neck, fever, and photophobia.

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Neither id nor ego have yet emerged from their common undifferentiated core treatment high blood pressure buy 75mg prothiaden amex, and distinctions between conscious and preconscious processes are irrelevant or do not yet exist anima sound medicine order prothiaden discount. The baby is unable to treatment trichomoniasis prothiaden 75mg low price discriminate objectively among things in his environment or between persons and things medicine vs engineering generic prothiaden 75mg online. Indeed, he cannot even distinguish clearly between himself and his environment, which implies that he cannot discriminate between sensory input from his own body and sensory input from the external world. Therefore, the newborn is described as experiencing everything as part of himself, or, in terms of developmental theory, all of his libidinal energy is contained within himself—a self which might include the not yet differentiated environment. Since the baby cannot even distinguish his mother from himself, he cannot relate to her as an external “object”—that is, a love object. This first period of life is characterised by what Freud called “primary narcissism”; others label this first period as “undifferentiated” or “objectless”. In general, the development of object relations is viewed here as proceeding through three main stages: 1. So-called undifferentiated narcissistic, or objectless, stage In emphasising the (relatively) undifferentiated nature of the newborn, the ego psychologists do not claim total lack of differentiation. They all acknowledge constitutional “givens” or inherited potentials (German: Anlagen), which are genetically determined beginnings of more complex processes, which will mature later. Transitional stage this is a period between the undifferentiated first stage and the stage in which clear-cut object relations are finally established. During this transitional period, certain ego functions develop, and one can speak of a primitive “body ego”. A distinction can be made between self and non-self, although this is by no means complete, and the infant is still viewed as being incapable of cathecting a true object. True object relations Anna Freud (1937) defined this stage as the stage of object constancy, which enables a positive inner image of the object to be maintained, irrespective of either satisfactions or dissatisfactions. Now he is capable of maintaining his tie to her, irrespective of his need state, and regardless of whether she is currently gratifying or frustrating his needs and wishes, and whether she is present or absent. Although the object cathexis is still too fragile to be sustained during very long absences of the mother or primary carer, the child has some internalised representation of her that will persist, if the separation is not too long. Even though the child’s bodily needs may be gratified by other persons while mother is absent, he misses her and is distressed. Part-objects and whole objects the central thesis in Klein’s object-relations theory was that objects (in the external world as well as internal objects in the child’s fantasy) play a decisive role in the development of a subject. Klein distinguishes between part objects and whole objects, depending on how the object is perceived: only as serving a certain function. Consequently, both the mother as a person, or just the mother’s breast or feeding function, can be the locus of satisfaction for a drive. Because of this inability, infants view objects as either all good or all bad, thus seeing only a part of that object instead of the object’s whole good–bad reality. Infants are too young to understand that objects can be both good and bad; they see only one part of the spectrum. This way of keeping separate good and bad relationship experiences is what we call the splitting defence mechanism. If the baby is hungry and mother is not there, she will not just be a good but absent mother, but, in the baby’s experience, she is a bad mother. If things go well enough, an infant/child will gradually learn that his objects are not only either good or bad (part objects), but there is a broad range of qualities between the extremes, from good to bad. In this way, part objects will come together and be integrated to form whole objects. Mature persons are able to perceive and acknowledge others as persons in their own right (whole persons, “whole objects”), not only as a means for satisfaction of one’s drives and needs (part objects). Recent decades in developmental psychological research have shown that the formation of a mental world is based upon, and enabled by, the infant–parent interpersonal interaction which was the main thesis of the so-called British object-relations tradition. These thoughts are linked to attachment theory, which was developed by Bowlby and Ainsworth, and which differentiates four different types of attachment styles (secure, ambivalent, insecure–avoidant, disturbed) related to four different levels of defence organisation in the adult personality. Children who grow up in dysfunctional families are at risk of having poor quality attachments to their parents and, as adults, are at risk of treating their children in the same way. The different schools of psychoanalytic theory have different concepts how psychic development works: by projection, projective identification, retrojection, symbolisation, mentalization, and others. In the end, however, they all agree on the fact that psychic development primarily evolves by internalisation of structures and relationships with and within the environment, which is also valid for cognitive development (Piaget) and moral development (Kohlberg). Internalisation is the motor by which experience is transformed into inner regulations of drives, affects, and behaviour, as well as intrapsychic dynamics in general. We should imagine this internalisation not as a one to one transformation from the outside to the inner world. Rather, it is the way that Piaget (1952) describes: cognitive development via accommodation and assimilation, the reactive and the active mode of integrating new experiences, and building up new stages of cognitive functioning. The development and differentiation of object relations will be shown later in comparison with the development of drives and of the self. Narcissism and self-system the term “narcissism” is derived from the Greek myth of Narcissus, which can be summarised as follows. In a valley lived a beautiful nymph named Echo, who loved to chatter all day long. As a consequence, Echo was no longer able to speak independently; she could only repeat, very faintly, the last few words of a sentence spoken by someone else. In the same valley lived a good-looking youth named Narcissus, who was so charming that every maiden who saw him fell in love with him. Narcissus, however, was totally absorbed with himself and did not love anybody else. One day, Narcissus was wandering with a group of friends but became separated from them and suddenly found himself alone. She would have liked to talk to him, but because she was under the spell, she was not able to do so. While Narcissus was parting some branches to look for his friends, he exclaimed, “Is anybody herefi Narcissus looked around, not knowing to whom the voice belonged, and said, “Where are youfi However, Narcissus rejected her and fled from her into the deepest part of the forest. Nemesis, the goddess of revenge, felt compassion for her and punished Narcissus for his vanity and coldness by making him unable to love anyone but himself. Just as he was about to sip from the pool, he saw the reflection of his own face in the water, without realising it was only a mirror image. He was fascinated by this image of a perfectly beautiful youth, which, however, was inaccessible, on the other side of the mirror. Afterwards, his body was transformed into a beautiful flower that was named after him, Narcissus (Picture 1. In this myth of Narcissus, we find some typical characteristics of what we call a “narcissistic personality”: his extreme vanity, his need to be loved and admired by others, and, at the same time, a deep fear of losing himself in a close and intimate relationship with another person who might become too important to him. There is still another important and often neglected part of the myth of Narcissus: the nymph Echo and his relationship with her. Narcissus, by Caravaggio (1594–1596), in the Galleria Nazionale d’Arte Antica, Rome. Finally, both will die, she from not being recognised and loved, he from being unable to love anyone but himself. So, both were trapped in the narcissistic mirror relationship with each other, unable to meet each other as individual persons in a real object relationship of intimacy and otherness. Narcissism and the self According to the German psychoanalyst, Mentzos (1982), we should recognise that the term narcissism is used in at least two different contexts and meanings. Narcissism, in the first sense, is a protective device, a defensive strategy, implying withdrawal from the object and turning towards the self. From this point of view, all those tendencies or fantasies that we call “narcissistic” are characterised by turning away from the object towards the self, resulting in increased libidinal cathexis of the self (or, in Freud’s terms, the ego) as a defence strategy against object-directed tendencies, mainly because of self-centred fears such as fear of losing oneself, or losing one’s independence, or losing the other’s admiration by turning out not to be the perfect person others had thought him to be. So, behind the “narcissistic” attitude, there is a deep insecurity about oneself and one’s own worth in the eyes of others. On the other hand, narcissism in the second sense, as synonymous to the self system, includes all needs, satisfactions, affects, mechanisms, etc. In this second meaning, the term “narcissistic” may be used, for instance, to characterize object relations which contribute to the increase of self esteem or self-identity, as well as experiences shattering self-esteem (so-called narcissistic injuries). Anger, grudge or rage as a result of hurt narcissism (humiliation, shame) is called “narcissistic rage” (Kohut, 1972).

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Based on the patient’s presentation treatment 2 stroke discount prothiaden 75mg online, history medicine gabapentin proven 75mg prothiaden, and presentation treatment whooping cough cheap 75mg prothiaden, which of the following is the most (A) Cystic fibrosis test results medications dogs can take order prothiaden australia, which of the following is the most 153. Gynecological (A) Chlamydia (C) Septic shock (A) Asbestosis exam reveals an open cervix. A healthy 55-year-old male presents for his annual (E) Trichomoniasis (E) Tuberculosis (B) Gestational trophoblastic disease office visit. Bisphosponate medications, such as alendronate V1 the patient’s history, which of the following is the (D) Bulimia nervosa and pamidronate, are the treatment of choice for most appropriate diagnosisfi Which of the following abnormalities is perceived (A) Adjustment disorder (A) Fibrous dysplasia on this electrocardiogramfi A 44-year-old female presents with a painful (B) Osteomalacia (A) Atrial bigeminy (C) Narcissistic personality disorder macular, fiery red rash with well-defined borders (C) Osteoporosis (B) Atrial fibrillation (D) Obsessive-compulsive disorder on her face. The rash has begun to spread to her (D) Paget’s disease (C) Atrial flutter (E) Paranoid disorder extremities. Based on the patient’s presentation, (E) Rickets (D) Junctional rhythm which of the following is the most appropriate 172. A 14-year-old female presents with low-grade fever, (E) Ventricular bigeminy diagnosisfi When treating a patient who exhibits signs of shock, malaise, headache, and muscle aches. Which of the following interventions is the most exam reveals erythematous macules that appear (B) Chlamydia glucose, urinalysis, and serum creatinine will assist appropriate treatment for scabiesfi Based on the patient’s presentation and (C) Gonorrhea you in determining which of the followingfi Which of the following medications is most (D) Severity of shock (E) Topical insecticides (C) Lyme disease effective for the treatment of chronic thrombocyto(E) Type of shock (D) Molluscum contagiosum penia secondary to systemic lupus erythematosusfi Which of the following medications would you (E) Varicella zoster (A) Erythropoietin 165. A 32-year-old male presents with sore throat that prescribe for the treatment of subacute thyroiditisfi A 37-year-old female presents with itchy, bleeding, (C) Prednisone symptoms of a head cold. Physical exam reveals (B) Antibiotics non-healing lesions on the lips, mouth and tongue. Strep screen was (C) Corticosteroids Biopsy of affected areas reveals the presence of (E) Vitamin D negative. Which of the following physical examination, which of the following is (E) Thyroid hormone courses of treatment would you prescribe for this 178. The electrocardiogram shown below was obtained (A) Peritonsillar cellulitis (A) Chemotherapy suffer from chronic illness and are at increased from a middle-aged patient admitted to the emer(B) Sinusitis (B) Complete eradication of the lesions risk for community-acquired pneumoniafi Minimizing exposure to ultraviolet radiation is (E) Polyvalent pneumococcal vaccine signs of respiratory distress. Chest X-ray shows suggested to decrease the risk of developing which air bronchograms, a “ground glass” appearance of the following ocular disordersfi Based on (A) Cataracts treatment for which of the following conditions the patient’s presentation and test results, which (B) Detached retina caused by thePseudomonas aeruginosabacteriumfi A 22-year-old female is underweight and ema(D) Transient tachypnea (E) Tuberculosis (B) Right-sided congestive heart failure ciated. Electrocardiogram performed in the which of the following is the accurate diagnosisfi The patient’s (B) Non-small cell lung carcinoma (B) Erythema multiforme electrocardiogram is illustrated below. Which of the following medications is administered (B) Atrial fibrillation (E) Malingering rhonchi. Chest X-ray was performed and appeared to a hypertensive pregnant female who must deliver (C) Atrial flutter 189. Which of the following medications is approved her baby early, to ensure fetal lung maturityfi Based on patient symptoms and physical (D) Junctional rhythm for treatment of gestational diabetesfi Which of the following is the most appropriate (B) Glucophage (C) Labetalol (B) Acute epiglottitis treatment for keratodermafi Prolonged use of phenothiazine medications, such (E) Tuberculosis (C) Lindane 190. Meniere’s disease is characterized by distention as compazine and thorazine, can cause which of (D) Liquid nitrogen of the endolymphatic compartment of the inner the following eye disordersfi Which of the following is used as an emergency for maintenance therapy for Meniere’s diseasefi A 42-year-old female presents by stating she finds (E) Prothrombin complex concentrate no pleasure in anything in her life. Which of the following radiological procedures is experiencing anorexia, weight loss, depression, V1 is the most definitive for diagnosing viable myoand sleep disturbances. V5 (B) Coronary angiography (A) Atypical depression (C) Echocardiogram (B) Catatonic depression 212 Which of the following treatment (C) Hormone-impregnated vaginal ring (E) Leads V4, V5, and V6 options would you prescribefi Electrocardiogram reveals tachy(D) Ophthalmic steroids for maintenance therapy for myasthenia gravisfi A 60-year-old female presents with pain in the (D) Leads V1, V2, and V3 (A) Bronchiectasis (B) Cellulitus big toe and states she is unable to find shoes that (E) Leads V4, V5, and V6 (B) Cystic fibrosis (C) Deep venous thrombosis fit her properly. A 60-year-old male presents with progressively deformity of the proximal phalanx at an angle of (D) Pulmonary embolism (E) Phlebitis worsening shortness of breath, excessive cough, approximately 25 degrees. A 24-year-old male was a victim of an occupational reveals decreased breath sounds and early inspithe proper diagnosisfi A 38-year-old male presents with intermittent accident and presents in the emergency room ratory crackles. Similar readings were obtained on previous the accumulation of air in the pleural space with lungs and a flat diaphragm. Physical exam reveals presentation and test results, which of the following (D) Gout and blood pressure reading, which of the following impaired ventilation. Which of the following treatment options, along (B) Chronic obstructive pulmonary disease (B) Hypoglycemia (B) Congestive heart failure with antibiotics, would be indicated for a patient (C) Emphysema (C) Malignant hypertension (C) Primary pneumothorax who presents with dacryocystitisfi A 70-year-old female presents with shortness motherapy and radiation therapy for lung cancer (D) Ophthalmic steroids diagnose which of the following gastrointestinal of breath, persistent non-productive cough, and presents to the Intensive Care Unit. Auscultation of the chest normal with a blood pressure of 130/70 mmHg and (A) Celiac disease reveals enlarged apical impulse, diminished first 203. The day following the procedure, (B) Crohn’s disease heart sound, an S3 gallop, and an S4 gallop. Blood culture is positive for (E) Ulcerative colitis presentation, physical exam, and test results, which Gram-negative bacteria. Which of the following forms of contraception and patient’s condition, which of the following is (A) Cystic fibrosis is characterized by the implantation of a single the accurate diagnosisfi A 62-year-old female recently underwent coronary sexual intercourse, painful bowel movements, 228. A 32-year-old male with a respiratory tract infection by the appreciation of a sausage-like mass upon bypass graft surgery and now presents with sudden and intermittent spotting. Based on the patient’s presents with a “herald patch” on the abdomen abdominal examination of a pediatric patientfi You suspect she has developed a pulmonary the following is the most appropriate diagnosisfi A 24-year-old female presents with redness, (D) Hemoglobin/hematocrit than: inflammation, burning, and small eruptions on 229. For which of the following disorders is Meclizine (E) Troponin (A) 4,500 mU her lower face, around the mouth. A 45-year-old obese sedentary female presents with patient’s presentation, which of the following is (A) Acute vertigo (C) 5,500 mU dull pain in the right leg associated with swelling, the most likely diagnosisfi D-dimer level is elevated (A) Cellulitis (C) Motion sickness (E) 6,500 mU at 1,460 ng/dL.

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Kerr served as Deputy Community from a broad perchanges at the grass roots level symptoms 9f anxiety buy generic prothiaden on line. Director of Central Intelligence; spective symptoms diabetes type 2 buy generic prothiaden 75mg on-line, focusing on systemic That is medications harmful to kidneys purchase genuine prothiaden online, changes in collection symptoms in spanish cheap 75mg prothiaden visa, Thomas H. Wolfe as Director of the issues that channeled analysts’ analysis, the nature of the prodOffice of Near Eastern & South evaluations and analyses. Pappas as the Intelligence Community Assistant National Intelligence itself has made some useful Officer for General Purpose Forces. Indeed, Community in an area where sis prior to the war was the intelligence assessments on postclassified information and techniextent of the Iraqi programs for Saddam issues were particularly insightful. Little or no attempt technical analysis, which has a Intelligence projections in this was made to examine or explain natural tendency to put bits and area, however, although largely the impact of each area on the pieces together as evidence of other. Thus, perspective and a accurate, had little or no impact coherent programs and to equate comprehensive sense of underon policy deliberations. As a standing of the Iraqi target per result the analysis, although se were lacking. This indepenthe bifurcation of analysis understandable and explainable, dent preparation of intelligence between the technical and the arrived at conclusions that were products in these distinct but cultural/political in the analytic seriously flawed, misleading, and interrelated areas raises signifiproduct and the resulting implieven wrong. In an temic problems in collection and Intelligence produced prior to the ironic twist, the policy commuwar on a wide range of other nity was receptive to technical analysis. Equally important, it issues accurately addressed such intelligence (the weapons proraises questions about how best topics as how the war would gram), where the analysis was to construct intelligence proddevelop and how Iraqi forces wrong, but apparently paid litucts to effectively and accurately would or would not fight. Any examination of the IntelliAccordingly, the Community in gence Community must acknowlcritical situations has faltered in edge the impact of more than 10 its analyses and failed to collect years of turmoil that adversely ” pertinent information. This has affected all collection and analytic Nonetheless, during the 1990s the occurred over a length of time efforts, including those on Iraq. Intelligence Community conand across crises sufficient in the Intelligence Community was fronted numerous crises in which number, quite apart from Iraq, to designed to focus on the Soviet to demonstrate the relevance of indicate systemic issues rather Union. It had developed a singleintelligence analysis to policy than just occasional missteps. Regional conflicts, detail that enriched its analysis, such as the first Gulf war and folparticularly with respect to Soviet low-on sanctions against Iraq, the Collection Impeded and military issues. The end of the breakup of Yugoslavia, and emergMisdirected Cold War, however, brought to a ing threats from North Korea and close that “stable” bipolar world Iran provided tests for intelliIntelligence collection against and left the United States without gence. The Intelligence ComSoviet threat were generally times faulty, leaving important munity had nothing like the richinsightful and its collection largely customers still wondering about ness, density, and detail that it effective, reflecting the accumulathe relevance of the intelligence worked hard to develop and tion of deep understanding develinput to policy deliberations. This developdefine its priorities was further perspective and context for those ment was compounded by the complicated as policymakers and issues. The resources seldom get increased separation of collection others raised questions not only returned to the line offices, which professionals from the analytic about the role of but even the historically have been better cadre who had been intimately need for intelligence. Accordequipped to provide complete involved in identifying collection ingly, intelligence came to be perspectives on country and gaps, needs, and priorities and seen as an area where the govregional issues. Iraq was not the only had a significant adverse impact the capabilities devoted to the significant intelligence problem on Intelligence Community capaSoviet Union and were seen by facing the Community in the bilities. Counterterrorism and counworking them, or what the doceration, and Arms Control. The capability and leadership attenwere slowed, put on hold, or even brief describes in great detail the tion. In Iraq, technical ued if, as he claimed, he had no to expose gaps in knowledge about collection priorities emphasized stockpiles of banned weapons. Neglected grams were ongoing, who was Weapons Intelligence, Nonproliftopics for collection included the 50 Studies in Intelligence Vol. Overall, the Intelligence attention appears to have been ” Community did not acquit itself paid, for example, to collecting with considerable effort. It may well in developing collection information on the oil-for-food also reside in the minds of groups strategies on Iraq. Considerable speculaof people who are accessible but tion was voiced that several not easily approachable and who countries and individuals were do not fall into the category of Analysis Adversely Affected profiting from this program. Although there Despite the fact that many of the is a strong argument that the No single act of omission or comtargets for this subject were outclandestine service should not mission accounts for the inconsisside Iraq, it received only spodivert its attention away from tent analytic performance of the radic attention. It appears to be Although collection itself was a society may be equally, if not the result of decisions made, and problem, analysts were led to more, important. This type of not made, since the fall of the rely on reporting whose sourcing information, however, does not fit Soviet Union, which had an was misleading and even unreliwith the reward system in the impact on the analytical environable. In addition, some critical the richness and density of inforwent changes in both its judgments were made on the mation required. A careful examorganization and its methodologibasis of intelligence provided by ination might have addressed the cal orientation. Finally, Iraq the analytic discipline and rigor situation it did not perform this demonstrates that collection that characterized Intelligence function well. On the other hand, strategies must take into account Community products through the the acquisition of “softer” intellithat the absence of dangerous Cold War. This latstrated in the presence of a secreintensive analysis that traditionter information can be found in tive and devious regime. Or, put ally and effectively preceded poldatabases, but they are too often differently, collection strategies icy deliberations was unavailable only accessible indirectly and should recognize the extreme difbecause of the shift away from Studies in Intelligence Vol. In reviewing the national the quality of basic finished intelligence products intelligence products associated assumptions. Allowing broad range of subjects but withfor a satisfying sense of volumiout extensive cross-reference, ” nous production, and reflecting and with no attempt to synthethe approval of receptive consumdid not seem to provoke internal size a broader understanding of ers, the policy-heavy process proreview within the Intelligence Iraq out of the many detailed vided positive feedback, while the Community. The narrowly focused internal archicertain gaps were acknowledged, absence of such a contextual tecture lacked the self-awareness no product or thread within the effort contributed to assessments that could otherwise have raised intelligence provided called into that failed to recognize the signifserious and timely warnings. Community the absence of a unifying analyAs noted earlier, the growing use Few issues have engaged greater sis was also disguised by the of centers also contributed to policymaker interest in intellirapidity and volume of interacwhat was at best a problematic gence than those concerning tions between intelligence and result. The increasing stream of analysis— ments that contributed, posipost-Cold War reductions both written and oral. Gaps in knowledge nically competent analysts, but demands are high and response were left undiscovered or unatas has been described elsewhere, time is short, most written inteltended, which to some degree is their efforts were not leavened ligence production is in the form explainable by the absence of through review by more broadly of policy-driven memos and briefs pervasive, intrusive, and effecbased colleagues. The result of this many products were appropriFinally, quality control was weaknarrowly focused and piecemeal ately caveated, the growing need ened. The extensive layers of critiintelligence flow is that it to caveat judgments to explain cal management review that neither fosters continuity of analthe absence of direct intelligence traditionally served to ensure ysis nor provides a context within 52 Studies in Intelligence Vol. Although provide a comprehensive picture viewed in that context as a probof how the country functioned as lem, serious pressure from policya whole. The Intelligence Com” makers almost always munity has made substantial, mixed bag of analytic product. The although sporadic, efforts over Consistent application of anamore relevant issue is how the the past decade and a half to lytic or evidentiary standards Intelligence Community responded explore better and more technobecame next to impossible. The fundamental question is not this climate contributed to the the results, however, have been whether national intelligence problem of inconsistent analytic modest at best. The requirement estimates add value to the existperformance, however, remains an to have background and contexing body of analytic work. Little indepenassociation with policy deliberagence Community remained firm dent knowledge or informed outtions can be troublesome. In the in its assessment that no operaside opinion is incorporated in case of Iraq, daily briefings and tional or collaborative relationestimative products. It was production, probably imparted a in the absence of strong policy done under an unusually tight greater sense of certainty to anainterest, analysts would have time constraint—three weeks—to lytic conclusions than the facts been more inclined to examine meet a deadline for congreswould bear. And it was the is unlikely that such examinaproduct of three separate draftSome in the Intelligence Commution would have changed judgers, each responsible for indepennity and elsewhere hold the view ments that were longstanding dent sections, drawing from a that intense policymaker demands and firmly held. The their potential risks weighed, but the intelligence world is one of alternative is the outcome on important issues ambiguity, nuance, and complexunthinkable. Dealing with these elements of these problems must bring a is difficult in the world intellirapid response. The enormous efforts undertaken, motivated community that repcontroversies over Iraq intellithe long hours and the intense resents an invaluable asset to gence can be expressed in the debate.

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