Combining clozapine with carbamazepine increases the risk of agranulocytosis, making it a hazardous drug combination. In the event of clozapine-induced seizures, sodium valproate is typically the preferred anticonvulsant.

Piaget’s Stages of Development and Key Concepts

Piaget developed four stages of development that describe how children think and acquire knowledge. The first stage is the Sensorimotor stage, which occurs from birth to 18-24 months. In this stage, infants learn through sensory observation and gain control of their motor functions through activity, exploration, and manipulation of the environment.

The second stage is the Preoperational stage, which occurs from 2 to 7 years. During this stage, children use symbols and language more extensively, but they are unable to think logically of deductively. They also use a type of magical thinking and animistic thinking.

The third stage is the Concrete Operational stage, which occurs from 7 to 11 years. In this stage, egocentric thought is replaced by operational thought, which involves dealing with a wide array of information outside the child. Children in this stage begin to use limited logical thought and can serialise, order, and group things into classes on the basis of common characteristics.

The fourth and final stage is the Formal Operations stage, which occurs from 11 through the end of adolescence. This stage is characterized by the ability to think abstractly, to reason deductively, to define concepts, and also by the emergence of skills for dealing with permutations and combinations.

Piaget also developed key concepts, including schema, assimilation, and accommodation. A schema is a category of knowledge and the process of obtaining that knowledge. Assimilation is the process of taking new information into an existing schema, while accommodation involves altering a schema in view of additional information.

Overall, Piaget’s stages of development and key concepts provide a framework for understanding how children learn and acquire knowledge.

Interview Techniques: Confrontation

Confrontation is a technique that can be employed during patient interviews to draw their attention to a particular issue. However, it is crucial to use this technique with care as it can potentially lead to the patient becoming defensive of hostile. Therefore, it is essential to approach confrontation tactfully and with sensitivity. By doing so, the interviewer can effectively communicate their concerns to the patient without causing any unnecessary tension of conflict. Proper use of confrontation can help patients recognize and address problematic behaviors of attitudes, leading to positive outcomes in their treatment.

Electroencephalography

Electroencephalography (EEG) is a clinical test that records the brain’s spontaneous electrical activity over a short period of time using multiple electrodes placed on the scalp. It is mainly used to rule out organic conditions and can help differentiate dementia from other disorders such as metabolic encephalopathies, CJD, herpes encephalitis, and non-convulsive status epilepticus. EEG can also distinguish possible psychotic episodes and acute confusional states from non-convulsive status epilepticus.

Not all abnormal EEGs represent an underlying condition, and psychotropic medications can affect EEG findings. EEG abnormalities can also be triggered purposely by activation procedures such as hyperventilation, photic stimulation, certain drugs, and sleep deprivation.

Specific waveforms are seen in an EEG, including delta, theta, alpha, sigma, beta, and gamma waves. Delta waves are found frontally in adults and posteriorly in children during slow wave sleep, and excessive amounts when awake may indicate pathology. Theta waves are generally seen in young children, drowsy and sleeping adults, and during meditation. Alpha waves are seen posteriorly when relaxed and when the eyes are closed, and are also seen in meditation. Sigma waves are bursts of oscillatory activity that occur in stage 2 sleep. Beta waves are seen frontally when busy of concentrating, and gamma waves are seen in advanced/very experienced meditators.

Certain conditions are associated with specific EEG changes, such as nonspecific slowing in early CJD, low voltage EEG in Huntington’s, diffuse slowing in encephalopathy, and reduced alpha and beta with increased delta and theta in Alzheimer’s.

Common epileptiform patterns include spikes, spike/sharp waves, and spike-waves. Medications can have important effects on EEG findings, with clozapine decreasing alpha and increasing delta and theta, lithium increasing all waveforms, lamotrigine decreasing all waveforms, and valproate having inconclusive effects on delta and theta and increasing beta.

Overall, EEG is a useful tool in clinical contexts for ruling out organic conditions and differentiating between various disorders.

Serotonin: Synthesis and Breakdown

Serotonin, also known as 5-Hydroxytryptamine (5-HT), is synthesized in the central nervous system (CNS) in the raphe nuclei located in the brainstem, as well as in the gastrointestinal (GI) tract in enterochromaffin cells. The amino acid L-tryptophan, obtained from the diet, is used to synthesize serotonin. L-tryptophan can cross the blood-brain barrier, but serotonin cannot.

The transformation of L-tryptophan into serotonin involves two steps. First, hydroxylation to 5-hydroxytryptophan is catalyzed by tryptophan hydroxylase. Second, decarboxylation of 5-hydroxytryptophan to serotonin (5-hydroxytryptamine) is catalyzed by L-aromatic amino acid decarboxylase.

Serotonin is taken up from the synapse by a monoamine transporter (SERT). Substances that block this transporter include MDMA, amphetamine, cocaine, TCAs, and SSRIs. Serotonin is broken down by monoamine oxidase (MAO) and then by aldehyde dehydrogenase to 5-Hydroxyindoleacetic acid (5-HIAA).

Harry Harlow conducted controversial experiments with rhesus macaque monkeys and surrogate ‘mothers’ made of inanimate objects, revealing that the infants preferred comfort and warmth over food.
Mary Ainsworth created the Strange Situation classification to categorize infants’ attachment behaviors.
John Bowlby coined the term ‘attachment’ to describe a child’s bond with their mother.
Konrad Lorenz studied imprinting in geese that were hatched in incubators.
Mary Main played a role in the development of the Adult Attachment Interview, which evaluates an individual’s early attachment experiences.

Antidepressants typically interfere with the natural pattern of sleep, especially by reducing REM sleep. However, Agomelatine has been found to enhance disrupted sleep-wake cycles in individuals with major depressive disorder.

Agomelatine: A New Drug for Depression Treatment

Agomelatine is a recently developed medication that is used to treat depression. Its mechanism of action involves acting as an agonist at melatonin M1 and M2 receptors, while also acting as an antagonist at 5HT2C receptors. The effects of melatonin appear to promote sleep, while the 5HT2C antagonism leads to the release of dopamine and norepinephrine in the frontal cortex. Interestingly, serotonin levels do not appear to be affected by this medication.

A neonatal death refers to the death of a newborn baby within 28 days of birth. If the death occurs within the first seven days, it is classified as an early neonatal death, while a death that occurs between seven and 28 days is considered a late neonatal death. A stillbirth is the term used to describe the death of a fetus before birth, but after 24 weeks of gestation. Finally, if a live-born infant dies after one month but before reaching one year of age, it is classified as a postnatal death.

RD Laing, a Scottish anti psychiatrist, established Kingsley Hall in response to a letter from Mary Barnes seeking therapy. Barnes, who later wrote a book about her experiences, is the most well-known patient. Laing encouraged her to embrace her madness and regress to infancy, leading to behaviors such as abandoning continence, fixating on her feces, and demanding to be fed milk, even from a male doctor’s breast. She also used her feces to decorate her surroundings and create babies.

Schizophrenia and Duration of Treatment

The NICE guidelines do not provide a specific recommendation on the duration of treatment for schizophrenia. However, they do caution patients about the risks of stopping medication.

According to the guidelines, patients should be informed that there is a high risk of relapse if they stop taking their medication within the next 1-2 years. This suggests that long-term treatment may be necessary to manage symptoms and prevent relapse. It is important for patients to understand the potential consequences of stopping medication and to work closely with their healthcare provider to develop a treatment plan that meets their individual needs.

It is not recommended to combine MAOIs with SSRIs, clomipramine, of ephedrine.

MAOIs: A Guide to Mechanism of Action, Adverse Effects, and Dietary Restrictions

First introduced in the 1950s, MAOIs were the first antidepressants introduced. However, they are not the first choice in treating mental health disorders due to several dietary restrictions and safety concerns. They are only a treatment option when all other medications are unsuccessful. MAOIs may be particularly useful in atypical depression (over eating / over sleeping, mood reactivity).

MAOIs block the monoamine oxidase enzyme, which breaks down different types of neurotransmitters from the brain: norepinephrine, serotonin, dopamine, as well as tyramine. There are two types of monoamine oxidase, A and B. The MOA A are mostly distributed in the placenta, gut, and liver, but MOA B is present in the brain, liver, and platelets. Selegiline and rasagiline are irreversible and selective inhibitors of MAO type B, but safinamide is a reversible and selective MAO B inhibitor.

The most common adverse effects of MAOIs occurring early in treatment are orthostatic hypotension, daytime sleepiness, insomnia, and nausea; later common effects include weight gain, muscle pain, myoclonus, paraesthesia, and sexual dysfunction.

Pharmacodynamic interactions with MAOIs can cause two types of problem: serotonin syndrome (mainly due to SSRIs) and elevated blood pressure (caused by indirectly acting sympathomimetic amines releasers, like pseudoephedrine and phenylephrine). The combination of MAOIs and some TCAs appears safe. Only those TCAs with significant serotonin reuptake inhibition (clomipramine and imipramine) are likely to increase the risk of serotonin syndrome.

Tyramine is a monoamine found in various foods, and is an indirect sympathomimetic that can cause a hypertensive reaction in patients receiving MAOI therapy. For this reason, dietary restrictions are required for patients receiving MAOIs. These restrictions include avoiding matured/aged cheese, fermented sausage, improperly stored meat, fava of broad bean pods, and certain drinks such as on-tap beer. Allowed foods include fresh cottage cheese, processed cheese slices, fresh packaged of processed meat, and other alcohol (no more than two bottled or canned beers of two standard glasses of wine, per day).

Hyperthyroidism is typically associated with brisk reflexes, while hypothyroidism is associated with reduced reflexes. However, the other symptoms and signs can be present in both hyperthyroidism and hypothyroidism.

Thyroid Examination Findings

Hypothyroidism:

– Weight gain (with decreased appetite)
– Intolerance to cold
– Lethargy
– Constipation
– Menstrual disturbances
– Decreased perspiration

Exam findings:

– Hair loss
– Bradycardia
– Periorbital puffiness and dry skin
– Coarse, brittle, straw-like hair
– Myxoedema
– Hyporeflexia

Hyperthyroidism:

– Weight loss (with increased appetite)
– Intolerance to heat
– Palpitations
– Menstrual disturbances

Exam findings:

– Hair loss
– Tachycardia
– Warm, moist, and smooth skin
– Tremor
– Brisk reflexes

Champix is a medication that contains varenicline, which acts as a partial agonist at nicotinic receptors.

Varenicline for Smoking Cessation: Safety and Efficacy

Varenicline is a medication used to aid smoking cessation by reducing cravings and pleasurable effects of tobacco products. It has a high affinity for the alpha 4 beta 2 nicotinic receptor and is recommended by NICE for smoking cessation. Varenicline is safe to use in cases of liver dysfunction as it undergoes very little hepatic metabolism. It has been found to be nearly 80% more effective than bupropion and more effective than 24-hour nicotine replacement therapy in two large randomized controlled trials. The initial course of treatment could last 12 weeks, with an additional 12 weeks offered to those who have successfully quit smoking. However, varenicline has been observed to exacerbate underlying psychiatric illness, including depression, and is associated with changes in behavior of thinking, anxiety, psychosis, mood swings, aggressive behavior, suicidal ideation, and behavior. Patients with a psychiatric history should be closely monitored while taking varenicline. One randomized controlled trial has challenged this concern. The FDA has issued a safety announcement that varenicline may be associated with a small, increased risk of certain cardiovascular adverse events in patients with cardiovascular disease. The very common side effects of varenicline include nasopharyngitis, abnormal dreams, insomnia, headache, and nausea.

Drug Stability

The stability of drugs can vary greatly, with some medications being unable to be included in compliance aids due to their susceptibility to environmental factors. Certain drugs have a tendency to absorb moisture from the air, rendering them ineffective, with light known to accelerate this process. Examples of drugs that are unsuitable for compliance aids due to their susceptibility to environmental factors include Sodium valproate, Zopiclone, Venlafaxine, Topiramate, Methylphenidate, Mirtazapine, Olanzapine, Amisulpride, and Aripiprazole.

Individuals with constructional apraxia are unable to replicate drawings of arrange objects to create patterns of designs.

Clock Drawing Test: A Screening Tool for Cognitive Dysfunction

The clock drawing test is a widely used screening tool for cognitive dysfunction. It involves asking the patient to draw a clock on a piece of paper, placing the numbers on the clock face and drawing the hands to indicate 10 minutes past 11. This simple task assesses a range of cognitive functions, including visuospatial ability, motor function, attention, and comprehension.

The test is quick and easy to administer, making it a useful tool for healthcare professionals to identify potential cognitive impairment in patients. The clock drawing test has been shown to be effective in detecting cognitive dysfunction in a variety of conditions, including Alzheimer’s and Parkinson’s disease.

The image below illustrates examples of clocks drawn correctly by healthy controls and those drawn by patients with Alzheimer’s and Parkinson’s disease. By comparing the drawings, healthcare professionals can quickly identify potential cognitive dysfunction and take appropriate action.

Electroencephalography

Electroencephalography (EEG) is a clinical test that records the brain’s spontaneous electrical activity over a short period of time using multiple electrodes placed on the scalp. It is mainly used to rule out organic conditions and can help differentiate dementia from other disorders such as metabolic encephalopathies, CJD, herpes encephalitis, and non-convulsive status epilepticus. EEG can also distinguish possible psychotic episodes and acute confusional states from non-convulsive status epilepticus.

Not all abnormal EEGs represent an underlying condition, and psychotropic medications can affect EEG findings. EEG abnormalities can also be triggered purposely by activation procedures such as hyperventilation, photic stimulation, certain drugs, and sleep deprivation.

Specific waveforms are seen in an EEG, including delta, theta, alpha, sigma, beta, and gamma waves. Delta waves are found frontally in adults and posteriorly in children during slow wave sleep, and excessive amounts when awake may indicate pathology. Theta waves are generally seen in young children, drowsy and sleeping adults, and during meditation. Alpha waves are seen posteriorly when relaxed and when the eyes are closed, and are also seen in meditation. Sigma waves are bursts of oscillatory activity that occur in stage 2 sleep. Beta waves are seen frontally when busy of concentrating, and gamma waves are seen in advanced/very experienced meditators.

Certain conditions are associated with specific EEG changes, such as nonspecific slowing in early CJD, low voltage EEG in Huntington’s, diffuse slowing in encephalopathy, and reduced alpha and beta with increased delta and theta in Alzheimer’s.

Common epileptiform patterns include spikes, spike/sharp waves, and spike-waves. Medications can have important effects on EEG findings, with clozapine decreasing alpha and increasing delta and theta, lithium increasing all waveforms, lamotrigine decreasing all waveforms, and valproate having inconclusive effects on delta and theta and increasing beta.

Overall, EEG is a useful tool in clinical contexts for ruling out organic conditions and differentiating between various disorders.

Overview of Cranial Nerves and Their Functions

The cranial nerves are a complex system of nerves that originate from the brain and control various functions of the head and neck. There are twelve cranial nerves, each with a specific function and origin. The following table provides a simplified overview of the cranial nerves, including their origin, skull exit, modality, and functions.

The first cranial nerve, the olfactory nerve, originates from the telencephalon and exits through the cribriform plate. It is a sensory nerve that controls the sense of smell. The second cranial nerve, the optic nerve, originates from the diencephalon and exits through the optic foramen. It is a sensory nerve that controls vision.

The third cranial nerve, the oculomotor nerve, originates from the midbrain and exits through the superior orbital fissure. It is a motor nerve that controls eye movement, pupillary constriction, and lens accommodation. The fourth cranial nerve, the trochlear nerve, also originates from the midbrain and exits through the superior orbital fissure. It is a motor nerve that controls eye movement.

The fifth cranial nerve, the trigeminal nerve, originates from the pons and exits through different foramina depending on the division. It is a mixed nerve that controls chewing and sensation of the anterior 2/3 of the scalp. It also tenses the tympanic membrane to dampen loud noises.

The sixth cranial nerve, the abducens nerve, originates from the pons and exits through the superior orbital fissure. It is a motor nerve that controls eye movement. The seventh cranial nerve, the facial nerve, also originates from the pons and exits through the internal auditory canal. It is a mixed nerve that controls facial expression, taste of the anterior 2/3 of the tongue, and tension on the stapes to dampen loud noises.

The eighth cranial nerve, the vestibulocochlear nerve, originates from the pons and exits through the internal auditory canal. It is a sensory nerve that controls hearing. The ninth cranial nerve, the glossopharyngeal nerve, originates from the medulla and exits through the jugular foramen. It is a mixed nerve that controls taste of the posterior 1/3 of the tongue, elevation of the larynx and pharynx, and swallowing.

The tenth cranial nerve, the vagus nerve, also originates from the medulla and exits through the jugular foramen. It is a mixed nerve that controls swallowing, voice production, and parasympathetic supply to nearly all thoracic and abdominal viscera. The eleventh cranial nerve, the accessory nerve, originates from the medulla and exits through the jugular foramen. It is a motor nerve that controls shoulder shrugging and head turning.

The twelfth cranial nerve, the hypoglossal nerve, originates from the medulla and exits through the hypoglossal canal. It is a motor nerve that controls tongue movement. Overall, the cranial nerves play a crucial role in controlling various functions of the head and neck, and any damage of dysfunction can have significant consequences.

The vulnerability of microglia to HIV infection is highest among all the cell types in the brain. This is because the CD4 and CCR5 receptors required for HIV cell entry are expressed in both parenchymal microglia and perivascular microglia/macrophages. Although there have been some reports of HIV infection in endothelial cells, neurons, and oligodendrocytes, it is generally accepted that such infections are rare and unlikely to play a significant role in HIV-related CNS disorders. Astrocytes are thought to be capable of only a limited form of HIV infection.

Choline, which is essential for the synthesis of the neurotransmitter acetylcholine, can be obtained in significant quantities from vegetables, seeds, egg yolk, and liver. However, it is only present in small amounts in most fruits, egg whites, and many beverages.

Post-traumatic stress disorder (PTSD) is a condition that develops in response to an exceptionally threatening of catastrophic event of situation, such as the one described above. It is only diagnosed if symptoms arise within six months of the traumatic event. The symptoms of PTSD can be categorized into three groups: re-experiencing the traumatic event (such as through nightmares of vivid thoughts), persistent avoidance of stimuli associated with the trauma, and persistent symptoms of increased arousal (such as difficulty sleeping of concentrating).

Agoraphobia is a fear of being in situations of places from which escape is difficult, leading to avoidance of many situations and confinement to the home. This fear is typically triggered by situations such as crowds, public places, of traveling alone of away from home.

Generalized anxiety disorder is characterized by persistent anxiety that is not limited to any specific environmental circumstance. To receive this diagnosis, a patient must experience symptoms of anxiety on most days for several weeks of months, with evidence of impairment in important areas of functioning. However, this diagnosis is not appropriate for the scenario described above, as the anxiety is related to a specific event of trigger.

Panic disorder involves sudden onset of severe anxiety, with at least three panic attacks experienced over a three-week period. Symptoms may include sweating, palpitations, shortness of breath, nausea, trembling, chest pain of discomfort, dizziness of lightheadedness, chills of hot flushes, fear of losing control of dying, paraesthesia, feeling of choking, and derealization or depersonalization.

Social phobia is characterized by a marked fear of social situations in which embarrassment may occur, leading to avoidance of these situations.

A woman is experiencing an obsessive thought that manifests as persistent imagery, which she cannot control. She tries to suppress the thought, indicating the development of compulsive behavior. She may also experience autoscopic hallucinations, where she sees a hallucinatory double of herself. Compulsions are repetitive behaviors that she uses to alleviate anxiety caused by obsessive experiences, which can be either motor of cognitive. Additionally, she may experience ruminative cognitions, which are repetitive thoughts that do not lead to any conclusion. In some cases, she may also experience thought insertion, where she attributes the source of the image to an external force.

Delusions that originate within the mind without any external influence are known as autochthonous. This term, derived from the Greek word for from the soil, emphasizes that the idea is self-generated rather than being triggered by a sensory experience of other external factor.

Within the psychodrama setting, the patient takes on the role of the protagonist and actively delves into their emotional conflict. This therapeutic approach was created by Jakob Moreno and involves the dramatisation of emotional struggles in a group setting. The group leader of therapist, known as the director, plays an active role in guiding the process.

Thought insertion is a symptom commonly experienced by individuals with schizophrenia, where they believe that their thoughts are not their own and have been placed in their head from an external source. This is one of the many first rank symptoms of schizophrenia, which also include delusional percept, audible thoughts, third person auditory hallucination, running commentary, thought withdrawal, thought broadcast, passivity of affect, passivity of impulses, passivity of volition, and somatic passivity. Third person auditory hallucinations involve hearing multiple voices discussing the patient as a third person. Thought broadcast is a passivity experience where the patient believes their thoughts are being widely broadcasted after being taken away from their head. Thought withdrawal is the belief that one’s thoughts are being taken away from their head against their will. Somatic passivity is a delusional belief that one’s body is being controlled from outside, which is different from haptic hallucination.

Catecholamines are a group of chemical compounds that have a distinct structure consisting of a benzene ring with two hydroxyl groups, an intermediate ethyl chain, and a terminal amine group. These compounds play an important role in the body and are involved in various physiological processes. The three main catecholamines found in the body are dopamine, adrenaline, and noradrenaline. All of these compounds are derived from the amino acid tyrosine. Overall, catecholamines are essential for maintaining proper bodily functions and are involved in a wide range of physiological processes.

Although there is a potential risk of infants being exposed to antidepressants through breast milk, leaving mental illness untreated can pose greater risks. The safety of psychotropic medication during breastfeeding is not well-established. Nonetheless, sertraline is considered one of the safest antidepressants for breastfeeding mothers as it is excreted in low levels. Therefore, if treatment is necessary, sertraline is a suitable option for breastfeeding mothers.

This scenario illustrates the concept of projection, where the athlete is projecting their own feelings of hatred onto their team mate. However, it does not involve projective identification as there is no indication of how the team mate is internalizing of reacting to the projection.

Intermediate Mechanism: Rationalisation

Rationalisation is a defense mechanism commonly used by individuals to create false but credible justifications for their behavior of actions. It involves the use of logical reasoning to explain away of justify unacceptable behavior of feelings. The individual may not be aware that they are using this mechanism, and it can be difficult to identify in oneself.

Rationalisation is considered an intermediate mechanism, as it is common in healthy individuals from ages three to ninety, as well as in neurotic disorders and in mastering acute adult stress. It can be dramatically changed by conventional psychotherapeutic interpretation.

Examples of rationalisation include a student who fails an exam and blames the teacher for not teaching the material well enough, of a person who cheats on their partner and justifies it by saying their partner was neglectful of unaffectionate. It allows the individual to avoid taking responsibility for their actions and to maintain a positive self-image.

Overall, rationalisation can be a useful defense mechanism in certain situations, but it can also be harmful if it leads to a lack of accountability and an inability to learn from mistakes.

In 1937, James Papez proposed a neural circuit that explained how emotional experiences occur in the brain. According to Papez, sensory messages related to emotional stimuli are first received by the thalamus, which then directs them to both the cortex (stream of thinking) and hypothalamus (stream of feeling). The cingulate cortex integrates this information from the hypothalamus and sensory cortex, leading to emotional experiences. The output via the hippocampus and hypothalamus allows cortical control of emotional responses. This circuit has since been reconceptualized as the limbic system.

The medial longitudinal fasciculus carries fibres from cranial nerves III, IV and IV. The nucleus accumbens plays a major role in the reward circuit, while the somatosensory cortex is involved in processing pain. The basal ganglia are involved in voluntary motor control.

Overall, the Papez circuit theory provides a framework for understanding the functional neuroanatomy of emotion. It highlights the importance of the limbic system in emotional experiences and the role of various brain regions in processing different aspects of emotional stimuli.

The boy seems to have disavowed his native culture and has not assimilated into the prevailing culture (as evidenced by his refusal to pursue education and interact with local peers). The concept of ‘biculturalism’ refers to the coexistence of two separate cultures.

Multiculturalism is the coexistence of various cultural of ethnic groups within a shared social and political framework. Acculturation is the process of cultural and psychological change that occurs when different cultural groups come into contact with each other. Canadian psychologist John Berry identified four paths to acculturation: assimilation, integration, separation, and marginalization. Assimilation involves giving up one’s home culture and adopting the dominant culture, while integration involves maintaining one’s home culture while also embracing the dominant culture. Separation involves maintaining one’s home culture while being isolated from the dominant culture, and marginalization involves giving up one’s home culture and failing to related properly to the dominant culture. There is a cultural debate regarding assimilation and multiculturalism, with two forms of assimilation recognized: total assimilation, which involves the obliteration of the non-dominant culture, and melting pot assimilation, which refers to a less extreme version where a new form of the dominant culture emerges. Laissez-faire multiculturalism refers to multiculturalism that occurs without planning, such as the existence of Chinatowns in most cities.

There are several factors that can make people more likely to be attracted to each other, including being close in proximity, having familiarity with each other, sharing similar interests and values, being exposed to each other frequently, perceiving each other as competent, experiencing mutual liking, engaging in self-disclosure, and being physically attractive.