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The iron butter y is another variation on neutral delta, neutral market spreads Truly the spread is nothing more than a protected short straddle You can look at it as an at-the-money credit spread on both sides of the market To create the iron butter y, you are selling an at-the-money put and at-the-money call while buying an out-of-the-money put and an out-of-the-money call The idea behind the iron butter y is to capitalize on reductions in implied volatility with limited risk If option implied volatility is high, then

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The intellectual, emotional, and behavioral activities of the human organism are so complex and varied that one may question the feasibility of using derangements of these activities as reliable indicators of cerebral disease Certainly they do not have the same reliability and ease of anatomic and physiologic interpretation as sensory and motor paralysis or aphasia Yet one observes particular patterns of disturbed higher cerebrocortical function with such regularity as to make them clinically useful in identifying certain diseases And some of these disturbances gain speci city because they are often combined in certain ways to form special syndromes The components of mentation and behavior that lend themselves to bedside examination are (1) the processes of attention, (2) perception and apperception (awareness of and interpretation of sensory stimuli); (3) the capacity to memorize and recall events of the recent and distant past; (4) the ability to think and reason; (5) temperament, mood, and emotion; (6) initiative, impulse, and drive; (7) social behavior; and (8) insight Of these, the rst two are sensory, the third and fourth are cognitive, the fth is affective, the sixth is conative or volitional, the seventh refers to the patient s relationships with those around him, and the last refers to the patient s capacity to assess his own normal or disordered functioning Each component of behavior and intellect has its objective side, expressed in the behavioral responses produced by certain stimuli, and its subjective side, expressed in the thinking and feeling described by the patient in relation to the stimuli Less accessible to the examiner but nevertheless possible to study by questioning of the patient is the constant stream of inner thought, memories, planning, and other psychic activities that continuously occupy the mind of an alert person They, too, are deranged or quantitatively diminished by cerebral disease.

Critical to clear thinking is a process of maintaining awareness of one or a limited number of external stimuli or internal thoughts for a xed period of time and to simultaneously disregard the numerous distracting sensations and ideas that constantly bombard the nervous system Without this ability to focus or pay attention and have an attention span, a coherent stream of thought or action is not possible The interruption of these activities by the intrusion other thoughts or actions is termed distractibility Two essential components are embodied in the attention mechanism, one, a continuous state or alertness that is normally present throughout waking life (and underlies self-awareness); the other, a process of selecting from the myriad sensations and thoughts those that are relevant to the immediate situation to the exclusion of all others The confused patient may demonstrate inattention in almost every task undertaken If the degree of confusion is slight, the patient himself reports dif culty with concentration If severe, there is a parallel lack of insight and the problem is evident by observing easy distractibility by ambient stimuli and by impersistence and perseveration in conversation and motor tasks Restated, attention has such a pervasive effect on all other aspects of mental performance that it is often dif cult to determine whether the confused

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patient has primary disorders of memory, executive, or visuospatial function, etc Indeed, retentive memory may appear to be severely reduced in confusional states Furthermore, the ability to carry out a series of actions or mental operations wherein one is required to hold in memory the result of the previous operation ( working memory ) is particularly prone to disruption The general ability to simply persist in a motor or mental task emphasizes an executive side of attention, but here one encounters a problem, because the term attention has been applied to a number of seemingly different mental activities One can view attention as a separate and unique cerebral function or simply a way of referring to the persistence or impersistence of any activity We would argue that the entire cerebrum participates in attentiveness and the frontal and perhaps the parietal lobes are responsible for directing its content, but that the thalamocortical system is in a special way responsible for its maintenance Mesulam considers the frontal and parietal lobes to be at the nexus of an attentional matrix ; in his model, the prefrontal, parietal association, and limbic cortices direct and modulate attention in an executive manner Certainly, the temporal lobes and other regions are involved as well Attention to a particular sensory modality requires the participation of the sensory cortex, which must simultaneously initiate the perceptive and apperceptive processes discussed below What are called modality and domain-speci c attentions (for example face or object recognition) are more complex, and disorders of these functions result in unique types of inattention, such as agnosia and anosognosia (lack of recognition of a part of the body, as discussed in Chap 22) These are not derived from the all-encompassing loss of attention that is part of general confusional states and can be viewed as restricted forms of lack of insight Another special type of disruption in mental function attends disturbances in language functions Here there is a loss of access to the symbolic representation of objects and actions (words) and a consequent problem with the inner stream of thought that gives the appearance of confusion Careful testing will reveal the primary problem with language.