This distinctive attribute may have influence not only in how people are perceived, but may also affect the way they perceive themselves. Perceived evaluative scrutiny: According to this model, dysphoric self-consciousness may increase when people feel under moderate or intensive evaluative social scrutiny such as when an asymmetric relationship is analyzed. For example, when asked about their relationships, doctoral students remembered events that they interpreted as significant to their degree of trust in their advisors when compared with their advisors. This suggests that students are more willing to pay more attention to their advisor than their advisor is motivated to pay attention to them. Also students spent more time ruminating about the behaviors, events, and their relationship in general. Uncertainty about social standing: The knowledge about the social standing is another factor that may induce paranoid social cognition. Many researchers have argued that experiencing uncertainty about a social position in a social system constitutes an adverse psychological state, one which people are highly motivated to reduce. Dysphoric self-consciousness
Refers to an aversive form of heightened public self-consciousness characterized by the feelings that one is under intensive evaluation or scrutiny. Becoming self-tormenting will increase the odds of interpreting others behaviors in a self-referential way. Hypervigilance and rumination
Self-consciousness was characterized as an aversive psychological state. According to this model, people experiencing self-consciousness will be highly motivated to reduce it, trying to make sense of what they are experiencing. These attempts promote hypervigilance and rumination in a circular relationship: more hypervigilance generates more rumination, whereupon more rumination generates more hypervigilance.
Paracentesis
In those with severe (tense) ascites, therapeutic paracentesis may be needed in addition to medical treatments listed above. As this may deplete serum albumin levels in the blood, albumin is generally administered intravenously in proportion to the amount of ascites removed. Surgery
Ascites that is refractory to medical therapy is considered an indication for liver transplantation. In the United States, the MELD score (online calculator) is used to prioritize people for transplantation. In a minority of people with advanced cirrhosis that have recurrent ascites, shunts may be used. Typical shunts used are portacaval shunt, peritoneovenous shunt, and the transjugular intrahepatic portosystemic shunt (TIPS). However, none of these shunts has been shown to extend life expectancy, and are considered to be bridged to liver transplantation. A meta-analysis of randomized controlled trials by the international Cochrane Collaboration concluded that "TIPS was more effective at removing ascites as compared with paracentesis...however, people with TIPS develop hepatic encephalopathy significantly more often".Another potential treatment option for patients with refractory/malignant ascites is the alfapump, (automated low flow ascites pump) which is an implantable device that removes ascites out of the peritoneal cavity and transports it via the pump into the bladder, where it passed naturally from the body through urination. Low SAAG ("exudative") ascites
Exudative ascites generally does not respond to manipulation of the salt balance or diuretic therapy. Repeated paracentesis and treatment of the underlying cause is the mainstay of treatment. Society and culture
It has been suggested that ascites was seen as a punishment especially for oath-breakers among the Proto-Indo-Europeans.