Epidemiology : a national survey of US
citizens has found that 6% of them have a debilitating mental illness.
More startling, almost 50% of those surveyed were found to have had a mental
disorder at some point during their lives; > 25% had had 1 in the year
before the interview. Treatment is hard to get, and often not sufficient
when available. Only about 33% of those in care receive "minimally adequate
treatment", such as the appropriate drugs or a few hours of therapy over
a period of several monthsref1,
ref2,
ref3,
ref4.
The statistics are nearly impossible to compare with previous studies,
thanks to constantly changing definitions of mental illness, but in general
things don't seem to have changed much over the past decade. > 9,000 US
adults, chosen randomly, were visited in their homes as part of the National
Comorbidity Survey, which looks at the incidence of multiple mental
disorders. An interview then probed to see whether they had mental difficulties
as determined by the latest Diagnostic and Statistical Manual of Mental
Disorders. The study also classified the severity of disorders, separating
them into severe, moderate or mild conditions. The definition of disorders
used by the study was quite broad. A few instances of road rage, for example,
might qualify as an intermittent
explosive disorder. Such a wide net may not be any use in determining
who needs medication or treatment, but the survey does provide some useful
information. It reveals, for example, that 50% of those with a mental disorder
encountered problems before their 14th birthday. This indicates that watching
for signs of mental distress in early years could help to avert larger
problems in the future. Progress will be made in finding biological markers
that can help distinguish children who are simply shy or have a quick temper
from those whose difficulties are likely to degenerate into illness, perhaps
through an analysis of genes or brain scans. Meanwhile, the first order
of business is to improve the quality of treatment. The prevalence of mental
disorders did not change during the decade (29.4% between 1990 and 1992
and 30.5% between 2001 and 2003), but the rate of treatment increased.
Among patients with a disorder, 20.3% received treatment between 1990 and
1992 and 32.9% received treatment between 2001 and 2003. Overall, 12.2%
of the population 18 to 54 years of age received treatment for emotional
disorders between 1990 and 1992 and 20.1% between 2001 and 2003. Only about
half those who received treatment had disorders that met diagnostic criteria
for a mental disorder. Significant increases in the rate of treatment (49.0%
between 1990 and 1992 and 49.9% between 2001 and 2003) were limited to
the sectors of general medical services (2.59 times as high in 2001 to
2003 as in 1990 to 1992), psychiatry services (2.17 times as high), and
other mental health services (1.59 times as high) and were independent
of the severity of the disorder and of the sociodemographic characteristics
of the respondents. Despite an increase in the rate of treatment, most
patients with a mental disorder did not receive treatment. Continued efforts
are needed to obtain data on the effectiveness of treatment in order to
increase the use of effective treatmentsref.
Web resources : Do
I Need Therapy online test
psyche : the human faculty for thought, judgment, and emotion; the
mental life, including both conscious and unconscious processes; the mind
in its totality, as distinguished from the body.
situation : the combination of factors with which an individual
is confronted. In psychology, the total sum of physical, psychological,
and sociocultural factors that act on a person and influence his behavior
ego-syntonic : denoting aspects of a person's thoughts, impulses,
attitudes, and behavior that are felt to be acceptable and consistent with
the rest of their personality.
ego-dystonic : denoting aspects of a
person's thoughts, impulses, attitudes, and behavior that are felt to be
repugnant, distressing, unacceptable, or inconsistent with the rest of
their personality.
psychiatry : that branch of medicine which deals with the study,
treatment, and prevention of mental disorders.
geriatric psychiatry / geropsychiatry
:
a subspecialty of psychiatry dealing with mental illness in the elderly.
neuropsychiatry : the branch of medicine which includes both neurology
and psychiatry.
addiction psychiatry : a subspecialty concerned with the diagnosis
and treatment of addiction and other problems related to substance use.
administrative psychiatry : that concerned with the organization
and management of mental health programs and facilities, including public
and private hospitals, clinics, and centers.
biological psychiatry : that which emphasizes biochemical, neurological,
and pharmacological causes and treatment approaches.
community psychiatry : the branch of psychiatry concerned with the
detection, prevention, and treatment of mental disorders as they develop
within psychosocial, cultural, or geographical areas, with emphasis given
to environmental factors.
consultation liaison psychiatry : that which connects psychiatry
with other areas of medicine, bringing a psychosocial approach to the biological
treatment of organic illness
cross-cultural or transcultural psychiatry : the study of mental
illness and mental health among different societies, nations, and cultures
descriptive psychiatry : psychiatry based on the study of observable
symptoms and behavioral phenomena, rather than underlying psychodynamic
processes
dynamic psychiatry : psychiatry based on the study of the unconscious
mechanisms, conflicts, and other emotional processes that motivate and
underlie human behavior, rather than the more observable behaviors themselves
existential psychiatry : that based on the existential philosophy
of Kierkegaard, Heidegger, Jaspers, and others, holding the view that a
person takes responsibility for his own existence.
forensic psychiatry : psychiatry which deals with the legal aspects
of mental disorders.
industrial or occupational psychiatry : that concerned with the
diagnosis and prevention of mental illness in the work setting, including
aspects of absenteeism, accident proneness, personnel policies, occupational
fatigue, substance abuse, vocational adjustment, retirement, interpersonal
relations, and related phenomena.
military psychiatry : the study and treatment of psychiatric problems
done under the auspices of military organizations such as induction centers,
training facilities, and military hospitals; it includes emergency and
nonemergency treatment for active-duty and retired military personnel and
their dependents.
orthomolecular psychiatry : that based on the theory that psychiatric
illnesses are due to disturbances in the molecular environment of the brain
and can be cured by restoration of optimal concentrations of substances
normally present in the body, such as vitamins (orthomolecular therapy).
preventive psychiatry : that broadly concerned with the amelioration,
control, and limitation of psychiatric disability. It is often categorized
as primary—measures to prevent a disorder; secondary—therapeutic measures
to limit a disorder; and tertiary—measures and intervention to reduce impairment
or disability following a disorder.
social psychiatry : that concerned with the cultural, ecologic,
and sociologic facts that engender, precipitate, intensify, prolong, or
otherwise complicate maladaptive patterns of behavior and their treatment.
orthopsychiatry : an interdisciplinary field that combines psychiatry
with principles of psychology, sociology, social work, and other fields
in the study and practice of maintaining or restoring mental health, emphasizing
a prophylactic approach to mental disease.
psychobiology / biopsychology : a field of study examining
the relationship between brain and mind, studying the effect of biological
influences, including biochemical, neurological, and pharmacological factors,
on psychological functioning or mental processes. Adolf Meyer's school
of psychiatric thought, in which the human being is viewed as an integrated
unit, incorporating psychological, social, and biological functions, with
behavior a function of the total organism.
mental disorder : any clinically
significant behavioral or psychological syndrome characterized by the presence
of distressing symptoms, impairment of functioning, or significantly increased
risk of suffering death, pain, disability, or loss of freedom. Mental disorders
are assumed to be the manifestation of a behavioral, psychological, or
biological dysfunction in the individual. The concept does not include
deviant behavior, disturbances that are essentially conflicts between the
individual and society, or expected and culturally sanctioned responses
to particular events
emotional illness : a colloquialism roughly equivalent to “mental
disorder,” but not usually applied to those with a specific organic etiology
or to mental retardation.
organic mental disorder :
a term formerly used to denote any mental disorder with a specifically
known or presumed organic etiology; now discouraged because of the implication
that other mental disorders do not have an organic basis. The term was
also sometimes used to denote an organic mental syndrome. Current
classification divides these disorders into :
organic hallucinosis : a term
used in a former system of classification, denoting an organic mental syndrome
characterized by the presence of hallucinations caused by a specific organic
factor and not associated with delirium. Such disorders are now mainly
classified as substance-induced
psychotic disorders and psychotic
disorders due to general medical condition
increased consciousness (secondary to stress or mania)
restriction of consciousness
obnubilation / clouding of consciousness
/ mental fog / obtundation : a lowered level of consciousness with
loss of ability to respond properly to external stimuli.
torpor :lack of response to normal
or ordinary stimuli.
Aetiology : transient large (up to 300-fold
compared with control patients) increase of endozepine-4
content in CSF and serum, with a return to normal concentrations between
attacks
Symptoms & signs : episodes of stupor
lasting hours or days beginning between ages 18 and 67 years; sometimes
spontaneously disappearing after 4-6 years with symptoms
Laboratory examinations : fast (14- to
16-Hz), unreactive background activity at EEGs
Differential diagnosis : exogenous bendodiazepine
intoxication
Therapy : oral flumazenil
(0.25 mg i.v.)
dreamy or oniroid state : a state of altered consciousness lasting
for a few minutes and accompanied by hallucinations;
associated with temporal lobe lesions
expansion of consciousness (trance, psychostimulant
substances)
autopsychic depersonalization : experiences are felt as foreign
somatopsychic depersonalization : the body or some parts seem not
self, detached, or died
allopsychic depersonalization / derealization
: a loss of the sensation of the reality of one's surroundings; the feeling
that something has happened, that the world has been changed and altered,
that one is detached from one's environment. It is seen most frequently
in schizophrenic disorders.
déjà entendu [Fr. “already heard”] : the feeling that
one has heard or perceived something previously although it is in fact
new to one's experience
déjà éprouvé [Fr. “already tested”]
: a feeling that one has previously engaged in or experienced something
when one has not
déjà fait [Fr. “already done”] : a feeling that what
is happening has happened before.
déjà pensé [Fr. “already thought”] : a feeling
that one has thought the same thoughts before.
déjà raconté [Fr. “already told”] : a feeling
when telling someone about an experience that one had previously related
the same experience either to them or to someone else, when in fact one
had not. 2. a feeling that a long-forgotten event which is being
recalled was told to one before, when it was not.
déjà vécu [Fr. “already
lived”] . a feeling that a new experience has been encountered before,
in a previous existence.
jamais vécu [Fr. “never lived”] : a feeling that a common
experience has never been encountered before
déjà voulu [Fr. “already desired”] : a feeling that
one has entertained the same desires before.
déjà vu [Fr. “already seen”]
: an illusion in which a new situation is incorrectly
viewed as a repetition of a previous situation
jamais vu [Fr. “never seen”] : the sensation that familiar surroundings
are strangely unfamiliar; the illusion that one
has never seen anything like that before.
asemia / asemasia / asymbolia
: aphasia with inability to employ or to understand either speech or signs
aphasia : any of a large group of speech disorders
involving defect or loss in thought <=> speech conversion (the power
of expression by speech, writing, or signs, or of comprehending spoken
or written language), due to injury or disease of the brain or to psychogenic
causes in patients who had acquired the ability of speech. Less severe
forms are known as dysphasia.
An inability to process language needn't stop you from doing maths
: 3 men with severe aphasia, a linguistic impairment, can understand 'grammatical'
rules in mathematics even though they cannot handle analogous rules in
language. Aphasia leaves people unable to use or comprehend words, and
is often triggered by stroke or other brain injuries. The discovery challenges
a commonly held view that linguistic and mathematical mental processing
draw on the same cognitive resources. According to the view of cognition
developed by linguist Noam Chomsky, language processing is a fundamental
skill that is used for related grammatical tasks in the brain, such as
certain mathematical ones. Previous studies of the relationship between
linguistic and mathematical ability have lent some support to this notion.
For example, brain-imaging studies have shown that some areas of the brain
involved in language processing also become active when people are performing
mathematical tasks. But it has been unclear whether this use of neural
language centres is essential for maths: there are also indications that
the two mental functions can work independently. All 3 of their patients
were aged between 50 and 60 and were well educated; one had been a university
professor before incurring a brain lesion. The 3 men were almost entirely
unable to communicate verbally or in writing, but they clearly retained
much of their higher mental functioning and could communicate, for example,
through "highly expressive" drawings. Their impairments left them unable
to decode the grammatical relationships of simple sentences. For example,
they had great difficulty distinguishing subject and object in the phrase
"The boy chased the girl," which they were unable to differentiate from
"The girl chased the boy." Analogous object-relation problems are posed
by mathematical expressions such as 90 ÷ 30 and 30 ÷ 90.
More complex expressions might involve problems of nesting, such as the
use of brackets (90 - [(3 + 17) x 3]), which mirror linguistic sub-clauses
and embedded relations, such as in the phrase "The man who killed the lion
was angry." Although the patients were unable to decode such linguistic
expressions, they were all able to perform the mathematical calculations
accurately with pen and paper. They could interpret Arabic numerals correctly
even though they struggled to understand number words such as 'three' or
'ninety', when spoken or written. It might be possible to use this capacity
for mathematical grammar to help the patients find a way to interpret speech
and the written word.
monophasia : aphasia with ability to utter but one word or phrase
paraphasia / paragrammatism / paraphemia / paraphrasia : a type
of dysphasia in which the patient employs wrong words or uses words in
wrong and senseless combinations
central paraphasia : that due to a brain lesion.
literal paraphasia / paralalia literalis : utterance of certain
consonant sounds, often as part of stuttering
thematic paraphasia : incoherent speech characterized by wandering
from the subject.
agrammatism / agrammatologia / dysgrammatism : inability to speak
grammatically because of brain
injuryor
disease, usually with simplified sentence structure (telegraphic speech)
and errors in tense, number, and gender
syntactical aphasia : a type of agrammatism in which some necessary
elements for coherent sentences are lacking.
acquired
epileptic aphasia / Landau-Kleffner syndrome (LKS) : an epileptic syndrome
in which children, usually 3-8 years of age who have developed age-appropriate
speech, experience language regression with verbal auditory agnosia, abnormal
epileptiform activity, behavioral disturbances, and sometimes overt partial
or generalized seizures, psychomotor abnormalities,
and aphasia progressing to mutism. The EEG from bilateral temporal regions
is abnormal, with spikes like those of benign
rolandic epilepsy.
Therapy : there are no controlled clinical
trials investigating the therapeutic options for LKS. Only open-label data
are available. Early diagnosis and initiation of prompt medical treatment
appear to be important to achieving better long-term prognosis. Several
antiepileptic drugs have been reported to be beneficial in treating this
syndrome. These include valproic acid, diazepam, ethosuximide, clobazam,
and clonazepam. Reports on the efficacy of lamotrigine, sultiame, felbamate,
nicardipine, vigabatrin, levetiracetam, vagal nerve stimulation, and a
ketogenic diet are few and more experience is needed. Carbamazepine and
possibly phenobarbital and phenytoin have been reported to occasionally
exacerbate the syndrome. As initial therapy, valproic acid or diazepam
is often empirically chosen. Subsequently, other antiepileptic drugs, corticosteroids,
or IVIG
therapy are often used. GR
agonists
therapy should probably not be delayed > 1-2 months after the initial diagnosis.
Various corticosteroid regimens including oral prednisone and, recently,
high doses of intravenous pulse corticosteroids, as well as ACTH
have been reported to be effective in LKS. Oral corticosteroids are used
more often and usually need to be maintained for a long period of time
to prevent relapses. The use of IVIG has been associated with an initial
dramatic response in only a few patients. In our experience, a long-term
worthwhile improvement has been noted in only 2 of 11 patients. These two
patients had an immediate response to IVIG initially and after relapses
before eventually achieving a long-term sustained remission.Surgical treatment
by multiple subpial transection, which is reserved for patients who have
not responded to multiple medical therapies, has been followed in selected
cases by a marked improvement in language skills and behavior. However,
a widely accepted consensus about suitable candidates for this surgery
and about its efficacy is still lacking. Speech therapy, including sign
language, and a number of classroom and behavioral interventions are helpful
in managing LKS, and should be used in all patientsref
anomic, amnesic, amnestic or nominal aphasia / aphasia nominnum / anomia
: defective recall of names of objects or words to verbalize his/her own
thought, with intact abilities of comprehension and repetition, due to
lesions of temporoparietooccipital carrefour. It is diagnosed when found
in > 20% of spontaneous speech
tactile aphasia : anomic aphasia characterized by inability to name
objects that are touched
acalculia : inability to do simple arithmetical
calculations
MRI
detects abnormal pulses of activity in the right intraparietal sulcus
Diagnosis is further complicated because many people simply dislike maths.
This might be due to mediocre teaching or low motivation
central aphasia : a term that has
been used as a synonym for various aphasias that involve disturbance in
word selection, grammar, and sentence structure apart from elementary auditory
or visual comprehension and the ability to write legible characters and
speak aloud. Many are presumed to be due to lesions of brain centers (motor
speech areas)
global, central, complete, expressive-receptive,
total or mixed aphasia : aphasia involving all the functions of spoken
or written language and comprehension, due to large lesions in speech areas
Broca's expressive, anterior, motor, frontocortical
or nonfluent aphasia / logaphasia : aphasia in which there is
impairment of the ability to speak (inertia, mutism) and write, owing to
a lesion in the insula and surrounding operculum, including Broca's motor
speech area. The patient understands many written and spoken words but
has difficulty uttering the words (loss of prosodia) => nosognosia
=> anger and depression. Often associated with manifest hemiplegia => the
patient is asked to write with the left hand as the right one is paretic.
Symptoms & signs : Dejerine-Lichtheim
sign or phenomenon : in some types of motor aphasia the patient cannot
speak but can indicate with fingers the number of syllables in a word being
thought of
Wernicke's receptive, impressive, posterior
or sensory aphasia : inability to understand written, spoken, or tactile
speech symbols, due to disease of the auditory and visual word centers.
The speech is began without difficulties and no motor deficiency is usually
associated.
acoustic or auditory aphasia / word deafness : a form of receptive
aphasia in which sounds are heard but convey no meaning to the person affected,
due to disease of the subcortical pathways leading to the main auditory
center of the brain, or disease of the center itself => hypo- or anosognosia
=> anger as he/she feels ununderstood
fluent aphasia: a type
of receptive aphasia in which speech is well articulated with satisfactory
melodic intonation, syllable stress, and phrasing but has gross errors
in grammatical structure and is lacking in content => "word salad"
(phonemic, verbal and semantic (within the same category) paraphasias,
neologisms)
semantic aphasia : aphasia characterized by a lack of recognition
of the full significance of words and phrases, or faulty use of words,
phrases, or sentences; words heard, seen, spoken, or written are misunderstood
or used incorrectly in place of other words in the same class.
associative, commissural or conduction
aphasia : a type of aphasia characterized by normal comprehension and
speech but inability to repeat words correctly; said to be caused
by lesions in the pathways connecting Broca's motor speech area and Wernicke's
area (arciform fasciculus)
transcortical aphasia : a type
of conduction aphasia believed to be caused by a lesion of a pathway between
the speech center and other cortical centers, but often reflecting large
lesions in brain areas other than the perisylvian region of the hemisphere
dominant for speech and language. The patient may repeat words (echolalia)
but cannot speak independently.
transcortical motor aphasia : due to lesions of anterior marginal
areas (premotor and prefrontal areas; secondary, marginal or accessory
areas). Symptoms are similar to those seen in Broca's aphasia (good comprehension
and reduced spontaneous speech), but repetition is impaired
transcortical fluent aphasia : due to lesions of posterior marginal
areas. Symptoms are similar to those seen in Wernicke's aphasia
conduite d'approche
phonemic
semantic
combined aphasia : aphasia of 2 or more forms occurring concomitantly
in the same person.
graphomotor aphasia / agraphia : impairment
or loss of the ability to write; it takes 2 forms, one involving poor morphology
of written letter forms and the other a reflection of the aphasia also
observed in spoken language
absolute or literal agraphia / agraphia atactica : loss of the power
to form even single letters.
acoustic agraphia : loss of the power of writing from dictation.
jargon agraphia / agraphia amnemonica : agraphia in which the patient
can write correctly formed letters but forms only senseless combinations
of letters or words.
cerebral or mental agraphia : agraphia due to inability to put thought
into phrases.
motor agraphia : inability to write because of lack of motor coordination.
musical agraphia : loss of the power to write musical symbols.
optic agraphia : inability to copy written or printed words, but
with ability to write from dictation.
verbal agraphia : ability to write single letters, with loss of
ability to combine them into words or sentences
dysgraphia : difficulty in writing
echographia / pseudoagraphia : a type of dysgraphia in which the
patient can copy writing, but cannot write to express ideas
micrographia : a dysgraphia in which
handwriting is tiny or decreases in size from normal to minute, seen in
parkinsonism
gibberish or jargon aphasia / jargonaphasia : utterance of meaningless
phrases, either neologisms or incoherently arranged known words; it is
sometimes a symptom of certain types of schizophrenia
bradylalia / bradylogia / bradyarthria / bradyphasia
: abnormally slow utterance of words due to a brain lesion or mental disorder
(e.g. parkinsonism)
Lichtheim test : if a patient is able to indicate the number of
syllables in a word which he cannot utter, it indicates that the cortex
is less involved than the association fibers.
Broadbent's test (for cerebral dominance of language function) :
different numbers (or words) are presented simultaneously to the 2 ears;
right-handed persons tend to report first the words going into the right
ear.
Liepmann's apraxia : loss of ability
to carry out familiar, purposeful movements in the absence of paralysis
or other motor or sensory impairment
akinetic apraxia : loss of ability to carry out spontaneous movement.
amnestic apraxia : loss of ability to carry out a movement on command
as a result of inability to remember the command, although ability to perform
the movement is present.
Cogan's congenital oculomotor apraxia : an absence or defect of
horizontal eye movements, so that when the patient tries to look at an
object off to one side, the head must turn to bring the eyes into line
with the object and the eyes exhibit nystagmus;
the cause is probably a brain lesion
constructional apraxia : a
type of deficit in motor skills characterized by lack of ability to copy
simple drawings or to reproduce patterns created with building blocks or
matchsticks.
dressing apraxia : inability to dress oneself properly, often on
just one side, as a result of a lesion in the parietal lobe, usually on
the nondominant side
buccofacial or facial apraxia : apraxia of the facial muscles with
inability to carry out movements for expression, articulation, and other
functions; caused by a lesion in either the supramarginal gyrus or the
motor association area on the dominant side. It may be associated with
ideokinetic apraxia
classic, ideokinetic, ideomotor or transcortical apraxia / apraxia
: inability to carry out movements that are part of normal activities when
requested, in imitation of a demonstration, or even when the person spontaneously
wishes to do them. The name is derived from the older concept that ideas
were not linked to movements
innervatory or motor apraxia : impairment of skilled movements that
is greater than or different in form from that caused by weakness of the
affected parts; the patient appears clumsy rather than weak
sensory or ideational apraxia : loss of ability to make proper use
of an object, due to lack of perception of its proper nature and purpose
or to gross disorganization of a plan of usage
apraxia of speech / aphemia : a speech disorder similar to motor
aphasia, due to apraxia of mouth and neck muscles because of a lesion
interfering with coordination of impulses from Broca's motor speech area
hemiapraxia : apraxia affecting one side
of the body only.
sensory or unilateral neglect / selective
inattention : hemiapraxia with failure to pay attention to bodily grooming
and stimuli on one side but not on the other, usually due to a lesion in
the CNS, as after a stroke
agnosia / pragmatagnosia :
pragmatamnesia / visual agnosia :
dysmnesia : properly said memory disorders,
impaired memory, as in the amnestic syndrome
quantitative disorders
hypermnesia : extreme retentiveness or
unusual clarity of memory
According to chronological succession of memories :
global amnesia
transient global amnesia
: an episode of short-term memory loss, usually nonrecurrent, and lasting
a few hours, without other signs or symptoms of neurological impairment;
the cause is usually unknown but may occasionally be an ischemic
or epileptic
attack. The patient is irrequiet and continuously repeats the same questions.
lacunar or localized amnesia : partial loss of memory; amnesia for
certain isolated experiences.
anterograde or fixation amnesia :
impairment of memory for events occurring after the onset of amnesia; inability
to form new memories
retrograde or reevocation amnesia
: inability to recall events that occurred before the actual onset of
amnesia; loss of memories of past events
retroanterograde amnesia
According to kinds to impaired memories :
simple amnesia : all kined of memories are impaired
systematic or selective amnesia : loss of memory for a group of
related events but not for other events occurring during the same period
of time.
episodic amnesia : amnesia for a particular episode or a small area
of experience.
Aetiology :
infantile amnesia : the usual inability to recall the events of
infancy and early childhood.
neurological amnesia : that caused by disease of or injury to the
nervous system.
post-traumatic or traumatic amnesia : amnesia resulting from concussion
or other brain injury
postconcussional amnesia : amnesia resulting from a concussion of
the brain.
posthypnotic amnesia : a directed forgetfulness of the subject for
experiences undergone while in the hypnotic state.
amnesic, amnestic-confabulatory or dysmnesic
syndrome : a mental disorder characterized by impaired memory with
anterograde
amnesia and sometimes retrograde amnesia
in a normal state of consciousness; i.e., the syndrome does not include
the impaired memory seen in dementia
or delirium.
There may be disorientation, confabulation, and lack of insight into the
memory deficit
any pathological process causing bilateral damage to parts of the medial
temporal lobe or diencephalon, such as the hippocampal formations, mammillary
bodies, or dorsal medial nuclei of the thalamus
bradyphrenia / bradyphrasia / mental insufficiency : stable
slowness of thought or fatigability of initiative, resulting from depression
or CNS disease
axis II : behavioural, polytethic diagnosis
(only some criteria have to be fulfilled => many false positives => repetibility
= 50%) : personality disorders, mental
retardation
problem related with interaction with legal system or criminality
other psychosocial or environmental problems
axis V : global assessment of functioning
(GAF) scale : a rating of psychiatric status from 1 (lowest level of
functioning) to 100 (highest level), assessing psychological, social, and
occupational functioning; widely used in studies of treatment effectiveness
(actual, at admission, at dimission, higher level in last year)
Social and Occupational Functioning Assessment Scale (SOFAS) : one
that describes the level of an individual's social and occupational functioning,
either present or past; unlike the GAF scale, it is not directly influenced
by the severity of the individual's psychological symptoms
disorders usually diagnosed for the first time in infancy, childhood,
or adolescence / developmental
disorders : a former classification of chronic disorders of mental
development with onset in childhood; such disorders are now classified
as ...
mental retardation : a mental disorder
characterized by significantly subaverage general intellectual functioning
associated with impairments in adaptive behavior and manifested before
age 18. It is classified on the basis of severity as ..
borderline mental retardation
: borderline intellectual functioning, that in which IQ is between 70 and
89.
mild mental retardation :
that in which IQ is between 50–55 and 69; the person can develop social
and communication skills during the preschool period, has minimal sensorimotor
impairment, by the late teens can acquire academic skills up to the sixth
grade level, and usually achieves social and vocational skills adequate
for minimal self-support.
moron : obsolete, offensive term for a person with mild mental retardation
imbecile : obsolete and offensive name for a person with an intermediate
level of mental retardation, now split into...
moderate mental retardation
: that in which IQ is between 35–40 and 49–55; the person may talk or learn
to communicate but has poor social awareness and only fair motor development,
is unlikely to progress to the second grade level in academic skills, but
can profit from vocational training and with moderate supervision can perform
personal care.
severe mental retardation :
that in which IQ is between 20–25 and 34–40; the person has poor motor
development and minimal speech in the preschool period, may learn to talk
by the late teens, can be trained in elementary hygiene skills, and as
an adult may learn to perform simple work under close supervision.
idiot savant [Fr. “learned idiot”] :
a person with severe mental retardation
in some respects, yet has a particular mental faculty that is developed
to an unusually high degree, as memory, mathematics, or music.
profound mental retardation
: that in which IQ is < 20–25; the person has limited sensorimotor development,
may achieve very limited self-care, and requires a highly structured environment
with constant supervision.
idiot : obsolete, offensive name for a person with profound mental
retardation
mongolian idiot : former name for a person affected with Down
syndrome;
now considered offensive
Aetiology : mutations in the gene polyglutamine
binding protein 1 (NPQBP1)
Symptoms & signs : in affected males
include mental retardation, microcephaly, short stature, spastic paraplegia
and midline defects.
Laboratory examinations : Denver Developmental
Screening test : a test for identification of infants and preschool
children with developmental delay.
Differential diagnosis :
learning disorders : a group of
disorders characterized by academic functioning that is substantially below
the level expected on the basis of the patient's age, intelligence, and
education, interfering with academic achievement or other functioning.
Included are :
reading disorder : a learning disorder in which the skill affected
is reading ability, including accuracy, speed, and comprehension
mathematics disorder : a learning disorder in which the skill affected
is mathematical calculation or reasoning.
disorder of written expression
:
a learning disorder in which the affected skill is written communication,
characterized by errors in spelling, grammar, or punctuation, by poor paragraph
organization, or by poor story composition or thematic development.
motor skills disorder : any
disorder characterized by inadequate development of motor coordination
severe enough to limit locomotion or restrict the ability to perform tasks,
schoolwork, or other activities. Included is
developmental coordination
disorder : problematic or delayed development of gross and fine motor
coordination skills, not due to a neurological disorder or to general mental
retardation; affected children appear to be clumsy rather than grossly
impaired. It may persist into adulthood.
Differential diagnosis :
specific neurological disorder (e.g. cerebral palsy, progressive cerebellar
lesions)
communication disorders :
mental disorders characterized by difficulties in speech or language, severe
enough to be a problem academically, occupationally, or socially; included
are
expressive language disorder
: a communication disorder occurring in children and characterized by problems
with the expression of language, either oral or signed. It includes difficulties
such as limited speech or vocabulary, vocabulary errors, difficulty or
hesitation in word selection, oversimplification of grammatical or sentence
structure, omission of parts of sentences, unusual word order, and slowed
acquisition of language skills. Two types are recognized, acquired and
developmental.
acquired aphasia associated with general medical condition
mixed receptive-expressive
language disorder : a communication disorder involving both the expression
and the comprehension of language, either spoken or signed. Patients have
difficulties with language production, such as in the selection of words
and the creation of appropriate sentences, and also have trouble understanding
words, sentences, or specific types of words
acquired aphasia associated with general medical condition
phonological disorder : a communication disorder of unknown etiology,
characterized by failure to use age- and dialect-appropriate sounds in
speaking, with errors occurring in the selection, production, or articulation
of sounds. The most common errors are omissions, substitutions, and distortions
of speech sounds
Epidemiology : 5% of people in the USA
at some time in their lives. Stuttering usually begins in the preschool
years, and there is a higher incidence in males. Stuttering usually starts
in the third and fourth years of life, after a period of apparently normal
speech development. Around 5% of children begin to stutter (Bloodstein
O. A handbook on stuttering. San Diego, CA: Singular Publishing Group,
1995). Although the recovery rate without professional intervention is
74%ref,
the natural recovery rate of cases presenting to clinics has not been researched.
To date, sex and family history of recovery are the major identified predictors
of natural recovery. Girls are more likely to recover than boys, and children
with a family history of recovery are more likely to recover than those
without such a history. Natural recovery does not seem to be related to
severity of stutteringref.
Aetiology : a complex interaction among
many factors, including genetic, language, motor and emotional. These findings
will help reduce the stigma – such as the myth that the disorder is the
result of poor parenting or a psychological problem – often associated
with stuttering
Pathogenesis : adults who stutter often
have great language skills, meaning they don't have problems with rules
of grammar or with the sounds we use to code the words of our language.
When they speak, however, their motor output falters, so they pause or
trip over words. The study of their brain activity when they were not stuttering
and, in fact, when they were not having to engage their speech motor systems
shows that individuals who stutter are using right hemisphere brain areas
to a greater extent to accomplish the rhyming tasks than those who don't
stutterref Symptoms & signs : a speech disorder
involving 3 factors:
dysfluency with repetition of words and parts of words, prolongations of
sounds, interjections of sounds or words, and long pauses
listener reaction, considering the dysfluency to be abnormal or unacceptable
the speaker's reaction to the dysfluency and to the listener's reaction,
with a self-conception as a stutterer.
Differential diagnosis :
auditory or other sensory deficit
word motory deficit
normal fluency anomalies that often occur in little babies
Therapy : the consensus now is that stuttering
should be treated in the preschool years, primarily because it becomes
less tractable as children get older. This is presumably because neural
plasticity decreases with age. Also, it is not possible to know in advance
whether an individual child will recover naturally. Early intervention
in the preschool years is therefore essential. Once stuttering becomes
chronic, communication can be severely impaired, with devastating social,
emotional, educational, and vocational effectsref1,
ref2.
Several treatments for early stuttering are currently available (Onslow
M, Packman A, eds. The handbook of early stuttering intervention. San Diego,
CA: Singular Publishing Group, 1999), but only one, the Lidcombe programme,
has been studied with phase I and II clinical trials (Onslow M, Packman
A, Harrison E, eds. The Lidcombe program of early stuttering intervention:
a clinician's guide. Austin, TX: Pro-Ed, 2003). This programme is a behavioural
treatment developed specifically for stuttering in children of preschool
age (younger than 6). Considerable research into the programme has been
conducted. Preliminary studies have produced positive outcomes, and stuttering
has been shown to be no longer present, or remaining at very low levels,
two to seven years after treatmentref1,
ref2,
ref3
(Lincoln M, Onslow M. Long-term outcome of an early intervention for stuttering.
Am J Speech-Language Pathol 1997;6: 51-8). The social validity and safety
of the programme have been shown (Lincoln M, Onslow M, Reed V. Social validity
of an early intervention for stuttering; the Lidcombe program. Am J Speech-Lang
Pathol 1997;6: 77-84). It does not seem to change children's behaviour
other than speech or affect the attachment of children and parents or use
of languageref1,
ref2.
Duration of treatment and its predictors have been investigated in two
independent file audits of preschool children attending specialist clinics,
one in Australiaref
and one in the United Kingdomref.
Outcomes of the Lidcombe programme have consistently been shown to be positiveref1,
ref2,
ref3,
ref4,
ref5,
ref6,
ref7
(Lincoln M, Onslow M. Long-term outcome of an early intervention for stuttering.
Am J Speech-Language Pathol 1997;6: 51-8; Lincoln M, Onslow M, Reed V.
Social validity of an early intervention for stuttering; the Lidcombe program.
Am J Speech-Lang Pathol 1997;6: 77-84) even in a randomised controlled
trialref.
Waiting for an extended period to see if natural recovery occurs is not
acceptable because it seems that the Lidcombe programme is less efficacious
once children move into the school age years (Lincoln M, Onslow M, Wilson
L, Lewis C. A clinical trial of an operant treatment for school-age stuttering
children. Am J Speech-Lang Pathol 1996;5: 73-85). In addition, delaying
treatment until the school age years is not a viable option because of
the negative social and cognitive consequences of stuttering at this ageref.
If the disorder persists into the school age years a child is exposed to
the unacceptable risk of experiencing the disabling effects of chronic
and intractable stuttering throughout life.
stammering : a speech disorder marked by
involuntary pauses; sometimes used synonymously with stuttering, especially
in Great Britain.
communication
disorder-not otherwise specified (NOS)
rhotacism / pararhotacism : a speech disorder
consisting of imperfect pronunciation of the r sound
pervasive developmental
disorders (PDD) / autistic spectrum disorders (ASD) : a group of disorders
characterized by impairment of development in multiple areas, including
the acquisition of reciprocal
social interaction, verbal and nonverbal
communication
skills (e.g declarative pointing, gaze monitoring, gaze escape, mimicking),
and imaginative activity and by stereotyped interests and behaviors
Epidemiology : prevalence = 4-5 cases
every 1,000 people
autism / autistic disorder / infantile autism /
Kanner's syndrome : a severe pervasive developmental disorder with
onset
usually before 3 years of age and a biological basis related to neurologic
or neurophysiologic factors
autistic thinking / autism : self-absorption; preoccupation with
inner thoughts, drives, and idiosyncratic logic; egocentric, subjective
thinking lacking objectivity and preferring a narcissistic, inner, private
reality to that which is externally validated. Used interchangeably with
dereistic thinking, although differing in emphasis
dereistic thinking / dereism : thinking not in accordance with the
facts of reality and experience and following illogical, idiosyncratic
reasoning. Used interchangeably with autistic thinking, although not an
exact synonym: dereistic emphasizes disconnection from reality and autistic
emphasizes preoccupation with inner experience.
Epidemiology : frequency of the disorder increased
from approximately 2.5 cases every 10,000 in 1960-1970s to 1 every 1,000
children in 1990s, with a male to female ratio of 4:1.
Aetiology :
genetic predispositionref
to autism is evident from family (frequency of autism among siblings of
probands with autism = 2-4% (RR = 20-60)) and monozygotic twin (high concordance)
studies, and heritability in idiopathic autism is estimated at over 90%.
Family studies and several genome-wide linkage analyses support the hypothesis
of complex inheritance with involvement of as many as 5-10 genes of moderate
effect. All chromosomes except 14 have at least 1 patient with autism associted
with them : mendelian, double hit, trinucleotide repeats, mtDNA, or polygenic
inheritance has been proposed. There is an autism susceptibility gene on
chromosome 1 and further on chromosomes 6 and 19. 33% of autistic individuals
experience seizures. A susceptibility locus for autism was mapped near
a cluster of voltage-gated sodium channel genes on chromosome 2. Mutations
in 2 of these genes, SCN1A
and SCN2A,
result in the seizure disorder GEFS+. The variant R1902C in SCN2A is located
in the calmodulin binding site and was found to reduce binding affinity
for calcium-bound calmodulin. R542Q in SCN1A was observed in one autism
family and had previously been identified in a patient with juvenile myoclonic
epilepsy
endocrine
infectious
some cases of late-onset (regressive) autism may involve abnormal flora
because oral vancomycin,
which is poorly absorbed, may lead to significant improvement in these
children. Fecal flora of children with regressive autism was compared with
that of control children, and clostridial counts were higher. The number
of clostridial species found in the stools of children with autism was
greater than in the stools of control children. Children with autism had
9 Clostridium spp.
not found in controls, whereas controls yielded only 3 species not found
in children with autism. In all, there were 25 different clostridial species
found. In gastric and duodenal specimens, the most striking finding was
total absence of non-spore-forming anaerobes and microaerophilic bacteria
from control children and significant numbers of such bacteria from children
with autism. These studies demonstrate significant alterations in the upper
and lower intestinal flora of children with late-onset autism and may provide
insights into the nature of this disorderref
subacute, chronic Clostridium
tetani
infection of the intestinal tract as the underlying cause for symptoms
of autism observed in some individuals. A significant percentage of individuals
with autism have a history of extensive antibiotic use. Oral antibiotics
significantly disrupt protective intestinal microbiota, creating a favorable
environment for colonization by opportunistic pathogens. C. tetani
is an ubiquitous anaerobic bacillus that produces a potent neurotoxin.
Intestinal colonization by C. tetani, and subsequent neurotoxin
release, have been demonstrated in laboratory animals which were fed vegetative
cells. The vagus nerve is capable of transporting tetanus neurotoxin (TeNT)
and provides a route of ascent from the intestinal tract to the CNS. This
route bypasses TeNT's normal preferential binding sites in the spinal cord,
and therefore the symptoms of a typical tetanus infection are not evident.
Once in the brain, TeNT disrupts the release of neurotransmitters by the
proteolytic cleavage of synaptobrevin, a synaptic vesicle membrane protein.
This inhibition of neurotransmitter release would explain a wide variety
of behavioral deficits apparent in autism. Lab animals injected in the
brain with TeNT have exhibited many of these behaviors. Some children with
autism have also shown a significant reduction in stereotyped behaviors
when treated with antimicrobials effective against intestinal clostridia.
When viewed as sequelae to a subacute, chronic tetanus infection, many
of the puzzling abnormalities of autism have a logical basisref.
toxic :
attenuated measles
vaccine
(expecially in measles-mumps-rubella
(MMR) vaccine).
The UK government has been accused of blocking imports of measles and mumps
vaccines, sending prices soaring to force parents into using the controversial
measles, mumps, rubella (MMR) triple jab. Doctors in Edinburgh, Glasgow
and London are now charging more than £100 for a single measles or
mumps vaccine because it is increasingly difficult to get them in the UK.
In recent months, the government has cut supplies further, restricting
them to only 25 doses per day.
Pathogenesis : mirror neurons are brain cells
in the premotor cortex. First identified in macaque monkeys in the early
1990s, the neurons -- also known as "monkey-see, monkey-do cells" -- fire
both when a monkey performs an action itself and when it observes another
living creature perform that same action. Though it has been impossible
to directly study the analogue of these neurons in people (since human
subjects cannot be implanted with electrodes), several indirect brain-imaging
measures, including EEG, have confirmed the presence of a mirror neuron
system in humans. The human mirror neuron system is now thought to be involved
not only in the execution and observation of movement, but also in higher
cognitive processes -- language, for instance, or being able to imitate
and learn from others' actions, or decode their intentions and empathize
with their pain. Suppression of m rhythm (8–13
Hz) over sensorimotor cortex correlates with mirror neuron activity and
is defective in subjects with autism spectrum disorders : one therapeutic
possibility suggested by the study's findings is biofeedback. Another possible
therapy would involve ordinary mirrorsref Symptoms & signs : affected individuals
look normal at birth, and the symptoms manifest at the first 2-3 years
of life (median : 13.8 months), with medical diagnosis at median 2.7-6.8
years (differential diagnosis with mental
retardation or language disorders is stable if done before age 2, sure
since month 18). The spectrum of clinical symptoms and the severity of
the disorder are variable even among siblings. Qualitative impairment in
reciprocal social interaction (e.g., lack of awareness of the existence
of feelings of others, failure to seek comfort at times of distress, lack
of imitation), in verbal and nonverbal communication, and in capacity for
symbolic play, and by restricted and unusual repertoire of activities and
interests. Other characteristics sometimes include cognitive impairment
(> 66% have some degree of mental retardation), hyper- or hyporeactivity
to certain stimuli, stereotypic behaviors, neurological abnormalities such
as seizures or altered muscle tone, sleeping or eating pattern abnormalities,
and severe behavioral problems. As adults they develop OCD and mental
retardation (higher functioning PDD : high IQ in adulthood).
Laboratory examinations : several screening
instruments have been developed to quickly gather information about a child's
social and communicative development within medical settings. Among them
are
modified Checklist for Autism in Toddlers (M-CHAT)
Screening Tool for Autism in Two-Year-Olds (STAT)ref
Social Communication Questionnaire (SCQ)ref
(for children 4 years of age and older).
Some screening instruments rely solely on parent responses to a questionnaire,
and some rely on a combination of parent report and observation. Key items
on these instruments that appear to differentiate children with autism
from other groups before the age of 2 include pointing and pretend play.
Screening instruments do not provide individual diagnosis but serve to
assess the need for referral for possible diagnosis of ASD. These screening
methods may not identify children with mild ASD, such as those with high-functioning
autism or Asperger syndrome.
Differential diagnosis :
Epidemiology : 1:10,000 individuals, occurring
exclusively in females and present from birth
Aetiology : dominant mutations in the
MECP2
gene, a X-linked transcriptional repressor, or its controlled genes, including
BDNF
or UQCRC1.
A severe early-onset Rett phenotype that often includes seizures or infantile
spasms can be caused by mutation in the CDKL5
gene
Pathogenesis : the timing of the period
of regression in RTT--during ages 1 to 2 years--parallels the period of
intense synaptic development. The effects of the MECP2 mutation also increases
concomitantly with peak synaptogenesis. Neuropathological findings in Rett
include the selective reduction of dendritric spines in the pyramidal cells
of RTT brains; this feature has also been reported in autism. Studies have
observed that MECP influences the expression of brain-derived neurotrophic
factor and thus may influence synaptic plasticity. Abnormalities in synapse
maintenance and modulation may contribute to regression in RTT and autism.
A recent study observed abnormal expression of MeCP2 in RTT and other neurodevelopmental
disorders such as autism. Although the genetic background and certain clinical
features differ in RTT and autism, a similar mechanism involving MeCP2
regulation and expression may contribute to regressionref.
Symptoms & signs : progressive and
is characterized by autistic behavior (but a preserved speech variant exists),
ataxia, dementia, seizures, and loss of purposeful
use of the hands, with cerebral atrophy, mild hyperammonemia, and decreased
levels of biogenic amines. During the regression stage, RTT girls display
many autistic features, such as loss of communication and social skills,
poor eye contact, and lack of interest, and initially may be given the
diagnosis of autism.
Differential diagnosis :
Experimental animal models : the phenotype
of one mouse model includes features such as regression and abnormal behavioral
and social interactions.
childhood disintegrative
disorder : pervasive developmental disorder characterized by marked
regression in a variety of skills, including language, social skills or
adaptive behavior, play, bowel or bladder control, and motor skills, after
at least 2, but less than 10, years of apparently normal development.
Asperger's syndrome : a pervasive
developmental disorder resembling autistic disorder,
being characterized by severe impairment of social interactions and by
restricted interests and behaviors, but lacking the delays in development
of language, cognitive function, and self-help skills that additionally
define autistic disorder. It may be equivalent to a high-functioning form
of autistic disorder.
Laboratory examinations : during the last
few years, screening instruments have been devised to screen for Asperger
syndrome and higher functioning autism. The Autism Spectrum Screening Questionnaire
(ASSQ)ref,
the Australian Scale for Asperger's Syndromeref,
and the most recent, the Childhood Asperger Syndrome Test (CAST)ref,
are some of the instruments that are reliable for identification of school-age
children with Asperger syndrome or higher functioning autism. These tools
concentrate on social and behavioral impairments in children without significant
language delay.
Differential diagnosis :
silent-treatment : a temporary act
of teenage rebellion, usually the result of being confronted by a parent;
extended silence used to avoid discussion about a drug or drinking problem
attention-deficit
/ hyperactivity disorder (ADHD) / hyperkinetic disorder (HKD) or syndrome
:
a childhood mental disorder
Epidemiology : prevalence = 3% to 10%
of the pediatric population. Datamonitor estimates that 23 million children
and adolescents across the 7 major pharmaceutical markets suffer from ADHD,
a physician perceived prevalence rate of about 15%. However currently only
12% of those, or only 1.8% of children in the total population, are actually
correctly diagnosed with ADHD. Despite the availability of numerous longer-acting
therapies, currently only 20% of newly diagnosed patients receive such
drugs as a first-line treatment, falling to 3% at second-line.
Pathogenesis : the number and density
of DATs and DAT binding sites are increased by up to 70 %
Symptoms & signs : inattention (such
as distractibility, forgetfulness, not finishing tasks, and not appearing
to listen), by hyperactivity and impulsivity (such as fidgeting and squirming,
difficulty in remaining seated, excessive running or climbing, feelings
of restlessness, difficulty awaiting one's turn, interrupting others, and
excessive talking) or by both types of behavior. The disorder is subtyped
as
combined type
predominantly inattentive type (attention-deficit
disorder (ADD))
predominantly hyperactive-impulsive type
Behavior must interfere with academic, social, or work functioning, with
impairment existing in at least two settings. Onset is before age 7 but
it can persist into adulthood.
Differential diagnosis :
stimulants, which, because of their addictive properties and potential
for abuse, are controlled substances. The 14-month, controlled Multimodal
Treatment Study of Children with Attention Deficit–Hyperactivity Disorder
(MTA study), sponsored by the National Institute of Mental Health, revealed
a high rate of response to stimulants (> 70%) and large effect sizes (0.6
to 1.2 standard deviations), with significantly lower rates of improvement
for subjects who underwent psychotherapyref1,
ref2,
ref3.
Although these drugs are the mainstay of treatment for ADHD, nearly one
third of patients may not respond to or be able to tolerate them. The FDA
advisory committee heard testimony indicating that 2.5 million children
now take stimulants for ADHD, including nearly 10% of all 10-year-old boys
in the USAref.
The committee also learned that the use of these agents is much less prevalent
in European countries, where the diagnosis of ADHD is relatively uncommon.
Even more strikingly, 1.5 million adults now take such stimulants on a
daily basis, with 10% of users older than 50 years of age. The diagnosis
of
"adult" ADHD is a relatively recent phenomenon and has resulted in the
most rapid growth in the use of such agentsref.
The vast increase in the diagnosis of ADHD and the frequency of treatment
for the condition in children is, unfortunately, no longer a phenomenon
specific to the United States. According to the latest Drug Prescription
Report (Schwabe U, Paffrath D. Arzneiverordnungsreport 2005. Berlin: Springer-Verlag,
2005), the number of daily doses of methylphenidate that are prescribed
in Germany has reached 26 million per year. Although the population-adjusted
volume in the USA is still 8 to 10 times that amount, the number of prescriptions
for the drug for German children rose by a factor of 20 during the past
10 years, with no signs of abating. The use of methylphenidate by adults
is similarly on the rise.
amphetamines :
d-threo-methylphenidate (d-MPH)
(a dopamine agonist that blocks DAT,
significantly increasing extra cellular dopamine, so correcting the dopamine
deficiency in the frontal lobes and basal ganglia (expecially the striatum)
structures, regions associated with attention and behaviouri. This is strikingly
similar to the mechanism of action of cocaine, a primary stimulant drug
of abuse. When administered intravenously, MPH like cocaine has reinforcing
effects (euphoria) at doses that exceed a DAT blockade threshold of 60%
(therapeutic doses of MPH block > 50% of DAT). When administered orally
at clinical doses, the pharmacological effects of MPH also exceed this
threshold, but reinforcing effects rarely occur). ADHD is a controversial
problem in sport since participants with this disorder often require banned
stimulant medication while competing.
disruptive behavior disorders
: a group of mental disorders of children and adolescents consisting of
behavior that violates social norms, is disruptive, and may be illegal,
often distressing others more than it does the person with the disorder.
It includes :
conduct disorder : a type of disruptive
behavior disorder of childhood and adolescence characterized by a persistent
pattern of conduct in which rights of others or age-appropriate societal
norms or rules are violated, with misconduct including aggression to people
or animals, destruction of property, deceitfulness or theft, and serious
violations of rules; depending on whether the behavior begins before or
after the age of 10, it is classified as
oppositional defiant disorder
:
a type of disruptive behavior disorder characterized by a recurrent pattern
of defiant, hostile, disobedient, and negativistic behavior directed toward
those in authority, including such actions as defying the requests or rules
of adults, deliberately annoying others, arguing, spitefulness, and vindictiveness
that occur much more frequently than would be expected on the basis of
age and developmental stage
feeding and eating disorders of infancy
or early childhood : any of several disorders in which abnormal feeding
habits are associated with psychological factors
bradyphagia : abnormal slowness in eating.
monophagia : desire for one kind of food only
pica : compulsive eating of nonnutritive
substances, such as
bone (osteophagia) due to a craving for phosphorus.
dung, or feces (coprophagy)
In children this syndrome, classified with the eating disorders in DSM-IV,
is a rare mental disorder with onset typically in the second year of life;
it usually remits in childhood but may persist into adolescence.
Aetiology :
pica and unusual food cravings (citta) are sometimes seen in pregnant
women
Kleine-Levin syndrome : episodic
periods of excessive sleep and overeating lasting for several weeks, with
amnesia for the attacks; it usually occurs in adolescent boys.
rumination disorder : an eating
disorder seen in infants under 1 year of age; after a period of
normal eating habits, the child begins excessive regurgitation and rechewing
of food, which is then ejected from the mouth or reswallowed
Prognosis : if untreated, death from malnutrition
may occur.
Differential diagnosis :
feeding
disorder of infancy or early childhood : loss of weight increase for
> 1 month in absence of gastrointestinal or other general medical condition
(e.g. gastroesophageal
reflux disease (GERD))
severe enough to explain the feeding anomaly and not attributable to other
mental disorder (e.g. rumination disorder)
or lack of available food.
selective mutism : a mental disorder
of childhood characterized by continuous refusal to speak in social situations
by a child who is able and willing to speak to selected persons.
nyctaphonia : elective mutism with loss of voice during the night.
reactive attachment disorder : a mental disorder of infancy or early
childhood, characterized by notably unusual and developmentally inappropriate
social relatedness, usually associated with grossly pathological care.
It may be :
inhibited type, with failure to initiate or respond to social interactions
disinhibited type, with indiscriminate sociability or attachment.
stereotypic movement disorder
: a mental disorder characterized by repetitive nonfunctional motor behavior,
such as hand waving, rocking, head-banging, or self-biting, which often
appears to be driven and can result in serious self-inflicted injuries
involuntary movements associated with neurological conditions
behaviours of self-stimulation appropriated to little babies developmental
stage (e.g. thumb suction, head hurting, ...)
behaviours of self-stimulation in subjects with sensory deficiencies (e.g.
blindness)
infancy, childhood, or adolescence disorder-not otherwise specified
(NOS)
delirium, dementia, amnestic disorders, and other cognitive disorders
delirium / acute (organic) brain syndrome
: an acute, transient disturbance of consciousness accompanied by
a change in cognition and having a fluctuating course. Characteristics
include reduced ability to maintain attention to external stimuli and disorganized
thinking as manifested by rambling, irrelevant, or incoherent speech; there
may also be a reduced level of consciousness, sensory misperceptions, disturbance
of the sleep-wake cycle and level of psychomotor activity, disorientation
to time, place, or person, and memory impairment.
Aetiology : conditions that result in
derangement of cerebral metabolism, including
postcardiotomy delirium / postcardiotomy
psychosis syndrome : anxiety,
confusion, and perceptual disturbances occurring > 3 days after open heart
surgery.
senile delirium : a form of senile
dementia, usually of acute onset and characterized by disorientation,
restlessness, insomnia, hallucinations,
and aimless wandering.
traumatic delirium : that which
follows severe head injury; superficially the patient is alert, but there
is marked disorientation, memory defect, and confabulation.
dementia : literally out of mind, loss of
self, i.e. a general acquired loss of intellectual and cognitive abilities,
including impairment of memory
as well as one or more of other abilities in subjects that have reached
normality (on the contrary of mental
retardation).
Epidemiology : 24.3 million people have
dementia today, with 4.6 million new cases of dementia every year (one
new case every 7 seconds). The number of people affected will double every
20 years to 81.1 million by 2040. Most people with dementia live in developing
countries (60% in 2001, rising to 71% by 2040). Rates of increase are not
uniform; numbers in developed countries are forecast to increase by 100%
between 2001 and 2040, but by more than 300% in India, China, and their
south Asian and western Pacific neighboursref.
Aetiology :
primary or degenerative dementias
cortical dementias
dementia of the Alzheimer
type (DAT) / Alzheimer-type dementia (ATD) (43.6-60% of all dementias)
: that occurring in Alzheimer's
disease,
being of insidious onset and gradually progressive course, with histopathological
changes characteristic of Alzheimer's disease and not due to other CNS,
systemic, or substance-induced conditions known to cause dementia. It is
subcategorized on the basis of accompanying features, including
Patients lose their ability to encode new memories, first of trivial and
then of important details of life => both declarative and nondeclarative
memory become profoundly impaired, and the capacities for reasoning, abstraction,
and language slip away.
presenile dementia / dementia of the
Alzheimer type, early onset : occurring before age 65
senile dementia / dementia of the Alzheimer
type, late onset : occurring after age 65
frontotemporal dementias
(FTD) (10%; higher in presenile cases, i.e. < 65 years) : due to
atrophy of frontal and eventually also temporal lobes
Pick disease / circumscribed cerebral atrophy
: a rare progressive degenerative disease of the brain very similar in
clinical manifestations and course to Alzheimer's
disease
but having a distinctive histopathology; cortical atrophy is symmetric
> asymmetric and is confined to the frontal and/or temporal lobes and
sometimes may involve the basal nuclei
Epidemiology : onset at age 40-60
Laboratory examinations : balloon degenerating
neurons contain Pick bodies
autosomal dominant frontotemporal dementia (FTD) linked to chromosome
3 (FTD3)
Aetiology : a mutation in CHMP2B, encoding
a component of the endosomal ESCRTIII complex, that results in aberrant
mRNA splicingref
Symptoms & signs : behavioural and appetite
disinhibition, emotive flattening, irritability, bulimia, weight gain,
preserved memory, copying, calculation, memory, socially inadequate behaviours
or isolation => rigidity and mutism (aphasia, echolalia),
impaired judgements and propriety sense, generally euphoric, hypocritical,
logorrheic, agitated, and with primitive reflexes.
primary progressive (nonfluent)
aphasia (PPA) : the primary symptoms of the disease are problems
speaking or understanding speech, and these problems gradually get worse
over time. People with PPA also may develop difficulty with math. Most
other functions remain normal for at least two years after the language
symptoms appear, but the disease may eventually cause other changes, such
as problems with memory, reasoning, and spatial abilities. PPA sometimes
runs in families : 85% of cases have PRNP codon 129 heterozigosityref
subcortical dementias :
diffuse Lewy
body
dementia (DLBD) (15.4%, the second most common degenerative dementia;
DLBD is diagnosed only when they are not associated with Alzheimer's
disease
or idiopathic Parkinson's
disease)
is a neuropathological entity, characterized by abundant LBs not only in
the basal ganglia and brain-stem but in the cerebral cortex, combined with
senile changes. Juvenile onset DLBD is called pure form of DLBD
because of no or few senile changes. The LBs are present in the amygdala,
nucleus basalis of Meynert, hypothalamic nuclei, substantia nigra, nucleus
paranigralis, locus caeruleus, dorsal vagal nucleus and reticular nuclei.
The cerebral LBs are numerous in the parahippocampal gyrus, cingular gyrus,
and insular, frontal and temporal cortices. The LBs show immunoreactivity
to ubiquitin and the ubiquitin-immunoreactive neurites in the CA2-3 region
appear to be specific for DLBD. The clinical features of DLBD in the senium
are progressive dementia, psychotic state (delirium,
visual > auditory hallucinations), falls,
potentially
fatal hazard of neuroleptics and benzodiazepines,
parkinsonism and autonomic signs. In general, progressive dementia is an
initial symptom, followed by parkinsonism in the later stage. Some show
progressive autonomic failure. A few present respiratory failure or vocal
cord palsy resulting in sudden death in DLBD. DLBD is characterized neurochemically
by severe affection of multiple neurotransmitters networks. In DLBD an
impairment of the innominato-cortical cholinergic and mesocortical dopaminergic
system, differentiating from Alzheimer's
disease
and idiopathic Parkinson's
disease,
may play an important role in developing disease process
idiopathic Parkinson's
disease.
It is estimated that dementia occurs in approximately 40% of people with
PD and that it may affect up to 80% of PD patients as the disease further
progresses. Previous studies suggest that patients with PD have up to a
6-fold increase in the risk of developing dementia compared to elderly
patients without PD
Pathogenesis : dopamine-neuromelanine
system ; disturbances of vitamin B5
metabolism ?
Laboratory examinations : MRI
shows bilaterally symmetrical hyperintense signal changes (due to gliosis,
demyelination, neuronal loss, and axonal swelling) in the external segment
of globus pallidus and substantia nigra, with surrounding hypointensity
(caused by loss of signal secondary to iron deposition) on T2wi. These
imaging features are fairly diagnostic and have been termed the "eye-of-the
tiger sign"
Klüver-Bucy syndrome : bizarre
behavior disturbances seen in monkeys following experimental bilateral
temporal lobectomy which destroys important limbic structures; reported
in humans after large injuries, usually from trauma, affecting the undersurface
of the anterior temporal lobes. It is characterized by a tendency to examine
objects orally, depression of drive and emotional reactions, hypermetamorphosis,
and lack of sexual inhibitions.
leukaraiosis : diffuse alterations of subcortical white matter at
MRI
multi-infarct dementia (MID) /
vascular dementia (VaD) : dementia of sudden onset with a stepwise
deteriorating course (a series of small strokes) and a patchy distribution
of neurologic deficits (affecting some functions and not others) caused
by cerebrovascular disease. It may be classified
HHV-5
/ CMV
in brains of 83% of VaD patients vs. 34% of age-matched normal people
posttraumatic dementia : dementia following head
trauma;
it may last from a few months to years
boxer's dementia / dementia pugilistica
/ punch-drunk encephalopathy / punchdrunk : a syndrome more serious
than boxer's traumatic encephalopathy, the result of cumulative head trauma
in boxers; characterized by forgetfulness, slowness in thinking, dysarthric
speech, and slow, uncertain movements, especially of the legs
Pathogenesis : widespread cerebral damage
or dysfunction. Age-related memory decline is thought to be triggered by
chronic stress, such as that caused by a long-term illness. This raises
levels of the stress hormone cortisol
in the brain : humans with chronically high cortisol levels have smaller
hippocampi
Course :
acute
subacute
chronic
progressive dementia
regularly progressive
irregularly progressive
not progressive
Symptoms & signs : variable due to background
and remodeling
abstract thinking, logic, and judgement deficiency
visuospatial deficiency
noncognitive symptoms
psychosis
delirium (37.5% in mild dementia, 42.6% in moderate
dementia, 43.8% in severe dementia)
hallucinations (18.7% in mild dementia, 27.8%
in moderate dementia, 53.1% in severe dementia)
sudden mood changes
depression (56.3% in mild dementia, 70.4% in
moderate dementia, 46.9% in severe dementia)
euphoria (43.7% in mild dementia, 13% in moderate
dementia, 9.4% in severe dementia)
lability
anxiety (25% in mild dementia, 46.3% in moderate dementia, 53.1% in severe
dementia)
neurovegetative symptoms
sleep
appetite
sexual behaviour
psychomotricity (afinalistic movements, akathisia) : crystallization of
thought (stereotypization and dogmatism), amplification of characters
agitation (56.9% in mild dementia, 59.3% in moderate dementia, 71.9% in
severe dementia)
aggressivity
vocalization
personality
indifference
disinhibition (25% in mild dementia, 20.4% in moderate dementia, 28.1%
in severe dementia)
apathy (87.5% in mild dementia, 85.2% in moderate dementia, 90.6% in severe
dementia)
irritability
episodical memory disturbances and mild behavioural modifications of common
finding (forget object or daily actions), easy irritability, loss of initiative
and interests => inability to remember recent events, diffiicult comprehension,
ideation and capacity to form sentences, sudden mood changes => difficult
of spoken word => mutism, inability to read, decreased response to uditive
stimuli, complete extraneity from surrounding world, probably without a
remaning "inner world".
Clinician's Interview-Based Impression of Change Plus Caregiver Input
(CIBIC-Plus) (score : 1-7; improved = 1, 2, or 3; steady = 4; worsened
= 5, 6, or 7)
Alzheimer's disease Cooperative Study Activities of Daily Living Inventory,
modified for more severe dementia (ADCS-ADL-sev)
Global Deterioration Scale (GDS) (score = 1-7)
Progressive Deterioration Scale (PDS) (score = 0-100 in instrumental
and elementary activities of daily living)
Mini-Mental State Examination (MMSE) (score = 0-30; pathological
if < 23; orientation, memory, attention, denomination, praxia, comprehension,
concentration)
Cohen-Mansfield Agitation Inventory (CMAI)
Caregiver's Burden Inventory (CBI)
CGI Severity of Alzheimer's disease (CGI-S AD)
Instrumental Activities of Daily Living (IADL) scale
Milan overall dementia assessment (MODA)
Therapy :
support (even to caregivers)
carbenoxolone
improves by 10% mental functioning in healthy elderly men and cognitively
impaired type-2 diabetic patients by lowering levels of cortisol in the
brainref.
pseudodementia : a disorder resembling
dementia but that is not due to organic brain disease and is potentially
reversible by treatment; usually due to depression or other psychiatric
disorder.
depressive pseudodementia : dementia syndrome of depression; the
term is discouraged as technically incorrect because the cognitive deficits
are now believed to be real, if reversible.
amnestic disorders : mental disorders
characterized by acquired impairment in the ability to learn and recall
new information, sometimes accompanied by inability to recall previously
learned information, and not coupled to dementia or delirium. The disorders
are subclassified on the basis of etiology as :
amnestic disorder due to a general medical condition
mental disorders due to general medical condition-not otherwise classified
catatonic disorders due to ...
personality modification due to ...
labile type
disinhibited
aggressive type
apathic type
paranoid type
different type
combined type
unspecified type
toxicomanias / drug abuse / chemical substance
dependence : a state of periodic or chronic intoxication, detrimental
to the individual and to society, produced by the repeated administration
of a drug.
drug habituation : psychic dependence with no physical dependence
physical dependence : continued
administration of the drug is required to maintain normal function => temporarywithdrawal
syndrome when administration is terminated (symptoms tend to be opposite
to the original effects produced by the drug before tolerance developed)
=> DA
in the "shell" of nucleus accumbens
=> positive reinforcing effect (e.g. conditioned place preference)
=> psychological dependence
: psychic abstinence syndrome
substance-related disorders
:
any of the mental disorders associated with excessive use of or exposure
to psychoactive substances, including drugs of abuse, medications, and
toxins. DSM-IV includes specific disorders for the classes
alcohol
amphetamines or similarly acting sympathomimetics
caffeine
cannabis
cocaine
hallucinogens
inhalants
nicotine
opioids
PCP or similarly acting substances
sedatives
hypnotics
anxiolytics
not otherwise specified (NOS)
The group is divided into substance use disorders and substance-induced
disorders, each of which is specified on the basis of etiology, e.g., alcohol
use disorders.
substance-induced disorders
: a subgroup of the substance-related disorders comprising a variety of
behavioral or psychological anomalies resulting from ingestion of or exposure
to a drug of abuse, medication, or toxin. Specific disorders or groups
are named on the basis of etiology, e.g., alcohol-induced disorders, alcohol
intoxication
substance intoxication : a
type of substance-induced disorder comprising reversible, substance-specific,
maladaptive behavioral or psychological changes directly resulting from
the physiologic effects on the central nervous system of recent ingestion
of or exposure to a psychoactive substance. Specific cases are named on
the basis of etiology, e.g., alcohol intoxication. DSM-IV recognizes specific
syndromes for these drugs: alcohol, amphetamines or related substances,
caffeine, cannabis, cocaine, hallucinogens, inhalants, opioids, PCP or
related substances, and sedatives, hypnotics, or anxiolytics.
alcohol intoxication : substance
intoxication occurring during or shortly after ingestion of alcohol and
characterized by maladaptive psychological or behavioral changes combined
with physiologic responses such as slurred speech, incoordination, impaired
memory or attention, unsteady gait, stupor, or coma.
alcohol idiosyncratic intoxication / pathological intoxication :
a term previously used for maladaptive behavioral change, usually belligerence,
produced by ingestion of amounts of alcohol insufficient to cause intoxication
in most persons. It is no longer considered to be separate from alcohol
intoxication because evidence for a distinction is lacking.
substance withdrawal / withdrawal,
withdrawal symptoms or syndrome / abstinence symptoms or syndrome :
a substance-specific mental disorder that follows the cessation of use
or reduction in intake of a psychoactive substance that had been regularly
used to induce a state of intoxication. DSM-IV includes specific withdrawal
syndromes for alcohol; amphetamines or similarly acting sympathomimetics;
cocaine; nicotine; opioids; and sedatives, hypnotics, or anxiolytics
alcohol withdrawal syndrome :
minor withdrawal syndrome : 6-8 hours-10 days after withdrawal, tremors,
irritability, anxiety, tachycardia, systemic
arterial hypertension,
gastrointestinal disturbances
alcohol or alcoholic hallucinosis
:
hallucinations
occurring in a clear sensorium in alcoholics with a long history of dependence
and heavy intake, usually following a bout of unusually heavy drinking.
After 24 hours since withdrawal, as above + visual hallucinations, behavioural
modifications (agitation, insomnia, confusion, disorientation), microzoopsia
substance intoxication
delirium : that which can occur during intoxication with any of a variety
of substances
alcohol
withdrawal delirium / delirium tremens : delirium caused by cessation
or reduction in alcohol consumption, typically in alcoholics with 10 years
or more of heavy drinking. Clinical manifestations include autonomic hyperactivity,
such as tachycardia, sweating, and systemic
arterial hypertension;
a coarse, irregular tremor, and delusions, vivid
hallucinations;
wild, agitated behavior, fever,
diarrhea,
and mydriasis. The onset is usually 2 or 3 days
after cessation of drinking; the delirium and other withdrawal symptoms
usually resolve in 3 or 4 days
Specific disorders are named for the substance involved.
substance withdrawal delirium
:
that which can occur during withdrawal from any of a variety of substances,
including alcohol and sedatives, hypnotics, and anxiolytics; specific disorders
are named for the substance involved.
medication side effects
toxic delirium : delirium caused by
poisons.
Individual cases are named for the specific substance involved, e.g., digitalis-induced
delirium.
substance-induced persisting dementia / toxic
dementia : that due to excessive exposure to a toxic substance, but
persisting long after exposure to the substance ends, usually with permanent
and worsening deficits. Individual cases are named for the specific substance
involved.
ethanol
(Wernicke-Korsakoff syndrome or psychosis
/ alcoholic dementia) : a syndrome of anterograde
amnesia
and retrograde amnesia
with confabulation associated with alcoholic or nonalcoholic polyneuritis
described as “cerebropathia psychica toxemica” by Korsakoff; currently
used synonymously with the term amnestic syndrome or, more narrowly,
to refer to the amnestic component of the Wernicke-Korsakoff syndrome,
i.e., an amnestic syndrome resulting from thiamine
deficiency
substance-induced
sexual dysfunction
with compromised desire
with compromised arousal
with compromised orgasm
with sexual pain
with onset during intoxication
substance-induced anxiety
disorder : an anxiety disorder characterized by prominent anxiety,
panic
attacks, obsessions, or compulsions
and directly due to the physiological effects of a psychogenic substance,
including drugs of abuse, medications, and toxins. Individual cases are
named for the specific substance involved.
abstinence
caffeine
CNS stimulating drugs
substance-induced mood
disorder : a prominent and lasting disturbance of mood, either manic,
depressive,
or both, due
to direct physiological effects of a psychoactive substance, including
medications, drugs of abuse, and toxins. Individual cases are named for
the specific substance involved.
with depressive manifestations
with maniac manifestations
with onset during intoxication
with onset during abstinence
substance-induced
persisting amnestic disorder : disorder caused by the lasting effects
of a drug of abuse, medication, or toxic substance, often remaining stable
or even worsening long after exposure to the substance has ended. Individual
cases are named for the specific substance involved.
substance-induced
psychotic disorder : persistent delusions or
hallucinations
related to the use of a psychoactive substance, the patient being unaware
of their etiology. Individual cases are named for the specific substance
involved.
substance-induced sleep
disorder : a disturbance of sleep due to the direct physiological effects
of a psychoactive substance, including drugs of abuse, medications, and
toxins; usually manifest as hypersomnia or insomnia
but sometimes as a parasomnia or of mixed type.
Individual disorders are named for the specific substance involved.
substance use disorders :
a subgroup of the substance-related disorders in which psychoactive substance
use or abuse repeatedly results in significantly adverse consequences.
The group comprises substance abuse and substance dependence; specific
disorders or groups of disorders are named on the basis of etiology, e.g.,
alcohol use disorders
alcohol abuse
alcohol dependence.
Differential diagnosis :
nonpathological substance use (e.g. society drinking)
use of drugs for appropriate therapeutic uses
mental disorders not induced by substances
symptoms of previous mental disorders exhacerbated by substance intoxication
or withdrawal
Laboratory examinations : Structured Clinical
Interview for the Spectrum of Substance Use (SCI-SUBS) Web resources :
psychotic disorders / psychoses : a mental
disorder characterized by gross impairment in reality testing as evidenced
by delusions, hallucinations,
markedly incoherent speech, or disorganized and agitated behavior, usually
without apparent awareness on the part of the patient of the incomprehensibility
of his behavior (anosognosia); called psychotic disorder in DSM-IV.
The term is also used in a more general sense to refer to mental disorders
in which mental functioning is sufficiently impaired as to interfere grossly
with the patient's capacity to meet the ordinary demands of life. Historically,
the term has been applied to many conditions, e.g., manic-depressive psychosis,
that were first described in psychotic patients, although many patients
with the disorder are not judged psychotic.
functional psychosis : a psychosis for which organic disease or
dysfunction cannot be found to play a causative role.
organic psychosis : a psychotic disorder with a known or presumed
organic etiology.
toxic
psychoses : a psychosis due to the ingestion of toxic agents (e.g.,
alcohol, opium) or to the presence of toxins within the body.
alcoholic psychoses : psychoses associated with alcohol use and
involving organic brain damage, a category that includes
14-24-year-olds have a 15% chance of showing psychotic symptoms at some
point during the 4 years even if they did not smoke cannabis and had no
predisposition to psychosisref
postpartum psychosis : a psychotic episode occurring in the postpartum
period.
prison psychosis : any psychosis for which a prison environment
has been a precipitating factor.
affective psychosis : one in which a disturbance in mood is the
prominent characteristic
depressive psychosis : older term for a psychosis characterized
by severe depression; now more commonly described as a form of major
depressive disorder.
senile psychosis : depressive or
paranoid delusions or hallucinations
or other mental disorders due primarily to degeneration of the brain in
old age, as in senile dementia.
Laboratory examinations : Redlich-Fisher
miliary plaques (thickened, dark colored areas in the neuroglia reticulum
of the brain, seen in cases of senile psychoses)
paraphrenia : older term for a condition theoretically lying midway
between paranoia and schizophrenia,
in which there are fantastic, absurd, well-systematized delusions
without severe personality deterioration; use of this term is discouraged
borderline, latent or prepsychotic
schizophrenia : a type of schizophrenia characterized by clear symptoms
of schizophrenia but no history of a psychotic schizophrenic episode; it
includes conditions that have been called ambulatory, borderline, prepsychotic,
pseudoneurotic, and pseudopsychopathic schizophrenia in which has there
has been no acute psychotic episode. Patients described by these terms
do not fit the DSM-IV definition of schizophrenia; most would be classified
as having schizotypal personality
disorder
simple schizophrenia : a form
characterized by gradual, insidious loss of drive, social withdrawal, and
emotional apathy, but without prominent psychotic features
schizophrenia : a mental disorder or
heterogeneous group of disorders (the schizophrenias or schizophrenic disorders)
comprising most major psychotic disorders and characterized by disturbances
in form and content of thought (loosening of associations, delusions,
and hallucinations), mood (blunted, flattened,
or inappropriate affect), sense of self and relationship to the external
world (loss of ego boundaries, dereistic thinking, and autistic withdrawal),
and behavior (bizarre, apparently purposeless, and stereotyped activity
or inactivity). The definition and clinical application of the concept
of schizophrenia have varied greatly. The DSM-IV criteria emphasize marked
disorder of thought (delusions, hallucinations,
or other thought disorder accompanied by disordered affect or behavior),
deterioration from a previous level of functioning, and chronicity (duration
> 6 months), thus excluding from this classification conditions referred
to by others as simple schizophrenia,
acute
schizophrenia, borderline or latent
schizophrenia. Originally called dementia praecox and characterized
as a psychosis with adolescent onset and a chronic course ending in deterioration.
The term schizophrenia was introduced by Bleuler because neither early
onset nor terminal deterioration is an essential feature; he emphasized
the splitting and lack of personality integration seen in the disorder
Types :
paranoid schizophrenia : a
type of schizophrenia characterized by preoccupation with one or more systematized
delusions
or with frequent auditory hallucinations but
without disorganized speech, disorganized or catatonic behavior, or flat
or inappropriate affect.
disorganized schizophrenia
/ hebephrenia / hebephrenic schizophrenia : a type that is characterized
by frequent incoherence, marked loosening of associations, or grossly disorganized
behavior and flat or grossly inappropriate affect and that does not meet
the criteria for the catatonic type; associated features include extreme
social withdrawal, grimacing, mannerisms, mirror gazing, inappropriate
giggling, and other unusual behavior.
catatonic schizophrenia :
a type of schizophrenia characterized by marked psychomotor disturbance,
including some combination of motoric immobility (stupor, catalepsy), excessive
motor activity, extreme negativism, mutism, echolalia,
echopraxia,
and peculiarities of voluntary movement such as posturing, mannerisms,
grimacing, or stereotyped behaviors.
catatonic disorder : catatonia due to the
physiological effects of a general medical condition and neither better
accounted for by another mental disorder nor occurring exclusively during
delirium
Experimental animal models : bulbocapnine
experiment : the experimental injection of the alkaloid bulbocapnine
into animals, which produces in them the motor phenomena typical of catatonia.
undifferentiated schizophrenia : a type of schizophrenia characterized
by the presence of prominent psychotic symptoms but not classifiable as
catatonic,
disorganized,
or paranoid.
residual schizophrenia : a type of schizophrenia characterized by
a history of one or more episodes of schizophrenia with prominent psychotic
symptoms, current lack of such symptoms, but continuing presence of other
schizophrenic symptoms, such as blunted or inappropriate affect, social
withdrawal, eccentric behavior, illogical thinking, or loosening of associations.
ambulatory schizophrenia : mild schizophrenia sufficiently well
compensated so that the patient can maintain himself in the community without
hospitalization.
childhood schizophrenia : schizophrenia-like symptoms with onset
before puberty, characterized by autistic, withdrawn behavior, failure
to develop an identity separate from the mother's, and gross developmental
immaturity, a category that formerly included all types of childhood “psychosis”
including symbiotic psychosis and infantile autism. DSM-IV, taking the
position that there is no clear relationship between these disorders and
adolescent and adult schizophrenia and other psychotic disorders, calls
them pervasive developmental
disorders
process schizophrenia : a subset of schizophrenias assumed (like
the original concept of dementia praecox) to have endogenous origin and
poor prognosis as compared to other cases, termed reactive schizophrenia,
that are assumed to be caused by predisposing or precipitating environmental
factors and to have a better prognosis.
pseudoneurotic schizophrenia : a form characterized by all-pervasive
anxiety and a wide variety of neurotic symptoms that initially mask underlying
psychotic tendencies, which may be manifest as occasional, brief psychotic
episodes. It is often considered to be more of a personality disorder
pseudopsychopathic schizophrenia : a term applied to patients in
whom antisocial, impulsive, or sociopathic tendencies initially mask underlying
psychotic tendencies typical of schizophrenia
reactive schizophrenia : a subset of schizophrenias assumed
to be caused by predisposing or precipitating environmental factors and
to have a more favorable prognosis than process schizophrenia.
intrinsic : some consider schizophrenia the low-fitness, unattractive version
of a sexually selected fitness indicator that evolved through mutual mate
choice. This hypothesis may explain schizophrenia's adolescent and early
adult onset; why it slashes rates of marriage and reproduction; why it
persists despite reproductive disadvantage; why it affects males earlier
and more severely; why neurodevelopmental abnormalities are common; why
it is associated with fetal hypoxia, viral infection and famine; why dopamine
antagonists are therapeutic; and why affected individuals are socially
stigmatizedref
ZDHHC8,
which encodes a putative transmembrane palmitoyltransferaseref
at least 11 oligodendrocyte genes are suppressed => impaired myelin and
glycolysis
extrinsic :
offspring of mothers whose blood topped 150 mg/L
of lead
are twice as likely to develop schizophrenia as those whose blood levels
were below this threshold. If the finding holds up in other groups, as
many as 25% of all schizophrenia cases in this same age group might be
explained by leadref.
In the 1950s and 60s, lead exposure in California was relatively high because
of the use of leaded gasoline
babies born to malnourished
mothers are twice as likely to develop schizophrenia. Most agree it is
likely to have both genetic and environmental triggers. Researchers first
saw a link between schizophrenia and hunger when investigating the Dutch
'hunger winter' of 1944-45, when the Nazis blocked food supplies to much
of the Netherlands. Babies born that year were twice as likely to become
schizophrenic, according to a 1992 studyref.
But as only 25 people in the sample were diagnosed with the illness, the
result could have been a statistical fluke. Now another famine, halfway
across the world, has lent support to the link between famine and schizophrenia.
In China around 1960, a combination of bad weather and Mao Zedong's Great
Leap Forward - in which farmland became industrial, and ineffective new
agriculture was tried - plunged the country into famine. One of the hardest-hit
areas was Anhui province in 1959-61. The researchers selected one area
in that province and gathered data from the local psychiatric hospital.
Just as in the Netherlands, the risk of children developing schizophrenia
doubled during the famine years: hundreds of children per year were later
diagnosed with the disease, putting their risk at 2%, compared to 1% for
children born in easier timesref.
The finding is unlikely to much affect the total number of schizophrenics,
as fewer babies overall survive during famines. Although the link between
malnurishment in the womb and schizophrenia is clear, the mechanism by
which they are related is still unknown. Nobody knows what is going on,
but we are beginning to think of it as a gene-environment interaction.
One popular idea is that a deficiency of folic acid is to blame. Lack of
this nutrient, found in leafy greens and some vitamin supplements, is also
implicated in developmental defects in the baby's spinal cord. Researchers
are looking at genes for folic acid metabolism and how these might relate
to mental illness. It is difficult to find natural experiments in which
to conduct such studies, as the famines must be at least 40 years old in
order to give schizophrenia a chance to develop. Epidemiologists and medical
researchers can take satisfaction in the fact that they can take something
so catastrophic and wring from it scientific knowledge that would otherwise
be unavailable. Wonderful as that is, lets none of us forget that we should
be active in the present to prevent further catastrophes.
several reports of a recent decline in the incidence of schizophrenia coinciding
with the introduction of polio vaccination
the observed winter excesses in schizophrenic births (in temperate climates)
could be explained by fetal exposure to poliovirus during the second trimester
of gestation which would occur during the summer when polio epidemics are
most frequent
there are increased rates of schizophrenia among immigrants to the UK from
regions of the world with low frequencies if immunity to polioviruses
there may be genetic variants in the poliovirus receptor gene that could
increase susceptibility to poliovirus infection
The very large discordance rates for schizophrenia in dichorionic-monozygotic
twins (about 90%), as well as the much smaller discordance rates for monochorionic-monozygotic
twins (about 40%) indicate the existence of both genetic and environmental
factors and the role of several allelic exclusion events expressed both
in T-cells and possibly in certain neurons. A child who has lost some glutamatergic
neurons due to viral infection during the second trimester of gestation,
may be able to compensate for this deficit to a large extent by the super-abundance
of excitatory synapses that exists in the brain until sexual maturity,
at which time a selective loss of excitatory (mainly glutamatergic) synapses
occurs together with hormonally induced changes in behavior, leading to
a much increased risk of a psychotic episoderef.
experiences
Pathogenesis : increased activity of mesolimbic
tract, decreased activity of nigrocortical tract. Amphetamine, LSD or PCP
each specifically targets one of the suspect neurotransmitter systems,
but has similar effects on brain and behaviour. Each hallucinogen alters
the same brain protein, DARPP-32
/ PPP1R1B : animals develop schizophrenic symptoms - in mice, this
involves repetitive grooming and nervousness. Mice lacking DARPP-32 are
immune to the drugs' psychotic effects
derailment : disordered thought or speech characteristic of schizophrenia
and marked by constant jumping around from one topic to another before
the first is fully realized, the topics often being clearly but obliquely
related or unrelated. The term is sometimes used synonymously with loosening
of associations.
intrapsychic ataxia : the separation of ideas and affect seen in
schizophrenic
disorders; inappropriateness of affect.
thought disorder (a disturbance in the thought process that is most
narrowly defined as disorganized thinking with altered associations, as
is characteristic of schizophrenia. The term is often used much more broadly
to include any disturbance of thought, such as confusion, hallucinations,
or delusions, which affects possession, quantity,
or content of thought)
glossolalia : speech in unknown or imaginary language, simulating
coherent speech, seen in some types of schizophrenia
verbigeration / cataphasia : stereotyped and meaningless repetition
of words and phrases; seen in some cases of schizophrenia
logorrhea / agitolalia / agitophasia / pressured speech / tachylalia
/ tachyphasia / verbomania : excessive volubility, with rapid, pressured
speech; as seen in manic episodes of bipolar disorder and in some types
of schizophrenia
perseveration : the inappropriate persistence or repetition of a
thought or act after the causative stimulus has ceased or in response to
different stimuli, e.g., answering a question correctly and then inappropriately
repeating that answer to succeeding questions; most often associated with
brain lesions but also seen in schizophrenia
asyndesis : a pattern of language in which words and phrases are
juxtaposed without grammatical linkage; seen in schizophrenic and other
mental disorders.
metonymy : a disturbance of language seen in schizophrenic disorders
in which an inappropriate but related term is used instead of the correct
one
..., atrophy at CT scan, negative prognosis, negative treatment response,
intellectual impairment, due to structural alteration with normal dopaminergic
function
Liddle's symptoms : psychomotor poverty, disorganization, and reality
distortion
double bind : a situation in which
one person receives conflicting messages from another and in which response
to either message, recognition of the conflict, or withdrawal is met with
rejection or disapproval; thought to be a characteristic mode of interaction
in some families of schizophrenics and in other dysfunctional families.
Differential diagnosis :
psychotic disorder due to a general medical condition
the addition of risperidone to clozapine did not improve symptoms in patients
with severe schizophreniaref
Prognosis : compared with the general population,
life expectancy in patients with schizophrenia is shorter by as much as
20%, attributable to higher rates of suicide, accidental deaths, and natural
causes such as cardiovascular disease, infectious disease, and endocrine
disorders
acute schizophrenia : acute schizophrenic
episode; a condition characterized by acute onset of schizophrenic symptoms;
since DSM-IV defines schizophrenia
as a chronic disorder, such conditions must now be classified in another
psychotic syndrome, such as :
schizophreniform disorder
: a mental disorder with the signs and symptoms of schizophrenia but duration
< 6 months
acute delusional psychosis / bouffée délirante : a
reactive psychosis resembling schizophrenia but having a duration of <
3 months and a favorable prognosis. It is roughly the French counterpart
to schizophreniform disorder
brief psychotic disorder
: an episode of psychotic symptoms (incoherence, loosening of associations,
delusions,
hallucinations,
disorganized or catatonic behavior) with sudden onset, lasting <
1 month. If it occurs in response to a stressful life event, it may
be called brief reactive psychosis.
Differential diagnosis :
psychotic disorder due to a general medical condition
schizoaffective disorder or psychosis
: a mental disorder in which a major depressive episode, manic episode,
or mixed episode occurs along with prominent psychotic symptoms characteristic
of schizophrenia, the symptoms
of the mood disorder being present for a substantial portion of the illness,
but not for its entirety, and the disturbance not being due to the effects
of a psychoactive substance.
bipolar type
depressive type
Differential diagnosis :
psychotic disorder due to a general medical condition
paranoia / delusional disorder : a mental
disorder marked by well-organized, logically consistent delusions
but lacking other psychotic symptoms. Most functioning is not markedly
impaired, the criteria for schizophrenia have never been satisfied, and
symptoms of a major mood disorder have been present only briefly if at
all. DSM-IV distinguishes 6 types on the basis of the predominant delusional
theme:
persecutory
jealous
erotomanic
somatic
grandiose
mixed
Differential diagnosis :
psychotic disorder due to a general medical condition
shared psychotic disorder
: a delusional system that develops in one or more persons as a result
of a close relationship with someone who already has a psychotic disorder
with prominent delusions. Most commonly it involves
2 people and is called folie à deux. Involvement of 3 people
would be folie à trois and so on.
Pathogenesis : increased activity of mesolimbic
tract => alterations in perceptions of time, place, sounds and colors.
childhood psychoses : disorders of cytoarchitecture
aduthood psyschoses : atrophy of frontal cortex
Symptoms :
positive
delusion : false beliefs
“Alice in Wonderland” syndrome : a delusional state manifested by
depersonalization,
alteration in the sense of the passage of time, distorted perception of
objects, hallucinations, and other delusions
or illusions. It may be associated with schizophrenia,
epilepsy, migraine, diseases of the parietal lobe, hypnagogic states, or
the use of hallucinogenic drugs
insulin coma therapy (ICT) : an older treatment for schizophrenia,
not currently used in the USA; sufficient insulin
is administered to place the patient in a deep hypoglycemic
coma,
which is reversed in an hour or less by administration of glucagon, usually
for 20 to 60 such treatments.
subcoma insulin therapy : i.m. administration of small doses of
insulin to produce mild hypoglycemia, sedation, and weight gain
chemotherapy
: the relative effectiveness of second-generation (atypical) antipsychotic
drugs as compared with that of older agents has been incompletely addressed,
though newer agents are currently used far more commonly. Olanzapine was
the most effective in terms of the rates of discontinuation, and the efficacy
of the conventional antipsychotic agent perphenazine appeared similar to
that of quetiapine, risperidone, and ziprasidone. Olanzapine was associated
with greater weight gain and increases in measures of glucose and lipid
metabolismref
neuroses : former name for a category
of mental disorders characterized by anxiety and avoidance behavior. In
general, the term refers to disorders in which the symptoms are distressing
to the person (ego-dystonic), reality testing
is intact (conscious disorder), behavior does not violate gross
social norms, and there is no apparent organic etiology (no fever, no anatomical
injuries). Classified in DSM-IV under anxiety disorders,
dissociative
disorders, mood disorders,
sexual
disorders, and somatoform disorders.
actual neurosis : Freud's term for
a neurosis caused by sexual excitement without adequate gratification
anxiety state : the condition of experiencing undue anxiety, as
in anxiety disorders. It was temporarily the official replacement for the
term anxiety neurosis
neurasthenia : a term introduced by Beard in 1869, and now virtually
obsolete, to refer to a syndrome of chronic mental and physical weakness
and fatigue, which was supposed to be caused by exhaustion of the nervous
system
psychoneurosis : Freud's term for a
neurosis caused by childhood experiences
hysteria : [Gr. hystera womb, from the antiquated
belief that wandering of the uterus caused mental disturbances] a
now somewhat nebulous term formerly used widely in psychiatry. Its meanings
have included :
fixation hysteria : a form of conversion disorder in which the symptoms
are based on an existing or previous organic disease or injury, as the
persistence of a nervous cough after pertussis.
anxiety hysteria : Freud's term for phobias, reflecting his view
that the same defense mechanisms, repression and displacement, and the
same unconscious conflicts involving infantile sexuality are involved in
both hysteria and phobias
major hysteria : la grande hystérie of Charcot, hysteria
with dramatic epileptiform attacks involving intense emotional display
hysteroepilepsy : hysteria with attacks imitating epileptic seizures.
psychasthenia : a term used by Janet to cover all psychoneuroses
not classified as hysteria; it mainly included what would now be called
anxiety disorders.
character neurosis : a type of character or personality disorder
with some neurotic characteristics, particularly one of a predominantly
obsessive-compulsive or hysterical nature
compensation or pension neurosis : an obsolete term for a factitious
disorder following injury and motivated in part by prospects of financial
compensation.
transference neurosis : a phenomenon occurring during psychoanalysis,
in which transference causes the patient to undergo, with the analyst as
the object, an intense repetition of childhood conflicts and traumas, reexperiencing
impulses, feelings, and fantasies that originally developed in relation
to the parents.
affective disorders / mood
disorders : disturbance of mood
dysphoric mood : one that is unpleasant.
elevated mood : one characterized by an exaggerated sense of well-being,
cheerfulness, or elation.
euthymic mood : one in the range of normal, being neither elevated
nor depressed.
expansive mood : one characterized by a lack of restraint in expressing
one's feelings, often with an overestimation of self-importance or significance.
irritable mood : one that is easily annoyed or provoked to anger.
In those mood disorders with psychotic features :
mood-congruent psychotic features are grandiose delusions
or related hallucinations occurring in a manic
episode or depressive delusions or related hallucinations
in a major depressive episode
mood-incongruent psychotic features are delusions or hallucinations
that either contradict or are inconsistent with the prevailing emotions,
such as delusions of persecution or of thought
insertion in either a manic or a depressive episode.
gender dysphoria : unhappiness with one's biological sex or its
usual gender role, with the desire for the body and role of the opposite
sex.
... manifested as one or more episodes of mania, hypomania,
depression, or some combination. Functional mood disorders are subclassified
as :
hypermania : severe mania
hypomania : an abnormality of mood resembling
mania
(persistent elevated or expansive mood, hyperactivity, inflated self-esteem,
etc.) but of lesser intensity (neither megalomania
nor delirium).
mania / manic syndrome : a phase of bipolar
disorder characterized by expansiveness, elation, agitation, hyperexcitability,
hyperactivity, and increased speed of thought and speech (flight of
ideas : a nearly continuous flow of rapid speech that jumps from topic
to topic, usually based on discernible associations, distractions, or plays
on words, but in severe cases so rapid as to be disorganized and incoherent.
It is most commonly seen in manic episodes but may also occur in other
mental disorders such as in manic phases of schizophrenia)
euphoric mania :
dysphoric mania :
mania with main psychomotory alterations
psychotic mania
mania with alterations of consciousness
mono- or oligoasymptomaticmania (expecially in the elderly)
chronic mania
secondary mania
delirious mania / hypermania : intense mania with overwhelming tensions,
marked disorientation, and incoherence
unproductive mania : a manic episode with some signs and symptoms
of depression, such as repression of thought and speech.
monomania : a form of mental disorder characterized by preoccupation
with one subject or idea.
oligomania : obsession with a few thoughts or ideas
megalomania : unreasonable conviction
of one's own extreme greatness, goodness, or power; the ideas in megalomania
are known as delusions of grandeur.
biting mania : a 15th-century epidemic of mass psychogenic illness
in which the compulsive urge to bite people spread among groups throughout
Germany, Holland, and Italy.
ablutomania : mania for washing oneself
aboulomania : pathological indecisiveness
agromania : intense desire to be in open spaces
anglomania : craze or obsession with England and the English
anthomania : obsession with flowers
aphrodisiomania : abnormal sexual interest
arithmomania : obsessive preoccupation with numbers; compulsive
counting, as paces when walking, steps in a staircase, etc., a common symptom
in obsessive-compulsive disorder.
balletomania : abnormal fondness for ballet
bibliomania : craze for books or reading
bruxomania : compulsion for grinding teeth
cacodemomania : pathological belief that one is inhabited by an
evil spirit
catapedamania : obsession with jumping from high places
chinamania : obsession with collecting china
choreomania : dancing mania or frenzy
clinomania : excessive desire to stay in bed
copromania : obsession with feces
dacnomania : obsession with killing
demonomania : pathological belief that one is possessed by demons
dinomania : mania for dancing
dipsomania : abnormal craving for alcohol
discomania : obsession for disco music
doramania : obsession with owning furs
doromania : obsession with giving gifts
drapetomania : intense desire to run away from home
dromomania : compulsive longing for travel
ecdemomania : abnormal compulsion for wandering
egomania: irrational self-centered attitude or self-worship
eleutheromania : manic desire for freedom
empleomania : mania for holding public office
enosimania : pathological belief that one has sinned
entheomania : abnormal belief that one is divinely inspired
epomania : craze for writing epics
ergasiomania : excessive desire to work; ergomania
ergomania : excessive desire to work; workaholism
etheromania : craving for ether
ethnomania : obsessive devotion to one's own people
eulogomania : obsessive craze for eulogies
flagellomania : abnormal enthusiasm for flogging
florimania : craze for flowers
francomania : craze or obsession with France and the French
gallomania : craze or obsession with France and the French
gamomania : obsession with issuing odd marriage proposals
Graecomania : obsession with Greece and the Greeks
graphomania : obsession with writing
gynaecomania : abnormal sexual obsession with women
Hellenomania : obsession with Greece and the Greeks; Graecomania
hexametromania : mania for writing in hexameter
hieromania : pathological religious visions or delusions
hippomania : obsession with horses
hydromania : irrational craving for water
hylomania : excessive tendency towards materialism
iconomania : obsession with icons or portraits
idolomania : obsession or devotion to idols
infomania : excessive devotion to accumulating facts
islomania : craze or obsession for islands
Italomania : obsession with Italy or Italians
logomania pathological loquacity
lypemania extreme pathological mournfulness
macromania delusion that objects are larger than natural size
melomania craze for music
methomania morbid craving for alcohol
metromania insatiable desire for writing verse
micromania pathological self-deprecation or belief that one
is very small
morphinomania habitual craving or desire for morphine
musomania obsession with music
mythomania lying or exaggerating to an abnormal extent
narcomania : uncontrollable craving for narcotics
necromania : sexual obsession with dead bodies; necrophilia
nosomania :delusion of suffering from a disease
nostomania : abnormal desire to go back to familiar places
oenomania : obsession or craze for wine
oniomania : mania for making purchases
onomamania : mania for names
onomatomania : irresistible desire to repeat certain words
onychotillomania : compulsive picking at the fingernails
opiomania : craving for opium
opsomania : abnormal love for one kind of food
orchidomania : abnormal obsession with orchids
parousiamania : obsession with the second coming of Christ
pathomania : moral insanity
peotillomania : abnormal compulsion for pulling on the penis
phagomania : excessive desire for food or eating
phaneromania : habit of biting one’s nails
pharmacomania : abnormal obsession with trying drugs
phonomania : pathological tendency to murder
photomania : pathological desire for light
phyllomania : excessive or abnormal production of leaves
phytomania : obsession with collecting plants
planomania : abnormal desire to wander and disobey social norms
plutomania : mania for money
polemomania : mania for war
politicomania : mania for politics
polkamania : craze for polka dancing
polymania : mania affecting several different mental faculties
poriomania : an irresistible impulse to
travel, run away, or wander off.
erotomania : abnormally powerful sex drive. Whereas traditional
psychiatry has considered erotomania to be almost entirely restricted to
women, recent studies have revealed that criminal offenses associated with
the condition occur much more frequently in men. Secondary erotomania has
mainly been associated with functional psychosis (especially schizophrenia)
and bipolar disorder. Traditionally, erotomania has been considered chronic
and refractory to treatment, although cases of secondary erotomania with
response to benzodiazepines, lithium, anticonvulsivants, antipsychotic
drugs and electroconvulsive therapy have been described.
pornomania : obsession with pornography.
Most children escape almost uninjured from visualization of pornography.
However some are either traumatized, or precipitated in a strict perversion.
The consequences on adolescents are similar, though more complex. The hypersexualization
of teenagers may become complicated by addiction (so called internet
addiction disorder (IAD)), isolation, and perversionref.
Men's sexual arousal is dependent upon the attractiveness of the female
actor, feeling interested, and both "imagining oneself as a participant"
and "watching as an observer." For women, with all variables entered, only
"imagining oneself as a participant" contributed to sexual arousal ratingsref.
The stark contrasts between romance novels and pornography, both multibillion
dollar global industries, underscore how different male and female erotic
fantasies actually are. These differences reflect the different selection
pressures males and females faced over human evolutionary history and highlight
the utility of using unobtrusive measures to study aspects of human nature.
slash : the depiction of a romantic or sexual relationship between typically
heterosexual male television protagonists, such as Kirk and Spock from
Star Trek
A sexually inappropriate family environment, use of pornography during
childhood and adolescence, and deviant sexual fantasies during childhood
and adolescence are related to the development of deviant sexual preferencesref,
e.g. sexual violence against children (sexual abuse, child pornography,
rape,
and incest). Generally, women who suffer negative
events, many of which are traumatic, are more likely to see both pornography
and having a homosexual friend or family member as acceptableref.
The Internet has become an important tool for finding health information,
especially among adolescents. Many computers have software designed to
block access to Internet pornography. Because pornography-blocking software
cannot perfectly discriminate between pornographic and nonpornographic
Web sites, such products may block access to health information sites,
particularly those related to sexuality. Blocking settings have a greater
impact than choice of blocking product on frequency of health information
blocking. At their least restrictive settings, overblocking of general
health information poses a relatively minor impediment. However, searches
on some terms related to sexuality led to substantially more health information
blocking. More restrictive blocking configurations blocked pornography
only slightly more, but substantially increased blocking of health information
sitesref.
potichomania : craze for imitating Oriental porcelain
potomania : abnormal desire to drink alcohol
pseudomania : irrational predilection for lying
pteridomania : passion for ferns
pyromania : craze for starting fires
rhinotillexomania : compulsive nose picking
rinkomania : obsession with skating
satyromania : abnormally great male sexual desire; satyriasis
scribbleomania : obsession with scribbling
sebastomania : religious insanity
shopping mania : mania for shopping
sitiomania : morbid aversion to food
sophomania : delusion that one is incredibly intelligent
squandermania : irrational propensity for spending money wastefully
stampomania : obsession with stamp-collecting
syphilomania : pathological belief that one is afflicted with syphilis
technomania : craze for technology
Teutomania : obsession with Teutonic or German things
thanatomania : belief that one has been affected by death magic,
and resulting illness
theatromania : craze for going to plays
theomania : belief that one is a god
timbromania : craze for stamp collecting
tomomania : irrational predilection for performing surgery
toxicomania : morbid craving for poisons
trichotillomania : neurosis where
patient pulls out own hair
Epidemiology : prevalence = 3-5%
Aetiology : mutations in SLITRK1ref Symptoms & signs : noticeable hair
loss or patches of baldness, often accompanied by other psychiatric conditions,
such as anxiety, depression, obsessive compulsive disorder or Tourette
syndrome
tulipomania : obsession with tulips
typhomania : delirious state resulting from typhus fever
typomania : craze for printing one’s lucubrations
uranomania : obsession with the idea of divinity
verbomania : craze for words
xenomania : inordinate attachment to foreign things
unipolar depression : mood disorders
unaccompanied by episodes of mania or hypomania,
as in major depressive disorder or dysthymic
disorder; the term is sometimes used to denote the former specifically.
According to Akiskal soft bipolar spectrum no unipolar depression
exists.
major depressive disorder (MDD) / major,
primary or endogenous depression (formerly including melancholia)
: a type of depression caused by somatic or biological factors rather than
environmental influences, in contrast to a reactive
depression. It is usually identified with a specific symptom and may
have sudden or gradual onset. It may occur in childhood (infantile depression),
adolescence (adolescent depression), middle or late age (senile depression).
double depression : a major depressive
episode superimposed for a time on a chronic dysthymic
disorder; after the episode ends the patient returns to the usual dysthymic
state.
retarded depression : major depressive
disorder with psychomotor retardation.
psychotic depression : in the
strict sense, major depressive disorder with psychotic features, such as
hallucinations,
delusions,
mutism, or stupor. However, this term is commonly used in a broader sense
to cover all severe depressions causing gross impairment of social or occupational
functioning, i.e., as a rough equivalent of major
depressive disorder or of endogenous depression
agitated depression : major depressive
disorder with psychomotor agitation
stuporous depression
anxious depression
depression with cognitive disorder (differential diagnosis with
dementia
and pseudodemential melancholia)
Cotard's syndrome : paranoia with
delusions
of negation (patients can't feel his/her organs and feels empty), a suicidal
tendency, and sensory disturbances.
atypical depression : better at
morning and worse at evening, lethargy,
hyperphagia and carbohydrate craving => weight gain, substance abuse; hypersensitivity
to denial; reactivity of mood
hysteroid dysphoria : patients
maintain consumatory pleasure when it is offered to them, but they don't
look for it
psychomotor symptoms : psychomotor retardation, early morning awakening,
weight loss, lack of reactivity to the environment, slowing, abulia, adynamia,
asthenia, reduced and fragmented mimic
affective symptoms : loss of interests, habits (family, job, hobbies, friends)
and vital force, moral pain and shiness, irritability, irrequietude, anxiet,
taedium vitae, desperation, apathy, depersonalization,
anhedonism, excessive guilt
cognitive symptoms : desire of death and suicide,
congruous / secondary (guilt, ruine) or uncongruous / primary (persecution)
delirium, dementia syndrome of depression (reversible dementia
occurring in association with depression in the elderly, the cognitive
deficits resolving with treatment of the depression), visual and uditive
hallucinations
vegetative symptoms : insomnia or hypersomnia, inapettency or hyperphagy,
reduction of libido, constipation, headache,
daily or seasonal alternance (usually worse at morning, better at evening)
mourning : the normal psychological processes
that follow the loss of a loved one; grief (the normal emotional
response to an external and consciously recognized loss; it involves a
period of mourning and generally is self-limited, gradually subsiding within
a reasonable time (< 2 months)) is the accompanying emotional state.
4 phases have been described:
a short phase of numbness and denial
a phase of yearning and protest marked by intense pining for the dead
a phase of disorganization marked by pain and despair
a phase of detachment and reorganization of love relationships
Social expressions of grief, such as funeral and burial services, prayers,
the wearing of black or other specific garments, or other rituals
It has variable duration (acute => chronic) and remission may be sudden
or gradual => remnant phenomena.
dysthymic disorder : a mood disorder
characterized by depressed feeling (sad, blue, low), loss of interest or
pleasure in one's usual activities, and by at least some of the following:
altered appetite, disturbed sleep patterns, lack of energy, low self esteem,
poor concentration or decision-making skills, and feelings of hopelessness.
Symptoms have persisted for most of the daytime for most of the days for
>
2 years but are not severe enough to meet the criteria for major depressive
disorder.
Prognosis :
2-year risk of relapse according to onset at age
20 : 20%
30 : 50%
> 50 : 80%
3-year risk of relapse after
1st episode : 50%
2nd episode : 70%
3rd episode : 80%
4th or subsequent episode : 90%
reactive,
exogenous or situational depression : a physiological, transient depression
that is precipitated by a stressful life event or other environmental factor,
in contrast to an endogenous depression, with an absence of significant
vegetative disturbances
postpartum depression
anaclitic depression : impairment
of an infant's physical, social, and intellectual development resulting
from absence of mothering
neurotic depression : any depression
that is not a psychotic depression; used sometimes broadly to indicate
any depression without psychotic features and sometimes more narrowly to
denote only milder forms of depression, which would be diagnosed as dysthymic
disorder by DSM-IV criteria or as reactive (rather than endogenous) depression.
depressive
disorder-not otherwise specified (NOS)
late luteal phase or premenstrual
dysphoric disorder (PMDD) or syndrome (PMS)
Epidemiology : 2-10% of fertile females
are severely affected, 30-80% mildly
Aetiology : unknown cause, conditioned
by maternal imprinting and axpiration to emancipation; chances of having
symptoms are more likely for heavier women with a higher
BMI
and less likely for women using hormonal
contraception Pathogenesis : reduced luteal development
=>
decreased progesterone,
prostaglandins, serotonin, GABA, vitamin
B6,
and intracellular magnesium
increased aldosterone, prolactin, noradrenalin, and endogenous opiates
Symptoms & signs (typically occurring
in the period between ovulation and the onset of menstruation, lasting
up to 2 weeks; occurring anamnestically for most of menstrual cycles for
many years and confirmed in the 2 following cycles)
:
feelings of depression, hopelessness, aggressiveness, increased fatigue
or lethargy,
anxiety, or anger, emotional lability (tendence to crying and social isolation,
decreased libido), bloating, diffuse edema with increased
body weight and sense of tenderness, pelvic pains and headache,
mammary tenderness or mastodynia, heat flushes, intestinal alterations,
acne, seborrhea, foruncles, changes in appetite or cravings for selected
foods, breast swelling and tenderness, constipation, and decreased ability
to concentrate. Rarely hyperthymic disorder.
Laboratory examinations :
Moos menstrual distress questionnaire
premenstrual assessment form
Therapy :
decrease salt and caffeine intake and increase water intake
seasonal affective disorder
(SAD) / mood disorder with seasonal pattern / seasonal mood disorder :
a cyclically recurring mood disorder characterized by depression, extreme
lethargy,
increased need for sleep, hyperphagia, and carbohydrate craving; it intensifies
in one or more specific seasons, most commonly the winter months, and is
hypothesized to be related to melatonin
levels
minor depressive episode (> 2 weeks)
brief recurrent depressive episode (2 days < x < 2 weeks)
Epidemiology : longlife prevalence = 16-20%
in females; 12-14% in males. The WHO has identified depression as the fourth
leading cause of disease burden, which is defined as years patients must
live with a disability. Since the disorder is now being diagnosed more
frequently, the WHO estimates that depression will become the first cause
of disease burden worldwide by the year 2020. Depression is a common condition,
contributing 12% of the total burden of nonfatal global diseaseref.
Variations in its treatment within the NHS are striking and perplexingref.
We welcome these guidelines and recent advice from the Medicines and Healthcare
products Regulatory Agency (MHRA) concerning the prescription of antidepressantsref1,
ref2.
The methods underpinning the guidelines were rigorous and produced a definitive
summary of current evidence. However, the uncertainty of many recommendations
is disappointing. The guidelines advocate a stepped care approach, but
the weakness of evidence supporting structured interventions for mild to
moderate depression limits the value of recommendations referring to initial
steps. To advance further the management of what is termed mild to moderate
depression, we need a better understanding of the interaction that occurs
when individuals seek medical help for an emotional problem. 2 trends deserve
attention. Firstly, changes in social networks leave the vulnerable with
limited access to informal emotional support. Secondly, professionals providing
support are increasingly obliged to restrict interventions to those with
evidence of effectiveness. On the whole these are limited to those evaluated
from a medical perspective. As a result distress may be defined as depression
by patients as a necessary means to access support and by doctors as a
way of legitimising the provision of such support. The idea that
societal change influences diagnosis is not new. This medicalisation of
unhappiness would benefit from sociological as well as clinical researchref Aetiology :
Pathogenesis : decrease in activity of CNS
noradrenergic
and serotoninergic
systems => decrease in BDNF
synthesis => decreased trophism of limbic system. Experimentally induced
by reserpine.
Symptoms & signs usually last 4-6
months and can chronicize when lasting > 2 years. They range from normal
feelings of “the blues” through dysthymic disorder to major depressive
disorder. It in many ways resembles the grief and mourning that follow
bereavement; there are often feelings of low self-esteem, guilt, and self-reproach,
withdrawal from interpersonal contact, and somatic symptoms such as eating
and sleep disturbances. There is only mild social or workplace impairment.
Grading :
LSAS and Clinical Global Impression (CGI)
29-item Hamilton Rating Scale for Depression (HRSD-29)
Hamilton Depression Rating Scale (HAM-D) : one designed to score
the severity of depression on the basis of a semistructured interview eliciting
depression-related symptoms.
Montgomery-Asberg depression rating scale (MADRS)
Therapy :
chemotherapy
1886 : pyretotherapy
1922 : sleep therapy
1933 : insulin coma
convulsive therapy / shock therapy : treatment by induction of convulsions
Therapy varies according to efficacy, side effects, concomitant somatic
disorders (e.g. anticholinergic drugs should not be used in patients with
BPH), other drugs, previous positive responses in the patient himself or
previous patients, kind of depression, psychiatric comorbidity, lifestyle,
job, costs. They could slatentize panic attacks.
The most common fears about antidepressants are : pharmacophobia,
fear of modification of personality in prolonged use, pseudoallergies,
sedation, pill ingestion, injection, and expecially weight gain. Therapy
is needed when :
transverse evaluation: moderate or severe symptoms (risk of suicide), melancholy
(guilt, ruine), psychotic symptoms (congruous or incongruous delirium)
psychotherapy
: cognitive therapy, when provided by an experienced therapist, may be
as effective as antidepressant medications in the initial treatment of
moderate to severe major depressionref
interpersonal psychotherapy : mourning, role transition, interpersonal
deficit, interpersonal contrast
familial psychotherapy : lifestyle modfiication of affected member reflect
on healthy members
bipolar
disorder (BPD) / manic-depressive psychosis : mania
alternated to depression
: mood disorders characterized by a history of manic,
hypomanic
or mixed (depression with manic motricity; accelerated ideation with depressive
setting; .... Often it has an organic cause) episodes, usually with concurrent
or previous history of one or more major depressive
episodes :
bipolar I disorder : a type of
bipolar disorder characterized by one or more manic
or mixed episodes, often with a history of one or more major depressive
episodes.
bipolar II disorder : a type of
bipolar disorder characterized by one or more major depressive episodes
accompanied by at least one hypomanic episode
but without any manic or mixed episodes.
cyclothymic disorder / cyclothymia
: a mood disorder characterized by numerous alternating short cycles of
hypomanic
and depressive
periods with symptoms like those of manic and major depressive episodes
but of lesser severity for > 2 years (> 1 year in babies and adolescents)
cycloid : characterized by alternating moods
of elation and depression. The terms cycloid, cyclothymic, and manic-depressive
overlap in meaning, although cycloid would generally be used for the least
severe, and manic-depressive for the most severe conditions.
Epidemiology : prevalence = 1 person in 100,
since age 20
Aetiology : SNPs in BDNF,
GRK3 Pathogenesis : up to 40% less grey matter
than normal in brain regions associated with mood
Mood Disorder
Questionnaire (MDQ) by AstraZeneca
Therapy :
Prognosis : without some form of therapy,
up to 20% of sufferers will commit suicide. But
up to 80% of sufferers have a positive reaction to lithium, and the suicide
rate is reduced by a factor of 8
Structured Clinical Interview for Mood Spectrum (SCI-MOODS) and
self-report
version (MOODS-SR) (intraclass correlation coefficients (ICC) ranged
from 0.88 to 0.97)
Structured Clinical Interview for Mood Spectrum, lifetime version (SCI-MOOD/LT)
Self-Report instrument for Mood Spectrum, lifetime version (MOODS-SR/LT)
Self-Report instrument for Mood Spectrum, last month version (MOODS-SR/LM)
Self-Report instrument for Mood Spectrum, last week version (MOODS-SR/LW)
anxiety disorders : a group of neuroses
(conscious disorders) in which anxiety and avoidance behavior
(due to anticipatory anxiety) predominate. A stressor causes a stress
that breaks the internal and external equilibria of the patient
anxiety : the unpleasant emotional state consisting
of psychophysiological responses to anticipation of unreal or imagined
danger, ostensibly resulting from unrecognized intrapsychic conflict(on
the contrary of fear, the unpleasant emotional state consisting
of psychological and psychophysiological responses to a real external
threat or danger, including agitation, alertness, tension, and physiological
mobilization of the alarm reaction).
psychological concomitants ("cortical anxiety") include feelings
of
physiological concomitants (anguish / "bulbar anxiety") : noradrenergic
discharges leading to a "fight or fly reaction" include
increased heart rate
altered respiration rate
sweating
trembling
weakness
fatigue
panic disorder (PD) with and without agoraphobia
/ panic attack : an anxiety disorder characterized by recurrent panic
(anxiety) attacks, episodes of intense apprehension, fear, or terror, usually
occurring while relaxed (unexpected, "out of the blue") or after long periods
of stress or hyperactivity (expected), in places where previous panic attacks
occurred (=> phobia for risk situations, including
claustrophobia),
e.g. in hospitals, dentists (fear of anaesthesia (fear to fall asleep)
and entrapment), sexual activity, restaurants, queues, unless forced self-exposure
is required by job.
There is usually chronic nervousness and tension between attacks (anticipatory
anxiety) => avoidance behavior (agoraphobia
and claustrophobia) => secondary social
phobia (fear to show the disease to others) => demoralization in the
post-critical phase lasting minutes to days, with dizziness, alienation,
unstable equilibrium, alertness and hypervigilance due to fear of relapse
=> high risk of suicide (20% when associated with
mood disorders). The patient can mantain self-control or may interrupt
activities to escape (rarely practices uncontrolled acts). They usually
need an accompanying friend (high sensitivity to rassicuration),
wear protective objects (hats, umbrellas, sunglasses, bikes, ...), practice
superstitious acts, and believe to be affected by organic lesions in respiratory,
cardiovascular or nervous systems (hypochondriasis).
They are very sensitive to drugs and hence avoid psychostimulants while
are commonly addicted by depressant drugs (e.g. ethanol, cannabinoids,
heroin, ...). Sometimes associated with hematophobia, pillophobia. It is
almost always associated with agoraphobia (panic
disorder with agoraphobia) but DSM-IV also recognizes panic
disorder without agoraphobia. This disorder does not include panic
attacks that may occur in phobias when the patient is exposed to the phobic
stimulus.
Aetiology :
lowered threshold for CO2
detection ([CO2]air > 9,000 ppm : a single inhalation
of 35% CO2 activates the hypothalamic-pituitary-adrenocortical
(HPA) axis, increases blood pressure (BP) and increases subjective fear
responses in healthy volunteers)
genes on chromosome 13q, and possibly on chromosome 22 as well, that influence
the susceptibility toward a pleiotropic syndrome that includes PD, interstitial
cystitis
(RR = 4), severe headache
(RR = 2), mitral
valve prolapse (MVP)
(20-30%; RR = 2; selection bias due to hypochondriasis
?), and thyroid conditions
hyperthermia
(patients use to switch radiators off)
reduction of 10- 33% in the number of 5-HT1A
receptors in the anterior cingulate cortex, the posterior cingulate cortex
and the raphe nucleus
BDZs
=> trycyclic antidepressants
(TCA)
=> SSRI (imipramine
(10-300 mg 3 times a day) => trimipramine
(25-200 mg 3 times a day; side effects : sleepiness and weight gain, diarrhea,
tachycardia due to anticholinergic effects); nowadays the drugs of choice
are paroxetine
> sertraline.
Fluoxetine
has disinhibiting effects). Cholinergic blockers are associated (sulpirides
cause decreased libido and limit erection and ejaculation
: once side effects were treated with testosterone
and gonadotropins,
but that caused increased PRL => gynecomastia and galactorrhea)
phobia : intense fear of a specific evolutionarily
conserved object, activity, or situation (the phobic stimulus), fear that
is recognized as being excessive or unreasonable by the individual himself.
When a phobia is a significant source of distress or interferes with social
functioning (counterphobia : the state of seeking out of situations
or objects which one fears or has feared, consciously or unconsciously),
it is considered a mental disorder (sometimes called a phobic disorder);
in DSM-IV phobias are subclassified as ...
agoraphobia : intense, irrational fear
of open spaces, characterized by marked fear of being alone or of being
in public places where escape would be difficult or help might be unavailable.
It may be ...
agoraphobia
without history of panic disorder : agoraphobia with fear of having
an attack of one or only a few incapacitating or embarrassing symptoms,
which the person may or may not have had in the past, rather than a full
panic attack.
panphobia : fear of everything; a vague
and persistent dread of some unknown evil.
simple or specific phobia : an
anxiety disorder characterized by persistent and excessive or unreasonable
fear of a circumscribed, well-defined object or situation. Common specific
phobias involve
acarophobia : irrational fear of mites or of other minute animate
(insects, worms) or inanimate (pins, needles) objects, sometimes accompanied
by fear of parasites crawling beneath the skin
acrophobia : irrational fear of heights.
Therapy : after 2 sessions of behavioural
therapy, patients reported a 10% decrease in anxiety levels. When the sessions
were supplemented with D-cycloserine
(DCS),
their anxiety dropped 50%
aerophobia : irrational fear of drafts or fresh air, often connected
with the idea of harmful airborne influences.
amathophobia : irrational dread of dust.
anemophobia : irrational fear of wind or of drafts.
anthropophobia : irrational dread of human society.
apiphobia : irrational fear of bees.
astrapophobia / astraphobia : irrational fear of thunder and lightning
belonephobia : irrational fear of pins, needles, and other sharp
objects
cancerphobia / cancerophobia : irrational fear of cancer.
chronophobia : extreme, irrational fear
of time; because it is so common in prisoners, it is sometimes called prison
neurosis
claustrophobia : irrational fear of
being shut in; fear of enclosed spaces, such as elevators and tunnels,
MRI machines, tight ties, rings, or belts.
Aetiology : primitive fear of lack of
O2 during life into caves :
smoke
floods
heat of blankets
ingestion of food
mother separation anxiety disorder
coitophobia : fear of sexual intercourse
cynophobia : irrational fear of dogs.
demonophobia : irrational fear of demons
eremophobia : irrational fear of being alone.
erotophobia : fear of love, especially
of sexual feelings and activity
ereutophobia : irration fear to become red in face
erythrophobia : irrational fear of the color red, often accompanied
by fear of blood (hematophobia).
gamophobia : fear of marriage
haphephobia : irrational fear of being touched.
harmatophobia : fear of sexual incompetence or making a mistake
helminthophobia : morbid fear of worms.
homophobia : fear of same gender sex partner
hydrophobia : irrational fear of water
(differential diagnosis with paralytic hydrophobia : choking, gagging,
and fear on attempts to drink in the acute neurologic phase of rabies,
caused by pain from spasms of the pharynx or larynx)
kathisophobia : intense, irrational
fear of sitting down.
glossophobia / lalophobia : irrational fear of speaking
mysophobia : irrational fear of dirt and contamination.
necrophobia : irrational fear of death or of dead bodies.
neophobia : irrational fear of novel but non-threatening situations
such as meeting a stranger or entering a new room. As many as 15% of children
are thought to suffer from it and they also have higher levels glucocorticoids
: neophobic scaredy-rats die an average of 3 months younger than their
outgoing brothers — equivalent to 10 years shaved off a human life
nyctophobia : irrational fear of darkness
parthenophobia : irrational fear of girls.
pathophobia / nosophobia : phobia of contracting a sexually transmitted
disease
pharmacophobia : irrational fear of
drugs or medicines
phobophobia : irrational fear of one's own fears or of acquiring
a phobia.
phonophobia : irrational fear of sounds or of speaking aloud
social phobia / social
anxiety disorder (SAD) : an anxiety disorder characterized by fear
and avoidance of social or performance situations in which the individual
fears possible embarrassment, defeat and humiliation, e.g., fears of speaking,
performing, or eating in public => low education, can't look into speaker's
eyes; usually excusating, low voice, flexed head. Panic
attacks may occur.
phobia of speaking in public
nongeneralized social phobia (< 3 situations)
generalized social phobia (> 3 situations)
performance anxiety : a social
phobia characterized by extreme anxiety and episodes of panic when performance,
particularly public performance, is required.
avoidant disorder of childhood or adolescence : former name for
a disorder that would now be included under the diagnosis of social phobia
Epidemiology : prevalence = 13-14% (underextimated
as shiness leads to reluctance to ask medical help), more common in females
due to evolutionarily preserved need to seem pretty in order to be chosen
by males; 80% has onset before age 18; usually diagnosed after > 20 years
(in the meanwhile complicances (toxicomanias, alcoholism, agoraphobia,
depression, ...) may mask the primary disease). Familiarity may be due
to elective affinities between parents or parental imprinting.
Symptoms & signs : antisocial behaviour
(delays at work, dismissals, brawls, )
Laboratory examinations :
Liebowitz social anxiety scale (LSAS) contains 24 items, 13 concerning
performance anxiety and 11 concerning social situations. Each item is rated
separately for fear (0 to 3 = none, mild, moderate, severe) and avoidance
behavior (0 to 3 = never, occasionally, often, usually). Thus, the LSAS
provides an overall social anxiety severity rating, and scores on 4 subscales:
1) performance fear, 2) performance avoidance, 3) social fear, and 4) social
avoidance.
Structured Clinical Interview for Social Phobia Spectrum, lifetime version
(SCI-SHY/LT)
Self-Report instrument for Social Phobia Spectrum, lifetime version
(SHY-SR/LT)
Self-Report instrument for Social Phobia Spectrum, last month version
(SHY-SR/LM)
Self-Report instrument for Social Phobia Spectrum, last week version
(SHY-SR/LW)
Aetiology :
primary : familiarity (patients couple with similar patients, so that severity
may increase in children)
b-blockers (propanolol
40-80 mg or atenolol
50-150 mg) 1-2 hours before social performances : they decrease anxiogenic
vegetative symptoms (tachycardia, tremors), but are not effective on generalized
social phobia and worse depression
castration anxiety or complex : in psychoanalytic theory, unconscious
thoughts and motives stemming from fear of loss of genitals as punishment
for forbidden sexual desires.
free-floating anxiety : severe, generalized anxiety having no apparent
connection to any specific object, situation, or idea.
cognitive dissonance : anxiety or other unpleasant feelings resulting
from a lack of agreement between a person's established ideas, beliefs,
and attitudes and some more recently acquired information or experience.
separation anxietydisorder
: excessive, prolonged (> 4 weeks), developmentally inappropriate anxiety
and apprehension in a child before age 18 (early if before age 6)
concerning removal from parents, home, or significant familiar surroundings.
On the contrary of dependence (a state of relying on or requiring
the aid of something, particularly for support or maintenance), patients
make their own choices. Only 3% of mammalian species has stable bonds.
Aetiology : deficiency of socializing
hormone(s) (oxytocin,
ADH
(e.g. high in montane vole (Microtus
montanus : asocial, minimally parental, low separation distress),
low in prairie vole (Microtus
ochrogaster : highly social, biparental, high separation distress,
high bonds)), opiates,
peptides, ,
ACTH,
PRL,
melatonin,
noradrenalin,
and serotonin).
Mating increases ADH
in males and oxytocin
in females.
Kinds of separation anxiety :
Comorbidity : sometimes accompanied by depression
and/or bipolar
disorder. In adulthood patients may develop partner separation anticipatory
anxiety disorder, inhability to separate from object the patient would
like to go away, or panic disorder.
Differential diagnosis :
Laboratory examinations : Structured Clinical
Interview for Separation Anxiety Spectrum, lifetime version (SCI-SAS/LT)
acute stress disorder : an anxiety
disorder characterized by development of anxiety and dissociative and other
symptoms within one month following exposure to an extremely traumatic
event, the symptoms including reexperiencing the event, avoidance of trauma-related
stimuli, anxiety or increased arousal, and some or all of the following:
a subjective sense of diminished emotional responsiveness, numbing, or
detachment, derealization, depersonalization,
and amnesia
for aspects of the event.
posttraumatic stress
disorder (PTSD) : an anxiety disorder caused by exposure to an intensely
traumatic event; characterized by reexperiencing the traumatic event in
recurrent
intrusive recollections, nightmares,
or flashbacks, by avoidance of trauma-associated stimuli, by generalized
numbing of emotional responsiveness, and by hyperalertness and difficulty
in sleeping, remembering, or concentrating. The onset may be delayed for
months to years after the event. Terms formerly used for disorders of this
type include gross stress reaction, shell shock, and combat
(or battle or war) exhaustion, fatigue, or neurosis. E.g. train-drivers
that can't prevent suicide on railways.
acute operational stress disorders
acute combat stress disorder
conversion reactions
counter-disaster syndrome
peacekeeper's acute
stress syndrome
Stockholm syndrome / traumatic or terror
bonding : bonding with an abusive partner. It seems to be an automatic,
probably unconscious emotional response to the traumatic experience of
being a victim, which becomes an efficient propagandist. It affects hostage
being kidnapped for ransom and hostage-taker alike and serves to unite
both, being victims of the siege environment, against outsiders. This positive
emotional bond between victim and subject is a defense mechanism of the
ego under stress. The priority in dealing with hostage situations is the
survival of all participants. The Stockholm syndrome may save the life
of victim and subject alike, as it reduces the subjects tendency towards
violence and thus the possible necessity for a seizure by the security
forcesref1,
ref2,ref3,
ref4,
ref5.
post-traumatic disorders :
classic PTSD : during the Civil War it was seen but didn't have
a name, other than 'malingering.' Guys never came back to themselves after
the war
Longer engagements made PTSD more common. A soldier would be hunkered down
in a trench, hearing explosions day after day, with little hope. After
30 days new guys would come in. But nobody put it together until after
World War I, when it was dubbed "battle shock". By World War II
it had become "battle fatigue", then later "post-Vietnam syndrome"
before PTSD. Vietnam was a milestone. No nation had rigorously conducted
an epidemiological survey of males and females in the theater, but scrutiny
was delayed. It was done in the mid-1980s, but the conflict raged in the
1960s and 1970s. For the first Gulf War, PTSD research began 5 years later.
The US military has already questioned 2,530 soldiers in Iraq and 3,671
in Afghanistan about PTSD symptoms pre- and postdeployment. The most telling
finding is that only 23% to 40% of those affected sought help, fearing
stigmatizationref.
Since in the past symptoms typically peaked 2 years postengagement, current
figures may be an underestimate.
combat neurosis : an older term used for forms of PTSD in which
the traumatic event is combat-related.
war neurosis : older term for a form of PTSD in which the traumatic
event is war-related.
mobbing : to crowd about, as a mob, and attack
or annoy; as, to mob a house or a person. It is diagnosed in employees
without previous psychiatric diagnoses and continued relationship with
his/her employer
burn-out : a sudden change from enthusiasm
to demotivation, cinism, depersonalization, occupational isolation and
drop in productivity after a shocking experience (seen in resuscitators,
oncologists, people assisting end-stage ill patients, ...)
night workers : at least 3 hours comprised in 7 continuative hours including
the period between 12 p.m. and 5 a.m. (i.e. from 10 p.m. to 5 a.m., from
11 p.m. to 6 a.m., or from 12 p.m. to 7 a.m.) for at least 80 days per
year => effect on
sleep/awake cycle (reduced duration of phase 2 and REM sleep => chronic
fatigue, anxiety, depression, and disruptive behaviours => psychoactive
drugs use)
working effectiveness (decreased vigilance and attention => increased risk
of injuries)
health status :
fast foods, excessive ingestion of stimulating drinks (tea and coffee),
cigarette smoke => dyspepsia, constipation/diarrhea, pyrosis, abdominal
pain
cardiovascular apparatus
menses alterations
family and social life
psychological
unsafety in front of modern technologies
frustration because of lack of progression in career
biological : consciousness of employment in activities noxious for health
Symptoms & signs : general adaptation
syndrome : prevalence of orthosympathetic system in front of pleasant
(eustress) or unpleasant (dystress) stimuli altering body homeostasis.
alarm reaction : aspecific and proportional to extent of stimuli
renal, gynecological, cutaneous, and ocular diseases
Laboratory examinations :
subjective (occupational psychologist)
interview
dialogue
inquiry with personal or collective questionnaires (on a representative
sample of workers)
mental tests
qualitative : inventory : a comprehensive
list of personality traits, aptitudes, and interests.
Beck Depression Inventory
: a self-report questionnaire for measuring the symptoms of depression,
focusing on the cognitive symptoms.
California Personality
Inventory (CPI) : a self-report, true-false test designed to measure
aspects of personality style; generally used in counseling situations or
for less than severe psychopathology.
Millon Clinical
Multiaxial Inventory (MCMI) : a self-report inventory designed to produce
a profile of the personality style and structure underlying mental disorders.
Minnesota
Multiphasic Personality Inventory (MMPI) : a self-report, true-false
test designed to evaluate personality and particularly to assess psychopathology.
Rorschach test (10 tables with symmetrical black&white spots
that the subject has to interpret)
IQ
psychotechnics : the employment of psychological methods in studying
sociological and other problems; study of human attitudes (perception,
memory, attention, manual ability, reaction times) to employments requiring
particular intellectual abilities, e.g. pilots, public transport drivers,
soldiers, airport control-towers workers, train engine-driver, workers
in high-risk employments requiring high precision
biological
direct metabolic markers
ACTH
corticosterone, cortisol
17-ketosteroids and 17-hydroxysteroids
free catecholamines
metanephrine and normetanephrine
vanylmandelic acid (VMA)
indirect metabolic markers
glycemia
lipidemia
uricemia
protidemia
serum and urine electrolytes
azotemia
creatininemia
functional markers
arterial pressure
heart rate
cardiac output
vigilance level
Epidemiology : first described in survivors
of Vietnam war; prevalence = 0.5-1%; 10% in urban USA communities; 60-70%
in communities exposed to disasters.
A bout of PTSD may do damage to the brain that kick-starts memory problems,
scientists have discovered. Even patients who had recovered from a period
of stress started to get age-related memory difficulties about a decade
earlier than non-traumatized people. Post-traumatic stress, a condition
that can cause patients to feel physical pain on remembering a traumatic
event, is known to have a number of effects on the mind and body. One of
the side effects is that patients tend to be forgetful, unable to remember
a story or a list of words after they've heard it, for example. This problem,
which could come from emotional distraction and an inability to concentrate,
can interfere with everyday tasks. The link between PTSD and memory problems
was investigated by looking at what happens to 3 groups of people as they
age (Yehuda R., et al. Biol. Psychiatry, (in the press) (2006)) : Holocaust
survivors with continued PTSD, survivors who had recovered from their trauma,
and a control group who had not lived through the Holocaust and had never
had PTSD. The researchers looked at the study participants' ability to
remember associations between common words such as 'desk and chair', a
task that is known to become more difficult as we age. They tested their
participants at the age of 67, and again at 72. Those who had PTSD, even
if they had subsequently recovered, could only come up with answers for
half of the questions by the age of 72, a score that's usually expected
from those over 80 years old. And they had showed a marked deterioration
in scores from when they were 67. Those who had not had a trauma consistently
got most, or all, of the questions right at both ages. Having PTSD early
in life seems to set up future problems. It's like getting sunburnt at
15 and developing melanoma later. Researchers aren't sure how this might
happen. Some think that stress hormones called glucocorticoids, which erupt
in the body after a traumatic event such as fighting in a war, attack the
hippocampus, a brain area that is key for memory. Some studies have shown
the hippocampus of PTSD patients being unusually small, perhaps because
it has been eaten away by stress hormones. Others think that people with
a naturally small hippocampus may be predisposed to both memory problems
and PTSD. Perhaps it isn't trauma that shrinks this part of the brain,
but a small hippocampus that increases the likelihood of a stress disorder
after a trauma. There's another possible explanation: perhaps some other
factor, such as diet, was very different between the Holocaust survivors
and the control group. The study didn't look at nutrition or weight loss
in the Holocaust survivors, and this could be linked to their memory problems
now. But it is stress that's to blame. Not all of the cognitive functions
were worse in the Holocaust survivors. The ability to learn and repeat
back a list of words, for example, a skill linked to the pre-frontal cortex,
was actually better in patients who had recovered from PTSD, as though
their brain was compensating for difficulties in the hippocampus. Ageing
and trauma will nibble away at memory performance but the brain will be
able to compensate to a point. The team's next steps are to look at soldiers
who fought in wars to see whether they show the same pattern of decline.
They are also going to look at young people who have been through trauma
and follow them up later in life
Onset of symptoms
:
situational anxiety : that occurring
specifically in relation to a situation or object.
generalized anxiety
disorder (GAD) : an anxiety disorder characterized by the presence
of excessive, uncontrollable anxiety and worry about > 2 life circumstances,
for > 6 months, accompanied by some combination of restlessness, fatigue,
muscle tension, irritability, disturbed concentration or sleep, and somatic
symptoms.
obsessive-compulsive
disorder (OCD) : an anxiety disorder characterized by recurrent obsessions
or compulsions, which are severe enough to interfere significantly with
personal or social functioning. Performing compulsive rituals may release
tension temporarily, and resisting them causes increased tension. This
disorder is not the same as obsessive-compulsive
personality disorder. Patients may develop depression
obsession : a recurrent, persistent thought,
image, or impulse that is unwanted and distressing (ego-dystonic)
and comes involuntarily to mind despite attempts to ignore or suppress
it. Common obsessions involve thoughts of ...
contamination from dirty objects
self-doubt (closures of gas plants, keys, ...)
phylosophical-existential : essence and reasons of world
contrast ideas : fear of hurting
sexual : sexual proposals, incestuous impulses
violence
numerical-mathematical
religious : fear to commit sin, swearing
compulsion : a compulsive act or ritual;
a repetitive and stereotyped action, such as hand-washing, touching, counting,
and checking, that is engaged in response to an obsession for an
unknown or unconscious purpose.
repetition compulsion : in psychoanalytic theory, the impulse to
reenact earlier emotional experiences or traumatic behavior
cleaning
order
symmetry
numerical compulsion
...
resistance : conscious or unconscious defenses that prevent material
in the unconscious, as repressed thoughts, from coming into awareness
interference : opposition to or hampering of an action or procedure
obsessive slowness : global slowing of all activities and latent
reactions
Epidemiology : prevalence in general population
= 5.5%
Aetiology : SNPs in SLC6A5
/ SERT Symptoms & signs : doubtful facing
new situations or situations implying an even minimal risk of failure
uncertainty : cognitive component
insecurity : affective component
indecision : volitive component
hypercontrol : they leave others decide for them (with no sense
of guilt on the contrary of patients with social
phobia or depression)
emotional control
heterodirected control
conformism to traditional values
magical thinking : that characterized
by the belief that thinking or wishing something can cause it to occur;
it is normal in childhood and dreams but also occurs in schizophrenia
and OCD.
temporal alterations : hyperechonomic or antiechonomic time gestion
Symptoms & signs (anxiety syndrome) :
palpitation of the heart, rapid and shallow respiration, sweating, pallor,
and a feeling of panic
Laboratory examinations :
Structured Interview for Disorders of Extreme Stress (SIDES)
Defensive Functioning Scale : a scale comprising defense mechanisms
used to prevent or allay anxiety.
relative stress scale (RSS)
Chemotherapy
(diazepam and imipramine)
Experimental animal models :
mouse marble burying test
zero maze
somatoform disorders : mental
disorders characterized by symptoms suggesting a general medical condition
but neither fully explained by a general medical condition, the direct
effects of a psychoactive substance, or another mental disorder nor under
voluntary control; this category includes
somatization disorder / Briquet's
syndrome : a mental disorder characterized by multiple somatic complaints
that cannot be fully explained by any known general medical condition or
the direct effect of a substance, but are not intentionally feigned or
produced, beginning before the age of 30 and occurring over several years.
Complaints comprise a combination of at least multiple pain symptoms, multiple
gastrointestinal symptoms, a sexual symptom, and a neurological symptom.
They are often presented in a dramatic, vague, or exaggerated way; many
physicians become involved in the medical care; and numerous diagnostic
evaluations and unnecessary medical treatment or surgery may be performed
undifferentiated
somatoform disorder : one or more physical complaints, not intentionally
produced or feigned and persisting for > 6 months, that cannot be
fully explained by a general medical condition or the direct effects of
a substance; the category comprises persisting disorders that do not completely
satisfy the criteria for other somatoform disorders.
conversion disorder : a mental
disorder characterized by conversion symptoms (loss or alteration of voluntary
motor or sensory functioning suggesting physical illness, such as seizures,
paralysis, dyskinesia
(hysterical chorea),
hysterical
anesthesia,
blindness, or aphonia) having no demonstrable physiological basis and whose
psychological basis is suggested by (1) exacerbation of symptoms at times
of psychological stress, (2) relief from tension or inner conflicts (primary
gain) provided by the symptoms, or (3) secondary gains (support, attention,
avoidance of unpleasant responsibilities) provided by the symptoms. Many
patients exhibit “la belle indifférence” [Fr. “beautiful
indifference”], an inappropriately complacent attitude (lack of concern)
toward their condition and impairment caused by the symptoms ; histrionic
personality traits are also common. Symptoms are neither intentionally
produced nor feigned, and are not limited to pain or sexual dysfunction.
pain disorder : a somatoform disorder
characterized by a chief complaint of severe chronic pain that causes substantial
distress or impairment in functioning; the pain is neither feigned nor
intentionally produced, and psychological factors appear to play a major
role in its onset, severity, exacerbation, or maintenance. It is subdivided
into
pain disorder
associated with psychological factors
pain disorder associated with both psychological factors and a general
medical condition
pain disorder associated with a general medical condition
is not considered a mental disorder.
hypochondria / hypochondriasis / hypochondriacal
neurosis [so called because it was supposed by the ancients to be due
to disturbed function of the organs of the upper abdomen; see also regio
hypochondriaca] a somatoform disorder characterized by a preoccupation
with bodily functions and the interpretation of normal sensations (such
as heart beats, sweating, peristaltic action, and bowel movements) or minor
abnormalities (such as a runny nose, minor aches and pains, or slightly
swollen lymph nodes) as indications of serious problems needing medical
attention. Negative results of diagnostic evaluations and reassurance by
physicians only increase the patient's anxious concern about his health,
although the concern is not of delusional intensity
body dysmorphic disorder / dysmorphophobia
: a mental disorder in which a normal-appearing person is either preoccupied
with some imagined defect in appearance or is overly concerned about some
very slight physical anomaly.
koro : a culture-specific acute delusional syndrome
occurring in south and east Asia in which the patient believes that the
penis or the vulva and nipples are shrinking and may disappear into the
abdomen, causing death.
somatoform
disorder-not otherwise specified (NOS)
pseudocyesis / pseudogestation / false or
spurious pregnancy : absence of the menses and presence of other signs
of pregnancy, without occurrence of conception and development of an embryo.
It may be due to psychogenic factors, to a tumor or mole, or to endocrine
disorders
hypochondriacal symptoms lasting < 6 months
unjustified physical complaints lasting < 6 months and not related to
other mental disorder
dissociative disorders : mental
disorders characterized by sudden, temporary alterations in identity, memory,
or consciousness, segregating normally integrated memories or parts of
the personality from the dominant identity of the individual. This category
includes :
dissociative identity disorder
(DID) / multiple personality disorder / double or dual personality
: a dissociative disorder characterized by the existence in an individual
of 2 or more distinct personalities, each having unique memories, characteristic
behavior, and social relationships. At least 2 of the personalities control
the patient's behavior in turns, the transition often being abrupt. The
host personality usually is totally unaware of the alternate personalities,
experiencing only inexplicable gaps of time and inability to recall important
personal information. Alternate personalities may or may not have awareness
of the others. Alternative personalities are typically developed by children
who suffer severe trauma or abuse and appears to help people cope by cutting
off difficult memories, making them seem as if they happened to someone
else. In one persona, patients recognize the traumatic history as their
own, and it triggers emotional centres in their brain. In the other personality,
they do not consciously recognize the tale as autobiographical, and it
fires up a wider brain network including regions involved in self-awareness
or conscious experience (medial prefrontal cortex (MPFC) and the posterior
associative cortices). These regions would not be expected to be active
in people with a single personality hearing stories that are not about
themselves. The brain has to actively suppress the traumatic information
: these additional brain regions stifle the autobiographical memories and
erase them from that personality's perceived pastref.
Differential diagnosis :
direct physiological consequence of a specific general medical condition
dissociative or psychogenic
fugue : a dissociative disorder characterized by an episode of sudden,
unexpected travel away from home or business, with amnesia for the past
and partial to total confusion about identity or assumption of a new identity;
the disorder is usually related to emotional conflicts due to some traumatic,
stressful, or overwhelming event, remits spontaneously, and rarely recurs.
A.k.a.... :
pibloktoq / Arctic hysteria : a culture-specific
syndrome seen chiefly among Eskimo women (Greenland Inuit people), marked
by sudden, short-lived attacks (of up to 30 minutes' duration) of screaming,
crying, running naked through the snow, and other dangerous or irrational
acts, sometimes with suicidal or homicidal tendencies, often followed by
convulsive seizures and coma lasting 12 or more hours
cathard of Polynesia
mal de pelea of Puerto Rico
our own Western "anorexia nervosa" and "bulimia nervosa"
grisi siknis / grisi munaia (literally
'going crazy') by Miskito of Honduras and Nicaragua in 2005. Between December
2003 and March 2004 > 150 people over a vast area of the North Atlantic
Autonomous Region of Nicaragua, including the 2 main towns, were affected.
It is more common in the very isolated villages of the upper and middle
sections of the Coco River, which marks the border between the Nicaraguan
and Honduran Miskito and Sumo regions. Typically the syndrome affects teenage
or young women, who suddenly enter a catatonic-type state, alternating
with episodes of agitation and panic attacks. Although news media reports
have mentioned violent episodes, that has not been my experience. The people
affected might, during the agitation phase, try to flee while screaming
in panic. I did learn of a few cases in which the women had grabbed a stick
or other "weapon" to try to "fight off" the supposed "attackers", since
the sufferers seem to be having hallucinations of people and/or animals
trying to harm them. But by far the main danger is to the patients themselves,
who in their agitated state might suffer falls, run into trees, or even
drown in the river while trying to escape their "pursuers". Most of the
time, though, the patient remains in a catatonic-like state, which may
last from hours to several days. Despite 250 years of contact with Europeans,
including Christian missionaries and western medicine, traditional beliefs
are extremely strong in Miskito society. These are deeply spiritual people
who typically attend Christian churches and actively participate in services,
but under the surface keep their traditional animist beliefs very much
alive and well. Central to these are beliefs in a host of creatures, including
the souls of deceased relatives or neighbors who have died violently or
suddenly, as well as those of animals (e.g. the evil Lhasa, or Jaguar's
Soul) and mythological creatures, like Liwa Mairin or Evil Siren. The experts
who are called upon to deal with this protean range of spirit creatures
are almost as many as the spirits themselves: ukuly or prophets, sukias
or witchdoctors, uhuras or curanderos (herbalists), and dilman or evil
witchdoctors, to mention just a few. The local belief is that the cause
of grisi siknis, better known among the locals as pauka prukan, is a sorcery
put into the person by an evil witchdoctor or dilman. No Western medicines,
including anticonvulsants or antidepressants, seem to have any effect,
the most effective "treatment" involves the intervention of the "good witches":
sukias and ukuly. Treatment involves a range of interventions including
chants, rituals, as well as local botanicals, which might contain psychoactive
chemicals. In the Honduran Mosquitia in 1985 there was indeed considerable
psychological stress from the contra war and Nicaraguan refugee resettlement
at that time. There were reported attacks of grisi siknis as well in Mocoron.
Latin America has a number of folk diagnoses which cannot be directly translated
into ICD-9 code, because certain features do not exactly match. Many of
these are folk explanations of syndromes we would attribute to physical
causes (ancias = anxiety disorder; empacho = bowel obstruction),
while others would translate into anger, fright, or fugue-like states (coraje
= extreme anger with violence; bilis = unexpressed anger associated
with bile in the classic Greek sense). I have seen, in Honduras, temporal
(?) lobe epilepsy in a woman attributed to "coraje" because she would become
unreasonably angry -- to the extent that she would convulse. She had such
a convulsion while waiting in line for medical care at an Army medical
action project. Phenytoin abolished the episodes. The psychosis described,
under the stressful conditions described, strongly suggests a shared psychological
disorder due to stress, upheaval, and despair. An epidemiological study
would likely show an index case in a stressed locale, if this is a "new"
syndrome. If it is recognized in folklore, it might arise simultaneously
in several such areas.
frenzy witchcarft by Navajo
amok / amuck [Malay “furious attack”] : a culture-specific
syndrome first reported in the Malay people (now in many Western Pacific
Islanders), almost always male, consisting of a sudden outburst of indiscriminate
aggressive or homicidal fury provoked by a perceived slight or insult or
possibly unprovoked (running amuck)
For more in-depth and expert information you might want to contact Philip
Dennis, a Professor of Anthropology at Texas Tech University, who has performed
some important research on ethnological and anthropological aspects of
Miskito culture, including grisi siknis : he wrote a useful article on
the topic that was published in a volume on "The Culture-Bound Syndromes"
appearing about 1985 (edited by White & Marsella). Teenage women are
particularly prone to mass hysterical episodes worldwide : this is taken
severely to task by a supporter of women's rights for libeling the gender,
but it just happens to be a fact -- between 1973 and 1993, there were 70
reports of mass hysteria in medical journals (see ProMED post 20020605.4409:
Unexplained rash illness - USA (multistate)(06).
Differential diagnosis :
direct physiological consequence of a specific general medical condition
dissociative or psychogenic amnesia
:
a dissociative disorder characterized by a sudden loss of memory for important
personal information, usually circumscribed or selective amnesia, rarely
generalized or continuous amnesia, and which is not due to the direct effects
of a psychogenic substance or a general medical condition; the amnesia
may follow severe psychological stress or may be an unconscious response
to internal conflicts or an intolerable life situation; complete recovery
of memory almost always occurs.
Differential diagnosis :
amnestic disorder due to general medical condition
depersonalization disorder
: a dissociative disorder characterized by one or more severe episodes
of depersonalization (feelings of unreality
and strangeness in one's perception of the self or one's body image) not
due to another mental disorder, such as schizophrenia.
The perception of reality remains intact; patients are aware of their incapacitation.
Episodes are usually accompanied by dizziness, anxiety, fears of going
insane, and derealization.
Differential diagnosis :
direct physiological consequence of a specific general medical condition
clinical pictures where there are not at least 2 different personality
statuses or there is no amnesia for important personal informations
derealization accompanied by depersonalization in adults
dissociation statuses in persons subjected to prolonged and intense forced
persuasion periods (e.g. brain-washing, thought reconditioning, or prisoners)
dissociative trance disorder
:
a dissociative disorder characterized by an involuntary state of trance
that is not a normal function of the person's cultural or religious practice
and that causes impairment or distress. A.k.a. :
falling-out : a culture-specific syndrome
occurring primarily in southern United States and Caribbean groups, characterized
by an episode of sudden collapse, sometimes without forewarning, with temporary
inability to speak, see, or move
jumping disease : any of several culture-specific
disorders characterized by exaggerated responses to small stimuli, muscle
tics including jumping, automatic obedience even to dangerous suggestions,
and sometimes coprolalia or echolalia. It is unclear whether they are neurogenic
or psychogenic in origin
jumping Frenchmen
of Maine syndrome : a form of jumping disease observed in a group of
lumbermen of French-Canadian descent working in a remote area of Maine;
affected individuals had exaggerated startle responses, automatic obedience,
and often echolalia. It is believed to have represented
a form of operant conditioning rather than a true diseaseref.
latah : a culture-specific type of jumping disease
seen chiefly among the Malays and other people of Southeast Asia, characterized
by hypersuggestibility, echolalia, echopraxis, coprolalia, disorganization,
and automatic obedience. It may be identical to myriachit.
myriachit / miryachit : a variety of jumping
disease seen in Siberia, possibly identical to latah
ataque de nervios (Latin America)
possession (India)
trance : a state of altered consciousness characterized
by heightened focal awareness and reduced peripheral awareness; a sleeplike
state of reduced consciousness and activity.
ecstasy : a state of rapture and trancelike elation
loss of consciousness, stupor, or coma not attributable to a general medical
condition
Ganser syndrome : the giving of inappropriate,
ridiculous, or approximate answers to questions, sometimes associated with
amnesia, disorientation, perceptual disturbances, and conversion symptoms;
it is most commonly seen in malingering prisoners
feigning psychosis.
vorbeireden : the giving of approximate or otherwise ridiculous
answers or talking past the point, as occurs in Ganser syndrome and other
mental disorders but which also may occur in tired or stressed but otherwise
mentally healthy individuals.
sexual disorders : any disorders
involving sexual functioning, desire, or performance. More specifically,
any such disorders that are caused at least in part by psychological factors
(psychosexual disorders)
sexual desire disorders :
sexual dysfunctions characterized by alteration in sexual desire
hypoactive sexual desire
disorder (HSDD) : a sexual dysfunction consisting of persistently or
recurrently low level or absence of sexual fantasies and desire for sexual
activity, causing pronounced distress or interpersonal difficulties.
Aetiology : women who have had bilateral
oophorectomy
typically experience a 50% drop in circulating testosterone,
which is associated with HSDD
Having too little sexual desire is the most common sexual issue among
women, reported by 10 to 51% of women surveyed in various countriesref1,
ref2
(Matthiesen S, Hauch M. Wenn sexuelle erfahrungen zum problem warden. Familiendynamik
2004;29:136-60). Data from these surveys, as well as from other sources,
indicate that a low level of desire is usually accompanied by low levels
of arousal and sexual excitement and infrequent orgasms and is frequently
associated with sexual dissatisfactionref1,
ref2,
ref3,
ref4
(Davis SR, van der Mooren MJ, van Lunsen RHW, et al. The efficacy and safety
of a testosterone patch for the treatment of hypoactive sexual desire disorder
in surgically menopausal women: a randomized, placebo controlled-trial.
Menopause). Current definitions of sexual dysfunction in women reflect
a change in our understanding of normal sexual responseref.
Rather than the traditional view of a sexual response progressing through
discrete phases in sequence (desire, arousal, orgasm, and resolution),
it is now recognized that these phases overlap and that the sequence can
vary. Also recognized is the importance to sexual satisfaction of the subjective
experience and of an environment and stimuli that are conducive to sexual
feelingsref.
Women have many motivations and reasons for engaging in sex, including
a desire for emotional closeness, whereas sexual desire is an infrequent
reason for women in established relationshipsref.
Among the 2400 multiethnic women (Hispanic, white non-Hispanic, African
American, Chinese, and Japanese) in six U.S. cities in midlife who completed
baseline questionnaires in the prospective Study of Women's Health across
the Nation (SWAN), 40% reported that they never or infrequently felt sexual
desireref.
Nevertheless, the majority reported being capable of arousal, and only
13% expressed discontent with their sexual experiences.
The prevalence of the sexual desire/interest disorder, diagnosed when
a woman fails to feel desire at any stage during the sexual experience,
is uncertain. Studies have focused on a lack of desire at the initiation
of and between sexual experiences, as well as on a lack of sexual thoughts.
However, sexual thoughts are infrequent in many women without apparent
sexual dissatisfactionref,
and the frequency of sexual fantasies or sexual thoughts has little correlation
with sexual satisfaction in womenref1,
ref2.
Arousal disorders are categorized according to whether there is a lack
of subjective arousal alone or a lack of both subjective arousal and awareness
of genital congestion. No objective measurements are used to establish
diagnoses. Arousal disorders also have an uncertain prevalence; most studies
focus only on vaginal lubrication. In a survey of 979 British women who
were 18 to 70 years of age, 17% identified problems with arousal (defined
as distinct from vaginal dryness)ref;
5% of women in SWAN did as wellref Definitions of sexual dysfunction :
APA definition
AUA definition
comments
hypoactive sexual desire disorder : persistent or recurrent deficiency
or absence of sexual fantasies and desire for sexual activity. Judgement
of deficiency is made by the physician, taking into account factors that
affect sexual functioning (such as age and context of the person's life)
sexual desire/interest disorder : absent or diminished feelings of
sexual interest or desire, absent sexual thoughts or fantasies, and a lack
of responsive desire. Motivations for attempting to become sexually aroused
are scarce or absent. Lack of interest goes beyond a normal lessening with
increasing age and relationship duration
minimal spontaneous sexual thinking or minimal desiring of sex ahead
of sexual experiences does not necessarily constitute a disorder (according
on data on women in sexually satisfactory, established relationships).
Lack of desire triggered during the sexual encounter (i.e., responsive
desire) is integral in the AUA Foundation diagnosis
lack of subjective arousal : no DSM-IV definition addresses the lack
of subjective arousal
combined arousal disorder : absent of markedly reduced feelings of
sexual arousal (sexual excitement and sexual pleasure) from any type of
stimulation, and absent or impaired genital sexual arousal (vulval swelling
and lubrication)
there is no sexual excitement in the mind and no awareness of reflexive
genital vasocongestion
lack of subjective arousal : no DSM-IV definition addresses the lack
of subjective arousal
subjective arousal disorder : absent of markedly reduced feelings of
sexual arousal (sexual excitement and sexual pleasure) from any type of
stimulation. Vaginal lubrication and other signs of physical response still
occur
there is no sexual excitement in the mind, but there is awareness of
adequate lubrication
female sexual arousal disorder : persistent or recurrent inability
to attain, or to maintain until completion of sexual activity, adequate
lubrication and swelling response to sexual excitement
genital arousal disorder : absent or impaired genital sexual arousal
(minimal vulval swelling or vaginal lubrification from any type of sexual
stimulation, and reduced sexual sensations when genitalia are caressed).
Subjective sexual excitement still occurs from nongenital sexual stimuli.
the presence of subjective arousal (sexual excitement) from nongenital
stimuli (e.g. erotica, stimulation of the partner, receiving breast stimulation,
kissing) is key to receiving the AUA Foundation diagnosis
female orgasmic disorder : persistent or recurrent delay or absence
of orgasm after a normal sexual excitement phase
orgasmic disorder : lack of orgasm, markedly diminished intensity of
orgasmic sensations, or marked delay or orgasm from any kind of stimulation,
despite self-reported high sexual arousal or excitement
women with arousal disorders rarely or never experience orgasm and
are frequently given a misdiagnosis of orgasmic disorder
Factors influencing desire and arousal : the basis of desire and perceived
arousal in women is poorly understood, but it appears to involve interactions
among multiple neurotransmitters, sex hormones, and environmental factors.
physiologic factors : genital vasocongestive responses occur in women within
seconds after erotic stimulationref.
Both parasympathetic and sympathetic nerves release nitric oxide and vasointestinal
polypeptide, which mediate vasodilatation, and acetylcholine, which blocks
noradrenergic, vasoconstrictive mechanisms and promotes endothelial release
of nitric oxide. Pelvic sympathetic nerves also release norepinephrine,
which is predominantly vasoconstrictive. The mediators of vaginal vasocongestion
are less clear but include vasoactive intestinal polypeptide. The relaxation
of vaginal smooth muscle permits vaginal expansion, and arteriolar dilatation
increases the transudation of interstitial fluid, which promotes lubrication.
estrogen levels : although low estrogen levels and vaginal atrophy are
associated with reduced measures of vaginal congestion when the woman is
not receiving sexual stimulation, the percent increase in congestion in
response to erotic stimuli is similar in the presence of low and high estrogen
levelsref.
Similarly, changes in the volume of the vaginal wall and clitoris and the
relative volume of regional blood in response to sexual stimulation are
similar before and after menopauseref.
Estrogen deficiency does not necessarily preclude adequate lubrication,
provided that stimulation is sufficientref.
However, up to 40% of women may have symptomatic vaginal atrophy that adversely
affects sexual functionref.
subjective arousal is poorly correlated with genital response. For example,
increases in genital vasocongestion in response to erotic videos are similar
among women who report problems with arousal and women who report no problems
with arousal.15 Also, there is a low correlation between brain activation
in areas controlling genital response (as assessed by functional magnetic
resonance imaging of the brain) and simultaneous ratings of subjective
arousalref.
indirect evidence suggests that testosterone and dopamine play a role in
modulating sexual response, since testosterone supplementation or treatment
with a dopaminergic agonist can augment responseref1,
ref2,
ref3,
ref4
(Davis SR, van der Mooren MJ, van Lunsen RHW, et al. The efficacy and safety
of a testosterone patch for the treatment of hypoactive sexual desire disorder
in surgically menopausal women: a randomized, placebo controlled-trial.
Menopause). Underproduction of androgen in women — as may occur with adrenal
disease, after bilateral oophorectomy, or during normal aging — is sometimes
associated with reduced desire and arousal. However, large population studies
have failed to find the expected positive correlations between sexual function
and serum testosterone levelsref1,
ref2.
One possible explanation is that serum levels do not reflect the intracellular
production of testosterone from adrenal and ovarian precursorsref
other factors : several factors have been associated with reduced subjective
arousal. These include distractions, expectations of a negative experience
(e.g., as a result of dyspareunia, the partner's sexual dysfunction, or
negative experiences in the past), sexual anxiety, fatigue, and depression.
Medications including selective serotonin-reuptake inhibitorsref
and oral contraceptivesref
have also been implicated. Oral contraceptives increase levels of sex hormone–binding
globulin, which in turn reduces free testosterone levels; it is hypothesized
that some women are particularly sensitive to these effects, which may
be prolonged (Panzer C, Wise S, Fantini G, et al. Impact of oral contraceptives
on sex hormone-binding globulin and androgen levels: a retrospective study
in women with sexual dysfunction. J Sex Med 2006;3:104-13). In a 1-year
prospective study, 19 of 79 women who received oral contraceptives reported
a decline in sexual desire; 37 discontinued oral contraceptive use within
12 months, many because of sexual side effectsref
On the basis of survey data, several factors have been closely linked to
women's sexual satisfaction and desire. These include stable past and current
mental healthref1,
ref2,
ref3,
positive emotional well-being and self-imageref,
rewarding past sexual experiencesref,
positive feelings for the partnerref1,
ref2,
and positive expectations for the relationshipref1,
ref2.
The partner's sexual dysfunctionref,
increased perceived stressref,
a history of infertility especially after extensive investigationref,
and increased duration of the relationshipref1,
ref2
are all linked with reduced desire. Certain diseases such as multiple sclerosisref,
renal failureref,
and premature menopause induced by chemotherapyref
are associated with a high incidence of sexual dysfunction. In women, unlike
men, vascular disease related to age does not appear to correlate with
reduced sexual satisfactionref.
Symptoms & signs :
a detailed history is the main tool in the assessment and diagnosis of
sexual dysfunction and is usually obtained from both partners. Important
aspects of the history include the quality of the couple's relationship,
the woman's mental and emotional health, the quality of past sexual experiences,
specific concerns related to sexual activity (such as insufficient nongenital
and nonpenetrative genital stimulation), and the woman's thoughts and emotions
during sexual activity.
details from the couple :
sexual problem and reason for seeking help at this time : ask patients
to describe problems in their own words, request clarification with direct
questions, provide options rather than ask leading questions, provide support
and encouragement, acknowledge their embarassement, and reassure patients
that sexual problems are common
duration, consistency and priority of problems : clarify whether problems
are present in all situations. If there is more than one problem, which
is most troubling ?
context of sexual problems : assess the emotional intimacy of the couple,
activity of behaviour just before sexual activity, degree of privacy they
have during sexual activity, degree of sexual communication, time of day
and fatigue level when sexual activity occurs, use of birth control (adequacy,
type), risk of sexually transmitted diseases, usefullness of sexual stimulation,
and sexual knowledge
each partner's sexual response other than that related to the problem :
elicit this information with respect to the present and the period before
the onset of the problem
reaction of each partner to the problem : determine how each has reacted
emotionally, sexually, and behaviorally
previous help sought by either partner : assess compliance with the previous
recommendations and their effectiveness
details from each partner when seen alone :
partner's own assessment of the problem : symptom severity (e.g. total
lack of desire) may be easier to disclose in the partner's absence
sexual response to self-stimulation : also inquire about sexual thoughts
and fantasies
past sexual experiences : discuss positive and negative aspects
developmental history : determine relationships to others in the home during
childhood and adolescence. Were there losses or traumas ? Was he or she
emotionally close to anyone ?Was he or she given physical affection, love
and respect ?
past or current sexual, emotional, or physical abuse : explains that questions
about abuse are routine and do not necessarily imply causation of sexual
problems. It is helpful to ask whether the partner has ever felt hurt or
threatened in the current relationship, and, if so, whether he or she wishes
to give more information
physical health, especially conditions leading to debility and fatigue,
impaired mobility, or difficulties with self-image (e.g., from the presence
of stomas, disfiguring surgery, or incontinence) : ask specifically about
medications with known sexual side effects, including SSRI, b-blockers,
antiandrogens, GnRH agonists, and oral contraceptives.
evaluation of mood : correlation of sexual function and mood (including
anxiety and depression) warrants routine screening for a mood disorder,
by means of either a questionnaire (e.g. the Beck Depression Inventory)
or a semistructured series of question
a physical examination, including a pelvic examination, is part of routine
care, but it infrequently identifies a cause of sexual dysfunction. Its
usefulness may be greater when there is associated dyspareunia. For some
women with a history of coercive or abusive sexual experiences, pelvic
examination may cause anxiety; explanation of what will and will not be
done may reduce such anxiety.
nongenital :
signs of systemic disease (e.g. anemia or bradycardia of hypothyroidism),
which could lead to low levels of energy, desire or arousability
signs of connective tissue diseases (such as Sjogren's syndrome) that are
associated with vaginal dryness
disabilities that might preclude movements involved in caressing a partner,
self-stimulation, or intercourse
disfigurements, stomas or catheters that may decrease sexual self-confidence
and lead to low levels of sexual desire or arousability
vulval skin disorders (including lichen sclerosus) that may result in soreness
on sexual stimulation
cracks or fissures in the interlabial folds, suggesting chronic candidiasis
labial abnormalities that may cause embarassement or sexual hesitancy (e.g.
particularly long or asymmetric labia)
introitus :
vulval disease involving the introitus
pallor, friability, or loss of elasticity and moisture from vulval atrophy
lichen sclerosus
recurrent splitting of the posterior fourchette, evident as just-visible
white lines perpendicular to the fourchette edge
abnormalities of the hymen
adhesions of the labia minora
swelling in the area of the major vestibular glands
allodynia of the crease between the outer edge of the hymen and the inner
edge of the labia minor, typical of vestibulitis
cystocele, rectocele, or prolapse that predispose women to incontinence
and reduce sexual self-image
inability to tighten and relax perivaginal muscles, often associated with
hypertonicity of pelvic muscles and midvaginal dyspareunia
abnormal vaginal discharge associated with burning dyspareunia
internal
increased tone of pelvic muscles
presence of "tender" trigger points on palpation of deep levator ani muscle,
due to hypertonicity
full bimanual
fixed retroversion of uterus or nodules, tenderness, or both in the cul-de-sac,
fornix vaginae, or along uterosacral ligaments, causing deep dyspareunia
tenderness on palpation of posterior bladder wall from anterior vaginal
wall, suggesting bladder disease
Sexual Activity Log (SAL) measures a woman's overall sexual satisfaction
Profile of Female Sexual Function measures desire, pleasure, arousal, responsiveness,
self-image and quality of orgasm
Personal Distress Scale measures sexually-related personal distress
The possibility that laboratory testing will identify causes of sexual
dysfunction is low. Estrogen deficiency, for example, is best detected
by taking a history and performing an examination. Even when signs of estrogen
deficiency are present, it is not necessarily the cause of sexual dysfunction.
In addition, as noted, serum levels of testosterone do not correlate with
sexual function.20,21 Measurement of prolactin or thyrotropin is warranted
if other symptoms or signs suggest the presence of abnormal levels.
Therapy : the management of sexual dysfunction
in women is guided by the history. Data from randomized trials that support
the use of any particular intervention are limited.
psychological interventions : cognitive behavioral therapy focuses on identifying
and modifying factors that contribute to sexual dysfunction, such as maladaptive
thoughts, unreasonable expectations, behaviors that reduce the partner's
interest or trust (such as disrespectful behavior or lack of honesty),
insufficient erotic stimuli, and insufficient nongenital physical stimulation.
Strategies are suggested to improve the couple's emotional closeness and
communication and to enhance erotic stimulation. The sessions vary in number
and usually include both partners. Sex therapy for couples is focused on
similar issues but also includes sensate focus techniques, consisting initially
of nonsexual physical touch, with gradual progression toward sexual touch;
partners are encouraged to alternately touch each other and to provide
feedback about what touches are pleasurable. These techniques help change
the undue focus on a performance goal (e.g., one partner's orgasm or mutual
orgasms). Controlled studies that provide support for the use of this approach
are scant, but in one that combined both cognitive behavioral therapy and
sex therapy, 74% of women had improved sexual and marital satisfaction
(Trudel G, Marchand A, Ravart M, Aubin S, Turgeon L, Fortier P. The effect
of a cognitive-behavioral group treatment program on hypoactive sexual
desire in women. Sex Relat Ther 2001;16:145-64). Satisfaction was maintained
in 64% of women at one year, as compared with minimal improvement in a
control group. Another intervention is short-term psychotherapy, generally
focused on poor sexual self-image and on nonsexual experiences in childhood
that are considered to relate to current sexual function (e.g., a chaotic
upbringing that predisposed a woman to need to be in control could interfere
with her "letting go" sexually as an adult). Data regarding the benefits
of this approach are lackingref.
pharmacologic interventions : other than estrogen therapy for dyspareunia
related to genitourinary atrophy, no medications are currently approved
by the Food and Drug Administration for the treatment of sexual dysfunction
in women. Several off-label uses of drugs have been considered, although
data about effectiveness are sparse
nonhormonal therapies : the involvement of nitric oxide in neurogenic vasodilatation
suggests that phosphodiesterase inhibitors may ameliorate genital arousal
disorder. In a small, laboratory-based, randomized trial, a single 50-mg
dose of sildenafil (Viagra, Pfizer) increased subjective arousal, genital
sensations, and ease of orgasm in some women with genital arousal disorderref.
The benefit was observed only among women who had a marked reduction in
the normal vasocongestive response to subjectively arousing visual erotic
stimulation. In 2 large, randomized clinical trials involving 781 women
in whom arousal and desire disorders (rather than genital arousal disorder)
were diagnosed, sildenafil improved no measure of sexual desire, sensation,
lubrication, or satisfactionref
hormonal therapies :
androgen therapies : supraphysiologic androgen therapy has been prescribed
for sexual dysfunction since the 1930s, but more recently, testosterone
at lower doses than originally prescribed have been studied in randomized
trials. In one recent randomized, controlled trial involving 218 women
who had undergone a natural or surgically induced menopause and who received
0.625 µg of esterified estrogens daily, the addition of 1.25 mg of
methyltestosterone improved sexual responsiveness and the level of desire,
as reported on one of two validated questionnaires usedref.
However, the frequency of desire was not affected, and measures of desire
and composite sexual function were not significantly improved, according
to responses on the second questionnaire. Also, the women who had undergone
natural menopause were not prescribed progestin, which limited the clinical
relevance of these results. Methyltestosterone is known to lower high-density
lipoprotein (HDL) cholesterol, and in this study, levels fell by a mean
of 12.5 mg per deciliter (0.3 mmol/l) after four months of treatment. The
results of 4 recent placebo-controlled, randomized trials involving a total
of 1619 women who had undergone surgically induced menopause show the efficacy
of a 300-µg testosterone patch applied twice weeklyref1,
ref2,
ref3
(Davis SR, van der Mooren MJ, van Lunsen RHW, et al. The efficacy and safety
of a testosterone patch for the treatment of hypoactive sexual desire disorder
in surgically menopausal women: a randomized, placebo controlled-trial.
Menopause). All participants were treated with estrogen (delivered transdermally
in one study (Davis SR, van der Mooren MJ, van Lunsen RHW, et al. The efficacy
and safety of a testosterone patch for the treatment of hypoactive sexual
desire disorder in surgically menopausal women: a randomized, placebo controlled-trial.
Menopause) orally in anotherref,
and by either route in 2 studiesref1,
ref2),
and the number of sexually satisfying events at baseline ranged from one
to three per month. Pooling the data revealed that women receiving testosterone
reported 1.9 more sexually satisfying events per month than they had at
baseline, as compared with 0.9 more among those receiving placebo. Scores
from validated questionnaires in each of the four studies showed a significant
increase in sexual desire and response, and scores in three of the studies
showed significant reductions in sexual distressref1,
ref2
(Davis SR, van der Mooren MJ, van Lunsen RHW, et al. The efficacy and safety
of a testosterone patch for the treatment of hypoactive sexual desire disorder
in surgically menopausal women: a randomized, placebo controlled-trial.
Menopause). One study also evaluated a twice-weekly patch containing 450
µg of testosterone; in contrast to the results for the lower-dose
patch, no benefits were foundref.
Unwanted androgenic effects, including hirsutism and acne, were uncommon
in all studies, but depilation rates were not assessed. Unlike with methyltestosterone,
there were no significant changes in lipid levels. Important limitations
of these four studies include their brevity (which is of particular importance,
given the expected long-term use of the drug) and that their results are
generalizable only to women in whom menopause was surgically induced and
who also receive estrogen therapy. In some women who have undergone natural
menopause, the ovaries continue to be an important source of androgens
(Davison SL, Bell R, Donath S, Montalto JG, Davis SR. Androgen levels in
adult females: changes with age, menopause, and oophorectomy. J Endocrinol
Metab 2005;90:3847-53), and thus, the effects of androgen supplementation
may differ from those in women whose ovaries have been surgically removed.
Furthermore, risks associated with the long-term use of conjugated estrogens
arouse concern about the use of any postmenopausal estrogen therapy over
time. Prescribing testosterone alone to women who lack estrogen would raise
their already high ratios of androgen to estrogen. There are no safety
or efficacy data for testosterone supplementation for estrogen-deficient
women. A chief concern with long-term androgen use is a potential increase
in insulin resistance, which could predispose a woman to the metabolic
syndrome or exacerbate the syndrome if it is already present. In SWAN,
low levels of sex hormone–binding globulin and higher circulating levels
of androgen were strongly associated with markers of the metabolic syndrome,
including a high body-mass index; a high waist-to-hip ratio; presence of
glucose intolerance, hypertriglyceridemia, or hypertension; and a low level
of HDL cholesterolref
dehydroepiandrosterone : because middle-aged and older women have a physiologic
decrease of as much as 70% in the amount of dehydroepiandrosterone producedref,
some researchers have suggested that supplementation with the steroid may
improve sexual function. However, rigorous data that support such supplementation
are lacking. Even among women with adrenal insufficiency, the results of
randomized trials of dehydroepiandrosterone supplementation have been inconsistentref1,
ref2,
ref3
estrogen : the role of systemic estrogen in increasing desire and subjective
arousal remains unclear. In patients with vasomotor symptoms and insomnia
or reduced levels of desire because of dyspareunia due to genital atrophy,
it is logical to conclude that estrogen supplementation would increase
sexual motivation, although this has not been rigorously tested. In the
Women's Health Initiative trial, no significant differences were found
between the estrogen and placebo groups in reported satisfaction after
sexual activityref.
However, sexual dysfunction was not a primary focus of the trial, and the
assessment tool was inadequate.
Off-label uses of drugs for investigational treatment of sexual dysfunction
:
type of sexual dysfunction
drug
comments
sexual desire/interest disorder, subjective and combined
arousal disorders
bupropion (a dopamine and norepinephrine agonist)
in one small, four-months study, nondepressed, premenopausal women
showed increased arousability and sexual response but not initial desireref
in 6-months randomized trialsref1,
ref2,
ref3
(Davis SR, van der Mooren MJ, van Lunsen RHW, et al. The efficacy and safety
of a testosterone patch for the treatment of hypoactive sexual desire disorder
in surgically menopausal women: a randomized, placebo controlled-trial.
Menopause), women had improved "total satisfying sexual activity" and improved
measures of desire and responses, as reported on questionnaires. No long-term
safety data on women lacking estrogen are available
a transdermal patch that delivers the equivalent to 300 mg
of testosterone. At the end of 24 weeks, there was a 74% increase in total
satisfying sexual activity scores in the testosterone group compared with
33% in the placebo group. Sexual desire scores improved by 56% and 29%,
respectively, and personal distress scores decreased by 65% and 40%, respectively.
Improvements were seen after at least 4 weeks of starting therapy and all
were highly significant. Around 70% of women had at least some adverse
reaction related to treatment, including site irritation (30%), as well
as acne and hirsutism, observed in approximately 6% of the treated women.
Deepening of the voice was reported in slightly > 2%. About 8% of treated
women found the adverse events serious enough to drop out of the study.
These adverse events were seen early in the study
dehydroepiandrosterone (a precursor of estradiol and testosterone)
data from trials involving women with adrenal insufficiency are conflictingref1,
ref2,
ref3.
A study of perimenopausal women with reduced feelings of well-being and
low level of desire showed no benefitref
data from small trials of postmenopausal women show improved sexual
function, as compared with those receiving placebo or a regimen of 17b-estradiol
(1 mg daily) plus norethindrone (1 mg daily). The drug has not been studied
in women with diagnosed sexual dysfunction and is associated with a possible
increased risk of breast cancerref
in large multicenter trials involving pre- and postmenopausal women,
no benefit from sildenafil was reportedref
yohimbine (a centrally acting noradrenergic agent) plus arginine (a
precursor of nitric oxide)
in one randomized, controlled crossover laboratory study of 24 women,
yohimbine (6 mg) plus arginine (6 g) increased vaginal congestion, but
not subjective arousal, in response to an erotic filmref.
ephedrine (agonist of a- and b-adrenergic receptors)
in one randomized, controlled crossover laboratory study of 20 women,
yohimbine (50 mg) increased vaginal congestion, but not subjective arousal,
in response to an erotic filmref.
genital arousal disorder despite estrogen-replete status
in one laboratory randomized trial, it was shown that only some women
given a diagnosis of genital arousal disorder have demonstrably reduced
genital congestion, and they alone showed evidence of benefit. It was not
possible clinically to distinguish this subgroupref.
In one randomized study of neurogenic genital arousal disorder from multiple
sclerosis, treatment with sildenafil led to increased lubricationref.
Sexual dysfunction associated with antidepressants : the prevalence
of sexual disorders that are associated with the use of antidepressants
in women is estimated at 22 to 58%, with higher rates reported for selective
serotonin-reuptake inhibitors and lower rates reported for bupropion than
for other drugsref.
A recent Cochrane review of strategies to ameliorate dysfunction associated
with antidepressants did not recommend any particular drug, although the
potential advantages of adding bupropion were notedref.
A drug holiday (e.g., halting the use of shorter-acting selective serotonin-reuptake
inhibitors over the weekend) seems to be a logical strategy but is not
recommended, owing to withdrawal symptoms and compromise of compliance.
Areas of uncertainty : a better understanding is needed of the endogenous
and environmental factors that mediate sexual desire and arousal. Randomized
clinical trials are also needed to assess the effects of psychological
and pharmacologic therapies alone and in combination. The risks and benefits
of long-term testosterone therapy require further study, including studies
of women with a complete loss of arousal and desire.
Guidelines : recommendations for the evaluation and management of sexual
dysfunction in women have been put forth by the American College of Obstetricians
and Gynecologists (Basson R. Sexuality and sexual disorders in women. Clinical
updates in women's health care monograph. Vol. 2. No. 2. Washington, D.C.:
American College of Obstetricians and Gynecologists, 2003:1-94), the Society
of Obstetricians and Gynaecologists of Canada (Blake J, Belisle S, Basson
R, et al. Canadian Consensus Conference on Menopause 2006 update. J Obstet
Gynecol Can 2006;28:Suppl:1-92), the North American Menopause Societyref,
and the members of the 2003 International Consensus on Sexual Medicine
(organized by the International Consultation on Urological Disease, the
International Society for Urology, and the International Society for Sexual
Medicine) (Basson R, Althof S, Davis S, et al. Summary of the recommendations
on sexual dysfunctions in women. J Sex Med 2004;1:24-34). These organizations
advocate attention to mental and overall health and to both interpersonal
and personal psychological issues. Local estrogen therapy is recommended
for dyspareunia that is associated with vulval atrophy that results in
reduced sexual motivation. The Society of Obstetricians and Gynaecologists
of Canada notes that testosterone therapy should be viewed as investigational
and should be prescribed only by clinicians who are knowledgeable about
sexual dysfunction in women (Blake J, Belisle S, Basson R, et al. Canadian
Consensus Conference on Menopause 2006 update. J Obstet Gynecol Can 2006;28:Suppl:1-92).
The recent position statement of the North American Menopause Society provides
cautious support for the use of testosterone "in appropriate post-menopausal
women via transdermal patches or topical gels or creams administered at
the lowest dose for the shortest time that meets treatment goals"ref.
Counseling about the potential risks and benefits of testosterone use is
also advocated, as is evaluation for causes of low levels of desire (including
physical and psychosocial factors and medications) before treatment.
Conclusions and Recommendations : for women with desire and arousal
disorders, such as the woman described in the vignette, the evaluation
involves taking a detailed history of sexual difficulties from both partners,
preferably seen individually as well as together. Also included are an
assessment of the woman's mental health (including self-image), feelings
about the relationship, medical history, and her thoughts and emotions
during sexual activity. On the basis of clinical experience and limited
data on outcomes, I would recommend a combination of cognitive behavioral
therapy and sex therapy (typically three to six sessions). Sessions should
be focused on altering maladaptive thoughts, unreasonable expectations,
and misinformation about women's sexuality, as well as on discussing strategies
for improving the couple's emotional closeness and communication and enhancing
erotic stimulation. If the couple is excessively focused on intercourse
(as is common if there is a history of infertility), they should be advised
to emphasize nongenital stimulation first. Any apparent interpersonal problems
should be addressed before further sexual therapy is pursued. At the present
time, I would not recommend any pharmacologic therapy, pending the availability
of more (and longer-term) data in support of such treatment.
sexual aversion disorder
: feelings of repugnance for and active avoidance of genital sexual contact
with a partner, causing substantial distress or interpersonal difficulty.
sexual arousal disorders
: sexual dysfunctions characterized by alterations in sexual arousal
female sexual arousal disorder
/ frigidity : a sexual dysfunction involving failure by a female either
to attain or maintain the lubrication and swelling response of sexual excitement
during sexual activity, after adequate stimulation, causing significant
distress or interpersonal difficulty. Both physiological and psychological
factors may be involved
persistent sexual
arousal syndrome (PSAS) is a newly described entity where women become
involuntarily aroused genitally and clitorally for extended periods in
time in the absence of sexual desire which persists despite one or more
orgasms and which usually feels intrusive and unwanted. Genital vasoengorgement
and oedema have been observed. These women are found to be usually very
distressed. The cause of the syndrome in the majority of cases is unknown,
although a number of women report symptoms after withdrawal from SSRI
antidepressants. There is no specific therapy at present, although electroconvulsive
therapy (ECT)
has resulted in clinical improvement in cases where there was concomitant
severe depressionref1,
ref2,
ref3.
male erectile disorder / penile
erectile dysfunction (ED) / psychogenic impotence : a sexual dysfunction
involving failure by a male to attain or maintain erection until completion
of sexual relations, causing significant distress or interpersonal difficulty
Pathogenesis : person's sex drive may be proportional
to the size of their amygdala : chronic temporal
lobe epilepsy
typically dampens sex drive and patients with the greater amount of amygdala
left intact after surgery have a larger sex drive. It is intimately linked
to other brain regions, including the hypothalamus, which sets off physical
responses to arousal, such as erectionsref.
Differential diagnosis :
orgasmic disorders : sexual dysfunctions
characterized by inhibited or premature orgasm
female orgasmic disorder
: a sexual dysfunction characterized by consistently delayed or absent
(coital anorgasmia) orgasm in a female, even after a normal phase
of sexual excitement and accounting for her age and sexual experience and
the amount of stimulation, and causing significant distress or interpersonal
difficulty. When women try to reach orgasm through masturbation, 51% of
their chance of success depended on their genes. But for other methods
of reaching orgasm, environmental factors are more important than genetic
factors. When they have penetrative sex, genes account for just 31% of
their chance of success, and 37% when a women and her partner used other
methods. Women do not need to climax in order to conceive and give birth,
a fact that makes the evolutionary cause of their orgasm slightly mysterious.
In contrast, men who cannot orgasm miss the chance to pass on their genes
and fall victim to natural selection. So what function does the female
orgasm serve? As well as making women more interested in the activity of
procreation, recent investigations have found the contractions it involves
can bring sperm closer to the egg, increasing the chance of conception.
Evolutionary psychologists have also suggested that the female orgasm might
help women to select caring partners: those who are particularly attentive
in the bedroom may also be more supportive in other aspects of life. But
studies of other primates suggest otherwise : female stump-tailed macaques
have orgasms too – but mainly during female-female mountings, which hardly
supports the fertility or mate-selection idea. Bonobos engage in highly
promiscuous sex and mutual masturbation, complete with orgasms, a practice
that is thought to promote group cohesion. This supports yet another theory:
that orgasm is important in bonding. But even if orgasm does play this
role, it cannot be crucial in humans. The finding that many women cannot
achieve orgasm because they do not have the genes for it shows that the
ability to orgasm is not a trait for which there has been strong evolutionary
selection. This supports her theory that as far as orgasms are concerned,
women have been riding on the genetic coat-tails of male evolution, and
that the female orgasm is merely an accidental echo of the male one, the
equivalent of male nipples. A 2003 study showed that > 50% of British women
reported at least one sexual problem lasting > 1 month during the previous
year, and around 25% rarely had orgasms, at best, in the previous 3 months.
Orgasmic dysfunction in females is commonly reported in the general population
with little consensus on its aetiology. A classical twin study was performed
to explore whether there were observable genetic influences on female orgasmic
dysfunction. Adult females from the TwinsUK register were sent a confidential
survey including questions on sexual problems. Complete responses to the
questions on orgasmic dysfunction were obtained from 4037 women consisting
of 683 monozygotic and 714 dizygotic pairs of female twins aged between
19 and 83 years. 14% always achieved orgasm during intercourse, while 32%
reported never (16%) or infrequently (16%) achieving orgasm during intercourse.
More women were able to orgasm during masturbation: 34% always reached
orgasm. 21% were still unable to orgasm more than a quarter of the time,
two-thirds of whom never achieved orgasm during masturbation. There was
no difference between the proportion of identical and nonidentical twins
who never or infrequently reached orgasm by either method. However, there
was less variation for the frequency of orgasm during intercourse and masturbation
in identical compared with nonidentical twins, suggesting a clear genetic
influence for both. 34 (overall)-45% (during masturbation) of the variation
in ability to orgasm can be explained by underlying genetic variation,
with little or no role for the shared environment (e.g. family environment,
religion, social class, or early education). This number could go even
higher if one could account for other variables, such as the different
techniques of the women's partners. Genetic influences have been seen to
account for as much as 60% of variability in other complex traits, such
as obesityref.
Only 30% of women experience orgasm with penovaginal intercourse. If you
can experience orgasm through other ways such as oral sex, self-stimulation,
or other, that is great and normal. For you to achieve orgasm during intercourse,
you are going to need to have sufficient clitoral stimulation. If it is
important for you to achieve orgasm during intercourse, I would encourage
you to focus on increasing the level of foreplay prior to sex and try positions
that increase clitoral stimulation and even consider incorporating a vibrator
: that being said, you should not feel pressured to achieve orgasm during
sex. The findings also challenge the notion that the failure to achieve
orgasm represents “female sexual dysfunction”, an idea popular with companies
keen to sell remedies for this so-called disorder. What definition of ‘normal’
could possibly justify labelling a third of women as ‘abnormal’? Even if
struggling to achieve orgasm is nothing unusual, it might be possible to
find ways to make it easier.
retarded ejaculation / male orgasmic
disorder : a sexual dysfunction characterized by consistently delayed
or absent (coital anorgasmia) orgasm in a male, even after a normal
phase of sexual excitement and stimulation that is adequate for his age
in focus, duration, and intensity, and which causes significant distress
or interpersonal difficulty.
permanent or acquired
generalized or situational
due to psychological or combined factors
premature ejaculation (PE) / ejaculatio
praecox / preblysis / tachorgasmia : ejaculation consistently occurring
either prior to, upon, or immediately after penetration and before it is
desired, taking into account factors such as age, novelty of the specific
situation, and recent frequency of the sexual act. Used officially [DSM-IV],
it denotes also significant resulting distress or interpersonal difficulty.
Therapy :
squeeze technique : one used for the treatment of premature ejaculation,
in which a man is repeatedly aroused almost to the point of ejaculatory
inevitability and then the the thumb and first two fingers are used to
forcibly squeeze the head of the penis, preventing ejaculation
paraphilia / divertissement / sexual aberration
or anomalies : a psychosexual disorder characterized by recurrent intense
sexual urges, by sexually arousing fantasies, or by behavior involving
use of a nonhuman object, the suffering or humiliation of oneself or one's
partner, or children or other nonconsenting partners; included are
sexual deviation or deviance : sexual behavior or fantasy outside
that which is morally, biologically, or legally sanctioned, often specifically
one of the paraphilias; practice that deviates from the majority of society
exhibitionism / peodeiktophilia : a
paraphilia characterized by recurrent intense sexual urges and sexually
arousing fantasies of exposing the genitals to an unsuspecting stranger.
Exhibitionism occurs almost exclusively in males.
fetishism : a paraphilia characterized by
recurrent, intense sexual urges and sexually arousing fantasies of the
use of inanimate objects (fetishes), most commonly articles of feminine
clothing such as shoes, earrings, or undergarments, as a preferred or necessary
adjunct to sexual arousal or orgasm.
autophagy : fetish for eating one's own skin
fetishes : an object that replaces people as primary object of love
exophilia : neophilia; fetish for the unusual or bizarre
organofact : fetish for some part of the body
altocalciphilia : high heel fetish
alvinolagnia : stomach fetish
crurofact : leg fetish
cyesolagnia : pregnant woman fetish
foot fetish : podophilia
genofact : genital fetish
mastofact : breast fetish
nasophilia: nose fetish
oculophilia : eye fetish
odontophilia : arousal from tooth extractions or tooth fetish
phallophilia : large penis fetish or preference
pygmalionism / agalmatophilia / statuophilia / galateism : the falling
in love with an object made by oneself; arousal from statues or manikins
: statue fetishism where person rubs their body against statue
retifism : shoe fetish
trichophilia : hair fetish
frotteurism / frottage : a paraphilia in which sexual arousal or
orgasm is achieved by rubbing up against another person, usually in a crowded
place with an unsuspecting victim, or by fantasies of such actions
toucherism : a paraphilia in which sexual arousal or orgasm is achieved
by touching or fondling or by such fantasies
pedophilia : a paraphilia in which an adult has recurrent, intense
sexual urges or sexually arousing fantasies of engaging in or repeatedly
engages in sexual activity with a prepubertal child.
sexual masochism : a paraphilia in which sexual gratification is
derived from being hurt, humiliated, or otherwise made to suffer physically
or psychologically.
sadism : the act or instance of gaining pleasure from inflicting
physical or psychological pain on another; the term is usually used to
denote sexual sadism
anal sadism : in freudian theory, the destructive and aggressive
manifestations of anal erotism, such as aggressiveness, selfishness, and
stinginess.
oral sadism : in freudian theory, a sadistic form of oral erotism
manifested by fantasies of chewing, biting, or otherwise using the mouth,
lips, or teeth aggressively or destructively.
phallic sadism : in freudian theory, the aggressive and destructive
tendencies associated with the childhood phallic
stage of development, stemming from the child's interpretation of sexual
intercourse as aggressive and violent.
sexual sadism : a paraphilia in which sexual gratification is derived
from hurting, humiliating, or otherwise inflicting physical or psychological
suffering on another.
necrosadism : mutilation of a corpse for the purpose of exciting
or gratifying sexual feelings.
sadomasochism : a state characterized by both sadistic and masochistic
tendencies.
transvestic fetishism / transvestism : a paraphilia of heterosexual
males, characterized by recurrent, intense sexual urges, arousal, or orgasm
associated with fantasized or actual cross-dressing
cross dressing / cross-dressing : the wearing of clothing specific
to or characteristic of the opposite sex
voyeurism / inspectionism / parascopism : a paraphilia characterized
by recurrent, intense sexual urges or arousal involving real or fantasized
observation of unsuspecting people who are naked, disrobing, or engaging
in sexual activity (peeping Tom)
paraphilia-not otherwise specified
necrophilia / necrophilism : fascination or obsession with death,
usually specifically sexual attraction to or sexual contact with dead bodies
coprophilia : an absorbing interest in feces or filth, particularly
a paraphilia in which sexual arousal or activity is linked to feces.
coprolagnia : sexual excitement occurring in association with feces
or defecation
urophilia : a paraphilia in which sexual arousal or activity is
linked to urine
urolagnia : sexual excitement associated with the sight or thought
of urine or urination
kleptolagnia : sexual gratification produced by theft
telephone scatologia : a paraphilia in which sexual arousal or activity
is linked to the placing of obscene phone calls using vulgar language,
or trying to elicit a reaction from the other party
partialism : a paraphilia characterized by exclusive focus on a
body part of the sexual partner.
klismaphilia : a paraphilia in which sexual arousal or activity
is linked to enema
fixation : in psychiatry, a term with 2 related meanings: (a) arrest
of development at a particular stage, which if temporary is a normal reaction
to difficulties but if continued is a cause of emotional problems; and
(b) a close and suffocating attachment to another person, especially a
childhood figure, such as a parent. Both meanings are derived from psychoanalytic
theory and refer to “fixation” of libidinal energy either in a specific
erogenous zone, hence fixation at the oral, anal,
or phallic stage, or in a specific object,
hence mother or father fixation
erotism : a sexual instinct or desire; the expression of one's instinctual
energy or drive, especially the sex drive.
anal erotism : fixation of libido at (or regression
to) the anal phase of infantile development,
said in psychoanalytic theory to produce egotistic, dogmatic, stubborn,
miserly character.
genital erotism : achievement and maintenance of libido
at the genital phase of psychosexual development,
said in psychoanalytic theory to permit acceptance of normal adult relationships
and responsibilities.
oral erotism : fixation of libido at (or regression
to) the oral phase of infantile development,
said in psychoanalytic theory to produce passive, insecure, sensitive character
erotomania / old maid's insanity / psychose passionelle / De Clerambault's
syndrome
: a disorder in which the subject believes that a person,
usually older and of higher social status, is deeply in love with them;
failure of the object of the delusion to respond to the subject's advances
are rationalized, and pursuit and harassment of the object of the delusion
may occur
erogenous or erotogenic zone : in psychoanalytic theory, an area
of the body through which the libido expresses itself
and which is therefore susceptible to erotic excitation upon stimulation;
the primary sites are the oral, anal, and genital regions, but the other
body orifices, breasts, and skin are also included.
hypersexuality : abnormally increased sexual desire or activity
nymphomania / andromania / arrhenothigmophilous / clitoromania / furor
uterinus / lagnoperissia / hysteromania / cytheromania : abnormal,
excessive, insatiable sexual desire in the female
satyriasis / satyromania : abnormal, excessive, insatiable sexual
desire in the male
Don Juanism : hypersexuality in a man
Differential diagnosis :
nonpathological use of sexual fantasies, behaviours or object as stimulus
for sexual arousal
gender identity disorder
: a disturbance of gender identification in which the affected person has
an overwhelming desire to change their anatomic sex or insists that they
are of the opposite sex, with persistent discomfort about their assigned
sex or about filling its usual gender role; the disorder may become apparent
in
childhood
adolescence or adulthood
sexually attracted by males
sexually attracted by females
sexually attracted by both males and females
sexually attracted by neither males nor females
Individuals may attempt to live as members of the opposite sex and may
seek hormonal and surgical treatment to bring their anatomy into conformity
with their belief.
transsexualism : the most severe manifestation
of gender identity disorder in adults, being a prolonged, persistent desire
to relinquish their primary and secondary sex characteristics and acquire
those of the opposite sex; particularly describing those persons who go
so far as to live as members of the opposite sex through dress, hormonal
treatments, or surgical reassignment.
anophelorastia : arousal from defiling or ravaging a partner
anoraptus : rapist who only attacks elderly women
antholagnia : arousal from smelling flowers
anthropomorphism : attributing human characteristics to half-human
half-animal characters
anthropophagy : cannibalism
apellous : circumcision
aphrodisiacs : drugs stimulating a sexual response
apotemnophilia : person who has sexual fantasies about loosing a
limb
arachnephilia : arousal from spiders
asceticism : religious self-denial often including celibacy
celibacy / aphallatia / lagnocolysis : abstinence from sex
asynodia : celibacy particularly due to impotence
sexual asphyxiaphilia / Koczwarism
: a life threatening eroticizing behavior practiced in women, as in men,
in order to heighten sexual excitement and to achieve orgasm, which is
in some women accompanied by expulsions of fluid from the urethra (female
ejaculation).
The relatively easily achieved orgasm induced by the mechanism of asphyxia
is hypothesized to be the common reason for repetitive deviant asphyxiophilic
behavior. Moreover, in women of the ejaculatory type (female ejaculators),
the desire to induce ejaculatory orgasm by asphyxia may also come into
play as this kind of orgasm is usually assessed as sensation of greater
delight than orgasm without ejaculationref.
oxygen regulation : regulating intake of oxygen for sexual enhancement
autoerotic asphyxia : arousal from oxygen deprivation and sometimes
risk of dying
asthenolagnia : arousal from weakness or being humiliated
autagonistophilia : exhibitionism, arousal from exposing naked body
or genitals to strangers while on stage or while being photographed
autassassinophilia : arousal from orchestrating one's own death
by the hands of another
autogynephilia : arousal from crossdressing
automasochism / deliberate self-harm syndrome : arousal from inflicting
intense sensations or pain on one's own body
autoerotica : self induced arousal (i.e. fantasies or other aids)
mysophilia : abnormal interest in dirt or filth, with a desire for
contact with it that may encompass a paraphilia; arousal from soiled clothing
or foul decaying odors
automysophilia : arousal from being dirty or defiled
autonepiophilia : infantilism ; arousal from dressing or being treated
like infant
autopederasty : person inserting their own penis into their anus
autophagy: self-cannibalism or eating own flesh
autosadism : infliction of pain or injury on oneself
avisodomy : breaking neck of bird while penetrating it for sex
axillism : penis penetrating an arm pit
ball dancing / bell dancing; self flagellation by hanging fruit
from hooks in skin
basoexia : arousal from kissing
bath house : commercial baths, some of which allow sex on premises
bed of nails : lying on a bed of nails for sensory enhancement
bee stings : the use of bees, such as to sting genitals
bell dancing : self-flagellation with bells or other ornaments hanging
the skin
belonephilia : arousal from use of needles
bestiality : zoophilia; sex with animals
bestialsadism : cruelty or mutilation of animals
bigynist : sex between 1 male and 2 females
Bihari surgery : cutting ligament above penis to make it appear
longer
bindings : wrapping feet or genitals with string or lace
bivirist : sex between 1 female and 2 males
blastolagnia : person aroused by young females
blindfolding : covering the eyes
borderline self-mutilator : automasochism
body worship : sex game where partner is made to adore another's
body
bondage : physical or mental restriction of partner
bottom : passive partner who experiences stimuli during sex games,
masochist, slave, submissive
brachioprotic eroticism : a deep form of fisting where the arm enters
the anus
bradycubia : slow movement during penetration
branding : burning patterns or initials into flesh
bundling : partners sleeping together clothed and without sex
candaulism : spouse who watches partner having sex with someone
else
caning : whipping that uses a switch or cane to discipline partner
capnolagnia : arousal from watching others smoke
cat fighting : women fighting without rules and often tearing off
each other's clothing
cataphilist : male submitting to female
catatasis : stretching of the penis
catheterophilia : arousal from use of catheters
chaperon : person who escorts a young couple to ensure they don't
engage in sex
charms : objects used to bring good luck and ward off evil
chastity : sexual abstinence
chastity belts : leather or metal belts used to prevent genital
penetration
chemise cagoule : long heavy night shirt with hole for penis
choreophilia : dancing to orgasmic release
chrematistophilia : person aroused by having to pay for sex or having
sex partner steal from them (see also harpaxophilia)
chronophilia : arousal from passage of time
chubby chasers : people who are aroused by obesity in partner
clamps : metal, plastic, or wood fasteners used on nipples or genitals
claustrophilia : arousal from being confined in small space
clitorilingus : licking a clitoris
cock rings : rings placed around the base of the male genitals to
maintain erections
cocktails : drinking of body secretions from a glass
coitobalnism : sex in a bathtub
coitolimia : tremendous sexual drive
coitus a cheval : couple having sex on the back of an animal or
one acting out role of horse
coitus a mammilla : penetration of penis between breasts
coitus a unda : sex or sex games in water
coitus intrafemoris : penetration between legs
colobosis : mutilation or castration of penis
compulsive cruising : compulsive search for sex partners
computer sex : the use of computers for sex games, communication,
and erotic photography
concubinage : use of female slaves as sex partners; living with
sex partner without being married
confessions : admitting a sin; in some cases to arouse potential
partner
coprography : writing obscene words or phrases, usually in public
toilets
coprolagnia : arousal from feces
coprolalia : arousal from using obscene language or writing
coprophilia / scat : arousal from playing with feces
coproscopist : arousal from watching a person defecate
corsetting : body modification or oxygen restriction from using
corsets
couvade : custom where male mimics child birth or is confined at
time of wife's delivery
couvade syndrome / chipil : a male who experiences symptoms of pregnancy
in sympathy for wife
cratolagnia : arousal from strength of partner
cross dressing : a person who wears the apparel of the opposite
sex
cryptoscopophilia : desire to see behavior of others in privacy
of their home, not necessarily sexual
cunnilalia : to talk about female genitals
oral or oro-genital sex : contact between
the mouth and genitals; use of the mouth in sex play. Oral sex is a common
sexual practice between both heterosexual and homosexual couples. Oro-genital
sex is implicated as a route of transmission for Neisseria
gonorrhoeae,
Treponema
pallidum subsp. pallidum,
Chlamydia
trachomatis,
Haemophilus
ducreyi,
and Neisseria meningitidis.
Other respiratory organisms such as streptococci, Haemophilus
influenzae,
and Mycoplasma
pneumoniae
could also be transmitted by this route. A link between oro-genital sex
and bacterial vaginosis is currently being studied. In view of the increased
practice of oral sex this has become a more important potential route of
transmission for oral, respiratory, and genital pathogensref.
cunnilingus / gamahucheur : oral stimulation
of the female genitalia.
anilingus : sexual stimulation of the anus
with the lips or tongue. Oro-anal sex is implicated in the transmission
of various enteric infections.
fellatio [L. fellare to suck] / corvus
/ irrumatio / penosugia : oral stimulation or manipulation of the penis
on a male. It confers risk for acquisition of infection by the oral
partner
autofellatio : fellatio performed on
oneself
Compared with white men, black men attending a genitourinary medicine clinic
were much more likely to be unemployed, to have commenced intercourse earlier
and to have urethral infection. They were much less likely to practice
fellatio, cunnilingus, or anal intercourse. However, there was no difference
between the two racial groups in respect of numbers of sexual partners
and condom useref.
cynophilia : arousal from sex with dogs
cyprieunia : sex with a prostitute
dacnolagnomania : lust murder
dacrylagnia : arousal from seeing tears in the eyes of a partner
dacryphilia : person who is aroused by seeing their partner cry
dame de voyage : dolls designed for genital penetration, often used
by sailors
danse du ventre : erotic or fertility dancing; belly dance
dating services : agencies arranging for strangers to meet each
other, usually for a fee
day belts : chastity device used for short day excursions
defecolagnia : arousal from defecation
defilement : arousal from partner or self becoming dirty or wet
dendrophilia : arousal from tree or fertility worship of them
depilation : shaving, waxing, or other type of hair removal
dermagraphism : marks left on the skin of a partner by biting, scratching
or sucking
dermaphilia / doraphilia : sexual stimulus from skin
dippoldism : sexual arousal from abusing children
docking : slipping one partner's foreskin over the glans penis of
another
dogging : couples who engage in sex in their car while others watch
from outside
doleros : algophilia; arousal from pain
dominance/submission : power exchange between partners
doraphilia : arousal from animal fur, leather, or skin
douches : rinsing out the anus or vagina with liquids
enema : the insertion and expulsion of fluids into the anus
golden enemas and douches : urine deposited into anus or vagina
enema cocktail : drinking purged contents of enema
dungeons : rooms that are decorated for SM play
dysmorphophilia : arousal from deformed or physically impaired partners
ecdemolagnia : arousal from traveling or being away from home
ecdyosis : arousal from removing clothes in front of others
ecorchement : flagellation
ecouteurism : listening to others having sex without consent
ederacinism : to tear out sex organs by the roots as in a frenzy
or to punish oneself for sexual cravings
electric shock : using electric shock for sensory enhancement
electrophilia: arousal from electrical stimulus
electrolysis: an electrical method of removing hair
elopement: hasty and clandestine marriage without consent of family
members
endytolagnia / endytophilia : arousal only from partners who are
clothed
entomocism : the use of insects
zooerasty / zoophilia : arousal from animals
entomophilia : arousal from insects or using, them in sex play
formicophilia : sex play with ants
eonism (from the French Chevalier D'Eon) : crossdressing
eopareunia : engaging in sex while young
ephebophilia : attraction to adolescent sex partner
episioclisia : suturing of the labia majora; infibulation
eproctolagniac : person aroused by flatulence
eproctophilia : arousal from flatulence
flatuphilia : arousal from having partner pass gas
erotica : sexual literature and photos
erotographomania : arousal from writing love poems or letters
erotomania : people who develop an unreasonable love of a stranger
or person not interested in them
erotophonophilia : lust murder
essayeurs : men who were hired by bordellos to become sexual with
women so that timid clients would follow their lead
eunuchs : castrated men
executions : a legal death sentence, some people become aroused
by watching executions
exmuliebrate : castration
fainting : passing out or losing consciousness
famulus : slaves, family
fantasy : mental image or illusion, sometimes
sexual
fantasy play : acting out sexual fantasies
felching : sucking semen out of vagina or anus; or inserting animals
into anus or vagina
female impersonators : men who dress in women's clothing, often
for pay
fibula : bar that runs through foreskin of male and attaches to
semi-circle device, used by Romans to prevent intercourse
fisting : inserting a fist or hand into the vagina or anus
flagellation : striking a person with an object
flirting : pretending to have affection for another person
florentine girdle : chastity belt
foot binding : the wrapping of feet, done by Chinese and others
fornicatory dolls : plastic blow up, rubber, or mechanical dolls
used for penetration
inflatable dolls : plastic dolls that are designed for genital penetration
furtling : the use of fingers underneath cut-outs in genital areas
of photos for arousal
gang bangs : sex with a series of waiting partners
gendermap : "A developmental representation or template synchronously
in the mind and brain depicting the details of one's G-I/R. It includes
the lovemap but is larger, insofar as it incorporates whatever is gender
coded vocationally, educationally, recreationally, sartorially, and legally
as well as in matters of etiquette, grooming, body language, and vocal
intonation." (John Money)
gendoloma : the use of sexual fantasies to hasten orgasm
genuphallation : insertion of penis between the knees of a partner
girdle of Venus : chastity belt
glory holes: a hole in a partition that allows a person on the other
side to engage in sexual activity
goddess worship : a toilet scene using Witchcraft rituals
gomphipothic : arousal by the sight of teeth
graffiti : drawing or inscription on public walls, sometimes sexual;
coprography
graphelagnia: arousal from photographs of nudity or sex
gregomulcia: arousal from being fondled in a crowd
groping: feeling of unknown or unidentified person in boxes, suits,
etc.
group sex / martymachlia / orgies : sex with more than one partner
or in close proximity of others
groupies: erotomania; people who are devoted to or who follow celebrities
gymnocryptosis: females talking about sex life of husbands
gymnophilia: arousal from nudity
gynandromorphous: hermaphrodite
gynecomania : compulsive desire for female sex partners
gynelophilous : arousal from pubic hair
gynelophism : scalping hair on pubic area, usually done by lust
murders
gynemimesis : male-to-female cross dressing
gynemimetophilia: person aroused by a male impersonating a female
gynephonia: effeminate voice
gynonudomanic : compulsion to rip clothes off others
handkerchief codes : color codes to identify sexual preferences
haptosis : non-consensual sexual touching
harmatophilia : arousal from sexual incompetence or mistakes, usually
in female partner
harnesses : body harnesses used in suspension or penis restriction
harpaxophilia : arousal from being robbed or burglarized
hebephilia : men aroused by teenage boys
hedonism : act of indulging in pleasure
hedonophilia : sexual arousal from engaging in pleasurable activity
hemerotism: daydreaming or fantasizing about sex or nudity
hemotigolagnia : arousal from bloody sanitary pads
hierophilia : arousal from sacred objects
hirsutophilia : arousal from armpit hair
hodophilia : arousal from traveling
homilophilia : sexual arousal from hearing or giving sermons
homoeroticism / homophilia / invert / iterandria / sexual inversion
/ lung-yang / uranism / zwischenstufe : sexual arousal from person
of same sex
humiliation : degrading partner to establish sexual power
hybristophilia : love of someone who has committed an outrage
hygrophilia : arousal from body fluids or moisture
hymenoclasis : surgical defloration of virgin
hymenorrhexis: defloration of hymen
hymenorrhaphy : suturing of the hymen; infibulation
hyperphilia : compulsive desire for sex
hyphephilia : arousal from touching skin, hair, leather, fur or
fabric
iantronudia : arousal from exposing oneself to a physician, usually
by faking an ailment
iconolagny : arousal from pictures or statues of nude people
idiosyncrat : compulsive desire for sex
idrophrodisia : arousal from the odor of perspiration, especially
from the genitals
incest : sexual intercourse or other sexual
activity between persons so closely related that marriage between them
is legally or culturally prohibited.
matrincest : sex with one's mother
fratrilagnia : arousal from having sex with one's brother
sororilagnia : sex with one's own sister
The prevalence and seriousness of incestuous abuse: stepfathers vs. biological
fathers. Analysis of interviews obtained from a random sample of 930 adult
women in San Francisco revealed that 17% of women who had a stepfather
as a principal figure in her childhood years, was sexually abused by him.
The comparable figures for biological fathers were 2%. In addition, when
a distinction was made between very serious sexual abuse (including experiences
ranging from forced penile-vaginal penetration to non-forceful attempted
fellatio, cunnilingus, and anal intercourse) and other less serious forms,
47% of the cases of sexual abuse by stepfathers were at the very serious
level of violation compared with 26% by biological fathersref.
infibulation : closing penis/vagina with suture or ring
intergenerational : sex between partners with > 20 years age difference
inunction: anointing or rubbing person with oil or lather
ischolagny: avoidance of women to prevent arousal
Jack gagger: a husband that procures men to pay for sex with his
wife
jactitation: a false boast that causes harm to others, sometimes
sexual
juvenilism: dressing or acting out role of a juvenile, sometimes
sexual
Kegel exercises : exercise of the pelvic muscles that control orgasm
kleptophilia: arousal from stealing
knismolagnia: arousal from tickling
kokigami : the wrapping of the penis in a paper costume
kolpeuryntomania : stretching of the vagina
labiorrhaphy: suturing of the labia
lacing: suturing body parts to another object for bondage
lactaphilia : arousal from lactating breasts
lagnolalia : discussion of sexual subjects
lagnonector : person who kills in order to have sex with corpse
lap dancing : squatting above a sitting person and rubbing against
them to create arousal without touching genitals
lectamia : bundling
leptosadism : mild form of sadism
levirate marriage : marriage of widow without a son to deceased
husband's brother
love map : "A developmental representation or template in the mind
and in the brain depicting the idealized lover and the idealized program
of sexuoerotic activity projected in imagery or actually engaged in with
that lover." (John Money)
love potions : potions that are thought to increase a person's sexual
desire
lubricants : a substance that reduces friction, often used to facilitate
penetration
lust murder : murdering a person one feels a sexual attraction toward
lygerastia : tendency to only be aroused in darkness
lacrogenitalism : arousal from large genitals
maieusiophilia : arousal from pregnant women
mammagymnophilia : arousal from female breasts
maschalophilous : arousal from armpits
mastigothymia : flagellation
mastix : female sadist
masturbation : self-stimulation of the genitals for sexual pleasure
and orgasm not involving penetration of partner
chezolagnia : masturbating while defecating
onanism [Onan, son of Judah] : coitus interruptus or masturbation
manuxorate : male using his hand to masturbate
penetration toys : devices used for penis insertion during masturbation
pompoir : vaginal muscle control that masturbates penis when inserted
sacofricosis : cutting a hole in pant pocket to facilitate masturbation
in public
maritate : female masturbating alone
amatripsis : masturbation by rubbing labia together
syntribate : rubbing thighs together to masturbate
bouginonia : female masturbation from the use of objects such as
dildos that stretch open the vagina
olisbos / paraphallus / dildos and plugs : instruments used for
genital penetration
botulinonia : using a sausage as a dildo
godemiche : dildo in the shape of a penis with scrotum used for
masturbation
sybian : a vibrating dildo that sits on top of an object that resembles
a saddle
triborgasmia : wife who masturbates husband
siphnianize : anal masturbation
butt plugs : anal inserts used for masturbation
mazoperosis : mutilation of breasts
mazophallate : rubbing penis between breasts
meatotomy : dilating urethra with a medical dilating device, the
urethra is stretched to eventually facilitate a finger or a penis
medocure : the clipping or perfuming of the penis
medolalia : talking about the penis
melolagnia : arousal from music
menage a trois : a husband and wife having sex with a third party
menophilist : arousal from menstruating women
menstrual taboo : separation of spouses during female's menstrual
cycle
merinthophilia : arousal from being bound
merlin : an artificial vagina used for penetration
miscegenation: sex between races
misogynist: a man who hates women
misogyny: hatred of women by either sex
mixoscopia : a paraphilia in which gratification is obtained by
the sight of the object of one's desire engaged in sexual intercourse with
another
moriaphilia: arousal from telling sexual jokes
morphophilia: arousal from person with a different physique
mummification : wrapping the full body in a manner that prevents
movement
Munchausen's syndrome : arousal from reopening a wound
mutilation: tearing the skin or otherwise deforming a person's body
manophilia: sexual attraction to a short partner
maphephilia: arousal from touching or being touched
narratophilia : person who is aroused by discussing sex with others
nasolingus : arousal from sucking nose of partner
mucophagy : consuming mucous secretions as in nasolingus
necrochlesis: sex with a female corpse
necrocoitus: penetration of corpses
necrophagia: cannibalism of corpses
necrophilia: sex with corpses
necrosadism: sadism or mutilation of corpses
neophilia : arousal from novelty or change
nepiolagnia / nepiophilia : arousal by infants of opposite sex
nepiphtherosis: attempted sex with an infant
nepirasty: arousal from handling infant often experienced by childless
females
niddah: abstaining from sex 1/3 of the time to create arousal during
rest of month
nomavalent : arousal from traveling or new places, usually impotent
at home
nonmonogamy: multiple sex partners
normophilia: those only aroused by acts considered normal by their
religion or society
nosolagnia / nosophilia : arousal from knowing partner has terminal
illness
recreational nudity : nudity in group settings, beaches, nudist
camps, etc.
nudomania / omolagnia : arousal from nudity
nympholepsy : trance state induced by erotic fantasies
nymphophilia : adult males who are attracted to young females
ochlophilia : arousal from being in a crowd
oculolinctus : licking partner's eyeball
odaxelagnia : arousal from biting
olfactophilia : arousal from odors
ondinisme : arousal from urine
oneiropornism: dreaming about prostitutes or sex
ophidicism : use of snakes, sometimes for sexual purposes
ophidiophilia : arousal from snakes
ordune : arousal from photographs of nudes or sex
osculocentric : arousal from kissing
osmolagnia / osmophilia / ozolagnia : arousal from odors
osphresiolagnia : arousal from odors
Othello's syndrome: jealousy
oageism : male submitting to female
pareunomania : compulsive desire for sex
parthenophagy : cannibalism of young girls
parthenophilia : sexual desire for virgins
passivism : submission
patrolagnia : sex with one's own father
pecattiphilia : arousal from sinning or possibly guilt
pediophilia : arousal from dolls
penis ligation : the tying of the foreskin of a penis
penis modification : physical alteration of penis
perogynia : mutilation of females
personal ads : advertisements designed to attract sex partners
petticoat discipline : the use of cross dressing adolescent boys
by their mothers as a form of control
phallolalia : talking about penises
philemanmania : compulsion to kiss
phobophilia : arousal from fear
phone sex : verbal sex between partners on a phone
phygephilia : sexual arousal from being a fugitive
pictophilia : arousal from pictures, video or movies with a sexual
subject
pie throwing : arousal from being hit with a pie
piercing: inserting needles into skin for arousal
podophilia: arousal from feet
polyandry: one wife with multiple husbands
polygamy: one person with multiple marriage partners
polygyny: one person with multiple wives
polyiterophilia : arousal only after having sex with a series of
partners
proctotitillia: tickling anus
professional dominatrix: woman hired to function as a top or sadist
psycholagny : the experiencing of sexual enjoyment from imagining
or thinking of sexual acts.
psychrophilia: arousal from being cold or watching others freeze
psychrotentiginous: arousal from cold weather
pubephilia : arousal from pubic hair
pubic dressing: coloring or adding ornaments to pubic hair
pudendacure: pubic dressing for female
pygophilemania: arousal from kissing buttocks
pygophilia: arousal from contact with buttocks
pygotripsis: arousal from rubbing buttocks
pyrophilia : arousal from fire or of its use in sex play
queening : sitting on the side of a person's face as a form of bondage
rape : nonconsensual sex involving coercion,
empowerment or anger; nonconsensual sexual penetration of an adolescent
or adult, obtained by force or threat, or in cases in which the victim
is not capable of consent.
rape rack : bondage device which leaves victim's genitals exposed
for sex or rape
anthropophagolagnia : rape with cannibalism
biastophilia : those preferring to violently rape their victims
raptophilia: arousal only from raping a victim
renifleur: person aroused die smell of urine or by sniffing underwear
rhabdophilia: arousal from being flagellated
rimming : penetration of anus with tongue
ringing: insertion of permanent jewelry into a body piercing
ritual sex: sex performed with specific rules of conduct (i.e.,
Wicca, weddings, slave training)
sadomasochism by proxy : arousal from watching others disciplined;
Dippoldism
salirophilia : person ingesting human sweat or saliva (fluids with
a salt content)
sapphosadism: lesbian sadism
sarmassophilia: arousal from kneading flesh
Satan worship: religious rituals performed to Satan as a god
scarfing: the use of a scarf in strangulation for sexual arousal
scopophilia: arousal from being stared at oneself
scoptolagnia : arousal from seeing the genitals of the opposite
sex
scoptophilia : arousal from looking at sexually stimulating scenes
scrotal infusion : infusion of saline into the scrotal sack so that
it enlarges
selgolalia : telling stories that include sex
sensory deprivation : using lack of sensations to create desire
sensory enhancement : increasing arousal by increased body sensations
sergeism : infliction of injury to suppress arousal, automasochism,
based on story of Sergius by Tolstoy
sex addiction : compulsion to have sex
sex magick : the use of witchcraft rituals for sexual purposes
sex play
hot wax : sex game where hot wax is melted onto partner
torture : inflicting pain to get information or for revenge, also
used in
terror play : sex play using terror or fear for arousal
stapling : inserting a U-shaped wire into skin during sex play
robotism : attraction to or the use of robots in sex play
infantilism : cross-dressing as a young child for sex play
abduction : to kidnap or carry a person away by force, also used
in sex play
medical scenes : sex play that involves using medical instruments
or settings as props
sex toys : mechanical objects used to assist in masturbation or
sex play
play room : room equipped with sex paraphernalia and used primarily
for sex play
sex rings : organized groups of children being sexually exploited
by one or more adults
sex surrogates : people who are trained to help people overcome
sexual dysfunctions
sexautism : tendency to be preoccupied with sexual thoughts
sexercise : exercises designed to improve muscles used for sex
snapping pussy: constrictions of muscles used for orgasm; sexercise
sexual sadist killer : lust murderer
shaving : removing the hair with a razor of a partner or oneself
for arousal
pubic hair sculpturing : removing pubic hair so that the remainder
forms a pattern (i.e. a heart)
showers : depositing body fluids onto a partner's body
Roman showers / emetophilia : arousal from vomiting on partner,
usually after drinking urine or wine
golden showers : urinating onto a partner's body
shunammitism : bundling
siderodromophilia : arousal from trains
sitophilia : arousal from food
slapping : slapping partner for arousal
sleeping princess syndrome : those aroused by partner who appears
to be asleep
slings : swings or other forms of support for suspension from which
a person may engage in sex
snuff films : films that portray the actual murder and mutilation
of one of the actors
sodomy : oral or anal intercourse involving penetration with male,
female, or animal
somnophilia : fondling stranger in their sleep
sororate marriage : right of spouse to engage in sex with sisters-in-law
or sometimes brothers-in-law
sounding : insertion of an object into the urethra
spanking : using hand to slap partner's buttocks for sensory enhancement
and arousal
spay : castration
spectrophilia : either coitus with spirits or arousal from image
in mirrors
speculum : dilating device used by physicians when doing pelvic
exams and in SM medical scenes
sphagia : a sacrifice used to placate the gods, the whole offering was
completely burned
splitting : splitting the penis from the glans toward the base
stabbing : insertion of a sharp object into flesh
stag parties : private parties where only men and possibly a female
stripper or entertainer are permitted
sthenolagnia: arousal from demonstration of strength or muscles
stigmatophilia: arousal from partner who is stigmatized (i.e., tattoos,
piercings, scars)
strabismus : arousal from eyes of partner
stretching: stretching body or genitals for arousal
string bondage: constrictions; wrapping string around body at certain
intervals for arousal
strip poker: card game where the losers remove articles of clothing
strip search: interrogation process where sex partner is stripped
and searched
stripping: removal of clothes, sometimes performed on stage in an
erotic manner
stuffing : insertion of objects into vagina or anus
subincision : cutting part of the glans penis from the tip toward
the base
suspension : suspending body for sensory deprivation and bondage
suttee : religious practice of killing wife upon husband's death
and burial
swinging : group sex or wife swapping
swing : an object that allows a person to be suspended and move
back and forth
switch : people who play either the top or bottom role (sadist or
masochist)
symphorophilia: arousal from arranging a disaster, crash, or explosion
tantalolagnia : arousal from teasing
tantra : yoga type sexual discipline
Kabbazah sex : tantra sex, male passive, female active
taphephilia : arousal from being buried alive
tattooing : tattooing for arousal and marking
teasing : to excite sexually but without fulfilling implied message
teledildonics : arousal from computer sex games
telegony : belief that first man impregnating woman will be the
father of any subsequent children
telephonicophilia : arousal from using phone calls for sexual conversations
teratophallic : large penises
thalpotentiginy : arousal from heat
thesauromania : compulsion to collect objects or clothing belonging
to females
thlipsosis : arousal from pinching others
3-legged bloomers : bondage underwear garment that has sleeve for
head that opens to genitals of partner
thygatria : sex between father and daughter
tickling : light touch that sometimes causes a laughter response
timophilia : when a person's primary arousal comes from gold or
wealth
titillagnia : arousal from tickling
tithiolagnia : having an orgasm while nursing
toilet training : urinating or defecating on a partner as a form
of slave training
top : term used for partner who controls stimuli during sex games
tourniquets: a device that compresses blood vessels to control bleeding,
sometimes sexual
toucheurism : touching a stranger for arousal
tragolimia : compulsive desire for sex regardless of attraction
of partner
transvestophilia : arousal from crossdressing
traumaphilia : arousal from wounds or trauma; automasochism
tribadism [Gr. tribein to rub] : 1. lesbianism;
usually used to denote that in which heterosexual intercourse is simulated;
sometimes used to refer to the use of an artificial penis. 2. mutual
friction of the genitals between women.
tripsolagnia : arousal from having hair shampooed
tripsolagnophilia : arousal from massage
tripsophilia : arousal from massage
troilism : arousal by being third party in sex scene
undinism : arousal from water
urethral self-instrumentation : sounding; inserting object into
urethra for arousal
urolagnia : arousal from urine
urtication : the use of nettles to create extra sensation
vampirism : consuming blood of partner for arousal
vertigo : dizziness, sometimes used to enhance sex acts
vicarphilia : arousal from other people's exciting experiences
vincilagnia : arousal from bondage
virimimism : adoption of masculinity
weight training : the use of hanging weights on genitals or hooks
for arousal
whipping : striking or flagellating a partner for sensory enhancement
wife swapping : exchanging spouses with another couple for sexual
purposes
wrestling : a physical struggle between two or more people, used
as sexual arousal by some
xenodynamic : person who is only potent with strangers
xenolimia / xenophilia : arousal from strangers
zelophilia : arousal from jealousy
gender role identity disorder
effemination / feminization : the induction or development of female
secondary sex characters in the male
aim identity disorders
homosexuality / commasculation : sexual
orientation toward or activity with those of the same sex, as distinguished
from heterosexuality.
lesbianism / sapphism / cymbalism / gynecozygosity / Harem effect
[Gr. Lesbios of Lesbos, a Greek island in the Aegean Sea, home of the poetess
Sappho and her followers] : homosexuality between women
androsodomy : anal sex with a male partner
pathicant : a minor who engages in anal sex with an adult
catamites / bardajes : young gay male lovers
pathicus : passive recipient in gay anal sex
drag queens : gay men who dress in female attire
Aetiology :
estrinsic
a significantly increased incidence of prenatal stress was found in bisexual
and, particularly, in homosexual menref.
War induces stress in pregnant women and stress might causes a drop in
fetal androgen levels which in turn leads to the development of a homosexual
"orientation". Out of 865 homosexual males who were registered by venerologists
in 6 districts of the GDR highly significantly more homosexuals were born
during the stressful war and early postwar period of the Second World War,
i.e. between 1941 and 1947 (with a maximum of relative frequency in 1944-1945),
than in the years before or after this critical periodref.
A replication not only failed to support this conclusion but also found
that even those cities that suffered the most severe bombing during World
War II showed no evidence of increased numbers of homosexualsref.
intrinsic :
male and female fruitflies have been engineered to switch courtship roles,
through the manipulation of a single gene. The mating behaviours of the
Drosophila
fruitfly are a far cry from intricate Hollywood romance. The male performs
a series of tapping and tilting movements, to which the female usually
responds if she has not recently mated. Females, in contrast, never court
at all. But this behaviour has been reversed by designing female flies
with the male version of a gene called fruitless. These insects
initiated courtship with other females as often as their male counterparts
did. The tweaked female flies could only be encouraged to court males if
the males were designed to emit female pheromones, a form of natural chemical
attractant. When male flies were given the female version of the fruitless
gene, they stopped courting and became passive about sex. Scientists are
still struggling with the question of how this gene affects sexual behaviour
so strongly. It does not influence fly morphology: the insects do not look
any different. Instead, it seems the gene influences the insect's nervous
system. Homosexuality has been documented in > 400 species, including many
mammals, and research has linked this behaviour to everything from social
factors to maternally inherited genes. It's pretty clear that the survival
of a species depends heavily on its ability to reproduce. So that's something
that you'd want programmed into the genes, but controls on a fruitfly's
sexual behaviour are undoubtedly different from our own. In the case of
humans, sexual behaviours are not irreversibly set by genes, but that doesn't
mean the genes have no influenceref
the same genes that are proposed to predispose to homosexuality may also
boost reproduction in women, solving the apparent Darwinian paradox of
why these genes have not been removed by natural selection. Maternal relatives
of homosexual men tend to produce more offspring than those of heterosexuals.
This suggests that the mothers and maternal aunts of homosexuals have a
genetic advantage - but one that reduces reproduction when passed to male
offspring. The trait is probably multigenic as if the effect were down
to a single gene it would probably spread easily throughout the population,
and homosexuality would presumably be much more common. But whatever the
genes are, the X chromosome is almost certainly involved. Besides having
more fecund mothers and aunts, homosexual men had more fellow homosexuals
in their maternal family, again hinting that their sexuality is influenced
by their mother's genes. What's more, homosexual men were more likely to
have older brothers, which supports a separate theory that homosexuality
is linked to changes in the mother's immune system during previous male
pregnancies. Overall, about 14% of the variation between homosexual and
heterosexual men is accounted for by increased maternal reproduction, and
about 6% by the trend to have older brothers. The remaining 80% could perhaps
be due to formative sexual and social experiences during early life or
even childhoodref
about 60% of these brothers shared identical DNA on 3 chromosomes - chromosome
7q36 (equivalent maternal and paternal contributions), 8p12 (equivalent
maternal and paternal contributions) and 10q26. If it were down to chance,
only 50% of these stretches would be shared. The region found on 10q26
correlated with sexual orientation only when it was inherited from the
mother. No linkage with Xq28 has been confirmedref.
bisexuality / ambisexuality / amphisexuality
/ androgynophilia / sexoschizia : sexual attraction to persons of both
sexes; exhibition of both homosexual and heterosexual behavior.
alloeroticism : sexual feeling directed to another person. The final
stage in the development of object relationships, a state of maturity,
characterized both by direction of erotic energies to another and also
by the ability to form a love relationship with that other
autoeroticism : sexual self-gratification or arousal without the
participation of another person, such as masturbation. In psychoanalytic
theory, the most primitive stage in the development of object relations,
preceding the narcissistic stage
heteroeroticism : sexual feeling directed toward someone of the
opposite sex. A stage in the development of object relationships in which
the erotic energy is directed toward objects other than oneself, specifically
to those of the opposite sex
misogyny : hatred of women.
misogamy : hatred of or aversion to marriage
The statistical profile of adolescent sexual activity in the US in 1993
indicates that over 50% of teenagers are virgins until at least 17 years
of age. 20% of boys and 24% of girls are virgins by the age of 20 years.
Only 6.9% of men 18-59 years old and 21% of women 18-59 years old were
still virgins on their wedding night. However, among a sample of high school
students, over 33% of male and female virgins had engaged in some form
of heterosexual genital sexual activity in the preceding year. 29% of virgins
had masturbated a partner of the opposite gender. 31% had been masturbated
by a partner of the opposite gender. 9% had engaged in fellatio with ejaculation
with a partner of the opposite gender. 10% had engaged in cunnilingus with
a partner of the opposite gender. 1% had engaged in anal intercourse with
a partner of the opposite gender. Comprehensive sex education aims to help
adolescents postpone sexual intercourse until they are ready for mature
relationships by helping them develop interpersonal skills to resist premature
sexual involvement. Messages include information about sexual abstinence,
contraception, and safer sex. A 1993 study found that sexual abstinence
messages were one of the most frequently covered topics in state curricula
and guidelines. Other key topics were families, decision making, and sexually
transmitted diseases including AIDS. The least covered topics were sexual
identity, shared sexual behavior, sexual response, masturbation, and abortion.
There were only six studies of abstinence-only programs, of which at least
two showed no impact on sexual or contraceptive behavior. The National
Institute of Health says that abstinence-only programs ignore the success
of other programs and conflict with scienceref.
malingering : the willful, deliberate,
and fraudulent feigning or exaggeration of the symptoms of illness or injury,
done for the purpose of a consciously desired end.
factitious disorder : a mental
disorder characterized by repeated, intentional simulation of physical
or psychological signs and symptoms of illness for no apparent purpose
other than obtaining treatment. It differs from malingering
in that there is no recognizable motive for feigning illness. It is subtyped
on the basis of whether the predominant signs and symptoms are
factitious
disorder with main physical signs and symptoms : Munchausen syndrome
: a condition characterized by habitual presentation for hospital treatment
of an apparent acute physical illness, the patient giving a plausible and
dramatic history, all of which is false
laparotomaphilia : Munchausen syndrome in which the patient desires
abdominal surgery.
factitious
disorder with main psychologicalsigns and symptoms
factitious
disorder with both psychologicaland physical signs and symptoms
factitious disorder by proxy : a form of factitious disorder in
which one person intentionally fabricates or induces signs and symptoms
of one or more physical (Munchausen
syndrome by proxy) or psychological disorders in another person under
their care and subjects that person to needless and sometimes dangerous
or disfiguring diagnostic procedures or treatment, without any external
incentives for the behavior. The dyad is usually that of mother and child.
eating disorders : any of several disorders in which abnormal feeding
habits are associated with psychological factors. Often the consequences
of eating disorders worsen them (e.g. mucositis)
Epidemiology : mostly females aged 12-25
years
bulimia : episodic binge eating usually followed
by behavior designed to negate the excessive caloric intake, most commonly
purging behaviors such as self-induced vomiting
or laxative abuse but sometimes other methods such as excessive exercise
or fasting. While it is usually associated with bulimia nervosa, it may
also occur in other disorders, such as anorexia
nervosa.
bulimia nervosa (BN)
Epidemiology : occurring predominantly
in females with high economical level, with onset usually at age 12-35;
prevalence = 1-2% of general population, 5-9% of universitary or high-school
population
Aetiology : autoimmune
disease Symptoms & signs : episodic subjective
or objective (20,000-30,000 cal) binge eating > 2 times a week for > 3
months, followed by binge behaviors designed to prevent weight gain,
including purging, vomiting, fasting, diuretics (very dangerous !) and/or
excessive exercise. Episodes of binge eating involve intake of quantifiably
or subjectively excessive quantities of food alone within a short, discrete
period (more times a day) as well as a sense of loss of control over food
intake during these periods. The person with bulimia nervosa has a preoccupying
pathological fear of becoming overweight, feels an unusually strong tie
between self-worth and local
body shape and size (hips, buttocks,
thighs, ...), is aware that the eating pattern is abnormal, and frequently
experiences feelings of self-recrimination. In contrast to persons with
anorexia
nervosa, patients with bulimia nervosa tend to be somewhat older, more
socially inclined, have less obsessive characteristics (cyclothymic
disorder), dress appariscent when happy and do not exhibit extreme
weight loss; it is not diagnosed in the presence of anorexia nervosa.
50% have transient amenorrhea
Prognosis : mortality due to hyperkalemia,
suicide,
self-lesionism, substance abuse
Differential diagnosis :
mild psychotherapy
(neither familiar psychotherapy nor psychanalysis)
anorexia : lack or loss of the appetite for
food.
anorexia
nervosa (AN) : refusal to maintain a normal minimal body weight
(<15% of ideal body weight), intense fear of gaining weight or becoming
obese, and a disturbance of
whole
body image resulting in a feeling
of being fat or having fat in certain areas even when extremely emaciated,
undue reliance on body weight or shape for self-evaluation, and amenorrhea
for > 3 months. Associated features often include denial of the illness
and resistance to psychotherapy, depressive
symptoms, markedly decreased libido, and obsessions
or peculiar behavior regarding food, such as hoarding. The disorder is
divided into 2 subtypes :
restricting type : weight loss is achieved primarily through diet
or exercise
binge-eating / purging type
: binge eating or purging behavior (enteroclysm, laxatives, diuretics)
also occur regularly; the latter type resembles bulimia
nervosa, which is not diagnosed in the presence of anorexia nervosa
Epidemiology : 90-95% are females (rarely
"reverse
anorexia" in males using anabolizing hormones and practicing a lot
of physical exercise), usually with onset at age 14-18; prevalence = 1
every 800
Aetiology : high-risk job (models) and
sports (dancers)
Symptoms & signs
Complications : edemas (also in intestinal
loops, distended by vegetarian diet => the abdominal wall is soft, also
due to muscle atrophy), dementia, cardiac arrest due to gastric pressure
over heart
Prognosis : mortality = 5-20% (33% due
to cardiac complications : prolongation of the QT interval and cases of
sudden death)
Differential diagnosis :
< 20 kg : immediate feeding with nasogastric probe
beginning of symptoms : propose adequate diet
30 kg, affected by many years : fair approach making the patient understand
therapy wants to preent or correct the complications of malnutrition, improve
her beauty and avoiding uncomfortable feelings (e.g. cold)
feeding (proteins to prevent edemas and carbohydrates to re-regulate endocrine
pancreas incretion)
AEDs (topiramate
and lamotrigine)
induce slimming
Regimens :
day hospital : study protocols, eat together with other patients, drink
nutritional mixes together with an assistant, receive polysaline or glucosated
infusions (lipid suspesions may cause fatty embolism and frighten the patients)
hospital admission for severe complications, risk of suicide, weigth <
62% of ideal (ie. BMI < 12 kg/m2), nasogastric tube feeding, TPN with
CVC; side effect : refeeding syndrome
binge-eating disorder (BED) :
an eating disorder characterized by repeated episodes of binge eating (>
2 days per week for > 6 months), as in bulimia nervosa, but not followed
by inappropriate compensatory behavior such as purging, fasting, or excessive
exercise
eating disorder, not otherwise specified (NOS)
anorexia nervosa with normal weight
anorexia nervosa with menses
anorexia nervosa with < 2 binge-eating episodes per week or for <
3 months
small compensating food quantities
chewing and throwing
Laboratory examinations :
Structured Clinical Interview for Eating Disorders Spectrum, lifetime
version (SCI-ABS/LT)
Self-Report instrument for Eating Disorders Spectrum, lifetime version
(ABS -SR/LT)
Aetiology : approximately 50% of the variation
in sleeping disorder symptoms can be pinned on genetic factors. For disruptive
snoring it is 42%, daytime sleepiness 45%, restless legs 54% and legs jerking
60%.
dyssomnia : a category of disorders consisting
of disturbances in the quality, amount, or timing of sleep, due to abnormalities
in the mechanisms generating the sleep/wake state or of the timing of sleep
and wakefulness; included are :
insomnia : inability to sleep; abnormal wakefulness
compromising daytime activities. The National Sleep Foundation has defined
insomnia as any of the following: difficulty falling asleep, waking a lot
during the night, waking too early with inability to get back to sleep
or waking up feeling tired.
initial insomnia : that characterized by difficulty falling asleep
primary insomnia : a dyssomnia characterized
by persistent difficulty initiating or maintaining sleep or by persistently
nonrestorative sleep; it is not due to another sleep disorder or mental
disorder or to a general medical condition or substance use.
Epidemiology : prevalence of insomnia in 48%
of USA according to NSF
Aetiology : nocturnal frontal epilepsy,
narcolepsy,
psychiatric disorders, neurological diseases, drugs, obesity, SNPs in T-type
calcium channel
(genetically altered rodents showed a loss of delta waves and exhibited
a higher incidence of brief awakening) which selects painful stimuli from
each part of the body and relays them to the cortices of the brain
Duration :
transient insomnia : a few days
short-term insomnia : < 4 weeks
chronic insomnia : > 4 weeks
Associated diseases :
irritable
bowel syndrome
is significantly more common in people with sleep disturbances than those
without sleep disturbances. It's uncertain whether GI disturbances and
sleep disturbances cause one another or they are caused by another underlying
problem.
hypersomnia / hypersomnolence / excessive
daytime sleepiness (EDS) : excessive sleeping or sleepiness, as in
any of a group of sleep disorders with a variety of physical and psychogenic
causes. The presence of EDS is more strongly associated with depression
and metabolic factors (obesity/diabetes)
than with sleep-disordered breathing or sleep disruption per seref
primary hypersomnia : a dyssomnia
consisting of persistent excessive sleepiness and sleeping, with prolonged
sleep episodes or regularly occurring voluntary or involuntary napping,
and not due to any other psychological or physical condition.
sleeptalking / somniloquism / somniloquy
: talking during sleep.
restless leg syndrome (RLS)
/ Ekbom syndrome : unpleasant deep discomfort inside the calves when
sitting or lying down, especially just before sleep, producing an irresistible
urge to move the legs. A majority of RLS patients experience periodic
leg movements during sleep (PLMS) and wakefulness; some develop Parkinson's
disease.
Aetiology : uremic
syndrome Therapy : as for Parkinson's disease
periodic limb movement
disorder (PLMD) / nocturnal myoclonus : nonpathological myoclonic jerks
of the limbs occurring as a person is falling asleep or is asleep; in the
latter case they may disrupt sleep.
breathing-related sleep
disorder : any of several disorders characterized by sleep disruption
due to some sleep-related breathing problem, resulting in excessive sleepiness
or insomnia; included are central and obstructive sleep apnea syndromes
and primary alveolar hypoventilation
narcolepsy / Gélineau's syndrome / paroxysmal
sleep : recurrent, uncontrollable, brief episodes of sleep, often associated
with hypnagogic or hypnopompic hallucinations,
cataplexy, and sleep paralysis
cataplexy / cataplexis : a condition in
which there are abrupt attacks of muscular weakness and hypotonia triggered
by an emotional stimulus such as mirth, anger, fear, or surprise. It is
often associated with narcolepsy.
multiple sleep latency
test (MSLT) : measurement of the speed at which an individual falls
asleep when given multiple opportunities to sleep throughout the day and
instructed not to resist doing so; used as a measure of physiological sleepiness.
maintenance of wakefulness test (MWT) : measurement of the length
of time for which an individual can remain awake in a dark, quiet room;
used as a measure of physiological sleepiness
circadian rhythm sleep
disorder / sleep-wake schedule disorder : a sleep disorder of the dyssomnia
group, consisting of a lack of synchrony between the schedule of sleeping
and waking required by the external environment and that of a person's
own circadian rhythm. It usually has an environmental cause such as rotating
shift work or long-distance air travel, although some individuals simply
have natural circadian rhythms sharply different from the predominant one
of their society.
Aetiology : shorter PER3
gene (75%) or mutations in arylalkylamine N-acetyltransferase (AANAT)
Pathogenesis : natural cycle is thought
to be much longer than 24 hours
Symptoms & signs : people sleep late
into the day and feel alert only when burning the midnight oil
Therapy : melatonin
Aetiology : mutations in PER2
and CKId Symptoms & signs : sleep for the same
length of time as non-sufferers but typically are wide awake and raring
to go long before everyone else is up and about
clock jump type
work type
unspecified type
dyssomnia-not
otherwise specified (NOS)
parasomnia : a category of sleep disorders
in which abnormal physiological or behavioral events occur during sleep,
due to inappropriately timed activation of physiological systems; it includes
:
arousal parasomnias
confused awakening
nightmare disorder / dream anxiety
disorder : a sleep disorder of the parasomnia group, consisting of
repeated episodes of nightmares that awaken the sleeper, who rapidly becomes
fully oriented and alert and can vividly recall the dreams. Onset is usually
in childhood or adolescence, and children often outgrow the disorder
day residue : the thoughts, feelings, and ideas related to the events
of the day that appear in or shape the contents of the dreams that night.
sleep terror disorder : a sleep
disorder of the parasomnia group, consisting of repeated episodes of pavor
nocturnus (sleep terrors) lasting 30"-3'
sleepwalking disorder : a sleep
disorder of the parasomnia group, consisting of repeated episodes of somnambulism
sleepwalking (SW) / somnambulism / noctambulation
/ somnambulance : rising out of bed and walking about or performing
other complex motor behavior during an apparent state of sleep, usually
occurring in the first third of the night and lasting a few minutes to
a half hour. The individual is relatively unresponsive, not alert, not
easily awakened, and usually amnesic for the episode later
REM sleep behavior disorder
(RBD) : a sleep disorder of the parasomnia group characterized by abnormal
EMG
activity (absence of muscular atonia), altered dreams (> 90%), and violent
behaviors out the dreams they are having during REM sleep (thrash, talk,
sometimes pummel their bed partner, >70% leading to self-injury); 3.1%
develop Parkinson's
disease
parahypnosis : abnormal sleep, as under
hypnosis
or during general anesthesia;
sometimes characterized by a suggestible state, somnambulism, or an unusual
partial awareness of the surroundings.
Symptoms & signs : chronic excessive
sleepiness during night work and insomnia when attempting to sleep during
the day
Therapy : 200 mg of modafinilref
During sleep, noise signals which are associated with danger (i.e. lorry
noise) have the potential to trigger stress reactions even if the noise
level is low and increases of cortisol in the first half of the night,
which increases significantly with increasing traffic load, increases relative
risks of asthma, chronic bronchitis and neurodermitisref Adolescents and young adults are often excessively sleepy. This excessive
sleepiness can have a profound negative effect on school performance, cognitive
function, and mood and has been associated with other serious consequences
such as increased incidence of automobile crashesref.
Sleep research data indicate that adolescents and even young adults under
21 still require 9-10 hours' sleep a night. But since the 1980s, the average
sack time for both college and high school students has diminished to 6-7
hours nightly. Youngsters who are aged 9-10 years tend to sleep, on average,
for about 10 hours on school nights and usually not more (and many times
a lot less!) on weekends. But teenagers typically begin to enjoy sleeping
in on the weekends. This trend increases during the high school years.
As teens also develop a yen for late-night activities, their sleep debt
increases daily. Developmental changes in circadian rhythms, endocrine
and neurobehavioral systems, not to mention busier schedules, earlier start
times for school, and parental supervision, also contribute to the problem
of a teenager's getting less sleep. Regardless of the causes, however,
this scenario often proves far more serious than a mere yawn or a brief
encounter in slumber land. Current high school start times contribute to
sleep deprivation among adolescents. Consistent with a delay in circadian
sleep phase, students performed better later in the day than in the early
morning. However, exposure to bright light in the morning did not change
the sleep/wake cycle or improve daytime performance during weekdays. Both
short-term and long-term strategies that address the epidemic of sleep
deprivation among adolescents will be necessary to improve health and maximize
school performanceref.
In USA the percentage of people who typically sleep < 6 hours was
: 12% in 1998; 13% in 2001; 15% in 2002; 16% in 2005. People who sleep
> 10 hours per night have an average BMI = 26.4 kg/mBSA2,
while people sleeping 2-4 hours per night have a BMI = 30.1 kg/mBSA2ref Therapy : chronotherapy : treatment
of certain sleep disorders by capitalizing on the natural phase delay in
adults; the bedtime is successively advanced by one to several hours each
day until the individual can retire, sleep, and arise at appropriate times.
impulse control disorders
: a group of mental disorders characterized by repeated failure to resist
an impulse to perform some act harmful to oneself or to others. The person
feels tension or an irresistible urge to perform the act which, even though
ego-dystonic,
gives pleasure or emotional release upon performance.
intermittent explosive
disorder : an impulse control disorder characterized by multiple discrete
episodes of loss of control of aggressive impulses resulting in serious
assault or destruction of property that are out of proportion to any precipitating
stressors; behavior in between such episodes lacks impulsiveness or aggressiveness
isolated explosive disorder : a former classification used to denote
a single violent catastrophic act performed for no apparent reason and
not attributable to any other disorder.
catathymic crisis : an isolated, nonrepetitive act of violence that
develops as a result of intolerable tension.
dyscontrol syndrome / episodic dyscontrol : a pattern of episodic,
abnormal, and often violent and uncontrollable social behavior with little
or no provocation; it may result from diseases of the limbic system or
the temporal lobe or may accompany abuse of alcohol or some other psychoactive
substance
kleptomania / klopemania : an uncontrollable
impulse to steal objects unnecessary for personal use or monetary value,
the act being preceded by tension and followed by pleasure or relief, and
not caused by anger, delusion, vengeance, or hallucination.
pyromania : an impulse control disorder
characterized by the compulsion to set or watch fires in the absence of
monetary or other gain, the act being preceded by tension or arousal and
resulting in pleasure or relief.
Differential diagnosis :
profit, sabotage, vendict; violation occultment; political revendication;
attention or recognition
pathological gambling : an impulse
control disorder consisting of persistent failure to resist the urge to
gamble (betting money or other valuables on the outcome of a game or event.),
to such an extent that personal, family, and vocational life are seriously
disrupted.
Internet addiction disorder
(IAD) : 2 groups are at greatest risk from Internet addiction disorder.
The first are teenagers. But more surprisingly, the second are women and
men in their mid-50s suffering from the loneliness of an "empty nest."
The symptoms of Internet addiction in both groups are vague and are often
difficult to diagnose. Sufferers may experience loss of sleep, anxiety
when not online, isolation from family and peer groups, loss of work, and
periods of deep depression.
impulse
control disorder-not otherwise specified (NOS)
potomania / dipsomania / alcoholism : an
intense persistent desire to drink alcoholic beverages to excess
adjustment disorder : a maladaptive
reaction to identifiable stressful life events, such as divorce, loss of
job, physical illness, or natural disaster; this diagnosis assumes that
the condition will remit when the stress ceases or when the patient adapts
to the situation
adjustment disorderwith
depressed mood
adjustment disorderwith anxiety
adjustment disorderwith mixed depressed mood and anxiety
adjustment disorderwith behaviour alteration
adjustment disorderwith mixed behaviour and emotional alteratio
personality disorders : a category
of mental disorders characterized by enduring, inflexible, and maladaptive
personality traits that deviate markedly from cultural expectations, are
self-perpetuating, pervade a broad range of situations, and either generate
subjective distress or result in significant impairments in social, occupational,
or other functioning. Onset is by adolescence or early adulthood.
group A personality disorders
: odd cluster
paranoid personality (disorder)
: a personality disorder marked by a view of other people as hostile, devious,
and untrustworthy and a combative response to disappointments or to events
experienced as rebuffs or humiliations. Notable are a questioning of the
loyalty of friends, the bearing of grudges, a tendency to read threatening
meanings into benign remarks, and unfounded suspicions of the fidelity
of a partner. Unlike delusional disorder or paranoid schizophrenia, in
which delusional or hallucinatory persecution occurs, it is not characterized
by psychosis.
schizoid personality (disorder)
/ seclusive personality / shut-in personality : a personality disorder
marked by detachment from social relationships and a restricted range of
emotional experience and expression. Qualifying characteristics include
lack of capacity for, or interest in, social relationships or family life,
coldness, aloofness, consistent preference for solitary activities, lack
of pleasure in activities, flattened affectivity, and indifference to praise,
criticism, or the feelings of others.
schizotypal personality
(disorder) : a personality disorder characterized by marked deficits
in social and interpersonal competence and eccentricities in ideation,
appearance, and behavior; ideas of reference are common, as are odd beliefs
or magical thinking, cognitive or perceptual
distortions, little capability or desire for close relationships, excessive
social anxiety, suspiciousness, and occasional paranoid ideation. It differs
from schizophrenia, to which it is related, in having only transient psychotic
episodes, if any.
group B personality disorder
: dramatic cluster
antisocial personality
(disorder) / sociopathy : a personality disorder characterized by continuous
and chronic antisocial behavior in which the rights of others or generally
accepted social norms are violated; associated personality traits include
impulsiveness, egocentricity, inability to tolerate boredom or frustration,
irritability and aggressiveness, recklessness, disregard for truth, and
inability to maintain consistent, responsible functioning at work, at school,
or as a parent. The concept of a personality disorder that predisposes
an individual toward criminality has a long history. Among the terms that
have been applied to this disorder are moral insanity, psychopathic personality,
and sociopathic personality.
borderline personality
(disorder) : a personality disorder marked by a pervasive instability
of mood, self-image or sense of self, and interpersonal relationships;
impulsive and self-damaging acts are common, as are uncontrolled anger,
fears of abandonment, chronic feelings of emptiness, recurrent self-mutilating
behavior and suicide threats, and transient, stress-induced
periods of paranoia and dissociation. 20% have bulimia or bipolar disorder.
histrionic personality (disorder)
/ hysterical personality : a personality disorder marked by excessive
emotionality and attention-seeking behavior; there is overconcern with
physical attractiveness, sexual seductiveness, intolerance of delayed gratification,
and rapid shifting and shallow expression of emotions.
depressive personality
(disorder) : a personality disorder characterized by a persistent and
pervasive pattern of depressive cognitions and behaviors, such as chronic
unhappiness, low self-esteem, pessimism, critical and derogatory attitudes
toward oneself and others, feelings of guilt or remorse, and an inability
to relax or feel enjoyment.
narcissistic personality
(disorder) : a personality disorder characterized by grandiosity (in
fantasy or behavior), a lack of social empathy combined with a hypersensitivity
to the judgment of others, interpersonal exploitiveness, enviousness, arrogance,
a sense of entitlement, and a need for constant signs of admiratio (narcissism
/ ipserotism)
group C personality disorders
: anxious cluster
avoidant personality (disorder)
: a personality disorder characterized by social discomfort, hypersensitivity
to criticism, low self-esteem, and an aversion to activities that involve
significant interpersonal contact; there is a proclivity to anxiety, an
exaggeration of difficulties, a desire for affection and acceptance that
is restrained for fear of rejection, and an avoidance of risks or new activities
for fear of embarrassment.
dependent personality
(disorder) : a personality disorder marked by an excessive need to
be taken care of, with submissiveness and clinging and preoccupation with
fears of being abandoned; features include need for advice and reassurance
in decision making, yielding of responsibility, initiative, and independence,
avoidance of disagreement for fear of loss of support, voluntarily undertaking
unpleasant tasks to ensure further care, and discomfort or helpless feelings
when alone, with an indiscriminate rush to a new relationship.
obsessive-compulsive
personality (disorder) / anancastic, obsessive or compulsive personality
: a personality disorder characterized by an emotionally constricted manner
that is unduly conventional, serious, rigid, stubborn, and stingy, by preoccupation
with trivial details, rules, order, organization, schedules, and lists
to the extent that the major point of an activity is lost or task completion
is delayed, by reluctance to delegate tasks or work cooperatively unless
everything is done one's own way, and by excessive devotion to work and
productivity to the detriment of interpersonal relationships. This is not
the same as
obsessive-compulsive
disorder, which is an anxiety disorder.
passive-aggressive personality (disorder) / negativistic personality
(disorder) : a personality disorder characterized by an indirect resistance
to demands for adequate social and occupational performance, such as by
obstructionism, procrastination, or forgetfulness, and by negative, defeatist
attitudes.
sadistic personality (disorder) : a pervasive pattern of cruel,
demeaning, and aggressive behavior; satisfaction is gained in intimidating,
coercing, humiliating, and inflicting pain and suffering on others.
self-defeating personality (disorder) : a persistent pattern of
behavior detrimental to the self, including being drawn to problematic
situations or relationships, failing to accomplish tasks crucial to life
objectives, excessive self-sacrifice, inviting criticism and anger, undermining
of pleasurable experiences, and inability to enjoy the rewards of success.
split personality : an obsolete term formerly used colloquially
for either schizophrenia or dissociative identity disorder.
as-if personality : one resembling normalcy but lacking real, enduring
emotion, the person adopting and appearing to express ordinary characteristics
but then able to summarily discard them and adopt others as situations
change.
cyclothymic personality : a temperament characterized by rapid,
frequent swings between sad and cheerful moods
psychosomatic disorder : a
disorder in which the physical symptoms are caused or exacerbated by psychological
factors, such as migraine headache,
lower
back pain,
or irritable
bowel syndrome.
The synonym psychophysiologic disorders, used in previous official
nomenclatures and defined as “physical disorders of presumably psychogenic
origin,” has been replaced in DSM-IV by the more neutral phrase psychological
factors affecting physical condition, which may be applied to any physical
condition judged to be adversely affected by one or more psychological
or behavioral factors, and is subtyped on the basis of the specific factors
involved.
mental disorder that influence a medical condition
psychological symptoms that influence a medical condition
personality traits or adaptation styles that influence a medical condition
maladaptive health habits that influence a medical condition
physiological stress-related reaction that influences a medical reaction
other factors or unspecified factors that influence a medical condition
drug-induced movement disorder-not otherwise specified (NOS)
other drug-induced disorder
pharmacological side effects-not otherwise specified
relational problems
relation problem related to a mental disorder or a general medical condition
parent-baby relational problem
relational problem between partners
relational problem between brothers
relational problem-not otherwise specified
problems related to maltreatment or abandon
physical maltreatment of baby
stepchildren are no more likely to be killed by their parents than biological
children, says a study of Swedish crime statistics from 1965-99. The finding
is evidence against the so-called Cinderella effect, which suggests
that evolution has led people to favour children carrying their own genes
at the expense of those who do not.
sexual abuse of baby
abandon of baby
physical maltreatment of adult
sexual abuse of adult
other conditions that can be object of clinical attention
alarm reaction / fight-or-flight reaction : the physiologic effects
in response to acute stress, fright, or rage (increased blood pressure
and cardiac output, increased blood flow to skeletal muscles, decreased
flow to the viscera, increased rate of glycolysis and blood glucose concentration),
mediated by sympathetic nervous system discharge and release of adrenal
medullary hormones
anniversary reaction : abnormal behavior, symptoms, illness, or
dreams occurring on the anniversary of a disturbing event.
anxiety reaction : a reaction characterized by abnormal apprehension
or uneasiness
associative reaction : a reaction in which the response is withheld
until the idea presented has suggested an associated idea.
depressive reaction : depression; the
term is sometimes used to denote specific types of depression, such as
reactive depression, or any of various mood disorders in which depression
plays the predominant role
psychotic depressive reaction : psychosis characterized by depressed
mood resulting from a specific event, usually in a patient without prior
history of severe depression; the condition has been incorporated into
major
depressive disorder
stress reaction : any of the biological reactions to adverse stimuli,
physical, mental, or emotional, internal or external, that tend to disturb
the organism's homeostasis; should these compensating reactions, physiological
or psychological, be inadequate or inappropriate, they may lead to disorders.
nyctophilia : a preference for darkness or for night.
Erickson's 8 psychosexual stages of man
oral-sensory (birth to 18 mo.) : trust/mistrust crisis
anal-muscular (18 mo. to 3 years) : autonomy/shame, self-doubt crisis
genital-locomotor control (3 to 5 years) : initiative/guilt crisis
latency (5 to 13 years) : industry, competence/inferiority, failure crisis
puberty (13 to 21 years) : identity/role confusion crisis
genitality (young adulthood, 21 to 40 years) : intimacy/isolation crisis
productivity (adulthood. 40 to 60 years) : generativity/self-absorption,
stagnation crisis
maturity (60 years to death) : integrity, self-worth/despair crisis
oral stage : in psychoanalytic theory,
the earliest stage of psychosexual development, lasting from birth to about
18 months, during which the oral zone is the center of the infant's needs,
expression, and pleasurable erotic experiences
anal stage : in psychoanalytic theory,
the second stage of psychosexual development, occurring between the ages
of 1 and 3 years, during which the infant's activities, interests, and
concerns are on the anal zone
phallic stage : in psychoanalytic theory,
the third stage in psychosexual development, lasting from age 2 or 3 years
to 5 or 6 years, during which sexual interest, curiosity, and pleasurable
experiences are centered on the penis in boys and the clitoris in girls
latency stage : in psychoanalytic theory,
the period of relative quiescence in psychosexual development, lasting
from age 5 or 6 years to adolescence, during which interest in persons
of the opposite sex ceases and the child tends to associate mainly with
persons of his own sex
genital stage : in psychoanalytic theory,
the last stage in psychosexual development, occurring during puberty, during
which the person can achieve sexual gratification from genital-to-genital
contact and is capable of a mature relationship with a person of the opposite
sex
complex : a group of interrelated ideas, mainly unconscious, that
have a common emotional tone and strongly influence a person's attitudes
and behavior
Oedipus complex : in psychoanalytic
theory, the feelings and conflicts occurring in a child during the phallic
phase of psychosexual development that result from sexual attraction
to the opposite-sex parent, including envious, aggressive feelings toward
the same-sex parent.
Electra complex : the counterpart
in females of the Oedipus complex, which was originally applied only to
males, involving the daughter's love for her father and jealousy or resentment
toward her mother; the term is now rarely used since Oedipus comlplex has
come to be applied to both sexes.
inferiority complex : unconscious feelings of inadequacy, producing
timidity or, as a compensation, exaggerated aggressiveness and expression
of superiority; based on Alfred Adler's concept that everyone is born with
a feeling of inferiority stemming from real or imagined physical or psychological
deficiency, with the manner in which the inferiority is handled determining
behavior
conflict : in psychiatry, a psychic struggle, often unconscious,
arising from the clash of incompatible or opposing impulses, wishes, drives,
or external demands.
approach-approach conflict : conflict resulting from 2 available
goals which are desirable but incompatible.
approach-avoidance conflict : conflict resulting from a single goal
having both desirable and undesirable consequences or qualities.
avoidance-avoidance conflict : conflict resulting from the desire
to avoid 2 equally distasteful alternatives.
extrapsychic conflict : conflict between a person's wishes or needs
and the expectations or desires of others.
intrapersonal or intrapsychic conflict : conflict between incompatible
and often unconscious wishes, impulses, needs, thoughts, or demands within
one's own mind
euphoria : an exaggerated feeling of physical
and mental well-being, especially when not justified by external reality.
Euphoria may be induced by drugs such as opioids, amphetamines, and alcohol
and is also a feature of mania
homicide : the taking of the life of one
person by another
patricide : homicide of father
matricide : homcide of mother
fratricide : homicide of brother/sister
uxoricide : homicide of wife
genocide : homicide of a whole race
suicide : the taking of one's own life. Only
a small minority has a rational base.
psychic suicide : the termination of one's own life without employment
of physical agents.
Epidemiology :
suicide
failed suicide
age
mature/advanced
< 35
female-to-male ratio
3:1
1:3
suicide way
violent
drugs (> 80%)
diagnosis
major depression
alcohol
schizophrenia
somatic disease
psychogenous reaction
Suicide rates for the elderly > 65 years continue to be the highest for
any age group
average prevalence of lifetime occurrence of suicide idea : 10%
average lifetime failed suicide attempt (quasi-completed suicides) prevalence
: 3 every 1,000. Those firing at foreface survive with "angel face".
average lifetime suicide prevalence : 10 every 100,000
suicide rates among doctors are higher than those in the general population.
The gap in suicide rates evidently begins as early as medical school, where
overall suicide rates are higher than in the age-matched populationref
suicide rates in different countries :
high rates (> 25 every 10,000) : Austria, Czech Republic, Hungary, Germany,
Japan (< 15,000 in the late 1960s, but it increased to > 20,000 (which
is as twice as the number of death by traffic accidents) in 1970s, which
has not been reduced up to the present and the highest number 256,000 was
recorded in 1986), Sweden, Denmark, Finland
suicide is the fifth leading cause of death in China, where < 287,000
people were victims of suicide annually between 1995 and 1999. In most
countries suicides are most common among males, but in China, suicides
and suicide attempts were most common among young Chinese women between
the ages of 15 and 30
intermediate rates (10-25 every 100,000) : France, Yugoslavia
USA suicide rate among all age groups also has dropped in recent years,
although it rose from 10.44 deaths per 100,000 in 2000 to 10.69 per 100,000
in 2001. The suicide rate for those ages 10 to 19 fell from 6.2 deaths
per 100,000 people in 1992 to 4.6 per 100,000 in 2001. The number of suicides
also fell in that period, from 2,151 to 1,883. The decrease in gun suicides
was most dramatic among children 10 to 14, dropping from 172 in 1992 to
90 in 2001. Among those 15 to 19, deaths from self-inflicted shootings
dropped from 1,251 to 838 during the same period. New safety measures for
keeping guns out of children's hands and greater acceptance of gays may
have played important roles (sexual orientation has been a factor in many
suicides among young males). Trigger locks, lock boxes and other measures
for keeping guns out of youngsters' hands have become more common in recent
years, but CDC officials said they did not know whether that accounts for
the decrease in suicides. The number of suicides by hanging or other forms
of suffocation, meanwhile, rose among young people from 1992 to 2001. Such
methods of suicides -- including use of belts, ropes or plastic bags --
rose from 96 to 163 in that period among youngsters 10 to 14. Among teens
ages 15 to 19, suicides by suffocation rose from 333 deaths to 551. CDC
researchers said they were surprised by the switch in suicide methods and
said they first noticed the trend in the early 1990s. By the end of the
decade, suffocations had surpassed self-inflected shootings. Suicide remains
the third leading cause of death among young people in this country. Other
youth-related findings included these:
1 in 20 high school students reported both suicide attempts and involvement
in physical fights in the past year. Students who reported attempting suicide
in the past 12 months were nearly 4 times as likely to report involvement
in physical fights.
of the lethal acts of school violence carried out by students between July
1, 1994, and June 30, 1999, > 20% were suicides. 25% suicide victims injured
or killed someone else before their suicide.
hispanic males were almost six times as likely to die by suicide as Hispanic
females, representing 85% of the 8,744 Hispanic suicides between 1997 and
2001. Hispanic youth are the fastest growing segment of the U.S. population
and account for 25% of all Hispanic suicide deaths
low rates (> 10 every 100,000) : Italy, Spain, Israel
Aetiology :
psychiatric disorders (30-50% of all suicides in the younger and prime
generations)
mood disorders (48%)
depression (19% of all depressed patients, mainly
after age 50; RR = 30)
Most frequently used method for committing suicide :
hanging
inhalation of car exhaust
drowning oneself
taking poisons : Tanax or T-61, a euthanasia solution commonly used in
veterinary medicine, has been often involved in suicide attempts (humans)
and malicious intoxications (animals). For forensic reasons, the identification
of one or more of the 3 components (embutramide, mebenzonium iodide, and
tetracaine hydrochloride) of Tanax is needed to confirm the hypothesis
of intoxication.ref
firearms
self-stabbing (craft knives, swords and recreational knives, fragments
of glass, carpenter's tools and surgical knives were used almost exclusively
by men, while more than 80% of women used kitchen knives or razors). The
majority of fatally wounded body sites are in the neck, chest, abdomen,
wrists and forearms
Prevention :
betterment of home life
mental independence
death education
forced intervention by psychiatrists
hot line : telephone assistance for those in need of crisis intervention
(q.v.), as in suicide prevention, usually available 24 hours a day, seven
days a week, and staffed by nonprofessionals with mental health professionals
serving as advisors or in a back-up capacity
since even one previous attempt multiplies suicide risk by 38-40 times
and suicide is the fourth leading cause of death for adults under 65, a
proven way to prevent repeat attempts has important public health implications.
Recent suicide attempters treated with cognitive therapy were 50% less
likely to try to kill themselves again within 18 months than those who
did not receive the therapyref
oedipism [from Oedipus, King of Thebes, who blinded himself after
unknowingly killing his father and marrying his mother] : intentional injury
of one's own eyes
borderline state :a diagnostic term used when it is difficult to
determine which of two states are indicated by the presenting symptoms,
generally for a state that has some characteristics of psychosis but in
which the patient has some contact with reality.
Epstein's symptom : a symptom seen in nervous infants, consisting
of failure of the upper lid to move downward, giving the child a frightened
expression
chronotaraxis : disorientation for time; observed as a transient
symptom following thalamic or frontal lobe lesions.
formal thought disorder : disturbance in the form, rather than the
content, of thought; disruption in the flow of ideas or speech; inability
to follow the normal semantic or syntactic rules in someone with adequate
intelligence and education and the cultural background to do so.
asceticism : a way of life or character trait described by the elimination
of pleasurable effects associated with experiences and characterized by
renunciation, self-denial, withdrawal from society, and sometimes dedication
to an unattainable ideal or to eradication of some specific evil.
psychataxia : a disordered mental condition marked by confusion
and inability to concentrate
psycholepsy : a sudden, intense lowering of mood level, usually
of short duration, in individuals with unstable psychic tension
hallucination : abnormal sensation
auditory hallucination (AH)
can
arise not only in psychotic disorders, but also in neurological conditions
affecting the parts of the brain used to process and monitor speechref1,
ref2,
which are thought to include frontal motor areas, the primary auditory
cortex, and Wernicke's arearef.
Brain injury can cause epilepsy; moreover, some psychotropic medications
can increase neuronal excitability, and lower the threshold for seizuresref
hallucinosis : a state characterized
by the presence of hallucinations without other impairment of consciousness
pseudohallucination : 1. an image
perceived to be occurring externally but which the subject knows to be
generated within the mind. 2. a hallucination which is perceived
as unre
illusion : a false or misinterpreted sensory
impression; a false interpretation of a real sensory image
delusion : a false belief that is firmly
maintained in spite of incontrovertible and obvious proof or evidence to
the contrary and in spite of the fact that other members of the culture
do not share the belief.
bizarre delusion : a delusion that is patently absurd and has no
possible basis in fact, such as delusions of being
controlled or thought broadcasting.
delusion of control / delusion of being controlled : the delusion
that one's thoughts, feelings, and actions are not one's own but are being
imposed by someone else or by some external force.
depressive delusion : a delusion that is congruent with a predominant
depressed mood, such as a delusion that one is being persecuted because
of one's sinfulness or inadequacy, somatic
delusions of serious illness, nihilistic
delusions, or delusions of poverty.
delusion of negation / nihilistic
delusion : a depressive delusion that the self or part of the self,
part of the body, other persons, or the whole world has ceased to exist.
encapsulated delusion : a delusion that has no significant effect
on behavior.
erotomanic delusion : a delusional conviction that some other person,
usually of higher status and often famous, is in love with the individual;
it is one of the subtypes of delusional disorder.
fragmentary delusions : unconnected delusions not organized around
a coherent theme.
paranoid delusions : an older term (its use is discouraged) denoting
...
delusion of grandeur / grandiose
or expansive delusion : a delusion involving an exaggerated concept
of one's importance, power, or knowledge or that one is, or has a special
relationship with, a deity or a famous person; it is one of the subtypes
of delusional disorder. Seen in megalomania
delusion of persecution / persecutory
delusion : a delusion that one is being attacked, harassed, cheated,
persecuted, or conspired against; it is one of the subtypes of delusional
disorder.
delusion of jealousy : a delusional belief that one's spouse or
lover is unfaithful, based on erroneous inferences drawn from innocent
events imagined to be evidence and often resulting in confrontation with
the accused. It is one of the subtypes of delusional disorder.
mixed delusion : one in which no central theme predominates; one
of the subtypes of delusional disorder.
mood-congruent delusion : a delusion occurring as a manifestation
of a mood disorder; see also mood-congruent.
mood-incongruent delusion : a delusion occurring as a manifestation
of a psychotic disorder; see also mood-incongruent.
delusion of poverty : delusion
that one is, or soon will be, bereft of material possessions.
delusion of reference : a delusional conviction that ordinary
events, objects, or behaviors of others have an unusual or peculiar meaning
specifically for oneself. When less frequent or intense, or if not organized
or systematized, such beliefs are called ideas of reference.
somatic delusion : a delusion that
there is some alteration in a bodily organ or its function; it is one of
the subtypes of delusional disorder.
systematized delusions : a group of delusions organized around a
common theme.
thought broadcasting : the delusion that one's thoughts are being
broadcast to the environment.
thought insertion : the delusion that thoughts that are not one's
own are being inserted into one's mind.
thought withdrawal : the delusion that someone or something is removing
thoughts from one's mind.
eviration : a delusional belief of a man that he has become a woman.
delusional parasitosis / Eckbom
syndrome / Morgellons disease : a false belief of infection or infestation
with parasites
Epidemiology : aas of February 2006, more
than 2,000 reports of the disease have been reported on the Foundation's
website. Reports come from all 50 U.S. states and 15 nations, including
Canada, the UK, Australia and The Netherlands. The majority of reports
have come from Texas, California and Florida. Interest in the disease was
recently rekindled after afflicted Texas teenager Travis Wilson committed
suicide in April 2006ref.
Symptoms & signs : feelings of insects
or parasites scuttling beneath their skin and open lesions that heal slowly
and which ooze out blue and white fibers, some as thick as spaghetti strands.
Attempts to remove the fibers are said to elicit shooting pains radiating
from the site. The lesions range from minor to disfiguring in appearance
and fibers appear either as single strands or as bundles. Patients also
sometimes report the presence of fibers or black granular specks on their
skin even in the absence of lesions. Some patients even report symptoms
of the disease in their pets—dogs mostly, but also cats and horses. About
95% of patients also report suffering from disabling fatigue, or "brain
fog," that hinders their ability to pay attention. Other reported symptoms
include joint pain, sleep disorders, hair loss, decline in vision, and
even the "disintegration" of perfectly healthy teeth. It appears that once
patients contract the disease, they have it for life. To date, there have
been no reports of spontaneous remissions. A preliminary analysis of the
fibers suggests they are more than just lint from household materials such
as clothing, carpets or bedding. The fibers are not common textiles, nor
are they black specks of pepper, as several dermatologists have proposed.
Further deepening the mystery, some analyses suggest the fibers might be
made of cellulose, a molecule generally found in plants. They're basically
fibers that you wouldn't expect to see in humans. The disease is named
after a medical condition described in 1674 by the British author Thomas
Browne. Known as "Morgellons," the disorder caused children to "critically
break out with harsh hairs on their backs…" It is doubtful that the 17th
century disease is related in any way to modern day Morgellons. The "matchbox
sign" of delusional parasitosis, when patients bring in hair, skin or clothing
lint, sometimes in matchboxes, that they claim contain the insects or parasites
responsible for their torment. However, when examined, the samples reveal
no such thing. The lesions and scratches sometimes seen on patients with
delusional parasitosis are usually self-inflicted.
Laboratory examinations : skin biopsies
to rule out infections
Therapy : anti-psychotic or anti-anxiety
medicines
Web resources : Morgellons
Research Foundation, a non-profit organization devoted to raising public
awareness about the disease.
misidentification : failure to identify correctly persons or objects
known to the subject, caused by confusion or memory loss.
delusional misidentification : that due to the mistaken belief that
a person or object has been transformed physically or mentally
Capgras' syndrome : a form of delusional misidentification in which
the patient believes that other persons in the environment are not their
real selves but doubles
Frégoli's phenomenon : a form of delusional misidentification
in which the subject believes that a stranger, particularly a persecutor,
is disguised as various people familiar to the subject
culture-specific syndrome : a form of disturbed behavior highly
specific to certain cultural systems and that does not conform to Western
nosologic entities; examples are amok, koro,
piblokto,
falling-out,
and windigo.
windigo / witigo [Ojibwa a cannibalistic monster
of the mythology of Eskimos and certain Native Americans] : a culture-specific
syndrome characterized by delusions of being possessed
by the windigo, with fears of becoming cannibalistic and agitated depression
Kleine-Levin syndrome : episodic periods of excessive sleep and
overeating lasting for several weeks, with amnesia for the attacks; it
usually occurs in adolescent boys.
maternal deprivation syndrome : failure to thrive with severe growth
retardation, unresponsiveness to the environment, depression, retarded
mental and emotional development, and behavioral problems resulting from
loss, absence, or neglect of the mother or other primary caregiver.
organic personality syndrome : a term used in a former system of
classification, denoting an organic mental syndrome characterized by a
marked change in behavior or personality, caused by a specific organic
factor and not associated with delirium or dementia. The most common causes
are space-occupying lesions of the brain, head trauma, and cerebrovascular
disease.
social breakdown syndrome : deterioration of social and interpersonal
skills, work habits, and behavior seen in chronically hospitalized psychiatric
patients; due to the effects of long-term institutionalization rather than
the primary illness. Symptoms include excessive passivity, assumption of
the chronic sick role, withdrawal, and apathy. Such effects are also seen
in long-term inmates of prisons or concentration camps.
acathexis : a lack of the emotional charge (cathexis) with which
an object or idea would normally be invested; detachment of feelings from
thoughts and ideas.
taboo [Tongan tabu forbidden, set apart] : any of the negative traditions,
objects, or behaviors that are generally regarded as harmful to social
welfare and are therefore prohibited
mores : the traditions and habits which are generally regarded as
conducive to social welfare.
psychic determinism : the concept, originated by Freud, that mental
events do not occur by chance but have their antecedent mental causes,
that even accidents, slips of the tongue, or whims commonly felt to be
inexplicable result from unconscious mental processes.
stigma : a distinguishing personal trait that is perceived as or
actually is physically, socially, or psychologically disadvantageous
psychic overtone : the consciousness of a fringe or halo of associated
relations that surrounds every image presented to the mind
organic drivenness : hyperactivity seen in brain-damaged individuals
as a result of injury to and disorganization of cerebellar structures.
Laboratory examinations :
Diagnostic Interview Schedule-IV (DIS-IV)
Objective Structured Clinical Examination (OSCE)
Self-Report instrument for General Spectrum Measures, lifetime version
(GSM V -SR/LT)
Semi-structured Clinical Interview for Children and Adolescents (SCICA)
Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I)
Structured Clinical Interview for DSM-IV Axis I Disorders-clinician
version (SCID-CV)
Structured Clinical Interview for DSM-IV Axis II Personality Disorders
(SCID-II)
Brazelton behavioral scale : a method for assessing infant behavior
by its responses to environmental stimuli.
Brief Psychiatric Rating Scale (BPRS) : a rating scale for assessing
psychopathology on the basis of a small number, usually 16 to 24, items
encompassing psychosis, depression, and anxiety symptoms.
Columbia Mental Maturity Scale : a test of specific kinds of mental
function and general abilities, suitable for children (ages 3 to 12) with
no speech or with limited physical capabilities, such as those with cerebral
palsy
psychomotor test . a test that assesses the subject's ability to
perceive instructions and perform motor responses, often including measurement
of the speed of the reaction.
psychological test : any test to measure a subject's development,
achievement, personality, intelligence, thought processes, etc
Denver Developmental Screening test: a test for identification
of infants and preschool children with developmental delay
reality testing: objective evaluation of the external world
and differentiation between it and the ego or self. Impaired reality testing
is seen in psychological defense mechanisms that falsify reality, such
as projection and denial, and it is a major criterion for psychosis
Bender Visual-Motor Gestalt test : a psychological test used for
evaluating perceptual-motor coordination, for assessing personality dynamics,
as a test of organic brain impairment, and for measuring neurological maturation.
The subject is asked to make free-hand copies of 9 simple geometric designs
presented separately on cards or sometimes to reproduce the design from
memory.
association test : a test based on associative reaction. It is usually
performed by mentioning words to a subject and noting what other words
he will give as the ones called up in his mind. The reaction time is also
noted
projective test: any of various tests in which an individual
interprets ambiguous stimulus situations, e.g., a series of inkblots (Rorschach
t.), according to his own unconscious dispositions, thus yielding information
about his personality structure, its underlying dynamics, and possible
psychopathology.
Thematic Apperception Test (TAT) : a projective test in which the
subject tells a story based on each of a series of standard ambiguous pictures,
so that his responses reflect a projection of some aspect of his personality
and current psychological preoccupations and conflicts.
abulia / aboulia : lack of will or willpower; inability to make
decisions
parabulia : perversion of the will, as when
an individual intends to perform a particular action but halts and substitutes
either an opposite action or an unrelated alternative; usually seen in
schizophrenics.
alogia :
paralogia : disturbance of the reasoning
faculty; marked by delusional or illogical speech.
thematic paralogia : that limited to one subject, on which the mind
dwells insistently
evasion : in psychiatry, suppression of an idea that would come
next in a thought sequence and substitution of a closely related idea;
a form of paralogia.
paralogism : the use of fallacious, meaningless, or illogical thought
or language, primarily characteristic of schizophrenia
pseudologia fantastica : a tendency to tell extravagant and fantastic
falsehoods centered about the storyteller, who often comes to believe in
and may act on them.
grandiosity : the condition of being grandiose;
an exaggerated belief of one's importance or identity.
idea : an impression, thought, or conception resulting from mental
activity.
autochthonous idea : a persistent idea originating within the mind,
usually from the unconscious, but seeming to have come from an outside
source and often therefore felt to be of malevolent origin.
dominant idea : one that controls or colors every action and thought.
fixed idea / idée fixe : a morbid impression or belief which
stays in the mind and cannot be changed by reason
overvalued idea : a false or exaggerated belief sustained beyond reason
or logic but with less rigidity than a delusion, also often being less
patently unbelievable.
idea of reference / referential idea : the assumption by a patient
that the words and actions of others refer to himself or the projection
of the causes of his own imaginary difficulties upon someone else; if frequent
or intense, or if organized and systematized, called delusion of reference.
ego ideal : the component of the superego comprising the internalized
image of what one desires to become and toward the attainment of which
the ego strives, formed through conscious or unconscious identification
with or emulation of one who plays a significant role or has a place of
esteem in the life of the developing child.
idealization : a conscious or unconscious mental mechanism in which
the individual overestimates an admired aspect or attribute of another
person.
ideation : the formation of a mental concept, image, or thought.
paranoid ideation : the persistent idea, not of delusional intensity,
that one is being persecuted, harassed, or otherwise unfairly treated.
identification : a largely unconscious process by which a person
patterns himself after one or more other people, associating closely with
them and assuming their viewpoints; sometimes used as a defense mechanism.
cosmic identification : identification of one's self with the universe,
as in schizophrenic delusions of omnipotence.
projective identification : an unconscious defense mechanism in
which unacceptable aspects of the self are falsely attributed to others;
it differs from projection in that the target is transformed, unconsciously
identifying and responding, and the aspects that are projected are not
completely disavowed but rather are perceived as justifiable reactions
to the other person's induced responses.
identity : the aggregate of characteristics by which an individual
is recognized by himself and others.
ego identity : a sense of unity and continuity of oneself.
core gender identity : a person's concept of himself as being male
and masculine or female and feminine, or ambivalent, usually based on physical
characteristics, parental attitudes and expectations, and psychological
and social pressures. It is the private experience of gender role
gender role : the public expression of gender; the image projected
by a person that identifies their maleness or femaleness, which need not
correspond to their gender identity
identity crisis : a period in the psychosocial development of an
individual, generally occurring during adolescence, usually manifested
by a loss of the sense of the sameness and historical continuity of one's
self, confusion over values, or an inability to accept the role the individual
perceives as being expected of him by society.
suggestion : 1. the act of offering an
idea for action or for consideration of action. 2. an idea so offered.
3. in psychiatry, the process of causing uncritical acceptance of an idea.
hypnotic suggestion : a suggestion imparted to a person in the hypnotic
state, by which he is induced to alter perceptions or memory or to perform
actions.
posthypnotic suggestion : implantation in the mind of a subject
during hypnosis of a suggestion to be acted upon after recovery from the
hypnotic state.
heterosuggestion : suggestion received from another person
autosuggestion : self-suggestion; the process by which a person
induces in himself an uncritical acceptance of an idea, belief, or opinion,
such as by self-hypnosis
paranormal : beyond the normal or natural
extrasensory perception
(ESP) / parapsychology : the study of psychical effects and experiences
which appear to fall outside the scope of physical law, e.g. :
telepathy : extrasensory perception of the
mental activity of another person
clairvoyance : a form of extrasensory
perception in which knowledge of objective events is acquired without the
use of the senses
telekinesis : the power claimed by certain
persons of moving objects without contact with the object moved; also motion
produced without contact with a moving body
telemnemonike : the gaining of consciousness of things in the memory
of another person
studies showing that transcranial
magnetic stimulation (TMS)
induces mystical/spiritual experiences are being queried by researchers
who cannot reproduce key results. If the traditional theory is wrong, scientists
will be left struggling to explain how such thoughts and sensations are
generated. In the past, scientists have claimed that religious or out-of-body
experiences result from excessive bursts of electrical activity in the
brain. In the 1980s, Michael Persinger, a neuroscientist at the Laurentian
University in Ontario, Canada, began exploring this idea through a series
of experiments. Participants wore helmets that targeted their temporal
lobes with weak magnetic fields, of roughly the same strength as those
generated by a computer monitor. This caused 80% of the people he tested
to feel an unexplained presence in the room. Magnetism causes bursts of
electrical activity in the temporal lobes of the brain, and he linked this
to the spiritual experiences. A group of Swedish researchers has now repeated
the work, but they say their study involves one crucial difference. They
ensured that neither the participants nor the experimenters interacting
with them had any idea who was being exposed to the magnetic fields, a
'double-blind' protocol. Without such a safeguard, "people in the experimental
group who are highly suggestible would pick up on cues from the experimenter
and they would be more likely to have these types of experiences. Beyond
the double-blind aspect, the nuts and bolts of the experiment mirrored
those conducted in the past. He and his colleagues tested 43 undergraduate
students by exposing them to magnetic fields that ranged from 3 to 7 mT
and were aimed just above and in front of the ears, to target the temporal
lobes. They also tested a control group of 46 volunteers who wore the helmet
but were not exposed to the magnetic field. The volunteers were then asked
to complete questionnaires about what they experienced during each session.
In contrast to the results from Persinger and others, the team found that
the magnetism had no discernable effects. 2 out of the 3 participants in
the Swedish study that reported strong spiritual experiences during the
study belonged to the control group, as did 11 out of the 22 who reported
subtle experiences. This seems to be quite a high level of spiritual experiences
overall, but it matches the level that Persinger saw in his control groups.
The researchers say they do not know what neurological mechanism could
be generating the experiences. However, using personality tests they did
find that people with an orientation toward unorthodox spirituality were
more likely to feel a supernatural presence, as were those who were, in
general, more suggestible. Persinger, however, argues that the Swedish
group did not expose the subjects to magnetic fields for long enough to
produce an effect and stresses that some of his studies were double blindedref
hyphedonia : pathologic diminution of the feeling of pleasure in
acts that normally give pleasure.
animism : 1. the obsolete doctrine that the soul is the source of
all organic development. 2. the belief that nonliving objects and
phenomena (such as clouds) are inhabited and motivated by a nonphysical
agent; it is a characteristic of the thinking of early childhood.
3. the theory that behavior is controlled by an immaterial mind or soul.
animus : ill will or hostility; animosity. In jungian psychology,
the masculine aspect of a woman's soul or inner being; see anima.
soul / anima :
anima : in jungian psychology, the soul or inner being of a person,
as opposed to the persona, the social role or facade presented to the world;
because the inner and outer facades are often opposing, Jung also used
the term to refer to the feminine aspect of a man's soul, the analogous
masculine aspect of a woman's soul being termed the animus.
persona [L. “mask”] : in jungian psychology, the personality mask
or facade presented by a person to the world, as opposed to the anima,
the inner being
perseveration : the inappropriate persistence or repetition of a
thought or act after the causative stimulus has ceased or in response to
different stimuli, e.g., answering a question correctly and then inappropriately
repeating that answer to succeeding questions; most often associated with
brain lesions but also seen in schizophrenia.
disposition / animus : a tendency, physical or mental, toward a
disease. 2. the prevailing temperament or character, giving a degree
of predictability to the response to a situation or other stimulus.
libido : 1. sexual desire. 2. the psychic
energy derived from instinctive biological drives; in early freudian theory
it was restricted to the sexual drive, then expanded to include all expressions
of love and pleasure, but the concept has evolved to include also the death
instinct. The mere thought of beer or wine can influence your sex drive,
according to a study of 82 male undergraduate students. Alcohol has long
been known to have a number of effects on dating behaviour: some good,
some bad. Enough booze can wipe away inhibitions and act as an aphrodisiac,
or it can dampen sexual performance. It can even produce what are jokingly
called 'beer goggles', which mean you judge people as more attractive when
you are drunk. But whatever effect someone expects from alcohol can be
produced by simple exposure to flashes of alcohol-related words on a computer
screen. The researchers first questioned the men about how they felt alcohol
affected their libido, and then presented them with rapidly flashing words
and jumbled letters on a computer screen. One group was exposed to cue
words that suggested alcohol, including beer, whisky, martini and malt;
the other, control group was exposed to words such as smoothie, espresso
and ice. The men then rated 21 female high-school graduation photos on
a scale of 1 to 9 in terms of attractiveness. The men who expected alcohol
to boost their libido rated photos more favourably after subconsciously
viewing alcohol cue words. Those who expected alcohol to reduce their performance
actually rated the girls as less attractive after boozy words. What is
most surprising is that mere expectancy can influence perception. The men
were also asked to rate the girls' intelligence based on their pictures.
In this case the flashing words had no impact on the results, so at least
beer goggles may not make the world seem smarter than it really is. The
findings shed some worrying light on our vulnerability to subconscious
cuesref.
These expectations about drugs or alcohol can be activated without your
awareness. Friedman stresses that other studies have shown how simple words
can sway our behaviour. One notable study found that after undergraduate
students were subconsciously exposed to phrases such as 'old age' and 'bingo'
they walked more slowly down hallwaysref.
Assessing the power of these veiled cues is important, agrees Jack Darkes,
a clinical psychologist at the University of South Florida in Tampa who
has studied assumptions about alcohol. It's another link in the chain that
supports what a lot of us have been saying for a while : appreciating the
difference between psychological and chemical effects may help those with
alcohol addictions to face up to their problem
lapsus : an error, or slip, thought to be revealing
of an unconscious wish or association
lapsus calami : an unconsciously motivated slip of the pen.
lapsus linguae : an unconsciously motivated slip of the tongue.
lapsus memoriae : an unconsciously motivated lapse of memory.
skepticism :
nihilism : an attitude of skepticism regarding
traditional values and beliefs or their frank rejection. 2. a delusion
of nonexistence of part or all of the self or the world.
therapeutic nihilism : skepticism
regarding the therapeutic value of drugs or treatment procedures.
In UK 23% of current and recent mental health patients had been in mixed-sex
accommodation, despite Government reassurances in 2002 that such wards
would be eliminated : those patients in mixed-sex wards had greater concerns
about their safety and said it compromised their privacy and dignity. 27%
rarely felt safe while in hospital, and only 20% felt they were treated
with respect and dignity by staff. 23% had been physically or verbally
threatened during their stay in hospital, with 20% reporting a physical
assault. And 7% of patients had been harassed or assaulted by staff. >
50% of patients said the hospital surroundings had not helped them recover,
and 33% thought they had made their health worse.
Among elderly people hospitalization of a spouse is associated with
an increased risk of death, and the effect of the illness of a spouse varies
among diagnoses. Such interpersonal health effects have clinical and policy
implications for the care of patients and their families. Overall, 383,480
husbands (74%) and 347,269 wives (67%) were hospitalized at least once,
and 252,557 husbands (49%) and 156,004 wives (30%) died. Mortality after
the hospitalization of a spouse varied according to the spouse's diagnosis.
Among men, 6.4% died within 1 year after a spouse's hospitalization for
colon
cancer,
6.9% after a spouse's hospitalization for stroke,
7.5% after a spouse's hospitalization for psychiatric disease, and 8.6%
after a spouse's hospitalization for dementia.
Among women, 3.0% died within 1 year after a spouse's hospitalization for
colon
cancer,
3.7% after a spouse's hospitalization for stroke,
5.7% after a spouse's hospitalization for psychiatric disease, and 5.0%
after a spouse's hospitalization for dementia.
After adjustment for measured covariates, the risk of death for men was
not significantly higher after a spouse's hospitalization for colon
cancer
(hazard ratio, 1.02; 95% confidence interval, 0.95 to 1.09) but was higher
after hospitalization for stroke
(hazard ratio, 1.06; 95% confidence interval, 1.03 to 1.09), congestive
heart failure
(hazard ratio, 1.12; 95% confidence interval, 1.07 to 1.16), hip
fracture
(hazard ratio, 1.15; 95% confidence interval, 1.11 to 1.18), psychiatric
disease (hazard ratio, 1.19; 95% confidence interval, 1.12 to 1.26), or
dementia
(hazard ratio, 1.22; 95% confidence interval, 1.12 to 1.32). For women,
the various risks of death after a spouse's hospitalization were similar.
Overall, for men, the risk of death associated with a spouse's hospitalization
was 22% of that associated with a spouse's death (95% confidence interval,
17 to 27%); for women, the risk was 16% of that associated with death (95%
confidence interval, 8 to 24%)ref.
According to the National Crime Victimization Survey for 1993 to 1999,
conducted by the Department of Justice, the annual rate of nonfatal, job-related,
violent crime was 12.6 per 1000 workers in all occupations. Among physicians,
the rate was 16.2 per 1000, and among nurses, 21.9 per 1000. But for psychiatrists
and mental health professionals, the rate was 68.2 per 1000, and for mental
health custodial workers, 69.0 per 1000. For Tim Exworthy, a forensic psychiatrist
at Redford Lodge Hospital in London who was recently assaulted by a patient,
the risk of job-related violence is no longer a dry statistic. He was beaten
unconscious by a 19-year-old psychotic man whom he had been treating in
the hospital for 5 months. I was talking with him in a room and telling
him why he couldn't leave, when I was suddenly aware of a few blows to
my head. The next thing I knew, I was at the nursing station wiping the
blood off my face. I never saw this coming and hadn't anticipated that
he would react like that. Such attacks by psychotic patients highlight
a larger question: Are people with mental illness really more likely than
others to engage in violent behavior? If so, which psychiatric illnesses
are associated with violence, and what is the magnitude of the increase
in risk? Posing these questions is itself not without risk: being perceived
as dangerous can have a devastating effect on a person's prospects for
relationships, employment, housing, and social functioning. People with
mental illness already bear the burden of much social stigma, and I am
loath to add to it. But without a realistic understanding of this risk,
medical practitioners can neither provide the best care for their patients
nor ensure their own safety when the clinical situation warrants it. Until
recently, most studies have focused on the rates of violence among inpatients
with mental illness or, conversely, the rates of mental illness among people
who have been arrested, convicted, or incarcerated for violent crimesref.
For example, one national survey showed that the lifetime risk of schizophrenia
was 5% among people convicted of homicide — a prevalence that is much higher
than any published rate of schizophrenia in the general population — suggesting
an association between schizophrenia and homicide convictionref.2
These studies, however, tend to be limited by selection bias: subjects
who are arrested, incarcerated, or hospitalized are by definition more
likely to be violent or very ill and thus are not representative of psychiatric
patients in the general population. A more accurate and less biased assessment
of the risk of violence perpetrated by the mentally ill comes from epidemiologic
studies of community samples. The best known is the NIMH's Epidemiologic
Catchment Area (ECA) study, which examined the rates of various psychiatric
disorders in a representative sample of 17,803 subjects in five U.S. communities.
Although this study was not initially designed to assess the prevalence
of violent behavior, data on violence were collected for about 7000 of
the subjects. "Violence" was defined as having used a weapon such as a
knife or gun in a fight and having become involved, with a person other
than a partner or spouse, in more than one fight that came to blows — behavior
that is likely to frighten most people.
Lifetime Prevalence of Violent Behavior among Persons with or without
Major Psychiatric Disorders and Substance Abuse.
The criteria for violent behavior were use of a weapon in a fight and
engaging, with someone other than one's partner or spouse, in a fight that
came to blows. Persons were considered to have a relevant psychiatric disorder
if they met the lifetime criteria delineated in the Diagnostic and Statistical
Manual of Mental Disorders (third edition) for schizophrenia, bipolar disorder,
or major depression and had had active symptoms of that disorder within
the previous 12 months (Swanson JW. Mental disorder, substance abuse, and
community violence: an epidemiological approach. In: Monahan J, Steadman
HJ, eds. Violence and mental disorder: developments in risk assessment.
Chicago: University of Chicago Press, 1994:101-36)
The study showed that patients with serious mental illness — those
with schizophrenia, major depression, or bipolar disorder — were two to
three times as likely as people without such an illness to be assaultive.
In absolute terms, the lifetime prevalence of violence among people with
serious mental illness was 16%, as compared with 7% among people without
mental illness. Although not all types of psychiatric illness are associated
with violence — anxiety disorders, for example, do not seem to increase
the risk — and although most people with schizophrenia, major depression,
or bipolar disorder do not commit assaultive acts, the presence of such
a disorder is significantly associated with an increased risk of violence.
Of course, because serious mental illness is quite rare, it actually contributes
very little to the overall rate of violence in the general population;
the attributable risk has been estimated to be 3 to 5% — much lower than
that associated with substance abuse, for example. (People with no mental
disorder who abuse alcohol or drugs are nearly seven times as likely as
those without substance abuse to report violent behavior.) But substance
abuse among the mentally ill compounds the increased risk of violence:
one study involving 802 adults with a psychotic or major mood disorder
showed that violence was independently correlated with several risk factors,
including substance abuse, a history of having been a victim of violence,
homelessness, and poor medical healthref.
The 1-year rate of violent behavior for subjects with none or only one
of these risk factors was 2% — a prevalence close to the ECA study's estimate
for the general population. Thus, violence in people with serious mental
illness probably results from multiple risk factors in several domains.
Much can be done to diminish the risk of violence among the mentally ill.
A study that compared the prevalence of violence in a group of psychiatric
patients during the year after hospital discharge with the rate in the
community in which the patients lived showed no difference in the risk
of violence between treated patients and people without a psychiatric disorderref.
Thus, symptoms of psychiatric illness, rather than the diagnosis itself,
appear to confer the risk of violent behavior. So patients with schizophrenia
who are free of the acute psychotic symptoms that increase this risk, such
as having paranoid thoughts or hearing voices that command them to hurt
others (called command auditory hallucinations), may be no more likely
to be violent than people without a mental disorder. The study did not
specifically monitor the treatments, but it seems possible that treating
psychiatric illness does not just make patients feel better; it may also
drastically reduce the risk of violent behavior. In the wake of Fenton's
killing, there may be renewed efforts to expand the criteria or lower the
clinical threshold for mandatory treatment of patients with psychosis —
a movement that is sure to be controversial. We know that most such patients
are not violent, but we also know that a patient with acute psychosis who
is paranoid and has command auditory hallucinations or a history of being
violent, being a victim of violence, or abusing alcohol or drugs is at
high risk for violent behavior. Currently, in order to protect civil liberties,
most states mandate treatment (whether hospitalization or medication) only
if there is unambiguous evidence of an immediate danger to others, which
is generally interpreted as overt threats or violent actions. Perhaps it
makes sense to reset the threshold at the presence of known clinical risk
factors — psychotic thoughts that are influencing behavior, a history of
violence, and significant concurrent substance abuse. But expanding the
criteria would require further substantiation that these factors can be
accurately identified by clinicians and that their use in mandating treatment
is warranted. The possibility that expanding the criteria might also discourage
people with psychotic illnesses and substance abuse problems from voluntarily
seeking treatment would also need to be considered. It is natural for psychiatrists
and other medical professionals who treat psychiatric patients to deny,
to some extent, the possible danger. After all, it is hard to have a therapeutic
relationship with a patient we fear. Still, we need to remind ourselves
that the risk of violence, though small, is real, and we must take necessary
precautions. As Exworthy put it, "I guess I let down my guard and paid
for it." Keeping up our guard means paying attention to our fear and anxiety
about a patient; no physician should ever treat a patient whom he or she
fears. It also means seeing patients with acute psychosis in locations
where there is adequate assistance and security, such as hospitals and
clinics, rather than in a private office setting. The challenge for medical
practitioners is to remain aware that some of their psychiatric patients
do in fact pose a small risk of violence, while not losing sight of the
larger perspective — that most people who are violent are not mentally
ill, and most people who are mentally ill are not violent.
Diagnostic and Statistical Manual (DSM) of Mental Disorders, Fourth
Edition (DSM-IV), 1994, by American Psychiatric Association and
DSM-IV-text
revision (TR))
Copyright © 2001-2014 Daniele Focosi.
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