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In w^omen medicine 524 buy genuine cabgolin online, the risk for suicide attempts is higher medications definitions generic cabgolin 0.5mg fast delivery, and the risk for suicide completion is lower treatment sciatica generic cabgolin 0.5mg online. The disparity in suicide rate by gender is not as great among those with depressive disorders as it is in the population as a whole medicine symbol purchase cabgolin overnight delivery. Suicide Risic the possibility of suicidal behavior exists at all times during major depressive episodes. The most consistently described risk factor is a past history of suicide attempts or threats, but it should be remembered that most completed suicides are not preceded by unsuccess­ ful attempts. Other features associated with an increased risk for completed suicide include male sex, being single or living alone, and having prominent feelings of hopeless­ ness. The presence of borderline personality disorder markedly increases risk for future suicide attempts. Functional Consequences of iVlajor Depressive Disorder Many of the functional consequences of major depressive disorder derive from individual symptoms. Impairment can be very mild, such that many of those who interact with the af­ fected individual are unaware of depressive symptoms. Impairment may, however, range to complete incapacity such that the depressed individual is unable to attend to basic self­ care needs or is mute or catatonic. Among individuals seen in general medical settings, those with major depressive disorder have more pain and physical illness and greater de­ creases in physical, social, and role functioning. Major depressive episodes with prominent irritable mood may be difficult to distinguish from manic episodes with irritable mood or from mixed episodes. This distinction requires a careful clinical evalua­ tion of the presence of manic symptoms. A major depressive episode is the appropriate diagnosis if the mood disturbance is not judged, based on individual history, physical examination, and laboratory findings, to be the direct pathophysiological conse­ quence of a specific medical condition. This disorder is distin­ guished from major depressive disorder by the fact that a substance. For ex­ ample, depressed mood that occurs only in the context of withdrawal from cocaine would be diagnosed as cocaine-induced depressive disorder. Distractibility and low frustration tolerance can occur in both attention-deficit/ hyperactivity disorder and a major depressive epi­ sode; if the criteria are met for both, attention-deficit/hyperactivity disorder may be diag­ nosed in addition to the mood disorder. However, the clinician must be cautious not to overdiagnose a major depressive episode in children with attention-deficit/hyperactivity disorder whose disturbance in mood is characterized by irritability rather than by sadness or loss of interest. A major depressive episode that occurs in response to a psychosocial stressor is distinguished from adjustment disorder w^ith de­ pressed mood by the fact that the full criteria for a major depressive episode are not met in adjustment disorder. These periods should not be diagnosed as a major depressive episode unless criteria are met for severity. The diagno­ sis other specified depressive disorder may be appropriate for presentations of depressed mood wiih clinically significant impairment that do not meet criteria for duration or se­ verity. Comorbidity Other disorders with which major depressive disorder frequently co-occurs are substancerelated disorders, panic disorder, obsessive-compulsive disorder, anorexia nervosa, buli­ mia nervosa, and borderline personality disorder. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year. During the 2-year period (1year for children or adolescents) of the disturbance, the individ­ ual has never been without the symptoms in Criteria A and B for more than 2 months at a time. There has never been a manic episode or a hypomanie episode, and criteria have never been met for cyclothymic disorder. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Note: Because the criteria for a major depressive episode include four symptoms that are absent from the symptom list for persistent depressive disorder (dysthymia), a very limited number of individuals will have depressive symptoms that have persisted longer than 2 years but will not mee| criteria for persistent depressive disorder. If full criteria for a major de­ pressive episode have been met at some point during the current episode of illness, they should be given a diagnosis of major depressive disorder. Othenwise, a diagnosis of other specified depressive disorder or unspecified depressive disorder is warranted. Specify if (for most recent 2 years of persistent depressive disorder): With pure dysthymic syndrome: Full criteria for a major depressive episode have not been met in at least the preceding 2 years. With persistent major depressive episode: Full criteria for a major depressive epi­ sode have been met throughout the preceding 2-year period. With intermittent major depressive episodes, with current episode: Full criteria for a major depressive episode are currently met, but there have been periods of at least 8 weeks in at least the preceding 2 years with symptoms below the threshold for a full major depressive episode. With intermittent major depressive episodes, without current episode: Full crite­ ria for a major depressive episode are not currently met, but there has been one or more major depressive episodes in at least the preceding 2 years. Major de­ pression may precede persistent depressive disorder, and major depressive episodes may occur during persistent depressive disorder. Individuals whose symptoms meet major de­ pressive disorder criteria for 2 years should be given a diagnosis of persistent depressive disorder as well as major depressive disorder. Individuals with persistent depressive disorder describe their mood as sad or "down in the dumps. E>uring the 2-year period (1 year for children or adolescents), any symptom-free intervals last no longer than 2 months (Criterion C). Development and Course Persistent depressive disorder often has an early and insidious onset. Among individuals with both persistent depressive disorder and borderline personality disorder, the covari­ ance of the corresponding features over time suggests the operation of a common mecha­ nism. When symptoms rise to the level of a major depressive episode, they are likely to sub­ sequently revert to a lower level. However, depressive symptoms are much less likely to resolve in a given period of time in the context of persistent depressive disorder than they are in a major depressive episode. Factors predictive of poorer long-term outcome include higher levels of neuroticism (negative affectivity), greater symptom severity, poorer global functioning, and presence of anxiety disorders or conduct disorder. Earlier findings pertaining to either disorder are therefore likely to apply to per­ sistent depressive disorder. It is thus likely that individuals with persistent depressive disorder will have a higher proportion of first-degree relatives with persistent depressive disorder than do individuals with major depressive disorder, and more depressive disor­ ders in general. Functional Consequences of Persistent Depressive Disorder the degree to which persistent depressive disorder impacts social and occupational func­ tioning is likely to vary widely, but effects can be as great as or greater than those of major depressive disorder. If there is a depressed mood plus two or more symptoms meeting criteria for a persistent depressive episode for 2 years or more, then the diagnosis of persistent depressive disorder is made. The diagnosis depends on the 2-year duration, which distinguishes it from episodes of depression that do not last 2 years. If the symptom criteria are sufficient for a diagnosis of a major depressive episode at any time during this pe­ riod, then the diagnosis of major depression should be noted, but it is coded not as a separate diagnosis but rather as a specifier with the diagnosis of persistent depressive disorder. If the major depressive episode has persisted for at least a 2-year duration and re­ mains present, then the specifier "with persistent major depressive episode" is used. When full major depressive episode criteria are not currently met but there has been at least one previous episode of major depression in the context of at least 2 years of persistent depres­ sive symptoms, then the specifier of "with intermittent major depressive episodes, without current episode" is used. If the individual has not experienced an episode of major depres­ sion in the last 2 years, then the specifier "with pure dysthymic syndrome" is used. Depressive symptoms are a common associated feature of chronic psychotic disorders. A separate diagnosis of persistent depressive disorder is not made if the symptoms occur only during the course of the psychotic disorder (including residual phases). Persistent depressive disorder must be distinguished from a depressive or bipolar and related dis­ order due to another medical condition. The diagnosis is depressive or bipolar and related disorder due to another medical condition if the mood disturbance is judged, based on his­ tory, physical examination, or laboratory findings, to be attributable to the direct patho­ physiological effects of a specific, usually chronic, medical condition. If it is judged that the depressive symptoms are not attributable to the physiolog­ ical effects of another medical condition, then the primary mental disorder. A substance/medi­ cation-induced depressive or bipolar and related disorder is distinguished from persis­ tent depressive disorder when a substance. Comorbidity In comparison to individuals with major depressive disorder, those with persistent de­ pressive disorder are at higher risk for psychiatric comorbidity in general, and for anxiety disorders and substance use disorders in particular.

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However medicine bag purchase discount cabgolin online, administration (strong recommendation medications gout buy cabgolin paypal, modthere are known risks of birth defects with first trimester erate quality) treatment 02 bournemouth cheap cabgolin 0.5mg with amex. Data from recent pregnancy administration (strong recommendation symptoms 7 days after conception cheap 0.5 mg cabgolin fast delivery, modregistries suggest less risk with exposure to some of the erate quality). If medical therapy is ate sodium, or levetiracetam (strong recommenchosen, continuous fetal heart monitoring, stand-by dation, moderate quality). However, pharmacokinetic seizures or burst suppression (strong recommendifferences, risk of adverse events. Alternative therapies can be considered if cessaSummary of Treatment Recommendations tion of seizures cannot be achieved; however, it is 1. However, options include burst suppression, complete background it is controversial whether these patterns cause additional suppression or seizure suppression. These concerns also exist in children with coma [217] and critical illness [218, 219]. These changes result in increased sensitivity to excitatory Future Directions neurotransmitters. The role of other or even absent motor activity, increasing refractoriness to neuroprotective compounds remains to be evaluated. There is suppression of spontaneous activity, and propagate through growing evidence that increasing refractoriness to treatgray matter at 1–5 mm/min. Krathese patterns have proven useful in the study of experimer, Marek Mirski, Andrea Rossetti, Robert Silbergleit, and Panayiotis N. An alternative perspective on the management of pattern is one of rhythmic generalized triphasic waves. Problems and controversies in V (periodic epileptiform discharges on a relatively fiat status epilepticus: a review and recommendations. American College of Cardiology/American Heart Association clinical practice guidelines: independent measure of ‘‘ictal-ness’’ or independent meaPart I: where do they come fromfi The secondarily generalized tonic-clonic possible, even in remote areas without immediate access to seizure: a videotape analysis. Status epilepticus: pathophysiology parameter: diagnostic assessment of the child with status epiand management in adults. In whom does status epilepticus after the control of convulsive status epilepstatus epilepticus occur: age-related differences in children. Airway management in neurological clonic status epilepticus with pentobarbital anesthesia after highemergencies. Standards of treatment of status epilepticus refractory to benzodiazepines and care for adults with convulsive status epilepticus: Belgian conphenytoin. Silbergleit R, Durkalski V, Lowenstein D, Conwit R, Pancioli A, Duration of refractory status epilepticus and outcome: loss of Palesch Y, Barsan W. Use of antiepileptic drugs in and prognosis of refractory status epilepticus treated in a neuthe treatment of epilepsy in people with intellectual disability. Prolonged childhood status epilepticus and serial seizures: effectiveness treatment for acute symptomatic refractory status epilepticus. Lorazemanagement of pediatric convulsive status epilepticus: a pam versus diazepam-phenytoin combination in the treatment of 123 Neurocrit Care convulsive status epilepticus in children: a randomized con118. Use of injectable valproic acid in status epilepticus: a for treatment of residential adult patients with serial seizures or pilot study. A comparison of innovative therapy in seizure emergency situations including buccal midazolam and rectal diazepam for the acute treatment of status epilepticus: experience in 102 adult patients. IntraComparison of intranasal midazolam with intravenous diazepam venous levetiracetam as treatment for status epilepticus. Intravenous levetiracetam for emergency treatment of seizures in children: a randomised for epileptic seizure emergencies in older people. Intravenous levetiracetam: treatment experience with the first adolescence: a randomised trial. Fattouch J, Di Bonaventura C, Casciato S, Bonini F, Petrucci S, line agent for status epilepticus in children. Parenteral diazepam in status levetiracetam infusion as add-on in status epilepticus. Treatment of valproate in mainland China for the treatment of diazepam status epilepticus: a prospective comparison of diazepam and refractory convulsive status epilepticus. Treatment of convulsive status epilepticus in infants well-tolerated drug for treatment of status epilepticus/serial and young children in Japan. Gilad R, Izkovitz N, Dabby R, Rapoport A, Sadeh M, Weller B, unstable patients with status epilepticus. Sodium valproate vs phenytoin in epilepticus: a prospective, population-based study. Moddel G, Bunten S, Dobis C, Kovac S, Dogan M, Fischera M, epilepticus in children: a randomized controlled trial. Continuous infusion of late stage progressive myoclonus epilepsy complicated with midazolam in the treatment of refractory generalized convulsive status epilepticus. Intravenous lacosamide: an effective add-on treattreatment of status epilepticus in children. Generalized convulsive status epilepticus therapy for refractory status epilepticus in children. Predictors of mortality in patients with suspected propofol epilepticus: a critical review of available therapies and a clinical infusion syndrome. Propofol infusion syndrome in and phenobarbital coma for refractory generalized status epipatients with refractory status epilepticus: an 11-year clinical lepticus. Relapse and survival after to sleep: ethical issues with the use of pharmacologic coma for barbiturate anesthetic treatment of refractory status epilepticus. Ten patients with refractory status epilepticus in an Prolonged coma from refractory status epilepticus. Kramer U, Shorer Z, Ben-Zeev B, Lerman-Sagie T, Goldbergbarbiturate anaesthesia with continuous monitoring of cerebral Stern H, Lahat E. Granata T, Fusco L, Gobbi G, Freri E, Ragona F, Broggi G, with controlled hypothermia. Super-refractory status epilepticus: an approach to Experience with immunomodulatory treatments in Rasmussen’s therapy in this difficult clinical situation. The treatment of convulsive status epilepticus in epilepticus initiating fever induced refractory epileptic encephachildren. Refractory status epilepticus in role of ketogenic diet in the treatment of refractory status epichildren: role of continuous diazepam infusion. Hypothermia Increased incidence and impact of nonconvulsive and convuland barbiturate coma for refractory status epilepticus. Loddenkemper T, Cosmo G, Kotagal P, Haut J, Klaas P, Gupta neurosurgical intensive care unit: clinical features and outcome. Spreading depolarizations have prolonged direct prolonged increase in intracranial pressure and metabolic crisis. Spreading depolarizations occur in human ischemic electrodes for continuous electroencephalogram monitoring in stroke with high incidence. Association of seizures with cortical spreading glutamate caused by reduced cerebral perfusion pressure and depression and peri-infarct depolarisations in the acutely injured seizures after human traumatic brain injury: a microdialysis human brain. The role of benzodiazepines in the management of low extracellular glucose correlates with poor outcome status epilepticus. Nonconvulsive seizures nosing epileptic seizures: report of the therapeutics and after traumatic brain injury are associated with hippocampal technology assessment subcommittee of the American academy atrophy. The major aphasic syndromes: Wernicke’s aphasia and Broca’s aphasia 60 Introduction. The most common etiology of aphasia is a stroke (close to 80% of the aphasia cases), and in about one third of stroke cases language difficulties are observed. And, (4) from the linguistic point of view, aphasia has furthered the analysis about the organization of the human language. As a matter of fact, aphasia is a central issue in different clinical and fundamental areas, including speech-language pathology, neuropsychology, neurology, psychology, and linguistics.

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Children who have decreased vision on screening examinations or any findings of strabismus or reduction in the quality of the red refiex should be referred for complete examinations by an ophthalmologist treatment quad tendonitis generic cabgolin 0.5mg online. This examination will then include examination of the anterior segment and dilated fundus examination for a more detailed examination of the intraocular structures symptoms quadriceps tendonitis buy cabgolin with american express. These devices make use of the red refiex and are able to symptoms 14 dpo purchase genuine cabgolin online evaluate a child from a distance treatment hypothyroidism purchase cabgolin 0.5 mg free shipping. The other advantage is the speed of the measurement which only requires a few seconds. Finally these devices as a screening tool do not necessitate the instillation of dilating drops, thereby making the exam faster for the patient and less discomfort is encountered since the patient does not have residual dilation of the pupils for the ensuing few hours. Generally one can get even a child with developmental delay to fixate or cooperate for the few seconds that photoscreening devices require. These machines are useful then in screening for strabismus and significant opacities in the visual system as well as significant refractive errors. Occasionally subjective measurements of vision are impossible and the examination must rely primarily on objective measurements such as the physical examination of the ocular structures with particular attention to the cornea, lens, refractive status, motility status, the optic nerve, and retina. When the ophthalmic examination alone does not provide adequate explanation for a degree of visual impairment, further testing must be done. Visual evoked potentials can provide quantitative information useful in predicting visual acuity. Examinations must be performed at birth or at the time of initial diagnosis, and repeated periodically to review findings (see Table 18. However, consistent follow-up is of utmost importance, and guidelines are being developed [14]. Common Causes of Vision Impairment Refractive errors include hyperopia, myopic, and astigmatic errors. Ametropia or uncorrected refractive errors are common in the general population and in children with neurodevelopmental disorders even more so. While mild hyperopia is the normal refractive state 18 Vision Impairment 287 Table 18. Eyes with extreme hyperopia may tend to have shallow anterior chambers and crowded optic nerves, which is occasionally mistaken for papilledema. Myopia is less frequently encountered in preschool children, but tends to increase in school-age children, as the eye enlarges. Children with exotropia or convergence issues tend to benefit even from mild myopic prescriptions. High myopia is also associated with retinal detachments and can be associated with certain syndromes. Severe astigmatism is not a common finding in early childhood, but irregularities of the cornea due to birth trauma or congenital malformations of the cornea can cause astigmatism. Toddlers who have more than two diopters of astigmatism should have glasses, even in the early nonverbal period, in order to prevent amblyopia. Finally the situation in which there are significant differences in the refraction of the two eyes is known as anisometropia. Bergwerk Amblyopia Amblyopia is caused by the lack of a clear image falling on the retina of a young child. Strabismic amblyopia occurs where an eye is deviated and therefore the image does not fall on the fovea. Deprivation amblyopia is due to a blockage of the transmission of light to the retina. This can be due to an opacity in the visual axis, such as congenital clouding of the cornea, or a congenital cataract. Refractive amblyopia can be divided into anisometropic amblyopia or ametropic amblyopia. Anisometropic amblyopia is unilateral in which there is a significant difference in the refraction of the eyes, and ametropic amblyopia is due to a high refractive error in both eyes. As visual acuity develops rapidly in the first few years of life, anything that interferes with the development of a clear retinal image can cause amblyopia. After the first decade of life, a child is no longer at risk for amblyopia as cortical plasticity is generally over by that age. Conversely, the younger amblyopia is discovered and treated, the better the result. Strabismus Strabismus is a common ocular problem in children and should be addressed as early as possible. In the general population esotropia is much more common than exotropia and vertical types of strabismus are much rarer. Children with hypotonia, cerebral palsy, or other neurodevelopmental issues have a higher incidence of strabismus. Premature children even without retinopathy of prematurity have a higher incidence of strabismus as well. Prior to age 6 months intermittent or mild deviations of the ocular alignment may be within the range of normal, but by age 6 months any misalignment requires evaluation and treatment. Parents tend to notice significant strabismus and bring it to the attention of their primary care provider. Occasionally children with very wide epicanthal folds have pseudostrabismus or pseudoesotropia, where they appear esotropic, but as the nose develops, the patient will appear normal. These children still require close follow-up to rule out the development of true strabismus. Children with congenital esotropia present early due to the generally large angle of their strabismus. The treatment for congenital esotropia is surgical with follow-up afterward, as frequently glasses are needed to maintain the surgical alignment results. Addressing the cause of the deprivation is vital, prior to repair of the strabismus. Accommodative esotropia is due to the presence of high hyperopic refraction and this may be ameliorated by the use of hyperopic glasses. Children with developmental delays or neurologic impairment tend to have more frequent exotropia. Untreated strabismus not only affects visual function but also is a cosmetic issue which may affect a child’s social interactions. Cataract Cataracts can be congenital, syndromic, age related, traumatic or occur with medical conditions such as diabetes or medications, and treatment such as steroids or radiation. The treatment for cataracts is surgery in which the cloudy lens which is obstructing the visual axis is replaced with a synthetic lens. While extraction of the cataract and implantation of an intraocular lens is the standard treatment in older children and adults, an intraocular lens may not be implanted in very small children. This is due to the small size of the eye and the rapid growth that ensues in the toddler years, making not only the surgery but also the refractive needs challenging. From approximately age 5 years and upward, there is no controversy and a lens is implanted. Occasionally spectacles are still needed to correct residual refractive needs including presbyopia. Cataract is the leading cause of blindness worldwide, therefore screening for cataracts and making surgery available is a high priority. Examples of Specific Clinical Entities Down Syndrome Down syndrome is the most common chromosomal anomaly accounting for intellectual disability occurring at a prevalence rate of 9. The prevalence of Down syndrome is increasing, especially in children born to mothers over age 35 [16]. Variations in the exact prevalence of findings occur depending on the study population involved; however, all studies demonstrate 290 K. Although exact statistics vary according to the population studied, Down syndrome children of school age have a high percentage (43%) of significant refractive errors [18]. Significant levels of refractive errors tend to increase with increasing age and doubled in school-age children [21]. Screening for this and providing spectacle correction can assist in maintaining a child’s interest in reading and school. As stated previously, these issues can all be potentially treated to provide increased visual performance. Children with Down syndrome were found to tolerate their spectacle correction well including bifocals as needed for issues of accommodation. In addition conditions such as nasolacrimal duct obstruction or blepharitis which both occur in approximately 30% can be treated as well. Cataracts occurred in 13–86 % and surgery should be made available to these patients when the need presents.

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Synonym: developmental dysphasia or aphasia symptoms 6 days after iui buy cabgolin on line, expressive type language disorder doctor of medicine buy cabgolin 0.5mg free shipping, receptive (F80 medications before surgery buy cheap cabgolin 0.5 mg online. In virtually all cases symptoms questions 0.5 mg cabgolin mastercard, expressive language is also markedly impaired, and abnormalities in word-sound production are common. There are at least two major subtypes of development language disorder, expressive language disorder and the more severe receptive language disorder. The clinical picture of the chronic form is dominated by weakness, persistent headache, depression, impaired concentration and memory, transient aphasia, disturbances of vision and hearing, and isolated visual and auditory hallucinations. Residual impair­ ments include cognitive defcits, epilepsy, blindness, and, in children, mental retardation and cerebral palsy. Lesch-Nyhan syndrome A severe neuromuscular disorder with involuntary cho­ reoathetoid movements, recurrent vomiting, mild to moderate mental retardation, self-mutilation such as biting the lips and fngertips, and a severe gouty arthritis associated with high uric acid levels. The abnormal purine metabolism is due to a genetic defciency of the enzyme hypoxanthine guanine phosphoribosyltransferase, transmitted as an X-linked recessive disorder. The clinical picture is one of a marked disturbance of memory for recent events, anxiety, depression, hallucinations, and, rarely, epilepsy. Synonym: limbic encephalopathy limbic epilepsy A subtype of temporal lobe epilepsy in which pathophysiological changes related to kindling in the mesolimbic system are suspected to lead to the gradual development of personality and behaviour alteration, to severe mood disorders, or to schizophrenia-like psychosis. The lesions, more often unifocal than multifocal, involve proliferation of atypical lymphocytes in a perivascular distribution. Among the most frequent causes are failure of normal digestion (as in gastrectomy, cirrhosis, pancreatic insufciency, anorexia nervosa, or bulimia nervosa), biochemical abnormalities (such as coeliac disease, sprue, and hereditary enzyme defciencies), and inadequate absorption surface (as in massive resection of the small intestine). Signs and symptoms include weight loss, muscle wasting, small stature, oedema, skeletal deformities, pale and bulky stools, and 61 Lexicon of psychiatric and mental health terms neuropathy, encephalopathy, and dementia secondary to multiple vitamin defciencies. Elation is accompanied by increased energy, re­ sulting in overactivity, pressure of speech, and a decreased need for sleep. Loss of normal social inhibitions may result in behaviour that is reckless, foolhardy, or inappropriate to the circumstances and out of character. In severe cases, flight of ideas and pressure of speech may result in the individual becoming incomprehensible; excitement may result in aggression or violence, and neglect of eating, drinking, and personal hygiene may result in dangerous states such as dehydration. In addition to this clinical state of mania without psychotic symptoms, there may be delusions (usually grandiose) or hallucinations (usually of voices speaking directly to the individual). While Kraepelin and others restricted its use to refer only to depression in the elderly, Freud redefned it as a morbid counterpart of normal mouring. In view of this lack of precision, and the contradictory connotations, the continued use of the term is not recommended. See also: depression memory span, reduction of A decrease in the number of cognitively unconnected elements or items (normally 6-10) that can be reproduced correctly after successive presentation on one single occasion. The dysfunction may be primary, as in diseases, injuries, and insults that afect the brain directly and selectively, or secondary, as in systemic diseases and disorders that attack the brain only as one of the multiple organs or body systems involved. See also: organic psychosyndrome mental retardation (F70-F79) A condition of arrested or incomplete development of the mind, especially characterized by impairment of skills manifested during the developmental period, contributing to the overall level of intelligence, i. Neither of these measures can provide more than an approximate indication of the degree of mental retardation. Intellectual functioning and social adaptation may change over time and may improve as a function of maturation and response to training and rehabilitation. Synonyms: amentia (deprecated); mental defciency; mental subnormality; oligophrenia microcephaly Congenital smallness of the head, with defective development of the brain and premature ossifcation of the skull. The attacks are commonly unilateral and are usually accompanied by anorexia, nausea, and vomiting. In some cases they are preceded by, or associated with, neurological disturbances especially afecting the feld of vision. The term implies that the level will be reached by the individual at a later age than expected, but there is a wide variation among nonnal children in the age at which milestones are attained. The clinical manifes­ tations include hyperactivity, motor incoordination, poor attention-span, emo­ tional lability, and antisocial conduct. See also: hyperkinetic disorder mirror movements Involuntary movements in one limb occurring almost simultan­ eously with, and copying, voluntary movements in the other limb. This mood change is usually accompanied by a change in the overall level of activity, and most of the other symptoms are either secondary to, or easily understood in the context of, these changes in mood and activity. Most mood disorders tend to be recurrent and the onset of individual episodes can often be related to stressful events or situations. Synonym: afective disorder See also: depression; mania mood disorder, persistent (F34) A persistent disorder of mood, usually of fuctuating severity, in which the majority of the individual episodes are not sufciently severe to warrant being described as hypomanic or mild depressive episodes. In some instances, recurrent or single manic or depressive episodes may become superimposed on a persistent afective disorder. Synonym: persistent afective disorder See also: cyclothymia; dysthmia mood, disturbance of A morbid change of afect extending beyond normal variation to subsume any of several states, including depression, elation, anxiety, irritability, and anger. There may be close resemblance to amost any variety of ataxia, apraxia, akinesia, aphonia, dysarthria, dyskinesia, seizures, or paralysis. These abnormalities include akinesia (difculty in the initiation of movements) and the various forms of dyskinesia, including tremor, chorea, torsion-spasm, torticollis, dystonia, ballismus, tics, and myoclo­ nus. Movement disorder may occur in some schizophrenic syndromes and not infrequently follows the administration of neuroleptic medication. The movements that are not of the self-injurious variety include: body-rocking, head-rocking, hair-plucking, hair-twisting, fnger-ficking mannerisms, and hand-flapping. Stereotyped self­ injurious behaviour includes repetitive head-banging, face-slapping, eye­ poking, and biting of hands, lips, or other body parts. All the stereotyped movement disorders occur most fequently in association with mental retar­ dation. This category is also used for misuse of drugs when the exact identity of some or even al the substances being used is uncertain or unknown, since many multiple drug users themselves often do not know the details of what they are taking. See also: dissociative [conversion] disorder Miinchhausen syndrome See intentional production or feigning of symptoms; peregrinating patient. The disorder is usually associated with marked personality features involving social anxiety, withdrawal, sensi­ tivity, or resistance. Myoclonus may be a 66 Definitions of terms manifestation of epilepsy or encephalomyelitis or, as an isolated event, may be a normal phenomenon occurring during sleep. The sleep attacks are often preceded by hypnagogic experiences and transient motor paralysis. See also: cataplexy near-death experience A subjective state of strong positive afect, dissociation from the physical self enhanced consciousness, and transcendental insight, sometimes reported by people who have survived near-fatal accidents or illness. The concept derives from the dissolution theory of Hughlings Jackson (1835-1911), which postulated a dual efect of cerebral lesions: defcits directly due to the lesion, and positive phenomena arising secondarily as ontogenically lower levels are released from the control of the superior centre. This view has had repercussions in psychiatry, notably in the descriptive psychopathol­ ogy of schizophrenia. Symptoms usually referred to as negative include poverty of speech, impairment of attention, afective blunting, apathy, and social withdrawal. However, there is no general agreement on the nature and the assessment of the negative symptoms, and little is known about their pathophysiological basis in schizophrenia. See also: positive symptoms neglect of child See child abuse; deprivation; maltreatment syndrome. In one type, the main feature is a complaint of increased fatigue after mental efort, often associated with some decrease in occupational performance or coping efciency in daily tasks. The mental fatigue is typically described as an unpleasant intrusion of distracting associations or recollections, difculty in concentrating, and generally inefcient thinking. In the other type, the emphasis is on feelings of bodily or physical weakness and exhaustion after only minimal efort, accompanied by muscular aches and pains and inability to relax. In both types, a variety of other unpleasat physical feelings commonly include dizziness, tension headaches, and feelings of general instability. Worry about decreasing mental and bodily well-being, irritability, anhedonia, and 67 Lexicon of psychiatric and mental health terms varying minor degrees of both depression and anxiety are all common. Many of the cases diagnosed as neurasthenia in the past would meet the current criteria for depressive disorder or anxiety disorder. See also: personality, psychasthenic neuritic argentophilic plaque A characteristic histopathological change in the brains of individuals sufering from Alzheimer disease, seen microscopically upon silver impregnation. The plaque is a spherical lesion, 5-200 Jlm in diameter, consisting of a central amyloid core and a periphery composed of rods and granules (possibly derived from axonal terminals), microglial cells, and astrocytes. These lesions are common in the hippocampus and amygdala, and less common in the mesencephalic grey cord. Microscopically, the tangles appear as loops in the cytoplasm of neurons, made up of bundles of paired flaments, each being 10-13 nm in diameter; these flaments are helically wound around each other at regular intervals. They are composed of protein fbrils, but the nature of the biochemical changes leading to their formation is not fully understood.

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