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By: H. Flint, M.A., Ph.D.

Associate Professor, The Ohio State University College of Medicine

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At least three of the following must be present, one of which is (2): (1) A marked tendency to act unexpectedly and without consideration of the consequences. At least four of the following must be present: (1) Self-dramatization, theatricality, or exaggerated expression of emotions. Comments: Egocentricity, self-indulgence, continuous longing for appreciation, lack of consideration for others, feelings that are easily hurt, and persistent manipulative behaviour complete the clinical picture, but are not required for the diagnosis. At least four of the following must be present: (1) Feelings of excessive doubt and caution. At least four of the following must be present: (1) Persistent and pervasive feelings of tension and apprehension. The personality change should be significant and represent inflexible and maladaptive features as indicated by the presence of at least two of the following: (1) A permanent hostile or distrustful attitude toward the world in a person who previously was not showing any such traits. This chronic state of inner tension and feeling threatened may be associated with a tendency to excessive drinking or use of drugs. The change should cause either significant interference with personal functioning in daily living, personal distress or adverse impact on the social environment. The personality change should have developed after the catastrophic experience and there should be no history of a pre-existing adult personality disorder or trait accentuation, or personality or developmental disorders during childhood or adolescence, that could explain the current personality traits. It is not related to episodes of other mental disorder, (except post-traumatic stress disorder) and cannot be explained by brain damage or disease. The personality change meeting the above criteria is often preceded by a post-traumatic stress disorder (F43. The symptoms of the two conditions can overlap and the personality change may be a chronic outcome of a posttraumatic stress disorder. However, an enduring personality change should not be assumed in such cases unless, in addition to at least two years of post-traumatic stress disorder there has been a further period of no less than two years during which the above criteria have been met. The personality change should be significant and represent inflexible and maladaptive features as indicated by the presence of at least two of the following: (1) Dependency on others (passively assumes, or demands, that others take responsibility for his/her own life; unwilling to decide on important issues related to own actions or future). This conviction or feeling may be strengthened by societal attitudes but cannot be completely explained by the objective social circumstances. This feature may be associated with hypochondriacal behaviour and an increased utilization of psychiatric or other medical services. The personality change should cause either significant interference with personal functioning in daily living, personal distress, or adverse impact on the social environment. There should be no history of a pre-existing previous adult personality disorder or trait accentuation or personality or developmental disorders during childhood or adolescence that could explain the current personality traits. The personality change has been present for at least two years and is not a manifestation of another mental disorder or secondary to brain damage or disease. These episodes do not have a profitable outcome for the person, but are continued despite personal distress and interference with personal functioning in daily living. The person describes an intense urge to gamble which is difficult to control, and reports that he or she is unable to stop gambling by an effort of will. The person is preoccupied with thoughts or mental images of the act of gambling or the circumstances surrounding the act. The person describes an intense urge to set fire to objects, with a feeling of tension before the act and relief afterwards. The person is pre-occupied with thoughts or mental images of fire-setting or of the circumstances surrounding the act. Repeated (two or more) acts in which the person steals without any apparent motive of gain to the individual or another person. The person describes an intense urge to steal with a feeling of tension before the act with relief afterwards. Noticeable hair-loss due to a persistent and recurrent failure to resist impulses to pull out hairs. The person describes an intense urge to pull out hairs with a mounting tension before and a sense of relief afterwards. Absence of a pre-existing inflammation of the skin; not in response to a delusion or hallucination.

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A total of 468 men had measured chemical concentrations and semen quality and were included in the analysis. When males with chemical concentrations in the fourth quartile were compared with those in the frst quartile, signifcant associations (at the 0. Although the majority of the comparisons were null, the researchers did observe associations between each chemical class and each type of semen quality parameter, with results indicating both positive and negative associations with semen quality. Cases (n = 24) were men whose semen quality was considered low based on having at least an alteration in at least one semen quality parameter as compared with baseline values. Participants underwent a complete clinical examination; completed a questionnaire soliciting socioeconomic information, medical history, tobacco/ alcohol consumption, and likely exposure to environmental chemicals; and gave blood and semen samples. The semen parameters that were measured included sperm concentration, volume, percent motile sperm, and percent of sperm that were morphologically normal. When levels were expressed as pg/g lipid, all comparisons showed higher levels in the case group which were statistically signifcant. Occupational exposure to herbicides (not otherwise specifed) and other agricultural chemicals was assessed via a structured questionnaire. Biological Plausibility Although a study reported that doses of 2,4-D greater than 50 mg/kg/ day produce acute testicular toxicity in male rats (Joshi et al. The mechanisms underlying those effects are not known, but the primary hypotheses are that the changes are mediated through the dysregulation of testicular steroidogenesis, altered Sertoli cell function, and increased oxidative stress. Eighty-fve men from a non-sprayed region in the north of the country served as controls. Some chemicals may disrupt the female hormonal balance necessary for proper functioning. Normal menstrual-cycle functioning is also important in the risk of hormonally related diseases, such as osteopenia, breast cancer, and cardiovascular disease. Generally speaking, chemicals can have multiple effects on the female system, including the modulation of hormone concentrations which results in uterine-cycle or ovarian-cycle irregularities, changes in menarche and menopause, and the impairment of fertility (Bretveld et al. The endometrium, the tissue that lines the inside of the uterus, is built up and shed each month during menstruation. The ectopic tissue develops into growths or lesions that continue to respond to hormonal changes in the body and break down and bleed each month in concert with the menstrual cycle. Unlike blood released during normal shedding of the endometrium, blood released from degenerating ectopic endometrium has no way to leave the body. The blood sets up an infammatory reaction causing pain, adhesions (scars), infertility, intestinal problems, or hematuria (blood in urine). There are several theories of the etiology of endometriosis, including one that posits a genetic contribution, but the cause remains unknown. Estrogen dependence and immune modulation are established features of endometriosis, but they do not adequately explain its cause. It has been proposed that endometrium is distributed through the body via blood or the lymphatic system; that menstrual tissue backs up into the fallopian tubes, implants in the abdomen, and grows; and that all women experience some form of tissue backup during menstruation but only those who have immune-system or hormonal problems experience the tissue growth associated with endometriosis. Despite numerous symptoms that can indicate endometriosis, defnitive diagnosis is possible only through laparoscopy or a more invasive surgical technique.

Fetal alcohol syndrome

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This short period coincides with dreamless sleep, often referred to as fibeauty sleep. People who work the night shift have a greater incidence of insomnia, infertility, cardiovascular illness, and stomach problems. Natural Mealtimes Ayurveda, the Science of Life, declared thousands of years ago that to maintain physical and emotional well-being, the body must be fed according to a natural time schedule. The secretions of bile and other digestive juices peak at midday and are at their lowest during the night. For this reason, it is best to eat the largest meal of the day at around midday and take relatively light meals at breakfast and dinner times. This enables the body to digest the ingested food efficiently and absorb the appropriate amount of nutrients necessary for the maintenance of all bodily functions. To avoid interfering with the secretion of digestive juices at lunchtime, it is ideal to eat breakfast no later than 8 a. Likewise, to digest your evening meal properly, it is best to eat it no later than 6:30 or 7 p. Any long-term disruption of this cycle, caused either by irregular eating habits or by placing the main emphasis on the evening meal and/or breakfast, leads to the accumulation of undigested foods and congests lymph and blood. If its instincts were intact and functioning properly, we would naturally want to eat only those foods that are suitable for our body type, and we would eat them when we could digest them best. One of the leading causes of gallstone formation is the accumulation of improperly digested foods in the intestinal tract. Eating meals irregularly, or having substantial meals at times of the day when the body is not prepared to produce the appropriate quantities of digestive juices, generates more waste than the body is able to eliminate (also see Disorders of the Digestive System in Chapter 1). Miscellaneous Causes Watching Television for Several Hours Scientific research has shown that watching television can dramatically increase cholesterol production in the body. Besides being a necessary component of most tissues and hormones in the body, cholesterol also serves as a stress hormone that increases during physical or mental strain. In fact, cholesterol is one of the first hormones transported to the site of an injury to help heal it. Cholesterol forms an essential constituent of all scar tissue formed during wound healing, whether it is a skin-related injury or a lesion in the wall of an artery. Such excessive secretions of cholesterol alter the composition of bile, which causes the formation of gallstones in the liver. Blood pressure rises to help move more oxygen, glucose, cholesterol, vitamins, and other nutrients to various parts of the body, including the brain. This stress response, in turn, contracts or tightens the large and small blood vessels in the body, causing the cells to suffer a shortage of water, sugar, and other nutrients. This shortage of nutrients, in turn, may create the phenomenon of fiinsatiable hungerfi that so many people experience in front of the television set. You may feel tired, shattered, exhausted, stiff in the neck and shoulders, very thirsty, lethargic, depressed, and even too tired to go to sleep. Since cholesterol is the basic ingredient of stress hormones, stressful situations use up large quantities of cholesterol to manufacture these hormones. To make up for the loss of cholesterol, the liver raises its production of this precious commodity. If the body did not bother to increase cholesterol levels during such stress encounters, we would have millions of fitelevision deathsfi by now. Nevertheless, the stress response comes with a number of side effects, one of which is the formation of gallstones. Lack of exercise can also lead to stasis in the bile ducts and, thus, cause gallstones. One of the leading stress-causing factors in life is not having enough time for oneself. If you do not give yourself sufficient time for the things you must do or want to do, you will feel pressured. Continuous pressure causes frustration, and frustration eventually turns into anger. It has an extremely taxing effect on the body that can be measured by the amounts of adrenaline and noradrenaline secreted into the blood by the adrenal glands. Under severe stress or excitement, these hormones increase the rate and force of the heartbeat, raise blood pressure, and constrict the blood vessels in the secretory glands of the digestive system.

McDowall syndrome

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For diagnosing most of the subtypes listed below, clear evidence is usually required of the presence of at least three of the traits or behaviours given in the clinical description. Despite extraordinary intelligence John was not able to complete or participate in any educational program. He wanted to have a normal life with a family and friends, but thought that he was rootless and he felt that other people thought that he was peculiar or odd. He was thought of as a lonely wolf and did not participate in the social life or games of sports with his peers. During school class he was often absent minded being absorbed in his own thoughts and fantasies. From around the age of thirteen he became interested in computers and was quite advanced in his understanding of mathematics. This vignette schizoid personality illustrates the difficulties how to establish a stable relationship to significant others like peers and family. Often it is regarded as unusual that a person with schizoid personality disorders complains by himself or herself to be isolated. Many schizoid patients, in the contrary, claim to be quite satisfied with their loneliness and it is quite unusual that he wish to have a family. Also schizoid persons usually accept their situation or even deny any desire for closer relationships. Individuals with this disorder are characterized by a profound defect in their ability to form personal relationships or to respond to others in an emotionally meaningful way and appear to lack a desire for intimacy. They are introverted, aloof, and seclusive, and select activities that do not include much interaction with others. The highest co-occurrences may perhaps be because of the high overlap between the two criteria sets. Conversely, introversion has been shown to be a highly heritable personality trait. The cognitive approach suggests that the most important source of dysfunctional behaviour and affects lie in incorrect attributions that people make. The disorder is most likely to come to medical attention in the course of intervention for another condition, in response to acute stressors or because of family influence. Others who come into treatment are forced to do so by family or even the legal system. Aims of long-term psychotherapeutic interventions are to maintain stability and support, to improve social skills and comfort, to help maximize quality of an isolated lifestyle. As they do not response to emotional leverage, therapists easily feel frustrated and ineffective. The contact between therapist and patient should be an important element of the therapy. An important step of the therapy should be to open possibilities to make new experiences and changes (Safi and Junemann, 2001). The therapist should be aware that major changes and modifications of character structure are unlikely. The therapy should be aimed at achieving modest reductions in social isolation and in prompting more effective adjustment to new circumstances (Kalus et al. Behavioural psychotherapy can be helpful for some patients including, for example, methods such as problem solving, social skills training or role plays. Confrontation should clarify the relation of emotions to thinking and encourage these clients to be present with reality. Individual psychoanalytically oriented psychotherapies are less likely to succeed (Kalus et al. Most psychopharmacological interventions apply to comorbid disorders such as depression or anxiousness. Since his childhood he had always been eccentric, withdrawn with no real friends anxiously fearing closer relationships, preoccupied with reading stories about Dracula and other myths.

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