MENTAL DISORDERS (see also diseases of the central nervous system)

Table of contents :

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developmental disorders mental retardation learning disorders motor skills disorder communication disorders pervasive developmental disorders attention-deficit/hyperactivity disorder and disruptive behavior disorders eating disorders tic disorders delirium, dementia, and amnestic disorders substance-related disorders psychoses mania schizophrenia paranoia

neuroses mood disorders depression bipolar disorder (BPD) / manic-depressive psychosis anxiety disorders panic disorder (PD) phobia obsessive-compulsive disorder (OCD) somatoform disorders dissociative disorders sexual disorders factitious disorders sleep disorders impulse control disorders adjustement disorders personality disorders

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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 months^{ref1, 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 treatments^ref.
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 :
• delirium, dementia, amnestic and other cognitive disorders
• mental disorders due to a general medical condition
• substance-related disorders
• 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
• disorders of consciousness
• quantitative (hypnoid) alterations
• 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.
• idiopathic recurrent stupor (IRS) / endozepine stupor

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.)
• coma
Aetiology :
• pharmacological (ethanol, cannabinoids)
• epilepsy
• complex partial seizure
• petit mal epilepsy
• transient global amnesia
• psychiatric disorders
• loss of consciousness
• malingering
• syncope
• generalized tonic-clonic epilepsy
• qualitative alterations (disorders of structuration of consciousness)
• disorientation
• confusional state (delirium)
• crepuscolar state
• 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)
• disorders of self consciousness (depersonalization : alteration in the perception of the self so that the usual sense of one's own reality is lost, manifested in a sense of unreality or self-estrangement, in changes of body image, or in a feeling that one does not control his own actions and speech; seen in disorders such as depersonalization disorder, depression, dissociative disorders, hypochondriacal neurosis / hypochondriasis, temporal lobe epilepsy, schizophrenic disorders, and schizotypal personality disorder. Some do not draw a distinction between depersonalization and derealization, using depersonalization to include both.
• 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.
• disorders of attention
• hyperprosexia : a condition in which the mind is occupied by one idea to the exclusion of others, e.g. in mania
• hypoprosexia : distraction, difficult concentration, attention deficit
• disorders of memory
• 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 : an epileptic syndrome of childhood characterized by 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.
• 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

Aetiology : Gerstmann's syndrome
• dyscalculia : impairment of the ability to do mathematical problems because of brain injury or disease

Aetiology : Turner's syndrome
Laboratory examinations :
• cognitive tests.
• 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
Aetiology : Gerstmann's syndrome
• 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)
• visual aphasia / alexia
Aetiology :
• functional aphasia : aphasia associated with a psychogenic disorder.
• intellectual or true aphasia : aphasia due to a lesion of any one of the speech centers
• acute : TIA
• chronic : space-occupying lesions
Laboratory examinations :
• 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.
Web resources : National Aphasia Association
• 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.
• Bruns' apraxia of gait / Bruns' frontal ataxia
• 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.

Aetiology : Gerstmann's syndrome
• 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
• permanent hypermnesia (e.g. Pico della Mirandola)
• idiot savant
• transient hypermnesia : mania, hypomania, hysteria
• hypomnesia : defective memory
• amnesia : lack or loss of memory; inability to remember past experiences.
• circumscribed or localized amnesia : loss of memory for all events during a discrete, specific period of time
• generalized amnesia : loss of memory encompassing the individual's entire life.
• continuous amnesia : loss of memory for all events after a certain time, continuing up to and including the present.
• tactile amnesia / astereognosis
• visual amnesia / alexia
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.
• dissociative or psychogenic amnesia
• 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

Aetiology :
• thiamine deficiency from chronic alcohol abuse (Wernicke-Korsakoff syndrome)
• 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
• brain injury
• brain tumors
• brain infarction
• cerebral hypoxia
• carbon monoxide poisoning
• herpes simplex encephalitis
• paramnesia : qualitative disorders, a disturbance of memory in which reality and fantasy are confused
• allomnesia / memory illusion : deformation of actual memories, incomplete memories, or inadequate in spatiotemporal location, alterated in meaning, easily correctable (e.g. holothymic thought, paranoid states, ...)
• pseudomnesia / memory hallucination : not correctable
• false identifications : new situations are seen as memories (dejà vu)
• false memories : incapacity to differentiate between fantasy and reality (e.g. confabulation, false memories in holothymic or delirating thought)
• disorders of intelligence
• bradyphrenia / bradyphrasia / mental insufficiency : stable slowness of thought or fatigability of initiative, resulting from depression or CNS disease
• dementia : generally evolutive deficiency
• axis I : symptomatology, monothetic diagnosis (all criteria have to be fulfilled => many false negatives => repetibility = 80%) : developmental disorders, delirium, dementia, and amnestic disorders, substance-related disorders, psychoses, neuroses, factitious disorders, sleep disorders, impulse control disorders, adjustement disorders
• axis II : behavioural, polytethic diagnosis (only some criteria have to be fulfilled => many false positives => repetibility = 50%) : personality disorders, mental retardation
• axis III : general medical conditions
• axis IV : psychosocial and environmental problems
• problems with main supporting group
• problems related to social environment
• learning disorders
• job problem
• house problem
• economical problems
• problems with access to health care services
• 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
• mental retardation-not otherwise specified (NOS)
Aetiology :
• hyperphenylalaninemia
• Cockayne syndrome (CS)
• von Hippel-Lindau (VHL) syndrome
• cerebrotendinous xanthomatosis
• Alport's syndrome
• Usher syndrome
• fragile site mental retardation (FMR)
• Patau syndrome
• Edwards syndrome
• Down syndrome
• X-linked mental retardation (XLMR)

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 :
• normal variations in school results
• lack of opportunities
• poor teaching
• cultural factors
• visual or auditory insufficiency
Web resources : Mental retardation at CDC
• 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.

Differential diagnosis :
• poor graphia
• developmental coordination disorder
• 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)
• mental retardation
• pervasive developmental disorders
• attention-deficit/hyperactivity disorder (ADHD)
• 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.

Differential diagnosis :
• mixed receptive-expressive language disorder
• autistic disorder
• mental retardation
• auditory or other sensory deficit
• word motory deficit
• severe environmental deprivation
• disorder of written expression
• selective mutism
• 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

Differential diagnosis :
• expressive language disorder
• autistic disorder
• mental retardation
• auditory or other sensory deficit
• word motory deficit
• severe environmental deprivation
• disorder of written expression
• selective mutism
• 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

Differential diagnosis :
• mental retardation
• auditory or other sensory deficit
• severe environmental deprivation
• stuttering
• communication disorder-not otherwise specified (NOS)
• stuttering / psellism

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 stuttering^ref.
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 stutter^ref
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 effects^{ref1, 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 treatment^{ref1, 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 language^{ref1, ref2}. Duration of treatment and its predictors have been investigated in two independent file audits of preschool children attending specialist clinics, one in Australia^ref and one in the United Kingdom^ref. Outcomes of the Lidcombe programme have consistently been shown to be positive^{ref1, 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 trial^ref. 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 age^ref. 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 predisposition^ref 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 disorder^ref
• 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 basis^ref.
• 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.
• diphtheria, tetanus and pertussis (DTwP) vaccine : it deposits 25 mg of ethyl mercury into a child.
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 mirrors^ref
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
• Checklist of Autism in Toddlers (CHAT)^ref
• 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 :
• Rett syndrome
• childhood disintegrative disorder
• Asperger's syndrome
• schizophrenia
• selective mutism
• expressive language disorder
• mixed receptive-expressive language disorder
• mental retardation
Therapy :
• educational approaches (Treatment and Education of Autistic and Related Communication Handicapped CHildren (TEACCH))
• psychosocial
• drugs (risperidone)
• probiotics
Web resources : Autism at CDC
• Rett syndrome (RTT / RTS) / cerebroatrophic hyperammonemia : a PDD affecting the gray matter of the brain

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. 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 regression^ref.
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 :
• autistic disorder
• childhood disintegrative disorder
• Asperger's syndrome
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.

Differential diagnosis :
• autistic disorder
• Rett syndrome
• Asperger's syndrome
• dementia
• 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 Syndrome^ref, 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 :
• autistic disorder
• Rett syndrome
• childhood disintegrative disorder
• obsessive-compulsive disorder (OCD)
• schizoid personality disorder
• pervasive developmental disorder-not otherwise specified (PDD-NOS)
• 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 and disruptive behavior disorders
• 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 :
• behaviour adequate to gorgeous babies
• mental retardation
• poorly stimulating environments
• oppositional defiant disorder
• other mental disorders
• pervasive developmental disorders
• psychotic disorder
• substance-related disorders-NOS
• bronchodilators
• isoniazid
• neuroleptic-induced acute akathisia
Chemotherapy :
• stimulants, which, because of their addictive properties and potential for abuse, are controlled substances. 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
• 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.
• mixed salts
• NRI (atomoxetine), a nonstimulant approved by the US Food and Drug Administration
Web resources : Attention-deficit / hyperactivity disorder (ADHD) at CDC
• attention-deficit / hyperactivity disorder (ADHD)-not otherwise specified (NOS)
• 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
• childhood-onset
• adolescent-onset
Differential diagnosis :
• oppositional defiant disorder
• attention-deficit/hyperactivity disorder (ADHD)
• mania
• adjustement disorders
• antisocial behaviour of child or adolescent
• antisocial personality (disorder)
• 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

Differential diagnosis :
• conduct disorder
• mood disorders
• psychotic disorder
• attention-deficit/hyperactivity disorder (ADHD)
• mental retardation
• compromised language comprehension
• deafness
• mixed receptive-expressive language disorder
• typical characteristic of certain developmental stages (early childhood, adolescence, ...)
• disruptive behavior disorder-not otherwise specified (NOS)
• 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
• ice (pagophagia)
• dirt (geophagia)
• gravel
• flaking paint or plaster
• clay
• hair (trichophagia) => trichobezoar
• laundry starch (amylophagia)
• 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
• iron deficiency or zinc deficiency
Differential diagnosis :
• pervasive developmental disorders
• 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.
• schizophrenia
• rumination disorder
• anorexia nervosa
• bulimia nervosa
• feeding disorder of infancy or early childhood
• 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 :
• congenital anomalies
• hypertrophic pyloric stenosis
• gastroesophageal reflux disease (GERD)
• normal involuntary vomiting of early childhood
• anorexia nervosa
• bulimia nervosa
• 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.

Differential diagnosis :
• gastrointestinal condition
• endocrinological condition
• neurological condition
• tic disorders
• Gilles de la Tourette's syndrome (lasting > 12 months)
• chronic motor or vocal tic disorder (lasting > 12 months)
• transient tic disorder (lasting 1 < x < 12 months)
• single episode
• relapsing
• tic disorder-not otherwise specified (NOS) : lasting < 1 month, onset > 18 years, or single motor or vocal tic)
Differential diagnosis :
• general medical conditions
• Huntington's disease
• Lesch-Nyhan syndrome
• Wilson's disease / hepatolenticular degeneration
• Sydenham's chorea
• multiple sclerosis (MS)
• acute disseminated encephalomyelitis (ADEM)
• head injuries
• direct effect of a substance (e.g. neuroleptic drug)
• chorea
• athetosis
• myoclonus
• hemiballismus
• spasms
• hemifacial spasms
• synkinesis
• drug-induced movement disorder-not otherwise specified (NOS)
• pervasive developmental disorders
• compulsions
• schizophrenia
• evacuation disorders
• encopresis (for babies with a mental age > 4 years)
• with constipation and overfilling incontinence
• withouth constipation and overfilling incontince
Differential diagnosis :
• fecal incontinence associated with other medical conditions (e.g. chronic diarrhea)
• enuresis (not due to a general medical condition)
• only during bedtime
• only during daytime
• bedtime and daytime
Differential diagnosis :
• neurological bladder
• general medical condition causing polyuria or imperious micturition (e.g. untreated diabetes mellitus or diabetes insipidus
• acute urinary tract infection (UTI)
• other infancy, childhood, or adolescence disorders
• separation anxiety disorder
• 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.
Differential diagnosis :
• communication disorders
• pervasive developmental disorders
• lack of knowledge of language in immigrants
• psychotic disorder
• severe mental retardation
• 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.
Differential diagnosis :
• pervasive developmental disorders
• mental retardation
• attention-deficit/hyperactivity disorder (ADHD)
• 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

Differential diagnosis :
• pervasive developmental disorders
• mental retardation
• obsessive-compulsive disorder (OCD)
• complex motor tic disorders
• trichotillomania
• factitious disorder with main physical signs and symptoms
• automutilation associated with certain psychotic disorder and personality disorders
• 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
• delirium due to general medical condition
• systemic infection
• cerebral tumor
• seizures or head trauma
• metabolic disturbances such as fluid, electrolyte, or acid-base imbalance, hypoxia, hypoglycemia, or hepatic or renal failure
• febrile delirium : the delirium of fever.
• 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.
• substance-induced delirium
• delirium due to multiple aetiologies
• delirium-not otherwise specified (NOS)
Grading :
• acute delirium : a suddenly appearing and severe delirium lasting only a short time.
• low delirium : delirium marked by confusion of ideas and slowness of mental action rather than by excitement.
Differential diagnosis :
• dementia
• susbtance intoxication
• substance withdrawal
• psychotic disorder
• mood disorders with psychotic features
• malingering
• factitious disorder
• 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).

Aetiology :
• primary or degenerative dementias
• cortical dementias
• dementia of the Alzheimer type / 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
• delirium
• delusion
• depression
• behavioral disturbances
• none (uncomplicated)
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
• frontotemporal dementia (FTD) with parkinsonism / frontotemporal lobar degeneration (FTLD) / multiple system tauopathy with presenile dementia (MSTD) / Wilhelmsen-Lynch disease (WLD) / disinhibition-dementia-parkinsonism-amyotrophy complex (DDPAC)

Aetiology : mutations in microtubule-associated protein (MAP) tau or presenilin 1 (PS1)
• 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 splicing^ref
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
• 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
• neurosyphilis
• 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

Therapy : rivastigmine tartrate^ref
• amyotrophic lateral sclerosis-Parkinsonian dementia complex (ALS-PDC)
• fragile X-associated tremor/ataxia syndrome (FXTAS)
• Huntington's disease
• Steele-Richardson-Olszewski syndrome / progressive supranuclear palsy (PSP)
• corticobasal degeneration (CBD)
• multiple sclerosis
• progressive myoclonic epilepsy
• Hallervorden-Spatz disease (HSD) / neurodegeneration with brain iron accumulation type I (NBIA-I) / pantothenate kinase associated neurodegeneration (PKAN) / late infantile neuroaxonal dystrophy is a rare neurodegenerative disorder characterized by progressive extrapyramidal dysfunction (dystonia, rigidity, choreoathetosis), pyramidal sign, schizophreniform psychotic symptoms, and dementia due to mutations in pantothenate kinase 2 (PANK2), which is allelic with hypoprebetalipoproteinemia, acanthocytosis, retinitis pigmentosa, and pallidal degeneration (HARP) syndrome. Onset is most commonly in late childhood or early adolescence. The disease can be familial or sporadic. In these patients, chronic repeated dystonic movements, especially of the head and neck, can lead to excessive stress on the cervical spine, resulting in early degenerative changes and myelopathy. This is an a-synucleinopathy : a-synuclein is present in axonal spheroids, Lewy-related dystrophic neurites, glial cytoplasmic inclusions (GCI) and neuronal cytoplasmic inclusions (NCI)

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"
• secondary dementias
• Creutzfeld-Jakob disease (CJD)
• hypothyroidism
• AIDS dementia complex
• 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
• CADASIL
• cerebral amyloid angiopathy / congophilic angiopathy
• metachromatic leukodystrophy (MLD) or leukoencephalopathy / sulfatide lipidosis
• progressive multifocal leukoencephalopathy (PML)
• cerebrovascular diseases
• Binswanger's dementia or disease or encephalitis / chronic subcortical encephalitis / subcortical arteriosclerotic encephalopathy
• 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
• uncomplicated
• occurring with
• delusion
• delirium
• depressed mood
• 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
• CNS infections
• transmissible spongiform encephalopathies (TSE)
• neurosyphilis
• viral infections
• AIDS dementia complex
• granulomatous infections
• neurotuberculosis
• neurosarcoidosis
• substance-induced persisting dementia / toxic dementia
• dementia due to general medical conditions not listed above
• CNS tumor
• occult normal-pressure hydrocephalus (1-2%)
• dementia due to multiple aetiologies
Causes of dementias with onset after age 65 :
• dementia of the Alzheimer type (50-60%, more common in females)
• multi-infarct dementia (MID) / vascular dementia (VaD) (10-20%, more common in males)
• mixed form (10-20%)
• other dementia (5-15%)
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
• reversible
• partially reversible
• irreversible
• cognitive symptoms :
• amnesia
• temporospatial disorientation
• apraxia
• aphasia
• alexia
• agraphia
• acalculia
• 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".
Differential diagnosis :
• delirium
• pseudodementia
• amnestic disorders
• mental retardation
• schizophrenia
• malingering
• factitious disorder
• depression
• age-related cognitive decline
Laboratory examinations :
• CBC
• urinalysis
• thyroid hormones
• vitamin B₁₂ and folic acid
• syphilis
• chest X-ray
• EKG
• SPECT/PET
• cognitive tests for assessment of neurocognitive function (NCF)
• Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog) (score : 0-70)
• 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 brain^ref.
• 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
• substance-induced persisting amnestic disorder
• amnestic disorder not otherwise specified (NOS)
DSM-IV eliminates the distinction between this term and amnestic syndrome.
Differential diagnosis :
• delirium
• dementia
• dissociative disorders
• susbtance intoxication
• substance withdrawal
• malingering
• factitious disorder
• age-related cognitive decline
• cognitive disorder-not otherwise specified (NOS)

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
• drug addiction : physical and psychic dependences

Drugs of abuse can be classified according to ...

• country laws
• legal drugs
• illegal drugs
• danger
• "light" drugs
• heavy drugs
• source
• naturally occurring drugs of abuse
• non-natural drugs of abuse
• semisynthetic drugs (e.g. heroin)
• synthetic drugs (e.g. amphetamines)
• pharmacodynamics and side effects

Multiple simultaneous variables affecting onset and continuation of drug abuse and addiction

• agent (drug)
• availability
• cost
• purity / potency
• mode of administration
• speed of onset and termination of effects (pharmacokinetics: combination of agent and host)
• reinforcement : ability of drugs to produce effects that make the user wish to take them again
• host (user)
• heredity
• metabolism of the drug
• psychiatric symptoms
• prior experience/expectations
• propensity for risk-taking behavior
• environment
• social setting
• community attitudes
• peer influence, role models
• availability of other reinforcers (sources of pleasure or recreation)
• employment or educational opportunities
• conditioned stimuli: environmental cues become associated with drugs after repeated use in the same environment

drug of abuse	acquired (nonspontaneous) tolerance / assuefaction		reverse tolerance / sensitization	dependence (depending on drug of abuse, consumer, and social environment)			toxic psychoses from dose-dependent psychotogens
	acute tolerance	chronic tolerance		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 crash (hours/days : craving, compulsion, depression, anxiety) withdrawal (weeks: dysphoric syndrome, apathy,..)  extintion (months/years)	social substance dependence
amphetamines (neurotoxicity : autooxidation of DA to 6-hydroxyDA or hyperactivity of Glu-ergic circuits => DA-ergic neurons)	+	+	+ (hypermotility, stereotypia, psychoses)		+		paranoideal psychosis  chorea-like syndrome  dysautonomic syndrome (anxiety, collapse, seizures)
LSD					+		+
cocaine			may involve conditioning after long-term exposure, has been linked to paranoid, psychotic manifestations	dysphoria, depression, sleepiness, fatigue, bradycardia	+		+
heroin		+		+	+	+
psilocybin					+
cannabinoids				seen clinically only in persons who use marijuana on a daily basis and then suddenly stop	+		+
mescaline					+
inhalants					+
nicotine				irritability, impatience, hostility, anxiety, dysphoric or depressed mood, difficulty concentrating, restlessness, bradycardia, hyperphagy or weight gain	with 10 puffs per cigarette, the one-pack-per-day smoker reinforces the habit 200 times daily	although > 80% of smokers express a desire to quit, only 35% try to stop each year, and < 5% are successful in unaided attempts to quit
caffeine / teine				fatigue, sedation, headache, nausea and vomiting	+
PCP				somnolence, tremor, seizures, diarrhea, piloerection, bruxism, and vocalizations			schizophrenia
opioids				regular withdrawal : mydriasis, restlessness, irritability, hyperalgesia, sweating, piloerection, tachycardia, nausea and vomiting, gastritis, colic, diarrhea, myalgia, systemic arterial hypertension, dysphoria, yawning, insomnia, anxiety, fever, strabismus, rhinorrhoea, crying, cough ;  protracted withdrawal (up to 6 months): anxiety, insomnia, cyclic changes in weight, pupil size, respiratory center sensitivity	+
chloral hydrate				+	+
paraldehyde				+	+
glutethimide				+	+
BDZ				moderate doses : anxiety, paresthesias (photophobia, increased sensitivity to sound), muscle cramps, myloclonic jerks, sleep disturbance, dizziness; high-doses :  seizures, delirium
meprobamate					+
barbiturates				+	+
ethanol				tremor, irritability, nausea and vomiting, sleep disturbance, tachycardia, systemic arterial hypertension, sweating, perceptual distortion, seizures (12-48 hrs after last drink); in conjunction with infection, trauma, malnutrition, or electrolyte imbalance => delirium tremens	+
SSRI				+

 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
• alcohol withdrawal delirium
• substance-induced delirium : that associated with
• 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
• amphetamines
• cannabinoids
• cocaine
• hallucinogens
• inhalants
• opioids
• phencyclidine and related substances
• anxiolytics / sedatives / hypnotics
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.
• sedatives / anxiolytics
• anti-epileptic drugs (AEDs)
• heavy metals
• bromide
• lead
• mercury
• manganese
• carbon monoxide
• organophosphate insecticides
• 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.
• hallucinogen-induced persisting perceptive disorder
• 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.
• insomnia type
• hypersomnia type
• parasomnia type
• mixed type
• with onset during intoxication
• with onset during abstinence
• 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 :

• National Institute on Drug Abuse (NIDA)
• Talk to Frank

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
• alcohol withdrawal delirium
• Korsakoff's psychosis
• alcohol hallucinosis
• alcoholic paranoia (concurrent paranoia and alcoholism).
• drug psychosis : any psychosis associated with drug use.
• cannabis
• emigration
• 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 psychosis^ref
• 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
• bipolar psychosis or disorder / manic-depressive psychosis
• 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)
• manic psychosis : the manic phase of bipolar psychosis or disorder / manic-depressive psychosis
• unipolar psychosis : a mood disorder characterized by recurrent major depressive episodes
• 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.
• schizoaffective schizophrenia or disorder
Epidemiology : worldwide prevalence = 24 million; incidence = 1% (between age 15-54)
Aetiology :
• 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 stigmatized^ref
• SNPs in
• dystrobrevin binding protein 1 (DTNBP1) / dysbindin
• neuregulin 1
• a₇ subunit of N_N and N_CNS ACh receptor
• ZDHHC8, which encodes a putative transmembrane palmitoyltransferase^ref
• 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 lead^ref. 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 study^ref. 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 times^ref. 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.
• prenatal maternal infections from
• Toxoplasma gondii
• HHV-2 / HSV-2
• polioviruses (John M. Eagles hypothesis)
• 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 episode^ref.
• 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.
Crow's classification :
• type I : more acute disorder, positive symptoms
• delusions
• hallucinations
• magical thinking
• 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
• parabulia
..., normal CT scan, positive prognosis, positive treatment response, no intellectual impairment, due to dopamine hypertone
• type II : more chronic disorder, negative symptoms
• blunted or flat affect
• anhedonism
• avolition
• alogia
..., 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
• delirium
• dementia
• mood disorder with psychotic manifestations
• schizoaffective disorder
• bipolar disorder-not otherwise specified (NOS)
• mood disorder with catatonic manifestations
• pervasive developmental disorders
• communication disorders
• attention-deficit/hyperactivity disorder (ADHD)
• schizotypal personality (disorder)
• schizoid personality (disorder)
• paranoid personality (disorder)
Therapy : D₂ antagonists are effective after 7-15 days
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
Differential diagnosis :
• brief psychotic 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
• delirium
• dementia
• substance-induced psychotic disorder
• schizophreniform disorder
• paranoia / delusional disorder
• mood disorder with catatonic manifestations
• psychotic disorder-not otherwise specified (NOS)
• factitious disorders with main psychological signs and symptoms
• malingering
• personality disorders
• 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
• delirium
• dementia
• 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
• delirium
• dementia
• substance-induced psychotic disorder
• schizophrenia
• schizophreniform disorder
• psychotic disorder-not otherwise specified (NOS)
• depressive disorder-not otherwise specified (NOS)
• bipolar disorder-not otherwise specified (NOS)
• shared psychotic disorder
• brief psychotic disorder
• hypochondriacal neurosis / hypochondriasis
• body dysmorphic disorder
• obsessive-compulsive disorder (OCD)
• paranoid personality (disorder)
• 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.

Differential diagnosis :
• schizophrenia
• paranoia / delusional disorder
• schizoaffective disorder
• mood disorder with psychotic manifestations
• psychotic disorder due to general medical condition
• with delirium
• with hallucinations
Aetiology :
• neurological conditions
• CNS neoplasms
• cerebrovascular disease
• Huntington's disease
• epilepsy
• auditory nerve injuries => deafness
• migraine
• CNS infections
• endocrine conditions
• hyperthyroidism
• hypothyroidism
• hypoparathyroidism
• hyperparathyroidism
• hypoadrenocorticism
• metabolic conditions
• hypoxia
• hypercapnia
• hypoglycemia
• hydroelectrolyte disequilibrium
• liver or renal diseases
• autoimmune CNS diseases (e.g. SLE)
Differential diagnosis :
• delirium
• dementia of the Alzheimer type
• multi-infarct dementia
• substance-induced psychotic disorder
• mood disorder with psychotic manifestations
• psychotic disorder-not otherwise specified (NOS)
• hypnagogic or hypnopompic hallucinations while falling sleep or awakening
• substance-induced psychotic disorder
• psychotic disorder-not otherwise specified (NOS)

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
• delirium
• hallucinations
• intepretation of hallucination
• negative
• autism

Therapy :

• 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
• electroshock therapy (EST)
• 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 metabolism^ref

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 neurosis : Freud's term for conditions now reclassified as panic disorder and generalized anxiety disorder.
• 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 :
• classic hysteria (now somatization disorder)
• hysterical neurosis (now divided into :
• conversion hysteria (now conversion disorder)
• 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.
• dissociative hysteria (now dissociative disorders)
• 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
• hysterical personality (now histrionic personality)
• 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.
• obsessions
• phobias
• cardiac neurosis / neurocirculatory asthenia
• 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.
• obsessional or compulsion neurosis / obsessive-compulsive neurosis / obsessive-compulsive disorder
• conversion neurosis / conversion disorder
• depersonalization neurosis / depersonalization disorder
• depressive neurosis / dysthymic disorder
• experimental neurosis : state produced in an experimental animal, usually by exposure to frustration or conflict, that resembles human neuroses.
• hypochondriacal neurosis / hypochondriasis
• hysterical neurosis : former name for a group of conditions now divided between conversion disorder and dissociative disorders
• phobic neurosis / phobia
• 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.
• traumatic neurosis / post-traumatic stress disorder
• vegetative neurosis / acrodynia.
• 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.
Pathological temperaments :
• dysthymia : depressive temperament
• hyperthymia : expansive temperament
• cyclothymia
• dysphoria : mixed temperament; disquiet; restlessness; malaise.
• 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).

Therapy : CCBs :
• verapamil : 120-360 mg/day
• nimodipine : 30-180 mg/day
• 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 oligoasymptomatic mania (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
• habromania : insanity featuring cheerful delusions
• hagiomania : mania for sainthood
• 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 perversion^ref. 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 ratings^ref. 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 preferences^ref, 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 acceptable^ref. 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 sites^ref.
• 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
• 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
• zoomania : insane fondness for animals
Chemotherapy : mood-stabilizing drugs
• in crises : benzodiazepines :
• clonazepam 4-16 mg/day
• diazepam : 10-30 mg/day
• chlordesmethyldiazepam : 4-16 mg/day
• diazepam 30 mg IV + haloperidol 2-4 mg i.m. + chlorpromazine 50-100 mg i.m. (eventually repeat after 1 hr)
• in chronic therapy :
• lithium 600-900 mg/day in acute phase => maintenance with plasma levels = 0.8-1.2 mEq/L (toxicity when > 2.0 mEq/L)
• anti-epileptic drugs (AEDs) : carbamazepine, valproate or dipropylacetamide 600-1200 mg/day
• D₂ antagonists (also in association) :
• haloperidol : 20-30 mg/day
• chlorpromazine : 200-600 mg/day
• levomepromazine : 50-600 mg/day
• clotiopine : 40-120 mg/day
• clozapine : 50-400 mg/day
• orphenodine : 50-150 mg/day
• trihexyphenidyl : 2-6 mg/day
• in drug-refractory mania : electroconvulsive therapy (ECT) / electroshock therapy (EST)
Differential diagnosis :
• mood disorder due to a general medical condition
• substance-induced mood disorder
• hypomania
• depressive episodes with predominant irritable mood
• attention-deficit/hyperactivity disorder (ADHD)
• depressive disorders
• 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, weight ggain, susbtance abuse
• hysteroid dysphoria : patients maintain consumatory pleasure when it is offered to them, but they don't look for it
• hyperparathyroidism
• obesity
Symptoms & signs :
• 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)
Differential diagnosis :
• mood disorder due to a general medical condition
• substance-induced mood disorder
• dementia
• mania with irritable mood
• mixed episodes
• attention-deficit/hyperactivity disorder (ADHD)
• adjustement disorder with depressed mood
• 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
• sadness periods
• depressive disorder-not otherwise specified (NOS)
• hypothyrodism
• HHV-4 / EBV
• influenzaviruses
• Treponema pallidum subsp. pallidum
• SLE
• Cushing disease
• dementia
Complications :
• suicide attempt
• substance abuse
• hydroelectrical disequilibrium
• physical disease
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
• moderate physical activity
• p.o. magnesium for > 4 months
• vitamin B₆
• monophasic estrogens or progestins (triphasic combinations may worsen mood disorders and headache)
• CSI for perimenstrual headache
• bromocriptine 2.5 mg/day in luteal phase, danazol 200 mg/day for 3 months, enantone or decapeptyl for mastodynia
• spironolactone in last 4-5 days for water retention
• alprazolam 0.25 mg/bid for anxiety (intermittent usage in luteal phase only may cause anxiety at suspension)
• fluoxetine for depression
• 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)
• postpsychotic depressive disorder of schizophrenia
• major depressive episode overlapped with paranoia / delusional disorder, psychotic disorder-not otherwise specified (NOS) or active phase of schizophrenia
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 disease^ref. Variations in its treatment within the NHS are striking and perplexing^ref. We welcome these guidelines and recent advice from the Medicines and Healthcare products Regulatory Agency (MHRA) concerning the prescription of antidepressants^{ref1, 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 research^ref
Aetiology :
• longer isoform of SLC6A4 / 5-HTT
• pancreatic cancer
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
• 1936 : pentylentetrazole
• 1938 : electroconvulsive therapy (ECT) / electroshock therapy (EST). Still indicated for elderly patients with durg-resistant depression or malignant hyperthermia
• 1952 : chlorpromazine
•  : isoniazid
• anti-depressant drugs :
• SSRI :
• fluvoxamine : 100-300 mg/day
• fluoxetine : 20-60 mg/day
• sertraline : 50-100 mg/day
• paroxetine : 20-60 mg/day
• citalopram : 20-60 mg/day
+ 1-2 mg/day lorazepam
• SNRI : venlafaxine : 75-375 mg/day
• SARI : trazodone : 150-600 mg/day
• NaSSA : mirtazepine : 15-45 mg/day
• NARI : reboxetine : 8-12 mg/day
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)
• longitudinal evaluation : chronicity, previous episodes, previous substance abse
• 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 depression^ref
• interpersonal psychotherapy : mourning, role transition, interpersonal deficit, interpersonal contrast
• familial psychotherapy : lifestyle modfiication of affected member reflect on healthy members
• cognitive psychotherapy : hopelessness, helplessness
• psychodynamic psychotherapy
Web resources : World Health Organization: Depression
• 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.
• + recent hypomanic episode
• mild, moderate, or severe without psychotic manifestations
• severe with psychotic manifestations
• in partial or complete remission
• + recent manic episode
• mild, moderate, or severe without psychotic manifestations
• severe with psychotic manifestations
• in partial or complete remission
• + recent mixed episode
• + recent depressive episode
• mild or moderate
• severe without psychotic manifestations
• severe with psychotic manifestations
• in partial or complete remission
• + recent unspecified episode
• fast cycles (> 4 episodes / year)
• 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.
• hypomanic current or most recent episode
• depressive current or most recent episode
• fast cycles (> 4 episodes / year)
• 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)

Differential diagnosis :
• mood disorder due to a general medical condition
• substance-induced mood disorder
• bipolar I disorder fast cycles
• bipolar II disorder fast cycles
• borderline personality (disorder)
• bipolar disorder-not otherwise specified (NOS)
• 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
Therapy :
• proved effectiveness : lithium (300 mg 3 times a day, monitoring lithemia in the range = 0.5-0.8 mEq/L), atypical antipsychotics (clozapine, olanzapine)
• doubtful effectiveness : anti-epileptic drugs (AEDs : valproate (500 mg 3 times a day), carbamazepine, gabapentin, lamotrigine, topiramate), CCB (verapamil, diltiazem)
• electroconvulsive therapy (ECT) / electroshock therapy (EST)
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
• mood disorder due to a general medical condition
• with depressive manifestations
• with major depressive-like episode
• with mixed manifestations
Aetiology :
• neurological conditions
• Parkinson's disease
• Huntington's disease
• cerebrovascular disease
• metabolic conditions : vitamin B₁₂ deficiency
• endocrine conditions
• hyperthyroidism
• hypothyrodism
• hypoparathyroidism
• hyperparathyroidism
• hypoadrenocorticism
• hyperadrenocorticism (60%)
• infections :
• viral hepatitis
• HHV-4 / EBV
• HIV-1
• autoimmune CNS diseases
• SLE
• pancreas adenocarcinoma
• substance-induced mood disorder
• mood disorder-not otherwise specified (NOS)
• acute agitation
Laboratory examinations :
• 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
• impending danger
• powerlessness
• apprehension
• tension
• Da Costa's syndrome / neurocirculatory asthenia
• 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.
• subjective manifestations
• malaise
• self-annihilation experiences
• somatic symptoms
• dyspnea or sensation of fatigue / asphyxia
• palpitations
• dizziness
• vertigo
• faintness
• shakiness
• tremors
• nausea or abdominal disturbance
• paresthesias of light and sound sensations
• chills or heat => sweating
• hyperthermia
• pollakiuria
• diarrhea
• tachycardia
• polypnea
• forced inspiration
• increased systolic blood pressure
• psychological or psychosensorial symptoms (mimicking temporal lobe epilepsy)
• acceleration of thoughts
• impaired distance perception
• slowing down of time course
• maintenance of self-control, sometimes interruption of activities and escape
• feelings of unreality ("hippocampal crisis")
• depersonalization
• derealization
• fears of dying
• fears of going crazy
• fears of losing control
According to number of symptoms :
• < 2 limited symptoms : minor panic attack
• > 3 symptoms (cardiovascular, vestibular, vegetative, and/or cognitive symptoms) : major panic attack
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-HT_1A receptors in the anterior cingulate cortex, the posterior cingulate cortex and the raphe nucleus
Associated diseases :
• limited avoidnat behaviour
• secondary social phobia
• agoraphobia
• secondary demoralization or depression
• bipolar disorder (BPD)
Differential diagnosis :
• generalized anxiety disorder (GAD)
• anorexia nervosa (panic attacks at sight of foods)
• phobia
• menopause (despite usual onset at age 20-30)
• psychotic disorder
• hyperthyroidism
• hyperparathyroidism
• systemic arterial hypertension
• pheochromocytoma
• hypoglycemia
• vestibular dysfunctions
• temporal lobe epilepsy
• somatization disorder
• schizoid personality disorder
• hypochondriacal neurosis / hypochondriasis (less interested in respiratory and cardiovascular diseases, more interested in gastrointestinal diseases)
• cardiac disorders
• arrhythmias
• supraventricular tachycardias
Laboratory examinations :
• Structured Clinical Interview for Panic Agoraphobic Spectrum, lifetime version (SCI-PAS/LT)
• Self-Report instrument for Panic Agoraphobic Spectrum, lifetime version (PAS-SR/LT)
• Self-Report instrument for Panic Agoraphobic Spectrum, last month version (PAS-SR/LM)
• Self-Report instrument for Panic Agoraphobic Spectrum, last week version (PAS-SR/LW)
• head CT
• head MRI
• head PET
Therapy (also to prevent complications : drug and/or substance abuse, suicide, ...) :
• pet therapy
• 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)
• psychotherapy for anticipatory anxiety (educational, existential, psychoanalytic, group, cognitive psychotherapy, meditation, relaxation, biofeedback, behavioural)
• succeeding attacks (status panicosus) : i.v. BDZs + trycyclic antidepressants (TCA)
Prognosis :
• 30% has no response to treatment
• 30% has partial response
• 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 ...
• associated with panic attacks (panic disorder with agoraphobia)
• 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.

Differential diagnosis :
• major depressive episodes
• social phobia
• specific phobia
• obsessive-compulsive disorder (OCD)
• separation anxiety disorder
• paranoia / delusional disorder
• realistic preoccupations
• syncope in patient with TIA
• diarrhea in patients with Crohn's disease
• 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
• photophobia
• sitophobia : irrational fear of eating or of food
• spermatophobia : fear of semen loss
• syphilophobia : irrational fear of syphilis
• tocophobia : irrational fear of childbirth.
• taphephobia : irrational fear of being buried alive
• zoophobia : irrational fear of animals
• dogs
• herpetophobia : irrational fear of reptiles or amphibians.
• insects
• arachnophobia : irrational fear of spiders.
• mice
• xenophobia : irrational fear of strangers
Differential diagnosis :
• traumatic neurosis / post-traumatic stress disorder
• social phobia
• obsessive-compulsive disorder (OCD) (contraphobic measures are not considered obsessions)
• separation anxiety disorder
• hypochondriacal neurosis / hypochondriasis
• anorexia nervosa
• bulimia nervosa
• psychotic disorder
• 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)
• shiness (prevalence = 20-30%)
• selective mutism
• secondary
• panic disorder
• body dysmorphic disorder
• eating disorders
• obsessive-compulsive disorder (OCD)
Co-morbidity :
• depression (35%)
• phobia
• ethanol addiction (> 20%; used as autotherapy)
• agoraphobia (20%)
• panic disorder (< 20%)
• substance abuse/dependence (> 15%)
Differential diagnosis :
• separation anxiety disorder
• specific phobia
• pervasive developmental disorders
• schizoid personality disorder
• avoidant personality (disorder)
• manifestation of other mental disorders
• performance anxiety
• set fear
• shyness
Therapy :
• MAOI : phenelzine and tranylcypromine (unusual worsening of anxiety). Moclobemide is not effective
• SSRI : paroxetine gives responses in 70%
• BDZs (side effect : sedation and depression)
• 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
• buspiron : contrasting findings
• gabapentin
• trycyclic antidepressants (TCA) are not effective !
• 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.
• transient situational disturbance : acute stress reaction
• separation anxiety disorder : 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 :
• child-mother separation anxiety

	prenatal conditioning	olfactory learning	maternal flavour conditioning	separation stasis (limbic area and cingulus)
opiates	+++	-	-	-
oxytocin	?	++	+++	+++ (in milk)
ADH	-	++	?	-
noradrenalin	-	+++	-	-
cortisol	-	-	-	++

• mother-child separation anxiety

	maternal motivation	avoidance inhibition	maternal behaviour	nidus contruction	selective maternal cure (e.g. in sheep)
estrogens	+++	-	-	-	-
progestins	+++	-	-	-	-
PRL	-	-	+++	+++
oxytocin	++	+++ (inhibits function of olfactory bulb)	+++ (only at the beginning)	-	+

Reorganization of olfactory bulb depends on glutamate, GABA and NE.
• nonparental male-female partner 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 :
• pervasive developmental disorders
• psychotic disorder
• panic disorder with agoraphobia
• agoraphobia without history of panic disorder
• conduct disorder
• sepration anxiety adequate to developmental level
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.

Differential diagnosis :
• brief psychotic disorder
• major depressive disorder
• exhacerbation of preexisting mental disorder
• traumatic neurosis / post-traumatic stress disorder
• adjustement disorders
• malingering
If persistent, it may become ...
• 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 forces^{ref1, 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 stigmatization^ref. 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.
• chronic fatigue syndrome (CFS)
• Gulf War syndrome (GWS)
• peacekeeper's stress syndrome
• survivor's guilt syndrome
• syndrome of lifestyle and cultural change
• occupational psychology
• 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, ...)

Laboratory examinations : Mosloch burnout inventory (MBI)
Occupational stressing factors :
• work organization :
• too much or too few to do
• incessant rhytms
• work fragmentation
• inadequate pauses
• kind of work
• absent or excessive responsability
• 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
• alienation
• fear of injuries
• failure
• fear of unemployment
• interpersonal factors :
• troubles with colleagues
• gerarchies
• roles
• mobbing
• 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
• resistance stage
• exausting stage
• cenesthopathies and neurovegetative disorders
• fatigue
• malaise
• hypochondriasis
• neurosis, schizophrenia, bipolar disorder, toxicomanias (including alcoholism), senile psychosis
• psychosomatic disease
• psychogenic or traumatic shock
• gastroduodenitis, peptic ulcer, ulcerative colitis
• arteriosclerosis, systemic arterial hypertension
• endocrine and metabolic disorders : diabetes mellitus, hypoglycemia, hyperinsulinism, hyperthyroidism, hypothyroidism, Cushing disease
• allergy (bronchial asthma), infections, connective tissue diseases
• 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
Onset of symptoms :
• type I : 1-3 months
• type II : > 3 months
• type III :
Laboratory examinations :
• Structured Interview for PTSD (SI-PTSD)
• Clinician-Administered PTSD Scale (CAPS)
Differential diagnosis :
• exhacerbation of pre-existing disease on axis I
• avoidant, torpid, increased arousal symptoms before exposure to stressor
• acute stress disorder
• obsessive-compulsive disorder (OCD)
• adjustement disorders
• dissociative disorders
• somatoform disorders
• personality disorders
• psychotic disorders
• malingering
Co-morbidity :
• somatization disorder
• schizophrenia
• major depressive disorder
• panic disorder
• obsessive-compulsive disorder (OCD)
• dysthymic disorder
Complicances :
• compromised social adaptation
• secondary depression
• alcohol or other substance abuse
Prognosis : if stress was severe it may last whole life
Therapy :
• BDZs
• trycyclic antidepressants (TCA)
• D₂ antagonists
• clonidine
• lithium
• anticonvulsant/antikindling agents (carbamazepine and valproate) reduce number of flashbacks
• psychotherapy
Web resources :
• The Stress Monitor Web Site
• The Stress Site
• 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.
• childhood hyperanxiety disorder
Differential diagnosis :
• anxiety disorder due to a general medical condition
• substance-induced anxiety disorder
• panic disorder (PD)
• social phobia
• obsessive-compulsive disorder (OCD)
• anorexia nervosa
• hypochondriacal neurosis / hypochondriasis
• somatization disorder
• traumatic neurosis / post-traumatic stress disorder
• adjustement disorders
• mood disorders
• psychotic disorders
• nonpathological anxiety
Laboratory examinations : Hamilton Anxiety scale (HAMA)
Therapy : escitalopram oxalate
• 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
• perfectionism
• precision
• order
• symmetry
• completeness
• repetition and automatism
Co-morbidity : other anxiety disorder (current risk = 30%; lifetime risk = 42%)
Differential diagnosis :
• anxiety disorder due to a general medical condition
• substance-induced anxiety disorder
• body dysmorphic disorder
• social phobia
• specific phobia
• trichotillomania
• major depressive disorder
• generalized anxiety disorder
• hypochondriacal neurosis / hypochondriasis
• delirium
• psychotic disorder-not otherwise specified (NOS)
• tic disorders
• schizophrenia
• obsessive-compulsive disorder (OCD)
• stereotypic movement disorder
• eating disorders
• paraphilias
• pathological gambling
• alcohol dependence or abuse
• obsessive-compulsive personality (disorder)
• superstition
• repetitive control movements
Laboratory examinations :
• Structured Clinical Interview for Obsessive Compulsive Spectrum, lifetime version (SCI-OBS/LT)
• Self-Report instrument for Obsessive Compulsive Spectrum, lifetime version (OBS-SR/LT)
• Self-Report instrument for Obsessive Compulsive Spectrum, last month version (OBS-SR/LM)
• Self-Report instrument for Obsessive Compulsive Spectrum, last week version (OBS-SR/LW)
Prognosis :
• panic disorder => bipolar disorder (78%)
• bipolar disorder => panic disorder (22%)
• substance-induced anxiety disorder
• anxiety disorder due to a general medical condition
• hypoxia
• respiratory insufficiency
• epilepsy
• endocrine conditions
• thyrotoxicosis
• hypothyroidism
• pheochromocytoma
• hypoglycemia
• cardiovascular conditions
• congestive heart failure (CHF)
• pulmonary embolism
• arrhythmias
• respiratory conditions
• COPD
• pneumonia
• hyperventilation
• metabolic conditions
• vitamin B₁₂ deficiency
• porphyrias
• neurological conditions
• CNS tumor
• vestibular dysfunctions
• encephalitis
• anxiety disorder-not otherwise specified (NOS)
• mixed anxious-depressive disorder
• symptoms of social phobia related with social impact due to being affected by a general medical condition (Parkinson's disease, dermatopathies) or mental disorder (stuttering, anorexia nervosa, body dysmorphic disorder )
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

Differential diagnosis :
• general medical condition
• schizophrenia
• panic disorder
• generalized anxiety disorder
• major depressive disorder
• pain disorder associated with psychological factors
• sexual dysfunction
• conversion disorder
• dissociative disorders
• hypochondriacal neurosis / hypochondriasis
• factitious disorder with main physical signs and symptoms
• malingering
• somatoform disorder-not otherwise specified (NOS)
• 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.

Differential diagnosis :
• somatoform disorder-not otherwise specified (NOS)
• major depressive disorder
• anxiety disorders
• adjustement disorders
• factitious disorder with main physical signs and symptoms
• malingering
• 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.
• with motor symptoms or deficiencies
• with epileptiform attacks or seizures
• with sensory symptoms or deficiencies
• with mixed symptomatology
Differential diagnosis :
• occult neurologic or general medical condition
• substance related aetiologies
• pain disorder
• sexual dysfunction
• somatization disorder
• hypochondriacal neurosis / hypochondriasis
• body dysmorphic disorder
• dissociative disorders
• hallucinations within the context of a psychotic disorder
• 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.
Differential diagnosis :
• somatization disorder
• dyspareunia
• conversion disorder
• other mental disorders
• factitious disorder with main physical signs and symptoms
• malingering
• 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

Differential diagnosis :
• general medical condition
• somatic symptoms in babies
• preoccupations for health in elderlies
• panic disorder
• generalized anxiety disorder
• specific phobia
• obsessive-compulsive disorder (OCD)
• major depressive disorder
• body dysmorphic disorder
• separation anxiety disorder
• psychotic disorder
• 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.

Differential diagnosis :
• normal preoccupations for physical apperance
• other mental disorder
• anorexia nervosa
• gender identity disorder
• major depressive disorder
• obsessive-compulsive disorder (OCD)
• delirium, somatic type
• 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 past^ref.

Differential diagnosis :
• direct physiological consequence of a specific general medical condition
• dissociative symptoms due to partial complex epilepsy
• direct physiological effects of a substance
• dissociative fugue
• depersonalization disorder
• dissociative amnesia
• dissoc
• maniac episode
• schizophrenia
• malingering
• factitious disorders
• 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.
• piblokto : a culture-specific syndrome seen chiefly among Eskimo women, marked by sudden, short-lived attacks 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
• grisi siknis by Miskito of Honduras and Nicaragua
• 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)
Differential diagnosis :
• direct physiological consequence of a specific general medical condition
• partial complex epilepsy
• mental disorder-not otherwise specified due to general medical condition
• direct physiological effects of a substance
• dissociative identity disorder
• depersonalization disorder
• dissociative amnesia
• dissociative disorder-not otherwise specified (NOS)
• schizophrenia
• bipolar disorder, fast cycles
• anxiety disorders
• somatization disorder
• personality disorders
• malingering
• 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
• amnestic disorder due to head trauma
• accessual disorder
• delirium
• dementia
• substance-induced persisting amnestic disorder
• susbtance intoxication
• dissociative fugue
• dissociative identity disorder
• depersonalization disorder
• traumatic neurosis / post-traumatic stress disorder
• acute stress disorder
• somatization disorder
• malingering
• age-related cognitive decline
• nonpathological amnestic forms
• 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
• direct physiological effects of a substance
• susbtance intoxication
• substance withdrawal
• panic disorder
• specific phobia
• social phobia
• traumatic neurosis / post-traumatic stress disorder
• acute stress disorder
• schizophrenia
• major depressive episodes
• dissociative disorder-not otherwise specified (NOS)
• 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. :
• amok (Indonesia)
• piblokto (Artic)
• bebainan (Indonesia)
• 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 disease.
• Gilles de la Tourette's syndrome
• 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.
• hypnotic trance : the state induced by hypnosis
• 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.
Laboratory examinations : structured clinical interview for DSM-IV dissociative disorders (SCID-D)
• 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 dysfunctions : decrease or other disturbance of sexual response cycle
• 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
Differential diagnosis :
• substance-induced sexual dysfunction
• sexual dysfunction due to a general medical condition
• other disorder in axis I
• occasional problems of sexual desire
Laboratory examinations :
• 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
Therapy : 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
• sexual aversion disorder : feelings of repugnance for and active avoidance of genital sexual contact with a partner, causing substantial distress or interpersonal difficulty.
• permanent or acquired
• generalized or situational
• due to psychological or combined factors
Differential diagnosis :
• other disorder in axis I
• erotophobia
• saltuary sexual aversion
• 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

Therapy : xenobiotics
• 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

Therapy : as for other kinds of ED
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 erections^ref.
Differential diagnosis :
• substance-induced sexual dysfunction
• sexual dysfunction due to a general medical condition
• other disorder in axis I
• occasional problems of arousal
• 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 obesity^ref. 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.

Web resources :
• Twin Research
• Medicinenet.com: the orgasm wars
• Medicinenet.com: orgasm disorder
• 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
• xenobiotics
Differential diagnosis :
• substance-induced sexual dysfunction
• sexual dysfunction due to a general medical condition
• other disorder in axis I
• occasional problems of orgasm
• no disorders of resolution phase exist
• sexual pain disorders : sexual dysfunctions characterized by pain associated with intercourse; they include
• dyspareunia (in males or females) not due to a general medical condition
• noncoital sexual pain disorder (in females)
• vaginismus (in females) not due to a general medical condition.
• sexual dysfunction due to a general medical condition
• female hypoactive sexual desire disorder due to ...
• male hypoactive sexual desire disorder due to ...
• male erection disorder due to ...
• female dyspareunia due to ...
• male dyspareunia due to ...
• other female sexual dysfunction due to ...
• other male sexual dysfunction due to ...
Aetiology :
• neurologic disorders
• multiple sclerosis
• spinal cord injuries (SCI)
• neuropathies
• temporal lobe lesions
• endocrine disorders
• diabetes mellitus
• hypothyroidism
• hypoadrenocorticism
• hyperadrenocorticism
• hyperprolactinemia
• hypogonadism
• hypopituitarism
• vascular disorders
• genitourinary disorders
• testicular diseases
• Peyronie disease
• urethral infections
• complicances of prostatectomy
• genital injury or infection
• atrophic vaginitis
• infections of vagina or external genitalia
• post-operatory complicances as ephysiotomy scars, shortened vagina, cystitis, endometriosis, uterine prolapse, PID, neoplasms)
• substance-induced sexual dysfunction
• sexual dysfunction-not otherwise specified (NOS)
• 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
• mental retardation
• dementia
• personality modifications due to a general medical condition
• substance intoxication
• maniac episode
• schizophrenia
• public micturition
• gender identity disorders
• 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.
• gender identity disorder-not otherwise specified (NOS)
• sexual disorder-not otherwise specified (NOS)
• unusual sex practices
• abrasions : scratching or rubbing off skin
• acomoclitic : preference for hairless genitals
• acousticophilia : arousal from sounds
• acrophilia : arousal from heights or high altitudes
• acrotomophilia : sexual preference for amputees
• actirasty : arousal from exposure to sun's rays
• acupressure : pressure points on body that induce certain responses, some sexual
• adolescentilism : cross-dressing or playing the role of an adolescent
• adultery / apistia / open marriage  : having sex outside a marriage
• agenobiosis : married couple who consent to live together without sex
• agonophilia : person who is aroused by partner pretending to struggle
• agoraphilia / bushie mall : arousal from open spaces or having sex in public
• agrexophilia : arousal from others knowing you are having sex
• albutophilia : arousal from water
• algophilia : arousal from experiencing pain
• aliphineur : person using lotion to arouse partner
• alloerasty : use of nudity of another person to arouse partner
• allopellia : having orgasm from watching others engaging in sex
• allorgasmia : arousal from fantasizing about someone other than one's partner
• allotriorasty : arousal from partners of other nations or races
• alphamegamia : arousal from partner of different age group
• amaurophilia : preference for a blind or blindfolded sex partner
• amomaxia : sex in a parked car
• amelotasis : attraction to absence of limb
• amokoscisia : arousal or sexual frenzy with desire to slash or mutilate women
• amychesis : act of scratching partner during sexual passion
• anaclitism : arousal from items used as infant
• analinctus / analingus / hedralingus : licking anus
• anophilemia : kissing anus
• anasteemaphilia : attraction to taller or shorter partners
• androidism : arousal from robots with human features
• androminetophilia : arousal from female partner who dresses like male
• anisonogamist : attraction to either older or younger partner
• gerontophilia : attraction to a partner whose age is that of different generation
• anililagnia / chronophilia / graophilia / matronolagnia : arousal from older female partner
• anocratism / arsometry / buggery / coitus analis / pederasty / proctophallism / sotadism : anal sex
• anomeatia : anal sex with a female partner
• corephallism : anal sex with young girl
• 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 ejaculation^ref.
• oxygen regulation : regulating intake of oxygen for sexual enhancement
• autoerotic asphyxia : arousal from oxygen deprivation and sometimes risk of dying
Complications : strangulation
• 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 pathogens^ref.
• cunnilingus / gamahucheur : oral stimulation of the female genitalia.

Side effects :
• vulvar hematoma secondary to a human bite^ref
• recurrent Candida vulvovaginitis
• HHV-4 / EBV
• amnionitis through an ascending infectious route.
• Capnocytophaga spp.
• Fusobacterium nucleatum
• Streptococcus viridans^ref
• 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 use^ref.
• 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 fathers^ref.
• 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 men^ref. 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 period^ref. 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 homosexuals^ref.
• 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 influence^ref
• 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 childhood^ref
• 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 confirmed^ref.
Complications : gay bowel syndrome
• 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 science^ref.

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 psychological signs and symptoms
• factitious disorder with both psychological and 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.
• factitious disorder-not otherwise specified (NOS)

Differential diagnosis :

• actual general medical condition
• actual mental disorder
• somatoform disorders
• malingering

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 :
• anorexia nervosa binge-eating / purging type
• Klein-Levine syndrome
• major depressive disorder with atypical manifestations
Therapy (relapses are frequent) :
• SSRI (fluoxetine, citalopram, sertraline and fluvoxamine) decrease hunger
• trycyclic antidepressants (TCA) stimulate appetite (poorly used)
• D₂ antagonists (haloperidol)
• 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
• due to malnutrition :
• bradycardia (41.3%), pericardial effusion due to hypoosmolarity and mitral valve prolapse (MVP) => arrhythmias => CHF
• irreversible low BMD (85%)
• hypercholesterolemia
• lanugo (a soft, downy body hair that develops on the chest and arms of anorexic women)
• hypothermia (22.4%) => very dressed
• anemia (38.6%) and leucopenia (34.4%)
• systemic arterial hypotension (16.1%)
• transaminitis (12.2%)
• fatigue
• fragile hair and nails
• due to purging behaviour :
• calli over hand knuckles caused by self-induced vomiting (Russell's sign)
• parotidomegaly and parotidolithiasis (lemon juice test), increased salivary amylasemia
• dental caries, gastric esophagitis and laryngitis due to acid reflux
• hypokalemia due to diuretics and metabolic alkalosis and hyponatremia (19.7%)
• dehydratation
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 :
• anorexia due to a general medical condition
• gastroenteric diseases
• cerebral neoplasms
• occult carcinomas
• AIDS
• upper mesenteric artery syndrome
• major depressive disorder
• schizophrenia
• social phobia
• obsessive-compulsive disorder (OCD)
• body dysmorphic disorder
Therapy (relapses are frequent) :
• < 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)
• SSRI (fluoxetine, citalopram, ...)
• trycyclic antidepressants (TCA) stimulate appetite (poorly used)
• D₂ antagonists (haloperidol)
• psychotherapy (difficult)
• 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)
• Eating Attitudes Test (EAT)
• Eating Disorder Inventory (EDI)

sleep disorders : chronic disorders involving sleep

• primary sleep disorders

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

Aetiology :
• anxiety
• tension
• depression
• middle insomnia : that characterized by awakening during the sleep period, with difficulty in falling back to sleep.
• terminal insomnia : that characterized by early awakening with difficulty in falling back to sleep

Aetiology :
• depression
• bereavement
• chronic anxiety
• cerebral arteriosclerosis
• 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.
• fatal familial insomnia
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.
• obesity
Laboratory examinations :
• Insomnia Diagnostic Interview (IDI)
• sleep diary
• polysomnography (parietal EEG, EOG, and supramentonear EMG)
• dynamic ambulatory EEG
• multiple sleep latency test (MSLT)
Therapy :
• chemotherapy (lormetazepam > triazolam > zolpidem > brotizolam > flurazepam > flunitrazepam > estazolam > zopiclone > temazepam > nitrazepam > zaleplon > nordiazepam)
• Valeriana officinalis > Passiflora incarnata > Crataegus oxyacantha > Chamaemelum nobile
• 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 se^ref
• 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.
• Pickwick's disease
• lethargy : a lowered level of consciousness marked by listlessness, drowsiness, and apathy
• 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.
• 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
• obstructive sleep apnoea syndrome (OSAS)
• central sleep apnea / central apnea
• narcolepsy / Gélineau's syndrome / paroxysmal sleep : recurrent, uncontrollable, brief episodes of sleep, often associated with hypnagogic or hypnopompic hallucinations, cataplexy, and sleep paralysis

Aetiology : autoimmune narcolepsy
• periodic hypersomnia
Laboratory examinations :
• 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
Chemotherapy : psychostimulants (modafinil activates orexins)
Web resources : Narcolepsy and Overwhelming Daytime Sleep Society of Australia (NODSS)
• 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.
• delayed sleep phase syndrome (DSPS)

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
• familial advanced sleep phase syndrome

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'

Differential diagnosis : epilepsy
• 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

Aetiology : autoimmune somnambulism
• vigilambulism : an ambulatory automatism resembling somnambulism but occurring in the waking state
Differential diagnosis :
• epilepsy
• dissociative fugue
• parasomnias of the sleep-awakening transition
• 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

Aetiology : autoimmune ?
Epidemiology : prevalence : 0.5%
• parasomnia-not otherwise specified (NOS)
• 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.
• secondary sleep disorders
• general medical condition
• other mental disorder
• insomnia related to ...
• hypersomnia related to ...
• psychoactive substance
• other sleep disorders
• sleep disorder due to ...
• insomnia type
• hypersomnia type
• parasomnia type
• mixed type
• substance-induced sleep disorder
• shift-work sleep disorder

Symptoms & signs : chronic excessive sleepiness during night work and insomnia when attempting to sleep during the day
Therapy : 200 mg of modafinil^ref

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 neurodermitis^ref
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 crashes^ref. 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 performance^ref.
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/m_BSA², while people sleeping 2-4 hours per night have a BMI = 30.1 kg/m_BSA^2ref
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
Differential diagnosis :
• delirium
• dementia
• personality modification due to a general medical condition, aggressive type
• susbtance intoxication
• substance withdrawal
• oppositional defiant disorder
• conduct disorder
• antisocial personality (disorder)
• borderline personality (disorder)
• maniac episode
• schizophrenia
• deliberated behaviour
• malingering
• 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.

Differential diagnosis :
• common thefts in markets or elsewhere
• malingering
• conduct disorder
• antisocial personality (disorder)
• maniac episode
• schizophrenia
• dementia
• 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
• developmental stage
• conduct disorder
• antisocial personality (disorder)
• maniac episode
• schizophrenia
• dementia
• mental retardation
• susbtance intoxication
• pathological gambling : an impulse control disorder consisting of persistent failure to r