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Allergic or autoimmune mechanisms are generally held to be the cause as the picture closely resembles that of experimental allergic encephalomyelitis heart attack the voice order furosemide without prescription. The clinical picture consists of headache prehypertension quiz purchase genuine furosemide online, drowsiness, photophobia and irritability, setting in some 314 days after the onset of the specific illness but with wide latitude of timing. There is commonly an interval of normal health between the acute viral illness and the encephalopathic development. Cranial nerve palsies may appear, or myoclonic and choreiform movements may be seen. The brainstem may be principally involved, with vertigo, vomiting, nystagmus and dysarthria; alternatively, in myelitic forms there may be paraparesis with retention of urine. Textbooks of neurology should be consulted for further details of the pictures seen with different infections. If the patient does not succumb during the first week or two a remarkably complete recovery may be seen. The mortality is much higher in infants than in older children or Intracranial Infections 439 adults. In some survivors there may be severe neurological sequelae, with hemiparesis, paraparesis, epilepsy and impairment of intellect. In children, behaviour disorders similar to those that follow encephalitis lethargica may occur. In adult survivors, varied neuropsychiatric sequelae have been reported after measles and rubella encephalitis, including schizophreniform psychosis (Stoler et al. It remains rare in developing countries, but higher incidences are reported, for example 21 cases per million in India. The initial features of the illness include more subtle cognitive impairment deteriorating into behavioural disturbance and clear-cut dementia. Sometimes, however, the possibility of other psychiatric illness is raised in the early stages. Visual changes are reported in 1050%, including cortical blindness, chorioretinitis and optic atrophy. In the most advanced stages the patient becomes quadriparetic with gradual decline into coma. Cases were first described by Dawson in 1933 (subacute inclusion body encephalitis), van Bogaert in 1945 (subacute sclerosing leucoencephalitis) and Brain et al. These now appear to be essentially variants of the same disease process (Adams 1976). The brain may be normal macroscopically, or firm and shrunken with areas of focal necrosis. Microscopy shows evidence of subacute inflammation, usually in both the grey and the white matter. There is perivascular infiltration with lymphocytes and plasma cells, and proliferation of astrocytes and microglia. In the grey matter neuronal degeneration is apparent, often with characteristic intranuclear inclusions, and in the white matter areas of demyelination are seen with fibrous gliosis. In severely degenerated cells the inclusions may fill the nucleus so that the surrounding cytoplasm is reduced to a vestige. Sometimes they are found in the cytoplasm itself, or in glial cells as well as neurones; such changes may be focal in distribution (see Kennedy 1968). Evidence has accumulated to suggest that the measles paramyxovirus is responsible. Almost all patients have a history of measles, usually at an early age, or of measles immunisation. Electron microscopy has shown particles indistinguishable from paramyxovirus budding from cytoplasmic inclusions, and measles virus has been isolated from brain cell tissue cultures derived from patients with the disease (Horta-Barbosa et al. Finally, the disease has been transmitted to animals by intracerebral inoculation of brain tissue from patients with the disorder (Lehrich et al.
Stereotypes can lead to expectations of certain groups hypertension quiz questions buy furosemide 40 mg with amex, which can create conditions that lead to confirmation of the stereotype blood pressure chart home use cheap 100mg furosemide, a process referred to as self-fulfilling prophecy. Prejudice is defined as an irrational positive or negative attitude toward a person, group, or thing prior to an actual experience. An in-group is a social group with which a person experiences a sense of belonging. Cultural relativism refers to the recognition that social groups and cultures should be studied on their own terms. Discrimination is when prejudicial attitudes cause individuals of a particular group to be treated differently from others. Individual discrimination refers to one person discriminating against a particular person or group. Institutional discrimination refers to the discrimination against a particular person or group by an entire institution. Interpersonal attraction is what makes people like each other and is influenced by at least five factors discussed in the chapter: physical attractiveness, similarity, self-disclosure, reciprocity, and proximity. Aggression is a behavior with the intention to cause harm or increase relative social dominance. Type of Attachment Secure Upset at departure of caregiver, comforted by return; trusts caregiver, who is viewed as a secure base Avoidant Shows no preference for a stranger or caregiver; shows little distress at departure and little relief by return of caregiver Ambivalent Disorganized Distressed by departure of caregiver with mixed reactions at return No clear pattern of behavior; sometimes exhibits repetitive behaviors or seems dazed, frozen, or confused Response to Caregiver 4. Social support is the perception or reality that one is cared for by a social network. There are five types discussed in this chapter: emotional support, esteem support, material support, informational support, and network support. The primacy effect is the power of first impressions over later impressions of an individual. The recency effect is weighing the most recent information of a person as the most important. The halo effect occurs when one applies general feelings about a person (usually, "good" or "bad") to specific characteristics of that person. The just-world hypothesis is the belief that good things happen to good people and bad things happen to bad people. Self-serving bias is the tendency to attribute our successes to internal factors and our failures to external factors. Attributions are divided into two types: dispositional (internal) causes, which relate to the features of the target, and situational (external) causes, which relate to features of the surroundings or context. Fundamental attribution error is the general bias toward making dispositional attributions rather than situational attributions about the behavior of others, especially in negative contexts. Attribute substitution occurs when individuals must make judgments that are complex but instead substitute a simpler solution or heuristic. Stereotypes occur when attitudes and impressions are made based on limited and superficial information about a person or a group of individuals and are cognitive. Prejudice is defined as an irrational negative, or occasionally positive, attitude toward a person, group, or thing, which is formed prior to an actual experience and is affective. Discrimination is when prejudicial attitudes cause individuals of a particular group to be treated differently than others and is behavioral. Power, prestige, and class all influence prejudice through unequal distribution of wealth, influence, and resources. Cultural relativism refers to the recognition that social groups and cultures must be studied on their own terms. In both cases, an individual perceives another group to which he or she does not belong; however, it is the reaction to that other group that determines which paradigm is being used. Shared Concepts Behavioral Sciences Chapter 5 Motivation, Emotion, and Stress Behavioral Sciences Chapter 6 Identity and Personality Behavioral Sciences Chapter 8 Social Processes, Attitudes, and Behavior Behavioral Sciences Chapter 9 Social Interaction Behavioral Sciences Chapter 11 Social Structure and Demographics Behavioral Sciences Chapter 12 Social Stratification Practice Questions 1. The tendency to become close friends with neighbors rather than people in other neighborhoods is most strongly related to which of the following factors? A child who cries when his mother departs and smiles and runs to his mother when she returns is displaying which type of attachment pattern?
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There is some suggestion of other changes in manifestation with age of onset arrhythmia cardiac discount 100 mg furosemide amex, striate rigidity predominating in the early twenties blood pressure medication used for withdrawal purchase furosemide with a visa, choreic symptoms in middle age and intention tremor after the age of 60. Considerable variation may be seen in the relationship between the neurological and psychiatric features. In the typical case involuntary movements precede dementia, although the reverse can also be seen. Occasionally, several years may separate the appearance of the two components, or the two may begin and proceed throughout together. Certainly once both are well established each tends to worsen in conformity with the other. Dementia without chorea has similarly been recorded, even when chorea was prominent in previous generations of the family. Other variations include the form the neurological abnormalities take, progressive rigidity with parkinsonism replacing the typical choreic movements in up to 10% of cases. All such variations usually appear sporadically; despite some indications in the literature, it is not well established that in different families the form of the disease tends to breed true. These are well recognised as premonitory symptoms by those who have practical dealings with communities in which the disease is relatively common. Paranoid developments may be the earliest change, with marked sensitivity and ideas of reference. Sometimes a florid schizophrenic illness may be present for several years before the true diagnosis becomes apparent. Neurological presentations were usually with choreiform movements, or less often with unsteadiness of gait, a tendency to fall or general clumsiness. Psychiatric presentations could be with symptoms of incipient dementia, but even more commonly with change of disposition, emotional disturbance and paranoia. Families with predominant psychiatric symptoms have been reported (Lovestone et al. Most observers agree that psychiatric changes are often present for some considerable time before chorea or intellectual impairment develops. A change in personality may be Neurological features the neurological features often go unrecognised at their first appearance. The typical early choreic movements consist of randomly distributed and irregularly timed muscle jerks, brief in duration and unpredictable in their appearance. Early movements may be no more than the twitching of a finger, or fleeting facial grimaces that pass for mannerisms. The movements usually start in the muscles of the face, hands or shoulders, or are first manifest in subtle changes of gait. For some time the patient may conceal the involuntary nature of the movements by exploiting them to perform some habitual activity such as smoothing the hair or the clothes. With worsening of the disease the pathological nature of the motor disturbance becomes abundantly obvious. The movements are abrupt, jerky, rapid and repetitive but variable from one muscle group to another. The face shows fleeting changes of expression and constant writhing contortions that bestow a grotesque appearance. The fingers twitch, the arms develop athetoid twisting movements and the proximal musculature is affected with shrugging of the shoulders. However, it is characteristic that even late into the disease the movements largely cease during sleep. The gait is sometimes affected by a curious dance-like ataxia that results from the variable choreic influences on the lower limbs: the weight tends to be carried on the heels while the toes are dorsiflexed, and often a foot will remain suspended off the ground for longer than usual. Eventually the patient walks with a wide base, exaggerated lumbar lordosis, wide arm abduction and zig-zag progression due to lurching of the trunk. Progress is interrupted by pauses and even backward steps, and accompanied by a great increase in choreiform movements of the upper limbs. Involvement of the diaphragm and bulbar muscles may lead to jerky breathing, explosive or staccato speech, dysphagia and difficulty in protruding the tongue.
Looking after people with dementia is difficult and looking after people with behavioural disturbance is harder heart attack vol 1 pt 15 buy cheapest furosemide. Sleep disturbance is particularly difficult for carers: it saps energy and is difficult to manage pulse pressure 53 40mg furosemide. There is some evidence that those with psychotic features tend to decline quicker than those without (Drevets & Rubin 1989; Rosen & Zubenko 1991) but are not at greater risk of early mortality (Stern et al. There is no consistency in the literature regarding whether psychoses occur most frequently early or late in the condition but there is an inherent confounder in these studies in that it is easier to ascertain psychosis in the early stages where individuals retain language and can make their experiences understood. Psychosis must be a supremely distressing symptom and it is no surprise to find a number of studies showing an association between psychosis and aggression (Deutsch et al. Delusions are the most common symptom and have a distinct flavour distinguishing them from the delusions of mood disorders or schizophrenia. Most common of all are delusions of theft, sometimes accompanied by a relatively complex explanation as to how the object was stolen. Prevalence (%) (approximate) Symptoms Psychotic Hallucinations Paranoid or delusional ideation Misidentification syndromes Mood Depression Mania Anxiety Activity Apathy Agitation Wandering Aggression Circadian rhythm disturbance Example references 2030 2030 1020 1025 <5 >50 1540 3070 1540 2040 3080 Teri et al. When her daughter visited she was treated with suspicion and at times shouted at and on one occasion had a stick raised to her. Needless to say this was distressing to the daughter and made caring for the patient difficult. Eventually the patient confessed to a community nurse that she believed that the daughter was systematically robbing her of her life savings and as evidence demonstrated that she did not know where her purse was. She claimed her daughter had taken it and when it was pointed out that the daughter had not been allowed to visit said the daughter came into the flat at night, climbing through the windows. In the case above the primary event appeared to be mislaying a purse, which led to the secondary delusion of theft, a belief which was held with unusual conviction, was not amenable to reason and was manifestly erroneous (Sims 1988). Visual hallucinations may be complex, often of small animals or people and may be unaccompanied by fear or anxiety. Typically they are silent and sometimes the person with dementia has some insight, recognising that these experiences are in some way different from normal perceptions. One very common manifestation of a misidentification syndrome is where family members are mistaken for one another. It can be difficult to distinguish a true misidentification event from a word-finding difficulty for names. Surprisingly, perhaps, as it is the exception rather than the rule, it is genetic studies that have been most replicable. Thus sib-pairs have been shown to share non-cognitive features more often than expected by chance alone in replicated studies (Tunstall et al. Depression is a common non-cognitive feature, can be a precursor or prodromal syndrome (Schweitzer et al. Of these, perhaps the most important is the first in that it is treatable and yet too often not treated. Major depressive episodes occur in approximately 10% or less of patients but minor depressive episodes occur in up to 30% and perhaps a majority of patients suffer some symptoms of depression (Reifler et al. Common environmental factors cannot be excluded but common genetic factors seem to have been. In late life, fluid intelligence, or problem-solving ability, is almost certainly affected (Denney 1985), although learnt skills and crystallised intelligence is not. Memory tasks involving processing of information are affected whereas the tasks that minimise working memory are relatively unaffected (Babcock & Salthouse 1990). Older people encode information poorly and are less effective in utilising strategies and instruction for retrieval (Verhaeghen & Marcoen 1996; Nyberg et al. All this amounts to some loss of effective memory together with a slowing of processing speed and changes in spatial cognition and language when they involve processing functions. Thus it has been argued that cerebral atrophy and its attendant histological changes are so common in later life that the structural state of the brain, as at present revealed, is of doubtful significance in relation to the disease process (Rothschild 1956).