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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
Treatment of mild metal fume fever consists of bedrest, keeping the patient well hydrated, and symptomatic therapy (e.g. aspirin for headaches) as indicated. In the case of non-allergic acute lung injury, standard or recommended approaches to treatment have not been defined.
The consumption of large quantities of cow's milk, either before or immediately after exposure is a traditional remedy. However, the United Kingdom Health and Safety Executive challenges this advice, warning, "Don’t believe the stories about drinking milk before welding. It does not prevent you getting metal fume fever."
Prevention of metal fume fever in workers who are at risk (such as welders) involves avoidance of direct contact with potentially toxic fumes, improved engineering controls (exhaust ventilation systems), personal protective equipment (respirators), and education of workers regarding the features of the syndrome itself and proactive measures to prevent its development.
In some cases, the product's design may be changed so as to eliminate the use of risky metals. NiCd rechargeable batteries are being replaced by NiMH. These contain other toxic metals, such as chromium, vanadium and cerium. Cadmium is often replaced by other metals. Zinc or nickel plating can be used instead of cadmium plating, and brazing filler alloys now rarely contain cadmium.
The mainstays of treatment are removal from the source of lead and, for people who have significantly high blood lead levels or who have symptoms of poisoning, chelation therapy. Treatment of iron, calcium, and zinc deficiencies, which are associated with increased lead absorption, is another part of treatment for lead poisoning. When lead-containing materials are present in the gastrointestinal tract (as evidenced by abdominal X-rays), whole bowel irrigation, cathartics, endoscopy, or even surgical removal may be used to eliminate it from the gut and prevent further exposure. Lead-containing bullets and shrapnel may also present a threat of further exposure and may need to be surgically removed if they are in or near fluid-filled or synovial spaces. If lead encephalopathy is present, anticonvulsants may be given to control seizures, and treatments to control swelling of the brain include corticosteroids and mannitol. Treatment of organic lead poisoning involves removing the lead compound from the skin, preventing further exposure, treating seizures, and possibly chelation therapy for people with high blood lead concentrations.
A chelating agent is a molecule with at least two negatively charged groups that allow it to form complexes with metal ions with multiple positive charges, such as lead. The chelate that is thus formed is nontoxic and can be excreted in the urine, initially at up to 50 times the normal rate. The chelating agents used for treatment of lead poisoning are edetate disodium calcium (CaNaEDTA), dimercaprol (BAL), which are injected, and succimer and d-penicillamine, which are administered orally.
Chelation therapy is used in cases of acute lead poisoning, severe poisoning, and encephalopathy, and is considered for people with blood lead levels above 25 µg/dL. While the use of chelation for people with symptoms of lead poisoning is widely supported, use in asymptomatic people with high blood lead levels is more controversial. Chelation therapy is of limited value for cases of chronic exposure to low levels of lead. Chelation therapy is usually stopped when symptoms resolve or when blood lead levels return to premorbid levels. When lead exposure has taken place over a long period, blood lead levels may rise after chelation is stopped because lead is leached into blood from stores in the bone; thus repeated treatments are often necessary.
People receiving dimercaprol need to be assessed for peanut allergies since the commercial formulation contains peanut oil. Calcium EDTA is also effective if administered four hours after the administration of dimercaprol. Administering dimercaprol, DMSA (Succimer), or DMPS prior to calcium EDTA is necessary to prevent the redistribution of lead into the central nervous system. Dimercaprol used alone may also redistribute lead to the brain and testes. An adverse side effect of calcium EDTA is renal toxicity. Succimer (DMSA) is the preferred agent in mild to moderate lead poisoning cases. This may be the case in instances where children have a blood lead level >25μg/dL. The most reported adverse side effect for succimer is gastrointestinal disturbances. It is also important to note that chelation therapy only lowers blood lead levels and may not prevent the lead-induced cognitive problems associated with lower lead levels in tissue. This may be because of the inability of these agents to remove sufficient amounts of lead from tissue or inability to reverse preexisting damage.
Chelating agents can have adverse effects; for example, chelation therapy can lower the body's levels of necessary nutrients like zinc. Chelating agents taken orally can increase the body's absorption of lead through the intestine.
Chelation challenge, also known as provocation testing, is used to indicate an elevated and mobilizable body burden of heavy metals including lead. This testing involves collecting urine before and after administering a one-off dose of chelating agent to mobilize heavy metals into the urine. Then urine is analyzed by a laboratory for levels of heavy metals; from this analysis overall body burden is inferred. Chelation challenge mainly measures the burden of lead in soft tissues, though whether it accurately reflects long-term exposure or the amount of lead stored in bone remains controversial. Although the technique has been used to determine whether chelation therapy is indicated and to diagnose heavy metal exposure, some evidence does not support these uses as blood levels after chelation are not comparable to the reference range typically used to diagnose heavy metal poisoning. The single chelation dose could also redistribute the heavy metals to more sensitive areas such as central nervous system tissue.
In most cases, lead poisoning is preventable by avoiding exposure to lead. Prevention strategies can be divided into individual (measures taken by a family), preventive medicine (identifying and intervening with high-risk individuals), and public health (reducing risk on a population level).
Recommended steps by individuals to reduce the blood lead levels of children include increasing their frequency of hand washing and their intake of calcium and iron, discouraging them from putting their hands to their mouths, vacuuming frequently, and eliminating the presence of lead-containing objects such as blinds and jewellery in the house. In houses with lead pipes or plumbing solder, these can be replaced. Less permanent but cheaper methods include running water in the morning to flush out the most contaminated water, or adjusting the water's chemistry to prevent corrosion of pipes. Lead testing kits are commercially available for detecting the presence of lead in the household. As hot water is more likely than cold water to contain higher amounts of lead, use only cold water from the tap for drinking, cooking, and for making baby formula. Since most of the lead in household water usually comes from plumbing in the house and not from the local water supply, using cold water can avoid lead exposure. Measures such as dust control and household education do not appear to be effective in changing children's blood levels.
Screening is an important method in preventive medicine strategies. Screening programs exist to test the blood of children at high risk for lead exposure, such as those who live near lead-related industries.
Prevention measures also exist on national and municipal levels. Recommendations by health professionals for lowering childhood exposures include banning the use of lead where it is not essential and strengthening regulations that limit the amount of lead in soil, water, air, household dust, and products. Regulations exist to limit the amount of lead in paint; for example, a 1978 law in the US restricted the lead in paint for residences, furniture, and toys to 0.06% or less. In October 2008, the US Environmental Protection Agency reduced the allowable lead level by a factor of ten to 0.15 micrograms per cubic meter of air, giving states five years to comply with the standards. The European Union's Restriction of Hazardous Substances Directive limits amounts of lead and other toxic substances in electronics and electrical equipment. In some places, remediation programs exist to reduce the presence of lead when it is found to be high, for example in drinking water. As a more radical solution, entire towns located near former lead mines have been "closed" by the government, and the population resettled elsewhere, as was the case with Picher, Oklahoma in 2009.
Too much copper in water may damage marine and freshwater organisms such as fish and molluscs. Fish species vary in their sensitivity to copper, with the LD50 for 96-h exposure to copper sulphate reported to be in the order of 58 mg per litre for Tilapia ("Oreochromis niloticus") and 70 mg per litre for catfish ("Clarias gariepinus") The chronic effect of sublethal concentrations of copper on fish and other creatures is damage to gills, liver, kidneys and the nervous system. It also interferes with the sense of smell in fish, thus preventing them from choosing good mates or finding their way to mating areas.
Copper-based paint is a common marine antifouling agent. In the United States, copper-based paint replaced tributyltin, which was banned due to its toxicity, as a way for boats to control organic growth on their hulls. In 2011, Washington state became the first U.S. state to ban the use of copper-based paint for boating, although it only applied to recreational boats. California has also pursued initiatives to reduce the effect of copper leaching, with the U.S. EPA pursuing research.
In cases of suspected copper poisoning, penicillamine is the drug of choice, and dimercaprol, a heavy metal chelating agent, is often administered. Vinegar is not recommended to be given, as it assists in solubilizing insoluble copper salts. The inflammatory symptoms are to be treated on general principles, as are the nervous ones.
There is some evidence that alpha-lipoic acid (ALA) may work as a milder chelator of tissue-bound copper. Alpha lipoic acid is also being researched for chelating other heavy metals, such as mercury.
Erysipelas is an acute infection typically with a skin rash, usually on any of the legs and toes, face, arms, and fingers. It is an infection of the upper dermis and superficial lymphatics, usually caused by beta-hemolytic group A "Streptococcus" bacteria on scratches or otherwise infected areas. Erysipelas is more superficial than cellulitis, and is typically more raised and demarcated. The term is from Greek ἐρυσίπελας, meaning "red skin".
Depending on the severity, treatment involves either oral or intravenous antibiotics, using penicillins, clindamycin, or erythromycin. While illness symptoms resolve in a day or two, the skin may take weeks to return to normal.
Because of the risk of reinfection, prophylactic antibiotics are sometimes used after resolution of the initial condition. However, this approach does not always stop reinfection.
Trench warfare protected the bodies but left the heads exposed. Ironically, the introduction of the steel helmet in 1915 made head shots more 'survivable', but this reduction of mortality meant a mutilated life for thousands.
At the start of the war those wounded to the head were generally not considered able to survive and they would not usually be 'helped first'. This changed in the course of the war, as progress was made in medical practices like oral and maxillofacial surgery and most notably in the new field of plastic surgery. Surgeons conducted experiments with bone, cartilage and tissue transplants and the likes of Hippolyte Morestin, Harold Gillies and Léon Dufourmentel made enormous advances. Because of the experimental character of this surgery some chose to remain as they were and others could just not be helped yet. Some of the latter were helped by all kinds of new prosthetics to make them look more or less 'normal'.
Gueules cassées (broken faces) is a French expression for facially disfigured servicemen which originated in World War I. Colonel Yves Picot is said to have coined the term when he was refused passing a checkpoint to a party.
Drug resistance poses a growing problem in 21st-century malaria treatment. Resistance is now common against all classes of antimalarial drugs apart from artemisinins. Treatment of resistant strains became increasingly dependent on this class of drugs. The cost of artemisinins limits their use in the developing world. Malaria strains found on the Cambodia–Thailand border are resistant to combination therapies that include artemisinins, and may, therefore, be untreatable. Exposure of the parasite population to artemisinin monotherapies in subtherapeutic doses for over 30 years and the availability of substandard artemisinins likely drove the selection of the resistant phenotype. Resistance to artemisinin has been detected in Cambodia, Myanmar, Thailand, and Vietnam, and there has been emerging resistance in Laos.
When properly treated, people with malaria can usually expect a complete recovery. However, severe malaria can progress extremely rapidly and cause death within hours or days. In the most severe cases of the disease, fatality rates can reach 20%, even with intensive care and treatment. Over the longer term, developmental impairments have been documented in children who have suffered episodes of severe malaria. Chronic infection without severe disease can occur in an immune-deficiency syndrome associated with a decreased responsiveness to "Salmonella" bacteria and the Epstein–Barr virus.
During childhood, malaria causes anemia during a period of rapid brain development, and also direct brain damage resulting from cerebral malaria. Some survivors of cerebral malaria have an increased risk of neurological and cognitive deficits, behavioural disorders, and epilepsy. Malaria prophylaxis was shown to improve cognitive function and school performance in clinical trials when compared to placebo groups.
Chimney sweeps' carcinoma is a squamous cell carcinoma of the skin of the scrotum. Warts caused by the irritation from soot particles, if not excised, developed into a scrotal cancer. This then invaded the dartos, enlarged the testicle, and proceeded up the spermatic cord into the abdomen where it proved fatal.
Chimney sweep's cancer, also called soot wart, is a squamous cell carcinoma of the skin of the scrotum. It has the distinction of being the first reported form of occupational cancer, and was initially identified by Percivall Pott in 1775. It was initially noticed as being prevalent amongst chimney sweeps.
As stated above, sufferers of focal dystonia have virtually no possibility of recovery from embouchure collapse. Sufferers of embouchure overuse, however, have been known to recover. The simplest way of doing so is to refrain from playing for an extended period of time, possibly years, before attempting to play again. The exact amount of time needed and whether or not the player will have to completely relearn the use of the embouchure is a largely subjective issue and depends on the individual.
Philip Smith, former principal trumpeter of the New York Philharmonic, has suffered from focal dystonia, which was part of the reason for his retirement. However, Smith had managed to gradually redevelop control over his embouchure and is now playing again, as well as teaching trumpet in the University of Georgia.
Hemoglobin Hopkins-2 (Hb Hop-2) is a mutation of the protein hemoglobin, which is responsible for the transportation of oxygen through the blood from the lungs to the musculature of the body in vertebrates. Generally, the mutation causes two abnormal α chains in the protein's structure. Within the chains, the mutation is the result of hemoglobin's histidine amino acid being replaced with aspartic acid in the protein's genetic sequence. This amino acid structure change occurs at residue 112. Additionally, within one of the mutated alpha chains, there are substitutes at 114 and 118, two points on the amino acid chain. This mutation can cause sickle cell anemia.
Following the initial discovery of hemoglobin, two researchers working at Johns Hopkins Hospital in the mid-twentieth century, Ernest W. Smith and J.V. Torbert, discovered the Hopkins-2 mutation of hemoglobin. Work by Harvey A. Itano and Elizabeth A. Robinson in 1960 confirmed Smith's and Torbert's finding and emphasized the importance of the alpha loci in the mutation. Later in the twentieth century, Samuel Charache, another Hopkins affiliated scientist and doctor, studied the physiological impacts of the variant on health. His findings suggest that the variant plays no effect clinically.
Cheilitis is inflammation of the lips. This inflammation may include the perioral skin (the skin around the mouth), the vermilion border, and/or the labial mucosa. The skin and the vermilion border are more commonly involved, as the mucosa is less affected by inflammatory and allergic reactions.
It is a general term, and there are many recognized types and different causes. Cheilitis can be either acute or chronic. Most cheilitis is caused by exogenous factors such as dryness (chapping) and acute sun exposure. Patch testing may identify allergens that cause cheilitis.
Embouchure collapse caused by focal dystonia can be diagnosed medically; embouchure collapse caused by embouchure overuse, however, is generally speaking not considered to be a specifically medical issue. A difficulty in diagnosis is that when a brass player describes the symptoms to a doctor or dentist (as is often the case), the medical practitioner does not fully understand what the patient means. This is because brass players learn their embouchure by "feel," and therefore words have a limited ability to describe embouchure problems, especially if the person listening to the description is not a brass player and has a limited knowledge of the embouchure.
Also, in less severe cases, the player may only be able to feel what is wrong while playing. Many players with an embouchure problem will, once they have realized that it is more than a simple case of tired lips, wish to refrain from playing. The fact that around 24 muscles are employed in forming a brass embouchure, and that each will change slightly as a player struggles to play when experiencing embouchure problems, mean that what players describe as being wrong will have not only worsened their condition when they play, but will be different each time they do so.
In the severest cases, the pain caused by embouchure overuse can be felt even when not playing; in some cases, other symptoms will manifest, such as loss of tissue and damaged nerves. This, however, occurs only in the rarest and most extreme circumstances and usually signals the end of the player's career.
Also termed "lip dermatitis", eczematous cheilitis is a diverse group of disorders which often have an unknown cause. Chronic eczematous reactions account for the majority of chronic cheilitis cases.
It is divided into endogenous (due to an inherent characteristic of the individual), and exogenous (where it is caused by an external agent). The main cause of endogenous eczematous cheilitis is atopic cheilitis (atopic dermatitis), and the main causes of exogenous eczematous cheilitis is irritant contact cheilitis ("e.g.", caused by a lip-licking habit) and allergic contact cheilitis. The latter is characterized by a dryness, fissuring, edema, and crusting. It affects females more commonly than males, in a ratio of about 9:1.
The most common causes of allergic contact cheilitis is lip cosmetics, including lipsticks and lip balm, followed by toothpastes. A lipstick allergy can be difficult to diagnose in some cases as it is possible that cheilitis can develop without the person even wearing lipstick. Instead, small exposure such as kissing someone who is wearing lipstick is enough to cause the condition.
Allergy to Balsam of Peru can manifest as cheilitis. Allergies to metal, wood, or other components can cause cheilitis reactions in musicians, especially players of woodwind and brass instruments, "e.g.", the so-called "clarinetist's cheilitis", or "flutist's cheilitis". "Pigmented contact cheilitis" is one type of allergic cheilitis in which a brown-black discoloration of the lips develops. Patch testing is used to identify the substance triggering allergic contact cheilitis.
There was a study on a three year old that was a carrier of the hemoglobin variant of Hopkins-2. The child had mild anemia and reticulocytosis, which is commonly seen in anemia. There were, however, no sickled cells found in the blood and they had no symptoms relating to sickle cell. There was also a reduced mean corpuscular volume (MCV), which is the average volume of red blood cell count.
During a period of 13 years (1980–1993) for which admissions to the Kfar Shaul Mental Health Centre in Jerusalem were analysed, it was reported that 1,200 tourists with severe, Jerusalem-themed mental problems were referred to this clinic. Of these, 470 were admitted to hospital. On average, 100 such tourists have been seen annually, 40 of them requiring admission to hospital. About three and a half million tourists visit Jerusalem each year. Kalian and Witztum note that as a proportion of the total numbers of tourists visiting the city, this is not significantly different from any other city.
Jerusalem syndrome is a group of mental phenomena involving the presence of either religiously themed obsessive ideas, delusions or other psychosis-like experiences that are triggered by a visit to the city of Jerusalem. It is not endemic to one single religion or denomination but has affected Jews, Christians, and Muslims of many different backgrounds.
The best known, although not the most prevalent, manifestation of Jerusalem syndrome is the phenomenon whereby a person who seems previously balanced and devoid of any signs of psychopathology becomes psychotic after arriving in Jerusalem. The psychosis is characterised by an intense religious theme and typically resolves to full recovery after a few weeks or after being removed from the area. The religious focus of Jerusalem syndrome distinguishes it from other phenomena, such as Stendhal syndrome in Florence or Paris syndrome for Japanese tourists.
In a 2000 article in the "British Journal of Psychiatry", Bar-El et al. claim to have identified and described a specific syndrome which emerges in tourists with no previous psychiatric history. However, this claim has been disputed by M. Kalian and E. Witztum. Kalian and Witztum stressed that nearly all of the tourists who demonstrated the described behaviours were mentally ill prior to their arrival in Jerusalem. They further noted that, of the small proportion of tourists alleged to have exhibited spontaneous psychosis after arrival in Jerusalem, Bar-El et al. had presented no evidence that the tourists had been well prior to their arrival in the city. Jerusalem syndrome is not listed or mentioned in the DSM nor in the ICD.
Juche (; ; ), usually left untranslated, or translated as "self-reliance", is the official state ideology of North Korea, described by the government as Kim Il-sung's "original, brilliant and revolutionary contribution to national and international thought". It postulates that "man is the master of his destiny", that the North Korean masses are to act as the "masters of the revolution and construction", and that by becoming self-reliant and strong a nation can achieve true socialism.
Kim Il-sung (1912–1994) developed the ideology, originally viewed as a variant of Marxism–Leninism until it became distinctly "Korean" in character, whilst incorporating the historical materialist ideas of Marxism–Leninism and strongly emphasising the individual, the nation state and its sovereignty. Consequently, "Juche" was adopted into a set of principles that the North Korean government has used to justify its policy decisions from the 1950s onwards. Such principles include moving the nation towards claimed ""jaju"" (independence), through the construction of ""jarip"" (national economy) and an emphasis upon ""jawi"" (self-defence), in order to establish socialism.
The Practice is firmly rooted in the ideals of sustainability through agricultural independence and a lack of dependency.
The "Juche" ideology has been criticized by many scholars and observers as a mechanism for sustaining the totalitarian rule of the North Korean regime, and justifying the country's heavy-handed isolationism and oppression of the North Korean people. It has also been described as a form of Korean ethnic nationalism, but one which promotes the Kim family as the saviours of the "Korean Race" and acts as a foundation of the subsequent personality cult surrounding them.
Samuel Taylor Coleridge (21 October 1772–25 July 1834) was an English poet, critic, and philosopher who was, along with his friend William Wordsworth, one of the founders of the Romantic Movement in England and one of the Lake Poets. He wrote the poems "The Rime of the Ancient Mariner" and "Kubla Khan", as well as the prose "Biographia Literaria".
Coleridge was widely known to have been a regular user of opium as a relaxant, analgesic, antidepressant, and treatment for numerous health concerns. "Kubla Khan" was apparently written under the drug's influence, but the degree to which he used the drug as a creative enhancement is not clear. Although Coleridge largely kept his addiction as hidden as possible from those close to him, it became public knowledge with the 1822 publication of "Confessions of an English Opium Eater" by his close friend Thomas de Quincey. The "Confessions" painted a rather negative picture of Coleridge and his reputation suffered accordingly.
Where Coleridge first developed his opium habit is an issue of some scholarly dispute but it clearly dates from a fairly youthful period in his life. Coleridge’s own explanation is clearly laid out in a letter to Joseph Cottle;
However, most scholars agree that Coleridge had resorted to the use of Laudanum (the tincture form of opium) before this date, particularly during times of nervousness and stress. Because Laudanum was widely available and widely used as an analgesic as well as a general sedative, many people were given the drug for all sorts of medical and nervous complaints. Coleridge was probably given the drug numerous times in his youth during several bouts of rheumatic illness. Small medicinal dosages seldom lead to full-blown addiction but for Coleridge, who experienced the painful return of the symptoms many times in his life, it surely introduced him to the use of the drug much earlier than his story to Cottle admits.
Regardless of when and where Coleridge’s opium addiction began, it is clear that the more reliant on the drug he became, the more his work suffered, the less he was able to focus and concentrate, and the more strained his relations became. In fact, it is arguable that any analysis of Coleridge’s life must be done against the constant background of opium usage. But as important as the issue of opium is in Coleridge’s life, it is never a straightforward issue because he often hid it from public and familial view and at other times he exaggerated its importance to his work. In the 1816 publication of his major ‘opium’ poems Coleridge purposely drew a connection between his creative work and his opium usage. Desperate for some financial success with his poetry, Coleridge intentionally attempted to portray himself as a dreamy opium eater because he, perhaps rightly, believed that it would draw a morbid fascination to his work. Opium played an interesting role in the public image of Romantic literature. There was, for a long time, a kind of cult glamorization of the drug and a morose allure to stories of its usage for respectable members of the bourgeoisie who were titillated by such taboo subjects. It was with this in mind that Coleridge generated an image of himself as dreamy poet who created drug induced fantasies.
This dreamy image of himself began even before he was widely known to have been addicted to opium. In one of a series of biographical letters written to his friend Thomas Poole, Coleridge painted this picture of himself, a picture that would always endure. Coleridge writes:
This slothful image was one that endured even with some of Coleridge’s close friends and may have been consciously created by Coleridge in the earlier part of his career in order to draw attention away from his addiction. It was only later that Coleridge perceived an advantage to drawing attention not to himself as simply a slothful scholar but a dreamy opium eater.
The most popular story that connects Coleridge’s work with his opium usage was told by Coleridge in his well-known preface to the poem Kubla Khan. Coleridge wrote:
The sleep of this story is said by Coleridge to be a sleep of opium, and Kubla Khan may be read as an early poetic description of this drug experience. The fact that the poem is generally regarded as one of Coleridge's best is one of the reasons for the continuing interest and debate about the role that opium may have played in his creative output, and in Romanticism in general.
Coleridge, in his lucid moments, understood the problems with which he struggled better than most. In an 1814 letter to his friend John Morgan, Coleridge wrote about his difficulties.
In some respects, Coleridge's life bears a resemblance to that of a modern opiate addict. Unfortunately, as much as Coleridge had some grasp of his addictions and its results, as well as an unusually sharp sense of how this addiction might be treated, many of his closest friends and peers did not understand. The people who might have served him best, like Southey and Wordsworth, were far too willing to maintain his image as slothful and selfish; this despite the professional help that he constantly bestowed upon them. Men like Robert Southey, naturally conservative in outlook were not forward looking enough to comprehend the possibility of Coleridge’s addiction being a largely physical dependence, despite the fact that Coleridge himself, as well as a growing number of professionals like his friend Gillman, were aware of the physical aspect of drug reliance. On more than one occasion Coleridge pointed to the fact that physical restraint might eventually lead to a cure, and on several occasions under the treatment of Dr. Gillman, he was led thus to the edge of freedom from the drug on which he had formed such a dependence. Southey wrote from the position of moral indignation and explicitly denied the physical aspect of the drug issue. Southey wrote to Cottle:
Before prescribing medication for these conditions which often resolve spontaneously, recommendations have pointed to improved skin hygiene, good hydration via fluids, good nutrition, and installation of padded bed rails with use of proper mattresses. Pharmacological treatments include the typical neuroleptic agents such as fluphenazine, pimozide, haloperidol and perphenazine which block dopamine receptors; these are the first line of treatment for hemiballismus. Quetiapine, sulpiride and olanzapine, the atypical neuroleptic agents, are less likely to yield drug-induced parkinsonism and tardive dyskinesia. Tetrabenazine works by depleting presynaptic dopamine and blocking postsynaptic dopamine receptors, while reserpine depletes the presynaptic catecholamine and serotonin stores; both of these drugs treat hemiballismus successfully but may cause depression, hypotension and parkinsonism. Sodium valproate and clonazepam have been successful in a limited number of cases. Stereotactic ventral intermediate thalamotomy and use of a thalamic stimulator have been shown to be effective in treating these conditions.