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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
Clinical vampirism, more commonly called Renfield's syndrome or Renfield syndrome, is an obsession with drinking blood. The earliest formal presentation of clinical vampirism to appear in the psychiatric literature, with the psychoanalytic interpretation of two cases, was contributed by Richard L. Vanden Bergh and John F. Kelley in 1964. As the authors point out, brief and sporadic reports of blood-drinking behaviors associated with sexual pleasure have appeared in the psychiatric literature at least since 1892 with the work of Austrian forensic psychiatrist Richard von Krafft-Ebing. Many medical publications concerning clinical vampirism can be found in the literature of forensic psychiatry, with the unusual behavior reported as one of many aspects of extraordinary violent crimes. The behavior has never gained official recognition by the psychiatric profession and is not found in any edition of the "International Classification of Diseases" or the "Diagnostic and Statistical Manual of Mental Disorders".
"Species dysphoria" is informally used mainly in psychological literature to compare the experiences of some individuals to those in the transgender community. Otherkin and therian communities have also used it to describe their experiences.
In a 2008 study by Gerbasi "et al.", 46% of people surveyed who identified as being in the furry fandom, (usually defined as a person who enjoys anthropomorphic animals, occasionally to an almost obsessive degree), answered "yes" to the question "Do you consider yourself to be less than 100% human?" and 41% answered "yes" to the question "If you could become 0% human, would you?" Questions that Gerbasi states as being deliberately designed to draw parallels with gender dysphoria, specifying "a persistent feeling of discomfort" about the human body and the feeling that the person was the "non-human species trapped in a human body", were answered "yes" by 24% and 29% of respondents, respectively. Likewise, these studies support the fact that the therianthropic, otherkin and furry communities are very similar in nature and are often interconnected.
As described by those who experience it, species dysphoria may include sensations of supernumerary phantom limbs associated with the species, such as phantom wings or claws. Species dysphoria involves feelings of being an animal or other creatures "trapped in" a human body and so, is considered different from the traditional definition of clinical lycanthropy, in which the patient believes they have actually been transformed into an animal or have the ability to physically shapeshift. However, some cases that have been labeled as "clinical lycanthropy" actually seem to be cases of species dysphoria, involving persons who have no delusion of transformation but instead have feelings of being in some way a non-human animal, while still acknowledging they possess a human form. Keck "et al." propose a redefinition for clinical lycanthropy that covers species dysphoric behaviours observed in several patients, including verbal reports, "during intervals of lucidity or retrospectively, that he or she was a particular animal" and behaving "in the manner of a particular animal, i.e. howling, growling, crawling on all fours". Keck "et al." describe one patient as a depressed individual who "had always suspected he was a cat" and "laments his lack of fur, stripes and a tail". Except for the persistent feeling of being feline, the patient's "thought processes and perception" were "usually logical".
In rare cases, individuals may believe that other people have transformed into animals. This has been termed "lycanthropic intermetamorphosis" and "lycanthropy spectrum". A 2009 study reported that, after the consumption of the drug MDMA (Ecstasy), a man displayed symptoms of paranoid psychosis by claiming that his relatives had changed into various animals such as a boar, a donkey and a horse.
Clinical lycanthropy is a rare condition and is largely considered to be an idiosyncratic expression of a psychotic episode caused by another condition such as schizophrenia, bipolar disorder or clinical depression.
However, there are suggestions that certain neurological conditions and cultural influences may result in the expression of the human-animal transformation theme that defines the condition.
Species dysphoria is the experience of dysphoria, sometimes including clinical lycanthropy (delusion or hallucination of one's self as an animal) and dysmorphia (excessive concern over one's body image), associated with the feeling that one's body is of the wrong species. Earls and Lalumière (2009) describe it as "the sense of being in the wrong (species) body... a desire to be an animal". Outside of psychological literature, the term is common within the otherkin and therian communities. The phenomenon is sometimes experienced in the context of sexual arousal to the image of one's self as an animal.
The syndrome (also Renfield syndrome) is named after Dracula's human zoophagous follower, R. M. Renfield, in the 1897 novel by Bram Stoker. According to an interview conducted by psychology professor Katherine Ramsland with clinical psychologist Richard Noll, who coined the eponymous term in a 1992 book, he invented the term and its purported diagnostic criteria as a whimsical parody of the "new DSM-speak" of the psychiatry of the 1980s. In a public lecture hosted by Penn State University's Institute for the Arts and Humanities on 7 October 2013, Noll traced the 20-year trajectory of his unintentionally created "monster" from the moment of its creation as a parody of DSM mental disorders to the cultural popularity of Renfield's syndrome today.
After Noll's book appeared in 1992 clinical vampirism has usually been referred to as Renfield's syndrome. In an NBC pre-Halloween special hosted by actor Peter Graves entitled "The Unexplained: Witches, Werewolves and Vampires" that aired on 23 October 1994 (and is available on YouTube, with the 34:11 mark beginning the segment), pages from Noll's book were shown on camera as Canadian psychologist Leonard George summarized Renfield's syndrome for a wide television audience.
Characters suffering from Renfield's Syndrome have appeared on television. The first appeared in a 2005 episode of "" titled "Committed" (Season 5, Episode 21). It was also mentioned in 2009 in episode 7, season 5 of "Criminal Minds" entitled "The Performer".
In 2010 an 11-episode Canadian television series, "The Renfield Syndrome", was filmed in Vancouver, B.C., but does not seem to have been aired.
On 15 August 2012 Renfield's syndrome was the subject of a video segment on "The Huffington Post" by Cara Santa Maria which again relied heavily on Noll's work and a recent scholarly article on the (pseudo-)syndrome published in the "Journal of the History of the Neurosciences".
In addition to references to Renfield's syndrome in the psychiatric literature and mass media, the horror writer Chelsea Quinn Yarbro published a story entitled "Renfield's Syndrome" in July 2002, which was then reprinted in an anthology that appeared the following year. It is also the title of a novel by J.A. Saare.
The twenty-year evolution of a farcical 3-page book section that shot through the mass media and then—uncritically—into the pages of a peer-reviewed scholarly journal should serve as a cautionary tale about the purported validity of other "mental disorders." Philosopher of science Ian Hacking refers to this process as "making up people" and critiques medical and psychiatric elites for the untoward effects of their "dynamic nominalism" on individual lives. Such arbitrary categories create new natural "kinds" of people (e.g., perverts, multiple personalities and so on) that serve larger political, cultural and moral purposes and change with historical contingencies.
According to the case history reports in the older psychiatric literature that formed the basis of Noll's parody, the condition starts with a key event in childhood that causes the experience of blood injury or the ingestion of blood to be exciting. After puberty, the excitement is experienced as sexual arousal. Throughout adolescence and adulthood, blood, its presence, and its consumption can also stimulate a sense of power and control. Noll speculated that Renfield's syndrome begins with autovampirism and then progresses to the consumption of the blood of other creatures.
The usefulness of this diagnostic label remains in question. Very few cases of the syndrome have been described, and the published reports that do exist refer to what has been proposed as Renfield's syndrome through the use of official psychiatric diagnostic categories such as schizophrenia or as a variety of paraphilia.
Involutional melancholia is classically treated with antidepressants and mood elevators.
Electroconvulsive therapy may also be used. Mid-century, there was a consensus that the technique indeed 'yields the best results in the long-lasting depressions of the change of life, the so-called "involutional melancholias", which before this form of treatment was introduced often required years of hospitalization'. The 21st century also records 'an excellent and rapid clinical response found in melancholia of recent onset...in older rather than younger patients' with ECT
Involutional melancholy's 'course was chronic, with agitation, depersonalization and delusions of bodily change and guilt' featuring strongly, but 'without manic features'. Symptoms of fear are also considered to occur, as well as despondency and hypochondriacal delusions. The late onset of the disorder was matched with a prolonged course with poor prognosis and/or deterioration, in the absence of treatment.
Somatic manifestations of MD are distinguished by an extreme diversity and include headaches, back pain, abdominal pain etc. Pathological behaviour masking depression may take the form of compulsive gambling, compulsive work, changes in arousal or orgasmic function, decreased libido or, on the contrary, impulsive sexual behaviour, alcoholism, drug addiction and more.
Masked depression (MD) was a proposed form of atypical depression in which somatic symptoms or behavioural disturbances dominate the clinical picture and disguise the underlying affective disorder. The concept is not currently supported by the mental health profession.
Heterogeneous medical condition in medicine are those medical conditions which have several etiologies, like hepatitis or diabetes. Medical conditions are normally defined pathologically (liver inflammation) or clinically (excessive urination) and not etiologically, and therefore it is normal to have more than one cause for them. The word is used as an opposition to homogeneous, meaning that given a group of patients, the disease is the same for all of them.
When a condition is heterogeneous, it is normally divided in endotypes.
The progression of symptoms varies widely between each case of FXTAS; the onset of symptoms may be gradual, with progression of the disease spanning multiple years or decades. Alternatively, symptoms may progress rapidly.
FXTAS has shown strong age-dependent penetrance, afflicting older permutation carriers with greater prevalence. Male carriers, age 50 and above have a 30% chance of acquiring FXTAS, while male carriers, age 75 and above, have a 75% chance of developing FXTAS. While initially described to affect male carriers, female carriers of the FMR1 gene mutation have also been found to develop FXTAS. However, due to X-inactivation, female carriers are much less likely to develop classic ataxia and tremor signs for FXTAS, instead demonstrating symptoms such as fibromyalgia, thyroid disease, hypertension, and seizures.
The medical management of FXTAS aims to reduce the level of disability and minimize symptoms. Presently, there are many gaps in the research on the management of FXTAS, as the disorder was first described in the literature in 2001. There is no treatment modality aimed at reversing the pathogenesis of FXTAS. However, there are a variety of drug therapies that are being utilized in the management of FXTAS symptoms, although there is a lack of randomized control trials assessing the efficacy these therapies and support is limited to anecdotal evidence. Therefore, many of the treatments are based on what has been helpful in disorders with similar clinical presentations.
There is no cure for FXTAS. Current treatment includes medications for alleviating symptoms of tremor, ataxia, mood changes, anxiety, cognitive decline, dementia, neuropathic pain, or fibromyalgia. Neurological rehabilitation has not been studied for patients with FXTAS but should also be considered as a possible form of therapy. Additionally, occupational and physical therapy may help to improve performance of functional tasks.
An endotype is a subtype of a condition, which is defined by a distinct functional or pathobiological mechanism. This is distinct from a phenotype, which is any observable characteristic or trait of a disease, such as morphology, development, biochemical or physiological properties, or behavior, without any implication of a mechanism. It is envisaged that patients with a specific endotype present themselves within phenotypic clusters of diseases.
One example is asthma, which is considered to be a syndrome, consisting of a series of endotypes. This is related to the concept of disease entity
MCI does not usually interfere with daily life, but around 50 percent of people diagnosed with it go on to develop the far more severe Alzheimer's disease within five years. However, some instances of MCI may simply remain stable over time or even remit.
there are no USFDA-approved medications for the treatment of mild cognitive impairment. Moreover, as of January 2018, there is no high-quality evidence that supports the efficacy of any pharmaceutical drugs or dietary supplements for improving cognitive symptoms in individuals with mild cognitive impairment. A moderate amount of high-quality evidence supports the efficacy of regular physical exercise for improving cognitive symptoms in individuals with MCI. The clinical trials that established the efficacy of exercise therapy for MCI involved twice weekly exercise over a period of six months. A small amount of high-quality evidence supports the efficacy of cognitive training for improving some measures of cognitive function in individuals with mild cognitive impairment. Due to the heterogeneity among studies which assessed the effect of cognitive training in individuals with MCI, there are no particular cognitive training interventions that have been found to provide greater symptomatic benefits for MCI relative to other forms of cognitive training.
The American Academy of Neurology's (AAN) clinical practice guideline on mild cognitive impairment from January 2018 stated that clinicians "should" identify modifiable risk factors in individuals with MCI, assess functional impairments, provide treatment for any behavioral or neuropsychiatric symptoms, and monitor the individual's cognitive status over time. It also stated that medications which cause cognitive impairment "should" be discontinued or avoided if possible. Due to the lack of evidence supporting the efficacy of cholinesterase inhibitors in individuals with MCI, the AAN guideline stated that clinicians who choose to prescribe them for the treatment of MCI "must" inform patients about the lack of evidence supporting this therapy. The guideline also indicated that clinicians "should" recommend that individuals with MCI engage in regular physical exercise for cognitive symptomatic benefits; clinicians "may" also recommend cognitive training, which appears to provide some symptomatic benefit in certain cognitive measures.
As MCI may represent a prodromal state to clinical Alzheimer's disease, treatments proposed for Alzheimer's disease, such as antioxidants and cholinesterase inhibitors, could potentially be useful; however, there is no evidence to support the efficacy of cholinesterase inhibitors for the treatment of mild cognitive impairment. Two drugs used to treat Alzheimer's disease have been assessed for their ability to treat MCI or prevent progression to full Alzheimer's disease. Rivastigmine failed to stop or slow progression to Alzheimer's disease or to improve cognitive function for individuals with mild cognitive impairment; donepezil showed only minor, short-term benefits and was associated with significant side effects.
In a two-year randomized trial of 168 people with MCI given either high-dose vitamins or placebo, vitamins cut the rate of brain shrinkage by up to half. The vitamins were the three B vitamins folic acid, vitamin B6, and vitamin B12, which inhibit production of the amino acid homocysteine. High blood levels of homocysteine are associated with increased risk of cognitive decline, dementia, and cardiovascular disease. A single study from 2012 showed a possible connection between macronutrient intake and development of MCI. It is also suggested that a dietary pattern with relatively high caloric intake from carbohydrates and low caloric intake from fat and proteins may increase the risk of MCI or dementia in elderly persons
Experimental non-pharmacological treatments for MCI include transcranial magnetic stimulation and transcranial direct current stimulation; the efficacy of these interventions for the treatment of MCI has not yet been established.
Hermansky–Pudlak syndrome patients, families, and caregivers are encouraged to join the NIH Rare Lung Diseases Consortium Contact Registry. This is a privacy protected site that provides up-to-date information for individuals interested in the latest scientific news, trials, and treatments related to rare lung diseases.
HPS is one of the rare lung diseases currently being studied by The Rare Lung Diseases Consortium (RLDC). The RLDC is part of the Rare Diseases Clinical Research Network (RDCRN), an initiative of the Office of Rare Diseases Research (ORDR), of the National Center for Advancing Translational Sciences (NCATS). The RLDC is dedicated to developing new diagnostics and therapeutics for patients with rare lung diseases, through collaboration between the NIH, patient organizations and clinical investigators.
The true prevalence of PMS has not been determined. More than 1200 people have been identified worldwide according the Phelan-McDermid Syndrome Foundation. However, it is believed to be underdiagnosed due to inadequate genetic testing and lack of specific clinical features. It is known to occur with equal frequency in males and females. Studies using chromosomal microarray for diagnosis indicate that at least 0.5% of cases of ASD can be explained by mutations or deletions in the "SHANK3" gene. In addition when ASD is associated with ID, "SHANK3" mutations or deletions have been found in up to 2% of individuals.
Since interleukin 1β plays a central role in the pathogenesis of the disease, therapy typically targets this cytokine in the form of monoclonal antibodies (such as canakinumab), binding proteins/traps (such as rilonacept), or interleukin 1 receptor antagonists (such as anakinra). These therapies are generally effective in alleviating symptoms and substantially reducing levels of inflammatory indices. Case reports suggest that thalidomide and the anti-IL-6 receptor antibody tocilizumab may also be effective.
22q13 deletion syndrome (spoken as "twenty-two q one three", see Locus (genetics)) is a genetic disorder caused by deletions or rearrangements on the q terminal end (long arm) of chromosome 22. Any abnormal genetic variation in the q13 region that presents with significant manifestations (phenotype) typical of a terminal deletion may be diagnosed as 22q13 deletion syndrome. 22q13 deletion syndrome is often called Phelan-McDermid syndrome (abbreviated PMS). There is disagreement among researchers as to the exact definition of 22q13 deletion syndrome. The Developmental Synaptopathies Consortium defines PMS as being caused by "SHANK3" mutations, a definition that appears to exclude terminal deletions. The requirement to include "SHANK3" in the definition is supported by many, but not by those who first described 22q13 deletion syndrome.
A prototypical terminal deletion of 22q13 can be uncovered by karyotype analysis, but many terminal and interstitial deletions are too small. The availability of DNA microarray technology for revealing multiple genetic problems simultaneously has been the diagnostic tool of choice. The falling cost for whole exome sequencing and, eventually, whole genome sequencing, may replace DNA microarray technology for candidate evaluation. However, fluorescence in situ hybridization (FISH) tests remain valuable for diagnosing cases of mosaicism (mosaic genetics) and chromosomal rearrangements (e.g., ring chromosome, unbalanced chromosomal translocation). Although early researchers sought a monogenic (single gene genetic disorder) explanation, recent studies have not supported that hypothesis (see Etiology, below).
Singleton Merten Syndrome is an autosomal dominate genetic disorder with variable expression with an onset of symptoms during childhood.
In examining the published studies on opioid-induced hyperalgesia (OIH), Reznikov "et al" criticize the methodologies employed on both humans and animals as being far-removed from the typical regimen and dosages of pain patients in the real world. They also note that some OIH studies were performed on drug addicts in methadone rehabilitation programs, and that such results are very difficult to generalize and apply to medical patients in chronic pain. In contrast, a study of 224 chronic pain patients receiving 'commonly-used' doses of oral opioids, in more typical clinical scenarios, found that the opioid-treated patients actually experienced no difference in pain sensitivity when compared to patients on non-opioid treatments. The authors conclude that opioid-induced hyperalgesia may not be an issue of any significance for normal, medically-treated chronic pain patients at all.
Opioid-induced hyperalgesia has also been criticized as overdiagnosed among chronic pain patients, due to poor differential practice in distinguishing it from the much more common phenomenon of opioid tolerance. The misdiagnosis of common opioid tolerance (OT) as opioid-induced hyperalgesia (OIH) can be problematic as the clinical actions suggested by each condition can be contrary to each other. Patients misdiagnosed with OIH may have their opioid dose mistakenly decreased (in the attempt to counter OIH) at times when it is actually appropriate for their dose to be increased or rotated (as a counter to opioid tolerance).
The suggestion that chronic pain patients who are diagnosed as experiencing opioid-induced hyperalgesia ought to be completely withdrawn from opioid therapy has also been met with criticism. This is not only because of the uncertainties surrounding the diagnosis of OIH in the first place, but because of the viability of rotating the patient between different opioid analgesics over time. Opioid rotation is considered a valid alternative to the reduction or cessation of opioid therapy, and multiple studies demonstrate the rotation of opioids to be a safe and effective protocol.
Kapur–Toriello syndrome is a rare autosomal recessive genetic disorder. The defining feature of Kapur–Toriello syndrome is abnormal morphology of the columella, which extends below the margin of the nares.
In terms of beta-mannosidosis treatment there is none currently, individuals that exhibit muscle weakness or seizures are treated based on the symptoms(since there's no cure)