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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 avoidant personality disorder can employ various techniques, such as social skills training, cognitive therapy, and exposure treatment to gradually increase social contacts, group therapy for practicing social skills, and sometimes drug therapy.
A key issue in treatment is gaining and keeping the patient's trust, since people with avoidant personality disorder will often start to avoid treatment sessions if they distrust the therapist or fear rejection. The primary purpose of both individual therapy and social skills group training is for individuals with avoidant personality disorder to begin challenging their exaggerated negative beliefs about themselves.
Significant improvement in the symptoms of personality disorders is possible, with the help of treatment and individual effort.
There are many different forms (modalities) of treatment used for personality disorders:
- Individual psychotherapy has been a mainstay of treatment. There are long-term and short-term (brief) forms.
- Family therapy, including couples therapy.
- Group therapy for personality dysfunction is probably the second most used.
- Psychological-education may be used as an addition.
- Self-help groups may provide resources for personality disorders.
- Psychiatric medications for treating symptoms of personality dysfunction or co-occurring conditions.
- Milieu therapy, a kind of group-based residential approach, has a history of use in treating personality disorders, including therapeutic communities.
- The practice of mindfulness that includes developing the ability to be nonjudgmentally aware of unpleasant emotions appears to be a promising clinical tool for managing different types of personality disorders.
There are different specific theories or schools of therapy within many of these modalities. They may, for example, emphasize psychodynamic techniques, or cognitive or behavioral techniques. In clinical practice, many therapists use an 'eclectic' approach, taking elements of different schools as and when they seem to fit to an individual client. There is also often a focus on common themes that seem to be beneficial regardless of techniques, including attributes of the therapist (e.g. trustworthiness, competence, caring), processes afforded to the client (e.g. ability to express and confide difficulties and emotions), and the match between the two (e.g. aiming for mutual respect, trust and boundaries).
Classical Adlerian psychology makes a distinction between primary and secondary inferiority feelings.
- A primary inferiority feeling is said to be rooted in the young child's original experience of weakness, helplessness and dependency. It can then be intensified by comparisons to siblings, romantic partners, and adults.
- A secondary inferiority feeling relates to an adult's experience of being unable to reach a subconscious, reassuring fictional final goal of subjective security and success to compensate for the inferiority feelings. The perceived distance from that reassuring goal would lead to a negative/depressed feeling that could then prompt the recall of the original inferiority feeling; this composite of inferiority feelings could be experienced as overwhelming. The reassuring goal invented to relieve the original, primary feeling of inferiority which actually causes the secondary feeling of inferiority is the "catch-22" of this dilemma, where the desperate attempt to obtain therapeutic reassurance and delivery from a depressing feeling of inferiority and worthlessness repeatedly fails. This vicious cycle is common in neurotic lifestyles.
An inferiority complex is the lack of self-worth, a doubt and uncertainty about oneself, and feelings of not measuring up to standards. It is often subconscious, and is thought to drive afflicted individuals to overcompensate, resulting either in spectacular achievement or extremely asocial behavior. In modern literature, the preferred terminology is "lack of covert self-esteem". For many, it is developed through a combination of genetic personality characteristics and personal experiences.
The management and treatment of personality disorders can be a challenging and controversial area, for by definition the difficulties have been enduring and affect multiple areas of functioning. This often involves interpersonal issues, and there can be difficulties in seeking and obtaining help from organizations in the first place, as well as with establishing and maintaining a specific therapeutic relationship. On the one hand, an individual may not consider themselves to have a mental health problem, while on the other, community mental health services may view individuals with personality disorders as too complex or difficult, and may directly or indirectly exclude individuals with such diagnoses or associated behaviors. The disruptiveness that people with personality disorders can create in an organisation makes these, arguably, the most challenging conditions to manage.
Apart from all these issues, an individual may not consider their personality to be disordered or the cause of problems. This perspective may be caused by the patient's ignorance or lack of insight into their own condition, an ego-syntonic perception of the problems with their personality that prevents them from experiencing it as being in conflict with their goals and self-image, or by the simple fact that there is no distinct or objective boundary between 'normal' and 'abnormal' personalities. Unfortunately, there is substantial social stigma and discrimination related to the diagnosis.
The term 'personality disorder' encompasses a wide range of issues, each with a different level of severity or disability; thus, personality disorders can require fundamentally different approaches and understandings. To illustrate the scope of the matter, consider that while some disorders or individuals are characterized by continual social withdrawal and the shunning of relationships, others may cause "fluctuations" in forwardness. The extremes are worse still: at one extreme lie self-harm and self-neglect, while at another extreme some individuals may commit violence and crime. There can be other factors such as problematic substance use or dependency or behavioral addictions. A person may meet the criteria for multiple personality disorder diagnoses and/or other mental disorders, either at particular times or continually, thus making coordinated input from multiple services a potential requirement.
Therapists in this area can become disheartened by lack of initial progress, or by apparent progress that then leads to setbacks. Clients may be perceived as negative, rejecting, demanding, aggressive or manipulative. This has been looked at in terms of both therapist and client; in terms of social skills, coping efforts, defense mechanisms, or deliberate strategies; and in terms of moral judgments or the need to consider underlying motivations for specific behaviors or conflicts. The vulnerabilities of a client, and indeed a therapist, may become lost behind actual or apparent strength and resilience. It is commonly stated that there is always a need to maintain appropriate professional personal boundaries, while allowing for emotional expression and therapeutic relationships. However, there can be difficulty acknowledging the different worlds and views that both the client and therapist may live with. A therapist may assume that the kinds of relationships and ways of interacting that make them feel safe and comfortable have the same effect on clients. As an example of one extreme, people who may have been exposed to hostility, deceptiveness, rejection, aggression or abuse in their lives, may in some cases be made confused, intimidated or suspicious by presentations of warmth, intimacy or positivity. On the other hand, reassurance, openness and clear communication are usually helpful and needed. It can take several months of sessions, and perhaps several stops and starts, to begin to develop a trusting relationship that can meaningfully address a client's issues.
Being a personality disorder, which are usually chronic and long-lasting mental conditions, avoidant personality disorder is not expected to improve with time without treatment. It is a poorly studied personality disorder and in light of prevalence rates, societal costs, and the current state of research, AvPD qualifies as a neglected disorder.
Treatment of muscle dysmorphia can be stymied by a patient's unawareness that the preoccupation is disordered or by avoidance of treatment. Scientific research on treatment of muscle dysmorphia is limited, the evidence largely in case reports and anecdotes, and no specific protocols have been validated. Still, evidence supports the efficacy of family-based therapy, cognitive behavioural therapy, and pharmacotherapy with selective serotonin reuptake inhibitors. Also limited is research on prognosis of the untreated.
Attraction to disability or devotism is a sexualised interest in the appearance, sensation and experience of disability. It may extend from normal human sexuality into a type of sexual fetishism. Sexologically, the pathological end of the attraction tends to be classified as a paraphilia. (Note, however, that the very concept "paraphilia" continues to elude satisfactory definition and remains a subject of ongoing debate in both professional and lay communities) Other researchers have approached it as a form of identity disorder. The most common interests are towards amputations, prosthesis, and crutches.
“Mongrel complex" ("Complexo de vira-Lata" in Portuguese) is an expression used to refer to a collective inferiority complex felt by some Brazilian people in comparison to Europe or the United States. The reference to a "mongrel" (as opposed to "pure-bred") carries negative connotations attributed to most Brazilians being racially mixed as well as a perception of lacking cultural refinement.
Until the 1990s, it tended to be described mostly as acrotomophilia, at the expense of other disabilities, or of the wish by some to pretend or acquire disability. Bruno (1997) systematised the attraction as factitious disability disorder. A decade on, others argue that erotic target location error is at play, classifying the attraction as an identity disorder. In the standard psychiatric reference "Diagnostic and Statistical Manual of Mental Disorders", text revision (DSM-IV-tr), the fetish falls under the general category of "Sexual and Gender Identity Disorders" and the more specific category of paraphilia, or sexual fetishes; this classification is preserved in DSM-5.
Muscle dysmorphia's classification has been widely debated, and alternative "DSM" classifications have been proposed.
- Eating disorder: Many of muscle dysmorphia's traits overlap with those of eating disorders, including focus on body weight, shape, and modification, whereas body dysmorphic disorder otherwise usually lacks such dietary and exercise components. Also, persons experiencing muscle dysmorphia tend to score high on the Eating Attitudes Test and Eating Disorder Inventory, while muscle dysmorphia and anorexia nervosa share diagnostic crossover. Meanwhile, both muscle dysmorphia and eating disorders associate with higher impairment than does body dysmorphic disorder otherwise. And treatment for eating disorders may be effective for muscle dysmorphia.
- Behavioral addiction: Some researchers seek muscle dysmorphia's reclassification as a behavioral addiction. Muscle dysmorphia's obsession to maintain body image is enacted through particular activities, such as exercise, diet, and related shopping, which activities, as in behavioral addiction, are highly valued, modify mood, and may cause interpersonal conflicts. Also, tolerance to muscle building and dietary restriction can drive escalation of these activities to restore physiological or psychological effects. Further, abstinence from these activities can provoke withdrawal symptoms, and relapse into excessive engagement is apt to occur.
Don Juanism or Don Juan syndrome is a non-clinical term for the desire, in a man, to have sex with many different female partners.
The name derives from the Don Juan of opera and fiction. The term satyriasis is sometimes used as a synonym for Don Juanism. The term has also been referred to as the male equivalent of nymphomania in women. These terms no longer apply with any accuracy as psychological or legal categories of psychological disorder.
It was originally coined by novelist and writer Nelson Rodrigues, in which originally he referred to the trauma suffered by Brazilians in 1950, when the National Soccer team was defeated by the Uruguayan national team in the final match of the Soccer World Cup in Maracanã. Brazil would just recover in 1958, when it won the World Cup for the first time.
For Rodrigues, the phenomenon was not exclusive related to soccer. According to him:
The expression "mongrel complex" was rediscovered in 2004 by the American journalist Larry Rohter, in an article for "The New York Times" about the Brazilian nuclear program, he wrote:
Psychiatrist Carl Jung believed that Don Juanism was an unconscious desire of a man to seek his mother in every woman he encountered. However, he didn't see the trait as entirely negative; Jung felt that positive aspects of Don Juanism included heroism, perseverance and strength of will.
Jung argues that related to the mother-complex "are homosexuality and Don Juanism, and sometimes also impotence. In homosexuality, the son's entire heterosexuality is tied to the mother in an unconscious form; in Don Juanism, he unconsciously seeks his mother in every woman he meets...Because of the difference in sex, a son's mother-complex does not appear in pure form. This is the reason why in every masculine mother-complex, side by side with the mother archetype, a significant role is played by the image of the man's sexual counterpart, the anima."
One of Theodore Millon's five narcissist variations is the amorous narcissist which includes histrionic features. According to Millon, the Don Juan or Casanova of our times is erotic and exhibitionistic.
A number of the effects that had been thought after early studies to be attributable to prenatal exposure to cocaine are actually due partially or wholly to other factors, such as exposure to other substances (including tobacco, alcohol, or marijuana) or to the environment in which the child is raised.
PCE is very difficult to study because of a variety of factors that may confound the results: pre- and postnatal care may be poor; the pregnant mother and child may be malnourished; the amount of cocaine a mother takes can vary; she may take a variety of drugs during pregnancy in addition to cocaine; measurements for detecting deficits may not be sensitive enough; and results that are found may only last a short time. Studies differ in how they define heavy or light cocaine use during pregnancy, and the time period of exposure during pregnancy on which they focus (e.g. first, second, or third trimester. Drug use by mothers puts children at high risk for exposure to toxic or otherwise dangerous environments, and PCE does not present much risk beyond these risk factors. PCE is clustered with other risk factors to the child, such as physical abuse and neglect, domestic violence, and prenatal exposure to other substances. Such environmental factors are known to adversely affect children in the same areas being studied with respect to PCE.
Most women who use cocaine while pregnant use other drugs too; one study found that 93% of those who use cocaine or opiates also use tobacco, marijuana, or alcohol. When researchers control for use of other drugs, many of the seeming effects of cocaine on head size, birth weight, Apgar scores, and prematurity disappear.
Addiction to any substance, including crack, may be a risk factor for child abuse or neglect. Crack addiction, like other addictions, distracts parents from the child and leads to inattentive parenting. Mothers who continue to use drugs once their babies are born have trouble forming the normal parental bonds, more often interacting with their babies with a detached, unenthusiastic, flat demeanor. Conversely, low-stress environments and responsive caregiving may provide a protective effect on the child's brain, potentially compensating for negative effects of PCE.
Many drug users do not get prenatal care, for a variety of reasons including that they may not know they are pregnant. Many crack addicts get no medical care at all and have extremely poor diets, and children who live around crack smoking are at risk of inhaling secondary smoke. Cocaine using mothers also have a higher rate of sexually transmitted infections such as HIV and hepatitis.
In some cases, it is not clear whether direct results of PCE lead to behavioral problems, or whether environmental factors are at fault. For example, children who have caregiver instability may have more behavioral problems as a result, or it may be that behavioral problems manifested by PCE children lead to greater turnover in caregivers. Other factors that make studying PCE difficult include unwillingness of mothers to tell the truth about drug history, uncertainty of dosages of street drugs and high rates of attrition (loss of participants) from studies.
The most common problem with syndactyly correction is creeping of the skin towards the fingertip over time. This is likely due to tension at the site of the repair between the digits. Additional surgery may be required to correct this. One critique of using skin grafts is that the grafts darken in the years after surgery and become more noticeable. Also, if the skin grafts are harvested from the groin area, the skin may grow hair. Finally, the fingers may deviate after surgery. This is most commonly seen in complex syndactyly (when there has been a bony joining of the fingers).
Because the circumference of the conjoined fingers is smaller than the circumference of the two separated fingers, there is not enough skin to cover both digits once they are separated at the time of surgery. Therefore, the surgeon must bring new skin into the area at the time of surgery. This is most commonly done with a skin graft (from groin or anterior elbow). Skin can also be used from the back of the hand by mobilizing it (called a "graftless" syndactyly correction), which requires planning over a period of months prior to surgery.
Though BLSII is an attractive candidate for gene therapy, bone marrow transplant is currently the only treatment.
One way to address problems with uncertainty about cocaine's effects due to confounding factors is to use animal models; these allow experimenters to study the effects at specific doses and times. Studies have used mice, other rodents, rabbits, and primates.
However, differences between species' physiology and gestation times mean findings in animals may not apply to humans. Mice, rats, and rabbits have shorter gestational times, so experimenters must continue giving drugs after they are born to more closely model human gestation; however this introduces more differences. Animals and humans metabolize drugs at different rates, and drugs that are highly teratogenic in animals may not be in humans and vice versa. Animals cannot be used to measure differences in abilities such as reasoning that are only found in humans.
Animal studies in various species have found that cocaine impacts brain structure, function, and chemistry, and causes long-term changes at the molecular, cellular, and behavioral levels. In research studies on pregnant rats, injected cocaine did less damage to cells than injected nicotine, and more recovery occurred between doses. Adult rats that were exposed to cocaine prenatally have deficits in learning, memory, and motor skills, and may have abnormalities in dopamine processing. Animal research has also shown that offspring of males that used cocaine while their sperm were forming may go on to have abnormalities later in life.
At the beginning of the surgery a tourniquet will be applied to the limb. A tourniquet compresses and control the arterial and venous circulation for about 2 hours. The constriction band must be dissected very carefully to avoid damaging the underlying neurovasculature. When the constriction band is excised, there will be a direct closure. This allows the fatty tissue to naturally reposition itself under the skin.
“With complete circumferential constriction bands, it is recommended that a two-stage correction approach be used. At the first operation, one-half of the circumference is excised and the other one-half can be excised after three to six months. This will avoid any problems to the distal circulation in the limb, which may already be compromised. Lymphedema, when present, will significantly improve within a few weeks of the first surgery.”
For the direct closure of the defect after dissecting a constriction band there are two different techniques:
1. Triangular flaps; For this technique the circumference between the two borders must be measured. Depending on the difference the number of triangular flaps can be decided. With a triangular flap you can create more skin.
2. Z/W-plasty; “Z-plasty is a plastic surgery technique that is used to improve the functional and cosmetic appearance of scars. It can elongate a contracted scar or rotate the scar tension line. The middle line of the Z-shaped incision (the central element) is made along the line of greatest tension or contraction, and triangular flaps are raised on opposite sides of the two ends and then transposed.”
In rare cases, if diagnosed in utero, fetal surgery may be considered to save a limb that is in danger of amputation or other deformity. This operation has been successfully performed on fetuses as young as 22 weeks. The Melbourne's Monash Medical Centre in Australia, as well as multiple facilities in the United States of America, have performed successful amniotic band release surgery.
Surgical correction is recommended when a constriction ring results in a limb contour deformity, with or without lymphedema.
Once an acute arrhythmia has been terminated, ongoing treatment may be indicated to prevent recurrence. However, those that have an isolated episode, or infrequent and minimally symptomatic episodes, usually do not warrant any treatment other than observation.
In general, patients with more frequent or disabling symptoms warrant some form of prevention. A variety of drugs including simple AV nodal blocking agents such as beta-blockers and verapamil, as well as anti-arrhythmics may be used, usually with good effect, although the risks of these therapies need to be weighed against potential benefits.
Radiofrequency ablation has revolutionized the treatment of tachycardia caused by a re-entrant pathway. This is a low-risk procedure that uses a catheter inside the heart to deliver radio frequency energy to locate and destroy the abnormal electrical pathways. Ablation has been shown to be highly effective: around 90% in the case of AVNRT. Similar high rates of success are achieved with AVRT and typical atrial flutter.
Cryoablation is a newer treatment for SVT involving the AV node directly. SVT involving the AV node is often a contraindication for using radiofrequency ablation due to the small (1%) incidence of injuring the AV node, requiring a permanent pacemaker. Cryoablation uses a catheter supercooled by nitrous oxide gas freezing the tissue to −10 °C. This provides the same result as radiofrequency ablation but does not carry the same risk. If you freeze the tissue and then realize you are in a dangerous spot, you can halt freezing the tissue and allow the tissue to spontaneously rewarm and the tissue is the same as if you never touched it. If after freezing the tissue to −10 °C you get the desired result, then you freeze the tissue down to a temperature of −73 °C and you permanently ablate the tissue.
This therapy has further improved the treatment options for people with AVNRT (and other SVTs with pathways close to the AV node), widening the application of curative ablation to young patients with relatively mild but still troublesome symptoms who would not have accepted the risk of requiring a pacemaker.
Direct treatment that stimulates the pyruvate dehydrogenase complex (PDC), provides alternative fuels, and prevents acute worsening of the syndrome. However, some correction of acidosis does not reverse all the symptoms. CNS damage is common and limits a full recovery. Ketogenic diets, with high fat and low carbohydrate intake have been used to control or minimize lactic acidosis and anecdotal evidence shows successful control of the disease, slowing progress and often showing rapid improvement. No study has yet been published demonstrating the effectiveness of the ketogenic diet for treatment of PDCD.
There is some evidence that dichloroacetate reduces the inhibitory phosphorylation of pyruvate dehydrogenase complex and thereby activates any residual functioning complex. Resolution of lactic acidosis is observed in patients with E1 alpha enzyme subunit mutations that reduce enzyme stability. However, treatment with dichloroacetate does not improve neurological damage. Oral citrate is often used to treat acidosis.
Emergency treatment is not needed if the person is asymptomatic or minimally symptomatic.
Management for mitochondrial trifunctional protein deficiency entails the following:
- Avoiding factors that might precipitate condition
- Glucose
- Low fat/high carbohydrate nutrition