n. an individual’s lack of interest in or concern for matters that might be expected to affect him or her significantly. A sign of impaired motivation, it is associated with *depression.
Apathy, obeying orders unquestioningly, accepting a standard routine, and loss of interests are the main features.... institutionalization
The chopped leaves are usually smoked but can be eaten in food or taken as tea. The active ingredient is tetrahydrocannibol. There is much public debate in western countries over the social use of cannabis: it is illegal to possess or supply the substance in the United Kingdom, but nevertheless cannabis is quite widely used. Cannabis is classi?ed as a Schedule 1 drug under the Misuse of Drugs Act 1971 and has not o?cially been used medicinally – despite some claims that it is helpful in ameliorating painful symptoms in certain serious chronic diseases such as multiple sclerosis. A related agent, NABILONE, is a synthetic cannabinoid licenced for use in treating nausea and vomiting caused by CYTOTOXIC drugs.... cannabis
Treatment If organic disease is identi?ed, it should, where possible, be treated; otherwise the treatment of dementia is alleviation of its symptoms. The affected person must be kept clean and properly fed. Good nursing care in comfortable surroundings is important and sedation with appropriate drugs may be required. Patients may eventually need institutional care. (See ALZHEIMER’S DISEASE.)... dementia
The dependence that most concerns modern society is one in which individuals become dependent on or addicted to certain substances such as alcohol, drugs, tobacco (nicotine), caffeine and solvents. This is often called substance abuse. Some people become addicted to certain foods or activities: examples of the latter include gambling, computer games and use of the Internet.
The 28th report of the World Health Organisation Expert Committee on Drug Dependence in 1993 de?ned drug dependence as: ‘A cluster of physiological, behavioural and cognitive phenomena of variable intensity, in which the use of a psychoactive drug (or drugs) takes on a high priority. The necessary descriptive characteristics are preoccupation with a desire to obtain and take the drug and persistent drug-seeking behaviour. Psychological dependence occurs when the substance abuser craves the drug’s desirable effects. Physical dependence occurs when the user has to continue taking the drug to avoid distressing withdrawal or abstinence symptoms. Thus, determinants and the problematic consequences of drug dependence may be biological, psychological or social and usually interact.’
Di?erent drugs cause di?erent rates of dependence: TOBACCO is the most common substance of addiction; HEROIN and COCAINE cause high rates of addiction; whereas ALCOHOL is much lower, and CANNABIS lower again. Smoking in the western world reached a peak after World War II with almost 80 per cent of the male population smoking. The reports on the link between smoking and cancer in the early 1960s resulted in a decline that has continued so that only around a quarter of the adult populations of the UK and USA smokes. Globally, tobacco consumption continues to grow, particularly in the developing world with multinational tobacco companies marketing their products aggressively.
Accurate ?gures for illegal drug-taking are hard to obtain, but probably approximately 4 per cent of the population is dependent on alcohol and 2 per cent on other drugs, both legal and illegal, at any one time in western countries.
How does dependence occur? More than 40 distinct theories or models of drug misuse have been put forward. One is that the individual consumes drugs to cope with personal problems or diffculties in relations with others. The other main model emphasises environmental in?uences such as drug availability, environmental pressures to consume drugs, and sociocultural in?uences such as peer pressure.
By contrast to these models of why people misuse drugs, models of compulsive drug use – where individuals have a compulsive addiction
– have been amenable to testing in the laboratory. Studies at cellular and nerve-receptor levels are attempting to identify mechanisms of tolerance and dependence for several substances. Classical behaviour theory is a key model for understanding drug dependence. This and current laboratory studies are being used to explain the reinforcing nature of dependent substances and are helping to provide an explanatory framework for dependence. Drug consumption is a learned form of behaviour. Numerous investigators have used conditioning theories to study why people misuse drugs. Laboratory studies are now locating the ‘reward pathways’ in the brain for opiates and stimulants where positive reinforcing mechanisms involve particular sectors of the brain. There is a consensus among experts in addiction that addictive behaviour is amenable to e?ective treatment, and that the extent to which an addict complies with treatment makes it possible to predict a positive outcome. But there is a long way to go before the mechanisms of drug addiction are properly understood or ways of treating it generally agreed.
Effects of drugs Cannabis, derived from the plant Cannabis sativa, is a widely used recreational drug. Its two main forms are marijuana, which comes from the dried leaves, and hashish which comes from the resin. Cannabis may be used in food and drink but is usually smoked in cigarettes to induce relaxation and a feeling of well-being. Heavy use can cause apathy and vagueness and may even cause psychosis. Whether or not cannabis leads people to using harder drugs is arguable, and a national debate is underway on whether its use should be legalised for medicinal use. Cannabis may alleviate the symptoms of some disorders – for example, MULTIPLE SCLEROSIS (MS) – and there are calls to allow the substance to be classi?ed as a prescribable drug.
About one in ten of Britain’s teenagers misuses volatile substances such as toluene at some time, but only about one in 40 does so regularly. These substances are given o? by certain glues, solvents, varnishes, and liquid fuels, all of which can be bought cheaply in shops, although their sale to children under 16 is illegal. They are often inhaled from plastic bags held over the nose and mouth. Central-nervous-system excitation, with euphoria and disinhibition, is followed by depression and lethargy. Unpleasant effects include facial rash, nausea and vomiting, tremor, dizziness, and clumsiness. Death from COMA and acute cardiac toxicity is a serious risk. Chronic heavy use can cause peripheral neuropathy and irreversible cerebellar damage. (See SOLVENT ABUSE (MISUSE).)
The hallucinogenic or psychedelic drugs include LYSERGIC ACID DIETHYLAMIDE (LSD) or acid, magic mushrooms, ecstasy (MDMA), and phencyclidine (PCP or ‘angel’ dust, mainly used in the USA). These drugs have no medicinal uses. Taken by mouth, they produce vivid ‘trips’, with heightened emotions and perceptions and sometimes with hallucinations. They are not physically addictive but can cause nightmarish bad trips during use and ?ashbacks (vivid reruns of trips) after use, and can probably trigger psychosis and even death, especially if drugs are mixed or taken with alcohol.
Stimulant drugs such as amphetamine and cocaine act like adrenaline and speed up the central nervous system, making the user feel con?dent, energetic, and powerful for several hours. They can also cause severe insomnia, anxiety, paranoia, psychosis, and even sudden death due to convulsions or tachycardia. Depression may occur on withdrawal of these drugs, and in some users this is su?ciently deterrent to cause psychological dependence. Amphetamine (‘speed’) is mainly synthesised illegally and may be eaten, sni?ed, or injected. Related drugs, such as dexamphetamine sulphate (Dexedrine), are prescribed pills that enter the black market. ECSTASY is another amphetamine derivative that has become a popular recreational drug; it may have fatal allergic effects. Cocaine and related drugs are used in medicine as local anaesthetics. Illegal supplies of cocaine (‘snow’ or ‘ice’) and its derivative, ‘crack’, come mainly from South America, where they are made from the plant Erythroxylon coca. Cocaine is usually sni?ed (‘snorted’) or rubbed into the gums; crack is burnt and inhaled.
Opiate drugs are derived from the opium poppy, Papaver somniferum. They are described as narcotic because they induce sleep. Their main medical use is as potent oral or injectable analgesics such as MORPHINE, DIAMORPHINE, PETHIDINE HYDROCHLORIDE, and CODEINE. The commonest illegal opiate is heroin, a powdered form of diamorphine that may be smoked, sni?ed, or injected to induce euphoria and drowsiness. Regular opiate misuse leads to tolerance (the need to take ever larger doses to achieve the same e?ect) and marked dependence. A less addictive oral opiate, METHADONE HYDROCHLORIDE, can be prescribed as a substitute that is easier to withdraw.
Some 75,000–150,000 Britons now misuse opiates and other drugs intravenously, and pose a huge public-health problem because injections with shared dirty needles can carry the blood-borne viruses that cause AIDS/HIV and HEPATITIS B. Many clinics now operate schemes to exchange old needles for clean ones, free of charge. Many addicts are often socially disruptive.
For help and advice see APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELF-HELP – National Dugs Helpline.
(See ALCOHOL and TOBACCO for detailed entries on those subjects.)... dependence
Shock may result from loss of blood or plasma volume. This may occur as a result of haemorrhage or severe diarrhoea and vomiting. It may also result from peripheral pooling of blood due to such causes as TOXAEMIA or ANAPHYLAXIS. The toxaemia is commonly the result of a SEPTICAEMIA in which leakage through capillaries reduces circulating blood volume. Another form is called cardogenic shock, and is due to failure of the heart as a pump. It is most commonly seen as a result of myocardial infarction (see under HEART, DISEASES OF).
If failure of adequate blood ?ow to vital organs is prolonged, the effects can be disastrous. The ischaemic intestine permits the transfer of toxic bacterial products and proteins across its wall into the blood; renal ISCHAEMIA prevents the maintenance of a normal electrolyte and acid-base balance.
Treatment If the shock is a result of haemorrhage or diarrhoea or vomiting, replacement of blood, lost ?uid and electrolytes is of prime importance. If it is due to septicaemia, treatment of the infection is of paramount importance, and in addition, intravenous ?uids and vasopressor drugs will be required. Cardiogenic shock is treated by attention to the underlying cause. Full intensive care is likely to be required, and arti?cial ventilation and DIALYSIS may both be needed.... shock
The chorea usually affects the face, arms, and trunk, resulting in random grimaces and twitches, and clumsiness. Dementia takes the form of irritability, personality and behavioural changes, memory loss, and apathy.
At present, there is no cure for Huntington’s disease, and treatment is aimed at reducing symptoms with drugs.... huntington’s disease
Causes There is an inherited element: parents, children or siblings of schizophrenic sufferers have a one in ten chance of developing the disorder; a twin has a 50 per cent chance if the other twin has schizophrenia. Some BRAIN disorders such as temporal lobe EPILEPSY, tumours and ENCEPHALITIS seem to be linked with schizophrenia. Certain drugs – for example, AMPHETAMINES – can precipitate schizophrenia and DOPAMINE-blocking drugs often relieve schizophrenic symptoms. Stress may worsen schizophrenia and recreational drugs may trigger an attack.
Symptoms These usually develop gradually until the individual’s behaviour becomes so distrubing or debilitating that work, relationships and basic activities such as eating and sleeping are interrupted. The patient may have disturbed perception with auditory HALLUCINATIONS, illogical thought-processes and DELUSIONS; low-key emotions (‘?at affect’); a sense of being invaded or controlled by outside forces; a lack of INSIGHT and inability to acknowledge reality; lethargy and/or agitation; a disrespect for personal appearance and hygiene; and a tendency to act strangely. Violence is rare although some sufferers commit violent acts which they believe their ‘inner voices’ have commanded.
Relatives and friends may try to cope with the affected person at home, but as severe episodes may last several months and require regular administration of powerful drugs – patients are not always good at taking their medication
– hospital admission may be necessary.
Treatment So far there is no cure for schizophrenia. Since the 1950s, however, a group of drugs called antipsychotics – also described as NEUROLEPTICS or major tranquillisers – have relieved ?orid symptoms such as thought disorder, hallucinations and delusions as well as preventing relapses, thus allowing many people to leave psychiatric hospitals and live more independently outside. Only some of these drugs have a tranquillising e?ect, but their sedative properties can calm patients with an acute attack. CHLORPROMAZINE is one such drug and is commonly used when treatment starts or to deal with an emergency. Halperidol, tri?uoperazine and pimozide are other drugs in the group; these have less sedative effects so are useful in treating those whose prominent symptoms are apathy and lethargy.
The antipsychotics’ mode of action is by blocking the activity of DOPAMINE, the chemical messenger in the brain that is faulty in schizophrenia. The drugs quicken the onset and prolong the remission of the disorder, and it is very important that patients take them inde?nitely. This is easier to ensure when a patient is in hospital or in a stable domestic environment.
CLOZAPINE – a newer, atypical antipsychotic drug – is used for treating schizophrenic patients unresponsive to, or intolerant of, conventional antipsychotics. It may cause AGRANULOCYTOSIS and use is con?ned to patients registered with the Clorazil (the drug’s registered name) Patient Monitoring Service. Amisulpride, olanzapine, quetiapine, risperidone, sertindole and zotepine are other antipsychotic drugs described as ‘atypical’ by the British National Formulary; they may be better tolerated than other antipsychotics, and their varying properties mean that they can be targeted at patients with a particular grouping of symptoms. They should, however, be used with caution.
The welcome long-term shift of mentally ill patients from large hospitals to community care (often in small units) has, because of a lack of resources, led to some schizophrenic patients not being properly supervised with the result that they fail to take their medication regularly. This leads to a recurrence of symptoms and there have been occasional episodes of such patients in community care becoming a danger to themselves and to the public.
The antipsychotic drugs are powerful agents and have a range of potentially troubling side-effects. These include blurred vision, constipation, dizziness, dry mouth, limb restlessness, shaking, sti?ness, weight gain, and in the long term, TARDIVE DYSKINESIA (abnormal movements and walking) which affects about 20 per cent of those under treatment. Some drugs can be given by long-term depot injection: these include compounds of ?upenthixol, zuclopenthixol and haloperidol.
Prognosis About 25 per cent of sufferers recover fully from their ?rst attack. Another 25 per cent are disabled by chronic schizophrenia, never recover and are unable to live independently. The remainder are between these extremes. There is a high risk of suicide.... schizophrenia
1. Agrimony. Those who suffer considerable inner torture which they try to dissemble behind a facade of cheerfulness.
2. Aspen. Apprehension and foreboding. Fears of unknown origin.
3. Beech. Critical and intolerant of others. Arrogant.
4. Centaury. Weakness of will; those who let themselves be exploited or imposed upon – become subservient; difficulty in saying ‘no’. Human doormat.
5. Cerato. Those who doubt their own judgement, seeks advice of others. Often influenced and misguided.
6. Cherry Plum. Fear of mental collapse/desperation/loss of control and fear of causing harm. Vicious rages.
7. Chestnut Bud. Refusal to learn by experience; continually repeating the same mistakes.
8. Chicory. The over-possessive, demands respect or attention (selfishness), likes others to conform to their standards. makes martyr of oneself.
9. Clematis. Indifferent, inattentive, dreamy, absent-minded. Mental escapist from reality.
10. Crab Apple. Cleanser. Feels unclean or ashamed of ailments. Self disgust/hatred. House proud.
11. Elm. Temporarily overcome by inadequacy or responsibility. Normally very capable.
12. Gentian. Despondent. Easily discouraged and dejected.
13. Gorse. Extreme hopelessness – pessimist – ‘Oh, what’s the use?’.
14. Heather. People who are obsessed with their own troubles and experiences. Talkative ‘bores’ – poor listeners.
15. Holly. For those who are jealous, envious, revengeful and suspicious. For those who hate.
16. Honeysuckle. For those with nostalgia and who constantly dwell in the past. Homesickness.
17. Hornbeam. ‘Monday morning’ feeling but once started, task is usually fulfilled. Procrastination.
18. Impatiens. Impatience, irritability.
19. Larch. Despondency due to lack of self-confidence; expectation of failure, so fails to make the attempt. Feels inferior though has the ability.
20. Mimulus. Fear of known things. Shyness, timidity.
21. Mustard. Deep gloom like an overshadowing dark cloud that descends for no known reason which can lift just as suddenly. Melancholy.
22. Oak. Brave determined types. Struggles on in illness and against adversity despite setbacks. Plodders.
23. Olive. Exhaustion – drained of energy – everything an effort.
24. Pine. Feelings of guilt. Blames self for mistakes of others. Feels unworthy.
25. Red Chestnut. Excessive fear and over caring for others especially those held dear.
26. Rock Rose. Terror, extreme fear or panic.
27. Rock Water. For those who are hard on themselves – often overwork. Rigid minded, self denying. 28. Scleranthus. Uncertainty/indecision/vacillation. Fluctuating moods.
29. Star of Bethlehem. For all the effect of serious news, or fright following an accident, etc.
30. Sweet Chestnut. Anguish of those who have reached the limit of endurance – only oblivion left.
31. Vervain. Over-enthusiasm, over-effort; straining. Fanatical and highly-strung. Incensed by injustices. 32. Vine. Dominating/inflexible/ambitious/tyrannical/autocratic. Arrogant Pride. Good leaders.
33. Walnut. Protection remedy from powerful influences, and helps adjustment to any transition or change, e.g. puberty, menopause, divorce, new surroundings.
34. Water Violet. Proud, reserved, sedate types, sometimes ‘superior’. Little emotional involvement but reliable/dependable.
35. White Chestnut. Persistent unwanted thoughts. Pre-occupation with some worry or episode. Mental arguments.
36. Wild Oat. Helps determine one’s intended path in life.
37. Wild Rose. Resignation, apathy. Drifters who accept their lot, making little effort for improvement – lacks ambition.
38. Willow. Resentment and bitterness with ‘not fair’ and ‘poor me’ attitude.
39. Rescue Remedy. A combination of Cherry Plum, Clematis, Impatiens, Rock Rose, Star of Bethlehem. All purpose emergency composite for causes of trauma, anguish, bereavement, examinations, going to the dentist, etc. ... bach remedies
Differential diagnosis: arterio-sclerosis, Sydenham’s chorea.
Action. Emotional instability ranging from apathy to irritability. Complicated by menstrual problems (Motherwort, Helonias, Black Cohosh). Regresses into dementia. No cure possible, but anti-convulsants may reduce contortions and restlessness. Institutional care may be necessary. Scientists claim the gene that causes Huntingdon’s disease has been identified.
Alternatives. Of Therapeutic Value. Betony, Black Cohosh, Chamomile (German), Cramp bark, Helonias, Ladyslipper, Motherwort, Oats, Passion flower, Sarsaparilla, Skullcap, Valerian, Feverfew. Tablets/capsules. Motherwort, Passion flower, Skullcap, Valerian.
Formula. Combine: equal parts, Black Cohosh, Mistletoe, Helonias. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extract: 1 teaspoon. Tinctures: 2 teaspoons. Thrice daily in water or honey.
Traditional, UK. Combine equal parts, Skullcap, Valerian, Mistletoe. 1oz (30g) to 1 pint (500ml) water; bring to boil; remove vessel when boiling point is reached. Dose: half-1 cup thrice daily.
Diet. Lacto-vegetarian. Yoghurt. Low salt. Oatmeal porridge, Muesli, regular raw food days. Supplements. Vitamin B-complex, Vitamin B6, Kelp, Calcium, Magnesium, Zinc.
Note: It would appear the Ginkgo would be an object of scientific study for the complaint. Treatment by or in liaison with general medical practitioner only. ... huntingdon’s chorea
Insomnia, malaise, agitation, and tearfulness are also common. Gradually, but usually within 2 years, the bereaved person adjusts to the loss.
Family and friends can often provide support. Outside help may be required and may be given by a social worker, health visitor, member of the clergy, or self-help group. For some people, when depression, apathy, and lethargy impede any chance of recovery, specialized counselling or psychotherapy is necessary. (See also stillbirth.)... bereavement
Korsakoff’s psychosis may follow Wernicke’s encephalopathy if treatment is not begun promptly enough. Symptoms consist of severe amnesia, apathy, and disorientation. Korsakoff’s psychosis is usually irreversible.... wernicke–korsakoff syndrome
FAMILY: Oleaceae
SYNONYMS: Jasmin, jessamine, common jasmine, poet’s jessamine.
GENERAL DESCRIPTION: An evergreen shrub or vine up to 10 metres high with delicate, bright green leaves and star-shaped very fragrant white flowers.
DISTRIBUTION: Native to China, northern India and west Asia; cultivated in the Mediterranean region, China and India (depending on the exact species). The concrete is produced in Italy, France, Morocco, Egypt, China, Japan, Algeria and Turkey; the absolute is mainly produced in France.
OTHER SPECIES: There are many species of jasmine used for medicine and perfumery work. Apart from the common jasmine, the most widespead varieties are the royal or Italian jasmine (J. grandiflorum) which is grown in the Mediterranean region, and its Eastern counterpart J. officinale var. grandiflorum or J. auriculatum. See the Botanical Classification section for a more comprehensive list.
HERBAL/FOLK TRADITION: In China the flowers of J. officinale var. grandiflorum are used to treat hepatitis, liver cirrhosis and dysentery; the flowers of J. sambac are used for conjunctivitis, dysentery, skin ulcers and tumours. The root is used to treat headaches, insomnia, pain due to dislocated joints and rheumatism.
In the West, the common jasmine was said to ‘warm the womb ... and facilitate the birth; it is useful for cough, difficulty of breathing, etc. It disperses crude humours, and is good for cold and catarrhous constitutions, but not for the hot.’ It was also used for hard, contracted limbs and problems with the nervous and reproductive systems.
ACTIONS: Analgesic (mild), antidepressant, anti-inflammatory, antiseptic, antispasmodic, aphrodisiac, carminative, cicatrisant, expectorant, galactagogue, parturient, sedative, tonic (uterine).
EXTRACTION: A concrete is produced by solvent extraction; the absolute is obtained from the concrete by separation with alcohol. An essential oil is produced by steam distillation of the absolute.
CHARACTERISTICS: The absolute is a dark orange-brown, viscous liquid with an intensely rich, warm, floral scent and a tealike undertone. It blends well with rose, sandalwood, clary sage, and all citrus oils. It has the ability to round off any rough notes and blend with virtually everything.
PRINCIPAL CONSTITUENTS: There are over 100 constituents in the oil including benzyl acetate, linalol, phenylacetic acid, benzyl alcohol, farnesol, methyl anthranilate, cis jasmone, methyl jasmonate, among others.
SAFETY DATA: Non-toxic, non-irritant, generally non-sensitizing. (An allergic reaction has been known to occur in some individuals.)
AROMATHERAPY/HOME: USE
Skin care: Dry, greasy, irritated, sensitive skin.
Circulation muscles and joints: Muscular spasm, sprains.
Respiratory system: Catarrh, coughs, hoarseness, laryngitis.
Genito-urinary system: Dysmenorrhoea, frigidity, labour pains, uterine disorders.
Nervous system: Depression, nervous exhaustion and stress-related conditions. ‘It ... produces a feeling of optimism, confidence and euphoria. It is most useful in cases where there is apathy, indifference or listlessness.’.
OTHER USES: Extensively used in soaps, toiletries, cosmetics and perfumes, especially high-class floral and oriental fragrances. The oil and absolute are employed in a wide range of food products, alcoholic and soft drinks. The dried flowers of J. sambac are used in jasmine tea.... jasmine
Health Encyclopedia