A deep feeling of discontent and tension because of unresolved problems, unfulfilled needs, or because the path to a goal is blocked. In some people, frustration may lead to regression, aggression, or depression.
Many modi?cations have been devised of the basic steroid molecule in an attempt to keep useful therapeutic effects and minimise unwanted side-effects. The main corticosteroid hormones currently available are CORTISONE, HYDROCORTISONE, PREDNISONE, PREDNISOLONE, methyl prednisolone, triamcinolone, dexamethasone, betamethasone, paramethasone and de?azacort.
They are used clinically in three quite distinct circumstances. First they constitute replacement therapy where a patient is unable to produce their own steroids – for example, in adrenocortical insu?ciency or hypopituitarism. In this situation the dose is physiological – namely, the equivalent of the normal adrenal output under similar circumstances – and is not associated with any side-effects. Secondly, steroids are used to depress activity of the adrenal cortex in conditions where this is abnormally high or where the adrenal cortex is producing abnormal hormones, as occurs in some hirsute women.
The third application for corticosteroids is in suppressing the manifestations of disease in a wide variety of in?ammatory and allergic conditions, and in reducing antibody production in a number of AUTOIMMUNE DISORDERS. The in?ammatory reaction is normally part of the body’s defence mechanism and is to be encouraged rather than inhibited. However, in the case of those diseases in which the body’s reaction is disproportionate to the o?ending agent, such that it causes unpleasant symptoms or frank illness, the steroid hormones can inhibit this undesirable response. Although the underlying condition is not cured as a result, it may resolve spontaneously. When corticosteroids are used for their anti-in?ammatory properties, the dose is pharmacological; that is, higher – often much higher – than the normal physiological requirement. Indeed, the necessary dose may exceed the normal maximum output of the healthy adrenal gland, which is about 250–300 mg cortisol per day. When doses of this order are used there are inevitable risks and side-effects: a drug-induced CUSHING’S SYNDROME will result.
Corticosteroid treatment of short duration, as in angioneurotic OEDEMA of the larynx or other allergic crises, may at the same time be life-saving and without signi?cant risk (see URTICARIA). Prolonged therapy of such connective-tissue disorders, such as POLYARTERITIS NODOSA with its attendant hazards, is generally accepted because there are no other agents of therapeutic value. Similarly the absence of alternative medical treatment for such conditions as autoimmune haemolytic ANAEMIA establishes steroid therapy as the treatment of choice which few would dispute. The use of steroids in such chronic conditions as RHEUMATOID ARTHRITIS, ASTHMA and DERMATITIS needs careful assessment and monitoring.
Although there is a risk of ill-effects, these should be set against the misery and danger of unrelieved chronic asthma or the incapacity, frustration and psychological trauma of rheumatoid arthritis. Patients should carry cards giving details of their dosage and possible complications.
The incidence and severity of side-effects are related to the dose and duration of treatment. Prolonged daily treatment with 15 mg of prednisolone, or more, will cause hypercortisonism; less than 10 mg prednisolone a day may be tolerated by most patients inde?nitely. Inhaled steroids rarely produce any ill-e?ect apart from a propensity to oral thrush (CANDIDA infection) unless given in excessive doses.
General side-effects may include weight gain, fat distribution of the cushingoid type, ACNE and HIRSUTISM, AMENORRHOEA, striae and increased bruising tendency. The more serious complications which can occur during long-term treatment include HYPERTENSION, oedema, DIABETES MELLITUS, psychosis, infection, DYSPEPSIA and peptic ulceration, gastrointestinal haemorrhage, adrenal suppression, osteoporosis (see BONE, DISORDERS OF), myopathy (see MUSCLES, DISORDERS OF), sodium retention and potassium depletion.... corticosteroids
People who have an antisocial personality lack a sense of guilt and cannot tolerate frustration.
They may have problems with relationships and are frequently in trouble with the law.
Behaviour therapy, and various forms of psychotherapy, may help to improve integration.
In general, the effects of this disorder decrease with age.... antisocial personality disorder
The child usually becomes red or even blue in the face after a few seconds, and may faint.
Breathing quickly resumes as a natural reflex, ending the attack.
Attacks cause no damage and are usually outgrown.... breath-holding attacks
Special needs The Children Act 1989, Education Acts 1981, 1986 and 1993, and the Chronically Sick and Disabled Persons Legislation 1979 impose various statutory duties to identify and provide assistance for children with special needs. They include the chronically ill as well as those with impaired development or disabilities such as CEREBRAL PALSY, or hearing, vision or intellectual impairment. Many CDTs keep a register of such children so that services can be e?ciently planned and evaluated. Parents of disabled children often feel isolated and neglected by society in general; they are frequently frustrated by the lack of resources available to help them cope with the sheer hard work involved. The CDT, through its key workers, does its best to absorb anger and divert frustration into constructive actions.
There are other groups of children who come to the attention of child health services. Community paediatricians act as advisers to adoption and fostering agencies, vital since many children needing alternative homes have special medical or educational needs or have behavioural or psychiatric problems. Many see a role in acting as advocates, not just for those with impairments but also for socially disadvantaged children, including those ‘looked after’ in children’s homes and those of travellers, asylum seekers, refugees and the homeless.
Child protection Regrettably, some children come to the attention of child health specialists because they have been beaten, neglected, emotionally or nutritionally starved or sexually assaulted by their parents or carers. Responsibility for the investigation of these children is that of local-authority social-services departments. However, child health professionals have a vital role in diagnosis, obtaining forensic evidence, advising courts, supervising the medical aspects of follow-up and teaching doctors, therapists and other professionals in training. (See CHILD ABUSE.)
School health services Once children have reached school age, the emphasis changes. The prime need becomes identifying those with problems that may interfere with learning – including those with special needs as de?ned above, but also those with behavioural problems. Teachers and parents are advised on how to manage these problems, while health promotion and health education are directed at children. Special problems, especially as children reach secondary school (aged 11–18) include accidents, substance abuse, psychosexual adjustment, antisocial behaviour, eating disorders and physical conditions which loom large in the minds of adolescents in particular, such as ACNE, short stature and delayed puberty.
There is no longer, in the UK, a universal school health service as many of its functions have been taken over by general practitioners and hospital and community paediatricians. However, most areas still have school nurses, some have school doctors, while others do not employ speci?c individuals for these tasks but share out aspects of the work between GPs, health visitors, community nurses and consultant paediatricians in child health.
Complementing their work is the community dental service whose role is to monitor the whole child population’s dental health, provide preventive programmes for all, and dental treatment for those who have di?culty using general dental services – for example, children with complex disability. All children in state-funded schools are dentally screened at ages ?ve and 15.
Successes and failures Since the inception of the NHS, hospital services for children have had enormous success: neonatal and infant mortality rates have fallen by two-thirds; deaths from PNEUMONIA have fallen from 600 per million children to a handful; and deaths from MENINGITIS have fallen to one-?fth of the previous level. Much of this has been due to the revolution in the management of pregnancy and labour, the invention of neonatal resuscitation and neonatal intensive care, and the provision of powerful antibiotics.
At the same time, some children acquire HIV infection and AIDS from their affected mothers (see AIDS/HIV); the prevalence of atopic (see ATOPY) diseases (ASTHMA, eczema – see DERMATITIS, HAY FEVER) is rising; more children attend hospital clinics with chronic CONSTIPATION; and little can be done for most viral diseases.
Community child health services can also boast of successes. The routine immunisation programme has wiped out SMALLPOX, DIPHTHERIA and POLIOMYELITIS and almost wiped out haemophilus and meningococcal C meningitis, measles and congenital RUBELLA syndrome. WHOOPING COUGH outbreaks continue but the death and chronic disability rates have been greatly reduced. Despite these huge health gains, continuing public scepticism about the safety of immunisation means that there can be no relaxation in the educational and health-promotion programme.
Services for severely and multiply disabled children have improved beyond all recognition with the closure of long-stay institutions, many of which were distinctly child-unfriendly. Nonetheless, scarce resources mean that families still carry heavy burdens. The incidence of SUDDEN INFANT DEATH SYNDROME (SIDS) has more than halved as a result of an educational programme based on ?rm scienti?c evidence that the risk can be reduced by putting babies to sleep on their backs, avoidance of parental smoking, not overheating, breast feeding and seeking medical attention early for illness.
Children have fewer accidents and better teeth but new problems have arisen: in the 1990s children throughout the developed world became fatter. A UK survey in 2004 found that one in ?ve children are overweight and one in 20 obese. Lack of exercise, the easy availability of food at all times and in all places, together with the rise of ‘snacking’, are likely to provoke signi?cant health problems as these children grow into adult life. Adolescents are at greater risk than ever of ill-health through substance abuse and unplanned pregnancy. Child health services are facing new challenges in the 21st century.... child development teams (cdts)
The nervous system can be likened to a computer. The central processing unit – which receives, processes and stores information and initiates instructions for bodily activities – is called the central nervous system: this is made up of the brain and SPINAL CORD. The peripheral nervous system – synonymous with the cables that transmit information to and from a computer’s processing unit – has two parts: sensory and motor. The former collects information from the body’s many sense organs. These respond to touch, temperature, pain, position, smells, sounds and visual images and the information is signalled to the brain via the sensory nerves. When information has been processed centrally, the brain and spinal cord send instructions for action via motor nerves to the ‘voluntary’ muscles controlling movements and speech, to the ‘involuntary’ muscles that operate the internal organs such as the heart and intestines, and to the various glands, including the sweat glands in the skin. (Details of the 12 pairs of cranial nerves and the 31 pairs of nerves emanating from the spinal cord are given in respective texts on brain and spinal cord.)
Functional divisions of nervous system As well as the nervous system’s anatomical divisions, the system is divided functionally, into autonomic and somatic parts. The autonomic nervous system, which is split into sympathetic and parasympathetic divisions, deals with the automatic or unconscious control of internal bodily activities such as heartbeat, muscular status of blood vessels, digestion and glandular functions. The somatic system is responsible for the skeletal (voluntary) muscles (see MUSCLE) which carry out intended movements initiated by the brain – for example, the activation of limbs, tongue, vocal cords (speech), anal muscles (defaecation), urethral sphincters (urination) or vaginal muscles (childbirth). In addition, many survival responses – the most powerfully instinctive animal drives, which range from avoiding danger and pain to shivering when cold or sweating when hot – are initiated unconsciously and automatically by the nervous system using the appropriate neural pathways to achieve the particular survival reaction required.
The complex functions of the nervous system include the ability to experience emotions, such as excitement and pleasure, anxiety and frustration, and to undertake intellectual activities. For these experiences an individual can utilise many built-in neurological programmes and he or she can enhance performance through learning – a vital human function that depends on MEMORY, a three stage-process in the brain of registration, storage and recall. The various anatomical and functional divisions of the nervous system that have been unravelled as science has strived to explain how it works may seem confusing. In practical terms, the nervous system works mainly by using automatic or relex reactions (see REFLEX ACTION) to various stimuli (described above), supplemented by voluntary actions triggered by the activity of the conscious (higher) areas of the brain. Some higher functions crucial to human activity – for example, visual perception, thought, memory and speech – are complex and subtle, and the mechanisms are not yet fully understood. But all these complex activities rest on the foundation of relatively simple electrochemical transmissions of impulses through the massive network of billions of specialised cells, the neurones.... nervous system
Constituents: flavonoids, iridoids including rutin, diterpenes.
Action: antispasmodic, laxative, diaphoretic, emmenagogue, vaso-constrictor. (Simon Mills) Nerve and heart sedative. Hypotensive. Action similar to Valerian. (Dr Rudolf F. Weiss) Cardiotonic.
Uses: angina on effort, simple uncomplicated heart conditions to enhance exercise duration; tachycardia from hyperactive thyroid, hypertension, absent or painful menstruation (hence its name), menopausal flushes, schizophrenic tendency, pre-menstrual tension.
“Drink Motherwort tea and live to be a source of continuous astonishment and frustration to waiting heirs.” (Old saying)
Not given in pregnancy.
Combines well with Vervain (equal parts) for relaxing nervine.
Practitioner combinations: Menstrual disorders, equal parts: Black Cohosh, Cramp bark, Motherwort. Heart disorders: Motherwort 1; Hawthorn 1; Lily of the Valley half.
Benzodiazepine addiction to assist withdrawal: equal parts, Motherwort, Skullcap and Valerian. Infusions, extracts or tinctures.
Preparations: Thrice daily.
Tea: 1-2 teaspoons to each cup boiling water; infuse 15 minutes. Half-1 cup.
Tea combination: equal parts, Motherwort, Balm and Lime flowers. 2 teaspoons to cup boiling water: infuse 15 minutes, 1 cup thrice daily. Angina and heart symptoms – to ameliorate.
Liquid Extract: 1:1, 25 per cent alcohol. Dose: 2-4ml (30-60 drops).
Tincture: 1:5, 25 per cent alcohol. Dose: 5-10ml (1-2 teaspoons).
Powders. 2 to 4g.
Tablets/capsules. Popular combination. Powdered extract Motherwort 4:1 – 50mg. Powdered Passion flower BHP (1983) – 90mg. Powdered extract Lime flowers 3:1 – 67mg. For a calming and sedating effect in stressful situations and insomnia. (Gerard House)
Note: Motherwort needs to be taken for weeks. ... motherwort
Specific remedial teaching can help the child develop “tricks” to overcome the deficit.
Avoidance of pressure from parents combined with praise for what the child can do is equally important.... dyslexia
Alcohol withdrawal symptoms start 6–8 hours after cessation of intake and may last up to 7 days. They include trembling of the hands, nausea, vomiting, sweating, cramps, anxiety, and, sometimes, seizures. (See also confusion, delirium tremens, and hallucinations.)
Opioid withdrawal symptoms start after 8–12 hours and may last for 7–10 days. Symptoms include restlessness, sweating, runny eyes and nose, yawning, diarrhoea, vomiting, abdominal cramps, dilated pupils, loss of appetite, irritability, weakness, tremor, and depression.
Withdrawal symptoms from barbiturate drugs and meprobamate start after 12–24 hours, beginning with tremor, anxiety, restlessness, and weakness, sometimes followed by delirium, hallucinations, and, occasionally, seizures. A period of prolonged sleep occurs 3–8 days after onset. Withdrawal from benzodiazepine drugs may begin much more slowly and can be life-threatening.
Withdrawal symptoms from nicotine develop gradually over 24–48 hours and include irritability, concentration problems, frustration, headaches, and anxiety. Discontinuation of cocaine or amfetamines results in extreme tiredness, lethargy, and dizziness. Cocaine withdrawal may also lead to tremor, severe depression, and sweating.
Withdrawal symptoms from marijuana include tremor, nausea, vomiting, diarrhoea, sweating, irritability, and sleep problems. Caffeine withdrawal may lead to tiredness, headaches, and irritability.
Severe withdrawal syndromes require medical treatment.
Symptoms may be suppressed by giving the patient small quantities of the drug he or she had been taking.
More commonly, a substitute drug is given, such as methadone for opioid drugs or diazepam for alcohol.
The dose of the drug is then gradually reduced.... withdrawal syndrome
FAMILY: Annonaceae
SYNONYMS: Unona odorantissimum, flower of flowers.
GENERAL DESCRIPTION: A tall tropical tree up to 20 metres high with large, tender, fragrant flowers, which can be pink, mauve or yellow. The yellow flowers are considered best for the extraction of essential oil.
DISTRIBUTION: Native to tropical Asia, especially Indonesia and the Philippines. Major oil producers are Madagascar, Reunion and the Comoro Islands.
OTHER SPECIES: Very closely related to cananga (C. odoratum var. macrophylla), although the oil produced from the ylang ylang is considered of superior quality for perfumery work, having a more refined quality.
HERBAL/FOLK TRADITION: In Indonesia, the flowers are spread on the beds of newly married couples on their wedding night. In the Molucca Islands, an ointment is made from ylang ylang and cucuma flowers in a coconut oil base for cosmetic and hair care, skin diseases, to prevent fever (including malaria) and fight infections.
In the Victorian age, the oil was used in the popular hair treatment Macassar oil, due to its stimulating effect on the scalp, encouraging hair growth. The oil was also used to soothe insect bites, and is thought to have a regulating effect on cardiac and respiratory rhythm.
ACTIONS: Aphrodisiac, antidepressant, anti infectious, antiseborrhoeic, antiseptic, euphoric, hypotensive, nervine, regulator, sedative (nervous), stimulant (circulatory), tonic.
EXTRACTION: Essential oil by water or steam distillation from the freshly picked flowers. The first distillate (about 40 per cent) is called ylang ylang extra, which is the top grade. There are then three further successive distillates, called Grades 1, 2 and 3. A ‘complete’ oil is also produced which represents the total or ‘unfractionated’ oil, but this is sometimes constructed by blending ylang ylang 1 and 2 together, which are the two least popular grades. (An absolute and concrete are also produced by solvent extraction for their long-lasting floral-balsamic effect.)
CHARACTERISTICS: Ylang ylang extra is a pale yellow, oily liquid with an intensely sweet, soft, floral-balsamic, slightly spicy scent – a good oil has a creamy rich topnote. A very intriguing perfume oil in its own right, it also blends well with rosewood, jasmine, vetiver, opopanax, bergamot, mimosa, cassie, Peru balsam, rose, tuberose, costus and others. It is an excellent fixative. The other grades lack the depth and richness of the ylang ylang extra.
PRINCIPAL CONSTITUENTS: Methyl benzoate, methyl salicylate, methyl paracretol, benzyl acetate, eugenol, geraniol, linalol and terpenes: pinene, cadinene, among others.
SAFETY DATA: Non-toxic, non-irritant, a few cases of sensitization reported. Use in moderation, since its heady scent can cause headaches or nausea.
AROMATHERAPY/HOME: USE
Skin care: Acne, hair growth, hair rinse, insect bites, irritated and oily skin, general skin care.
Circulation muscles and joints: High blood pressure, hyperpnoea (abnormally fast breathing), tachycardia, palpitations.
Nervous system: Depression, frigidity, impotence, insomnia, nervous tension and stress-related disorders – ‘The writer, working with odorous materials for more than twenty years, long ago noticed that ... ylang ylang soothes and inhibits anger born of frustration.’.
OTHER USES: Extensively used as a fragrance component and fixative in soaps, cosmetics and perfumes, especially oriental and floral types; ylang ylang extra tends to be used in high-class perfumes, ylang ylang 3 in soaps, detergents, etc. Used as a flavour ingredient, mainly in alcoholic and soft drinks, fruit flavours and desserts.... ylang ylang
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