Obsessional traits Health Dictionary

The transfer of characteristics, traits and disorders from parents to children by means of

GENES carried in the CHROMOSOMES of the germ cells. (See GERM CELL; GENETIC CODE; GENETIC DISORDERS.)... inheritance

A general term applied to mental or emotional disturbance in which, as opposed to PSYCHOSIS, there is no serious disturbance in the perception or understanding of external reality. However, the boundaries between neurosis and psychosis are not always clearly de?ned. Neuroses are usually classi?ed into anxiety neuroses, depressive neuroses, phobias (see PHOBIA), HYPOCHONDRIASIS, HYSTERIA and obsessional neuroses.

Anxiety neurosis, or anxiety state, constitutes the most common form of neurosis; fortunately it is also among the most responsive to treatment. Once the neurosis develops, sufferers are in a state of persistent anxiety and worry, ‘tensed up’, always fatigued and unable to sleep at night. In addition, there are often physical complaints – for example, palpitations, sweating, apparent discomfort on swallowing (‘globus’), and headache.

Obsessional neuroses are much less common and constitute only about 5 per cent of all neuroses. Like other neuroses, they usually develop in early adult life. (See MENTAL ILLNESS.)... neurosis

A lifelong personality disorder, evident from childhood and regarded as a mild form of AUTISM. Persons with the syndrome tend to have great di?culty with personal relationships. They tend to take what is said to them as literal fact and have great di?culty in understanding irony, metaphors or even jokes. They appear shy with a distant and aloof character, emotional rigidity and inability to adapt to new situations. They are often mocked and ill-treated at school by their fellows because they appear unusual. Many people with Asperger’s seem to take refuge in intense interests or hobbies, often conducted to an obsessional degree. Many become skilled in mathematics and particularly information technology. Frustration with the outside world which is so hard to comprehend may provoke aggressive outbursts when stressed.... asperger’s syndrome

Obsessional fear about the state of the heart. It tends to occur after a heart attack and may result in the patient’s experiencing the symptoms of another attack.... cardiac neurosis

A social group within a cultural and social system that shares complex traits of religious, linguistic, ancestral and/or physical characteristics.... ethnicity

The absence of psychiatric disorders or traits. It can be influenced by biological, environmental, emotional and cultural factors. This term is highly variable in definition, depending on time and place.... mental health

De?ned simply, this is a disorder of the brain’s processes that makes the sufferer feel or seem ill, and may prevent that person from coping with daily life. Psychiatrists – doctors specialising in diagnosing and treating mental illness – have, however, come up with a range of much more complicated de?nitions over the years.

Psychiatrists like to categorise mental illnesses because mental signs and symptoms do occur together in clusters or syndromes, each tending to respond to certain treatments. The idea that illnesses can be diagnosed simply by recognising their symptom patterns may not seem very scienti?c in these days of high technology. For most common mental illnesses, however, this is the only method of diagnosis; whatever is going wrong in the brain is usually too poorly understood and too subtle to show up in laboratory tests or computed tomography scans of the brain. And symptom-based definitions of mental illnesses are, generally, a lot more meaningful than the vague lay term ‘nervous breakdown’, which is used to cover an attack of anything from AGORAPHOBIA to total inability to function.

There is still a lot to learn about the workings of the brain, but psychiatry has developed plenty of practical knowledge about the probable causes of mental illness, ways of relieving symptoms, and ways of aiding recovery. Most experts now believe that mental illnesses generally arise from di?erent combinations of inherited risk and psychological STRESS, sometimes with additional environmental exposure – for example, viruses, drugs or ALCOHOL.

The range of common mental illnesses includes anxiety states, PHOBIA, DEPRESSION, alcohol and drug problems, the EATING DISORDERS anorexia and bulimia nervosa, MANIC DEPRESSION, SCHIZOPHRENIA, DEMENTIA, and a group of problems related to coping with life that psychiatrists call personality disorders.

Of these mental illnesses, dementia is the best understood. It is an irreversible and fatal form of mental deterioration (starting with forgetfulness and eventually leading to severe failure of all the brain’s functions), caused by rapid death of brain cells and consequent brain shrinkage. Schizophrenia is another serious mental illness which disrupts thought-processes, speech, emotions and perception (how the brain handles signals from the ?ve senses). Manic depression, in which prolonged ‘highs’ of extremely elevated mood and overexcitement alternate with abject misery, has similar effects on the mental processes. In both schizophrenia and manic depression the sufferer loses touch with reality, develops unshakeable but completely unrealistic ideas (delusions), and hallucinates (vividly experiences sensations that are not real, e.g. hears voices when there is nobody there). This triad of symptoms is called psychosis and it is what lay people, through fear and lack of understanding, sometimes call lunacy, madness or insanity.

The other mental illnesses mentioned above are sometimes called neuroses. But the term has become derogatory in ordinary lay language; indeed, many people assume that neuroses are mild disorders that only affect weak people who cannot ‘pull themselves together’, while psychoses are always severe. In reality, psychoses can be brief and reversible and neuroses can cause lifelong disability.

However de?ned and categorised, mental illness is a big public-health problem. In the UK, up to one in ?ve women and around one in seven men have had mental illness. About half a million people in Britain suffer from schizophrenia: it is three times commoner than cancer. And at any one time, up to a tenth of the adult population is ill with depression.

Treatment settings Most people with mental-health problems get the help they need from their own family doctor(s), without ever seeing a psychiatrist. General practictitioners in Britain treat nine out of ten recognised mental-health problems and see around 12 million adults with mental illness each year. Even for the one in ten of these patients referred to psychiatrists, general practitioners usually handle those problems that continue or recur.

Psychiatrists, psychiatric nurses, social workers, psychologists, counsellors and therapists often see patients at local doctors’ surgeries and will do home visits if necessary. Community mental-health centres – like general-practice health centres but catering solely for mental-health problems – o?er another short-cut to psychiatric help. The more traditional, and still more common, route to a psychiatrist for many people, however, is from the general practititioner to a hospital outpatient department.

Specialist psychiatric help In many ways, a visit to a psychiatrist is much like any trip to a hospital doctor – and, indeed, psychiatric clinics are often based in the outpatient departments of general hospitals. First appointments with psychiatrists can last an hour or more because the psychiatrist – and sometimes other members of the team such as nurses, doctors in training, and social workers – need to ask lots of questions and record the whole consultation in a set of con?dential case notes.

Psychiatric assessment usually includes an interview and an examination, and is sometimes backed up by a range of tests. The interview begins with the patient’s history – the personal story that explains how and, to some extent, why help is needed now. Mental-health problems almost invariably develop from a mixture of causes – emotional, social, physical and familial – and it helps psychiatrists to know what the people they see are normally like and what kind of lives they have led. These questions may seem unnecessarily intrusive, but they allow psychiatrists to understand patients’ problems and decide on the best way to help them.

The next stage in assessment is the mental-state examination. This is how psychiatrists examine minds, or at least their current state. Mental-state examination entails asking more questions and using careful observation to assess feelings, thoughts and mental symptoms, as well as the way the mind is working (for example, in terms of memory and concentration). During ?rst consultations psychiatrists usually make diagnoses and explain them. The boundary between a life problem that will clear up spontaneously and a mental illness that needs treatment is sometimes quite blurred; one consultation may be enough to put the problem in perspective and help to solve it.

Further assessment in the clinic may be needed, or some additional tests. Simple blood tests can be done in outpatient clinics but other investigations will mean referral to another department, usually on another day.

Further assessment and tests

PSYCHOLOGICAL TESTS Psychologists work in or alongside the psychiatric team, helping in both assessment and treatment. The range of psychological tests studies memory, intelligence, personality, perception and capability for abstract thinking. PHYSICAL TESTS Blood tests and brain scans may be useful to rule out a physical illness causing psychological symptoms. SOCIAL ASSESSMENT Many patients have social diffculties that can be teased out and helped by a psychiatric social worker. ‘Approved social workers’ have special training in the use of the Mental Health Act, the law that authorises compulsory admissions to psychiatric hospitals and compulsory psychiatric treatments. These social workers also know about all the mental-health services o?ered by local councils and voluntary organisations, and can refer clients to them. The role of some social workers has been widened greatly in recent years by the expansion of community care. OCCUPATIONAL THERAPY ASSESSMENT Mental-health problems causing practical disabilities – for instance, inability to work, cook or look after oneself – can be assessed and helped by occupational therapists.

Treatment The aims of psychiatric treatment are to help sufferers shake o?, or at least cope with, symptoms and to gain or regain an acceptable quality of life. A range of psychological and physical treatments is available.

COUNSELLING This is a widely used ‘talking cure’, particularly in general practice. Counsellors listen to their clients, help them to explore feelings, and help them to ?nd personal and practical solutions to their problems. Counsellors do not probe into clients’ pasts or analyse them. PSYCHOTHERAPY This is the best known ‘talking cure’. The term psychotherapy is a generalisation covering many di?erent concepts. They all started, however, with Sigmund Freud (see FREUDIAN THEORY), the father of modern psychotherapy. Freud was a doctor who discovered that, as well as the conscious thoughts that guide our feelings and actions, there are powerful psychological forces of which we are not usually aware. Applying his theories to his patients’ freely expressed thoughts, Freud was able to cure many illnesses, some of which had been presumed completely physical. This was the beginning of individual analytical psychotherapy, or PSYCHOANALYSIS. Although Freud’s principles underpin all subsequent theories about the psyche, many di?erent schools of thought have emerged and in?uenced psychotherapists (see ADLER; JUNGIAN ANALYSIS; PSYCHOTHERAPY). BEHAVIOUR THERAPY This springs from theories of human behaviour, many of which are based on studies of animals. The therapists, mostly psychologists, help people to look at problematic patterns of behaviour and thought, and to change them. Cognitive therapy is very e?ective, particularly in depression and eating disorders. PHYSICAL TREATMENTS The most widely used physical treatments in psychiatry are drugs. Tranquillising and anxiety-reducing BENZODIAZEPINES like diazepam, well known by its trade name of Valium, were prescribed widely in the 1960s and 70s because they seemed an e?ective and safe substitute for barbiturates. Benzodiazepines are, however, addictive and are now recommended only for short-term relief of anxiety that is severe, disabling, or unacceptably distressing. They are also used for short-term treatment of patients drying out from alcohol.

ANTIDEPRESSANT DRUGS like amitriptyline and ?uoxetine are given to lift depressed mood and to relieve the physical symptoms that sometimes occur in depression, such as insomnia and poor appetite. The side-effects of antidepressants are mostly relatively mild, when recommended doses are not exceeded – although one group, the monoamine oxidase inhibitors, can lead to sudden and dangerous high blood pressure if taken with certain foods.

Manic depression virtually always has to be treated with mood-stabilising drugs. Lithium carbonate is used in acute mania to lower mood and stop psychotic symptoms; it can also be used in severe depression. However lithium’s main use is to prevent relapse in manic depression. Long-term unwanted effects may include kidney and thyroid problems, and short-term problems in the nervous system and kidney may occur if the blood concentration of lithium is too high – therefore it must be monitored by regular blood tests. Carbamazepine, a treatment for EPILEPSY, has also been found to stabilise mood, and also necessitates blood tests.

Antipsychotic drugs, also called neuroleptics, and major tranquillisers are the only e?ective treatments for relieving serious mental illnesses with hallucinations and delusions. They are used mainly in schizophrenia and include the short-acting drugs chlorpromazine and clozapine as well as the long-lasting injections given once every few weeks like ?uphenazine decanoate. In the long term, however, some of the older antipsychotic drugs can cause a brain problem called TARDIVE DYSKINESIA that affects control of movement and is not always reversible. And the antipsychotic drugs’ short-term side-effects such as shaking and sti?ness sometimes have to be counteracted by other drugs called anticholinergic drugs such as procyclidine and benzhexol. Newer antipsychotic drugs such as clozapine do not cause tardive dyskinesia, but clozapine cannot be given as a long-lasting injection and its concentration in the body has to be monitored by regular blood tests to avoid toxicity. OTHER PHYSICAL TREATMENTS The other two physical treatments used in psychiatry are particularly controversial: electroconvulsive therapy (ECT) and psychosurgery. In ECT, which can be life-saving for patients who have severe life-threatening depression, a small electric current is passed through the brain to induce a ?t or seizure. Before the treatment the patient is anaesthetised and given a muscle-relaxing injection that reduces the magnitude of the ?t to a slight twitching or shaking. Scientists do not really understand how ECT works, but it does, for carefully selected patients. Psychosurgery – operating on the brain to alleviate psychiatric illness or di?cult personality traits – is extremely uncommon these days. Stereo-tactic surgery, in which small cuts are made in speci?c brain ?bres under X-ray guidance, has super-seded the more generalised lobotomies of old. The Mental Health Act 1983 ensures that psychosurgery is performed only when the patient has given fully informed consent and a second medical opinion has agreed that it is necessary. For all other psychiatric treatments (except another rare treatment, hormone implantation for reducing the sex drive of sex o?enders), either consent or a second opinion is needed – not both. TREATMENT IN HOSPITAL Psychiatric wards do not look like medical or surgical wards and sta? may not wear uniforms. Patients do not need to be in their beds during the day, so the beds are in separate dormitories. The main part of most wards is a living space with a day room, an activity and television room, quiet rooms, a dining room, and a kitchen. Ward life usually has a certain routine. The day often starts with a community meeting at which patients and nurses discuss issues that affect the whole ward. Patients may go to the occupational therapy department during the day, but there may also be some therapy groups on the ward, such as relaxation training. Patients’ symptoms and problems are assessed continuously during a stay in hospital. When patients seem well enough they are allowed home for trial periods; then discharge can be arranged. Patients are usually followed up in the outpatient clinic at least once.

TREATING PATIENTS WITH ACUTE PSYCHIATRIC ILLNESS Psychiatric emergencies – patients with acute psychiatric illness – may develop from psychological, physical, or practical crises. Any of these crises may need quick professional intervention. Relatives and friends often have to get this urgent help because the sufferer is not ?t enough to do it or, if psychotic, does not recognise the need. First, they should ring the person’s general practitioner. If the general practitioner is not available and help is needed very urgently, relatives or friends should phone the local social-services department and ask for the duty social worker (on 24-hour call). In a dire emergency, the police will know what to do.

Any disturbed adult who threatens his or her own or others’ health and safety and refuses psychiatric help may be moved and detained by law. The Mental Health Act of 1983 authorises emergency assessment and treatment of any person with apparent psychiatric problems that ful?l these criteria.

Although admission to hospital may be the best solution, there are other ways that psychiatric services can respond to emergencies. In some districts there are ‘crisis intervention’ teams of psychiatrists, nurses, and social workers who can visit patients urgently at home (at a GP’s request) and, sometimes, avert unnecessary admission. And research has shown that home treatment for a range of acute psychiatric problems can be e?ective.

LONG-TERM TREATMENT AND COMMUNITY CARE Long-term treatment is often provided by GPs with support and guidance from psychiatric teams. That is ?ne for people whose problems allow them to look after themselves, and for those with plenty of support from family and friends. But some people need much more intensive long-term treatment and many need help with running their daily lives.

Since the 1950s, successive governments have closed the old psychiatric hospitals and have tried to provide as much care as possible outside hospital – in ‘the community’. Community care is e?ective as long as everyone who needs inpatient care, or residential care, can have it. But demand exceeds supply. Research has shown that some homeless people have long-term mental illnesses and have somehow lost touch with psychiatric services. Many more have developed more general long-term health problems, particularly related to alcohol, without ever getting help.

The NHS and Community Care Act 1990, in force since 1993, established a new breed of professionals called care managers to assess people whose long-term illnesses and disabilities make them unable to cope completely independently with life. Care managers are given budgets by local councils to assess people’s needs and to arrange for them tailor-made packages of care, including services like home helps and day centres. But co-ordination between health and social services has sometimes failed – and resources are limited – and the government decided in 1997 to tighten up arrangements and pool community-care budgets.

Since 1992 psychiatrists have had to ensure that people with severe mental illnesses have full programmes of care set up before discharge from hospital, to be overseen by named key workers. And since 1996 psychiatrists have used a new power called Supervised Discharge to ensure that the most vulnerable patients cannot lose touch with mental-health services. There is not, however, any law that allows compulsory treatment in the community.

There is ample evidence that community care can work and that it need not cost more than hospital care. Critics argue, however, that even one tragedy resulting from inadequate care, perhaps a suicide or even a homicide, should reverse the march to community care. And, according to the National Schizophrenia Fellowship, many of the 10–15 homicides a year carried out by people with severe mental illnesses result from inadequate community care.

Further information can be obtained from the Mental Health Act Commission, and from MIND, the National Association for Mental Health. MIND also acts as a campaigning and advice organisation on all aspects of mental health.... mental illness

A benzodiazpine anxiolytic drug (see BENZODIAZEPINES; ANXIOLYTICS). Like all benzodiazepines, oxazepam should be prescribed with caution at the lowest possible dosage for the shortest possible time, as patients can become dependent on it (see DEPENDENCE). The indication for use is short-term relief of severe anxiety, including panic attacks. Oxazepam has an advantage over many diazepams in being shorter acting, and it can be used for patients with impairment of LIVER function. The drug is inappropriate for treatment of DEPRESSION, obsessional states or PSYCHOSIS (see MENTAL ILLNESS).... oxazepam

This was introduced in 1936 by Egas Moniz, Professor of Medicine in Lisbon University, for the surgical treatment of certain psychoses (see PSYCHOSIS). For his work in this ?eld he shared the Nobel prize in 1949. The original operation, known as leucotomy, consisted of cutting white ?bres in the frontal lobe of the BRAIN. It was accompanied by certain hazards such as persistent EPILEPSY and undesirable changes in personality; pre-frontal leucotomy is now regarded as obsolete. Modern stereotactic surgery may be indicated in certain intractable psychiatric illnesses in which the patient is chronically incapacitated, especially where there is a high suicide risk. Patients are only considered for psychosurgery when they have failed to respond to routine therapies. One contraindication is marked histrionic or antisocial personality. The conditions in which a favour-able response has been obtained are intractable and chronic obsessional neuroses (see NEUROSIS), anxiety states and severe chronic DEPRESSION.

Psychosurgery is now rare in Britain. The Mental Health Act 1983 requires not only consent by the patient – con?rmed by an independent doctor, and two other representatives of the Mental Health Act Commission – but also that the Commission’s appointed medical representative also advise on the likelihood of the treatment alleviating or preventing a deterioration in the patient’s condition.... psychosurgery

An obsessional impulse to pull out one’s own hair.... trichotillomania

The transmission of traits and disorders through genetic mechanisms. Each individual inherits a combination of genes via the sperm and egg cells from which he or she is derived. The interaction of the genes determines inherited characteristics, including, in some cases, disorders or susceptibility to disorders.

(See also genetic disorders; inheritance.)... heredity

The sum of a person’s traits, habits, and experiences.

Temperament, intelligence, emotion, and motivation are important aspects.

The development of personality seems to depend on the interaction of heredity and environment.... personality

Questionnaires designed to define various personality traits or types. Tests may be designed to detect psychiatric symptoms, underlying personality traits, how outgoing or reserved a person is, and predisposition to developing neurotic illness.... personality tests

The passing on to the next generation of a trait or disorder determined by the sex chromosomes, or by the genes carried on them.

Disorders caused by an abnormal number of sex chromosomes include Turner’s syndrome and Klinefelter’s syndrome.

Most other sex-linked traits or disorders are caused by recessive genes on the X chromosome (see genetic disorders).... sex-linked inheritance

An abnormal condition of early childhood where the child is unable to make contact and develop relationships with people. Scanning techniques show that blood-flow in the frontal and temporal lobes is impaired. A passive child fails to become emotionally involved with other people and isolates himself. When the even tenor of his existence is disturbed he flies into a rage or retires into anxious brooding. Diagnosis is assisted by recognising young children being socially withdrawn and teenagers developing peculiar mannerisms and gait.

A child may avoid looking a person in the face, occupying himself or herself elsewhere to avoid direct contact. Obsessional motions include erratic movements of the fingers or limbs or facial twitch or grimace. Corrective efforts by parents to educate into more civilised behaviour meet with instant hostility, even hysteria. Hyperactivity may give rise to tantrums when every degree of self-control is lost. For such times, harmless non habit-forming herbal sedatives are helpful (Skullcap, Valerian, Mistletoe).

A link has been discovered between a deficiency of magnesium and autism. Magnesium is essential for the body’s use of Vitamin B6. Nutritionists attribute the condition stemming from an inadequate intake of vitamins and minerals at pregnancy. Alcohol in the expectant mother is a common cause of such deficiencies. Personal requirements of autistic children will be higher than normal levels of Vitamin B complex (especially B6) C, E and Magnesium.

Such children grow up to be ‘temperamental’, of extreme sensibility, some with rare talents. Medicine is not required, but for crisis periods calm and poise can be restored by:–

Motherwort tea: equal parts, Motherwort, Balm and Valerian: 1-2 teaspoons to each cup boiling water; infuse 10-15 minutes; 1 cup 2-3 times daily. Honey renders it more palatable.

Alternatives:– Teas, tablets or other preparations: Hops, German Chamomile, Ginseng, Passion flower, Skullcap, Devil’s Claw, Vervain, Mistletoe, Ginkgo.

Diet. Lacto-vegetarian. 2-3 bananas (for potassium) daily.

Supplements. Daily. Vitamin B-complex, Vitamin B6 50mg, Calcium, Magnesium, Zinc. Aromatherapy. Inhalation of Lavender oil may act as a mood-lifter.

Note: A scientific study revealed a link with the yeast syndrome as associated with candidiasis. ... autism

A psychotic state often found with alcoholism, dementia and depression. Obsessional suspicion and aggression. Morbid jealousy. Such symptoms are often of physical causation and will not improve until the condition is remedied. Consider low thyroid function (Kelp), drug dependency (Valerian), auto-toxaemia (Echinacea).

Even as too low body fluids may kindle emotions of anger and irritability, so too much water has a depressing effect, bringing about an emotional state simulating paranoia. Administration of a timely diuretic (Parsley or Juniper berry tea) is sometimes known to raise the spirits.

Pulsatilla. (N. Gosling FNIMH, Herbal Practitioner, Apr 1979, p.11) ... paranoia

A collection of techniques, based on psychological theory, for changing abnormal behaviour or treating anxiety. The treatment relies on 2 basic ideas: that exposure to a feared experience under safe conditions will render it less threatening, and that desirable behaviour can be encouraged by using a system of rewards.

Specific behaviour therapy techniques include exposure therapy (also called desensitization), response prevention, flooding, and modelling. Exposure therapy is commonly used to treat phobic disorders such as agoraphobia, animal phobias, and flying phobias. It consists of exposing the patient in stages to the cause of the anxiety. The patient is taught to cope with anxiety symptoms by using relaxation techniques. In flooding, the patient is confronted with the anxiety-provoking stimulus all at once, but with the support of the therapist. In response prevention, the patient is prevented from carrying out an obsessional task; the technique is used in combination with other methods. In modelling, the therapist acts as a model for the patient, performing the anxiety-provoking activity first, in order that the patient may copy.... behaviour therapy

A condition characterised by a deterioration in brain function. Dementia is almost always due to Alzheimer’s disease or to cerebrovascular disease, including strokes. Cerebrovascular dis-ease is often due to narrowed or blocked arteries in the brain. Recurrent loss of blood supply to the brain usually results in deterioration that occurs gradually but in stages. A small proportion of cases of dementia in people younger than 65 have a underlying treatable cause such as head injury, brain tumour, encephalitis, or alcohol dependence.

The main symptoms of dementia are progressive memory loss, disorientation, and confusion. Sudden outbursts or embarrassing behaviour may be the first signs of the condition. Unpleasant personality traits may be magnified; families may have to endure accusations, unreasonable demands, or even assault. Paranoia, depression, and delusions may occur as the disease worsens. Irritability or anxiety gives way to indifference towards all feelings. Personal habits deteriorate, and speech becomes incoherent. Affected people may eventually need total nursing care.

Management of the most common

Alzheimer-type illness is based on the treatment of symptoms. Sedative drugs may be given for restlessness or paranoia. Drugs for dementia, for example donepezil, can slow mental decline in some people with mild to moderate Alzheimer’s disease (see acetylcholinesterase inhibitors).... dementia

Any characteristic or condition that is inherited (determined by 1 or more genes). Blue or brown eye colour, dark or light skin, body proportions, and nose shape are examples of genetic traits. The term trait is also sometimes used to describe a mild form of a recessive genetic disorder.... trait

adj. describing a collection of longstanding personality traits in ICD-10 (see International Classification of Diseases), including stubbornness, meanness, an over-meticulous concern to be accurate in small details, a disposition to check things unnecessarily, severe feelings of insecurity about personal worth, and an excessive tendency to doubt evident facts. These traits, sometimes described as obsessional traits, can amount to a *personality disorder if they are severe.... anankastic

n. (in psychiatry) a symptom of thought disturbance in which thinking and speech proceed slowly and with many unnecessary trivial details. It is sometimes seen in organic *psychosis, in *schizophrenia, and in people of obsessional personality.... circumstantiality

Prescribed according to mental symptoms or personality traits:

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

A psychiatric condition in which a person is dogged by persistent ideas (obsessions) that lead to repetitive, ritualized acts (compulsions). Obsessions are commonly based on fears about security or becoming infected. In obsessional rumination, there is constant brooding over a word, phrase, or unanswerable problem. Compulsions may occur frequently enough to disrupt work and social life. The disorder is often accompanied by depression and anxiety. If severe, a person may become housebound.

The disorder usually starts in adolescence. Genetic factors, an obsessive personality, or a tendency to neurotic symptoms may contribute. Some types of brain damage, especially in encephalitis, can cause obsessional symptoms. Many sufferers respond well to behaviour therapy, which may be combined with antidepressant drugs, but symptoms may recur under stress.... obsessive–compulsive disorder

n. a sedative tricyclic *antidepressant taken by mouth to treat depressive illness, phobias, and obsessional states. Common side-effects are dry mouth and blurred vision.... clomipramine

n. a recurrent thought, feeling, or impulse that is unpleasant and provokes anxiety but cannot be eliminated. Although an obsession dominates the person, he (or she) realizes its senselessness and struggles to resist it: this resistance causes anxiety. It is a feature of *obsessive–compulsive disorder and sometimes of depression and of organic states, such as encephalitis. —obsessional adj.... obsession

n. one of the three traits used by the British psychologist Hans Eysenck in his personality model, the others being extroversion and *neuroticism. Psychoticism is a personality pattern typified by aggressiveness and interpersonal hostility. Eysenck believed that high levels of this trait were linked to increased vulnerability to *psychosis but this has never been verified by subsequent research.... psychoticism

n. (in psychiatry) an obsessional type of thinking in which the same thoughts or themes are experienced repetitively, to the exclusion of other forms of mental activity. Rumination is a feature of obsessive–compulsive disorder and depression.... rumination

n. a technique of *behaviour therapy used in the treatment of obsessional thoughts. Attention is voluntarily withdrawn from these thoughts and focused on some other vivid image or engrossing activity.... thought-stopping

n. 1. (extraversion) an enduring personality trait characterized by interest in the outside world rather than the self. People high in extroversion (extroverts), as measured by questionnaires and tests, are gregarious and outgoing, prefer to change activities frequently, and are not susceptible to permanent *conditioning. Extroversion was first described by Carl Jung as a tendency to action rather than thought, to scientific rather than philosophical interests, and to emotional rather than intellectual reactions. Eysenck used it as one of the main personality traits in his widely used personality questionnaire. Compare introversion. 2. a turning inside out of a hollow organ, such as the uterus (which sometimes occurs after childbirth).... extroversion

n. either of two hereditary conditions inherited as autosomal *dominant traits and characterized by benign tumours growing from the fibrous coverings of nerves (see neurofibroma). In neurofibromatosis type I (von Recklinghausen’s disease), in which the abnormal gene is found on chromosome 17, numerous tumours affect the peripheral nerves. The tumours can be felt beneath the skin along the course of the nerves; they may become large, causing disfigurement, and rarely they become malignant, giving rise to neurofibrosarcomas. Pigmented patches on the skin (see café au lait spots) are commonly found and *Lisch nodules are present. Neurofibromatosis type II presents with bilateral *vestibular schwannomas (causing hearing loss) and *meningiomas. The abnormal gene is on chromosome 22.... neurofibromatosis

theories that emphasize the ethical importance of the virtues (e.g., honesty or courage), true happiness, and practical wisdom (compare consequentialism; deontology). In medical ethics, the traits of a ‘good doctor’ provide the moral compass by which to assess professional practice.... virtue ethics

an inherited disorder of the blood that is characterized by episodes of spontaneous bleeding similar to *haemophilia. It is due to a variety of abnormalities of the von Willebrand factor, a glycoprotein necessary for *platelet activation. This results in a bleeding tendency. The most common type of von Willebrand’s disease is inherited as an autosomal *dominant trait; some types are inherited as autosomal *recessive traits. [A. von Willebrand (1870–1949), Swedish physician]... von willebrand’s disease