Phenazopyridine

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Peter Sedman MBChB FRCS

• Consultant surgeon
• Hull and East Yorkshire NHS Trust, Hull
• Honorary senior lecturer, Hull York Medical School
• Tutor in laparoscopic surgery
• Royal College of Surgeons of England,
• London, UK

If a trial of augmentation therapy is undertaken gastritis or gastroenteritis effective 200mg phenazopyridine, it is important to consider the potential additive effects of the medications on side effects and the potential for drug drug interactions gastritis diet ðáê generic phenazopyridine 200 mg with mastercard. As noted previously gastritis en ninos discount phenazopyridine generic, longitudinal use of a quantitative measure can assist in making such determinations gastritis diet ýëåêòðîííàÿ buy phenazopyridine 200 mg on line. Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Benefits Use of clozapine in individuals with treatment-resistant schizophrenia can be associated with reductions in psychotic symp to ms, higher rates of treatment response, and lower rates of treatment discontinuation due to lack of efficacy (low to moderate strength of research evidence) as well as lower rates of self-harm, suicide attempts, or hospitalizations to prevent suicide (moderate strength of research evidence). Overall rates of hospitalization are also reduced during treatment with clozapine as compared to other oral antipsychotic medications (low strength of research evidence). All-cause mortality is also reduced in individuals treated with clozapine as compared to other individuals with treatment-resistant schizophrenia (moderate strength of research evidence). Seizures are also more frequent with clozapine than other antipsychotics but can be minimized by slow titration of the clozapine dose, avoidance of very high clozapine doses, and attention to pharmacokinetic fac to rs that may lead to rapid shifts in clozapine levels. Constipation can also be significant with clozapine and in some patients associated with fecal impaction or paralytic ileus. Concerns about other side effects, such as weight gain or somnolence, may also contribute to a reluctance to switch to clozapine (Achtyes et al. For individuals with treatment-resistant schizophrenia, the risks of inadequately treated illness are substantial in terms of reduced quality of life (Kennedy et al. Even in individuals who have had an inadequate response to other antipsychotic medications, a substantial fraction shows a clinically relevant response to clozapine. With careful moni to ring to minimize the risk of harms from clozapine, the benefits of clozapine in patients with treatment-resistant schizophrenia were viewed as significantly outweighing the harms of treatment. Thus, internal quality improvement programs may wish to focus on ways to increase use of clozapine in individuals with treatment-resistant schizophrenia and track rates of clozapine use in this patient population. Internal quality improvement programs could also focus on increasing use of quantitative measures. If quality measures are considered for development at the provider, facility, health plan-, integrated delivery system-, or population-level, testing of feasibility, usability, reliability, and validity would be essential prior to use for purposes of accountability. Electronic decision support would be challenging to implement and would depend on accurate and consistent entry of structured information. Nevertheless, in combination with rating scale data and prior prescribing his to ries, electronic decision support could help identify individuals with treatment-resistant illness who would benefit from a trial of clozapine. In addition, treatment with clozapine can be effective in reducing rates of suicide attempts and suicide in individuals with schizophrenia, regardless of whether formal criteria for treatment resistance have been met. Risk fac to rs for suicidal behavior in individuals with schizophrenia are described under Statement 1: Implementation. Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Benefits In individuals with schizophrenia who are at significant risk for suicide attempts or suicide, use of clozapine can be associated with lower rates of self-harm, suicide attempts, or hospitalization to prevent suicide (moderate strength of research evidence). Additional benefits of clozapine treatment include higher rates of treatment response (low to moderate strength of research evidence) and reductions in psychotic symp to ms, all-cause mortality, overall hospitalization rates, and treatment discontinuation due to lack of efficacy (low to moderate strength of research evidence). Other side effects that are more common with clozapine than other antipsychotic medications include sialorrhea, tachycardia, fever, dizziness, sedation, and weight gain. Concerns about other side effects, such as weight gain or somnolence, may also contribute to 130 a reluctance to switch to clozapine (Achtyes et al. Balancing of Benefits and Harms the potential benefits of this recommendation were viewed as far outweighing the potential harms. For individuals at significant risk for suicide attempts or suicide despite other treatments, the benefit of clozapine in reducing suicide-related risk is significant. With careful moni to ring to minimize the risk of harms from clozapine, the benefit of clozapine in such patients was viewed as significantly outweighing the harms of treatment. Review of Available Guidelines from Other Organizations Other guidelines do not specifically mention the use of clozapine for individuals with schizophrenia who are at substantial risk for suicide attempts or suicide despite other treatment. Quality Measurement Considerations Studies suggest that clozapine is underused and that a significant proportion of individuals with treatment-resistant schizophrenia do not receive treatment with clozapine, although there is significant variation between and within countries (Adding to n et al. Thus, internal quality improvement programs may wish to focus on ways to increase and track use of clozapine in individuals with schizophrenia who have significant suicide risk that persists despite other treatments. Internal quality improvement programs could also focus on increasing the use of quantitative measures to improve identification and moni to ring of individuals with risk fac to rs for suicide. In particular, it is currently not possible to identify people at increased risk for suicide from most administrative data. Electronic decision support using passive alerts may be able to prompt clinicians to consider clozapine; however, such prompts would be challenging to implement as they would depend on accurate and consistent entry of structured information about diagnosis, suicidal ideation, and suicide attempts. Nevertheless, in combination with rating scale data, electronic decision support could help identify individuals with schizophrenia and significant suicide risk who would benefit from a trial of clozapine. As in other circumstances in which patients do not appear to be responding fully to treatment, attention to adherence is crucial. Although demographic and his to rical risk fac to rs are static, a number of other risk fac to rs are potentially modifiable and can serve as targets of intervention in constructing a plan of treatment. Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement Benefits In individuals with schizophrenia who are at significant risk for aggressive behavior, use of clozapine may reduce the likelihood of aggressive behaviors (low strength of research evidence). Additional benefits of clozapine treatment include higher rates of treatment response (low to moderate strength of research evidence); reductions in psychotic symp to ms, all-cause mortality, overall hospitalization rates, and treatment discontinuation due to lack of efficacy (low to moderate strength of research evidence); and lower rates of self-harm, suicide attempts, or hospitalizations to prevent suicide (moderate strength of research evidence). Harms Although overall rates of adverse events do not differ with clozapine as compared to risperidone (low strength of research evidence), clozapine does have a higher risk of study withdrawal due to adverse * this guideline statement should be implemented in the context of a person-centered treatment plan that includes evidence-based nonpharmacological and pharmacological treatments for schizophrenia. Patient Preferences Clinical experience suggests that many patients are cooperative with and accepting of clozapine as part of a treatment plan; however, other patients may express concerns about the burdens of required blood work including logistical barriers such as transportation (Farooq et al. On the other hand, most patients value an ability to think more clearly and s to p hallucinations or delusions in deciding about medication changes (Achtyes et al. For example, one large survey of individuals with schizophrenia or schizoaffective disorder who were taking an antipsychotic medication found that the vast majority of those taking clozapine adhered to treatment and found it helpful, whereas only approximately 5% found it was not helpful. For individuals at significant risk for aggressive behavior despite other treatments, there appears to be some benefit of clozapine in reducing aggression risk. In addition, clozapine may lead to indirect reductions in the risk of aggressive behavior by reducing other contribu to ry risk fac to rs for aggression such as hallucinations and delusions. Thus, with consideration of patient preferences and careful moni to ring to minimize the risk of harms from clozapine, the benefit of clozapine in such patients was viewed as likely to outweigh the harms of treatment. Review of Available Guidelines from Other Organizations Information from other guidelines is consistent with this guideline statement. Quality Measurement Considerations As a suggestion, this guideline statement is not appropriate for use as a quality measure for purposes of accountability. Electronic decision support using passive alerts may be able to prompt clinicians to consider clozapine; however, such prompts would be challenging to implement as they would depend on accurate and consistent entry of structured information about diagnosis and risk fac to rs for aggression. Nevertheless, in combination with rating scale data, electronic decision support could help identify individuals with schizophrenia and significant aggression risk who may benefit from a trial of clozapine. Although some patients may not wish to experience the discomfort associated with receiving injections of medications, this is not a major barrier for most patients. Skill and experience in administering injections may be lacking and nursing staff may not be available to give injections. At an organizational level, there may be a lack of resources, space, or trained personnel to administer injections (Velligan et al. For some patients, side effects may be less problematic because peaks and troughs of medication levels will be less prominent than with oral medications due to the pharmacokinetic differences in the medication formulations. Many patients prefer the convenience of receiving an infrequent injection rather than needing to remember to take oral medications. On the other hand, some patients may not wish to experience the discomfort associated with receiving injections of medications. Balancing of Benefits and Harms the potential benefits of this guideline statement were viewed as likely to outweigh the potential harms. Review of Available Guidelines from Other Organizations Information from other guidelines is consistent with this guideline statement (Barnes et al. A dys to nic spasm of the axial muscles along the spinal cord can result in opistho to nos, in which the head, neck, and spinal column are hyperextended in an arched position. Acute dys to nia is sudden in onset and painful and can cause patients great distress. Because of its dramatic appearance, health professionals who are unfamiliar with acute dys to nia may incorrectly attribute these reactions to cata to nic signs or unusual behavior on the part of patients, whereas oculogyric crises can sometimes be misinterpreted as indicative of seizure activity. Additional fac to rs that increase the risk of acute dys to nia with antipsychotic medication include young age, male gender, ethnicity, recent cocaine use, high medication dose, and intramuscular route of medication administration (Gray and Pi 1998; Spina et al.

Without their participation and involvement gastritis kidney pain purchase 200 mg phenazopyridine with mastercard, there is a risk of misuse or non-use of the sanitation facilities gastritis diet ÿíäåêñ purchase phenazopyridine 200mg on line. Sanitation and health: fi the link between sanitation gastritis diet popcorn buy phenazopyridine 200mg without a prescription, water supply and health are directly affected by hygiene behaviour gastritis que puedo comer discount phenazopyridine 200 mg without prescription. The benefits of access to sanitation services are never met without good hygiene behaviour; fi Sanitation facilities should be hygienic so that they do not endanger the health of the users and the community as a whole. If funeral feasts cannot be cancelled, meticulous hand washing with soap and clean water is essential before food is prepared and handled. Recommendations for handling corpses: fi It is important to ensure disinfection of corpses with a 0. Surveillance Descriptive epidemiology fi the important information is the number of cases and deaths by area, time and by population sub-groups; calculations of attack and case fatality rates allow the comparison of different areas and periods. Attack rate: fi Calculated as the number of cases/population at risk in a given period. When the attack rate is high, it indicates that: fi There is a common source of infection; fi the area is very crowded (as in urban areas, for example). Public health guide for emergencies I 439 8 6 Table 8-22: Essential rules in a cholera treatment unit Mode of Essential rules in the cholera Additional recommended rules transmission treatment unit People Access limited to patient + one Ideally one carer per patient only family member + staff Three separate spaces within One-way flow of people cholera treatment unit Water Safe water (chlorination Ideally fifty litres per patient per concentration according to day specific use) Large quantity needed (minimum 10 litres per person per day) Hands Hand-washing stations with safe Cut and clean nails water and soap in sufficient quantities Wash hands with water and soap fi Before and after taking care of patients; fi After using latrines; fi Before cooking or eating; fi After leaving the admission ward. For People with fi the biggest danger of cholera is loss of water from the body; diarrhoea fi Do not panic, but act quickly; fi Drink a solution of oral rehydration salts made with safe (boiled or chlorinated) water; fi Go immediately to the health centre. Table 8-25: Rules for safe preparation of food to prevent cholera Cook (raw) food Fish, shellfish, and vegetables are often contaminated with cholera thoroughly bacteria. Eat cooked foods When there is a delay between cooking and eating food as when it is immediately sold in restaurants or by street vendors, it should be kept over at heat of 60fiC or more until served. S to re cooked foods If you must prepare foods in advance or want to keep lef to vers, be sure carefully to cool them to below 10fiC as soon as possible and then s to re them in a refrigera to r or icebox below 10fiC. Foods for infants should be eaten immediately after being prepared, and should not be s to red at all. Reheat cooked foods Proper s to rage at low temperature slows down the growth of bacteria thoroughly but does not kill them. Once again, thorough reheating means that all parts of the food must reach at least 70fiC. Avoid contact Safely cooked food can be contaminated through even the slightest between raw foods contact with raw food directly or indirectly through cutting surfaces or and cook foods knife blades. After preparing raw foods such as fish or shellfish wash your hands again before handling other foods. Keep all kitchen Since foods are so easily contaminated, any surface used for food surfaces clean preparation must be kept clean. Clothes used for washing or drying food, preparation surfaces, dishes, and utensils should be changed every day and boiled before reuse. Use safe water Safe water is just as important for food preparation as for drinking. The chapter is also a reference manual for training staff on food security and emergency nutrition policies, guidelines, programme strategies, technical issues and best practices. Learning objectives fi Recognising a food and nutrition emergency; fi Targeting and equitably distributing an adequate quality and quantity of food aid; fi Key emergency nutrition interventions such as therapeutic feeding and vitamin A supplementation; fi Moni to ring the adequacy of the food aid and emergency nutrition response and nutrition surveillance. Key Competencies fi Use of nutrition surveillance as part of early warning and for benchmarking; fi Use of standard methods to conduct a population nutrition survey to assess acute and severe malnutrition; fi Management of the food aid logistics, targeting and the equitable distribution of an adequate general food ration; fi Vitamin A supplementation in a nutrition emergency; fi When and how to implement supplementary food distribution; fi Treatment of severe acute malnutrition and operation of therapeutic and supplementary feeding centres; fi Treatment of severe anaemia; fi Moni to ring and evaluation of food aid and nutrition interventions. Introduction Every man, woman and child has the inalienable right to be free from hunger. The right to adequate food is recognised in international legal instruments including declarations, which are nonbinding and conventions, which are treaties that carry the force of the law. The Convention on the Elimination of All Forms of Discrimination against Women in 1979 and the Convention on the Rights of the Child in 1989 state that states and non-state ac to rs have responsibilities in fulfilling the right to food. Refugees and displaced people have the same human right to food as do non-refugees. Deliberate starvation or destruction of livelihoods such as production of crops and lives to ck as a war strategy is a violation of international law. If the actions of individuals and of the state fail, the state must proactively take action, which might be economic support or the provision of direct food aid as a last resort to those who are unable to feed themselves. Poverty and hunger are perpetuated by economic and food insecurity all of which increase the vulnerability of populations to food and nutrition emergencies. Figure 9-1 Stages of a food and nutrition emergency Potential cause of a food and nutrition emergency (drought, flood, armed conflict, economic shock, population displacement, poverty); early warning indica to rs Field assessment of affected population(s); information indicates a food emergency exists Procurement and distribution of general food ration to the affected population; food security situation stabilises Nutrition moni to ring of the affected population Potential increase in acute malnutrition (nutrition emergency); implementation of micronutrient supplementation and supplementary and therapeutic feeding as needed Nutrition moni to ring of the affected population Food security situation improves [glo1]and stabilises; the decrease in acute malnutrition Public health guide for emergencies I 445 9 Causes of food and nutrition emergencies Access to food and adequate nutrition is critical to survival in an emergency situation. A food emergency exists if depleted food supplies are not replaced in the short term by food aid. A famine occurs in a population whose food consumption is reduced to the extent that the population becomes acutely malnourished and there is a rise in mortality. A nutrition emergency exists when there is the risk of or an actual rise in mortality due to acute malnutrition. A complex emergency is an internal crisis in the state where the capacity to sustain livelihood and life is threatened by primarily political fac to rs and, in particular, high levels of violence. In complex emergencies, the focus is typically short term in response to changing circumstances such as movements of armies and bandits. Food and nutrition insecurity result from the following: fi A natural disaster due to climatic or other environmental conditions such as drought, flooding, major s to rms or insect infestation such as locusts; global warming might also contribute to an increase in droughts and floods; fi Armed conflict, war or political upheaval; fi Disruption or collapse of the food distribution network and/or the marketing system of a population. A drought is any unusual, prolonged dry period that reduces soil moisture and water supplies below the minimum level necessary for sustaining plant, animal and human life. Droughts occur because of low, sporadic or late rainfall and as a result of human activities such as deforestation, overgrazing by lives to ck, erosion, lack of soil conservation, reliance on the cultivation of single cash crops and traditional farming methods such as slash and burn. The effects of drought are as follows: fi Overtaxing and drying up of water supplies resulting in the loss of crops, lives to ck and the lack of drinking water and water for washing and bathing; fi Crop failure, the depletion of food s to cks and grazing for lives to ck causing temporary migration of families to areas with more pasture for remaining lives to ck or to cities for alternative sources of income. Prolonged and repeated droughts may result in permanent changes in settlement, social and living patterns and major ecological changes. Most scientists agree that global warming because of increased emission of what are known as greenhouse gases is occurring. The effect of global warming is an increase in extreme erratic weather and a rise in sea level leading to coastal erosion. Large-scale changes in rainfall and rainfall distribution will increase the risk in the subtropics of both droughts and floods because it will rain harder when it does rain. Food emergencies due to violent conflict occur when civilian populations flee and/or are cut off from food markets and humanitarian aide or by the deliberate destruction of crops or lives to ck. Conflicts can create famine by leading to the following: fi Disruption of the agricultural cycle; fi Displacement of farmers from the land; fi Interference in the market; fi Destruction of food s to cks and harvests; fi Creation of food shortages that drive prices up to levels that low-income households cannot afford; fi Reducing physical access to displaced populations. Major armed conflict occurred in seventeen countries in Africa during the period 1990 to 2003. Africa, where the prevalence of underweight among children under the age of five is the highest B in the world, is especially vulnerable to nutrition emergencies. When a food emergency occurs, malnutrition, the resilience of livelihoods and household food insecurity to some extent predict the severity of the ensuing nutrition emergency and the ability of households to recover. When a household income earner becomes to o sick to work, the household may be forced to develop knowledge, skills, assets and activities required for a new livelihood so that the household has access to food or income to buy food.

Cheap 200mg phenazopyridine visa. How to Treat an Enlarged Prostate Naturally - Enlarged Prostate Cure.

Organization of the vocabulary in to a sequence of communicative priorities gastritis icd 9 code buy phenazopyridine 200 mg amex, within stages gastritis symptoms heart palpitations purchase 200 mg phenazopyridine mastercard. The combined use of the different approaches of speech gastritis special diet order phenazopyridine with a mastercard, manual sign and picture symbol gastritis quiz generic phenazopyridine 200mg on line. The Maka to n fi Universal organisation provides extensive training to parents, carers and professionals for the use of its resources fi Targeted through a network of tu to rs. The Maka to n organisation indicates that the system has been adapted for use in nearly fifty fi Specialist countries around the world. Beyond the initial fi Other training there is no standard way of delivering the programme which tends to be integrated in to other 69 activities. Although it can be used with Format individuals it is generally recommended that, for the sake of consistency, it be used by all those fi Manual interacting with the child. For example, a study of a symbol Evidence rating system given to randomly allocated adults with learning disability suggested that there was not real fi Strong advantage of Maka to n over a written system to aid understanding (Poncelas & Murphy 2007). Yet fi Moderate Maka to n has excellent face validity as demonstrated by its very wide use. There a number of descriptions fi Indicative of its use with different groups of participants and it is often used as an adjunct to specific therapies. The Maka to n Vocabulary: Using manual signs and graphic symbols to develop interpersonal communication Augmentative and Alternative Communication 6, 15-28. Educational Psychology in Practice: theory, research and practice in educational 70 psychology 49, 161 173. Effect of alternative and augmentative communication on language and social behavior of children with autism Educational Research and Reviews, 5(3), pp. Accessible information for people with intellectual disabilities: Do symbols really helpfi This is in contrast to the more typical driver for target selection which proposes that targets are fi Universal selected in a developmental sequence and thus, are generally less rather than more complex for the fi Targeted child. With the complexity approach, phonemes and clusters which are developmentally more complex fi Specialist will be selected over those that are developmentally simple. The rationale for this is Delivered by that choosing more complex sounds and words is more likely to evoke system wide change in the target fi Specialist and also in all simpler phonemes/clusters. Words which are considered complex include high frequency fi Teacher words and words from low density neighbourhoods. Intervention within the complexity approach typically uses contrastive techniques similar to that of minimal 72 pair therapy. Evidence rating Delivery fi Strong Studies using maximal oppositions or treatment of the empty set have typically delivered the intervention fi Moderate in one- to -one sessions for 30-60 minutes, three times a week. Though other models of delivery have not fi Indicative been tested, they could also work. Prior to intervention, eight non-word pairs are developed based on the targets and contrasts selected. Intervention begins with imitation followed by spontaneous production and this continues till specified levels of accuracy are achieved. Activities used to carry out imitation and spontaneous naming include drill and play based tasks such as sorting, matching and s to ry-telling. Level of Evidence A number of studies have been reported in the literature which have investigated a range of aspects within complexity theory including maximal oppositions, treatment of the empty set and targeting of more complex single to n consonants and clusters over simpler ones. A number of case studies and quasi experimental designs using single cases have found support for the variety of approaches based on principles of complexity; there has also been one controlled study without randomisation (Mota et al. Finally, Rvachew and Nowak in their study of 48 children found that selecting later developmental targets rather than earlier did not replicate the positive findings that Gierut and her team had found in their smaller scale studies. In summary, while a number of studies have been carried out exploring various aspects of the complexity approach, the evidence is equivocal and more comparative and large scale studies are needed to quantify the possible benefit of targeting more complex phonemes in intervention. However, the outcomes for children are mixed, with some positive results, some comparable with other approaches and some not as positive. It is therefore a useful approach to consider, though services should determine where and when it is most effective for the children they work with, particularly in relation to other approaches. A functional analysis of phonological knowledge and generalisation learning in misarticulating children. Comparative analyses of the effectiveness of three different phonological therapy models. The common aim of all these therapies is improved speech production in children with fi Communication phonological impairment. Focus of intervention A minimal pair is defined as a set of words that differ by a single speech sound which is sufficient to fi Universal change the meaning. Typically the speech sounds contrasted in these word pairs will contain only small fi Targeted differences from a speech point of view. Minimal pair intervention focuses on only one error pattern at fi Specialist a time making it less suitable for children with lots of different processes in their speech. It has also been fi Teacher suggested that it is more suited to children with consistent rather than inconsistent errors (Crosbie et al. Baker (2010) identifies two distinct versions of the approach: those fi Manual based on the early studies which move directly to production of contrasts (Abraham, 1993; Blache et al. Baker (2010) identified 42 different studies including 25 quasi-experimental designs (21 single fi Moderate case experimental designs and 4 group studies) and 15 case studies. Differential treatment of phonological disability in children with impaired hearing who were trained orally. A minimal-word-pair model for teaching the linguistic significant difference of distinctive feature properties. Intervention for children with severe speech disorder: A comparison of two approaches. The use of different service delivery models for children with phonological disorders. Treatment of phonological disability using the method of meaningful minimal contrast: Two case studies. Similar to Minimal Pairs fi Complex needs treatment, this approach highlights the contrasts among speech sounds and sound properties. Metaphon Age range places emphasis on the child being an active participant in the intervention process (Hulterstam, 2002). The child learns to self moni to r and fi Secondary correct his//her speech production (Hulterstam, 2002). No guidance is given regarding the time fi Other scale or context for the intervention however Howell & Dean (1998) comment that the average number of 79 sessions required for clients in their efficacy study was 22. Format Level of Evidence fi Manual Howell and Dean (1998) report on a quasi-experimental study in which a group of 13 children made progress fi Approach following Metaphon. Some children made progress only in those phonological processes which were treated fi Technique while others made general progress in treated and untreated processes. This study was written up in the Howell and Dean book and therefore not subject to peer review and quality appraisal. Hulterstam and Evidence rating Nettelbladt (2002) found that some children struggled with the concepts introduced in Metaphon. This study fi Strong was a comparative study but did not compare across children or across clinicians so results are difficult to fi Moderate interpret.

The term personality disorder is an abstraction built on several tenuous theories www gastritis diet com discount 200 mg phenazopyridine with visa. The way in which the term has been developed and its relationship with neurosis is dealt with elsewhere (Sims gastritis diet ÿíäåõ cheap phenazopyridine, 1983) chronic gastritis symptoms stress order generic phenazopyridine on line. The intention here is only to discuss the effects that different types of personality have on actions and behaviour gastritis symptoms uk generic phenazopyridine 200mg visa. This leads to a characteristic pattern of behaviour that allows us, to some extent, to predict his future actions and to describe what makes this individual different. The clinical designation of personality is purely descriptive and carries no theoretical implications, otherwise there is a logical faw in describing personality type in terms of consistent behaviour and at the same time claiming the type accounts for defnite patterns of behaviour. Acute and detailed observation of the characteristics of personality and its evaluation is a useful psychiatric skill that has, regrettably, been much neglected for many years. These characteristics of behaviour, including the capacity for and nature of relationships with other people, are brought to gether to describe traits or personality types; obviously, to be clinically relevant these traits must have implications for the functioning of the individual. The distinction between trait, the predisposition associated with personality, and state, the current mental condi tion, is very important. Certain characteristics have clinical signifcance, such as the degree to which the person is aware of the feelings, and is sensi tive to the judgements, of other people. Abnormal personality is found when a personality trait considered to be clinically signifcant is present to either to o small or to o great an extent to conform statistically with the mass of mankind. The concepts of personality and personality disorder were discussed by Tantam (1988), and more recently personality disorder has been reviewed by Tyrer and Stein (1993). There are considerable problems with the descriptions of types of personality disorders. The most signifcant are the lack of specifcity in the defnitions of personality disorders, the excessive comorbidity among personality disorders, the questionable validity of the identifed categories and the instability of these diagnostic terms over time (Skodol, 2012). Furthermore, it is recognized that part of the problem with the current classifcation system is the unsatisfac to ry nature of personality typologies and the need for an integration of dimensional thinking in to how personality and personality disorder are conceptualized. This development in thinking about personality disorders is also drawing attention to the need to base discussions about personality disorder on what is unders to od about normal personality traits. The Five-Fac to r model of personality includes neuroticism, extraversion, openness, agreeableness and conscientiousness as the relevant fac to rs. The hope is that an integration of normal and abnormal personality within a common hierarchical structure would allow for a more precise and individualized description of person ality structure for each individual (Widiger et al. He worried that he might not be able to cope with the job, that he might not be able to persuade the men in his charge to sort letters to his own high standards, that he would not be able to mix socially with his superiors and equals, that he would make a fool of himself and that other people would laugh at him. Because of his abnormal, obsessional (anankastic) personality, he responded to the stress of promo tion by becoming acutely distressed and developing neurotic depressive symp to ms. His psychopathic blunting of appreciation for the way others would experience his behaviour and their consequent feelings resulted in him causing suffering to others. Whether or not it manifests as personality disorder depends to a considerable extent on social circumstances. A highly abnor mal personality that in one situation may be considered criminal psychopathy and be possessed by a convicted prisoner, in another situation will be the driving force in a highly successful and relatively creative political revolutionary. Personality in an individual cannot be divorced from its social and cultural setting. Indeed, some have argued that the personality disorder constructs that we currently utilize are derived from and calibrated against Western middle-class cultural norms (Mulder, 2012). Having ascertained whether personality disorder is present, its type should be categorized using an accepted system. It is often extremely diffcult to ft people in to arbitrary categories of personality, and the whole to pic of classifcation is still highly unsatisfac to ry. It may be much better to use a few descriptive sentences for the personality, and probably it is best to combine description with categorization. They all start from the same bases: the defnition of personal ity, the evaluation of abnormality and the observation of certain infuential and regularly occurring traits. It is important to realize that these categories are not mutually exclusive: mixed personality types are more frequent than a single personality type in pure form. In descriptive psychopathology, this debate is almost entirely concerned with dissocial personality disorder, but those taking part in the discussion tend to ignore other personality types, thus causing confusion for the assessment and classifcation of those with other personality disorders such as anankastic or anxious avoidant personality disorder. This can result in inappropriate treatment or lack of treatment being administered by mental health professionals and unjustifable stigmatization being experienced by the sufferers. Paranoid Personality Disorder the essential feature of this type of personality disorder is self-reference, the proper psychiatric sense of the word paranoid; such people misinterpret the words and actions of others as having special signifcance for, and being directed against, themselves. Theoretically, self-referent ideas could imply that others are always noticing them in an admiring and benevolent way; in practice, such people would not consult a psychiatrist and those presenting in psychiatry have ideas of persecution. They mistrust other people and are very sensitive and suspicious, believing that others are against them and that what they say about them is deroga to ry. The active paranoid personality manifests suspiciousness and is hostile and untrusting. Such a person is quarrelsome, litigious, quick to take offence, intensely suspicious and sometimes violent; he will go to enormous lengths to defend his rights or to address real or imagined injus tices. He is extremely vigilant and tenacious in taking precautions against any perceived threat. They repudi ate blame and may be regarded by others as devious, scheming and secretive. Morbid jealousy may be shown, and such a person may be involved in acts of violence because of imagined injustice. Such a personality may fnd creative expression in social and political life but is likely to be very destructive within the family. A person with passive paranoid personality faces the world from a position of submission and humiliation. Like the active type, he is suspicious, sensitive and self-referent and misconstrues circumstances and other people. He believes that other people will dislike him and that they will ultimately let him down. Other people tend to take advantage of him, thus fulflling his pessimistic expectations. A frequent manifestation of psychopathology within the context of paranoid personality is the presence of an overvalued idea (Chapter 8). This, alternatively described as a fxed idea (idee fxe), is a belief that might seem reasonable both to the patient and to other people. Schizoid Personality Disorder this personality disorder is characterized by a lack of need for, and defect in, the capacity to form social relationships. Such people show withdrawal from social involvement; emotional cool ness and detachment; and indifference to the praise, criticism and feelings of other people. They lack tender feelings, have little interest in sexual experience and are not interested in the company of others. They are not depressed in mood, nor are they shy or sensitive to wards other people, but they are solitary and prefer not to be involved in social occupations. Their interests and hobbies usually tend to increase their isolation from other people, as they are more interested in things, objects and machines.