Mark Corson

By L. Mannig. Lake Forest College. 2018.

During periods of recall buy ranitidine 300 mg without a prescription, carriers of ε4 allele had greater average increase in hippocampal signal intensity and greater mean number of activated brain regions than did ε3 allele carriers discount ranitidine 300 mg with amex. Dutch study of centenarians assessed 15 of 17 people over 100 (in one area) and found all were demented buy ranitidine 150mg otc, 12 having greater than mild dementia. Workers assessed and followed up 1435 Swedish non-demented people aged 75-95 years for three years and found that only 18% of future dementia cases could be identified. Feeding tubes do not increase survival rates in dementia and can have significant adverse effects. Both high and no alcohol intake in middle life led to increase in mild cognitive impairment, and, less certainly, to dementia – this has been interpreted as a U-shaped relationship but it could also be spurious. Whilst donepezil lowers the rate of such progression in the first 12 months of treatment, the rate of progression catches up later. If tau production is turned off in transgenic mice that over-express mutant tau the mice demonstrate improved cognition despite continued neurofibrillary tangle accumulation. Uncontrolled hypertension in middle age increases risk for dementia in old age but hypotension in the elderly is related to the development of dementia. In later-myelinating regions, severity and rate of myelin breakdown in healthy older people are associated with ApoE status. Donepezil was of no benefit in chronic schizophrenia regarding cognition or negative symptoms. Inconclusive results with trampirosate, a vaccine that binds to beta-amyloid protein. Depressed homebound elderly had lower plasma Aβ42 levels and a higher Aβ40:Aβ42 ratio than controls. Carers of community-dwelling people with dementia attending a Dublin service had high levels of met and unmet needs. The apparent preservation of receptors is part of the rationale for replacement therapy. These neurotransmitters are largely made in subcortical structures, such as the nucleus of Meynert and locus ceruleus. Older cases have a mainly cholinergic deficit whereas younger cases have not 2784 Epitope = antigenic determinant. The balance between transmitters may be more important than the absolute level of any single substance. He also points out that there is gross loss of basal forebrain cholinergic neurones in olivopontocerebellar atrophy with no clinical dementia. Studies conducted during the 1980s found that clinico-pathological agreement on diagnosis approached 90%, an increase from 70% of some years previously. Aluminium injected into the brains of animals can produce neurofibrillary tangles, but there are ultrastructural differences between aluminium-induced and Alzheimer tangles. It is potentially possible that a genetic defect might facilitate the entry of aluminium into the brain. There is a higher level of aluminium in the water on Guam (see below) but these people get amyotrophic lateral sclerosis, and the water there is also low in calcium and magnesium. Dialysis dementia (high brain aluminium levels, no plaques or tangles) occurs unless the aluminium level has been reduced by purification procedures. Aluminium is used as a coagulant to remove particulate matter containing toxic pollutants in water. Those antioxidants may act synergistically as free radical scavengers and it is suggested that vitamin E may protect muscarinic receptors. Levels of the free radical defensive enzyme superoxide dismutase are reduced by 25-30% in the frontal cortex and hippocampus. Superoxide dismutase converts the superoxide free radical to H2O2 that is then converted to H2O by other enzymes. In the presence of certain metal ions like iron the H2O2 can be converted to the extremely toxic hydroxyl free radical. The excess of superoxide dismutase in Down’s syndrome may cause excess production of the hydroxy radical. One piece of good advice is to eat a healthy diet, including fruit and vegetables. Alzheimer patients with depression are more cognitively impaired and more disabled than are their non- depressed fellows. Eventually the postman may bring the patient home in a distressed state after the latter becomes lost on a familiar route. Clinical features of Alzheimer’s disease divided into four arbitrary stages Stage I: Memory and concentration are poor. Dysarthria, reduced vocabulary, poor grammatical construction, logoclonia (reiterating parts of words), echolalia, misspelling and duplication of parts of words, reduced reading ability, reduced ability to comprehend the speech of others, urinary incontinence, epilepsy (5-10%), dyspraxia and agnosia may be noted. Misidentification occurs (mirror sign, or talking to photographs), as do depression, delusions and hallucinations, especially visual. There are behaviour problems, emotional lability, catastrophic reactions, motor restlessness, phases of inertia, muscular rigidity, and gait apraxia. It is essential that the family and the patient know enough to initiate proceedings to cover financial, health-care and other matters before competence is lost. Treatments have been aimed at replacing neurotransmitters, stimulating intact receptors, and alleviating 2790 disturbed behaviour symptomatically.

When information reaches the feres with an individual’s work or academic University indicating that a student has been performance or creates an intimidating generic 150mg ranitidine amex, engaged in the distribution of controlled dan- hostile or offensive working or academic gerous substances buy ranitidine 300mg cheap, whether on or off Univer- environment buy cheap ranitidine 150 mg line. Students are also advised that because of his/her gender, marital status, the University may decline to furnish and may pregnancy, race, color, ethnicity, national withdraw letters of recommendation for those origin, age, disability, religion, sexual ori- who have engaged in the illegal distribution, entation, gender identity or expression, possession and use of controlled dangerous personal appearance, veteran status, or any other legally protected characteristic substances. The Johns Hopkins University is committed 4) Sexual harassment, whether between to providing its staff, faculty and students people of different sexes or the same sex, the opportunity to pursue excellence in their is defned to include, but is not limited to, academic and professional endeavors. This unwelcome sexual advances, requests opportunity can exist only when each mem- for sexual favors, and other behavior of a ber of our community is assured an atmo- sexual nature when: sphere of mutual respect. The free and open a) submission to such conduct is made exchange of ideas is fundamental to the Uni- implicitly or explicitly a term or condition of versity’s purpose. It is not the University’s an individual’s employment or participation intent in promulgating this policy to inhibit free in an education program; speech or the free communication of ideas by members of the academic community. Accordingly, harass- creates an intimidating, hostile or offensive ment based on an individual’s gender, working or educational environment. The Johns Hopkins University is committed to providing a safe educational and working 5) Retaliation against an individual who com- environment for its faculty, staff and students. Intention- about the increase in reports of sexual ally making a false accusation of harass- offenses occurring on the nation’s campuses. The University has adopted a policy address- Responsibilities Under this Policy ing sexual assaults and offenses involving The University is committed to enforcement sexual violence in order to inform faculty, staff of this policy. Individuals who are found to and students of their rights in the event they have violated this policy will be subject to the are involved in an assault, and of the services full range of sanctions, up to and including available to victims of such offenses. Members of the University community who are victims of, or who have knowledge of, a 1) All individuals are expected to conduct sexual assault occurring on University prop- themselves in a manner consistent with erty, or occurring in the course of a University this Policy. Campus security and the may be discriminatory harassment of Offce of General Counsel will provide assis- another are encouraged to report their tance to a complainant to reach law enforce- concerns as soon as possible to the Offce ment authorities. Persons who have been of harassment will be treated in a conf- sexually assaulted will be taken to one of the dential manner, within the bounds of the three hospitals in Baltimore City designated University’s legal obligation to respond as rape treatment centers. University of Maryland Hospital, 22 South 5) Managers, including faculty managers, Greene Street (410-328-8667); Johns Hop- who receive reports of harassment should kins Bayview Medical Center, 4940 Eastern contact human resources or the Offce of Avenue (410-550-0100). These hospitals Institutional Equity for assistance in inves- are equipped with the State Police Sexual tigating and resolving the issue. The University will provide counseling to 6) Managers, including faculty managers, are any member of the Hopkins community who required to implement corrective action is a victim of a sexual assault, and also will where, after completing the investiga- provide information about other victim ser- tion, it is determined corrective action is vices. The University will not accommodate the request if such classes tolerate violent acts on its campuses, at off- and housing are reasonably available. This policy of “zero assault also may pursue internal University tolerance” extends not only to actual violent disciplinary action against a perpetrator with conduct but also to verbal threats and intimi- a University affliation. The University’s disci- dation, whether by students, faculty, staff, or plinary process may be initiated by bringing visitors to the University. The University’s Vice Provost for Alternatively, students are urged to report Institutional Equity is also available to render concerns about violence to the divisional assistance to any complainant. Allegations offce responsible for student matters, faculty of sexual assault will be investigated by the to the divisional offce responsible for faculty appropriate security offces and any other matters, and staff to the applicable human offces whose assistance may be valuable for resources offces. Disciplinary actions against students conduct and threats of violence will be inves- accused of sexual assaults will be processed tigated, and, if warranted, disciplinary action by the appropriate student affairs offce of the will be taken in accordance with applicable School or campus attended by the accused procedures. The University will notify law student in accordance with established dis- enforcement authorities of criminal conduct. Disciplin- als accused of violations of this policy for an ary actions against staff members will be assessment of the likelihood that they will governed by the procedures set out in the carry out violent acts. Disciplinary ence of an individual on campus threatens or actions against members of the faculty will be disrupts the conduct of University business, processed by the offces of the Dean of the the individual may be suspended from par- appropriate academic division according to ticipation in University programs or activities the procedures established by that division. Both a complainant and the person When advised of circumstances warrant- accused of a sexual assault will be afforded ing intervention, the University will render the same opportunity to have others present assistance by contacting local or federal law during a University disciplinary proceeding. Indi- Attorneys, however, will not be permitted to vidual members of the University community personally participate in University disciplin- who receive threats of bodily harm or who are ary proceedings. Both the complainant and the targets of harassing or stalking behaviors the accused will be informed of the resolu- are urged to contact Campus Security and to tion of any University disciplinary proceeding avail themselves of the services offered by arising from a charge that a sexual assault student counseling offces and the Faculty has been committed. The disciplinary measures which may be Every effort will be made to respect the imposed for sexual assault will vary accord- privacy of all individuals involved in the mat- ing to the severity of the conduct, and may ter. However, the necessity to investigate the include expulsion of a student from the Uni- matter and to cooperate with law enforce- versity and termination of the employment of ment authorities may require the disclosure a member of the staff or faculty. Individuals accused of engaging in inci- dents of campus violence may seek legal Policy Addressing Campus counsel at their own expense. Individuals and Violence their attorneys are reminded that attorneys The Johns Hopkins University is committed do not participate in any internal University to providing a learning and working environ- hearing. These photographs and flms will be used in such publications as cat- The possession, wearing, carrying, trans- alogs, posters, advertisements, recruitment porting, or use of a frearm or pellet weapon and development materials, as well as on is strictly forbidden on University premises. Violation of this regulation will result in a disciplinary action and sanc- be photographed only with the permission of tions up to and including expulsion, in the the faculty member. Disci- digital media-which will be kept in the fles plinary action for violations of this regulation and archive of the Johns Hopkins University, will be the responsibility of the divisional stu- will remain available for use by the university dent affairs offcer, Dean or Director, or the without time limitations or restrictions. Facul- Vice President of Human Resources, as may ty, students, and staff are made aware by vir- be appropriate, in accordance with applica- tue of this policy that the university reserves ble procedures. Any questions regarding this the right to alter photography and flm for cre- policy, including the granting of exceptions ative purposes. Faculty, students, and staff for law enforcement offcers and for persons who do not want their photographs used in acting under the supervision of authorized the manner(s) described in this policy state- University personnel, should be addressed to ment should contact the Offce of Communi- the appropriate chief campus security offce. The Women’s Advisory Committee is avail- The University campus and those areas of able for consultation by women medical stu- University buildings generally accessible to dents. The purpose and composition of this faculty, students, and staff are considered Committee are presented in the appendix to public places for the purpose of this policy. Adult primary care Medical Student Teaching services are provided by internists and nurse The rules established by the Animal Care and practitioners for students and dependents Use Committee will be observed in all cours- enrolled in the Student Health Program.

For example buy discount ranitidine 150mg on-line, it is not considered a moral failing (nor appropriate to take legal action) if parents occasionally shout at children order 300mg ranitidine overnight delivery, leave them with child- minders buy discount ranitidine 300 mg, or quieten them with chocolate, even if, in excess, these things are harmful. For example, if smoking in the presence of a fetus or newborn had an identical risk of harm to growth, should a pregnant mother suVer more discomfort for them both to be acting equally reasonably? She should not put cigarettes in the child’s mouth, and would be commended if she did not smoke in the child’s presence, but giving up entirely would not be the minimum reasonable behaviour. It seems unjust to have a minimum standard of behaviour that is markedly diVerent to that expected of parents of newborns, especially when it is only applicable to the mother. However, it might be argued that extra duties (beyond reasonable steps) are incurred because a pregnant woman has a diVerent relationship from that of a mother of a newborn, though both are in a special relationship with their oVspring. In such a case, either the maternal obligation is less (which seems unjust to the unplanned fetus, who is less protected by maternal duty than the planned one), or we accept that special relationships thrust more than reasonable obligations even upon raped women, against their will. For example, no one else has an obligation to have their bodily integrity violated to save the life of another (McFall v Shimp, 1978), and yet this was the basis for enforced Caesarean section orders before their legal validity was overturned (Kluge, 1988). A mother might not have an obligation to have her bodily integrity violated (or to take more than reasonable steps) for her fetus, but she would be uncharitable if she did not. A parallel can be drawn with the pregnancy cases where the mother fails to protect her baby from harm (rather than fails to save its life by Caesarean section). It would seem unjust that pregnant women have a diVerent standard by which to measure fulWlment of the obligation to fetuses than is found in any other special relationship. Parents of a sick child may be expected to do more than when the child is well, but the standard, of doing what is reasonable (given the situation), does not change. Some might require taking a short course of drugs (for example antibiotics); others might require long hospital admission for rest, and separation from other children who might also suVer (for example, for recurrent stillbirth). By giving up smoking, alcohol, sports or certain foods, attending frequently for health checks, or classes, evincing tremendous interest and concern, and submitting themselves to invasive tests, procedures and hospitalization, women perform daily acts on behalf of their fetuses that are well beyond the reasonable minimum (thus beyond the call of duty, or supererogatory) (Department of Health, 1998). Society’s response and the permissibility of different strategies to stop a mother harming her fetus If children are not their parents’ property, but rather future members of society, then society has a legitimate interest in their welfare. If pregnant women fail to fulWl their obligations, and serious harms occur, society must respond on behalf of the unborn, as it too has an obligation to its future members to take reasonable steps to ensure that they are born in good health. Society’s aim could be: (1) to stop drug-taking in pregnancy; (2) to make women fulWl their obligations; or (3) to minimize preventable harms to babies. If the goals overlapped but were not identical, society would be able to tolerate a situation where babies were healthy despite the persistence of drug-taking and mothers who failed to fulWl their obligations. Offers and threats The diVerence between a proposal that contains an oVer or a threat is that, in the former, the receiver is no worse oV than before by rejecting the oVer, whereas, in the latter, she is worse oV if she does not comply with the threat. A unipolar threat would be ‘If you do not get oV drugs, your name Restricting the freedom of pregnant women 137 will be published for public condemnation’. By contrast with the oVer, this threat requires a justiWcation (such as the beneWt of preventing fetal damage outweighing the humiliation and harm caused to women). If the two uni- polar strategies are equally eVective, the choice of the threat strategy rather than the oVer one is not justiWable, because nothing now weighs against the harms caused through threatening people. To opt for a threat, if an oVer is available, requires Wrstly, that it is more eVective and secondly, that the diVerence in eVectiveness is itself justiWed. If 1000 drug addicts stop before or after having their names publicized, as opposed to 999 with the medal option, it has to be argued that the one extra drug-free baby justiWes 1000 women being threatened with ostracism by their neighbours. DiVerent types of threat to pregnant women can be identiWed: to imprison during pregnancy; to punish after delivery; or to separate the mother and baby after birth (by imprisoning the mother or taking the baby away). If women know that they will be jailed or their babies taken away on the basis of a blood or urine test on the newborn, this is a threat operating during the antenatal period to persuade them to stop drugs. It is used as a means to threaten its mother rather than being treated as an end in itself, which seems inconsistent with the concern for fetal and neonatal well-being from which the threat sprang. If drug-taking during pregnancy is a form of ‘fetal abuse’ (Landwith, 1987), once the baby is born the abuse stops, as the drug no longer crosses the placenta. Bewley Use of the Mental Health Act could also be seen as a threat to pregnant women, except that it is correctly applied only to enforce non-consensual treatments for psychiatric illnesses. If a woman is mentally incompetent through such an illness, decisions about interventions can be made (such as consent for Caesarean section) in her ‘best interests’, but abuse of this provision is not to be encouraged. If a woman had Lassa fever (often fatal and highly infectious through airborne passage) it would be justiWed to quarantine her (and override her right of liberty) as she is presenting a serious danger to others and cannot voluntarily stop breathing. A man with Hepatitis B (often fatal though not highly infectious, and transmitted only through close con- tact with bodily Xuids) presents a danger to others only if he engages in certain activities (such as sex or blood donation). Quarantine might be used as a last resort only if many people with Hepatitis B neglected their obligations to others, and would wrong those who would not have put others at risk. If society could increase the likelihood of a drug-taker stopping with oVers or non-coercive threats, but does not, then if she continues to take drugs she is less reprehensible than if she had rejected such oVers or threats, although she is not guiltless. Unlike the alcoholic driver, the pregnant alcoholic cannot separate taking alcohol from the eVect on the fetus – although she could avoid other additional reckless behaviour, such as driving when intoxicated, she cannot avoid giving the fetus a dose of the drug as she satisWes her craving. The two behaviours, satisfying the craving and delivering alcohol to the fetus, cannot be separated, even if she would like to do one but not the other. It is diYcult to know what to make of this conclusion except to note that it must be impossible to determine which pregnancies are conceived recklessly, and what would be an appropriate punishment. If one woman cannot respond to the threat, and another can but did not, both will have positive urine tests but only one persists in intentional wrongdoing. If punishment should be reserved for wrong acts performed freely, then it would be wrong to punish merely for failure to respond to a threat (as this includes both women who can and cannot stop their harmful behaviour).

It has no known cause generic 300mg ranitidine overnight delivery, yet it comprises approximately 95% of all cases of hypertension purchase ranitidine 150mg with visa. Alcohol consumption should be moder- ated order 300mg ranitidine otc, no more than two glasses of wine per day for men and one glass per day for women. Essential or idiopathic hyper- tension is the most common form of hypertension, comprising 90% to 95% of cases, but approximately 5% to 10% of cases of hypertension are caused by secondary causes (Table 9–1). To identify the secondary (and potentially reversible) causes of hypertension, the clinician must be aware of the clinical and laboratory manifestations of the processes. The major risk factors of cardiovascular disease are age, cigarette smoking, dyslipidemia, diabetes mellitus, obesity, kidney disease, and a family history of premature cardiovascular disease. Target organ damage of hyper- tension includes cardiomyopathy, nephropathy, and retinopathy. Counseling patients on lifestyle changes is important at any blood pressure level and includes weight loss, limitation of alcohol intake, increased aerobic physical activity, reduced sodium intake, cessation of smoking, and reduced intake of dietary saturated fat and cholesterol. For those with prehypertension (blood pressure 120-139/80-89 mm Hg), lifestyle modifications are the only interventions indicated unless they have another comorbid condition, such as heart failure or diabetes, which necessitates use of an antihypertensive. For most patients, a low dose of the initial drug of choice should be admin- istered slowly, titrating upward at a schedule dependent on the patient’s age, needs, and responses. The target blood pressure typically is 135/85 mm Hg, unless the patient has diabetes or renal disease, in which case the target would be lower than 130/80 mm Hg. A long-acting formulation that pro- vides 24-hour efficacy is preferred over short-acting agents for better compliance and more consistent blood pressure control. Because they are associated with a decrease in mortality in all types of patients, thiazide diuretics should be considered in all patients with hypertension who do not have compelling contraindications to this class of drugs. Both thiazide diuretics and beta-blockers should be used first in patents with uncomplicated hypertension, unless there are specific compelling indications to use other drugs. It is critical to tailor the treatment to the patient’s personal, financial, lifestyle, and medical factors, and to periodically review compliance and adverse effects. Selected Causes of Secondary Hypertension The most common cause of secondary hypertension is renal disease (renal parenchymal or renal vascular). Renal artery stenosis is caused by athero- sclerotic disease with hemodynamically significant blockage of the renal artery in older patients or by fibromuscular dysplasia in younger adults. The clinician must have a high index of suspicion, and further testing may be indicated, for instance, in an individual with diffuse atherosclerotic disease. Potassium level may be low or borderline low in patients with renal artery stenosis caused by second- ary hyperaldosteronism. A captopril-enhanced radionuclide renal scan often is helpful in establishing the diagnosis; other diagnostic tools include mag- netic resonance angiography and spiral computed tomography. The classic clinical findings are positive family history of polycystic kidney disease, bilateral flank masses, flank pain, elevated blood pressure, and hematuria. Other causes of secondary hypertension include primary hyperaldosteronism, which typically will cause hypertension and hypokalemia. Anabolic steroids, sym- pathomimetic drugs, tricyclic antidepressants, nonsteroidal anti-inflammatory agents, and illicit drugs, such as cocaine, as well as licit ones, such as caffeine and tobacco, are included in possible secondary causes of hypertension. The cause of obstructive sleep apnea is a critical narrowing of the upper air- way that occurs when the resistance of the upper airway musculature fails against the negative pressure generated by inspiration. In most patients, this is a result of a reduced airway size that is congenital or perhaps complicated by obesity. These patients frequently become hypoxic and hypercarbic multi- ple times during sleep, which, among other things, eventually can lead to sys- temic vasoconstriction, systolic hypertension, and pulmonary hypertension. The patient will have a widened pulse pressure with increased systolic blood pressure and decreased diastolic blood pressure, as well as a hyperdynamic precordium. Glucocorticoid excess states, including Cushing syndrome, and iatro- genic (treatment with glucocorticoids) states usually present with, thinning of the extremities with truncal obesity, round moon face, supraclavicular fat pad, purple striae, acne, and possible psychiatric symptoms. An excess of corticosteroids can cause secondary hypertension because many glucocorti- coid hormones have mineralocorticoid activity. Dexamethasone suppression testing of the serum cortisol level aids in the diagnosis of Cushing syndrome. Coarctation of the aorta is a congenital narrowing of the aortic lumen and usually is diagnosed in younger patients by finding hypertension along with discordant upper and lower extremity blood pressures. Coarctation of the aorta can cause leg claudication, cold extremities, and diminished or absence of femoral pulses as a result of decreased blood pressure in the lower extremities. Carcinoid tumors arise from the enterochromaffin cells located in the gastrointestinal tract and in the lungs. Clinical manifestations include cutaneous flushing, headache, diarrhea, and bronchial construction with wheezing. Pheochromocytoma is a catecholamine-releasing tumor that typically pro- duces hypertension. Clinical manifestations include headaches, palpitations, diaphoresis, and chest pain. Other symptoms include anxiety, nervousness, tremor, pallor, malaise, and, occasionally nausea and/or vomiting. Thus, in the evaluation of newly diagnosed hypertension, orthostatic blood pressure measurements may be helpful. Which of the following would most likely provide prognostic information regarding this patient? Which of the following antihypertensive agents are generally considered first- line agents for this individual? The central obesity, abdominal striae, hirsutism, and easy bruis- ability are consistent with Cushing syndrome, a disease of adrenal steroid overproduction. Prognosis in hypertension depends on the patient’s other cardio- vascular risks and observed end-organ effects from the hypertension.

Clinics were already overburdened and under-resourced in caring for the current indigenous population buy ranitidine 300 mg online. There felt that they did not have adequate resources to liaise with outside agencies with responsibility for asylum seekers discount ranitidine 300mg without a prescription. There was an acceptance that the psychiatric reports that they were already providing require a high input of time and effort purchase ranitidine 300mg without prescription. The need to collect collateral information and adequate and appropriate translation services placed high demands on clinical time. There was consensus that special skills are needed and that transcultural psychiatry must be developed further. Consultant led multidisciplinary teams with special interest in mental health of asylum seekers and refugees to be established in the major urban centres. Special interest section on transcultural psychiatry should be established within the College of Psychiatry of Ireland. The College or other appropriate organisations should provide training courses on the preparation of psychiatric reports on asylum seekers. There must be rapid access to mental health care and high quality social and legal services for unaccompanied minors. Prisons should not be used as places of detention for people with legal difficulties related to their immigration status. Some useful terms Acculturation: assumption of characteristics of larger or more advanced society. Acculturation problems: difficulties in adapting to a different culture or environment that cannot be attributed to a coexistent mental disorder. Alloplastic adaptation: adapting by changing the environment (alloplastic = externalised). Assimilation: total absorption in the larger society, and therefore calling for greater change than in acculturation. Culture: a set of values, norms, beliefs, and understandings common to a human group. Ecology: science of organisms as effected by their environment; human ecology applies ecological principles to the study of human societies. Ethnicity: a person’s sense of belonging to a human group who share the same origin, history, and culture. Ethology: study of animal behaviour, including its origins; classically studied in natural settings, but increasingly performed in experimental situations; associated with the Austrian Konrad Lorenz (1903-88), Karl von Frisch (1886-1982) and Nikolaas Tinbergen (1907-88), a Dutch zoologist based in Britain. Sweat: water is poured over hot rocks in a confined place by Native Americans; the resultant steam is used for prayer, cleansing and healing. Sociology490 ‘The more a form of behaviour deviates from current social norms the more likely are its perpetrators to differ from the rest of the population’. Western adolescents are expected to walk a thin line between responsibility for the self (individuation) and being responsible to their elders. In many ‘underdeveloped cultures, the transition to adult responsibility is less obvious. Early relationships are extremely important in determining how the final product, the adult, functions. Highly developed Western societies have more nuclear (parents and immediate offspring only) than extended (grandparents and other relatives) families; this, and broken relationships, significantly 494 reduce the available pool of family carers. However, even when they seem to be wholly our own doing they may have been primed by numerous other factors acting independently of us, e. Nevertheless, subgroups within the same society may vary widely in terms of what is seen as acceptable behavior and what constitutes reprehensible acts. Societies, which measure success, perhaps financially, may be so structured as to erect barriers against the attainment of goals for some members, and so they promote deviancy. Some sociologists lump criminal conviction and applying a psychiatric diagnosis together as acts whereby a label of primary deviance (from what society expects) is given to individuals. This deviance is then amplified (secondary deviance) by the changes that follow in the labelled individual’s behaviour. Thus, both legal and medical authorities are responsible for alienating individuals, i. There is undoubtedly some truth in this but, at least in part, the flaw may be in applying the result to 490 The burden of mental and personality disorders in society is reflected in the early onset of most such conditions. Avoiding a necessary diagnosis does not make it go away and psychiatrists are more aware than ever of their obligations in terms of keeping their restrictions on individual liberty to what is necessary in the patient’s interest and also their crucial role in areas such as enabling, promoting recovery, and fighting stigma, lack of resources, and inequalities. The author remembers well when tuberculosis and cancer, not to mention homosexuality, were subject to the same stigma as mental illness. A major aim of the medical profession is to improve the efficacy of our interventions, an important way of reducing the fear associated with diagnosis! Those with an internal locus of control do not have the same need for social support in order to cope with life’s stresses, and have low symptom scores even when negative life events are combined with weak supports. Kendler ea (2005) point out that women have higher rates of major depression than men, but they also have stronger, more intimate social networks! However, they found that emotional support proted women more than men from major depression. An internal locus of control is more highly valued in individual oriented Western society with its emphasis on the autonomy of the person than it is in traditional societies where decisions are made by the family. Casey and Craven (1999) state that large scale attempts at reducing the suicide rate may be more of a socio-political and religious issue than a medical one. It is often not realised that psychiatric patients in general have increased standard mortality ratios for all three major classes of unnatural death: suicide, homicide, and accidents.