299.00 (F84.0)

Autism is a lifelong neuro-developmental disability that affects the development of the brain in areas of social interaction and communication. People with autism have difficulties in communicating and forming relationships with people, in developing language and in using abstract concepts. It also impacts on their ability to make sense of the world around them. It was first described by Leo Kanner in 1943. The following year in 1944, a German scientist named Hans Asperger describes a "milder" form of autism now known as Asperger's Syndrome. It wasn't until 1994 that Asperger's Syndrome was added to the DSM, expanding the autism spectrum to include milder cases in which individuals tend to be more highly functioning.

 

Over the years, the definition, classification and diagnostic specifics of autism have undergone many significant changes. In 2013 the DSM-5 folded all subcategories of the condition into one umbrella diagnosis of autism spectrum disorder (ASD). Asperger's Syndrome is no longer considered a separate condition. The severity levels for Autism Spectrum Disorder, 299.00 (F84.0) from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are outlined below.

Level 3: "Requiring very substantial support"

Social communication: Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches.

Restricted, repetitive behaviours: Inflexibility of behaviour, extreme difficulty coping with change, or other restricted / repetitive behaviours markedly interfere with functioning in all spheres. Great distress / difficulty changing focus or action.

Level 2: "Requiring substantial support"

Social communication: Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or  abnormal responses to social overtures from others. For example, a person who speaks simple sentences, whose interaction is limited  to narrow special interests, and how has markedly odd nonverbal communication.

Restricted, repetitive behaviours: Inflexibility of behaviour, difficulty coping with change, or other restricted / repetitive behaviours appear frequently enough to be obvious to the casual observer and interfere with functioning in  a variety of contexts. Distress and / or difficulty changing focus or action.

Level 1: "Requiring support"

Social communication: Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful response to social overtures of others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences and engages in communication but whose to-and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful.

Restricted, repetitive behaviours: Inflexibility of behaviour causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence.

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'If they can't learn the way we teach, we teach the way they learn' ~ O. Ivar Lovaas 

Schizophrenia: The Dopamine Hypothesis

Dopamine, a major excitatory neurotransmitter, may play a key role in schizophrenia. According to the dopamine hypothesis, the symptoms of schizophrenia - particularly positive symptoms (e.g. delusions and hallucinations), are produced by over-activity of the dopamine in areas of the brain that regulate emotional expression, motivated behaviour and cognitive functioning.

 

Having "too much" of this neurotransmitter is probably too simplistic; the better term is a functional excess (Lieberman, 1990). This may be caused by a failure of any of the many processes involved in breaking down and re-creating the neurotransmitter, or disruption to the receptor system (such as the receptor functioning "too well"), or there may be problems with re-uptake into the presynaptic membrane.

 

Dopamine Pathways

People diagnosed with schizophrenia have more dopamine receptors on neuron membranes than do non-schizophrenics, and these receptors seem to be over-active to dopamine stimulation (Wong, 1986). Additional support comes from the finding that the effectiveness of antipsychotic drugs used to treat schizophrenia is positively related to their ability to reduce dopamine-produced synaptic activity (Green, 1997).

 

The hypothesis that dopamine and dopaminergic mechanisms are central to schizophrenia has been one of the most enduring ideas about the illness. It was not until the 1970's, however, that the dopamine hypothesis was finally crystallized with the finding that the clinical effectiveness of antipsychotic drugs was directly related to their affinity for dopamine receptors. To date, their have been more than 6800 articles on the topic of dopamine and schizophrenia since 1991.

 

In summary, molecular imaging studies show that presynaptic striatal dopaminergic function is elevated in patients with schizophrenia; however blockade of this heightened transmission, either by decreasing dopamine levels or blocking dopamine transmission, leads to a resolution of symptoms for most patients (Howes, 2009).  

Game of Thrones

All men must die ... be unethically labelled.

The Hound

Post Traumatic Stress Disorder - an anxiety disorder associated with serious traumatic events and recurrent thoughts and images. PTSD develops after a terrifying ordeal that involved physical harm or the threat of physical harm. The person who develops PTSD may have been the one who was harmed, the harm may have happened to a loved one, or the person may have witnessed a harmful event that happened to loved ones or strangers.

John Snow

Martyr Complex - in psychology, a person who has a martyr complex, sometimes associated with the term victim complex, desires the feeling of being a martyr for his/her own sake, seeking out suffering or persecution because it feeds a psychological need. In some cases, this results from the belief that the martyr has been singled out for persecution because of exceptional ability or integrity. Other martyr complexes involve wilful suffering in the name of love or duty.
 

Tyrion Lannister

''I'm not a fighter, I'm a bleeder''

Small Man Syndrome - a popular term for the inferiority complex that short men in society are commonly assumed to possess, which causes them, at least per theory, to overcompensate by trying harder than men of average height in life’s activities.

Nothing some lemon cake won't sort out.

Sansa Stark
The Masochist - a person who obtains a primary or secondary gain from tolerating mental abuse from those in his or her circle of contact. The word  masochistic  is now commonly used to describe personality traits in an emotional, rather than sexual sense. 

Mag Mar Tun Doh Weg (Giant)
Marfan Syndrome - a genetic disorder that affects the body’s connective tissue. People with Marfan tend to be unusually tall, with long limbs and long, thin fingers. In most cases, Marfan syndrome is passed down through families (inherited). However, up to 30% of patients have no family history, which is called "sporadic." In sporadic cases, the syndrome is believed to be caused by a new gene change.

''Couldn't give a monkeys mate''

Joffrey Baratheon
Anti Social Personality Disorder - a type of chronic mental condition in which a person's ways of thinking, perceiving situations and relating to others are dysfunctional - and destructive. People with antisocial personality disorder typically have no regard for right and wrong and often disregard the rights, wishes and feelings of others. Those with antisocial personality disorder tend to antagonize, manipulate or treat others either harshly or with callous indifference. They may often violate the law, landing in frequent trouble, yet they show no guilt or remorse.

Reek
The Cataleptic - a body's persistence in unusual postures, with waxy rigidity of the limbs, mutism, and complete inactivity, regardless of outside stimuli.

He's available for children's parties too.

Ser Gregor Clegane
The Sadist - someone who enjoys inflicting pain on others; a sadist is all about hurting others, usually to get off sexually. However, this word is about more than sex. Anyone who is mean and enjoys it, like a bully, could be considered a sadist. The word sadistic is now commonly used to describe personality traits in an emotional, rather than sexual sense. Oh Mountain, you're going to be so annoyed when we explain all these jokes later.





 

Samwell Tarley
The Obese - excess body fat has accumulated to the extent that it may have a negative effect on health, leading to reduced life expectancy and/or increased health problems. I've seen less bloated men dredged out of rivers. Forget about White Walkers and sealing the tunnel, it's time to plug up Tarley's top-hole.

''Wat ye fookin say about me curls Snow?''

Ser Alliser Thorne

The Narcissist - an inflated sense of their own importance and a deep need for admiration. Those with narcissistic personality disorder believe that they're superior to others and have little regard for other people's feelings. But behind this mask of ultra-confidence lies a fragile self-esteem, vulnerable to the slightest criticism.


 

''Not to be technical brother, but according to Pycell's
chemistry - alcohol is a solution''

 

 

Cersei Lannister
Alcoholism - a chronic disorder marked by excessive and usually compulsive drinking of alcohol leading to psychological and physical dependence or addiction. Forget about the simple Lannister cousin and his beetle smashing, it's the grape apocalypse that's more concerning. I think it's time to put the plug in the jug.

 

 

Anyone for bitty?

Robin Arryn
Oedipus Complex - a child's positive libidinal feelings toward the parent of the opposite sex and hostile or jealous feelings toward the parent of the same sex that develop usually between the ages of three and six and that may be a source of adult personality disorder when unresolved - used especially of the male child.


 

 

 

''Twerkin' ye say?''

 

Grand Maester Pycelle
The Malingerer - fabricating or exaggerating the symptoms of mental or physical disorders for a variety of "secondary gain" motives, especially in order to shirk one's duty, avoid work, etc.

 

 

She seems vexed...and yet she looked
so relaxed in the bath this morning?

 

 

Jorah Mormont
Obsessive love - a hypothetical state in which one person feels an overwhelming obsessive desire to possess another person toward whom they feel a strong attraction, with an inability to accept failure or rejection.

 

Always. Always. Wear a helmet.

Oberyn Martell
The Sex Addict - ''Make sure you f**ked your fill before that day.''

The gene pool could do with a little chlorine

Lysa Arryn

Delusional Jealousy - a person with this delusion falsely believes that a spouse or lover is having an affair, with no proof to back up their claim. Othello Syndrome is a type of delusional jealousy, marked by suspecting a faithful partner of infidelity, with accompanying jealousy, attempts at monitoring and control, and sometimes violence. The problem is named for Shakespeare’s Othello, who murdered his beautiful wife Desdemona because he believed her unfaithful.



 

Hodor's date night was heating up.

Bran Stark
The Psychotic -  an abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality".

Tywin Lannister
The Megalomaniac - ruthless, ambitious, amoral and the lust or craving for power. An arrow hurts just the same whether it's on the Iron Throne or the porcelain throne.

Drogon
The Pyromaniac - a mania for fire setting.










Podrick Payne
Casanova - What happened in that room?

Walder Frey
The Wedding Crasher
Back stabber
Bastard
[insert your own]

''It's sweaty balls up in here...''

Varys
Castration Complex - I suppose?

The armour discretely covered
her 'Who's the man' tattoo

Brienne of Tarth
Masculinity Complex - looks as though she could punch a train unconscious. Enough said.







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''Never forget what you are, for surely the world will not. Make it your strength. Then it can never be your weakness. Armour yourself in it, and it will never be used to hurt you.''
                                         ~ George R.R. Martin, A Game of Thrones    

Trichotillomania

Trichotillomania (TTM) is a condition in which people feel an overpowering urge to pull out their hair.  The urges seem uncontrollable and are often exacerbated by stress or other emotional upsets. The term was coined by the French dermatologist François Henri Hallopeau in 1889.

 

People who suffer from TTM will pull, pluck, or twist their hair until it comes out. Others may use instruments to achieve this goal. Sufferers will pull hair from any part of their body: scalp, face, eyelashes, arms, legs, or sometimes a combination of these areas. However the scalp is the most common pulling site. Some people may also have the compulsion to eat the hair. Less common is unconscious (or sleep-induced) hair pulling, in which the person doesn't consciously realize he or she is doing it. Symptoms usually begin before the age of 17 and it is more often seen in women, but can inflict either sex.

 

Analogous to self-injury , the act of hair pulling is usually followed by a period of intense self-blame, shame and sometimes anger because the 'puller' knows that the behaviour is in some way self-damaging, yet they can feel helpless to stop.

How many people does it affect?

The true prevalence of TTM isn't exactly clear, since people are often ashamed of their behaviour and are subsequently reluctant to discuss it, even with their GP. So it is therefore difficult to get reliable statistics. Historically it was thought to be rare, but the condition is now better understood and more people are seeking help. Recent estimates range from 1 to 3.5% of the population, depending on the definition used.

 

Treatment

Behaviour Therapy approaches include several techniques. The most central of these is Functional Analysis, or identification of the antecedents (precipitating behaviours, events, emotions, sensory experiences), behaviours (when, where and how does pulling occur?), and consequences (what does the youth get out of pulling?) associated with pulling. Other behavioural techniques include Habit Reversal Training (HRT) which consists of developing an awareness of sensations preceding and during pulling behaviour through self-monitoring and related techniques and the use of competing responses or compensatory behaviours that are incongruous to pulling. Stimulus Control which focuses on reducing environmental or other circumstances that trigger pulling is often included as well. Relaxation and other anxiety-management strategies, cognitive restructuring of thoughts related to pulling and self-soothing, and strategies to enhance motivation for treatment compliance may also be utilized as part of a behavioural approach.

 

 

 

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''It's a bit bigger than what you look like. It does something to you inside. Both happy and sad''.

Neuroleptic-Induced Dystonia

Dystonia is a neurological movement disorder which may affect anyone at any age. It is characterised by involuntary muscle contractions which force certain parts of the body into abnormal, sometimes painful, movements or postures. Dystonia can affect any part of the body including the arms and legs, trunk, neck, eyelids, face, or vocal cords.



The disordered tonicity of muscles that occurs in dystonia can also be associated with neuroleptics, a dopamine antagonist drug. This secondary, or acquired dystonia, can be a problem encountered specifically with the use of antipsychotic medication (Hansen, 1997), as one side effect of these drugs is debilitating movement disorders known as extrapyramidal symptoms (Yamamoto & Inada, 2012). Drugs that decrease the effectiveness of neurotransmission are known as antagonists. Antipsychotic medication blocks dopamine receptors and this in turn can lead to the dystonic reactions.

With Parkinson’s, the disease is caused by cell death in the substantia nigra, which has dopamine producing functions. This loss of dopamine activity results in a decreased stimulation of the motor cortex which can lead to movement disruptions in the body. Similarly, the dopamine blockade effect of neuroleptic antagonists reduces the activity of transmitters in the synapse causing involuntary muscle contractions (Hansen, 1997). Therefore the severe disturbances of motor behaviour are often caused by the drug-induced dysfunction of the dopaminergic extrapyramidal system, which plays a vital role in movement control (Smelser & Baltes, 2001).

Extrapyramidal symptoms can be categorised as acute and tardive. Acute dystonia has a sudden onset and is often seen within the first five days of starting an antipsychotic course of treatment. Conversely, tardive begins after a long-term use of dopamine antagonist medication (Van Harten & Kahn, 1999).

Neuroleptic-Induced acute dystonia can result in abnormal positioning or spasm of muscles in the head, such as the eyes (oculogyric), neck (impaired swallowing), limbs, and trunk. Acute dystonic reactions generally disappear once the drug dose is lowered or there is complete cessation of the antipsychotic (Yamamodo & Inada, 2012). With tardive dystonia there is currently no established course of treatment, however administration of clozapine has been cited as the only drug helpful if it is tolerated by the patient.

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''Life has many twists and turns.

But when it literally involves your body, then the above saying takes on a whole different meaning''

Schizophrenia

Unlike the disruptions of mental tranquillity that disturb everyone from time to time, schizophrenic episodes represent a severe departure from normal mental functioning. The disorder has a distinctly biological character, suggesting that its fierce psychotic episodes reflect physiological alterations in normal brain function.

Schizophrenia is the diagnostic term for a family of severe mental disorders that involve psychotic features - a loss of contact with reality - and a widespread deterioration of the level of mental functioning affecting multiple psychological processes (Kandel, 1991). The disorder always involves delusions, hallucinations, or characteristic disturbances in the form of thought. By definition, schizophrenic disorders are relatively long lasting: brief, isolated psychotic episodes are not classified as schizophrenic. Schizophrenia, strictly defined, has an incidence of approximately 1 in 200. Rates of schizophrenia are generally similar from country to country - about 1 percent of the population. There are variations - but the variance is difficult to track due to differing measuring standards in many countries, etc. It is equally common in men and women.

Delusions are a major abnormality in the content of thought. Schizophrenic delusions - false beliefs about external reality - are often persecutory, as in the belief that a television newscaster is making fun of the viewing individual. Other typical delusions are more bizarre: The individual may believe that his or her thoughts are being broadcast so that everyone nearby can hear them, or that other people are inserting thoughts and their behaviour is controlled by others, perhaps by radio waves. Such delusional beliefs represent a marked failure in assessing reality.

Characteristic abnormalities in the form of thought also frequently occur. Most common is a loosening of associations , in which ideas shift from one topic to another in an apparently unrelated manner. When this is severe, speech becomes incoherent.

Hallucinations - perception without external stimulation of the sensory systems - are also characteristic of schizophrenia. Most hallucinations are auditory, involving voices that may make insulting statements or provide a continuing critical commentary on the individual's behaviour. Tactile and somatic hallucinations, such as the perception of snakes crawling inside the abdomen, also occur. However, visual hallucinations are less common.

The emotions of the schizophrenic patient are usually flattened or inappropriate. ''Flattened'' means a loss of emotional intensity: the patient speaks in a monotone, the face is expressionless, and the patient reports that normal feelings are no longer experienced. At other times, emotion may be present but is inappropriate to the circumstance.

The combination of symptoms leads to a gross distortion of the person's interactions with the real world. There is a deterioration in functioning, resulting in part from a preoccupation with internal thoughts and fantasies. In many cases, the acute active phase of florid schizophrenic symptoms persists for a prolonged period. It may be followed by a relative remission of symptoms, but a complete return to normal function is extremely unusual. In fact, such a recovery calls into question the original diagnosis of schizophrenia.

Despite the bizarre and florid nature of the schizophrenic symptoms, there is still considerable controversy as to the nature of the disorder. Many investigators believe that schizophrenia is not a single disease but forms a group of related psychotic disorders.

In schizophrenia, there seems to be an inheritable predisposition or susceptibility to the disorder. In the general population, the risk of schizophrenia is less than 1 percent. However, this risk is much greater for relatives of schizophrenics. The parents of a schizophrenic child have about a 5 percent risk of schizophrenia, the siblings of a schizophrenic have about a 10 percent risk, and the children of a schizophrenic parent have about a 14 percent chance of developing the disorder. If both parents are schizophrenic, the child has a risk factor of about 50 percent.

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''If you talk to God, you are praying; If God talks to you, you have schizophrenia.''
                                                                                                         ~ Thomas Szasz