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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.
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His view that the "mid-forms" are dependent on character traits, and that in their mild form they are indistinguishable from personality deviations, is interes ting (pp. During the devel opment of melancholia in to mania a conglomerate of "manic and depressive symp to ms can be observed" (Griesinger 1845, pp. From a practical point of view it can be said that almost all pre-Kraepelian authors described mixed states, as can be seen in tables from the most prominent old diagnostic classifications (presented by Karl Kahlbaum in his book of 1863) (Marneros 2000b). In 1852, Pohl, in Prague, in a large monograph on melancholia, described mixed states occurring during the transition from melancholia to mania (pp. Emil Kraepelin distilled, conceptualized and categorized previous knowl edge regarding mixed states as well as other mental disorders. Kraepelin used the term "Mischzustande" ("mixed states") or "Mischformen" ("mixed forms") for the first time in the 5th edition of his textbook (1896, p. He practically completed their theoretical conceptualization in the 6th edition (1899, pp. In 1893 Kraepelin did not use the term "mixed states" expressis verbis, but the 20 A. But even before the first use of the term "mixed states" in 1896, Kraepelin described "manic stupor" (1893, pp. In the final description of the mixed states Bipolar disorders: roots and evolution 21 (8th edition of the handbook in 1913, pp. Although Kraepelin is undoubtedly the crea to r of the concept in the sense of clarification of previous reviews and their systematization, the work of Wilhelm Weygandt makes it difficult to distinguish the respective roles of the two men with regard to the development of the final concept. It is, however, beyond any doubt that the clarification of former views, the systematic descriptions, and the theory are the work of Kraepelin. However, it can be assumed that their final clinical description, their categorization and the systematic gathering of data on the to pic is the common work of both men. Angst In his slim, 63-page monograph Uber die Mischzustande des manisch-depres siven Irreseins, Weygandt (1899) gives a very plastic description of mixed states in a style very similar to that of Kraepelin. But a year before the publication of his monograph Weygandt had presented his findings during the 29th meeting of "South-western German Alienists", held in Heidelberg on 27 November 1898. Weygandt wrote in his book: "It is very common, both in the manic and in the depressive episodes of manic depressive or circular insanity, for there to be not only periods of time which are mostly without symp to ms, but also, often, hours or days when the symp to ms switch to the opposite pole. So during a manic episode the euphoria can suddenly change in to a deeply depressive mood, while the other symp to ms of exaltation, such as hyperkinesia and hyperactivity, distractability and excitability, logorrhea, and flight Bipolar disorders: roots and evolution 23 of ideas persist; or after a monthlong depression suddenly a smile can be observed on the face of the patient and the depressive mood can change for hours or days in to a high or manic mood, but without any change in psychomo to r behaviour, in the inhibition or, sometimes, in the severe stupor. Less common, but actually frequent enough if observation is careful, is a temporary change in psychomo to r behaviour while the affective aspects of the psychosis continue without any change; the patients remain euphoric, but the manic excitability changes in to a psychomo to r inhibition. Instead of tireless hyperactivity the patients stay in bed, show slowness of movements and less or no mutism. In patients with the phenomenological picture of depression with stupor, one can sometimes observe a change to mild excitability, agitation and urge to speak lasting for hours or days, while the depressive mood continues. Similar to the euphoric mood and the psychomo to r excitability for mania are also morbid changes in the domain of thinking, the flight of ideas. These states, very well known but because of their short duration usually less noted, are a mix of manic and depressive episodes of circular insanity" (Weygandt 1899, pp.
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It is dificult to analytically separate the infiuence Models of future biome distributions in tropical of each of these drivers, as anthropogenic climate South America have found that substantial change and its efiects are intimately dependent on shifts in the region may lead to the substitution interactions with other pressures such as land-use of Amazonian forest cover by savannah-like change and attendant habitat loss, and changes in vegetation (Salazar et al. Tese deforestation and fire can also lead to widespread interactions in turn infiuence the ability of natural forest dieback, with some parts moving in to a systems to respond at various spatial and temporal self-perpetuating cycle of more frequent fires and scales (Campbell et al. At the same time, more frequent the complex interactions between these variables is and powerful forest fires can compromise both the critical, and we must also consider the underlying productivity of forests and their ability to s to re socioeconomic and other drivers of land-use change carbon (Barlow and Peres 2008; Bush et al. Other models examining changes in natural An abundant number of predictive scenarios vegetation structure and function in response to have shown no signs of abatement without the climate change predict that changes in vegetation implementation of additional measures, including cover in the tropics,fi particularly in portions of robust climate mitigation and adaptation West and southern Africa and South America, strategies. Alarmingly, also include forest dieback (Alo and Wang 2008; some recent studies suggest that the impact of Barlow and Peres 2008). Continued warming climate change on biodiversity has been estimated trends in oceans will accompany acidification as to have surpassed that attributed to land-use a result of increased carbon emissions, resulting change and habitat loss (Selwood et al. As in widespread degradation of tropical coral scientific research on individual drivers continues reefsfi (Doney et al. The complex interactions between proximate and underlying causes interact over time (in a limited number of ways) to drive land management decisions and practices. Climate change challenges at Climate-driven shifts in species distribution, abundance, seasonal cycles, desynchronized timing the intersection of biodiversity of life his to ry events and ecosystem disruptions and human health caused by extreme weather events have profound Climate change and variability have irreversible potential to disrupt and erode ecosystem services, impacts on the global environment by altering release pathogens from previous constraints, and hydrological systems and freshwater supplies, leave human populations ill-equipped to deal with advancing land degradation and loss of compounding health challenges. Tese fac to rs are are relatively recent (McMichael and Wilcox closely interrelated, as deforestation, industrial 2009). Figure 1 shows the complexity of the agriculture and centralized lives to ck production nexus between climate, biodiversity and social systems further accelerate climate change and interactions. Resilient or vulnerable communities biodiversity loss, thus contributing potential risks may cope better, or worse, with both climate and to food security, nutrition, and other aspects of biodiversity changes. Despite this biodiversity, and the ecosystem goods, functions challenge, observation and predictive studies and services they provide for livelihoods; and (iii) of the direct, indirect and cumulative efiects of risk of food insecurity and the breakdown of food climate change on human health acting through systems linked to warming, drought, fiooding, multiple levels of biodiversity are increasing. This and precipitation variability and extremes, body of information is guiding surveillance and particularly for poorer populations (Field et al. This is particularly the case for the least developed countries and most vulnerable Connecting Global Priorities: Biodiversity and Human Health 227 fiGfijofi fi Interactions between climate, biodiversity and social fac to rs. The arrows are not causal but an expression of the dynamics inherent in the drivers. Social fac to rs may be protective or harmful to health and well-being; climate drivers impact on biodiversity, on the social fac to rs and directly or indirectly on health. Changes in biodiversity and ecosystems interact synergistically with climate change and are infiuenced by social fac to rs.
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During the first operational phase, when the primary objective is to provide life saving assistance (safe water, shelter, basic health etc), local and indigenous coping mechanisms are often overwhelmed. When the situation stabilises and even during the recovery phase, all coping mechanism must be boosted, integrated in to the management cycle and reach a higher capacity level than before the disaster. Narrow targeting Many emergencies occur in developing countries that rely heavily on international aid or external development assistance to provide routine health care for its own people. It is crucial that the plight and needs of host communities are also addressed when assisting displaced communities. In their desire for rapid response, relief agencies often try to recruit local aid workers or volunteers. Skilled workers from among the affected population may not be present, and as pointed out, they are also affected by the disaster. The climate change, changing disease patterns, population growth and migration and other fac to rs will result in more frequent disasters, with more heavy impact and increased vulnerabilities will shorten the time for recovery and negatively affect the government capacity to do appropriate recovery work. Human resources Working in a relief operation places unique demands on relief workers. Many of them work under high stress conditions with little support from headquarters and no career development or future prospects. It is not uncommon for them to leave the agency in search of better opportunities. Again, the early phase of a post disaster situation requires the handling of a huge volume of beneficiaries, concentrating on basic care. Sadly, many relief agencies disrupt the routine health system by poaching on the more competent workers by offering higher salaries and fringe benefits. Better human resource planning is needed among all concerned stakeholders to assure the smooth running of services. In short, coordination between the government and the supporting relief agencies affects not only the intervention priorities, but also how to make best use of existing human and other resources. Good leadership and team building will also foster team spirit and increase commitment to assisting the most vulnerable. More attention is needed on staff training, motivation, conflict resolution, staff health and welfare.
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