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However purchase toradol with a visa postoperative pain treatment guidelines, many interesting and important questions buy discount toradol 10mg on line holistic treatment for shingles pain, such as “why”, “how to”, and “which”, about the mechanism of acupuncture effect still needs to be addressed. Though these results are significant, they are inadequate to explain the mechanism of infertility treatment using acupuncture. In 1977, Mayer first reported that acupuncture analgesia may be involved in the production of brain endorphin and may be antagonized by the narcotic antagonist, naloxone. Similarly, subsequent studies showed that most of the effects of acupuncture are mediated by the nervous system, comprising neurotransmitters, neuropeptides including endogenous opioid peptides and neurohormones, as well as cytokinins. Nevertheless, the mechanisms through acupuncture affects the endocrine system are yet to be elucidated. Ovulation resulted in 5 cases (ovulatory group), and 3 of the 5 infertile cases became pregnant in the stimulating cycle. However, 5 cases failed to ovulate after acupuncture treatment (anovulatory group). The ovarian follicular size increased dramatically in the ovulatory group, but stopped growing at 14 16 mm diameter in 3 out of the 5 cases without ovulation, after acupuncture treatment. Yang and Yu (2001) examined 14 ovariectomized women with low blood E2 level and perimenopausal syndrome. Consequently, their blood E2 level elevated significantly; however, no change in the E2 level was observed in 8 normal controls after acupuncture treatment. These results suggest that acupuncture might normalize the E2 level when a woman is in the gynecologic status. After acupuncture treatment, the sympathetic nerve activity was evaluated by examining the norepinephrine level, skin temperature, blood pressure, and pain-tolerance threshold, which were all observed to be decreased (Knardahl et al. Based on the previous observation, the anovulatory cases were selected with adequate estrogen levels, and changes in the sympathetic nervous system after acupuncture treatment were observed. According to modern medicine, the blood flow requires the dilation of blood vessels, and the velocity of the blood flow is partly controlled by the innervations of the sympathetic nerve on the vascular wall. In an earlier study, the hand temperature and blood E-endorphin-like immunoreactive substances were measured before and after acupuncture to reflect the sympathetic nerve activity. Thus, the actual effects and mechanism of this enzyme still needs to be elucidated. Subsequently, the aromatase present in those tissues may convert the blood androgen into estrogen, thus, compensating for the deficiency of estrogen induced by ovariectomy. Though it has been reported that the splanchnic tissue is a minor site for extraglandular aromatization of androgens (Longcope et al. With its central sympathoinhibitory effect, acupuncture may contribute to reduce the uterine artery impedance, and thus, increase the blood flow to the uterus. However, the relationship between stress and infertility is that of a vicious cycle. Social stigmatization, decreased self-esteem, unmet reproductive potential of sexual relationship, physical and mental burden of treatment, and the lack of control on treatment outcome are some of the factors that can lead to psychological stress in any couple seeking infertility treatment. The use of acupuncture for reducing anxiety and stress possibly through its sympathoinhibitory property and impact on E-endorphin levels has been reviewed (Chen and Yu 1991; Dong 1993), and the efficacy of acupuncture in treating depression has also been studied (Luo et al. As the pharmacological side 402 14 Acupuncture Treatment for Female Infertility effects of anxiolytic and antidepressant drugs on infertility treatment outcome are largely unknown, acupuncture may provide an excellent alternative for stress reduction in women undergoing infertility treatment. In this chapter, we summarized the data of clinical and experimental studies, and discussed the reproduction-neuroendocrine mechanism of acupuncture treatment for woman infertility. Irrespective of its use in the treatment of diseases or in acupuncture analgesia, certain modern scientific mechanism underlies all its applications. Acup Res 20: 55 58 (in Chinese with English abstract) Harada N, Ota H, Yoshimura N, Katsuyama T, Takagi Y (1998) Localized aberrant expression of cytochrome P450 aromatase in primary and metastatic malignant tumors of human liver. Endocrinology 113: 1679 1682 Luo H, Meng F, Jia Y, Zhao X (1998) Clinical research on the therapeutic effect of the electroacupuncture treatment in patients with depression. Hum Reprod 11: 1314 1317 Stener Victorin E, Matts W, Urban W, Thomas Lundeberg (2002) Alternative treatment in reproductive medicine: Much ado about nothing. Acupuncture a method of treatment in reproductive medicine: Lack of evidence of an effect does not equal evidence of the lack of an effect. Hum Reprod 17 (8): 1942 1946 Stener Victorin E, Peter H (2006) Use of acupuncture in female infertility and a summary of recent acupuncture studies related to embryo transfer. Acupuncture in Medicine 24: 157 163 Yang D, Yu J (2001) Treatment of perimenopausal syndrome with ear acupressing in ovariectomized women. Acup Res 29: 135 39 (in Chinese with English abstract) Yoshiji S, Yamamoto T, Okada H (1986) Aromatization of androstenedione and 19 nortestosterone in human placenta, liver and adipose tissues. Nippon Naibunpi Gakkai Zasshi 62:18 25 (in Japanese) Yu J (2002) Induction of ovulation with acupuncture. Reproductive Biology and Endocrinology 3: 6 406 15 Acupuncture Therapy for Menopausal and Perimenopausal Syndrome Zhanzhuang Tian and Hong Zhao Department of Integrative Medicine and Neruobiology Shanghai Medical College of Fudan University, Shanghai 200032, P. China Summary This chapter summarizes the clinical practice and mechanistic exploration of acupuncture therapy for menopausal and perimenopausal syndrome. Accumulating clinic data suggest that acupuncture is an effective and economical therapy for menopausal and perimenopausal syndrome. The mechanistic research has developed the idea that acupuncture signals initiated at the acupoints are transferred to the brain through the nervous pathway, and thus, modulate multiple neurotransmitter systems. On the other hand, acupuncture is observed to activate the endocrine secretion, hormonal, dielectric, and other pathways. There is also evidence showing that the mechanisms of acupuncture are related to the regulation of gene expression and intracellular signal transduction. At present, with many women in the developing and developed countries living at least one-third of their lives after the menopause, it is not surprising to observe the increasing media attention on the health aspects during this crucial period. During perimenopausal period, women commonly report irregular menstrual Acupuncture Therapy of Neurological Diseases: A Neurobiological View periods, hot flashes, sleep disturbances, and vaginal dryness. A group of symptoms, including nervousness, anxiety, irritability, and depression, have also been observed to be associated with menopause. When women reach the menopausal stage, the decision to seek treatment is based on the severity of short-term symptoms, risk of diseases in the later years, and personal attitudes about menopause and medication. Many women go through natural menopause with minimal discomfort during the perimenopausal years. For most of them, the disturbances diminish or disappear over time, or are reduced with lifestyle changes, such as exercise and diet modification. Some perimenopausal women find adequate symptom relief from nonprescription remedies, while others may need prescription therapies during this transition. Sometimes, prescription therapies are needed to protect against osteoporosis and other diseases. Prior to beginning any treatment or a combination of treatments, either intended to alleviate the symptoms or prevent the diseases later in life, a woman needs to be assured that the treatment regimen selected is the best for her. Hormone treatment should always employ the lowest dose for the shortest time needed.
Varicella (chickenpox) is an acute exanthematous Laboratory tests to confirm the diagnosis are the and highly contagious disease of childhood caused isolation of the virus and serology purchase 10mg toradol with amex sports spine pain treatment center westchester, although they by primary infection with the varicella-zoster are not usually needed cheap toradol 10 mg on line treatment pain genital herpes. New elements appear in succes- sive waves over 2 to 4 days and the presence of Acute lymphonodular pharyngitis is an acute fe- lesions at different stages is a characteristic clinical brile disease caused by Coxsackie virus A10. The trunk, face, and scalp are most com- The disease frequently affects children and monly involved. Oral lesions are days by a characteristic nonvesicular eruption on common and show a predilection for the palate the uvula, soft palate, anterior tonsillar pillars, and the lips. The size of the lesions varies from 3 to 6 mm The differential diagnosis of oral lesions includes in diameter and they last 4 to 8 days. Laboratory tests to confirm the diagnosis are the isolation of the virus and serologic examination. Herpangina is a specific acute infection caused by Coxsackie virus group A, types 1-6, 8, 10, and 22 and occasionally other types. It has a peak inci- dence during summer and autumn and frequently affects children and young adults. Clinically, the disease presents with sudden fever (ranging from 38° to 40°C), sore throat, headache, dysphagia, and malaise followed within 24 to 48 hours by diffuse erythema and a vesicular eruption of the posterior oral mucosa and oropharynx. The vesicles are numerous, small, and soon rupture, leaving painful shallow ulcers that heal in 7 to 10 days (Fig. The lesions characteristi- cally involve the soft palate and uvula, the tonsils, faucial pillars, posterior pharyngeal wall, and rarely the buccal mucosa and the tongue. The absence of lesions from the lips, gingiva, and the floor of the mouth are characteristic. The disease lasts for 7 to 12 days, and the diagnosis is exclusively based on clinical criteria. The differential diagnosis includes primary her- petic gingivostomatitis, aphthous ulcers, her- petiform ulcers, acute lymphonodular pharyngitis, 1 5. Acute lymphonodular pharyngitis, multiple discrete papules on the soft palate and uvula. Hand-Foot-and-Mouth Disease Measles Hand-foot-and-mouth disease is usually associ- Measles is an acute, contagious infection of child- ated with Coxsackie virus A16, occasionally with hood, caused by a specific paramyxovirus. It an incubation period of 8 to 12 days the patient usually affects children and young adults. The presents with fever, malaise, chills, cough, and disease may occur in epidemics or isolated cases. Three to 4 days later a characteris- Clinically, there appear a few (5 to 10 in number) tic maculopapular rash appears behind the ears small vesicles that soon rupture, leaving slightly and on the forehead and spreads within 24 hours painful, shallow ulcers (2 to 6 mm in diameter) to the rest of the face, the neck, the trunk, and the surrounded by a red halo (Fig. The rash fades from the 6th to 10th buccal mucosa, and palate are the usual sites of days. The lateral and dorsal surfaces of the second molars, 1 to 2 days before onset of the fingers and toes are the more frequently involved rash. A diffuse erythema, petechiae, and rarely occur on the palms, soles, and buttocks. Low- small round erosions on the oral mucosa may also grade fever of short duration and malaise may be be observed (Fig. The differential diagnosis includes aphthous The differential diagnosis of oral lesions includes ulcers, herpetiform ulcers, primary and secondary acute candidosis, minor aphthous ulcers, herpetic herpetic stomatitis, and herpangina. Serologic tests are useful in the tion in newborn mice may be needed to confirm diagnosis of atypical cases. Infectious mononucleosis is more com- by serologic examination and isolation of the virus mon in children and young adults. Elevated serum amylase and relative period is about 30 to 50 days, followed by low- lymphocytosis may be present. Bed rest during the lymphadenopathy also begins early and is a com- febrile period, and analgesics. Splenomegaly, hepatomegaly, and very rarely central nervous system involve- ment may also occur. A maculopapular eruption Verruca Vulgaris usually on the trunk and arms is present in 5 to 15% of cases. The most prevalent sites of exudate, diffuse erythema of the oral mucosa, localization are the backs of the fingers and the gingivitis, and rarely ulcers (Fig. From these lesions, the virus may be auto- throat, tonsillitis, and pharyngitis may also occur inoculated to the oral mucosa. Verruca vulgaris is relatively uncommon in the The diagnosis is usually based on the clinical oral mucosa and is clinically and histologically features. Clinically, it appears as a small sessile, well-defined exophytic The differential diagnosis of oral lesions includes growth with a cauliflower surface and whitish or lesions from fellatio, streptococcal oropharyngitis, normal color (Fig. Mumps or epidemic parotitis is an acute viral infection most commonly affecting children between 5 and 15 years of age and rarely older individuals. The parotid gland and less often the subman- dibular and sublingual glands are predominantly affected. Clinically, after an incubation period of 14 - 21 days, variable fever, chills, headache, and malaise develop, accompanied by pain in the parotid area. Tender, rubbery, and edematous swelling of one or both of the parotids are the presenting signs and last for about 7 days (Fig. Orchitis, meningoencephalitis, and pancreatitis are the most common complications. The differential diagnosis includes acute suppura- tive parotitis, calculi in the salivary glands, buccal 1 5. Viral Infections Condyloma Acuminatum Molluscum Contagiosum Condyloma acuminatum, or genital wart, is a Molluscum contagiosum is a benign lesion usually common benign virus-induced lesion mainly seen on the skin and caused by a pox virus. The disease is lesions may develop at any age, but the majority sexually transmitted and is caused by a human of cases are found in children. Clini- lation from genital condyloma acuminatum or cally, the lesions are characterized by grouped, during orogenital contact. Clinically, it appears as single or multiple exude on pressure from these lesions. Any skin small sessile or pedunculated nodules that may region may be involved, but the head, eyelids, proliferate and coalesce, forming cauliflower-like trunk, and genitalia are most often affected. The lesions have whitish or luscum contagiosum is extremely rare in the oral normal color and display a tendency to recur. The clinical picture of oral lesions is similar dorsum of the tongue, lip mucosa, gingiva, buccal to the skin lesions and is characterized by multiple mucosa, especially near the commissure, and the small hemispheric papules with a central umbilica- palate are the sites most commonly affected. The buccal mucosa, labial mucosa, and palate are the sites of involvement in the The differential diagnosis includes verruca vul- garis, papilloma, verrucous carcinoma, ver- reported cases. Surgical excision or cryotherapy are Treatment consists of surgical excision or elec- the preferred modes of treatment of oral lesions. On stretching the mucosa, the lesions Focal epithelial hyperplasia is a benign hyperplas- tend to disappear.
These adverse effects are often transitorily associated with acupuncture treatment purchase toradol 10mg amex pain treatment after root canal. Though acupuncture treatment is generally safe in most situations and the side effects are commonly minimum discount toradol 10mg mastercard pain treatment in cancer, some severe side effects have been reported. Although minor side effects have been observed, they are well-tolerated by patients. Furthermore, the serious side effects are rare and can be avoided if acupuncture is performed by well-trained 185 Acupuncture Therapy of Neurological Diseases: A Neurobiological View acupuncturists. This review has summarized the analgesic effects of acupuncture on several pain conditions. We have found good and promising evidence on the efficacy of acupuncture in treating most of the pain conditions described in this chapter. The endogenous pain modulating system is observed to be activated during the process of acupuncture analgesia, which might be the major mechanism underlying this process. Generally, a well-trained acupuncturist is recommended for administering acupuncture treatment to avoid unnecessary side effects, and proper acupuncture approaches are suggested to yield better analgesic effect. Furthermore, acupuncture combined with drugs is considered to be a good technique to enhance the analgesic effect, which has been well confirmed by our previous studies. However, we did observe some inconsistent results from different clinical trials, which might be owing to the methodological differences among the acupuncturists. For example, the intervention time, criteria for efficacy evaluation, time of observation of the therapeutic effect, statistical method, and control group are often different in various trials. Therefore, it is necessary to properly design the clinical trial, including the selection of proper control and the use of uniform acupuncture manipulation, to achieve convincing results. With the increasing evidence from numerous studies on the analgesic effect of acupuncture in the treatment of different kinds of acute and chronic pain, we believe that more and more people would be benefited from the use of acupuncture in pain relief, with the advantages of low costs, simple manipulation, and minimal adverse effects. Acknowledgements This work was supported by the National Natural Science Foundation (No. Diabetes Res Clin Pract 39: 115 121 186 7 Acupuncture Analgesia in Clinical Practice Ahonen E, Hakumaki M, Mahlamaki S, Partanen J, Riekkinen P, Sivenius J (1984) Effectiveness of acupuncture and physiotherapy on myogenic headache: A comparative study. J Altern Complement Med 10: 468 480 Bradbrook D (2004) Acupuncture treatment of phantom limb pain and phantom limb sensation in amputees. Clin J Pain 17: 296 305 Chen L (2006) Comparison of therapeutic effects between normal acupuncture and shallow needling with short needle on periarthritis of shoulder. J Tradit Chin Med 12: 119 Dana G (2003) Acupuncture for the management of cluster headaches. Med Acupunc 14: 14 15 Dang W, Yang J (1998) Clinical study on acupuncture treatment of stomach carcinoma pain. Br J Rheumatol 37: 1118 1122 de Wit R, van Dam F, Loonstra S, Zandbelt L, van Buuren A, van der Heijden K, Leenhouts G, Huijer Abu Saad H (2001) The Amsterdam Pain Management Index compared to eight frequently used outcome measures to evaluate the adequacy of pain treatment in cancer patients with chronic pain. Br Dent J 184: 443 447 Eshkevari L (2003) Acupuncture and pain: A review of the literature. Spine 30: 944 963 Green S, Buchbinder R, Barnsley L, Hall S, White M, Smidt N, Assendelft W (2002) Acupuncture for lateral elbow pain. Zhong Xi Yi Jie He Xue Bao (J Chin Integr Med) 3: 310 311 (in Chinese with English abstract) Irnich D, Behrens N, Molzen H, Konig A, Gleditsch J, Krauss M, Natalis M, Senn E, Beyer A, Schops P (2001) Randomised trial of acupuncture compared with conventional massage and “sham” laser acupuncture for treatment of chronic neck pain. Scand J Dent Res 85: 456 470 Kitade T, Ohyabu H (2000) Analgesic effects of acupuncture on pain after mandibular wisdom tooth extraction. Taehan Kanho Hakhoe Chi 33: 79 86 (in Korean with English abstract) Lin B (1991) Treatment of frontal headache with acupuncture on zhongwan A report of 110 cases. J Tradit Chin Med 11: 7 8 Linde K, Streng A, Hoppe A, Weidenhammer W, Wagenpfeil S, Melchart D (2007a) Randomized trial vs. Pain 128: 264 271 List T, Helkimo M (1987) Acupuncture in the treatment of patients with chronic facial pain and mandibular dysfunction. Zhongguo Zhen Jiu (Chinese Acupuncture & Moxibustion) 26: 796 798 (in Chinese with English abstract) Manheimer E, White A, Berman B, Forys K, Ernst E (2005) Meta analysis: acupuncture for low back pain. Mayo Clin Proc 81: 749 757 Mayhew E, Ernst E (2007) Acupuncture for fibromyalgia A systematic review of randomized clinical trials. Rheumatology (Oxford) 42: 1508 1517 Mercadante S (2001) Recent progress in the pharmacotherapy of cancer pain. Arch Phys Med Rehabil 82: 1578 1586 Peck C, Coleman G (1991) Implications of placebo theory for clinical research and practice in pain management. Theor Med 12: 247 270 Peuker E (2004) Case report of tension pneumothorax related to acupuncture. J Spinal Cord Med 26: 21 26 Samuels N (2002) Acupuncture for cancer patients: why not? Altern Ther Health Med 12: 34 41 Soderberg E, Carlsson J, Stener Victorin E (2006) Chronic tension type headache treated with acupuncture, physical training and relaxation training. Cephalalgia 26: 1320 1329 Sprott H (1998) Efficiency of acupuncture in patients with fibromyalgia. Clin Bull Myofascual Therapy 3: 37 43 Streng A, Linde K, Hoppe A, Pfaffenrath V, Hammes M, Wagenpfeil S, Weidenhammer W, Melchart D (2006) Effectiveness and tolerability of acupuncture compared with metoprolol in migraine prophylaxis. Singapore Med J 48: E32 E33 Takeda W, Wessel J (1994) Acupuncture for the treatment of pain of osteoarthritic knees. Acta Anaesthesiol Scand 38: 63 69 Tillu A, Roberts C, Tillu S (2001) Unilateral versus bilateral acupuncture on knee function in advanced osteoarthritis of the knee A prospective randomised trial. Acupunct Med 19: 15 18 Trinh K, Graham N, Gross A, Goldsmith C, Wang E, Cameron I, Kay T (2007) Acupuncture for neck disorders. Pain 126: 245 255 Veith I (2002) The Yellow Emperor’s Classic of internal Medicine. Brain Res 526: 221 227 Wang W, Yin X, He Y, Wei J, Wang J, Di F (1990b) Treatment of periarthritis of the shoulder with acupuncture at the Zhongping (foot) extrapoint in 345 cases. J Tradit Chin Med 10: 209 212 Weidenhammer W, Linde K, Streng A, Hoppe A, Melchart D (2007) Acupuncture for chronic low back pain in routine care: a multicenter observational study. Clin J Pain 23: 128 135 White A (2004) A cumulative review of the range and incidence of significant adverse events associated with acupuncture. Acupunct Med 22: 122 133 White P, Lewith G, Hopwood V, Prescott P (2003) The placebo needle, is it a valid and convincing placebo for use in acupuncture trials? Pain 106: 401 409 White P, Lewith G, Prescott P, Conway J (2004) Acupuncture versus placebo for the treatment of chronic mechanical neck pain: a randomized, controlled trial. Arthritis Rheum 54: 3485 3493 Woolhouse M (2005) Migraine and tension headache A complementary and alternative medicine approach. J Tradit Chin Med 7: 116 118 Xing G (1998) Acupuncture treatment of phantom limb pain A report of 9 cases. J Tradit Chin Med 18: 199 201 192 7 Acupuncture Analgesia in Clinical Practice Yamashita H, Tsukayama H, Hori N, Kimura T, Tanno Y (2000) Incidence of adverse reactions associated with acupuncture.
Compulsive personality Obsessional personality Excludes: obsessive-compulsive disorder (300 purchase toradol 10mg fast delivery valley pain treatment center. Psychoinfantile personality Histrionic personality Excludes: hysterical neurosis (300 generic 10 mg toradol with mastercard pain treatment for lyme disease. Lack of vigor may show itself in the intellectual or emotional spheres; there is little capacity for enjoyment. Dependent personality Passive personality Inadequate personality Excludes: neurasthenia (300. People with this personality are often affectively cold and may be abnormally aggressive or irresponsible. Their tolerance to frustration is low; they blame others or offer plausible rationalizations for the behavior which brings them into conflict with society. Amoral personality Asocial personality Antisocial personality Excludes: disturbance of conduct without specifiable personality disorder (312. The limits and features of normal sexual inclination and behavior have not been stated absolutely in different societies and cultures but are broadly such as serve approved social and biological purposes. The sexual activity of affected persons is directed primarily either towards people not of the opposite sex, or towards sexual acts not associated with coitus normally, or towards coitus performed under abnormal circumstances. If the anomalous behavior becomes manifest only during psychosis or other mental illness the condition should be classified under the major illness. It is common for more than one anomaly to occur together in the same individual; in that case the predominant deviation is classified. There is no consistent attempt to take on the identity or behavior of the opposite sex. The resulting behavior is directed towards either changing the sexual organs by operation or completely concealing the bodily sex by adopting both the dress and behavior of the opposite sex. Cross-dressing is intermittent, although it may be frequent, and identification with the behavior and appearance of the opposite sex is not yet fixed. Less severe degrees of this disorder that also give rise to consultation should also be coded here. Impotence--sustained inability, due to psychological causes, to maintain an erection which will allow normal heterosexual penetration and ejaculation to take place. Dyspareunia, psychogenic Excludes: impotence of organic origin normal transient symptoms from ruptured hymen transient or occasional failures of erection due to fatigue, anxiety, alcohol or drugs 302. If dependence is associated with alcoholic psychosis or with physical complications, both should be coded. Acute drunkenness in Chronic alcoholism alcoholism Dipsomania Excludes: alcoholic psychoses (291. Excludes: when due to mental disorders classified elsewhere when of organic origin 307. The level of activity and alertness is characteristically high in relation to the degree of emaciation. Typically the disorder begins in teenage girls but it may sometimes begin before puberty and rarely it occurs in males. Amenorrhoea is usual and there may be a variety of other physiological changes including slow pulse and respiration, low body temperature and dependent oedema. Unusual eating habits and attitudes toward food are typical and sometimes starvation follows or alternates with periods of overeating. Only one form of tic may be present, or there may be a combination of tics which are carried out simultaneously, alternatively or consecutively. Includes head-banging, spasmus nutans, rocking, twirling, finger-flicking mannerisms and eye poking. Such movements are particularly common in cases of mental retardation with sensory impairment or with environmental monotony. Of nonorganic origin: Of nonorganic origin: Hypersomnia Nightmares Insomnia Night terrors Inversion of sleep rhythm Sleepwalking Excludes: narcolepsy (347) when of unspecified cause (780. Of nonorganic origin: Of nonorganic origin: Infantile feeding Overeating disturbances Pica Loss of appetite Psychogenic vomiting Excludes: anorexia: nervosa (307. Sometimes the child will have failed to gain bladder control and in other cases he will have gained control and then lost it. Sometimes the child has failed to gain bowel control, and sometimes he has gained control but then later again became encopretic. There may be a variety of associated psychiatric symptoms and there may be smearing of faeces. Encopresis (continuous) (discontinuous) of nonorganic origin Excludes: encopresis of unspecified cause (787. Most of the items listed in the inclusion terms are not indicative of psychiatric disorder and are included only because such terms may sometimes still appear as diagnoses. Catastrophic stress Exhaustion delirium Combat fatigue Excludes: adjustment reaction (309. The category of mixed disorders should only be used when there is such an admixture that this cannot be done. Such disorders are often relatively circumscribed or situation- specific, are generally reversible, and usually last only a few months. They are usually closely related in time and content to stresses such as bereave- ment, migration or separation experiences. In children such disorders are associated with no significant distortion of development. For example, an adolescent grief reaction resulting in aggressive or antisocial disorder would be included here. Excludes: neuroses, personality disorders, or other nonpsychotic conditions occurring in a form similar to that seen with functional disorders but in association with a physical condition; code to 300. There is a general diminution of self-control, foresight, creativity and spontaneity, which may be manifest as increased irritability, selfishness, restlessness and lack of concern for others. Conscientiousness and powers of concentration are often diminished, but measurable deterioration of intellect or memory is not necessarily present. The overall picture is often one of emotional dullness, lack of drive and slowness; but, particularly in persons previously with energetic, restless or aggressive characteristics, there may be a change towards impulsiveness, boastfulness, temper outbursts, silly fatuous humour, and the development of unrealistic ambitions; the direction of change usually depends upon the previous personality. A considerable degree of recovery is possible and continue over the course of several years. These states are often associated with old age, and may precede more severe states due to brain damage classifiable under dementia of any type (290. Mood may fluctuate, and quite ordinary stress may produce exaggerated fear and apprehension. There may be marked intolerance of mental and physical exertion, undue sensitivity to noise, and hypochondriacal preoccupation. The symptoms are more common in persons who have previously suffered from neurotic or personality disorders or when there is a possibility of compensation. This syndrome is particularly associated with the closed type of head injury when signs of localized brain damage are slight or absent, but it may also occur in other conditions. Postcontusional syndrome (encephalopathy) Post-traumatic brain syndrome, nonpsychotic Status postcommotio cerebri Excludes: frontal lobe syndrome (310. It should be used for abnormal behavior, in individuals of any age, which gives rise to social disapproval but which is not part of any other psychiatric condition.