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Burriss and Lionel Casson, Latin and Greek in Current Use, 2nd edition (Englewood Cliffs, N. Born in Victoria, Peter graduated high school with the highest marks in the province and took his undergraduate degrees at Victoria College and the University of British Columbia. He then had a brief teaching year in Ottawa, but by the early 1960s Peter was home again and began his professional career as a teacher and administrator with the newly formed University of Victoria. Peter had an exacting but jovial manner that students and colleagues can never forget. The Department of Greek and Roman Studies is extremely happy to have assisted the University of Victoria library staff with the publication of this textbook which served one of the many popular courses Peter taught for our Department. The Legacy of Greek In a course on classical roots in English, there are several good reasons to examine the Latin influence first, despite the historical priority of Greek. In learning Latin roots, we are often just meeting old and familiar friends in a slightly different guise. Greek, in contrast, is likely to seem rather more exotic, since much of its influence has been felt in technical or academic areas of English usage. But many of these came into English only after they had been borrowed first by the Romans, in order to fill semantic gaps in Latin. When they entered English, they followed the pattern 1 of Latin loan-words, and you will therefore understand their English form better if you know some Latin. This convenient fact means that we can survey many basic features of Greek word formation without laboriously repeating all the steps that we took in the early chapters of Part I. As the extant evidence of an historical culture, the ancient Greek language is centuries older than Latin. A recognizable form of Greek was spoken and written in the era of the Mycenaean Bronze Age, some 1500 years before the birth of Christ and the rule of Augustus Caesar. Thanks to the fame of Socrates, Plato, and Aristotle, Athens became also the city most renowned for philosophical and intellectual studies. Still, it would be a serious mistake to equate ancient Greek culture with this one community. The classical city-states extended from Asia Minor and the Black Sea 2 Chapter 15 in the east to Sicily and southern Italy in the west.

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Development and Course Consistent with a half-life of caffeine of approximately 4-6 hours, caffeine intoxication symptoms usually remit within the first day or so and do not have any known long-lasting consequences. Caffeine intoxication among young individuals after consumption of highly caffeinated products, including energy drinks, has been observed. The temporal relationship of the symptoms to increased caffeine use or to abstinence from caffeine helps to establish the diagnosis. With acute, extremely high doses of caffeine, grand mal seizures and respiratory failure may result in death. Abrupt cessation of or reduction in caffeine use, followed within 24 hours by three (or more) of the following signs or symptoms: 1. The signs or symptoms are not associated with the physiological effects of another medical condition. Headache is the hallmark feature of caffeine withdrawal and may be diffuse, gradual in development, throbbing, severe, and sensitive to movement. However, other symptoms of caffeine withdrawal can occur in the absence of headache. Because caffeine ingestion is often integrated into social customs and daily rituals. The probability and severity of caffeine withdrawal generally increase as a function of usual daily caffeine dose. However, there is large variability among individuals and within individuals across different episodes in the incidence, severity, and time course of withdrawal symptoms. Caffeine withdrawal symptoms may occur after abrupt cessation of relatively low chronic daily doses of caffeine. Electroencephalographic studies have shown that caffeine withdrawal symptoms are significantly associated with increases in theta power and decreases in beta-2 power.

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Diagnostic characteristics of 93 cases of prepubertal and early adolescent bipolar disorder phenotype by gender, puberty and comorbid attention attention-deficit/hyperactivity disorder. Developmental aspects of obsessive-compulsive disorder: Findings in children, adolescents, and adults. Clinical correlates of obsessive-compulsive disorder in children and adolescents referred to specialized and non-specialized clinical settings. A meta-analysis of pharmacotherapy trials in pediatric obsessive-compulsive disorder. A controlled trial of behavior modification and methylphenidate in hyperactive children. Tic reduction with risperidone versus pimozide in a randomized, double-blind, crossover trial. A double-blind comparison of clomipramine, desipramine, and placebo in the treatment of autistic disorder. Management of child and adolescent eating disorders: the current evidence base and future directions. Psychotropic medication use in a population of children who have attention-deficit/hyperactivity disorder. Undergraduate ratings of the acceptability of single and combined treatments for depression: A comparative analysis. Development of depression from preadolescence to young adulthood: Emerging gender differences in a 10 year longitudinal study. Randomized trial of a home-based family intervention of children who have deliberately poisoned themselves. A growth curve analysis of parent training outcomes: Examining the influence of child risk factors (inattention, impulsivity, and hyperactivity problems), parental and family risk factors. Individual psychotherapy in the outpatient treatment of adults with anorexia nervosa. Efficacy of tricyclic drugs in treating child and adolescent depression: A meta-analysis. A randomized controlled trial of clonidine added to psychostimulant medication for hyperactive and aggressive children. Lines of evidence on the risks of suicide with selective serotonin reuptake inhibitors. Lithium side-effects and predictors of hypothyroidism in patients with bipolar disorder: Sex differences. Emerging brain-based interventions for children and adolescents: overview and clinical perspective. A placebo controlled crossover trial of liquid fluoxetine on repetitive behaviors in childhood and adolescent autism. Parent training for students with attention-deficit/hyperactivity disorder: Effects on reading performance at home and school. The effectiveness of psychological and pharmacological treatments for nocturnal enuresis. Multisystemic therapy effects on attempted suicide by youths presenting psychiatric emergencies. Cost-effectiveness and medical cost offset considerations in psychological service provision. Adjunctive antipsychotic treatment of adolescents with bipolar psychosis Journal of the American Academy of Child & Adolescent Psychiatry, 40(12), 1448-1456. Journal of the American Academy of Child & Adolescent Psychiatry, 42(9), 1038-1045. Comparison of cognitive-behavioral, relaxation and self-modeling interventions for depression among middle-school students. Disruptive behavior disorders in children and adolescents: How do girls differ from boys

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Interestingly, it was not included in the list of forbidden sacred names detailed in the legislation of the fifteenth and sixteenth centuries, which focused mainly on the names of God, Jesus, Christ, and the Devil. Mencken, following an unpublished source, gives laud, law, lawks, lawdy, and lawsy (1963, 395). In Elizabethan times, when companies of actors needed pa tronage to obtain a license for their productions, the Lord Chamberlain became one such benefactor. However, the Lord Chamberlain also had indirect power of censorship over the stage and public entertainments via the Master of the Revels, a court officer in his service who was increasingly given the pre emptive right to censor plays. Although the Licensing Act was in reality a form of private political revenge by Walpole, effectively silencing Fielding and bringing his career as a dramatist to an end, the powers of the Lord Chamberlain remained in place, astonishingly, for over two centuries. As with the procedure used by his predecessor, the Master of the Revels, plays had to be approved and receive a license prior to performance. Petitions by public authors of note made in 1865 and 1907 resulted in greater flexibility, but the responsibilities of the Lord Chamberlain for theatrical censorship were abolished only in the Theatres Act of 1968. Grounds for the refusing of a license varied greatly and included obscenity, profanity, blasphemy, immorality, and indecency. If an author or manager refused to comply with the editing prescribed by Examiner, the matter would be handed over to the Director of Public Prosecutions to proceed with a case against the theatre. The files of the Lord Chamberlain and his staff from 1901 to 1968 were withheld from the public domain until 1991. The formal device was to have a select club performance, but many anecdotes attest to the effectiveness of irony.

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Because of the breakdown in security within areas of Palestinian control in recent years, it is hard to see how Palestinians can assume the responsibility and gain the ability to provide adequate security, objectively and in Israeli eyes, without international support and involvement. Successful security arrangements range from patrol and protection of the bor ders themselves to workable justice and public safety systems within them. Tere is no room in this chain for weak links: Internal leniency toward violent extremists will likely lead to Israeli reactions; and failure to monitor and manage who and what enters Palestine can only weaken internal public safety. The borders of an independent Pales tinian state, including the degree of territorial contiguity and whether Palestinian ter ritory surrounds Israeli settlements, will signi cantly a ect the success of any security arrangements. It will take more than Palestinian good faith and e ort to meet such standards of security, even under the most favorable conditions. It will also require extensive inter national assistance and close cooperation among security personnel. Good Governance and Political Legitimacy Palestinian national aspirations have evolved over time since the creation of Israel in 1948. Moreover, surveys suggest that some three-fourths of Palestinians in the6 West Bank and Gaza would support reconciliation with Israel following a peace treaty and the establishment of an independent Palestinian state. In practice, the willingness and ability of the Palestinian state to resist or co-opt such factions will depend on its political legitimacy. Legitimacy, in turn, will depend on a number of factors, including the form and e ectiveness of governance; economic and social development; territorial size and contiguity; the status of Jerusalem; and the status and the treatment of Palestinian refugees, particularly those currently living in Lebanon, Syria, and Jordan. Finally, the passing of Yasser Arafat is likely to generate new challenges and opportunities. An independent Pales 6 The o cial Palestinian position today is to create a Palestinian state in the entirety of the West Bank and Gaza, with East Jerusalem as its capital, and living side by side with Israel. As we describe in this book (see Chapter Five), there are a number of prerequisites for successful economic development in a Palestinian state. Tese include security; adequate and contiguous territory (although we assume that the West Bank and Gaza will remain physically separate); stable access to adequate supplies of power and water; adequate infrastructure for transporting goods, both domestically and internationally, and the ability to use it; and an improved communication infrastructure. Since Pales tinian territory has limited natural resources, economic development will depend criti cally on human resources, with stronger systems of primary, secondary, and vocational education as crucial down payments on any future economic success. Historically, income from Palestinians working in Israel has been an important component of Palestinian national income. However, the degree of access by Palestin ians to Israeli labor markets has uctuated greatly and is minimal at the time of this writing. The extent of such access in the future is another important variable discussed in this book that will a ect Palestinian economic development under independence. A new Palestinian state will not be successful without signi cant economic devel opment. Such development will require considerable external assistance in the form of investment capital in addition to good governance and human capital formation. At the same time, an independent Palestinian state cannot be truly characterized as successful until the amount and scope of external assistance diminishes and the state becomes largely self-reliant. The requirements for external assistance estimated in this study are considered essential to enable a Palestinian state to succeed.

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A numerical index (usually symbolized by multiple personality R) of the degree to which a target variable n. The presence of two or more distinct per can be predicted by two or more predictor sonalities or identities in the same person variables using a linear model. Any nerve cell which has more than one of two or more distinct personalities or iden dendrite. A tabular display of the correlations of sev and the history of the person involved. Also eral traits measured in several ways and all called dissociative identity disorder. The correlation of a trait measured in one way with itself is multiple regression a measure of the reliability of the measure. A statistical procedure in which more than the correlations between any measure of a one predictor variable is correlated with a tar trait and another measure of the same trait get variable as well as with the other predictor constitute measures of the convergent valid variables in order to form a linear model using ity of both measures. The correlation of a a weighted sum of the predictor variables to trait with other traits measured the same way predict values of the target variable. Of or relating to the inclusion of more ing and the nerve beneath it, disrupting the than one variable in a research design or sta neural pathway in which the nerve lies. Often, the frst symp multivariate analysis methods tom is disruption of vision, which can be fol n. Any of several statistical procedures that lowed by fatigue and weakness, particularly in analyze the variance among multiple inde the hands and feet, and numbness, stiffness, pendent and multiple dependent measures. Some victims ferences in more than one dependent variable also suffer cognitive impairment of various in two or more groups defned by indepen sorts. This is used to test hypotheses about predict the course of the disease in individu differences among the groups with the object als, although the more different symptoms of being able to attribute any such differences that appear early in the course of the disease to effects of the independent variable(s) on the worse the prognosis. The causes of the disease are multivariate analysis of variance unknown, but some experts believe it to be an n. It is more common in within to between-group differences in more 323 multivariate statistics mutism than one dependent variable in two or more in the brain, muscarinic receptors predomi groups defned by independent variables. Atropine (similar to ophthalmological ences in the dependent variables between eye drops used to dilate the pupil) inhibits the groups with the object of being able to cholinergic muscarinic receptor sites. Any of the sensory nerves connected to Munchausen syndrome intrafusal fbers that lie within muscles and n. A disorder characterized by repeatedly send impulses toward the spinal cord and producing or feigning psychological or medi brain when the muscle is stretched. A method of psychotherapy in which cli Munchhausen syndrome by proxy ents use the performance of music as a way of n. A disorder characterized by repeatedly pro relieving their psychological symptoms. X-rays and gamma rays which causes a perma nent change in the genetic material in a cell. A numerical method of describing or spec mutation ifying colors by means of hue, saturation, n. A part of cholinergic transmission which change over time as some of the mutations is activated through a metabotropic route, produce offspring that are better adapted necessarily slower than transmission at a nico for survival in the particular environment in tinic-ionic receptor site. Muscarinic receptor which the organism lives and so increase the action requires a multiple-stage metabolic chance individuals with that genetic form will alteration involving a G-protein coupling to survive and procreate. The refusal or inability to speak, which may stimulation of a muscarinic receptor site may result from malformation or damage to the alter protein production within the neuron. The medulla oblongata or the part of the fetal hindbrain that develops into the medulla myostatic re ex oblongata. A refex involving a single stretch receptor and a single efferent nerve fber in which the myelin stretching of a muscle causes contraction of n. A hallucinogenic drug found in nutmeg around nerves which electrically insulates and mace which is structurally similar to mes them from surrounding tissue, enabling caline and affects serotonin, norepinephrine, more rapid transmission of nerve impulses, and dopamine receptors. It is also used as an and gives portions of the brain and nerve herbal treatment for arthritis. A phrase coined by Thomas Szasz, who or the other end of each polarity and then suggests that categories of mental illness are assigned to 1 of the 16 possible types formed not disease entities but categories of socially by the four polarities.

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Back and spine examination: the back should be assessed for symme try, tenderness, or masses. The flank regions particularly are important to assess for pain on percussion that may indicate renal disease. Extremities/Skin: the presence of joint effusions, tenderness, rashes, edema, and cyanosis should be recorded. Neurologic examination: Patients who present with neurologic com plaints require a thorough assessment including mental status, cranial nerves, muscle tone, and strength, sensation, reflexes, and cerebellar function, and gait to determine where the lesion or problem is located in the nervous system. Locating the lesion is the first step to generat ing a differential of possible diagnoses and implementing a plan for management. Coordination and gait: Rapid alternating movements, point-to-point movements, Romberg test, and gait (walk, heel-to-toe in straight line, walk on toes and heels, shallow bend and get up from sitting). Mental status examination: A thorough neurologic examination requires a mental status examination. The Mini-Mental Status examination is a series of verbal and non-verbal tasks that serves to detect impairments in memory, concentration, language, and spatial orientation. Arterial blood gas measurements give information about oxygena tion, but also carbon dioxide and pH readings. Lumbar puncture is indicated to assess any inflammatory, infec tious, or neoplastic processes that can affect the brain, spinal cord, or nerve roots. Yet another individual who is a 60-year-old man with right sided facial weakness and left arm numbness likely has an ischemic stroke. For example, cancer staging is used for the strict assessment of extent of malignancy. Treating based on Stage Many illnesses are characterized by stage or severity because this affects prognosis and treatment. As an example, a patient with mild lower extremity weakness and areflexia that develops over 2 weeks may be care fully observed; however once respiratory depression occurs, then respiratory sup port must be given. The clinician must be prepared to know what to do if the patient does not respond as expected. Is the next step to treat again, to reassess the diagnosis, or to follow up with another more spe cific test Patients rarely present with a clear diagno sis; hence, the student must become skilled in applying textbook information to the clinical scenario. Because reading with a purpose improves the retention of information, the student should read with the goal of answering specific questions. The method of establishing the diagnosis has been covered in the previous sec tion. One way of attacking this problem is to develop standard approaches to common clinical problems.

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For reasons that are never entirely clear, the knowledge and understanding of these early writers was lost or forgotten for the next 1500 years or so of European history. Those with any interest in the brain concentrated on attempts to nd the location of the soul. Their search focused on easily identi able brain structures including the pineal gland and the corpus callosum, structures that today are known to be involved in the control of bodily rhythms and communication between the two sides of the brain respectively. Descartes: French the uid cavities of the brain (the ventricles), the pineal and pituitary glands, and philosopher famous for his corpus callosum. However, their ideas about the functions of these structures were ideas about the separate usually well wide of the mark: Descartes (1664), for example, mistakenly argued identities of mind and body. To reiterate, the pineal gland Localisation of function: the concept that different is today regarded as an entirely soul-less endocrine gland involved in the control of parts of the brain carry out bodily rhythms. It should be noted at the outset that Gall and Spurzheim, like modern-day neuropsychologists, were more interested in localisation of function within the cerebral cortex (the outer surface of the brain), with its characteristic bumps (gyri) and folds (sulci), than in the subcortical structures mentioned earlier. For example, Gall was the rst person to distinguish between grey and white matter (neuron cell bodies and their bundled axons respectively) in the brain, and also described the rst case of aphasia (impaired language production) associated with frontal damage resulting from a fencing injury. Through a combination of serendipity and chance observations, Gall came to the view that each of the two sides of the cerebral cortex (also sometimes called the left and right cerebral hemispheres) consisted of 27 compartments or regional faculties. These ranged from commonsense (or at least recognisable) ones such as language and perception, to ambiguous and obscure ones including hope and self-esteem. Accordingly, the more a person used particular faculties, the bigger the brain in that region grew, causing the shape of the skull to be distorted. Each Neuron cell bodies: the observation was simply taken as con rmation of the general theory, except that central part of neurons the number of faculties crept up to 35. Obviously, Gall and production and/or Spurzheim had no way of measuring internal brain structure in living people, comprehension of language. Actually, records show that Gall had access to a small number of such cases, but unfortunately he seemed to regard them as being of only anec dotal interest, failing to realise that brain-injured people could o er an important test of his theory. Working mainly with Open head injuries: Head injuries involving damage to birds, he developed the technique of surgically removing small areas of brain the cranium so that the brain tissue and, after a period of recovery, observing the e ects of the surgery on is exposed or visible. First, he worked with pigeons and chickens, which are now known to have almost no cortex. Third, his surgical procedure was imprecise, leaving open the possibility that behavioural changes were caused by damage or lesions to brain structures beyond the cortex. French physicians Bouillaud and Dax had independently described a handful of patients they had seen who had lost the power of speech after brain damage. Those with left-sided damage often became paralysed in the right side of their bodies too, despite no apparent loss in intelligence.

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Despite the clear dif ference in de nitions, dystonia and spasticity are commonly confused in practice. Developing the skills to differentiate the two is important for patient care, as different treatment approaches are often needed. Dystonia involves involuntary muscle contractions that cause twisting, repetitive movement, and abnormal postures [64]. Interventions for spasticity usually start with passive stretching and other phys ical therapy interventions [65]. The choice of which steps to take next depends on whether the spasticity is generalized or localized. Localized spasticity, such as in the heel cords or hamstrings, can respond well to injections of botulinum toxin [66] or phenol [67]. In more generalized spasticity, considerations include oral medi cations, such as baclofen [68], dorsal rhizotomy [69], and intrathecal baclofen by implanted pump [70]. For the generalist, what is most important is to realize that treatment options do exist and to help families nd them when appropriate. Also important for those who care for children with intrathecal baclofen pumps is awareness of the signs and symptoms of both baclofen withdrawal and overdose, as both situations 15 Medical Management of Cerebral Palsy 239 can be life threatening. Symptoms of baclofen withdrawal include fever, itching, and increased stiffness, while lethargy, seizures, and respiratory suppression can be seen with excessive doses. All patients with baclofen pumps are instructed to carry emergency procedure information with them at all times. In general, it responds less robustly and predictably to a narrower spectrum of medications, such as trihexyphenidyl [71]. Dystonia may also respond to intrathecal baclofen [72], but usually requires higher doses [73]. Vision Individuals with cerebral palsy have a high incidence of eye disorders, which range from refractive errors and strabismus to visual impairment [74]. Those with a severe global central nervous system insult or dis proportionate occipital involvement are at more risk of cortical visual impairment, and the severity of visual de cits increases with increasing severity of motor impair ment. Regardless of cause, ophthalmologic problems are important to identify, as they are often treat able. All children with cerebral palsy should be evaluated by a pediatric ophthalmologist as soon as vision concerns are suspected. Children with con rmed visual impairment qualify for and should receive specialized vision services through the schools [79]. Just as in the case of vision, preterm infants are at increased risk, as are those who suffered a hypoxic or infectious insult. Former premature infants, as well as infants treated with extracorporeal membrane oxygenations [81] and those with intrauterine cytomegalovirus infections [82], may experience late onset or progressive hearing loss and thus require periodic hearing assessment over the rst several years of life. Urologic A poorly de ned subset of individuals with cerebral palsy may experience void ing dysfunction [83]. Studies have indicated that, on average, children with cerebral palsy achieve continence later than their peers [84], but the data were not controlled for cognitive level. These include malocclusion due to the abnormal forces in the oromotor musculature [86]. Some children with cerebral palsy have a hyperactive gag re ex or oral aversion, which makes dental hygiene dif cult.

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These are currently one of the most often pre However, moderate to high dose dependence is best scribed drugs. The best treatment is probably prevention by limit Benzodiazepine (or sedative-hypnotic) use disor ing benzodiazepine use to no more than 2-4 weeks of der can be either iatrogenic or originating with illicit prescription at most. Dependence, both physical and psychologi After the detoxi cation phase, an adequate follow-up cal, can occur and tolerance is usually moderate. Excessive doses can lead to respira line (petrol), glues, aerosols (spray paints), thinners, tory depression, coma and death while chronic use has varnish remover and industrial solvents. Withdrawal Syndrome Intoxication and Complications A typical withdrawal syndrome, after cessation of Inhalation of a volatile solvent leads to euphoria, ex prolonged use (more than 4-6 weeks) of moderate citement, belligerence, dizziness, slurring of speech, 52 A Short Textbook of Psychiatry apathy, impaired judgement, and neurological signs depression and impairment in cognitive functions (such as decreased re exes, ataxia, nystagmus, incoor have been reported. Death can occur due to respiratory Treatment depression, cardiac arrhythmias, or asphyxia. There is often an associated psy There is no speci c treatment for phencyclidine chiatric disorder (usually schizophrenia or personality withdrawal syndrome. Nicotine use (often in the form of smoking) is more However, its use was soon restricted to veterinary common in schizophrenia and depression. Smoking anaesthesia as some human subjects developed predisposes to increased risk of cardiovascular dis delirium while emerging from anaesthesia. Classi ed ease, respiratory disease and cancer, and can affect as an atypical hallucinogen (street names: Peace pill; metabolism of several psychotropic drugs. Other features last smoke and can present with anxiety, restless may include impulsiveness, agitation, impaired social ness, poor concentration, decreased sleep, increased judgement, assaultativeness, feeling of numbness appetite and exacerbation of psychiatric symptoms in and inability to move. These clinically signi cant distress or impairment in social, should only be initiated after a discussion of possible occupational or other areas of functioning, and the adverse effects with the patient. Caffeine is also or more of the following: restlessness, nervousness, present in chocolate. Schizophrenia 5 Schizophrenia has puzzled physicians, philosophers, outcome (dementia: deterioration; praecox: early and general public for centuries. To understand what schizophrenia is, it is impor Eugen Bleuler (1911), while renaming dementia tant to have a brief look at the history of evolution of praecox as schizophrenia (meaning mental splitting), the concept of schizophrenia. Therefore, Although earlier descriptions of schizophrenia-like he used the term, a group of schizophrenias. He hebephrenia), the scienti c study of the disorder also described accessory symptoms of schizophrenia began with the description of dementia praecox by (thought to be secondary to fundamental symptoms). Emil Kraepelin Kurt Schneider In 1896, Emil Kraepelin differentiated the major psychiatric illnesses into two clinical types: Dementia Kurt Schneider (1959) described symptoms which, praecox, and Manic depressive illness. The emphasis in diagnosis of He also described the second rank symptoms of dementia praecox was on an early onset and a poor schizophrenia (which were considered by him as less Schizophrenia 55 Table 5. Voices heard arguing: Two or more hallucinatory few exceptions in the prevalence rates in some isolated voices discussing the subject in third person. The onset of schizophrenia occurs experiences them as removed by an external force. Thought insertion: Experience of thoughts imposed benign course, as compared to men. The diagnosis is entirely clinical and is based ses or acts which are imposed by some external on the following clinical features, none of which are force. Somatic passivity: Bodily sensations, especially Autistic thinking is one of the most classical features sensory symptoms, are experienced as imposed on of schizophrenia. Delusional perception: Normal perception has a things identical because they have identical predicates private and illogical meaning. If 56 A Short Textbook of Psychiatry the loosening becomes very severe, speech becomes the commonly seen delusions in schizophrenia virtually incomprehensible. Delusions of persecution (being persecuted Thought blocking is a characteristic feature of against. Delusions of reference (being referred to by others; plex partial seizures (temporal lobe epilepsy). Delusions of control (being controlled by an exter times be associated with thought withdrawal.

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