130-404: Agoraphobia is a mental and behavioral disorder , specifically an anxiety disorder characterized by symptoms of anxiety in situations where the person perceives their environment to be unsafe with no easy way to escape. These situations can include public transit, shopping centers, crowds and queues , or simply being outside their home on their own. Being in these situations may result in
260-615: A mental illness , a mental health condition , or a psychiatric disability , is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in a social context . Such disturbances may occur as single episodes, may be persistent, or may be relapsing–remitting . There are many different types of mental disorders, with signs and symptoms that vary widely between specific disorders. A mental disorder
390-465: A panic attack . Those affected will go to great lengths to avoid these situations. In severe cases, people may become completely unable to leave their homes. Agoraphobia is believed to be due to a combination of genetic and environmental factors. The condition often runs in families, and stressful or traumatic events such as the death of a parent or being attacked may be a trigger. In the DSM-5 , agoraphobia
520-480: A self-help or support group (telephone conference-call support groups or online support groups being of particular help for completely housebound individuals). Sharing problems and achievements with others, as well as sharing various self-help tools, are common activities in these groups. In particular, stress management techniques and various kinds of meditation practices and visualization techniques can help people with anxiety disorders calm themselves and may enhance
650-525: A virtual reality study, agoraphobics showed impaired processing of changing audiovisual data in comparison with subjects without agoraphobia. Chronic use of tranquilizers and sleeping pills such as benzodiazepines has been linked to onset of agoraphobia. In 10 patients who had developed agoraphobia during benzodiazepine dependence , symptoms abated within the first year of assisted withdrawal. Similarly, alcohol use disorders are associated with panic with or without agoraphobia; this association may be due to
780-513: A "fuzzy prototype " that can never be precisely defined, or conversely that the concept always involves a mixture of scientific facts and subjective value judgments. Although the diagnostic categories are referred to as 'disorders', they are presented as medical diseases, but are not validated in the same way as most medical diagnoses. Some neurologists argue that classification will only be reliable and valid when based on neurobiological features rather than clinical interview, while others suggest that
910-427: A cafe or a busy street). Antidepressant medications most commonly used to treat anxiety disorders are mainly selective serotonin reuptake inhibitors . Benzodiazepines , monoamine oxidase inhibitor , and tricyclic antidepressants are also sometimes prescribed for treatment of agoraphobia. Antidepressants are important because some have anxiolytic effects. Antidepressants should be used in conjunction with exposure as
1040-460: A category for enduring personality change after a catastrophic experience or psychiatric illness. If an inability to sufficiently adjust to life circumstances begins within three months of a particular event or situation, and ends within six months after the stressor stops or is eliminated, it may instead be classed as an adjustment disorder . There is an emerging consensus that personality disorders, similar to personality traits in general, incorporate
1170-442: A category of relational disorder , where the diagnosis is of a relationship rather than on any one individual in that relationship. The relationship may be between children and their parents, between couples, or others. There already exists, under the category of psychosis, a diagnosis of shared psychotic disorder where two or more individuals share a particular delusion because of their close relationship with each other. There are
1300-399: A clinic) during a period of 1 year, only 1 fit the diagnosis of agoraphobia without panic attacks, and even this particular classification was questionable...Do not expect to see too many agoraphobics without panic". In spite of this earlier skepticism, current thinking is that agoraphobia without panic disorder is indeed a valid, unique illness which has gone largely unnoticed, since those with
1430-455: A combination of factors may also explain the association between tobacco smoking and agoraphobia and panic. Some scholars have explained agoraphobia as an attachment deficit, i.e., the temporary loss of the ability to tolerate spatial separations from a secure base. Recent empirical research has also linked attachment and spatial theories of agoraphobia. In the social sciences, a perceived clinical bias exists in agoraphobia research. Branches of
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#17328592316941560-496: A conflict in the mind of agoraphobic individuals. An evolutionary psychology view is that the more unusual primary agoraphobia without panic attacks may be due to a different mechanism from agoraphobia with panic attacks. Primary agoraphobia without panic attacks may be a specific phobia explained by it once having been evolutionarily advantageous to avoid exposed, large, open spaces without cover or concealment. Agoraphobia with panic attacks may be an avoidance response secondary to
1690-574: A control group. These subjects also reported a more intense fear from the films and greater mean intensity of negative memories than control subjects. The findings from this study demonstrate that there are learned associations between negative feelings and levels of adrenaline. Overall, the greater amount of adrenaline is positively correlated with an aroused state of negative emotions . These findings can be an effect in part that adrenaline elicits physiological sympathetic responses, including an increased heart rate and knee shaking, which can be attributed to
1820-508: A diagnosis of panic disorder . Other syndromes like obsessive–compulsive disorder or post-traumatic stress disorder can also cause agoraphobia. Any irrational fear that keeps one from going outside can cause the syndrome. People with agoraphobia may experience temporary separation anxiety disorder when certain individuals of the household depart from the residence temporarily, such as a parent or spouse, or when they are left home alone. These situations can result in an increase in anxiety or
1950-545: A diagnosis. Services for mental disorders are usually based in psychiatric hospitals , outpatient clinics , or in the community , Treatments are provided by mental health professionals. Common treatment options are psychotherapy or psychiatric medication , while lifestyle changes, social interventions, peer support , and self-help are also options. In a minority of cases, there may be involuntary detention or treatment . Prevention programs have been shown to reduce depression. In 2019, common mental disorders around
2080-579: A diagnostic aid, to monitor therapeutic administration, or to identify the causative agent in a potential poisoning victim. Endogenous plasma adrenaline concentrations in resting adults usually are less than 10 ng/L, but they may increase by 10-fold during exercise and by 50-fold or more during times of stress. Pheochromocytoma patients often have plasma adrenaline levels of 1000–10,000 ng/L. Parenteral administration of adrenaline to acute-care cardiac patients can produce plasma concentrations of 10,000 to 100,000 ng/L. In chemical terms, adrenaline
2210-440: A dimension or spectrum of mood, is subject to some scientific debate. Patterns of belief, language use and perception of reality can become dysregulated (e.g., delusions , thought disorder , hallucinations ). Psychotic disorders in this domain include schizophrenia , and delusional disorder . Schizoaffective disorder is a category used for individuals showing aspects of both schizophrenia and affective disorders. Schizotypy
2340-476: A disorder, it generally needs to cause dysfunction. Most international clinical documents use the term mental "disorder", while "illness" is also common. It has been noted that using the term "mental" (i.e., of the mind ) is not necessarily meant to imply separateness from the brain or body . According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV ), published in 1994,
2470-427: A disorder. Obsessive–compulsive disorder can sometimes involve an inability to resist certain acts but is classed separately as being primarily an anxiety disorder. Substance use disorder : This disorder refers to the use of drugs (legal or illegal, including alcohol ) that persists despite significant problems or harm related to its use. Substance dependence and substance abuse fall under this umbrella category in
2600-403: A dysfunction in the individual. DSM-IV predicates the definition with caveats, stating that, as in the case with many medical terms, mental disorder "lacks a consistent operational definition that covers all situations", noting that different levels of abstraction can be used for medical definitions, including pathology, symptomology, deviance from a normal range, or etiology, and that the same
2730-907: A fear of dying, fear of losing control of emotions, or fear of losing control of behaviors. Agoraphobia is believed to be due to a combination of genetic and environmental factors. The condition often runs in families, and stressful or traumatic events such as the death of a parent or being attacked may be a trigger. Research has uncovered a link between agoraphobia and difficulties with spatial orientation. Individuals without agoraphobia are able to maintain balance by combining information from their vestibular system , their visual system , and their proprioceptive sense. A disproportionate number of agoraphobics have weak vestibular function and consequently rely more on visual or tactile signals. They may become disoriented when visual cues are sparse (as in wide-open spaces) or overwhelming (as in crowds). Likewise, they may be confused by sloping or irregular surfaces. In
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#17328592316942860-399: A few anxiety disorders tend to appear in childhood. Some other anxiety disorders, substance disorders, and mood disorders emerge later in the mid-teens. Symptoms of schizophrenia typically manifest from late adolescence to early twenties. The likely course and outcome of mental disorders vary and are dependent on numerous factors related to the disorder itself, the individual as a whole, and
2990-534: A form of self-help or with cognitive behaviour therapy. A combination of medication and cognitive behaviour therapy is sometimes the most effective treatment for agoraphobia. Eye movement desensitization and reprocessing (EMDR) has been studied as a possible treatment for agoraphobia, with poor results. As such, EMDR is only recommended in cases where cognitive-behavioral approaches have proven ineffective or in cases where agoraphobia has developed following trauma. Many people with anxiety disorders benefit from joining
3120-551: A mechanism that depends on β adrenoceptors. Adrenaline does not readily cross the blood-brain barrier, so its effects on memory consolidation are at least partly initiated by β adrenoceptors in the periphery. Studies have found that sotalol , a β adrenoceptor antagonist that also does not readily enter the brain, blocks the enhancing effects of peripherally administered adrenaline on memory. These findings suggest that β adrenoceptors are necessary for adrenaline to have an impact on memory consolidation. Increased adrenaline secretion
3250-449: A mental disorder is a psychological syndrome or pattern that is associated with distress (e.g., via a painful symptom ), disability (impairment in one or more important areas of functioning), increased risk of death, or causes a significant loss of autonomy; however, it excludes normal responses such as the grief from loss of a loved one and also excludes deviant behavior for political, religious, or societal reasons not arising from
3380-416: A mixture of acute dysfunctional behaviors that may resolve in short periods, and maladaptive temperamental traits that are more enduring. Furthermore, there are also non-categorical schemes that rate all individuals via a profile of different dimensions of personality without a symptom-based cutoff from normal personality variation, for example through schemes based on dimensional models. An eating disorder
3510-500: A number of uncommon psychiatric syndromes , which are often named after the person who first described them, such as Capgras syndrome , De Clerambault syndrome , Othello syndrome , Ganser syndrome , Cotard delusion , and Ekbom syndrome , and additional disorders such as the Couvade syndrome and Geschwind syndrome . The onset of psychiatric disorders usually occurs from childhood to early adulthood. Impulse-control disorders and
3640-403: A panic attack or feeling the need to separate themselves from family or friends. People with agoraphobia sometimes fear waiting outside for long periods of time; that symptom can be called "macrophobia". Agoraphobia patients can experience sudden panic attacks when traveling to places where they fear they are out of control, help would be difficult to obtain, or they could be embarrassed. During
3770-447: A panic attack, epinephrine is released in large amounts, triggering the body's natural fight-or-flight response. A panic attack typically has an abrupt onset, building to maximum intensity within 10 to 15 minutes, and rarely lasts longer than 30 minutes. Symptoms of a panic attack include palpitations, rapid heartbeat, sweating, trembling, nausea, vomiting, dizziness, tightness in the throat, and shortness of breath. Many patients report
3900-402: A participant through a dianoetic discussion, with the intent of replacing irrational, counterproductive beliefs with more factual and beneficial ones. Relaxation techniques are often useful skills for the agoraphobic to develop, as they can be used to stop or prevent symptoms of anxiety and panic. Videoconferencing psychotherapy (VCP) is an emerging modality used to treat various disorders in
4030-410: A physiologist at University College of London published a paper about the active component of adrenal gland extract causing the increase in blood pressure and heart rate was from the medulla, but not the cortex of the adrenal gland. In 1897, John Jacob Abel (1857–1938) of Johns Hopkins University , the first chairman of the first US department of pharmacology, found a compound called epinephrine with
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4160-424: A remote method. Similar to traditional face-to-face interventions, VCP can be used to administer CBT. Virtual reality computer stimulated therapy has been suggested to help people with psychosis and agoraphobia manage their avoidance of outside environments. In the therapy, the user wears a headset and a virtual character provides psychological advice and guides them as they explore simulated environments (such as
4290-693: A separate axis II in the case of the DSM-IV. A number of different personality disorders are listed, including those sometimes classed as eccentric , such as paranoid , schizoid and schizotypal personality disorders; types that have described as dramatic or emotional, such as antisocial , borderline , histrionic or narcissistic personality disorders; and those sometimes classed as fear-related, such as anxious-avoidant , dependent , or obsessive–compulsive personality disorders. Personality disorders, in general, are defined as emerging in childhood, or at least by adolescence or early adulthood. The ICD also has
4420-414: A severe psychiatric disability. Disability in this context may or may not involve such things as: In terms of total disability-adjusted life years (DALYs), which is an estimate of how many years of life are lost due to premature death or to being in a state of poor health and disability, psychiatric disabilities rank amongst the most disabling conditions. Unipolar (also known as Major) depressive disorder
4550-543: A sleep center for analysis, during which doctors ask for a detailed sleep history and sleep records. Doctors also use actigraphs and polysomnography . Doctors will do a multiple sleep latency test, which measures how long it takes a person to fall asleep. Sleep apnea, when breathing repeatedly stops and starts during sleep, can be a serious sleep disorder. Three types of sleep apnea include obstructive sleep apnea , central sleep apnea , and complex sleep apnea . Sleep apnea can be diagnosed at home or with polysomnography at
4680-644: A sleep center. An ear, nose, and throat doctor may further help with the sleeping habits. Sexual disorders include dyspareunia and various kinds of paraphilia (sexual arousal to objects, situations, or individuals that are considered abnormal or harmful to the person or others). Impulse control disorder : People who are abnormally unable to resist certain urges or impulses that could be harmful to themselves or others, may be classified as having an impulse control disorder, and disorders such as kleptomania (stealing) or pyromania (fire-setting). Various behavioral addictions, such as gambling addiction, may be classed as
4810-524: A small minority of cases, however, agoraphobia can develop by itself without being triggered by the onset of panic attacks . Agoraphobia can be caused by traumatic experiences, such as bullying or abuse. Historically, there has been debate over whether agoraphobia without panic genuinely existed, or whether it was simply a manifestation of other disorders such as panic disorder, generalized anxiety disorder , avoidant personality disorder and social phobia . One researcher said: "out of 41 agoraphobics seen (at
4940-447: A small number of neurons that use adrenaline as a neurotransmitter . Following adrenalectomy , adrenaline disappears below the detection limit in the bloodstream. Pharmacological doses of adrenaline stimulate α 1 , α 2 , β 1 , β 2 , and β 3 adrenoceptors of the sympathetic nervous system . Sympathetic nerve receptors are classified as adrenergic, based on their responsiveness to adrenaline. The term "adrenergic"
5070-451: A very similar definition. The terms "mental breakdown" or "nervous breakdown" may be used by the general population to mean a mental disorder. The terms "nervous breakdown" and "mental breakdown" have not been formally defined through a medical diagnostic system such as the DSM-5 or ICD-10 and are nearly absent from scientific literature regarding mental illness. Although "nervous breakdown"
5200-455: A white microcrystalline granule. Adrenaline is normally produced by the adrenal glands and by a small number of neurons in the medulla oblongata . It plays an essential role in the fight-or-flight response by increasing blood flow to muscles, heart output by acting on the SA node , pupil dilation response , and blood sugar level . It does this by binding to alpha and beta receptors . It
5330-486: Is anxiety or fear that interferes with normal functioning may be classified as an anxiety disorder. Commonly recognized categories include specific phobias , generalized anxiety disorder , social anxiety disorder , panic disorder , agoraphobia , obsessive–compulsive disorder and post-traumatic stress disorder . Other affective (emotion/mood) processes can also become disordered. Mood disorder involving unusually intense and sustained sadness, melancholia, or despair
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5460-462: Is insomnia , which is described as difficulty falling and/or staying asleep. Other sleep disorders include narcolepsy , sleep apnea , REM sleep behavior disorder , chronic sleep deprivation , and restless leg syndrome . Narcolepsy is a condition of extreme tendencies to fall asleep whenever and wherever. People with narcolepsy feel refreshed after their random sleep, but eventually get sleepy again. Narcolepsy diagnosis requires an overnight stay at
5590-463: Is a category used for individuals showing some of the characteristics associated with schizophrenia, but without meeting cutoff criteria. Personality —the fundamental characteristics of a person that influence thoughts and behaviors across situations and time—may be considered disordered if judged to be abnormally rigid and maladaptive . Although treated separately by some, the commonly used categorical schemes include them as mental disorders, albeit on
5720-445: Is a condition where individuals become anxious in unfamiliar environments or where they perceive that they have little control. Triggers for this anxiety may include wide-open spaces, crowds (social anxiety), or traveling (even short distances). Agoraphobia is often, but not always, compounded by a fear of social embarrassment, as a person experiencing agoraphobia fears the onset of a panic attack and appearing distraught in public. Most of
5850-422: Is a nervous breakdown. But that term has vanished from medicine, although not from the way we speak.... The nervous patients of yesteryear are the depressives of today. That is the bad news.... There is a deeper illness that drives depression and the symptoms of mood. We can call this deeper illness something else, or invent a neologism, but we need to get the discussion off depression and onto this deeper disorder in
5980-509: Is a nonselective agonist of all adrenergic receptors, including the major subtypes α 1 , α 2 , β 1 , β 2 , and β 3 . Adrenaline's binding to these receptors triggers a number of metabolic changes. Binding to α-adrenergic receptors inhibits insulin secretion by the pancreas , stimulates glycogenolysis in the liver and muscle , and stimulates glycolysis and inhibits insulin-mediated glycogenesis in muscle. β adrenergic receptor binding triggers glucagon secretion in
6110-477: Is a serious mental health condition that involves an unhealthy relationship with food and body image. They can cause severe physical and psychological problems. Eating disorders involve disproportionate concern in matters of food and weight. Categories of disorder in this area include anorexia nervosa , bulimia nervosa , exercise bulimia or binge eating disorder . Sleep disorders are associated with disruption to normal sleep patterns. A common sleep disorder
6240-523: Is an old diagnosis involving somatic complaints as well as fatigue and low spirits/depression, which is officially recognized by the ICD-10 but no longer by the DSM-IV. Factitious disorders are diagnosed where symptoms are thought to be reported for personal gain. Symptoms are often deliberately produced or feigned, and may relate to either symptoms in the individual or in someone close to them, particularly people they care for. There are attempts to introduce
6370-413: Is classified as a phobia along with specific phobias and social phobia . Other conditions that can produce similar symptoms include separation anxiety , post-traumatic stress disorder , and major depressive disorder . The diagnosis of agoraphobia has been shown to be comorbid with depression, substance abuse, and suicide ideation. Without treatment, it is uncommon for agoraphobia to resolve. Treatment
6500-416: Is first oxidized to L -DOPA by tyrosine hydroxylase ; this is the rate-limiting step. Then it is subsequently decarboxylated to give dopamine by DOPA decarboxylase ( aromatic L -amino acid decarboxylase ). Dopamine is then converted to noradrenaline by dopamine beta-hydroxylase , which utilizes ascorbic acid ( vitamin C ) and copper. The final step in adrenaline biosynthesis is the methylation of
6630-525: Is found in many animals, including humans, and some single-celled organisms . It has also been isolated from the plant Scoparia dulcis found in Northern Vietnam. As a medication, it is used to treat several conditions, including allergic reaction anaphylaxis , cardiac arrest , and superficial bleeding. Inhaled adrenaline may be used to improve the symptoms of croup . It may also be used for asthma when other treatments are not effective. It
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#17328592316946760-447: Is given intravenously , by injection into a muscle , by inhalation, or by injection just under the skin . Common side effects include shakiness, anxiety , and sweating. A fast heart rate and high blood pressure may occur. Occasionally it may result in an abnormal heart rhythm . While the safety of its use during pregnancy and breastfeeding is unclear, the benefits to the mother must be taken into account. A case has been made for
6890-456: Is known as major depression (also known as unipolar or clinical depression). Milder, but still prolonged depression, can be diagnosed as dysthymia . Bipolar disorder (also known as manic depression) involves abnormally "high" or pressured mood states, known as mania or hypomania , alternating with normal or depressed moods. The extent to which unipolar and bipolar mood phenomena represent distinct categories of disorder, or mix and merge along
7020-403: Is most often done in response to stress. The sympathetic nervous system, acting via splanchnic nerves to the adrenal medulla, stimulates the release of adrenaline. Acetylcholine released by preganglionic sympathetic fibers of these nerves acts on nicotinic acetylcholine receptors , causing cell depolarization and an influx of calcium through voltage-gated calcium channels . Calcium triggers
7150-488: Is much more common in adolescence and early adulthood and occurs more often in people of above average intelligence. Panic disorder with or without agoraphobia affects roughly 5.1% of Americans, and about 1/3 of this population with panic disorder have co-morbid agoraphobia. It is uncommon to have agoraphobia without panic attacks, with only 0.17% of people with agoraphobia not presenting panic disorders as well. Mental disorder A mental disorder , also referred to as
7280-405: Is not prevented by beta-blockade. The progressive airway dilation with increasing exercise is mediated by a progressive reduction in resting vagal tone. Beta blockade with propranolol causes a rebound in airway resistance after exercise in normal subjects over the same time course as the bronchoconstriction seen with exercise-induced asthma. The reduction in airway resistance during exercise reduces
7410-399: Is not rigorously defined, surveys of laypersons suggest that the term refers to a specific acute time-limited reactive disorder involving symptoms such as anxiety or depression, usually precipitated by external stressors . Many health experts today refer to a nervous breakdown as a mental health crisis . In addition to the concept of mental disorder, some people have argued for a return to
7540-461: Is observed in pheochromocytoma , hypoglycemia , myocardial infarction , and to a lesser degree, in essential tremor (also known as benign, familial, or idiopathic tremor). A general increase in sympathetic neural activity is usually accompanied by increased adrenaline secretion, but there is selectivity during hypoxia and hypoglycemia, when the ratio of adrenaline to noradrenaline is considerably increased. Therefore, there must be some autonomy of
7670-414: Is often misinterpreted in that the main sympathetic neurotransmitter is noradrenaline , rather than adrenaline, as discovered by Ulf von Euler in 1946. Adrenaline has a β 2 adrenoceptor-mediated effect on metabolism and the airway , with no direct neural connection from the sympathetic ganglia to the airway . Walter Bradford Cannon originally proposed the concept of the adrenal medulla and
7800-603: Is one aspect of mental health . The causes of mental disorders are often unclear. Theories incorporate findings from a range of fields. Disorders may be associated with particular regions or functions of the brain. Disorders are usually diagnosed or assessed by a mental health professional , such as a clinical psychologist , psychiatrist , psychiatric nurse, or clinical social worker , using various methods such as psychometric tests , but often relying on observation and questioning. Cultural and religious beliefs, as well as social norms , should be taken into account when making
7930-402: Is one of a group of monoamines called the catecholamines . Adrenaline is synthesized in the chromaffin cells of the adrenal gland 's adrenal medulla and a small number of neurons in the medulla oblongata in the brain through a metabolic pathway that converts the amino acids phenylalanine and tyrosine into a series of metabolic intermediates and, ultimately, adrenaline. Tyrosine
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#17328592316948060-411: Is reviewed by Rao. As a hormone, adrenaline acts on nearly all body tissues by binding to adrenergic receptors . Its effects on various tissues depend on the type of tissue and expression of specific forms of adrenergic receptors . For example, high levels of adrenaline cause smooth muscle relaxation in the airways but causes contraction of the smooth muscle that lines most arterioles . Adrenaline
8190-517: Is secondary to the activation of the sympathetic nerves innervating the adrenal medulla, as it is rapid and not present in animals where the adrenal gland has been removed. Although such stress triggers adrenaline release, it also activates many other responses within the central nervous system reward system , which drives behavioral responses; while the circulating adrenaline concentration is present, it may not drive behavior. Nevertheless, adrenaline infusion alone does increase alertness and has roles in
8320-425: Is someone who engages in sensation-seeking behavior through "the pursuit of novel and intense experiences without regard for physical, social, legal or financial risk". Such activities include extreme and risky sports, substance abuse, unsafe sex, and crime. The term relates to the increase in circulating levels of adrenaline during physiological stress . Such an increase in the circulating concentration of adrenaline
8450-449: Is still plausible. The World Health Organization (WHO) concluded that the long-term studies' findings converged with others in "relieving patients, carers and clinicians of the chronicity paradigm which dominated thinking throughout much of the 20th century." A follow-up study by Tohen and coworkers revealed that around half of people initially diagnosed with bipolar disorder achieve symptomatic recovery (no longer meeting criteria for
8580-430: Is that genetic, psychological, and environmental factors all contribute to the development or progression of mental disorders. Different risk factors may be present at different ages, with risk occurring as early as during prenatal period. Epinephrine Adrenaline , also known as epinephrine , is a hormone and medication which is involved in regulating visceral functions (e.g., respiration). It appears as
8710-747: Is the third leading cause of disability worldwide, of any condition mental or physical, accounting for 65.5 million years lost. The first systematic description of global disability arising in youth, in 2011, found that among 10- to 24-year-olds nearly half of all disability (current and as estimated to continue) was due to psychiatric disabilities, including substance use disorders and conditions involving self-harm . Second to this were accidental injuries (mainly traffic collisions) accounting for 12 percent of disability, followed by communicable diseases at 10 percent. The psychiatric disabilities associated with most disabilities in high-income countries were unipolar major depression (20%) and alcohol use disorder (11%). In
8840-462: Is to increase coronary and cerebral perfusion pressures and therefore increase oxygen exchange at the cellular level. While adrenaline does increase aortic, cerebral, and carotid circulation pressure, it lowers carotid blood flow and end-tidal CO 2 or E T CO 2 levels. It appears that adrenaline improves microcirculation at the expense of the capillary beds where perfusion takes place. Adrenaline may be quantified in blood, plasma, or serum as
8970-597: Is true for mental disorders, so that sometimes one type of definition is appropriate and sometimes another, depending on the situation. In 2013, the American Psychiatric Association (APA) redefined mental disorders in the DSM-5 as "a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning." The final draft of ICD-11 contains
9100-429: Is typically determined when symptoms are worse than panic disorder, but also do not meet the criteria for other mental disorders such as depression. Agoraphobia without a history of panic disorder (also called primary agoraphobia ) is an anxiety disorder where the individual with the diagnosis does not meet the DSM-5 criteria for panic disorder. Agoraphobia typically develops as a result of having panic disorder. In
9230-493: Is typically with a type of counselling called cognitive behavioral therapy (CBT). CBT results in resolution for about half of people. In some instances, those with a diagnosis of agoraphobia have reported taking benzodiazepines and antipsychotics. Agoraphobia affects about 1.7% of adults. Women are affected about twice as often as men. The condition is rare in children, often begins in adolescence or early adulthood, and becomes more common at age 65 or above. The term agoraphobia
9360-453: The central nervous system . Adrenocorticotropic hormone (ACTH) and the sympathetic nervous system stimulate the synthesis of adrenaline precursors by enhancing the activity of tyrosine hydroxylase and dopamine β-hydroxylase , two key enzymes involved in catecholamine synthesis. ACTH also stimulates the adrenal cortex to release cortisol , which increases the expression of PNMT in chromaffin cells, enhancing adrenaline synthesis. This
9490-747: The exocytosis of chromaffin granules and, thus, the release of adrenaline (and noradrenaline) into the bloodstream. For noradrenaline to be acted upon by PNMT in the cytosol, it must first be shipped out of granules of the chromaffin cells. This may occur via the catecholamine-H exchanger VMAT1 . VMAT1 is also responsible for transporting newly synthesized adrenaline from the cytosol back into chromaffin granules in preparation for release. Unlike many other hormones, adrenaline (as with other catecholamines) does not exert negative feedback to down-regulate its own synthesis. Abnormal adrenaline levels can occur in various conditions, such as surreptitious adrenaline administration, pheochromocytoma , and other tumors of
9620-459: The long-term effects of alcohol consumption causing a distortion in brain chemistry. Tobacco smoking has also been associated with the development and emergence of agoraphobia, often with panic disorder; it is uncertain how tobacco smoking results in anxiety-panic with or without agoraphobia symptoms, but the direct effects of nicotine dependence or the effects of tobacco smoke on breathing have been suggested as possible causes. Self-medication or
9750-616: The primary amine of noradrenaline. This reaction is catalyzed by the enzyme phenylethanolamine N -methyltransferase (PNMT), which utilizes S -adenosyl methionine (SAMe) as the methyl donor. While PNMT is found primarily in the cytosol of the endocrine cells of the adrenal medulla (also known as chromaffin cells ), it has been detected at low levels in both the heart and brain . The major physiologic triggers of adrenaline release center upon stresses , such as physical threat, excitement, noise, bright lights, and high or low ambient temperature. All of these stimuli are processed in
9880-622: The sympathetic ganglia . Its action is terminated with reuptake into nerve terminal endings, some minute dilution, and metabolism by monoamine oxidase and catechol- O -methyl transferase into 3,4-Dihydroxymandelic acid and Metanephrine . Extracts of the adrenal gland were first obtained by Polish physiologist Napoleon Cybulski in 1895. These extracts, which he called nadnerczyna ("adrenalin"), contained adrenaline and other catecholamines. American ophthalmologist William H. Bates discovered adrenaline's usage for eye surgeries prior to 20 April 1896. In 1897, John Jacob Abel (1857–1938),
10010-415: The sympathetic nervous system being involved in the flight, fight, and fright response. But the adrenal medulla, in contrast to the adrenal cortex, is not required for survival. In adrenalectomized patients, hemodynamic and metabolic responses to stimuli such as hypoglycemia and exercise remain normal. One physiological stimulus to adrenaline secretion is exercise. This was first demonstrated by measuring
10140-466: The DSM and ICD, some approaches are not based on identifying distinct categories of disorder using dichotomous symptom profiles intended to separate the abnormal from the normal. There is significant scientific debate about the relative merits of categorical versus such non-categorical (or hybrid) schemes, also known as continuum or dimensional models. A spectrum approach may incorporate elements of both. In
10270-495: The DSM. Substance use disorder may be due to a pattern of compulsive and repetitive use of a drug that results in tolerance to its effects and withdrawal symptoms when use is reduced or stopped. Dissociative disorder : People with severe disturbances of their self-identity, memory, and general awareness of themselves and their surroundings may be classified as having these types of disorders, including depersonalization derealization disorder or dissociative identity disorder (which
10400-520: The ICD). Popular labels such as psychopath (or sociopath) do not appear in the DSM or ICD but are linked by some to these diagnoses. Somatoform disorders may be diagnosed when there are problems that appear to originate in the body that are thought to be manifestations of a mental disorder. This includes somatization disorder and conversion disorder . There are also disorders of how a person perceives their body, such as body dysmorphic disorder . Neurasthenia
10530-492: The US. The British Approved Name and European Pharmacopoeia term for this drug is hence adrenaline (from Latin ad , "on", and rēnālis , "of the kidney", from ren , "kidney"). However, the pharmacologist John Abel had already prepared an extract from adrenal glands as early as 1897, and he coined the name epinephrine to describe it (from Ancient Greek ἐπῐ́ ( epí ), "upon", and νεφρός ( nephrós ), "kidney"). As
10660-402: The adrenal cortex, as with Addison's disease , can suppress adrenaline secretion as the activity of the synthesizing enzyme, phenylethanolamine- N -methyltransferase , depends on the high concentration of cortisol that drains from the cortex to the medulla. In 1901, Jōkichi Takamine patented a purified extract from the adrenal glands , which was trademarked by Parke, Davis & Co in
10790-557: The adrenal medulla from the rest of the sympathetic system. Myocardial infarction is associated with high levels of circulating adrenaline and noradrenaline, particularly in cardiogenic shock. Benign familial tremor (essential tremor) (BFT) is responsive to peripheral β adrenergic blockers, and β 2 -stimulation is known to cause tremor. Patients with BFT were found to have increased plasma adrenaline but not noradrenaline. Low or absent concentrations of adrenaline can be seen in autonomic neuropathy or following adrenalectomy. Failure of
10920-715: The blood, acting through both alpha and beta-adrenergic receptors to stimulate glycogenolysis. Adrenaline binds to β 2 receptors on liver cells, which changes conformation and helps G s , a heterotrimeric G protein , exchange GDP to GTP. This trimeric G protein dissociates to G s alpha and G s beta/gamma subunits. G s alpha stimulates adenylyl cyclase , thus converting adenosine triphosphate into cyclic adenosine monophosphate (AMP). Cyclic AMP activates protein kinase A . Protein kinase A phosphorylates and partially activates phosphorylase kinase . Adrenaline also binds to α 1 adrenergic receptors, causing an increase in inositol trisphosphate , inducing calcium ions to enter
11050-683: The brain and body. That is the point. In eliminating the nervous breakdown, psychiatry has come close to having its own nervous breakdown. Nerves stand at the core of common mental illness, no matter how much we try to forget them. "Nervous breakdown" is a pseudo-medical term to describe a wealth of stress-related feelings and they are often made worse by the belief that there is a real phenomenon called "nervous breakdown". There are currently two widely established systems that classify mental disorders: Both of these list categories of disorder and provide standardized criteria for diagnosis. They have deliberately converged their codes in recent revisions so that
11180-572: The condition are far less likely to seek clinical treatment. According to the DSM-IV-TR , a widely-used manual for diagnosing mental disorders , the condition is diagnosed when agoraphobia is present without panic disorder where symptoms are not caused by or are unreasonable to an underlying medical problem or pharmacological influence. The DSM-5 decoupled agoraphobia and panic disorder, making them separate disorders that can be diagnosed together . Systematic desensitization can provide lasting relief to
11310-404: The constrictor effects of inhaled histamine. A link between the sympathetic nervous system and the lungs was shown in 1887 when Grossman showed that stimulation of cardiac accelerator nerves reversed muscarine-induced airway constriction. In experiments in the dog, where the sympathetic chain was cut at the level of the diaphragm, Jackson showed that there was no direct sympathetic innervation to
11440-508: The cytoplasm. Calcium ions bind to calmodulin , which leads to further activation of phosphorylase kinase. Phosphorylase kinase phosphorylates glycogen phosphorylase , which then breaks down glycogen leading to the production of glucose. Adrenaline also has significant effects on the cardiovascular system. It increases peripheral resistance via α 1 receptor -dependent vasoconstriction and increases cardiac output by binding to β 1 receptors. The goal of reducing peripheral circulation
11570-427: The developmental period. Stigma and discrimination can add to the suffering and disability associated with mental disorders, leading to various social movements attempting to increase understanding and challenge social exclusion . The definition and classification of mental disorders are key issues for researchers as well as service providers and those who may be diagnosed. For a mental state to be classified as
11700-424: The diagnosis) within six weeks, and nearly all achieve it within two years, with nearly half regaining their prior occupational and residential status in that period. Less than half go on to experience a new episode of mania or major depression within the next two years. Some disorders may be very limited in their functional effects, while others may involve substantial disability and support needs. In this context,
11830-556: The differing ideological and practical perspectives need to be better integrated. The DSM and ICD approach remains under attack both because of the implied causality model and because some researchers believe it better to aim at underlying brain differences which can precede symptoms by many years. The high degree of comorbidity between disorders in categorical models such as the DSM and ICD have led some to propose dimensional models. Studying comorbidity between disorders have demonstrated two latent (unobserved) factors or dimensions in
11960-407: The dilation of a (denervated) pupil of a cat on a treadmill, later confirmed using a biological assay of urine samples. Biochemical methods for measuring catecholamines in plasma were published from 1950 onwards. Although much valuable work has been published using fluorimetric assays to measure total catecholamine concentrations, the method is too non-specific and insensitive to accurately determine
12090-496: The eastern Mediterranean region, it was unipolar major depression (12%) and schizophrenia (7%), and in Africa it was unipolar major depression (7%) and bipolar disorder (5%). Suicide, which is often attributed to some underlying mental disorder, is a leading cause of death among teenagers and adults under 35. There are an estimated 10 to 20 million non-fatal attempted suicides every year worldwide. The predominant view as of 2018
12220-481: The effects of therapy, as can service to others, which can distract from the self-absorption that tends to go with anxiety problems. Also, preliminary evidence suggests aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided. Agoraphobia occurs about twice as commonly among women as it does in men. It can develop at any age but
12350-720: The events, ensuring memory strength that is proportional to memory importance. Post-learning adrenaline activity also interacts with the degree of arousal associated with the initial coding. There is evidence that suggests adrenaline does have a role in long-term stress adaptation and emotional memory encoding specifically. Adrenaline may also play a role in elevating arousal and fear memory under particular pathological conditions, including post-traumatic stress disorder . Overall, "Extensive evidence indicates that epinephrine (EPI) modulates memory consolidation for emotionally arousing tasks in animals and human subjects." Studies have also found that recognition memory involving adrenaline depends on
12480-420: The father of modern pharmacology, found a natural substance produced by the adrenal glands that he named epinephrine. The first hormone to be identified, it remains a crucial, first-line treatment for cardiac arrests, severe allergic reactions, and other conditions. In 1901, Jokichi Takamine successfully isolated and purified the hormone from the adrenal glands of sheep and oxen. Adrenaline was first synthesized in
12610-474: The feeling of fear regardless of the actual level of fear elicited from the video. Although studies have found a definite relation between adrenaline and fear, other emotions have not had such results. In the same study, subjects did not express a greater amusement to an amusement film nor greater anger to an anger film. Similar findings were also supported in a study that involved rodent subjects that either were able or unable to produce adrenaline. Findings support
12740-514: The few differences between the INN and BAN systems of names. Although European health professionals and scientists preferentially use the term adrenaline , the converse is true among American health professionals and scientists. Nevertheless, even among the latter, receptors for this substance are called adrenergic receptors or adrenoceptors , and pharmaceuticals that mimic its effects are often called adrenergics . The history of adrenaline and epinephrine
12870-456: The globe include: depression , which affects about 264 million people; dementia , which affects about 50 million; bipolar disorder , which affects about 45 million; and schizophrenia and other psychoses , which affect about 20 million people. Neurodevelopmental disorders include attention deficit hyperactivity disorder (ADHD) , autism spectrum disorder (ASD) , and intellectual disability , of which onset occurs early in
13000-417: The idea that adrenaline has a role in facilitating the encoding of emotionally arousing events, contributing to higher levels of arousal due to fear. It has been found that adrenergic hormones, such as adrenaline, can produce retrograde enhancement of long-term memory in humans. The release of adrenaline due to emotionally stressful events, which is endogenous adrenaline, can modulate memory consolidation of
13130-477: The increased secretion of the adrenal medulla and partly from the decreased metabolism of adrenaline due to reduced blood flow to the liver. Infusion of adrenaline to reproduce exercise circulating concentrations of adrenaline in subjects at rest has little hemodynamic effect other than a slight β 2 -mediated fall in diastolic blood pressure. Infusion of adrenaline well within the physiological range suppresses human airway hyper-reactivity sufficiently to antagonize
13260-679: The internalizing-externalizing distinction, but also supports the formation of a third dimension of thought disorders such as schizophrenia. Biological evidence also supports the validity of the internalizing-externalizing structure of mental disorders, with twin and adoption studies supporting heritable factors for externalizing and internalizing disorders. A leading dimensional model is the Hierarchical Taxonomy of Psychopathology . There are many different categories of mental disorder, and many different facets of human behavior and personality that can become disordered. An anxiety disorder
13390-481: The laboratory by Friedrich Stolz and Henry Drysdale Dakin , independently, in 1904. Although secretin is mentioned as the first hormone, adrenaline is the first hormone since the discovery of the activity of adrenal extract on blood pressure was observed in 1895 before that of secretin in 1902. In 1895, George Oliver (1841–1915), a general practitioner in North Yorkshire, and Edward Albert Schäfer (1850–1935),
13520-426: The lung, but bronchoconstriction was reversed by the release of adrenaline from the adrenal medulla. An increased incidence of asthma has not been reported for adrenalectomized patients; those with a predisposition to asthma will have some protection from airway hyper-reactivity from their corticosteroid replacement therapy. Exercise induces progressive airway dilation in normal subjects that correlates with workload and
13650-422: The majority of patients with panic disorder and agoraphobia. The disappearance of residual and sub-clinical agoraphobic avoidance, and not simply of panic attacks, should be the aim of exposure therapy. Many patients can deal with exposure easier if they are in the company of a friend on whom they can rely. In this approach, it is suggested that people being treated remain in the situation that provokes anxiety until
13780-625: The manuals are often broadly comparable, although significant differences remain. Other classification schemes may be used in non-western cultures, for example, the Chinese Classification of Mental Disorders , and other manuals may be used by those of alternative theoretical persuasions, such as the Psychodynamic Diagnostic Manual . In general, mental disorders are classified separately from neurological disorders , learning disabilities or intellectual disability . Unlike
13910-569: The molecular formula of C 17 H 15 NO 4 . Abel claimed his principle from adrenal gland extract was active. In 1900, Jōkichi Takamine (1854–1922), a Japanese chemist, worked with his assistant, Keizo Uenaka [ ja ] (1876–1960), to purify a 2000 times more active principle than epinephrine from the adrenal gland, named adrenaline with the molecular formula C 10 H 15 NO 3 . Additionally, in 1900 Thomas Aldrich of Parke-Davis Scientific Laboratory also purified adrenaline independently. Takamine and Parke-Davis later in 1901 both got
14040-558: The old-fashioned concept of nervous illness. In How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown (2013), Edward Shorter, a professor of psychiatry and the history of medicine, says: About half of them are depressed. Or at least that is the diagnosis that they got when they were put on antidepressants. ... They go to work but they are unhappy and uncomfortable; they are somewhat anxious; they are tired; they have various physical pains—and they tend to obsess about
14170-413: The outflow of aqueous humor in the eye. This lowers the intraocular pressure in the eye and thus aids in treatment. The adrenal medulla is a major contributor to total circulating catecholamines ( L -DOPA is at a higher concentration in the plasma ), though it contributes over 90% of circulating adrenaline. Little adrenaline is found in other tissues, mostly in scattered chromaffin cells and in
14300-428: The pancreas, increased adrenocorticotropic hormone (ACTH) secretion by the pituitary gland , and increased lipolysis by adipose tissue . Together, these effects increase blood glucose and fatty acids , providing substrates for energy production within cells throughout the body. Binding of β adrenergic receptor also increases the production of cyclic AMP. Adrenaline causes liver cells to release glucose into
14430-497: The panic attacks, due to fear of the situations in which the panic attacks occurred. Most people who present to mental health specialists develop agoraphobia after the onset of panic disorder. Agoraphobia is best understood as an adverse behavioral outcome of repeated panic attacks and subsequent anxiety and preoccupation with these attacks that leads to an avoidance of situations where a panic attack could occur. Early treatment of panic disorder can often prevent agoraphobia. Agoraphobia
14560-484: The patent for adrenaline. The fight for terminology between adrenaline and epinephrine was not ended until the first adrenaline structural discovery by Hermann Pauly (1870–1950) in 1903 and the first adrenaline synthesis by Friedrich Stolz (1860–1936), a German chemist in 1904. They both believed that Takamine's compound was the active principle while Abel's compound was the inactive one. Stolz synthesized adrenaline from its ketone form (adrenalone). An adrenaline junkie
14690-405: The patient is fearful or avoids a location. Some refuse to leave their homes in medical emergencies because the fear of being outside of their comfort areas is too great. The person with this condition can sometimes go to great lengths to avoid the locations where they have experienced the onset of a panic attack. Agoraphobia, as described in this manner, is a symptom professionals check when making
14820-452: The public perception of the level of disability associated with mental disorders can change. Nevertheless, internationally, people report equal or greater disability from commonly occurring mental conditions than from commonly occurring physical conditions, particularly in their social roles and personal relationships. The proportion with access to professional help for mental disorders is far lower, however, even among those assessed as having
14950-414: The scientific and academic literature on the definition or classification of mental disorder, one extreme argues that it is entirely a matter of value judgements (including of what is normal ) while another proposes that it is or could be entirely objective and scientific (including by reference to statistical norms). Common hybrid views argue that the concept of mental disorder is objective even if only
15080-466: The social environment. Some disorders may last a brief period of time, while others may be long-term in nature. All disorders can have a varied course. Long-term international studies of schizophrenia have found that over a half of individuals recover in terms of symptoms, and around a fifth to a third in terms of symptoms and functioning, with many requiring no medication. While some have serious difficulties and support needs for many years, "late" recovery
15210-421: The social sciences, especially geography , have increasingly become interested in what may be thought of as a spatial phenomenon. One such approach links the development of agoraphobia with modernity . Factors considered contributing to agoraphobia within modernity are the ubiquity of cars and urbanization. These have helped develop the expansion of public space and the contraction of private space, thus creating
15340-470: The stress of having to hide a condition in work or school, etc., by adverse effects of medications or other substances, or by mismatches between illness-related variations and demands for regularity. It is also the case that, while often being characterized in purely negative terms, some mental traits or states labeled as psychiatric disabilities can also involve above-average creativity, non- conformity , goal-striving, meticulousness, or empathy. In addition,
15470-428: The structure of mental disorders that are thought to possibly reflect etiological processes. These two dimensions reflect a distinction between internalizing disorders, such as mood or anxiety symptoms, and externalizing disorders such as behavioral or substance use symptoms. A single general factor of psychopathology, similar to the g factor for intelligence, has been empirically supported. The p factor model supports
15600-451: The symptoms anxiety have subsided because if they leave the situation, the phobic response will not decrease and it may even rise. A related exposure treatment is in vivo exposure, a cognitive behavioral therapy method, that gradually exposes patients to the feared situations or objects. This treatment was largely effective with an effect size from d = 0.78 to d = 1.34, and these effects were shown to increase over time, proving that
15730-399: The term Adrenaline was a registered trademark in the US, and in the belief that Abel's extract was the same as Takamine's (a belief since disputed), epinephrine instead became the generic name used in the US and remains the pharmaceutical's United States Adopted Name and International Nonproprietary Name (though the name adrenaline is frequently used ). The terminology is now one of
15860-420: The terms psychiatric disability and psychological disability are sometimes used instead of mental disorder . The degree of ability or disability may vary over time and across different life domains. Furthermore, psychiatric disability has been linked to institutionalization , discrimination and social exclusion as well as to the inherent effects of disorders. Alternatively, functioning may be affected by
15990-411: The time they avoid these areas and stay in the comfort of a known, controllable space, usually their home. Agoraphobia is also defined as "a fear, sometimes terrifying, by those who have experienced one or more panic attacks". In these cases, the patient is fearful of a particular place because they have previously experienced a panic attack at the same location. Fearing the onset of another panic attack,
16120-451: The treatment had long-term efficacy (up to 12 months after treatment). Psychological interventions in combination with pharmaceutical treatments were overall more effective than treatments simply involving either CBT or pharmaceuticals. Further research showed there was no significant effect between using group CBT versus individual CBT. Cognitive restructuring has also proved useful in treating agoraphobia. This treatment involves coaching
16250-514: The use of adrenaline infusion in place of the widely accepted treatment of inotropes for preterm infants with clinical cardiovascular compromise. Although sufficient data strongly recommends adrenaline infusions as a viable treatment, more trials are needed to conclusively determine that these infusions will successfully reduce morbidity and mortality rates among preterm, cardiovascularly compromised infants. Epinephrine can also be used to treat open-angle glaucoma, as it has been found to increase
16380-437: The very small quantities of adrenaline in plasma. The development of extraction methods and enzyme–isotope derivate radio-enzymatic assays (REA) transformed the analysis down to a sensitivity of 1 pg for adrenaline. Early REA plasma assays indicated that adrenaline and total catecholamines rise late in exercise, mostly when anaerobic metabolism commences. During exercise, the adrenaline blood concentration rises partially from
16510-449: The whole business. There is a term for what they have, and it is a good old-fashioned term that has gone out of use. They have nerves or a nervous illness. It is an illness not just of mind or brain, but a disorder of the entire body. ... We have a package here of five symptoms—mild depression, some anxiety, fatigue, somatic pains, and obsessive thinking. ... We have had nervous illness for centuries. When you are too nervous to function ... it
16640-463: The work of breathing. Every emotional response has a behavioral, an autonomic, and a hormonal component. The hormonal component includes the release of adrenaline, an adrenomedullary response to stress controlled by the sympathetic nervous system . The major emotion studied in relation to adrenaline is fear. In an experiment, subjects who were injected with adrenaline expressed more negative and fewer positive facial expressions to fear films compared to
16770-481: Was coined in German in 1871 by pioneering German psychologist Karl Friedrich Otto Westphal (1833–1890), in his article " Die Agoraphobie, eine neuropathische Erscheinung ". Archiv für Psychiatrie und Nervenkrankheiten , Berlin, 1871–72; 3: 138–161. It is derived from Greek ἀγορά ( agorā́ ), meaning ' place of assembly ' or ' market-place ' and -φοβία ( -phobía ), meaning ' fear ' . Agoraphobia
16900-687: Was previously referred to as multiple personality disorder or "split personality"). Cognitive disorder : These affect cognitive abilities, including learning and memory. This category includes delirium and mild and major neurocognitive disorder (previously termed dementia ). Developmental disorder : These disorders initially occur in childhood. Some examples include autism spectrum disorder, oppositional defiant disorder and conduct disorder , and attention deficit hyperactivity disorder (ADHD), which may continue into adulthood. Conduct disorder, if continuing into adulthood, may be diagnosed as antisocial personality disorder (dissocial personality disorder in
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