<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Receptive aphasia and explain in detail? [/INST] Wernickes aphasia, also known as receptive aphasia, sensory aphasia or posterior aphasia, is a type of aphasia in which individuals have difficulty understanding written and spoken language. Patients with Wernickes aphasia demonstrate fluent speech, which is characterized by typical speech rate, intact syntactic abilities and effortless speech output. Writing often reflects speech in that it tends to lack content or meaning. In most cases, motor deficits (i.e. hemiparesis) do not occur in individuals with Wernickes aphasia. Therefore, they may produce a large amount of speech without much meaning. Individuals with Wernickes aphasia are typically unaware of their errors in speech and do not realize their speech may lack meaning. They typically remain unaware of even their most profound language deficits.
Like many acquired language disorders, Wernickes aphasia can be experienced in many different ways and to many different degrees. Patients diagnosed with Wernickes aphasia can show severe language comprehension deficits; however, this is dependent on the severity and extent of the lesion. Severity levels may range from being unable to understand even the simplest spoken and/or written information to missing minor details of a conversation. Many diagnosed with Wernickes aphasia have difficulty with repetition in words and sentences and/or working memory.Wernickes aphasia was named after German physician Carl Wernicke, who is credited with discovering the area of the brain responsible for language comprehension (Wernickes area).

Signs and symptoms
The following are common symptoms seen in patients with Wernickes aphasia:

Impaired comprehension: deficits in understanding (receptive) written and spoken language. This is because Wernickes area is responsible for assigning meaning to the language that is heard, so if it is damaged, the brain cannot comprehend the information that is being received.
Poor word retrieval: ability to retrieve target words is impaired. This is also referred to as anomia.
Fluent speech: individuals with Wernickes aphasia do not have difficulty with producing connected speech that flows. Although the connection of the words may be appropriate, the words they are using may not belong together or make sense (see Production of jargon below).
Production of jargon: speech that lacks content, consists of typical intonation, and is structurally intact. Jargon can consist of a string of neologisms, as well as a combination of real words that do not make sense together in context. The jargon may include word salads.
Awareness: Individuals with Wernickes aphasia are often not aware of their incorrect productions, which would further explain why they do not correct themselves when they produce jargon, paraphasias, or neologisms.
Paraphasias:Phonemic (literal) paraphasias: involves the substitution, addition, or rearrangement of sounds so that an error can be defined as sounding like the target word. Often, half of the word is still intact which allows for easy comparison to the appropriate, original word.
E.g. "bap" for "map"
Semantic (verbal) paraphasias: saying a word that is related to the target word in meaning or category; frequently observed in Wernickes aphasia.
E.g. "jet" for "airplane" or "knife" for "fork"
Neologisms: nonwords that have no relation to the target word.E.g. "dorflur" for "shoe"
Circumlocution: talking around the target word.E.g. "uhhh its white... its flat... you write on it..." (when referencing paper)
Press of speech: run-on speech.If a clinician asks, "what do you do at a supermarket?" And the individual responds with "Well, the supermarket is a place. It is a place with a lot of food. My favorite food is Italian food. At a supermarket, I buy different kinds of food. There are carts and baskets. Supermarkets have lots of customers, and workers..."
Lack of hemiparesis: typically, no motor deficits are seen with a localized lesion in Wernickes area.
Reduced retention span: reduced ability to retain information for extended periods of time.
Impairments in reading and writing: impairments can be seen in both reading and writing with differing severity levels.How to differentiate from other types of aphasia
Expressive aphasia (non-fluent Brocas aphasia): individuals have great difficulty forming complete sentences with generally only basic content words (leaving out words like "is" and "the").
Global aphasia: individuals have extreme difficulties with both expressive (producing language) and receptive (understanding language).
Anomic aphasia: the biggest hallmark is ones poor word-finding abilities; ones speech is fluent and appropriate, but full of circumlocutions (evident in both writing and speech).
Conduction aphasia: individuals can comprehend what is being said and are fluent in spontaneous speech, but they cannot repeat what is being said to them.

Causes
The most common cause of Wernickes aphasia is stroke. Strokes may occur when blood flow to the brain is completely interrupted or severely reduced. This has a direct effect on the amount of oxygen and nutrients being able to supply the brain, which causes brain cells to die within minutes."The middle cerebral arteries supply blood to the cortical areas involved in speech, language and swallowing. The left middle cerebral artery provides Brocas area, Wernickes area, Heschls gyrus, and the angular gyrus with blood". Therefore, in patients with Wernickes aphasia, there is typically an occlusion to the left middle cerebral artery.As a result of the occlusion in the left middle cerebral artery, Wernickes aphasia is most commonly caused by a lesion in the posterior superior temporal gyrus (Wernickes area). This area is posterior to the primary auditory cortex (PAC) which is responsible for decoding individual speech sounds. Wernickes primary responsibility is to assign meaning to these speech sounds. The extent of the lesion will determine the severity of the patients deficits related to language. Damage to the surrounding areas (perisylvian region) may also result in Wernickes aphasia symptoms due to variation in individual neuroanatomical structure and any co-occurring damage in adjacent areas of the brain.

Diagnosis
Aphasia is usually first recognized by the physician who treats the person for his or her brain injury. Most individuals will undergo a magnetic resonance imaging (MRI) or computed tomography (CT) scan to confirm the presence of a brain injury and to identify its precise location. In circumstances where a person is showing possible signs of aphasia, the physician will refer him or her to a speech-language pathologist (SLP) for a comprehensive speech and language evaluation. SLPs will examine the individuals ability to express him or herself through speech, understand language in written and spoken forms, write independently, and perform socially.The American Speech, Language, Hearing Association (ASHA) states a comprehensive assessment should be conducted in order to analyze the patients communication functioning on multiple levels; as well as the effect of possible communication deficits on activities of daily living. Typical components of an aphasia assessment include: case history, self report, oral-motor examination, language skills, identification of environmental and personal factors, and the assessment results. A comprehensive aphasia assessment includes both formal and informal measures.Formal assessments include:

Boston Diagnostic Aphasia Examination (BDAE): diagnoses the presence and type of aphasia, focusing on location of lesion and the underlying linguistic processes.
Western Aphasia Battery – Revised (WAB): determines the presence, severity, and type of aphasia; and can also determine baseline abilities of patient.
Communication Activities of Daily Living - Second Edition (CADL-2): measures functional communication abilities; focuses on reading, writing, social interactions, and varying levels of communication.
Revised Token Test (RTT): assess receptive language and auditory comprehension; focuses on patients ability to follow directions.Informal assessments, which aid in the diagnosis of patients with suspected aphasia, include:
Conversational speech and language sample
Family interview
Case history or medical chart review
Behavioral observationsDiagnostic information should be scored and analyzed appropriately. Treatment plans and individual goals should be developed based on diagnostic information, as well as patient and caregiver needs, desires, and priorities.

Treatment
According to Bates et al. (2005), "the primary goal of rehabilitation is to prevent complications, minimize impairments, and maximize function". The topics of intensity and timing of intervention are widely debated across various fields. Results are contradictory: some studies indicate better outcomes with early intervention, while other studies indicate starting therapy too early may be detrimental to the patients recovery. Recent research suggests, that therapy be functional and focus on communication goals that are appropriate for the patients individual lifestyle.Specific treatment considerations for working with individuals with Wernickes aphasia (or those who exhibit deficits in auditory comprehension) include using familiar materials, using shorter and slower utterances when speaking, giving direct instructions, and using repetition as needed.

Role of neuroplasticity in recovery
Neuroplasticity is defined as the brains ability to reorganize itself, lay new pathways, and rearrange existing ones, as a result of experience. Neuronal changes after damage to the brain such as collateral sprouting, increased activation of the homologous areas, and map extension demonstrate the brains neuroplastic abilities. According to Thomson, "Portions of the right hemisphere, extended left brain sites, or both have been shown to be recruited to perform language functions after brain damage. All of the neuronal changes recruit areas not originally or directly responsible for large portions of linguistic processing. Principles of neuroplasticity have been proven effective in neurorehabilitation after damage to the brain. These principles include: incorporating multiple modalities into treatment to create stronger neural connections, using stimuli that evoke positive emotion, linking concepts with simultaneous and related presentations, and finding the appropriate intensity and duration of treatment for each individual patient.

Auditory comprehension treatment
Auditory comprehension is a primary focus in treatment for Wernickes aphasia, as it is the main deficit related to this diagnosis. Therapy activities may include:

Single-word comprehension: A common treatment method used to support single-word comprehension skills is known as a pointing drill. Through this method, clinicians lay out a variety of images in front of a patient. The patient is asked to point to the image that corresponds to the word provided by the clinician.
Understanding spoken sentences: "Treatment to improve comprehension of spoken sentences typically consists of drills in which patients answer questions, follow directions or verify the meaning of sentences".
Understanding conversation: An effective treatment method to support comprehension of discourse includes providing a patient with a conversational sample and asking him or her questions about that sample. Individuals with less severe deficits in auditory comprehension may also be able to retell aspects of the conversation.

Word retrieval
Anomia is consistently seen in aphasia, so many treatment techniques aim to help patients with word finding problems. One example of a semantic approach is referred to as semantic feature analyses. The process includes naming the target object shown in the picture and producing words that are semantically related to the target. Through production of semantically similar features, participants develop more skilled in naming stimuli due to the increase in lexical activation.

Restorative therapy approach
Neuroplasticity is a central component to restorative therapy to compensate for brain damage. This approach is especially useful in Wernickes aphasia patients that have had a stroke to the left brain hemisphere.Schuells stimulation approach is a main method in traditional aphasia therapy that follows principles to retrieve function in the auditory modality of language and influence surrounding regions through stimulation. The guidelines to have the most effective stimulation are as follows:
Auditory stimulation of language should be intensive and always present when other language modalities are stimulated.
The stimulus should be presented at a difficulty level equal to or just below the patients ability.
Sensory stimulation must be present and repeated throughout the treatment.
Each stimulus applied should produce a response; if there is no response more stimulation cues should be provided.
Response to stimuli should be maximized to create more opportunities for success and feedback for the speech-language pathologist.
The feedback of the speech-language pathologist should promote further success and patient and encouragement.
Therapy should follow an intensive and systemic method to create success by progressing in difficulty.
Therapies should be varied and build off of mastered therapy tasks.Schuells stimulation utilizes stimulation through therapy tasks beginning at a simplified task and progressing to become more difficult including:

Point to tasks. During these tasks the patient is directed to point to an object or multiple objects. As the skill is learned the level of complexity increases by increasing the number of objects the patient must point to.Simple: "Point to the book."
Complex: "Point to the book and then to the ceiling after touching your ear."
Following directions with objects. During these tasks the patient is instructed to follow the instruction of manually following directions that increase in complexity as the skill is learned.Simple: "Pick up the book."
Complex: "Pick up the book and put it down on the bench after I move the cup."
Yes or no questions – This task requires the patient to respond to various yes or no questions that can range from simple to complex.Paraphrasing and retelling – This task requires the patient to read a paragraph and, afterwards, paraphrase it aloud. This is the most complex of Schuells stimulation tasks because it requires comprehension, recall, and communication.

Social approach to treatment
The social approach involves a collaborative effort on behalf of patients and clinicians to determine goals and outcomes for therapy that could improve the patients quality of life. A conversational approach is thought to provide opportunities for development and the use of strategies to overcome barriers to communication. The main goals of this treatment method are to improve the patients conversational confidence and skills in natural contexts using conversational coaching, supported conversations, and partner training.
Conversational coaching involves patients with aphasia and their speech language pathologists, who serve as a "coach" discussing strategies to approach various communicative scenarios. The "coach" will help the patient develop a script for a scenario (such as ordering food at a restaurant), and help the patient practice and perform the scenario in and out of the clinic while evaluating the outcome.
Supported conversation also involves using a communicative partner who supports the patients learning by providing contextual cues, slowing their own rate of speech, and increasing their messages redundancy to promote the patients comprehension.Additionally, it is important to include the families of patients with aphasia in treatment programs. Clinicians can teach family members how to support one another, and how to adjust their speaking patterns to facilitate their loved ones treatment and rehabilitation.

Prognosis
Prognosis is strongly dependent on the location and extent of the lesion (damage) to the brain. Many personal factors also influence how a person will recover, which include age, previous medical history, level of education, gender, and motivation. All of these factors influence the brains ability to adapt to change, restore previous skills, and learn new skills. It is important to remember that all the presentations of Receptive Aphasia may vary. The presentation of symptoms and prognosis are both dependent on personal components related to the individuals neural organization before the stroke, the extent of the damage, and the influence of environmental and behavioral factors after the damage occurs. The quicker a diagnosis of a stroke is made by a medical team, the more positive the patients recovery may be </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Ocular dysmetria and explain in detail? [/INST]  </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Femoroacetabular impingement and explain in detail? [/INST] Femoroacetabular impingement (FAI) is a condition involving one or more anatomical abnormalities of the hip joint, which is a ball and socket joint. It is a common cause of hip pain and discomfort in young and middle-aged adults. It occurs when the ball shaped femoral head contacts the acetabulum abnormally or does not permit a normal range of motion in the acetabular socket. Damage can occur to the articular cartilage, or labral cartilage (soft tissue, ring-shaped bumper of the socket), or both. The condition may be symptomatic or asymptomatic. It may cause osteoarthritis of the hip. Treatment options range from conservative management to surgery.

Signs and symptoms
Pain is the most common complaint in those with FAI. It is experienced in a number of areas, making the diagnosis challenging, but commonly occurs in the groin, upper buttock/lower back, the buttock or beneath the buttock, side of the affected hip and posterior upper leg. Onset of symptoms has been reported to present in both an acute and more gradual manner.  The pain is often significant enough to cause a decrease in activity level and movement. Some will also describe decreased range of motion of the affected hip. Another symptom is groin pain associated with activity and no prior history of trauma. Inability to perform activities such as high hip flexion or prolong sitting can also be seen in individuals with FAI.

Cause
FAI is characterized by abnormal contact between the proximal femur and rim of the acetabulum (hip socket). In most cases, patients present with a deformity in the femoral head, or acetabulum, a poorly positioned femoral-acetabular junction, or any or all of the foregoing. The cause of FAI is currently unknown, but both congenital and acquired etiologies have been put forth. Studies have shown an increased incidence in siblings, suggesting a genetic component. At least one study has also shown a predilection in the white population. It has also been reported to be more common in males. However, there is no concrete evidence to suggest a genetic trait and instead, the most favored theory currently supports that FAI (the cam type in particular) is due to repetitive movements involving the hip (e.g. squatting) in young athletes. Aggravating activities that are commonly reported include repetitive or prolonged squatting, twisting movements of the hip, like pivoting during athletics, getting in and out of cars, and even sitting for prolonged periods. A combination of these factors may also predispose to a form of FAI; predominantly, a marginal developmental hip abnormality together with environmental factors such as recurrent motion of the legs within a supraphysiologic range.Three types of FAI are recognized (see title image). The first involves an excess of bone along the upper surface of the femoral head, known as a cam deformity (abbreviation for camshaft, which the shape of the femoral head and neck resembles). The second is due to an excess of growth of the upper lip of the acetabular cup and is known as a pincer deformity.  The third is a combination of the two, generally referred to as mixed. The most common type seen, approximately 70% of the time, is the mixed type. A complicating issue is that some of the radiographic findings of FAI have also been described in asymptomatic subjects.Current literature suggests that the cam type of impingement is associated with the development of hip osteoarthritis. Thus far, no correlation has been seen between the pincer type and development of hip osteoarthritis.

Anatomy
The hip joint is classified as a ball and socket joint. This type of synovial joint allows for multidirectional movement and rotation. There are two bones that make up the hip joint and create an articulation between the femur and pelvis. This articulation connects the axial skeleton with the lower extremity. The pelvic bone, also known as the innominate bone, is formed by three bones fused together: the ilium, ischium, and pubis. The musculature of the hip is divided into anterior hip muscles and posterior hip muscles. The major nerve supply that runs through the hip joint is the femoral nerve and the sciatic nerve.

Diagnosis
Clinical evaluation is the first step in diagnosis, but will rarely lead to the diagnosis on its own, due to inconsistent and vague nature of the pain. Childhood and current activity should be inquired about. Physical exam should also involve assessing passive internal rotation of the hip during flexion, as range of motion is reduced in proportion to the size of a cam lesion. Flexing the hip to 90 degrees, adducting, and internally rotating the hip, known as the FADDIR test, should also be performed. It is positive when it causes pain. The FABER test should also be performed, this test involves flexing, abducting, and externally rotating the hip. The FABER test is useful when diagnosing concurrently with a labral pathology and is considered positive if the position elicits pain. Additional non-invasive ways to observe possible FAI is changes in gait that include a lower peak hip extension and internal rotation to compensate for bony growth.

X-ray
Projectional radiography ("X-ray")is often considered first line for FAI. Anterior-posterior pelvis and a lateral image of the hip in question should be attained. A 45-degree Dunn view is also recommended.

Other modalities
MRI imaging may follow, particularly if there is no specific evidence on radiographs, producing a three-dimensional reconstruction of the joint for better definition, to evaluate the hip cartilage, or measure hip socket angles (e.g. the alpha-angle as described by Nötzli in 2-D and by Siebenrock in 3-D). MR arthrogram had been used in the past, as it was more sensitive for picking up soft tissue lesions; however, due to improvement in technology, MRI is now considered comparable for picking up such lesions. CT is not usually used due to radiation exposure and no benefit above MRI. It is possible to perform dynamic simulation of hip motion with CT or MRI assisting to establish whether, where, and to what extent, impingement is occurring.
The diagnosis is often made in conjunction with a labral tear.

Differential Diagnosis
Piriformis syndrome or strain
Labral tear without FAI
Adductor muscle strain
Sciatica
Athletic pubalgia
Gluteus medius/minimus or illiopsoas tendinopathy
Stress fracture
Femoral head osteonecrosis
Other impingements, including anterior inferior iliac spine, ischiofemoral and iliopsoas
Loose body in the joint (intra-articular body)

Prevention
Prevention is currently being investigated. The goal of prevention would be to avoid joint damage and premature hip osteoarthritis. Studies are examining the effectiveness of screening adolescents in school and targeting at-risk individuals for education, physical therapy and decreasing participation in possibly harmful activities/sports as referenced in the epidemiology section.

Treatment
Treatment of FAI can be divided into those that are non-operative (conservative) and operative. Conservative treatment is often prescribed for those who have not yet received any therapy. Conservative treatment includes physical therapy, avoidance of those activities that produce pain, and  nonsteroidal anti-inflammatory drugs. It may also include joint injections with cortisone or hyaluronic acid, particularly for those who wish to avoid surgery.Physical therapy is implemented for the purpose of improving joint mobility, strengthening muscles surrounding the joint, correcting posture, and treating any other muscle or joint deficits that may be exacerbating the condition. A movement analysis may also be performed to identify specific movement patterns that may be causing injury. Studies to demonstrate the effectiveness of physical therapy are currently underway, with no conclusive results to date.Operative treatment is generally recommended to those who continue to have symptoms. It involves the surgical correction of any bony abnormalities causing the impingement and correction of any soft tissue lesions, such as labral tears. The primary aim of surgery is to correct the fit of the femoral head and acetabulum to create a hip socket that reduces contact between the two, allowing a greater range of movement. This includes femoral head sculpting and/or trimming of the acetabular rim.Surgery may be arthroscopic or open. A 2011 study analyzing current surgical methods for management of symptomatic femoral acetabular impingement, suggested that the arthroscopic method had surgical outcomes equal to or better than other methods with a lower rate of major complications when performed by experienced surgeons; consequently, the surgery is now rarely done open.Outcomes of arthroscopic surgery are currently being studied, but have generally been positive. According to a 2019 meta-analysis, the risk of having surgery fail or need to be re-operated on is about 5.5% whereas the complication rate is 1.7%. Additionally, patient reported outcomes show that approximately three to six months post-operative hip arthroscopy is when pain reduction and activities of daily life are improved. For sport function this timeline is about six months to a year. Failure of hip arthroscopy is more likely to fail in older patients, females, or those who have experienced the symptoms of FAI for a long period of time.When performed on elite athletes, most are able to return their previous level of competition. These athletes also have a higher rate of return to sport than recreational and collegiate athletes.Long term, randomized controlled trials evaluating the efficacy of conservative and operative treatments are underway.

Epidemiology
There has been limited research on the prevalence of FAI among a general population according to a literature review by Algarni. On the other hand, there are many sources that discuss the prevalence of athletes with the condition especially those that are younger and white. Hockey, tennis, soccer, and equestrian are all sports where the prevalence of a femoral neck abnormalities are higher due to the nature of the sport to force athletes into forced, loaded flexion and internal rotation.Cam lesions are more common in males, where pincer lesions are more common in females due to differences in anatomical development of the pelvis.

History
FAI is a relatively recent discovery </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Angioma serpiginosum and explain in detail? [/INST]  </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Tuberculoid leprosy and explain in detail? [/INST]  </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Caffeine dependence and explain in detail? [/INST] Caffeine dependence is the condition of having a substance dependence on caffeine, a commonplace central nervous system stimulant drug which occurs in nature in coffee, tea, yerba mate, cocoa, and other plants. Caffeine is also an additive in many consumer products, including beverages such as caffeinated alcoholic beverages, energy drinks, and colas.
Caffeines mechanism of action is somewhat different from that of cocaine and the substituted amphetamines; caffeine blocks adenosine receptors A1 and A2A. Adenosine is a by-product of cellular activity, and stimulation of adenosine receptors produces feelings of tiredness and the need to sleep. Caffeines ability to block these receptors means the levels of the bodys natural stimulants, dopamine and norepinephrine, continue at higher levels.
The Diagnostic and Statistical Manual of Mental Disorders describes four caffeine-related disorders including intoxication, withdrawal, anxiety, and sleep.

Dependence
Mild physical dependence can result from long-term caffeine use.  Caffeine addiction, or a pathological and compulsive form of use, has been documented in humans.

Addiction vs. Dependence
Caffeine use is classified as a dependence, not an addiction. For a drug to be considered addictive, it must activate the brains reward circuit. Caffeine, like addictive drugs, enhances dopamine signaling in the brain (is eugeroic), but not enough to activate the brains reward circuit like addictive substances such as cocaine, morphine, and nicotine. Caffeine dependence forms due to caffeine antagonizing the adenosine A2A receptor, effectively blocking adenosine from the adenosine receptor site. This delays the onset of drowsiness and releases dopamine.Studies have demonstrated that people who take in a minimum of 100 mg of caffeine per day (about the amount in one cup of coffee) can acquire a physical dependence that would trigger withdrawal symptoms that include headaches, muscle pain and stiffness, lethargy, nausea, vomiting, depressed mood, and marked irritability.  Professor Roland R. Griffiths, a professor of neurology at Johns Hopkins in Baltimore strongly believes that caffeine withdrawal should be classified as a psychological disorder. His research suggested that withdrawal affects 50% of habitual coffee drinkers,  beginning within  12–24 hours after cessation of caffeine intake, and peaking in 20–48 hours, lasting as long as 9 days.Continued exposure to caffeine leads the body to create more adenosine-receptors in the central nervous system, which makes it more sensitive to the effects of adenosine. It reduces the stimulatory effects of caffeine by increasing tolerance, and it increases the withdrawal symptoms of caffeine as the body becomes more sensitive to the effects of adenosine once caffeine intake decreases. Caffeine tolerance develops very quickly. Tolerance to the sleep disruption effects of caffeine were seen after consumption of 400 mg of caffeine 3 times a day for 7 days, whereas complete tolerance was observed after consumption of 300 mg taken 3 times a day for 18 days.

Physiological effects
When a person becomes caffeine dependent, it can cause a person to suffer different physiological effects which could lead to withdrawal. Symptoms can range from mild to severe that are dependent on the amount of caffeine consumed daily. Tests are still being done to get a better understanding of the effects that occur to someone when they become dependent on different forms of caffeine to make it through the day.

Adults
Caffeine is consumed by many each day and from this a dependence is formed. For the most part caffeine consumption is safe, but consuming over 400 mg of caffeine has shown adverse physiological and psychological effects; especially in people that have pre-existing conditions. When adults form a dependence on caffeine, it can cause a range of health problems such as headaches, insomnia, dizziness, cardiac issues, hypertension and others. When an adult is dependent on this substance, they must consume a certain amount of caffeine every day to avoid these effects.

Pregnancy
If pregnant, it is recommended not to consume over 200 mg of caffeine a day (depending on size of person) </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Amebic encephalitis and explain in detail? [/INST]  </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Christianson syndrome and explain in detail? [/INST]  </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Periungual wart and explain in detail? [/INST]  </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Occupational injury and explain in detail? [/INST] An occupational injury is bodily damage resulting from working. The most common organs involved are the spine, hands, the head, lungs, eyes, skeleton, and skin. Occupational injuries can result from exposure to occupational hazards (physical, chemical, biological, or psychosocial), such as temperature, noise, insect or animal bites, blood-borne pathogens, aerosols, hazardous chemicals, radiation, and occupational burnout.While many prevention methods are set in place, injuries may still occur due to poor ergonomics, manual handling of heavy loads, misuse or failure of equipment, exposure to general hazards, and inadequate safety training.

Worldwide
It has been estimated that worldwide there are more than 350,000 workplace fatalities and more than 270 million workplace injuries annually. In 2000 there were approximately 2.9 billion workers worldwide. Occupational injuries resulted in the loss of 3.5 years of healthy life for every 1,000 workers. 300,000 of the occupational injuries resulted in a fatality.The most common occupations associated with these hazards vary throughout the world depending on the major industries in a particular country. Overall, the most hazardous occupations are in farming, fishing, and forestry. In more developed countries, construction  and manufacturing  occupations are associated with high rates of spine, hand, and wrist injuries.

By country
United States
In the United States in 2012, 4,383 workers died from job injuries, 92% of which were men, and nearly 3 million nonfatal workplace injuries & illness were reported which cost businesses a collective loss of $198.2 billion and 60 million workdays. In 2007, 5,488 workers died from job injuries, 92% of which were men, and 49,000 died from work-related injuries. NIOSH estimates that 4 million workers in the U.S. in 2007 sustained non-fatal work related injuries or illnesses.According to data from the National Institute for Occupational Safety and Health (NIOSH) and the Bureau of Labor Statistics, an average of 15 workers die from traumatic injuries each day in the United States, and an additional 200 workers are hospitalized.In a study in the state of Washington, injured workers were followed for 14 years to determine the long term effects of work injury on employment. The work injuries resulted in an average of 1.06 years of lost productivity for each of the 31,588 allowed claims.In 2010, 25% of occupational injuries and illnesses that were not fatal but caused work absences were related to injuries to the upper limb.

Dangerous sectors
In the U.S. the Bureau of Labor Statistics makes available extensive statistics on workplace accidents and injuries. For example:

Common injuries
As in the United Kingdom, slips, trips and falls (STF) are common and account for 20-40% of disabling occupational injuries. Often these accidents result in a back injury that can persist to a permanent disability. In the United States, a high risk of back injuries occurs in the health care industry. 25% of reported injuries in health care workers in the state of Pennsylvania are for back pain. Among nurses, the prevalence of lower back pain may be as high as 72% mostly as a result of transferring patients. Some of these injuries can be prevented with the availability of patient lifts, improved worker training, and allocation of more time to perform work procedures. Another common type of injury is carpal tunnel syndrome associated with overuse of the hands and wrists. Studies on a cohort of newly hired workers have thus far identified forceful gripping, repetitive lifting of > 1 kg, and using vibrating power tools as high risk work activities.Additionally, noise exposure in the workplace can cause hearing loss, which accounted for 14% of reported occupational illnesses in 2007. Many initiatives have been created to prevent this common workplace injury. For example, the Buy Quiet program encourages employers to purchase tools and machines that produce less noise and the Safe-In-Sound Award was created to recognize companies and program that excel in the area of hearing loss prevention.Accidental injection or needlestick injuries are a common injury that plague agriculture workers and veterinarians. The majority of these injuries are located to the hands or legs, and can result in mild to severe reactions, including possible hospitalization. Due to the wide variety of biologics used in animal agriculture, needlestick injuries can result in bacterial or fungal infections, lacerations, local inflammation, vaccine/antibiotic reactions, amputations, miscarriage, and death. Due to daily human-animal interactions, livestock related injuries are also a prevalent injury of agriculture workers, and are responsible for the majority of nonfatal worker injuries on dairy farms. Additionally, approximately 30 people die of cattle and horse-related deaths in the United States annually.

Employees at risk
Perhaps the most important personal factor that predisposes to an increased risk is age. In the United States in 1998 17 million workers were over age 55 and by 2018 this population is expected to more than double. Workers in this age group are more likely to develop lower back pain that may be worsened by work conditions that normally do not affect a younger worker. Older workers are also more likely by be killed in a construction related fall. They are also at higher risk for injury due to age-related hearing loss, visual impairment, and use of multiple prescription medications that has been linked to higher rates of work injuries.  In addition to age, other personal risk factors for injury include obesity  particularly its associated risk with back injury, and depression.Lack of proper education or training can also predispose an individual to an occupational injury. For example, there is limited needlestick injury awareness among agriculture workers, and there is a need for comprehensive programs to prevent needlestick injuries on livestock operations. Proper animal handling techniques and training, or stockmanship, can also decrease the risk of livestock injury. A handlers timing, positioning, speed, direction of movement, and sounds made will affect the behavior of an animal and consequently the safety of the handler. The agriculture industry has begun to focus more on proper education and training, and has made a variety of resources available to producers. For example, organizations like the Upper Midwest Agriculture Safety and Health Center (UMASH) have a variety of informational fact sheets and training videos easily accessible online. Additionally, organizations like Beef Quality Assurance offers stockmanship training seminars and demonstrations.

Regulation
In the United States, the Occupational Safety and Health Administration (OSHA) sets and enforces national standards for occupational safety across all sectors.

United Kingdom
In the UK, a total of 111 fatal injuries happened in a single year. According to the HSE, a total of 111 workers died in work related injuries in the UK during 2019–20. The biggest cause for these fatal injuries was falling from heights that alone was responsible for 29 deaths during the same year. Other causes include injuries from moving vehicles and other objects, and contact with the moving machinery.In the United Kingdom in 2013–2014, 133 people were killed at work. Of those 133 people, 89 were employed, while 44 were self-employed. In 2013–2014, an estimated 629,000 injuries occurred at work </s>


<s> [INST] <<SYS>> You are a helpful, respectful, and honest assistant. Always answer as helpfully as possible, while being safe. Your answers should not include any harmful, unethical, racist, sexist, toxic, dangerous, or illegal content. Please ensure that your responses are socially unbiased and positive in nature. If a question does not make any sense or is not factually coherent, explain why instead of answering something not correct. If you don't know the answer to a question, please don't share false information. <</SYS>> What is Schizoid personality disorder and explain in detail? [/INST] Schizoid personality disorder (, often abbreviated as SzPD or ScPD) is a personality disorder characterized by a lack of interest in social relationships, a tendency toward a solitary or sheltered lifestyle, secretiveness, emotional coldness, detachment and apathy. Affected individuals may be unable to form intimate attachments to others and simultaneously possess a rich and elaborate but exclusively internal fantasy world. Other associated features include stilted speech, a lack of deriving enjoyment from most activities, feeling as though one is an "observer" rather than a participant in life, an inability to tolerate emotional expectations of others, apparent indifference when praised or criticized, a degree of asexuality, and idiosyncratic moral or political beliefs. Symptoms typically start in late childhood or adolescence.The cause of SzPD is uncertain, but there is some evidence of links and shared genetic risk between SzPD, other cluster A personality disorders (such as schizotypal personality disorder) and schizophrenia. Thus, SzPD is considered to be a "schizophrenia-like personality disorder". It is diagnosed by clinical observation, and it can be very difficult to distinguish SzPD from other mental disorders or conditions (such as autism spectrum disorder, with which it may sometimes overlap).The effectiveness of psychotherapeutic and pharmacological treatments for the disorder has yet to be empirically and systematically investigated. This is largely because people with SzPD rarely seek treatment for their condition. Originally, low doses of atypical antipsychotics were also used to treat some symptoms of SzPD, but their use is no longer recommended. The substituted amphetamine bupropion may be used to treat associated anhedonia. However, it is not general practice to treat SzPD with medications, other than for the short-term treatment of acute co-occurring disorders (e.g. depression). Talk therapies such as cognitive behavioral therapy (CBT) may not be effective, because people with SzPD may have a hard time forming a good working relationship with a therapist.SzPD is a poorly studied disorder, and there is little clinical data on SzPD because it is rarely encountered in clinical settings. Studies have generally reported a prevalence of less than 1%. It is more commonly diagnosed in males than in females. SzPD is linked to negative outcomes, including a significantly compromised quality of life, reduced overall functioning even after 15 years and one of the lowest levels of "life success" of all personality disorders (measured as "status, wealth and successful relationships"). Bullying is particularly common towards schizoid individuals. Suicide may be a running mental theme for schizoid individuals, though they are not likely to actually attempt it. Some symptoms of SzPD (e.g. solitary lifestyle, emotional detachment, loneliness, and impaired communication), however, have been stated as general risk factors for serious suicidal behaviour.

Signs and symptoms
People with SzPD are often aloof, cold and indifferent, which causes interpersonal difficulty. Most individuals diagnosed with SzPD have trouble establishing personal relationships or expressing their feelings meaningfully. They may remain passive in the face of unfavorable situations. Their communication with other people may be indifferent and terse at times. Schizoid personality types often lack the ability to assess the impact of their own actions in social situations.A person with SzPD may feel suffocated when their personal space is violated and take actions to avoid this feeling. People who have SzPD tend to be happiest when in relationships in which their partner places few emotional or intimate demands on them and does not expect phatic or social niceties. It is not necessarily people they want to avoid, but negative or positive emotional expectations, emotional intimacy and self-disclosure. Therefore, it is possible for individuals with SzPD to form relationships with others based on intellectual, physical, familial, occupational or recreational activities, as long as there is no need for emotional intimacy. Donald Winnicott explains this is because schizoid individuals "prefer to make relationships on their own terms and not in terms of the impulses of other people." Failing to attain that, they prefer isolation. In general, friendship among schizoids is usually limited to one person, often also schizoid, forming what has been called a union of two eccentrics; "within it – the ecstatic cult of personality, outside it – everything is sharply rejected and despised".Although there is the belief people with SzPD are complacent and unaware of their feelings, many recognize their differences from others. Some individuals with SzPD who are in treatment say "life passes them by" or they feel like living inside a shell; they see themselves as "missing the bus" and speak of observing life from a distance.Aaron Beck and his colleagues report that people with SzPD seem comfortable with their aloof lifestyle and consider themselves observers, rather than participants in the world around them. But they also mention that many of their schizoid patients recognize themselves as socially deviant (or even defective) when confronted with the different lives of ordinary people – especially when they read books or see movies focusing on relationships. Even when schizoid individuals may not long for closeness, they can become weary of being "on the outside, looking in". These feelings may lead to depression or depersonalization. If they do, schizoid people often experience feeling "like a robot" or "going through life in a dream".According to Guntrip, Klein and others, people with SzPD may possess a hidden sense of superiority and lack dependence on other peoples opinions. This is very different from the grandiosity seen in narcissistic personality disorder, which is described as "burdened with envy" and with a desire to destroy or put down others. Additionally, schizoids do not go out of their way to achieve social validation.: 60  Unlike the narcissist, the schizoid will often keep their creations private to avoid unwelcome attention or the feeling that their ideas and thoughts are being appropriated by the public.: 174 The related schizotypal personality disorder and schizophrenia are reported to have ties to creative thinking, and it is speculated that the internal fantasy aspect of SzPD may also be reflective of this thinking. Alternatively, there has been an especially large contribution of people with schizoid symptoms to science and theoretical areas of knowledge, including maths, physics, economics, etc. At the same time, people with SzPD are helpless at many practical activities because of their symptoms.

Secret schizoids
Many schizoid individuals display an engaging, interactive personality, contradicting the observable characteristic emphasized by the DSM-5 and ICD-10 definitions of the schizoid personality. Guntrip (using ideas of Klein, Fairbairn and Winnicott) classifies these individuals as "secret schizoids", who behave with socially available, interested, engaged and involved interaction yet remain emotionally withdrawn and sequestered within the safety of the internal world.: 17  Klein distinguishes between a "classic" SzPD and a "secret" SzPD, which occur "just as often" as each other. Klein cautions one should not misidentify the schizoid person as a result of the patients defensive, compensatory interaction with the external world. He suggests one ask the person what their subjective experience is, to detect the presence of the schizoid refusal of emotional intimacy and preference for objective fact.Frequently, a schizoid individuals social functioning improves, sometimes dramatically, when the individual knows they are an anonymous participant in a real-time conversation or correspondence, e.g. in an online chatroom or message board. It is often the case the individuals online correspondent will report nothing amiss in the individuals engagement and affect. A 2013 study looking at personality disorders and Internet use found that being online more hours per day predicted signs of SzPD. Additionally, SzPD correlated with lower phone call use and fewer Facebook friends.Descriptions of the schizoid personality as "hidden" behind an outward appearance of emotional engagement have been recognized since 1940, with Fairbairns description of "schizoid exhibitionism", in which the schizoid individual is able to express a great deal of feeling and to make what appear to be impressive social contacts yet in reality gives nothing and loses nothing. Because they are "playing a part", their personality is not involved. According to Fairbairn, the person disowns the part they are playing, and the schizoid individual seeks to preserve their personality intact and immune from compromise. The schizoids false persona is based around what those around them define as normal or good behaviour, as a form of compliance.: 143  Further references to the secret schizoid come from Masud Khan, Jeffrey Seinfeld and Philip Manfield, who give a description of an SzPD individual who "enjoys" public speaking engagements but experiences great difficulty in the breaks when audience members would attempt to engage him emotionally. These references expose the problems in relying on outer observable behavior for assessing the presence of personality disorders in certain individuals.

Schizoid fantasy
A pathological reliance on fantasizing and preoccupation with inner experience is often part of the schizoid withdrawal from the world. Fantasy thus becomes a core component of the self in exile, though fantasizing in schizoid individuals is far more complicated than a means of facilitating withdrawal.: 64 Fantasy is also a relationship with the world and with others by proxy. It is a substitute relationship, but a relationship nonetheless, characterized by idealized, defensive and compensatory mechanisms. This is self-contained and free from the dangers and anxieties associated with emotional connection to real persons and situations. Klein explains it as "an expression of the self struggling to connect to objects, albeit internal objects. Fantasy permits schizoid patients to feel connected, and yet still free from the imprisonment in relationships. In short, in fantasy one can be attached (to internal objects) and still be free." This aspect of schizoid pathology has been generously elaborated in works by R. D. Laing, Donald Winnicott and Ralph Klein.: 64

Sexuality
People with SzPD are sometimes sexually apathetic, though they do not typically experience anorgasmia. Their preference to remain alone and detached may cause their need for sex to appear to be less than that of those who do not have SzPD. Sex often causes individuals with SzPD to feel that their personal space is being violated, and they commonly feel that masturbation or sexual abstinence is preferable to the emotional closeness they must tolerate when having sex. Significantly broadening this picture are notable exceptions of SzPD individuals who engage in occasional or even frequent sexual activities with others.Fairbairn notes that schizoids can fear that in a relationship, their needs will weaken and exhaust their partner, so they feel forced to disown them and move to satisfy solely the needs of the partner. The net result of this is a loss of dignity and sense of self within any relationship they enter, eventually leading to intolerable frustration and friction. Appel notes that these fears result in the schizoids negativism, stubbornness and reluctance to love. Thus, a central conflict of the schizoid is between an immense longing for relationships but a deep anxiety and avoidance of relationships, manifested by the choosing of the "lesser evil" of abandoning others.: 100 Individuals with SzPD have long been noted to have an increased rate of unconventional sexual tendencies, though if present, these are rarely acted upon. The schizoid is often labelled asexual or presents with "a lack of sexual identity". Kernberg states that this apparent lack of a sexuality does not represent a lack of sexual definition but rather a combination of several strong fixations to cope with the same conflicts.: 125  People with SzPD are often able to pursue any fantasies with content on the Internet while remaining completely unengaged with the outside world.: 127

Akhtars profile
American psychoanalyst Salman Akhtar provided a comprehensive phenomenological profile of SzPD in which classic and contemporary descriptive views are synthesized with psychoanalytic observations. This profile is summarized in the table reproduced below that lists clinical features that involve six areas of psychosocial functioning and are organized by "overt" and "covert" manifestations.
"Overt" and "covert" are intended to denote seemingly contradictory aspects that may both simultaneously be present in an individual. These designations do not necessarily imply their conscious or unconscious existence. The covert characteristics are by definition difficult to discern and not immediately apparent. Additionally, the lack of data on the frequency of many of the features makes their relative diagnostic weight difficult to distinguish at this time. However, Akhtar states that his profile has several advantages over the DSM in terms of maintaining historical continuity of the use of the word schizoid, valuing depth and complexity over descriptive oversimplification and helping provide a more meaningful differential diagnosis of SzPD from other personality disorders.

Causes
Some evidence suggests the cluster A personality disorders have shared genetic and environmental risk factors, and there is an increased prevalence of SzPD in relatives of people with schizophrenia and schizotypal personality disorder. Twin studies with SzPD traits (e.g. low sociability and low warmth) suggest these are inherited. Besides this indirect evidence, the direct heritability estimates of SzPD range from 50 to 59%. To Sula Wolff, who did extensive research and clinical work with children and teenagers with schizoid symptoms, "schizoid personality has a constitutional, probably genetic, basis." The link between SzPD and being underweight may also point to the involvement of biological factors.In general, prenatal caloric malnutrition, premature birth and a low birth weight are risk factors for having a mental disorder and may contribute to the development of SzPD as well. Those who have experienced traumatic brain injury may be also at risk of developing features reflective of SzPD.Other historical researchers had hypothesized excessively perfectionist, unloving or neglectful parenting could play a role.

Diagnosis
DSM-5 criteria
The Diagnostic and Statistical Manual of Mental Disorders is a widely used manual for diagnosing mental disorders. DSM-5 includes SzPD with the same criteria as in DSM-IV. In the DSM-5, SzPD is described as a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by at least four of the following:
Neither desires nor enjoys close relationships, including being part of a family.
Almost always chooses solitary activities.
Has little, if any, interest in having sexual experiences with another person.
Takes pleasure in few, if any, activities.
Lacks close friends or confidants other than first-degree relatives.
Appears indifferent to the praise or criticism of others.
Shows emotional coldness, detachment, or flattened affectivity.According to the DSM, those with SzPD may often be unable to, or will rarely express aggressiveness or hostility, even when provoked directly. These individuals can seem vague or drifting about their goals and their lives may appear directionless. Others view them as indecisive in their actions, self-absorbed, absent-minded and detached from their surroundings. Excessive daydreaming is often present. In cases with severe defects in the capacity to form social relationships, dating and marriage may not be possible.

ICD-10 criteria
The Classification of Mental and Behavioural Disorders of ICD-10 lists SzPD under (F60.1).The general criteria of personality disorder (F60) should be met first. In addition, at least four of the following criteria must be present:

Few, if any, activities provide pleasure.
Displays emotional coldness, detachment, or flattened affectivity.
Limited capacity to express warm, tender feelings for others as well as anger.
Appears indifferent to either praise or criticism from others.
Little interest in having sexual experiences with another person (taking into account age).
Almost always chooses solitary activities.
Excessive preoccupation with fantasy and introspection.
Neither desires, nor has, any close friends or confiding relationships (or only one).
Marked insensitivity to prevailing social norms and conventions; if these are not followed, this is unintentional.

Guntrip criteria
Ralph Klein, Clinical Director of the Masterson Institute, delineates the following nine characteristics of the schizoid personality as described by Harry Guntrip:: 13–23
Introversion
Withdrawnness
Narcissism
Self-sufficiency
A sense of superiority
Loss of affect
Loneliness
Depersonalization
RegressionThe description of Guntrips nine characteristics should clarify some differences between the traditional DSM portrait of SzPD and the traditional informed object relations view. All nine characteristics are consistent. Most, if not all, must be present to diagnose a schizoid disorder.

Millons subtypes
Theodore Millon restricted the term "schizoid" to those personalities who lack the capacity to form social relationships. He characterizes their way of thinking as being vague and void of thoughts and as sometimes having a "defective perceptual scanning". Because they often do not perceive cues that trigger affective responses, they experience fewer emotional reactions.For Millon, SzPD is distinguished from other personality disorders in that it is "the personality disorder that lacks a personality." He criticizes that this may be due to the current diagnostic criteria: They describe SzPD only by an absence of certain traits, which results in a "deficit syndrome" or "vacuum". Instead of delineating the presence of something, they mention solely what is lacking. Therefore, it is hard to describe and research such a concept.He identified four subtypes of SzPD. Any individual schizoid may exhibit none or one of the following:

Differential diagnosis
While SzPD shares several symptoms with other mental disorders, there are some important differentiating features:

Comorbidity
SzPD is often found to be comorbid with at least one of several disorders or pathologies. Sometimes, a person with SzPD may meet criteria for an additional personality disorder; when this happens, it is most often avoidant, schizotypal or paranoid PD. Alexithymia (the inability to identify and describe emotions) is often present in SzPD. Sharon Ekleberry suggests that some people with schizoid personality features may occasionally experience instances of brief reactive psychosis when under stress.

Substance use disorder
Very little data exists for rates of substance use disorder among people with SzPD, but existing studies suggest they are less likely to have substance abuse problems than the general population. One study found that significantly fewer boys with SzPD had alcohol problems than a control group of non-schizoids. Another study evaluating personality disorder profiles in substance abusers found that substance abusers who showed schizoid symptoms were more likely to abuse one substance rather than many, in contrast to other personality disorders such as borderline, antisocial or histrionic, which were more likely to abuse many.American psychotherapist Sharon Ekleberry states that the impoverished social connections experienced by people with SzPD limit their exposure to the drug culture and that they have limited inclination to learn how to do illegal drugs. Describing them as "highly resistant to influence", she additionally states that even if they could access illegal drugs, they would be disinclined to use them in public or social settings, and because they would be more likely to use alcohol or cannabis alone than for social disinhibition, they would not be particularly vulnerable to negative consequences in early use.

Suicide
Suicide may be a running theme for schizoid individuals, in part due to the knowledge of the large-scale ostracism that would result if their idiosyncratic views were revealed and their experience that most, if not all people, are unrelatable or have polar opposite reactions to them on societally sensitive issues, though they are not likely to actually attempt it. They might be down and depressed when all possible connections have been cut off, but as long as there is some relationship or even hope for one the risk will be low. The idea of suicide is a driving force against the persons schizoid defenses. Often among people with SzPD, there is a rationally grounded and reasoned position on why they want to die, and this "suicidal construct" takes a stable position in the mind.
A mini-review indicates that SzPD or schizoid traits are a major risk factor for both suicide attempts and suicide. Schizoids tend to hide their suicidal thoughts and intentions. Demonstrative suicides or suicide blackmail, as seen in cluster B personality disorders such as borderline, histrionic or antisocial, are extremely rare among schizoid individuals.In cases with schizoid disorder, the characteristics of the premorbidities (emotional coldness, autism, inability to have fun) also affected suicidal behaviour. Their suicides were always genuine in nature, well-planned, and it was only by chance that these patients survived (usually the fatal outcome was prevented by the sudden appearance of others). They denied the existence of suicidal experiences earlier, but argued that in the current circumstances, suicide seemed to them the most appropriate way out. This "suicidal construction" was well-reasoned and took a stable position in the mind. Important in all these cases was the absence of any significant anti-suicidal factors (most were found in a situation of relative social isolation; there were no professional and personal interests). The high ability to introspect in these cases only increased the isolation from reality and made the choice in favour of suicide more reasonable.As in other clinical mental health settings, among suicidal inpatients, individuals with SzPD are not as well-represented as some other groups. A 2011 study on suicidal inpatients at a Moscow hospital found that schizoids were the least common patients, while those with cluster B personality disorders were the most common.

Asperger syndrome
Several studies have reported an overlap or comorbidity with the autism spectrum disorder Asperger syndrome. Asperger syndrome had traditionally been called "schizoid disorder of childhood", and Eugen Bleuler coined both the terms "autism" and "schizoid" to describe withdrawal to an internal fantasy, against which any influence from outside becomes an intolerable disturbance. In a 2012 study of a sample of 54 young adults with Asperger syndrome, it was found that 26% of them also met criteria for SzPD, the highest comorbidity out of any personality disorder in the sample (the other comorbidities were 19% for obsessive–compulsive personality disorder, 13% for avoidant personality disorder and one female with schizotypal personality disorder). Additionally, twice as many men with Asperger syndrome met criteria for SzPD than women. While 41% of the whole sample were unemployed with no occupation, this rose to 62% for the Aspergers and SzPD comorbid group. Tantam suggested that Asperger syndrome may confer an increased risk of developing SzPD. A 2019 study found that 54% of a group of males aged 11 to 25 with Asperger syndrome showed significant SzPD traits, with 6% meeting full diagnostic criteria for SzPD, compared to 0% of a control.In the 2012 study, it was noted that the DSM may complicate diagnosis by requiring the exclusion of a pervasive developmental disorder (PDD) before establishing a diagnosis of SzPD. The study found that social interaction impairments, stereotyped behaviours and specific interests were more severe in the individuals with Asperger syndrome also fulfilling SzPD criteria, against the notion that social interaction skills are unimpaired in SzPD. The authors believe that substantial subgroup of people with autism spectrum disorder or PDD have clear "schizoid traits" and correspond largely to the "loners" in Lorna Wings classification The autism spectrum (Lancet 1997), described by Sula Wolff. The authors of the 2019 study hypothesised that it is extremely likely that historic cohorts of adults diagnosed with SzPD either also had childhood-onset autistic syndromes or were misdiagnosed. They stressed that further research to clarify overlap and distinctions between these two syndromes was strongly warranted, especially given that high-functioning autism spectrum disorders are now recognised in around 1% of the population.

Low weight
A study which looked at the body mass index (BMI) of a sample of both male adolescents diagnosed with SzPD and those diagnosed with Asperger syndrome found that the BMI of all patients was significantly below normal. Clinical records indicated abnormal eating behaviour by some patients. Some patients would only eat when alone and refused to eat out. Restrictive diets and fears of disease were also found. It was suggested that the anhedonia of SzPD may also cover eating, leading schizoid individuals to not enjoy it. Alternatively, it was suggested that schizoid individuals may not feel hunger as strongly as others or not respond to it, a certain withdrawal "from themselves".

Anti-social conduct
Another study looked at rates of anti-social conduct in boys with either SzPD or Asperger syndrome compared with a control group of non-schizoid individuals and found the incidence of anti-social conduct to be the same in both groups. However, the schizoid boys stole significantly less. Upon follow-up in adulthood, out of a matched group of 19 boys with SzPD and 19 boys without, four of the schizoid boys reported having exclusively internal violent fantasies (concerned with Zulu wars, abattoirs, fascists and communists and a collection of knives, respectively), which were pursued entirely by themselves, while the only non-schizoid subject to report a violent fantasy life shared his with a group of young men (dressing up and riding motorcycles as a self-styled "panzer" group).An absent parent or socio-economic disadvantage did not seem to affect the risk of anti-social conduct in schizoid individuals as much as it did in non-schizoid individuals. Absent parents and parental socio-economic disadvantage were also less common in the schizoid group.

Controversy
The original concept of the schizoid character developed by Ernst Kretschmer in the 1920s comprised an amalgamation of avoidant, schizotypal and schizoid traits. It was not until 1980 and the work of Theodore Millon that led to splitting this concept into three personality disorders (now schizoid, schizotypal and avoidant). This caused debate about whether this was accurate or if these traits were different expressions of a single personality disorder. It has also been argued due to the poor consistency and efficiency of diagnosis due to overlapping traits that SzPD should be removed altogether from the DSM.A 2012 article suggested that two different disorders may better represent SzPD: one affect-constricted disorder (belonging to schizotypal PD) and a seclusive disorder (belonging to avoidant PD). They called for the replacement of the SzPD category from future editions of the DSM by a dimensional model which would allow for the description of schizoid traits on an individual basis.Some critics such as Nancy McWilliams of Rutgers University and Parpottas Panagiotis of European University Cyprus argue that the definition of SzPD is flawed due to cultural bias and that it does not constitute a mental disorder but simply an avoidant attachment style requiring more distant emotional proximity. If that is true, then many of the more problematic reactions these individuals show in social situations may be partly accounted for by the judgements commonly imposed on people with this style. However, impairment is mandatory for any behaviour to be diagnosed as a personality disorder. SzPD seems to satisfy this criterion because it is linked to negative outcomes. These include a significantly compromised quality of life, reduced overall functioning even after 15 years and one of the lowest levels of "life success" of all personality disorders (measured as "status, wealth and successful relationships"). However, determination of what qualify as "impairments" or as "negative outcomes" is itself potentially subject to cultural bias. People with SzPD may not regard a lack of social-status or successful relationships, for example, as a harm. Furthermore, correlation with negative outcomes does not necessarily demonstrate that these outcomes were directly caused by the schizoidal traits. Rather, it may be that these outcomes are the result of discrimination against people with SzPD, who may be viewed as abnormal.

Treatment
People with SzPD rarely seek treatment for their condition. This issue is found in many personality disorders, which prevents many people with these conditions from seeking treatment: they tend to view their condition as not conflicting with their self-image and their abnormal perceptions and behaviors as rational and appropriate. There are little data on the effectiveness of various treatments on this personality disorder because it is seldom seen in clinical settings. However, those in treatment have the option of medication and psychotherapy.

Medication
No medications are indicated for directly treating SzPD, but certain medications may reduce the symptoms of SzPD as well as treat co-occurring mental disorders. The symptoms of SzPD mirror the negative symptoms of schizophrenia, such as anhedonia, blunted affect and low energy, and SzPD is thought to be part of the "schizophrenic spectrum" of disorders, which also includes the schizotypal and paranoid personality disorders, and may benefit from the medications indicated for schizophrenia. Originally, low doses of atypical antipsychotics like risperidone or olanzapine were used to alleviate social deficits and blunted affect. However, a 2012 review concluded that atypical antipsychotics were ineffective for treating personality disorders.In contrast, the substituted amphetamine bupropion may be used to treat anhedonia. Likewise, modafinil may be effective in treating some of the negative symptoms of schizophrenia, which are reflected in the symptomatology of SzPD and therefore may help as well. Lamotrigine, SSRIs, TCAs, MAOIs and hydroxyzine may help counter social anxiety in people with SzPD if present, though social anxiety may not be a main concern for the people who have SzPD. However, it is not general practice to treat SzPD with medications, other than for the short-term treatment of acute co-occurring axis I conditions (e.g. depression).

Psychotherapy
Despite the relative emotional comfort, psychoanalytic therapy of schizoid individuals takes a long time and causes many difficulties. Schizoids are generally poorly involved in psychotherapy due to difficulties in establishing empathic relations with a psychotherapist and low motivation for treatment.Supportive psychotherapy is used in an inpatient or outpatient setting by a trained professional that focuses on areas such as coping skills, improvement of social skills and social interactions, communication and self-esteem issues. People with SzPD may also have a perceptual tendency to miss subtle differences in expression. That causes an inability to pick up hints from the environment because social cues from others that might normally provoke an emotional response are not perceived. That in turn limits their own emotional experience. The perception of varied events only increases their fear for intimacy and limits them in their interpersonal relationships. Their aloofness may limit their opportunities to refine the social skills and behavior necessary to effectively pursue relationships.Besides psychodynamic therapy, cognitive behavioral therapy (CBT) can be used. But because CBT generally begins with identifying the automatic thoughts, one should be aware of the potential hazards that can happen when working with schizoid patients. People with SzPD seem to be distinguished from those with other personality disorders in that they often report having few or no automatic thoughts at all. That poverty of thought may have to do with their apathetic lifestyle. But another possible explanation could be the paucity of emotion many schizoids display, which would influence their thought patterns as well.Socialization groups may help people with SzPD. Educational strategies in which people who have SzPD identify their positive and negative emotions also may be effective. Such identification helps them to learn about their own emotions and the emotions they draw out from others and to feel the common emotions with other people with whom they relate. This can help people with SzPD create empathy with the outside world.

Shorter-term treatment
The concept of "closer compromise" means that the schizoid patient may be encouraged to experience intermediate positions between the extremes of emotional closeness and permanent exile. A lack of injections of interpersonal reality causes an impoverishment in which the schizoid individuals self-image becomes increasingly empty and volatilized and leads the individual to feel unreal. To create a more adaptive and self-enriching interaction with others in which one "feels real", the patient is encouraged to take risks through greater connection, communication and sharing of ideas, feelings and actions. Closer compromise means that while the patients vulnerability to anxieties is not overcome, it is modified and managed more adaptively. Here, the therapist repeatedly conveys to the patient that anxiety is inevitable but manageable, without any illusion that the vulnerability to such anxiety can be permanently dispensed with. The limiting factor is the point at which the dangers of intimacy become overwhelming and the patient must again retreat.
Klein suggests that patients must take the responsibility to place themselves at risk and to take the initiative for following through with treatment suggestions in their personal lives. It is emphasized that these are the therapists impressions and that he or she is not reading the patients mind or imposing an agenda but is simply stating a position that is an extension of the patients therapeutic wish. Finally, the therapist directs attention to the need to employ these actions outside of the therapeutic setting.

Longer-term therapy
Klein suggests that "working through" is the second longer-term tier of psychotherapeutic work with schizoid patients. Its goals are to change fundamentally the old ways of feeling and thinking and to rid oneself of the vulnerability to those emotions associated with old feelings and thoughts. A new therapeutic operation of "remembering with feeling" that draws on D. W. Winnicotts concepts of false self and true self is called for. The patient must remember with feeling the emergence of his or her false self through childhood and remember the conditions and proscriptions that were imposed on the individuals freedom to experience the self in company with others.Remembering with feeling ultimately leads the patient to understand that he or she had no opportunity to choose from a selection of possible ways of experiencing the self and of relating with others and had few, if any, options other than to develop a schizoid stance toward others. The false self was simply the best way in which the patient could experience the repetitive predictable acknowledgement, affirmation and approval necessary for emotional survival while warding off the effects associated with the abandonment depression.If the goal of shorter-term therapy is for patients to understand that they are not the way they appear to be and can act differently, then the longer-term goal of working through is for patients to understand who and what they are as human beings, what they truly are like and what they truly contain. The goal of working through is not achieved by the patients sudden discovery of a hidden, fully formed talented and creative self living inside, but is a process of slowly freeing oneself from the confinement of abandonment depression in order to uncover a potential. It is a process of experimentation with the spontaneous, nonreactive elements that can be experienced in relationship with others.Working through abandonment depression is a complicated, lengthy and conflicted process that can be an enormously painful experience in terms of what is remembered and what must be felt. It involves mourning and grieving for the loss of the illusion that the patient had adequate support for the emergence of the real self. There is also a mourning for the loss of an identity, the false self, which the person constructed and with which he or she has negotiated much of his or her life. The dismantling of the false self requires relinquishing the only way that the patient has ever known of how to interact with others. This interaction was better than not to have a stable, organized experience of the self, no matter how false, defensive or destructive that identity may be.
The dismantling of the false self "leaves the impaired real self with the opportunity to convert its potential and its possibilities into actualities." Working through brings unique rewards, of which the most important element is the growing realization that the individual has a fundamental, internal need for relatedness that may be expressed in a variety of ways. "Only schizoid patients", suggests Klein, "who have worked through the abandonment depression ... ultimately will believe that the capacity for relatedness and the wish for relatedness are woven into the structure of their beings, that they are truly part of who the patients are and what they contain as human beings. It is this sense that finally allows the schizoid patient to feel the most intimate sense of being connected with humanity more generally, and with another person more personally. For the schizoid patient, this degree of certainty is the most gratifying revelation, and a profound new organizer of the self experience.": 127

Development and course
SzPD can be first apparent in childhood and adolescence with solitariness, poor peer relationships and underachievement in school. This may mark these children as different and make them subject to teasing.Being a personality disorder, which is usually chronic and long-lasting mental conditions, SzPD is not expected to improve with time without treatment; however, much remains unknown because it is rarely encountered in clinical settings.

Epidemiology
SzPD is uncommon in clinical settings (about 2.2%) and occurs more commonly in males. It is rare compared with other personality disorders, with a prevalence estimated at less than 1% of the general population.Philip Manfield suggests that the "schizoid condition", which roughly includes the DSM schizoid, avoidant and schizotypal personality disorders, is represented by "as many as forty percent of all personality disorders." Manfield adds "This huge discrepancy [from the ten percent reported by therapists for the condition] is probably largely because someone with a schizoid disorder is less likely to seek treatment than someone with other axis-II disorders."A 2008 study assessing personality and mood disorder prevalence among homeless people at New York City drop-in centres reported an SzPD rate of 65% among this sample. The study did not assess homeless people who did not show up at drop-in centres, and the rates of most other personality and mood disorders within the drop-in centres was lower than that of SzPD. The authors noted the limitations of the study, including the higher male-to-female ratio in the sample and the absence of subjects outside the support system or receiving other support (e.g., shelters) as well as the absence of subjects in geographical settings outside New York City, a large city often considered a magnet for disenfranchised people.A University of Colorado Colorado Springs study comparing personality disorders and Myers–Briggs Type Indicator types found that the disorder had a significant correlation with the Introverted (I) and Thinking (T) preferences.

History
The term "schizoid" was coined in 1908 by Eugen Bleuler to designate a human tendency to direct attention toward ones inner life and away from the external world, a concept akin to introversion in that it was not viewed in terms of psychopathology. Bleuler labeled the exaggeration of this tendency the "schizoid personality". He described these personalities as "comfortably dull and at the same time sensitive, people who in a narrow manner pursue vague purposes".In 1910, August Hoch introduced a very similar concept called the "shut-in" personality. Characteristics of it were reticence, seclusiveness, shyness and a preference for living in fantasy worlds, among others </s>