"The roaring current of change," he said, was producing visible and measurable effects in individuals that fractured marriages, overwhelmed families and caused "confusional breakdowns" manifested in rising crime, drug use and social alienation.
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"In a person experiencing confusional arousal because of Ambien, you wouldn't expect to hear comments from that person that seem to fit into the context of the environment that they are in," said Dr. Michel Cramer Bornemann, a lead investigator of Sleep Forensics Associates.
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It is necessary to distinguish confusional arousals in adults from children.
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Violent behaviours in confusional arousals slightly differ from those in sleepwalking or night terrors. Above all, during an episode of confusional arousal the patient never leaves the bed unlike sleepwalking. Bed partner or parent who tries to calm or restrain the patient by grabbing him or her may trigger a violent reaction as with sleepwalkers. In case of a confusional arousal triggered by an attempt of awakening the patient, violent behaviours may occur almost spontaneously.
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Confusional arousals are at the time not considered as a disorder in the current 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). This absence may be explained by the fact that confusional arousals have been understudied by the scientific community. Adding confusional arousals as a sleep disorder in the major classification, which is the DSM-V, would increase awareness and attention among physicians and patients and contribute to further investigations.
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Ohayon MM, Guilleminault C, Priest RG. Night terrors, sleepwalking, and confusional arousals in the general population: their frequency and relationship to other sleep and mental disorders. J Clin Psychiatry. 1999;60(4):268-76. Infants and toddlers usually experience confusional arousals beginning with large amounts of movement and moaning, which can later progress to occasional thrashings or inconsolable crying. In rare cases, confusional arousals can cause injuries and drowsy driving accidents, thus it can also be considered dangerous.
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Confusional arousals can occur during or following an arousal of deep sleep (see slow-wave sleep) and upon an attempt of awakening the subject from sleep in the morning. In children, confusional arousals can often be reproduced artificially by awakening the child during deep sleep. However, it doesn’t have any clinical significance without deeper investigation. Children living an episode of confusional arousal typically sit up in bed, whimper, cry, moan, and may utter words like “no” or “go away”.
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Volare/Nedbo Zip (7", Italian Records 1980) Confusional Quartet (LP, Italian Records 1980) Confusional Quartet (EP 10", Italian Records 1981) Documentario (3xFlexi 7", Italian Records 1981) Mission Is Terminated - Nice Tracks (2LP, AAVV, Nice Label 1982) Confusional Quartet - reissue (CD - Elica 1999) Confuzed Disco Sampler 1 (remix by Scuola Furano) (LP, AAVV, Mantra Vibes 2005) Made in Italy 1978-1982 (CD, Astroman 2010) Italia Calibro X (CD, Ansaldi Records 2011) Music? No Control! (CD, AAVV, Sfera Cubica 2012) Confusional Quartet (CD-LP, Hell Yeah Recordings 2012) Italia No!-Contaminazioni No Wave italiane 1980-1985 (CD-LP, AAVV, Spittle Records) Italian Records-The Singles 7" Collection 1980-1984 (CD Box Set, AAVV, Spittle-Goodfellas 2013) Confusional Quartet play Demetrio Stratos (CD- LP, Expanded Music-Goodfellas 2014) Bibliography (selected) Giancarlo Riccio - Percorsi del rock italiano, Ed. Il Formichiere, 1980 Lucio Mazzi, Roberto Rossi Gandolfi - Bologna la rock, Ed. FuoriThema, 1991 Alessandro Bolli - Dizionario dei Nomi Rock, Arcana Editore, 1998 Arturo Compagnoni - Italia '80.
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Confusional arousals have often been linked to sleep-related violence (self-injury or injury to the bed partner). The latter highlights important medical and legal issues when such behaviours are suspected and purported to have caused a criminal offense. The first documented case of homicide as a result of confusional arousal was reported in medieval times by the case of the Silesian woodcutter Bernard Schedmaizig. Sleep-related abnormal sexual behaviours (also called sexsomnia or sleep sex) are mainly classified as confusional arousals and more rarely associated to sleepwalking (also known as somnambulism).
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According to one meta-analysis, the two most prevalent sleep disorders among children are confusional arousals and sleep walking. An estimated 17.3% of kids between 3 and 13 years old experience confusional arousals. About 17% of children sleep walk, with the disorder being more common among boys than girls. The peak ages of sleep walking are from 8 to 12 years old.
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Confusional arousal is more common in children than in adults. It has a lifetime prevalence of 18.5% in children and a lifetime prevalence of 2.9-4.2% in adults.Ohayon MM, Priest RG, Zulley J, Smirne S. The place of confusional arousals in sleep and mental disorders: findings in a general population sample of 13,057 subjects. J Nerv Ment Dis. 2000;188(6):340-8.
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Confusional Quartet is one of the most recognized Italian bands in the so- called New Wave era, a period ranging from the late seventies to the mid- eighties.
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Even if sleep-related violence may occur during an episode of confusional arousal, it remains extremely rare and there are no specific predisposition to aggression during these episodes.
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The current prevalence of confusional arousals varies according to the year and the sample population and is approximately 4% (4.2% in 1999 in UK sample population, 6.1% (15–24 years old), 3.3% (25–34 y.o.) and 2% (35+ y.o.) in 2000 in UK, Germany and Italy sample population, 6.9% in 2010 in Norway sample population with a lifetime prevalence of 18.5%). The current prevalence of confusional arousals in children (3–13 y.
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According to the 2nd edition of the International Classification of Sleep Disorders (ICSD-2), confusional arousals are classified in NREM parasomnias embedded in the non-epileptic paroxysmal motor events during sleep, which include (1) Parasomnia, (2) Sleep- related movement disorders and (3) Isolated symptoms, apparently normal variants and unresolved issues. NREM parasomnias (or disorders of arousal) also include sleep terrors (see night terror) and sleepwalking. Confusional arousals are characterised by more or less complex movements without leaving bed with whimpering, sitting up in bed and some articulation without walking or terror. In comparison of other arousal parasomnias the age onset of sleep walking is generally between 5 and 10 years whereas confusional arousals and sleep terror may occur 3 years earlier.
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Unlike confusional arousals and sleep walking, patients experiencing night terrors seem to react to some type of frightening image. Therefore, the violent reaction may occur if another individual is encountered or is in proximity.
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People can present with sudden increase in blood pressure, acute confusional state, headaches, vomiting, and seizure. Retinal hemorrhages and hard exudates may be present on funduscopic exam. Hypertensive leukoencephalopathy may have concurrent cardiac ischemia and hematuria.
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In 2013 the drummer Gianni Cuoghi left the band, replaced by Claudio Trotta. In 2014 the band publishes "Confusional Quartet play Demetrio Stratos", an album made using previously unreleased material by the famous vocalist-experimenter Demetrio Stratos.
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Some independent risk factors associated with confusional arousals have been identified. According to studies, they are shift work, hypnagogic hallucinations (also known as hypnagogia), excessive daytime sleepiness, insomnia and hypersomnia disorder, circadian rhythm sleep disorder, restless legs syndrome, obstructive sleep apnea syndrome (OSAS), bipolar disorder, daily smoking, and age of 15–24 years. These risk factors of confusional arousals are somehow related to mental disorders and medical conditions and affecting mostly younger subjects regardless of gender. Precipitating factors include sleep deprivation, use of hypnotics or tranquilisers before bedtime, and sudden awakening from sleep (e.g.
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Confusional arousals are classified as “partial awakenings in which the state of consciousness remains impaired for several minutes without any accompanying major behavioural disorders or severe autonomic responses”. Complete or partial amnesia of the episodes may be present.
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Pilon M; Zadra A; Joncas S et al. Hypersynchronous delta waves and somnambulism: brain topography and effect of sleep deprivation. SLEEP 2006;29(1): 77–84. Parasomnias which occur deep in NREM sleep also include sleep terrors and confusional arousals.
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Avoid the concomitant use of chlorprothixene and tramadol (Ultram). Seizures may be encountered with this combination. Consider additive sedative effects and confusional states to emerge, if chlorprothixene is given with benzodiazepines or barbiturates. Choose particular low doses of these drugs.
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Sleep terrors are mainly characterised by screaming, agitation, flushed face, sweating and only share the inconsolability with confusional arousals. The current 3rd edition of the International Classification of Sleep Disorders (ICSD-3) added the sleep- related eating disorders in the disorders of arousal from NREM sleep.
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They can be triggered in certain individuals, by alcohol, sleep deprivation, physical activity, emotional stress, depression, medications, or a fevered illness. These disorders of arousal can range from confusional arousals, somnambulism, to night terrors. Other specific disorders include sleepeating, sleep sex, teeth grinding, rhythmic movement disorder, restless legs syndrome, and somniloquy.
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Oxford University Press. 2007. It is part of an overall model where there's regulation of the "overall level" of the consciousness of the brain and aspects responsible for "arousal" or "wakefulness" and awareness of oneself and of the environmentAugusto Caraceni; Luigi Grassi (2011). Delirium: Acute Confusional States in Palliative Medicine. Oxford University Press.
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Confusional arousal is a condition when an individual awakens from sleep and remains in a confused state. It is characterized by the individual's partial awakening and sitting up to look around. They usually remain in bed and then return to sleep. These episodes last anywhere from seconds to minutes and may not be reactive to stimuli.
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Confusional arousals are accompanied by mental confusion and disorientation, relative lack of response to environmental stimuli, and difficulty of awakening the subject. Vocalisation accompanied with coherent speech is common. Patients may appear upset and some of them become aggressive or agitated. As well as for children, attempting of awakening or consoling an adult patient may increase agitation.
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Leipzig and Wien, Deutlicke. that they could be distinguished from other causes of postpartum psychosis. Infective delirium hardly ever starts during pregnancy, and usually begins in the first postpartum week. The onset of sepsis and delirium are closely related, and the course parallels the infection, although about 20% of patients continue to suffer from chronic confusional states after recovery from the infection.
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In 1982 they stopped their activity, until 2011, when the four original members (Lucio Ardito, bass, Marco Bertoni, keyboards, Gianni Cuoghi, drums, Enrico Serotti, guitar) decided to reform the band. In 2012 two new albums have been published, "Italia calibro X" and the (once again) homonymous "Confusional Quartet". The single "Futurfunk" has been written together with Sir Bob Cornelius Rifo a.k.a. The Bloody Beetroots.
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Delirium, also known as acute confusional state, is an organically caused decline from a previous baseline mental functioning that develops over a short period of time, typically hours to days. Delirium is a syndrome encompassing disturbances in attention, consciousness, and cognition. It may also involve other neurological deficits, such as psychomotor disturbances (e.g. hyperactive, hypoactive, or mixed), impaired sleep-wake cycle, emotional disturbances, and perceptual disturbances (e.g.
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Similar to other prion diseases, the diagnosis can only be confirmed by a brain autopsy at post-mortem. Fatal insomnia has no known cure and involves progressively worsening insomnia, which leads to hallucinations, delirium, confusional states like that of dementia, and eventually death. The average survival time from onset of symptoms is 18 months. The first recorded case was an Italian man, who died in Venice in 1765.
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Sleep-related abnormal sexual behavior, Sleep sex, or sexsomnia, is a form of confusional arousal that may overlap with somnambulism. Thereby, a person will engage in sexual acts while still asleep. It can include such acts as masturbation, inappropriate fondling themselves or others, having sex with another person; and in more extreme cases, sexual assault. These behaviors are unconscious, occur frequently without dreaming, and bring along clinical, social, and legal implications.
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In case of suspicion parents are encouraged to use infrared camera to record the behaviour of their child during sleep. Association of video recordings of nocturnal episodes with historical features is an important tool for both understanding and correctly diagnosing the disorder differently from other episodes of parasomnia. Confusional arousals as well as arousal parasomnias in general must be distinguished from epileptic seizure on the basis of clinical and electroencephalographic features (see electroencephalography).
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Roger in 1932 coined the term parasomnia and classified hypersomnia, insomnia and parasomnia. Kleitman in 1939 recognized types of parasomnias as nightmares, night terrors, somniloquy (sleep-talking), somnambulism (sleepwalking), grinding of teeth, jactatians, enuresis, delirium, nonepileptic convulsions and personality dissociation. Broughton in 1968 developed classification of the arousal disorders as confusional arousals: night terrors and sleep walking. Insomnias were classified as primary and secondary till 1970 when they were recognized as symptoms of other disorders.
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Only about 50 chorea psychoses have been reported, and only one this century; but it could return if the streptococcus escapes control. Alcohol withdrawal states (delirium tremens) occur in addicts whose intake has been interrupted by trauma or surgery; this can happen after childbirth. Postpartum confusional states have also been reported during withdrawal from opium Hill N M (1891) Four cases of puerperal insanity. Transactions of the Iowa State Medical Society 9: 132-134.
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Bish's scholarship covered three broad topics. First, he was a gifted historian in C-L psychiatry.8,9 He also had an abiding interest in and knowledge about the interface of C-L psychiatry and neurology, in particular the problem of delirium. His work in this area culminated in Delirium: Acute Confusional States, a scholarly tour de force on an important and increasingly recognized topic, but one that had been ignored by mainstream psychiatry for many years.
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Confusional arousals are associated with behavioural awakening with persistent slow-wave electroencephalographic activity (see slow-wave sleep) during Non-rapid eye movement sleep (NREM). It suggests that sensorimotor network is activated while non sensorimotor areas are still "asleep". The altered state of consciousness may be explained by a hypersynchronous delta activity (see delta wave) in network involving the frontoparietal cortices (suggesting to be "asleep"), and higher frequency activities in sensorimotor, orbitofrontal, and temporal lateral cortices (suggesting an "awakening").
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Night terrors can often be mistaken for confusional arousal. While nightmares (bad dreams during REM sleep that cause feelings of horror or fear) are relatively common during childhood, night terrors occur less frequently. The prevalence of sleep terrors in general is unknown. The number of small children who experience sleep terror (distinct from sleep terror , which is recurrent and causes distress or impairment) are estimated at 36.9% at 18 months of age and at 19.7% at 30 months.
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Drug-induced cognitive problems can have serious consequences for elderly people and can lead to confusional states and "pseudo-dementia". About 10% of elderly patients referred to memory clinics actually have a drug-induced cause that most often is benzodiazepines. Benzodiazepines have also been linked to an increased risk of road traffic accidents and falls in the elderly. The long-term effects of benzodiazepines are still not fully understood in the elderly or any age group.
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Oneirophenia and schizophrenia are often confused although there are distinct differences between the conditions. Oneirophrenia has some of the characteristics of schizophrenia, such as a confusional state and clouding of consciousness, but without presenting the dissociative symptoms which are typical of that disorder. Oneiophrenia often begins with the inability to focus on things while schizophrenia frequently starts with a traumatic event. Persons affected by oneirophrenia have a feeling of dream-like derealization which, in its extreme form, may progress to delusions and hallucinations.
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Allergic side effects and liver damage seem to appear with an appreciable lower frequency. The elderly are particularly sensitive to anticholinergic side effects of chlorprothixene (precipitation of narrow angle glaucoma, severe obstipation, difficulties in urinating, confusional and delirant states). In patients >60 years the doses should be particularly low. Early and late extrapyramidal side effects may occur but have been noted with a low frequency (one study with a great number of participants has delivered a total number of only 1%).
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However, a study concluded, "Our findings suggest that, despite previous suggestions, moderate alcohol consumption does not protect older people from cognitive decline." Wernicke–Korsakoff syndrome is a manifestation of thiamine deficiency, usually as a secondary effect of alcohol abuse. The syndrome is a combined manifestation of two eponymous disorders, Korsakoff's Psychosis and Wernicke's encephalopathy. Wernicke's encephalopathy is the acute presentation of the syndrome and is characterised by a confusional state while Korsakoff's psychosis main symptoms are amnesia and executive dysfunction.
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Perampanel's label has a black box warning noting that some people taking the drug have undergone serious psychiatric and behavioral changes. These events occurred in people who had no history of such issues, as well as people who had such a history. The psychiatric changes included mood changes like euphoric mood, anger, irritability, aggression, belligerence, agitation, and anxiety, as well as psychosis (acute psychosis, hallucinations, delusions, paranoia) and delirium (delirium, confusional state, disorientation, memory impairment). Behavioral changes included physical assault and homicidal ideation and/or threats.
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NREM parasomnias are arousal disorders that occur during stage 3 (or 4 by the R&K; standardization) of NREM sleep—also known as slow wave sleep (SWS). They are caused by a physiological activation in which the patient's brain exits from SWS and is caught in between a sleeping and waking state. In particular, these disorders involve activation of the autonomic nervous system, motor system, or cognitive processes during sleep or sleep-wake transitions. Some NREM parasomnias (sleep-walking, night-terrors, and confusional arousal) are common during childhood but decrease in frequency with increasing age.
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About a third of patients with mild head injury are reported to have "islands of memory", in which the patient can recall only some events. During PTA, the patient's consciousness is "clouded". Because PTA involves confusion in addition to the memory loss typical of amnesia, the term "post-traumatic confusional state" has been proposed as an alternative. There are two types of amnesia: retrograde amnesia (loss of memories that were formed shortly before the injury) and anterograde amnesia (problems with creating new memories after the injury has taken place).
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5 line 49, tablet BM 22446. The demon features in the Diagnostic Handbook. In the chapter on infectious diseases, tablet 22, lines 62 to 64 read: In the chapter concerning neurological syndromes, on tablet 27 a variant of line 4 provides the omen: The demon frequently appears in prescriptions such as those for the fashioning of a figurine for a neurological disorder caused by a pursuing ghost, where “The evi[l confusional stat]e (causing ghost or) mukīl rēš lemutti-demon [which] was set [on] (personal name) son of (personal name)–he is your husband.
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In one of the few reported cases, the subject presented with muscle weakness and fatigue, muscle twitching, excessive sweating and salivation, small joint pain, itching and weight loss. The subject also developed confusional episodes with spatial and temporal disorientation, visual and auditory hallucinations, complex behavior during sleep and progressive nocturnal insomnia associated with diurnal drowsiness. There was also severe constipation, urinary incontinence, and excessive lacrimation. When left alone, the subject would slowly lapse into a stuporous state with dreamlike episodes characterized by complex and quasi-purposeful gestures and movements (enacted dreams).
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Most patients with severe TBI who recover consciousness suffer from cognitive disabilities, including the loss of many higher-level mental skills. Cognitive deficits that can follow TBI include impaired attention; disrupted insight, judgement, and thought; reduced processing speed; distractibility; and deficits in executive functions such as abstract reasoning, planning, problem-solving, and multitasking. Memory loss, the most common cognitive impairment among head-injured people, occurs in 20–79% of people with closed head trauma, depending on severity. Post- traumatic amnesia (PTA), a confusional state with impaired memory, is characterized by loss of specific memories or the partial inability to form or store new ones.
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In all of the reported cases, the need for sleep was severely reduced and in some cases not necessary. The duration of sleep in one case decreased to about 2–4 hours per 24-hour period. Clinical features pertaining to insomnia include daytime drowsiness associated with a loss of ability to sleep, intermingled with confusional oneiric status, and the emergence of atypical REM sleep from wakefulness. The polysomnogram (PSG) picture of this disease is characterized by an inability to generate physiological sleep (key features are the suppression of the hallmarks of stage 2 non-REM sleep: spindles and K complexes) and by the emergence of REM sleep without atonia.
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Formed in 1978, they had quite enthusiastic consent during their activity, playing a mixture of instrumental, avant-garde, experimental rock. The band published several works on vinyl, the single "Volare" (a futurist, instrumental cover of the famous song "Nel blu dipinto di blu" by Domenico Modugno), the homonymous LP, a mini LP and a limited edition of flexy discs. They 've also been included in various compilations, and their original records have been reissued on CDs. Confusional Quartet performed live in countless gigs, and because of their "arty" nature, they were invited to some contemporary art events, such as the "IV Settimana internazionale della Performance" (Bologna 1980) and "Universität für angewandte Kunst Festival" (Wien, 1981).
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Other common neuropsychiatric manifestations of SLE include cognitive dysfunction, mood disorder, cerebrovascular disease, seizures, polyneuropathy, anxiety disorder, psychosis, depression, and in some extreme cases, personality disorders. Steroid psychosis can also occur as a result of treating the disease. It can rarely present with intracranial hypertension syndrome, characterized by an elevated intracranial pressure, papilledema, and headache with occasional abducens nerve paresis, absence of a space-occupying lesion or ventricular enlargement, and normal cerebrospinal fluid chemical and hematological constituents. More rare manifestations are acute confusional state, Guillain–Barré syndrome, aseptic meningitis, autonomic disorder, demyelinating syndrome, mononeuropathy (which might manifest as mononeuritis multiplex), movement disorder (more specifically, chorea), myasthenia gravis, myelopathy, cranial neuropathy and plexopathy.
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A case study involving two patients who suffered from acute confusional state and abulia was conducted to see if these symptoms were the result of an infarct in the capsular genu. Using clinical neuropsychological and MRI evaluations at baseline and one year later showed that the cognitive impairment was still there one year after the stroke. Cognitive and behavioral alterations due to a genu infarct are most likely because the thalamo-cortical projection fibers that originate from the ventral-anterior and medial-dorsal nuclei traverse the internal capsule genu. These tracts are part of a complex system of cortical and subcortical frontal circuits through which the flow of information from the entire cortex takes place before reaching the basal ganglia.
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Swank and Marchand's WWII study found that after sixty days of continuous combat, 98% of all surviving military personnel will become psychiatric casualties. Psychiatric casualties manifest themselves in fatigue cases, confusional states, conversion hysteria, anxiety, obsessional and compulsive states, and character disorders. The Apotheosis of War (1871) by Vasily Vereshchagin Additionally, it has been estimated anywhere from 18% to 54% of Vietnam war veterans suffered from posttraumatic stress disorder. Based on 1860 census figures, 8% of all white American males aged 13 to 43 died in the American Civil War, including about 6% in the North and approximately 18% in the South. The war remains the deadliest conflict in American history, resulting in the deaths of 620,000 military personnel. United States military casualties of war since 1775 have totaled over two million. Of the 60 million European military personnel who were mobilized in World War I, 8 million were killed, 7 million were permanently disabled, and 15 million were seriously injured.Kitchen, Martin (2000), The Treaty of Versailles and its Consequences , New York: Longman The remains of dead Crow Indians killed and scalped by Sioux c.
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