open-index/open-wikipedia-markdown huggingface dataset:
Panic attack

**Panic attacks** be sudden periods of intense fear den discomfort wey fi include palpitations, otherwise dem define as a rapid, irregular heartbeat, sweating, chest pain anaa discomfort, shortness of breath, trembling, dizziness, numbness, confusion, anaa a sense of impending doom anaa loss of control. Typically, dese symptoms be de worst within ten minutes of onset wey fi last for roughly 30 minutes, though dem fi vary anywer from seconds to hours. While they can be extremely distressing, panic attacks themselves are not physically dangerous.

De *Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition* (DSM-5) dey define dem as "an abrupt surge of intense fear anaa intense discomfort wey dey reach a peak within minutes den during wich time four anaa more of de following symptoms dey occur." Dese symptoms dey include, buh no be limited to, de ones dem mention above.

Panic attacks dey function as a marker for assessing severity, course, den comorbidity (de simultaneous presence of two anaa more diagnoses) of different disorders, wey dey include anxiety disorders. Hence, while panic attacks cannot be applied to all disorders found in the DSM, they are a common comorbidity.

Panic attacks fi be caused by an identifiable source, anaa dem fi happen widout any warning den widout a specific, recognizable situation. Sam known causes wey dey increase de risk of having a panic attack dey include medical den psychiatric conditions (e.g., panic disorder, social anxiety disorder, post-traumatic stress disorder, substance use disorder, depression), substances (e.g., nicotine, caffeine), den psychological stress.

Before making a diagnosis, physicians dey seek to eliminate oda conditions wey fi produce similar symptoms, such as hyperthyroidism (an overactive thyroid), hyperparathyroidism (an overactive parathyroid), heart disease, lung disease, den dysautonomia, disease of de system wey dey regulate de body ein involuntary processes.

Treatment of panic attacks for be directed at de underlying cause. Insyd those plus frequent attacks, counseling anaa medications fi be used, as both preventative den abortive measures, ones wey dey stop de attack while e dey happen. Breathing training den muscle relaxation techniques sanso fi be useful.

Panic attacks often dey appear frightening to both those experiencing den those wey dey witness dem, den often, people sam times dey think dem get heart attacks secof de symptoms. However, while dem no dey cause much immediate physical harm, dem fi be a predictive risk factor for cardiac den oda illnesses.

Na previous studies suggest dat those wey dey suffer from anxiety disorders (e.g., panic disorder) be at higher risk of suicide.

Insyd Europe, approximately 3% of de population get a panic attack insyd a given year, while insyd de United States, dem affect about 11%. Panic attacks be more commonly diagnosed insyd females dan males den often dey begin during late puberty anaa early adulthood. Panic attacks fi continue on den off for a lifetime, anaa appear infrequently per. Young kiddies be less commonly affected.
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Ceftazidime

**Ceftazidime**, dem sell under de brand name **Fortaz** among odas, be a third-generation cephalosporin antibiotic useful for de treatment of a number of bacterial infections. Specifically dem dey use am for joint infections, meningitis, pneumonia, sepsis, urinary tract infections, malignant otitis externa, *Pseudomonas aeruginosa* infection, den vibrio infection. Dem dey give am by injection into a vein, muscle, anaa eye.

Common side effects dey include nausea, allergic reactions, den pain at de site of injection. Oda side effects fi include *Clostridioides difficile* diarrhea. Dem no recommend am insyd people wey na dem previous get anaphylaxis to a penicillin. Ein use be relatively safe during pregnancy den breastfeeding. E dey insyd de third-generation cephalosporin family of medications wey e dey work by interfering plus de bacteria ein cell wall.

Na dem patent ceftazidime insyd 1978 wey e cam into commercial use insyd 1984. E dey on de World Health Organization's List of Essential Medicines. Ceftazidime be available as a generic medication.

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Buspirone

**Buspirone**, dem sell under de name **Buspar** among odas, be an anxiolytic medication dem primarily use for de treatment of generalized anxiety disorder. Unlike benzodiazepines, buspirone no dey produce significant sedation, dependence, anaa withdrawal effects. Ein principal mechanism of action dey involve partial agonism at postsynaptic serotonin 5-HT1A receptors den full agonism at presynaptic 5-HT1A autoreceptors, wich initially dey reduce serotonergic neuron firing. Over time, autoreceptor desensitization dey occur, wey dey lead to increased serotonin release den enhanced serotonergic tone, wich fi contribute to ein clinical efficacy. Buspirone sanso get weak antagonistic effects at dopamine D2, D3, den D4 receptors den α1- den α2-adrenergic receptors.

Buspirone be approved for de management of generalized anxiety disorder. Dem sam times dey use off-label give oda anxiety disorders, depression augmentation, den certain behavioral conditions. Buspirone no be effective as a sedative-hypnotic anaa muscle relaxant wey e no get anticonvulsant properties.

Common side effects of buspirone dey include nausea, headaches, dizziness, den difficulty concentrating. Serious side effects fi include movement disorders, serotonin syndrome, den seizures. Ein use insyd pregnancy dey appear to be safe buh e no be well studied, den ein use during breastfeeding no be well studied either.

Na dem develop buspirone insyd 1968 wey na dem approve am for medical use insyd de United States insyd 1986. E be available as a generic medication. Insyd 2023, na e be de 40th most commonly prescribed medication insyd de United States, plus more dan 15million prescriptions.

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Porphyria

**Porphyria** (/pɔːrˈfɪriə/ anaa /pɔːrˈfaɪriə/) be a group of disorders insyd wich substances dem call porphyrins dey build up insyd de body, adversely dey affect de skin anaa nervous system. De types wey dey affect de nervous system sanso be known as acute porphyria, as symptoms be rapid insyd onset den short insyd duration. Symptoms of an attack dey include abdominal pain, chest pain, vomiting, confusion, constipation, fever, high blood pressure, den high heart rate. De attacks usually dey last for days to weeks. Complications fi include paralysis, low blood sodium levels, den seizures. Attacks fi be triggered by alcohol, smoking, hormonal changes, fasting, stress, anaa certain medications. If de skin be affected, blisters anaa itching fi occur plus sunlight exposure.

Chaw types of porphyria be inherited from one anaa both of a person ein parents den be secof a mutation insyd one of de genes wey dey make heme. Dem fi be inherited insyd an autosomal dominant, autosomal recessive, anaa X-linked dominant manner. One type, *porphyria cutanea tarda*, sanso be secof hemochromatosis (increased iron insyd de liver), hepatitis C, alcohol, anaa HIV/AIDS. De underlying mechanism dey result in a decrease insyd de amount of heme dem produce den a build-up of substances wey be involved insyd making heme. Porphyrias sanso fi be classified by whether de liver anaa bone marrow be affected. Diagnosis typically be made by blood, urine, den stool tests. Dem fi do genetic testing to determine de specific mutation. Hepatic porphyrias be those insyd wich de enzyme deficiency dey occur insyd de liver. Hepatic porphyrias dey include acute intermittent porphyria (AIP), variegate porphyria (VP), aminolevulinic acid dehydratase deficiency porphyria (ALAD), hereditary coproporphyria (HCP), den porphyria cutanea tarda.

Treatment dey depend on de type of porphyria den de person ein symptoms. Treatment of porphyria of de skin generally dey involve de avoidance of sunlight, while treatment for acute porphyria fi involve giving intravenous heme anaa a glucose solution. Rarely, dem fi carry out a liver transplant.

De precise prevalence of porphyria be unclear, buh e be estimated to affect between 1 den 100 per 50,000 people. Rates be different around de world. Dem dey believe porphyria cutanea tarda to be de most common type. Na dem describe de disease as early as 370 BC by Hippocrates. Na de underlying mechanism be first described by German physiologist den chemist Felix Hoppe-Seyler insyd 1871. De name *porphyria* be from de Greek πορφύρα, *porphyra*, wey dey mean "purple", a reference to de color of de urine wey fi be present during an attack.

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## External links

* The Drug Database for Acute Porphyria - comprehensive database on drug porphyrinogenicity
* Orphanet's disease page on Porphyria
Panic disorder

**Panic disorder** be an anxiety disorder wey be characterized by reoccurring unexpected panic attacks. Panic attacks be sudden periods of intense fear wey fi include palpitations, sweating, shaking, shortness of breath, numbness, anaa a sense of impending doom. De maximum degree of symptoms dey occur within minutes. Der fi be ongoing worries about having further attacks den avoidance of places wer na attacks occur insyd de past.

Dem no dey fully understand exact cause of panic disorder; however, der be chaw factors dem link to de disorder, such as a stressful anaa traumatic life event, having close family members plus de disorder, den an imbalance of neurotransmitters. Diagnosis dey involve ruling out oda potential causes of anxiety wey dey include oda mental disorders, medical conditions such as heart disease anaa hyperthyroidism, den drug use. Screening give de condition fi be done using a questionnaire.

Panic disorder usually be treated plus counselling den medications. De type of counselling dem use be typically cognitive behavioral therapy (CBT), which is effective in more than half of people. Medications used include antidepressants, benzodiazepines, and beta blockers. Following stopping treatment, up to 30% of people have a recurrence.

Panic disorder dey affect about 2.5% of people at sam point insyd dema lives. E usually dey begin during adolescence anaa early adulthood, buh fi affect people of any age. E be less common insyd kiddies den elderly people. Women be more likely dan men to develop panic disorder.

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Psychological stress

Insyd psychology, **stress** be a feeling of emotional strain den pressure. Stress be a form of psychological den mental discomfort. Small amounts of stress fi be beneficial, as e fi improve athletic performance, motivation den reaction to de environment. Excessive amounts of stress, however, fi increase de risk of strokes, heart attacks, ulcers, den mental illnesses such as depression den sanso aggravate pre-existing conditions.

Psychological stress fi be external den relate to de environment, buh sanso be caused by internal perceptions wey dey cause an individual to experience anxiety anaa oda negative emotions wey dey surround a situation, such as pressure, discomfort, etc., wich dem then deem stressful.

Na Hans Selye (1974) propose four variations of stress. On one axis, he dey locate good stress (eustress) den bad stress (distress). On de oda be over-stress (hyperstress) den understress (hypostress). Selye dey advocate balancing dese: na de ultimate goal go be to balance hyperstress den hypostress perfectly wey e get as much eustress as possible.

De term "eustress" dey cam from de Greek root *eu-* wich dey mean "good" (as insyd "euphoria"). Eustress dey result wen a person dey perceive a stressor as positive. "Distress" dey stem from de Latin root *dis-* (as insyd "dissonance" anaa "disagreement"). Medically dem define distress be a threat to de quality of life. E dey occur wen a demand vastly dey exceed a person ein capabilities.

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Aripiprazole

**Aripiprazole**, dem sell under de brand name **Abilify**, **Aripiprex**, **Ariply** among odas, be an atypical antipsychotic dem primarily use insyd de treatment of schizophrenia, bipolar disorder, den irritability dem associate plus autism spectrum disorder; oda uses dey include as an add-on treatment for major depressive disorder den tic disorders. Dem dey take aripiprazole by mouth anaa via injection into a muscle.

Common side effects dey include restlessness, insomnia, transient weight gain, nausea, vomiting, constipation, dizziness, den mild sedation. Serious side effects fi include neuroleptic malignant syndrome, tardive dyskinesia, den anaphylaxis. E no be recommended give older people plus dementia-related psychosis secof an increased risk of death. Insyd pregnancy, der be evidence of possible harm to de fetus. E no be recommended insyd women wey be breastfeeding. E no be very well studied insyd people younger dan 18 years old.

Na dem approve aripiprazole for medical use insyd de United States insyd 2002. E be available as a generic medication. Insyd 2023, na e be de 95th most commonly prescribed medication insyd de United States, plus more dan 7million prescriptions. E be on de World Health Organization's List of Essential Medicines.

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Rosuvastatin

**Rosuvastatin**, dem sell under de brand name **Crestor** among odas, be a statin medication, dem use to prevent cardiovascular disease insyd those at high risk den treat abnormal lipids. E be recommended to be used plus dietary changes, exercise, den weight loss. Dem dey take am orally (by mouth).

Common side effects dey include abdominal pain, nausea, headaches, den muscle pains. Serious side effects fi include rhabdomyolysis, liver problems, den diabetes. Ein use during pregnancy fi harm de baby. Like all statins, rosuvastatin dey work by inhibiting HMG-CoA reductase, an enzyme dem find insyd de liver wey dey play a role in producing cholesterol.

Na dem patent rosuvastatin insyd 1991 wey na dem approve am for medical use insyd de United States insyd 2003. E be available as a generic medication. Insyd 2023, na e be de twelfth most commonly prescribed medication insyd de United States, plus more dan 42million prescriptions. Insyd Australia, na e be one of de top 10 most prescribed medications between 2017 den 2023.

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Oxytocin

**Oxytocin** be a peptide hormone den neuropeptide dem normally produce insyd de hypothalamus wey e be released by de posterior pituitary. Present insyd animals since early stages of evolution, insyd humans e dey play roles insyd behavior wey dey include social bonding, love, reproduction, childbirth, den de period after childbirth. Oxytocin be released into de bloodstream as a hormone in response to sexual activity den during childbirth. E sanso be available insyd pharmaceutical form. Insyd either form, oxytocin dey stimulate uterine contractions to speed up de process of childbirth.

Insyd ein natural form, e sanso dey play a role in maternal bonding den milk production. Production den secretion of oxytocin be controlled by a positive feedback mechanism, wer ein initial release dey stimulate production den release of further oxytocin. For example, wen oxytocin be released during a contraction of de uterus at de start of childbirth, dis dey stimulate production den release of more oxytocin den an increase insyd de intensity den frequency of contractions. Dis process dey compound insyd intensity den frequency den dey continue til de triggering activity ceases. A similar process dey take place during lactation den during sexual activity.

Oxytocin be derived by enzymatic wey dey split from de peptide precursor encoded by de human OXT gene. De deduced structure of de active nonapeptide be:

Cys – Tyr – Ile – Gln – Asn – Cys – Pro – Leu – Gly – NH2, or CYIQNCPLG-NH2.

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Acute stress reaction

**Acute stress reaction** (**ASR**), dem sanso know as **psychological shock**, **mental shock**, anaa simply **shock**, as well as **acute stress disorder** (**ASD**), be a psychological response to a terrifying, traumatic, anaa surprising experience. De reactions fi include buh no be limited to intrusive thoughts, anaa dissociation, den reactivity symptoms such as avoidance anaa hyperarousal. E fi be exhibited for days anaa weeks after de traumatic event. If de condition no be correctly addressed, e fi develop into post-traumatic stress disorder (PTSD).

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Dissociative disorder

**Dissociative disorders** (**DDs**) be a range of mental disorders wey be characterized by significant disruptions anaa fragmentation "insyd de normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, den behavior." Dissociative disorders dey involve involuntary dissociation as an unconscious defense mechanism, wherein de individual plus a dissociative disorder dey experience separation insyd dese areas as a means to protect against traumatic stress. Sam dissociative disorders be caused by major psychological trauma, though de onset of depersonalization-derealization disorder fi be preceded by less severe stress, by de influence of psychoactive substances, anaa occur widout any discernible trigger.

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* Dissociative disorders—Mayo Clinic
* Depersonalization Disorder—Cleveland Clinic
* International Society for the Study of Trauma and Dissociation
Depersonalization-derealization disorder

**Depersonalization-derealization disorder** (**DPDR**, **DDD**) be a dissociative disorder insyd wich de person get persistent anaa recurrent feelings of depersonalization den/anaa derealization. Depersonalization be described as feeling disconnected anaa detached from one ein self. Individuals fi report feeling as if dem be an outsyd observer of dema own thoughts anaa body, den often report feeling a loss of control over dema thoughts anaa actions. Derealization be described as detachment from one ein surroundings. Individuals dey experience derealization fi report perceiving de world around dem as foggy, dreamlike, surreal, den/anaa visually distorted.

Dem dey think depersonalization-derealization disorder to be caused largely by interpersonal trauma such as early childhood abuse. Adverse childhood experiences, specifically emotional abuse den neglect, na dem be linked to de development of depersonalization symptoms. Feelings of depersonalization den derealization be common from significant stress, anxiety, anaa panic attacks. Individuals fi remain insyd a depersonalized state for de duration of a typical panic attack. However, insyd sam cases, de dissociated state fi last for hours, days, weeks, anaa even months at a time. Insyd rare cases, symptoms of a single episode fi last for years.

Diagnostic criteria for depersonalization-derealization disorder dey include persistent anaa recurrent feelings of detachment from one ein mental anaa bodily processes anaa from one ein surroundings. Dem dey make a diagnosis wen de dissociation be persistent, dey interfere plus de social anaa occupational functions of daily life, den/anaa causes marked distress insyd de patient.

Na while depersonalization-derealization disorder once be considered rare, lifetime experiences plus am dey occur insyd about 1–2% of de general population. Na de chronic form of de disorder get a reported prevalence of 0.8 to 1.9%. While brief episodes of depersonalization anaa derealization fi be common insyd de general population, de disorder only be diagnosed wen dese symptoms cause substantial distress anaa impair social, occupational, anaa oda important areas of functioning.

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Minoxidil

**Minoxidil**, dem sell under de brand names **Loniten** den **Rogaine** among odas, be a medication dem use for de treatment of high blood pressure den pattern hair loss. E be an antihypertensive den a vasodilator. E be available as a generic medication by prescription insyd oral tablet form den over-the-counter as a topical liquid anaa foam.

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Sudden infant death syndrome

**Sudden infant death syndrome** (**SIDS**), sam times dem know as **cot death** anaa **crib death**, be de sudden unexplained death of a kiddie of less dan one year of age. Diagnosis dey require dat de death remain unexplained even after a thorough autopsy den detailed death scene investigation. SIDS dey usually occur between de hours of midnight den 9:00 a.m., anaa wen de baby be sleeping. Der be usually no noise anaa evidence of struggle. SIDS dey remain one of de leading causes of infant mortality insyd Western countries, wey dey constitute almost 1/3 of all post-neonatal deaths.

De exact cause of SIDS be unknown. De requirement of a combination of factors wey dey include a specific underlying susceptibility, a specific time insyd development, wey na dem propose an environmental stressor. Dese environmental stressors fi include sleeping on de stomach anaa side, overheating, den exposure to tobacco smoke. Accidental suffocation from bed sharing (dem sanso know as co-sleeping) anaa soft objects sanso fi play a role. Anoda risk factor be dem born before 37 weeks of gestation. Between 1% den 5% of SIDS cases be estimated to be misidentified infanticides wey cause by intentional suffocation. SIDS dey make up about 80% of sudden den unexpected infant deaths (SUIDs). De oda 20% of cases often be caused by infections, genetic disorders, den heart problems.

De most effective method of reducing de risk of SIDS be putting a kiddie less dan one year old on dema back to sleep. Oda measures dey include a firm mattress separate from buh close to caregivers, no loose bedding, a relatively cool sleeping environment, using a pacifier, den dey avoid exposure to tobacco smoke. Breastfeeding den immunization sanso fi be preventative. Measures wey no show to be useful dey include positioning devices den baby monitors. Evidence no be sufficient for de use of fans. Grief support for families wey be affected by SIDS be important, as de death of de infant be unexpected, unexplained, den fi cause suspicion na de infant fi been intentionally harmed.

Rates of SIDS dey vary nearly tenfold insyd developed countries from one insyd a thousand to one insyd ten thousand. Globally, e result in about 19,200 deaths insyd 2015, down from 22,000 deaths insyd 1990. Na SIDS be de third leading cause of death insyd kiddies less dan one year old insyd de United States insyd 2011. E be de most common cause of death between one month den one year of age. About 90% of cases dey happen before six months of age, wey e be most frequent between two months den four months of age. E be more common insyd boys dan girls. Na rates of SIDS decrease by up to 80% insyd areas plus "Safe to Sleep" campaigns.

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Prednisone

**Prednisone** be a glucocorticoid medication dem mostly use to suppress de immune system den decrease inflammation insyd conditions such as asthma, COPD, den rheumatologic diseases. E sanso be used to treat high blood calcium secof cancer den adrenal insufficiency along plus oda corticosteroids. Dem dey take am by mouth.

Common side effects fi include cataracts, bone loss, easy bruising, muscle weakness, den thrush. Oda side effects dey include weight gain, swelling, high blood sugar, increased risk of infection, den psychosis. E be generally considered safe insyd pregnancy den low doses dey appear to be safe while de user dey breastfeed. After prolonged use, prednisone for be stopped gradually.

Prednisone be a prodrug wey e for be converted to prednisolone by de liver before e cam be active. Prednisolone then dey bind to glucocorticoid receptors, wey dey activate dem den dey trigger changes insyd gene expression. Dese changes dey inhibit function den decrease de number of key leukocytes insyd de bloodstream.

Na dem patent prednisone insyd 1954 wey na dem approve for medical use insyd de United States insyd 1955. Prednisone be a therapeutic alternative on de World Health Organization's List of Essential Medicines. E be available as a generic medication. Insyd 2023, na e be de 38th most commonly prescribed medication insyd de United States, plus more dan 15million prescriptions.

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Dissociative fugue

**Dissociative fugue** (/fjuːɡ/ *FYOOG*), dem previously refer to as a **fugue state** anaa **psychogenic fugue**, be a rare psychiatric condition wey be characterized by reversible amnesia wey dey regard one ein identity, often be accompanied by unexpected travel anaa wandering. Insyd sam cases, individuals fi assume a new identity den be unable to recall personal information from before de onset of symptoms. E be classified as a mental den behavioral disorder wey e be variously categorized as a dissociative disorder, a conversion disorder, anaa a somatic symptom disorder. According to de *Diagnostic and Statistical Manual of Mental Disorders* (DSM-5), dissociative fugue be a subset of dissociative amnesia.

Recovery from a fugue state typically dey result in de restoration of prior memories, den additional treatment be generally unnecessary. Dem no dey consider episodes dissociative fugue if attributable to psychotropic substances, physical trauma, general medical conditions, anaa disorders such as dissociative identity disorder, delirium, anaa dementia. Dissociative fugue often be triggered by prolonged traumatic experiences wey e be most frequently associated plus individuals wey experience childhood sexual abuse, during wich dem develop dissociative amnesia to suppress memories of de abuse.

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*"Dissociative Fugue" from the Merck & Co. website.
Dissociative amnesia

**Dissociative amnesia** anaa **psychogenic amnesia** be a dissociative disorder "wey be characterized by retrospectively reported memory gaps. Dese gaps dey involve an inability to recall personal information, usually of a traumatic anaa stressful nature." De concept be scientifically controversial den remain disputed.

Na dissociative amnesia previously be known as psychogenic amnesia, a memory disorder, wich na e be characterized by sudden retrograde episodic memory loss, dem say to occur for a period of time wey dey range from hours to years to decades.

De atypical clinical syndrome of de memory disorder (as dem oppose to organic amnesia) be say a person plus dissociative amnesia be profoundly unable to remember personal information about demaselves; der be a lack of conscious self-knowledge wich dey affect even simple self-knowledge, such as who dem be. Dissociative amnesia be distinguished from organic amnesia insyd say e be supposed to result from a nonorganic cause: na no structural brain damage for be evident buh sam form of psychological stress for precipitate de amnesia. Dissociative amnesia as a memory disorder be controversial.

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Body dysmorphic disorder

**Body dysmorphic disorder** (**BDD**), dem sanso know insyd sam contexts as **dysmorphophobia** anaa **dysmorphia**, be a mental disorder dem define by an overwhelming preoccupation plus a perceived flaw insyd one ein physical appearance. Insyd BDD ein delusional variant, de flaw be imagined. Wen an actual visible difference dey exist, ein importance be disproportionately magnified insyd de mind of de individual. Whether de physical issue be real anaa imagined, ruminations wey dey concern dis perceived defect cam be pervasive den intrusive, wey dey consume substantial mental bandwidth for extended periods each day. Dis excessive preoccupation dey induce severe emotional distress den sanso dey disrupt daily functioning den activities. De DSM-5 dey place BDD within de obsessive–compulsive spectrum, wey dey distinguish am from disorders such as anorexia nervosa.

BDD be estimated to affect from 0.7% to 2.4% of de population. E usually dey start during adolescence den dey affect both men den women. De BDD subtype muscle dysmorphia, wey dey perceive de body as too small, dey affect mostly men. In addition to thinking about am, de sufferer typically dey check den compare de perceived flaw repetitively wey fi adopt unusual routines to avoid social contact wey dey expose am. Fearing de stigma of vanity, dem usually dey hide dis preoccupation. Dem commonly overlook even by psychiatrists, na BDD be underdiagnosed. As de disorder severely dey impair quality of life secof educational den occupational dysfunction den social isolation, those wey dey experience BDD tend to get high rates of suicidal thoughts wey dem fi attempt suicide.

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Impetigo

**Impetigo** be a contagious bacterial infection wey dey involve de superficial skin. De most common presentation be yellowish crusts on de face, arms, anaa legs. Less commonly der fi be large blisters wich dey affect de groin anaa armpits. De lesions fi be painful anaa itchy. Fever be uncommon.

E be typically secof either *Staphylococcus aureus* anaa *Streptococcus pyogenes*. Risk factors dey include attending day care, crowding, poor nutrition, diabetes mellitus, contact sports, den breaks insyd de skin such as from mosquito bites, eczema, scabies, anaa herpes. With contact it can spread around or between people. Diagnosis typically be based on de symptoms den appearance.

Prevention be by hand washing, avoiding people wey be infected, den cleaning injuries. Dem sam times dey use Ivermectin Mass Drug Administrations to prevent cases insyd high-prevalence settings such as Fiji, wer impetigo be commonly a scabies sequela. Treatment typically be plus antibiotic creams such as mupirocin anaa fusidic acid. Antibiotics by mouth, such as cefalexin, fi be used if large areas be affected. Na dem find antibiotic-resistant forms. Healing generally dey occur widout scarring.

Na impetigo affect about 140&nbsp;million people (2% of de world population) insyd 2010. E fi occur at any age, buh e most common be insyd young kiddies aged two to five. Insyd sam places de condition sanso be known as "school sores". Widout treatment people typically get better within three weeks. Recurring infections fi occur secof colonization of de nose by de bacteria. Complications fi include cellulitis or poststreptococcal glomerulonephritis. De name be from de Latin  wey dey mean "attack".

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* Impetigo and Ecthyma at *The Merck Manual of Diagnosis and Therapy* Professional Edition
Insomnia

**Insomnia**, dem sanso know as **sleeplessness**, be a sleep disorder wey dey cause difficulty falling asleep anaa staying asleep for as long as desired. Insomnia typically be followed by daytime sleepiness, low energy, irritability, den a depressed mood. E fi result in an increased risk of accidents as well as problems focusing den learning. Insomnia fi be short-term, lasting for days anaa weeks, anaa long-term, wey dey last more dan a month. De concept of de word *insomnia* get two distinct possibilities: insomnia disorder anaa insomnia symptoms.

Insomnia fi occur independently anaa as a result of anoda problem. Conditions wey fi result in insomnia dey include psychological stress, chronic pain, heart failure, hyperthyroidism, heartburn, restless leg syndrome, menopause, certain medications, den drugs such as caffeine, nicotine, den alcohol. Risk factors dey include working night shifts den sleep apnea. Diagnosis dey base on sleep habits den an examination to look for underlying causes. Dem fi do a sleep study to look for underlying sleep disorders. Dem fi do screening plus questions like "You dey experience difficulty sleeping anaa?" anaa "You get difficulty falling anaa staying asleep?"

Dem dey consider cognitive behavioral therapy de first-line treatment. Sleep hygiene den lifestyle changes sanso be recommended for insomnia, though dema efficacy no be definitely established. Sleep hygiene dey include a consistent bedtime, a quiet den dark room, exposure to sunlight during de day den regular exercise. Sleeping pills fi improve sleep, though sam be associated plus falls, cognitive impairment, den dependence. Dese medications no be recommended for more dan four anaa five weeks buh fi be used longer insyd certain instances. Among dese, lemborexant den eszopiclone get de most favorable efficacy den safety profiles. De efficacy den safety of alternative medicine treatments be unclear.

Between 10% den 30% of adults get insomnia at any given point in time, den up to half of people get insomnia insyd a given year. About 6% of people get insomnia wey no be secof anoda problem den dey last for more dan a month. People over de age of 65 be affected more often dan younger people. Women be more often affected dan men. Descriptions of insomnia dey occur at least as far back as ancient Greece. 

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Trypophobia

**Trypophobia** be an aversion to de sight of repetitive patterns, anaa clusters, of small holes anaa bumps. Although no be clinically recognized as a separate mental anaa emotional disorder, trypophobia fi fall under de category of 'specific phobia' insyd cases wer e dey cause excessive fear anaa distress. Most sufferers normally dey experience mainly disgust wen dem see trypophobic imagery, although sam dey experience equal levels of fear den disgust.

, trypophobia be poorly understood by de scientific community. Insyd de few studies wey na take place, na chaw researchers hypothesize say e be de result of a biological revulsion, wey dey cause de afflicted to associate trypophobic shapes plus danger anaa disease, wey therefore fi get sam evolutionary basis, den dat exposure therapy fi be a possible treatment.

Na dem coin de term *trypophobia* by an anonymous member of an online forum insyd 2005. Na e since cam be a common topic on social networking sites.

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Thalidomide

**Thalidomide**, dem sell under de brand names **Contergan**, **Distaval** den **Thalomid** among odas, be an oral administered medication dem use to treat a number of cancers (e.g., multiple myeloma), graft-versus-host disease, den chaw skin disorders (e.g., complications of leprosy such as skin lesions). Na dem use thalidomide to treat conditions wey be associated plus HIV: aphthous ulcers, HIV-associated wasting syndrome, diarrhea, den Kaposi's sarcoma, buh na dem report increases insyd HIV viral load.

Common side effects dey include sleepiness, rash, den dizziness. Severe side effects dey include tumor lysis syndrome, blood clots, den peripheral neuropathy. Thalidomide be a known human teratogen den dey carry an extremely high risk of severe, life-threatening birth defects if dem administer anaa take am during pregnancy. E dey cause skeletal deformities such as amelia (absence of legs den/anaa arms), absence of bones, den phocomelia (malformation of de limbs). A single dose of thalidomide, regardless of dosage, be enough to cause teratogenic effects.

Na dem first market thalidomide insyd 1957 insyd West Germany, wer na e be available as an over-the-counter drug. Wen na dem first release am, na dem promote thalidomide for anxiety, trouble sleeping, "tension", den morning sickness. While na dem initially think e be safe insyd pregnancy, na dem find thalidomide to cause birth defects, wey resulting in ein removal from de market insyd Europe insyd 1961. Na de total number of infants severely harm by thalidomide use during pregnancy be estimated at over 10,000, possibly 20,000, of whom na about 40% died around de time of birth. Na those wey survive get limb, eye, urinary tract, den heart problems. Na ein initial entry into de US market be prevented by Frances Kelsey, a reviewer at de FDA. De birth defects wey be caused by thalidomide lead to de development of greater drug regulation den monitoring insyd chaw countries.

Na dem approve am insyd de United States insyd 1998 for use as a treatment give cancer. E dey on de World Health Organization's List of Essential Medicines. E be available as a generic medication.

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Cholangiocarcinoma

**Cholangiocarcinoma**, dem sanso know as **bile duct cancer**, be a type of cancer wey dey form insyd de bile ducts. Symptoms of cholangiocarcinoma fi include abdominal pain, yellowish skin, weight loss, generalized itching, den fever. Light colored stool anaa dark urine sanso fi occur. Oda biliary tract cancers dey include gallbladder cancer den cancer of de ampulla of Vater.

Risk factors give cholangiocarcinoma dey include primary sclerosing cholangitis (an inflammatory disease of de bile ducts), ulcerative colitis, cirrhosis, hepatitis C, hepatitis B, infection plus certain liver flukes, den sam congenital liver malformations. Chaw people get no identifiable risk factors. De diagnosis be suspected based on a combination of blood tests, medical imaging, endoscopy, den sam times surgical exploration. De disease be confirmed by examination of cells from de tumor under a microscope. E typically be an adenocarcinoma (a cancer wey dey form glands anaa dey secrete mucin).

Cholangiocarcinoma typically be incurable at diagnosis, wich be why early detection be ideal. Insyd dese cases palliative treatments fi include surgical resection, chemotherapy, radiation therapy, den stenting procedures. Insyd about a third of cases wey dey involve de common bile duct den, less commonly, plus oda locations, de tumor fi be completely removed by surgery, wey dey offer a chance of a cure. Even wen surgical removal be successful, chemotherapy den radiation therapy be generally recommended. Insyd sam instances, surgery fi include a liver transplantation. Even wen surgery be successful, de 5-year survival probability typically be less dan 50%.

Cholangiocarcinoma be rare insyd de Western world, plus estimates of e dey occur insyd 0.5–2 people per 100,000 per year. Rates be higher insyd Southeast Asia wer liver flukes be common. Rates insyd parts of Thailand be 60 per 100,000 per year. E typically dey occur insyd people insyd dema 70s, den insyd de 40s for those plus primary sclerosing cholangitis. Na rates of cholangiocarcinoma within de liver insyd de Western world increase.

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## External links

* American Cancer Society Detailed Guide to Bile Duct Cancer.
* Patient information on extrahepatic bile duct tumors, from the National Cancer Institute.
* Cancer.Net: Bile Duct Cancer 
* Cholangiocarcinoma Foundation
* World Cholangiocarcinoma Day
Pantoprazole

**Pantoprazole**, dem sell under de brand name **Protonix**, among odas, be a medication dem use for de treatment of stomach ulcers, short-term treatment of erosive esophagitis secof gastroesophageal reflux disease (GERD), maintenance of healing of erosive esophagitis, den pathological hypersecretory conditions wey dey include Zollinger–Ellison syndrome. E sanso fi be used along plus oda medications to eliminate *[[Helicobacter pylori]]*. Pantoprazole be a proton-pump inhibitor (PPI) wey ein effectiveness be similar to dat of oda PPIs. E be available by mouth den by injection into a vein.

Common side effects dey include headaches, diarrhea, abdominal pain, den joint pain. More serious side effects fi include severe allergic reactions, a type of chronic inflammation dem know as atrophic gastritis, *Clostridioides difficile* colitis, low magnesium, den vitamin B12 deficiency. Ein use insyd pregnancy dey appear to be safe. Pantoprazole be a proton pump inhibitor wey dey decrease gastric acid secretion. E dey work by inactivating (H+/K+)-ATPase function insyd de stomach.

Na de study of pantoprazole begin insyd 1985, wey na e cam into medical use insyd Germany insyd 1994. E be available as a generic medication. Insyd 2023, na e be de thirteenth most commonly prescribed medication insyd de United States, plus more dan 37million prescriptions. Insyd Australia, na e be one of de top 10 most prescribed medications between 2017 den 2023.

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Conversion disorder

Na **conversion disorder** (**CD**) be a formerly diagnosed psychiatric disorder wey be characterized by abnormal sensory experiences den movement problems during periods of high psychological stress. Individuals dem diagnose plus CD dem present plus highly distressing neurological symptoms such as numbness, blindness, paralysis, anaa convulsions, na none of wich be consistent plus a well-established organic cause wey na dem fi be traced back to a psychological trigger. CD no longer be a diagnosis insyd de WHO ein ICD-11 anaa APA ein DSM-5 wey na e be superseded by functional neurologic disorder (FND), a similar diagnosis wey notably remove de requirement for a psychological stressor to be present.

Na e be thought dat dese symptoms dey arise insyd response to stressful situations wey dey affect a patient ein mental health. Individuals dem diagnose plus conversion disorder get a greater chance of experiencing certain psychiatric disorders wey deu include anxiety disorders, mood disorders, den personality disordersdem compare to those dem diagnose plus neurological disorders.

Na conversion disorder partly be retained insyd de DSM-5-TR den ICD-11, buh na dem rename to functional neurological symptom disorder (FNSD) den dissociative neurological symptom disorder (DNSD), respectively. FNSD dey cover a similar range of symptoms dem find insyd conversion disorder, buh no dey include de requirements for a psychological stressor to be present. De new criteria no longer dey require feigning to be disproven before diagnosing FNSD. A fifth criterion dey describe a limitation insyd sexual functioning wey na e include insyd de DSM-IV dem remove insyd de DSM-5 as well. De ICD-11 dey classify DNSD as a dissociative disorder plus unspecified neurological symptoms. 

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Ganser syndrome

**Ganser syndrome** be a rare dissociative disorder wey be characterized by nonsensical anaa wrong answers to questions den oda dissociative symptoms such as fugue, amnesia anaa conversion disorder, often plus visual pseudohallucinations den a decreased state of consciousness. Na de syndrome sanso be called *nonsense syndrome*, *balderdash syndrome*, *syndrome of approximate answers*, *hysterical pseudodementia* anaa *prison psychosis*.

De term **prison psychosis** sam times be used secof de syndrome dey occur most frequently insyd prison inmates, wer e fi be seen as an attempt to gain leniency from prison anaa court officials. Psychological symptoms generally dey resemble de patient ein sense of mental illness rada dan any recognized category. De syndrome fi occur insyd persons plus oda mental disorders such as schizophrenia, depressive disorders, toxic states, paresis, alcohol use disorders den factitious disorders. Ganser syndrome sam times fi be diagnosed as merely malingering, buh e be more often defined as a dissociative disorder.

De identification of Ganser syndrome be attributed to German psychiatrist Sigbert Ganser (1853–1931). Insyd 1898, na he describe de disorder insyd prisoners wey dey await trial insyd a penal institution insyd Halle, Germany. Na he name impaired consciousness den distorted communication, namely insyd de form of approximate answers (dem sanso refer to as *Vorbeireden* insyd de literature, German for "to talk past; to have a misunderstanding"), as de defining symptoms of de syndrome. Vorbeireden involves the inability to answer questions precisely, although the content of the questions is understood.

Ganser syndrome be described as a dissociative disorder not otherwise specified (DDNOS) insyd de DSM-IV, wey e currently no be listed insyd de DSM-5. E be a rare den an often overlooked clinical phenomenon. Insyd chaw cases, e be preceded by extreme stress wey be followed by amnesia for de period of psychosis. In addition to approximate answers, oda symptoms dey include a clouding of consciousness, somatic conversion disorder symptoms, confusion, stress, loss of personal identity, echolalia, den echopraxia.

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Duloxetine

**Duloxetine**, dem sell under de brand name **Cymbalta** among odas, be a medication dem use to treat major depressive disorder, generalized anxiety disorder, obsessive–compulsive disorder, fibromyalgia, neuropathic pain, central sensitization, den oda types of chronic pain. Dem dey take am by mouth.

Duloxetine be a serotonin–norepinephrine reuptake inhibitor (SNRI). De precise mechanism give ein antidepressant den anxiolytic effects no be known.

Common side effects dey include dry mouth, nausea, constipation, loss of appetite, drowsiness, sexual problems, den increased sweating. Severe side effects dey include an increased risk of suicide, serotonin syndrome, mania, den liver problems. Antidepressant withdrawal syndrome fi occur if dem stop. Ein use during de later part of pregnancy fi increase de risk of bleeding anaa cause complications for de fetus.

Na dem approve duloxetine for medical use insyd de United States den de European Union insyd 2004. E be available as a generic medication. Insyd 2023, na e be de 31st most commonly prescribed medication insyd de United States, plus more dan 18million prescriptions.

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Globus pharyngeus

**Globus pharyngeus** (dem sanso term **globus pharyngis**, **globus hystericus**, anaa **globus sensation**) be de persistent buh painless sensation of having a pill, food bolus, anaa sam oda sort of obstruction insyd de throat wen der be none. Swallowing be typically performed normally, so e no be a true case of dysphagia, buh e fi cam be quite irritating. E be common, plus 22–45% of people wey dey experience am at least once insyd dema lifetime.

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Psychogenic non-epileptic seizure

**Psychogenic non-epileptic seizures** (**PNES**), dem sanso refer to as **functional seizures** anaa **dissociative seizures**, be episodes wey dey resemble epileptic seizures buh dem no be caused by abnormal electrical activity insyd de brain. Instead, dem be classified as a type of functional neurological disorder (FND), insyd wich symptoms fi arise from changes in brain function rada dan structural disease anaa epilepsy. During a PNES episode, seizure-like behavior dey occur insyd de absence of epileptiform activity on electroencephalogram (EEG).

PNES fi be difficult to distinguish from epileptic seizures based on clinical observation alone. Diagnosis typically be confirmed thru video-EEG monitoring, wich dey record both de clinical event den de absence of epileptiform activity. Dese episodes be involuntary den genuine, no be consciously produced. Management primarily dey involve psychological treatment, particularly cognitive behavioral therapy (CBT). Outcomes dey vary wey fi be influenced by factors such as early diagnosis, therapeutic engagement, den coexisting psychiatric conditions.

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False pregnancy

**False pregnancy** (anaa **pseudocyesis**, from Ancient Greek *pseudes* 'false' den  *kyesis* 'pregnancy"') be de appearance of clinical anaa subclinical signs den symptoms wey be associated plus pregnancy although de individual no be physically dey carry a fetus. De mistaken impression wey one be pregnant dey include signs den symptoms such as tender breasts plus secretions, abdominal growth, delayed menstrual periods, den subjective feelings of a moving fetus. Examination, ultrasound, den pregnancy tests fi be used to rule out false pregnancy.

False pregnancy get a prominent psychiatric component as well as physical manifestations of pregnancy. E fi be caused by trauma (either physical anaa mental), a chemical imbalance of hormones, den sam medical conditions. Contributing psychological factors dey include a strong desire for pregnancy anaa misinterpretation of objective bodily sensations. Although rare, men fi experience false pregnancy symptoms, dem call Couvade syndrome anaa "sympathetic pregnancy", wich fi occur wen dema partner dey preg den dey deal plus pregnancy symptoms. Psychotherapy, pharmacotherapy plus antidepressants anaa antipsychotics, hormonal therapy, den uterine curettage be sam times dem need as treatment.

While extremely rare insyd de United States secof de frequent use of medical imaging, insyd developing regions such as India den sub-Saharan Africa, de incidence of false pregnancy be higher. Rural areas spy more instances of false pregnancy secof such women be less often examined by a health care professional anaa midwife during de duration of believed pregnancy.

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