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The support offered by a spouse may have a protective role for physical health during parental bereavement. Lack of social support, mental illness, conflict or excessive dependency, and alcoholism, may increase mortality after loss of a close other. It is difficult to distinguish the effects of social isolation and low social support on the heart from that exercised by bereavement, since men return to the 1553 Modern scientific interest in bereavement dates to Erich Lindemann and the Coconut Grove fire in Boston, Massachusetts during World War Two. Lindemann influenced a generation of Boston investigators, including Gerald Caplan, Robert Weiss, and Colin Murray Parkes, Parkes bringing this work in England. Lymphocytic response seems to be diminished 1556 in early bereavement, in major depression and in other forms of stress, (Rogers & Reich, 1988) but enhanced immune response has been reported in those people anticipating grief. The dying may displace their hostility onto the doctor and the aged may displace it onto the young who misspend their youth. Depression is common after the loss of a spouse, especially for young widows and widowers with a history of depression. A balance must be struck between ones own needs and those of our charges, we must acknowledge fallibility and accept help as needed. We too often see death as something to be avoided, postponed or resisted at the expense of a humanistic approach to the dying. Distinguishing grief from depression* Grief Depression Intense symptoms for at least 1-2 months** Longer duration Usually no suicidal ideation*** Such ideas are common Visions or voice of deceased transient only**** May have sustained depressive delusions Pangs interspersed with normal feelings Continuous, pervasive depressed mood May blame deceased Blames self Improves with time No change or worsening *If in doubt, treat for depression ­ antidepressants do not retard the grieving process. With regard to stillbirth, it is important to know when to promote grieving and when not to blow the event up out of proportion in the mind of the bereaved. It is suggested that women experiencing a stillbirth be nursed on a gynaecology ward instead of a postnatal ward after delivery. Anticipatory guidance involves covering such topics as how to explain the loss to others, giving away clothes and toys, meeting friends with young babies, and anything else that may help the woman to cope when she goes home. Fathers may be almost as anxious antenatally as the mother when there is a history of previous stillbirth. It has been suggested that induction of delivery should be considered as soon as feasible after diagnosis of death in utero. The mother may have experienced unusually high numbers of family losses in her own childhood. The home may have a funereal atmosphere with a palpable obsession with links to the deceased. Men may be more secretive about infertility than are women and men may experience difficulty performing sexually according to prescribed schedules. Occasional cases of infertility are associated with nonconsummation or anorexia nervosa. She may harbour guilt over past sexual acts and regret over past induced abortion or she may blame herself for delaying attempts to conceive for career reasons. Some cases who do conceive may paradoxically become depressed, possibly as a let down after years of fantasising about how wonderful ordinary parenting would be. Clomiphene, used to induce ovulation, may be associated with depression, anxiety, and poor sleep. Assisted reproduction is associated with a small increase in low birth weight and congenital defects, although the great majority of such babies are normal. Older women who conceive as a result of medical intervention are at increased risk of having babies with chromosomal abnormalities. They may develop grief because of lost hopes, 1558 anger that it happened to them or because they were wrongly reassured, denial of the reality of the situation, anxiety for future children or 1557 1558 Founded in 1978 in Britain as the Stillbirth Association. The intellectually disabled themselves may express grief in ways other than speech, such as insomnia, anorexia, searching, externally-directed aggression, a decline in intellectual or other skills, incontinence, or indifference. The fact that intellectually disabled people are living longer means that more of them experience the death of loved ones. The relatives of suicides tend to be shocked, to search for an explanation, to find it difficult to share feelings, to feel guilty or stigmatised (often reinforced by the media and others: Harwood ea, 2002; de Groot ea, 2007), or to feel relief (if the relationship with the suicide was poor). There may be an increased mortality from suicide among the bereaved following suicide, although attribution of cause is difficult because, for example, there may be a shared tendency to affective disorder. The same difficulty applies to interpreting reports of a history of exposure to suicide attempts or threats by friends or relatives in the histories of suicide completers: shared cultural and genetic factors act as confounders.

Depending on how one defines such symptoms, 3-10% of cases may experience such episodes at some stage. Even when one considers bipolar disorder, schizoaffective disorder, druginduced disorder1153, and somatic disorders. Diet and schizophrenia: Schizophrenic patients smoke heavily, are often overweight1155 or obese, eat too much saturated fat, have a low intake of antioxidants, and eat too little fruit and vegetable. Veen ea (2004) reported a strong association between use of cannabis 1156 and earlier age at first psychotic episode in males with schizophrenia. Henquet ea (2005), in a prospective and population-based (Munich) sample, found that cannabis use in people aged 14 to 24 years moderately increased the risk for psychotic symptoms but had a much stronger effect in those with evidence of predisposition for psychosis. An increase in psychotic symptoms predicted relapse to cannabis abuse and medication adherence reduced cannabis relapse risk in a prospective postdischarge study of psychotic patients. Further work conducted by Arendt ea (2008) was suggestive of cannabis-induced psychosis being an early manifestation of schizophrenia rather than a distinct disorder. Barnett ea (2007) reported increased substance use in people with first-episode psychosis, age at first use of cannabis, cocaine, ecstasy and amphetamine being significantly associated with age at first psychotic symptoms. Moore ea (2007) performed a systematic review and concluded that cannabis increases risk of psychotic outcomes independent of confounding and transient psychotic effects. Miettunen ea (2008) found cannabis use to be associated with prodromal symptoms of psychosis in adolescence and Mata ea (2008) found that cannabis abuse was associated with impaired decision-making before onset of psychosis but could not determine direction of causality1158. Veling ea (2008b) conducted a study among non-Western immigrants to the Hague with first-episode schizophrenia. Cannabis use predicted schizophrenia but genetic predisposition did not predict schizophrenia. Weiser and Noy (2005) suggest that, rather than cannabis causing schizophrenia, an abnormal endogenous cannabinoid system might be common to both schizophrenia and the tendency to use cannabis. Acute cannabis use induced psychotomimetic symptoms in people prone to psychosis in a study conducted by Mason ea. Henquet ea (2010) found that patients had an acute enhancement of mood and subacute hallucinations from cannabis and, again, they found no direct connection between cannabis use and attempts at self-medication. From the most to the least common the order seems to be a mixture of the two types, type I, and type 2. Under the same nosological rubric was subsumed the occasional manic, depressive, or personality disorder. However, if standard diagnostic methods were employed then one could still demonstrate a core of patients in all centres with similar symptomatology. At the Serbsky Institute in Moscow, Snezhnevsky offered a broad concept of schizophrenia - many eccentrics and personality-disordered individuals were included in his idea of schizophrenia. Snezhnevsky took more cognisance of the course of the illness than of the manifestations. Hegarty ea (1994) reported that only 40% of subjects could be considered to have improved after follow up averaging 5. Outcome was better with broad or undefined criteria, but poorer (27%) with narrow criteria. Outcome varied for different reasons (treatment, criteria changes) at different times. In the closing years of the 19th century Kraepelin viewed schizophrenia as a disorder which always carried a poor prognosis. In the 1960s Brown and others found that after five years 56% of discharged schizophrenics made a social recovery, 35% were socially damaged but lived outside hospital, and only 11% had spent all their time in hospital. Bland and Orn (1978) found that after fourteen years about half were coping well with minimal disability, one-quarter had moderate to marked disability and a further quarter were disabled psychiatrically, socially and occupationally. Manfred Bleuler (in 1974, lived 1903-94) followed up 208 patients for over twenty years and found that there was usually no further deterioration after five years; in fact, some even improved. Also, there have been reports of a relatively good outcome for schizophrenia in some industrialised societies (Prague, Nottingham) and of a poor outcome in Cali. Threeyear outcomes were similar to that of affective psychosis and significantly superior to that of schizophrenia. Also, in non-affective psychotic disorders, being a woman and having good premorbid function, but not acute onset or early remission, predicts favourable outcome at three years. Sikanerty and Eaton (1984) reported a lower prevalence for schizophrenia in the Third World. There are also reports from developing countries of symptomatic, severely disabled chronic, untreated patients living with extended families.

Often experimental results are based on group averages and no one is average (Halpern, 2006). As a consequence, the differences or similarities found between women and men depend largely on the tests and measurements used. In this sense, it has been argued that the magnitude is relative and depends on what and how it is measured; as Halpern (1989) says: "what you see depends on where you look". Intelligence and gender: the sexism of scientific interpretations of cognitive skills Since the 1960s, psychologists have tried to explore sex differences in intelligence more systematically, referring mainly to a special trend of men on optical perception of space and in mathematics and of women in language. The "supposed" intellectual differentiations between women and men have been used as an explanation of the occupational segregation by sex. This book explores scientific ideas and discussions around cognitive sex differences and the political and social use of these ideas. Some studies referred to explanations of sex differences on the basis of the different intellectual skills between men and women. According to the author, the different scientific interpretations of cognitive sex differences, are not evidence-based and have serious theoretical and methodological problems. The author blames the idea of physical cognitive differences and specific professional trends. The criticism also includes the definition and the structure of gender and intelligence, the history and political use of psychometrics, the history and sociology of occupational segregation by sex, as well as the efforts to attribute cognitive abilities to biological phenomenon, such as genes, hormones and the functional organization of the brain. The differences in intelligence between sexes are only small deviations to the mean values. The hypothesis that women are more linguistically skilled is problematic, as it is not clear what linguistic skill means and the observed differences are very small. Research aiming to understanding the underrepresentation of men in the arts, humanities and social sciences is almost nonexistent. Additionally, considering cross-national differences in mathematical performance, results have not been consistently replicated in different countries and, as a result, are not conclusive. In this sense, a comprehensive review with the accumulated data and methodologies should be developed. The debate over the gender gap in maths revolves around aspects such as the origin of the gap, the magnitude, whether or not it is narrowing, the causes of the gap and its effects as men and women choose their careers, and possible ways to eliminate the divide. Yet the agreement or disagreement with the existence of a gender gap in these fields has a lot to do with when the researchers originally conducted the investigations. Research conducted in the area of the gender divide in mathematics before the 1990s suggests that the divide exists and is very large. However, since the late 1980s, research has pointed to the idea that the gender gap in average mathematical performance is not only small but has been declining over time (Hyde, Fennema and Lammon, 1990; Dunlap, 2002; Xie and Shauman, 2003). On the basis of their synthesis of the research on gender differences in science, Linn and Hyde (1989) concluded that differences in verbal and spatial ability are diminishing. Increasing evidence indicates that young females and males are equally talented and interested in the field of mathematics, and that the sex gap no longer exists at high school and college levels (Suter, 2006). According to Xie and Shauman (2003) "there is disagreement about the magnitude of the differences, the timing of their emergence, and their stability over time. More recently, neither the existence nor the magnitude of sex gaps has been clearly demonstrated (Gallagher and Kaufman, 2005). In summary, as the sex gap has narrowed in the last decades and gender disparities in education seem to be turning in favour of girls (in terms of participation and performance), there do not seem to be differences in performance for the biological and cognitive theories to explain. Male students tend to surpass females on science and math achievement tests, but only in certain types of skills Differences slightly favour females prior to adolescence, whereas males outperform though high school across all grade levels Sex differences in average performance are significant but small in comparison to differences within each gender group Males are more dispersed in the high and low ends of the achievement spectrum, and women are underrepresented amongst the top achievers Gender differences in average mathematics achievement and in high level mathematics achievement do not explain gender differences in majoring or degree attainment in science the magnitude of the gap in science achievement do not seem to be declining over time Fuente: Xie, Y. Educational outcomes are influenced by certain individual characteristics like intelligence, aptitudes or career aspirations. Xie and Shauman (2003) suggest that while attainment of academic credentials depends on cognitive ability, the causal effects are not deterministic. To trace gender differences throughout the career process of becoming a scientist/engineer, the authors adopted a life-course approach in order to be able to recognize interactive effects (across multiple domains in a life, such as education, family and work), individual variations and the cumulative nature of these effects. The magnitude/stability of gender gaps in 21 Meta-analysis of gender and science research Topic report "Stereotypes and Identity" standardized maths and science achievement tests at different points of the educational trajectory (from the seventh to the twelfth grade) from the early 1970s to the early 1990s is examined. The authors also explore the causal connections between gender gaps in maths attainment and gender gaps in the science and engineering career choices and professional aspirations explored. Women are graduating in very high numbers with degrees in science fields, so women obviously have the innate ability to do science.

Syndromes

• Autoimmune disorders (such as systemic lupus erythematosus and scleroderma)
• Trouble moving the eyes up and down (vertical supranuclear gaze palsy)
• Decreased vision
• Hepatitis C
• Males: 12 to 72 mg/dL
• Cancer
• Bleeding
• Salactic Film
• Difficulty breathing or shortness of breath

Krakowski ea (2006) found clozapine superior to olanzapine, the latter being superior to haloperidol, in reducing violence associated with schizophrenia and schizoaffective disorder. McCue ea (2006) found haloperidol, olanzapine, and risperidone superior to aripiprazole, quetiapine, and ziprasidone in the treatment of acute schizophrenia. Fertility and mortality: All psychiatric disorders carry an increased risk of premature death, the highest risk, from natural and unnatural causes, being associated with substance abuse and eating disorders. A disturbing report from Sweden found that the number of people with schizophrenia whose bodies were not discovered for some time after death increased in keeping with the decline in bed availability during 1952-2005 in Malmo. A Finnish study suggests that long-term antipsychotic treatment, especially clozapine 957, is associated with lower mortality compared with the nonuse of antipsychotics. The steepest rise in cardiovascular mortality appeared to coincide with the introduction of the newer antipsychotic drugs although the authors felt unable to form any firm cause-effect conclusions from this observation. However, schizophrenia seems to continue to occur at a similar rate to that in the past 50 years. The gene (at 22q11) contains a functional polymorphism (Val108/158Met) that affects enzyme activity. Howard ea, 2002) Study of a Swedish birth cohort (MacCabe ea, 2009) found that, relative to the general population, people with schizophrenia had less children and grandchildren (partly due to lower marriage rates), their unaffected siblings had no more children than the population norm, there was a trend for offspring of schizophrenia patients to have more children, and patients with affective psychosis and their relatives resembled the general population regarding fertility measures. It seems, therefore, that either environmental factors are aetiologically important or that new mutations keep it going. An alternative hypothesis is that schizophrenia confers a biological advantage on the sufferer, although the evidence for this is not strong. Reduced fertility among Finnish schizophrenics is not compensated for by higher fertility among their siblings. The apparent decline in the frequency of some subtypes, such as catatonia961 (Cf later), has been noted with interest, although some authors contest the validity of this decline on methodological grounds. The authors suggest that their finding suggest a need for greater involvement by primary care services. A survey of Norwegian psychiatric inpatients born from 1866 to 1939 revealed a striking excess of winter births, a tendency which was less marked in patients from the higher social classes. Being born or reared in urban areas may add to the risk of viral infection in utero. Research on urban/rural place of birth, the relevance of being male/female, and the time of year when one is born is on-going. Finnish work on birth cohorts suggest a move from rural to urban births over time, but there are still clusters that suggest possible genetic isolation. Van Os ea (2003, 2004) found both level of urbanicity and familial liability independently and synergistically increased risk for psychotic disorder. Genetics: Schizophrenia often runs in families, the risk increasing with the number of affected relatives 965. If both parents have schizophrenia the risk for their child is about 45%, compared to 1% in the general population. Of course, there are other possible explanations, such as whatever psychosocial factors drive procreation practices in parents. Various loci968 have been highlighted by research as possibly being important in schizophrenia. It has also been implicated in bipolar disorder, especially when accompanied by psychosis. Mood incongruent psychotic features in bipolar patients may be linked to 13q21-33. However, Williams ea (2004) using Cardiff and Dublin samples, produced evidence that variations in the dysbindin gene confers susceptibility to schizophrenia. Fanous ea (2005) found that a haplotype for dysbindin may predispose to psychosis with high levels of negative symptoms. Kishimoto ea (2008) found preliminary evidence that the dysbindin gene is associated with risk of metamphetamine psychosis.