Multiple sclerosis (MS) is a major inflammatory and demyelinating disease of the central nervous system. Although a significant incidence and prevalence of psychological disorders in MS has been reported there is limited data on the prevalence of personality disorders (PD) in these patients. Recent findings indicate the need for early diagnosis and treatment of PD in MS patients in the interests of prognosis, conformity to treatment and patient's quality of life improvement. This article summarizes existing evidence on prevalence, types and diagnostic criteria of PD in MS, clinical manifestations of personality pathology or changes in MS patients, and instruments currently used for diagnosis and assessment of PD in this group of patients. Underlying mechanisms suggested as causes of personality changes in MS patients are also discussed. The article reviews therapeutic strategies, including pharmacotherapy and psychotherapy interventions and emphasizes the need for a multidisciplinary approach to patient's treatment.
Informed consent is a question of central importance in contemporary medical ethics, and clinical practice is inconceivable without considering the issues it raises. Although it is often vigorously argued that consent, informed or otherwise, is a recent phenomenon and that no sources testify to its existence before the 20th century, it is difficult to accept that a process for regulating the common and fundamental parameters in the relationship between doctor and patient and the planning of treatment had not concerned previous eras. A review of the Registers of the Islamic Court of Candia (Heraklion) in Crete, a series of records that touches on, among other things, matters of medical interest, reveals that the concept of informed consent was not only known during a period that stretched from the mid-17th to the early 19th century, but it was concerned with the same principles that prevail or have been a point of contention today. An extension of this study into other periods may thus provide contemporary researchers with material and information valuable in the discussion of today's bioethical issues.
Objective
The purpose of this study is to identify clinical manifestations of eating disorders in the Eastern Mediterranean region from the first century AD until the seventh century AD and evaluate relevant awareness among the physicians of the era.
Method
The authors searched original medical texts written in Greek by physicians practicing in the Eastern Mediterranean region from the first century AD to the seventh century AD. The search focused on passages that include possible references to clinical entities analogous to anorexia nervosa (AN) and bulimia nervosa (BN) as described in the DSM‐5 and the contemporary literature.
Results
Descriptions of conditions that resemble AN or BN can be found in the work of Galen, Oribasius, Aetius of Amida, Leon Philoumenos, Alexander Trallian, and Paul of Egina. Successive physicians confirmed the observations of their predecessors and add to the description of the clinical presentations and their etiology.
Discussion
This research provides evidence of awareness of presentations resembling currently defined eating disorders in the Eastern Mediterranean region during a period with different norms and values. Observations from the period can serve as a point for reflection about the characteristics and etiology of AN and BN in the 21st century.
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