Clin Med
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The hormone melatonin is increasingly used for the treatment of certain sleep disorders, particularly those related to disturbed biological rhythms. This article summarises current knowledge of its mechanism of action and identifies situations where there is good evidence for its efficacy. The authors provide advice, based on their own experience and consistent published data, concerning the dose range of melatonin to be used and the critically important question of the timing of treatment. Anecdotal evidence for the use of melatonin needs to be replaced by data from well-controlled, preferably multi-centre, randomised clinical trials.
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Hubris syndrome is associated with power, more likely to manifest itself the longer the person exercises power and the greater the power they exercise. A syndrome not to be applied to anyone with existing mental illness or brain damage. ⋯ It is less likely to develop in people who retain a personal modesty, remain open to criticism, have a degree of cynicism or well developed sense of humour. Four heads of government in the last 100 years are singled out as having developed hubris syndrome: David Lloyd George, Margaret Thatcher, George W Bush and Tony Blair.
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The diagnosis of personality disorder often appears to tell as much about the diagnoser as the diagnosed. For many it describes those who are deemed personally offensive, and as such it is not so much a diagnosis as a value judgment, the product of a negative interaction between two people that is given spurious respectability by a medical label. ⋯ This can be avoided by recoding personality in terms of severity. New treatments are now beginning to show evidence of efficacy and it is not unreasonable to hope that a condition that has been muttered about for years in parentheses will now be better recognised and defined, exposed without misunderstanding, and managed appropriately and well.