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Wednesday, May 15, 2013

STATUS DIPLOMATICUS


(The author wishes to thank the voices in his head for continuously guiding and inspiring him and their help in writing this article)
Status Diplomaticus is a condition of unknown aetiology, characterised by extremely sweet behaviour, inability to speak ill about others and perpetual Risus Sardonicus. The condition is strongly associated with the Type A personalities.

Historical Background:


Status diplomaticus though being described in literature for the first time has been known to the mankind since ages. It is widely believed that many Egyptian Papyruses dating back to 2500 BC have described the condition, but the claim cannot be ascertained as no one has, however, been able to decipher them.

Modern History:

The attention of the author was drawn to this condition when during one of his surgery OPDs a few years ago when he was still learning his clinical skills, that someone happened to ask, "Are you the CR because of your good PR skills, or do you have good PR skills because you are the CR?" (The author urges the readers to kindly read, understand and most importantly imagine 'Public Relations'.) The lone study was conducted by the author for which no ethics committee permission was deemed necessary and barring a few unsuspecting humans, no animals were involved.


Pathophysiology:


The precipitating event is usually an involuntary involvement in a conflicting situation usually in early childhood. Each situation precipitates the next. The condition progresses slowly until about adolescence, when it becomes prominent and is characterized by a shift to voluntary involvement (involvementohphilia). It is characterized by periods of remission during which no such voluntary activity is seen, probable mechanisms being fatigue of the CNS pathways or proximity of an examination. It recurrence may be precipitated by involuntary involvement or may be spontaneous. Complete remission is never seen.


Signs and Symptoms:


The individuals usually present as very informative, friendly and accommodating. They are usually resistant to heat and pressure upto 100 friendPascals. Some variants are non-compromising in varied amounts. They are reliable. Most of them are very non-committal. Workoholism may be seen in most. They usually have "freshness of ideas" and "risk taking behaviour". They have a very strong past history of similar events and though it may appear to be easy, it is quite difficult to predict the occurrence of next precipitating event. Inability to divulge clinically significant information is pathognomonic of the condition.


Laboratory diagnosis:




1. Demonstration of high titres of self-interest protective antibodies. However, it doesnot have any detrimental effects on the well being of those associated with them.
2. Any demonstration of any iota of commitment in any sample of conversation strongly rules out the diagnosis. It may rarely be false positive.

The Differential Diagnosis:


Differentials though few, are very important because misdiagnosis can lead to improper categorization of the individual which can have far reaching social and mental consequences.

1. The chameleon:
Though the initial presentation is similar, they can be differentiated easily whenever a conflicting situation arises. In some lucky cases however, no such condition may occur for years together and they may be well treated.

2. The opportunist:
The condition is characterised by periods of over friendly behaviour, alternating with periods of extreme aggression or selective mutism. Individuals are usually of good nature until a clash of interest develops. This is one condition which is relatively easy to diagnose. They usually have a past history of similar episodes. One interaction with an opportunist will definitely provide understanding that lasts almost a life time in about 95% of the general population.

3. Chaatooism:
In India a special type of population is identified. The term 'chaatoo' roughly translates to 'lickers'. A current study is underway in which extracts from chaatoos are being administered to individuals with Sjogren’s syndrome. 

Diagnosis:
i. Tailing and trailing are two important signs that are easy to pick up and are pathognomonic of Chaatooism.
ii. Excessive drooling of saliva, actual or apparent, in the absence of identifiable causes such as Downs Syndrome, Mental Retardation, Cretinism, etc. must raise a suspicion of this disorder.
Complications: 
Though no fatalities have been recorded as of yet, they are a high risk population for aspirating and choking on their own drool and a strong theoretical concern prevails.
Treatment:
Vaseline is preferred treatment of contact/friction glossitis which may be seen in some cases.
Nystatin is the Drug of Choice for oral thrush.


4. Vaccardia (Latin; vacca-cow):
This is a very harmless and benign and innocuous condition. It is again easily differentiated by demonstration of diminished power in the challenging situations test. The power gradually diminishes on consequent exposure to challenging situations. It is usually an acquired condition.


Multiple conditions may co-exist in the same individual and may manifest themselves in response to varied precipitating conditions. Vaccardia and Status Diplomaticus are pure forms and no association with any other condition has been identified.


Treatment:


Isolated attempts at treatment have been made in the past by administering electrical shocks, psychotherapy in the form of threats and the 'pinching' technique. However, in the author's personal opinion and experience, such drastic modalities need not be attempted. Tender love and care are sufficient.


The Future:


The author wishes to start a support group for individuals with Status Diplomaticus and their caretakers. 

He hopes to receive a Nobel Prize for his contribution towards the understanding of the condition and also hopes that International Diplomaticus Day be celebrated on 24th November, which happens to coincide with his Birthday.