mental deficiency

insanity

[in-san-i-tee]

In criminal law, a disease, defect, or condition of the mind that renders one unable to understand the nature of a criminal act or the fact that it is wrong. Tests of insanity are not intended as medical diagnoses but rather only as determinations of whether a person may be held criminally responsible for his or her actions. The most enduring definition of insanity in Anglo-American law was that proposed by Alexander Cockburn (1843). Many U.S. states and several courts have adopted a standard under which the accused must lack “substantial capacity either to appreciate the criminality of his conduct or to conform his conduct to the requirements of the law.” Some states have abolished the insanity plea, and others allow a finding of “guilty but mentally ill.” Seealso diminished responsibility.

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Iodine is an essential trace element; the thyroid hormones thyroxine and triiodotyronine contain iodine. In areas where there is little iodine in the diet—typically remote inland areas where no marine foods are eaten—iodine deficiency gives rise to goiter (so-called endemic goitre), as well as cretinism, which results in developmental delays and other health problems.

In some such areas, this is now combatted by the addition of small amounts of iodine to table salt in form of sodium iodide, potassium iodide, and/or potassium iodate—this product is known as iodized salt. Iodine compounds have also been added to other foodstuffs, such as flour, water and milk in areas of deficiency. Seaweed is also a well known source of iodine. Thus iodine deficiency is more common in mountainous regions of the world where food is grown in soil poor in iodine.

Goitre

Low amounts of thyroxine (T4, one of the two thyroid hormones) in the blood, due to lack of dietary iodine to make them, gives rise to high levels of thyroid stimulating hormone TSH, which stimulates the thyroid gland to increase many biochemical processes; the cellular growth and proliferation can result in th characteristic swelling or hyperplasia of the thyroid gland, or goitre. The introduction of iodized salt since the early 1900s has eliminated this condition in many affluent countries; however, in Australia, New Zealand, and several European countries, iodine deficiency is a significant public health problem . It is more common in poorer nations. Public health initiatives to lower the risk of cardiovascular disease have resulted in lower discretionary salt use at the table, and with a trend towards consuming more processed foods. The non-iodized salt used in these foods also means that people are less likely to obtain iodine from adding salt during cooking.

Goitre is said to be endemic when the prevalence in a population is > 10%, and in most cases goitre can be treated with iodine supplementation. If goitre is untreated for around 5 years, however, iodine supplementation or thyroxine treatment may not reduce the size of the thyroid gland because the thyroid is permanently damaged.

Cretinism

Iodine deficiency is one of the leading cause of preventable mental retardation, producing typical reductions in IQ of 10 to 15 IQ points. It has been speculated that deficiency of iodine and other micronutrients may be a possible factor in observed differences in IQ between ethnic groups: see race and intelligence for a further discussion of this controversial issue.

Cretinism is a condition associated with iodine deficiency and goitre, commonly characterised by mental deficiency, deaf-mutism, squint, disorders of stance and gait, stunted growth and hypothyroidism. Paracelsus was the first to point out the relation between goitrous parents and mentally retarded children. As a result of restricted diet, isolation, intermarriage, etc., as well as low iodine content in their food, children often had peculiar stunted bodies and retarded mental faculties, a condition later known to be associated with thyroid deficiency. Diderot in his 1754 Encyclopédie described these patients as "crétins". In French, the term "crétin des Alpes" also became current, since the condition was observed in remote valleys of the Alps in particular. The word cretin appeared in English in 1779.

Local impact

Certain areas of the world, due to natural deficiency and governmental inaction, are severely affected by iodine deficiency, which affects approximately two billion people worldwide. It is particularly common in Western Pacific, South-East Asia and Africa.

India is the most outstanding, with 500 million suffering from deficiency, 54 million from goitre, and two million from cretinism.

Among other nations affected by iodine deficiency, China and Kazakhstan have begun taking action, while Russia has not. Successful campaigns for the adoption of the use of iodized salt require education and regulation of salt producers and sellers and a communication campaign directed at the public, the salt trade, politicians and policy makers. The cost of adding iodine to salt is negligible.

Iodine deficiency has largely been confined to the developing world for several generations, but reductions in salt consumption and changes in dairy processing practices eliminating the use of iodine-based disinfectants have led to increasing prevalence of the condition in Australia and New Zealand in recent years. A proposal to mandate the use of iodized salt in most commercial breadmaking is expected to be adopted in 2009 .

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