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Depression Screening Tools

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5941. Subclinical Hypothyroidism

. There is no absolute consensus on which patients to treat, although there are some clear recommendations. [ , ] Measurement of serum TSH is generally considered the best screening test for thyroid disease. Increased values indicate hypothyroidism. The test is both sensitive and specific. Serum TSH concentrations have a logarithmic relationship with serum thyroxine, so that a doubling in thyroxine produces a hundredfold change in TSH. TSH is thus a much more sensitive test. The population reference laboratory (...) a significant decrease from a previous normal of 10 mcg/dL, and is low for this particular patient. Some studies have suggested that if symptoms are present then treatment with thyroxine will resolve them. Common clinical features of hypothyroidism include: Depression and fatigue Hyperlipidaemia and hyperhomocysteinaemia Goitre Coarse hair Cold intolerance Constipation and weight gain Hoarseness Hearing loss Menorrhagia Slow return phase in knee reflexes Bradycardia Coronary artery disease or cardiac risk

2008 Mentor

5942. Substitute Prescribing for Opioid Dependence

populations. J Gen Intern Med. 2010 Apr25(4):305-9. doi: 10.1007/s11606-009-1225-0. Epub 2010 Jan 20. ; NICE Evidence Services (UK access only) ; J Subst Abuse Treat. 2012 Jun 15. ; J Psychiatr Ment Health Nurs. 2012 Aug19(6):563-7. doi: 10.1111/j.1365-2850.2011.01810.x. Epub 2011 Sep 20. i was placed on subutex after a year long codeine addiction 13 years ago i was kept. on it for 8 years then had a detox due to the most dramatic depressive state i was in i relapsed, back on subs... Tez22 Health Tools (...) of the dangers of concomitant use of central nervous system (CNS) depressants. Understanding the importance of keeping medication away from children. See separate article, which includes details on their prescribing and on record keeping. The GP's role [ ] In 2011, the Royal College of General Practitioners produced guidance for the use of substitute prescribing in the treatment of opioid dependence in primary care. The main points are as follows: All GPs have a duty to provide basic medical services

2008 Mentor

5943. Stress and Post-traumatic Stress Disorder

, depression, drug or alcohol misuse or anger, make sensitive enquiry about traumatic experiences in the past. Make similar enquiries of frequent attenders with unexplained physical symptoms. Ask children directly about their experiences. Comorbidities are common - eg, depression, anxiety, substance abuse. Although the problem starts soon after the event, in 85% it may present later so that the relationship with the event is less obvious, especially if features are less specific, such as anxiety (...) , depression, insomnia or hypochondria with frequent attendance. It may be necessary to distinguish PTSD from traumatic or complicated grief reactions that may develop a year or more after a bereavement, with symptoms of intense, intrusive thoughts, pangs of severe emotion, distressing yearnings, feeling excessively alone and empty, excessively avoiding tasks associated with the deceased, unusual sleep disturbances and loss of interest in personal activities. The two conditions can, of course, co-exist

2008 Mentor

5944. Thalassaemia Full Text available with Trip Pro

, as giving more iron will only aggravate the condition. Screening Pre-conceptual testing for haemoglobinopathies is recommended in at-risk groups. [ ] Policies for antenatal and neonatal screening vary throughout the UK (for further information, see link to UK Screening Portal under 'Further reading & references', below). [ ] Laboratories performing antenatal screening should utilise methods capable of detecting significant variants and be capable of quantitating haemoglobins A 2 and F. Differential (...) status is often confused with iron deficiency due to reduced MCV and MCH). In the severe forms of thalassaemia, the haemoglobin level ranges from 2-8 g/dL. White blood cell (WBC) count is usually elevated from the haemolytic process. Platelet count may be depressed in splenomegaly. Serum iron level is elevated, with saturation as high as 80%. Ferritin is also raised. Haemoglobin electrophoresis usually reveals the diagnosis. Normal HbA 2 is between 1.5 and 3.0% whilst HbA2 >3.5 % is diagnostic. DNA

2008 Mentor

5945. Systemic Lupus Erythematosus

). [ ] Management Patients often require considerable counselling about their individual prognosis and symptoms. Avoid sun exposure as much as possible and use sun screens. Identify and treat any underlying cause (eg, anaemia, depression) and encourage regular aerobic exercise. Joint and muscle pains, headaches, and musculoskeletal chest pains respond to simple analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) - the latter should be used with caution because of gastrointestinal, renal (...) : pleurisy, fibrosing alveolitis, obliterative bronchiolitis. Patients with the secondary antiphospholipid syndrome (APLS) are at increased risk of pulmonary embolus. Cardiovascular: pericarditis, hypertension, Libman-Sacks endocarditis, an increased risk of coronary heart disease. Renal: nephritis is often asymptomatic and is detected by , , hypertension or a raised serum urea or creatinine. is common in lupus patients. Neuropsychiatric: anxiety and depression are common. Patients may also develop

2008 Mentor

5946. Tinnitus

that those with tinnitus report depression at a far higher rate than non-tinnitus patients [ ] although more recent data have shown only a weak association between tinnitus and depression [ ] . There is no firm association between tinnitus and suicide [ ] . Presentation Symptoms Patients often take a long time before seeking medical attention. Most common sounds are: Ringing Buzzing Cricket-like Hissing Whistling Humming The condition is reported to be unilateral in 22%, equal in both ears in 34% and one (...) of the ototoxicity of the drugs used to treat the hypertension (ACE-inhibitors, diuretics, calcium-channel blockers, potassium-sparing diuretics and aspirin all have a weak association with tinnitus) [ ] . Routine brain imaging for bilateral tinnitus is not recommended [ ] . The history should include an enquiry about depression or anxiety, which can worsen tinnitus. Alleviating the underlying emotional health problem can help with the tinnitus. Although patients report sound as being loud, hearing tests

2008 Mentor

5947. Systemic Sclerosis (Scleroderma)

[ ] . A leading cause of death in SSc. The presence of PAH drastically reduces survival rate (50% mortality within three years of diagnosis of PAH [ ] . Outcome is worse than for other causes of PAH). Symptoms and signs: exertional dyspnoea, syncope, right ventricular strain features. Research has attempted to define predictive screening tools. These include monitoring lung function, ECG, echocardiogram, urate levels and N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and by taking (...) -19. doi: 10.1016/j.semarthrit.2014.05.010. Epub 2014 May 14. I don't even know where to start. I am 31, male, and health wise am pretty healthy. I do have big depression and anxiety issues and have been on meds all of my life for that. I exercise daily and eat... simon15564 Health Tools Feeling unwell? Assess your symptoms online with our free symptom checker. Article Information Last Reviewed 10 November 2016 Next Review 09 November 2021 Document ID 2831 (v25) Author Peer reviewer Dr John Cox

2008 Mentor

5948. Delay In Walking

may find one of our more useful. In this article In This Article Delay In Walking In this article Most developmental screening is done by health visitors but, if they suspect a problem, they will bring it to the attention of the GP. Hence, even doctors who are not directly involved in developmental assessment must have knowledge of normal development. If a child has failed to reach a milestone at a given time but appears to be on the threshold of achieving it then a safe option is to review (...) inherited conditions in the family? A family history of muscular dystrophy or some other neurological disorder may be significant. Carer circumstances Has the mother been trying to get the baby to walk? An overprotective or immature mother may be treating the baby like a doll - just feeding, changing and keeping in the pram or cot. Has the baby had a chance to try to develop motor skills? Has the mother encouraged these? Is there untreated maternal postnatal depression to be considered? Examination

2008 Mentor

5949. Cushing's Syndrome

with ACTH-dependent causes. Psychological problems: depression, cognitive dysfunction and emotional lability. Osteopenia or osteoporosis. Oedema. Women may complain of irregular menses. Thirst, polydipsia, polyuria. Impaired immune function: increased infections, difficulty with wound healing. Child: growth restriction. Patients with an ACTH-producing pituitary tumour may develop headaches, visual problems and galactorrhoea. Destruction of the anterior pituitary may cause hypothyroidism and amenorrhoea (...) % between collections. False positives may occur with pregnancy, anorexia, exercise, psychoses, alcohol and alcohol withdrawal. Strenuous exercise and illness raise cortisol secretion. Low-dose dexamethasone suppression test: A useful screening test in those who are unable to reliably collect a 24-hour urine sample. 1 mg of dexamethasone is ingested at 11 pm and serum cortisol is measured at 8 am the next morning. Mild Cushing's syndrome is often difficult to distinguish from normal cortisol secretion

2008 Mentor

5950. Critical Illness Rehabilitation

on intensive care. Any evidence of psychiatric disorders, including post-traumatic stress disorder, merit in-patient review by psychiatrists. Patients will normally be screened by the nursing staff and, if appropriate, referred to social worker, physiotherapists and teams. The outcome of the multidisciplinary approach will result in the production of medium-term goals in the form of a structured rehabilitation programme lasting a minimum of 6 weeks. This will usually begin as an in-patient and be completed (...) [ ] The patient's rehabilitation needs and goals should be reviewed 2-3 months post-discharge from hospital. This can occur in the community or in clinic. Review presence or absence of the physical and non-physical problems listed above. Remember that financial problems may not become apparent until a few months after discharge, and refer early to social workers. Ongoing problems, eg depression or myopathy may require referral to specialists. Patients will often ask about when they can return to work

2008 Mentor

5951. Disability in Older People

in Brazil found that the main risk factors for functional disability in elderly people in the community were lack of schooling, rented housing, chronic diseases, arthritis, diabetes, visual impairment, obesity, poor self-perceived health, cognitive impairment, depression, slow gait, sedentary lifestyle, tiredness while performing daily activities, and limited diversity in social relations. [ ] These factors may be influenced by access to healthcare and the cost of healthcare in different countries (...) to heart failure, angina or myocardial infarction. Diabetes - complications which can contribute to disability in a variety of ways (eg, the contribution of diabetic neuropathy to poor mobility) may be underestimated. Alzheimer's disease is the most common neurodegenerative disease. By the age of 85 years, 30% of the population has Alzheimer's disease. Urinary problems can be disabling, particularly if causing incontinence. Depression is often the result of disability but it also makes disability worse

2008 Mentor

5952. Diphtheria Vaccination

findings are vesicles or pustules that quickly rupture to form a 'punched-out' ulcer up to several centimetres in diameter. It often appears on the lower legs, feet and hands. It may be painful in the first week or two and covered with a dark pseudomembrane which separates to show a haemorrhagic base which may have exudate. The surrounding tissue is pink or purple and oedematous. It usually heals in 2-3 months to leave a depressed scar. Infections at other mucocutaneous sites include (...) would like to report a specific issue with this page, please visit our . Thank you, we just sent a survey email to confirm your preferences. Further reading and references ; World Health Organization, 2014 ; World Health Organization ; Diphtheria in the postepidemic period, Europe, 2000-2009. Emerg Infect Dis. 2012 Feb18(2):217-25. doi: 10.3201/eid1802.110987. ; Diphtheria in Europe: current problems and new challenges. Future Microbiol. 2012 May7(5):595-607. doi: 10.2217/fmb.12.24. ; Screening

2008 Mentor

5953. Diphtheria

or pustules that quickly rupture to form a 'punched-out' ulcer up to several centimetres in diameter. It often appears on the lower legs, feet and hands. It may be painful in the first week or two and covered with a dark pseudomembrane which separates to show a haemorrhagic base which may have exudate. The surrounding tissue is pink or purple and oedematous. It usually heals in 2-3 months to leave a depressed scar. Infections at other mucocutaneous sites include , and vulvovaginitis. Effects of toxin (...) a specific issue with this page, please visit our . Thank you, we just sent a survey email to confirm your preferences. Further reading and references ; World Health Organization, 2014 ; World Health Organization ; Diphtheria in the postepidemic period, Europe, 2000-2009. Emerg Infect Dis. 2012 Feb18(2):217-25. doi: 10.3201/eid1802.110987. ; Diphtheria in Europe: current problems and new challenges. Future Microbiol. 2012 May7(5):595-607. doi: 10.2217/fmb.12.24. ; Screening for Corynebacterium

2008 Mentor

5954. Disease-modifying Anti-rheumatic Drugs (DMARDs)

, and is the most common first-line agent for the early treatment of RA in the UK. [ ] Azathioprine: It is a cytotoxic drug and a prodrug of mercaptopurine. It is used as an immunosuppressant for many autoimmune conditions and to suppress transplant rejection. It acts in a similar manner to methotrexate but is usually reserved as second-line due to its toxicity. Ciclosporin: It is a powerful immunosuppressant that appears to act specifically on lymphocytes (mainly helper T cells) resulting in depression (...) TNF-alpha inhibitors can be life-threatening, and deaths from tuberculosis have occurred in these patients. All patients should be screened before starting treatment and monitored closely during treatment. Worsening of demyelinating disease, suppression of bone marrow and a variety of unusual idiosyncratic side-effects may also occur. Choosing the right DMARD Methotrexate should be part of the initial treatment strategy in patients with active RA. In cases of contra-indications or early

2008 Mentor

5955. Diabetic Ketoacidosis

the chest for signs of pneumonic consolidation. Check cardiovascular system for signs of cardiac failure, pericardial rub and murmurs. Examine the abdomen to identify any intra-abdominal precipitant. Assess mental status and orientation. Perform a screening neurological examination. Check the skin surface for evidence of abscesses, boils or other rashes. Differential diagnosis Alcoholic ketoacidosis. . . Other causes of - eg, aspirin overdose or ingestion of methanol/ethylene glycol. . without (...) + may be high due to dehydration, low due to interference of glucose/ketones with assay, or normal; K + may be high due to the effect of acidosis, normal or occasionally low but overall there is cell depletion of K + . Urea and creatinine - elevated due to prerenal acute kidney injury or where renal impairment is the primary cause. Arterial blood gases - metabolic acidosis with low pH and low HCO 3 ; pCO 2 should be normal but can be depressed by respiratory compensation; low pO 2 may indicate

2008 Mentor

5956. Diabetic Foot

. Foot assessment as part of routine diabetic care [ ] Effective care involves a partnership between patients and professionals. All decision making should be shared. Organise a recall system. Arrange recall and annual review as part of ongoing care. As part of annual review, trained personnel should examine patients' feet to detect risk factors for ulceration. All people with diabetes should be regularly screened to assess their risk of developing a foot ulcer [ ] . Examination of patients' feet (...) of painful neuropathy See also separate article. Provide emotional support for the depressing and disabling nature of the condition. Consider initially: Bed foot cradles for problems at night. Simple analgesia taken in advance of diurnal symptoms. Contact dressings. Consider therapeutic trials of [ ] : Tricyclic antidepressants (TCAs), which should be used as first-line therapy in painful diabetic neuropathy. Carbamazepine, which is also effective. Gabapentin, which is also recommended in painful

2008 Mentor

5957. Electrical Injuries and Lightning Strikes

injuries account for about 5% of burns unit admissions. Electricians and linesmen are at highest risk but those working with electrical tools also form a significant proportion of this patient group. [ ] Electrical injuries in children are unusual and are mainly due to misguided exploration outside the home. [ ] For every death, there are two serious injuries and 36 reported electric shocks. Death most often occurs in young males (male:female = 9:1). Most deaths occur in the spring and summer months (...) structures before it causes significant skin damage (there may be serious deep injury with spared skin). [ ] A current passing along the surface of the body to earth can cause very deep burns over a large area. There will be a range of clinical manifestations with different effects on different organs. Be aware of potential secondary injuries from falling or being thrown to the ground. Burns [ ] These range from first-degree to third-degree: there is typically a depressed charred central area

2008 Mentor

5958. Dyspareunia

. In a Scandinavian questionnaire-based study in 2003, out of 3,017 women aged 20-60 attending a cervical screening programme, 9.3% reported prolonged dyspareunia: 13% of women aged 20-29 years and 6.5% of women aged 50-60 years. [ ] A simillar population-based study, of 200 Brazilian-born women, aged 40-65 years, with eleven years or more of formal education, found a prevalence of dyspareunia of 39.5%. [ ] In this study co-existent nervousness and depression increased the likelihood of dyspareunia and both (...) . Rigidity of the hymenal ring. Inadequate lubrication, including psychological problems like: Past or present abuse. [ ] Anxiety and depression. (genitourinary syndrome of menopause). Problems of arousal (including insufficient foreplay, and medication). Congenital abnormality of the vagina. Vaginitis (from infection, chemical irritation or allergy, including from spermicides). . Mid-vaginal pain: Congenitally shortened vagina. Acute or chronic , or . [ ] Urethritis. Pain with orgasm: Uterine

2008 Mentor

5959. Dyslexia

. Inability to distinguish sounds or shapes on the page. Associated features include poor spelling and handwriting, and mathematical difficulties. Assessment Assessment is usually carried out by an educational psychologist following a referral from a parent or teacher. Standardised measures, such as the Wechsler Intelligence Scale for Children, are used to assess general intellectual ability. More specific tools (eg, the Dyslexia Early Screening Test for testing early years, the Dyslexia Screening Test (...) (eg, Irlen coloured overlay lenses) have been widely used to improve reading performance. [ ] It may also be helpful to have coloured paper for writing and adjust the colours and brightness on computer screens. A number of other educational methods have been studied - eg, exercise-based therapy, which remains controversial. [ , ] Complications Rates of behavioural problems, social maladjustment, anxiety, withdrawal, and depression are higher in children with reading disorders. Social problems may

2008 Mentor

5960. Cornelia De Lange Syndrome

are listed. Hearing screening should be undertaken. Echocardiography and ultrasound screening of the renal tract may be indicated. CT scanning of the temporal bone can be used to identify typical abnormalities of the external auditory meatus, middle ear and inner ear. [ ] Management [ ] Although the management is mainly specialist-based, the GP's role is in ensuring overall health supervision, making sure hospital reviews take place and referring for . For spontaneous mutations the risk of recurrence (...) described and consists of micrognathia, a prominent upper lip and a depressed nasal bridge with somewhat anteverted nares. If the pathogenic variant has been identified in an affected family member, prenatal testing for pregnancies at increased risk can be done using molecular genetic testing. History The condition was first referred to by Brachmann in 1916 when he described an isolated case with autopsy findings. Cornelia de Lange published in 1933 and described two unrelated girls and proposed a new

2008 Mentor

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