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Depression Screening Tools

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5981. Arsenic Poisoning

motor neuropathy. Details of acute poisoning features Garlic odour - often present in breath and body tissues. Gastrointestinal (GI): Hypersalivation, abdominal pain, vomiting, diarrhoea leading to hypovolaemic shock. Trivalent arsenic is corrosive - may cause oral burns, dysphagia and GI bleeding. Cardiovascular: Myocardial depression. Dehydration, hypovolaemia or shock. ECG changes including ST-segment changes, prolonged QT interval, ventricular tachycardia, torsades de pointes and ventricular (...) fibrillation. Gangrene of extremities. Respiratory: Pulmonary oedema, adult respiratory distress syndrome and acute respiratory failure. Inhaled arsenic causes irritation, bronchospasm and pulmonary oedema. Renal and hepatic: Haematuria or haemoglobinuria (from acute haemolysis), proteinuria, acute tubular necrosis with acute kidney injury. Jaundice, hepatomegaly, pancreatitis. Neurological: CNS depression, encephalopathy and coma. Seizures. Haematological: Acute haemolysis. Bone marrow suppression

2008 Mentor

5982. Antipsychotics

Guidelines. You may find one of our more useful. In this article In This Article Psychosis - Diagnosis and Management In this article Psychosis is a severe mental disorder in which there is extreme impairment of ability to think clearly, respond with appropriate emotion, communicate effectively, understand reality and behave appropriately. Psychosis occurs in a number of serious mental illnesses and not just schizophrenia - eg, depression, bipolar disorder (manic-depressive illness), puerperal psychosis (...) of the patient's mental state: Is there loss of touch with reality; are there delusions or a bewildered mood? Is thought or speech disorganised, abstract or vague? Is emotion normal and appropriate? Remember that such experiences will naturally cause extreme anxiety but are there inappropriate emotional outbursts? Is there excitement or confusion? Is there depression or suicidal ideation? Depression can cause psychosis and all forms of mental illness have a risk of suicide, not just depression

2008 Mentor

5983. Antisocial Personality Disorder

. Egocentricity. A disregard for the feelings of others. A wide range of interpersonal and social disturbance. Comorbid depression and anxiety. Comorbid alcohol and drug misuse. It is important to note that dissocial personality disorder is not formally diagnosed before the age of 18 but there may be a history of conduct disorders before this age. Conduct disorders may be manifested as antisocial, aggressive or defiant behaviour, which is persistent and repetitive. This includes aggressive behaviour (...) and the high frequency of comorbid conditions and problems. Premorbid and developmental history from third parties can be helpful when making a diagnosis: . Mental disorders secondary to medical conditions ( , ). . . . Brief psychotic disorder. . . . . . Investigations Toxicology screen because substance abuse is common (as with many personality disorders). Intoxication can lead patients to present with some features of personality disorders. [ ] Screening for HIV and other sexually transmitted infections

2008 Mentor

5984. Cardiac Rehabilitation

. Reassurance and correction of any misconceptions. Education. Initial mobilisation. Plan for discharge. Phase 2: the post-discharge stage The early discharge period is the time at which the patient is the most vulnerable and psychological distress at this stage is a predictor of poor outcome and increased use of hospital services independent of the physical damage to the heart. Patients should be screened for anxiety and depression at this stage and should be treated with suitable non-cardiotoxic (...) distress, hospital readmission rates and anxiety and depression scores at one year [ ] . Engaging patients Although cardiac rehabilitation has been proven to be beneficial, uptake has been suboptimal. Reasons provided by patients are varied and include difficulty in attending the hospital (transport, car parking), a dislike of groups, and work or domestic commitments. There is only weak evidence to suggest that interventions to increase the uptake of cardiac rehabilitation are effective. However

2008 Mentor

5985. Bulimia Nervosa

throat and dental problems due to vomiting. Mood disturbance and anxiety are common, as are low self-esteem, and self-harm. Severe comorbid conditions may be present - eg, depression and substance abuse. Examination Physical examination is usually normal and is mainly aimed at excluding medical complications such as dehydration or dysrhythmias (induced by hypokalaemia). Examination must include height and weight (and calculation of the BMI) and blood pressure. In severe cases signs may be present (...) responsible. Recommend regular dental reviews and dental hygiene (eg, rinse the mouth after vomiting). Reduce laxatives slowly. Screen for osteoporosis. For those with bulimia and diabetes, collaboration is required with the person, the diabetes team and the family. Sugars and ketones may need close monitoring, and be aware of the possibility of insulin misuse. Monitor potassium carefully. Complications Haematemesis, and metabolic complications (eg, hypokalaemia), following excessive self-induced vomiting

2008 Mentor

5986. Coma

reacting briskly to light - metabolic cause (eg, hepatic or renal failure). Corneal reflexes: these are normally intact until there is a very deep coma. In drug intoxication, they may be absent in a patient otherwise in a light coma. Otherwise, loss of corneal reflex is indicative of a poor prognosis. Eye movements Spontaneous eye movements Conjugate deviation of the eyes - possible focal hemispheric or brainstem lesion. Depression of the eyes - lesion in the midbrain at the level of the tectum. Skew (...) There are a number of potential causes for coma and these can be divided in many different ways - eg, reversible/irreversible, according to systems, duration of onset, etc. The following table divides the causes into systems. Causes of comatose states Trauma . Depressed cranial fracture. Intracerebral haemorrhage. . Toxic Ethanol. Drug overdose - eg, opiates, benzodiazepines, neuroleptics. Sedatives. Recreational drugs - eg: Gamma-hydroxybutyrate [ ] Ecstasy Cocaine Poisons- eg, , solvents. Metabolic

2008 Mentor

5987. Cocaine Addiction and Abuse

and Northern Ireland Executive (2007) ; The Scottish Government 2010 ; NICE Clinical Guideline (July 2007) ; Novel pharmacotherapeutic treatments for cocaine addiction. BMC Med. 2011 Nov 39:119. doi: 10.1186/1741-7015-9-119. 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 Feeling unwell? Assess your symptoms online with our free symptom (...) , psychological and mental health and forensic history. Establish why they are consulting you now and why they want to stop now. The social situation should be assessed, during which it should be determined whether anyone else in the household is at immediate risk (eg, children, vulnerable adults). Physical and mental state examination. Offer screening for drugs, hepatitis, HIV and sexually transmitted infections (STIs) after appropriate counselling. Ongoing care (This may need to be adapted to fit local

2008 Mentor

5988. Acute Poisoning - General Measures

) guidelines on Adult Basic Life Support and Paediatric Basic Life Support. [ , ] Airway Open, suction, maintain and intubate as necessary. Breathing Assess work and effectiveness of ventilation. Give oxygen ± assisted ventilation (avoid mouth-to-mouth). Respiratory depression - consider opiates, benzodiazepines. Tachypnoea - consider metabolic acidosis - eg, salicylates, methanol. Circulation Attach a cardiac monitor, assess pulse, blood pressure and perfusion. Establish intravenous (IV) access (...) sulphide), organic solvents. Mouth - perioral acneiform lesions (solvent abuse), dry mouth (anticholinergics), hypersalivation (parasympathomimetics). Investigations 12-lead electrocardiogram. U&E, laboratory glucose, anion gap ± lactate and osmolal gap. LFTs and clotting. Arterial blood gases. Paracetamol level (also salicylates, [ ] theophylline, digoxin, lithium, antiepileptics - if it was likely that they had been taken). Comprehensive toxicology screens not normally indicated in the emergency

2008 Mentor

5989. Acute Myocardial Infarction Management Full Text available with Trip Pro

with GTN sublingual/spray and/or an intravenous opioid 2.5-5 mg diamorphine or 5-10 mg morphine intravenously with an anti-emetic. [ ] Avoid intramuscular injections, as absorption is unreliable and the injection site may bleed if the patient later receives thrombolytic therapy. Aspirin 300 mg orally (dispersible or chewed). Insert a Venflon® for intravenous access and take blood tests for FBC, renal function and electrolytes, glucose, lipids, clotting screen, C-reactive protein (CRP) and cardiac (...) (reteplase or tenecteplase) rather than an infusion for pre-hospital thrombolysis. [ ] Management initiated in hospital If not already done, insert a Venflon® for intravenous access and take blood tests for cardiac enzymes (troponin I or T), FBC, renal function and electrolytes, glucose, lipids, CRP, and clotting screen. See separate article for a more detailed discussion of investigations. Continue close clinical monitoring (including symptoms, pulse, blood pressure, heart rhythm and oxygen saturation

2008 Mentor

5990. Acute Confusional State

to determine the patient's premorbid level of function. There are very useful cognitive function screening tools - eg, the abbreviated mental test score and the confusion assessment method. [ ] The mental tests should be performed regularly and on all high-risk patients. However, it may not be appropriate or possible to do these tests on a sick patient. The diagnosis of delirium is clinical. The following features may be present: Usually acute or subacute presentation. Fluctuating course. Consciousness (...) , and the sleep-wake schedule. The duration is variable and the degree of severity ranges from mild to very severe. Subtypes of delirium [ ] Hypoactive subtype - apathy and quiet confusion are present and easily missed. This type can be confused with depression. Hyperactive subtype - agitation, delusions and disorientation are prominent and it can be confused with schizophrenia. Mixed subtype - patients vary from hypoactive to hyperactive. Assessment Check: Airway/breathing/circulation. Conscious level. Vital

2008 Mentor

5991. Acute Alcohol Withdrawal and Delirium Tremens

symptoms or a history of adverse outcomes and need close inpatient supervision. [ ] Problems associated with alcohol withdrawal can include: [ ] Uncomfortable withdrawal symptoms. Delirium tremens. The Wernicke-Korsakoff syndrome. Seizures. Depression. Polysubstance abuse. Electrolyte disturbances. Complications due to associated liver disease. Presentation This may be in a number of different ways: [ ] A patient may present in acute alcohol withdrawal. A patient may be admitted to hospital for another (...) symptoms (can appear 6-12 hours after alcohol has stopped): [ , ] Insomnia and fatigue. Tremor. Mild anxiety/feeling nervous. Mild restlessness/agitation. Nausea and vomiting. Headache. Excessive sweating. Palpitations. Anorexia. Depression. Craving for alcohol. Alcoholic hallucinosis (can appear 12-24 hours after alcohol has stopped): [ ] Includes visual, auditory or . Withdrawal seizures (can appear 24-48 hours after alcohol has stopped): [ , ] These are generalised tonic-clonic seizures. Alcohol

2008 Mentor

5992. Acoustic Neuromas

neuroma may be diagnosed incidentally and earlier as a result of investigations for unrelated problems. Associated diseases Bilateral acoustic neuroma occurs in neurofibromatosis-type 2 (NF2). NF2 is an autosomal dominant disorder (ie has a 50% risk of transmission from a parent) but also shows high levels of mosaicism. 7% of patients with acoustic neuroma also have NF2. [ ] Acoustic neuroma due to NF2 tends to present earlier, typically around 30 years old. Genetic screening for NF2 in patients (...) presenting with sporadic, unilateral acoustic neuroma is usually only productive in cases of very early onset (younger than 20 years). [ ] NF2 patients are predisposed not only to developing acoustic neuroma but also schwannomas of other cranial nerves. [ ] Increasing symptoms associated with acoustic neuroma increases the likelihood of clinically significant anxiety and depression. [ ] Differential diagnosis Other CPA tumours include , epidermoids, lower cranial nerve schwannomas and arachnoid cysts

2008 Mentor

5993. Acromegaly

is also prolactin-secreting [ ] . Hypopituitarism: decreased secretion of anterior pituitary hormones and compression of pituitary stalk. Investigations [ ] See also separate article. Blood glucose; serum phosphate, urinary calcium and serum triglycerides may also be raised. IGF-1 is recommended as the initial screen for suspected acromegaly: It has a correlation with GH levels, long half life of 15 hours and relatively stable serum levels. Highly sensitive, such that a normal level usually excludes (...) sensitive than CT scan. Visual field tests are used: If a tumour is found to abut the optic chiasm on imaging. In pregnant women with a macroadenoma, when they may be performed serially. CT scan may be indicated: for lung, pancreatic, adrenal or ovarian tumours that may secrete ectopic GH or GHRH. Total body scintigraphy with radio-labelled OctreoScan® (somatostatin) may be used to aid localisation of the tumour but is rarely required. Cardiac assessment: electrocardiogram, echocardiogram. Screening

2008 Mentor

5994. Antenatal Care

should be given: Information about breast-feeding. Information to prepare her for labour and birth (birth plan, pain relief options, how to recognise the onset of active labour). Information about care of the new baby and preparations needed. Information about routine procedures such as newborn screening and vitamin K prophylaxis. Advice about postnatal self-care, along with information about postnatal depression and "baby blues". At 38 weeks, she should be given: Information about management options (...) advises healthcare professionals, at a woman's first contact with primary care, her booking visit and during the early postnatal period, to: Consider asking questions to screen for depression and anxiety as part of a general discussion about a woman's mental health and well-being. Ask about any past or present severe mental illness. Ask about past or present treatment by a specialist mental health service, including inpatient care Ask about any severe perinatal mental illness in a first-degree

2008 Mentor

5995. Antenatal Mental Health Problems

Act. Early detection - enquiry regarding past psychiatric history and family history of perinatal mental illness at first contact with services in the antenatal period. Screening for depression at first contact in primary care and booking clinic. The Royal College of Obstetricians and Gynaecologists (RCOG) guidelines further advise that at first booking appointment, women should be sensitively asked about history of intimate partner violence, sexual abuse/assault, use of illegal drugs, self-harm (...) evidence, UK and European Guidelines. You may find the article more useful, or one of our other . In this article In This Article Antenatal Mental Health Problems In this article Psychiatric disorders during pregnancy and following delivery are common: [ ] For the majority of women who develop mental health problems during pregnancy, this is usually a mild depressive illness, often combined with anxiety. Pregnancy protects against developing a serious mental illness (schizophrenia, bipolar disorder

2008 Mentor

5996. Anorexia Nervosa

[ ] . The main risk factors are thought to be: Female gender. Age. Living in a Western society. Family history of eating disorder, depression or substance misuse. Results of twin studies are inconclusive, with some suggesting a strong link, and others none. Premorbid experiences. These include: Sexual abuse. Dieting behaviour within family or personal experience. Occupational or recreational pressure to be slim (dancers, gymnasts, jockeys, models). Onset of puberty. Criticism or perceived criticism about (...) but findings could include bradycardia, hypotension, peripheral oedema, gaunt face, lanugo hair, scanty pubic hair, and acrocyanosis (hands or feet are red or purple). Investigations [ ] An ESR and TFTs are useful screens for other causes of weight loss. Other tests will depend on the individual presentation. U&Es should be checked in all those with behaviours such as vomiting, taking laxatives or diuretics or water loading. In patients with eating disorders and BMI below 15, a history of purging or high

2008 Mentor

5997. Amfetamine (Amphetamine) Abuse and Intoxication

loss. Repetitive motor activity. (sensory of insects crawling on/under skin, leading to obsessive scratching) and ulceration. Withdrawal effects [ ] Amfetamine withdrawal severity declines from an initial peak within 24 hours of last use, to near control levels by the end of the first week. This acute phase of withdrawal is characterised by: Increased eating. Fatigue and increased sleeping. Depression. Anxiety and craving-related symptoms. Differential diagnosis Abuse of other stimulants (...) such as . . Psychotic illness, eg , . . Investigations [ ] Consider the use of other substances - a toxicology screen may be helpful. Amfetamines are detectable in urine for about 48 hours after use. Other investigations depend on symptomatology and extent of toxicity/overdose - for example, electrolytes, renal and liver function, creatine kinase (to exclude which may complicate overdose), ECG, CXR, and neurological imaging. Management [ ] There is no specific treatment available for amfetamine overdose

2008 Mentor

5998. Alzheimer's Disease Full Text available with Trip Pro

of Alzheimer's disease. Normal ageing Other forms of dementia - see separate article . There is often significant overlap. . . . Drug-induced cognitive impairment - eg, benzodiazepines. . , . , amnesia. Neurosyphilis, AIDS dementia complex. Investigations There are several tools available for screening for cognitive impairment, and other routine investigations are detailed in the separate article MRI scans are the investigation of choice to exclude other cerebral pathology. To differentiate Alzheimer's (...) disease from vascular dementia or frontotemporal dementia, NICE guidance advises perfusion hexamethylpropyleneamine oxime (HMPAO) single-photon emission computed tomography (SPECT). This is not useful if the person has Down's syndrome. Note that cognitive screening tests such as the mini mental state examination (MMSE) are not diagnostic of dementia, but are useful screening tools to assess who should be referred to specialist services. [ ] Management: general principles [ , , ] People with dementia

2008 Mentor

5999. Vestibular Neuritis

after several days to a few weeks in the majority of cases of both vestibular neuritis and viral labyrinthitis, with or without symptomatic treatment. Labyrinthitis: recovery of hearing loss is more variable: Suppurative labyrinthitis usually leaves permanent and profound hearing loss. Hearing loss associated with viral labyrinthitis may recover. Disequilibrium or positional vertigo may be present long-term following resolution of the acute infection. Anxiety disorders and depression have been shown (...) to be associated with self-reported vestibular vertigo, as has cognitive impairment [ ] . A study of 68 patients with organic vertigo syndromes found [ ] : Psychiatric comorbidity rates for those with vestibular neuritis corresponded roughly with those in the general population. Anxiety, phobic disorders and depression are increased in people with vestibular migraine and those with Ménière's disease; the reasons for this may be neuro-anatomical and neuro-biological. Did you find this information useful? Thanks

2008 Mentor

6000. Vascular Dementia

, hemiparesis, visual field defects) or extrapyramidal signs (eg, dystonias and Parkinsonian features). Difficulty with attention and concentration. Seizures. Depression and/or anxiety accompanying the memory disturbance. Early presence of disturbance in gait, unsteadiness and frequent, unprovoked falls. The patient has bladder symptoms (eg, incontinence) without a demonstrable urological condition. Features of pseudobulbar palsy Emotional problems - eg, emotional lability, psychomotor retardation (...) or depression. For objective evidence, carry out a test of cognitive functioning (see under 'Diagnosis', below). Also consider in elderly patients presenting with hallucinations, lucid periods, movement disorders, falls or syncope. Making this diagnosis will have important implications for treatment, as the use of neuroleptics in these patients is associated with an increased risk of adverse reactions, and may cause an increase in mortality. [ ] Diagnosis The diagnosis of dementia requires

2008 Mentor

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