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Depression Screening Tools

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6101. Alzheimer's Disease (Full text)

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 PubMed abstract

6102. 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

6103. 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

6104. Vaginismus and Orgasmic Problems in Women (Full text)

and whether it is universal or situational varies between affected women. This can occur when there is adequate arousal but may be related to other sexual problems, as vaginismus is part of a spectrum of female sexual dysfunction. These problems are common and may be related to numerous factors in the woman's life: Overwork Depression Unrelated disease Relationship problems Drug abuse Alcohol problems Hormonal changes Prescribed drugs Epidemiology This is an issue many women find difficult to bring (...) to inform this. The willingness of the woman to come forward with the problem and participate in treatment may be a significant factor, although spontaneous improvement has been noted in up to 10% of women with vaginismus. [ ] Complications [ ] Vaginismus may result in marital or relationship difficulties and may affect quality of life adversely. It may be associated with poor self-esteem, depression and anxiety. Infertility may be an issue. The woman may be unable to participate in the cervical

2008 Mentor PubMed abstract

6105. Vaginal Discharge

of persistent discharge [ ] In some cases, repeated examination and screening yield no positive results, yet the patient still complains of vaginal discharge. It is then appropriate to explore with the patient the nature of the discharge and relate this to normal physiological discharge, to review personal hygiene habits (advise to avoid douches, perfumed products and tight synthetic clothing) and to explore the possibility of the hidden complaint, such as depression, anxiety or psychosexual dysfunction (...) outcomes, particularly preterm birth. Routine screening during pregnancy for asymptomatic BV is not recommended as it has not been shown to reduce the risks of preterm birth. There may, however, be a role for screening women who are at high risk of preterm delivery and treating them before 20 weeks of gestation but the evidence is conflicting. Candidiasis: [ ] Common in pregnancy (30-40%) and often asymptomatic. There is no evidence of any harm to the fetus. C.trachomatis : Incidence is highest

2008 Mentor

6106. Wilson's Disease

features Hepatic disease due to Wilson's disease is diverse. Patients may simply present with persistent asymptomatic hepatomegaly or elevation of serum aminotransferases. The major patterns of hepatic involvement are: . and . Severe chronic liver disease with small, shrunken liver, splenomegaly and ascites. Fulminant hepatic failure ± haemolytic anaemia. Psychiatric features Psychiatric disorders and behavioural problems are common and may be the main clinical feature. Severe depression or various (...) with the neurological features. It is common to find increased density in the basal ganglia. ECG may indicate cardiac involvement. Family screening of first-degree relatives should occur, as the chance of a sibling being homozygous (and therefore developing clinical symptoms) is 25%. [ ] This is done by genetic analysis of the ATP7B gene, especially in patients with indeterminate clinical and biochemical features. Management [ ] Unlike many genetic disorders, Wilson's disease is treatable. The goal of treatment

2008 Mentor

6107. Whiplash and Cervical Spine Injury

tenderness. Headache, fatigue, dizziness, vertigo, blurring of vision, nausea. Numbness in shoulders and arms. Paraesthesia and weakness in the arms and legs - depending on presence and site of any cord contusion. There may be retropharyngeal swelling and dysphagia. Insomnia, anxiety (general anxiety and/or travel anxiety when in a car) or depression. Leg weakness, hyperactive tendon reflexes in the legs, upgoing plantar response, and/or sphincter disturbance, suggest damage to the spinal cord. Arm (...) injury, which include a history of neck surgery, and risk factors for osteoporosis (eg, premature menopause, use of systemic steroids), as minor trauma may fracture the spine in people with osteoporosis. Always consider and assess for other injuries, including head injury. Consider other serious causes of neck pain. See separate article. Assess the presence of associated stress, anxiety, or depression and poor concentration; look for 'yellow flags' that indicate psychosocial barriers to recovery

2008 Mentor

6108. Who Benefits from Antidepressants

and alcohol use, a history of parental depression, homelessness, refugee status and living in institutional settings [ ] . Presentation [ ] Screening This is covered by a separate article on recognition of depression: . Depression is common but is often undetected by the medical profession. However, a diagnosis of depression in primary care has a sensitivity of about 50% and specificity of 81%, with the risk of misidentification outweighing the risk of missed cases [ ] . In other words, GPs may be good (...) . doi: 10.3310/hta16280. ; Self-rated health and long-term prognosis of depression. Ann Fam Med. 2014 Jan-Feb12(1):57-65. doi: 10.1370/afm.1562. i asked about trazodone and very few replies. is there anybody else using it for anxiety and depression? Not sure if its working, just need information ann55375 Health Tools Feeling unwell? Assess your symptoms online with our free symptom checker. Article Information Last Reviewed 15 March 2019 Next Review 13 March 2024 Document ID 2037 (v28) Author Peer

2008 Mentor

6109. Hyaluronates and Viscosupplementation

mood (screen for depression) - determine whether there is any other stress. Pain assessment - ask what the patient has tried, including any drugs used (dose, side-effects, timing). Ask whether there are other treatable sources of pain (eg, periarticular pain, trigger finger, ganglion or bursitis). Enquire whether a chronic pain syndrome has developed. Promote function and reduce adverse effects on activities and sleep; referral to physiotherapy and/or occupational therapy may be indicated. Consider (...) Ensure that the person has been offered at least the core (non-surgical) treatment options before referral. Base decisions on referral thresholds on discussions between patients, referring clinicians and surgeons, rather than using scoring tools for prioritisation. Do not refer for arthroscopic lavage and debridement as part of treatment for OA, unless the person has knee OA with a clear history of mechanical locking (as opposed to morning joint stiffness, 'giving way' or X-ray evidence of loose

2008 Mentor

6110. HRT - Initial Consultation

improve vasomotor symptoms [ ] . In addition, weight loss, mindfulness and cognitive behavioural therapy can have a mild-to-moderate effect on these symptoms [ ] . Discuss with women any modifiable risk factors for cardiovascular disease, such as alcohol, smoking, diabetes and hypertension control. Take the opportunity for health promotion and offer lifestyle advice: Smoking and alcohol. Diet and exercise. Check cervical smear is up to date. Discuss breast self-examination and breast cancer screening (...) , improve sleep and improve mood. However, it is not a treatment for clinical anxiety or depression. Discuss potential risks Advise the woman that there is a small increased risk of: Breast cancer - the risk is only with HRT containing oestrogen and progestogen. Venous thromboembolism (VTE), pulmonary embolism and stroke with taking oral HRT (combined oestrogen and progestogen, and oestrogen-only) increases the risk of these. However, the increased occurrence of these events (VTE, pulmonary embolism

2008 Mentor

6111. HRT - follow-up assessments

of side-effects', below). Check blood pressure and weight. Encourage breast awareness and participation in screening mammography and also cervical screening if appropriate for age. A review and discussion of an individual's risk:benefit ratio concerning HRT should occur at least annually. If appropriate, consider switching from cyclical HRT to continuous combined HRT (see below). The decision on whether to advise continuation of HRT should be based on symptoms and ongoing risks and benefits, rather (...) include: Fluid retention. Headaches or migraine. Breast tenderness. Mood swings and depression. Symptoms of premenstrual syndrome. Acne. Lower abdominal and back pain. Again encourage perseverance, as symptoms may improve over three months. If there is no improvement at that point strategies include: If bleeding is heavy or irregular on sequential combined HRT then the dose of progestogen can be doubled or increased in duration to 21 days. Alternatively the type of progestogen can be changed. Erratic

2008 Mentor

6112. History and Physical Examination

to know their past medical history, even if it is the first time that they have consulted with you, because they know that you have the records. It is certainly worth noting the last consultation and the major problems as displayed on the screen. Think about your timing. Hospital consultants may allow up to an hour for new patient consultations, whereas general practice generally allocates a total of 10 minutes for history, examination and explanation (you are doing very well if you manage to fit (...) in that they reduce the chance of forgetting or overlooking something important. Doctors need to embrace protocols and to engage in their formulation and implementation. Past medical history Patients assume that the doctor has their medical records and is fully conversant with their past medical history. Although major events should be displayed on the screen, some may be incomplete and it is worth checking both for completeness and to assure the patient of one's thoroughness. The habitual loss of medical records

2008 Mentor

6113. Hereditary Haemochromatosis

or hypogonadism. Cirrhosis. Diabetes mellitus. Cardiac disease - arrhythmias or cardiomyopathy. Neurological or psychiatric symptoms - impaired memory, mood swings, irritability, depression. Screening Recommendations for genetic testing: [ ] General population: genetic screening for HFE-HC is not recommended, as disease penetrance is low and only in few C282Y homozygotes will iron overload progress. HFE testing should be considered in patients with unexplained chronic liver disease pre-selected for increased (...) . 2011 Aug43(5):433-9. ; Hereditary hemochromatosis: insights from the Hemochromatosis and Iron Overload Screening (HEIRS) Study. Hematology Am Soc Hematol Educ Program. 2009:195-206. doi: 10.1182/asheducation-2009.1.195. ; Online Mendelian Inheritance in Man (OMIM) Hiya,I've just had my genetic test results and I have one of the genes.I'm not sure what this means long term, I've to go next week for an iron panel.My ferratin levels are mid 200s.Hopefully this... lornacs Health Tools Feeling unwell

2008 Mentor

6114. Hypothermia

, cold and pale skin, fatigue, lethargy and apathy. A depressed level of consciousness is the most common feature of hypothermia. The patient is cold to touch and appears grey and cyanotic. Vital signs (pulse rate, respiratory rate and blood pressure) are variable. Severe depression of respiratory rate and heart rate may result in signs of respiratory and cardiac activity being easily missed. Hypothermia can be classified as mild, moderate or severe: [ ] Mild hypothermia (32-35°C): lethargy (...) transfer to a critical care setting. Assess for and treat any associated disorders - eg, diabetes, sepsis, drug or alcohol ingestion, or occult injuries. Blood investigations: FBC, electrolytes, blood glucose, alcohol, toxin screen, creatinine, amylase and blood cultures. Cardiac monitoring: dysrhythmias, changes of hyperkalaemia; J waves are pathognomonic of hypothermia: Cardiac output falls proportionately to the degree of hypothermia and cardiac irritability begins at about 33°C. Ventricular

2008 Mentor

6115. Hypothyroidism

email to confirm your preferences. Further reading and references ; NICE CKS, February 2011 (UK access only) ; British Thyroid Association (2006) ; Thyroid hormone in health and disease. J Endocrinol. 2005 Oct187(1):1-15. ; Screening for thyroid disease in pregnancy J Clin Pathol. 2005 May ; DermNet NZ ; Hypothyroidism: an update. Am Fam Physician. 2012 Aug 186(3):244-51. ; Hypothyroidism and depression. Eur Thyroid J. 2013 Sep2(3):168-79. doi: 10.1159/000353777. Epub 2013 Aug 27. ; Graves (...) , intolerance to cold. Dry skin and hair loss. Slowing of intellectual activity - eg, poor memory and difficulty concentrating. Constipation. Decreased appetite with weight gain. Deep hoarse voice. Menorrhagia and later oligomenorrhoea or amenorrhoea. Impaired hearing due to fluid in middle ear. Reduced libido. A relationship between hypothyroidism and depression has been assumed for many years. However, the true nature of this association has been difficult to define with many conflicting studies. Large

2008 Mentor

6116. Hyperventilation

hyperventilation Chronic hyperventilation may be rather more difficult to diagnose. The patient rarely hyperventilates in a clinically apparent manner and may have been through multiple investigations already. There may be a persistently low arterial pCO 2 with a high renal excretion of bicarbonate so that pH is normal. Occasional deep, sighing breaths may be noted. These keep the pCO 2 depressed. They may hyperventilate more obviously when stressed and readily produce symptoms under these conditions (...) exclude coronary heart disease or arrhythmia and D-dimer testing and CXR may be required in case of pulmonary embolism or pneumothorax. It may also reveal a prolonged QT interval due to hypocalcaemia during an acute attack. Pulmonary function tests and lung gas transfer help to rule out other underlying lung conditions, such as asthma or pulmonary embolism. Toxicology screen. Acute hyperventilation syndrome can be clinically misdiagnosed as epileptic seizures. Therefore an electroencephalogram (EEG

2008 Mentor

6117. Hallucinogen Persisting Perception Disorder

. Int Clin Psychopharmacol. 2003 Mar18(2):101-5. ; LSD-induced Hallucinogen Persisting Perception Disorder with depressive features treated with reboxetine: case report. Isr J Psychiatry Relat Sci. 200239(2):100-3. ; LSD-induced hallucinogen persisting perception disorder treatment with clonidine: an open pilot study. Int Clin Psychopharmacol. 2000 Jan15(1):35-7. Health Tools Feeling unwell? Assess your symptoms online with our free symptom checker. Article Information Last Reviewed 20 April 2011 (...) , delirium, dementia, visual due to activity. Visual hallucinations due to another drug and/or associated medical condition, eg and L-dopa. Factitious illness. Acute withdrawal from alcohol or drugs (take full substance use history). Ocular disease causing perceptual disturbance. Hypnogogic or hypnapompic hallucinations. Investigations There are no useful confirmatory tests. Screening blood tests, cerebral imaging and electroencephalography (EEG) may be used to exclude other causes of the symptoms

2008 Mentor

6118. Gradual Loss of Vision

Guidelines. You may find the article more useful, or one of our other . In this article In This Article Gradual Loss of Vision In this article The separate article covers acute vision loss. Overview There are a number of reasons why a patient's vision may be gradually declining. This can be very worrying for some patients. In others, the loss is so subtle that it is only picked up on routine screening by the optician. When the patient presents, it is important to take a thorough history, as the patient's (...) or reduced. When viewing an Amsler chart (or graph paper), patients may see breaks, waviness, or missing portions of the lines. Refer urgently if AMD is suspected (see box 'Urgent referral for suspected AMD', below). - is most commonly picked up through screening. If it is so advanced that the patient is the first to notice it, very little can be done. It is characterised by a progressive peripheral visual field loss and 'cupping' of the optic discs (the central area of the optic disc enlarges

2008 Mentor

6119. Gilles de la Tourette's Syndrome

history (include age of onset, whether tics wax and wane and family history of Huntington's or Wilson's disease) and examination. Include a mental state examination. There are scales available - eg, MOVES scale for tic severity. Recognise co-existent disorders - eg, attention deficit hyperactivity disorder (ADHD), depression, sleep problems or learning disabilities. Each of these will need treatment. Differentiate tics from other movement disorders - eg, dystonias and chorea. Check TFT and consider (...) a throat swab for streptococcus if there is rapid onset. An electroencephalogram (EEG) may help if there is concern regarding presence of epilepsy. A urine drug screen may help. Rule out secondary causes of tics: Genetic - eg, Huntington's chorea, Klinefelter's syndrome. Acquired - eg, encephalitis, CVA, hyperthyroidism, CO poisoning, streptococcus-induced autoimmune Tourette's syndrome. Primary neuropsychiatric disorders - eg, schizophrenia. Drugs - eg, cocaine, amfetamines, lithium, antipsychotics

2008 Mentor

6120. Gynaecology History and Examination

:g4531. doi: 10.1136/bmj.g4531. ; Diagnosis and initial management of dysmenorrhea. Am Fam Physician. 2014 Mar 189(5):341-6. ; Impact of vulvovaginal atrophy on sexual health and quality of life at postmenopause. Climacteric. 2014 Feb17(1):3-9. doi: 10.3109/13697137.2013.871696. ; Royal College of Nursing (RCN), 2013 ; Royal College of Obstetricians and Gynaecologists (May 2012) ; General Medical Council ; NICE Technology Appraisals, Oct 2003 ; UK Screening Portal Health Tools Feeling unwell? Assess (...) . Dyspareunia - superficial or deep. Urinary symptoms Leakage. Cloudiness. Haematuria. Hesitancy. Dysuria. Frequency. Strangury. Stress or urge incontinence. Obstetric history Number of children, details of pregnancy, labour and delivery, birth weights, complications. Miscarriages/terminations. Any postnatal problems - eg, depression. Conception difficulties/subfertility. Contraception Contraceptive history. Any recent unprotected intercourse. Reliability of method and user. Potential contra-indications

2008 Mentor

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