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161. Parasomnias (Treatment)

and occasionally become injured). The prognosis for resolution with maturation is excellent. Sleep-disordered breathing and, to a lesser extent, RLS have been associated with sleepwalking in children, though less often than in adults. The incidence of associated sleep disorders has been reported to be as high as 61%. Prolonged disturbed sleep may be associated with school and behavioral issues. A relationship with hyperactivity is suggested but not clear. In adolescents and adults, morbidity may be more (...) and zolpidem. Ann Pharmacother . 2003 Oct. 37(10):1429-33. . Oulis P, Kokras N, Papadimitriou GN, Masdrakis VG. Bupropion-induced sleepwalking. J Clin Psychopharmacol . 2010 Feb. 30(1):83-4. . Mathew T, Sarma GR, Nadig R, Varghese R. Topiramate-induced somnambulism in a migraineur: a probable idiosyncratic adverse effect. J Clin Sleep Med . 2012 Apr 15. 8(2):197-8. . . Owens J, Opipari L, Nobile C, Spirito A. Sleep and daytime behavior in children with obstructive sleep apnea and behavioral sleep disorders

2014 eMedicine.com

162. Psychosocial and Environmental Pregnancy Risks (Treatment)

maternal BPA levels and pregnancy and pediatric outcomes such as miscarriage rates, infant reactive airway disease, low birth weight, liver dysfunction, and neurologic complaints (eg, hyperactivity). [ , , , ] A recent study found increased rates of depression and behavioral problems in young boys who were exposed to BPA in utero; this included an increase in rates of oppositional defiance disorder (ODD). [ ] Plant estrogens from soy and legumes can adversely affect reproduction in rats and sheep (...) dose because the fetus is in direct line with the x-ray beam, but the average exposure is still only 100 mrad. Trauma series radiographs of the extremities, skull, and ribs deliver low doses because of fetal distance to the target area, except for the hip or pelvic radiograph, which delivers about 200 mrad Computed tomography (CT) scanning This important imaging modality is used commonly to evaluate for multiple disorders. Newer generation tomography equipment is more sensitive and there is less

2014 eMedicine.com

163. Pulmonary Rehabilitation (Treatment)

See the list below: Peripheral muscle dysfunction Respiratory muscle dysfunction Nutritional abnormalities Cardiac impairment Skeletal disease Sensory deficits Psychosocial dysfunction Mechanisms for these morbidities See the list below: Deconditioning Malnutrition Effects of hypoxemia Steroid myopathy or intensive care unit (ICU) neuropathy Hyperinflation Diaphragmatic fatigue Frequent hospitalizations Effects of various medications Psychosocial dysfunction resulting from anxiety, depression (...) ) for patients with chronic respiratory disease. These goals are achieved through patient and family education, exercise training, psychosocial and behavioral intervention, and outcome assessment. The rehabilitation intervention is geared toward the unique problems and needs of each patient and is implemented by a multidisciplinary team of health care professionals. For patient education resources, see the , as well as . Next: Benefits of Pulmonary Rehabilitation The benefits of pulmonary rehabilitation

2014 eMedicine.com

164. Obesity (Treatment)

== processing > Obesity Treatment & Management Updated: Mar 20, 2018 Author: Osama Hamdy, MD, PhD; Chief Editor: Romesh Khardori, MD, PhD, FACP Share Email Print Feedback Close Sections Sections Obesity Treatment Approach Considerations Treatment of obesity starts with comprehensive lifestyle management (ie, diet, physical activity, behavior modification), which should include the following [ ] : Self-monitoring of caloric intake and physical activity Goal setting Stimulus control Nonfood rewards Relapse (...) between 5% and 10% for the long-term. [ , ] In January, 2015, the Endocrine Society released new guidelines on the treatment of obesity to include the following: [ , ] Diet, exercise, and behavioral modification should be included in all obesity management approaches for body mass index (BMI) of 25 kg/m 2 or higher. Other tools, such as pharmacotherapy for BMI of 27 kg/m 2 or higher with comorbidity or BMI over 30 kg/m2 and bariatric surgery for BMI of 35 kg/m 2 with comorbidity or BMI over 40 kg/m 2

2014 eMedicine.com

165. Parasomnias (Overview)

and occasionally become injured). The prognosis for resolution with maturation is excellent. Sleep-disordered breathing and, to a lesser extent, RLS have been associated with sleepwalking in children, though less often than in adults. The incidence of associated sleep disorders has been reported to be as high as 61%. Prolonged disturbed sleep may be associated with school and behavioral issues. A relationship with hyperactivity is suggested but not clear. In adolescents and adults, morbidity may be more (...) and zolpidem. Ann Pharmacother . 2003 Oct. 37(10):1429-33. . Oulis P, Kokras N, Papadimitriou GN, Masdrakis VG. Bupropion-induced sleepwalking. J Clin Psychopharmacol . 2010 Feb. 30(1):83-4. . Mathew T, Sarma GR, Nadig R, Varghese R. Topiramate-induced somnambulism in a migraineur: a probable idiosyncratic adverse effect. J Clin Sleep Med . 2012 Apr 15. 8(2):197-8. . . Owens J, Opipari L, Nobile C, Spirito A. Sleep and daytime behavior in children with obstructive sleep apnea and behavioral sleep disorders

2014 eMedicine.com

166. Tourette Syndrome (Treatment)

drugs clonidine and guanfacine are first-line agents in treating mild to moderate tics. Clonidine decreases plasma norepinephrine levels and can also reduce the symptoms of attention deficithyperactivity disorder (ADHD). The daily dosage range for clonidine is 0.1-0.3 mg in divided doses. Guanfacine, with a similar mechanism of action as clonidine, has a longer half-life and may treat ADHD symptoms not responsive to clonidine. For guanfacine, the daily dosage range is 0.5-3.0 mg in divided doses (...) of tics. However, with prolonged use, the initial worsening of tics may stabilize. The dopamine-blocking agents can be used concurrently with the CNS stimulants for tic suppression. Alpha2-adrenergic blockers may be helpful in controlling tics and treating symptoms of ADHD. Both clonidine and guanfacine can control the symptoms of ADHD and impulse control. Other medications that can be effective in treating ADHD symptoms without worsening tics include bupropion and the tricyclic antidepressants

2014 eMedicine.com

167. Tourette Syndrome and Other Tic Disorders (Treatment)

studies, other treatments for tics, treatment for obsessive-compulsive symptoms in patients with tics, treatment for attention deficithyperactivity disorder (ADHD) in patients with tics, and treatment for other symptoms in patients with tics. Next: Treatments for Tics Treatments for tics that have demonstrated efficacy in replicated controlled trials (RCTs) include the following: Dopamine D2 receptor antagonist therapy Dopamine agonist therapy Habit reversal therapy Dopamine D2 receptor antagonist (...) : evidence from transcranial magnetic stimulation. Am J Psychiatry . 1997 Sep. 154(9):1277-84. . Moll GH, Heinrich H, Trott GE, et al. Children with comorbid attention-deficit-hyperactivity disorder and tic disorder: evidence for additive inhibitory deficits within the motor system. Ann Neurol . 2001 Mar. 49(3):393-6. . Gilbert DL, Bansal AS, Sethuraman G, et al. Association of cortical disinhibition with tic, ADHD, and OCD severity in Tourette syndrome. Mov Disord . 2004 Apr. 19(4):416-25. . Gilbert DL

2014 eMedicine.com

168. Teratology and Drug Use During Pregnancy (Treatment)

are death, malformation, growth retardation, and functional disorder. 5. The access of adverse environmental influences to developing tissues depends on the nature of the agent. 6. Manifestations of deviant development increase in degree as dosage increases from the no-effect to the totally lethal effect. [ ] Previous Next: Drug Exposures in the Male Partner Research is increasingly addressing the role of paternal exposure to medications before conception or during his partner’s pregnancy. Certain (...) outcomes bases on all relevant human data, animal data, and the drugs pharmacology. Adverse developmental outcomes include the four groups of developmental toxicities: - "Structural abnormalities" describes dysmorphology, which includes malformations, variations, deformations, and disruptions. - "Embryo-fetal and/or infant mortality" describes development mortality, which includes miscarriage, stillbirth, and infant death (including neonatal death). - "Functional impairment" describes functional

2014 eMedicine.com

169. Geriatric Rehabilitation (Overview)

] < 20 mm Hg), balance disorders, and vasovagal syncope. Depression, confusion, dementia, and other cognitive deficits also contribute to falls. Cognitive impairment, depressive symptoms, and orthostatic hypotension most contribute to gait dysfunction. Slower performance on the Timed Up-and-Go Test (TUG), a mobility task, is independently associated with poorer performance on measures of global cognition, executive function, memory, and processing speed, suggesting that a thorough cognitive (...) they are discharged from a hospital after an established fracture. Attention to the male, as well as the female, geriatric population is warranted in regard to the prevention and treatment of osteoporosis. Compared with women, men generally develop osteoporosis at an older age. Types of osteoporosis Different types of osteoporosis are described. Localized osteoporosis is seen in primary disorders, such as complex regional pain syndrome (CRPS) (type I formerly known as reflex sympathetic dystrophy and type II

2014 eMedicine.com

170. Tourette Syndrome and Other Tic Disorders (Overview)

, such as blinking, sniffing, facial movements, or tensing of the abdominal musculature. Other neurobehavioral manifestations include attention-deficit-hyperactivity disorder, obsessive-compulsive disorder, poor impulse control, and other behavioral problems. Symptoms wax and wane and vary significantly from one patient to another. Although diagnosis requires the presence of chronic multiple independent motor tics and at least one phonic tic, these are not always the patient's most disabling symptom. Historical (...) -compulsive disorder (OCD) and attention deficithyperactivity disorder (ADHD). Neuropathological studies, however, have failed to reveal any consistent structural abnormalities in these areas. Volumetric MRI studies have suggested that the normal asymmetry of the basal ganglia is lost in affected individuals. Healthy right-handed males normally demonstrate a predominance of the left putamen but this appears to be absent in TS, supporting the possibility of a developmental abnormality. Little is known

2014 eMedicine.com

171. Parasomnias (Follow-up)

and occasionally become injured). The prognosis for resolution with maturation is excellent. Sleep-disordered breathing and, to a lesser extent, RLS have been associated with sleepwalking in children, though less often than in adults. The incidence of associated sleep disorders has been reported to be as high as 61%. Prolonged disturbed sleep may be associated with school and behavioral issues. A relationship with hyperactivity is suggested but not clear. In adolescents and adults, morbidity may be more (...) and zolpidem. Ann Pharmacother . 2003 Oct. 37(10):1429-33. . Oulis P, Kokras N, Papadimitriou GN, Masdrakis VG. Bupropion-induced sleepwalking. J Clin Psychopharmacol . 2010 Feb. 30(1):83-4. . Mathew T, Sarma GR, Nadig R, Varghese R. Topiramate-induced somnambulism in a migraineur: a probable idiosyncratic adverse effect. J Clin Sleep Med . 2012 Apr 15. 8(2):197-8. . . Owens J, Opipari L, Nobile C, Spirito A. Sleep and daytime behavior in children with obstructive sleep apnea and behavioral sleep disorders

2014 eMedicine.com

172. Pulmonary Rehabilitation (Follow-up)

See the list below: Peripheral muscle dysfunction Respiratory muscle dysfunction Nutritional abnormalities Cardiac impairment Skeletal disease Sensory deficits Psychosocial dysfunction Mechanisms for these morbidities See the list below: Deconditioning Malnutrition Effects of hypoxemia Steroid myopathy or intensive care unit (ICU) neuropathy Hyperinflation Diaphragmatic fatigue Frequent hospitalizations Effects of various medications Psychosocial dysfunction resulting from anxiety, depression (...) ) for patients with chronic respiratory disease. These goals are achieved through patient and family education, exercise training, psychosocial and behavioral intervention, and outcome assessment. The rehabilitation intervention is geared toward the unique problems and needs of each patient and is implemented by a multidisciplinary team of health care professionals. For patient education resources, see the , as well as . Next: Benefits of Pulmonary Rehabilitation The benefits of pulmonary rehabilitation

2014 eMedicine.com

173. Assistive Devices to Improve Independence (Overview)

mobility, orthostatic hypotension (systolic blood pressure [SBP] < 20 mm Hg), balance disorders, and vasovagal syncope. Depression, confusion, dementia, and other cognitive deficits also contribute to falls. Cognitive impairment, depressive symptoms, and orthostatic hypotension most contribute to gait dysfunction. Slower performance on the Timed Up-and-Go Test (TUG), a mobility task, is independently associated with poorer performance on measures of global cognition, executive function, memory (...) they are discharged from a hospital after an established fracture. Attention to the male, as well as the female, geriatric population is warranted in regard to the prevention and treatment of osteoporosis. Compared with women, men generally develop osteoporosis at an older age. Types of osteoporosis Different types of osteoporosis are described. Localized osteoporosis is seen in primary disorders, such as complex regional pain syndrome (CRPS) (type I formerly known as reflex sympathetic dystrophy and type II

2014 eMedicine.com

174. Amphetamine-Related Psychiatric Disorders (Overview)

: Summary of National Findings. 2014. Available at . Mosholder AD, Gelperin K, Hammad TA, Phelan K, Johann-Liang R. Hallucinations and other psychotic symptoms associated with the use of attention-deficit/hyperactivity disorder drugs in children. Pediatrics . 2009 Feb. 123(2):611-6. . Alem A, Kebede D, Kullgren G. The prevalence and socio-demographic correlates of khat chewing in Butajira, Ethiopia. Acta Psychiatr Scand Suppl . 1999. 397:84-91. . Shen W, Liu Y, Li L, Zhang Y, Zhou W. Negative moods (...) antidepressant-resistant amphetamine-induced depression. Of interest, low-dose amphetamines can be used as an adjunct in the treatment of depression, especially in patients with medical compromise, lethargy, hypersomnia, low energy, or decreased attention. Sleep disturbances appear in a fashion similar to mood disorders. During intoxication, sleep can be decreased markedly. In withdrawal, sleep often increases. A disrupted circadian rhythm can result from late or high doses of prescription amphetamines

2014 eMedicine.com

175. Psychosocial and Environmental Pregnancy Risks (Follow-up)

maternal BPA levels and pregnancy and pediatric outcomes such as miscarriage rates, infant reactive airway disease, low birth weight, liver dysfunction, and neurologic complaints (eg, hyperactivity). [ , , , ] A recent study found increased rates of depression and behavioral problems in young boys who were exposed to BPA in utero; this included an increase in rates of oppositional defiance disorder (ODD). [ ] Plant estrogens from soy and legumes can adversely affect reproduction in rats and sheep (...) dose because the fetus is in direct line with the x-ray beam, but the average exposure is still only 100 mrad. Trauma series radiographs of the extremities, skull, and ribs deliver low doses because of fetal distance to the target area, except for the hip or pelvic radiograph, which delivers about 200 mrad Computed tomography (CT) scanning This important imaging modality is used commonly to evaluate for multiple disorders. Newer generation tomography equipment is more sensitive and there is less

2014 eMedicine.com

176. Obesity (Follow-up)

== processing > Obesity Treatment & Management Updated: Mar 20, 2018 Author: Osama Hamdy, MD, PhD; Chief Editor: Romesh Khardori, MD, PhD, FACP Share Email Print Feedback Close Sections Sections Obesity Treatment Approach Considerations Treatment of obesity starts with comprehensive lifestyle management (ie, diet, physical activity, behavior modification), which should include the following [ ] : Self-monitoring of caloric intake and physical activity Goal setting Stimulus control Nonfood rewards Relapse (...) between 5% and 10% for the long-term. [ , ] In January, 2015, the Endocrine Society released new guidelines on the treatment of obesity to include the following: [ , ] Diet, exercise, and behavioral modification should be included in all obesity management approaches for body mass index (BMI) of 25 kg/m 2 or higher. Other tools, such as pharmacotherapy for BMI of 27 kg/m 2 or higher with comorbidity or BMI over 30 kg/m2 and bariatric surgery for BMI of 35 kg/m 2 with comorbidity or BMI over 40 kg/m 2

2014 eMedicine.com

177. Stroke, Ischemic (Treatment)

of hyperglycemia in acute stroke remains an area of uncertainty. [ ] Extreme hyperglycemia is detrimental in the setting of acute stroke. Hyperglycemia is common after acute ischemic stroke, even in patients without diabetes. A Cochrane review found that the use of IV insulin to maintain serum glucose in the range of 4–7.5 mmol/L (72-135 mg/dL) in the first 24 hours of ischemic stroke did not improve functional outcome, death rates, or final neurologic deficit and significantly increased the risk (...) deficits. Unfortunately, fibrinolytics may also cause symptomatic intracranial hemorrhage. Other complications include potentially extracranial hemorrhage and angioedema or allergic reactions. [ ] Inclusion/exclusion criteria Therefore, if the patient is a candidate for fibrinolytic therapy, a thorough review of the inclusion and exclusion criteria must be performed. The exclusion criteria largely focus on identifying risk of hemorrhagic complications associated with fibrinolytic use. The American

2014 eMedicine Emergency Medicine

178. Tourette Syndrome (Follow-up)

drugs clonidine and guanfacine are first-line agents in treating mild to moderate tics. Clonidine decreases plasma norepinephrine levels and can also reduce the symptoms of attention deficithyperactivity disorder (ADHD). The daily dosage range for clonidine is 0.1-0.3 mg in divided doses. Guanfacine, with a similar mechanism of action as clonidine, has a longer half-life and may treat ADHD symptoms not responsive to clonidine. For guanfacine, the daily dosage range is 0.5-3.0 mg in divided doses (...) of tics. However, with prolonged use, the initial worsening of tics may stabilize. The dopamine-blocking agents can be used concurrently with the CNS stimulants for tic suppression. Alpha2-adrenergic blockers may be helpful in controlling tics and treating symptoms of ADHD. Both clonidine and guanfacine can control the symptoms of ADHD and impulse control. Other medications that can be effective in treating ADHD symptoms without worsening tics include bupropion and the tricyclic antidepressants

2014 eMedicine.com

179. Depression (Follow-up)

to other medications. TCAs may also be useful for those with comorbid attention deficit hyperactivity disorder (ADHD), enuresis, and narcolepsy, as well as for augmentation strategies. The TCAs require a baseline electrocardiogram (...) depressive disorder. While more structured than dynamic treatments, IPT has less structure than cognitive and behavioral approaches. IPT draws from attachment theory and emphasizes the role of interpersonal relationships, [ ] focusing on current interpersonal difficulties. Specific areas of emphasis include grief, interpersonal disputes, role transitions, and interpersonal deficits. [ ] The initial phase of treatment (sessions 1-4) focuses on building a working alliance as well as identifying an area

2014 eMedicine.com

180. Teratology and Drug Use During Pregnancy (Follow-up)

are death, malformation, growth retardation, and functional disorder. 5. The access of adverse environmental influences to developing tissues depends on the nature of the agent. 6. Manifestations of deviant development increase in degree as dosage increases from the no-effect to the totally lethal effect. [ ] Previous Next: Drug Exposures in the Male Partner Research is increasingly addressing the role of paternal exposure to medications before conception or during his partner’s pregnancy. Certain (...) outcomes bases on all relevant human data, animal data, and the drugs pharmacology. Adverse developmental outcomes include the four groups of developmental toxicities: - "Structural abnormalities" describes dysmorphology, which includes malformations, variations, deformations, and disruptions. - "Embryo-fetal and/or infant mortality" describes development mortality, which includes miscarriage, stillbirth, and infant death (including neonatal death). - "Functional impairment" describes functional

2014 eMedicine.com

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