Medical disorder

Q Acute Pain related to medical or surgical disorder (speaty) Q Chronic Pain related to medical disorder (speaty)... 

Preanesthetic drugs may be omitted in those 60 years or older because many of the medical disorders for which these drugsare contraindicated are seen in older individuals For example, atropine and glycopyrrolate, drugs that can be used to decrease secretions of the upper respiratory tract, are contraindicated in certain medical disorders such as prostatic hypertrophy, glaucoma, and myocardial ischemia. Other preanesthetic drugs that depress the central nervous astern (CN, such as narcotics barbiturates and antianxiety drugs with or without antiemetic properties may be contraindicated in the older individual. 

Diuretics are used in a variety of medical disorders. The primary health care provider selects the type of diuretic diat will most likely be effective for treatment of a specific disorder. In some instances, hypertension may be treated with the administration of an antihypertensive drug and a diuretic. The diuretics used for this combination tiierapy include the loop diuretics and the thiazides and related diuretics. The specific uses of each type of diuretic drug are discussed in the following sections. 

Medications that have been used as treatment for anxiety and depression in the postwithdrawal state include antidepressants, benzodia2epines and other anxiolytics, antipsychotics, and lithium. In general, the indications for use of these medications in alcoholic patients are similar to those for use in nonalcoholic patients with psychiatric illness. However, following careful differential diagnosis, the choice of medications should take into account the increased potential for adverse effects when the medications are prescribed to alcoholic patients. For example, adverse effects can result from pharmacodynamic interactions with medical disorders commonly present in alcoholic patients, as well as from pharmacokinetic interactions with medications prescribed to treat these disorders (Sullivan and O Connor 2004). 

Sullivan LE, O Connor PC Medical disorders in substance abuse patients, in Dual Diagnosis and Psychiatric Treatment Substance Abuse and Comorbid Disorders, 2nd Edition. Edited by Kranzler HR, Tinsley JA. New York, Marcel Dekker, 2004, pp 515-553... 

Obtain a thorough history of prescription, nonprescription, natural, and illicit drug product use. Rule out medications or medical disorders that may cause or mimic depressive symptoms. 

Typically presents in late adolescence or early adulthood. Onset in older adults increases suspicion of relationship to medical disorders or substance use. Laboratory evaluation must be driven by history and physical examination. 

Medical disorders (e.g., chronic renal disease, anorexia nervosa, endocrine disorders)... 

Information from the US National Institute of Neurological Disorders and Stroke www.ninds.nih.gov/health and medical/disorders/parkinsons disease.htm... 

From a statistical standpoint, there was no significant difference between disorder rates in the LSD subjects and national rates for such disorders. Specific medical disorders that suggested a difference occurred in too small in number to be meaningful. 

Third is the presence of other psychiatric or medical disorders. This can help gnide antidepressant selection in several ways. In some cases, an antidepressant may be preferred becanse it can treat both disorders. For example, the extensive evidence that flnoxetine is an effective treatment for bnlimia nervosa makes it preferable for patients with depression and bnlimia. Similarly, the depressed Parkinson s disease patient whose nenrological illness results from a lack of dopamine in a particular area of the brain may have both her depression and her Parkinson s disease improved by bnpropion, which increases brain dopamine activity. In other cases, an antidepressant shonld be avoided if it worsens the other illness or interacts adversely with a medication needed to treat the other illness. For example, TCAs and MAOIs can complicate glncose control in diabetics and shonld not rontinely be used by depressed diabetics. (See Table 3.11.)... 

Traditionally, lead compounds have been discovered in one of two ways. The hrst is one of trial and error. This is the way many plant and animal products and minerals have been found to be effective in the treatment of some medical disorder. For example, no one knows when the hrst person learned that chewing on the bark of the willow tree [Salix alba) helped relieve pain and reduce fever, but willow bark has been used in many cultures for untold centuries for just that purpose. Today we know that the active ingredient in willow bark is a derivative of salicylic acid (CgH4(OH)COOH), which today is sold commercially as aspirin or one of its analogs. Drug researchers continue to rely heavily on the study of folk medicines—a science known as ethnopharmacology—for the discovery of new plant and animal products that may have medical applications in the modern world. Indeed, scientists have discovered that the medical... 

Rheumatic disease is defined as disease of connective tissue and medical disorders of the musculoskeletal system . The medical discipline concerned with these diseases is referred to as rheumatology. The majority of rheumatic diseases are soft tissue rheumatism and nonspecific low back pain (LBP), autoimmune inflammatory rheumatic diseases, osteoarthritis (OA), osteoporosis, crystal-deposition disease and infectious arthritis. 

Investigate the mechanisms for comorbidity of specific medical disorders wifh anxiefy symptoms and disorders. 

Psychoeducation of the patient and family is required to avoid the development of hopelessness in both the patient and family, and the clinician. Comparing these strategies with other treatments of medical disorders can be useful to help patients and their families understand the medication plan and to improve compliance with and tolerance of treatment. In this instance the example of hypertension is appropriate diuretics may be used alone, or combined with other antihypertensives in different trials, according to response. 

After the patient has been asymptomatic for a period of approximately 6-12 months (continuation phase), the clinician has to decide who should receive maintenance therapy, which therapy to use, and for how long. The main goal of the maintenance phase is to prevent recurrences. This phase may last from 1 year to much longer, and is typically conducted at a visit frequency of every 1 to 3 months, depending on the patient s clinical status, functioning, support systems, environmental stressors, and motivation for treatment, and the existence of other psychiatric or medical disorders (Fig. 36.4). 

It should be noted that polypharmacy per se is not necessarily an inappropriate practice. Most medical disorders, from asthma to AIDS to allergies, are managed with medication combinations. However, it is important to note that the use of multiple concurrent medications appears to rising substantially, suggesting that there is a great need for research data and well-designed studies to inform this practice. In some instances, it may be that the combination, while popular, may be more likely to result in side effects and not particular advantages in treatment efficacy and clinical outcomes (Connor et ak, 2000). 

Organic factors may cause or contribute to affective illness in up to 50% of patients (Hall et al. 1981). In a patient with TRD, it is critical to rule out the presence of underlying medical disorders (Akiskal 1982 MacEwan and Remick 1988). Moreover, iatrogenic depression may result from the coadministration of medications for acute and chronic medical illnesses (Metzger and Friedman 1994). A partial list of organic causes of TRD with references is presented in Table 18-3. 

Seizures. Treatment-emergent seizures are rare in the absence of concomitant medical disorders. Olanzapine should be used with caution in patients with a history of seizures and in patients with conditions that may lower the seizure threshold, such as dementia. 

Benzodiazepines and barbiturates are used as anticonvulsant drugs in the treatment of epilepsy. Epilepsy, a medical disorder characterized by recurrent seizures, has many different forms. The four most common seizure types are generalized tonic-clonic seizures (old name grand mal seizures), generalized absence seizures (petit mal seizures), complex partial seizures (psychomotor or temporal lobe seizures), and simple partial seizures (focal seizures). 

The availability of endogenous enzymes and their variants has allowed the use of enzymes as replacement therapy and as therapeutic agents. With continued refinement in recombinant protein technology, the cost of human recombinant proteins may become more affordable. As more novel human recombinant enzymes are developed, a wide variety of medical disorders will be amenable to enzyme therapies. Additional molecular engineering such as pegylation or creation and modification of... 

Assessment of physical, as well as psychiatric status, is also critically important. The presence of intercurrent medical disorders, as well as any medication used to manage them, increases the likelihood of an adverse outcome with an otherwise appropriate medication. With a recent history of myocardial infarction, certain tricyclic antidepressants (TCAs) or low-potency antipsychotics might be contraindicated due to potential adverse effects on cardiac function. Another example is the avoidance of carbamazepine in a bipolar patient with a persistently low white blood cell count. Finally, b-blockers are typically contraindicated in a patient with asthma. 

Evaluation of memory and orientation is critical to the differentiation of a psychiatric versus a nonpsychiatric medical disorder. Memory for immediate, recent, and remote events can be readily tested, as well as orientation to time, place, person, space, and situation. Assuming the level of anxiety is not sufficient to impair responses to questions in these areas, deficits usually imply some impairment of brain functioning, which may or may not be reversible. 

Identification of medical disorders that present with cognitive, affective, and behavioral changes, or when psychiatric disorders mimic medical-neurological syndromes... 

To monitor patients with other medical disorders or on concurrent psychotropics or other medical drugs... 

A long list of adverse effects may imply that most patients experience many of them to a significant degree. In fact, although almost all patients will experience some mild side effects with these drugs, such as dry mouth or tremor, they are usually transitory and disappear with time, medication reduction, or discontinuation. Fortunately, these effects are rarely serious or irreversible, and on average, the typical complications with antipsychotics are no worse than with medications prescribed for other medical disorders. 

Both the primary/psychiatric versus nonpsychiatric/medical disorder dichotomy and the uncomplicated versus complicated dichotomy are considered. 

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