Primary diagnosis

The cross-national prescribing database using the same methodology provided a useful and valid comparison of patterns of prescribing psychotropic medications in mental health services in Australia, Thailand, and Malaysia (Ng et al, submitted). The study was carried out in three outpatient mental health centres in North Western Mental Health (NWMH) in Melbourne (September to November 2002), Prince of Songkla University Hospital in Hat Yai (January to March 2003), and Hospital Kuala Lumpur (January to March 2003). The proportions of outpatients treated with a primary diagnosis of a psychotic illness were 91%, 41%, and 75% in the Australian, Thai, and Malaysian samples respectively. Considering psychotropic prescriptions in schizophrenia alone, the majority of patients were prescribed antipsychotics Australia (93.7%), Thailand (92.9%), and Malaysia (97.7%). 

Diagnosis 2.1. Primary Diagnosis 2.1.1. Daily Fecal Fat Output... 

In another study, B. Black et al. [1992] reported an open trial of fluoxetine in 14 subjects, all with a primary diagnosis of social phobia, generalized subtype. Ten of the subjects were treated with only fluoxetine. Four subjects... 

Another open trial of fluoxetine was reported by Van Ameringen et al. (1993). In this study, 16 subjects with a primary diagnosis of social phobia were entered into a 12-week clinical trial. Treatment started at a dose of 20 mg/day and was increased every 4 weeks, according to clinical response and side effects, to a maximum daily dose of 60 mg. Of the 16 subjects, 10 were considered responders, 3 were nonresponders, and 3 dropped out of the trial as a result of adverse effects related to the medication. The response rate of the different subtypes of social phobia was not reported in this study. 

One study of 17 OCD patients on medication found that nine of the 10 responders no longer met criteria for the diagnosis of a personality disorder, whereas five of the seven nonresponders continued to meet criteria. These data imply that some personality disorders may be secondary to a primary diagnosis of OCD ( 181). 

Worthington JJ III, Pollack MH, Otto MW, et al. Long-term experience with clonazepam in patients with a primary diagnosis of panic disorder. Psychopharmacol Bull 1998 34 199-205. 

In a retrospective case-control study, a primary diagnosis of hypoglycemia was identified in 413 patients registered as diabetic in 1993 (164). Five controls of the same age and sex, without hypoglycemia, were selected for each case from the same cohort. The relative risks of hypoglycemia with ACE inhibitors, beta-blockers, calcium antagonists, and salicylates were determined. There was an association between enalapril and sulfonylureas. However, other ACE inhibitors could not be identified as a risk factor. There was no interaction with beta-blockers, calcium channel blockers, or salicylates. 

Body weight Primary diagnosis Secondary diagnosis... 

The diagnostic criteria of DSM-IV (Diagnostic and Statistical Manual) or ICD 10 (International Classification of Disease) are generally used. Both divide anxiety into a series of sub-syndromes with clear operational criteria to assist in distinguishing them. At any one time many patients may have symptoms of more than one S5mdrome but making the primary diagnosis is important as this markedly influences the choice of treatment. 

Two women aged 24 and 44 years, whose primary diagnosis was relapsing multiple sclerosis, developed renal impairment and a thrombotic thrombocytopenic pur-pura-like syndrome within 2-4 weeks after starting interferon beta-la (44). Thrombocytopenia and renal function normalized in the first patient, whereas the second patient had thrombotic angiopathy on renal biopsy and required dialysis while awaiting renal transplantation. 

Mamdani etaLlU3] 2004 Population- Primary diagnosis based ofCHF retrospective cohort 38882 individuals 66 years and older who were prescribed study and 100000 randomly selected non-NSAID users matched by sex and age % study cohort w/ admission procedures for CHF in past 5 years Non-NSAID 4% (4475/100000). Celexocib 6% (1170/18908) Rofecoxib 6% (857/14583). Non-selective NSAIDS 5% (542/11606) Adjusted Rate Ratio Rofecoxib relative to celecoxib for admission for CHF 1.8 (1.4-2.4) Non-selective NSAIDs relative to celecoxib for admission for CHF 1.4 (1.0-1.9) and (rofecoxib users relative to non-NSAID users. Additional analysis with age-matched and sex-matched controls showed similar patterns. Increased risk of CHF in elderly patients when using rofecoxib and non-selective NSAIDs (but not celecoxib)... 

Figure 45-12 Trends in incident rates of end-stage renal disease (ESRD) by primary diagnosis. Diabetes is the primary cause of ESRD in 42% to 47% of adult dialysis patients in the United States.The overall incidence of ESRD has increased by 50% between 199 [ and 2000. (From United States Renal Data System Excerpts from the USRDS annual data report atlas of ESRD in the United States. Am J Kidney Dis 2003 (suppl 2) 41 50, with permission from the National Kidney Foundation.)...

Although the etiology of autism is not understood, the defining or core symptoms of autistic disorder are considered to be impaired social interaction, impaired verbal and nonverbal communication, and restrictive, repetitive patterns of behavior. In addition, most patients with a primary diagnosis of autism exhibit other neurological or psychiatric symptoms, which may include seizures, sleep disorders, anxiety, panic attacks, attention deficit/hyperactivity, self-injury, and cognitive impairment (Simonoff et ah, 2008). It is not known to what extent these comorbidities reflect the primary pathology of autism and to what extent they represent unrelated vulnerabilities that are exacerbated by the impaired social interaction and communication that is characteristic of the disorder. 

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