Prodromal signs

Some researchers have investigated the notion of intermittent treatment. Patients are intensively monitored off medication, and a medication is started once prodromal signs of an impending acnte exacerbation are detected. One thought is that this minimizes the risk of side effects snch as tardive dyskinesia. Althongh in theory this may sound attractive, nnfortnnately, it rarely is successful in practice. Patients receiving intermittent treatment are at exceptionally high risk for relapse. 

Prodromal signs of hypertensive crisis are increased headache, palpitations discontinue drug immediately... 

Prophylaxis may act by treating episodes as they occur, thus attenuating a major exacerbation. In this light, an alternate drug maintenance approach may be to carefully follow patients longitudinally, and only medicate to abort an episode when there are early warnings of a relapse. Unfortunately, many relapses occur abruptly, and it is doubtful that an episode can be halted once the process has started. Yet, some episodes may be preceded by a week or two of prodromal signs. 

An alternate strategy would be to maintain patients on a continuous lower dose of antipsychotics (either long-acting parenteral or oral) that is then increased only when prodromal signs occur. Studies have shown that standard doses are more effective than lower doses, but again, many factors should be considered before embarking on a given approach. 

A decreased need for sleep is a frequent prodromal sign and is characterized by early awakening (sometimes by several hours), a significant reduction in total sleep time, and when severe, several sleepless days with no apparent fatigue. 

Gossypol causes potassium loss, perhaps by a direct toxic effect on the renal tubules (3), which can cause renal tubular acidosis (4). Hypokalemic paralysis (5) has been reported in about 1 % of 8806 volunteers and in China was more common in areas of low dietary potassium intake, such as Nanjing (6) muscular weakness and severe fatigue are prodromal signs (7). Neither potassium supplementation nor triamterene prevented potassium loss in patients taking gossypol (8). 

Arguments have been advanced for the abandonment of thiacetazone as an antituberculosis drug (11,12), despite its cheapness, on the grounds that it often causes severe skin reactions, some rapidly fatal, in patients infected with HIV-1 (13). The WHO and lUATLD has recommended careful information and surveillance of possible adverse reactions, particularly cutaneous, in patients treated for tuberculosis in such countries and immediate replacement with ethambutol if there are any prodromal signs of toxicity. 

Cardiac ruptures are much less frequent with the currently available therapies. However, they may still be found in 2-3% of Q-wave infarctions and are still an important cause of mortality in the acute phase (Figueras et al, 1995). Additionally, cardiac rupture may occur without prodromal signs in patients with evolving Q-wave or equivalent infarction, sometimes small and for that their occurrence is even more dramatic. Therefore, it is extremely important to assess correctly the subtle premonitory data, such as some electrocardiographic details. Contrary to what occurs in primary VF, which may be virtually always resolved in the coronary care unit, cardiac rupture requires urgent surgical treatment. The mortality rate is only below that of cardiogenic shock secondary to a massive infarction. Fortunately, also the latter is much less frequent with the currently available therapies. 

C. Duration Continuous signs of disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet criterion A (i.e., active-phase symptoms), and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of disturbance may be manifested by only negative symptoms, or by two or more symptoms listed in category A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences). 

The most common clinical signs of bronchiolitis are found in Table 43-4. A prodrome suggesting an upper respiratory tract infection, usually lasting from 2 to 8 days, precedes the onset of clinical symptoms. 

Intermittent therapy 200 mg every 4 hours 5 times daily for 5 days. Initiate therapy at the earliest sign or symptom (prodrome) of recurrence. 

Inhalational anthrax Cough, chest pain, dyspnea, viral URI symptoms (sore throat, myalgias, mild fever) during prodrome Lymphadenopathy, widened mediastinum on chest radiograph, pleural effusions. Signs/symptoms progress to respiratory failure, sepsis, and hemodynamic collapse in preterminal stages. 

Prodromal phase This is characterized by such vague complaints as weakness, mental slowness, short memory, reduced working capacity, insomnia, headache, and anxiety. These sjmptoms can easily be dismissed as non-specific, and can persist for more than 2 years before further signs develop. In general, however, the course is gradually progressive toward the symptoms of the next phase. 

Outbreaks may begin with a prodromal phase of up to 24 hours before any visible signs appear, during which the area on or around the lips begins to tingle, burn or itch. 

C. Duration Continuous signs of the disorder for at least 6 months. This must include at least 1 month of symptoms fulfilling criterion A (unless successfully treated). This 6 months may include prodromal or residual symptoms. 

C. Radiation Injury Severe. These casualties are judged to have received a radiation dose that is potentially fatal. Nausea and vomiting will be almost universal for persons in this group. The prodromal phase may also include prompt explosive bloody diarrhea, significant hypotension, and signs of necrologic injury. These patients should be sorted according to the availability of resources. Patients should receive symptomatic care. Lymphocyte analysis is necessary to support this classification. 

Major depression (also called unipolar depression) is the most serious type of depression is manifested by a combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy once-pleasurable activities and may reoccur several times during a lifetime (5). Many people with major depression cannot continue to function normally. Major depression seems to run in families, suggesting that depressive illnesses can be inherited. Early signs (prodromal symptoms) of major depression include changes in brain function in those individuals having low self-esteem, who consistently view themselves and the world with pessimism or who are readily overwhelmed by stress. The treatments for major depression are medication, psychotherapy, and in extreme cases, electroconvulsive therapy. 

A. Acute radiation syndrome (ARS) consists of a constellation of symptoms and signs indicative of systemic radiation injury. It is often described in four stages (prodrome, latency, manifest illness, and recovery). The onset and severity of each stage of radiation poisoning are detennined largely by the dose. 

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