Prodromal symptoms

Assess the patient complaint to yield a detailed description of headache precipitating factors presence or absence of prodromal symptoms location, intensity, and duration of pain changes in sensory acuity and neurologic alterations. 

Nonspecific prodromal symptoms that develop insidiously over weeks to months may include fatigue, weakness, low-grade fever, loss of appetite, and joint pain. Stiffness and myalgias may precede development of synovitis. 

In closed-angle glaucoma, patients typically experience intermittent prodromal symptoms (e.g., blurred or hazy vision with halos around lights and occasionally, headache). Acute episodes produce symptoms associated with a cloudy, edematous cornea ocular pain nausea, vomiting, and abdominal pain and diaphoresis. 

Leading up to the first break, most individuals with schizophrenia go through a prodromal phase of illness. This prodrome is a departure from the patient s usual behavior, but patients seldom seek treatment during this phase. The prodromal symptoms are usually limited to negative symptoms of apathy or social isolation or to lesser variants of the positive symptoms taking the form of eccentric beliefs or a... 

Reserve chronic suppressive therapy for patients without prodromal symptoms who have frequent recurrences... 

Muller and Schoneich (1992) also reported on favorable experience with intensive outpatient psychotherapy combined with antipsychotic drug treatment. On the basis of a before-and-after comparison over 2x5 years in a university outpatient clinic, they were able to show that the duration of rehospitalizations required by 89 patients could be reduced from a mean of 10 weeks to 2 weeks per year when a special schizophrenia outpatient service offering individualized psychotherapy and psychosocial treatment was available to the patients instead of the routine psychiatric outpatient service. A beneficial effect of psychotherapy was demonstrated both in those patients taking antipsvchotics continuously for long-term prophylaxis and in those taking the drugs intermittently when prodromal symptoms appeared in order to prevent relapse. 

Because the continued symptoms of a treated episode cannot always be separated from the prodromal symptoms of a subsequent episode (Fava and Kellner, 1991), the continuation or rapid resumption of drug therapy is advisable in all such cases. A prerequisite is close cooperation between doctors, patients and relatives so that symptoms are recognized early and reported, and the necessary measures can be taken (CINP Task Force, 1993). 

Fava, GA, Kellner, R. Prodromal symptoms in affective disorders. Am. J. Psychiatry 148, 823-830, 1991. 

This is an acute psychotic response to a severe stressor that generally subsides in 1 day to 1 month. This phenomenon is frequently seen in adolescence or young adulthood without prodromal symptoms or lasting impairment. Little information is available about such factors as prevalence and heredity, other than that which is inherent in the diagnosis. The role of antipsychotics for this disorder has not been studied in controlled investigations. 

In targeted treatment, pharmacotherapy is only used when prodromal symptoms become manifest, in the few days or weeks preceding a recurrence. Such nonspecific symptoms may include ... 

Hypertensive crisis often occurs as a result of the interaction of two or more drugs acting via different mechanisms to potentiate the cardiovascular effects of NE. It can also occur as a result of a drug-food interaction involving MAOIs and tyramine-containing foods. Like the serotonin syndrome, hypertensive crisis can be fatal. Prodromal symptoms include the following ... 

Although reduced sleep is often an early prodromal symptom, patients are usually brought for evaluation and treatment when their behaviors create the potential for more severe consequences (e.g., self-injurious behavior, atypical sexual behavior, significant financial indiscretions). 

The guanosine analog penciclovir, the active metabolite of famciclovir, is available for topical use. Penciclovir cream (1%) is effective for the treatment of recurrent herpes labialis (Table 49-1). When applied within 1 hour of the onset of prodromal symptoms and continued every 2 hours during waking hours for 4 days, median time until healing was shortened by 17 hours compared with placebo. Adverse effects are uncommon, although application site reactions occur in about 1%. 

Docosanol is a saturated 22-carbon aliphatic alcohol that inhibits fusion between the plasma membrane and the HSV envelope, thereby preventing viral entry into cells and subsequent viral replication. Topical docosanol 10% cream is available without a prescription application site reactions occur in approximately 2%. When applied within 12 hours of the onset of prodromal symptoms, five times daily, median healing time was shortened by 18 hours compared with placebo in recurrent orolabial herpes. 

Herz M (1985) Prodromal symptoms and prevention of relapse in schizophrenia. J Clin... 

Negative correlation between thalamic NAA and duration of prodromal symptoms correlation between Cho and duration of psychosis in thalamus and ACC 4 NAA/Cr in FL gray matter of patients No differences between groups in occipital GM... 

Five cases of gastric perforation (rather than the more common duodenal perforation) have been reported in young male smokers of crack, all of whom had only brief histories of prodromal symptoms and none of whom had long-standing peptic ulcer disease (196). 

In both of these cases reasonable precautions had been taken to ensure correct catheter placement, but nevertheless systemic toxicity occurred. However, neither patient had any serious cardiotoxicity. However, it is worth emphasizing that large doses of local anesthetics should be given slowly and in divided doses and that lidocaine, one of the least toxic of the commonly used local anesthetics, has more obvious prodromal symptoms than ropivacaine, and could be a useful marker for intravenous injection (9). 

The goal of medication treatment is to reduce symptoms so that the person can function better and benefit more from other forms of treatment, such as individual, group, or family therapy and social or vocational rehabilitation. An important part of such therapy involves educating the patient to prodromal symptoms and effects and side effects of medications. It is also important to address patients beliefs that taking medications means they are sick (and conversely, that not taking medications means they aren t). Especially with paranoid patients, the belief that medications are a means of being controlled by others must be worked through. 

The eruption rapidly occurs over a period of 12 to 24 hours. In about half the cases there are prodromal symptoms of an upper respiratory infection accompanied by fever, malaise, and varying degrees of muscular and joint pains. 

The clinical picture resembles an extensive second-degree burn the patient is acutely ill. Fatigue, vomiting, diarrhea and angina are prodromal symptoms. In a few hours the condition becomes grave. 

Other smallpox prodromic symptoms, absent in chickenpox, include prostration, headache, backache, chills, abdominal pain, or vomiting. Unlike patients with chickenpox, patients with the smallpox prodrome are typically too sick to engage in normal activities and generally stay in bed. 

---