Secondary medical conditions

O Headache maybe a primary, or a secondary disorder due to an underlying medical condition. 

Assess the patient s symptoms to determine if selftreatment with OTC antifungal therapy is appropriate or whether the patient should be evaluated by a practitioner. Exclusions for self-treatment include infection of nails or hair, unsuccessful initial treatment, worsening condition, signs of secondary bacterial or systemic infection, or chronic medical conditions such as diabetes, immunosuppression, or impaired circulation. 

Mood Disorder Due to a General Medical Condition. Commonly called secondary manias, certain medical and neurological illnesses produce symptoms that mimic mania. Often, secondary manias occur when injury or disease interferes with right-sided brain function. As one might anticipate, this is in contrast to the predilection for left-sided brain injury to be associated with depressive symptoms. 

TABLE 3.15. Medical Conditions that May Cause Secondary Mania... 

Pediatric patients with psychiatric syndromes arising secondary to their medical condition (e.g. a hypoxic patient who becomes agitated secondary to delirium)... 

Pediatric patients with psychiatric symptomatology secondary to medications being used to treat medical conditions (e.g., a transplant patient treated with high-dose corticosteroids for organ rejection who develops irritability)... 

What is the relationship of the psychiatric symptoms or syndrome to the underlying medical illness Were the symptoms premorbid, secondary to, or coincident with the medical illness Is there a family history of similar syndromes in nonmedically ill family members that might warrant consideration of treating the psychiatric disorder more independently from the medical condition ... 

Bipolar disorder can be divided into primary and secondary types, with the latter developing as a consequence of various medical conditions or substances that can alter brain function or structure. This categorization underscores the view of mania as a syndrome subsequent to various pathophysiologies. 

Insomnia secondary to a general medical condition, especially with pain- or sleep-disordered breathing Circadian rhythm disturbance Periodic limb movement disorder Restless legs syndrome... 

Children with other chronic medical conditions, such as asthma [37] or atopy [38] and cystic fibrosis, can be prone to sleep disruption either from medication used to treat the underlying condition, or as a result of poor symptom control. In addition, other factors such as the psychological response to illness, family dynamics, hospitalization-related disruption of normal sleep routines, and related secondary symptoms, such as pain, can significantly impact sleep in these children. Medical conditions which may place children particularly at risk for sleep problems also include severe burns, sickle cell anemia, rheumatological disorders, and chronic headaches. 

If the insomnia is precipitated or aggravated by another sleep disorder or mental disorder, or if it is due to the direct physiological effects of a substance of abuse or a general medical condition, then the other disorder is termed primary and the insomnia secondary [13, 14],... 

Secondary insomnia is the most frequent form of insomnia. The determinants of secondary insomnia can be grouped into the following categories (1) mental disorders (2) neurological diseases (3) medical conditions and (4) abuse of drug-or medication-induced sleep disorder [15]. A list of major factors is included as Tab. 1. 

Secondary anxiety Caused by a medical condition or use of medication. Anxiolytics are not prescribed for secondary anxiety. The cause of the anxiety is treated. 

Hypertension is a heterogeneous medical condition. In most patients it results from unknown pathophysiologic etiology (essential or primary hypertension). While this form of hypertension cannot be cured, it can be controlled. A small percentage of patients have a specific cause of their hypertension (secondary hypertension). There are many potential secondary causes that are either concurrent medical conditions or are endogenously induced. If the cause of secondary hypertension can be identified, hypertension in these patients potentially can be cured. 

The essential feature of enuresis is repeated involuntary or intentional voiding of urine by day or night that is not caused by a general medical condition (Table 61-7). Medical causes of inappropriate voiding (e.g., diabetes mellitus, diabetes insipidus, seizure disorders, or urinary tract infections) should be ruled out. Enuresis may be primary or secondary. Primary enuresis, the most common type, is diagnosed if the child has never established urinary continence. Secondary enuresis follows an established period (3 to 6 months) of urinary continence. 

Disturbance in mood that is secondary to a general medical condition (see Table 68-2) Disturbance in mood that is secondary to the effects of a substance (e.g., medication, toxin, drug abuse, somatic treatments see Table 68-2)... 

Because medical conditions, emotional/behavioral symptoms, and physiologic indices change during the premenstrual and per-imenopause phases, it is important to rule out other disorders that may contribute to mood fluctuations or pain syndromes (Table 78-2). For example, dysmenorrhea may be primary, which occurs during ovulatory cycles, or secondary, which relates to pelvic pathology (e.g., infection caused by the placement of intrauterine devices, endometriosis, pelvic inflammatory disease, ovarian cyst, endometrial cancer, adhesions, and benign uterine tumors). 

Influenza is respiratory illness that is characterized by abrupt onset of fever, myalgia, headache, severe malaise, cough, sore throat, and rhinitis. The fllness typically resolves in several days but can exacerbate a chronic medical condition or lead to secondary bacterial pneumonia. Influenza activity each winter results in increased numbers of physician visits, hospitalizations, and deaths. 

Most weight loss interventions consist of a combination of lifestyle changes, diet, drug therapy if indicated, and in some cases surgery (see Fig. 140-3). Prior to recommending any therapy, the clinician must evaluate the patient for the presence of secondary causes of obesity. If a secondary cause is suspected, then a more complete diagnostic work-up and appropriate therapy are paramount. The next step in the patient evaluation is to determine the presence and severity of other medical conditions either directly associated with obesity... 

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