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Diagnostic Considerations (diagnostic + consideration)
Selected AbstractsAuditory Hallucinations in Nonpsychotic Children: Diagnostic ConsiderationsCHILD AND ADOLESCENT MENTAL HEALTH, Issue 1 2004Peter Mertin Background:, Auditory hallucinations in childhood and adolescence are not necessarily an indication of psychosis, but are more frequently associated with a range of other mental health problems. Although not specifically linked to abuse as an aetiological factor, the literature reporting on hallucinations in children alludes to a range of family dysfunction and disruption. Method:, This study reports on the auditory hallucinations of 13 children referred to a community-based child and family mental health service exhibiting a variety of emotional and behavioural difficulties. The presence of the hallucinations was generally revealed during the course of the initial assessment. Results:, None of the children were considered psychotic at initial presentation; however, all were experiencing high levels of stress and/or anxiety in their lives. Following the initial assessments children were given diagnoses ranging from generalised anxiety disorder, through adjustment disorder, to posttraumatic stress disorder. The hallucinations gradually disappeared over the course of therapy. Two case studies describe the hallucinations and family histories in more detail. Conclusions:, The present study adds further confirmation of the presence of auditory hallucinations in nonpsychotic children. The clinical presentation of the children in the present study indicates an association between hallucinations and high levels of stress and anxiety, suggesting that mental health professionals should enquire more routinely about auditory hallucinations, particularly with those children from abusive and violent backgrounds. [source] Diagnostic consideration of Morita shinkeishitsu and DSM-III-RPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 6 2002KENJI KITANISHI Abstract The purpose of the present study was to empirically and objectively clarify the diagnostic standing of Morita shinkeishitsu, the subject of Morita therapy, by comparing and contrasting it with the operational diagnosis of the Diagnostic and Statistical Manual of Mental Disorders (3rd edition, revised; DSM-III-R). Morita therapists' clinical diagnoses of 88 outpatients who requested Morita therapy were compared with the results of the independently conducted operational diagnoses (structured clinical interview for DSM (SCID) for DSM-III-R, the Japanese version). In view of the result of axis I diagnoses, Morita shinkeishitsu corresponds to anxiety disorders, although it is a complex that also embodies mood disorders, which were found in one-quarter of the cases, as well as personality disorders, which were found in half of the cases, especially cluster C (avoidant, obsessive,compulsive, and dependent personality disorders). Morita shinkeishitsu is almost equivalent to anxiety disorders (DSM-III-R, axis I), and is a complex, a part of which includes mood disorders and cluster C personality disorders. [source] Diagnostic considerations for acute death in horses: How common is acute death associated with renal cell carcinoma and other neoplasms in horses?EQUINE VETERINARY EDUCATION, Issue 9 2008E. Davis No abstract is available for this article. [source] Diagnostic considerations in juvenile parkinsonismMOVEMENT DISORDERS, Issue 2 2004Dominic C. Paviour MRCP Abstract Juvenile parkinsonism (JP) describes patients in whom the clinical features of parkinsonism manifest before 21 years of age. Many reported cases that had a good response to levodopa have proved to have autosomal recessive juvenile parkinsonism (AR-JP) due to mutations in the parkin gene. With the exception of parkin mutations and dopa-responsive dystonia, most causes are associated with the presence of additional neurological signs, resulting from additional lesions outside of the basal ganglia. Lewy body pathology has only been reported in one case, suggesting that a juvenile form of idiopathic Parkinson's disease may be extremely rare. © 2003 Movement Disorder Society [source] The rapidly growing thyroid massBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 6 2006A. Sitges-Serra Diagnostic considerations [source] Spinal cord injury at birth: a hidden causative factorACTA PAEDIATRICA, Issue 6 2008Jesper Fenger-Gron Abstract A case of perinatally acquired spinal cord injury (SCI) is presented. The foetus was vigorous until birth, the breech presented and delivery was performed by a non-traumatic Caesarean section. The infant displayed symptoms of severe SCI but diagnosis was delayed due to severe co-morbidity. Diagnostic considerations are briefly reviewed. Ventilatory support was withdrawn at the age of 20 days when the infant had still not exhibited any respiratory effort or spontaneous movements. Autopsy revealed a serious congenital malalignment of the upper cervical vertebrae and at the histological examination extensive reactive changes were observed in the same area. To our knowledge such findings have not been published previously. Conclusion: In cases of serious perinatally acquired SCI, claim of malpractice is often apparent. In this case a hidden congenital malformation of the cervical vertebrae was revealed, highlighting the need of careful postmortem examinations in such cases. [source] Cutaneous Congenital Plexiform Cellular Schwannoma: A Simulant of Malignant Peripheral Nerve Sheath Tumor of Childhood , A Case Report and Literature ReviewJOURNAL OF CUTANEOUS PATHOLOGY, Issue 1 2005M. Matthews Cutaneous plexiform schwannoma is a rare multilobulated variant of benign schwannoma. When presenting as the cellular subtype with significantly increased proliferative rate, diagnostic consideration of a malignant peripheral nerve sheath tumor is prompted. However, follow up demonstrates a benign natural history with propensity for local recurrence and typical lack of association with neurocutaneous syndromes. These lesions most commonly occur as cutaneous and subcutaneous masses of the extremities in the first four decades. Only 9 cases of congenital tumors are reported. A case of congenital plexiform cellular schwannoma, presenting as a cutaneous mass measuring 3.5 × 2.5 × 2.0 cm, excised from the left upper arm of a 16 month old female is discussed. Regions of increased cellularity and proliferation co-localized and were unassociated with nuclear anaplasia. Mitotic figures numbered 7 per 10 400x fields. The tumor cells were strongly immunoreactive for S-100 protein. The MIB-1index was multifocally 25% and p53 protein over expression was present in 50% of nuclei. Following excision with free margins the tumor locally recurred after 16 months. The recurrence was morphologically identical to the original lesion. Recognition of the clinical and morphological characteristics of this rarely encountered benign neoplasm will facilitate in diagnosing this entity. [source] Comparison of Serum-Free Thyroxine Concentrations Determined by Standard Equilibrium Dialysis, Modified Equilibrium Dialysis, and 5 Radioimmunoassays in DogsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 3 2004Sara Schachter Measurement of serum-free thyroxine (fT4) concentration provides a more accurate assessment of thyroid gland function than serum thyroxine (T4) or 3,5,3'-triiodothyronine (T3). Techniques for measuring serum fT4 concentration include standard equilibrium dialysis (SED), radioimmunoassay (RIA), and a combination of both (modified equilibrium dialysis [MED]). This study compared results of serum fT4 measurements by means of SED, MED, and 5 RIAs in 30 healthy dogs, 10 dogs with hypothyroidism, and 31 euthyroid dogs with concurrent illness for which hypothyroidism was a diagnostic consideration. Serum fT4 concentrations were comparable when determined by the SED and MED techniques, and mean serum fT4 concentrations were significantly (P<.01) lower in dogs with hypothyroidism than in healthy dogs and euthyroid dogs with concurrent illness. Significant (P < .05) differences in fT4 concentrations were identified among the 5 RIAs and among the RIAs and MED and SED. Serum fT4 concentrations were consistently lower when fT4 was determined by the RIAs, compared with either equilibrium dialysis technique. Serum fT4 concentrations were significantly lower (P < .01) in dogs with hypothyroidism than in healthy dogs for all RIAs; were significantly lower (P < .05) in dogs with hypothyroidism than in euthyroid dogs with concurrent illness for 4 RIAs; and were significantly lower (P < .01) in euthyroid dogs with concurrent illness than in healthy dogs for 4 RIAs. RIAs had the highest number of low serum fT4 concentrations in euthyroid dogs with concurrent illness. This study documented differences in test results among fT4 assays, emphasizing the importance of maintaining consistency in the assay used to measure serum fT4 concentrations in the clinical or research setting. [source] Agoraphobia: a review of the diagnostic classificatory position and criteria,,DEPRESSION AND ANXIETY, Issue 2 2010Hans-Ulrich Wittchen Ph.D. Abstract The status of agoraphobia (AG) as an independent diagnostic category is reviewed and preliminary options and recommendations for the fifth edition of The Diagnostic and Statistical Manual (DSM-V) are presented. The review concentrates on epidemiology, psychopathology, neurobiology, vulnerability and risk factors, clinical course and outcome, and correlates and consequences of AG since 1990. Differences and similarities across conventions and criteria of DSM and ICD-10 are considered. Three core questions are addressed. First, what is the evidence for AG as a diagnosis independent of panic disorder? Second, should AG be conceptualized as a subordinate form of panic disorder (PD) as currently stipulated in DSM-IV-TR? Third, is there evidence for modifying or changing the current diagnostic criteria? We come to the conclusion that AG should be conceptualized as an independent disorder with more specific criteria rather than a subordinate, residual form of PD as currently stipulated in DSM-IV-TR. Among other issues, this conclusion was based on psychometric evaluations of the construct, epidemiological investigations which show that AG can exist independently of panic disorder, and the impact of agoraphobic avoidance upon clinical course and outcome. However, evidence from basic and clinic validation studies remains incomplete and partly contradictory. The apparent advantages of a more straightforward, simpler classification without implicit hierarchies and insufficiently supported differential diagnostic considerations, plus the option for improved further research, led to favoring the separate diagnostic criteria for AG as a diagnosis independent of panic disorder. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source] Early diagnosis of dementia in primary care: a representative eight-year follow-up study in Lower Saxony, GermanyINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 1 2007Lienhard Maeck Abstract Objective To investigate whether primary care competency in early diagnosis of dementia might have changed during 1993 and 2001. Method By means of a representative follow-up survey 122 out of 170 (71.8%) family physicians (FPs) in Lower Saxony, Germany, were randomly assigned to two written case samples presenting a patient with mild cognitive impairment (case 1a vs. 1b: female vs. male patient) and moderate dementia (case 2a vs 2b: vascular type (VD) vs Alzheimer's disease (DAT)), respectively. By means of a structured face-to-face interview, they were asked for their diagnostic considerations. Results In comparison to 1993, dementia was significantly more frequently considered. However, there was a striking tendency in overestimating vascular aetiology and under-diagnosing probable DAT (case 1a/1b: DAT: 11.0% in 1993 vs 26.2% in 2001; VD: 2.1% in 1993 vs 17.2% in 2001). As a possible contributor to a dementia syndrome, concomitant medication was considered only exceptionally (case 2a/2b: 4.4% in 1993 vs 2.5% in 2001). Physicians above 50 years of age showed a significantly lower early diagnostic awareness. At follow-up, the presumed interest in geriatric (psychiatric) topics dramatically faded from 66.9% to 35.2%. Conclusions Our results demonstrate a persistent need of training efforts aiming at the early recognition of dementia, especially of DAT, in primary care. Copyright © 2006 John Wiley & Sons, Ltd. [source] Periorbital dermatitis: Causes, differential diagnoses and therapyJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 3 2010Alexandra Feser Summary Periorbital dermatitis is common and frequently difficult to treat. Patients with periorbital dermatitis often suffer severely because their disease is in such a visible location. Because of the variety of clinical appearance, the differential diagnostic considerations are often difficult. We examined the causes of periorbital dermatitis and compared the data of 88 patients from the Department of Dermatology, University Hospital Erlangen to those of the German IVDK (Information Network of the Departments of Dermatology). Between 1999 and 2004, predominant causes of periorbital dermatitis were allergic contact dermatitis (Erlangen 44 %, IVDK 32 %), atopic eczema (Erlangen 25 %, IVDK 14 %), airborne contact dermatitis (Erlangen 10 %, IVDK 2 %) and irritant contact dermatitis (Erlangen 9 %, IVDK 8 %). Less frequent causes for secondary eczematous periocular skin lesions were periorbital rosacea, allergic conjunctivitis or psoriasis vulgaris. Female gender, atopic skin diathesis and age of 40 years and older were identified as risk factors for periocular dermatitis. Common elicitors of periorbital allergic contact dermatitis were leave-on cosmetic products (face cream, eye shadow) and eye drops with the usual allergens being fragrances, preservatives and drugs. Exact identification of relevant contact allergens and allergen elimination are essential for successful treatment. Calcineurin inhibitors are the first-line therapy for facial atopic eczema. They may be also effective in periocular eczematous lesions of other origins although they are not approved for such use. [source] Review article: small intestinal bacterial overgrowth, bile acid malabsorption and gluten intolerance as possible causes of chronic watery diarrhoeaALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 10 2009X. FAN Summary Background, Chronic watery diarrhoea is one of the most common symptoms prompting GI evaluation. Recently, new diagnostic considerations have emerged as possible factors in chronic diarrhoea. Aim, To review available data regarding diagnosis and treatment of chronic diarrhoea with an emphasis on bacterial overgrowth and bile acid malabsorption. Methods, A systematic search of the English language literature of chronic diarrhoea was performed focused on three possible aetiologies of diarrhoea: small intestinal bacterial overgrowth (SIBO), idiopathic bile salt malabsorption (IBAM), gluten responsive enteropathy. Results, Recent studies suggest that SIBO and bile acid malabsorption may have been underestimated as possible causes of chronic watery diarrhoea. Gluten intolerance with negative coeliac serology is a contentious possible cause of watery diarrhoea, but requires further research before acceptance as an entity. Conclusion, In patients with otherwise unexplained chronic watery diarrhoea, small intestinal bacterial overgrowth and bile salt malabsorption should be considered and investigated. [source] Fatal encephalitis in a patient with refractory celiac disease presenting with myorhythmia and carpal spasmMOVEMENT DISORDERS, Issue 3 2007Elliot L. Dimberg MD Abstract We report the case of a woman with refractory celiac disease who developed abnormal spontaneous movements of the extremities and face consistent with myorhythmia. Investigation led to a diagnosis of encephalitis, confirmed by postmortem examination. The movements were likely caused by nonparaneoplastic encephalitis associated with refractory celiac disease. Etiologic and diagnostic considerations and treatment options are discussed. © 2006 Movement Disorder Society [source] Pleomorphic xanthoastrocytoma with anaplastic features presenting without GFAP immunoreactivity: Implications for differential diagnosisNEUROPATHOLOGY, Issue 3 2005Ellen Gelpi Pleomorphic xanthoastrocytoma (PXA) is an uncommon, usually low-grade, astrocytic tumor. Characteristic histological features include tumor cell pleomorphism and lipidization of tumor cells. Albeit prognosis in PXA is generally good, cases with histological signs of anaplasia have been observed. In these cases, the differential diagnosis needs to exclude other malignancies, for example, glioblastoma or malignant fibrous histiocytoma. Immunocytochemical detection of GFAP may support exclusion of non-glial neoplasms resembling PXA. However, GFAP expression in PXA may be faint or focal, although complete lack of GFAP has not been described. A 43-year-old woman was operated on for a left occipital parasagital tumor attached to the dura. Histopathology showed a pleomorphic tumor with moderate mitotic activity and necrosis, lack of GFAP immunoreactivity and ultrastructural detection of premelanosome-like structures. These features led to the tentative diagnosis of amelanotic melanoma, and the patient was irradiated. Three years later she had local tumor recurrence and underwent another operation. The recurrent tumor showed similar plain histology as the first specimen. In contrast, anti-GFAP immunoreactivity was now detectable in pleomorphic tumor cells. Anti-GFAP staining of the first biopsy was repeated using monoclonal and polyclonal antibodies in combination with prolonged tissue pretreatment. Focal GFAP staining of tumor cells was now achieved. We conclude that non-standard GFAP staining protocols may enhance sensitivity and thus lead to detection of a low level of GFAP expression in tumor specimens, in which PXA is considered in the differential diagnosis. This may avoid misleading diagnostic considerations that impact on postoperative patient management. [source] Bilateral Extensive Ductitis Obliterans Manifested by Bloody Nipple Discharge in a Patient with Long-Term Diabetes MellitusTHE BREAST JOURNAL, Issue 6 2007Zhiqin Wang MD Abstract:, Ductitis obliterans or mastitis obliterans is a rare late manifestation of mammary ductal ectasia. We describe a long-term diabetic patient who presented with bilateral bloody nipple discharge and poorly defined nodularities around the nipple of both breasts. The ductography showed multiple segments of irregular ductal narrowing and intraluminal filling defects in both breasts. The bilateral resection of the sub-areolar portion of the breast showed exuberant fibrous obliteration of the large- and medium-sized ducts by granulation tissue associated with few histiocytes. Ductal dilatation and intraductal accumulation of histiocytes was also present. This represents a late and florid form of mammary ductal ectasia. Differential diagnostic considerations including fibrocystic changes, diabetic sclerosing lymphocytic lobulitis, idiopathic granulomatous lobular mastitis, and periductal mastitis (Zuska disease) are discussed. Accurate diagnosis can help avoid or limit radical surgeries in this group of patients. [source] | ||||||||||||||||||||||