BIOSOFT HELP FILES

See under hearing loss

Age > 50 yrs, abdominal surgery, pelvic surgery, hip surgery, knee surgery, cancer, prolonged travel, major disease, pregnancy, puerperium, fracture, polycythaemia, thrombocytosis, oral contraceptives, antiphospholipid syndrome, nephrotic syndrome, Behcet’s syndrome, congenital coagulation deficits

1)      Mild Dehydration – anorexia, thirst, skin flushing, fatigue, dry eyes and crying with few tears or no tears, slightly dry mouth, irritable

2)      Moderate Dehydration - Sunken appearing eyes, Sluggish or lethargic, Skin feels dry and not springy, tachycardia, tachypnea, reduced sweating, reduced urination, rising body temperature, cramps,

3)      Signs of severe dehydration – Cramps, vomiting, confusion, wrinkled skin, tachycardia, tachypnea, no urine output in 6 hours  When skin is pinched between fingers, it fails to spring back to its original shape  Very lethargic or possibly unconscious

1)      Mild Dehydration - thirst, dry eyes and crying with few tears or no tears, slightly dry mouth, dark urine, fewer wet diapers than usual, less active than usual or irritable, capillary refill delay < 2 secs,  normal respiration, normal BP, normal skin and turgor, child alert, in summary, child is thirsty and reduced urine output

2)      Moderate Dehydration – anorexia, vomiting, Sunken appearing eyes, Sluggish or lethargic, Skin feels dry and not springy, capillary refill delay 2-4 secs, tachypnea, BP postural dop, skin turgor slow, lethargic,

3)      Signs of severe dehydration – food refusal, high temperature, sunken fontanelle (the soft spot on top of the head), capillary refill delay > 2 secs, tachypnea, BP drops, No urine output in 6 hours  When skin is pinched between fingers, it fails to spring back to its original shape and remain tented, Very lethargic or confused, tears absent

1)      Hypovolemic shock

2)      Sepsis syndrome

3)      Fits

1)      Hypovolemic shock

2)      Sepsis syndrome

3)      Any neurological symptom or sign – hypo or hypernatremic dehydration

4)      Loss of  hypertonic fluid, serum Na < 135 meq/L, signs and symptoms of dehydration proportionately more than the fluid loss - Hyponatremic dehydration

5)      Loss of hypotonic fluid, serum Na > 150 meq/L,  signs and symptoms of dehydration proportionately less than the fluid loss - Hypernatremic dehydration

The feeling of the unreality of the body.  Some examples: patient complaining the body part being swollen and looking very big out of proportion.  Usually seen in severe anxiety states.  Patients might not volunteer such information unless particularly probed.

1)      Normal Sadness

2)      Bereavement

3)      Adjustment disorders – See under somatic depressive symptom syndrome

4)      Major depression –  Drug Tx – (Initial dose-target dose-maximum dose) Fluoxetine 10-20-40 mg, Paroxetine 10-20-40 mg, Sertraline 50-100-200 mg, Citalopram 20-40-60 mg, Mirtazapine 30-45-60 mg, Duloxetine 30-60-60 mg, Bupropion 150-200-450 mg, Nortriptyline 50-75-150 mg, Imipramine 25-100-150 mg, continue treatment for 6 wees, target dose is the optimal dose, except bupropion other drugs once daily,

5)      Postpartum depression – onset of depression with 3/52 – 4/12 after delivery

6)      Baby Blues – starting a few days postpartum, feeling sad, irritable, anxiety, weeping, confusion, peak symptom intensity about 4^th postpartum day and resolve by 10th day,  usually no functional disability

7)      ADHD adults – recurrent stress-induced depressive syndromes not amounting to MDE, interpersonal relationship problems, Interpersonal relationship problems, difficulties at work, poor school performance, poor work performance (due to inattention, impulsiveness, hyperactivity), low self–esteem, low chance of success, and satisfaction in many areas of life, increased risk of tobacco use, substance use, prone for injuries and accidents, symptoms must be present at least from age 7 yrs, Tx - Atomoxetine, amphetamines, dexmethylphenidate, behavior therapy, life skills training,

8)      Recurrent short-lasting depressive episodes as in premenstrual dysphoric disorder -

1)      Suicidal plans

2)      Thoughts of harming the infant in postnatal depression

3)      Disorganized thought, bizarre behavior, visual, olfactory, tactile hallucinations, and delusions within 2/52 of delivery (postpartum psychosis – high risk of suicide and infanticide, urgent psychiatric referral)

4)      Signs and symptoms of hypothyroidism

5)      Signs and symptoms of hyperthyroidism

1)      Severe motor retardation

2)      More sleep more appetite and weight gain

3)      Sensitivity to rejection

4)      Earlier onset of depression in adolescence

5)      More frequent depressive episodes

6)      Behavioral activation and mood lability during antidepressant therapy

7)      Periods of increased energy and activity with less need for sleep

8)      Cormorbid anxiety disorders, substance use disorders, and attention deficit disorders

9)      Lack of response to antidepressant treatment

10)    F/H of bipolar disorder in a first-degree biological relative

11)    F/H any affective disorder in multiple generations

12)    Recurrent interpersonal conflicts

13)    Extreme extroversion

14)    Episodic impulsivity – legal problems related to sexual promiscuity, STD, sudden frequent job changes