https://www.wikidoc.org/api.php?action=feedcontributions&user=Irfan+Dotani&feedformat=atomwikidoc - User contributions [en]2024-03-28T19:53:46ZUser contributionsMediaWiki 1.40.0https://www.wikidoc.org/index.php?title=Generalized_anxiety_disorder_pathophysiology&diff=1492577Generalized anxiety disorder pathophysiology2018-08-29T22:26:30Z<p>Irfan Dotani: </p>
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{{Generalized anxiety disorder}}<br />
{{CMG}} {{AE}} {{I.D.}}<br />
<br />
==Overview==<br />
[[Generalized anxiety disorder]] has been linked to the disrupted functional connectivity of the [[amygdala]] and its processing of [[fear]] and [[anxiety]]. [[Sensory information]] enters the [[amygdala]] through the [[nuclei]] of the [[basolateral complex]] (consisting of lateral, basal and [[accessory basal nuclei]]).<br />
<br />
==Pathophysiology==<br />
*[[Generalized anxiety disorder]] has been linked to the disrupted functional connectivity of the [[amygdala]] and its processing of [[fear]] and [[anxiety]].<ref name="pmid19996041">{{cite journal| author=Etkin A, Prater KE, Schatzberg AF, Menon V, Greicius MD| title=Disrupted amygdalar subregion functional connectivity and evidence of a compensatory network in generalized anxiety disorder. | journal=Arch Gen Psychiatry | year= 2009 | volume= 66 | issue= 12 | pages= 1361-72 | pmid=19996041 | doi=10.1001/archgenpsychiatry.2009.104 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19996041 }} </ref><br />
*[[Sensory information]] enters the [[amygdala]] through the [[nuclei]] of the [[basolateral complex]] (consisting of lateral, basal and [[accessory basal nuclei]]). The [[basolateral complex processes]] the [[sensory-related fear]] memories and communicates their threat importance to elsewhere in the [[brain]], such as the [[medial prefrontal cortex]] and [[sensory cortices]], along with:<ref name="pmid11225507">{{cite journal| author=Kessler RC, Keller MB, Wittchen HU| title=The epidemiology of generalized anxiety disorder. | journal=Psychiatr Clin North Am | year= 2001 | volume= 24 | issue= 1 | pages= 19-39 | pmid=11225507 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11225507 }} </ref><br />
**[[Memory processing]]<br />
**[[Sensory processing]]<br />
*Another area, the [[adjacent central nucleus]] of the amygdala, controls species-specific fear responses in its connections to the [[brainstem]], [[hypothalamus]] and [[cerebellum]] areas. <br />
*In those with generalized anxiety disorder, these connections seem less functionally distinct, and there is greater [[gray matter]] in the [[central nucleus]].<br />
*Another difference is that the amygdala areas have decreased connectivity with the [[insula]] and [[cingulate areas]] that control general stimulus salience while having greater connectivity with the [[parietal cortex]] and [[prefrontal cortex]] circuits that underlie executive functions.<ref name="pmid22059936">{{cite journal| author=Baldwin DS, Allgulander C, Bandelow B, Ferre F, Pallanti S| title=An international survey of reported prescribing practice in the treatment of patients with generalised anxiety disorder. | journal=World J Biol Psychiatry | year= 2012 | volume= 13 | issue= 7 | pages= 510-6 | pmid=22059936 | doi=10.3109/15622975.2011.624548 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22059936 }} </ref><br />
**The latter suggests a compensation strategy for dysfunctional [[amygdala]] processing of [[anxiety]]. <br />
**This is consistent with cognitive theories that suggest the use in this disorder of attempts to reduce the involvement of emotions with compensatory cognitive strategies.<ref name="pmid16202187">{{cite journal| author=Grant BF, Hasin DS, Stinson FS, Dawson DA, June Ruan W, Goldstein RB et al.| title=Prevalence, correlates, co-morbidity, and comparative disability of DSM-IV generalized anxiety disorder in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions. | journal=Psychol Med | year= 2005 | volume= 35 | issue= 12 | pages= 1747-59 | pmid=16202187 | doi=10.1017/S0033291705006069 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16202187 }} </ref><br />
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==References==<br />
<br />
{{Reflist|2}}<br />
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[[Category:Needs content]]<br />
[[Category:Disease]]<br />
[[Category:Psychiatry]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Generalized_anxiety_disorder_natural_history,_complications_and_prognosis&diff=1492575Generalized anxiety disorder natural history, complications and prognosis2018-08-29T22:25:01Z<p>Irfan Dotani: </p>
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<div>__NOTOC__<br />
{{Generalized anxiety disorder}}<br />
{{CMG}} {{AE}} {{I.D.}}<br />
<br />
==Overview==<br />
In the National Comorbidity Survey (2005), 58% of patients diagnosed with [[Clinical depression|major depression]] were found to have an anxiety disorder. Accumulating evidence indicates that patients with comorbid depression and anxiety tend to have greater illness severity and a lower treatment response than those with either disorder alone. In addition, social function and quality of life are more greatly impaired. Approximately one-quarter of the patients with generalized anxiety disorder, will develop [[panic disorder]].<br />
<br />
==Natural History, Complications and Prognosis==<br />
*In the National Comorbidity Survey (2005), 58% of patients diagnosed with [[Clinical depression|major depression]] were found to have an anxiety disorder; among these patients, the rate of comorbidity with GAD was 17.2%, and with [[panic disorder]], 9.9%. <br />
*Patients with a diagnosed anxiety disorder also had high rates of comorbid depression, including 22.4% of patients with [[social phobia]], 9.4% with [[agoraphobia]], and 2.3% with panic disorder.<ref name="pmid17338599">{{cite journal| author=Morissette SB, Tull MT, Gulliver SB, Kamholz BW, Zimering RT| title=Anxiety, anxiety disorders, tobacco use, and nicotine: a critical review of interrelationships. | journal=Psychol Bull | year= 2007 | volume= 133 | issue= 2 | pages= 245-72 | pmid=17338599 | doi=10.1037/0033-2909.133.2.245 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17338599 }} </ref><br />
**For many, the symptoms of both depression and anxiety are not severe enough (i.e. are subsyndromal) to justify a primary diagnosis of either major depressive disorder (MDD) or an anxiety disorder. <br />
*Patients can also be categorized as having mixed anxiety-depressive disorder, and they are at significantly increased risk of developing full-blown depression or anxiety. Appropriate treatment is necessary to alleviate symptoms and prevent the emergence of more serious disease.<ref>{{cite journal |vauthors=Kessler RC, Keller MB, Wittchen HU |title=The epidemiology of generalized anxiety disorder |journal=Psychiatr. Clin. North Am. |volume=24 |issue=1 |pages=19–39 |date=March 2001 |pmid=11225507 |doi= |url=}}</ref><br />
*Accumulating evidence indicates that patients with comorbid depression and anxiety tend to have greater illness severity and a lower treatment response than those with either disorder alone. In addition, social function and quality of life are more greatly impaired. <br />
**In addition to coexisting with depression, research shows that GAD often coexists with [[substance abuse]] or other conditions associated with [[Stress (medicine)|stress]], such as [[irritable bowel syndrome]].<br />
*Patients with physical symptoms such as [[insomnia]] or [[headache]]s should also tell their doctors about their feelings of worry and tension.<ref name="pmid20171328">{{cite journal| author=Newman MG, Przeworski A, Fisher AJ, Borkovec TD| title=Diagnostic comorbidity in adults with generalized anxiety disorder: impact of comorbidity on psychotherapy outcome and impact of psychotherapy on comorbid diagnoses. | journal=Behav Ther | year= 2010 | volume= 41 | issue= 1 | pages= 59-72 | pmid=20171328 | doi=10.1016/j.beth.2008.12.005 | pmc=2827339 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20171328 }} </ref><br />
**This will help the patient's health care provider to recognize whether the person is suffering from GAD.<br />
*Approximately one-quarter of the patients with generalized anxiety disorder, will develop [[panic disorder]].<ref name="pmid24419039">{{cite journal| author=Shalev I, Moffitt TE, Braithwaite AW, Danese A, Fleming NI, Goldman-Mellor S et al.| title=Internalizing disorders and leukocyte telomere erosion: a prospective study of depression, generalized anxiety disorder and post-traumatic stress disorder. | journal=Mol Psychiatry | year= 2014 | volume= 19 | issue= 11 | pages= 1163-70 | pmid=24419039 | doi=10.1038/mp.2013.183 | pmc=4098012 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24419039 }} </ref><br />
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==References==<br />
<br />
{{Reflist|2}}<br />
<br />
[[Category:Needs content]]<br />
[[Category:Disease]]<br />
[[Category:Psychiatry]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Generalized_anxiety_disorder_overview&diff=1492573Generalized anxiety disorder overview2018-08-29T22:22:36Z<p>Irfan Dotani: </p>
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__NOTOC__<br />
{{Generalized anxiety disorder}}<br />
{{CMG}}; {{AE}} {{I.D.}}<br />
<br />
==Overview==<br />
'''Generalized anxiety disorder''' ('''GAD''') is an [[anxiety disorder]] that is characterized by excessive, uncontrollable and often irrational worry about everyday things, which is disproportionate to the actual source of worry. This excessive worry often interferes with daily functioning, as individuals suffering from GAD typically catastrophize, anticipate disaster, and are overly concerned about everyday matters such as [[health]] issues, money, [[family]] problems, or work difficulties.<ref name="nimh">[http://www.nimh.nih.gov/publicat/anxiety.cfm#anx7 "Anxiety Disorders"], National Institute of Mental Health. Accessed [[28 May]] [[2008]].</ref> They often exhibit a variety of physical symptoms, including [[fatigue (medical)|fatigue]], [[headache]]s, muscle tension, [[Myalgia|muscle aches]], difficulty [[swallowing]], [[tremor|trembling]], [[Muscle contraction|twitching]], [[irritability]], [[sweating]], and [[hot flashes]]. These symptoms must be consistent and on-going, persisting at least 6 months, for a formal diagnosis of GAD to be introduced. <ref name="nimh" /> Approximately 6.8 million [[United States|American]] adults experience GAD, affecting about twice as many women as men.<ref name="numbers">[http://www.nimh.nih.gov/publicat/numbers.cfm "The Numbers Count"], National Institute of Mental Health. Accessed [[28 May]] [[2007]].</ref><br />
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==Historical Perspective==<br />
Generalized anxiety disorder was first recognized as a [[symptom]] by [[Sigmund Freud]]. In 1980, 'The American Psychiatric Association' introduced GAD as a diagnosis in the [[DSM-III]].<br />
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==Classification==<br />
Generalized anxiety disorder falls under the category of anxiety disorder.<ref name="pmid19445546">{{cite journal| author=Keeton CP, Kolos AC, Walkup JT| title=Pediatric generalized anxiety disorder: epidemiology, diagnosis, and management. | journal=Paediatr Drugs | year= 2009 | volume= 11 | issue= 3 | pages= 171-83 | pmid=19445546 | doi=10.2165/00148581-200911030-00003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19445546 }} </ref><br />
<br />
==Pathophysiology==<br />
[[Generalized anxiety disorder]] has been linked to the disrupted functional connectivity of the [[amygdala]] and its processing of [[fear]] and [[anxiety]].<ref name="pmid19996041">{{cite journal| author=Etkin A, Prater KE, Schatzberg AF, Menon V, Greicius MD| title=Disrupted amygdalar subregion functional connectivity and evidence of a compensatory network in generalized anxiety disorder. | journal=Arch Gen Psychiatry | year= 2009 | volume= 66 | issue= 12 | pages= 1361-72 | pmid=19996041 | doi=10.1001/archgenpsychiatry.2009.104 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19996041 }} </ref><br />
<br />
==Differentiating Generalized anxiety disorder from other Disorders==<br />
The differential diagnosis in generalized anxiety disorder is similar to that of [[panic disorder]]. It is important to rule out drug-induced conditions. The mental status examination should take in consideration the possibility of [[schizophrenia]], [[obsessive-compulsive disorder]], [[major depressive disorder]], and both specific and social phobias.<br />
<br />
==Epidemiology and Demographics==<br />
Generalized anxiety disorder is relatively common and has a lifetime prevalence of about 4-7% in the general population. It is more common in women, and can develop in any age although it more commonly occurs in the third and fourth decade of life. Approximately one quarter of the patients with generalized anxiety disorder, will develop [[panic disorder]].<br />
<br />
==Risk Factors==<br />
Risk factors for developing generalized anxiety disorder include family history, early adulthood, and a recent life stressor.<br />
==History and Symptoms==<br />
The criteria for generalized anxiety disorder include at least 6 months of excessive anxiety or worry, about a number of situations, which is difficult to control. The worry may also be associated with three of the following symptoms; [[restlessness]]. [[fatigue]], [[irritability]], [[muscle tension]], poor sleep, and difficulty concentrating. There are several disorders that have a tendency to co-occur with generalized anxiety disorder. These include; [[major depressive disorder]], [[panic disorder]], [[social phobia]], [[agoraphobia]], [[substance abuse]], [[irritable bowel syndrome]] and sleep disorders.<br />
<br />
==Natural history, Complications, and Prognosis==<br />
In the National Comorbidity Survey (2005), 58% of patients diagnosed with [[Clinical depression|major depression]] were found to have an anxiety disorder; among these patients, the rate of comorbidity with GAD was 17.2%, and with [[panic disorder]], 9.9%.<br />
<br />
==Diagnostic Criteria==<br />
The criteria for generalized anxiety disorder include at least 6 months of excessive anxiety or worry, about a number of situations, which is difficult to control. The worry may also be associated with three of the following symptoms; [[restlessness]]. [[fatigue]], [[irritability]], [[muscle tension]], poor sleep, and difficulty concentrating.<br />
<br />
==History and Symptoms==<br />
There are several disorders that have a tendency to co-occur with generalized anxiety disorder. These include; [[major depressive disorder]], [[panic disorder]], [[social phobia]], [[agoraphobia]], [[substance abuse]], [[irritable bowel syndrome]] and sleep disorders.<br />
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===Laboratory Findings===<br />
<br />
There are no laboratory findings associated with generalized anxiety disorder.<br />
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===Other Imaging Findings===<br />
There are no other imaging findings associated with generalized anxiety disorder.<br />
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===Other Diagnostic Studies===<br />
There are no other diagnostic studies associated with generalized anxiety disorder.<br />
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==Medical Therapy==<br />
There are a variety of medications which can be used to treat generalized anxiety disorder, and they generally work well particularly in conjunction with [[psychotherapy]]. The first line treatments are the [[SSRI]] class of antidepressants such as [[fluoxetine]], [[paroxetine]], and [[escitalopram]]. Other antidepressants such as [[imipramine]], [[venlafaxine]], and [[buspirone]] may also be effective. [[Benzodiazepines]] provide quick, effective relief from anxiety, however must be prescribed with caution due to a high risk of abuse and dependence.<br />
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==Psychotherapy==<br />
A [[psychological]] method of treatment for GAD is [[cognitive behavioral therapy]] (CBT), which involves a [[therapist]] working with the patient to understand how [[thought]]s and [[feeling]]s influence [[behavior]].<ref name="cbt">[http://www.babcp.com/babcp/what_is_CBT.htm "A Guide to Understanding Cognitive and Behavioural Psychotherapies"], British Association of Behavioural and Cognitive Psychotherapies. Accessed [[29 May]] [[2007]].</ref> The goal of the therapy is to change negative thought patterns that lead to the patient's anxiety, replacing them with positive, more realistic ones. Elements of the therapy include [[Exposure Therapy|exposure strategies]] to allow the patient to gradually confront their anxieties and feel more comfortable in anxiety-provoking situations, as well as to practice the skills they have learned. CBT can be used alone or in conjunction with [[medication]].<br />
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==Brain Stimulation Therapy==<br />
There is no FDA approved brain stimulation therapy available for generalized anxiety disorder.<br />
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==References==<br />
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{{Reflist|2}}<br />
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[[Category:Needs content]]<br />
[[Category:Disease]]<br />
[[Category:Psychiatry]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Schizophrenia_epidemiology_and_demographics&diff=1490879Schizophrenia epidemiology and demographics2018-08-17T12:40:07Z<p>Irfan Dotani: </p>
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<div>__NOTOC__<br />
{{Schizophrenia}}<br />
{{CMG}}; {{AE}} {{Vbe}} {{I.D.}}<br />
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==Overview==<br />
*The prevalence of [[schizophrenia]] is 300 to 700 per 100,000 (0.3%-0.7%) of the overall population.<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref><br />
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*It occurs 1.4 times more frequently in males than females and typically appears earlier in men[14]—the peak ages of onset are 25 years for males and 27 years for females.[174] <br />
*Onset in childhood is much rarer, as is onset in middle or old age.[175][176]<br />
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*Despite the prior belief that schizophrenia occurs at similar rates worldwide, its frequency varies across the world, within countries, and at the local and neighborhood level.[5][177][178][179] <br />
*This variation has been estimated to be fivefold.[4] <br />
*It causes approximately one percent of worldwide disability adjusted life years and resulted in 20,000 deaths in 2010.[180] <br />
*The rate of schizophrenia varies up to threefold depending on how it is defined.[9][14]<br />
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*In 2000, the World Health Organization found the percentage of people affected and the number of new cases that develop each year is roughly similar around the world, with age-standardized prevalence per 100,000 ranging from 343 in Africa to 544 in Japan and Oceania for men, and from 378 in Africa to 527 in Southeastern Europe for women.[181] <br />
*About 1.1% of adults have schizophrenia in the United States.<br />
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==References==<br />
{{Reflist|2}}<br />
<br />
<br />
[[Category:Disease]]<br />
[[Category:Psychiatry]]<br />
[[Category:Primary care]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Schizophrenia_social_impact&diff=1490789Schizophrenia social impact2018-08-15T18:04:13Z<p>Irfan Dotani: /* Diagnostic Issues and Controversies */</p>
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<div>__NOTOC__<br />
{{Schizophrenia}}<br />
{{CMG}};{{AE}}{{Vbe}} {{I.D.}}<br />
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==Social Impact and Misconceptions==<br />
*Views held by the public about [[mental]] [[disorders]], including [[schizophrenia]], may not coincide with available evidence or with the views held by some [[mental]] [[health]] professionals.<br />
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===Treatment===<br />
*Some [[psychiatrists]] believe [[patients]] can be discouraged by friends or family members from taking prescribed [[medication]] because of the latters' non-[[biological]] views of [[mental]] [[disorders]].<ref name="PsychNews00">American Psychiatric Association. Americans Still Cling to Myths About Mental Illness, Survey Finds. ''Psychiatric News.'' December 7, 2001 Volume 36 Number 23 [http://pn.psychiatryonline.org/cgi/content/full/36/23/14-a Full text]</ref> <br />
*There is scientific difference of opinion about the use of [[medication]] in [[schizophrenia]].<ref>Gould, JE. (2006) Ethical Considerations in Medication-Free Research with Schizophrenia Patients: An Expert Interview with William T. Carpenter, Jr., M.D. ''Medscape Psychiatry & Mental Health'' 2006:11(2) [http://www.medscape.com/viewarticle/546243 Full text available]</ref> <br />
*Consumers' views on [[Treatment-resistant depression|treatment]] and recovery may differ from those of [[mental]] [[health]] professionals.<ref name="Bellack06" /><br />
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===Violence===<br />
*The relationship between violent acts and [[schizophrenia]] is a contentious topic. <br />
*One survey found that 61% of [[Americans with Disabilities Act of 1990|Americans]] judged individuals with [[schizophrenia]] as likely to commit an act of interpersonal violence, while only 17% thought such an act likely to be committed by a person described as "troubled".<ref>Pescosolido BA, Monahan J, Link BG, Stueve A, Kikuzawa S (1999). The public's view of the competence, dangerousness, and need for legal coercion of persons with mental health problems. ''[[American Journal of Public Health]].'' Sep;89(9):1339–45. PMID 10474550</ref><br />
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*Research on violence indicates that the percentage of people with [[schizophrenia]] who commit violent acts is several times higher than the percentage of people without any [[disorder]], but lower than is found for disorders such as [[alcoholism]], and the difference is reduced or not found in same-neighbourhood comparisons when related factors are taken into account, notably sociodemographic variables and substance misuse.<ref name="Walsh02">Walsh E, Buchanan A, Fahy T (2002). Violence and schizophrenia: examining the evidence. ''British Journal of Psychiatry.'' 2002 Jun;180:490–5. PMID 12042226</ref><ref name="Stuart 03">Stuart, H (2003). Violence and mental illness: an overview. ''World Psychiatry.'' June; 2(2): 121–124. PMID 16946914 [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1525086 Full text,] Retrieved on [[2007-05-17]].</ref><ref>Steadman HJ, Mulvey EP, Monahan J, ''et al'' (1998). Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. ''Archives of General Psychiatry.'' May;55(5):393–401. PMID 9596041</ref><ref>Swanson JW, Swartz MS, Van Dorn RA, Elbogen EB, ''et al'' (2006). A national study of violent behavior in persons with schizophrenia. ''Archives of General Psychiatry.'' May;63(5):490–9. PMID 16651506</ref><ref>Swanson JW, Holzer CE, Ganju VK, Jono RT. (1990) Violence and Psychiatric Disorder in the Community: Evidence From the Epidemiologic Catchment Area Surveys ''Hosp Community Psychiatry'' 41:761-770, July 1990 PMID 2142118</ref> <br />
*Studies have indicated that 5 to 10% of those charged with murder in Western countries have a [[schizophrenia]] spectrum disorder.<ref name="Mullen 06">Mullen PE (2006). Schizophrenia and violence: from correlations to preventive strategies. ''Advances in Psychiatric Treatment'' 12: 239–248. [http://apt.rcpsych.org/cgi/content/abstract/12/4/239 Full text available,] Retrieved on [[2007-05-17]].</ref><ref name="fn_52">Simpson AI, McKenna B, Moskowitz A, Skipworth J, Barry-Walsh J (2004). Homicide and mental illness in New Zealand, 1970–2000. ''British Journal of Psychiatry'', 185, 394–8. PMID 15516547</ref><ref name="fn_53">Fazel S, Grann M (2004). Psychiatric morbidity among homicide offenders: a Swedish population study. ''American Journal of Psychiatry'', 161(11), 2129–31. PMID 15514419</ref> <br />
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*The occurrence of [[psychosis]] in [[schizophrenia]] has sometimes been linked to a higher risk of violent acts. Findings on the specific role of [[delusions]] or [[hallucinations]] have been inconsistent, but have focused on [[Delusional|delusiona]]<nowiki/>l jealousy, perception of threat and command [[hallucinations]]. <br />
*It has been proposed that a certain type of individual with [[schizophrenia]] may be most likely to offend, characterized by a history of educational difficulties, low IQ, conduct disorder, early-onset substance misuse and offending prior to [[diagnosis]].<ref name="Mullen 06" /><br />
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*A consistent finding is that individuals with a [[diagnosis]] of [[schizophrenia]] are often the victims of violent crime—at least 14 times more often than they are perpetrators.<ref>Brekke JS, Prindle C, Bae SW, Long JD (2001). Risks for individuals with schizophrenia who are living in the community. ''Psychiatric Services.'' Oct;52(10):1358–66. PMID 11585953</ref><ref name="fn_55">Fitzgerald PB, de Castella AR, Filia KM, Filia SL, Benitez J, Kulkarni J (2005). Victimization of patients with schizophrenia and related disorders. ''Australia and New Zealand Journal of Psychiatry'', 39(3), 169-74. (1), 187–9. PMID 15701066</ref> <br />
*Another consistent finding is a link to substance misuse, particularly [[alcohol]], among the minority who commit violent acts. Violence by or against individuals with [[schizophrenia]] typically occurs in the context of complex [[Social (pragmatic) communication disorder|social]] interactions within a family setting, and is also an issue in [[clinical]] services and in the wider community.<ref name="fn_51">Walsh E, Gilvarry C, Samele C, ''et al'' (2004). Predicting violence in schizophrenia: a prospective study. ''Schizophrenia Research'', 67(2–3), 247-52. PMID 14984884</ref><ref>Solomon PL, Cavanaugh MM, Gelles RJ (2005). Family Violence among Adults with Severe Mental Illness. ''Trauma, Violence, & Abuse'', Vol. 6, No. 1, 40–54. PMID 15574672[http://tva.sagepub.com/cgi/content/abstract/6/1/40 Full text available.]</ref><ref>Chou KR, Lu RB, Chang M (2001). Assaultive behavior by psychiatric in-patients and its related factors. ''Journal of Nursing Research.'' Dec;9(5):139–51. PMID 11779087</ref><ref>Logdberg B, Nilsson LL, Levander MT, Levander S (2004). Schizophrenia, neighbourhood, and crime. ''Acta Psychiatrica Scandinavica,'' 110(2) Page 92. PMID 15233709 [http://www.blackwell-synergy.com/links/doi/10.1111/j.1600-0047.2004.00322.x/abs/ Full text available,] Retrieved on [[2007-05-16]]</ref><br />
*Despite its [[etymology]], [[schizophrenia]] is not synonymous with [[dissociative identity disorder]], previously known as [[Multiple-conclusion logic|multiple]] [[personality disorder]] or split personality; in popular culture the two are often confused.<br />
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==Diagnostic Issues and Controversies==<br />
*[[Schizophrenia]] as a [[diagnostic]] entity has been criticized as lacking in scientific validity or reliability, part of a larger criticism of the validity of [[psychiatric]] diagnoses in general.<ref name="Bentall1992">Bentall RP (1992) ''Reconstructing Schizophrenia''. London: Routledge. ISBN 0415075246</ref><ref name="Boyle2002">Boyle M (2002) ''Schizophrenia: A Scientific Delusion?''. London: Routledge. ISBN 0415227186</ref> <br />
*One alternative suggests that the issues with the [[diagnosis]] would be better addressed as individual dimensions along which everyone varies, such that there is a spectrum or continuum rather than a cut-off between normal and ill. <br />
*This approach appears consistent with [[research]] on [[schizotypy]] and of a relatively high [[prevalence]] of [[psychotic]] experiences<ref name="fn_5">Verdoux H, van Os J (2002). Psychotic symptoms in non-clinical populations and the continuum of psychosis. ''Schizophrenia Research'', 54(1&ndash;2), 59&ndash;65. PMID 11853979</ref><ref name="fn_65">LC, van Os J. (2001). The continuity of psychotic experiences in the general population. ''Clinical Psychology Review'', 21 (8),1125–41. PMID 11702510</ref> and often non-distressing [[delusional]] beliefs<ref name="fn_67">Peters ER, Day S, McKenna J, Orbach G(2005). Measuring delusional ideation: the 21-item Peters et al. Delusions Inventory (PDI). ''Schizophrenia Bulletin'', 30, 1005–22. PMID 15954204</ref> amongst the general public.<ref name="Johns_vanOs_2001">Johns LC, van Os J (2001) The continuity of psychotic experiences in the general population. ''Clinical Psychology Review'', 21 (8), 1125–41. PMID 11702510.</ref><br />
<br />
*Another criticism is that the definitions used for criteria lack consistency; this is particularly relevant to the evaluation of [[delusion#Diagnostic issues and controversies|delusion]]s and [[thought disorder#Diagnostic issues and controversies|thought disorder]].<ref name="David1999">David AS (1999) On the impossibility of defining delusions. ''Philosophy, Psychiatry and Psychology'', 6 (1), 17–20</ref><br />
*More recently, it has been argued that [[psychotic]] [[symptoms]] are not a good basis for making a [[diagnosis]] of [[schizophrenia]] as "psychosis is the 'fever' of mental illness &mdash; a serious but nonspecific indicator".<ref name="fn_6">Tsuang MT, Stone WS, Faraone SV (2000). Toward reformulating the diagnosis of schizophrenia. ''American Journal of Psychiatry'', 157(7), 1041&ndash;1050. PMID 10873908</ref><br />
<br />
*Perhaps because of these factors, studies examining the [[diagnosis]] of [[schizophrenia]] have typically shown relatively low or inconsistent levels of [[Diagnostic criteria|diagnostic]] reliability. <br />
*Most famously, David Rosenhan's 1972 study, published as ''[[Rosenhan experiment|On being sane in insane places]]'', demonstrated that the [[diagnosis]] of [[schizophrenia]] was (at least at the time) often subjective and unreliable.<ref>Rosenhan D (1973). On being sane in insane places. ''Science'', 179, 250-8. PMID 4683124[http://www.stanford.edu/~kocabas/onbeingsane.pdf Full text as PDF]</ref> <br />
*More recent studies have found agreement between any two [[psychiatrists]] when [[Diagnosing Heart Failure in the Emergency Department|diagnosing]] [[schizophrenia]] tends to reach about 65% at best.<ref name="fn_7">McGorry PD, Mihalopoulos C, Henry L, Dakis J, Jackson HJ, Flaum M, Harrigan S, McKenzie D, Kulkarni J, Karoly R (1995). Spurious precision: procedural validity of diagnostic assessment in psychotic disorders. ''American Journal of Psychiatry'', 152 (2), 220&ndash;3. PMID 7840355</ref> <br />
*This, and the results of earlier studies of [[diagnostic]] reliability (which typically reported even lower levels of agreement), have led some critics to argue that the [[diagnosis]] of [[schizophrenia]] should be abandoned.<ref name="fn_8">Read J (2004) Does 'schizophrenia' exist? Reliability and validity. In Read J, Mosher LR, Bentall RP (eds) ''Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia''. ISBN 1-58391-906-6</ref><br />
<br />
*In 2004 in Japan, the Japanese term for [[schizophrenia]] was changed from ''Seishin-Bunretsu-Byo'' (mind-split-disease) to ''Tōgō-shitchō-shō'' ([[integration disorder]]).<ref name="Sato">Sato M (2004). Renaming schizophrenia: a Japanese perspective. ''World Psychiatry'', 5(1), 53–5. PMID 16757998</ref> <br />
*In 2006, campaigners in the UK, under the banner of Campaign for Abolition of the [[Schizophrenia]] Label, argued for a similar rejection of the [[diagnosis]] of [[schizophrenia]] and a different approach to the [[Treatment-resistant depression|treatment]] and understanding of the [[symptoms]] currently associated with it.<ref name="schizophrenia_invalid">[http://news.bbc.co.uk/2/hi/health/6033013.stm Schizophrenia term use 'invalid'.] BBC News Online, ([[9 October]] [[2006]]). Retrieved on [[2007-05-16]]. </ref><br />
<br />
*Alternatively, other proponents have put forward using the presence of specific [[neurocognitive deficit]]s to make a [[diagnosis]]. <br />
*These take the form of a reduction or impairment in basic [[psychological]] functions such as [[memory]], [[attention]], [[executive function]] and [[problem solving]]. <br />
*It is these sorts of difficulties, rather than the [[psychotic]] [[symptoms]] (which can in many cases be controlled by [[antipsychotic]] medication), which seem to be the cause of most [[disability]] in [[schizophrenia]]. <br />
**However, this argument is relatively new and it is unlikely that the method of [[Diagnosing Heart Failure in the Emergency Department|diagnosing]] [[schizophrenia]] will change radically in the near future.<ref name="GreenSchizophreniaBook">Green MF (2001) ''Schizophrenia Revealed: From Neurons to Social Interactions''. New York: W.W. Norton. ISBN 0393703347</ref><br />
<br />
*The [[diagnosis]] of [[schizophrenia]] has been used for political rather than [[therapeutic]] purposes. <br />
*In the Soviet Union, an additional sub-classification of [[sluggishly progressing schizophrenia]] was created. <br />
**Particularly in the RSFSR (Russian Soviet Federated Socialist Republic), this [[Diagnosis|diagnosi]]<nowiki/>s was used for the purpose of silencing political dissidents or forcing them to recant their ideas by the use of forcible confinement and [[Treatment-resistant depression|treatment]].<ref name="Wilkinson1986">Wilkinson G (1986) Political dissent and "sluggish" schizophrenia in the Soviet Union. ''Br Med J (Clin Res Ed)'', 293(6548), 641-2. PMID 3092963</ref> <br />
*In 2000, there were similar concerns regarding detention and '[[Treatment-resistant depression|treatment]]' of practitioners of the Falun Gong movement by the Chinese government. <br />
*This led the [[American Psychiatric Association|American Psychiatric Association's]] ''Committee on the Abuse of Psychiatry and Psychiatrists'' to pass a resolution to urge the [[World Psychiatric Association]] to investigate the situation in China.<ref name="Lyons2001">Lyons D (2001). Soviet-style psychiatry is alive and well in the People's Republic. ''British Journal of Psychiatry'', 178, 380–381. PMID 11282823</ref><br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Disease]]<br />
[[Category:Psychiatry]]<br />
[[Category:Mature chapter]]<br />
[[Category:Primary care]]<br />
[[Category:Needs overview]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Schizophrenia_social_impact&diff=1490788Schizophrenia social impact2018-08-15T18:00:35Z<p>Irfan Dotani: /* Violence */</p>
<hr />
<div>__NOTOC__<br />
{{Schizophrenia}}<br />
{{CMG}};{{AE}}{{Vbe}} {{I.D.}}<br />
<br />
==Social Impact and Misconceptions==<br />
*Views held by the public about [[mental]] [[disorders]], including [[schizophrenia]], may not coincide with available evidence or with the views held by some [[mental]] [[health]] professionals.<br />
<br />
===Treatment===<br />
*Some [[psychiatrists]] believe [[patients]] can be discouraged by friends or family members from taking prescribed [[medication]] because of the latters' non-[[biological]] views of [[mental]] [[disorders]].<ref name="PsychNews00">American Psychiatric Association. Americans Still Cling to Myths About Mental Illness, Survey Finds. ''Psychiatric News.'' December 7, 2001 Volume 36 Number 23 [http://pn.psychiatryonline.org/cgi/content/full/36/23/14-a Full text]</ref> <br />
*There is scientific difference of opinion about the use of [[medication]] in [[schizophrenia]].<ref>Gould, JE. (2006) Ethical Considerations in Medication-Free Research with Schizophrenia Patients: An Expert Interview with William T. Carpenter, Jr., M.D. ''Medscape Psychiatry & Mental Health'' 2006:11(2) [http://www.medscape.com/viewarticle/546243 Full text available]</ref> <br />
*Consumers' views on [[Treatment-resistant depression|treatment]] and recovery may differ from those of [[mental]] [[health]] professionals.<ref name="Bellack06" /><br />
<br />
===Violence===<br />
*The relationship between violent acts and [[schizophrenia]] is a contentious topic. <br />
*One survey found that 61% of [[Americans with Disabilities Act of 1990|Americans]] judged individuals with [[schizophrenia]] as likely to commit an act of interpersonal violence, while only 17% thought such an act likely to be committed by a person described as "troubled".<ref>Pescosolido BA, Monahan J, Link BG, Stueve A, Kikuzawa S (1999). The public's view of the competence, dangerousness, and need for legal coercion of persons with mental health problems. ''[[American Journal of Public Health]].'' Sep;89(9):1339–45. PMID 10474550</ref><br />
<br />
*Research on violence indicates that the percentage of people with [[schizophrenia]] who commit violent acts is several times higher than the percentage of people without any [[disorder]], but lower than is found for disorders such as [[alcoholism]], and the difference is reduced or not found in same-neighbourhood comparisons when related factors are taken into account, notably sociodemographic variables and substance misuse.<ref name="Walsh02">Walsh E, Buchanan A, Fahy T (2002). Violence and schizophrenia: examining the evidence. ''British Journal of Psychiatry.'' 2002 Jun;180:490–5. PMID 12042226</ref><ref name="Stuart 03">Stuart, H (2003). Violence and mental illness: an overview. ''World Psychiatry.'' June; 2(2): 121–124. PMID 16946914 [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1525086 Full text,] Retrieved on [[2007-05-17]].</ref><ref>Steadman HJ, Mulvey EP, Monahan J, ''et al'' (1998). Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. ''Archives of General Psychiatry.'' May;55(5):393–401. PMID 9596041</ref><ref>Swanson JW, Swartz MS, Van Dorn RA, Elbogen EB, ''et al'' (2006). A national study of violent behavior in persons with schizophrenia. ''Archives of General Psychiatry.'' May;63(5):490–9. PMID 16651506</ref><ref>Swanson JW, Holzer CE, Ganju VK, Jono RT. (1990) Violence and Psychiatric Disorder in the Community: Evidence From the Epidemiologic Catchment Area Surveys ''Hosp Community Psychiatry'' 41:761-770, July 1990 PMID 2142118</ref> <br />
*Studies have indicated that 5 to 10% of those charged with murder in Western countries have a [[schizophrenia]] spectrum disorder.<ref name="Mullen 06">Mullen PE (2006). Schizophrenia and violence: from correlations to preventive strategies. ''Advances in Psychiatric Treatment'' 12: 239–248. [http://apt.rcpsych.org/cgi/content/abstract/12/4/239 Full text available,] Retrieved on [[2007-05-17]].</ref><ref name="fn_52">Simpson AI, McKenna B, Moskowitz A, Skipworth J, Barry-Walsh J (2004). Homicide and mental illness in New Zealand, 1970–2000. ''British Journal of Psychiatry'', 185, 394–8. PMID 15516547</ref><ref name="fn_53">Fazel S, Grann M (2004). Psychiatric morbidity among homicide offenders: a Swedish population study. ''American Journal of Psychiatry'', 161(11), 2129–31. PMID 15514419</ref> <br />
<br />
*The occurrence of [[psychosis]] in [[schizophrenia]] has sometimes been linked to a higher risk of violent acts. Findings on the specific role of [[delusions]] or [[hallucinations]] have been inconsistent, but have focused on [[Delusional|delusiona]]<nowiki/>l jealousy, perception of threat and command [[hallucinations]]. <br />
*It has been proposed that a certain type of individual with [[schizophrenia]] may be most likely to offend, characterized by a history of educational difficulties, low IQ, conduct disorder, early-onset substance misuse and offending prior to [[diagnosis]].<ref name="Mullen 06" /><br />
<br />
*A consistent finding is that individuals with a [[diagnosis]] of [[schizophrenia]] are often the victims of violent crime—at least 14 times more often than they are perpetrators.<ref>Brekke JS, Prindle C, Bae SW, Long JD (2001). Risks for individuals with schizophrenia who are living in the community. ''Psychiatric Services.'' Oct;52(10):1358–66. PMID 11585953</ref><ref name="fn_55">Fitzgerald PB, de Castella AR, Filia KM, Filia SL, Benitez J, Kulkarni J (2005). Victimization of patients with schizophrenia and related disorders. ''Australia and New Zealand Journal of Psychiatry'', 39(3), 169-74. (1), 187–9. PMID 15701066</ref> <br />
*Another consistent finding is a link to substance misuse, particularly [[alcohol]], among the minority who commit violent acts. Violence by or against individuals with [[schizophrenia]] typically occurs in the context of complex [[Social (pragmatic) communication disorder|social]] interactions within a family setting, and is also an issue in [[clinical]] services and in the wider community.<ref name="fn_51">Walsh E, Gilvarry C, Samele C, ''et al'' (2004). Predicting violence in schizophrenia: a prospective study. ''Schizophrenia Research'', 67(2–3), 247-52. PMID 14984884</ref><ref>Solomon PL, Cavanaugh MM, Gelles RJ (2005). Family Violence among Adults with Severe Mental Illness. ''Trauma, Violence, & Abuse'', Vol. 6, No. 1, 40–54. PMID 15574672[http://tva.sagepub.com/cgi/content/abstract/6/1/40 Full text available.]</ref><ref>Chou KR, Lu RB, Chang M (2001). Assaultive behavior by psychiatric in-patients and its related factors. ''Journal of Nursing Research.'' Dec;9(5):139–51. PMID 11779087</ref><ref>Logdberg B, Nilsson LL, Levander MT, Levander S (2004). Schizophrenia, neighbourhood, and crime. ''Acta Psychiatrica Scandinavica,'' 110(2) Page 92. PMID 15233709 [http://www.blackwell-synergy.com/links/doi/10.1111/j.1600-0047.2004.00322.x/abs/ Full text available,] Retrieved on [[2007-05-16]]</ref><br />
*Despite its [[etymology]], [[schizophrenia]] is not synonymous with [[dissociative identity disorder]], previously known as [[Multiple-conclusion logic|multiple]] [[personality disorder]] or split personality; in popular culture the two are often confused.<br />
<br />
==Diagnostic Issues and Controversies==<br />
[[Schizophrenia]] as a [[diagnostic]] entity has been criticized as lacking in scientific validity or reliability,<ref name="Bentall1992">Bentall RP (1992) ''Reconstructing Schizophrenia''. London: Routledge. ISBN 0415075246</ref><ref name="Boyle2002">Boyle M (2002) ''Schizophrenia: A Scientific Delusion?''. London: Routledge. ISBN 0415227186</ref> part of a larger criticism of the validity of [[psychiatric]] diagnoses in general. One alternative suggests that the issues with the [[diagnosis]] would be better addressed as individual dimensions along which everyone varies, such that there is a spectrum or continuum rather than a cut-off between normal and ill. This approach appears consistent with [[research]] on [[schizotypy]] and of a relatively high [[prevalence]] of [[psychotic]] experiences<ref name="fn_5">Verdoux H, van Os J (2002). Psychotic symptoms in non-clinical populations and the continuum of psychosis. ''Schizophrenia Research'', 54(1&ndash;2), 59&ndash;65. PMID 11853979</ref><ref name="fn_65">LC, van Os J. (2001). The continuity of psychotic experiences in the general population. ''Clinical Psychology Review'', 21 (8),1125–41. PMID 11702510</ref> and often non-distressing [[delusional]] beliefs<ref name="fn_67">Peters ER, Day S, McKenna J, Orbach G(2005). Measuring delusional ideation: the 21-item Peters et al. Delusions Inventory (PDI). ''Schizophrenia Bulletin'', 30, 1005–22. PMID 15954204</ref> amongst the general public.<ref name="Johns_vanOs_2001">Johns LC, van Os J (2001) The continuity of psychotic experiences in the general population. ''Clinical Psychology Review'', 21 (8), 1125–41. PMID 11702510.</ref><br />
<br />
Another criticism is that the definitions used for criteria lack consistency;<ref name="David1999">David AS (1999) On the impossibility of defining delusions. ''Philosophy, Psychiatry and Psychology'', 6 (1), 17–20</ref> this is particularly relevant to the evaluation of [[delusion#Diagnostic issues and controversies|delusion]]s and [[thought disorder#Diagnostic issues and controversies|thought disorder]]. More recently, it has been argued that [[psychotic]] [[symptoms]] are not a good basis for making a [[diagnosis]] of [[schizophrenia]] as "psychosis is the 'fever' of mental illness &mdash; a serious but nonspecific indicator".<ref name="fn_6">Tsuang MT, Stone WS, Faraone SV (2000). Toward reformulating the diagnosis of schizophrenia. ''American Journal of Psychiatry'', 157(7), 1041&ndash;1050. PMID 10873908</ref><br />
<br />
Perhaps because of these factors, studies examining the [[diagnosis]] of [[schizophrenia]] have typically shown relatively low or inconsistent levels of [[Diagnostic criteria|diagnostic]] reliability. Most famously, David Rosenhan's 1972 study, published as ''[[Rosenhan experiment|On being sane in insane places]]'', demonstrated that the [[diagnosis]] of [[schizophrenia]] was (at least at the time) often subjective and unreliable.<ref>Rosenhan D (1973). On being sane in insane places. ''Science'', 179, 250-8. PMID 4683124[http://www.stanford.edu/~kocabas/onbeingsane.pdf Full text as PDF]</ref> More recent studies have found agreement between any two [[psychiatrists]] when [[Diagnosing Heart Failure in the Emergency Department|diagnosing]] [[schizophrenia]] tends to reach about 65% at best.<ref name="fn_7">McGorry PD, Mihalopoulos C, Henry L, Dakis J, Jackson HJ, Flaum M, Harrigan S, McKenzie D, Kulkarni J, Karoly R (1995). Spurious precision: procedural validity of diagnostic assessment in psychotic disorders. ''American Journal of Psychiatry'', 152 (2), 220&ndash;3. PMID 7840355</ref> This, and the results of earlier studies of [[diagnostic]] reliability (which typically reported even lower levels of agreement) have led some critics to argue that the [[diagnosis]] of [[schizophrenia]] should be abandoned.<ref name="fn_8">Read J (2004) Does 'schizophrenia' exist? Reliability and validity. In Read J, Mosher LR, Bentall RP (eds) ''Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia''. ISBN 1-58391-906-6</ref><br />
<br />
In 2004 in Japan, the Japanese term for [[schizophrenia]] was changed from ''Seishin-Bunretsu-Byo'' (mind-split-disease) to ''Tōgō-shitchō-shō'' ([[integration disorder]]).<ref name="Sato">Sato M (2004). Renaming schizophrenia: a Japanese perspective. ''World Psychiatry'', 5(1), 53–5. PMID 16757998</ref> In 2006, campaigners in the UK, under the banner of Campaign for Abolition of the [[Schizophrenia]] Label, argued for a similar rejection of the [[diagnosis]] of [[schizophrenia]] and a different approach to the [[Treatment-resistant depression|treatment]] and understanding of the [[symptoms]] currently associated with it.<ref name="schizophrenia_invalid">[http://news.bbc.co.uk/2/hi/health/6033013.stm Schizophrenia term use 'invalid'.] BBC News Online, ([[9 October]] [[2006]]). Retrieved on [[2007-05-16]]. </ref><br />
<br />
Alternatively, other proponents have put forward using the presence of specific [[neurocognitive deficit]]s to make a [[diagnosis]]. These take the form of a reduction or impairment in basic [[psychological]] functions such as [[memory]], [[attention]], [[executive function]] and [[problem solving]]. It is these sorts of difficulties, rather than the [[psychotic]] [[symptoms]] (which can in many cases be controlled by [[antipsychotic]] medication), which seem to be the cause of most [[disability]] in [[schizophrenia]]. However, this argument is relatively new and it is unlikely that the method of [[Diagnosing Heart Failure in the Emergency Department|diagnosing]] [[schizophrenia]] will change radically in the near future.<ref name="GreenSchizophreniaBook">Green MF (2001) ''Schizophrenia Revealed: From Neurons to Social Interactions''. New York: W.W. Norton. ISBN 0393703347</ref><br />
<br />
The [[diagnosis]] of [[schizophrenia]] has been used for political rather than [[therapeutic]] purposes; in the Soviet Union an additional sub-classification of [[sluggishly progressing schizophrenia]] was created. Particularly in the RSFSR (Russian Soviet Federated Socialist Republic), this [[Diagnosis|diagnosi]]<nowiki/>s was used for the purpose of silencing political dissidents or forcing them to recant their ideas by the use of forcible confinement and [[Treatment-resistant depression|treatment]].<ref name="Wilkinson1986">Wilkinson G (1986) Political dissent and "sluggish" schizophrenia in the Soviet Union. ''Br Med J (Clin Res Ed)'', 293(6548), 641-2. PMID 3092963</ref> In 2000 there were similar concerns regarding detention and '[[Treatment-resistant depression|treatment]]' of practitioners of the Falun Gong movement by the Chinese government. This led the [[American Psychiatric Association|American Psychiatric Association's]] ''Committee on the Abuse of Psychiatry and Psychiatrists'' to pass a resolution to urge the [[World Psychiatric Association]] to investigate the situation in China.<ref name="Lyons2001">Lyons D (2001). Soviet-style psychiatry is alive and well in the People's Republic. ''British Journal of Psychiatry'', 178, 380–381. PMID 11282823</ref><br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Disease]]<br />
[[Category:Psychiatry]]<br />
[[Category:Mature chapter]]<br />
[[Category:Primary care]]<br />
[[Category:Needs overview]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Schizophrenia_social_impact&diff=1490775Schizophrenia social impact2018-08-15T17:29:10Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Schizophrenia}}<br />
{{CMG}};{{AE}}{{Vbe}} {{I.D.}}<br />
<br />
==Social Impact and Misconceptions==<br />
*Views held by the public about [[mental]] [[disorders]], including [[schizophrenia]], may not coincide with available evidence or with the views held by some [[mental]] [[health]] professionals.<br />
<br />
===Treatment===<br />
*Some [[psychiatrists]] believe [[patients]] can be discouraged by friends or family members from taking prescribed [[medication]] because of the latters' non-[[biological]] views of [[mental]] [[disorders]].<ref name="PsychNews00">American Psychiatric Association. Americans Still Cling to Myths About Mental Illness, Survey Finds. ''Psychiatric News.'' December 7, 2001 Volume 36 Number 23 [http://pn.psychiatryonline.org/cgi/content/full/36/23/14-a Full text]</ref> <br />
*There is scientific difference of opinion about the use of [[medication]] in [[schizophrenia]].<ref>Gould, JE. (2006) Ethical Considerations in Medication-Free Research with Schizophrenia Patients: An Expert Interview with William T. Carpenter, Jr., M.D. ''Medscape Psychiatry & Mental Health'' 2006:11(2) [http://www.medscape.com/viewarticle/546243 Full text available]</ref> <br />
*Consumers' views on [[Treatment-resistant depression|treatment]] and recovery may differ from those of [[mental]] [[health]] professionals.<ref name="Bellack06" /><br />
<br />
===Violence===<br />
The relationship between violent acts and [[schizophrenia]] is a contentious topic. One survey found that 61% of [[Americans with Disabilities Act of 1990|Americans]] judged individuals with [[schizophrenia]] as likely to commit an act of interpersonal violence, while only 17% thought such an act likely to be committed by a person described as "troubled".<ref>Pescosolido BA, Monahan J, Link BG, Stueve A, Kikuzawa S (1999). The public's view of the competence, dangerousness, and need for legal coercion of persons with mental health problems. ''[[American Journal of Public Health]].'' Sep;89(9):1339–45. PMID 10474550</ref><br />
<br />
Research on violence indicates that the percentage of people with [[schizophrenia]] who commit violent acts is several times higher than the percentage of people without any [[disorder]], but lower than is found for disorders such as [[alcoholism]], and the difference is reduced or not found in same-neighbourhood comparisons when related factors are taken into account, notably sociodemographic variables and substance misuse.<ref name="Walsh02">Walsh E, Buchanan A, Fahy T (2002). Violence and schizophrenia: examining the evidence. ''British Journal of Psychiatry.'' 2002 Jun;180:490–5. PMID 12042226</ref><ref name="Stuart 03">Stuart, H (2003). Violence and mental illness: an overview. ''World Psychiatry.'' June; 2(2): 121–124. PMID 16946914 [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1525086 Full text,] Retrieved on [[2007-05-17]].</ref><ref>Steadman HJ, Mulvey EP, Monahan J, ''et al'' (1998). Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. ''Archives of General Psychiatry.'' May;55(5):393–401. PMID 9596041</ref><ref>Swanson JW, Swartz MS, Van Dorn RA, Elbogen EB, ''et al'' (2006). A national study of violent behavior in persons with schizophrenia. ''Archives of General Psychiatry.'' May;63(5):490–9. PMID 16651506</ref><ref>Swanson JW, Holzer CE, Ganju VK, Jono RT. (1990) Violence and Psychiatric Disorder in the Community: Evidence From the Epidemiologic Catchment Area Surveys ''Hosp Community Psychiatry'' 41:761-770, July 1990 PMID 2142118</ref> Studies have indicated that 5 to 10% of those charged with murder in Western countries have a [[schizophrenia]] spectrum disorder.<ref name="Mullen 06">Mullen PE (2006). Schizophrenia and violence: from correlations to preventive strategies. ''Advances in Psychiatric Treatment'' 12: 239–248. [http://apt.rcpsych.org/cgi/content/abstract/12/4/239 Full text available,] Retrieved on [[2007-05-17]].</ref><ref name="fn_52">Simpson AI, McKenna B, Moskowitz A, Skipworth J, Barry-Walsh J (2004). Homicide and mental illness in New Zealand, 1970–2000. ''British Journal of Psychiatry'', 185, 394–8. PMID 15516547</ref><ref name="fn_53">Fazel S, Grann M (2004). Psychiatric morbidity among homicide offenders: a Swedish population study. ''American Journal of Psychiatry'', 161(11), 2129–31. PMID 15514419</ref> <br />
<br />
The occurrence of [[psychosis]] in [[schizophrenia]] has sometimes been linked to a higher risk of violent acts. Findings on the specific role of [[delusions]] or [[hallucinations]] have been inconsistent, but have focused on [[Delusional|delusiona]]<nowiki/>l jealousy, perception of threat and command [[hallucinations]]. It has been proposed that a certain type of individual with [[schizophrenia]] may be most likely to offend, characterized by a history of educational difficulties, low IQ, conduct disorder, early-onset substance misuse and offending prior to [[diagnosis]].<ref name="Mullen 06" /><br />
<br />
A consistent finding is that individuals with a [[diagnosis]] of [[schizophrenia]] are often the victims of violent crime—at least 14 times more often than they are perpetrators.<ref>Brekke JS, Prindle C, Bae SW, Long JD (2001). Risks for individuals with schizophrenia who are living in the community. ''Psychiatric Services.'' Oct;52(10):1358–66. PMID 11585953</ref><ref name="fn_55">Fitzgerald PB, de Castella AR, Filia KM, Filia SL, Benitez J, Kulkarni J (2005). Victimization of patients with schizophrenia and related disorders. ''Australia and New Zealand Journal of Psychiatry'', 39(3), 169-74. (1), 187–9. PMID 15701066</ref> Another consistent finding is a link to substance misuse, particularly [[alcohol]],<ref name="fn_51">Walsh E, Gilvarry C, Samele C, ''et al'' (2004). Predicting violence in schizophrenia: a prospective study. ''Schizophrenia Research'', 67(2–3), 247-52. PMID 14984884</ref> among the minority who commit violent acts. Violence by or against individuals with [[schizophrenia]] typically occurs in the context of complex [[Social (pragmatic) communication disorder|social]] interactions within a family setting,<ref>Solomon PL, Cavanaugh MM, Gelles RJ (2005). Family Violence among Adults with Severe Mental Illness. ''Trauma, Violence, & Abuse'', Vol. 6, No. 1, 40–54. PMID 15574672[http://tva.sagepub.com/cgi/content/abstract/6/1/40 Full text available.]</ref> and is also an issue in [[clinical]] services<ref>Chou KR, Lu RB, Chang M (2001). Assaultive behavior by psychiatric in-patients and its related factors. ''Journal of Nursing Research.'' Dec;9(5):139–51. PMID 11779087</ref> and in the wider community.<ref>Logdberg B, Nilsson LL, Levander MT, Levander S (2004). Schizophrenia, neighbourhood, and crime. ''Acta Psychiatrica Scandinavica,'' 110(2) Page 92. PMID 15233709 [http://www.blackwell-synergy.com/links/doi/10.1111/j.1600-0047.2004.00322.x/abs/ Full text available,] Retrieved on [[2007-05-16]]</ref><br />
Despite its [[etymology]], [[schizophrenia]] is not synonymous with [[dissociative identity disorder]], previously known as [[Multiple-conclusion logic|multiple]] [[personality disorder]] or split personality; in popular culture the two are often confused.<br />
<br />
==Diagnostic Issues and Controversies==<br />
[[Schizophrenia]] as a [[diagnostic]] entity has been criticized as lacking in scientific validity or reliability,<ref name="Bentall1992">Bentall RP (1992) ''Reconstructing Schizophrenia''. London: Routledge. ISBN 0415075246</ref><ref name="Boyle2002">Boyle M (2002) ''Schizophrenia: A Scientific Delusion?''. London: Routledge. ISBN 0415227186</ref> part of a larger criticism of the validity of [[psychiatric]] diagnoses in general. One alternative suggests that the issues with the [[diagnosis]] would be better addressed as individual dimensions along which everyone varies, such that there is a spectrum or continuum rather than a cut-off between normal and ill. This approach appears consistent with [[research]] on [[schizotypy]] and of a relatively high [[prevalence]] of [[psychotic]] experiences<ref name="fn_5">Verdoux H, van Os J (2002). Psychotic symptoms in non-clinical populations and the continuum of psychosis. ''Schizophrenia Research'', 54(1&ndash;2), 59&ndash;65. PMID 11853979</ref><ref name="fn_65">LC, van Os J. (2001). The continuity of psychotic experiences in the general population. ''Clinical Psychology Review'', 21 (8),1125–41. PMID 11702510</ref> and often non-distressing [[delusional]] beliefs<ref name="fn_67">Peters ER, Day S, McKenna J, Orbach G(2005). Measuring delusional ideation: the 21-item Peters et al. Delusions Inventory (PDI). ''Schizophrenia Bulletin'', 30, 1005–22. PMID 15954204</ref> amongst the general public.<ref name="Johns_vanOs_2001">Johns LC, van Os J (2001) The continuity of psychotic experiences in the general population. ''Clinical Psychology Review'', 21 (8), 1125–41. PMID 11702510.</ref><br />
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Another criticism is that the definitions used for criteria lack consistency;<ref name="David1999">David AS (1999) On the impossibility of defining delusions. ''Philosophy, Psychiatry and Psychology'', 6 (1), 17–20</ref> this is particularly relevant to the evaluation of [[delusion#Diagnostic issues and controversies|delusion]]s and [[thought disorder#Diagnostic issues and controversies|thought disorder]]. More recently, it has been argued that [[psychotic]] [[symptoms]] are not a good basis for making a [[diagnosis]] of [[schizophrenia]] as "psychosis is the 'fever' of mental illness &mdash; a serious but nonspecific indicator".<ref name="fn_6">Tsuang MT, Stone WS, Faraone SV (2000). Toward reformulating the diagnosis of schizophrenia. ''American Journal of Psychiatry'', 157(7), 1041&ndash;1050. PMID 10873908</ref><br />
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Perhaps because of these factors, studies examining the [[diagnosis]] of [[schizophrenia]] have typically shown relatively low or inconsistent levels of [[Diagnostic criteria|diagnostic]] reliability. Most famously, David Rosenhan's 1972 study, published as ''[[Rosenhan experiment|On being sane in insane places]]'', demonstrated that the [[diagnosis]] of [[schizophrenia]] was (at least at the time) often subjective and unreliable.<ref>Rosenhan D (1973). On being sane in insane places. ''Science'', 179, 250-8. PMID 4683124[http://www.stanford.edu/~kocabas/onbeingsane.pdf Full text as PDF]</ref> More recent studies have found agreement between any two [[psychiatrists]] when [[Diagnosing Heart Failure in the Emergency Department|diagnosing]] [[schizophrenia]] tends to reach about 65% at best.<ref name="fn_7">McGorry PD, Mihalopoulos C, Henry L, Dakis J, Jackson HJ, Flaum M, Harrigan S, McKenzie D, Kulkarni J, Karoly R (1995). Spurious precision: procedural validity of diagnostic assessment in psychotic disorders. ''American Journal of Psychiatry'', 152 (2), 220&ndash;3. PMID 7840355</ref> This, and the results of earlier studies of [[diagnostic]] reliability (which typically reported even lower levels of agreement) have led some critics to argue that the [[diagnosis]] of [[schizophrenia]] should be abandoned.<ref name="fn_8">Read J (2004) Does 'schizophrenia' exist? Reliability and validity. In Read J, Mosher LR, Bentall RP (eds) ''Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia''. ISBN 1-58391-906-6</ref><br />
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In 2004 in Japan, the Japanese term for [[schizophrenia]] was changed from ''Seishin-Bunretsu-Byo'' (mind-split-disease) to ''Tōgō-shitchō-shō'' ([[integration disorder]]).<ref name="Sato">Sato M (2004). Renaming schizophrenia: a Japanese perspective. ''World Psychiatry'', 5(1), 53–5. PMID 16757998</ref> In 2006, campaigners in the UK, under the banner of Campaign for Abolition of the [[Schizophrenia]] Label, argued for a similar rejection of the [[diagnosis]] of [[schizophrenia]] and a different approach to the [[Treatment-resistant depression|treatment]] and understanding of the [[symptoms]] currently associated with it.<ref name="schizophrenia_invalid">[http://news.bbc.co.uk/2/hi/health/6033013.stm Schizophrenia term use 'invalid'.] BBC News Online, ([[9 October]] [[2006]]). Retrieved on [[2007-05-16]]. </ref><br />
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Alternatively, other proponents have put forward using the presence of specific [[neurocognitive deficit]]s to make a [[diagnosis]]. These take the form of a reduction or impairment in basic [[psychological]] functions such as [[memory]], [[attention]], [[executive function]] and [[problem solving]]. It is these sorts of difficulties, rather than the [[psychotic]] [[symptoms]] (which can in many cases be controlled by [[antipsychotic]] medication), which seem to be the cause of most [[disability]] in [[schizophrenia]]. However, this argument is relatively new and it is unlikely that the method of [[Diagnosing Heart Failure in the Emergency Department|diagnosing]] [[schizophrenia]] will change radically in the near future.<ref name="GreenSchizophreniaBook">Green MF (2001) ''Schizophrenia Revealed: From Neurons to Social Interactions''. New York: W.W. Norton. ISBN 0393703347</ref><br />
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The [[diagnosis]] of [[schizophrenia]] has been used for political rather than [[therapeutic]] purposes; in the Soviet Union an additional sub-classification of [[sluggishly progressing schizophrenia]] was created. Particularly in the RSFSR (Russian Soviet Federated Socialist Republic), this [[Diagnosis|diagnosi]]<nowiki/>s was used for the purpose of silencing political dissidents or forcing them to recant their ideas by the use of forcible confinement and [[Treatment-resistant depression|treatment]].<ref name="Wilkinson1986">Wilkinson G (1986) Political dissent and "sluggish" schizophrenia in the Soviet Union. ''Br Med J (Clin Res Ed)'', 293(6548), 641-2. PMID 3092963</ref> In 2000 there were similar concerns regarding detention and '[[Treatment-resistant depression|treatment]]' of practitioners of the Falun Gong movement by the Chinese government. This led the [[American Psychiatric Association|American Psychiatric Association's]] ''Committee on the Abuse of Psychiatry and Psychiatrists'' to pass a resolution to urge the [[World Psychiatric Association]] to investigate the situation in China.<ref name="Lyons2001">Lyons D (2001). Soviet-style psychiatry is alive and well in the People's Republic. ''British Journal of Psychiatry'', 178, 380–381. PMID 11282823</ref><br />
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==References==<br />
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{{WH}}<br />
{{WS}}</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Schizophrenia_brain_stimulation_therapy&diff=1490773Schizophrenia brain stimulation therapy2018-08-15T17:25:22Z<p>Irfan Dotani: </p>
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<div>__NOTOC__<br />
{{Schizophrenia}}<br />
{{CMG}};{{AE}}{{Vbe}} {{I.D.}}<br />
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==Electroconvulsive Therapy==<br />
*[[Electroconvulsive therapy]] is not considered a [[first line treatment]] but may be prescribed in cases where other [[treatments]] have failed.<br />
*It is more effective where [[symptoms]] of [[catatonia]] are present, and is recommended for use under [[National Institute for Health and Clinical Excellence|NICE]] guidelines in the UK for catatonia if previously effective, though there is no recommendation for use for [[schizophrenia]] otherwise.<ref>{{cite journal |author=Greenhalgh J, Knight C, Hind D, Beverley C, Walters S |year=2005 |month=March |title= Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania: systematic reviews and economic modeling studies.|journal= Health Technol Assess.|volume= 9|issue=9 |pages=1-156 |url=http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15774232 (abstract) |accessdate= 2007-06-17}}</ref><ref>{{cite web |url=http://www.nice.org.uk/page.aspx?o=TA059 |title= The clinical effectiveness and cost effectiveness of electroconvulsive Therapy (ECT) for depressive illness, schizophrenia, catatonia and mania.|accessdate=2007-06-17 |author= National Institute for Health and Clinical Excellence|year= 2003|month=April |publisher= National Institute for Health and Clinical Excellence|language= English}}</ref> <br />
*[[Psychosurgery]] has now become a rare procedure and is not a recommended [[Treatment-resistant depression|treatment]] for [[schizophrenia]].<ref name="Mashour_et_al_2005">Mashour GA, Walker EE, Martuza RL. (2005) Psychosurgery: past, present, and future. ''Brain Research: Brain Research Reviews'', 48 (3), 409-19. PMID 15914249</ref><br />
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==References==<br />
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{{WH}}<br />
{{WS}}</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Schizophrenia_psychotherapy&diff=1490771Schizophrenia psychotherapy2018-08-15T17:24:12Z<p>Irfan Dotani: </p>
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<div>__NOTOC__<br />
{{Schizophrenia}}<br />
{{CMG}};{{AE}}{{Vbe}} {{I.D.}}<br />
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==Psychotherapy==<br />
*[[Psychotherapy]] is also widely recommended and used in the [[Treatment-resistant depression|treatment]] of [[schizophrenia]], although services may often be confined to [[pharmacotherapy]] because of reimbursement problems or lack of training.<ref>Moran, M (2005). [http://pn.psychiatryonline.org/cgi/content/full/40/22/24-b Psychosocial Treatment Often Missing From Schizophrenia Regimens.] ''Psychiatr News'' [[November 18]] [[2005]], Volume 40, Number 22, page 24. Retrieved on [[2007-05-17]].</ref> <br />
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==Cognitive Behavioral Therapy==<br />
*[[Cognitive behavioral therapy]] (CBT) is used to reduce [[symptoms]] and improve related issues such as [[self-esteem]], social [[Functioning carcinoid|functioning]], and insight. <br />
*Although the results of early trials were inconclusive, more recent reviews suggest that CBT can be an effective [[Treatment-resistant depression|treatment]] for the [[psychotic]] [[symptoms]] of [[schizophrenia]].<ref name="fn_38">Cormac I, Jones C, Campbell C (2002). Cognitive behaviour therapy for schizophrenia. ''Cochrane Database of [[systematic review]]s'', (1), CD000524. PMID 11869579</ref><ref name="fn_39">Zimmermann G, Favrod J, Trieu VH, Pomini V (2005). The effect of cognitive behavioral treatment on the positive symptoms of schizophrenia spectrum disorders: a meta-analysis. ''[[Schizophrenia Research]]'', 77, 1–9. PMID 16005380</ref> <br />
*Another approach is [[cognitive]] remediation [[therapy]], a technique aimed at remediating the [[neurocognitive deficit]]s sometimes present in [[schizophrenia]]. *Based on techniques of [[neuropsychological rehabilitation]], early evidence has shown it to be cognitively effective, with some improvements related to measurable changes in brain activation as measured by [[fMRI]].<ref name="fn_40">Wykes T, Brammer M, Mellers J, ''et al'' (2002). Effects on the brain of a psychological treatment: cognitive remediation therapy: functional magnetic resonance imaging in schizophrenia. ''[[British Journal of Psychiatry]]'', 181, 144–52. PMID 12151286</ref> <br />
*A similar approach known as [[cognitive]] enhancement therapy, which focuses on social cognition as well as neurocognition, has shown efficacy.<ref>Hogarty GE, Flesher S, Ulrich R, Carter M, ''et al'' (2004). Cognitive enhancement therapy for schizophrenia: effects of a 2-year randomized trial on cognition and behavior. ''Arch Gen Psychiatry.'' Sep;61(9):866–76.PMID 15351765</ref><br />
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==Family Therapy and Other Therapies==<br />
*Family Therapy or [[Education]], which addresses the whole family system of an individual with a diagnosis of [[schizophrenia]], has been consistently found to be beneficial, at least if the duration of intervention is longer-term.<ref>McFarlane WR, Dixon L, Lukens E, Lucksted A (2003). Family psychoeducation and schizophrenia: a review of the literature. ''J Marital Fam Ther.'' Apr;29(2):223–45. PMID 12728780</ref><ref>Glynn SM, Cohen AN, Niv N (2007). New challenges in family interventions for schizophrenia. '' Expert Rev Neurother.'' Jan;7(1):33–43. PMID 17187495</ref><ref>Pharoah F, Mari J, Rathbone J, Wong W. (2006) [http://www.cochrane.org/reviews/en/ab000088.html Family intervention for schizophrenia] Cochrane Database of Systematic Reviews, Issue 4</ref> <br />
*Aside from [[therapy]], the impact of [[schizophrenia]] on families and the burden on carers has been recognized, with the increasing availability of self-help books on the subject.<ref>{{cite book | author = Jones, S., Hayward, P. | title = Coping with Schizophrenia: A Guide for Patients, Families and Caregivers | publisher = Oneworld Pub. | date = 2004 | location = Oxford, England | id = ISBN 1-85168-344-5}}</ref><ref>{{cite book | last = Torrey | first = EF | authorlink = E. Fuller Torrey | title = Surviving Schizophrenia: A Manual for Families, Consumers, and Providers (5th Edition) | publisher = HarperCollins | date = 2006 | id = ISBN 0-06-084259-8}}</ref> <br />
*There is also some evidence for benefits from [[social skills training]], although there have also been significant negative findings.<ref>Kopelowicz A, Liberman RP, Zarate R (2006). Recent advances in social skills training for schizophrenia. ''[[Schizophrenia Bulletin]].'' 2006 Oct;32 Suppl 1:S12–23. PMID 16885207 </ref><ref>American Psychiatric Association (2004) Practice Guideline for the Treatment of Patients With Schizophrenia. Second Edition.</ref> <br />
(Some [[Studies on Hysteria|studies]] have explored the possible benefits of music therapy and other creative [[Therapies for multiple sclerosis|therapies]].<ref>Talwar N, Crawford MJ, Maratos A, Nur U, McDermott O, Procter S (2006). Music therapy for in-patients with schizophrenia: Exploratory randomised controlled trial. ''The [[British Journal of Psychiatry]].'' Nov;189:405–9. PMID 17077429 [http://bjp.rcpsych.org/cgi/content/abstract/189/5/405 Full text available.] </ref><ref>Ruddy R, Milnes D. (2005) [http://www.cochrane.org/reviews/en/ab000088.html Art therapy for schizophrenia or schizophrenia-like illnesses.] Cochrane Database of Systematic Reviews, Issue 4</ref><ref>Ruddy RA, Dent-Brown K. (2007) [http://www.cochrane.org/reviews/en/ab005378.html Drama therapy for schizophrenia or schizophrenia-like illnesses.] Cochrane Database of Systematic Reviews, Issue 1.</ref><br />
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==References==<br />
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{{WS}}</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Schizophrenia_medical_therapy&diff=1490768Schizophrenia medical therapy2018-08-15T17:18:29Z<p>Irfan Dotani: </p>
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<div>__NOTOC__<br />
{{Schizophrenia}}<br />
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==Medical Therapy==<br />
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*The mainstay of [[psychiatric]] [[Treatment-resistant depression|treatment]] for [[schizophrenia]] is an [[antipsychotic]] [[medication]].<ref name="fn_72">The Royal College of Psychiatrists & The British Psychological Society (2003). [http://www.nice.org.uk/download.aspx?o=289559 ''Schizophrenia. Full national clinical guideline on core interventions in primary and secondary care''] (PDF). London: Gaskell and the British Psychological Society. Retrieved on [[2007-05-17]].</ref> <br />
*These can reduce the "positive" [[symptoms]] of [[psychosis]]. <br />
*Most [[antipsychotics]] take around 7–14 days to have their main effect. <br />
[[Image:Risperdal tablets.jpg|thumb|left|150px|[[Risperidone]] (trade name '''Risperdal''') is a common [[atypical antipsychotic]] medication.]] <br />
*Though expensive, the newer [[atypical antipsychotic]] drugs are usually preferred for [[first-line treatment|initial treatment]] over the older [[typical antipsychotic]]s; they are often better tolerated and associated with lower rates of [[tardive dyskinesia]], although they are more likely to induce weight gain and [[obesity]]-related diseases.<ref name="fn_62">Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, Keefe RS, Davis SM, Davis CE, Lebowitz BD, Severe J, Hsiao JK, Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators. (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. ''[[The New England Journal of Medicine]]'', 353 (12), 1209–23. PMID 16172203</ref> <br />
*[[Prolactin]] elevations have been reported in women with [[schizophrenia]] taking atypical [[antipsychotics]].<ref name="Dickson_et_al_1995">Dickson RA, Dalby JT, Williams R, Edwards AL. (1995) Risperidone induced prolactin elevations in premenopausal women with schizophrenia. ''American Journal of Psychiatry'',152,1102-1103. PMID 7540803</ref><br />
*It remains unclear whether the newer [[antipsychotics]] reduce the chances of developing [[neuroleptic malignant syndrome]], a rare but serious and potentially fatal [[Neurological disorders|neurological]] disorder most often caused by an adverse reaction to [[neuroleptic]] or [[Antipsychotic drugs|antipsychotic]] drugs.<ref name="Ananth_et_al_2004">Ananth J, Parameswaran S, Gunatilake S, Burgoyne K, Sidhom T. (2004) Neuroleptic malignant syndrome and atypical antipsychotic drugs. ''Journal of Clinical Psychiatry'', 65 (4), 464-70. PMID 15119907</ref><br />
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*The two classes of [[antipsychotics]] are generally thought equally effective for the treatment of the positive symptoms. <br />
*Some researchers have suggested that the atypicals offer additional benefit for the negative [[symptoms]] and [[cognitive]] deficits associated with [[schizophrenia]], although the [[clinical]] significance of these effects has yet to be established. <br />
*Recent reviews have refuted the claim that atypical [[antipsychotics]] have fewer extrapyramidal side effects than typical antipsychotics, especially when the latter are used in low doses or when low potency antipsychotics are chosen.<ref name="fn_36">Leucht S, Wahlbeck K, Hamann J, Kissling W (2003). New generation antipsychotics versus low-potency conventional antipsychotics: a [[systematic review]] and meta-analysis. ''[[The Lancet]]'', 361(9369), 1581–9. PMID 12747876</ref> <br />
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*Response of [[symptoms]] to mediation is variable; "Treatment-resistant schizophrenia" is a term used for the failure of [[symptoms]] to respond satisfactorily to at least two different [[antipsychotics]].<ref>{{cite journal | author = Meltzer HY | title = Treatment-resistant schizophrenia--the role of clozapine | journal = Current Medical Research and Opinion | volume = 14 | issue = 1 | pages = 1–20 | date = 1997 | pmid=9524789 }}</ref> <br />
*Patients in this category may be prescribed [[clozapine]], a [[medication]] of superior effectiveness but several potentially lethal side effects including [[agranulocytosis]] and [[myocarditis]].<ref>{{cite journal | author = Wahlbeck K, Cheine MV, Essali A | title = Clozapine versus typical neuroleptic medication for schizophrenia | journal = The Cochrane Database of Systematic Reviews | volume = | issue = 2 | pages = | publisher = John Wiley and Sons, Ltd. | date = 2007 | pmid=10796289 | doi = 10.1002/14651858.CD000059 | id = ISSN 1464-780X}}</ref><ref>{{cite journal | author = Haas SJ, Hill R, Krum H | title = Clozapine-associated myocarditis: a review of 116 cases of suspected myocarditis associated with the use of clozapine in Australia during 1993–2003 | journal = Drug Safety | volume = 30 | pages = 47–57 | date = 2007 | pmid=17194170 }}</ref> <br />
*[[Clozapine]] may have the additional benefit of reducing propensity for substance abuse in [[schizophrenic]] patients. <ref>{{cite journal |author = Lee M, Dickson RA, Campbell M, Oliphant J, Gretton H, Dalby JT. |title = Clozapine and substance abuse in patients with schizophrenia |journal = Canadian Journal of Psychiatry |volume = 43 |pages = 855-856 |date = 1998 }}</ref> <br />
*For other [[patients]] who are unwilling or unable to take [[medication]] regularly, long-acting [[Typical antipsychotic#Depot injections|depot]] preparations of [[antipsychotics]] may be given every two weeks to achieve control. <br />
*America and Australia are two countries with [[Outpatient commitment|laws]] allowing the forced administration of this type of [[medication]] on those who refuse but are otherwise stable and living in the community. <br />
*Nevertheless, some findings indicate that in the longer-term many individuals do better without taking antipsychotics.<ref>Harrow M, Jobe TH. (2007) Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: a 15-year multifollow-up study. ''J Nerv Ment Dis.'' May;195(5):406-14. PMID 17502806</ref><br />
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==References==<br />
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{{WS}}</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Schizophrenia_other_diagnostic_studies&diff=1490767Schizophrenia other diagnostic studies2018-08-15T17:14:54Z<p>Irfan Dotani: </p>
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<div>__NOTOC__<br />
{{Schizophrenia}}<br />
{{CMG}};{{AE}}{{Vbe}} {{I.D.}}<br />
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==Overview==<br />
Two commonly ordered investigations are [[Electroencephalography|EEG]] to exclude [[epilepsy]], and a [[Computed tomography|CT scan]] of the head to exclude [[brain]] [[lesions]].<br />
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==Other Diagnostic Studies==<br />
*Two commonly ordered investigations are:<ref name="pmid11198061">{{cite journal| author=Taylor DM, Duncan-McConnell D| title=Refractory schizophrenia and atypical antipsychotics. | journal=J Psychopharmacol | year= 2000 | volume= 14 | issue= 4 | pages= 409-18 | pmid=11198061 | doi=10.1177/026988110001400411 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11198061 }} </ref><br />
**[[Electroencephalography|EEG]] to exclude [[epilepsy]]<br />
**[[Computed tomography|CT scan]] of the head to exclude [[brain]] lesions<br />
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==References==<br />
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[[Category:Needs content]]<br />
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{{WH}}<br />
{{WS}}</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Schizophrenia_other_diagnostic_studies&diff=1490766Schizophrenia other diagnostic studies2018-08-15T17:14:26Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Schizophrenia}}<br />
{{CMG}};{{AE}}{{Vbe}} {{I.D.}}<br />
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==Overview==<br />
Two commonly ordered investigations are [[Electroencephalography|EEG]] to exclude [[epilepsy]], and a [[Computed tomography|CT scan]] of the head to exclude [[brain]] [[lesions]].<br />
<br />
==Other Diagnostic Studies==<br />
*Two commonly ordered investigations are: <br />
**[[Electroencephalography|EEG]] to exclude [[epilepsy]]<br />
**[[Computed tomography|CT scan]] of the head to exclude [[brain]] lesions<br />
<br />
==References==<br />
{{Reflist|2}}<br />
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[[Category:Needs content]]<br />
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{{WH}}<br />
{{WS}}</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Schizophrenia_laboratory_findings&diff=1490765Schizophrenia laboratory findings2018-08-15T17:12:38Z<p>Irfan Dotani: </p>
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<div>__NOTOC__<br />
{{Schizophrenia}}<br />
{{CMG}};{{AE}}{{Vbe}} {{I.D.}}<br />
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==Overview==<br />
<br />
An initial assessment includes a comprehensive [[History and Physical examination|history]] and [[Physical culture|physical]] [[examination]] by a [[physician]]. Although there are no [[biological]] tests which confirm [[schizophrenia]], tests are carried out to exclude [[medical]] illnesses which may rarely present with [[psychotic]] [[schizophrenia]]-like [[symptoms]]. These include [[blood]] tests measuring [[Thyroid-stimulating hormone|TSH]] to exclude [[hypothyroidism|hypo-]] or [[hyperthyroidism]], [[Blood tests#Blood chemistry tests|basic electrolytes]] and serum [[calcium]] to rule out a [[metabolic]] disturbance, [[Complete blood count|full blood count]] including [[Erythrocyte sedimentation rate|ESR]] to rule out a systemic [[infection]] or [[Chronic (medical)|chronic]] [[disease]], and [[serology]] to exclude [[syphilis]] or [[HIV]] infection. Drugs of [[abuse]] should also be tested for with a urine [[drug]] [[Screening (medicine)|screen]], and further [[Diagnostic criteria|diagnostic]] workup is detailed [[Schizophrenia diagnostic studies|here]].<ref name="pmid20464730">{{cite journal| author=Gorczynski P, Faulkner G| title=Exercise therapy for schizophrenia. | journal=Cochrane Database Syst Rev | year= 2010 | volume= | issue= 5 | pages= CD004412 | pmid=20464730 | doi=10.1002/14651858.CD004412.pub2 | pmc=4164954 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20464730 }} </ref><br />
<br />
<br />
==Laboratory Findings==<br />
*An [[Initial-stress-derived noun|initial]] assessment includes a comprehensive [[History and Physical examination|history]] and [[Physical culture|physical]] [[Physical examination|examination]] by a physician.<ref name="pmid26289586">{{cite journal| author=Dougall N, Maayan N, Soares-Weiser K, McDermott LM, McIntosh A| title=Transcranial magnetic stimulation (TMS) for schizophrenia. | journal=Cochrane Database Syst Rev | year= 2015 | volume= | issue= 8 | pages= CD006081 | pmid=26289586 | doi=10.1002/14651858.CD006081.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26289586 }} </ref><br />
*Although there are no [[biological]] tests which confirm [[schizophrenia]], tests are carried out to exclude medical illnesses which may rarely present with psychotic schizophrenia-like symptoms.<ref name="pmid18291627">{{cite journal| author=Tandon R, Keshavan MS, Nasrallah HA| title=Schizophrenia, "Just the Facts": what we know in 2008 part 1: overview. | journal=Schizophr Res | year= 2008 | volume= 100 | issue= 1-3 | pages= 4-19 | pmid=18291627 | doi=10.1016/j.schres.2008.01.022 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18291627 }} </ref><br />
**These include blood tests measuring [[Thyroid-stimulating hormone|TSH]] to exclude [[hypothyroidism|hypo-]] or [[hyperthyroidism]], [[Blood tests#Blood chemistry tests|basic electrolytes]] and serum [[calcium]] to rule out a metabolic disturbance, [[Complete blood count|full blood count]] including [[Erythrocyte sedimentation rate|ESR]] to rule out a systemic infection or chronic disease, and [[serology]] to exclude [[syphilis]] or [[HIV]] infection.<br />
**[[Drugs]] of [[abuse]] should also be tested for with a urine drug screen, and further [[diagnostic]] workup is detailed [[Schzophrenia diagnostic studies|here]].<br />
<br />
*Investigations are not generally repeated for relapse unless there is a specific ''[[medical]]'' indication.<ref name="pmid22560607">{{cite journal| author=Leucht S, Tardy M, Komossa K, Heres S, Kissling W, Salanti G et al.| title=Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis. | journal=Lancet | year= 2012 | volume= 379 | issue= 9831 | pages= 2063-71 | pmid=22560607 | doi=10.1016/S0140-6736(12)60239-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22560607 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=22904562 Review in: Evid Based Ment Health. 2012 Nov;15(4):92] </ref><br />
*These may include [[serum]] [[blood]] [[sugar]] level if [[olanzapine]] has previously been prescribed, [[liver]] function tests if [[chlorpromazine]] or [[CPK]] to exclude [[neuroleptic malignant syndrome]]. <br />
*Assessment and [[Treatment-resistant depression|treatment]] are usually done on an [[outpatient]] basis; admission to an [[inpatient]] facility is considered if there is a [[Risk-benefit analysis|risk]] to self or others.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
[[Category:Disease]]<br />
[[Category:Psychiatry]]<br />
[[Category:Mature chapter]]<br />
[[Category:Primary care]]<br />
[[Category:Needs overview]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Schizophrenia_history_and_symptoms&diff=1490762Schizophrenia history and symptoms2018-08-15T17:04:17Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Schizophrenia}}<br />
{{CMG}};{{Vbe}} {{I.D.}}<br />
<br />
==History and Symptoms==<br />
*A person experiencing schizophrenia may demonstrate symptoms such as [[Thought disorder|disorganized thinking]], auditory [[hallucination]]s, and [[delusion]]s. <br />
*In severe cases, the person may be largely mute, remain motionless in bizarre postures, or exhibit purposeless agitation; these are [[medical sign|sign]]s of [[catatonia]]. <br />
*The current classification of psychoses holds that symptoms need to have been present for at least one month in a period of at least six months of disturbed functioning. <br />
*A schizophrenia-like psychosis of shorter duration is termed a [[schizophreniform disorder]].<ref name="DSM-IV-TR">American Psychiatric Association (2004) Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Text Revision). American Psychiatric Association. ISBN 0890420246. [http://www.behavenet.com/capsules/disorders/schiz.htm DSM-IV & DSM-IV-TR Schizophrenia criteria]</ref> <br />
*No one sign is diagnostic of schizophrenia, and all can occur in other medical and psychiatric conditions.<ref name="DSM-IV-TR" /><br />
<br />
*Social isolation commonly occurs and may be due to a number of factors. <br />
*Impairment in [[social cognition]] is associated with schizophrenia, as are the active symptoms of paranoia from delusions and hallucinations, and the negative symptoms of apathy and [[avolition]]. <br />
*Many people diagnosed with schizophrenia avoid potentially stressful social situations that may exacerbate mental distress.<ref name="Freeman_BRT_2007">Freeman D, Garety PA, Kuipers E, Fowler D, Bebbington PE, Dunn G. (2007) Acting on persecutory delusions: the importance of safety seeking. ''Behaviour Research and Therapy'', 45 (1), 89–99. PMID 16530161</ref><br />
<br />
*Late adolescence and early adulthood are peak years for the onset of schizophrenia. <br />
**These are critical periods in a young adult's social and vocational development, and they can be severely disrupted by disease onset. <br />
*To minimize the impact of schizophrenia, much work has recently been done to identify and treat the [[prodrome|prodromal (pre-onset)]] phase of the illness, which has been detected up to 30 months before the onset of symptoms, but may be present longer.<ref name="Addington_et_al_2007">Addington J, Cadenhead KS, Cannon TD, Cornblatt B, McGlashan TH, Perkins DO, Seidman LJ, Tsuang M, Walker EF, Woods SW, Heinssen R. (2007) North American prodrome longitudinal study: a collaborative multisite approach to prodromal schizophrenia research. ''Schizophrenia Bulletin'', 33 (3), 665-72. PMID 17255119</ref> <br />
*Those who go on to develop schizophrenia may experience the non-specific symptoms of social withdrawal, irritability and [[dysphoria]] in the prodromal period, and transient or self-limiting psychotic symptoms in the prodromal phase before psychosis becomes apparent.<ref name="ParnasJorgensen1989">Parnas J, Jorgensen A. (1989) Pre-morbid psychopathology in schizophrenia spectrum. ''British Journal of Psychiatry'', 155, 623–7.</ref><ref name="Amminger_et_al_2006">Amminger GP, Leicester S, Yung AR, Phillips LJ, Berger GE, Francey SM, Yuen HP, McGorry PD. (2006) Early-onset of symptoms predicts conversion to non-affective psychosis in ultra-high risk individuals. ''Schizophrenia Research'', 84 (1), 67–76. PMID 16677803</ref><br />
<br />
===Positive and Negative Symptoms===<br />
*Schizophrenia is often described in terms of ''positive'' (or productive) and ''negative'' (or deficit) symptoms.<ref name="Sims_2002">Sims A (2002) Symptoms in the Mind: An Introduction to Descriptive Psychopathology (3rd edition). Edinburgh: Elsevier Science Ltd. ISBN 0-7020-2627-1</ref> <br />
**Positive symptoms include [[delusion]]s, [[hallucination|auditory hallucinations]], and [[thought disorder]], and are typically regarded as manifestations of [[psychosis]]. <br />
**Negative symptoms are so-named because they are considered to be the loss or absence of normal traits or abilities, and include features such as flat or [[blunted affect]] and [[emotion]], poverty of [[Speech communication|speech]] ([[alogia]]), [[anhedonia]], and lack of [[motivation]] ([[avolition]]). <br />
*Despite the appearance of blunted affect, recent studies indicate that there is often a normal or even heightened level of emotionality in Schizophrenia especially in response to stressful or negative events.<ref>Cohen & Docherty (2004). Affective reactivity of speech and emotional experience in patients with schizophrenia. ''Schizophr Res'', 1;69(1):7–14. PMID 15145465 </ref> <br />
*A third symptom grouping, the ''disorganization syndrome'', is commonly described, and includes chaotic speech, thought, and behaviour. <br />
*There is evidence for a number of other symptom classifications.<ref name="Peralta_Cuesta_2001">Peralta V, Cuesta MJ. (2001) How many and which are the psychopathological dimensions in schizophrenia? Issues influencing their ascertainment. ''Schizophrenia Research'', 30, 49(3), 269-85. PMID 11356588</ref><br />
<br />
==References==<br />
<br />
{{Reflist|2}}<br />
<br />
[[Category:Disease]]<br />
[[Category:Psychiatry]]<br />
[[Category:Mature chapter]]<br />
[[Category:Primary care]]<br />
[[Category:Needs overview]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Schizophrenia_history_and_symptoms&diff=1490733Schizophrenia history and symptoms2018-08-15T16:06:56Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Schizophrenia}}<br />
{{CMG}};{{Vbe}} {{I.D.}}<br />
<br />
==History and Symptoms==<br />
A person experiencing schizophrenia may demonstrate symptoms such as [[Thought disorder|disorganized thinking]], auditory [[hallucination]]s, and [[delusion]]s. In severe cases, the person may be largely mute, remain motionless in bizarre postures, or exhibit purposeless agitation; these are [[medical sign|sign]]s of [[catatonia]]. The current classification of psychoses holds that symptoms need to have been present for at least one month in a period of at least six months of disturbed functioning. A schizophrenia-like psychosis of shorter duration is termed a [[schizophreniform disorder]].<ref name="DSM-IV-TR">American Psychiatric Association (2004) Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Text Revision). American Psychiatric Association. ISBN 0890420246. [http://www.behavenet.com/capsules/disorders/schiz.htm DSM-IV & DSM-IV-TR Schizophrenia criteria]</ref> No one sign is diagnostic of schizophrenia, and all can occur in other medical and psychiatric conditions.<ref name="DSM-IV-TR" /><br />
<br />
Social isolation commonly occurs and may be due to a number of factors. Impairment in [[social cognition]] is associated with schizophrenia, as are the active symptoms of paranoia from delusions and hallucinations, and the negative symptoms of apathy and [[avolition]]. Many people diagnosed with schizophrenia avoid potentially stressful social situations that may exacerbate mental distress.<ref name="Freeman_BRT_2007">Freeman D, Garety PA, Kuipers E, Fowler D, Bebbington PE, Dunn G. (2007) Acting on persecutory delusions: the importance of safety seeking. ''Behaviour Research and Therapy'', 45 (1), 89–99. PMID 16530161</ref><br />
<br />
Late adolescence and early adulthood are peak years for the onset of schizophrenia. These are critical periods in a young adult's social and vocational development, and they can be severely disrupted by disease onset. To minimize the impact of schizophrenia, much work has recently been done to identify and treat the [[prodrome|prodromal (pre-onset)]] phase of the illness, which has been detected up to 30 months before the onset of symptoms, but may be present longer.<ref name="Addington_et_al_2007">Addington J, Cadenhead KS, Cannon TD, Cornblatt B, McGlashan TH, Perkins DO, Seidman LJ, Tsuang M, Walker EF, Woods SW, Heinssen R. (2007) North American prodrome longitudinal study: a collaborative multisite approach to prodromal schizophrenia research. ''Schizophrenia Bulletin'', 33 (3), 665-72. PMID 17255119</ref> Those who go on to develop schizophrenia may experience the non-specific symptoms of social withdrawal, irritability and [[dysphoria]] in the prodromal period,<ref name="ParnasJorgensen1989">Parnas J, Jorgensen A. (1989) Pre-morbid psychopathology in schizophrenia spectrum. ''British Journal of Psychiatry'', 155, 623–7.</ref> and transient or self-limiting psychotic symptoms in the prodromal phase before psychosis becomes apparent.<ref name="Amminger_et_al_2006">Amminger GP, Leicester S, Yung AR, Phillips LJ, Berger GE, Francey SM, Yuen HP, McGorry PD. (2006) Early-onset of symptoms predicts conversion to non-affective psychosis in ultra-high risk individuals. ''Schizophrenia Research'', 84 (1), 67–76. PMID 16677803</ref><br />
<br />
===Positive and Negative Symptoms===<br />
Schizophrenia is often described in terms of ''positive'' (or productive) and ''negative'' (or deficit) symptoms.<ref name="Sims_2002">Sims A (2002) Symptoms in the Mind: An Introduction to Descriptive Psychopathology (3rd edition). Edinburgh: Elsevier Science Ltd. ISBN 0-7020-2627-1</ref> Positive symptoms include [[delusion]]s, [[hallucination|auditory hallucinations]], and [[thought disorder]], and are typically regarded as manifestations of [[psychosis]]. Negative symptoms are so-named because they are considered to be the loss or absence of normal traits or abilities, and include features such as flat or [[blunted affect]] and [[emotion]], poverty of [[Speech communication|speech]] ([[alogia]]), [[anhedonia]], and lack of [[motivation]] ([[avolition]]). Despite the appearance of blunted affect, recent studies indicate that there is often a normal or even heightened level of emotionality in Schizophrenia especially in response to stressful or negative events.<ref>Cohen & Docherty (2004). Affective reactivity of speech and emotional experience in patients with schizophrenia. ''Schizophr Res'', 1;69(1):7–14. PMID 15145465 </ref> A third symptom grouping, the ''disorganization syndrome'', is commonly described, and includes chaotic speech, thought, and behaviour. There is evidence for a number of other symptom classifications.<ref name="Peralta_Cuesta_2001">Peralta V, Cuesta MJ. (2001) How many and which are the psychopathological dimensions in schizophrenia? Issues influencing their ascertainment. ''Schizophrenia Research'', 30, 49(3), 269-85. PMID 11356588</ref><br />
<br />
==References==<br />
<br />
{{Reflist|2}}<br />
<br />
[[Category:Disease]]<br />
[[Category:Psychiatry]]<br />
[[Category:Mature chapter]]<br />
[[Category:Primary care]]<br />
[[Category:Needs overview]]<br />
<br />
{{WH}}<br />
{{WS}}</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Schizophrenia_diagnostic_criteria&diff=1490732Schizophrenia diagnostic criteria2018-08-15T16:05:54Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Schizophrenia}}<br />
{{CMG}}; {{AE}} {{JH}}{{Vbe}} {{I.D.}}<br />
<br />
==Diagnostic Criteria==<br />
===DSM-V Diagnostic Criteria for Schizophrenia===<br />
{{cquote|<br />
* A. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref><br />
<br />
# [[Delusion]]s<br />
# [[Hallucination]]s<br />
# [[Disorganized speech]] (e.g., frequent derailment or incoherence)<br />
# Grossly disorganized or catatonic behavior<br />
# Negative symptoms (i.e., [[diminished emotional expression]] or [[avolition]])<br />
<br />
'''''AND''''' <br />
<br />
* B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).<br />
<br />
'''''AND''''' <br />
<br />
* C. Continuous signs of the 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 the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).<br />
<br />
'''''AND''''' <br />
<br />
* D. [[Schizoaffective disorder]] and depressive or [[bipolar disorder]] with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.<br />
<br />
'''''AND''''' <br />
<br />
* E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.<br />
<br />
'''''AND''''' <br />
<br />
* F. If there is a history of [[autism spectrum disorder]] or a [[communication disorder]] of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated).<br />
<br />
''Specify if:''<br />
<br />
The following course specifiers are only to be used after a 1-year duration of the disorder and if they are not in contradiction to the diagnostic course criteria.<br />
<br />
'''First episode, currently in acute episode:''' First manifestation of the disorder meeting the defining diagnostic symptom and time criteria. An acute episode is a time period in which the symptom criteria are fulfilled.<br />
<br />
'''First episode, currently in partial remission:''' Partial remission is a period of time during which an improvement after a previous episode is maintained and in which the defining criteria of the disorder are only partially fulfilled.<br />
<br />
'''First episode, currently in full remission:''' Full remission is a period of time after a previous episode during which no disorder-specific symptoms are present.<br />
<br />
'''Multiple episodes, currently in acute episode:''' Multiple episodes may be determined after a minimum of two episodes (i.e., after a first episode, a remission and a minimum of one relapse).<br />
<br />
'''Multiple episodes, currently in partial remission'''<br />
<br />
'''Multiple episodes, currently in full remission''' Continuous: Symptoms fulfilling the diagnostic symptom criteria of the disorder are remaining for the majority of the illness course, with subthreshold symptom periods being very brief relative to the overall course.<br />
<br />
'''Unspecified'''<br />
<br />
''Specify if:''<br />
<br />
'''With catatonia'''<br />
<br />
<br />
''Specify current severity:''<br />
<br />
Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe).<br />
Note: Diagnosis of schizophrenia can be made without using this severity specifier.<br />
<br />
}}<br />
<br />
<SMALL>''Note: Diagnosis of schizophrenia can be made without using this severity specifier.''</SMALL><br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
[[Category:DSM-V Diagnostic Criteria]]<br />
[[Category:Psychiatric Disease]]<br />
[[Category:Psychiatry]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_future_or_investigational_therapies&diff=1490731Toxic epidermal necrolysis future or investigational therapies2018-08-15T16:04:55Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
{{CMG}}; {{AE}}<br />
<br />
==Overview==<br />
<br />
==Future or Investigational Therapies==<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
<br />
[[Category: (name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_cost-effectiveness_of_therapy&diff=1490730Toxic epidermal necrolysis cost-effectiveness of therapy2018-08-15T16:04:43Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
{{CMG}}; {{AE}} <br />
<br />
==Overview==<br />
<br />
<br />
==Cost-effectiveness of Therapy==<br />
<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
<br />
[[Category: (name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_secondary_prevention&diff=1490729Toxic epidermal necrolysis secondary prevention2018-08-15T16:04:32Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
{{CMG}}; {{AE}} <br />
<br />
==Overview==<br />
There are no established measures for the secondary prevention of [disease name].<br />
<br />
OR<br />
<br />
Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].<br />
<br />
==Secondary Prevention==<br />
There are no established measures for the secondary prevention of [disease name].<br />
<br />
OR<br />
<br />
Effective measures for the secondary prevention of [disease name] include:<br />
*[Strategy 1]<br />
*[Strategy 2]<br />
*[Strategy 3]<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_primary_prevention&diff=1490728Toxic epidermal necrolysis primary prevention2018-08-15T16:04:21Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
{{CMG}}; {{AE}} <br />
<br />
==Overview==<br />
There are no established measures for the primary prevention of [disease name].<br />
<br />
OR<br />
<br />
There are no available vaccines against [disease name].<br />
<br />
OR<br />
<br />
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].<br />
<br />
OR<br />
<br />
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].<br />
<br />
==Primary Prevention==<br />
There are no established measures for the primary prevention of [disease name].<br />
<br />
OR<br />
<br />
There are no available vaccines against [disease name].<br />
<br />
OR<br />
<br />
Effective measures for the primary prevention of [disease name] include:<br />
*[Measure1]<br />
*[Measure2]<br />
*[Measure3]<br />
<br />
OR<br />
<br />
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include:<br />
*[Strategy 1]<br />
*[Strategy 2]<br />
*[Strategy 3]<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_surgery&diff=1490727Toxic epidermal necrolysis surgery2018-08-15T16:04:08Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
{{CMG}}; {{AE}} <br />
<br />
==Overview==<br />
Surgical intervention is not recommended for the management of [disease name].<br />
<br />
OR<br />
<br />
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]<br />
<br />
OR<br />
<br />
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].<br />
<br />
OR<br />
<br />
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.<br />
<br />
OR<br />
<br />
Surgery is the mainstay of treatment for [disease or malignancy].<br />
<br />
==Indications==<br />
<br />
*Surgical intervention is not recommended for the management of [disease name].<br />
OR<br />
*Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either:<br />
**[Indication 1] <br />
**[Indication 2]<br />
**[Indication 3]<br />
*The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either:<br />
**[Indication 1] <br />
**[Indication 2] <br />
**[Indication 3]<br />
<br />
==Surgery==<br />
<br />
*The feasibility of surgery depends on the stage of [malignancy] at diagnosis.<br />
OR<br />
*Surgery is the mainstay of treatment for [disease or malignancy].<br />
<br />
==Contraindications==<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_medical_therapy&diff=1490726Toxic epidermal necrolysis medical therapy2018-08-15T16:04:00Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
{{CMG}}; {{AE}}<br />
<br />
==Overview==<br />
There is no treatment for [disease name]; the mainstay of therapy is supportive care.<br />
<br />
OR<br />
<br />
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].<br />
<br />
OR<br />
<br />
The majority of cases of [disease name] are self-limited and require only supportive care.<br />
<br />
OR<br />
<br />
[Disease name] is a medical emergency and requires prompt treatment.<br />
<br />
OR<br />
<br />
The mainstay of treatment for [disease name] is [therapy].<br />
<br />
OR<br />
<br />
The optimal therapy for [malignancy name] depends on the stage at diagnosis.<br />
<br />
OR<br />
<br />
[Therapy] is recommended among all patients who develop [disease name].<br />
<br />
OR<br />
<br />
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].<br />
<br />
OR<br />
<br />
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].<br />
<br />
OR<br />
<br />
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].<br />
<br />
OR<br />
<br />
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].<br />
<br />
==Medical Therapy==<br />
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3]. <br />
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].<br />
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].<br />
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].<br />
===Disease Name===<br />
<br />
* '''1 Stage 1 - Name of stage'''<br />
** 1.1 '''Specific Organ system involved 1'''<br />
*** 1.1.1 '''Adult'''<br />
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' <br />
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days<br />
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days<br />
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days <br />
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days<br />
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days<br />
*** 1.1.2 '''Pediatric'''<br />
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')<br />
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) <br />
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)<br />
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)<br />
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)<br />
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)<br />
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')<br />
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h(maximum, 100 mg per dose)<br />
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)<br />
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) <br />
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)<br />
** 1.2 '''Specific Organ system involved 2'''<br />
*** 1.2.1 '''Adult'''<br />
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h <br />
*** 1.2.2 '''Pediatric'''<br />
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)<br />
<br />
* 2 '''Stage 2 - Name of stage'''<br />
** 2.1 '''Specific Organ system involved 1 '''<br />
**: '''Note (1):''' <br />
**: '''Note (2)''': <br />
**: '''Note (3):''' <br />
*** 2.1.1 '''Adult'''<br />
**** Parenteral regimen<br />
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days<br />
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days<br />
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days<br />
**** Oral regimen<br />
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days <br />
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days <br />
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days<br />
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days <br />
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days <br />
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days<br />
*** 2.1.2 '''Pediatric'''<br />
**** Parenteral regimen<br />
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)<br />
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)<br />
***** Alternative regimen (2): [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''<br />
**** Oral regimen<br />
***** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)<br />
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)<br />
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)<br />
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)<br />
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)<br />
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)<br />
** 2.2 '<nowiki/>'''''Other Organ system involved 2''''''<br />
**: '''Note (1):''' <br />
**: '''Note (2)''': <br />
**: '''Note (3):''' <br />
*** 2.2.1 '''Adult'''<br />
**** Parenteral regimen<br />
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days<br />
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days<br />
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days <br />
**** Oral regimen<br />
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days <br />
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days <br />
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days<br />
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days <br />
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days <br />
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days<br />
*** 2.2.2 '''Pediatric'''<br />
**** Parenteral regimen<br />
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)<br />
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)<br />
***** Alternative regimen (2): [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) <br />
**** Oral regimen<br />
***** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)<br />
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)<br />
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)<br />
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)<br />
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)<br />
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_other_diagnostic_studies&diff=1490725Toxic epidermal necrolysis other diagnostic studies2018-08-15T16:03:47Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
{{CMG}}; {{AE}} <br />
<br />
==Overview==<br />
There are no other diagnostic studies associated with [disease name].<br />
<br />
OR<br />
<br />
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
OR<br />
<br />
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].<br />
<br />
==Other Diagnostic Studies==<br />
<br />
There are no other diagnostic studies associated with [disease name].<br />
<br />
OR<br />
<br />
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include:<br />
*[Finding 1]<br />
*[Finding 2]<br />
*[Finding 3]<br />
<br />
OR<br />
<br />
Other diagnostic studies for [disease name] include:<br />
*[Diagnostic study 1], which demonstrates:<br />
**[Finding 1]<br />
**[Finding 2]<br />
**[Finding 3]<br />
*[Diagnostic study 2], which demonstrates: <br />
**[Finding 1]<br />
**[Finding 2]<br />
**[Finding 3]<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_other_imaging_findings&diff=1490724Toxic epidermal necrolysis other imaging findings2018-08-15T16:03:37Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
<br />
{{CMG}}; {{AE}} <br />
<br />
==Overview==<br />
There are no other imaging findings associated with [disease name].<br />
<br />
OR<br />
<br />
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
==Other Imaging Findings==<br />
There are no other imaging findings associated with [disease name].<br />
<br />
OR<br />
<br />
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include:<br />
*[Finding 1]<br />
*[Finding 2]<br />
*[Finding 3]<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (Name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_mri&diff=1490723Toxic epidermal necrolysis mri2018-08-15T16:03:26Z<p>Irfan Dotani: Created page with "__NOTOC__ {{Toxic epidermal necrolysis}} {{CMG}}; {{AE}} ==Overview== There are no MRI findings associated with [disease name]. OR [Location] MRI may be helpful in the d..."</p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
<br />
{{CMG}}; {{AE}} <br />
<br />
==Overview==<br />
<br />
There are no MRI findings associated with [disease name].<br />
<br />
OR<br />
<br />
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
OR<br />
<br />
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
<br />
==MRI==<br />
<br />
There are no MRI findings associated with [disease name].<br />
<br />
OR<br />
<br />
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include:<br />
*[Finding 1]<br />
*[Finding 2]<br />
*[Finding 3]<br />
<br />
OR<br />
<br />
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include:<br />
*[Complication 1]<br />
*[Complication 2]<br />
*[Complication 3]<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (Name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_ct_scan&diff=1490722Toxic epidermal necrolysis ct scan2018-08-15T16:03:14Z<p>Irfan Dotani: Created page with "__NOTOC__ {{Toxic epidermal necrolysis}} {{CMG}}; {{AE}} ==Overview== There are no CT scan findings associated with [disease name]. OR [Location] CT scan may be helpful in..."</p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
{{CMG}}; {{AE}}<br />
<br />
==Overview==<br />
<br />
There are no CT scan findings associated with [disease name].<br />
<br />
OR<br />
<br />
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
OR<br />
<br />
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
<br />
==CT scan==<br />
<br />
There are no CT scan findings associated with [disease name].<br />
<br />
OR<br />
<br />
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include:<br />
*[Finding 1]<br />
*[Finding 2]<br />
*[Finding 3]<br />
<br />
OR<br />
<br />
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include:<br />
*[Complication 1]<br />
*[Complication 2]<br />
*[Complication 3]<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (Name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_echocardiography_and_ultrasound&diff=1490720Toxic epidermal necrolysis echocardiography and ultrasound2018-08-15T16:03:01Z<p>Irfan Dotani: Created page with "__NOTOC__ {{Toxic epidermal necrolysis}} {{CMG}}; {{AE}} ==Overview== There are no echocardiography/ultrasound findings associated with [disease name]. OR Echocardiograp..."</p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
<br />
{{CMG}}; {{AE}} <br />
<br />
==Overview==<br />
<br />
There are no echocardiography/ultrasound findings associated with [disease name].<br />
<br />
OR<br />
<br />
Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
OR<br />
<br />
There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
<br />
==Echocardiography/Ultrasound==<br />
<br />
There are no echocardiography/ultrasound findings associated with [disease name].<br />
<br />
OR<br />
<br />
Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include:<br />
*[Finding 1]<br />
*[Finding 2]<br />
*[Finding 3]<br />
<br />
OR<br />
<br />
There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include:<br />
*[Complication 1]<br />
*[Complication 2]<br />
*[Complication 3]<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (Name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_x_ray&diff=1490719Toxic epidermal necrolysis x ray2018-08-15T16:02:48Z<p>Irfan Dotani: Created page with "__NOTOC__ {{Toxic epidermal necrolysis}} {{CMG}}; {{AE}} ==Overview== There are no x-ray findings associated with [disease name]. OR An x-ray may be helpful in the diagno..."</p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
<br />
There are no x-ray findings associated with [disease name].<br />
<br />
OR<br />
<br />
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
OR<br />
<br />
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].<br />
<br />
==X Ray==<br />
<br />
There are no x-ray findings associated with [disease name].<br />
<br />
OR<br />
<br />
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include:<br />
*[Finding 1]<br />
*[Finding 2]<br />
*[Finding 3]<br />
<br />
OR<br />
<br />
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include:<br />
*[Complication 1]<br />
*[Complication 2]<br />
*[Complication 3]<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_electrocardiogram&diff=1490718Toxic epidermal necrolysis electrocardiogram2018-08-15T16:02:33Z<p>Irfan Dotani: Created page with "__NOTOC__ {{Toxic epidermal necrolysis}} {{CMG}}; {{AE}} ==Overview== There are no ECG findings associated with [disease name]. OR An ECG may be helpful in the diagnosis o..."</p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
{{CMG}}; {{AE}} <br />
<br />
==Overview==<br />
There are no ECG findings associated with [disease name].<br />
<br />
OR<br />
<br />
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
==Electrocardiogram==<br />
<br />
There are no ECG findings associated with [disease name].<br />
<br />
OR<br />
<br />
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include <br />
*[Finding 1]<br />
*[Finding 2]<br />
*[Finding 3]<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_laboratory_findings&diff=1490717Toxic epidermal necrolysis laboratory findings2018-08-15T16:02:22Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
<br />
{{CMG}}; {{AE}} <br />
<br />
==Overview==<br />
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].<br />
<br />
OR<br />
<br />
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].<br />
<br />
OR<br />
<br />
[Test] is usually normal for patients with [disease name].<br />
<br />
OR<br />
<br />
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].<br />
<br />
OR<br />
<br />
There are no diagnostic laboratory findings associated with [disease name].<br />
<br />
==Laboratory Findings==<br />
<br />
There are no diagnostic laboratory findings associated with [disease name].<br />
<br />
OR<br />
<br />
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].<br />
<br />
OR<br />
<br />
[Test] is usually normal among patients with [disease name].<br />
<br />
OR<br />
<br />
Laboratory findings consistent with the diagnosis of [disease name] include:<br />
*[Abnormal test 1]<br />
*[Abnormal test 2]<br />
*[Abnormal test 3]<br />
<br />
OR<br />
<br />
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_physical_examination&diff=1490716Toxic epidermal necrolysis physical examination2018-08-15T16:02:06Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
<br />
{{CMG}}; {{AE}}<br />
<br />
==Overview==<br />
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].<br />
<br />
OR<br />
<br />
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].<br />
<br />
OR<br />
<br />
The presence of [finding(s)] on physical examination is diagnostic of [disease name].<br />
<br />
OR<br />
<br />
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].<br />
<br />
==Physical Examination==<br />
Physical examination of patients with [disease name] is usually normal.<br />
<br />
OR<br />
<br />
Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].<br />
<br />
OR<br />
<br />
The presence of [finding(s)] on physical examination is diagnostic of [disease name].<br />
<br />
OR<br />
<br />
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].<br />
<br />
===Appearance of the Patient===<br />
*Patients with [disease name] usually appear [general appearance]. <br />
<br />
===Vital Signs===<br />
<br />
*High-grade / low-grade fever<br />
*[[Hypothermia]] / hyperthermia may be present<br />
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse<br />
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse<br />
*Tachypnea / bradypnea<br />
*Kussmal respirations may be present in _____ (advanced disease state)<br />
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse<br />
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]<br />
<br />
===Skin===<br />
* Skin examination of patients with [disease name] is usually normal.<br />
OR<br />
*[[Cyanosis]] <br />
*[[Jaundice]]<br />
* [[Pallor]]<br />
* Bruises<br />
<br />
<gallery widths="150px"><br />
<br />
UploadedImage-01.jpg | Description {{dermref}}<br />
UploadedImage-02.jpg | Description {{dermref}}<br />
<br />
</gallery><br />
<br />
===HEENT===<br />
* HEENT examination of patients with [disease name] is usually normal.<br />
OR<br />
* Abnormalities of the head/hair may include ___<br />
* Evidence of trauma<br />
* Icteric sclera <br />
* [[Nystagmus]] <br />
* Extra-ocular movements may be abnormal<br />
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation<br />
*Ophthalmoscopic exam may be abnormal with findings of ___<br />
* Hearing acuity may be reduced<br />
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)<br />
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)<br />
* [[Exudate]] from the ear canal<br />
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)<br />
*Inflamed nares / congested nares<br />
* [[Purulent]] exudate from the nares<br />
* Facial tenderness<br />
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae<br />
<br />
===Neck===<br />
* Neck examination of patients with [disease name] is usually normal.<br />
OR<br />
*[[Jugular venous distension]]<br />
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope<br />
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)<br />
*[[Thyromegaly]] / thyroid nodules<br />
*[[Hepatojugular reflux]]<br />
<br />
===Lungs===<br />
* Pulmonary examination of patients with [disease name] is usually normal.<br />
OR<br />
* Asymmetric chest expansion OR decreased chest expansion<br />
*Lungs are hyporesonant OR hyperresonant<br />
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally<br />
*Rhonchi<br />
*Vesicular breath sounds OR distant breath sounds<br />
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase<br />
*[[Wheezing]] may be present<br />
*[[Egophony]] present/absent<br />
*[[Bronchophony]] present/absent<br />
*Normal/reduced [[tactile fremitus]]<br />
<br />
===Heart===<br />
* Cardiovascular examination of patients with [disease name] is usually normal.<br />
OR<br />
*Chest tenderness upon palpation<br />
*PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____<br />
*[[Heave]] / [[thrill]]<br />
*[[Friction rub]]<br />
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]<br />
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]<br />
*[[Heart sounds#Third heart sound S3|S3]]<br />
*[[Heart sounds#Fourth heart sound S4|S4]]<br />
*[[Heart sounds#Summation Gallop|Gallops]]<br />
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope<br />
<br />
===Abdomen===<br />
* Abdominal examination of patients with [disease name] is usually normal.<br />
OR<br />
*[[Abdominal distention]] <br />
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant <br />
*[[Rebound tenderness]] (positive Blumberg sign)<br />
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant<br />
*Guarding may be present<br />
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]<br />
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test<br />
<br />
===Back===<br />
* Back examination of patients with [disease name] is usually normal.<br />
OR<br />
*Point tenderness over __ vertebrae (e.g. L3-L4)<br />
*Sacral edema<br />
*Costovertebral angle tenderness bilaterally/unilaterally<br />
*Buffalo hump<br />
<br />
===Genitourinary===<br />
* Genitourinary examination of patients with [disease name] is usually normal.<br />
OR<br />
*A pelvic/adnexal mass may be palpated<br />
*Inflamed mucosa<br />
*Clear/(color), foul-smelling/odorless penile/vaginal discharge<br />
<br />
===Neuromuscular===<br />
* Neuromuscular examination of patients with [disease name] is usually normal.<br />
OR<br />
*Patient is usually oriented to persons, place, and time<br />
* Altered mental status<br />
* Glasgow coma scale is ___ / 15<br />
* Clonus may be present<br />
* Hyperreflexia / hyporeflexia / areflexia<br />
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally<br />
* Muscle rigidity<br />
* Proximal/distal muscle weakness unilaterally/bilaterally<br />
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)<br />
*Unilateral/bilateral upper/lower extremity weakness<br />
*Unilateral/bilateral sensory loss in the upper/lower extremity<br />
*Positive straight leg raise test<br />
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)<br />
*Positive/negative Trendelenburg sign<br />
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)<br />
*Normal finger-to-nose test / Dysmetria<br />
*Absent/present dysdiadochokinesia (palm tapping test)<br />
<br />
===Extremities===<br />
* Extremities examination of patients with [disease name] is usually normal.<br />
OR<br />
*[[Clubbing]] <br />
*[[Cyanosis]] <br />
*Pitting/non-pitting [[edema]] of the upper/lower extremities<br />
*Muscle atrophy<br />
*Fasciculations in the upper/lower extremity<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_history_and_symptoms&diff=1490715Toxic epidermal necrolysis history and symptoms2018-08-15T16:01:43Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
The majority of patients with [disease name] are asymptomatic.<br />
<br />
OR<br />
<br />
The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].<br />
<br />
==History and Symptoms==<br />
TEN affects many parts of the body, but it most severely affects the [[mucous membrane]]s, such as the [[mouth]], [[eyes]], and [[vagina]]. The severe findings of TEN are often preceded by 1 to 2 weeks of [[fever]]. These symptoms may mimic those of a common [[upper respiratory tract infection]]. When the [[rash]] appears it may be over large and varied parts of the body, and it is usually warm and appears red. In hours, the skin becomes painful and the epidermis can be easily peeled away from the underlying dermis. The mouth becomes blistered and eroded, making eating difficult and sometimes necessitating feeding through a [[nasogastric tube]] through the nose or a gastric tube directly into the stomach. The eyes are affected, becoming swollen, crusted, and ulcerated. Often, the diagnosis can be made clinically. Generally, if the clinical history is consistent with Stevens-Johnson syndrome, and the skin lesion covers greater than 30% of the body surface area, the diagnosis of TEN is appropriate. Sometimes, however, examination of affected tissue under the microscope may be needed to distinguish it between other entities such as [[staphylococcal scalded skin syndrome]].<br />
<br />
===History===<br />
Patients with [disease name]] may have a positive history of:<br />
*[History finding 1]<br />
*[History finding 2]<br />
*[History finding 3]<br />
<br />
===Common Symptoms===<br />
Common symptoms of [disease] include:<br />
*[Symptom 1]<br />
*[Symptom 2]<br />
*[Symptom 3]<br />
<br />
===Less Common Symptoms===<br />
Less common symptoms of [disease name] include <br />
*[Symptom 1]<br />
*[Symptom 2]<br />
*[Symptom 3]<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_diagnostic_study_of_choice&diff=1490714Toxic epidermal necrolysis diagnostic study of choice2018-08-15T16:01:04Z<p>Irfan Dotani: Created page with "__NOTOC__ {{Toxic epidermal necrolysis}} {{CMG}}; {{AE}} == Overview == == Diagnostic Study of Choice == === Study of choice === [Name of the investigation] is the gold stan..."</p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
{{CMG}}; {{AE}}<br />
== Overview ==<br />
<br />
== Diagnostic Study of Choice ==<br />
<br />
=== Study of choice ===<br />
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].<br />
<br />
OR<br />
<br />
The following result of [gold standard test] is confirmatory of [disease name]:<br />
* [Result 1]<br />
* [Result 2]<br />
<br />
OR<br />
<br />
[Name of the investigation] must be performed when:<br />
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].<br />
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.<br />
<br />
OR<br />
<br />
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].<br />
<br />
OR<br />
<br />
The diagnostic study of choice for [disease name] is [name of the investigation].<br />
<br />
OR<br />
<br />
There is no single diagnostic study of choice for the diagnosis of [disease name]. <br />
<br />
OR<br />
<br />
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].<br />
<br />
OR<br />
<br />
[Disease name] is primarily diagnosed based on the clinical presentation.<br />
<br />
OR<br />
<br />
Investigations:<br />
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.<br />
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.<br />
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.<br />
<br />
==== The comparison of various diagnostic studies for [disease name] ====<br />
{|<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity<br />
|-<br />
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%<br />
|-<br />
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%<br />
|}<br />
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small><br />
<br />
===== Diagnostic results =====<br />
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:<br />
* [Finding 1]<br />
* [Finding 2]<br />
<br />
===== Sequence of Diagnostic Studies =====<br />
The [name of investigation] must be performed when:<br />
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.<br />
* A positive [test] is detected in the patient, to confirm the diagnosis.<br />
<br />
OR<br />
<br />
The various investigations must be performed in the following order:<br />
* [Initial investigation]<br />
* [2nd investigation]<br />
<br />
=== Name of Diagnostic Criteria ===<br />
<br />
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''<br />
<br />
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].<br />
<br />
OR<br />
<br />
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].<br />
<br />
OR<br />
<br />
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].<br />
<br />
OR<br />
<br />
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].<br />
<br />
OR <br />
<br />
[Disease name] may be diagnosed at any time if one or more of the following criteria are met: <br />
* Criteria 1<br />
* Criteria 2<br />
* Criteria 3<br />
<br />
OR<br />
<br />
'''IF there are clear, established diagnostic criteria'''<br />
<br />
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].<br />
<br />
OR<br />
<br />
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].<br />
<br />
OR<br />
<br />
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].<br />
<br />
OR<br />
<br />
'''IF there are no established diagnostic criteria'''<br />
<br />
There are no established criteria for the diagnosis of [disease name].<br />
<br />
==References==<br />
{{Reflist|2}}<br />
{{WH}}<br />
{{WS}}</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_natural_history,_complications_and_prognosis&diff=1490713Toxic epidermal necrolysis natural history, complications and prognosis2018-08-15T16:00:34Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
The mortality for toxic epidermal necrolysis is 30-40%.<ref name=garra>Garra, GP (2007). "[http://www.emedicine.com/EMERG/topic599.htm Toxic Epidermal Necrolysis]". Emedicine.com. Retrieved on December 13, 2007.</ref> Loss of the skin leaves patients vulnerable to infections from fungi and bacteria, and can result in [[septicemia]], the leading cause of death in the disease.<ref name=garra/> Death is caused either by [[infection]] or by [[respiratory distress]] which is either due to [[pneumonia]] or damage to the linings of the airway. Microscopic analysis of tissue (especially the degree of dermal mononuclear inflammation and the degree of inflammation in general) can play a role in determining the prognosis of individual cases.<ref>{{cite journal |author=Quinn AM et al |title=Uncovering histological criteria with prognostic significance in toxic epidermal necrolysis |journal=Arch Dermatol |volume=141 |issue=6 |pages=683-7 |year=2005 |pmid=15967913}}</ref>.<br />
==Natural History, Complications, and Prognosis==<br />
<br />
===Natural History===<br />
*The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___. <br />
*The symptoms of (disease name) typically develop ___ years after exposure to ___. <br />
*If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].<br />
<br />
===Complications===<br />
*Common complications of [disease name] include:<br />
**[Complication 1]<br />
**[Complication 2]<br />
**[Complication 3]<br />
<br />
===Prognosis===<br />
*Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [--]%.<br />
*Depending on the extent of the [tumor/disease progression] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent.<br />
*The presence of [characteristic of disease] is associated with a particularly [good/poor] prognosis among patients with [disease/malignancy].<br />
*[Subtype of disease/malignancy] is associated with the most favorable prognosis.<br />
*The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis.<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_screening&diff=1490712Toxic epidermal necrolysis screening2018-08-15T15:59:36Z<p>Irfan Dotani: Created page with "__NOTOC__ {{Toxic epidermal necrolysis}} {{CMG}}; {{AE}} ==Overview== There is insufficient evidence to recommend routine screening for [disease/malignancy]. OR Accordin..."</p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
<br />
There is insufficient evidence to recommend routine screening for [disease/malignancy]. <br />
<br />
OR<br />
<br />
According to the [guideline name], screening for [disease name] is not recommended.<br />
<br />
OR<br />
<br />
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].<br />
==Screening==<br />
There is insufficient evidence to recommend routine screening for [disease/malignancy].<br />
<br />
OR<br />
<br />
According to the [guideline name], screening for [disease name] is not recommended.<br />
<br />
OR<br />
<br />
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with:<br />
*[Condition 1]<br />
*[Condition 2]<br />
*[Condition 3]<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_risk_factors&diff=1490711Toxic epidermal necrolysis risk factors2018-08-15T15:59:19Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
There are no established risk factors for [disease name].<br />
<br />
OR<br />
<br />
The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].<br />
<br />
OR<br />
<br />
Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].<br />
<br />
OR<br />
<br />
Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.<br />
<br />
==Risk Factors==<br />
There are no established risk factors for [disease name].<br />
<br />
OR<br />
<br />
The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].<br />
<br />
OR<br />
<br />
Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].<br />
===Common Risk Factors===<br />
*Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.<br />
*Common risk factors in the development of [disease name] include:<br />
**[Risk factor 1]<br />
**[Risk factor 2]<br />
**[Risk factor 3]<br />
<br />
===Less Common Risk Factors===<br />
*Less common risk factors in the development of [disease name] include:<br />
**[Risk factor 1]<br />
**[Risk factor 2]<br />
**[Risk factor 3]<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_epidemiology_and_demographics&diff=1490710Toxic epidermal necrolysis epidemiology and demographics2018-08-15T15:59:05Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
<br />
==Epidemiology and Demographics==<br />
===Incidence===<br />
*The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.<br />
*In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.<br />
<br />
===Prevalence===<br />
*The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.<br />
*In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.<br />
*The prevalence of [disease/malignancy] is estimated to be [number] cases annually.<br />
<br />
===Case-fatality rate/Mortality rate===<br />
*In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate/mortality rate of [number range]%.<br />
*The case-fatality rate/mortality rate of [disease name] is approximately [number range].<br />
<br />
===Age===<br />
*Patients of all age groups may develop [disease name].<br />
*The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.<br />
*[Disease name] commonly affects individuals younger than/older than [number of years] years of age. <br />
*[Chronic disease name] is usually first diagnosed among [age group].<br />
*[Acute disease name] commonly affects [age group].<br />
<br />
===Race===<br />
*There is no racial predilection to [disease name].<br />
*[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].<br />
===Gender===<br />
*[Disease name] affects men and women equally.<br />
*[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.<br />
<br />
===Region===<br />
*The majority of [disease name] cases are reported in [geographical region].<br />
<br />
*[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].<br />
<br />
===Developed Countries===<br />
<br />
===Developing Countries===<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_differential_diagnosis&diff=1490709Toxic epidermal necrolysis differential diagnosis2018-08-15T15:58:38Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
{{CMG}}; {{AE}} <br />
<br />
==Overview==<br />
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].<br />
<br />
OR<br />
<br />
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].<br />
<br />
==Differentiating [Disease name] from other Diseases==<br />
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].<br />
<br />
OR<br />
<br />
[Disease name] must be differentiated from [differential dx1], [differential dx2], and [differential dx3].<br />
<br />
OR<br />
<br />
As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].<br />
<br />
===Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]===<br />
<br />
On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].<br />
{|<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases<br />
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''<br />
! colspan="7" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Para-clinical findings<br />
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''<br />
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings<br />
|-<br />
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''<br />
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination<br />
|-<br />
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab Findings<br />
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging<br />
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Histopathology<br />
|- <br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 1<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 2<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 3<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 1<br />
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 2<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 3<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 1<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 2<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab 3<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 1<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 2<br />
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging 3<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 1<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 2<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 3<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"<br />
!Diseases<br />
!Symptom 1<br />
! colspan="1" rowspan="1" |Symptom 2<br />
!Symptom 3<br />
!Physical exam 1<br />
! colspan="1" rowspan="1" |Physical exam 2<br />
!Physical exam 3<br />
!Lab 1<br />
!Lab 2<br />
!Lab 3<br />
!Imaging 1<br />
!Imaging 2<br />
!Imaging 3<br />
!Histopathology<br />
|'''Gold standard'''<br />
!Additional findings<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 4<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 5<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
|-<br />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Differential Diagnosis 6<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
| style="background: #F5F5F5; padding: 5px;" |<br />
|}<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_causes&diff=1490708Toxic epidermal necrolysis causes2018-08-15T15:57:37Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
Toxic epidermal necrolysis is a rare and usually severe adverse reaction to certain drugs. History of medication use exists in over 95% of patients with TEN. The drugs most often implicated in TEN are antibiotics such as sulfonamides, [[nonsteroidal anti-inflammatory drugs]], [[allopurinol]], [[antiretroviral drugs]], [[corticosteroids]] and [[anticonvulsant]]s such as [[phenobarbital]], [[phenytoin]], [[carbamazepine]], and [[valproic acid]]. The condition might also result from immunizations, infection with agents such as ''[[Mycoplasma pneumoniae]]'' or [[herpes virus]] and [[Organ transplant|transplant]]s of [[bone marrow]] or organs.<br />
<br />
==Causes==<br />
===Life-threatening Causes===<br />
*Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. There are no life-threatening causes of [[disease name]], however complications resulting from untreated [[disease name]] is common.<br />
*Life-threatening causes of [symptom/manifestation] include [cause1], [cause2], and [cause3].<br />
*[Cause] is a life-threatening cause of [disease].<br />
<br />
===Common Causes===<br />
Common causes of [disease name] may include:<br />
*[Cause1]<br />
*[Cause2]<br />
*[Cause3]<br />
<br />
<br />
OR<br />
<br />
<br />
*[Disease name] is caused by an infection with [pathogen name].<br />
*[Pathogen name] is caused by [pathogen name].<br />
<br />
===Less Common Causes===<br />
Less common causes of [disease name] include:<br />
*[Cause1]<br />
*[Cause2]<br />
*[Cause3]<br />
<br />
===Genetic Causes===<br />
*[Disease name] is caused by a mutation in the [gene name] gene.<br />
<br />
===Causes by Organ System===<br />
<br />
{|style="width:80%; height:100px" border="1"<br />
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''<br />
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes<br />
|-<br />
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Dental'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Dermatologic'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Drug Side Effect'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Ear Nose Throat'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Endocrine'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Environmental'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Gastroenterologic'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Genetic'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Hematologic'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Iatrogenic'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Infectious Disease'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Musculoskeletal/Orthopedic'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Neurologic'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Nutritional/Metabolic'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Obstetric/Gynecologic'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Oncologic'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Ophthalmologic'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Overdose/Toxicity'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Psychiatric'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Pulmonary'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Renal/Electrolyte'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Rheumatology/Immunology/Allergy'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Sexual'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Trauma'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Urologic'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|-bgcolor="LightSteelBlue"<br />
| '''Miscellaneous'''<br />
|bgcolor="Beige"| No underlying causes<br />
|-<br />
|}<br />
<br />
<br />
===Causes in Alphabetical Order===<br />
Drug Side Effects<br />
* [[Acetaminophen]]<br />
* [[Amifostine]]<br />
* [[Amoxycillin]]<br />
* [[Aztreonam]]<br />
* [[Butalbital]]<br />
* [[Cefadroxil]]<br />
* [[Cefaclor]]<br />
* [[Ceftibuten]]<br />
* [[Cefotaxime sodium]]<br />
* [[Cefotetan disodium]]<br />
* [[Ceftazidime]]<br />
* [[Certolizumab pegol]]<br />
* [[Cladribine]]<br />
* [[Clobazam]]<br />
* [[clofarabine]]<br />
*[[Cysteamine]]<br />
* [[Cytarabine]]<br />
* [[Dactinomycin]]<br />
* [[diclofenac (patch)]]<br />
* [[Doripenem]]<br />
* [[Etravirine]]<br />
* [[Flurbiprofen]]<br />
*[[Idelalisib]]<br />
* [[Piperacillin/tazobactam]]<br />
*[[Pralatrexate]]<br />
* [[Lacosamide]]<br />
* [[Rifampin]]<br />
* [[Ritonavir]]<br />
* [[Ibritumomab tiuxetan]]<br />
* [[Isotretinoin]]<br />
* [[Meropenem]]<br />
*[[Oxaprozin]]<br />
* [[Terconazole]]<br />
* [[[[Tolmetin]]<br />
* [[Piperacillin]]<br />
* [[Sorafenib]]<br />
* [[Spironolactone]]<br />
* [[Sulfasalazine]]<br />
* [[Sulfacetamide]]<br />
* [[Sulfamethoxazole/Trimethoprim (oral)]]<br />
* [[Trovafloxacin mesylate]]<br />
<br />
* [[Valdecoxib]],<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_pathophysiology&diff=1490707Toxic epidermal necrolysis pathophysiology2018-08-15T15:56:41Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
The exact pathogenesis of [disease name] is not fully understood.<br />
<br />
OR<br />
<br />
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].<br />
<br />
OR<br />
<br />
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.<br />
<br />
OR<br />
<br />
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.<br />
<br />
OR<br />
<br />
<br />
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].<br />
<br />
OR<br />
<br />
The progression to [disease name] usually involves the [molecular pathway].<br />
<br />
OR<br />
<br />
The pathophysiology of [disease/malignancy] depends on the histological subtype.<br />
<br />
==Pathophysiology==<br />
===Physiology===<br />
The normal physiology of [name of process] can be understood as follows:<br />
<br />
===Pathogenesis===<br />
*The exact pathogenesis of [disease name] is not completely understood.<br />
OR<br />
*It is understood that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].<br />
*[Pathogen name] is usually transmitted via the [transmission route] route to the human host.<br />
*Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.<br />
*[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].<br />
*The progression to [disease name] usually involves the [molecular pathway].<br />
*The pathophysiology of [disease/malignancy] depends on the histological subtype.<br />
<br />
==Genetics==<br />
[Disease name] is transmitted in [mode of genetic transmission] pattern.<br />
<br />
OR<br />
<br />
Genes involved in the pathogenesis of [disease name] include:<br />
*[Gene1]<br />
*[Gene2]<br />
*[Gene3]<br />
<br />
OR<br />
<br />
The development of [disease name] is the result of multiple genetic mutations such as:<br />
<br />
*[Mutation 1]<br />
*[Mutation 2]<br />
*[Mutation 3]<br />
<br />
==Associated Conditions==<br />
<br />
==Gross Pathology==<br />
On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].<br />
<br />
==Microscopic Pathology==<br />
On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_classification&diff=1490706Toxic epidermal necrolysis classification2018-08-15T15:56:27Z<p>Irfan Dotani: Created page with "__NOTOC__ {{Toxic epidermal necrolysis}} {{CMG}}; {{AE}} ==Overview== There is no established system for the classification of [disease name]. OR [Disease name] may be cla..."</p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
<br />
{{CMG}}; {{AE}} <br />
==Overview==<br />
There is no established system for the classification of [disease name].<br />
<br />
OR<br />
<br />
[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].<br />
<br />
OR<br />
<br />
[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].<br />
[Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].<br />
<br />
OR<br />
<br />
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.<br />
<br />
OR<br />
<br />
If the staging system involves specific and characteristic findings and features:<br />
According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].<br />
<br />
OR<br />
<br />
The staging of [malignancy name] is based on the [staging system].<br />
<br />
OR<br />
<br />
There is no established system for the staging of [malignancy name].<br />
<br />
==Classification==<br />
<br />
There is no established system for the classification of [disease name].<br />
<br />
OR<br />
<br />
[Disease name] may be classified according to [classification method] into [number] subtypes/groups: <br />
*[Group1]<br />
*[Group2]<br />
*[Group3]<br />
*[Group4]<br />
<br />
OR<br />
<br />
[Disease name] may be classified into [large number > 6] subtypes based on: <br />
*[Classification method 1]<br />
*[Classification method 2]<br />
*[Classification method 3]<br />
<br />
[Disease name] may be classified into several subtypes based on: <br />
*[Classification method 1]<br />
*[Classification method 2]<br />
*[Classification method 3]<br />
<br />
OR<br />
<br />
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.<br />
<br />
OR<br />
<br />
'''If the staging system involves specific and characteristic findings and features:'''<br />
<br />
According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].<br />
<br />
OR<br />
<br />
The staging of [malignancy name] is based on the [staging system].<br />
<br />
OR<br />
<br />
There is no established system for the staging of [malignancy name].<br />
<br />
==References==<br />
{{Reflist|2}}<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_overview&diff=1490705Toxic epidermal necrolysis overview2018-08-15T15:56:08Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
{{CMG}}; {{AE}}<br />
<br />
==Overview==<br />
'''Toxic Epidermal Necrolysis''' is a life-threatening [[dermatology|dermatological]] condition that is frequently induced by a reaction to medications. It is characterized by the detachment of the top layer of skin (the [[epidermis]]) from the lower layers of the skin (the [[dermis]]) all over the body. There is broad agreement in the medical literature that TEN can be considered a more severe form of [[Stevens-Johnson syndrome]] and debate whether it falls on a spectrum of disease that includes [[erythema multiforme]].<ref>{{cite journal |author=Carrozzo M, Togliatto M, Gandolfo S |title=[Erythema multiforme. A heterogeneous pathologic phenotype] |journal=Minerva Stomatol |volume=48 |issue=5 |pages=217-26 |year=1999 |pmid=10434539}}</ref><ref>{{cite journal |author=Farthing P, Bagan J, Scully C |title=Mucosal disease series. Number IV. Erythema multiforme |journal=Oral Dis |volume=11 |issue=5 |pages=261-7 |year=2005 |pmid=16120111}}</ref><br />
<br />
==Historical Perspective==<br />
<br />
==Classification==<br />
<br />
==Pathophysiology==<br />
Microscopically, TEN causes [[cell death]] throughout the epidermis. [[Keratinocytes]], which are the cells found lower in the dermis, specialize in holding the skin cells together, undergo [[necrosis]] (uncontrolled cell death).<br />
<br />
==Causes==<br />
Toxic epidermal necrolysis is a rare and usually severe adverse reaction to certain drugs. History of medication use exists in over 95% of patients with TEN. The drugs most often implicated in TEN are antibiotics such as sulfonamides, [[nonsteroidal anti-inflammatory drugs]], [[allopurinol]], [[antiretroviral drugs]], [[corticosteroids]] and [[anticonvulsant]]s such as [[phenobarbital]], [[phenytoin]], [[carbamazepine]], and [[valproic acid]]. The condition might also result from immunizations, infection with agents such as ''[[Mycoplasma pneumoniae]]'' or [[herpes virus]] and [[Organ transplant|transplant]]s of [[bone marrow]] or organs.<br />
<br />
==Differentiating Xyz from Other Diseases==<br />
<br />
==Epidemiology and Demographics==<br />
The [[incidence (epidemiology)|incidence]] is between 0.4 and 1.2 cases per 100,000 each year.<br />
<br />
==Risk Factors==<br />
<br />
==Screening==<br />
<br />
==Natural History, Complications, and Prognosis==<br />
The mortality for toxic epidermal necrolysis is 30-40%.<ref name=garra>Garra, GP (2007). "[http://www.emedicine.com/EMERG/topic599.htm Toxic Epidermal Necrolysis]". Emedicine.com. Retrieved on December 13, 2007.</ref> Loss of the skin leaves patients vulnerable to infections from fungi and bacteria, and can result in [[septicemia]], the leading cause of death in the disease.<ref name=garra/> Death is caused either by [[infection]] or by [[respiratory distress]] which is either due to [[pneumonia]] or damage to the linings of the airway. Microscopic analysis of tissue (especially the degree of dermal mononuclear inflammation and the degree of inflammation in general) can play a role in determining the prognosis of individual cases.<ref>{{cite journal |author=Quinn AM et al |title=Uncovering histological criteria with prognostic significance in toxic epidermal necrolysis |journal=Arch Dermatol |volume=141 |issue=6 |pages=683-7 |year=2005 |pmid=15967913}}</ref><br />
<br />
==Diagnosis==<br />
===Diagnostic Study of Choice===<br />
<br />
===History and Symptoms===<br />
<br />
===Physical Examination===<br />
<br />
===Laboratory Findings===<br />
Sometimes, however, examination of affected tissue under the microscope may be needed to distinguish it between other entities such as [[staphylococcal scalded skin syndrome]]. Typical histological criteria of TEN include mild infiltrate of lymphocytes which may obscure the dermoepidermal junction and prominent cell death with basal vacuolar change and individual cell necrosis.<ref>{{cite journal |author=Pereira FA, Mudgil AV, Rosmarin DM |title=Toxic Epidermal Necrolysis |journal=J Am Acad Dermatol |volume=56 |issue=2 |pages=181-200 |year=2007 |pmid=17224365}}</ref><br />
<br />
===Electrocardiogram===<br />
<br />
===X-ray===<br />
<br />
===Echocardiography and Ultrasound===<br />
<br />
===CT scan===<br />
<br />
===MRI===<br />
<br />
===Other Imaging Findings===<br />
<br />
===Other Diagnostic Studies===<br />
<br />
==Treatment==<br />
===Medical Therapy===<br />
<br />
=== Interventions ===<br />
<br />
===Surgery===<br />
<br />
===Primary Prevention===<br />
<br />
===Secondary Prevention===<br />
<br />
==References==<br />
{{reflist|2}}<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}<br />
[[Category: (name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis_historical_perspective&diff=1490704Toxic epidermal necrolysis historical perspective2018-08-15T15:54:54Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
<br />
{{CMG}}; {{AE}} <br />
<br />
==Overview==<br />
<br />
==Historical Perspective==<br />
<br />
===Discovery===<br />
*[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].<br />
<br />
*The association between [important risk factor/cause] and [disease name] was made in/during [year/event].<br />
*In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].<br />
*In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].<br />
<br />
==Outbreaks==<br />
There have been several outbreaks of [disease name], which are summarized below:<br />
<br />
==Landmark Events in the Development of Treatment Strategies==<br />
In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].<br />
<br />
==Impact on Cultural History==<br />
<br />
==Famous Cases==<br />
The following are a few famous cases of [[disease name]]:<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Toxic_epidermal_necrolysis&diff=1490699Toxic epidermal necrolysis2018-08-15T15:51:35Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Toxic epidermal necrolysis}}<br />
'''For patient information, click [[Toxic epidermal necrolysis (patient information)|here]]'''<br />
<br />
{{CMG}}<br />
<br />
{{SK}} Lyell's syndrome; TEN<br />
==[[Toxic epidermal necrolysis overview|Overview]]==<br />
<br />
==[[Toxic epidermal necrolysis historical perspective|Historical Perspective]]==<br />
<br />
==[[Toxic epidermal necrolysis classification|Classification]]==<br />
<br />
==[[Toxic epidermal necrolysis pathophysiology|Pathophysiology]]==<br />
<br />
==[[Toxic epidermal necrolysis causes|Causes]]==<br />
<br />
==[[Toxic epidermal necrolysis differential diagnosis|Differentiating Toxic Epidermal Necrolysis from other Diseases]]==<br />
<br />
==[[Toxic epidermal necrolysis epidemiology and demographics|Epidemiology and Demographics]]==<br />
<br />
==[[Toxic epidermal necrolysis risk factors|Risk Factors]]==<br />
<br />
==[[Toxic epidermal necrolysis screening|Screening]]==<br />
<br />
==[[Toxic epidermal necrolysis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==<br />
<br />
==Diagnosis==<br />
[[Toxic epidermal necrolysis diagnostic study of choice|Diagnostic Study of Choice]] | [[Toxic epidermal necrolysis history and symptoms|History and Symptoms]] | [[Toxic epidermal necrolysis physical examination|Physical Examination]] | [[Toxic epidermal necrolysis laboratory findings|Laboratory Findings]] | [[Toxic epidermal necrolysis electrocardiogram|Electrocardiogram]] | [[Toxic epidermal necrolysis x ray|X Ray]] | [[Toxic epidermal necrolysis echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Toxic epidermal necrolysis ct scan|CT scan]] | [[Toxic epidermal necrolysis mri|MRI]] | [[Toxic epidermal necrolysis other imaging findings|Other Imaging Findings]] | [[Toxic epidermal necrolysis other diagnostic studies|Other Diagnostic Studies]]<br />
<br />
==Treatment==<br />
[[Toxic epidermal necrolysis medical therapy|Medical Therapy]] | [[Toxic epidermal necrolysis surgery|Surgery]] | [[Toxic epidermal necrolysis primary prevention|Primary Prevention]] | [[Toxic epidermal necrolysis secondary prevention|Secondary Prevention]] | [[Toxic epidermal necrolysis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Toxic epidermal necrolysis future or investigational therapies|Future or Investigational Therapies]]<br />
<br />
== Case Studies ==<br />
[[Toxic epidermal necrolysis case study one|Case #1]]<br />
==Related Chapters==<br />
* [[Stevens-Johnson syndrome]]<br />
<br />
{{Diseases of the skin and subcutaneous tissue}}<br />
[[Category:Dermatology]]<br />
[[Category:Medical emergencies]]<br />
[[Category:Emergency medicine]]<br />
[[Category:Disease]]<br />
<br />
<br />
[[fr:Syndrome de Lyell]]<br />
[[pl:Rumień wielopostaciowy]]<br />
<br />
{{WikiDoc Help Menu}}<br />
{{WikiDoc Sources}}</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Template:Toxic_epidermal_necrolysis&diff=1490697Template:Toxic epidermal necrolysis2018-08-15T15:51:27Z<p>Irfan Dotani: </p>
<hr />
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[[Toxic epidermal necrolysis ct scan|CT scan]]<br />
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[[Toxic epidermal necrolysis medical therapy|Medical Therapy]]<br />
|- <br />
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[[Toxic epidermal necrolysis surgery|Surgery]]<br />
|- <br />
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[[Toxic epidermal necrolysis primary prevention|Primary Prevention]]<br />
|- <br />
!<br />
<br />
|- bgcolor="PaleTurquoise"<br />
!<br />
[[Toxic epidermal necrolysis secondary prevention|Secondary Prevention]]<br />
|- <br />
!<br />
<br />
|- bgcolor="PaleTurquoise"<br />
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[[Toxic epidermal necrolysis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]]<br />
|- <br />
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[[Toxic epidermal necrolysis future or investigational therapies|Future or Investigational Therapies]]<br />
|- <br />
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Case Studies<br />
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[[Toxic epidermal necrolysis case study one|Case #1]]<br />
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{{PAGENAME}} On the Web<br />
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[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&db=pubmed&term={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}} Most recent articles]<br />
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[http://www.google.com/search?hl=en&client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&hs=QWo&q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}}+AND+risk+score+OR+risk+calculator&btnG=Search Risk calculators and risk factors for {{PAGENAME}}]<br />
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|}</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Stevens-Johnson_syndrome_future_or_investigational_therapies&diff=1490692Stevens-Johnson syndrome future or investigational therapies2018-08-15T15:45:33Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Stevens-Johnson syndrome}}<br />
{{CMG}}; {{AE}}<br />
<br />
==Overview==<br />
<br />
==Future or Investigational Therapies==<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
<br />
[[Category: (name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Stevens-Johnson_syndrome_cost-effectiveness_of_therapy&diff=1490691Stevens-Johnson syndrome cost-effectiveness of therapy2018-08-15T15:45:22Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Stevens-Johnson syndrome}}<br />
{{CMG}}; {{AE}} <br />
<br />
==Overview==<br />
<br />
<br />
==Cost-effectiveness of Therapy==<br />
<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
<br />
[[Category: (name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Stevens-Johnson_syndrome_secondary_prevention&diff=1490690Stevens-Johnson syndrome secondary prevention2018-08-15T15:45:08Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Stevens-Johnson syndrome}}<br />
{{CMG}}; {{AE}} <br />
<br />
==Overview==<br />
There are no established measures for the secondary prevention of [disease name].<br />
<br />
OR<br />
<br />
Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].<br />
<br />
==Secondary Prevention==<br />
There are no established measures for the secondary prevention of [disease name].<br />
<br />
OR<br />
<br />
Effective measures for the secondary prevention of [disease name] include:<br />
*[Strategy 1]<br />
*[Strategy 2]<br />
*[Strategy 3]<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Stevens-Johnson_syndrome_primary_prevention&diff=1490689Stevens-Johnson syndrome primary prevention2018-08-15T15:44:53Z<p>Irfan Dotani: </p>
<hr />
<div>__NOTOC__<br />
{{Stevens-Johnson syndrome}}<br />
{{CMG}}; {{AE}} <br />
<br />
==Overview==<br />
There are no established measures for the primary prevention of [disease name].<br />
<br />
OR<br />
<br />
There are no available vaccines against [disease name].<br />
<br />
OR<br />
<br />
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].<br />
<br />
OR<br />
<br />
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].<br />
<br />
==Primary Prevention==<br />
There are no established measures for the primary prevention of [disease name].<br />
<br />
OR<br />
<br />
There are no available vaccines against [disease name].<br />
<br />
OR<br />
<br />
Effective measures for the primary prevention of [disease name] include:<br />
*[Measure1]<br />
*[Measure2]<br />
*[Measure3]<br />
<br />
OR<br />
<br />
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include:<br />
*[Strategy 1]<br />
*[Strategy 2]<br />
*[Strategy 3]<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}</div>Irfan Dotanihttps://www.wikidoc.org/index.php?title=Stevens-Johnson_syndrome_surgery&diff=1490688Stevens-Johnson syndrome surgery2018-08-15T15:44:38Z<p>Irfan Dotani: Created page with "__NOTOC__ {{Stevens-Johnson syndrome}} {{CMG}}; {{AE}} ==Overview== Surgical intervention is not recommended for the management of [disease name]. OR Surgery is not the fi..."</p>
<hr />
<div>__NOTOC__<br />
{{Stevens-Johnson syndrome}}<br />
{{CMG}}; {{AE}} <br />
<br />
==Overview==<br />
Surgical intervention is not recommended for the management of [disease name].<br />
<br />
OR<br />
<br />
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]<br />
<br />
OR<br />
<br />
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].<br />
<br />
OR<br />
<br />
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.<br />
<br />
OR<br />
<br />
Surgery is the mainstay of treatment for [disease or malignancy].<br />
<br />
==Indications==<br />
<br />
*Surgical intervention is not recommended for the management of [disease name].<br />
OR<br />
*Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either:<br />
**[Indication 1] <br />
**[Indication 2]<br />
**[Indication 3]<br />
*The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either:<br />
**[Indication 1] <br />
**[Indication 2] <br />
**[Indication 3]<br />
<br />
==Surgery==<br />
<br />
*The feasibility of surgery depends on the stage of [malignancy] at diagnosis.<br />
OR<br />
*Surgery is the mainstay of treatment for [disease or malignancy].<br />
<br />
==Contraindications==<br />
<br />
==References==<br />
{{Reflist|2}}<br />
<br />
{{WH}}<br />
{{WS}}<br />
[[Category: (name of the system)]]</div>Irfan Dotani