CME : Your SA Journal of CPD - Volume 22, Issue 10, 2004
Volume 22, Issue 10, 2004
Source: CME : Your SA Journal of CPD 22, pp 552 –555 (2004)More Less
Panic disorder is a common condition. <br>Panic disorder is often accompanied by agoraphobia, where patients will avoid situations where help is not readily available or from which it may be difficult to escape. <br>Panic disorder often co-exists with major depressive disorder. <br>Medical disorders which may mimic panic attacks should be ruled out before a final diagnosis is made. <br>Treatment consists of a combination of medication and psychotherapy SSRIs are the first line of pharmacological treatment. <br>The most important principle in the pharmacological treatment of panic disorder is: 'Start low, go slow, end high'. <br>Patients should be treated until they are symptom-free for at least a year. <br>Psychoeducation forms an integral part of the treatment of panic disorder.
Author Bavanisha VythilingumSource: CME : Your SA Journal of CPD 22, pp 556 –559 (2004)More Less
Intimate partner violence is common, affecting up to 55% of women at some time in their lives. <br>It is a high-risk factor for the development of PTSD. <br>PTSD in the setting of IPV is associated with higher rates of depression and substance abuse and worse functioning and quality of life. <br>It is important to screen all women (including adolescent girls) for IPV. <br>When screening ask direct questions. <br>If a woman is a victim of IPV assess for PTSD. <br>Management is multidisciplinary and includes social interventions and psychotherapy. <br>SSRIs are the first-line medication agents of choice. <br>Look at confounding issues, e.g. ongoing violence, co-morbid substance use and non-compliance when assessing poor response to medication.
Author Paul D. CareySource: CME : Your SA Journal of CPD 22, pp 560 –564 (2004)More Less
Worry is abnormal if it is excessively distressing or persistent. <br>A total of 25% of primary care visits relate to anxiety and depression. <br>Enquiry about symptoms is central to more effective identification. <br>Populations with a higher risk for anxiety include children, women in the post-partum period, the chronically ill and the elderly. <br>Comprehensive evaluation and examination is essential for appropriate management. <br>SSRIs are recommended first-line treatments for anxiety disorders. <br>Benzodiazepines may be helpful for short-term relief of symptoms. <br>CBT may be particularly helpful for relapse prevention. <br>Referral to a specialist is necessary in cases of failure to respond to treatment and in those of complex co-morbidity.
Author D.J.H. NiehausSource: CME : Your SA Journal of CPD 22, pp 565 –567 (2004)More Less
OCD consists of obsessions and compulsions. <br>OCD symptoms seem to be mediated by the serotonin system. <br>There is high co-morbidity with other psychiatric disorders, especially depression. <br>Treatment should include: <ul> <li>setting of treatment goals</li> <li>psycho-education and support</li> <li>medication (higher doses of selective serotonin re-uptake inhibitors may be needed) </li> <li>continuation of treatment for at least 1 year from time of improvement</li> <li>cognitive behavioural therapy - an effective option</li> <li>long-term follow-up.</li>
Author David FainmanSource: CME : Your SA Journal of CPD 22, pp 568 –571 (2004)More Less
Depression and anxiety commonly occur together as symptoms or syndromes. <br>The lifetime prevalence of any anxiety disorder is 1 in 4 and of major depressive disorder 1 in 6. <br>Anxiety and depression may selectively distort cognitions and perceptions to fit the particular affect. <br>Common medical causes for anxiety and depression include hypoxia, epilepsy, amphetamines/ cocaine/alcohol. <br>The amygdala mediates stress and fear responses, with the locus coeruleus/raphe nuclei mediating anxiety. Limbic system, basal ganglia and hypothalamic dysfunction occurs across the anxiety and depressive disorders. <br>In anxiety and depressive disorders, there is blunted cortisol response to ACTH, blunted GH response to clonidine, blunted TSH and prolactin responses to TRH, and noradrenergic system hyperactivity. <br>In general, MDD is co-morbid with all anxiety disorders. <br>Antidepressants (especially SSRIs) are also effective anxiolytics at higher doses. <br>CBT is effective in mild to moderate major depression and in most anxiety disorders, and produces less relapse on cessation compared with pharmacotherapy.
Management of children with cerebral palsy, CME : Your SA Journal of CPD, 22(8) 2004, pp.434-438 : erratumAuthor Barbara LaughtonSource: CME : Your SA Journal of CPD 22 (2004)More Less
Author Jenny EdgeSource: CME : Your SA Journal of CPD 22, pp 585 –587 (2004)More Less
Author N.D. Van der MerweSource: CME : Your SA Journal of CPD 22, pp 588 –589 (2004)More Less
Symptomatic ventricular pre-excitation through an accessory pathway is known as the Wolff-Parkinson- White (WPW) syndrome. <br>The usual arrhythmia in WPW syndrome is a narrow QRS atrioventricular re-entry tachycardia, but a rarer, wide QRS (antidromic) tachycardia may also occur. <br>Atrial fibrillation occurring in the setting of WPW may be potentially life-threatening and it is therefore advisable for all patients with this syndrome to be referred to an arrhythmia specialist.