In association with depression, the patient often has other mental disorders as well, most commonly anxiety disorders (10–50 %), substance abuse disorders (10–30 %) and personality disorders (10–50 %).The associated disorders have significance on the prognosis and functional ability so that concomitant occurrence of the disorders renders the treatment more challenging and increases the risk of a reduction in the functional ability.
The term dual diagnosis denotes a condition where substance dependence, or other excessive substance use, co-occurs with at least one mental health disorder that is not a direct effect of the substance use (intoxication and withdrawal symptoms).Substance abuse (alcohol, legal and illegal drugs and solvents) may affect a patient’s mental illness in different ways. It may precipitate mental illness worsen mental illness alleviate mental illness have no effect on mental illness. The relationship between the patient’s different mental health disorders and substance abuse is not necessarily always the same. In dual diagnosis, mental illness will persist even when substance use has ceased for a prolonged length of time.
Every doctor will need at some stage to answer questions relating to the hereditary nature of diseases and discuss relevant issues with the patient. A patient should be referred to a genetics specialist when hereditary issues require further investigation, for example when a condition occurring in family members or relatives is suspected to be genetic and the diagnosis is not clear a genetic condition, often very rare, has been diagnosed in the family about which it proves difficult to find further information. The role of a genetics specialist (medical geneticist) is purely an advisory one and he/she will not take part in decisions relating to, for example, family planning, prenatal diagnosis, carrier testing or predictive testing. The patient's treating doctor may provide genetic counselling about more common diseases, such as diabetes asthma and other allergies dyslipidaemias cancer when no suggestive evidence exists for its hereditary nature (breast cancer , colorectal cancer ) mental health problems.
Learning disorders include difficulties in reading and writing, disturbances in arithmetic skills, disturbances in speech and language, and developmental disturbances in motor functions.If left untreated, learning disorders may lead to more extensive difficulties or significantly impair scholastic progress in the early school years.
The aim of the anti-doping work is to prevent the use of substances and methods that are hazardous for health and/or improve performance, to ensure the right to fair and pure sports and to control the adherence to the ethical principles of sports and medicine. The national anti-doping committees are responsible for doping control of athletes who participate in organized sports. They continually update doping regulations that are based on the regulations of World Anti-Doping Agency (WADA , www.wada-ama.org). This article describes the general principles of anti-doping regulation and provides guidance and examples for some common situations. Whenever there is uncertainty, check the facts at the website of your national anti-doping organization or WADA.
Health problems that are characteristic to Down syndrome (DS) should be identified early (particularly congenital heart anomalies, vision and hearing impairment, hypothyroidism and coeliac disease). The monitoring and treatment of DS is the responsibility of the primary health care. Support services for intellectual and developmental disabilities should only be involved when specialist expertise is needed, e.g. for rehabilitation purposes.
Urinary incontinence in an elderly person has an effect on the patient’s and his/her family’s quality of life as well as on health care costs. It increases the risk of falls and the need for long-term institutional care. The patient is often too embarrassed to seek appropriate help. Various treatment options that either cure or at least ease the situation are available to manage urinary incontinence in an elderly person.
Dislocation may occur almost spontaneously in some persons or in association with e.g. trauma, yawning, dental examination etc. The dislocation is usually unilateral but may be bilateral. After an acute dislocation the condition easily becomes recurrent. Reposition is usually easy if the mandible is intact. If the mandible is dislocated backwards the patient has a condylar fracture. In such case, consult an oral and maxillofacial surgeon directly.
The possibility of neuroleptic malignant syndrome should be kept in mind in patients on antipsychotic medication with fever extrapyramidal symptoms disturbances in the function of the autonomic nervous system disturbances of consciousnessleucocytosis or an increase in the plasma creatine kinase (CK) concentration as an additional laboratory finding. NMS may occur with any type of antipsychotic drug and also with metoclopramide.Other disorders causing clouding of consciousness, confusion and elevation of body temperature should be excluded.Restarting antipsychotic medication after NMS requires the opinion of a specialist.
Transsexualism refers to the most extreme form of incongruity between an individual's gender identity and anatomic sex. In 1994, the diagnosis of transsexualism was replaced with ”gender identity disorder" by the DSM-IV committee. Transsexualism is associated with distress because the individual, due to his/her physical characteristics, is not treated as a representative of the gender he/she identifies with and cannot therefore live in a gender role with which he/she identifies. The sexual anatomy of the body also feels alien and inappropriate. Transsexualism that causes distress is treated with sex reassignment therapy. The aim is to alter body characteristics and anatomy closer to those of the target gender as well as to facilitate the integration into the social role of the opposite sex. Investigations and surgery are often only available in specialist centres.