Diagnostic Tests for Self Harm
Self Harm Tests: Book Excerpts
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Self Harm Diagnosis: Book Excerpts
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Diagnostic Tests for Self Harm: Online Medical Books
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DEPRESSION:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
If the patient is suicidal, one should not hesitate to make a psychiatric referral or plan hospitalization immediately. To rule out organic causes, routine laboratory studies include a CBC, sedimentation rate, chemistry panel, VDRL test, and thyroid profile. If Cushing's syndrome is suspected, a serum cortisol and cortisol suppression test should be done. If menopause is suspected, order a serum FSH and estradiol level. A trial of estrogen therapy may be warranted. A CT scan of the brain should probably be done in all cases to exclude a brain tumor, especially if there is no response to treatment! Office tests to evaluate nonorganic depression include the Beck Depression Inventory and the Hamilton Depression Scale. A referral to a psychiatrist should also be considered early if the depression is severe or if there is suicidal ideation.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Depression:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
During the examination, determine how the patient feels about herself, her family, and her environment. Your goal is to explore the nature of her depression, the extent to which other factors affect it, and her coping mechanisms and their effectiveness. Begin by asking what's bothering her. How does her current mood differ from her usual mood? Then ask her to describe the way she feels about herself. What are her plans and dreams? How realistic are they? Is she generally satisfied with what she has accomplished in her work, relationships, and other interests? Ask about changes in her social interactions, sleep patterns, appetite, normal activities, or ability to make decisions and concentrate. Determine patterns of drug and alcohol use. Listen for clues that she may be suicidal. (SeeSuicide: Caring for the high-risk patient.)
Ask the patient about her family — its patterns of interaction and characteristic responses to success and failure. What part does she feel she plays in her family life? Find out if other family members have been depressed, and whether anyone important to the patient has been sick or has died in the past year. Finally, ask the patient about her environment. Has her lifestyle changed in the past month? Six months? Year? When she's feeling blue, where does she go and what does she do to feel better? Find out how she feels about her role in the community and the resources that are available to her. Try to determine if she has an adequate support network to help her cope with her depression.
Cultural cue
Patients who don't speak English fluently may have difficulty communicating their feelings and thoughts. Consider using someone outside the family as an interpreter to allow the patient to express her feelings more freely.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Fontanel depression:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Obtain a thorough patient history from a parent or caretaker, focusing on recent fever, vomiting, diarrhea, and behavioral changes. Monitor the infant’s fluid intake and urine output over the past 24 hours, including the number of wet diapers during that time. Ask about the child’s preillness weight, and compare it to his current weight; weight loss in an infant reflects water loss.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Depression:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
During the examination, determine how the patient feels about herself, her family, and her environment. Your goal is to explore the nature of her depression, the extent to which other factors affect it, and her coping mechanisms and their effectiveness. Begin by asking what’s bothering her. How does her current mood differ from her usual mood? Then ask her to describe the way she feels about herself. What are her plans and dreams? How realistic are they? Is she generally satisfied with what she has accomplished in her work, relationships, and other interests? Ask about changes in her social interactions, sleep patterns, appetite, normal activities, or ability to make decisions and concentrate. Determine patterns of drug and alcohol use. Listen for clues that she may be suicidal. (See Suicide: Caring for the high-risk patient, page 234.)
Ask the patient about her family—its patterns of interaction and characteristic responses to success and failure. What part does she feel she plays in her family life? Find out if other family members have been depressed and whether anyone important to her has been sick or has died in the past year. Finally, ask the patient about her environment. Has her lifestyle changed in the past month? Six months? Year? When she’s feeling blue, where does she go and what does she do to feel better? Find out how she feels about her role in the community and the resources that are available to her. Try to determine if she has an adequate support network to help her cope with her depression.
Cultural Cue: Patients who don’t speak English fluently may have difficulty communicating their feelings and thoughts. Consider using someone outside the family as an interpreter to allow the patient to express her feelings more freely.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Fontanel depression:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Obtain a thorough patient history from a parent or caregiver, focusing on recent fever, vomiting, diarrhea, and behavioral changes. Monitor the infant’s fluid intake and urine output over the last 24 hours, including the number of wet diapers during that time. Ask about the child’s pre-illness weight, and compare it with his current weight; weight loss in an infant reflects water loss.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Depression:
Physical examination.
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
Any patient with severe depression sufficient to warrant treatment should have both a general screening physical examination, paying particular attention to signs of anemia and endocrinopathies (e.g., hypothyroidism) and a careful screening neurologic examination.
Testing.
For typical mild major depressions, no tests are routinely indicated except as guided by the general medical history and physical examination. However, the following circumstances do warrant a laboratory workup: first onset of depression in later life; severely debilitating or treatment-refractory depression; or the presence of atypical features (e.g., onset despite the absence of past or family history or psychosocial stressors; severe cognitive complaints). Few empirical data guide the cost-effective use of screening laboratory tests in these cases, but most experienced clinicians would agree with performing most of the following: complete blood count; erythrocyte sedimentation rate; serum electrolytes, glucose, blood urea nitrogen, creatinine, hepatic transaminases, and serologic test for syphilis; and urinalysis. Older patients should also have an electrocardiogram and a chest x-ray study.
Diagnostic assessment
If the history and mental status examination reveal five depressive symptoms (including either depressed mood or decreased interests) present most of the day, nearly every day for a minimum of 2 consecutive weeks, then the patient has a major depressive syndrome. Such a syndrome can occur in the context of many conditions and not merely idiopathic major depression, so definitive diagnosis depends on the larger clinical picture. Depressive symptoms can occur in the context of delirium or dementia, either of which are evidenced by the presence of cognitive deficits (Chapters 4.3 and 4.4). Prior episodes of mania are indicative of bipolar disorder, whereas prior episodes of psychosis in the absence of mood syndrome indicate schizoaffective disorder. If the depression is caused by an identifiable physiologic factor (e.g., drugs or a general medical or neurologic disorder), it is a secondary depression (formerly known as “organic mood disorder”).
Clinically meaningful depressive symptoms that do not meet full criteria for a major depressive syndrome are even more common than full-fledged major depression in the primary care settings. Whereas some such patients are captured by diagnostic concepts such as dysthymic disorder or minor depression, many elude diagnostic categorization. Making the diagnostic distinction between major depression and other forms is important, because a large body of empirical evidence supports the efficacy of specific treatments for major depression and dysthymic disorder; however, the efficacy of treatments for other depressive conditions is largely unknown.
The following should lead to psychiatric referral sooner rather than later: prominent or imminent suicidality; psychotic symptoms; history of mania; psychiatric comorbidity such as alcohol dependence or a personality, anxiety, or eating disorder; and treatment intolerance or failure to respond to therapy.
References
1. Depression Guideline Panel. Depression in Primary Care: Volume 1. Detection and diagnosis. Clinical Practice Guideline, Number 5. Rockville, MD: US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; April 1993. AHCPR publication 93-0550.
2. Spitzer RL, Williams JBW, Kroenke K, et al. Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA 1994;
272:1749–1756.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Depression:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Depression often presents in primary care settings masked in the form of somatic symptoms, such as anorexia, weight loss, fatigue, insomnia (especially early morning awakening), or difficulty concentrating. It is also common for the perception of symptoms produced by another organic cause to be heightened by depression. Depression becomes pathologic when it interferes with normal function.
Once depression is identified, it is critical to assess suicide risk. The best way to do this is to straightforwardly ask patient, if they have thought of harming themselves and if so, do they have a plan. Risk factors for suicide include living alone, prior suicide attempt, family history of suicide attempt or substance abuse, general medical illness, extreme hopelessness, psychosis, and substance abuse.
The SQ is a one-question screen: “Have you felt depressed or sad much of the time in the past year?”. The CAGE questionnaire is designed to identify drinkers who are alcohol-dependent or heavy drinkers (>8 drinks/day):
1) “Have you ever felt you should Cut down your drinking?” 2) “Have people Annoyed you by criticizing your drinking?” 3) “Have you ever felt bad or Guilty about your drinking?” 4) “Have you ever taken a drink first thing in the morning (Eye-opener)?”.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Fontanel depression:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Obtain a thorough patient history from a parent or caretaker, focusing on recent fever, vomiting, diarrhea, and behavioral changes. Monitor the infant's fluid intake and urine output over the past 24 hours, including the number of wet diapers during that time. Ask about the child's preillness weight, and compare it with his current weight; weight loss in an infant reflects water loss. Then perform a complete physical examination.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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