Using Psychotherapy and Medications to Treat a Teenager with Prodromal Symptoms
Ragy R. Girgis, Gary Brucato, Jeffrey A. Lieberman in Understanding and Caring for People with Schizophrenia, 2020
In this chapter, the case of “Fran,” a 17-year-old Mormon female at high-risk for developing psychosis, who had a number of bizarre symptoms, including feeling that her pet fish were spying on her, and came to us on a number of medications, will be discussed. The chapter will present the two-pronged approach that was used to treat her symptoms, both by decreasing her medication load as well as by developing a very unique and personalized psychotherapeutic approach to dealing with her symptoms; namely, by developing a mantra, “Be a Hiruti,” to remind Fran of the emotional and psychological depth that she had, as exemplified by her favorite geisha Hiruti (not a real geisha), and that she could use to better understand her symptoms. In this chapter the meaning of “clinical high-risk” and “prodromal” will be discussed, as well as the many other nonspecific symptoms people may have before they become psychotic.
The acutely collapsed patient
Andrew Stewart in Pocket On Call, 2015
Patients with a transient loss of consciousness may have suffered an episode of syncope. Vasovagal syncope is the ‘simple’ faint and represents a complex autonomic reflex. Patients experience a varied prodrome with features such as feeling hot and dizzy with wobbly legs. Patients make a rapid recovery following loss of consciousness. Other potential causes for transient loss of consciousness include concussion and short runs of significant cardiac dysrhythmias for example ventricular tachycardia. Following an acute intra-cranial event, various cardiovascular side effects may occur, many of which can result in low blood pressure. When clinicians refer to an acutely ‘collapsed’ patient, they are usually describing a patient who has suddenly lost consciousness, often in a dramatic fashion, either by falling to the floor or by collapsing backwards in bed. The altered consciousness level may be transient or sustained. This, therefore, provides a rare example whereby the patient’s low level of consciousness may not be completely attributed to the co-existing hypotension.
Acute erythematous rash on the face
Richard Ashton, Barbara Leppard in Differential Diagnosis in Dermatology, 2021
Angioedema is oedema in the dermis due to increased vascular permeability. A phototoxic rash looks like sunburn but occurs in a patient who has not been exposed to excessive sunlight. Acute sunburn presents as painful erythema with or without blisters, between a few hours and 2 days after sun exposure. Subacute eczema occurs without obvious vesicles and exudate. There will be erythematous patches and plaques where the border of the rash is ill defined merging imperceptibly into normal skin. Acute eczema on the face presents as tiny vesicles, weeping and crusting, and is usually due to an allergic contact dermatitis or atopic eczema. Herpes simplex is differentiated from impetigo by the history of recurrent episodes, prodromal pain and initial vesicles containing clear fluid, and in adults is the more likely diagnosis. The rash is usually symmetrical and uncomfortable and itchy rather than painful as in herpes zoster.
Recognition and management of Parkinson’s disease during the premotor (prodromal) phase
Published in Expert Review of Neurotherapeutics, 2009
Daniel D Truong, Erik C Wolters
Therapeutic strategies in Parkinson’s disease (PD) provide control of motor (nigral) and nonmotor (extranigral) symptoms. Nigral dopamine-related signs and symptoms are addressed by supplementation or substitution of cerebral dopamine, and extranigral nondopamine-related symptoms are treated by addressing specific autonomic, neuropsychiatric and sleep dysfunctions. However, the ultimate goal in treating PD is to slow, stop or modify disease progression through early and appropriate intervention. Recognition of the various nonmotor clinical manifestations of PD is critical to early diagnosis and treatment. Disease-modifying drugs, once identified, should be initiated as soon as possible, preferably in the prodromal (premotor) phase of the disease. In this review, clinical signs and symptoms of this phase will be described, as will the (suggested) criteria for diagnosis and optimal initiation of disease-modifying agents. Both symptomatic and disease-modifying agents applicable in the premotor phase of PD will also be addressed.
IgA vasculitis presenting as abdominal pain and rash
Published in Baylor University Medical Center Proceedings, 2019
Anil Kopparapu, Diane Jarrett, Shashank Kraleti
A 57-year-old white man presented with acute abdominal pain and rash without any prodromal symptoms. The skin biopsy confirmed immunoglobulin A (IgA) vasculitis with small vessel vasculitis and perivascular IgA, C3, and fibrin deposition. IgA vasculitis is diagnosed most commonly in children and presents in adults in only 10% of cases. Treatment is usually supportive care, and interventions may be required to avoid complications such as nephrotic syndrome or acute gastrointestinal bleeding. Clinicians should be aware of IgA vasculitis as a potential cause for abdominal pain and rash in adult populations.
The motivation for very early intervention for infants at high risk for autism spectrum disorders
Published in International Journal of Speech-Language Pathology, 2014
Sara Jane Webb, Emily J. H. Jones, Jean Kelly, Geraldine Dawson
The first Autism Research Matrix (IACC, 2003) listed the identification of behavioural and biological markers of risk for autism as a top priority. This emphasis was based on the hypothesis that intervention with infants at-risk, at an early age when the brain is developing and before core autism symptoms have emerged, could significantly alter the developmental trajectory of children at risk for the disorder and impact long-range outcome. Research has provided support for specific models of early autism intervention (e.g., Early Start Denver Model) for improving outcomes in young children with autism, based on both behavioural and brain activity measures. Although great strides have been made in ability to identify risk markers for autism in younger infant/toddler samples, how and when to intervene during the prodromal state remains a critical question. Emerging evidence suggests that abnormal brain circuitry in autism precedes altered social behaviours; thus, an intervention designed to promote early social engagement and reciprocity potentially could steer brain development back toward the normal trajectory and remit or reduce the expression of symptoms.