1/4. depression, chronic fatigue, and the premenstrual syndrome.depression, chronic fatigue, and premenstrual syndrome often coexist in women seeking treatment for premenstrual distress. A reliable diagnosis can be made by prospectively rating symptoms for two cycles, taking a careful history, performing physical and gynecologic examinations, and obtaining basic laboratory test results and a psychosocial evaluation. Appropriate dietary, hormonal, or antidepressant treatment provided in a caring and competent manner can benefit many women suffering from this otherwise disabling/condition.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/4. Recognition and treatment of premenstrual syndrome.premenstrual syndrome (PMS) is the title applied to a broad range of physical and psychological symptoms that occur cyclically, usually seven to 14 days prior to the onset of a woman's menstruation, and disappear during menstruation. Although the symptoms of premenstrual syndrome were described more than 50 years ago, recognition of PMS by the medical establishment as a discrete condition, which requires attention and treatment, is a fairly recent development. It is estimated that 30 percent of women experience PMS in a debilitating form at some point in their lifetimes from menarche to menopause. The symptomatology of PMS is varied; it includes such psychological symptoms as irritability, depression, oversensitivity, mood swings and anxiety, in addition to such physical symptoms as water retention, breast tenderness, weight gain and migraines. This broad range of symptoms has increased the difficulty of establishing an etiology for the syndrome, and it is now suggested that there may be several processes at work, each responsible for a different aspect of PMS. Care of the PMS patient by nurse practitioners initially requires acknowledgment of the legitimacy of her condition. A detailed physical examination should be accompanied by careful interviewing to elicit the most complete picture of the patient's experience with PMS. Treatment, which can involve dietary changes, hormone or antigonadotropin administration, must be individualized according to a patient's initial symptomatology and subsequent response. At present, research is in progress which will enhance our understanding and ability to deal with PMS.- - - - - - - - - - ranking = 3keywords = physical (Clic here for more details about this article) |
3/4. Biochemical victims: false negative diagnosis through overreliance on laboratory results--a personal report.The increasing tendency of doctors to base diagnosis on the results of laboratory investigations entails a corresponding decrease in the exercise of clinical judgment. This state of affairs can have harmful consequences for patients suffering from biochemically atypical forms of disorder, who may acquire functional psychiatric labels when they are in fact suffering from organic physical disorders. The author's personal experience of this invidious predicament is described. Although hypothyroidism was correctly diagnosed on clinical grounds within a few months of presentation, laboratory results were inconclusive and three years and three specialist consultations were to elapse before replacement therapy was obtained, and then only through unofficial channels. The handling of this case illustrates some unfortunate trends in contemporary medical practice with important implications for the health of patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/4. Hormonal therapy in the management of premenstrual syndrome.BACKGROUND: premenstrual syndrome (PMS) is characterized by any of a number of physical and psychological symptoms consistently occurring in the late luteal phase. progesterone therapy is often recommended based on anecdotal evidence, although controlled studies have shown it to be ineffective. Oral contraceptives are more often used with mixed results. When hormonal therapy for PMS is indicated, the most appropriate choice remains a challenge. methods: We describe a case report of successful hormonal therapy for PMS and a review of the literature on the effectiveness of hormonal therapies. RESULTS AND CONCLUSIONS: Estrogen is clearly effective in relieving symptoms of PMS, whereas progesterone is ineffective and might even worsen symptoms. Combination oral contraceptives are effective, undoubtedly as a result of the estrogen component. While little comparative data exist to guide choice of an oral contraceptive, maximizing the relative estrogenic potency of the oral contraceptive seems logical. Depressive symptoms might not respond to hormonal treatment, and new research suggests that selective serotonin reuptake inhibitors might be particularly effective.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |