פרק 23 Chapter 23 Fatigue, Asthenia, Anxiety, and Depression

Question 1

Answer 1

שתן לקטכולאמינים

Symptoms of persistent anxiety
with insomnia, lassitude, and fatigue should always raise the suspicion of a depressive illness, especially when they begin in middle adult life or beyond. Also, unexplained anxiety or panic attacks may sometimes herald the onset of a schizophrenic illness. As with fatigue, the symptoms of both anxiety and depression are prominent features of the postconcussion syndrome, and of posttraumatic stress syndrome (see Chap. 35). These disorders highlight the difficulty in separating generalized anxiety disorder as a unique psychiatric entity. When visceral symptoms predominate or the psychic counterparts of fear and apprehension are absent, the presence of thyrotoxicosis, Cushing disease, pheochromocytoma, hypoglycemia, and menopausal symptoms should be considered.

Question 2

מה הפתוגן שמקושר עם
chronic fatigue syndrome?
1. EBV
2. west nile
3. ricketssia

Answer 2

EBV

The majority of patients are women between 20 and 40 years of age, but there are undoubtedly young men with the same illness. A few such patients had been found to have unusually high titers of antibody to Epstein-Barr virus (EBV), which suggested a causal relationship and gave rise to terms such as the chronic infectious mononucleosis or chronic EBV syndrome
In intractable cases, tuberculosis, brucellosis, Lyme disease, hepatitis, bacterial endocarditis, mycoplasmal pneumonia, HIV, EBV, cytomegalovirus (CMV), coxsackie B, and other viral infections, and malaria, hookworm, giardiasis, and other parasitic infections need to be considered in the differential diagnosis, and an inquiry made for their characteristic symptoms, signs, and when appropriate, laboratory findings; however, such infections are infrequently found

Question 3

בן 21 היה מעורב בתאונת אופנוע לפני שלושה חודשים. מאז הוא חולם חלומות על התאונה ונמנע
מנהיגה. מההגדרה המתאימה למצבו?
א. Acute stress disorder
ב. Conversion disorder
ג. Dysthymia
ד. Post traumatic stress disorder

Answer 3

Post traumatic stress disorder

Posttraumatic Stress Disorder
extremely stressful or traumatic event causes fear and helplessness, triggering a persistent psychologic state in which the patient reexperiences the event, avoids reminders of it, and is in a constant state of hyperarousal. Current diagnostic criteria require that this condition persist for over a month; if **briefer, the condition is termed “acute stress disorder.” **

overlap with anxious depression, the critical difference being the existence of a triggering traumatic event.

The biologic distinctions between anxious depression and PTSD include lower-than-normal cortisol levels, an attenuated increase of these levels in the immediate aftermath of the event, and an exaggerated suppression in response to dexamethasone. However, elevated circulating levels of norepinephrine and increased sensitivity of alpha2-adrenergic receptors that are found in the posttraumatic syndrome are shared with all other anxiety states

PTSD represents a special type of induced anxiety state with fairly stereotyped psychologic aspects, often with an accompanying depression and somatic symptoms.
. An emerging notion is that sedatives or narcotics administered immediately after the inciting event may reduce the incidence and severity of PTSD, for example in battlefield conditions.
Selective serotonin reuptake inhibitors have been suggested for initial treatment but the other classes of antidepression drugs are also effective.