By X. Mirzo. Robert Morris College, Pittsburgh, PA.
In 2009 the factory received a large order for armour plates cheap maxalt 10mg with amex arch pain treatment running, which meant that for a long period of time he only worked with steel with added vanadium order maxalt 10 mg without prescription drug treatment for shingles pain. Subsequently he developed irritation of eyes and nose cheap 10 mg maxalt fast delivery shoulder pain treatment guidelines, and a few days later he was diagnosed with pneumonia. The injured person was exposed to vanadium, which is released in connection with the production of steel/armour plates. There is good time correlation between the exposure in the workplace and the disease. Item on the list The following mental disease is included on the list of occupational diseases (Group F, item 1): Disease Exposure F. Posttraumatic stress Traumatic events or situations of short or longer duration that are of an disorder (where symptom exceptionally ominous or catastrophic nature onset of the disease is within six months and the disease is fully present within a few years) 1. A: Exposure to stressful events or situations (either short- or long-lasting) of an exceptionally threatening or catastrophic nature B: 1. Repeated reliving of the trauma in intrusive memories ("flashbacks") or nightmares, or 2. Severe discomfort at exposure to circumstances reminiscent of the trauma C: Avoidance of all activities reminiscent of the trauma D: 1. Partial or total loss of memory (amnesia) regarding the traumatic experiences or 2. Persistent symptoms of autonomic hyper arousal with hyper vigilance, including at least two of the following a. However, the English version also shows that it is possible to specifically disregard the requirement. Recognition will be based on an assessment of the diagnosis made by a specialist of psychiatry. It is the National Board of Industrial Injuries that assesses whether the diagnosis requirements are met, including the requirements for extraordinarily stressful mental exposures and the time correlation. Other diagnoses such as stress response (including acute or unspecified stress response), adjustment reaction and depression are not covered by item F. A number of the other conditions/diseases may, however, in case of extraordinary mental stresses, be recognised without the list after submission of the case to the Occupational Diseases Committee. Exposure requirements The disease is deemed to be caused mainly by external stresses and may perhaps have permanent mental consequences. In principle it is not possible to make this diagnosis unless there has been exposure to traumatic events or situations, short- or long-lasting, of an exceptionally threatening or catastrophic nature. Examples of relevant exposure may be severe threats causing a sense of mortal danger, for instance war action, being under fire, or dangerous driving in mined areas rescue work in catastrophe areas with severe stresses mortal danger when exposed to violence or threats of violence 1. Examples of pre-existing and competitive diseases/factors In some cases there may be pre-existing or competitive mental illness which is without any correlation with the particularly stressful exposures in the workplace, but relevant for the overall pathological picture. Similarly, other circumstances than circumstances related to work may be significant for a persons mental condition. Examples of pre-existing or competitive diseases may be depression, anxiety, psychoses, or similar disorders. Other symptoms or exposures not on the list will in special cases qualify for recognition after submission to the Occupational Diseases Committee. The following mental diseases may, after a concrete assessment, be deemed to have been caused by external stresses and may be recognised after submission of the claim to the Committee: Stress response (including acute stress response, other stress disorders and unspecified forms of stress response (F43)) Depression (including depressive single episode F32). Most depressions are passing, and usually it is not possible to distinguish these from the more persistent types of depression, other than by following the course of the disorder. Enduring psychoses are not, however, deemed generally to have external stress factors as dominant causes Enduring personality change after catastrophic experience F62 (when the disease is not covered by the diagnosis of posttraumatic stress disorder) Whether these mental diseases will be deemed to have been caused by a work-related exposure will depend on a concrete assessment including symptom onset, the course of the disease and the nature and extent of mental exposures. Mental illness with the diagnosis of adjustment reaction will not normally qualify for recognition as an occupational disease. This diagnosis covers very moderate, unspecified and passing mental complaints which are not usually regarded as actual occupational diseases within the meaning of the Act and may besides develop after even very moderate exposures. Examples of decisions based on the list Posting (military stationing and relief work) Example 1: Recognition after stationing to the peace-keeping forces An officer who was stationed more than once, to regions at war, in the peace-keeping forces saw how a local soldier was executed by being shot through the mouth. He was furthermore exposed to a number of violent incidents, both direct war action and assaults on civilians. As part of the service in the peace-keeping forces, the officer had been exposed to a number of stressful situations. The medical examinations established a mental disease in the form of posttraumatic stress disorder, and there was good correlation between the work-related exposures of an exceptionally threatening and stressful nature and the disease. Example 2: Recognition after relief work A driver drove relief supplies to regions at war. He saw how whole towns were wiped out and he had to drive in regions with direct war action. The convoy was stopped every day by armed soldiers or civilians who threatened him with arms to get money etc. The driver developed posttraumatic stress syndrome after having been exposed to a number of violent incidents as a driver delivering relief supplies in regions with direct war action and threats in connection with robberies and similar incidents. There is furthermore good correlation between the work-related exposures and the disease. Example 3: Recognition after work for relief organisation in Kosovo A male employee in a Danish relief organisation worked for nearly 6 months as a warehouse manager in a major city in a region at war, where he was exposed to violence and murder threats.
Organic personality disorder has been described buy 10 mg maxalt blaustein pain treatment center, particularly among the apathetic elderly maxalt 10mg visa cape fear pain treatment center dr gootman. Distraibility and over-arousal have also been reported purchase maxalt 10 mg free shipping tailbone pain treatment home remedy, sometimes leading to persistent cognitive impairment, which may continue even after the patient is euthyroid (Stern et al, 1996). Specific cognitive difficulties in hyperthyroid patient have been described, such as deterioration of memory, concentration or visuomotor speed (MacCrimmon et al. The initial symptoms in hyperthyroidism may be quite similar to anxiety disorders, but the described, unusual symptoms of anxiety may alert the clinicians (Kathol et al. Other symptoms that should alert the physicians are the preference for cold and intolerance to heat, or loss of weight coupled with increased appetite. A careful medical history and examination are mandatory in such cases and the laboratory test would usually give unequivocal answers to the diagnostic difficulties. An accelerated pulse during sleep or cognitive difficulties are also considered to suggest the diagnosis of hyperthyroidism in such cases (Hall et al. To help in the differential diagnosis some specific scales have been developed (Iacovides et al, 2000). Transient thyroid hormone elevations, usually mild, may occur in approximately 10% of psychiatric inpatients, but should not be diagnosed of hyperthyroidism. Thyroid abnormalities have also been documented in some studies in primary affective disorders (Oomen et al. Other clinical situations may mimic the thyroid condition before the laboratory results are available, such as abuse of stimulants or drug intoxications. However, the nervousness and emotional lability in hyperthyroid patients may be wrongly diagnosed as alcohol abuse or abstinence. The clinical interest derives from the fact that it has been associated with cognitive deterioration and dementia in the elderly (Kalmijn,2000;Ceresini,2009), both in cross-sectional and longitudinal studies. While the clinical and epidemiological studies reviewed support the association of hyperthyroid function with psychopathological disturbance, the causal mechanisms are not clear (Bunevicius et al. One study suggested that the active thyroid hormone (T3) influenced mental performance in healthy subjects (Kathmann et al. The individuals overestimated time intervals and increased their word fluency, but no other cognitive problems were detected. Prez-Echeverra (1985) and Lobo et al (1988) documented direct, convincing correlations between abnormal levels of thyroid hormones and psychopathology. The abnormal psychological phenomenon seemed to be directly related to the endocrine disturbance, since non-endocrine medical patients in the same ward, and with similar levels of illness severity had lower levels of psychopathology. In general, there is a good resolution of anxiety and depression with antithyroid treatment alone, unless there is previous psychiatric history (Kathol et al. Beta-blockers such as propanolol are also considered to be effective in cases of anxiety (Trzepacz et al, 1988). However, recovery may be slow and reduced psychological well-being has been reported in a considerable proportion of remitted hyperthyroidism (Prez-Echeverra, 1985). Bunevicius also reported persistent mood and anxiety symptoms in treated hyperthyroidism (Bunevicius et al. Low potency 248 Thyroid and Parathyroid Diseases New Insights into Some Old and Some New Issues neuroleptics such as haloperidol and perphenazine have been reported, including symptoms resembling thyroid storm and malignant neuroleptic syndrome. Finally, treatment of depression is recommended if psychopathological symptoms are severe or persistent. Hypothyroidism Classical symptoms of hypothyroidism include fatigue and weakness, somnolence, weight gain, constipation and cold intolerance. However, other common symptoms may suggest primary psychiatric disease and include lethargy, progressive slowing, diminished initiative and impaired concentration and memory. Congenital hypothyroidism is also well known, and usually occurs as the consequence of thyroid dysgenesis, and more rarely as the result of inherited defects in the synthesis of thyroid hormone. This syndrome is characterized by mental retardation, aside from the classical somatic and neurological signs. Screening programs for hypothyroidism at birth are now mandatory to prevent this severe condition. The most frequent cause of adult hypothyroidism is Hashimotos thyroiditis or autoimmune thyroiditis. Treatment of Graves disease with radioactive iodine may also lead to hypothyroidism, but an important iatrogenic cause in psychiatric patients is the side effect of lithium, particularly in vulnerable individuals such as women or rapid cyclers. There are no good prevalence studies of psychiatric disturbance in hypothyroid patients, but the main psychiatric syndromes have been described in case reports and/or clinical samples. The depressive syndromes may mimic primary affective disorder, particularly in old women, and may need the checking of hormonal levels for the differential diagnosis. Marked irritability and labiliy of mood may alert to the presence of atypical syndromes, suggesting an organic condition. Thyroid replacement is required in such cases and is usually effective, although depression persists in a proportion of patients A special emphasis should be placed in subclinical hypothyroidism. The relevance of subclinical hypothyroidism is derived from the fact that depression is common and may severely affect quality of life. The same authors have recently reported that depression in such patients is more frequent than among patients with overt hyperthyroidism (Chueire et al. Furthermore, they conclude that subclinical hypothyroidism increases more than four times the risk of depression, and highlight the relevance of thyroid screening tests in Thyroid and Parathyroid Diseases and Psychiatric Disturbance 249 the elderly. It has been suggested that subclinical hypothyroidism is rather common in the general population, particularly in the adult and elderly women, but may go undetected and untreated.