Tag: management

Cervical Incompetence-Management


Cervical Incompetence-Management


Cervical incompetence managed by using cerclage procedures. The 3 types of cerclage that are used are:

1. McDonald’s Cerclage (M/C)

2. Shirodkar Cerclage

3. Abdominal Cerclage -Benson & Durfee Cerclage

Antiphospholipid antibody syndrome-Management


Antiphospholipid antibody syndrome-Management


If APLA is diagnosed based on H/O Abortion then aspirin along with low molecular weight heparin has to be given
Aspirin:
• Aspirin low doses= 50-100mg (80mg)

• Started-Urine Pregnancy Test (UPT) +ve

• Continued throughout Pregnancy

• Stopped 4-6 days before labor

Heparin:

Started- Only after confirmation of IU pregnancy

Continued throughout Pregnancy

Stopped at onset of labor

If APLA is diagnosed based on the criteria of Preterm Labor give only Aspirin @ the end of first trimester ;dose- 50-100mg (80mg).

Sickle cell crisis


Sickle cell crisis


→ It is characterized by intense bone pain due to intense sequestration of sickled erythrocytes & infarction in various organs.

→ Pregnancy can precipitate sickle cell crisis in both women with sickle cell trait and sickle cell disease.

Management:

→ IV fluids, O2

→ Epidural analgesia

→ Antibiotics

→ Thromboprophylaxis

Note: Red cell transfusion after the onset of pain do not have much benefit but prophylactic transfusions before the crisis, helps in decreasing the pain and shortening the duration of crisis.

Keratoconus-Management


Keratoconus-Management


Keratoconus is managed by:

→ Glasses

→ Contact lenses:

  • Soft contact lenses should not be used
  • Semi soft contact lenses are prescribed

→ Corneal Hydrops:

  • Occurs in Keratoconus
  • Descemet’s membrane perforates & aqueous humour enters corneal stroma.
  • With time hydrops heals with central scarring.
  • Rx by Keratoplasty.

→ C3 R (CxR)

  • Corneal collagen crosslinking with Riboflavin, new modality of Rx.
  • Stops progression, increases strength of cornea with covalent bonding (UV irradiation with riboflavin)

PTSD


PTSD


  • Follow significant traumatic events to self or others
  • Symptoms Include
  • Intrusion Symptoms – Flashbacks & Nightmares
  • Avoidance – Avoids all stimuli which reminds of the trauma
  • Arousal Symptoms – Hypervigilance, ↑ Startle response, insomnia, poor concentration
  • Other – Emotional numbing, emotional detachment, anhedonia
  • Symptoms > 1 month then PTSD, if < 1 Month then ACUTE STRESS SYNDROME
  • IF symptoms occur after 6 months then delayed PTSD
  • Involved Hippocampus and amygdala

Management:

  • SSRIs
  • Cognitive behavioral therapy, Psychodynamic therapy and EMDR
  • EMDR [Eye movement desensitization and reprocessing]

Adjustment disorders


Adjustment disorders


  • Characterized by emotional response to stressful events like financial, medical, relationship problems
  • Symptom complex include anxiety and depressive symptoms
  • Need to be differentiated from depression. Diagnosis of depression takes precedence
  • Management – Psychotherapy [Supportive psychotherapy]

Phobia-Management


Phobias-Management


  • Pharmacotherapy – BDZs, SSRIs
  • Psychotherapy – Behavior therapy is the most effective
  • Systematic Desensitization – [Exposure / Relaxation] Best Evidence in T/T of Phobias
  • Therapeutic graded exposure [Exposure and response prevention]
  • Flooding [Implosion]- Exposed in Most severe form
  • Modeling [Participant modeling]- Therapist himself makes contact with phobic stimulus

Social Anxiety Disorder [Social Phobia]:

  • Fear of social situation including contact with strangers
  • Afraid of embarrassing themselves

OCD-Management & prognosis


OCD-Management & prognosis


Management:

Pharmacotherapy:

  • First Line – SSRIs and Clomipramine [adverse side effect profile]
  • If first line fails then antipsychotics [Haloperidol, quetiapine, risperidone, olanzapine]
  • Other Drugs [Venlafaxine, Lithium, valproate and carbamazepine]

Psychotherapy:

  • Cognitive Behavior therapy [Exposure & Response prevention]
  • Desensitization, thought stopping, flooding and aversive conditioning

Other T/T modalities – ECT, Psychosurgery [Cingulotomy, capsulotomy – Caudate tractotomy]

Prognosis:

Acute Onset – 50%. 20-30% Significant improvement, 40-50% moderate, rest may so deterioration

Panic Disorder-Management


Panic Disorder-Management


Establishing a Differential Diagnosis:

  • MI / Angina / Other Cardiac Conditions
  • Asthma / Other Pulmonary conditions
  • Hypothyroidism, Hypoglycemia, Carcinoid Syndrome, Pheochromocytoma.

After ruling out all the above-mentioned conditions, the management of panic disorder involves:

  • BDZ and SSRIs
  • Psychotherapy – Cognitive Behavioral therapy
  • Relaxation techniques

Agoraphobia


Agoraphobia


Fear of places where escape might be difficult

  • Fear of being in open spaces / Crowded Spaces
  • Fear of enclosed spaces
  • Fear of travelling alone or using public transport

Very disabling phobia as patient may become home bound

Management:

  • BDZ and SSRIs
  • Behavior therapy – Systematic desensitization, flooding, exposure and response prevention
  • Relaxation techniques
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