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It was determined that Samantha more likely had a personality-related emotional dysregulation condition, namely a borderline personality style. Because of Samantha’ s relatively high level of functioning, it was considered she had a borderline style rather than meeting full DSM-5 criteria for the disorder. Drug and alcohol use were noted as an important comorbid issue, but not the primary cause of mood swings.
The evidence indicated that psychotherapy should be the primary focus of treatment— such as dialectical behaviour therapy( DBT). 3 This therapy works across multiple domains including distress tolerance, interpersonal effectiveness, mindfulness and emotion regulation, with evidence that mood swings improve. 4
Outcome There can be a reluctance to diagnose BPD, as it is often considered a pejorative diagnosis or one
The Recommended Dose Podcast of the Week
THIS new podcast from Cochrane Australia involves candid long-form interviews with some of the most interesting figures in global health.
But do not let the cordial discussion style of the host, world-reknown-reporter-turnedresearcher Dr Ray Moynihan( PhD), disarm you. He asks plenty of tough questions and extracts some
fascinating answers. The first episode’ s guest is the editor-in-chief of the BMJ, Dr Fiona Godlee, who discusses political interference in medicine and why the journal decides to run hardhitting campaigns such as the need for transparency on statin research, among other juicy topics.
Subsequent guests include
in which treatment is ineffective. Discussion with Samantha involved explaining that the mood swings arose from her personality style rather than from a mood disorder, namely bipolar disorder. Samantha felt that the borderline personality style diagnosis“ made sense”, particularly in light of her rapid shifts in mood being triggered by relationship problems.
She was also relieved that she did not need to start medication. We discussed referral to a clinical psychologist with expertise in DBT to work on skills over 10 sessions. Additionally, she was taking steps to limit her drug and alcohol intake. A scheduled review was made to evaluate her progress and determine whether more intensive treatment was warranted, such as through a private hospital outpatient group DBT program. ● References on request.
controversial US psychiatrist Dr Allen Frances and pharmacologist / researcher Professor Lisa Bero.
The podcast is published by Cochrane Australia, and new episodes are released every week.
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Q. This X-ray is pathognomonic of? a. Calcaneal cyst. b. Osteochondroma. c. Intraosseous lipoma. d. Osteogenic sarcoma. e. Metastasis. A. The answer is c. This site is the classical position for a number of lesions including the calcaneal pseudocyst. This appears to be present because of the paucity of trabeculae causing a normal triangle in this location, but it is normal. It is also the site for the true calcaneal cyst and the intraosseous calcaneal lipoma. It is a very unusual site for any of the other conditions. Features to look for in addition to site include margins and the presence or absence of any central density / matrix. In this case, there is a dense central nodule. Intraosseous lipomata are always situated within the medullary cavity. Some 32 % are in the calcaneus, and they are the most common calcaneal lesion. |
Q. What has caused the central density? a. Fat necrosis. b. Calcifying matrix. c. Ossifying matrix. A. The answer is a. The central density is classical for fat necrosis. Other lesions with central density are usually either bone or cartilage tumours, but the bony or calcific matrix is usually less well-defined and less obviously central. It is described as being arcs and rings and is more smudgy. The nodule is seen so well because the central area of fat necrosis is within an area of fat( which is very low density). The contrast between high and low radiographic density is maximal in this lesion. Without the nodule, the appearance would be indistinguishable from a bone cyst and CT or MRI would be necessary to differentiate the two. This is, however, rarely done because they are both benign and of limited significance. |
Q. Which complications |
may occur? a. Lesions may become malignant. b. Lesions may fracture. c. Both of the above. A. The answer is c. This does require sporadic follow-up. These lesions may be painful with or without complication. Very rarely they may become malignant but more commonly may fracture depending on lesion size and trauma / force applied.
Q. Is osteomyelitis excluded? a. No. b. Yes. A. The answer is a. Osteomyelitis can never be excluded on plain film. Findings are extremely subtle unless chronic. The acute findings are soft tissue swelling / blurred soft tissue planes, localised osteopenia and rarely, cortical loss or periosteal reaction. Occasionally, chronic signs will be seen and include the formation of involucram, sequestrum( dead dense bone) and cloacae( for drainage).
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Don’ t fear the walking dead
Medical history
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ARE werewolves just hairy humans? Are vampires simply in need of an iron supplement? And should zombies swap their cries for brains for a call to poison control? It seems many mythological monsters may have more medical than mystical origins.
The metamorphosis of man into beast, into something subhuman, is central in the legends and lore of lycanthropy.
An obvious medical inspiration is hypertrichosis, known colloquially as‘ werewolf syndrome’: a condition causing excessive hair growth on the body. Similarly, a rabid patient mirrors
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the werewolf myth very closely. Rabies, which has plagued mankind throughout history, is transmitted by the bite of an infected animal. Directly affecting the CNS, symptoms include agitation, hallucinations, hypersalivation and fear of water, with the condition being invariably fatal before immunisation or post-exposure prophylaxis.
And it seems rabies has a lot to answer for. The zoonotic disease may have also spawned the zombie idea, transforming the bitten into the mindless, flesh-seeking‘ undead’. Supposedly, real-life zombies have been documented in Haiti, where in one case, a teenage boy came back from
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the dead almost a year after his burial.
While locals assumed he was the victim of a voodoo curse, a doctor studying the incident concluded that he was more likely poisoned using a paralysing powder from a native puffer fish, only mimicking death.
The doctor purported that his altered mental state was caused by oxygen deprivation from his burial and that the boy must have managed to claw his way out of his shallow grave before wandering aimlessly around the area for a year— which, granted, is only marginally less terrifying than the real thing.
Sophie Attwood
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