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The relationship between depression and medical illness
Depression frequently coexists with medical illnesses, complicating treatment of both conditions. Some evidence even suggests a bidirectional relationship between mood disorders and certain medical illnesses. How do medical illnesses and mood disorders interact, and what are the clinical implications?
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Sarcoidosis: An enigmatic disease calls for a measured workup
Treatment options for sarcoidosis range from observation to complex immunosuppressive agents and organ transplant. A careful examination will help you assess the likelihood of spontaneous remission and determine when to initiate appropriate treatment to forestall organ damage.
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Cultural Competence: Caring for refugees
A female refugee from Bosnia presents with severe migraine headaches. Earlier in her life, she'd had one or two migraine episodes, but recently they've grown much more frequent and more intense. Now they're disabling. Why? The doctor looks for triggers to no avail.
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CASE & COMMENT: A machinist with a very painful hand
A 44-year-old white man presents with a painful right hand that is white and cold, with apparent early-stage ulceration in the fingertip pads of the index, middle, and ring fingers. The pain limits his ability to adjust his milling machine at work as he was instructed; by banging the butt of his palm on the levers and wrenches. The patient describes a gradually worsening throbbing pain of 1 month's duration that is exacerbated by cold. Cradling the hand attenuates the pain. No symptoms are reported that are consistent with systemic disease, Raynaud's syndrome, infection, prescription drug use, or other nontraumatic cause of injury. The patient is a smoker and uses alcohol.
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