How is Your Brain Working Now? A Questionnaire for Hypothyroid Patients
|
|
- Julius Percival Hampton
- 8 years ago
- Views:
Transcription
1 How is Your Brain Working Now? A Questionnaire for Hypothyroid Patients In the Volume XIII, Number 1 issue of The Bridge, we asked patients who had formerly been hyperthyroid how they felt. Most thyroidologists would have guessed along with me that the majority of thyroid patients would have said they felt well, but that wasn t the case. Only 34% of these patients said they felt well. 66% complained of weight gain and 32% felt they were more than 20 pounds over their optimum weight. There is a good deal of research going on right now about weight loss in general and if some research suggests that special techniques work best for thyroid patients with weight problems, we will keep you informed in this newsletter and on our website, Cognitive Function Complaints Thyroid patients had other concerns that were almost as common. 59% complained of myalgia, lethargy, depression, or a combination of all three, and a surprising number commented without a related question being asked that they felt their brain just wasn t working right. This vague area about how hypothyroid patients feel on their treatment is a particularly hot topic in thyroid research today. Investigators are looking in particular at the question of whether individuals with hypothyroidism feel better with a combination of rapidly acting T3 hormone (cytomel) in addition to the usually prescribed T4 (thyroxine) including Levythroid, Levoxyl, and Synthroid. (See Bridge Vol. XIV, No. 1.) We thought we would take a closer look and try to find out exactly what kind of cognitive problems thyroid patients are experiencing and see if we can get some clues which might help guide researchers into understanding these patients better. If You Take Thyroid, Please Respond! It could be that individuals who are hypothyroid after treatment for Graves disease are different from those whose thyroid has been removed for thyroid cancer or a hyperfunctioning thyroid nodule. Therefore, if you are hypothyroid now from any cause, please complete this questionnaire so we can tell if there are differences in individuals with these different disorders. We re particularly anxious to have patients with cancer who have never been hyperthyroid answer the questionnaire. Obtaining the Results of the Survey If you will send us your address we will send you a copy of the survey report when completed. Your name, address, and/or will not be shared with anyone else and is only retained by us to be able to send you the report or possibly to contact you if we can t
2 read your handwriting or want to understand one of your answers to a survey question. Finally, if you know of other individuals who are hypothyroid, please do not hesitate to pass the questionnaire along to them too. Additional copies can be obtained by telephoning our home office at Background Information Cognitive Function in Patients with Hypothyroidism Name Last First Middle Initial Address Street City State ZIP Telephone number ( ) - Your Diagnosis (note all that apply to you): Hyperthyroidism ψ Graves disease (diffuse toxic goiter) ψ Hyperfunctioning thyroid nodule Hypothyroidism Hypothyroidism after treatment for hyperthyroidism ψ Radioiodine ψ Surgery ψ Medication ψ Hypothyroidism due to chronic thyroiditis (Hashimoto s disease) ψ Hypothyroidism after surgery for goiter ψ Hypothyroidism after treatment for thyroid cancer Year of onset of hyperthyroidism Year of onset of hypothyroidism Year of treatment for thyroid cancer: Surgery Radioiodine
3 Current thyroid medication and dose Date of last TSH blood test to be sure treatment dose is correct Do you have problems with mental function including thinking, concentration, memory, organizing, planning, and distractibility? Yes No If yes, what year did these problems begin? If yes, please answer the questions under A below Do you have problems with depression or sadness Yes No If yes, please write the year(s) when depression occurred If yes, please answer the questions under B below A (Cognitive Function) 1. I have difficulty concentrating. 2. I have a hard time completing tasks. 3. I have trouble getting organized. 4. I have trouble planning how to do something. 5. I am easily distracted. 6. I get mad easily. 7. I have trouble planning to do what is most important. 8. I can t keep track of time. 9. I can t remember appointments. 10. I have trouble paying attention. 11. I feel hyperactive a lot of the time. 12. I am not as productive as I used to be. 13. I feel guilty a lot. 14. It s hard to adjust when plans must be changed. 15. I am impulsive. 17. Because my brain isn t working right, I had to A Lot (Yes) A Little Not at All (No)
4 change jobs. 18 I am confrontive (argue a lot). B (Depression) 1. I am often moody and sad. 2. I cry a lot. 3. I have trouble sleeping. 4. I have an eating disorder because I am depressed. 5. Sometimes I don t think much of myself. 6. I have been treated for depression with medication. 7. I have been hospitalized for depression. 8. I have an intermittent depression, sometimes feeling well and sometimes depressed. A Lot (Yes) A Little Not at All (No) Childhood recollections and general characteristics 1. I am left-handed. 2. I am right-handed. 3. I am ambidextrous. (Do you do anything lefthanded? Please comment.) A Lot (Yes) A Little Not at All (No) When you fold your arms comfortably in front of your chest, which arm is on top? 4. I have trouble spelling. 5. I have poor handwriting that others often cannot read. 6. I sometimes reverse letters or numbers. 7. I don t read books for pleasure, preferring other sources of information. 8. I stayed back one or more years in school. 9. I have had a diagnosis of dyslexia. (Please state
5 year.) 10. I have had a diagnosis of ADHD (Attention Deficit Hyperactivity Disorder). (Please state year.) 11. I know I am smart, but do not do well in school. 12. I have had trouble with confrontive behavior (fighting or arguing). 13. I have an addictive disorder (gambling, alcohol, smoking). 14. I am a very good athlete. 15. I am a very good musician. 16. I am very artistic. 17. I have trouble with muscle spasm (tics). (Please state years.) The effect of illness and medication on cognitive function I felt better before age 20 than I do now. When I was hyperthyroid, I felt ψ Better (please specify) ψ Worse (please specify) During pregnancy I felt ψ Better (please specify) ψ Worse (please specify) Treatments If you have received any of the following treatments we would like to know whether it helped so that we can encourage thyroid investigators to study these treatments more. Please tell us whether you have been treated with any of the following and say whether it helped a lot, a little, or not at all. Date Helped Helped Did Not
6 Educational counseling in school Psychotherapy Hospitalization Medications Lithium Amitriptyline Desipramine A Lot A Little Help Welbutrin Prozac Paxil Ritalin Dexedrine Conserta Adderal Tomoxetine Provigil Other (specify) What s Next? Thank you for answering these questions. We hope that by summarizing the experience of a number of thyroid patients we ll be able to tell whether particular patterns of cognitive function seem to be more common inpatients with certain kinds of hypothyroidism. We will send you a copy of the summary and pass it on to thyroid specialists who are investigating these areas in the hope that it will help develop new techniques to treat thyroid patients who are having trouble with cognitive function. Thank you for taking the time to respond to this informal survey. We hope that our efforts will help investigators understand thyroid patients better and enable them to develop new techniques to help those in need. Lawrence C. Wood, M.D., F.A.C.P. Medical Director, TFA the completed questionnaire to: info@tsh.org or mail to: The Thyroid Foundation of America, Inc., 410 Stuart Street Boston, MA 02116
Patient Guide to Radioiodine Treatment For Thyrotoxicosis (Overactive Thyroid Gland or Hyperthyroidism)
Patient Guide to Radioiodine Treatment For Thyrotoxicosis (Overactive Thyroid Gland or Hyperthyroidism) Your doctor has referred you to Nuclear Medicine for treatment of your overactive thyroid gland.
More informationThyroid-Stimulating Hormone (TSH)
Thyroid-Stimulating Hormone (TSH) Table of Contents Test Overview Why It Is Done How To Prepare How It Is Done How It Feels Risks Results What Affects the Test What To Think About References Credits Test
More informationEverything You Ever Wanted to Know About the Thyroid
Everything You Ever Wanted to Know About the Thyroid (but were afraid to ask ) Caroline Messer, MD Board Certified Internist, Endocrinologist, and Physician Nutrition Specialist Topics Thyroid Nodules
More informationBipolar Disorder. in Children and Teens. Does your child go through intense mood changes? Does your child have
Bipolar Disorder in Children and Teens Does your child go through intense mood changes? Does your child have extreme behavior changes too? Does your child get too excited or silly sometimes? Do you notice
More informationDepression is a medical illness that causes a persistent feeling of sadness and loss of interest. Depression can cause physical symptoms, too.
The Family Library DEPRESSION What is depression? Depression is a medical illness that causes a persistent feeling of sadness and loss of interest. Depression can cause physical symptoms, too. Also called
More informationDepression Overview. Symptoms
1 of 6 6/3/2014 10:15 AM Return to Web version Depression Overview What is depression? When doctors talk about depression, they mean the medical illness called major depression. Someone who has major depression
More informationPost-Traumatic Stress Disorder (PTSD)
Have you lived through a scary and dangerous event? A R E A L I L L N E S S Post-Traumatic Stress Disorder (PTSD) U S DEPARTMENT OF HEALTH AND HUMAN SERVICES NATIONAL INSTITUTES OF HEALTH II National Institute
More informationPost-Traumatic Stress Disorder (PTSD)
Have you lived through a very scary and dangerous event? A R E A L I L L N E S S Post-Traumatic Stress Disorder (PTSD) Post Traumatic Stress Disorder (PTSD) NIH Publication No. 00-4675 Does This Sound
More informationThyroid Disorders. Hypothyroidism
1 There are a number of problems associated with the thyroid gland. Hypothyroidism, hyperthyroidism, and thyroid nodules will be presented here. The thyroid gland is located in the middle of the neck,
More informationInterview for Adult ADHD (Parent or Adult Questionnaire)
Interview for Adult ADHD (Parent or Adult Questionnaire) (client s name here) is undergoing evaluation for Attention Deficit Hyperactivity Disorder (ADHD). You have been identified as someone who could
More informationGoiter. This reference summary explains goiters. It covers symptoms and causes of the condition, as well as treatment options.
Goiter Introduction The thyroid gland is located at the base of your neck. If the gland becomes abnormally enlarged, it is called a goiter. Goiters usually do not cause pain. But a large goiter could cause
More informationHow To Write A Recipe Card
Joanne R. Festa, PhD (PLEASE PRINT) NAME: DATE OF BIRTH: NEUROPSYCHOLOGY INITIAL VISIT DATE: AGE: Do you have any areas of concern about your cognitive functioning? (i.e., problems with memory, attention,
More informationPARTNERING WITH YOUR DOCTOR:
PARTNERING WITH YOUR DOCTOR: A Guide for Persons with Memory Problems and Their Care Partners Alzheimer s Association Table of Contents PARTNERING WITH YOUR DOCTOR: When is Memory Loss a Problem? 2 What
More informationBipolar Disorder. When people with bipolar disorder feel very happy and "up," they are also much more active than usual. This is called mania.
Bipolar Disorder Introduction Bipolar disorder is a serious mental disorder. People who have bipolar disorder feel very happy and energized some days, and very sad and depressed on other days. Abnormal
More informationA story of bipolar disorder
A story of bipolar disorder (manic-depressive illness) Does this sound like you? D E P A R T M E N T O F H E A L T H A N D H U M A N S E R V I C E S P U B L I C H E A L T H S E R V I C E N A T I O N A
More informationBRIEF NOTES ON THE MENTAL HEALTH OF CHILDREN AND ADOLESCENTS
BRIEF NOTES ON THE MENTAL HEALTH OF CHILDREN AND ADOLESCENTS The future of our country depends on the mental health and strength of our young people. However, many children have mental health problems
More informationNeuropsychological Testing Appointment
Neuropsychological Testing Appointment Steven A. Rogers, PhD Kathleen D. Tingus, PhD 1701 Solar Drive, Suite 140 Oxnard, CA 93030 When will it be? Date: Time: Examiner: What will I have to do? Each appointment
More informationSeniors and. Depression. What You Need to Know. Behavioral Healthcare Options, Inc.
Seniors and Depression What You Need to Know Behavioral Healthcare Options, Inc. Depression More Than Just The Blues ou may not know exactly what is wrong with you, but you do know that you just don t
More informationTreating Depression to Remission in the Primary Care Setting. James M. Slayton, M.D., M.B.A. Medical Director United Behavioral Health
Treating Depression to Remission in the Primary Care Setting James M. Slayton, M.D., M.B.A. Medical Director United Behavioral Health 2007 United Behavioral Health 1 2007 United Behavioral Health Goals
More informationUnderstanding. Depression. The Road to Feeling Better Helping Yourself. Your Treatment Options A Note for Family Members
TM Understanding Depression The Road to Feeling Better Helping Yourself Your Treatment Options A Note for Family Members Understanding Depression Depression is a biological illness. It affects more than
More informationLife with MS: Mastering Early Treatment
Life with MS: Mastering Early Treatment Essential Information About MS Multiple sclerosis (MS) is a disease that attacks the central nervous system (CNS). Approximately 2.5 million people worldwide and
More informationNEUROPSYCHOLOGY QUESTIONNAIRE. (Please fill this out prior to your appointment and bring it with you.) Name: Date of appointment: Home address:
NEUROPSYCHOLOGY QUESTIONNAIRE (Please fill this out prior to your appointment and bring it with you.) Name: Date of appointment: Date of birth: Age: _ Home address: _ Home phone: Cell phone: Work phone:
More informationThyroid Problems after Childhood Cancer
Thyroid Problems after Childhood Cancer Some people who were treated for cancer during childhood may develop endocrine (hormone) problems as a result of changes in the function of a complex system of glands
More informationA Parent s Guide to Understanding Congenital Hypothyroidism. Children s of Alabama Department of Pediatric Endocrinology
A Parent s Guide to Understanding Congenital Hypothyroidism Children s of Alabama Department of Pediatric Endocrinology How did you get here? Every baby born in the state of Alabama is required by law
More informationDepression in Older Persons
Depression in Older Persons How common is depression in later life? Depression affects more than 6.5 million of the 35 million Americans aged 65 or older. Most people in this stage of life with depression
More informationDepression. What Causes Depression?
National Institute on Aging AgePage Depression Everyone feels blue now and then. It s part of life. But, if you no longer enjoy activities that you usually like, you may have a more serious problem. Feeling
More informationMEDICATION INFORMATION FOR PARENTS - STIMULANTS
MEDICATION INFORMATION FOR PARENTS - STIMULANTS Patient Name is taking Medication Doctor's name If you have any questions about this medicine, please call the office at 631-3510. General Information about
More informationAre you feeling... Tired, Sad, Angry, Irritable, Hopeless?
Are you feeling... Tired, Sad, Angry, Irritable, Hopeless? I feel tired and achy all the time. I can t concentrate and my body just doesn t feel right. Ray B. I don t want to get out of bed in the morning
More informationProvidence Alliance for Catholic Teachers (PACT)
Providence Alliance for Catholic Teachers (PACT) Health and Wellness History Please place this form in a separate sealed envelope, marked with your name and Health and Wellness History. Submit to PACT
More informationBipolar Disorder. Some people with these symptoms have bipolar disorder, a serious mental illness. Read this brochure to find out more.
Bipolar Disorder Do you go through intense moods? Do you feel very happy and energized some days, and very sad and depressed on other days? Do these moods last for a week or more? Do your mood changes
More informationAdult Information Form Page 1
Adult Information Form Page 1 Client Name: Age: DOB: Date: Address: City: State: Zip: Home Phone: ( ) OK to leave message? Yes No Work Phone: ( ) OK to leave message? Yes No Current Employer (or school
More informationDENVER CHIROPRACTIC CENTER GLENN D. HYMAN, DC, CSCS
DENVER CHIROPRACTIC CENTER GLENN D. HYMAN, DC, CSCS Are you in the right place? Please read this before proceeding with paperwork: At Denver Chiropractic Center, we specialize in treating muscles with
More informationWHEN PROSTATE CANCER RETURNS: ADVANCED PROSTATE CANCER. How Will I Know If My Prostate Cancer Returns?
WHEN PROSTATE CANCER RETURNS: ADVANCED PROSTATE CANCER (The following information is based on the general experiences of many prostate cancer patients. Your experience may be different.) How Will I Know
More informationA Depression Education Toolkit
A Depression Education Toolkit Facts about Depression in Older Adults What is Depression? Depression is a medical illness. When sadness persists or interferes with everyday life, it may be depression.
More informationA story of bipolar disorder
A story of bipolar disorder (manic-depressive illness) Does this sound like you? D E P A R T M E N T O F H E A L T H A N D H U M A N S E R V I C E S P U B L I C H E A L T H S E R V I C E N A T I O N A
More informationDrug Abuse and Addiction
Drug Abuse and Addiction Introduction A drug is a chemical substance that can change how your body and mind work. People may abuse drugs to get high or change how they feel. Addiction is when a drug user
More informationMegan Ogle, PsyD Clinical Psychologist 1215 SW 18 th Avenue, Portland, OR 97205 971.313.4518 dr.meganogle@gmail.com
Megan Ogle, PsyD Clinical Psychologist 1215 SW 18 th Avenue, Portland, OR 97205 971.313.4518 dr.meganogle@gmail.com Client Information Date: Name: Preferred First Name: Date of Birth: / / SSN: - - Address:
More informationPATIENT INTAKE / HISTORY FORM PATIENT INFORMATION
Mona Mikael, Psy.D., PSY 25089 Neuro- Rehabilitation Psychologist Neuro- Rehab Psychological Consultation & Treatment 630 S. Raymond Ave., #340 Pasadena, CA 91105 626-710- 7838 Web: www.neurorehabtlc.com
More informationBIPOLAR DISORDER IN PRIMARY CARE
E-Resource January, 2014 BIPOLAR DISORDER IN PRIMARY CARE Mood Disorder Questionnaire Common Comorbidities Evaluation of Patients with BPD Management of BPD in Primary Care Patient resource Patients with
More informationADHD Medication: a Letter from Dr. Gray
ADHD MEDICATION ADHD Medication: a Letter from Dr. Gray After specializing in the medical assessment and treatment of ADHD for the past 20 years, I have seen what a positive impact medication can have
More informationPost-Traumatic Stress Disorder (PTSD)
Have you lived through a very scary and dangerous event? A R E A L I L L N E S S Post-Traumatic Stress Disorder (PTSD) Post Traumatic Stress Disorder (PTSD) NIH Publication No. 00-4675 Does This Sound
More informationCocaine. Like heroin, cocaine is a drug that is illegal in some areas of the world. Cocaine is a commonly abused drug.
Cocaine Introduction Cocaine is a powerful drug that stimulates the brain. People who use it can form a strong addiction. Addiction is when a drug user can t stop taking a drug, even when he or she wants
More informationNEW PATIENT HISTORY QUESTIONNAIRE. Physician Initials Date PATIENT INFORMATION
NEW PATIENT HISTORY QUESTIONNAIRE Physician Initials Date PATIENT INFORMATION JHH# DOB# AGE HOME PH CELL PH DAY PH EMAIL Who is your REFERRING PHYSICIAN? (The doctor who referred you to Johns Hopkins Neurology.)
More informationPARTNERS IN PEDIATRIC CARE. Intake and History for Mental Health Referral
PARTNERS IN PEDIATRIC CARE Intake and History for Mental Health Referral This form is designed to give you an opportunity to provide us with background information that will help us help you. Please read
More informationSUICIDAL THOUGHTS IN LATER LIFE
SUICIDAL THOUGHTS IN LATER LIFE Last year, I felt like there was no point of living another day and there was nobody who would miss me if I wasn t here. Nobody was more surprised than me when I started
More informationloving life YOUR GUIDE TO YOUR THYROID
loving life YOUR GUIDE TO YOUR THYROID one THE THYROID two HYPOTHYROIDISM three HYPERTHYROIDISM four TREATING HYPERTHYROIDISM five THYROID NODULES AND GOITRES one THE THYROID What is the thyroid? The thyroid
More informationNew England Pain Management Consultants At New England Baptist Hospital
New England Pain Management Consultants At New England Baptist Hospital Pain Management Center Health Assessment Dear New Pain Management Patient, Welcome to the New England Pain Management Consultants
More informationCaring for depression
Caring for depression Aetna Health Connections SM Disease Management Program Get information. Get help. Get better. 21.05.300.1 B (6/08) Get back to being you How this guide can help you Having an ongoing
More informationDEPRESSION DURING THE TRANSITION TO MENOPAUSE: A Guide for Patients and Families
DEPRESSION DURING THE TRANSITION TO MENOPAUSE: A Guide for Patients and Families David A. Kahn, MD, Margaret L. Moline, PhD, Ruth W. Ross, MA, Lori L. Altshuler, MD, and Lee S. Cohen, MD www.womensmentalhealth.org
More informationSymptoms of mania can include: 3
Bipolar Disorder This factsheet gives information on bipolar disorder. It explains the symptoms of bipolar disorder, treatments and ways to manage symptoms. It also covers what treatment the National Institute
More informationBehavioral and Developmental Referral Center
Dear Parent, Thank you for allowing us the opportunity to serve your family. We will make every effort to best meet your needs. You will find a brief questionnaire enclosed with this letter. This information
More informationChildhood - Onset Bipolar Disorder: A Guide for Families
Bay-Arenac Behavioral Health Childhood - Onset Bipolar Disorder: A Guide for Families For best results, the parents of a child diagnosed with Bipolar Disorder need to play an active role in their child
More informationGeneral Information. Age: Date of Birth: Gender (circle one) Male Female. Address: City: State: Zip Code: Telephone Numbers: (day) (evening)
Kelly Bernstein, MS, LCDC, LPC Medical Center Psychological Services 7272 Wurzbach Road, Suite 1504 San Antonio, Texas 78240 Office: (210) 522-1187 Fax: (210) 647-7805 Functional Assessment Tool The purpose
More informationNon-epileptic seizures
Non-epileptic seizures a short guide for patients and families Information for patients Department of Neurology Royal Hallamshire Hospital What are non-epileptic seizures? In a seizure people lose control
More informationAsthma, anxiety & depression
Anxiety and are common in people with asthma. The good news is that there are effective treatments both for asthma and for anxiety and. With careful management, the symptoms of anxiety and can be treated
More informationCoping With Stress and Anxiety
Coping With Stress and Anxiety Stress and anxiety are the fight-and-flight instincts that are your body s way of responding to emergencies. An intruder crawling through your bedroom window in the dark
More informationWhat Is Medically. Supervised Detoxification? Chapter 13
Chapter 13 What Is Medically Supervised Detoxification? T I have been a heroin addict for three years and am desperately trying to stop. As the withdrawal symptoms are very severe, the muscle cramps, shakes,
More informationA Student s Guide to Considering Medication for Depression or Anxiety
A Student s Guide to Considering Medication for Depression or Anxiety Real answers to your most important questions!! University!of!Missouri Kansas!City! Counseling!&!Testing!Center! 4825!Troost,!Suite!206!
More informationDepression & Multiple Sclerosis
Depression & Multiple Sclerosis Managing specific issues Aaron, diagnosed in 1995. The words depressed and depression are used so casually in everyday conversation that their meaning has become murky.
More informationPregnancy and hypothyroidism
Pregnancy and hypothyroidism Departments of Endocrinology & Obstetrics Patient Information What What is hypothyroidism? is hypothyroidism? Hypothyroidism means an underactive thyroid gland, which does
More informationA Guide for Enabling Scouts with Cognitive Impairments
A Guide for Enabling Scouts with Cognitive Impairments What cognitive impairments are discussed in this manual? Autism Spectrum Disorder Attention Deficit Hyper Activity Disorder Depression Down Syndrome
More informationI. INTAKE INFORMATION
Name: ID# : Tobacco Use Intake, Assessment and Treatment Planning Form I. INTAKE INFORMATION Smoking History: Current number of cigarettes per day: approx. 20 per day How soon after awaking is first cigarette
More informationOK to leave Messages?
Jami Howell, Psy.D., LLC Licensed Clinical Psychologist 1215 SW 18 th Avenue, Portland OR 97205 p (503) 504-5222 f (503) 224-2134 jami@doctorjamihowell.com Client Information Name: Preferred Name: Date
More informationPostnatal depression is an illness. It is not a sign that you don't love your baby or can't look after your baby properly.
Patient information from the BMJ Group Postnatal depression Postnatal depression is an illness that women can get after having a baby. If you have it, you may feel sad and anxious, and find it hard to
More informationDown s Syndrome Association Medical Series. Notes for parents & carers
An updated version of one of a series of leaflets available from the Down s Syndrome Association Down s Syndrome Association Medical Series 1. THYROID DISORDER AMONG PEOPLE WITH DOWN S SYNDROME Notes for
More informationADDICTIONS. BEHAVIOURAL Internet Shopping Work Sex Gambling Food. SUBSTANCE - RELATED Alcohol Drugs Medicine Tobacco
ADDICTIONS BEHAVIOURAL Internet Shopping Work Sex Gambling Food SUBSTANCE - RELATED Alcohol Drugs Medicine Tobacco Addiction is a chronic, relapsing disease affecting the brains's reward, motivation and
More informationApplication For Admission To The Non-Surgical Spinal Decompression Program At The Spinal Decompression Center of Long Beach
Application For Admission To The Non-Surgical Spinal Decompression Program At The Spinal Decompression Center of Long Beach If you are reading this form, you have qualified for a consultation with Dr.
More informationTherapies for Treatment- Resistant Depression. A Review of the Research
Therapies for Treatment- Resistant Depression A Review of the Research Is This Information Right for Me or Someone I Care For? Yes, if: A doctor or health care professional has told you that you have major
More informationNew Patient Evaluation
What area hurts you the most? (Please choose one) When did this pain start? Neck Other: Back How did this pain start? How often do you experience this pain? Describe what this pain feels like. What makes
More informationMemorial Hospital Sleep Center. Rock Springs, Wyoming 82901. Sleep lab Phone: 307-352- 8229 (Mon - Wed 5:00 pm 7:00 am)
Memorial Hospital Sleep Center Rock Springs, Wyoming 82901 Sleep lab Phone: 307-352- 8229 (Mon - Wed 5:00 pm 7:00 am) Office Phone: 307-352- 8390 (Mon Fri 8:00 am 4:00 pm ) Patient Name: Sex Age Date Occupation:
More informationTowards Developing a Manual for Residential Treatment Centers to Support Individuals with an FASD and Their Families
Towards Developing a Manual for Residential Treatment Centers to Support Individuals with an FASD and Their Families Presented By Dr. Pamela Gillen University of Colorado Anschutz Medical Campus and Dan
More informationHow To Overcome Depression With Diabetes
BREAKING FREE FROM DEPRESSION AND DIABETES 10 THINGS YOU NEED TO KNOW AND DO DepressionPageFINAL.indd 1 Depression is like a black hole. It can take the joy out of life, drain your energy and motivation,
More informationPATIENT INFORMATION INSURANCE INFORMATION
(mm/dd/yyyy): Have you been to Physicians Urgent Care before? Yes No Arrival Time: If yes, when? Is this a follow-up to a previous visit: Yes No PATIENT INFORMATION Patient s First Name: Middle Name: Last
More informationAbout Postpartum Depression and other Perinatal Mood Disorders
About Postpartum Depression and other Perinatal Mood Disorders The entire period of pregnancy up to one year after delivery is described as the perinatal period. Many physical and emotional changes occur
More informationPrescription Drug Abuse
Prescription Drug Abuse Introduction Most people take medicines only for the reasons their health care providers prescribe them. But millions of people around the world have used prescription drugs for
More informationCHIEF COMPLAINT: Please number your symptoms (1 is the most severe) that you have developed since the accident.
VANCE CHIROPRACTIC PERSONAL INJURY QUESTIONAIRE (PLEASE BE VERY SPECIFIC WITH YOUR ANSWERS THANK YOU!) Last Name First Name Middle Home Phone Work Phone Street Address and Number Mailing Address if Different
More informationClinical Trials Network
National Drug Abuse Treatment Clinical Trials Network STOP SMOKING STUDY Should I Join? NATIONAL INSTITUTES OF HEALTH U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Introduction Many people who abuse drugs
More informationAdolescent drug abuse and the impact of the family dynamic. This is Stay Happily Married: Episode #279.
Announcer: Adolescent drug abuse and the impact of the family dynamic. This is Stay Happily Married: Episode #279. Welcome to Stay Happily Married; your source for weekly updates on the latest tips and
More informationANTISOCIAL PERSONALITY DISORDER
ANTISOCIAL PERSONALITY DISORDER Antisocial personality disorder is a type of chronic mental illness in which your ways of thinking, perceiving situations and relating to others are dysfunctional. When
More informationMAJOR DEPRESSION DURING CONCEPTION AND PREGNANCY: A Guide for Patients and Families
MAJOR DEPRESSION DURING CONCEPTION AND PREGNANCY: A Guide for Patients and Families David A. Kahn, MD, Margaret L. Moline, PhD, Ruth W. Ross, MA, Lee S. Cohen, MD, and Lori L. Altshuler, MD www.womensmentalhealth.org
More informationADHD in Children vs. Adults
ADHD in Children vs. Adults ADHD Symptoms In Children DSM-IV INATTENTION 1) Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities. 2) Often
More informationNew Patient Registration Information
New Patient Registration Information Form 8026 5/09 3038 PR&C Dear WellSpan Orthopedics Patient: Welcome to WellSpan Orthopedics. Thank you for allowing us the opportunity to assist with your health care
More informationHow to get the most from your UnitedHealthcare health care plan.
How to get the most from your UnitedHealthcare health care plan. Your UnitedHealthcare health care plan includes many features and benefits that help you get the care you need and enjoy better overall
More informationTreatment Options for ADHD in Children and Teens. A Review of Research for Parents and Caregivers
Treatment Options for ADHD in Children and Teens A Review of Research for Parents and Caregivers Is This Summary Right for Me? Yes, if: A doctor said that your child or teen has attention deficit hyperactivity
More informationWendy Richardson, MA, MFT, CAS. AddandAddiction.com (831) 479-4742 3121 Park Ave. Suit F Soquel, CA. 95073
Wendy Richardson, MA, MFT, CAS AddandAddiction.com (831) 479-4742 3121 Park Ave. Suit F Soquel, CA. 95073 Adolescents ADHD and Addiction Looking Down at the Problem AD/HD symptoms! Problems focusing attention!
More informationOriginal Article: http://www.mayoclinic.com/health/esophageal-spasms/ds00763
MayoClinic.com reprints This single copy is for your personal, noncommercial use only. For permission to reprint multiple copies or to order presentation-ready copies for distribution, use the reprints
More informationWhat is ADHD/ADD and Do I Have It?
What is ADHD/ADD and Do I Have It? ADHD Definition and Symptoms Adults with ADHD Possible Coexistent Conditions Medications and Treatments Additional Resources Works Cited What is Attention Deficit Hyperactivity
More informationADULT NEUROPSYCHOLOGICAL HISTORY
ADULT NEUROPSYCHOLOGICAL HISTORY Person completing this form: Patient Spouse Parent Other Patient's Name: Date: Date of Birth: Age: Sex: Race: Marital Status: Address: SS#: Phone #s: Home: Work: Cell:
More informationArrive 15 minutes before your scheduled appointment time.
Thank you for choosing Dr. Townsend and Associates, P.A. for your counseling and evaluation needs. We respect your time and would like to provide you with a full 45 minute session. In order for your therapist
More informationHealth Information Sheet
Health Information Sheet What is depression? Depression -- How Medicine Can Help Depression is a medical illness like diabetes or high blood pressure. It affects about 17% of people at some time in their
More informationRevised 7/05. Copyright 2005 St. Jude Children's Research Hospital www.stjude.org Page 1 of 6
Antidepressants are drugs used, most often, to treat depression. Depression is a complex illness that involves sad and hopeless feelings that do not go away. Doctors sometimes order these drugs for other
More informationDepression in children and adolescents
Patient information from the BMJ Group Depression in children and adolescents Depression is an illness that affects people of all ages, including children and teenagers. It can stop a child or teenager
More informationOrdering and interpreting thyroid tests in children. Paul Kaplowitz, MD, PhD Children s National Medical Center, Washington, DC
Ordering and interpreting thyroid tests in children Paul Kaplowitz, MD, PhD Children s National Medical Center, Washington, DC Objectives To review indications for thyroid testing To discuss which tests
More informationADHD: what treatments work?
Patient information from the BMJ Group ADHD: what treatments work? Caring for a child who has attention deficit hyperactivity disorder (ADHD) can put a strain on you and your family. If your child has
More informationDRUGS? NO THANKS! What are some of the leading factors that cause you to. become interested in experimenting with illegal drugs?
DRUGS? NO THANKS! What are some of the leading factors that cause you to become interested in experimenting with illegal drugs? It is easily available: During adolescence, you are trying to figure out
More informationLearning Disabilities, Behavioral/Emotional Disorders, and Other Brain Disorders: What We Know
Learning Disabilities, Behavioral/Emotional Disorders, and Other Brain Disorders: What We Know by Ted Schettler, MD There are many ways that something can go awry in the brain, which can impair our ability
More informationInsomnia affects 1 in 3 adults every year in the U.S. and Canada.
Insomnia What is insomnia? Having insomnia means you often have trouble falling or staying asleep or going back to sleep if you awaken. Insomnia can be either a short-term or a long-term problem. Insomnia
More informationPractice Test for Special Education EC-12
Practice Test for Special Education EC-12 1. The Individualized Educational Program (IEP) includes: A. Written evaluation B. Assessment tests C. Interviews 2. Learning disabilities include: A. Cerebral
More informationThank you for making an appointment with our office. We look forward to serving your visual needs.
Dear New Patient, Thank you for making an appointment with our office. We look forward to serving your visual needs. Enclosed you will find our New Patient Questionnaires. Please complete these and fax
More informationSPOUSE / PARTNER ONE TO COMPLETE THIS SECTION SEPARATELY. Name: (Last) (First) (Middle Initial)
Katherine E. Walker, PhD, LPC, NCC, BCIA-C Licensed Professional Counselor 8300 Health Park, Suite 201 Raleigh, NC 27615 Mobile: 919-760-3068 Fax: 919-676-9946 Email: walker@carolinaperformance.net Couples
More information