The Maudsley Handbook of Practical Psychiatry

2015 ◽  
Keyword(s):  
Treatment Plan ◽  
Legal Issues ◽  
Specific Patient ◽  
Active Involvement ◽  
Online Edition ◽  
Adults And Children ◽  
Self Harm ◽  
Orange Book

The Maudsley Handbook of Practical Psychiatry has long served trainees in psychiatry, presenting them with practical and essential advice. This new online edition of ‘the orange book’ provides guidance on the psychiatric and neuropsychiatric examination and interviewing of adults and children, not just as a central skill, but as the basis for reaching a diagnosis, formulation and defining a treatment plan. It covers special situations, such as dealing with specific patient reactions, and conducting a complicated assessment in cases of self-harm. It concludes with important legal issues and is supported by helpful appendices for ready-reference. It has been revised and rewritten with the full and active involvement of a group of consultant psychiatrists and trainees, making it a highly relevant and practical handbook for psychiatrists at all levels of practice.

IOP Assessment and Structure

2020 ◽  
pp. 15-46
Author(s):  
Sheila A. M. Rauch ◽  
Barbara O. Rothbaum ◽  
Erin R. Smith ◽  
Edna B. Foa
Keyword(s):  
Prolonged Exposure ◽  
Moral Injury ◽  
Interdisciplinary Treatment ◽  
Treatment Team ◽  
Specific Patient ◽  
Military Sexual Assault ◽  
Assessment And Treatment ◽  
Key Issues ◽  
Self Harm ◽  
Screening Assessment

This chapter presents key assessment issues and recommendations to assist in patient selection and examination of response across the prolonged exposure-intensive outpatient (PE-IOP) treatment program. The authors discuss key issues including dissociation, suicide and self-harm risk, anger, moral injury, complex trauma, personality disorder, guilt, and comorbidity. Specific patient populations are discussed, including military, sexual assault, and traumatic brain injury populations. Discussion of a process for screening, assessment, and treatment planning using an interdisciplinary treatment team is presented.

Cognitive-Behavioral Therapy for Deliberate Self-Harm

Crisis ◽  
2007 ◽  
Vol 28 (4) ◽  
pp. 175-182 ◽  
Author(s):  
Nadja Slee ◽  
Ella Arensman ◽  
Nadia Garnefski ◽  
Philip Spinhoven
Keyword(s):  
Cognitive Theory ◽  
Behavioral Therapy ◽  
Treatment Plan ◽  
Behavioral Pattern ◽  
Behavioral Theory ◽  
Relationship Building ◽  
Cognitive Behavioral ◽  
Deliberate Self Harm ◽  
Self Harm ◽  
Cognitive Behavioral Theory

Patients who engage in deliberate self-harm (DSH) form a heterogeneous population. There is a need for psychotherapeutic interventions that give therapists the flexibility to tailor the treatment plan to the needs of an individual patient. To detect essential ingredients for treatment, three different cognitive-behavioral theories of DSH will be reviewed: (1) the cognitive-behavioral theory of Linehan (1993a) , (2) the cognitive theory of Berk, Henriques, Warman, Brown, and Beck (2004) , and (3) the cognitive-behavioral theory of Rudd, Joiner, and Rajab (2001) . A review of these theories makes it possible to compare the different approaches to the essential aspects in the treatment of DSH: a trusting patient-therapist relationship, building emotion regulation skills, cognitive restructuring, and behavioral pattern breaking. An overview will be given of therapeutic techniques that can be used to address the cognitive, emotional, behavioral, and interpersonal problems associated with DSH.

scholarly journals Expert consensus on management of dermatophytosis in elderly patients, patients with comorbidities, and immunocompromised status: an Indian perspective

2020 ◽  
Vol 7 (1) ◽  
pp. 141
Author(s):  
Jayakar Thomas ◽  
Anchala Parthasaradhi ◽  
A. K. Bajaj ◽  
Mukesh Girdhar ◽  
Asok Ghoshal ◽  
...  
Keyword(s):  
Antifungal Agents ◽  
Treatment Plan ◽  
Sequential Therapy ◽  
Clinical History ◽  
Antifungal Drugs ◽  
Special Populations ◽  
Comorbid Conditions ◽  
Specific Patient ◽  
Regular Treatment ◽  
Clinical Scenarios

<p class="abstract">Dermatophytosis is a common fungal infection of skin contributing to increasing disease burden worldwide. Increasing age, presence of comorbid conditions and immunity have a profound impact on the manifestation of dermatophyte infections. Treatment of dermatophytosis includes monotherapy, combination therapy, or sequential therapy of antifungal drugs. However, specific patient populations such as the elderly, people with comorbid conditions, immunocompromised patients, etc. are subjected to inappropriate adverse events due to highly interacting host and drug factors. Thus, the management of dermatophytosis in special populations is a challenge, and it demands a change in the regular treatment plan. A group of Indian experts reviewed the evidence available on different antifungal agents for the management of dermatophytosis and provided their expert opinion on safe and effective management of the condition in special clinical scenarios. This article summarizes the consensus clinical viewpoint of the entire expert panel for a choice of the antifungal drug, factors to be assessed, and treatment considerations in special populations with dermatophytosis. The panel emphasized that complete knowledge of patient's clinical history, presence of comorbid conditions, and pharmacokinetic and pharmacodynamic characteristics of antifungal agents and associated potential drug interactions are essential for the successful management of dermatophytosis in these patients. Also, regular monitoring of drug toxicity is important during antifungal therapy in special population.</p>

Application of EMDR Therapy to Self-Harming Behaviors

2016 ◽  
Vol 10 (2) ◽  
pp. 119-128 ◽  
Author(s):  
Dolores Mosquera ◽  
Colin A. Ross
Keyword(s):  
Life Experiences ◽  
Treatment Plan ◽  
Treatment Strategies ◽  
Skill Deficits ◽  
Case Vignettes ◽  
History Of ◽  
Self Harm ◽  
Adaptive Information Processing ◽  
Single Approach ◽  
Emdr Therapy

Self-harm is frequently a trauma-driven coping strategy that can be understood from the perspective of the adaptive information processing (AIP) model and treated with eye movement desensitization and reprocessing (EMDR) therapy (Shapiro, 1995, 2001). Self-harm is often connected with memories of adverse and traumatic life experiences. Identifying and processing these memories with EMDR therapy can put an end to the self-injurious behavior. In addition, self-harm is often based on a lack of regulation skills, and these skill deficits can be addressed in EMDR therapy as well. In this article, the authors describe strategies for treating self-harm throughout the 8 phases of EMDR. Although there is no single approach that applies to all cases, the therapist needs to take a careful history of self-harm, its historical origins, and its triggers and functions in the present to formulate a treatment plan. Often, in the authors’ experience, self-harm functions as a self-soothing strategy that redissociates traumatic affect from childhood. Treatment strategies for Phases 3–8 of EMDR therapy are illustrated through case vignettes.

Treating Eating Disorder–Posttraumatic Stress Disorder Patients

2017 ◽  
pp. 40-59
Author(s):  
Julie G. Trim ◽  
Tara E. Galovski ◽  
Amy Wagner ◽  
Timothy D. Brewerton
Keyword(s):  
Eating Disorder ◽  
Dialectical Behavior Therapy ◽  
Stress Disorder ◽  
Treatment Plan ◽  
Post Traumatic Stress ◽  
High Risk Behaviors ◽  
Concurrent Treatment ◽  
Ptsd Treatment ◽  
Self Harm ◽  
Post Traumatic

Despite elevated prevalence rates of trauma and post-traumatic stress disorder (PTSD) in eating disorder (ED) individuals, there is a surprising lack of data on how to effectively treat this population. The most significant gaps in the literature include the “what” (which PTSD treatment to use) and “when” (sequential vs. concurrent treatment) of PTSD treatment. Clinicians are often fearful in working with this ED subgroup, particularly given that these patients often report high-risk behaviors such as suicidality and self-harm. This chapter presents a new approach to treating comorbid PTSD that seems to be very promising for ED–PTSD patients. Borrowed from dialectical behavior therapy (DBT), this approach (called DBT PE) outlines readiness criteria and a protocol for altering the treatment plan if concerning behaviors emerge during the course of PTSD treatment. ED clinicians are encouraged to use DBT PE principles and to disseminate their results.

scholarly journals Psychosocial Assessment in the Emergency Department

Crisis ◽  
2021 ◽  
Author(s):  
Penny Xanthopoulou ◽  
Mary Ryan ◽  
Matthew Lomas ◽  
Rose McCabe
Keyword(s):  
Emergency Department ◽  
Treatment Plan ◽  
Psychosocial Assessment ◽  
Care Plan ◽  
Worth Living ◽  
Therapeutic Communication ◽  
Face To Face ◽  
Therapeutic Interaction ◽  
The Future ◽  
Self Harm

Abstract. Background: In the United Kingdom, suicide risk is assessed in the emergency department (ED) in a face-to-face assessment with psychiatric liaison practitioners. This study aimed to explore patient experiences of psychosocial assessment after presenting with self-harm/suicidality. Method: A total of 28 patients were interviewed within 2 weeks of ED attendance for self-harm/suicidality. Interviews were transcribed and analyzed using inductive thematic analysis. Results: People described two different experiences. A therapeutic interaction was about the “person” and made people feel their life mattered and instilled hope for the future. This was characterized by: unscripted conversation; warmth promoting disclosure; psychological exploration of feelings; validation of distress; and a coproduced care plan. A formulaic assessment was about the “risk” and made people feel their life did not matter and hopeless about the future. This was characterized by: feeling judged and not worthy of help; a focus on risk and form filling; a trivial treatment plan; and loss of trust in services. Limitations: Our study comprised a single ED and used a non-diverse sample. Conclusion: Psychosocial assessment in the ED impacts on hope for people in crisis. A focus on therapeutic communication that is about the person, as well as the risk, improves patient experience, decreases distress, and instills hope that life is worth living.

scholarly journals Use of Clindamycin Disks To Detect Macrolide Resistance Mediated by ermB and mefE in Streptococcus pneumoniae Isolates from Adults and Children

2000 ◽  
Vol 38 (5) ◽  
pp. 1731-1734 ◽  
Author(s):  
Ken Waites ◽  
Crystal Johnson ◽  
Barry Gray ◽  
Kathryn Edwards ◽  
Marilyn Crain ◽  
...  
Keyword(s):  
Streptococcus Pneumoniae ◽  
Respiratory Tract ◽  
Clinical Studies ◽  
Relative Frequency ◽  
Resistance Mechanism ◽  
Macrolide Resistance ◽  
Inexpensive Method ◽  
Specific Patient ◽  
Adults And Children ◽  
Disk Testing

We studied 198 macrolide-resistant S. pneumoniaeisolates obtained from adults and children to evaluate whether 2-μg clindamycin disks can distinguish between isolates manifestingermB- versus mefE-mediated resistance to clarithromycin and to determine the relative frequency with which each resistance mechanism occurred in these populations. ThemefE gene was predominant among 109 isolates from children, occurring in 73.4% versus 50.6% of 89 isolates from adults. Three isolates (1.5%) did not amplify either gene. Among 125mefE + isolates, the MIC of clarithromycin at which 90% of the isolates tested were inhibited, determined by Etest, was 32 μg/ml versus >256 μg/ml in 70 ermB +isolates. All ermB + isolates were highly resistant to clindamycin (MICs >256 μg/ml), whereas all mefE + isolates were susceptible to clindamycin using the 2-μg disk. Testing S. pneumoniae from the respiratory tract for susceptibility to clindamycin by agar disk diffusion is an easy and inexpensive method to estimate the frequency of resistance mediated by ermB in specific patient populations. Macrolide resistance mediated by ermB is usually of greater magnitude than that due to mefE. Clinical studies are needed to determine the significance of high- versus low-level macrolide resistance in S. pneumoniae.

Palliative care issues encountered by radiation oncologists caring for advanced cancer patients.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 14-14
Author(s):  
Gregory Parker ◽  
Virginia LeBaron ◽  
Monica Shalini Krishnan ◽  
Ron Y. Shiloh ◽  
Margarita Racsa ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Coordination ◽  
Radiation Oncology ◽  
Treatment Plan ◽  
Physical Symptoms ◽  
Legal Issues ◽  
Spiritual Needs ◽  
Goals Of Care ◽  
Cultural Considerations ◽  
Ethical And Legal Issues

14 Background: Palliative radiation therapy (PRT) is often administered to patients with advanced cancers. These patients may present to radiation oncology clinicians with other palliative care needs. To date, the types and frequencies of palliative care issues encountered in this setting have not been well characterized. Methods: This study assesses palliative care issues encountered by radiation oncology clinicians during PRT consults at 3 Boston-area, community and academic, hospital-based centers. For consecutive consults from 5/19/14 to 9/15/14, participating physicians and nurse practitioners complete a survey to identify and rank the relevance (5-point scale, 'not at all' to 'extremely') of palliative care issues. Eight domains adapted from national palliative care guidelines – physical symptoms, psychosocial issues, cultural considerations, spiritual needs, care coordination, advance care planning, goals of care, and ethical and legal issues – are evaluated. Preliminary descriptive statistics based on 51 completed surveys are reported (response rate = 94%; anticipated sample size = 198). Results: Most (82%) consults had 2 or more palliative care domains ranked as very or extremely relevant to patient care. The domains of physical symptoms (92%), care coordination (75%), and goals of care (57%) were very or extremely relevant in >50% of consults. Within these domains, the issues most often reported as relevant were interdisciplinary care coordination (92%), consideration of prognosis in treatment plan development (86%), pain management (71%), and discussion of patient values and priorities in treatment plan development (67%). Advanced care planning (24%), cultural considerations (10%), spiritual needs (10%), and ethical and legal issues (10%) were least commonly ranked as very or extremely relevant. Conclusions: Radiation oncology clinicians encounter multiple palliative care issues when consulting on patients for PRT. Clinicians identified physical symptoms, care coordination, and goals of care as the most relevant palliative care domains. These findings can help guide palliative care development within radiation oncology, including education and structures of care delivery.

A Prospective Noninterventional Study to Evaluate Survival and Success of Reduced Diameter Implants Made From Titanium-Zirconium Alloy

2015 ◽  
Vol 41 (4) ◽  
pp. e118-e125 ◽  
Author(s):  
Bilal Al-Nawas ◽  
Peter Domagala ◽  
Giuliano Fragola ◽  
Philip Freiberger ◽  
Alberto Ortiz-Vigón ◽  
...  
Keyword(s):  
Treatment Plan ◽  
Small Diameter ◽  
Dental Practice ◽  
Success Rates ◽  
Specific Patient ◽  
Increased Risk ◽  
Bone Level ◽  
Marginal Bone Level ◽  
Noninterventional Study ◽  
Implant Loading

Narrow diameter implants may be at increased risk of overload due to occlusal forces; therefore, implants with higher fatigue strength may be beneficial. The aim of this observational study was to evaluate survival and success of narrow diameter (Ø 3.3 mm) TiZr alloy (Roxolid, Institut Straumann AG, Basel, Switzerland) implants for 2 years in daily dental practice. This was a prospective, non-interventional, multicenter study; no specific patient inclusion or exclusion criteria were applied. Each patient received at least one TiZr implant; the treatment plan, including implant loading and final restoration, was at the investigator's discretion. The primary outcome was implant survival and success after 1 year. Secondary outcomes included 2-year survival and success and marginal bone level change. A total of 603 implants were placed in 357 patients. Cumulative survival and success rates were 97.8% and 97.6%, respectively, after 1 year and 97.6% and 97.4%, respectively, after 2 years. Bone levels remained stable in the majority of patients, and soft tissue remained stable up to 2 years. Within the limitations of a non-interventional study design, TiZr implants showed excellent survival and success with minimal bone loss up to 2 years in daily dental practice. The results compare favorably with those of small-diameter implants in controlled clinical trials.

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