The Collaborative Assessment and Management of Suicidality (CAMS): An Evolving Evidence-Based Clinical Approach to Suicidal Risk

2012 ◽  
Vol 42 (6) ◽  
pp. 640-653 ◽  
Author(s):  
David A. Jobes
Keyword(s):  
Clinical Approach ◽  
Evidence Based ◽  
Suicidal Risk ◽  
Collaborative Assessment

scholarly journals One Size Does Not Fit All: A Comprehensive Clinical Approach to Reducing Suicidal Ideation, Attempts, and Deaths

2019 ◽  
Vol 16 (19) ◽  
pp. 3606 ◽  
Author(s):  
David A. Jobes ◽  
Samantha A. Chalker
Keyword(s):  
Mentally Ill ◽  
Health Management ◽  
Clinical Care ◽  
Cost Effective ◽  
Evidence Base ◽  
Stepped Care ◽  
Clinical Approach ◽  
Evidence Based ◽  
Suicidal Risk ◽  
The One

While the existence of mental illness has been documented for centuries, the understanding and treatment of such illnesses has evolved considerably over time. Ritual exorcisms and locking mentally ill patients in asylums have been fundamentally replaced by the use of psychotropic medications and evidence-based psychological practices. Yet the historic roots of mental health management and care has left a certain legacy. With regard to suicidal risk, the authors argue that suicidal patients are by definition seen as mentally ill and out of control, which demands hospitalization and the treatment of the mental disorder (often using a medication-only approach). Notably, however, the evidence for inpatient care and a medication-only approach for suicidal risk is either limited or totally lacking. Thus, the “one-size-fits-all” approach to treating suicidal risk needs to be re-considered in lieu of the evolving evidence base. To this end, the authors highlight a series of evidence-based considerations for suicide-focused clinical care, culminating in a stepped care public health model for optimal clinical of suicidal risk that is cost-effective, least-restrictive, and evidence-based.

The Collaborative Assessment and Management of Suicidality with Suicidal Service Members

2017 ◽  
pp. 147-165
Author(s):  
David A. Jobes ◽  
Blaire C. Schembari ◽  
Keith W. Jennings
Keyword(s):  
Evidence Base ◽  
Service Members ◽  
Suicidal Patient ◽  
Clinical Approach ◽  
Us Army ◽  
Clinical Trial Research ◽  
Collaborative Assessment ◽  
Treatment Facilities ◽  
Specific Care ◽  
Outcome Tool

This chapter provides an overview of an evidence-based, suicide-specific, clinical approach called the Collaborative Assessment and Management of Suicidality (CAMS). CAMS has a robust evidence base from nonrandomized and randomized clinical trial research. CAMS is designed to form a strong therapeutic alliance and to increase patient motivation to be engaged in their own suicide-specific care. The Suicide Status Form is a multipurpose clinical assessment, treatment-planning, tracking, and outcome tool that provides the essential CAMS roadmap for engaging a suicidal patient in successful treatment. This chapter features the case example of “Jon,” a multiply-deployed suicidal US Army sergeant, to illustrate how CAMS can be used as both a philosophy suicide-specific care tool as well as a flexible clinical framework for engaging and effectively treating suicidal service members in military treatment facilities.

scholarly journals Mental disorders of known aetiology and precision medicine in psychiatry: a promising but neglected alliance

2016 ◽  
Vol 47 (2) ◽  
pp. 193-197 ◽  
Author(s):  
D. Fraguas ◽  
C. M. Díaz-Caneja ◽  
M. W. State ◽  
M. C. O'Donovan ◽  
R. E. Gur ◽  
...  
Keyword(s):  
Personalized Medicine ◽  
Mental Disorders ◽  
Precision Medicine ◽  
Psychiatric Disorders ◽  
Evidence Based Medicine ◽  
Prediction Models ◽  
Deletion Syndrome ◽  
Clinical Approach ◽  
Evidence Based ◽  
Based Medicine

Personalized or precision medicine is predicated on the assumption that the average response to treatment is not necessarily representative of the response of each individual. A commitment to personalized medicine demands an effort to bring evidence-based medicine and personalized medicine closer together. The use of relatively homogeneous groups, defined using a priori criteria, may constitute a promising initial step for developing more accurate risk-prediction models with which to advance the development of personalized evidence-based medicine approaches to heterogeneous syndromes such as schizophrenia. However, this can lead to a paradoxical situation in the field of psychiatry. Since there has been a tendency to loosely define psychiatric disorders as ones without a known aetiology, the discovery of an aetiology for psychiatric syndromes (e.g. 22q11.2 deletion syndrome in some cases of schizophrenia), while offering a path toward more precise treatments, may also lead to their reclassification away from psychiatry. We contend that psychiatric disorders with a known aetiology should not be removed from the field of psychiatry. This knowledge should be used instead to guide treatment, inasmuch as psychotherapies, pharmacotherapies and other treatments can all be valid approaches to mental disorders. The translation of the personalized clinical approach inherent to psychiatry into evidence-based precision medicine can lead to the development of novel treatment options for mental disorders and improve outcomes.

Evidence-Based Medicine and Headache Patient Management by General Practitioners in Italy

Cephalalgia ◽  
2005 ◽  
Vol 25 (10) ◽  
pp. 767-775 ◽  
Author(s):  
A Bianco ◽  
MM Parente ◽  
E De Caro ◽  
R Iannacchero ◽  
U Cannistrà ◽  
...  
Keyword(s):  
Clinical Trials ◽  
General Practitioners ◽  
Evidence Based Medicine ◽  
Clinical Effectiveness ◽  
Clinical Approach ◽  
Evidence Based ◽  
Sources Of Information ◽  
Headache Patient ◽  
Practice Characteristics ◽  
Based Medicine

The study explores the awareness of technical terms used in evidence-based medicine (EBM) and manner of treating patients with migraine among a random sample of 500 general practitioners (GPs). A mailed questionnaire included questions on GPs' demographics and practice characteristics; awareness of EBM; sources of information about migraine and EBM; and patient's treatment behaviour. Only 27.2% of GPs agreed that clinical trials are needed to evaluate the efficacy of treatments and this awareness was higher in those who learned about migraine from scientific journals or continuing education courses and who attended courses on EBM. For two-thirds of GPs, disability is equivalent to illness diagnosis, and this behaviour was more prevalent in those who agreed that clinical trials are needed to evaluate the efficacy of preventive or curative treatments of migraine and that the clinical approach to migraine required an evaluation of clinical effectiveness, in those who treated a lower number of headache patients, who were older, and in those who did not use guidelines. The majority (93.1%) of GPs indicated that it is important to integrate clinical practice and the best available evidence, and this behaviour was significantly more frequent in those who agreed that the clinical approach to migraine required a clinical effectiveness evaluation, that clinical trials are needed to evaluate the efficacy of preventive or curative treatments of migraine, and in those who attended courses on EBM. Training and continuing educational programmes on EBM and guidelines on treatments of headache for GPs are strongly needed.

Psychogenic Nonepileptic Seizures in Women

2017 ◽  
Vol 37 (06) ◽  
pp. 624-631 ◽  
Author(s):  
Gaston Baslet ◽  
Barbara Dworetzky
Keyword(s):  
Risk Factors ◽  
Tertiary Care ◽  
Traumatic Experiences ◽  
Clinical Approach ◽  
Evidence Based ◽  
Accurate Identification ◽  
Psychogenic Nonepileptic Seizures ◽  
Evidence Based Treatments ◽  
Nonepileptic Seizures ◽  
The Difference

AbstractPsychogenic nonepileptic seizures (PNES) are the most common type of functional neurological symptom disorders and are frequently diagnosed in tertiary care epilepsy monitoring units. These are associated with significant decline in social functioning and quality of life. The majority of patients with PNES are women, outnumbering men by a ratio of 3:1. Female sex preponderance occurs after puberty and usually before the age of 55 years. Many of the psychiatric risk factors in PNES (depression, anxiety, history of traumatic experiences, other somatic symptom disorders) are more common in women and may partially account for the difference in sex prevalence. Neurobiological and neurohumoral mechanisms may also play a role, but our understanding is limited at this point. In this review, we present information on epidemiology and risk factors, neurobiological and psychological mechanisms, clinical approach to diagnosis, evidence-based treatment, and long-term outcomes. We highlight findings related to differences between women and men in PNES. Most of these data are not decisive and require further corroboration. While the disorder may be more frequently suspected in women, all patients with suspected PNES deserve an objective and thorough investigation of their symptoms. Early and accurate identification of this disorder should be a priority, especially as evidence-based treatments, which may lead to improved outcomes, are increasingly available.

scholarly journals Therapeutic Diet: What We Need to Consider!

2018 ◽  
Vol 5 (2) ◽  
pp. 25-27
Author(s):  
Amrita Ghosh
Keyword(s):  
Clinical Outcomes ◽  
Medical Practice ◽  
Dietary Guidelines ◽  
Considerable Progress ◽  
Dietary Advice ◽  
Clinical Approach ◽  
Evidence Based ◽  
Research Groups ◽  
Nutritional Factors ◽  
User Friendly

ABSTRACT Therapeutic diet is needed so that nutritional factors may not affect individuals in diseases during convalescence and rehabilitation. Different research groups have observed a correlation between diseases and diets with diagnosis, prognosis, clinical outcomes and complications. In spite of considerable progress in healthcare, there is scarce evidence-based research excellence on community-level compliance on dietary advice. We need to change our mindset to find user-friendly dietary guidelines for the improvement in clinical approach and treatment in patients with diverse diseases in daily medical practice.

scholarly journals Approach to Chilblains During the COVID-19 Pandemic

2020 ◽  
Vol 24 (5) ◽  
pp. 504-517 ◽  
Author(s):  
Malika A. Ladha ◽  
Nadia Luca ◽  
Cora Constantinescu ◽  
Karen Naert ◽  
Michele L. Ramien
Keyword(s):  
Public Health ◽  
Severe Acute Respiratory Syndrome ◽  
Narrative Review ◽  
Clinical Approach ◽  
Evidence Based ◽  
Cutaneous Pattern ◽  
Timing Of Onset ◽  
Distinguishing Features

Coronavirus disease (COVID-19) chilblains is a well-reported cutaneous pattern of severe acute respiratory syndrome coronavirus (SARS-CoV-2). Through this narrative review, we provide an evidence-based overview of idiopathic and secondary chilblains, distinguishing features of COVID-19 chilblains, and a systematic clinical approach to history, examination, investigations, and treatment. In the absence of cold or damp exposure, COVID-19 should be considered as a cause of acute chilblains. The timing of onset of COVID-19 chilblains relative to active SARS-CoV-2 viremia remains unclear. Patients with suspected COVID-19 chilblains should thus follow public health guidelines for COVID-19 testing and self-isolation.

scholarly journals Essential Thrombocythemia and Acquired von Willebrand Syndrome: The Shadowlands between Thrombosis and Bleeding

Cancers ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1746 ◽  
Author(s):  
Hassan Awada ◽  
Maria Voso ◽  
Paola Guglielmelli ◽  
Carmelo Gurnari
Keyword(s):  
Essential Thrombocythemia ◽  
Clinical Evidence ◽  
Antiplatelet Agents ◽  
Bleeding Risk ◽  
Clinical Approach ◽  
Evidence Based ◽  
Vascular Events ◽  
Acquired Von Willebrand Syndrome ◽  
The Past ◽  
Von Willebrand

Over the past decade, new insights have emerged on the pathophysiology of essential thrombocythemia (ET), its clinical management, and associated thrombohemostatic disturbances. Here, we review the latest diagnostic and risk stratification modalities of ET and its therapeutics. Moreover, we discuss the clinical evidence-based benefits, deriving from major clinical trials, of using cytoreductive therapy and antiplatelet agents to lower the risk of fatal vascular events. Also, we focus on the condition of extreme thrombocytosis (>1000 × 109/L) and bleeding risk, the development and pathogenesis of acquired von Willebrand syndrome, and the clinical approach to this paradoxical scenario in ET.

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