Anxiety and Depression Management for General Providers
|
|
- Coral Jemimah Smith
- 6 years ago
- Views:
Transcription
1 Anxiety and Depression Management for General Providers Meaghan Rudolph RN MS PMHCNS-BC Stephanie Mahnks RN MSN PMHNP-BC Massachusetts General Hospital Dept of Psychiatry
2 Nothing to disclose Disclosures
3 Prevalence Current estimates indicate that 50% of the population experience at least one mental disorder in their lifetime and that at least 25% have suffered a mental disorder in the past year. At least 1/3 of office visits in primary care have a direct and explicit psychological component. Recognition, diagnosis, treatment, and referral depend overwhelmingly on general practitioners.
4 Assessment What is the patient telling me? Their interpretation of symptoms How this is impacting them What is the patient NOT telling me? Appearance, what do they look like usually? What is different from their usual presentation? Who and what is with them? Take in the whole picture: movement, mannerisms, attire, gait Start your assessment in the waiting room *Once have some data for mood/thought disorder, be sure these are primary psych, r/o all medical causes
5 Females > Males Depression Female lifetime prevalence M.D. 21.3%; dysthymia--8% Male lifetime prevalence M.D. 12.7%; dysthymia 4.8% Culture May express somatic concerns more than sadness/mood disturbance Onset mean age of onset 40 50% onset between 20 and 50 years of age.
6 Risk Factor for Depression Prior episode Family history Lack of social support Stressful life event Current substance abuse Medical comorbidity
7 Depression? Reactive sadness Emotional response to event Few hours/days Does not interfere with functioning Grief Interpersonal loss Sadness tied to the event, no loss of self-esteem Medical/Medication induced Thyroid, menopause, CHF, Caffeine, benzo, birth control, antihypertensive
8 Diagnostic Criteria Depression Depressed Mood or Loss of interest or pleasure (for two weeks) Plus 4 or more of these: Weight/appetite change Change in sleep Psychomotor agitation/retardation Fatigue/loss of energy Feelings of worthlessness or guilt Cognitive changes/difficulty concentrating Thought of death/suicide
9
10 Depressive Disorders Major Depressive Disorder Single Episode Recurrent Dysthymic Disorder Milder, chronic disorder Distinguishing feature duration (2 years) Seasonal Affective Disorder Depressive episodes related to seasonal variation in light. Depressive symptoms in fall and winter; full remission in spring and summer Has occurred for at least two years
11 SIGECAPS S Sleep decreased or increased I Interest deficit; anhedonia G Guilt including worthlessness/ hopelessness/regret E Energy--deficit C Concentration--deficit A Appetite increased or decreased P Psychomotor activity--agitation/retardation S Sex deficit of desire S Suicide ideation/planning present
12 Assessment Mnemonics To diagnosis depression need: Depressed mood/anhedonia for two weeks PLUS 4 SIG E CAPSS Symptoms To diagnose dysthymia Depressed mood/anhedonia for two years PLUS 2 of *SIG E CAPSS Symptoms
13 PHQ-9 Name: Date: Over the last two weeks, how often have you been bothered by any of the following problems? Not at all Several days More than half the days Nearly every day Little interest or pleasure in doing things Feeling down, depressed, or hopeless Trouble falling or staying asleep, or sleeping too much Feeling tired or having little energy Poor appetite or overeating Feeling bad about yourself, or that you are a failure, or that you have let yourself or your family down Trouble concentrating on things, such as reading the newspaper or watching television Moving or speaking so slowly that other people could have noticed? Or the opposite, being so fidgety or restless that you have been moving around a lot more than usual Thoughts that you would be better off dead, or of hurting yourself in some way Total = PHQ-9 score 10: Likely major depression Depression score ranges: 5 to 9: mild 10 to 14: moderate 15 to 19: moderately severe
14 Hallmark: Bipolar DO ELEVATED MOOD described as euphoric: unusually good, cheerful or high EXPANSIVE QUALITY OF MOOD characterized by unceasing and indiscriminate enthusiasm for interpersonal, sexual, or occupational interactions Must last at least 1 week (or less if hospitalization is required) Uninvolved people may not recognize pathology those who know the patient recognize it as abnormal
15 Mania Assessment DIGFAST D = Distractibility and easy frustration I = Irresponsibility and erratic uninhibited behavior G = Grandiosity F = Flight of ideas A = Activity increased with weight loss and increased libido S = Sleep is decreased (but feel rested) T = Talkativeness (noticed by others)
16 Substance Use Alcohol Marijuana Vaping Edibles Ilicits Stimulants Impact on presentation, treatment and prognosis
17 Treatment Modalities Collaborative Care Psychotherapy CBT Interpersonal therapy Supportive therapy Group Therapy Complementary techniques Relaxation Meditation Exercise Light Therapy ECT (electroconvulsive therapy)
18 Psychopharmacologic Treatment of Depression Medication Severity of illness Sustained physiological symptoms Selective serotonin reuptake inhibitors (SSRIs) Serotonin/norepinephrine reuptake inhibitors(snris) Atypical antidepressants Tricyclic antidepressants (TCAs) Monamine oxidase inhibitors (MAOIs)
19 Treatment Efficacy of medication in general is comparable between classes, but fine tuned to patient profile Initial selection of medication: Target symptoms identified Side effects/patient preference Comorbid illness Drug/drug interactions First degree relative response Cost Characteristics of Depression Agitated, irritable, suicidal ideation: SSRI Apathy, low energy: dopamine, SNRI
20 Determining Treatment Escitalopram* Fewer side effects Less drug drug interactions Citalopram Paroxetine Wt gain, sexual dysfunction Sertraline GI toxicity
21 Treatment with SSRIs Some patients may experience increased energy/activation early after initiation of treatment But onset usually delayed 2-4 weeks If no response after 6-8 weeks Wait- failure of a med is often due to adequate trial Increase dose When tapering UP schedule face to face/phone to assess efficacy Increase if SE tolerable Max dose Change SSRI Cross taper Treatment may be indefinite Best augmentation if partial response: psychotherapy Consider augmenting with another appropriate agent
22 Serotonin Syndrome After initiation of serotonergic agent (24 hours) Life theratenting Neuromuscular hyperactivity (tremor, hyperreflexia) Hyperthermia Agitation, altered MS Treatment Discontinue agents Supportive care to normalize VS Serotonin antagonists Future: determine treatment without use of serotonergic agents
23 Frequency, Intensity, and Burden of Side Effects Ratings (FIBSER)
24 Managing Side Effects Most Side Effects are Immediate, go away with time Anorgasmia Reduce dose Sildenafil prn Add bupropion Weight Gain Exercise Diet
25 Augmenting Treatment Tolerating current SSRI well Illness severity Time urgency Willingness to take other medications Modality Additional SSRI Additional Agent Bupropion Trazodone Antipsychotic Mood Stabilizer
26 Continuation and Maintenance Continuation After resolution of major depressive episode Preserve and enhance remission Relapse prevention Maintenance After recovery Prevention of subsequent episodes Pharmacotherapy 6 months + Maintain/restore baseline functioning Eliminate any residual symptoms
27 Discontinuation Syndrome Abruptly stopping SSRI Occurs within 1-4 days Symptoms Dizziness Fatigue Headache Nausea Least Risk: Fluoxetine Intermediate: Citalopram, escitalopram, sertraline Most: Paroxetine
28 Management of Discontinuation Syndrome Taper slowly as per specific drug recs/patient situation Need to taper (adverse effect, pregnancy) Severity of symptoms Length of treatment (longer then 3-5 weeks requires taper) Longer ½ life 2-3 weeks Shorter ½ life (<24 hours) 4 weeks
29 Assessment of anxiety Varies with each disorder disorders In the last few months have you Been frequently worried about several things in life? Is it hard to control or stop worrying? Any recurrent panic attacks? Do experiences cause significant trouble at home or work
30 GAD 7 Over the last 2 weeks, how often have you been bothered by the following problems? 1. Feeling nervous, anxious, or on edge 2. Not being able to stop or control worrying 3. Worrying too much about different things 4. Trouble relaxing 5. Being so restless that it's hard to sit still 6. Becoming easily annoyed or irritable 7. Feeling afraid as if something awful might happen Add the score for each column Total Score (add your column scores) =
31 Diagnosis of Anxiety DO Inclusion and exclusion criteria Duration Symptoms Modifiers and alternatives Includes symptoms that cannot be explained by another psychiatric disorder Symptoms cannot be explained by: medical condition substance use
32 Generalized Anxiety Disorder (GAD) Excessive anxiety and worry that is difficult to control occurring more days than not for at least six months Associated with at least three symptoms: Restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance r/o substance abuse; r/o medical causes
33 Panic Disorder Recurrent panic attacks as characterized by at least four of the follow symptoms: Palpitations, sweating, trembling, sensation of shortness of breath, sensation of choking, chest pain, nausea or abdominal pain, dizziness, chills or heat sensation, paresthesias, fear of losing control, fear of dying Derealization vs. depersonalization At least one panic attack is followed by at least one month of the following: Persistent worry about consequences i.e. ongoing panic attacks Maladaptive changes to avoid panic attacks
34 Post Traumatic Stress Disorder (PTSD) Exposure to actual or threatened death, serious injury or sexual violation, either first hand or witnessed. Person must have at least one of the follow intrusion symptoms for at least one month following experience: Memories, dreams, flashbacks, exposure distress, physiological reactions In addition, affected persons must experience one of the following avoidance symptoms for at least one month following experience: Internal reminders, i.e. avoid thoughts or feelings, External reminders, i.e. avoid people or places In addition, affected persons must experience at least two of the following negative symptoms for at least one month following experience: Impaired memory, negative self-image, blame, negative emotional state, decreased participation, detachment, inability to experience positive emotions And two of the following arousal behaviors: Irritable or aggressive, reckless, hypervigilance, exaggerate startle response, impaired concentration, sleep disturbance
35 Treatment Modalities SSRIs gold standard Block serotonin reuptake pump Desensitizes serotonin receptors, particularly 1A receptors
36 Which one?
37 Fluoxetine MDD, OCD, PMDD, bulimia nervosa, panic d/o, bipolar depression, treatment resistant depression in combination with olanzapine, social anxiety d/o, PTSD has antagonist properties of 5HT2C receptors would could increase norepinephrine and dopamine
38 Fluoxetine side effects: increased serotonin can cause diminished dopamine responsible for emotional flattened, cognitive slowing, apathy most side effects are immediate and go away with time notable SE: sexual dysfunction, GI, CNS (insomnia, h/a), sweating, bruising life threatening: rare seizures, induction of mania, activation of SI weight gain and sedation are unlikely dose range once daily: mg for anxiety disorders
39 Fluoxetine Stopping med: taper rarely necessary as med has long half-life and will taper itself upon abrupt discontinuation Notable drug interactions: Tramadol: increase risk of seizures Use with caution with TCAS as can increase level Can cause fatal serotonin syndrome when used with MAOIs and need to have stopped MAOI For at least two weeks prior to starting Prozac, conversely do not start MAOI after stopping Prozac for at least five weeks NSAIDS may impair efficacy of SSRIs
40 Sertraline -MDD, panic d/o, PTSD, GAD, OCD, social anxiety d/o Block serotonin reuptake pump Desensitizes serotonin receptors, particularly 1A receptors Also has some ability to block dopamine reuptake pump Some patients may experience increased energy/activation early after initiation of treatment, however onset usually delayed 2-4 weeks If no response after 6-8 weeks, may increase dose or may change SSRI Treatment may be indefinite Side effects the same Augmentation therapies: same as above Also rare sedation an rare weight gain Dosing mg once daily
41 Sertraline With PMDD dose may fluctuate throughout the month based on symptoms Mild taper to avoid withdrawal effects: dizziness, nausea, GI symptoms, generally 50 percent dose reduction for three days, then repeat until discontinued Drug interactions: same as above
42 Citalopram MDD, PMDD, OCD, Panic d/o, GAD, PTSD, social anxiety d/o Block serotonin reuptake pump Desensitizes serotonin receptors, particularly 1A receptors Also has mild antagonist actions at H1 histamine receptors No known activation effect, onset usually within 2-4 weeks If no response after 6-8 weeks, may increase dose or may change SSRI Treatment may be indefinite Side effects similar however sedation more common due to mild antihistamine properties Augmentation therapies: same as above Weight gain unusual Dose range is mg daily Taper similar to Sertraline and not usually necessary Drug interactions: same as above
43 Augmenting treatment trazodone: best response for insomnia benzodiazepines: panic attacks gabapentin: ongoing anxiety Wellbutrin
44 Case
45 Selected References
Depression & Anxiety in Adolescents
Depression & Anxiety in Adolescents Objectives 1) Review diagnosis of anxiety and depression in adolescents 2) Provide overview of evidence-based treatment options 3) Increase provider comfort level with
More informationPRACTICAL MANAGEMENT OF DEPRESSION IN OLDER ADULTS. Lee A. Jennings, MD MSHS Assistant Professor Division of Geriatrics, UCLA
CASE #1 PRACTICAL MANAGEMENT OF DEPRESSION IN OLDER ADULTS Lee A. Jennings, MD MSHS Assistant Professor Division of Geriatrics, UCLA OBJECTIVES Epidemiology Presentation in older adults Assessment Treatment
More informationANXIETY: SCREENING, DIFFERENTIAL DIAGNOSIS, TREATMENT MONITORING
Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences ANXIETY: SCREENING, DIFFERENTIAL DIAGNOSIS, TREATMENT MONITORING DEB COWLEY MD OCTOBER 20, 2016 OBJECTIVES At the
More informationAre All Older Adults Depressed? Common Mental Health Disorders in Older Adults
Are All Older Adults Depressed? Common Mental Health Disorders in Older Adults Cherie Simpson, PhD, APRN, CNS-BC Myth vs Fact All old people get depressed. Depression in late life is more enduring and
More informationMOOD (AFFECTIVE) DISORDERS and ANXIETY DISORDERS
MOOD (AFFECTIVE) DISORDERS and ANXIETY DISORDERS Shelley Klipp AS91 Spring 2010 TIP 42 Pages 226-231 and 369-379 DSM IV-TR APA 2000 Co-Occurring Substance Abuse and Mental Disorders by John Smith Types
More informationManagement Of Depression And Anxiety
Management Of Depression And Anxiety CME Financial Disclosure Statement I, or an immediate family member including spouse/partner, have at present and/or have had within the last 12 months, or anticipate
More informationDiagnosis & Management of Major Depression: A Review of What s Old and New. Cerrone Cohen, MD
Diagnosis & Management of Major Depression: A Review of What s Old and New Cerrone Cohen, MD Why You re Treating So Much Mental Health 59% of Psychiatrists Are Over the Age of 55 AAMC 2014 Physician specialty
More informationShort Clinical Guidelines: General Anxiety Disorder (GAD)
Definition is one of the most prevalent psychiatric disorders seen in the primary care office and is characterized by excessive anxiety and worry about a number of events that cause clinically significant
More informationDepression Assessment and Management. John Kern MD Clinical Professor University of Washington
Depression Assessment and Management John Kern MD Clinical Professor University of Washington Handouts Antidepressant Treatment Flowchart Managing antidepressant nonresponse handouts 2 Diagnosis PHQ-9
More informationDepression in Late Life
Depression in Late Life Robert Madan MD FRCPC Geriatric Psychiatrist Key Learnings Robert Madan MD FRCPC Key Learnings By the end of the session, participants will be able to List the symptoms of depression
More informationDepression and Anxiety. What is Depression? What is Depression? By Christopher Okiishi, MD Spring Not just being sad A syndrome of symptoms
Depression and Anxiety By Christopher Okiishi, MD Spring 2016 What is Depression? Not just being sad A syndrome of symptoms Depressed mood Sleep disturbance Decreased interest in usual activities (anhedonia)
More informationProblem Summary. * 1. Name
Problem Summary This questionnaire is an important part of providing you with the best health care possible. Your answers will help in understanding problems that you may have. Please answer every question
More informationDepressive and Bipolar Disorders
Depressive and Bipolar Disorders Symptoms Associated with Depressive and Bipolar Disorders Characteristics of mood symptoms Affects a person s well being, school, work, or social functioning Continues
More informationAntidepressants. Dr Malek Zihlif
Antidepressants The optimal use of antidepressant required a clear understanding of their mechanism of action, pharmacokinetics, potential drug interaction and the deferential diagnosis of psychiatric
More informationAN OVERVIEW OF ANXIETY
AN OVERVIEW OF ANXIETY Fear and anxiety are a normal part of life. Normal anxiety keeps us alert. Intervention is required when fear and anxiety becomes overwhelming intruding on a persons quality of life.
More informationADULT QUESTIONNAIRE. Date of Birth: Briefly describe the history and development of this issue from onset to present.
ADULT QUESTIONNAIRE Name: Address: Preferred phone number to reach you: Is it okay to leave a message? Yes No (Please check one) Date of Birth: Reason(s) for seeking treatment at this time? Briefly describe
More informationPATIENT HEALTH QUESTIONNAIRE PHQ-9 FOR DEPRESSION
PATIENT HEALTH QUESTIONNAIRE PHQ-9 FOR DEPRESSION USING PHQ-9 DIAGNOSIS AND SCORE FOR INITIAL TREATMENT SELECTION A depression diagnosis that warrants treatment or treatment change, needs at least one
More informationBrief Pain Inventory (Short Form)
Brief Pain Inventory (Short Form) Study ID# Hospital# Do not write above this line Date: Time: Name: Last First Middle Initial 1) Throughout our lives, most of us have had pain from time to time (such
More informationCOUPLE & FAMILY INSTITUTE OF TRI-CITIES AMEN ADULT GENERAL SYMPTOM CHECKLIST
COUPLE & FAMILY INSTITUTE OF TRI-CITIES AMEN ADULT GENERAL SYMPTOM CHECKLIST Please rate yourself on each symptom listed below. Please use the following scale: 0--------------------------1---------------------------2--------------------------3--------------------------4
More informationMeasurement of Psychopathology in Populations. William W. Eaton, PhD Johns Hopkins University
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this
More informationJessica Gifford, LICSW Mental Health Educator Jessica Gifford, LICSW Mental Health Educator
Alleviating Depression and Anxiety through Wellness Promotion Jessica Gifford, LICSW Mental Health Educator Jessica Gifford, LICSW Mental Health Educator Public Health Approach Mental Health is a public
More informationDr. Catherine Mancini and Laura Mishko
Dr. Catherine Mancini and Laura Mishko Interviewing Depression, with case study Screening When it needs treatment Anxiety, with case study Screening When it needs treatment Observation Asking questions
More informationAnxiety Disorders. Fear & Anxiety. Anxiety Disorder? 26/5/2014. J. H. Atkinson, M.D. Fear. Anxiety. An anxiety disorder is present when
Anxiety s J. H. Atkinson, M.D. HIV Neurobehavioral Research Center University of California, San Diego Department of Psychiatry & Veterans Affairs Healthcare System, San Diego Materials courtesy of Dr.
More informationAdult Depression - Clinical Practice Guideline
1 Adult Depression - Clinical Practice Guideline 05/2018 Diagnosis and Screening Diagnostic criteria o Please refer to Attachment A Screening o The United States Preventative Services Task Force (USPSTF)
More informationDepression and Anxiety
Depression and Anxiety ANN HACKMAN, M.D. ASSOCIATE PROFESSOR, UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE DEPARTMENT OF PSYCHIATRY Feelings of depression and anxiety vs. diagnosis Everyone feels down sometimes
More informationTreatment of Anxiety (without benzos)
Treatment of Anxiety (without benzos) Alison C. Lynch MD MS Clinical Professor Departments of Psychiatry and Family Medicine University of Iowa Health Care None Disclosures Overview/objectives Review common
More informationCBT Intake Form. Patient Name: Preferred Name: Last. First. Best contact phone number: address: Address:
Patient Information CBT Intake Form Patient Name: Preferred Name: Last Date of Birth: _// Age: _ First MM DD YYYY Gender: Best contact phone number: Email address: _ Address: _ Primary Care Physician:
More informationSome newer, investigational approaches to treating refractory major depression are being used.
CREATED EXCLUSIVELY FOR FINANCIAL PROFESSIONALS Rx FOR SUCCESS Depression and Anxiety Disorders Mood and anxiety disorders are common, and the mortality risk is due primarily to suicide, cardiovascular
More informationPHARMACY INFORMATION:
Patient Name: Date of Birth: Referred by: Reason for Visit: Current psychiatric medications and doses: PHARMACY INFORMATION: Name of Pharmacy: Phone Number: Fax Number: Address: PRIMARY CARE PHYSICIAN
More informationReducing the Anxiety of Pediatric Anxiety Part 2: Treatment
Reducing the Anxiety of Pediatric Anxiety Part 2: Treatment Lisa Lloyd Giles, MD Medical Director, Behavioral Consultation, Crisis, and Community Services Primary Children s Hospital Associate Professor,
More informationClient s Name: Today s Date: Partner s Name (if being seen as a couple): Address, City, State, Zip: Home phone: Work phone: Cell phone:
Client s Name: Today s Date: Partner s Name (if being seen as a couple): Address, City, State, Zip: Home phone: Work phone: Cell phone: Private email address: Student? If yes, where and major? May we leave
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 informationDrugs for Emotional and Mood Disorders Chapter 16
Drugs for Emotional and Mood Disorders Chapter 16 NCLEX-RN Review Question 1 Choices Please note Question #1 at the end of Ch 16 pg 202 & Key pg 805 answer is #4 1. Psychomotor symptoms 2. Tachycardia,
More informationDepression, Anxiety, and the Adolescent Athlete: Introduction to Identification and Treatment
Depression, Anxiety, and the Adolescent Athlete: Introduction to Identification and Treatment Jamie E. Pardini, PhD Sports Medicine and Concussion Specialists Banner University Medical Center-Phoenix University
More informationMedical condition SELF Mother Father Sibling (list brother or sister) Anxiety Bipolar disorder Heart Disease Depression Diabetes High Cholesterol
PRE-EVALUATION FORM Medical condition SELF Mother Father Sibling (list brother or sister) Anxiety Bipolar disorder Heart Disease Depression Diabetes High Cholesterol High Blood Pressure Obesity Heart Defect
More informationPresentation is Being Recorded
Integrated Care for Depression & Anxiety Psychotropic Medication Management for Primary Care Providers Los Angeles County Department of Mental Health September 20, 2011 Presentation is Being Recorded Please
More informationPOST-STROKE DEPRESSION
POST-STROKE DEPRESSION Stroke Annual Review March 7 th & 8 th, 2018 Justine Spencer, PhD, CPsych OVERVIEW What is Post-Stroke Depression (PSD)? Risk factors/predictors Impact of PSD Treatment and Management
More informationDepression major depressive disorder. Some terms: Major Depressive Disorder: Major Depressive Disorder:
Depression major depressive disorder Oldest recognized disorder: melancholia It is a positive and active anguish, a sort of psychical neuralgia wholly unknown to normal life. - William James "I am now
More informationManaging Anxiety Disorder in Primary Care
Saturday General Session Managing Anxiety Disorder in Primary Care Chris Ticknor, MD Private Practice, Psychiatry Adjunct Professor of Psychiatry UT Health Science Center at San Antonio San Antonio, Texas
More informationPrepared by: Elizabeth Vicens-Fernandez, LMHC, Ph.D.
Prepared by: Elizabeth Vicens-Fernandez, LMHC, Ph.D. Sources: National Institute of Mental Health (NIMH), the National Alliance on Mental Illness (NAMI), and from the American Psychological Association
More informationJonathan Haverkampf BIPOLAR DISORDR BIPOLAR DISORDER. Dr. Jonathan Haverkampf, M.D.
BIPOLAR DISORDER Dr., M.D. Abstract - Bipolar disorder is a condition affecting an individual s affective states (mood). The different flavors of bipolar disorder have in common that there are alterations
More informationKEY MESSAGES. It is often under-recognised and 30-50% of MDD cases in primary care and medical settings are not detected.
KEY MESSAGES Major depressive disorder (MDD) is a significant mental health problem that disrupts a person s mood and affects his psychosocial and occupational functioning. It is often under-recognised
More information9/20/2011. Integrated Care for Depression & Anxiety: Psychotropic Medication Management for PCPs. Presentation is Being Recorded
Integrated Care for Depression & Anxiety Psychotropic Medication Management for Primary Care Providers Los Angeles County Department of Mental Health September 20, 2011 Presentation is Being Recorded Please
More informationPeer Support / Social Activities Overview and Application Form
Peer Support / Social Activities Overview and Application Form What is Peer Support? Peer support is when people use their own experiences to help each other. What happens during peer support sessions
More informationINSOMNIA SEVERITY INDEX
Name: Date: INSOMNIA SEVERITY INDEX For each of the items below, please circle the number that most closely corresponds to how you feel. 1. Please rate the CURRENT (i.e. last 2 weeks) severity of your
More informationESCITALOPRAM. THERAPEUTICS Brands Lexapro see index for additional brand names. Generic? Yes
ESCITALOPRAM THERAPEUTICS Brands Lexapro see index for additional brand names Generic? Yes Class SSRI (selective serotonin reuptake inhibitor); often classified as an antidepressant, but it is not just
More informationFamily Medicine Forum November 10, 2017 Montreal., Quebec. Jon Davine, CCFP, FRCP(C) Associate Professor, McMaster University
APPROACH TO DEPRESSION IN PRIMARY CARE Family Medicine Forum November 10, 2017 Montreal., Quebec. Jon Davine, CCFP, FRCP(C) Associate Professor, McMaster University DISCLOSURE Speaker/Presenter Disclosure
More informationAnti-Depressant Medications
Anti-Depressant Medications A Introduction: This topic may be a little bit underestimated here in Jordan, while in western countries it has more significance. The function of anti-depressants is to change
More informationContemporary Psychiatric-Mental Health Nursing Third Edition. Introduction. Introduction 9/10/ % of US suffers from Mood Disorders
Contemporary Psychiatric-Mental Health Nursing Third Edition CHAPTER 17 Mood Disorders Introduction 12% of US suffers from Mood Disorders MD are a group of psychiatric DO characterized by physical, emotional
More informationPATIENT NAME: DATE OF DISCHARGE: DISCHARGE SURVEY
PATIENT NAME: DATE OF DISCHARGE: DISCHARGE SURVEY Please indicate whether you feel Living Hope Eating Disorder Treatment Center provided either Satisfactory or Unsatisfactory service for each number listed
More informationIntegrated Health and Well-Being
Integrated Health and Well-Being CF Physical Health Health and Well-Being Mental Health 1 Depression A Continuum Normal Mood Lowering Abnormal Mood Lowering Abnormal Mood Lowering and Loss of Functioning
More informationKari A. Stephens, PhD & Wayne Bentham, MD Psychiatry & Behavioral Sciences University of Washington. Approach for doing differential diagnosis of PTSD
IN PRIMARY CARE June 17, 2010 Kari A. Stephens, PhD & Wayne Bentham, MD Psychiatry & Behavioral Sciences University of Washington Defining and assessing Approach for doing differential diagnosis of Best
More informationGuidelines MANAGEMENT OF MAJOR DEPRESSIVE DISORDER (MDD)
MANAGEMENT OF MAJOR DEPRESSIVE DISORDER (MDD) Guidelines CH Lim, B Baizury, on behalf of Development Group Clinical Practice Guidelines Management of Major Depressive Disorder A. Introduction Major depressive
More informationAnxiety vs. Fear. Anxiety. Fear. Both involve physiological arousal. Both can be adaptive. Apprehension about a future threat
Anxiety Disorders Anxiety vs. Fear Anxiety Apprehension about a future threat Fear Response to an immediate threat Both involve physiological arousal Sympathetic nervous system Both can be adaptive Fear
More informationDepression in the Eldery Handout Package
Depression in the Eldery Handout Package Depression in the Elderly 1 Learning Objectives Upon completion of this module, you should be able to: 1. State the prevalence and describe the consequences of
More informationMental illness A Broad Overview. Dr H Pathmanandam March 2017
Mental illness A Broad Overview Dr H Pathmanandam March 2017 Introduction Mental disorders are common in primary and secondary care Many are not recognised and not treated Some receive unnecessary or inappropriate
More informationAppendix 4B - Guidance for the use of Pharmacological Agents for the Treatment of Depression in Adults (18 years and over)
Appendix 4B - Guidance for the use of Pharmacological Agents for the Treatment of Depression in Adults (18 years and over) Introduction / Background Treatment comes after diagnosis Diagnosis is based on
More informationANTI-DEPRESSANT MEDICATIONS
ANTI-DEPRESSANT MEDICATIONS This information is not intended to be a substitute for medical advice. It s purpose is solely informative. If your client or yourself are taking antidepressants, do not change
More informationDepression. University of Illinois at Chicago College of Nursing
Depression University of Illinois at Chicago College of Nursing 1 Learning Objectives Upon completion of this session, participants will be better able to: 1. Recognize depression, its symptoms and behaviors
More informationHow to Manage Anxiety
How to Manage Anxiety Dr Tony Fernando Psychological Medicine University of Auckland Auckland District Health Board www.insomniaspecialist.co.nz www.calm.auckland.ac.nz Topics How to diagnose How to manage
More informationMedication Guide Fluoxetine Oral Solution USP What is the most important information I should know about fluoxetine oral solution?
Medication Guide Fluoxetine Oral Solution USP Read the Medication Guide that comes with fluoxetine before you start taking it and each time you get a refill. There may be new information. This Medication
More informationTreating Childhood Depression in Pediatrics. Martha U. Barnard, Ph.D. University of Kansas Medical Center Pediatrics/Behavioral Sciences
Treating Childhood Depression in Pediatrics Martha U. Barnard, Ph.D. University of Kansas Medical Center Pediatrics/Behavioral Sciences Objectives The learner will: Describe the signs and symptoms of childhood
More informationThese questionnaires are used by psychology services to help us understand how people feel. One questionnaire measures how sad people feel.
ADAPTED PHQ-9 & GAD-7 QUESTIONNAIRES How to fill in these questionnaires: These questionnaires are used by psychology services to help us understand how people feel. One questionnaire measures how sad
More informationDepression. Content. Depression is common. Depression Facts. Depression kills. Depression attacks young people
Content Depression Dr. Anna Lam Associate Consultant Department of Psychiatry, Queen Mary Hospital Honorary Clinical Assistant Professor Li Ka Shing Faculty of Medicine, The University of Hong Kong 1.
More informationVenlafaxine hydrochloride extended-release and other antidepressant medicines may cause serious side effects, including:
Medication Guide VENLAFAXINE XR (venlafaxine hydrochloride) (Extended-Release Capsules) Read the Medication Guide that comes with venlafaxine hydrochloride extended-release before you start taking it and
More informationAnxiety Disorders.
Anxiety Disorders Shamim Nejad, MD Medical Director, Psycho-Oncology Services Swedish Cancer Institute Swedish Medical Center Seattle, Washington Shamim.Nejad@swedish.org Disclosures Neither I nor my spouse/partner
More informationMedication Guide SARAFEM (SAIR-a-fem) (fluoxetine hydrochloride) Tablets
Medication Guide SARAFEM (SAIR-a-fem) (fluoxetine hydrochloride) Tablets Read the Medication Guide that comes with SARAFEM before you start taking it and each time you get a refill. There may be new information.
More informationJonathan Haverkampf PANIC ATTACKS PANIC ATTACKS. Christian Jonathan Haverkampf MD
Christian MD Panic attacks can be highly debilitating as they occur spontaneously and come with a dread of impending doom and often death. Their unpredictability and the strong feelings of anxiety can
More informationWestminster IAPT Primary Care Psychology Service. Opt-In Questionnaire
Westminster IAPT Primary Care Psychology Service Opt-In Questionnaire In order to get a better idea of your difficulties, we would be grateful if you could complete the attached registration form and questionnaire.
More informationChristina Pucel Counseling 416 W. Main St Monongahela, PA /
ADULT INTAKE Name: Gender: M F DOB: Address: City: State: Zip: Telephone: Home Mobile Highest Level Education: Occupation: Emergency Contact: Relationship: Phone: Referred by: Family Members: Name Gender
More informationThis initial discovery led to the creation of two classes of first generation antidepressants:
Antidepressants - TCAs, MAOIs, SSRIs & SNRIs First generation antidepressants TCAs and MAOIs The discovery of antidepressants could be described as a lucky accident. During the 1950s, while carrying out
More informationA Basic Approach to Mood and Anxiety Disorders in the Elderly
A Basic Approach to Mood and Anxiety Disorders in the Elderly November 1 2013 Sarah Colman MD FRCPC Clinical Fellow, Geriatric Psychiatry Mount Sinai Hospital, University of Toronto Disclosure No conflict
More informationCoping with Advanced Stage Heart Failure and LVAD/Transplant. Kristin Kuntz, Ph.D. Department of Psychiatry and Behavioral Health
Coping with Advanced Stage Heart Failure and LVAD/Transplant Kristin Kuntz, Ph.D. Department of Psychiatry and Behavioral Health What is Health Psychology? Health psychology focuses on how biology, psychology,
More informationDepression: selective serotonin reuptake inhibitors
Depression: selective serotonin reuptake inhibitors Selective serotonin reuptake inhibitors (SSRIs) are considered first-line treatment for the majority of patients with depression. citalopram and fluoxetine
More informationLambeth Psychological Therapies
Complaints procedure: If you are not happy about your experience with our service, you can speak to a member of staff directly; alternatively, you can contact the PALS Office. To make a formal complaint,
More informationAffective or Mood Disorders. Dr. Alia Shatanawi March 12, 2018
Affective or Mood Disorders Dr. Alia Shatanawi March 12, 2018 Affective or Mood Disorders Reactive Depression. Secondary: Medical Neurological Drugs Major (Endogenous) Depression = Unipolar: Depressed
More informationDepression. There are several forms of depression (depressive disorders). Major depressive disorder and dysthymic disorder are the most common.
Depression Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings and sense of well-being. People with depressed mood can feel sad, anxious,
More informationZoloft (sertraline) FDA ALERT [05/2007] Suicidal Thoughts or Actions in Children and Adults
Zoloft (sertraline) FDA Alerts FDA ALERT [05/2007] Suicidal Thoughts or Actions in Children and Adults Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality)
More informationDepressive, Bipolar and Related Disorders
Depressive, Bipolar and Related Disorders Robert Kelly, MD Assistant Professor of Psychiatry Weill Cornell Medical College White Plains, New York Lecture available at www.robertkelly.us Financial Conflicts
More informationDepression & Suicide 7/11/2017 DISCLOSURES. DSM 5 Depressive Disorders. Objectives
DISCLOSURES Depression & Suicide July 19, 2017 GenaLynne C. Mooneyham, MD, MS Pediatrics/Psychiatry/Child & Adolescent Psychiatry No financial disclosures There may be discussion of off label medication
More information25 Things To Know. mood. disorders
25 Things To Know mood disorders Mood Disorders Depression Bipolar Anxiety Depression Major Depressive Disorder Lasts for weeks at a time Depression Symptoms Lack energy & pleasure Helpless Sad Depression
More informationOverview. Part II: Part I: Screening for Depression and Anxiety Risk Assessment Diagnosis of Depressive Disorders
1 Learning Objectives 1. Providers will become familiar with methods of screening for depression and anxiety. 2. Providers will become more comfortable with diagnosis and management of these common pediatric
More informationMental Health Nursing: Mood Disorders. By Mary B. Knutson, RN, MS, FCP
Mental Health Nursing: Mood Disorders By Mary B. Knutson, RN, MS, FCP A Definition of Mood Prolonged emotional state that influences the person s whole personality and life functioning Adaptive Functions
More informationAnswer Key for Case Studies. Grading for each case study. All Case Studies
Answer Key for Case Studies Grading for each case study All Case Studies *give 5 points for listing at least four accurate symptoms of the disorder *give 3 points for listing 2 symptoms of the disorder
More informationDisclosures. Objectives. Symptoms of fear. The Fifteen Minute Hour: Psychotherapy & Medications for Anxiety Management in Primary Care 4/5/18
Disclosures The Fifteen Minute Hour: Psychotherapy & Medications for Anxiety Management in Primary Care I have nothing to disclose Emma Samelson-Jones, MD Assistant Clinical Professor UCSF Department of
More informationC HAPTER 8 A NXIETY D ISORDERS IN P ATIENTS W ITH HIV/AIDS
C HAPTER 8 A NXIETY D ISORDERS IN P ATIENTS W ITH HIV/AIDS GENERAL RECOMMENDATION: Primary care practitioners should recognize the distinct anxiety disorders that are common in persons with HIV infection.
More informationRN Behavioral Health Care Manager in Primary Care Settings
RN Behavioral Health Care Manager in Primary Care Settings Integrated Care and the Expanding Role of Nurses Seattle Airport Marriott, SeaTac, WA Tuesday, January 9, 2018 The Healthier Washington Practice
More informationPSYCHOLOGICAL DISORDERS Abnormal Behavior/Mental Disorders. How do we define these?
PSYCHOLOGICAL DISORDERS Abnormal Behavior/Mental Disorders How do we define these? Abnormality is identified from three vantage points: 1. That of society 2. That of the individual 3. That of the mental
More informationAnxiolytics and anxiety disorders. MUDr. Vítězslav Pálenský Dept. of Psychiatry, Masaryk University, Brno
Anxiolytics and anxiety disorders MUDr. Vítězslav Pálenský Dept. of Psychiatry, Masaryk University, Brno Anxiety disorders 1. Panic disorders and agoraphobia 2. Specific phobia and social phobia 3. Obsessive
More informationDementia Medications Acetylcholinesterase Inhibitors (AChEIs) and Glutamate (NMDA) Receptor Antagonist
Dementia Medications Acetylcholinesterase Inhibitors (AChEIs) and Glutamate (NMDA) Receptor Antagonist Medication Dosage Indication for Use Aricept (donepezil) Exelon (rivastigmine) 5mg 23mg* ODT 5mg Solution
More informationPsychiatry curbside: Answers to a primary care doctor s top mental health questions
Psychiatry curbside: Answers to a primary care doctor s top mental health questions April 27, 2018 Laurel Ralston, DO Psychiatrist, Taussig Cancer Institute Objectives Review current diagnostic and prescribing
More informationDepression in Pregnancy
TREATING THE MOTHER PROTECTING THE UNBORN A MOTHERISK Educational Program The content of this program reflects the expression of a consensus on emerging clinical and scientific advances as of the date
More informationIntroduction into Psychiatric Disorders. Dr Jon Spear- Psychiatrist
Introduction into Psychiatric Disorders Dr Jon Spear- Psychiatrist Content Stress Major depressive disorder Adjustment disorder Generalised anxiety disorder Post traumatic stress disorder Borderline personality
More informationP A N A N X I E T Y C
P A N A N X I E T Y C The terms panic attack and anxiety attack are used interchangeably, but they are not the same. Key characteristics distinguish one from the other, though they have several symptoms
More information1.Suicidal thoughts or actions:
Medication Guide FLUOXETINE (Floa-OX-e-teen) TABLETS, USP Read the Medication Guide that comes with fluoxetine tablets before you start taking it and each time you get a refill. There may be new information.
More informationQuick Guide to Common Antidepressants-Adults
Quick Guide to Common Antidepressants-Adults Medication Therapeutic Range (mg/day) Initial Suggested Serotonin Reuptake Inhibitors (SSRIs) All available as generic FLUOXETINE (Prozac) CITALOPRAM (Celexa
More informationSome Common Mental Disorders in Young People Module 3B
Some Common Mental Disorders in Young People Module 3B MENTAL ILLNESS AND TEENS About 70% of all mental illnesses can be diagnosed before 25 years of age When they start, most mental illnesses are mild
More informationPanic disorder is a chronic and recurrent illness associated
CLINICAL PRACTICE GUIDELINES Management of Anxiety Disorders. Panic Disorder, With or Without Agoraphobia Epidemiology Panic disorder is a chronic and recurrent illness associated with significant functional
More informationTreatment Options for Bipolar Disorder Contents
Keeping Your Balance Treatment Options for Bipolar Disorder Contents Medication Treatment for Bipolar Disorder 2 Page Medication Record 5 Psychosocial Treatments for Bipolar Disorder 6 Module Summary 8
More informationAppendix B: Screening and Assessment Instruments
Appendix B: Screening and Assessment Instruments Appendix B-1: Quick Guide to the Patient Health Questionnaire (PHQ) Purpose. The Patient Health Questionnaire (PHQ) is designed to facilitate the recognition
More information