This document discusses bipolar disorder and depression. It provides information on diagnosing and differentially diagnosing bipolar disorder and depression. It covers the goals of treatment, which include preventing relapse and improving functioning. Medication and psychosocial interventions are discussed as core treatment approaches, along with managing side effects and enhancing treatment compliance. The needs of specific populations like children, adolescents, and the elderly are also addressed.
Identify the characteristics of various eating disorders, gambling and substance addiction and explore issues related to the proposed diagnostic criteria for internet and sex addiction
Listen to the presentation for FREE on the Counselor Toolbox podcast or watch the video on our youtube channel https://youtube.com/allceuseducation.
Sign up for Counseling CEU webinars at https://www.allceus.com/live-interactive-webinars/
Listen to the presentation for FREE on the Counselor Toolbox podcast or watch the video on our youtube channel https://youtube.com/allceuseducation.
Sign up for Counseling CEU webinars at https://www.allceus.com/live-interactive-webinars/
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
This was released as Episode 380 of Counselor Toolbox Podcast. You can find specific episodes and CEU courses based on the podcasts at https://allceus.com/counselortoolbox You can also subscribe on your favorite podcast app like Apple Podcasts, Google Play or Castbox.
Identify the characteristics of various eating disorders, gambling and substance addiction and explore issues related to the proposed diagnostic criteria for internet and sex addiction
Listen to the presentation for FREE on the Counselor Toolbox podcast or watch the video on our youtube channel https://youtube.com/allceuseducation.
Sign up for Counseling CEU webinars at https://www.allceus.com/live-interactive-webinars/
Listen to the presentation for FREE on the Counselor Toolbox podcast or watch the video on our youtube channel https://youtube.com/allceuseducation.
Sign up for Counseling CEU webinars at https://www.allceus.com/live-interactive-webinars/
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
This was released as Episode 380 of Counselor Toolbox Podcast. You can find specific episodes and CEU courses based on the podcasts at https://allceus.com/counselortoolbox You can also subscribe on your favorite podcast app like Apple Podcasts, Google Play or Castbox.
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week in the form of live webinars (https://allceus.com/webinar ) and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
This was released as Episode 389 of Counselor Toolbox Podcast. You can find specific episodes and CEU courses based on the podcasts at https://allceus.com/counselortoolbox You can also subscribe on your favorite podcast app like Apple Podcasts, Google Play or Castbox.
Provides an overview of different types of kink-related behaviors, the psychology of kink and much more. Listen to this as a podcast on Counselor Toolbox Podcast, available on any podcast app. Earn CEUs for listening to the podcast at https://www.allceus.com/member/cart/index/product/id/953/c/
This was released as Episode 377 of Counselor Toolbox Podcast. You can find specific episodes and CEU courses based on the podcasts at https://allceus.com/counselortoolbox You can also subscribe on your favorite podcast app like Apple Podcasts, Google Play or Castbox.
This was released as Episode 373 of Counselor Toolbox Podcast. You can find specific episodes and CEU courses based on the podcasts at https://allceus.com/counselortoolbox You can also subscribe on your favorite podcast app like Apple Podcasts, Google Play or Castbox.
Behavioral, psychological, social, and health effects of psychoactive substances.
The effects of chronic substance use on consumers, significant others, and communities within a social, political, cultural, and economic context.
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
Live Counseling and Social Work CEU Webinar: 1-24-2018 at 1pm EST 1.5 CEUs for $10 Register here: https://www.allceus.com/member/cart/index/index?c=30
Objectives
Review the data about substance abuse and gambling issues in older adults
Review screening for substance use and mental health disorders in the elderly
Identify risk factors for SA and MH issues
Review placement and treatment issues specific to older adults
An on-demand CEU course can be found here: https://www.allceus.com/member/cart/index/product/id/109/c/
This was released as Episode 379 of Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes. You can find specific episodes and CEU courses based on the podcasts at https://allceus.com/counselortoolbox You can also subscribe on your favorite podcast app like Apple Podcasts, Google Play or Castbox.
The video for this presentation is available on our Youtube channel:
https://youtube.com/allceuseducation A continuing education course for this presentation can be found at https://www.allceus.com/member/cart/index/index?c=
We explore the impact of neurotransmitters, thyroid hormones, sex hormones, stress hormones and behavioral factors such as sleep on each other and on mood.
Presented by: Dr. Melissa Graham, SAPD Psychologist
Jeanie Paradise, Clinical Director Crisis Care Center
Lt. Teri Neal, Director SAPD Communications Unit
Emile Clede, SAPD Communications Training Coordinator
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week in the form of live webinars (https://allceus.com/webinar ) and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
This was released as Episode 389 of Counselor Toolbox Podcast. You can find specific episodes and CEU courses based on the podcasts at https://allceus.com/counselortoolbox You can also subscribe on your favorite podcast app like Apple Podcasts, Google Play or Castbox.
Provides an overview of different types of kink-related behaviors, the psychology of kink and much more. Listen to this as a podcast on Counselor Toolbox Podcast, available on any podcast app. Earn CEUs for listening to the podcast at https://www.allceus.com/member/cart/index/product/id/953/c/
This was released as Episode 377 of Counselor Toolbox Podcast. You can find specific episodes and CEU courses based on the podcasts at https://allceus.com/counselortoolbox You can also subscribe on your favorite podcast app like Apple Podcasts, Google Play or Castbox.
This was released as Episode 373 of Counselor Toolbox Podcast. You can find specific episodes and CEU courses based on the podcasts at https://allceus.com/counselortoolbox You can also subscribe on your favorite podcast app like Apple Podcasts, Google Play or Castbox.
Behavioral, psychological, social, and health effects of psychoactive substances.
The effects of chronic substance use on consumers, significant others, and communities within a social, political, cultural, and economic context.
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
Live Counseling and Social Work CEU Webinar: 1-24-2018 at 1pm EST 1.5 CEUs for $10 Register here: https://www.allceus.com/member/cart/index/index?c=30
Objectives
Review the data about substance abuse and gambling issues in older adults
Review screening for substance use and mental health disorders in the elderly
Identify risk factors for SA and MH issues
Review placement and treatment issues specific to older adults
An on-demand CEU course can be found here: https://www.allceus.com/member/cart/index/product/id/109/c/
This was released as Episode 379 of Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes. You can find specific episodes and CEU courses based on the podcasts at https://allceus.com/counselortoolbox You can also subscribe on your favorite podcast app like Apple Podcasts, Google Play or Castbox.
The video for this presentation is available on our Youtube channel:
https://youtube.com/allceuseducation A continuing education course for this presentation can be found at https://www.allceus.com/member/cart/index/index?c=
We explore the impact of neurotransmitters, thyroid hormones, sex hormones, stress hormones and behavioral factors such as sleep on each other and on mood.
Presented by: Dr. Melissa Graham, SAPD Psychologist
Jeanie Paradise, Clinical Director Crisis Care Center
Lt. Teri Neal, Director SAPD Communications Unit
Emile Clede, SAPD Communications Training Coordinator
INTRODUCTION
HISTORY OF CANNABIS
EPIDEMIOLOGY
RISK FACTORS
CAUSES
HIGH RISK GROUP
PATHOPHYSIOLOGY
D/D
PREPARATION OF CANNABIS
METHOD OF USE
CLINICAL PICTURES
CANNABIS INDUCED DISORDER
COMPLICATION
MANAGEMENT
BRAIN STORMING
REFERENCES
Supercharge your brain and ditch anxiety and depression for good!Patients Medical
Dr. Vivian DeNise of Patients Medical and Dr. Sandlin Lowe of The Amen Clinic New York explain the causes of anxiety and depression, the cutting-edge technology that can be used to diagnose deficiencies in the brain that cause these conditions and several non-invasive holistic medical approaches that we use to treat.
This is a project for a high school AP psychology course. This is a fictionalized account of having a psychological ailment. For questions about this blog project or it’s content please email the teacher Chris Jocham: jocham@fultonschools.org.
Depression
Background
Pathophysiology
• The monoamine theory of depression is that it results from a central deficit in the monoamine neurotransmitters serotonin (5-HT) and norepinephrine.
• Other reported physiological features include ↑cortisol and a blunted TSH response.
• However, there is no widely accepted and definitively proven biological model of depression.
Epidemiology
• Time course: for most it is an episodic illness, but for other it follows a more chronic course.
• Incidence: 5% annual risk, 20% lifetime risk.
Presentation
DSM and NICE criteria
These are based on DSM-4, though DSM-5 does not significantly differ.
Major depressive disorder is ≥2 weeks of low mood and/or anhedonia, and at least 4 symptoms out of:
• ↓Energy or fatigue.
• ↓Concentration
• ↓Weight/appetite.
• Disturbed sleep, which commonly includes early waking. Diurnal pattern to symptoms also seen, with symptoms often worse in the morning.
• Slowing of thought and movements (psychomotor slowing) or agitation.
• Ideas of worthlessness or guilt.
• Recurrent thoughts of death or suicide.
• All but the last 2 are considered 'biological' symptoms.
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week in the form of live webinars (https://allceus.com/webinar ) and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week in the form of live webinars (https://allceus.com/webinar ) and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week in the form of live webinars (https://allceus.com/webinar ) and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week in the form of live webinars (https://allceus.com/webinar ) and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
Infographic is based on Counselor Toolbox Podcast which can be subscribed to on any podcast player like Apple Podcasts, Castbox or Google Play. Counseling and Social Work CEUs are available on this topic at AllCEUs.com
Infographic is based on Counselor Toolbox Podcast which can be subscribed to on any podcast player like Apple Podcasts, Castbox or Google Play. Counseling and Social Work CEUs are available on this topic at AllCEUs.com
Infographic is based on Counselor Toolbox Podcast which can be subscribed to on any podcast player like Apple Podcasts, Castbox or Google Play. Counseling and Social Work CEUs are available on this topic at AllCEUs.com
Infographic is based on Counselor Toolbox Podcast which can be subscribed to on any podcast player like Apple Podcasts, Castbox or Google Play. Counseling and Social Work CEUs are available on this topic at AllCEUs.com
Infographic is based on Counselor Toolbox Podcast which can be subscribed to on any podcast player like Apple Podcasts, Castbox or Google Play. Counseling and Social Work CEUs are available on this topic at AllCEUs.com
Infographic is based on Counselor Toolbox Podcast which can be subscribed to on any podcast player like Apple Podcasts, Castbox or Google Play. Counseling and Social Work CEUs are available on this topic at AllCEUs.com
Infographic is based on Counselor Toolbox Podcast which can be subscribed to on any podcast player like Apple Podcasts, Castbox or Google Play. Counseling and Social Work CEUs are available on this topic at AllCEUs.com
Infographic is based on Counselor Toolbox Podcast which can be subscribed to on any podcast player like Apple Podcasts, Castbox or Google Play. Counseling and Social Work CEUs are available on this topic at AllCEUs.com
Infographic is based on Counselor Toolbox Podcast which can be subscribed to on any podcast player like Apple Podcasts, Castbox or Google Play. Counseling and Social Work CEUs are available on this topic at AllCEUs.com
Infographic is based on Counselor Toolbox Podcast which can be subscribed to on any podcast player like Apple Podcasts, Castbox or Google Play. Counseling and Social Work CEUs are available on this topic at AllCEUs.com
More from Dr. DawnElise Snipes ★AllCEUs★ Unlimited Counselor Training (20)
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
1. Bipolar and Depression
Dr. Dawn-Elise Snipes PhD, LMHC
Executive Director, AllCEUs.com
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
2. Objectives
Differentially Diagnose Bipolar Disorder and Depression
Recognize general medical conditions and drugs that may
mimic depression or mania
Understand the goals of psychiatric management of
bipolar disorder and depression
Identify bipolar patients at increased risk of suicide
Understand the link between bipolar disorder and
substance abuse
Identify key areas of consideration when making a
treatment placement decision
Learn about the areas which patients with bipolar
disorder and their families may need education
Familiarize with the most common psychopharmacological
interventions for bipolar disorder
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
3. Bipolar I and II
Bipolar I disorder: at least one
episode can be characterized as mania
Episodic, lifelong illness with a
variable course
The first episode may be manic,
hypomanic, mixed, or depressive
Patients may experience several
episodes of depression before a manic
episode
Biploar II has depressive episodes
but no mania.
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
4. Differential Diagnosis
Ask about a history of depression
accompanied or followed by manic or
hypomanic symptoms
Assess for substance use disorder, other
general medical conditions or medications
Medical conditions associated with manic-
like symptoms include:
Multiple sclerosis
Lesions closely linked to the limbic
system
Hyper or hypothyroid
Head injuries
Encephalitis
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
5. Medications Associated with Manic-
like Symptoms
L-Dopa
Corticosteroids
High-dose decongestants
Stimulants (weight loss, ADHD)
Antidepressants may trigger a manic episode
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
6. Substance Use
May cause manic-like episodes
May help patient self-medicate
Stimulants (manic like symptoms)
Cocaine
Methamphetamines/Amphetamines
Ephedrine
Ecstasy/MDMA
Caffeine
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
7. Patients with Bipolar
Seek treatment during depressive episodes
Rarely volunteer information about manic or
hypomanic symptoms
Do not see the symptoms of hypomania to be
distressing
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
8. Suicide
Completed suicide rates 10% to 15%
Suicide attempts associated with
depressive episodes or depressive features
of mixed episodes
Ask every patient about suicidal ideation
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
9. Increased Risk Factors
Factors associated with increased
risk:
Means
Lethality
Family history of suicide
Pervasive insomnia
Impulsiveness
Psychiatric comorbidity
Psychosis
Personality disorder
Lack of social support
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
10. Hospitalization
Patients who:
Pose a serious threat of harm to themselves
Are severely ill
Lack adequate social support
Demonstrate significantly impaired judgment
Have complicating psychiatric or general
medical conditions
Have not responded adequately to outpatient
treatment.
Re-evaluate treatment setting regularly
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
11. Education
Should introduce facts about the
illness and its treatment
Use printed, verbal and videotaped
material
Present in an ongoing gradual and
consistent process
Use psychoeducational groups
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
12. Stressors
Commonly precede episodes
Disrupted sleep-wake cycles may specifically
trigger manic episodes
Physical illnesses that cause changes in
eating and/or dehydration
Alter blood plasma levels
May require dose adjustment
Regular patterns should be promoted
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
13. Counselor Activities
Preplanning
Plan for impairments in functioning
Assisting patient in scheduling absences from
work
Avoid major life changes
Plan for the needs of their children while the
patient is in an acute state
Assist the patient who is able to work in
contacting vocational rehab
Assist the patient in linking with a case
manager and/or services
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
14. Medication
Severe mania or mixed episodes:
Antipsychotic and valproate or lithium
Mild to moderate mania or mixed episodes:
Monotherapy with an antipsychotic, valproate
or lithium
Short-term adjunctive treatment with a
benzodiazepine may be helpful
Mixed episodes:
Certain drugs preferred over lithium
Atypical antipsychotics preferred over
typical antipsychotics
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
15. Antidepressants
Use earlier for bipolar II depression
than for bipolar I
Patients with bipolar II disorder have
lower rates of antidepressant induced
switching into hypomania or mania
Antidepressants may increase mood
cycling
Recommended to combine mood stabilizer
with antidepressant
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
16. Electroconvulsive Therapy (ECT)
May be considered for:
Patients who are severely ill
Whose mania or depression is treatment
resistant
Who experience symptoms during pregnancy
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
17. Goals of Treatment
Prevent relapse and recurrence
Reduce cycling frequency and subthreshold
symptoms
Reduce suicide risk
Improve overall functioning
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
19. Enhance Treatment Compliance
Assess potential barriers: Lack of motivation or
excessive pessimism; side effects of treatment;
problems in the therapeutic relationship; and
logistical, economic, or cultural barriers to
treatment.
Collaborate with the patient (and, if possible,
the family) to min-imize barriers.
Encourage the patient to articulate concerns
about treatment or its side effects, and
consider the patient’s preferences for treatment
Recognize that during the acute phase, depressed
patients may be poorly motivated and unduly
pessimistic and may suffer deficits of memory.
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
20. Enhance Treatment Compliance
During the maintenance phase, euthymic
patients may undervalue the benefits and
focus on the burdens of treatment.
In patients who prefer complementary and
alternative thera-pies, S-adenosyl methionine
(SAMe) or St. John’s wort might be
considered, although evidence for their
efficacy is modest, and careful attention to
drug-drug
Bright light therapy may be considered to
treat seasonal affective disorder as well as
nonseasonal depression.
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
21. Enhance Compliance…
Promote awareness patterns of activity and
sleep
Work with the patient to anticipate and
address early signs of relapse
Evaluate and manage functional impairment
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
22. Side Effects
Bruxism
Activation or sedation
Headaches (assess etiology and treat)
Medications used for migraine treatment, called
triptans, and SSRIs both increase the brain chemical
serotonin. Serotonin syndrome, which causes
flushing, rapid heart rate, and headache, can occur
if these medications are taken together.
Nausea
Divided doses
Administer with food
Weight gain
Evaluate causes
Bupropion (not in people with a hx of ED)
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
24. Postpartum Period
Associated with increased risk for relapse
into mania, depression, psychosis
Rate of postpartum relapse is as high as 50%
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
25. Prevalence in Children and
Adolescents
1%
Additional 5% to 6% have mood symptoms NOS
Children with bipolar disorder often have:
Mixed mania
Rapid cycling
Psychosis
Often comorbid with attention deficit and
conduct disorders
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
26. Prevalence in Children and
Adolescents
Children and teens having a manic episode may:
Feel very happy or act silly in a way that's unusual
Have a very short temper
Talk really fast about a lot of different things
Have trouble sleeping but not feel tired
Have trouble staying focused
Talk and think about sex more often
Do risky things.
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
27. Prevalence in Children and
Adolescents
Children and teens having a depressive episode may:
Feel very sad
Complain about pain a lot, like stomachaches and headaches
Sleep too little or too much
Feel guilty and worthless
Eat too little or too much
Have little energy and no interest in fun activities
Think about death or suicide.
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
28. Elderly
In patients over 65 years of age, prevalence
rates of bipolar disorder range from 0.1% to
0.4%
Most manic symptoms are due to a general
medical condition or medication
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
29. Summary
Bipolar can be diagnosed in children, adults
and elderly
Wide range of medications effective in
treatment
Psychosocial interventions focus on
minimizing stress and increasing routines
Copyright AllCEUs Unlimited CEUs $59 | Specialty Certificate Training $89 | Webinars $5
Editor's Notes
Times for a mini mental status include missed/cancelled appointments, calling office in crisis, scheduled appointments
Means: access to
Lethality of means
Family history of suicide
Pervasive insomnia often leads to poor decision making and/or self medication to sleep (if not part of a manic episode)
Impulsiveness (while under the influence of substances or when in a manic episode)
Psychiatric comorbidity (anxiety, schizophrenia, addiction)
Psychosis (especially with command hallucinations)
Personality disorder (especially Borderline)
Lack of social support (no stress buffer, easier to withdraw and disappear)
Pose a serious threat of harm to themselves (lack of self care, combining meds with illicit drugs or alcohol)
Are severely ill with complicating psychiatric or general medical conditions (mentally or physically)
Lack adequate social support
Demonstrate significantly impaired judgment
Have not responded adequately to outpatient treatment
Patient Handouts http://www.nimh.nih.gov/health/publications/index.shtml
Bipolar Disorder in Children and Teens (Easy to Read)http://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-and-teens-easy-to-read.shtml
Bipolar Disorder (Easy to Read)
http://www.nimh.nih.gov/health/publications/bipolar-disorder-easy-to-read.shtml
Group topics
Adjusting to the reality of the illnessthe predictable reactions of patients who learn that they have a chronic, recurrent, and potentially life-threatening illness. These reactions are denial, anger, ambivalence, and anxiety, all of which must be approached in psychotherapy.
LossPatients must be helped to deal with their psychological reactions to loss, including loss of relationships, loss of employment, and loss of self-esteem. The effect of bipolar illness on marriages, children's well-being, and extended family relationships is often devastating and seemingly irreversible.
ComplianceCompliance with an informed treatment plan that includes medications and other forms of treatment requires the development of a working alliance with the patient
Emotional or physical stressors commonly precede episodes Many physical illnesses lead to changes in eating, diarrhea or vomiting all of which can affect medication effectiveness and dosage. Additionally, the use of antihistamines or decongestants with many psychotropics can have unintended consequences.
Family visits, holiday gatherings, anniversaries of trauma, death of a loved one or pet, changing jobs, moving and many other stressors can be sufficient to trigger an episode.
Disrupted sleep-wake cycles may specifically trigger manic episodes. Traveling/jet lag, new baby in the house, particularly rainy days that disrupt circadian rhythms,
Regular patterns should be promoted including sleeping, eating, daily activity… Work with the person’s temperament. If they like to be a bit spontaneous, or to sleep in every once in a while, talk about how to work that in (day trips might involve packing an extra dose of medication in case they have car trouble or decide to stay overnight, identifying things that might be stressful on a trip---wondering if they forgot to unplug the iron, worrying about their pet if they are gone longer than expected, heavy traffic, long lines like at Disney…) None of these stressors is insurmountable, but the person should be aware of them and their solutions. If they prefer to be very structured, then so much the easier.
Preplanning
Plan for impairments in functioning---when meds need to be adjusted, if there is an acute crisis that precipitates an event
Assisting patient in scheduling absences from work—have the phone number and contact person available for the patient or caregiver
Avoid major life changes during the episode if possible (marriage, divorce, moving)
Plan for the needs of their children while the patient is in an acute state (care, school, medical records, birth certificate, social security card and health insurance)
Assist the patient who is able to work in contacting vocational rehab if necessary and becoming familiar with the ADA to understand and be able to ask for reasonable accommodations
Assist the patient in linking with a case manager and/or services as needed: housing, transportation, food stamps, insurance, financial planning (co-signers),
Mood Stabilizers
Lithium, the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) for treatment of mania, is often very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.
Anticonvulsant medications, such as valproate (Depakote®) or carbamazepine (Tegretol®), also can have mood-stabilizing effects and may be especially useful for difficult-to-treat bipolar episodes. Valproate was FDA-approved in 1995 for treatment of mania.
Newer anticonvulsant medications, including lamotrigine (Lamictal®), gabapentin (Neurontin®), and topiramate (Topamax®), are being studied to determine how well they work in stabilizing mood cycles.
Anticonvulsant medications may be combined with lithium, or with each other, for maximum effect.
Children and adolescents with bipolar disorder generally are treated with lithium, but valproate and carbamazepine also are used. Researchers are evaluating the safety and efficacy of these and other psychotropic medications in children and adolescents. There is some evidence that valproate may lead to adverse hormone changes in teenage girls and polycystic ovary syndrome in women who began taking the medication before age 20.13 Therefore, young female patients taking valproate should be monitored carefully by a physician.
Women with bipolar disorder who wish to conceive, or who become pregnant, face special challenges due to the possible harmful effects of existing mood stabilizing medications on the developing fetus and the nursing infant.14 Therefore, the benefits and risks of all available treatment options should be discussed with a clinician skilled in this area. New treatments with reduced risks during pregnancy and lactation are under study.
Mood Stabilizers
Atypical antipsychotic medications, including clozapine (Clozaril®), olanzapine (Zyprexa®), risperidone (Risperdal®), quetiapine (Seroquel®), and ziprasidone (Geodon®), are being studied as possible treatments for bipolar disorder. Evidence suggests clozapine may be helpful as a mood stabilizer for people who do not respond to lithium or anticonvulsants.16 Other research has supported the efficacy of olanzapine for acute mania, an indication that has recently received FDA approval.17 Olanzapine may also help relieve psychotic depression.18
Aripiprazole (Abilify) is another atypical antipsychotic medication used to treat the symptoms of schizophrenia and manic or mixed (manic and depressive) episodes of bipolar I disorder. Aripiprazole is in tablet and liquid form. An injectable form is used in the treatment of symptoms of agitation in schizophrenia and manic or mixed episodes of bipolar I disorder. Olanzapine may also help relieve psychotic depression.19
If insomnia is a problem, a high-potency benzodiazepine medication such as clonazepam (Klonopin®) or lorazepam (Ativan®) may be helpful to promote better sleep. However, since these medications may be habit-forming, they are best prescribed on a short-term basis. Other types of sedative medications, such as zolpidem (Ambien®), are sometimes used instead.
Prevent relapse and recurrence
Reduce cycling frequency and subthreshold symptoms.
Reduce suicide risk
Improve overall functioning: emotionally, mentally, physically (reduce aches and pains, lethargy, constipation, improve immunity) , socially, occupationally
Factors Associated with Postpartum Relapse
Change in medications
Lack of sleep/irregular sleep wake cycles
Hormone changes
Weight changes
Lack of support
PTSD triggered by childbirth
The “window” can be anywhere from the beginning of pregnancy (especially if meds are changed or discontinued) through 9 months after the cessation of breast feeding
Young children’s irregular sleep-wake cycles can be an added stress for the first couple of years.
Mood episodes last a week or two—sometimes longer. During an episode, the symptoms last every day for most of the day.
Mood episodes are intense. The feelings are strong and happen along with extreme changes in behavior and energy levels.
Children and teens having a manic episode may:
Feel very happy or act silly in a way that's unusual
Have a very short temper
Talk really fast about a lot of different things
Have trouble sleeping but not feel tired
Have trouble staying focused
Talk and think about sex more often
Do risky things.
Children and teens having a depressive episode may:
Feel very sad
Complain about pain a lot, like stomachaches and headaches
Sleep too little or too much
Feel guilty and worthless
Eat too little or too much
Have little energy and no interest in fun activities
Think about death or suicide.
Mood episodes last a week or two—sometimes longer. During an episode, the symptoms last every day for most of the day.
Mood episodes are intense. The feelings are strong and happen along with extreme changes in behavior and energy levels.
Children and teens having a manic episode may:
Feel very happy or act silly in a way that's unusual
Have a very short temper
Talk really fast about a lot of different things
Have trouble sleeping but not feel tired
Have trouble staying focused
Talk and think about sex more often
Do risky things.
Children and teens having a depressive episode may:
Feel very sad
Complain about pain a lot, like stomachaches and headaches
Sleep too little or too much
Feel guilty and worthless
Eat too little or too much
Have little energy and no interest in fun activities
Think about death or suicide.
Mood episodes last a week or two—sometimes longer. During an episode, the symptoms last every day for most of the day.
Mood episodes are intense. The feelings are strong and happen along with extreme changes in behavior and energy levels.
Children and teens having a manic episode may:
Feel very happy or act silly in a way that's unusual
Have a very short temper
Talk really fast about a lot of different things
Have trouble sleeping but not feel tired
Have trouble staying focused
Talk and think about sex more often
Do risky things.
Children and teens having a depressive episode may:
Feel very sad
Complain about pain a lot, like stomachaches and headaches
Sleep too little or too much
Feel guilty and worthless
Eat too little or too much
Have little energy and no interest in fun activities
Think about death or suicide.
elderly bipolar manic patients have deficits in executive functioning compared with NC samples and provide evidence that the executive deficits demonstrated by bipolar manic elders can be more severe than those in unipolar depressed elders.