Chapter 6. Assessment of the
Patient
https://doi-
org.ezp.waldenulibrary.org/10.1176/appi.books.9781615370030.mg06
Shelly F. Greenfield, M.D., M.P.H.Grace Hennessy, M.D.
A number of factors influence the accurate identification, assessment, and
diagnosis of substance-related disorders among patients presenting for
treatment. These include the clinical setting, the style of interviewing, the attitude
of the clinician, and patient characteristics such as the presence of co-occurring
medical and psychiatric disorders and the stage of use or abuse of the substance.
The goals of assessing patients with substance-related disorders are to 1) identify
the presence of a substance-related disorder, as well as signs of harmful or
hazardous use so that prevention and early intervention may take place; 2) make
an accurate diagnosis and relating this to any other co-occurring medical or
psychiatric disorders; 3) identify barriers to treatment as well as strengths and
supports; 4) assess and enhance the patient’s motivation to change; and 5)
formulate and help to initiate appropriate evidence-based interventions and
treatments. In this chapter, we review principles of eliciting a substance use,
psychiatric, and medical history, as well as formulating an accurate diagnosis.
Eliciting the Substance Abuse History
Interviewing Style
The clinician’s attitude and style of history taking can facilitate a thorough and accurate
assessment. Patients with substance-related disorders often report that they do not discuss their
substance use openly with physicians because of their feelings of shame, discomfort, fear,
distrust, and hopelessness (Center for Substance Abuse Treatment 2004; Weiss et al. 2000a).
Obstacles to obtaining an accurate history include the patient’s defenses, such as denial,
minimization, rationalization, projection, and externalization (Schottenfeld and Pantalon 1999).
Asking open-ended questions such as “What brought you here to see me today?” may
circumvent these obstacles. Open-ended questions help the clinician understand how the patient
defines the problem, and this can set the direction for the rest of the interview.
Asking questions in an honest, respectful, and matter-of-fact manner is likely to be most
effective (Center for Substance Abuse Treatment 2004). Maintaining a nonjudgmental stance is
helpful to patients who may have feelings of shame or denial. For example, a clinician may ask,
“How were you feeling before you drank?” rather than “Why did you drink alcohol then?”
Another approach to reducing shame can be phrasing questions in such a manner as “Some
https://doi-org.ezp.waldenulibrary.org/10.1176/appi.books.9781615370030.mg06
https://doi-org.ezp.waldenulibrary.org/10.1176/appi.books.9781615370030.mg06
https://psychiatryonline-org.ezp.waldenulibrary.org/doi/full/10.1176/appi.books.9781615370030.mg06#u2014-04-03T12581333-0400d1e670
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Alcoholism refers to uncontrolled alcohol intake and is considered a disease with physical and mental components. Treatments for alcoholism include aversion-desensitization therapy, home detoxification, and outpatient treatment for women. Aversion-desensitization therapy involves patients watching videos of their drinking confessions and being confronted by therapists in order to associate negative feelings with alcohol.
This document discusses treatment options for alcohol use disorders. It notes that while treatment options have expanded beyond 12-step programs like Alcoholics Anonymous, most people with alcohol use disorders remain untreated. It summarizes recent research exploring improved diagnosis, medications, behavioral therapies, and ways to broaden treatment access, such as through primary care settings and emerging technologies like online therapy programs.
This document discusses substance dependence disorder. It begins by outlining the diagnostic criteria according to the DSM-IV, including tolerance, withdrawal symptoms, and impairment. It then discusses epidemiology, finding higher rates in males and those aged 18-25. Comorbidity is also common, especially with other psychiatric disorders in youth. Treatment approaches are suggested, notably motivational interviewing which has been shown as effective as other programs.
Generalist Practice A Presentation on Steps of The Problem-SolvMatthewTennant613
Generalist Practice: A Presentation on Steps of The Problem-Solving Process
Name:
Date: May 5th, 2021
Pamela Easter !!!
1
Problem Identification or Engagement
Identify the type of problem – drug addiction and its effects on Family members.(Janice Walker is at the center of problem)
Identify how the problem has affected the rest of the community- substance abuse effects cost in the community in measurable ways including loss of productivity and unemployability; impairment in physical and mental health; reduced quality of life; increase violence; and Crime; abuse and neglect of children.
The community's general perception of the problem- the economic consequences of drug abuse severely burden federal , State, and local government resources, and the taxpayer.
The root cause of the problem- most often the cause of addiction is chronic stress, a history of trauma (PTSD), mental illness, lastly family history with addiction
Problem Identification/Engagement. The first step is to identify the type of problem the researcher is dealing with. Identify how the problem has affected the rest of the community and the community's general perception of the problem. The next step is to evaluate how the problem has affected the community or a client. Lastly, identify the root cause of the problem; where did the problem come from, or how did the victim get the problem they are facing.
2
Data Collection
Three major ways of collecting data from Clients are Interviews, Observation, and surveys
Interviews:
Engaging with the client one-on-one. Listening to client’s perspective of the problem
This method has ability to untangle the individual's problem, emotions, background, and the general social context, The Advocate can get the client's perception of the treatment
Observation:
It obtains data from clients by assessing the reaction to their respective environments
The researcher can identify factors contributing to the Client's condition
Data collection. There are many ways to collect data from a client. Three major ways of collecting data from a client are Interviews, Observation, and First Extraction.
Interviews: The researcher can speak with the patient on a one-on-one basis. A researcher or a nurse can use this method because of its ability to untangle the individual's problem, emotions, background, and the general social context, which in this paper largely revolves around the family relationship (Cohen et al., 2017). This data collection method paves the way for a nurse to get the patient's perception of the treatment and some of the elements that motivated them to embrace treatment.
Observation: it is used to obtain data from clients by assessing the reaction to their respective environments. Observation methods allow the researcher to identify social dimensions and family background factors contributing to the patient's condition.
3
Data Collection cont’d
Surveys : Can discover the problem
Clients Family History background details o ...
Dual diagnosis occurs when a person has both a substance abuse disorder and a mental health disorder. Treating both conditions is necessary for recovery, which typically involves detoxification followed by rehabilitation for substance abuse and treatment for the mental health disorder. Over half of those with substance abuse or dependence have also experienced a mental health disorder at some point. Integrated treatment programs that address substance abuse, psychiatric symptoms, and other issues like housing, employment, legal concerns, and family/medical problems are recommended for those with dual diagnoses.
This document discusses therapies for patients with impulsivity, compulsivity, and substance use disorders. It provides learning objectives about assessing patient factors to develop personalized therapy plans, analyzing factors influencing pharmacokinetics and pharmacodynamics, and considering ethical and legal implications of therapies. The document includes a case study assignment assessing and treating a Puerto Rican woman with comorbid addiction issues. Students are asked to make three medication decisions and justify their choices based on evidence from the literature.
systematic approach in answering Drug queries.pptxDrpradeepthi
1) The document outlines the steps in a systematic approach to answering drug information queries. This involves gathering background information on the requestor and patient, categorizing the question, developing a search strategy, evaluating the data found, and formulating a response.
2) Key steps include determining the requestor's profession and patient details if applicable, selecting relevant references based on the question category, prioritizing sources by likelihood of containing the answer, and critically analyzing findings in the context of the inquiry.
3) The goal is to efficiently provide an accurate, unbiased response by following a standardized process for clarifying the request, searching appropriately for the answer, and synthesizing the data.
This document discusses the assessment and treatment of alcohol use disorder. It covers barriers to assessment such as denial, guilt, and stigma. It also discusses components of assessment including history, examination, and laboratory tests. Screening tools like MAST and CAGE are mentioned. Treatment settings and goals are outlined, including detoxification using benzodiazepines. Long-term pharmacological treatments aim to maintain abstinence using deterrent, antagonist, or anticraving agents like disulfiram.
Alcoholism refers to uncontrolled alcohol intake and is considered a disease with physical and mental components. Treatments for alcoholism include aversion-desensitization therapy, home detoxification, and outpatient treatment for women. Aversion-desensitization therapy involves patients watching videos of their drinking confessions and being confronted by therapists in order to associate negative feelings with alcohol.
This document discusses treatment options for alcohol use disorders. It notes that while treatment options have expanded beyond 12-step programs like Alcoholics Anonymous, most people with alcohol use disorders remain untreated. It summarizes recent research exploring improved diagnosis, medications, behavioral therapies, and ways to broaden treatment access, such as through primary care settings and emerging technologies like online therapy programs.
This document discusses substance dependence disorder. It begins by outlining the diagnostic criteria according to the DSM-IV, including tolerance, withdrawal symptoms, and impairment. It then discusses epidemiology, finding higher rates in males and those aged 18-25. Comorbidity is also common, especially with other psychiatric disorders in youth. Treatment approaches are suggested, notably motivational interviewing which has been shown as effective as other programs.
Generalist Practice A Presentation on Steps of The Problem-SolvMatthewTennant613
Generalist Practice: A Presentation on Steps of The Problem-Solving Process
Name:
Date: May 5th, 2021
Pamela Easter !!!
1
Problem Identification or Engagement
Identify the type of problem – drug addiction and its effects on Family members.(Janice Walker is at the center of problem)
Identify how the problem has affected the rest of the community- substance abuse effects cost in the community in measurable ways including loss of productivity and unemployability; impairment in physical and mental health; reduced quality of life; increase violence; and Crime; abuse and neglect of children.
The community's general perception of the problem- the economic consequences of drug abuse severely burden federal , State, and local government resources, and the taxpayer.
The root cause of the problem- most often the cause of addiction is chronic stress, a history of trauma (PTSD), mental illness, lastly family history with addiction
Problem Identification/Engagement. The first step is to identify the type of problem the researcher is dealing with. Identify how the problem has affected the rest of the community and the community's general perception of the problem. The next step is to evaluate how the problem has affected the community or a client. Lastly, identify the root cause of the problem; where did the problem come from, or how did the victim get the problem they are facing.
2
Data Collection
Three major ways of collecting data from Clients are Interviews, Observation, and surveys
Interviews:
Engaging with the client one-on-one. Listening to client’s perspective of the problem
This method has ability to untangle the individual's problem, emotions, background, and the general social context, The Advocate can get the client's perception of the treatment
Observation:
It obtains data from clients by assessing the reaction to their respective environments
The researcher can identify factors contributing to the Client's condition
Data collection. There are many ways to collect data from a client. Three major ways of collecting data from a client are Interviews, Observation, and First Extraction.
Interviews: The researcher can speak with the patient on a one-on-one basis. A researcher or a nurse can use this method because of its ability to untangle the individual's problem, emotions, background, and the general social context, which in this paper largely revolves around the family relationship (Cohen et al., 2017). This data collection method paves the way for a nurse to get the patient's perception of the treatment and some of the elements that motivated them to embrace treatment.
Observation: it is used to obtain data from clients by assessing the reaction to their respective environments. Observation methods allow the researcher to identify social dimensions and family background factors contributing to the patient's condition.
3
Data Collection cont’d
Surveys : Can discover the problem
Clients Family History background details o ...
Dual diagnosis occurs when a person has both a substance abuse disorder and a mental health disorder. Treating both conditions is necessary for recovery, which typically involves detoxification followed by rehabilitation for substance abuse and treatment for the mental health disorder. Over half of those with substance abuse or dependence have also experienced a mental health disorder at some point. Integrated treatment programs that address substance abuse, psychiatric symptoms, and other issues like housing, employment, legal concerns, and family/medical problems are recommended for those with dual diagnoses.
This document discusses therapies for patients with impulsivity, compulsivity, and substance use disorders. It provides learning objectives about assessing patient factors to develop personalized therapy plans, analyzing factors influencing pharmacokinetics and pharmacodynamics, and considering ethical and legal implications of therapies. The document includes a case study assignment assessing and treating a Puerto Rican woman with comorbid addiction issues. Students are asked to make three medication decisions and justify their choices based on evidence from the literature.
systematic approach in answering Drug queries.pptxDrpradeepthi
1) The document outlines the steps in a systematic approach to answering drug information queries. This involves gathering background information on the requestor and patient, categorizing the question, developing a search strategy, evaluating the data found, and formulating a response.
2) Key steps include determining the requestor's profession and patient details if applicable, selecting relevant references based on the question category, prioritizing sources by likelihood of containing the answer, and critically analyzing findings in the context of the inquiry.
3) The goal is to efficiently provide an accurate, unbiased response by following a standardized process for clarifying the request, searching appropriately for the answer, and synthesizing the data.
This document discusses the assessment and treatment of alcohol use disorder. It covers barriers to assessment such as denial, guilt, and stigma. It also discusses components of assessment including history, examination, and laboratory tests. Screening tools like MAST and CAGE are mentioned. Treatment settings and goals are outlined, including detoxification using benzodiazepines. Long-term pharmacological treatments aim to maintain abstinence using deterrent, antagonist, or anticraving agents like disulfiram.
CASE STUDYFemale, 15, separation anxiety disorder, Depression.docxbartholomeocoombs
CASE STUDY:
Female, 15, separation anxiety disorder, Depression
The patient is a fifteen-year-old female teenager who presents to the clinic with her mother for her first assessment. Patient is being referral to the clinic by the school counselor due to low grades and poor school assistance. During the session, both the patient and the mother are neatly dressed. Her mother seems to be worried about her daughter. The patient said, "I worry a lot about my family members. I fear that one day my parents will be abducted or fatally injured. The worries and fears make me have difficulties concentrating on personal well-being and my studies in school." The mental assessment shows that the patient is depressed, and she refuses to leave the proximity of her mother. Her mother says that her daughter has been experiencing depression or anxiety attacks. The physical assessment shows that the patient has been experiencing physical aches and pains. She maintains good eye contact. Her mood is a little anxious. The symptoms conclude that the patient has separation anxiety disorder because the symptoms have progressed for the past six months. Treatments include antidepressants, group therapy, family therapy, dialectical behavioral therapy, and cognitive-behavioral therapy. A follow-up is to be done in two weeks.
Assignment 2: Focused SOAP Note and Patient Case Presentation
Psychiatric notes are a way to reflect on your practicum experiences and connect them to the didactic learning you gain from your NRNP courses. Focused SOAP notes, such as the ones required in this practicum course, are often used in clinical settings to document patient care.
For this Assignment, you will document information about a patient that you examined during the last three weeks, using the Focused SOAP Note Template provided. You will then use this note to develop and record a case presentation for this patient.
To Prepare
· Present the full complex case study. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; current psychiatric diagnosis including differentials that were ruled out; and plan for treatment and management.
· Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.
· Specifically address the following for the patient, using your SOAP note as a guide:
·
Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
·
Objective: What observations did you make during the psychiatric assessment?
·
Assessment: Discuss their mental status examination results. What were your differential diagnoses? Provide a minimum o.
Social workers currently do not have the authority to prescribe or administer medication, though they play an important role in medication management and adherence. Some other non-physician professions, like psychologists, have begun gaining limited prescribing privileges. This document discusses the expanding roles of social workers in medication management, reviews new laws allowing prescribing by psychologists in New Mexico and Louisiana, and raises questions about whether social work should also pursue prescribing privileges.
Chapter 5 Screening, Diagnosis, Assessment, and ReferralThis chapt.docxmccormicknadine86
Chapter 5 Screening, Diagnosis, Assessment, and Referral
This chapter presents a systems or biopsychosocial approach to determining whether an individual has a chemical abuse or dependency problem. The first steps in this approach are screening and diagnosis. The chapter also considers the extension of this process, called assessment, to examine the client’s needs further. A thorough assessment is generally needed to develop a treatment plan and to make referrals to appropriate resources.
Some individuals with alcohol and drug problems experience medical emergencies (intentional overdoses, accidental alcohol or drug poisoning, pancreatitis, delirium tremens, seizures, etc.) that require immediate attention. Social workers, psychologists, and other human service professionals should know what these emergencies are, but these problems can be diagnosed and treated only by qualified medical personnel. This chapter focuses primarily on the work of helping professionals once such medical crises have been resolved or when a client is seen by a helping professional before these medical complications arise.
We begin by discussing screening, which may be defined as the use of rapid assessment instruments and other tools to determine the likelihood that an individual has a chemical abuse or chemical dependency problem. In practice, much screening is informal and is not done with structured or standardized instruments. For example, after reviewing a parolee’s “rap sheet” containing repeated alcohol- or drug-related arrests, a parole officer may feel that is all the screening necessary for referring the client to a chemical dependency treatment program or insisting on participation in a mutual-help group as a condition of parole.
Diagnosis is the confirmation of a chemical abuse or dependency problem based on established clinical criteria. The diagnostic process generally involves an interview with the patient or client and often includes information from other sources such as a medical examination, including laboratory tests, and previous medical, psychological or psychiatric, criminal, school, and other records. Consultation with other professionals might also be used as is information from collaterals (e.g., family) who know the patient or client well.
The term assessment is sometimes used synonymously with the term diagnosis, but we use it to mean an in-depth consideration of the client’s chemical abuse or dependency problems as they have affected his or her psychological well-being, social circumstances (including interpersonal relationships), financial status, employment or education, health, and so forth. This process also includes consideration of the individual’s strengths and resources that may be assets in treatment and recovery. Going beyond a confirmatory diagnosis, this type of multidimensional or biopsychosocial assessment provides the basis for treatment planning.
The cornerstones of screening, diagnosis, and assessment are knowledge of su ...
The pharmaceutical industry has made it very difficult to know what the clinical trial evidence actually is regarding psychotropics. Consequently, primary care physicians and other front-line practitioners are at a disadvantage when attempting to adhere to the ethical and scientific mandates of evidence based prescriptive practice. This article calls for a higher standard of prescriptive care derived from a risk/benefit analysis of clinical trial evidence. The authors assert that current prescribing practices are empirically unsound and unduly influenced by pharmaceutical company interests, resulting in unnecessary risks to patients. In the spirit of evidenced based medicine’s inclusion of patient values as well as the movement toward health home, we present a patient bill of rights for psychotropic prescription. We then offer guidelines to raise the bar of care equal to the available science for all prescribers of psychiatric medications.
The document outlines the tasks and competencies assessed throughout the USMLE examinations. It provides a comprehensive list of physician tasks and competencies in several domains, including medical knowledge, patient care, communication, professionalism, systems-based practice, practice-based learning, and applied biostatistics. The tasks range from applying foundational science concepts to understanding quality improvement and recognizing sources of error. While this outline is common to all USMLE exams, each step emphasizes different parts of the outline.
LBDA: Ask the Expert - Daniel Kaufer Live Webinar June 2016wef
Clinical trials are research studies that test new medical treatments and are conducted according to a research plan called a protocol. A clinical trial has a principal investigator and research team who are responsible for overseeing the trial. Participants must meet eligibility criteria and provide informed consent to enroll. The trial follows a treatment plan, which may involve experimental treatments, standard treatments, or placebos. Participants are monitored by an Institutional Review Board to ensure safety and ethical treatment. Clinical trials provide information about new treatments and help advance medical knowledge, but may not directly benefit participants.
Chapter 5 Screening, Diagnosis, Assessment, and ReferralThis.docxchristinemaritza
Chapter 5 Screening, Diagnosis, Assessment, and Referral
This chapter presents a systems or biopsychosocial approach to determining whether an individual has a chemical abuse or dependency problem. The first steps in this approach are screening and diagnosis. The chapter also considers the extension of this process, called assessment, to examine the client’s needs further. A thorough assessment is generally needed to develop a treatment plan and to make referrals to appropriate resources.
Some individuals with alcohol and drug problems experience medical emergencies (intentional overdoses, accidental alcohol or drug poisoning, pancreatitis, delirium tremens, seizures, etc.) that require immediate attention. Social workers, psychologists, and other human service professionals should know what these emergencies are, but these problems can be diagnosed and treated only by qualified medical personnel. This chapter focuses primarily on the work of helping professionals once such medical crises have been resolved or when a client is seen by a helping professional before these medical complications arise.
We begin by discussing screening, which may be defined as the use of rapid assessment instruments and other tools to determine the likelihood that an individual has a chemical abuse or chemical dependency problem. In practice, much screening is informal and is not done with structured or standardized instruments. For example, after reviewing a parolee’s “rap sheet” containing repeated alcohol- or drug-related arrests, a parole officer may feel that is all the screening necessary for referring the client to a chemical dependency treatment program or insisting on participation in a mutual-help group as a condition of parole.
Diagnosis is the confirmation of a chemical abuse or dependency problem based on established clinical criteria. The diagnostic process generally involves an interview with the patient or client and often includes information from other sources such as a medical examination, including laboratory tests, and previous medical, psychological or psychiatric, criminal, school, and other records. Consultation with other professionals might also be used as is information from collaterals (e.g., family) who know the patient or client well.
The term assessment is sometimes used synonymously with the term diagnosis, but we use it to mean an in-depth consideration of the client’s chemical abuse or dependency problems as they have affected his or her psychological well-being, social circumstances (including interpersonal relationships), financial status, employment or education, health, and so forth. This process also includes consideration of the individual’s strengths and resources that may be assets in treatment and recovery. Going beyond a confirmatory diagnosis, this type of multidimensional or biopsychosocial assessment provides the basis for treatment planning.
The cornerstones of screening, diagnosis, and assessment are knowledge ...
CBT is used to treat cocaine addiction by helping patients learn new behaviors to stop cocaine abuse. Key principles of CBT include modeling new behaviors, operant conditioning to understand triggers of use and develop alternative reinforcers to cocaine, and classical conditioning to reduce cravings by extinguishing conditioned cues. Treatment is individualized and focuses on teaching patients skills like coping with cravings and managing thoughts to initially gain control over cocaine use and achieve abstinence.
The document discusses relapse prevention in substance use disorders. It covers several key points:
1. Relapse is common in addiction recovery, with rates as high as 60-90% within a year of treatment. Prevention of relapse is critical for effective treatment.
2. Relapse is a process that occurs in phases, from initial internal changes to full loss of control over substance use. There are warning signs in each phase.
3. High-risk situations like negative emotions, conflicts, and social pressure can lead to relapse if the person does not have coping skills. The "abstinence violation effect" can also undermine commitment to sobriety.
4. Understanding relapse as a complex, multi
Loss prevention planAnuja SabharwalDavenport Univers.docxSHIVA101531
Loss prevention plan
Anuja Sabharwal
Davenport University
November 23, 2015
Section C. Risk Control Treatment Selection with Implementation Plan
The proper dispensation of psychiatric care involves meeting the challenges that are involved. Employee training, the revision of rules and regulations, the provision of better equipment and the policy revision are the first steps towards the provision of quality psychiatric care to the patients. The departmental heads in the quality assurance, clinical and psychiatric ward need to identify members that are incompetent or that are lacking, these staff members need to be knowledgeable about the provision of services like how to deal with emergencies and safety measures or ways while securing patients, the proper medical terminologies and jargon and the proper way to deal with patients. The goals of treatment are aimed towards ensuring that symptom remission or control is sustained, maintaining or improving the patient’s level of functioning and quality of life while effectively treating the increasing symptoms or relapses and the continued monitoring for adverse treatment effects.
Emphasis should be laid upon working with team members, the patient, and the family to ensure that services are well coordinated and that referrals for additional services are made when appropriate. This entails the proper documentation of the treatment since patients may have been reviewed by different practitioners over their course of illness, this requires the integration of treatment from multiple clinicians. The development of a therapeutic alliance and the promotion of treatment adherence is a key policy that should be firmly considered in the provision of mental health care. The staff is mandated to identify the patient’s goals and aspirations, and be able to relate them to the treatment outcomes thereby increasing treatment adherence. The goal of this adherence is steered towards the control of disturbed behavior and the determination and addressing the factors that may have led to the occurrence of the psychotic episode. Proper guidelines and regulations should be put in place to ensure that the correct and proper ways of carrying out treatment plans and the behavior to exude while dealing with emergencies. The clinic should insulate itself from legal ramifications in the event of the reoccurrence of the same incident. It may be necessary and permissible to speak with others without the patient’s consent by routinely interviewing the family members or other individuals who are knowledgeable about the patient, unless the patient refuses to grant permission, this information may come in handy during emergency circumstances like safety risk. The individuals who violate the rules and regulations should face disciplinary actions like suspension, termination or face legal ramifications.
The training of all staff members is essential since there has been clear signs of lack of knowledge a ...
Substance abuse has significant negative impacts on mental health. It can lead to the development of mental health conditions like depression and anxiety. People who abuse substances often have co-occurring mental illnesses. Treating both substance abuse and mental health issues simultaneously is challenging and integrated treatment approaches are needed. Substance abuse disorders are also linked to poorer psychosocial functioning and problems with relationships, work, and daily life. Women may be particularly vulnerable as substance abuse can stem from attempts to self-medicate physical or mental health conditions.
Presentation on medication history interview and soap notessuchitrauppicherla
pharmacy practice is vital activity performed by pharmadians along with physicians to enhance the quality and span of life of patient .mediaction history interview is is an essential to know and presentation of case collected in universally accepted format .
The family demonstrated some progress in their treatment plan by attending parenting classes and practicing new skills. However, they continued to struggle with drug addiction and cravings. Safety issues were identified for the children due to lack of supervision. The treatment plan included medication, counseling, and referrals to address the family's drug abuse and parenting issues. Compliance with the treatment was good initially but financial issues led to an early termination.
Over the counter drugs and drug abuse among healthcare professionals is discussed. The document examines the prevalence of substance use among healthcare workers, citing studies that found 65.1% of males and 34.9% of females reporting abuse of over-the-counter drugs. Reasons for abuse included easy accessibility, saving time and money, and treating minor ailments. Intervention and prevention measures are recommended, including anonymous physician health programs for evaluation and treatment, medical interventions like rehabilitation programs, and conditions for licensure to help prevent relapse. Education on substance use and effects should begin in high school and continue during university and professional training.
TO REPLY 1 COMMENT TO EACH POST WITH CITATION AND TWO REFERENCE EACH.docxrowthechang
TO REPLY 1 COMMENT TO EACH POST WITH CITATION AND TWO REFERENCE EACH COMMENT APA ABOVE 2013.
POST 1
Three Questions for the Patient
After reviewing the material presented in this case study, there are some concerning questions regarding this patient’s psychiatric history. Additional questions would include:
After each discontinuation of medication after an episode of depression, was this decision the choice of a physician or self -initiated? This question would provide knowledge of the patient’s medication compliance. For example, does the patient stop taking prescribed medication on symptoms are alleviated?
What were the circumstances prior to each depressive episode? his question would enlighten the practitioner on triggers and factors that personally affect the patient before a depressive episode occurs.
There appears to be history of alcohol abuse and depression in your family, has anyone in your family received treatment? This question would provide a view into the patient’s understanding of psychiatric treatment. Since the patient does not believe in psychotherapy due to religious reason, the patient may not know what treatments were, are or will be available to him.
Feedback from People in Patient’s Life
The patient has been married for 33 years. Assuming his spouse is around before, during and after an episode, she may provide information the patient failed to share or may not have been honest about. The first person to be questioned would be the patient’s wife. Some of the questions for the patient’s wife would include onset of symptoms. What occurs before each episode of depression? Is there conflict between you and your spouse? Are there any stressors, such as financial plaguing your spouse and you?
The patient also has three children. All three of his children suffer from some form of depression. Questioning the patient’s children may provide a historical history of the patient. For example, the children may have noticed symptoms leading to the patient’s depression years ago. Questions for the children may include did your parent’s argue often while you were growing up? Did your father ever lose interest in your childhood years? Did you feel love or rejection while growing up from your father? What were your father’s behaviors? Did you ever notice any alcohol or drug abuse while growing up?
Physical and Diagnostic Exams for Patient
Unfortunately, there is not a certain test for depression. The primary goal of physical exam and diagnostic testing would to rule out other conditions causing similar symptoms. A physical exam should be preformed assessing respiratory and cardiovascular system. Vital signs should be taken as well.
Certain labs should be assessed in the patient. The practitioner should check the patient’s thyroid levels. Thyroid hormones have been linked to depression (Stahl, 2008). Depression can be caused by an underactive or overactive thyroid.
Another lab test to consider would be dexamethasone ...
This review summarizes evidence from 54 existing systematic reviews on behavioral counseling and pharmacotherapy interventions for tobacco cessation among adults and pregnant women. The reviews found that behavioral interventions and pharmacotherapy alone or combined are effective for reducing smoking rates in adults, with behavioral interventions particularly helpful for pregnant women. Nicotine replacement therapy, bupropion, and varenicline were found to increase quit rates compared to placebo, with no major adverse events. Behavioral interventions like counseling also increased quit rates compared to various controls. Limited evidence suggested no benefit of e-cigarettes for smoking cessation. Future research should focus on direct drug comparisons, serious adverse events, e-cigarette effectiveness and safety, and interventions for pregnant women and those with
Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Systematic Review for the U.S. Preventive Services Task Force
Masters thesis differential effectiveness of substance abuse treatment by j f...Joyce Fuller
This thesis examines the differential effectiveness of standard substance abuse treatment for those with histories of drug use versus those arrested for drug trafficking. The study analyzed data from 1,348 individuals who completed drug and alcohol treatment. It found that outcomes tended to be poorer for drug traffickers than substance users across 64 of 77 outcome variables. Specifically, drug traffickers had significantly different and poorer outcomes than substance users in the categories of continued drug/alcohol use, reinstitutionalization, environmental issues, high-risk sexual behaviors, and relationship issues. The thesis considers why drug traffickers may receive treatment designed for substance users and potential alternative treatment options.
1. The ALIVE status of each SEX. (SEX needs to be integrated into th.docxketurahhazelhurst
1. The ALIVE status of each SEX. (SEX needs to be integrated into the only Male, Female, ND, and Other) (bar comparison chart, pie comparison chart)
2. How many Male, Female, ND, and Other are there in each ALIGN. (Bar comparison chart)
3. How many red-haired heroes do Marvel and DC have?
.
1. Some potentially pathogenic bacteria and fungi, including strains.docxketurahhazelhurst
1. Some potentially pathogenic bacteria and fungi, including strains of Enterococcus, Staphylococcus, Candida, and Aspergillus, can survive for one to three months on a variety of materials found in hospitals, including scrub suits, lab coats, plastic aprons, and computer keyboards. What can hospital personnel do to reduce the spread of these pathogens?
2. Human immunodeficiency virus (HIV) preferentially destroys CD4+ cells. Specifically, what effect does this have on antibody and cell-mediated immunity?
**Provide APA references for each
.
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CASE STUDY:
Female, 15, separation anxiety disorder, Depression
The patient is a fifteen-year-old female teenager who presents to the clinic with her mother for her first assessment. Patient is being referral to the clinic by the school counselor due to low grades and poor school assistance. During the session, both the patient and the mother are neatly dressed. Her mother seems to be worried about her daughter. The patient said, "I worry a lot about my family members. I fear that one day my parents will be abducted or fatally injured. The worries and fears make me have difficulties concentrating on personal well-being and my studies in school." The mental assessment shows that the patient is depressed, and she refuses to leave the proximity of her mother. Her mother says that her daughter has been experiencing depression or anxiety attacks. The physical assessment shows that the patient has been experiencing physical aches and pains. She maintains good eye contact. Her mood is a little anxious. The symptoms conclude that the patient has separation anxiety disorder because the symptoms have progressed for the past six months. Treatments include antidepressants, group therapy, family therapy, dialectical behavioral therapy, and cognitive-behavioral therapy. A follow-up is to be done in two weeks.
Assignment 2: Focused SOAP Note and Patient Case Presentation
Psychiatric notes are a way to reflect on your practicum experiences and connect them to the didactic learning you gain from your NRNP courses. Focused SOAP notes, such as the ones required in this practicum course, are often used in clinical settings to document patient care.
For this Assignment, you will document information about a patient that you examined during the last three weeks, using the Focused SOAP Note Template provided. You will then use this note to develop and record a case presentation for this patient.
To Prepare
· Present the full complex case study. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; current psychiatric diagnosis including differentials that were ruled out; and plan for treatment and management.
· Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.
· Specifically address the following for the patient, using your SOAP note as a guide:
·
Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
·
Objective: What observations did you make during the psychiatric assessment?
·
Assessment: Discuss their mental status examination results. What were your differential diagnoses? Provide a minimum o.
Social workers currently do not have the authority to prescribe or administer medication, though they play an important role in medication management and adherence. Some other non-physician professions, like psychologists, have begun gaining limited prescribing privileges. This document discusses the expanding roles of social workers in medication management, reviews new laws allowing prescribing by psychologists in New Mexico and Louisiana, and raises questions about whether social work should also pursue prescribing privileges.
Chapter 5 Screening, Diagnosis, Assessment, and ReferralThis chapt.docxmccormicknadine86
Chapter 5 Screening, Diagnosis, Assessment, and Referral
This chapter presents a systems or biopsychosocial approach to determining whether an individual has a chemical abuse or dependency problem. The first steps in this approach are screening and diagnosis. The chapter also considers the extension of this process, called assessment, to examine the client’s needs further. A thorough assessment is generally needed to develop a treatment plan and to make referrals to appropriate resources.
Some individuals with alcohol and drug problems experience medical emergencies (intentional overdoses, accidental alcohol or drug poisoning, pancreatitis, delirium tremens, seizures, etc.) that require immediate attention. Social workers, psychologists, and other human service professionals should know what these emergencies are, but these problems can be diagnosed and treated only by qualified medical personnel. This chapter focuses primarily on the work of helping professionals once such medical crises have been resolved or when a client is seen by a helping professional before these medical complications arise.
We begin by discussing screening, which may be defined as the use of rapid assessment instruments and other tools to determine the likelihood that an individual has a chemical abuse or chemical dependency problem. In practice, much screening is informal and is not done with structured or standardized instruments. For example, after reviewing a parolee’s “rap sheet” containing repeated alcohol- or drug-related arrests, a parole officer may feel that is all the screening necessary for referring the client to a chemical dependency treatment program or insisting on participation in a mutual-help group as a condition of parole.
Diagnosis is the confirmation of a chemical abuse or dependency problem based on established clinical criteria. The diagnostic process generally involves an interview with the patient or client and often includes information from other sources such as a medical examination, including laboratory tests, and previous medical, psychological or psychiatric, criminal, school, and other records. Consultation with other professionals might also be used as is information from collaterals (e.g., family) who know the patient or client well.
The term assessment is sometimes used synonymously with the term diagnosis, but we use it to mean an in-depth consideration of the client’s chemical abuse or dependency problems as they have affected his or her psychological well-being, social circumstances (including interpersonal relationships), financial status, employment or education, health, and so forth. This process also includes consideration of the individual’s strengths and resources that may be assets in treatment and recovery. Going beyond a confirmatory diagnosis, this type of multidimensional or biopsychosocial assessment provides the basis for treatment planning.
The cornerstones of screening, diagnosis, and assessment are knowledge of su ...
The pharmaceutical industry has made it very difficult to know what the clinical trial evidence actually is regarding psychotropics. Consequently, primary care physicians and other front-line practitioners are at a disadvantage when attempting to adhere to the ethical and scientific mandates of evidence based prescriptive practice. This article calls for a higher standard of prescriptive care derived from a risk/benefit analysis of clinical trial evidence. The authors assert that current prescribing practices are empirically unsound and unduly influenced by pharmaceutical company interests, resulting in unnecessary risks to patients. In the spirit of evidenced based medicine’s inclusion of patient values as well as the movement toward health home, we present a patient bill of rights for psychotropic prescription. We then offer guidelines to raise the bar of care equal to the available science for all prescribers of psychiatric medications.
The document outlines the tasks and competencies assessed throughout the USMLE examinations. It provides a comprehensive list of physician tasks and competencies in several domains, including medical knowledge, patient care, communication, professionalism, systems-based practice, practice-based learning, and applied biostatistics. The tasks range from applying foundational science concepts to understanding quality improvement and recognizing sources of error. While this outline is common to all USMLE exams, each step emphasizes different parts of the outline.
LBDA: Ask the Expert - Daniel Kaufer Live Webinar June 2016wef
Clinical trials are research studies that test new medical treatments and are conducted according to a research plan called a protocol. A clinical trial has a principal investigator and research team who are responsible for overseeing the trial. Participants must meet eligibility criteria and provide informed consent to enroll. The trial follows a treatment plan, which may involve experimental treatments, standard treatments, or placebos. Participants are monitored by an Institutional Review Board to ensure safety and ethical treatment. Clinical trials provide information about new treatments and help advance medical knowledge, but may not directly benefit participants.
Chapter 5 Screening, Diagnosis, Assessment, and ReferralThis.docxchristinemaritza
Chapter 5 Screening, Diagnosis, Assessment, and Referral
This chapter presents a systems or biopsychosocial approach to determining whether an individual has a chemical abuse or dependency problem. The first steps in this approach are screening and diagnosis. The chapter also considers the extension of this process, called assessment, to examine the client’s needs further. A thorough assessment is generally needed to develop a treatment plan and to make referrals to appropriate resources.
Some individuals with alcohol and drug problems experience medical emergencies (intentional overdoses, accidental alcohol or drug poisoning, pancreatitis, delirium tremens, seizures, etc.) that require immediate attention. Social workers, psychologists, and other human service professionals should know what these emergencies are, but these problems can be diagnosed and treated only by qualified medical personnel. This chapter focuses primarily on the work of helping professionals once such medical crises have been resolved or when a client is seen by a helping professional before these medical complications arise.
We begin by discussing screening, which may be defined as the use of rapid assessment instruments and other tools to determine the likelihood that an individual has a chemical abuse or chemical dependency problem. In practice, much screening is informal and is not done with structured or standardized instruments. For example, after reviewing a parolee’s “rap sheet” containing repeated alcohol- or drug-related arrests, a parole officer may feel that is all the screening necessary for referring the client to a chemical dependency treatment program or insisting on participation in a mutual-help group as a condition of parole.
Diagnosis is the confirmation of a chemical abuse or dependency problem based on established clinical criteria. The diagnostic process generally involves an interview with the patient or client and often includes information from other sources such as a medical examination, including laboratory tests, and previous medical, psychological or psychiatric, criminal, school, and other records. Consultation with other professionals might also be used as is information from collaterals (e.g., family) who know the patient or client well.
The term assessment is sometimes used synonymously with the term diagnosis, but we use it to mean an in-depth consideration of the client’s chemical abuse or dependency problems as they have affected his or her psychological well-being, social circumstances (including interpersonal relationships), financial status, employment or education, health, and so forth. This process also includes consideration of the individual’s strengths and resources that may be assets in treatment and recovery. Going beyond a confirmatory diagnosis, this type of multidimensional or biopsychosocial assessment provides the basis for treatment planning.
The cornerstones of screening, diagnosis, and assessment are knowledge ...
CBT is used to treat cocaine addiction by helping patients learn new behaviors to stop cocaine abuse. Key principles of CBT include modeling new behaviors, operant conditioning to understand triggers of use and develop alternative reinforcers to cocaine, and classical conditioning to reduce cravings by extinguishing conditioned cues. Treatment is individualized and focuses on teaching patients skills like coping with cravings and managing thoughts to initially gain control over cocaine use and achieve abstinence.
The document discusses relapse prevention in substance use disorders. It covers several key points:
1. Relapse is common in addiction recovery, with rates as high as 60-90% within a year of treatment. Prevention of relapse is critical for effective treatment.
2. Relapse is a process that occurs in phases, from initial internal changes to full loss of control over substance use. There are warning signs in each phase.
3. High-risk situations like negative emotions, conflicts, and social pressure can lead to relapse if the person does not have coping skills. The "abstinence violation effect" can also undermine commitment to sobriety.
4. Understanding relapse as a complex, multi
Loss prevention planAnuja SabharwalDavenport Univers.docxSHIVA101531
Loss prevention plan
Anuja Sabharwal
Davenport University
November 23, 2015
Section C. Risk Control Treatment Selection with Implementation Plan
The proper dispensation of psychiatric care involves meeting the challenges that are involved. Employee training, the revision of rules and regulations, the provision of better equipment and the policy revision are the first steps towards the provision of quality psychiatric care to the patients. The departmental heads in the quality assurance, clinical and psychiatric ward need to identify members that are incompetent or that are lacking, these staff members need to be knowledgeable about the provision of services like how to deal with emergencies and safety measures or ways while securing patients, the proper medical terminologies and jargon and the proper way to deal with patients. The goals of treatment are aimed towards ensuring that symptom remission or control is sustained, maintaining or improving the patient’s level of functioning and quality of life while effectively treating the increasing symptoms or relapses and the continued monitoring for adverse treatment effects.
Emphasis should be laid upon working with team members, the patient, and the family to ensure that services are well coordinated and that referrals for additional services are made when appropriate. This entails the proper documentation of the treatment since patients may have been reviewed by different practitioners over their course of illness, this requires the integration of treatment from multiple clinicians. The development of a therapeutic alliance and the promotion of treatment adherence is a key policy that should be firmly considered in the provision of mental health care. The staff is mandated to identify the patient’s goals and aspirations, and be able to relate them to the treatment outcomes thereby increasing treatment adherence. The goal of this adherence is steered towards the control of disturbed behavior and the determination and addressing the factors that may have led to the occurrence of the psychotic episode. Proper guidelines and regulations should be put in place to ensure that the correct and proper ways of carrying out treatment plans and the behavior to exude while dealing with emergencies. The clinic should insulate itself from legal ramifications in the event of the reoccurrence of the same incident. It may be necessary and permissible to speak with others without the patient’s consent by routinely interviewing the family members or other individuals who are knowledgeable about the patient, unless the patient refuses to grant permission, this information may come in handy during emergency circumstances like safety risk. The individuals who violate the rules and regulations should face disciplinary actions like suspension, termination or face legal ramifications.
The training of all staff members is essential since there has been clear signs of lack of knowledge a ...
Substance abuse has significant negative impacts on mental health. It can lead to the development of mental health conditions like depression and anxiety. People who abuse substances often have co-occurring mental illnesses. Treating both substance abuse and mental health issues simultaneously is challenging and integrated treatment approaches are needed. Substance abuse disorders are also linked to poorer psychosocial functioning and problems with relationships, work, and daily life. Women may be particularly vulnerable as substance abuse can stem from attempts to self-medicate physical or mental health conditions.
Presentation on medication history interview and soap notessuchitrauppicherla
pharmacy practice is vital activity performed by pharmadians along with physicians to enhance the quality and span of life of patient .mediaction history interview is is an essential to know and presentation of case collected in universally accepted format .
The family demonstrated some progress in their treatment plan by attending parenting classes and practicing new skills. However, they continued to struggle with drug addiction and cravings. Safety issues were identified for the children due to lack of supervision. The treatment plan included medication, counseling, and referrals to address the family's drug abuse and parenting issues. Compliance with the treatment was good initially but financial issues led to an early termination.
Over the counter drugs and drug abuse among healthcare professionals is discussed. The document examines the prevalence of substance use among healthcare workers, citing studies that found 65.1% of males and 34.9% of females reporting abuse of over-the-counter drugs. Reasons for abuse included easy accessibility, saving time and money, and treating minor ailments. Intervention and prevention measures are recommended, including anonymous physician health programs for evaluation and treatment, medical interventions like rehabilitation programs, and conditions for licensure to help prevent relapse. Education on substance use and effects should begin in high school and continue during university and professional training.
TO REPLY 1 COMMENT TO EACH POST WITH CITATION AND TWO REFERENCE EACH.docxrowthechang
TO REPLY 1 COMMENT TO EACH POST WITH CITATION AND TWO REFERENCE EACH COMMENT APA ABOVE 2013.
POST 1
Three Questions for the Patient
After reviewing the material presented in this case study, there are some concerning questions regarding this patient’s psychiatric history. Additional questions would include:
After each discontinuation of medication after an episode of depression, was this decision the choice of a physician or self -initiated? This question would provide knowledge of the patient’s medication compliance. For example, does the patient stop taking prescribed medication on symptoms are alleviated?
What were the circumstances prior to each depressive episode? his question would enlighten the practitioner on triggers and factors that personally affect the patient before a depressive episode occurs.
There appears to be history of alcohol abuse and depression in your family, has anyone in your family received treatment? This question would provide a view into the patient’s understanding of psychiatric treatment. Since the patient does not believe in psychotherapy due to religious reason, the patient may not know what treatments were, are or will be available to him.
Feedback from People in Patient’s Life
The patient has been married for 33 years. Assuming his spouse is around before, during and after an episode, she may provide information the patient failed to share or may not have been honest about. The first person to be questioned would be the patient’s wife. Some of the questions for the patient’s wife would include onset of symptoms. What occurs before each episode of depression? Is there conflict between you and your spouse? Are there any stressors, such as financial plaguing your spouse and you?
The patient also has three children. All three of his children suffer from some form of depression. Questioning the patient’s children may provide a historical history of the patient. For example, the children may have noticed symptoms leading to the patient’s depression years ago. Questions for the children may include did your parent’s argue often while you were growing up? Did your father ever lose interest in your childhood years? Did you feel love or rejection while growing up from your father? What were your father’s behaviors? Did you ever notice any alcohol or drug abuse while growing up?
Physical and Diagnostic Exams for Patient
Unfortunately, there is not a certain test for depression. The primary goal of physical exam and diagnostic testing would to rule out other conditions causing similar symptoms. A physical exam should be preformed assessing respiratory and cardiovascular system. Vital signs should be taken as well.
Certain labs should be assessed in the patient. The practitioner should check the patient’s thyroid levels. Thyroid hormones have been linked to depression (Stahl, 2008). Depression can be caused by an underactive or overactive thyroid.
Another lab test to consider would be dexamethasone ...
This review summarizes evidence from 54 existing systematic reviews on behavioral counseling and pharmacotherapy interventions for tobacco cessation among adults and pregnant women. The reviews found that behavioral interventions and pharmacotherapy alone or combined are effective for reducing smoking rates in adults, with behavioral interventions particularly helpful for pregnant women. Nicotine replacement therapy, bupropion, and varenicline were found to increase quit rates compared to placebo, with no major adverse events. Behavioral interventions like counseling also increased quit rates compared to various controls. Limited evidence suggested no benefit of e-cigarettes for smoking cessation. Future research should focus on direct drug comparisons, serious adverse events, e-cigarette effectiveness and safety, and interventions for pregnant women and those with
Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Systematic Review for the U.S. Preventive Services Task Force
Masters thesis differential effectiveness of substance abuse treatment by j f...Joyce Fuller
This thesis examines the differential effectiveness of standard substance abuse treatment for those with histories of drug use versus those arrested for drug trafficking. The study analyzed data from 1,348 individuals who completed drug and alcohol treatment. It found that outcomes tended to be poorer for drug traffickers than substance users across 64 of 77 outcome variables. Specifically, drug traffickers had significantly different and poorer outcomes than substance users in the categories of continued drug/alcohol use, reinstitutionalization, environmental issues, high-risk sexual behaviors, and relationship issues. The thesis considers why drug traffickers may receive treatment designed for substance users and potential alternative treatment options.
Similar to Chapter 6. Assessment of the Patient httpsdoi-org.ez.docx (20)
1. The ALIVE status of each SEX. (SEX needs to be integrated into th.docxketurahhazelhurst
1. The ALIVE status of each SEX. (SEX needs to be integrated into the only Male, Female, ND, and Other) (bar comparison chart, pie comparison chart)
2. How many Male, Female, ND, and Other are there in each ALIGN. (Bar comparison chart)
3. How many red-haired heroes do Marvel and DC have?
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1. Some potentially pathogenic bacteria and fungi, including strains.docxketurahhazelhurst
1. Some potentially pathogenic bacteria and fungi, including strains of Enterococcus, Staphylococcus, Candida, and Aspergillus, can survive for one to three months on a variety of materials found in hospitals, including scrub suits, lab coats, plastic aprons, and computer keyboards. What can hospital personnel do to reduce the spread of these pathogens?
2. Human immunodeficiency virus (HIV) preferentially destroys CD4+ cells. Specifically, what effect does this have on antibody and cell-mediated immunity?
**Provide APA references for each
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1. Taking turns to listen to other students is not always easy f.docxketurahhazelhurst
1. Taking turns to listen to other students is not always easy for young children. What does the research show about promoting good listeners in the classroom setting?
2. How would you help the shyest student to become a confident speaker? How would you help the overly confident speaker to have self-control? Why are these skills important to instill in children at this age? How can becoming a confident speaker encourage stronger advocacy skills for themselves? Likewise, how does maintaining self-control encourage better listening?
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1. The main characters names in The Shape of Things are Adam and E.docxketurahhazelhurst
1. The main characters names in "The Shape of Things" are Adam and Evelyn, suggesting the play is a retelling of the original creation myth. Compare the original “Adam and Eve” and characters in the Judea-Christian creation account to Adam and Evelyn. How is The Shape of Things similar or different from the traditional Judea-Xian account? (Keep in mind the main difference being art and artistic versus theistic creation).
2. The “garden” is the museum, and roped off sculpture with the fig leaf is, like the tree of good and evil, what you’re not supposed to touch. Why does the author present the museum as a creation space? How is the sculpture like the tree of good and evil? What happens when they cross the line and touch (or photograph) it?
3. Compare Evelyn and Pygmalion as creators. How does their gender effect their position in history and creation? How do both their creations critique the culture in which they exist? Describe the "changes" to society that Evelyn and Pygmalion aspire to in their art.
4. How much are the creators (Evelyn and Pygmalion) in control of creation and their art work? Where does their control break down? What is the difference between creator and creature; or is the creature reducible to its creator?
5. When does Adam assert his own mind, (if at all) or veer towards independence by not relying on the tools to achieve superficial beauty that Evelyn imparts?
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1. Select one movie from the list belowShutter Island (2010; My.docxketurahhazelhurst
1. Select one movie from the list below:
Shutter Island (2010; Mystery, Thriller; Leonardo DiCaprio, Mark Ruffalo
2. Watch the film you have selected as a psychology student and not merely as an ordinary film viewer (it is suggested that you watch the selected film multiple times).
3. Provide your own summary of the film, using psychological terms and concepts that you have learned in class and from your textbook. State clearly the psychological disorder you have seen portrayed in the film you have chosen, using DSM criteria/language. You should explain the psychological disorder portrayed in the movie. Determine and evaluate if the disorder identified in the film is accurate according to your textbook and other resource materials. Provide evidence using actual behaviors seen in the film. Is the depiction of the psychological disorder in the film accurate or not? Give evidence to support your claims using observable behaviors from the movie.
4. Based on the information from the film, determine what clinical diagnosis (or diagnoses) a character from the movie most likely has/have (can be the main character or supporting characters). Use criteria provided by the DSM-5 and provide an evidence-based diagnosis/diagnoses of the person. You will need to justify their diagnoses by demonstrating how the character’s symptoms meet some or all the criteria outlined in the DSM-5 as evidence of your diagnosis/diagnoses. Everything that you assert should be supported by evidence.
7. Be sure to use APA format using the latest edition of the APA Manual (7th edition).
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1. Select a system of your choice and describe the system life-cycle.docxketurahhazelhurst
1. Select a system of your choice and describe the system life-cycle. Construct a detailed flow diagram tailored to your situation
2. What characteristics of an airplane would you attribute to the system as a whole rather than to a collection of its parts? Explain why.
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1. Sensation refers to an actual event; perception refers to how we .docxketurahhazelhurst
1. Sensation refers to an actual event; perception refers to how we interpret the event. What are some cultural differences that might affect responses to particular stimuli, particularly in taste and pain?
2. Most of us feel like we never get enough sleep. What are the stages of sleep and what is the importance of sleep? What are some common sleep disorders and treatments?
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1. The Institute of Medicine (now a renamed as a part of the N.docxketurahhazelhurst
1. The Institute of Medicine (now a renamed as a part of the
National Academies of Sciences, Engineering, and Medicine
) defined patient-centered care as: "Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.”[1] While this definition clearly emphasizes the importance of a patient’s perspective in the context of clinical care delivery, it does not allow managers to focus on the actual “person” inside the institutional role of the patient.
In the same sense that a person who is incarcerated in a prison may receive extremely humane treatment, the “person” is still defined into the role of an “inmate,” and as such cannot, by definition, be granted the same rights and privileges as a non-institutionalized member of the civil order enjoys. In other words, I may be placed in a cell with great empathy and understanding of my preferences, needs, and values, but I am still being locked-up in jail.
No one is suggesting that being admitted into a jail cell is the same as being admitted into a hospital bed. There are many obvious differences between the two, including the basic purpose of the two institutions.
But while much is different, what is the same is how a pre-existing set of structured behaviors and processes are used to firmly, and without asking or negotiating, radically transform a “regular” person into a defined role of a “patient” that then can be diagnosed, treated, and discharged back into the world once the patient has finished their “time” in the “system.”
While patient-centered care emphasizes the value of increased sensitivity to a patient’s preferences, needs, and values, what we want to focus on is how decisions made by healthcare leaders affect the actual experience of a person receiving that care.
So with the "real person" in mind, this week's question is:
What can healthcare leaders do in improve the actual personal experience that "real people" go through as our "patients?"
(Be sure to develop your answers AFTER you review the definition and roles of "Leadership" in the readings for this week).
[1] Institute on Medicine, Crossing the Quality Chasm: A New Health System for the 21st Century, March, 2001
2. Health Information Technonogy - PPP Discussion
The board has created an innovation fund designed to foster improved quality, increased access, or reduced costs in healthcare delivery. Select a health information technology related to genomics, precision medicine, or diagnostics that you would propose to be funded for implementation. Prepare a PowerPoint presentation that describes the selected health information technology, what it does, why it would be beneficial, and what risks may be involved. Please note, this activity is weighted 5% toward the final grade. The PowerPoint should be no more than 5-6 slides with the presenter's notes. Follow the APA format.
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1. The Documentary Hypothesis holds that the Pentateuch has a number.docxketurahhazelhurst
1. The Documentary Hypothesis holds that the Pentateuch has a number of underlying documents (alt., sources) that were ultimately gathered and sewn into the Pentateuch as we now have it. The method of separating those underlying documents is called source criticism. Please perform a source-critical analysis of Gen 1-3. In so doing, please identify the significant features that distinguish each underlying document. Note: There are many such features.
2. Why are covenants important in the Bible? What do they accomplish? Are they all the same, whether in structure or outlook? Do the different writers view them differently? What does the ancient Near Eastern background to the biblical covenant contribute to our understanding?
3. Dt 6:4 used to be translated
“Hear, O Israel: The LORD [YHWH] our God, the LORD [YHWH] is one.”
Currently, we translate
“Hear, O Israel: The LORD [YHWH] is our God, the LORD [YHWH] alone.”
In all likelihood, the second translation is grammatically preferable. What is the interpretive difference between “one” and “alone”? Is it significant? How, if at all, does this verse relate to the First Commandment? How does this verse relate to Gen 1:26, 3:22, and 11:7? How does this verse relate to the variant non-MT variant in Dt 32:8-9 (as reproduced in HarperCollins)? Why is any of this important?
Be sure to provide a careful, well-written essay which gives ample biblical examples (proof texts) to support the point(s) you wish to make.
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1. Search the internet and learn about the cases of nurses Julie.docxketurahhazelhurst
1. Search the internet and learn about the cases of nurses Julie Thao and Kimberly Hiatt.
2. List and discuss lessons that you and all healthcare professionals can learn from these two cases.
3. Describe how the principle of beneficence and the virtue of benevolence could be applied to these cases. Do you think the hospital adminstrators handled the situations legally and ethically?
4. In addition to benevolence, which other virtues exhibited by their colleagues might have helped Thao and Hiatt?
5. Discuss personal virtues that might be helpful to second victims themselves to navigate the grieving process.
Scholarly article, APA format, and no grammar error
.
1. Search the internet and learn about the cases of nurses Julie Tha.docxketurahhazelhurst
1. Search the internet and learn about the cases of nurses Julie Thao and Kimberly Hiatt.
2. List and discuss lessons that you and all healthcare professionals can learn from these two cases.
3. Describe how the principle of beneficence and the virtue of benevolence could be applied to these cases. Do you think the hospital adminstrators handled the situations legally and ethically?
4. In addition to benevolence, which other virtues exhibited by their colleagues might have helped Thao and Hiatt?
5. Discuss personal virtues that might be helpful to second victims themselves to navigate the grieving process.
use reference and scholarly nursing article.
.
1. Review the three articles about Inflation that are found below th.docxketurahhazelhurst
1. Review the three articles about Inflation that are found below this.
Globalization and Inflatio
n
Drivers of Inflation
Inflation
and Unemploymen
t
2. Locate two JOURNAL articles which discuss this topic further. You need to focus on the Abstract, Introduction, Results, and Conclusion. For our purposes, you are not expected to fully understand the Data and Methodology.
3. Summarize these journal articles. Please use your own words. No copy-and-paste. Cite your sources.
4.The replies are due by the deadline specified in the Course Schedule.
Please post (in APA format) your article citation.
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1. Review the following request from a customerWe have a ne.docxketurahhazelhurst
1. Review the following request from a customer:
We have a need to replace the aging Signage Application. This application is housed in District 4 and serves the district as well as two other districts. We would like a new application that can be used statewide to track all information related to road signs.
The current system is old and doesn’t do most of what we need it to.
The current system has a whole bunch of reports, but no way for the user to update them by themselves without getting IT involved.
We also can’t create our own reports, on-demand, when we need to. Currently, data is entered into the application manually by Administrative Staff, but in the future, we would like to be able to take a picture of the road sign using a phone app, and have it automagically populate the database with geospatial location and other information. We thought about having a Smart Watch interface, but we don’t need that. Also, the current method does not have any way to manage the quality of the data that is entered, so there is a lot of garbage information there. There is no way to centrally manage security access, with the existing application. We want to get real time alerts when a sign gets knocked over in an accident and have a dashboard that shows where signs have been knocked over across the state. This is kind of important, but not super-critical. We need to store location information, types of signs, when a new sign is installed, who installed it, etc. We plan to provide the phone app to drivers in each district who will drive around, take pictures of the signs, and upload them to the database at the end of each day, or in realtime, if a data connection is available.
Back in Central Office, reviewers will review the sign information and validate it. A report will be printed every month with the results and a map. There are probably other things, but we can’t think of anything else right now.
2. List the main goal(s) of this request
3. Write all the user stories you see (include value statements and acceptance criteria, if possible)
4. Prioritize the user stories as
a. Critical
b. Important
c. Useful
d. Out of Scope
5. Are the user stories sufficiently detailed? If not, what steps would you take to split them/further define them?
6. What are the known Data Entities?
7. Is there an implied business process? Draw an activity diagram or a flow chart of it
8. Who are the actors/roles?
9. What questions would you ask of the stakeholders to get more information?
10. What technology should be used to implement the solution?
11. What would you do next as the assigned Business Analyst working on an Agile team?
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1. Research risk assessment approaches.2. Create an outline .docxketurahhazelhurst
1. Research risk assessment approaches.
2. Create an outline for a basic qualitative risk assessment plan.
3. Write an introduction to the plan explaining its purpose and importance.
4. Define the scope and boundaries for the risk assessment.
5. Identify data center assets and activities to be assessed.
6. Identify relevant threats and vulnerabilities. Include those listed in the scenario and add to the list if needed.
7. Identify relevant types of controls to be assessed.
8. Identify the key roles and responsibilities of individuals and departments within the organization as they pertain to risk assessments.
9. Develop a proposed schedule for the risk assessment process.
10. Complete the draft risk assessment plan detailing the information above. Risk assessment plans often include tables, but you choose the best format to present the material. Format the bulk of the plan similar to a professional business report and cite any sources you used.
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1. Research has narrowed the thousands of leadership behaviors into .docxketurahhazelhurst
1. Research has narrowed the thousands of leadership behaviors into two primary dimensions. Please list and discuss these two behaviors.
2. Distinguish between charismatic, transformational, and authentic leadership. Could an individual display all three types of leadership?
.
1. Research Topic Super Computer Data MiningThe aim of this.docxketurahhazelhurst
1. Research Topic: Super Computer Data Mining
The aim of this project is to produce a super-computing data mining resource for use by the UK academic community which utilizes a number of advanced machine learning and statistical algorithms for large datasets. In particular, a number of evolutionary computing-based algorithms and the ensemble machine approach will be used to exploit the large-scale parallelism possible in super-computing. This purpose is embodied in the following objectives:
1. to develop a massively parallel approach for commonly used statistical and machine learning techniques for exploratory data analysis
1. to develop a massively parallel approach to the use of evolutionary computing techniques for feature creation and selection
1. to develop a massively parallel approach to the use of evolutionary computing techniques for data modelling
1. to develop a massively parallel approach to the use of ensemble machines for data modelling consisting of many well-known machine learning algorithms;
1. to develop an appropriate super-computing infra-structure to support the use of such advanced machine learning techniques with large datasets.
Research Needs:
Problem definition – In the first phase problem definition is listed i.e. business aims and objectives are determined taking into consideration certain factors like the current background and future prospective.
Data exploration – Required data is collected and explored using various statistical methods along with identification of underlying problems.
Data preparation – The data is prepared for modeling by cleansing and formatting the raw data in the desired way. The meaning of data is not changed while preparing.
Modeling – In this phase the data model is created by applying certain mathematical functions and modeling techniques. After the model is created it goes through validation and verification.
Evaluation – After the model is created, it is evaluated by a team of experts to check whether it satisfies business objectives or not.
Deployment – After evaluation, the model is deployed and further plans are made for its maintenance. A properly organized report is prepared with the summary of the work done.
Research paper Policy
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. Abstract
. Introduction
. The problem
4. Are there any sub-problems?
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. The solutions
5. Steps of the solutions
. Compare the solution to other solution
. Any suggestion to improve the solution
. Conclusion
. References
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1. Research and then describe about The Coca-Cola Company primary bu.docxketurahhazelhurst
1. Research and then describe about The Coca-Cola Company primary business activities. Include: Minimum 7 Pages. Excluding reference page
2.
A. A brief historical summary,
B. A list of competitors,
C. The company's position within the industry,
D. Recent developments within the company/industry,
E. Future direction, and
F. Other items of significance to your corporation.
3. Include information from a variety of resources. For example:
A. Consult the Form 10-K filed with the SEC.
B. Review the Annual Report and especially the Letter to Shareholders
C. Explore the corporate website.
D. Select at least two significant news items from recent business periodicals
The report should be well written with cover page, introduction, the body of the paper (with appropriate subheadings), conclusion, and reference page.
.
1. Prepare a risk management plan for the project of finding a job a.docxketurahhazelhurst
1. Prepare a risk management plan for the project of finding a job after graduation.
and
2. Develop a reward system for motivating IPT members to do their jobs more conscientiously and to take on more responsibility.
[The assignment should be at least 400 words minimum and in APA format (including Times New Roman with font size 12 and double spaced), and attached as a WORD file.]
Plagiarism free
.
1. Please define the term social class. How is it usually measured .docxketurahhazelhurst
1. Please define the term social class. How is it usually measured? What are some ways that social class is affecting health outcomes for people who become ill with COVID-19?
2. What is the CARES Act? Has it been enough? What has happened to people's ability to pay their bills since it expired?
3. As things stand now, data is showing higher COVID-19 related mortality rates for African Americans. Given what you know from the textbook and from the attached articles, what are some explanations for the disparity?
4. What is environmental racism (injustice)? How does environmental racism put some populations at higher risk for severe medical complications than others? (Vice article)
https://www.theatlantic.com/ideas/archive/2020/07/600-week-buys-freedom-fear/613972/
https://www.vox.com/2020/4/10/21207520/coronavirus-deaths-economy-layoffs-inequality-covid-pandemic
https://www.vice.com/en_us/article/pke94n/cancer-alley-has-some-of-the-highest-coronavirus-death-rates-in-the-country
https://www.theguardian.com/us-news/2020/apr/12/coronavirus-us-deep-south-poverty-race-perfect-storm
.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
Chapter 6. Assessment of the Patient httpsdoi-org.ez.docx
1. Chapter 6. Assessment of the
Patient
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Shelly F. Greenfield, M.D., M.P.H.Grace Hennessy, M.D.
A number of factors influence the accurate identification,
assessment, and
diagnosis of substance-related disorders among patients
presenting for
treatment. These include the clinical setting, the style of
interviewing, the attitude
of the clinician, and patient characteristics such as the presence
of co-occurring
medical and psychiatric disorders and the stage of use or abuse
of the substance.
The goals of assessing patients with substance-related disorders
are to 1) identify
the presence of a substance-related disorder, as well as signs of
harmful or
hazardous use so that prevention and early intervention may
take place; 2) make
an accurate diagnosis and relating this to any other co-occurring
medical or
psychiatric disorders; 3) identify barriers to treatment as well as
strengths and
supports; 4) assess and enhance the patient’s motivation to
change; and 5)
formulate and help to initiate appropriate evidence-based
2. interventions and
treatments. In this chapter, we review principles of eliciting a
substance use,
psychiatric, and medical history, as well as formulating an
accurate diagnosis.
Eliciting the Substance Abuse History
Interviewing Style
The clinician’s attitude and style of history taking can facilitate
a thorough and accurate
assessment. Patients with substance-related disorders often
report that they do not discuss their
substance use openly with physicians because of their feelings
of shame, discomfort, fear,
distrust, and hopelessness (Center for Substance Abuse
Treatment 2004; Weiss et al. 2000a).
Obstacles to obtaining an accurate history include the patient’s
defenses, such as denial,
minimization, rationalization, projection, and externalization
(Schottenfeld and Pantalon 1999).
Asking open-ended questions such as “What brought you here to
see me today?” may
circumvent these obstacles. Open-ended questions help the
clinician understand how the patient
defines the problem, and this can set the direction for the rest of
the interview.
3. Asking questions in an honest, respectful, and matter-of-fact
manner is likely to be most
effective (Center for Substance Abuse Treatment 2004).
Maintaining a nonjudgmental stance is
helpful to patients who may have feelings of shame or denial.
For example, a clinician may ask,
“How were you feeling before you drank?” rather than “Why
did you drink alcohol then?”
Another approach to reducing shame can be phrasing questions
in such a manner as “Some
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4. people who have alcohol problems experience blackouts. I
wonder if you have ever had that
experience.” This technique can help reduce shame by
conveying to the patient that there is a
range of experiences that others with similar problems have
had. It also demonstrates the
clinician’s knowledge about these experiences and ability to
hear the patient’s perspective.
Clinicians can also avoid using labels; instead, they can ask
patients to describe their pattern of
use without labeling it. For example, if the patient says, “I’m
not an addict. I just snort coke
sometimes,” the clinician can explain, “It would be helpful for
me to understand the pattern of
your cocaine use, so let’s look at this past week [or other period
of time].” Clinician attributes
that are effective in establishing a therapeutic alliance with
patients presenting with addiction
problems include a respectful, genuine, empathic, and
supportive style, as well as reflective
listening and a patient-centered approach (Center for Substance
Abuse Treatment 2004; Miller
and Rollnick 2012).
Patient Characteristics
5. The interview can also be influenced by a number of patient
characteristics that can affect the
clinical presentation of the substance-related disorder. These
characteristics include 1) age,
gender, partner or marital status, legal and employment status,
culture, and ethnicity; 2) level of
insight into as well as personal explanation for the nature of the
problem; 3) psychiatric or
medical comorbidity; 4) stage in the course of illness (e.g., first
treatment, recovery, recent
relapse); 5) current phase of use (e.g., intoxicated, withdrawing,
interepisode); and 6) stage of
readiness for change.
For example, an interview with an adolescent who is dependent
on marijuana may require a
different style of interviewing than an interview with an elderly
widow who developed a
drinking problem in the years after her husband’s death. Women
may be more likely than men to
explain their presenting problem as mood or anxiety related and
may see their drinking or
substance use as a result of these difficulties and not as the
primary problem (Greenfield et al.
6. 2007). Cultural norms may differ regarding the quantity or
frequency of substance use and may
affect the social acceptability and the patient’s description of
his or her use (Westermeyer 2009).
A patient’s marital or partner status and employment status may
also influence his or her
presentation; individuals may present for evaluation because of
the urging or demands of
significant others or because of work or legal complications
resulting from substance use. The
clinical presentation may also vary depending on whether the
patient presents for treatment early
in the course of illness or at a more advanced phase of illness.
The current phase of drug use will also influence the clinical
presentation and interview. Patients
may present in a state of intoxication, withdrawal, remission,
slip, relapse, or maintenance. The
clinician is unlikely to elicit a valid history from an acutely
intoxicated patient (Babor et al.
1987). If possible, an interview during intoxication may be
confined to the ascertainment of
acute medical conditions in need of intervention. The complete
history is best deferred to a time
when the patient is no longer intoxicated.
7. Clinicians may interview substance-using patients when they
are requesting detoxification or
exhibiting signs and symptoms of acute withdrawal (American
Psychiatric Association 2006). In
this circumstance, determining the medical need for
detoxification and preventing withdrawal
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complications are the most important goals of the assessment.
The clinician must first assess for
signs and symptoms of withdrawal because untreated
withdrawal from alcohol or sedatives,
hypnotics, or anxiolytics (e.g., benzodiazepines, barbiturates)
can result in seizures, delirium
tremens, and death. Although opioid withdrawal is not
associated with severe medical
complications, inpatient detoxification may be necessary to
ameliorate withdrawal symptoms
that, if left untreated, could result in ongoing opioid use.
Withdrawal syndromes associated with
the use of marijuana and stimulants such as cocaine and
amphetamines do not require inpatient
detoxification (American Psychiatric Association 2006).
Nicotine withdrawal is also managed on
an outpatient basis (American Psychiatric Association 2006).
A patient may also present in full remission from a substance-
related disorder but may report
symptoms of another medical or psychiatric illness or a new
onset of urges and craving. It will be
important to find out the supports the patient has used to
9. maintain abstinence and recovery, to
examine how any other chronic or new-onset illnesses may be
affecting the patient’s recovery,
and to ascertain what types of treatments or interventions may
help support the patient’s ongoing
recovery. Similarly, a patient who presents with a recent slip or
relapse to substance use may be
directed toward understanding the triggers to the recent drug
use, as well as attempting to
identify strategies that will limit the relapse and help the patient
get back on the recovery track.
The patient’s current stage of motivation for change can affect
the interview (Prochaska et al.
1992). The interview with a patient who is precontemplative
will usually require more probing to
elicit the history. Interview strategies that focus on establishing
a pattern of use and that then
elicit advantages and disadvantages of such use may be helpful.
The clinician might use a
calendar method to determine days of use in the past week,
month, 3 months, 6 months, and year
(Sobell et al. 1992). For more recent time periods, the clinician
can ask for patterns of use (type
of substance, quantity, frequency, time of day, etc.) for each
10. day of the past week or month. For
more distant time periods, the questions may focus on seasonal
events, such as winter holidays,
or important life events, such as birthdays. Alternatively, the
clinician might ask the patient to
compare the past month’s substance use to previous 6-month
time intervals to determine if
substance use has lessened or increased over time.
A similar interviewing style can be used to obtain the lifetime
substance use history, with the
clinician asking for patterns of use during successive
developmental periods, such as childhood,
adolescence, young adulthood, and so on. Anchoring questions
to educational achievements and
other important life events (e.g., marriage, employment,
military service) can also help the
clinician understand the course of substance use throughout the
lifespan. After these use patterns
are identified, the patient might be encouraged to identify ways
in which he or she perceives that
substance use has caused negative consequences for him or her.
This interview will likely differ
from interviews with patients who have had a brief relapse after
a sustained period of recovery.
11. Eliciting the patient’s earlier history is likely to be more
straightforward and to require less
probing. These interviews are more likely to focus on the nature
of the relapse, the particular
triggers to substance use, the consequences of the relapse, and
the plans to help the patient return
to abstinence and recovery.
It is important to reserve time at the end of the interview to
summarize what the clinician has
heard about the patient’s history, the way in which the clinician
formulates this information, any
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diagnostic implications that the clinician is considering, and
12. any possible treatment options and
recommendations. The clinician may begin this part of the
interview by informing the patient
that feedback about the patient’s history will be provided but
then asking the patient if he or she
wants to add any information that has not been discussed or
asked. After the patient has had a
chance to add any further information, the clinician can present
what he or she has heard. It is
often useful to first let the patient know of any particular risk
factors or vulnerabilities that he or
she may have. For example, the clinician might say, “It sounds
to me as if you have a number of
risk factors. You reported that both parents had alcohol
problems, and we know that this is likely
to have made you more vulnerable to the substance. Second, you
reported that you have
struggled with a mood disorder, and we know that often patients
with other psychiatric disorders
such as mood disorders are more vulnerable to developing drug
and alcohol problems.” Then the
clinician might summarize the history the patient has given and
relate the key elements of the
history to specific diagnostic criteria. This should then lead to a
13. formulation of the diagnosis and
the treatment implications.
When the clinician is in the process of eliciting key elements of
the history that will allow him or
her to formulate the diagnosis and to relate these elements back
to the patient in a straightforward
manner, it is important to have in mind the diagnostic criteria
and to use the interview to elicit
history that will help establish a differential diagnosis and
exclude or include the likely diagnosis
for the particular patient.
Diagnosing Substance-Related Disorders
Substance-Related Disorders
In DSM-5 (American Psychiatric Association 2013), the DSM-
IV-TR (American Psychiatric
Association 2000) diagnoses of substance abuse and substance
dependence have been replaced
with one diagnosis, substance use disorder. Although each
substance has its own substance use
disorder criteria, criteria for substance use disorders are similar
across the different substances
(see Box 6–1). In general, a substance use disorder is described
as a problematic pattern of
14. substance use leading to clinically significant impairment or
distress, as manifested by at least
two symptoms occurring in a 12-month period. Current severity
for substance use disorders is
described as mild if two to three symptoms are present,
moderate if four to five symptoms are
present, or severe if six or more symptoms are present. The
criteria for substance-related
disorders are listed in the appendix to this textbook.
DSM-5 Diagnostic Criteria for Substance Use Disorder
A. A problematic pattern of use leading to clinically significant
impairment or distress, as
manifested by at least two of the following, occurring within a
12-month period:
1.
1. The substance is often taken in larger amounts or over a
longer period than
was intended.
2. There is a persistent desire or unsuccessful efforts to cut
down or control
use.
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16. recurrent physical or psychological problem that is likely to
have been
caused or exacerbated by the substance.
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of the substance to
achieve
intoxication or desired effect.
b. A markedly diminished effect with continued use of the same
amount of the substance.
11. Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for the substance
(refer to
Criteria A and B of the specific criteria sets in the appendix to
this
textbook for withdrawal from the specific substances.
b. The substance (or a closely related substance) is taken to
relieve or
avoid withdrawal symptoms.
phencyclidines, hallucinogens, and inhalants, and so this
criterion
does not apply for those substances.
Specify if:
17. Specify if:
use disorder only)
Specify current severity:
: Presence of 2–3 symptoms.
–5 symptoms.
DSM-5 also provides for a number of course specifiers. In early
remission is specified if none of
the substance-related disorder criteria have been met for at least
3 months but for less than 12
months. In sustained remission is specified when none of the
criteria have been present for 12
months or longer. It should be noted that for these remission
specifiers, the criterion “craving, or
a strong desire or urge to use” the substance, may be met. For
opioid use disorder, the additional
18. specifier on maintenance therapy is used if the individual is
taking a prescribed agonist, partial
agonist, or agonist/antagonist medication and no criteria for the
opioid-related disorder have
been met for that class of medication (except tolerance to, or
withdrawal from, the agonist
medication). This specifier is also used for tobacco-related
disorder when long-term maintenance
medications, such as nicotine replacement therapies, are
prescribed. The specifier in a controlled
environment is similarly used when the individual is in an
environment where there is restricted
access to substances. Such an environment could be a locked
hospital unit, a supervised
residential setting, or a substance-free prison.
Substance Intoxication and Substance Withdrawal
Substance intoxication occurs after the recent use of a substance
and causes clinically significant
problematic behavioral or psychological changes that developed
during or shortly after substance
use. Substance withdrawal occurs when there is a reduction in
or cessation of substance use that
has been heavy or prolonged and symptoms characteristic of
withdrawal from a particular
19. substance are experienced. Although all categories of
substances except tobacco produce an
intoxication syndrome, the symptoms, signs, and durations of
the syndromes vary by substance
category. On the other hand, according to DSM-5,
phencyclidine and other hallucinogens, and
inhalants, do not produce a withdrawal syndrome. Knowledge of
the syndromes characteristic of
each category of substances is important in eliciting an accurate
history and clinical status.
Content of the Interview
Understanding the major categories of addictive substances
provides the interviewer with
knowledge about their characteristic intoxication and
withdrawal syndromes. This knowledge
helps the interviewer assess the patient and make appropriate
treatment recommendations. It is
important to ask patients about all categories of substances and
not only the primary substance.
The major categories of addictive substances are listed in Table
6–1.
History of the Substance-Related Disorder Major categories of
substances of
abuse
20. Enlarge table
A systematic and organized way of collecting information about
the patient’s history of
substance use is to address the following areas: 1) age at first
substance use, 2) frequency of
substance use, 3) amount of substance taken during an episode
of use, 4) route of administration
for the substance, 5) consequences associated with substance
use, 6) treatment history, 7) periods
of abstinence, and 8) relapses.
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The information obtained by asking about the age at first
substance use serves as the framework
for the history and guides the interviewer’s subsequent
questions. In addition, the age when the
patient began using substances has diagnostic and prognostic
implications. Early onset (before
age 15 years) of substance use is associated with the subsequent
development of substance-
21. related disorders (Chen et al. 2005; Hingson et al. 2006).
Inquiries about the frequency of substance use as well as the
amount of the substance used and
the route of administration (oral, inhaled, insufflated or snorted,
intravenous, subcutaneous) help
the interviewer understand the progression of substance use
over time. For example, a patient
who says she started snorting (route of administration) one bag
(amount) of heroin once a week
for 1 year (frequency) and then began injecting three bags of
heroin per day is reporting her
progression of heroin use in all three areas. In addition, the
frequency, amount, and route of
administration of use may be related to the development of
medical disorders associated with a
particular substance.
General questions about the consequences of substance use
focus on changes in academic
performance, occupational functioning, and interpersonal
relationships, as well as medical and
legal problems associated with substance use. The history of
addiction treatment includes
questions about hospital admissions for detoxification, as well
22. as admissions to other controlled
living situations (e.g., residential programs, halfway houses,
sober houses, therapeutic
communities) to support ongoing abstinence. Outpatient
programs such as partial hospital
programs, as well as group, individual, and pharmacological
therapies (e.g., disulfiram,
naltrexone, buprenorphine-naloxone, methadone, nicotine
replacement therapies), may also be a
part of the patient’s prior treatment. Understanding which
earlier treatments did or did not help
the patient achieve and maintain abstinence can serve as a guide
for treatment recommendations.
The interviewer should also ask about involvement in self-help
groups (e.g., Alcoholics
Anonymous, Narcotics Anonymous, Self-Management and
Recovery Training, Rational
Recovery, Women for Sobriety). Some patients may express
positive or negative feelings about a
particular type of self-help group. The interviewer should not
support or discredit the patient’s
feelings about self-help groups but instead should seek to
understand the patient’s experiences,
both to educate the patient about the effectiveness of self-help
23. groups and to formulate a realistic
treatment plan that will benefit the patient.
Information about a patient’s periods of abstinence as well as
relapses indicates the progression
or remission of substance use, the severity of the disorder, and
external factors—such as
interpersonal, psychiatric, occupational, legal or medical
problems, and treatment termination—
that may have influenced the return to substance use. The
interviewer should also review current
use of all substances even if no history of past use has been
provided from which to ascertain
current use patterns.
Psychiatric History
There is an increased prevalence of substance-related disorders
among patients diagnosed with
other psychiatric disorders (Compton et al. 2007; Kessler et al.
1997; Regier et al. 1990).
Conversely, patients diagnosed with substance-related disorders
are more likely to have a co-
occurring psychiatric disorder (Brady et al. 1991; Currie et al.
2005; Mueser et al. 2000). Studies
https://psychiatryonline-
25. treatment improves and enhances outcomes for both disorders
(Bennett et al. 2001; Najavits et al.
1998, 2005; Weiss et al. 2000b), it is important to assess
substance-related disorders in patients
presenting for treatment of other psychiatric disorders and
equally important to assess psychiatric
disorders among patients presenting for treatment of substance-
related disorders.
If the patient reports symptoms consistent with a psychiatric
disorder, the interviewer should
inquire about the relationship between substance use and the
emergence, exacerbation, or
regression of psychiatric symptoms. A diagnosis of a substance-
induced mental disorder is made
when the development of the full criteria for a mental disorder
occurs during or within 1 month
of an intoxication with or withdrawal from a substance that is
capable of causing the mental
disorder (American Psychiatric Association 2013). A mental
disorder would be considered
independent of a substance if the disorder preceded the onset of
severe intoxication or
withdrawal, or if the mental disorder persisted for a substantial
period of time (e.g., at least 1
26. month) after substance intoxication or substance withdrawal
ended. Additionally, the disorder
cannot occur exclusively during the course of a delirium and the
disorder must cause clinically
significant distress or impairment in important areas of
functioning. DSM-5 criteria for other
psychiatric disorders include the specifiers with onset during
intoxication and with onset during
discontinuation/withdrawal. Reviewing the patient’s history of
psychiatric symptoms before the
onset of substance use, during episodes of intoxication with or
withdrawal from substances, and
after cessation of substance use can help the interviewer
distinguish between substance-induced
mental disorders and co-occurring psychiatric and substance-
related disorders.
A complete medical history—including current and past medical
problems, surgical procedures,
and medication allergies—is necessary for patients presenting
for assessment of a substance-
related disorder. Medical problems require treatment regardless
of their relationship to substance
use, and the interviewing clinician should make treatment
recommendations or referrals for
27. further evaluation for any conditions. In addition, patients with
substance-related disorders have
often neglected their health and routine medical care and are at
risk for a number of co-occurring
medical disorders. The clinician should ask about the dates of
the last complete physical
examination and follow-ups for any medical problems, past or
current. For each medical
condition, the interviewer should try to determine whether the
symptoms are related to or
independent of substance use. Questions about a reported
medical problem should include
inquiries about the temporal relationship between the
development of the medical condition and
substance use. It is also important to ask about current and past
medical problems that are
specific to use of a particular substance. A description of all the
medical problems associated
with each category of substances is beyond the scope of this
chapter; the major medical problems
and disorders associated with the more commonly abused
substances are listed in Table 6–2.
Medical History Medical problems associated with substance-
related
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Obtaining a reproductive health history is important in the
evaluation of women with substance-
related disorders. Relevant history among women of
childbearing age includes a menstrual
history and determining whether the patient is or may be
pregnant. Women who know they are
pregnant may want additional information on risk of substance
use. A pregnancy test can be
offered if a pregnancy is in question. Pregnancy can serve as a
powerful motivator for cessation
of substance use, and pregnant women may wish to seek
substance abuse treatment that has
specialized services (Brady and Ashley 2005). During different
phases of the menstrual cycle,
women can experience changes in craving and substance use, as
well as differences in likelihood
of stopping their substance use (Greenfield et al. 2011).
Changes in sleep or symptoms such as
hot flashes may be relevant factors in the use of substances for
perimenopausal and
30. postmenopausal women.
Lastly, understanding the relationship between the development
and exacerbation of the patient’s
medical disorders and the patient’s substance use provides the
interviewer with information that
may motivate the patient to change addictive behavior. The
medical history will also provide the
information necessary to refer the patient to appropriate medical
care regardless of the origin of
the medical disorder.
Family History
The family history of substance-related disorders may reveal a
genetic vulnerability to the
patient’s own development of these disorders (Agrawal and
Lynskey 2008). The environment
created by families with substance-related disorders may also
have an impact on the
development of substance-related disorders in their children.
Interviewers can educate patients
about genetic vulnerability and family environmental factors
associated with substance-related
disorders. This information may provide patients with an
understanding of their current problems
31. with substances as well as compelling reasons why they should
refrain from substance use.
Social and Developmental History
Important psychosocial factors to explore include the patient’s
relationships with others, the
influence of these relationships on both initiation and continued
use of substances, and the
existence of any supportive relationships that help the patient
abstain from substances or stop
using substances after starting. Childhood physical or sexual
abuse (Nelson et al. 2006) is a risk
factor for the development of substance-related disorders as
well as for poorer drinking outcomes
(Greenfield et al. 2002) and psychiatric outcomes (Pirard et al.
2005). Developing meaningful
interpersonal relationships, however, can help patients build a
social network that supports
recovery (Havassy et al. 1991). The presence or absence of a
spouse or partner can have an
important influence on the development and perpetuation of a
substance-related disorder (Hser et
al. 1987) and may also have positive or negative effects on
treatment outcomes (Walitzer and
Dearing 2006). Educational attainment and employment can be
32. affected by substance use.
Substance use may lead to school absenteeism, poor school
performance, and dropout (Lynskey
and Hall 2000; Lynskey et al. 2003); lower educational status
(Crum et al. 1998); and lower
income (Mullahy and Sindelar 1989).
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34. a physical examination due to lack of appropriate space,
equipment, and training. Patient factors
such as refusal to undergo an examination or inability to
cooperate with the examination due to
substance intoxication or withdrawal may also be reasons to
defer the physical examination.
Under such circumstances, the interviewer should refer the
patient to the appropriate person
(e.g., primary care physician) or facility (e.g., emergency room)
for a complete physical
examination.
Specific signs of substance use that may present during the
physical or mental status examination
will depend on the type of substance used and the presence of
intoxication with or withdrawal
from substances (Washburn 2002). The signs and symptoms of
substance intoxication and
withdrawal, according to DSM-5, are listed in Tables 6–3 and
6–4, respectively.
Physical and Mental Status Examinations DSM-5 signs and
symptoms of
substance intoxication
Enlarge table
Physical and Mental Status Examinations DSM-5 signs and
35. symptoms of
substance withdrawal
Enlarge table
Although many physical signs of substance use are easily
observed when the interviewer
performs the mental status examination, other signs of
substance use are best detected by
performing a thorough physical examination. For example, a
patient with hepatic damage as a
result of chronic alcohol use or hepatitis infection resulting
from intravenous drug use may
present with a slightly enlarged liver or, in more advanced cases
of hepatic damage, jaundice,
abdominal distention secondary to ascites, gynecomastia, spider
angiomas, palmar erythema, and
caput medusa. A complete description of all the physical
findings associated with substance use
is beyond the scope of this chapter; this example is presented to
illustrate the importance of a
thorough physical examination to detect other signs of
substance-related medical disorders that
require immediate treatment.
The physical and mental status examinations of a patient
presenting for an evaluation of a
36. substance-related disorder can be dramatically affected by states
of intoxication or withdrawal.
Alterations in mood, affect, psychiatric symptoms, thought
processes, thought content, speech,
memory, orientation, cognition, insight, and judgment are
commonly seen when patients are
intoxicated with or are withdrawing from a particular substance.
Similarly, substance
intoxication or withdrawal can lead to significant changes in the
patient’s physiological state,
including abnormalities in blood pressure, body temperature,
and level of consciousness, as well
as disruption in the stability and functioning of major organ
systems such as the neurological and
gastrointestinal systems. In addition, the mental status
examination provides important
information for the diagnosis of other psychiatric disorders and
for the evaluation of the current
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remission, recurrence, or stability of any other concurrent
psychiatric disorder. A comparison of
the patient’s physical and mental status examinations during
different stages of substance abuse
treatment is one way to evaluate changes in substance use and
in any concurrent medical and
psychiatric disorders.
Obtaining Additional Information
A patient’s significant others can often serve as collateral
informants who can
corroborate and provide additional information about the
patient’s reported
substance use history (Carroll 1995). Speaking with the
patient’s significant
others also allows for their early involvement in treatment
planning and may help
in establishing social networks that can potentially support the
patient’s recovery
and help maintain abstinence (Havassy et al. 1991). Contact
with collateral
informants should occur only with written permission from the
patient.
38. Biological markers can help in detecting the degree and
regularity of the patient’s
substance use (Kolodziej et al. 2002) and may be useful in spite
of the limitations
of each specific test. These tests include breath alcohol testing,
quantitative urine
or serum drug screens, and serum tests for blood markers of
hepatic dysfunction
or hematological problems. Finally, a number of standardized
instruments exist
for screening, diagnostic assessment, and evaluation of severity
and may be
helpful in the overall assessment of the patient (Knight et al.
2003).
Conclusion
In this chapter we have discussed the importance of assessing
substance use in all
patients seen in the clinical setting. We have outlined the
content areas of inquiry
of the interview as well as the adjunctive use of the physical
examination and
mental status examination. A careful and accurate assessment of
the patient will
provide the necessary information for intervention and
treatment planning and
will increase motivation by beginning to engage the patient in
the process of
change.
Key Points
1. Successful treatment of substance-related disorders depends
on a careful,
39. accurate assessment and diagnosis.
2. Accurate assessment is facilitated by interview settings that
provide privacy
and patient confidentiality and that permit adequate time to ask
key
questions, to follow up on positive patient responses, and to
give feedback
to the patient.
3. A substance use history should be obtained from all patients
presenting for
treatment.
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4. Patient assessment can be influenced by a number of patient
characteristics, including the patient’s age, gender, ethnicity,
and legal,
marital, and employment status; degree of insight into the
nature of the
problem; medical or psychiatric comorbidity; stage in the
course of illness
(e.g., recovery, recent relapse, first treatment); current phase of
40. use (e.g.,
intoxication, withdrawal, interepisode); and stage of readiness
for change
and motivation.
5. A complete substance use assessment requires eliciting the
history of use
for all the major categories of substances, with a focus on age at
first use,
frequency and amount of use, consequences of use, substance
abuse
treatment history, and complete psychiatric, medical and social,
and
developmental histories.
6. Collateral informant interviews, standardized questionnaires,
and
biological testing may also provide additional helpful
information for some
patients.
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