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Disorders
Published in Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson, Pocket Prescriber Psychiatry, 2019
Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson
If intolerable side effects, adverse reactions or poor response, then consider switching to an alternative antipsychotic: Consider the risk of destabilisation of illness and adverse effects of the new drug.Gradually cross-taper over 2–4 wk.Avoid abrupt discontinuation, especially of clozapine (unless for serious adverse effect).If switching from oral to depot, gradually reduce oral dose after giving depot.
Challenges in the provision of mental health care for refugees in Germany
Published in Katja Kuehlmeyer, Corinna Klingler, Richard Huxtable, Ethical, Legal and Social Aspects of Health Care for, 2018
Kerstin Hein, Barbara Abdallah-Steinkopff
Finally, in the course of the asylum procedure, mental health care professionals may be asked to assess the mental health care status of asylum seekers and write an expert opinion to be considered during the legal proceedings at the Federal Office for Migration and Refugees or the Federal Administrative Court. The certification of recognised psychological disorders may prevent deportation and thus acquires existential meaning for asylum applicants. In 2003, the German Medical Association determined quality standards for this kind of document, based on the Istanbul Protocol (Frewer et al. 2009) and the suggestions of a special working group (Gierlichs et al. 2012). These standards are conveyed in certified training sessions for mental health care professionals, particularly medical and psychological psychotherapists. Professional assessments require several sessions to properly evaluate traumatic events. Assessors need to be able to reconstruct the details of the trauma and clear up any contradictions that may emerge during the process to ensure the credibility of their expertise. However, the exploration of trauma may constitute a scary and straining experience for the affected person as it may lead to uncontrollable stimulus satiation. Therefore, evaluators need to pay special attention to early signs of destabilisation, introduce breaks, and use stabilising measures to prevent a re-emergence of symptoms. Normally, treating psychotherapists do not perform such assessments, but delegate these procedures to uninvolved certified evaluators to avoid burdening the therapeutic relationship.
Imaging of Cardiovascular Disease
Published in George C. Kagadis, Nancy L. Ford, Dimitrios N. Karnabatidis, George K. Loudos, Handbook of Small Animal Imaging, 2018
Aleksandra Kalinowska, Lawrence W. Dobrucki
If treatment is not administered, the inflammatory response progresses significantly and causes further complications. The process is complex—monocytes in the arterial wall differentiate into macrophages, which then internalize previously modified lipoproteins and settle as foam cells in the arterial tunica intima. If the organism’s anti-inflammatory signals do not counterbalance atherogenic pathways, plaques undergo destabilization. Destabilization may eventually result in ruptures and thrombi formation. A thromboembolic event at the site of or downstream from the plaque rupture is a quite common clinical consequence of atherosclerosis. Imaging of thrombosis has therefore been proven a successful approach in helping confirm the diagnosis of atherosclerotic changes.
A new perspective of the risk of caustic substance ingestion: the outcomes of 468 patients in one North Taiwan medical center within 20 years
Published in Clinical Toxicology, 2021
Yu-Jhou Chen, Chen-June Seak, Shih-Ching Kang, Tsung-Hsing Chen, Chien-Cheng Chen, Chip-Jin Ng, Chao-Wei Lee, Ming-Yao Su, Hsin-Chih Huang, Pin-Cheng Chen, Chun-Hsiang Ooyang, Sen-Yung Hsieh, Hao-Tsai Cheng
Proton pump inhibitors or H2 antagonists were prescribed to treat caustic injury. Patients received parenteral nutrition without oral intake until their clinical status was regarded as stable. In cases of suspected infection, blood cultures were obtained before the administration of antibiotics (gentamicin and first-generation cephalosporins). Once destabilization or respiratory difficulty was encountered, a patient was transferred to the ICU for critical care. Follow-up EGD was performed if indicated. After discharge, patients were followed up in the outpatient clinic for at least 6 months. Although the exact treatment strategies might have been altered individually according to different clinical conditions, the major principles for similar cases did not change significantly during the past 20 years at our center.
Utility of the READMIT Index to Identify Community Hospital 30-Day Psychiatric Readmissions
Published in Issues in Mental Health Nursing, 2020
Emily N. Spinner, Marilyn Stapleton, Jane E. Oppenlander, Evangeline Murray, Raad Shaikh, Elizabeth Ramkirpaul
This study, like others of its kind, found that a history of inpatient psychiatric admissions increases the likelihood of future admissions. According to Montgomery and Kirkpatrick (2002), patients with a history of past psychiatric inpatient admissions are more likely to seek future inpatient treatment. These patients have a history of noncompliance in the community, resulting in destabilization, and the subsequent need for inpatient admission. Evans et al. (2017) proposed that patients with multiple readmissions may have a greater number of care-coordinators, and incomplete communication and collaboration among these individuals may affect patient care, resulting in repeat admissions. Like patients with multiple ED visits, a history of repeat readmissions indicates that patients are having difficulties managing their condition while in the community. These patients are familiar with the inpatient setting and are more likely to utilize inpatient admission for stabilization.
How can multidisciplinary management with remote monitoring improve the outcome of patients with chronic cardiac diseases?
Published in Expert Review of Medical Devices, 2020
Simonetta Scalvini, Laura Comini, Palmira Bernocchi
A continued focus on the development of remote monitoring devices and management could outline ‘the home’ as the right place where we can continue care and cure of cardiac chronic condition helping caregivers, who spend an enormous amount of time to assist patients with impaired activities of daily living, as well. One possible solution is that, in a very close time, the patient’s home, where clinicians can combine old-fashioned sensibilities and care with the application of new technologies, could respond to major demographic, epidemiologic, and healthcare trend; it seems inevitable that healthcare is going home [5]. For older adults who live alone with little family support, the management of chronic cardiac syndrome is even more challenging due to increased risk of destabilization; in this condition, elderly people need a professional healthcare support [6].