Working with the Suicidal Patient: A Guide for Health Care Professionals

Working with the Suicidal Patient: A Guide for Health Care Professionals, is a useful tool for assessment and management of suicidality for providers without a mental health background, including those that may be working in an acute care/emergency setting. Task One: ASSESS Assess current suicidal ideation Obtain details if there is a suicidal plan Gather details on current and previous attempts Obtain information on psychiatric and other history Conduct mental status examination Task Two: ADVISE Provide meaning and support Develop a safety plan Provide Information Follow-up Communicate with families/ significant other(s) When to make a specialist referra

Coping with Suicidal Thoughts

Coping with Suicidal Thoughts is intended for individuals who are currently experiencing suicidal ideation and/or have had a plan or made an attempt to hurt themselves. The document is designed to offer resources, information, support, and practical steps to help cope with suicidality

Health Service Patterns Indicate Potential Benefit of Supported Self-Management for Depression in Primary Care

Objective: To examine health service delivery in a Canadian province (British Columbia) toconsider how Canadian health care services might be developed to best address the large numberof individuals with mildly to moderately severe depressive illnesses.Method: We used provincial administrative data to describe patterns of medical servicesprovided to individuals suffering from depression during 3 different time periods (1991–1992,1995–1996, and 2000–2001) and to determine the frequency with which depression patientsreceive treatment from primary care physicians and psychiatrists. We then used these findings toconsider the feasibility and potential applicability of the various approaches that have beendescribed to decrease the burden of disease related to depression.Results: In the fiscal year 1991–1992, the “treated prevalence” rate was 7.7%; in 1995–1996, itwas 8.7%; and in 2000–2001, it was 9.5%. In each cohort over the 10-year period, theproportion of individuals who received a diagnosis of depression and who were then treated byprimary care physicians alone (no psychiatric services were provided) remained constant at 92%.Conclusions: Supported self-management is identified as a promising intervention that could beintegrated into primary health care within the context of the Canadian health care system. Itconstitutes a feasible and practical approach to enhance the role of family physicians in thedelivery of services to individuals with milder forms of depression and promotes the activeengagement of individuals in their recovery and in prevention of future episodes

Positive Coping with Health Conditions

Positive Coping with Health Conditions, A Self-Care Workbook (Dan Bilsker, PhD, RPsych, Joti Samra, PhD, RPsych, Elliot Goldner, MD, FRC(P), MHSc) is a self-care manual authored by scientist-practitioners with expertise in issues relating to coping with health conditions.  This manual is designed for individuals who deal with health conditions, including patients, physicians, psychologists, nurses, rehabilitation professionals and researchers

Dealing With Depression: Antidepressant Skills for Teens

  Dealing with Depression is a workbook for teens that explains depression and teaches three main antidepressant skills you can use to help overcome or prevent it. The skills are presented in a step-by-step way so that you may learn them easily and apply them to your life. Sometimes these antidepressant skills can be used on their own, when the mood problem isn\u27t too severe, and sometimes they have to be used along with treatments prescribed by professionals. Either way, practicing these antidepressant skills will help you deal more effectively with low mood and depression

Depression & Work Function: Bridging the Gap Between Mental Health Care & the Workplace

Depression is rapidly emerging as both a public health and occupational health challenge. This document reviews many of the current clinical and workplace issues associated with this complex disorder and provides a framework for an integrated and comprehensive approach to managing depression in the workplace. In an effort to catalyze action, the report strives to maintain a practical perspective that will appeal to the many stakeholders who must collaborate to create a psychologically healthy workplace. This paper examines clinical and occupational best practices, recommends a systematic array of potential interventions, and identifies numerous resources to assist organizations to develop a customized response that meets their unique needs

Dose-related beneficial long-term hemodynamic and clinical efficacy of irbesartan in heart failure

AbstractOBJECTIVESThe primary purpose of this study was to determine the acute and long-term hemodynamic and clinical effects of irbesartan in patients with heart failure.BACKGROUNDInhibition of angiotensin II production by angiotensin-converting enzyme (ACE) inhibitors reduces morbidity and mortality in patients with heart failure. Irbesartan is an orally active antagonist of the angiotensin II AT1receptor subtype with potential efficacy in heart failure.METHODSTwo hundred eighteen patients with symptomatic heart failure (New York Heart Association [NYHA] class II–IV) and left ventricular ejection fraction ≤40% participated in the study. Serial hemodynamic measurements were made over 24 h following randomization to irbesartan 12.5 mg, 37.5 mg, 75 mg, 150 mg or placebo. After the first dose of study medication, patients receiving placebo were reallocated to one of the four irbesartan doses, treatment was continued for 12 weeks and hemodynamic measurements were repeated.RESULTSIrbesartan induced significant dose-related decreases in pulmonary capillary wedge pressure (average change −5.9 ± 0.9 mm Hg and −5.3 ± 0.9 mm Hg for irbesartan 75 mg and 150 mg, respectively) after 12 weeks of therapy without causing reflex tachycardia and without increasing plasma norepinephrine. The neurohormonal effects of irbesartan were highly variable and none of the changes was statistically significant. There was a significant dose-related decrease in the percentage of patients discontinuing study medication because of worsening heart failure. Irbesartan was well tolerated without evidence of dose-related cough or azotemia.CONCLUSIONSIrbesartan, at once-daily doses of 75 mg and 150 mg, induced sustained hemodynamic improvement and prevented worsening heart failure

“It’s hard to tell”. The challenges of scoring patients on standardised outcome measures by multidisciplinary teams: a case study of Neurorehabilitation

Background Interest is increasing in the application of standardised outcome measures in clinical practice. Measures designed for use in research may not be sufficiently precise to be used in monitoring individual patients. However, little is known about how clinicians and in particular, multidisciplinary teams, score patients using these measures. This paper explores the challenges faced by multidisciplinary teams in allocating scores on standardised outcome measures in clinical practice. Methods Qualitative case study of an inpatient neurorehabilitation team who routinely collected standardised outcome measures on their patients. Data were collected using non participant observation, fieldnotes and tape recordings of 16 multidisciplinary team meetings during which the measures were recited and scored. Eleven clinicians from a range of different professions were also interviewed. Data were analysed used grounded theory techniques. Results We identified a number of instances where scoring the patient was 'problematic'. In 'problematic' scoring, the scores were uncertain and subject to revision and adjustment. They sometimes required negotiation to agree on a shared understanding of concepts to be measured and the guidelines for scoring. Several factors gave rise to this problematic scoring. Team members' knowledge about patients' problems changed over time so that initial scores had to be revised or dismissed, creating an impression of deterioration when none had occurred. Patients had complex problems which could not easily be distinguished from each other and patients themselves varied in their ability to perform tasks over time and across different settings. Team members from different professions worked with patients in different ways and had different perspectives on patients' problems. This was particularly an issue in the scoring of concepts such as anxiety, depression, orientation, social integration and cognitive problems. Conclusion From a psychometric perspective these problems would raise questions about the validity, reliability and responsiveness of the scores. However, from a clinical perspective, such characteristics are an inherent part of clinical judgement and reasoning. It is important to highlight the challenges faced by multidisciplinary teams in scoring patients on standardised outcome measures but it would be unwarranted to conclude that such challenges imply that these measures should not be used in clinical practice for decision making about individual patients. However, our findings do raise some concerns about the use of such measures for performance management

Reluctant empiricists: community mental health nurses and the art of evidence-based praxis

The definitive version of this article is available at www.blackwell-synergy.comThe National Service Framework for Mental Health (1999) emphasizes the need for a culture of evidence-based practice (EBP) in mental health care. However, there is relatively little research addressing EBP from the perspective of community mental health nurses and we are still unsure of why the uptake of this style of working has been slow. This paper suggests that rather than thinking in terms of ‘barriers’ to the uptake of EBP, the issue may best be conceptualized as a form of praxis on the part of nurses, as they seek to manage the diversity of ideologies and practices in their working lives. From an interview and focus group study, we identify how practitioners’ narrow definition of EBP itself, their formulation of how EBP was at odds with the nurse’s professional activity and the organizational constraints within which they work were perceived to inhibit access to information and offer little time and managerial support for information seeking. Those who attempt to further the involvement of community mental health staff in EBP will have to reconceptualize the reasons why staff have yet to incorporate it fully, and acknowledge that this does not occur because staff are simply ‘ignorant Luddites’, but that this resistance enables them to retain a sense of control over their working lives and retain a focus on work with clients. Future EBP initiatives will have to address these ideological and organizational factors in order for uptake to be accelerated. This may involve changing organizational cultures and work roles and even encouraging activism on the part of the practitioners so as to enable them to learn from each other and educate and change their work environments

Quality assurance in psychiatry: quality indicators and guideline implementation

In many occasions, routine mental health care does not correspond to the standards that the medical profession itself puts forward. Hope exists to improve the outcome of severe mental illness by improving the quality of mental health care and by implementing evidence-based consensus guidelines. Adherence to guideline recommendations should reduce costly complications and unnecessary procedures. To measure the quality of mental health care and disease outcome reliably and validly, quality indicators have to be available. These indicators of process and outcome quality should be easily measurable with routine data, should have a strong evidence base, and should be able to describe quality aspects across all sectors over the whole disease course. Measurement-based quality improvement will not be successful when it results in overwhelming documentation reducing the time for clinicians for active treatment interventions. To overcome difficulties in the implementation guidelines and to reduce guideline non-adherence, guideline implementation and quality assurance should be embedded in a complex programme consisting of multifaceted interventions using specific psychological methods for implementation, consultation by experts, and reimbursement of documentation efforts. There are a number of challenges to select appropriate quality indicators in order to allow a fair comparison across different approaches of care. Carefully used, the use of quality indicators and improved guideline adherence can address suboptimal clinical outcomes, reduce practice variations, and narrow the gap between optimal and routine care