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Mental Health Specialists (mental + health_specialist)
Selected AbstractsDepression Treatment in Rural California:Preliminary Survey of Nonpsychiatric PhysiciansTHE JOURNAL OF RURAL HEALTH, Issue 4 2002Bernardo Ng M.D. Depressive disorders have been recognized as disabling conditions of public health proportions. However, in areas underserved by mental health professionals, the treatment of depressed patients becomes challenging. Furthermore, patients living in rural areas and communities underserwd by health professionals are at risk for high levels of depressive symptoms and low access to care. Physicians (N = 58)of multiple nonpsychiatric specialties in Imperial County, a rural underserved area in California, were surveyed to ascertain their preferred strategies in the management of depressed patients. More than half (57%) of the respondents preferred to either refer patients to a mental health specialist(p > .01) as the only strategy, or in combination with counseling, prescribing medication, or both. The most commonly reported form of counseling was of a supportive nature. The most commonly prescribed drugs were selective serotonin reuptake inhibitors (in order of frequency: fluoxetine, sertraline, and paroxetine). Tricyclic antidepressants and benzodiazepines were identified as first-line drugs by some pediatricians and surgeons. The results of this study support the need for enhanced postgraduate training in the treatment of depression for nonpsychiatric physicians, and greater exposure of psychiatric residents to rural psychiatry. [source] A Primary Care Intervention for DepressionTHE JOURNAL OF RURAL HEALTH, Issue 4 2000Jeffrey I. Smith B.S. The study enrolled 479 depressed patients, with 432 (90.2 percent) completing telephone follow-up at six months. Multilevel analytic models revealed that rural enhanced care patients had 2.70 times the odds (P=0.02) of rural usual care patients of taking a three-month course of antidepressant medication at recommended dosages in the six months following baseline; urban enhanced care patients had 2.43 times the odds compared with their urban usual care counterparts (P=0.007). Rural enhanced care patients had 3.00 times the odds of rural usual care patients of making eight or more visits to a mental health specialist for counseling in the six months following baseline (P=0.03). Comparisons of patients in enhanced care practices showed that rural enhanced care patients had 2.00 times the odds (P=0.12) of urban enhanced care patients of making at least one visit to a mental health specialist for counseling in the six months following baseline and had comparable odds to urban enhanced care patients (odds ratio [OR] = 1.06, P=0.77) of making eight or more visits to such specialists during that interval. The study's intervention improved the care received by both rural and urban depressed primary care patients. Moreover, the interventions effect appears to have been greater in rural settings, particularly in terms of increasing depressed rural patients' use of mental health specialists for counseling. [source] Fits and starts: A mother,infant case-study involving intergenerational violent trauma and pseudoseizures across three generationsINFANT MENTAL HEALTH JOURNAL, Issue 5 2003Daniel S. Schechter This case-study presents in detail the clinical assessment of a 29-year-old mother and her daughter who first presented to infant mental health specialists at age 16 months, with a hospital record suggesting the presence of a dyadic disturbance since age eight months. Data from psychiatric and neurological assessments, as well as observational measures of child and mother, are reviewed with attention to issues of disturbed attachment, intergenerational trauma, and cultural factors for this innercity Latino dyad. Severe maternal affect dysregulation in the wake of chronic, early-onset violent-trauma exposure manifested as psychogenic seizures, referred to in the mother's native Spanish as "ataques de nervios," the latter, an idiom of distress, commonly associated with childhood trauma and dissociation. We explore the mechanisms by which the mothers' reexperiencing of violent traumatic experience, together with physiologic hyperarousal and associated negative affects, are communicated to the very young child and the clinician-observer via action and language from moment to moment during the assessment process. The article concludes with a discussion of diagnostic and treatment implications by Drs. Marshall, Gaensbauer, and Zeanah. ©2003 Michigan Association for Infant Mental Health. [source] Two-Minute Mental Health Care for Elderly Patients: Inside Primary Care VisitsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2007(See editorial comments by Drs. Charles Reynolds, Bruce L. Rollman), Carrie Farmer Teh, Mario Cruz OBJECTIVES: To assess how care is delivered for mental disorders using videotapes of office visits involving elderly patients. DESIGN: Mixed-method observational analysis of the nature of the topics discussed, content of discussion, and the time spent on mental health. SETTINGS: Three types of settings: an academic medical center, a managed care group, and fee-for-service solo practitioners. PARTICIPANTS: Thirty-five primary care physicians and 366 of their elderly patients. MEASUREMENTS: Videotapes of 385 visits covering 2,472 diverse topics were analyzed. Coding of the videotapes identified topics, determined talk time, and coded the dynamics of talk. RESULTS: Mental health topics occurred in 22% of visits, although patient survey indicated that 50% of the patients were depressed. A typical mental health discussion lasted approximately 2 minutes. Qualitative analysis suggested wide variations in physician effort in providing mental health care. Referrals to mental health specialists were rare even for severely depressed and suicidal patients. CONCLUSION: Little time is spent on mental health care for elderly patients despite heavy disease burdens. Standards of care based on a count of visits "during which a mental health problem is discussed" may need to be supplemented with guidelines about what should happen during the visit. System-level interventions are needed. [source] Rural telepsychology services for children and adolescentsJOURNAL OF CLINICAL PSYCHOLOGY, Issue 5 2010Eve-Lynn Nelson Abstract Because of the overwhelming maldistribution of mental health specialists in metropolitan areas and the many underserved families living in rural settings, rural areas are natural homes for the use of telemedicine or videoconferencing technology for clinical services. The authors describe telepsychology services for rural clients, placing best psychology practices within the context of broader telemental health services. The goal is to approximate evidence-based child psychotherapy from face-to-face practice using the videoconferencing technology. Telepsychology is illustrated with a case report of a rural Hispanic teen and her family presenting through the teen's primary care clinic. © 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 66:1,12, 2010. [source] Practitioner Review: Psychological Management of Anxiety Disorders in ChildhoodTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 8 2001Mark R. Dadds Many anxiety problems begin in childhood and are a common form of psychological problem that can be highly distressing and associated with a range of social impairments. Thus, skills for conceptualising, assessing, and treating childhood anxiety problems should be in the repertoire of all child mental health specialists. This paper reviews psychosocial treatments for the most common anxiety disorders in children and adolescents. Developmental models of anxiety disorders emphasise maximum risk in children with shy or inhibited temperaments who are exposed to high family anxiety and avoidance, and/or acutely distressing experiences. As children mature these temperamental and environmental experiences are internalised to low self-competence and high threat expectancy. Both individual or group-based interventions utilising cognitive-behavioural strategies to address multiple risk factors are highly efficacious and family involvement can contribute to positive outcomes. Guidelines for assessment and treatment are presented, and suggestions are made for effectively managing clinical process. [source] A Primary Care Intervention for DepressionTHE JOURNAL OF RURAL HEALTH, Issue 4 2000Jeffrey I. Smith B.S. The study enrolled 479 depressed patients, with 432 (90.2 percent) completing telephone follow-up at six months. Multilevel analytic models revealed that rural enhanced care patients had 2.70 times the odds (P=0.02) of rural usual care patients of taking a three-month course of antidepressant medication at recommended dosages in the six months following baseline; urban enhanced care patients had 2.43 times the odds compared with their urban usual care counterparts (P=0.007). Rural enhanced care patients had 3.00 times the odds of rural usual care patients of making eight or more visits to a mental health specialist for counseling in the six months following baseline (P=0.03). Comparisons of patients in enhanced care practices showed that rural enhanced care patients had 2.00 times the odds (P=0.12) of urban enhanced care patients of making at least one visit to a mental health specialist for counseling in the six months following baseline and had comparable odds to urban enhanced care patients (odds ratio [OR] = 1.06, P=0.77) of making eight or more visits to such specialists during that interval. The study's intervention improved the care received by both rural and urban depressed primary care patients. Moreover, the interventions effect appears to have been greater in rural settings, particularly in terms of increasing depressed rural patients' use of mental health specialists for counseling. [source] Psychiatric disorders in advanced cancerCANCER, Issue 8 2007Michael Miovic MD Abstract BACKGROUND. Emotional distress and psychiatric disorders are common among patients with advanced cancer. Oncologists play an important role in screening for these conditions, providing first-line treatment and referring patients for further evaluation and treatment when indicated. METHODS. The literature on psycho-oncology was reviewed, focusing on the epidemiology, assessment, and treatment of psychiatric disorders (adjustment disorders, major depression, anxiety and post-traumatic stress, personality disorders, substance abuse, and major mental disorders such as schizophrenia and bipolar disorder) in patients with advanced cancer. Communication skills and the role of the oncologist in dealing with end-of-life issues were also reviewed. Relevant data were summarized from the most recent systematic reviews, epidemiological studies, and intervention trials. Clinical recommendations are provided. RESULTS. About 50% of patients with advanced cancer meet criteria for a psychiatric disorder, the most common being adjustment disorders (11%,35%) and major depression (5%,26%). Both psychosocial and pharmacological treatments are effective for anxiety and depression, although existing studies have methodological limitations. Collaboration with mental health specialists is recommended for patients with personality disorders, major mental illness, and substance abuse problems. Effective communication involves active listening, exploring emotion and meaning, addressing prognosis, and discussing end-of-life issues when relevant. CONCLUSIONS. Treating psychiatric conditions improves quality of life in patients with advanced cancer. Oncologists play a key role in screening for psychiatric disorders, initiating first-line treatments for depression and anxiety, and communicating with patients and caregivers about prognosis and end-of-life issues. Cancer 2007. © 2007 American Cancer Society. [source] | |||||||||||||