Introduction With Treating Depression

Health care providers can take care of depressed people. A physician, for one, has also training in treating psychiatric disorders. The same goes with the physician assistant and the nurse practitioner. If the case is severe, these health care providers will automatically refer the patient to mental health specialists.

The mental health specialists are composed of the following: psychiatrist, psychologist, a psychiatric nurse specialist and even a social worker.

The psychiatrist offers treatment and diagnosis for mental and psychiatric patients. A psychologist, on the other hand, is trained for counseling, psychological examination and psychotherapy. The social worker knows counseling to a certain degree, whereas a registered nurse who has taken masterals in psychiatric nursing can help out the patient.

Before the diagnosis can be made, the health care providers or mental health specialists will ask the patient on the following: symptoms, overall health and medical and mental history of the family. A physical exam will be carried out as well as some lab tests.

Depression, being an illness, requires tremendous emotional support from the family. A family member must accompany the patient on doctor visits to give the latter a boost.

During the course of the visit, the doctor will figure out if the case is severe, mild or moderate. Depression is severe if the person experiences all the symptoms and if it keeps him from doing all his daily activities. Moderate, if the person has a lot of the symptoms that it hampers his activities. It can be categorized mild if the person has some of the depression symptoms and if he needs more push to do all the things he needs to do.

No one must underestimate depression. It is a real illness, and therefore the patient needs all the help and attention he can get.

As said earlier, you are not alone in this problem. Fortunately, depression, of all psychiatric illnesses, proves to be one of the most treatable. With proper care, more than 80 percent of those suffering from major depression experience significant improvement. Even those suffering from severe depression can helped. Here are some treatments for depression problems:

Psychotherapy There are many types and methods of therapeutic approaches used for treating depression. The most common types are behavioral therapy, cognitive behavioral therapy, rational emotive therapy, and interpersonal therapy. Approaches also include psychodynamic and family approaches. Both the individual as well as group modalities have been used commonly, but these depend on the severity of one’s depression, the financial resources of the person, and resources that are available locally.

Arguably the most prominent therapy in treating depression, the cognitive behavioral therapy is commonly used for handling the condition. There has been extensive research and medical studies that conducted to check or assess the safety as well as the effectiveness in treating depression using this type of therapy.

Considered the father of cognitive behavioral therapy, many written studies and books support this type of therapy. Cognitive behavioral therapy uses simple techniques that focus primarily on the patient’s negative thought patterns. These negative thought patterns are also known as cognitive distortions. A person suffering from depression may from time to time use these cognitive distortions, igniting the condition.

The therapy starts with the establishment of a supportive and warm environment for one suffering from depression. Making the patient learn about how his or her depression problem may be a result of thinking in cognitive distortions is generally the next step. The types of faulty logic and thinking are also discussed in this step (such as “everything or nothing logic,” “blame mis-attribution,” “overgeneralization,” among others) and the person being treated is encouraged to start taking notes of the thoughts he or she has been having as they happen throughout his or her day. This is conducted for the person to understand and realize how often and common this kind of thoughts are occuring.

In this type of therapy, the emphasis is mainly placed on realizing the thoughts as well as the behaviors that are associated with the depression problem rather than on the emotions themselves. The rationale for this emphasis is that is strongly believed that by altering one’s thoughts and consequently, behaviors, his or her emotions will most likely change as well. Because of this type of therapy, cognitive-behavioral therapy is often short-term (generally lasts up to a dozen sessions or two only) and best suits people that are experiencing some kind of distress that is related to the depression they are having. Individuals that are able to handle a problem using a perspective that is unique and therefore are most likely cognitively-oriented could also do well under this approach.

Interpersonal therapy, on the other hand, is also a therapy on a short-term basis used for treating depression. In this type of treatment, the focus usually lies on the social relationships of the patient and determine ways in improving these relationships. It is strongly believed that in order to improve the overall well-being of a person (or the patient in the case); he or she needs to have a stable and good social support.

When a person’s relationships become unhealthy, the person would most likely suffer from this problem. This therapy approach then seeks to enrich one’s skills in social relationships, expression of his or her emotions, assertiveness, and communication skills. This type of approach is usually done individually but sometimes can be used also in a setting for group therapy.

Many individual approaches would place importance more on the patient’s active personal involvement in recovering from depression. Persons being treated under an individual approach are usually enticed and encouraged to finish homework assignments between sessions. If the person is not capable yet to join in therapy sessions actively, then his or her therapist could be the one to first provide the patient an environment that supports him or her until the medication starts to help improve his or her state of feelings and mind.

Psychodynamic or psychoanalytic approaches in treating depression currently do not have much research to recommend their use. Although there are some therapists that might use psychodynamic theory in helping conceptualize a patient’s personality, there are some issues raised on how this could prove to be an effective and efficient depression treatment.

Couples or family therapy could also be considered if the depression of the patient directly affects family relationships. These types of therapy focus on the interpersonal relationships among family members. In addition, these approaches seek to ensure good communication in the family. The roles of the family members in a patient’s depression could be examined. Education about the depression problem in general might also be used as part of the family therapy.

Medication The Food and Drug Administration (FDA) has approved numerous medications for treating depression. These drugs have been sorted into classes; each medication has a unique chemical structure which acts on various chemicals present in the brain.

It is necessary to remember that all medications approved by the DFA to treat depression are effective and recommended – they just do not work the same effect for everybody.

You might want to closely work with the doctor in determining which drug is the best for your condition. Sometimes, conditions may involve having more than just one medication; some work with a mixture of medications. This is important: Do not change your medication or discontinue your dosage without asking your doctor.

www.dragresti.com ~ (561) 842-9550 Dr. Mark Agresti, West Palm Beach Mental Health Specialist — Psychiatrist, explains what is Major Depression. He explains the symptoms of major depression; such as, but not limited to, sadness, hopelessness, despair, thoughts of death and more. Learn the behaviors and some of the treatments used to treat major depression. Major depression is the most common mental illness in the United States and is treatable with a very high success rate. Call Dr. Agresti today to get help with Major Depression.
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Applying the 4 Quadrant Healthcare Model and Evidence-Based Practices to Behavioral Health

APPLICATION OF THE FOUR QUADRANT HEALTHCARE MODEL TO VARIOUS POPULATIONS -

The examples used in the diagram of the Four Quadrant Integration model are for adult populations; the same template can be used to create models that are specific for children and adolescents, or older adults, reflecting the unique issues of serving those populations (for example, the role of schools and school based services in serving children). Older adults, particularly, have been shown to utilize primary care settings for psychosocial, non-organic somatic complaints and to be underrepresented in specialty behavioral health populations — research suggests they are willing to receive behavioral health services in a primary care setting and that targeted interventions can make a difference in depression symptoms. Ethnic, language and racial groups also have unique issues in receiving language and culturally appropriate behavioral health services. Primary care based behavioral health services can improve access for these populations and lead to appropriate engagement with behavioral health specialty services as needed. For example, the Bridge Program in metropolitan New York has been successful in reaching the Asian-American community via their primary care settings.

There are also differences between rural and urban environments and among regional markets in terms of the resources available and ease or difficulty of access to services. The Four Quadrant Integration model provides a template for considering the resources locally available and developing alternative methods of coordination (for example, telemedicine) that may be required when specialty care (either physical or behavioral health) is delivered in another community.

The Four Quadrant Clinical Integration model is not diagnosis specific; it looks at degree of clinical complexity and risk/level of functioning. Further, the evidence-base is at different levels of development in each of the Quadrants. The model is intended to provide a conceptual construct for how to integrate services. Diagnosis specific guidelines should be used to provide detailed guidance for the scope of the primary care provider, the primary care based behavioral health provider, and the specialty behavioral health provider.

THE FOUR QUADRANT MODEL AND EVIDENCE-BASED PRACTICES IN HEALTHCARE AND BEHAVIORAL HEALTH -

In the healthcare system, there are numerous evidence-based practice guidelines that are diagnosis/condition specific. The National Guideline Clearinghouse (NGC) is a public resource for evidence-based clinical practice guidelines. NGC is sponsored by the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services, in partnership with the American Medical Association and the American Association of Health Plans. There are over 1000 disease/condition guidelines that can be accessed through their website (www.guideline.gov).

The Chronic Care Model (CCM) (http://www.improvingchroniccare.org/change/index.html) was developed under the Improving Chronic Illness Care Program. The CCM is in use in a variety of healthcare settings, providing a structured approach for clinical improvement.

The CCM has been used to develop specific approaches for serving patients with diabetes, cardiovascular disease, asthma and depression in a project sponsored by the Bureau of Primary Health Care (BPHC) with the Institute for Healthcare Improvement (IHI), a not-for-profit organization driving the improvement of health by advancing the quality and value of health care. The Health Disparities Collaboratives (http://www.healthdisparities.net/) are a multi-year national initiative to implement models of patient care and change management in order to transform the system of care for underserved populations.

The organizing principles for each of Health Disparities Manuals follows the key elements of the CCM; many of the components apply to each disease entity (e.g., diabetes, asthma, depression), while specific tasks and tools are unique to the specific disease entity. The key change concepts found in the Depression Collaborative manual include:

Organization of Health Care/Leadership -

>   Make sure senior leaders and staff visibly support and promote the effort to improve chronic care
>   Make improving chronic care a part of the organization’s vision, mission, goals, performance improvement, and business plan
>   Make sure senior leaders actively support the improvement effort by removing barriers and  providing necessary resources
>   Assign day-to-day leadership for continued clinical improvement
>   Integrate collaborative models into the quality improvement program

Decision Support -

>   Embed evidence-based guidelines in the care delivery system
>   Establish linkages with key specialists to assure that primary care providers have access to expert support
>   Provide skill oriented interactive training programs for all staff in support of chronic illness improvement
>   Educate patients about guidelines

Delivery System Design -

>   Identify depressed patients during visits for other purposes
>   Use the registry to proactively review care and plan visits
>   Assign roles, duties and tasks for planned visits to a multidisciplinary care team. Use cross training to expand staff capability
>   Use planned visits in individual and group settings
>   Make designated staff responsible for follow-up by various methods, including outreach workers, telephone calls and home visits

Clinical Information System –

>   Establish a registry
>   Develop processes for use of the registry, including designating personnel to enter data, assure data integrity, and maintain the registry
>   Use the registry to generate reminders and care planning tools for individual patients
>   Use the registry to provide feedback to care team and leaders

Self- Management -

>   Use depression self management tools that are based on evidence of effectiveness
>   Set and document self management goals collaboratively with patients
>   Train providers and other key staff on how to help patients with self management goals
>   Follow up and monitor self management goals
>   Use group visits to support self management

Community -

>   Establish links with organizations to develop support programs and policies
>   Link to community resources for defrayed medication costs, education and materials
>   Encourage participation in community education classes and support groups
>   Raise community awareness through networking, outreach and education
>   Provide a list of community resources to patients, families and staff

EVIDENCE-BASED PRACTICES IN THE BEHAVIORAL HEALTH SYSTEM -

The Chronic Care Model (CCM) has also been adapted by The National Program Office for Depression in Primary Care (http://www.wpic.pitt.edu/dppc/), to develop a clinical framework for all partnering organizations to follow. Its Flexible Blueprint was developed after a review of published interventions used to treat depression, interviews with a variety of primary care physicians, mental health specialists and other experts in the field, and selected site visits to view elements of the Chronic Care Model in action.

The Substance Abuse and Mental Health Services Administration (SAMHSA) is supporting the Implementing Evidence Based Practices Project. This project is focused on people who have severe mental illness; these people are most frequently served in the public mental health system (http://www.mentalhealthpractices.org/).

There are six areas that have been researched. Toolkits have been developed based on the multi-state demonstrations that have been underway. The six areas are described below, based on the website materials:

Illness Management and Recovery –

This is a program of weekly sessions where specially trained MH practitioners help people develop personal strategies for coping with mental illness and moving forward in their lives. The program emphasizes helping people set and pursue personal goals and become better able to realize their vision of recovery.

Medication Management Approaches In Psychiatry (Medmap) –

This focuses on using medication in a systematic and effective way, providing guidelines and steps for decision-making based on current evidence and outcomes, monitoring and recording information about medication results, and involving consumers in the decision-making process.

Assertive Community Treatment (ACT) -

This program is for people who experience the most severe symptoms of mental illness. The goal is to help people stay out of the hospital and develop skills for living in the community. Services are provided by a team of practitioners, are available whenever and wherever needed, 24-hours a day, and are provided for as long as they are wanted and needed.

Family Psychoeducation –

This involves a strong partnership between consumers, families and supporters, and practitioners. People work toward recovery by developing better skills for overcoming everyday problems and illness-related issues, developing social support, and improving communication with treatment providers.

Supported Employment –

This is a well-defined approach to helping people with mental illness find and keep competitive employment. These programs are for anyone who expresses

How ADHD Can Affects Mental Health of Children Younger Then 7?

Signs and symptoms of ADHD

Inattention, hyperactivity, and impulsivity are the key symptoms of ADHD. Get easily distracted Hyperactivity involves moving around, jumping, and climbing when others are seated.

The child cannot sit still and behaves at par than others. A doctor may adopt various medications in various doses to see the benefits of it on the child and his responsiveness to it. Children with ADHD carry a thin version of brain tissue from their genes in the areas associated with brain attention Environmental factors such as smoking and alcohol during pregnancy have a potential link with ADHD A small percentage of children with brain injury show signs of ADHD

What other illness can exist with ADHD?

Parents being the main support for the child require good education and knowledge of the treatment along with the doctor to help child come out of this mental health problem. Children have difficulty in focusing and forget things fast. Children with this kind of mental disorder have impaired functioning in home, schools, and relationship with their peer groups.

Difficulty in organizing and following instructions Have difficulty processing information and get easily bored. However certain environmental factors, nutrition and brain injury cannot be disregarded. Every child has different temperaments and personalities. ADHD can also coexist with bedwetting, substance abuse, sleep disorder, and other mental health disorders.

Behavioral therapy attempts to change behavior patterns of the child helping him to focus, organize, react positively to his goals, and receive awards for the same. ADHD is a mental health disorder that needs supervision and support.

How can ADHD be treated?

Children with ADHD can have other illness like: Learning disability mental health disorders like depression and Bipolar disorder Conduct disorder where a child can lie, or resort to stealing Oppositional defiant disorder where a child is over rebellious and refuses to obey orders of an adult.

Specialists and mental health professionals achieve in treating the child by developing an individualized long-term plan where the goal is to help the child control his behavior and the families to create an atmosphere where this is possible.

Many children with ADHD are able to control their behavioral structures when they get individual attention and are allowed to enjoy in playful activities. This mental illness is diagnosed between the age of 3 to 6 by a mental health specialist or a pediatrician.

The disorder can have long-term adverse effects in adolescence and adulthood if not treated on time. Many studies state that like many other mental health disorders genes are a vital cause for ADHD. Teachers, doctors, family and therapists all play a vital role in the child’s treatment and you being a stronger advocate to your child should take advantage of all the support available and help the child navigate towards success.

ADHD cannot not be compared or related with other disorders. It is a neurobehavioral disorder, which affects the mental health of the children globally before seven years of age. Mental Health – Individualized Attention can prevent ADHD Attention Deficit Hyperactivity Disorder or ADHD is the most common psychiatric disorder diagnosed in children.

A specialist focuses on the child’s behavior patterns, the environment he is used to, his family history, and his performance in school as well as in other outdoor and indoor activities. ADHD can be effectively managed but cannot be cured.

Children with this kind of mental health disorder can only be diagnosed if the symptoms persist for more than six months or to a greater degree. Behavioral therapy and medication is considered very effective in treating ADHD but requires close monitoring by the specialist as well as the family. It is very normal for children to possess these behavioral patterns but those with ADHD, these mental health behaviors are severe and occur very frequently.

Children are constantly in motion Talk non-stop and have difficulty in doing quite activities Cannot sit at a dinner table and jump around Impulsivity involves: Reacting quickly without thinking Blurting out inappropriate comments Being impatient Interrupting conversations very often

How can ADHD be diagnosed?

Inattention exists due to the following: The child is Daydreaming or is not bothered about the surroundings and is in his own world.

Types of Mental Health Service Providers

When a person is experiencing psychological or emotional difficulties (hereafter called “mental health problems”), they may well attend their GP. The GP will interview them and based on the nature and severity of the persons symptoms may either recommend treatment himself or refer the person on to a specialist. There can seem a bewildering array of such specialists, all with rather similar titles, and one can wonder as to why they’ve been referred to one specialist rather than another. In this article I give an outline of the qualifications, roles and typical working styles of these specialists. This may be of interest to anyone who is about to, or already seeing, these specialists.

The General Practitioner

Although not a mental health specialist, the GP is a common first contact for those with mental health problems. A GP is a doctor who possesses a medical degree (usually a five-year course) and has completed a one-year “pre-registration” period in a general hospital (six-months on a surgical ward and six-months on a medical ward as a “junior house officer”). Following this a GP has completed a number of six-month placements in various hospital-based specialities – typical choices include obstetrics and gynaecology, paediatrics, psychiatry and/or general medicine. Finally, a year is spent in general practice as a “GP registrar” under the supervision of a senior GP. During this period, most doctors will take examinations to obtain the professional qualification of the Royal College of General Practitioners (“Member of the Royal College of General Practitioners”, or MRCGP). Others qualifications, such as diplomas in child health, may also be obtained.

The GP is thus a doctor with a wide range of skills and experience, able to recognise and treat a multitude of conditions. Of course the necessity of this wide range of experience places limits on the depth of knowledge and skills that they can acquire. Therefore, if a patient’s condition is rare or, complicated, or particularly severe and requiring hospital-based treatment, then they will refer that patient on to a specialist.

Focusing on mental health problems it will be noted that whilst the majority of GP’s have completed a six-month placement in psychiatry, such a placement is not compulsory for GP’s. However, mental health problems are a common reason for attending the GP and, subsequently, GP’s tend to acquire a lot of experience “on the job”.

Most GP’s feel able to diagnose and treat the common mental health problems such as depression and anxiety. The treatments will typically consist of prescribing medication (such as antidepressants or anxiolytics) in the first instance. If these are ineffective, alternative medication may be tried, or they may refer the patient to a specialist. GP’s are more likely to refer a patient to a specialist immediately if their condition is severe, or they are suicidal, or they are experiencing “psychotic” symptoms such as hallucinations and delusions.

The Psychiatrist

This is a fully qualified doctor (possessing a medical degree plus one year pre-registration year in general hospital) who has specialised in the diagnosis and treatment of mental health problems. Most psychiatrists commence their psychiatric training immediately following their pre-registration year and so have limited experience in other areas of physical illness (although some have trained as GP’s and then switched to psychiatry at a later date). Psychiatric training typically consists of a three-year “basic” training followed by a three year “specialist training”. During basic training, the doctor (as a “Senior House Officer” or SHO) undertakes six-month placements in a variety of psychiatric specialities taken from a list such as; General Adult Psychiatry, Old Age Psychiatry (Psychogeriatrics), Child and Family Psychiatry, Forensic Psychiatry (the diagnosis and treatment of mentally ill offenders), Learning Disabilities and the Psychiatry of Addictions. During basic training, the doctor takes examinations to obtain the professional qualification of the Royal College of Psychiatrists (“Member of the Royal College of Psychiatrists” or MRCPsych).

After obtaining this qualification, the doctor undertakes a further three-year specialist-training placement as a “Specialist Registrar” or SpR. At this point the doctor chooses which area of psychiatry to specialise in – General Adult Psychiatry, Old Age Psychiatry etc – and his placements are selected appropriately. There are no further examinations, and following successful completion of this three-year period, the doctor receives a “Certificate of Completion of Specialist Training” or CCST. He can now be appointed as a Consultant Psychiatrist.

The above is a typical career path for a psychiatrist. However, there are an increasing number of job titles out with the SHO-SpR-Consultant rubric. These include such titles as “Staff Grade Psychiatrist” and “Associate Specialist in Psychiatry”. The doctors with these titles have varying qualifications and degrees of experience. Some may possess the MRCPsych but not the CCST (typically, these are the Associate Specialists); others may possess neither or only part of the MRCPsych (many Staff Grades).

Psychiatrists of any level or job title will have significant experience in the diagnosis and treatment of people with mental health difficulties, and all (unless themselves a consultant) will be supervised by a consultant.

Psychiatrists have particular skill in the diagnosis of mental health problems, and will generally be able to provide a more detailed diagnosis (i.e. what the condition is) and prognosis (i.e. how the condition changes over time and responds to treatment) than a GP. The psychiatrist is also in a better position to access other mental health specialists (such as Psychologists and Community Psychiatric Nurses or CPNs) when needed. They also have access to inpatient and day patient services for those with severe mental health problems.

The mainstay of treatment by a psychiatrist is, like with GP’s, medication. However, they will be more experienced and confident in prescribing from the entire range of psychiatric medications – some medications (such as the antipsychotic Clozapine) are only available under psychiatric supervision and others (such as the mood-stabiliser Lithium) are rarely prescribed by GP’s
without consulting a psychiatrist first.

A psychiatrist, as a rule, does not offer “talking treatments” such as psychotherapy, cognitive therapy or counselling. The latter may be available “in-house” at the GP surgery – some surgeries employ a counsellor to whom they can refer directly.

Psychologists and allied mental health staff typically provide the more intensive talking therapies. Some senior mental health nurses and CPNs will have been trained in specific talking therapies. It is to a Psychologist or a trained nurse that a psychiatrist will refer a patient for talking therapy. These therapies are suitable for certain conditions and not for others – generally, conditions such as Schizophrenia and psychosis are less appropriate for these therapies than the less severe and more common conditions such as depression, anxiety, post-traumatic stress disorder, phobia(s) and addictions. In many cases, a patient will be prescribed both medication and a talking therapy – thus they may be seen by both a therapist and a psychiatrist over the course of their treatment.

The Psychologist

A qualified clinical psychologist is educated and trained to an impressive degree. In addition to a basic degree in Psychology (a three year course) they will also have completed a PhD (“Doctor of Philosophy” or “Doctorate”) – a further three-year course involving innovative and independent research in some aspect of psychology. They will also be formally trained in the assessment and treatment of psychological conditions, although with a more “psychological” slant than that of psychiatrists. Psychologists do not prescribe medication. They are able to offer a wide range of talking therapies to patients, although they typically specialise and become expert in one particular style of therapy. The therapies a particular psychologist will offer may vary from a colleague, but will usually be classifiable under the title of Psychotherapy (e.g. Analytic Psychotherapy, Transactional Analysis, Emotive therapy, Narrative therapy etc) or Cognitive Therapy (e.g. Cognitive Behavioural Therapy (CBT) or Neuro-Linguistic Programming (NLP) etc).

The Community Psychiatric Nurse (CPN)

These are mental health trained nurses that work in the community. They will have completed a two or three year training programme in mental health nursing – this leads to either a diploma or a degree, depending on the specific course. They are not usually “general trained”, meaning their experience of physical illness will be limited. Following completion of the course they will have spent a variable amount of time in placements on an inpatient psychiatric unit – this time can range from twelve months to several years. They can then apply to be a CPN – they are required to show a good knowledge and significant experience of mental health problems before being appointed.

CPNs are attached to Community Mental Health Teams and work closely with psychiatrists, psychologists and other staff. They offer support, advice and monitoring of patients in the community, usually visiting them at home. They can liaise with other mental health staff on behalf of the patient and investigate other support networks available (such as the mental health charities).

Some CPNs will be formally trained in one or more “talking therapies”, usually a cognitive therapy such as CBT (see “Allied Therapists”