In the opening case study, Mrs. D.'s depressive symptoms should have been identified by the clinician, and the initiation of a complete workup should have been scheduled (see Figure 1 flow chart). Depression, although frequently difficult to diagnose in the elderly, is a common treatable illness. Screening for depression and asking the patient during routine visits about their mood will assist in identifying patients at risk. A systematic approach to the clinical evaluation, including a thorough history and physical examination, as well as laboratory tests necessary to identify comorbid medical conditions, is mandatory. Primary care providers need to be aware of confusing and confounding variables that may present in the patient's presentation. Once the diagnosis is made, a comprehensive treatment plan, including patient and family education, psychosocial intervention, and medication, when necessary, should be instituted. The primary care provider can positively affect the health and wellbeing of the elderly patient if they are diligent in the diagnosis and appropriate treatment of depression.
{"title":"Diagnosis of depression in the elderly patient.","authors":"K S Burkhart","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In the opening case study, Mrs. D.'s depressive symptoms should have been identified by the clinician, and the initiation of a complete workup should have been scheduled (see Figure 1 flow chart). Depression, although frequently difficult to diagnose in the elderly, is a common treatable illness. Screening for depression and asking the patient during routine visits about their mood will assist in identifying patients at risk. A systematic approach to the clinical evaluation, including a thorough history and physical examination, as well as laboratory tests necessary to identify comorbid medical conditions, is mandatory. Primary care providers need to be aware of confusing and confounding variables that may present in the patient's presentation. Once the diagnosis is made, a comprehensive treatment plan, including patient and family education, psychosocial intervention, and medication, when necessary, should be instituted. The primary care provider can positively affect the health and wellbeing of the elderly patient if they are diligent in the diagnosis and appropriate treatment of depression.</p>","PeriodicalId":79509,"journal":{"name":"Lippincott's primary care practice","volume":"4 2","pages":"149-62"},"PeriodicalIF":0.0,"publicationDate":"2000-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21965164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Domestic violence affects millions of Americans, many of whom deny or refuse to admit that that they are victims of abuse. Assessing patients at risk for domestic violence is a critical aspect of providing comprehensive primary care. As social agents, with moral and ethical responsibility, primary care providers must advocate for clients in the fight against domestic violence. Primary health care agencies must adopt uniform policies that assure that all women, children, and elders at risk for abuse are screened using a simple tool that becomes part of the primary care record. Screening for abuse should become part of an annual screening process, not unlike screening patients for high blood pressure or high cholesterol. If patients are suspected of being abused, document this on the problem list so subsequent providers will know to explore the possibility of abuse with patients. Multiple forms of abuse occur in families, and signs of abuse are usually subtle in nature. Abuse may be the reason for failed office visits, noncompliance with medications, depression, and other unexplained physical and psychological signs and symptoms. If we fail to ask, we will never know how many of our patients are victims of abuse and in need of our help.
{"title":"Domestic violence: a life-span approach to assessment and intervention.","authors":"M McAllister","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Domestic violence affects millions of Americans, many of whom deny or refuse to admit that that they are victims of abuse. Assessing patients at risk for domestic violence is a critical aspect of providing comprehensive primary care. As social agents, with moral and ethical responsibility, primary care providers must advocate for clients in the fight against domestic violence. Primary health care agencies must adopt uniform policies that assure that all women, children, and elders at risk for abuse are screened using a simple tool that becomes part of the primary care record. Screening for abuse should become part of an annual screening process, not unlike screening patients for high blood pressure or high cholesterol. If patients are suspected of being abused, document this on the problem list so subsequent providers will know to explore the possibility of abuse with patients. Multiple forms of abuse occur in families, and signs of abuse are usually subtle in nature. Abuse may be the reason for failed office visits, noncompliance with medications, depression, and other unexplained physical and psychological signs and symptoms. If we fail to ask, we will never know how many of our patients are victims of abuse and in need of our help.</p>","PeriodicalId":79509,"journal":{"name":"Lippincott's primary care practice","volume":"4 2","pages":"174-89; quiz 190-2"},"PeriodicalIF":0.0,"publicationDate":"2000-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21965166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Panic disorder.","authors":"A C Martin","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79509,"journal":{"name":"Lippincott's primary care practice","volume":"4 2","pages":"228-33"},"PeriodicalIF":0.0,"publicationDate":"2000-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21965173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Protocol for alcohol outpatient detoxification.","authors":"A C Martin","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79509,"journal":{"name":"Lippincott's primary care practice","volume":"4 2","pages":"221-7"},"PeriodicalIF":0.0,"publicationDate":"2000-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21965172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Stress management.","authors":"S B Malone","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79509,"journal":{"name":"Lippincott's primary care practice","volume":"4 2","pages":"234-6"},"PeriodicalIF":0.0,"publicationDate":"2000-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21965175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Attention deficit/hyperactivity disorder (ADHD) is a term used to describe a constellation of inappropriate levels of inattention and impulsivity. The history of name changes from minimal brain syndrome, to hyperkinetic syndrome, to what is now known as ADHD, reflects the influence of neurology, pediatrics, and psychiatry. This "evolutionary" process has been replete with controversy stemming from the diverse views of broad disciplines that have attempted to define its range, scope, and treatment. ADHD has been defined within a "neurobiopyschoeducational" context, which has made the diagnosis and treatment of this disorder more challenging. The aim of this article is to highlight the current revisions to the ADHD DSM-IV diagnostic criteria and to identify current assessment issues and strategies to aid in making the proper diagnosis and treatment plan.
{"title":"ADHD: making the appropriate pediatric assessment.","authors":"J Sangare","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Attention deficit/hyperactivity disorder (ADHD) is a term used to describe a constellation of inappropriate levels of inattention and impulsivity. The history of name changes from minimal brain syndrome, to hyperkinetic syndrome, to what is now known as ADHD, reflects the influence of neurology, pediatrics, and psychiatry. This \"evolutionary\" process has been replete with controversy stemming from the diverse views of broad disciplines that have attempted to define its range, scope, and treatment. ADHD has been defined within a \"neurobiopyschoeducational\" context, which has made the diagnosis and treatment of this disorder more challenging. The aim of this article is to highlight the current revisions to the ADHD DSM-IV diagnostic criteria and to identify current assessment issues and strategies to aid in making the proper diagnosis and treatment plan.</p>","PeriodicalId":79509,"journal":{"name":"Lippincott's primary care practice","volume":"4 2","pages":"193-206"},"PeriodicalIF":0.0,"publicationDate":"2000-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21965167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Patient education. HIV medications.","authors":"S Brinkley-Laughton","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79509,"journal":{"name":"Lippincott's primary care practice","volume":"4 1","pages":"117-20"},"PeriodicalIF":0.0,"publicationDate":"2000-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21855474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The initial evaluation and management of an HIV(+) patient.","authors":"G Parr","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79509,"journal":{"name":"Lippincott's primary care practice","volume":"4 1","pages":"101-5"},"PeriodicalIF":0.0,"publicationDate":"2000-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21855471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acute laryngitis.","authors":"J. S. Lynch, C. G. Roberti","doi":"10.32388/i1q11l","DOIUrl":"https://doi.org/10.32388/i1q11l","url":null,"abstract":"","PeriodicalId":79509,"journal":{"name":"Lippincott's primary care practice","volume":"4 5 1","pages":"534-8"},"PeriodicalIF":0.0,"publicationDate":"2000-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69632191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-01-01DOI: 10.4135/9781452204925.n7
M. McDonnell, C. Kessenich
Women are the fastest growing segment of people with acquired immunodeficiency syndrome (AIDS), yet they often receive this diagnosis when the disease is in its advanced stages. New therapies have caused human immunodeficiency virus (HIV) to become a chronic and treatable disease for many of those afflicted. Primary care providers must be cognizant of the initial symptoms to facilitate early diagnosis and prompt treatment for women with HIV. Early signs of HIV in women are subtle. Providers must consider a diagnosis of HIV in women who present with vaginal infections, abnormal pap smears, or sexually transmitted diseases that are unusually severe, recurrent, and resistant to treatment efforts. These signs and symptoms, along with a corroborating history, may be early clues to HIV. Primary care providers, in conjunction with HIV specialists, must strive to decrease the incidence, morbidity, and mortality of the disease in women.
{"title":"HIV/AIDS and women.","authors":"M. McDonnell, C. Kessenich","doi":"10.4135/9781452204925.n7","DOIUrl":"https://doi.org/10.4135/9781452204925.n7","url":null,"abstract":"Women are the fastest growing segment of people with acquired immunodeficiency syndrome (AIDS), yet they often receive this diagnosis when the disease is in its advanced stages. New therapies have caused human immunodeficiency virus (HIV) to become a chronic and treatable disease for many of those afflicted. Primary care providers must be cognizant of the initial symptoms to facilitate early diagnosis and prompt treatment for women with HIV. Early signs of HIV in women are subtle. Providers must consider a diagnosis of HIV in women who present with vaginal infections, abnormal pap smears, or sexually transmitted diseases that are unusually severe, recurrent, and resistant to treatment efforts. These signs and symptoms, along with a corroborating history, may be early clues to HIV. Primary care providers, in conjunction with HIV specialists, must strive to decrease the incidence, morbidity, and mortality of the disease in women.","PeriodicalId":79509,"journal":{"name":"Lippincott's primary care practice","volume":"4 1 1","pages":"66-73"},"PeriodicalIF":0.0,"publicationDate":"2000-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70573787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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