most domains Some hope and energy to help self No or only vague suicidal thoughts Psychoeducation Self care Address unhelpful beliefs Guilt Hexing Excessive demands or expectations Severe depression Poor function Prior severe episode Severely disrupted sleep Psycho education Self care Address unhelpful beliefs Guilt Hexing Excessive demands or expectations Medication – SSRI only for teens or older. Psychotic delusions or hallucinations Treat with antipsychotic No Yes
Patient/family education for low mood Talking points about low mood • Depression is a common problem and effective treatments are available. • Depression is not weakness or laziness. • Depression can affect patients’ ability to cope – so when they are not depressed they will be able to do more for themselves. • It is normal to feel “down” or briefly hopeless when life is difficult, but that does not mean that there are no ways to try to feel better. • If physical symptoms (headache, abdominal pain, aches and fatigue) are the main way the patient is experiencing their depression, discuss the link between physical symptoms and mood. Patients can be receptive to the idea that the physical symptoms are linked to stressful events. As an example, if someone has a headache you can say that it is reasonable that the stressor is causing you pain, or that a more serious stressor would cause you pain everywhere. • If there are strong beliefs about the feelings being caused by Satan, hexing, or the consequence of some bad conduct, you can respect those beliefs without having to directly agree; suggest that what you are proposing may still be effective. Brief advice • Identify current life problems or stresses. Focus on small, specific steps to take towards reducing or managing these problems, even if it’s only a little. Talk about ways to lighten the person’s load temporarily, if that is possible. • Avoid major decisions or life changes – provide assurance that it is OK to put these off until feeling better. Encourage the patient to resist pessimism and self- criticism and not to act on pessimistic ideas (e.g. ending marriage, leaving job), and not to concentrate on negative or guilty thoughts. • Plan short-term activities which give the patient enjoyment or build confidence. • Exercise may be helpful both to lift spirits and prevent low mood. • Advise reduction in caffeine intake and drug and alcohol use. • Support the development of good sleep patterns and encourage good nutrition if possible. • For teens and children, explore ways to reduce conflict with parents; see if teens can find other adults who would be acceptable sources of support (teachers, elders). Community referrals. What organizations can help with practical matters including housing, work, transportation, food, HIV support?
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- Fall '19
- Psychiatry, Seizure, Seizure types