After-treatment plan

Testing for HP is only recommended if eradication therapy is considered. If endoscopy is not planned, serologic antibody testing is reasonable to determine HP status. The UBT is the preferred nonendoscopic method to verify HP eradication after treatment. 

Note The remainder of this book presents many ideas that may be useful to share with your client, including suggestions for how the client can choose the right services (in Chapters 3 and 5), how the client can help develop a treatment plan that will serve him or her well in therapy (Chapter 4), steps the client can take to succeed in reaching his or her goals after treatment or therapy, and how the client can move forward into a new life free from drug problems (Chapters 6-8). 

On the other hand, identifying problem areas allows for interventions to be devised to reduce or remove roadblocks to recovery. In a well-designed treatment plan, a problem area and its specific links with the drug use are identified and described. After the descriptive portion of the problem area, the treatment plan prescribes specific courses of action on the part of the client, with therapist or counselor support, to change the problem behavior. Problems areas may be biological, environmental, behavioral, cognitive, or emotional domains, or in some cases may represent complex combinations in more than one of these areas. 

After the client is safe and committed to treatment, other important problems may be addressed effectively. For a client with a drug problem, the next priority is to address problems directly related to drug use behavior. These problems in the third tier may include consequences of drug use in all the domains that have been discussed in this book, or may include behaviors that contribute to drug use. Many of those behaviors that contribute to drug use may be associated with other health or mental health problems. In such instances, a treatment plan will... 

If a physical examination is not possible, then a therapist or counselor will have to assess physical health in an interview format. The therapist can ask specific questions about health conditions and symptoms in the intake interview, and then can address specific health concerns through referrals as part of the treatment plan. It may be that a particular non-life-threatening health problem cannot be addressed during the course of therapy or treatment, but can be listed as a quality-of-life problem in the treatment plan to be addressed at a later date. In that way, the therapist and client can brainstorm ideas about treating the problem while in therapy and develop a plan of action for addressing the health concern after therapy is completed. 

Engelhart et al., 1999). This instrument assesses many more areas of cognitive function than does the MMSE. I Iowever, as a screening tool, it too has limits to what it can tell you. My recommendation is that if a client of yours screens positive for a cognitive problem on one of these measures, you refer that client for a comprehensive neuropsychological workup as part of the treatment plan. Note that sometimes a person will screen positive during detoxification, but will clear cognitively after that period is finished. You should probably retest after detox has been completed if the client screens positive while in detox. 

Many new challenges can arise after treatment for partners. A family therapist can prepare the partner for these challenges as part of a family orientation to aftercare. Such a meeting will occur around the same time as the client develops his or her continuing care plan just prior to discharge from treatment. The family therapist may address adjustment concerns that many partners experience when a client is discharged from treatment. The family therapist can prepare the partner for what to reasonably expect from the loved one after treatment ends. 

Reducing dosage and stopping treatment - Make the decision to discontinue therapy with buprenorphine or buprenorphine/naloxone after a period of maintenance or brief stabilization as part of a comprehensive treatment plan. Gradual and abrupt discontinuation have been used but there is not a best method of tapering the dose at the end of treatment. 

The recovering patient who remains depressed after appropriate treatment of the abstinence syndrome should be given an antidepressant trial. Treatment planning should take into account the patient s physical status, especially because it may affect the pharmacokinetics and pharmacodynamics of the agent selected (see Chapter 3). 

Why did Ms. J think a psychiatric evaluation for Mr. K was so important after meeting him only once First, Ms. J saw that his symptoms could be indicative of at least a couple of different disorders. As for Mr. K s sinus complaints, she was having trouble distinguishing between an obsessional thought and a delusion. In addition to wanting more information from Mr. K himself, she also wanted the opinion of another mental health professional. Second, Ms. J knew that OCD can be very difficult to treat without medication. She knew that for Mr. K to experience optimal relief from his symptoms, medication should at least be considered as part of the treatment plan. 

A system with very stiff electrode pins has been developed for the treatment of bone metastases. In this system, a bone metastasis is defined, and pins positioned according to a treatment planning system, in and on all sides of the lesion. After pulse delivery the pins are removed and treatment completed. Extensive preclinical data have been obtained [32] and the first phase 1 chnical trial has commenced. 

Testing for HP is only recommended if eradication therapy is considered. If endoscopy is not planned, serologic antibody testing is a reasonable choice to determine HP status. Posttreatment evaluation to confirm eradication is unnecessary in most patients with PUD unless they have recurrent symptoms, complicated ulcer, MALT lymphoma, or gastric cancer. The UBT is the preferred nonendoscopic method to verify HP eradication after treatment. To avoid confusing bacterial suppression with eradication, the UBT must be delayed at least 4 weeks after the completion of treatment. The term eradication or cure is used when posttreatment tests conducted 4 weeks after the end of treatment do not detect the organism. Quantitative antibody tests are considered impractical for posttreatment eradication as antibody titers remain elevated for long periods of time. 

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