Psychiatric illness medication history

Before starting therapy for the hospitalized patient, the nurse obtains a complete psychiatric and medical history. In the case of psychosis, patients often are unable to give a reliable history of their illness. When a psychosis is present, the nurse obtains the psychiatric history from a family member or friend. During the time the history is taken, the nurse observes the patient... 

A complete medical history and physical examination by a pediatrician or primary care provider should have been completed since the onset of symptoms or within the past year. Chronic medical illnesses such as asthma, cancer, diabetes mellitus, and neurologic disorders increase the risk for psychiatric disorders, par-... 

Complicated mania is an elaboration on the theme of the secondary type and is defined as the presence of antecedent or coexisting nonaffective psychiatric disorders and/or serious medical disorders ( 34). These patients can be grouped into psychiatric or medical cluster patients. The psychiatric cluster patients have had fewer prior psychiatric hospitalizations, an earlier onset of illness, and a history of prior suicide attempts. This contrasts with the medical cluster, which has a later age of onset, no prior history of suicide attempts, more organic features, and more deaths during the follow-up period. 

Additional information besides the DSM-IV-TR diagnosis is required before a comprehensive treatment plan can be developed. The American Psychiatric Association Practice Guidelines for Psychiatric Evaluation of Adults offers a more comprehensive approach to patient assessment. It includes a full discussion of the domains needed for a thorough clinical evaluation, including chief complaint history of present illness past psychiatric history general medical history social, family, and occupational history physical and mental status examinations and diagnostic tests. It further describes issues of privacy, evaluations in the elderly, and techniques for working with multidisciplinary teams. ... 

Both medical iflnesses and medications can cause psychiatric symptoms. The rapidity of onset of psychiatric symptoms is an important clue that a medical cause may be present. Most chronic mental illnesses have a prodromal period, whereas medically based psychiatric symptoms often have a more rapid onset of symptoms. Patients over age 40 at first presentation are more likely to have a medical cause for their psychiatric symptoms because major psychiatric illnesses such as schizophrenia and bipolar disorder usually first present in adolescence or early adulthood. A family history of physical illnesses with a psychiatric component, such as Huntington s chorea or systemic lupus erythematosus, may provide an additional clue. 

Mental retardation, major psychiatric illness, alcoholism, or other chemical abuse, and/or a history of repeatedly taking OCs or other medications incorrectly, make compliance with OC regimens difficult. 

Subject and experimental considerations in studies of abstinence Exclusion criteria that applied to all of our subjects include (1) major medical and psychiatric illnesses (2) head injuries with loss of consciousness for more than 5 min (3) evidence of any neurological abnormalities by history or examination (4) human immunodeficiency virus (HIV) seropositivity and (5) excessive illicit drag or alco-... 

The differential diagnosis of depression is organized along both symptomatic and causative lines. Symptomatically, major depression is differentiated from other disorders by its clinical presentation or its long-term history. This is, of course, the primary means of distinguishing psychiatric disorders in DSM-1V. The symptomatic differential of major depression includes other mood disorders such as dysthymic disorder and bipolar disorder, other disorders that frequently manifest depressed mood including schizoaffective disorder, schizophrenia, dementia, adjustment disorder, and post-traumatic stress disorder, and, finally, other nonpsychiatric conditions that resemble depression such as bereavement and medical illnesses like cancer or AIDS. 

For these reasons, the interview of a medically ill pediatric patient is generally briefer than that of a physically healthy child. Because the illness biases psychiatric assessment, the consultant must rely heavily on premorbid history and other informants such as the parents, nurses, and primary care physician in assessing the meaning of current symptoms. Diagnostic criteria as supplied by DSM-FV should also be used. 

What is the relationship of the psychiatric symptoms or syndrome to the underlying medical illness Were the symptoms premorbid, secondary to, or coincident with the medical illness Is there a family history of similar syndromes in nonmedically ill family members that might warrant consideration of treating the psychiatric disorder more independently from the medical condition ... 

Delirium. Characteristics include the sudden onset of symptoms, disorientation, visual hallucinations, and transient, often paranoid, delusions. The intensity of symptoms often fluctuates, and the patient may have a known medical illness but no psychiatric history. 

The focus of our text is the collaboration between therapist and physician and the use of medication to treat psychiatric symptoms. Although we use medications to treat mental illness, it is critical for the therapist to know that the use of certain medications for general medical conditions can cause psychiatric symptoms. The therapist must take a careful history, including knowledge of all of the medications that a person takes for any reason if it is possible that a medication is causing the mental health problem, the patient must be promptly referred to his or her physician for medication adjustment. 

Social work practitioners in clinical practice quickly learn that as with many other mental illnesses, the psychiatric problems clients present are complex and multifaceted. It is not unusual that clients with bipolar disorders often have other psychiatric problems that require attention and treatment. For example, many clients with bipolar disorder also have alcohol or drug-related problems (Carlson, Bromet, Jandorf, 1998). Identifying other disorders is important during the assessment phase and continues to be so throughout the treatment phase. Clients with a history of alcohol and drug use will require special considerations when it comes to prescribing medications for the bipolar disorder. Failure to obtain this information at the point of assessment can put a client in harm if the client uses medications while taking these substances. 

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