Psychosocial evaluation

Victims of blast injuries may also require psychosocial evaluation and treatment, as discussed in... 

Evaluate the patient s symptoms to determine if they are consistent with UC or CD. Determine whether the patient has evidence of extraintestinal manifestations or Gl complications related to IBD. Identify any psychosocial problems related to the presence of IBD. 

Dietary habits should be evaluated and attention paid to psychosocial issues. A complete family history should be obtained,... 

Important outcome indicators to evaluate postintoxication and/or postwithdrawal treatment of substance abuse and dependence can be divided into three major groups decreased consumption of substances, decreased problems associated with substance use, and increased psychosocial functioning. Although it is less commonly employed, a quality-of-life scale can help determine how substance abuse/dependence treatment has affected your patients lives. If you are involved in the cost-justification of services, a cost-benefit analysis could also become important, although this is more often used at the administrative level,... 

Approximately one-third of patients with MDD do not respond satisfactorily to their first antidepressant medication.37 In such cases, the clinician must evaluate the adequacy of antidepressant therapy, including dosage, duration, and patient compliance.17 Treatment reappraisal also should include verification of the patient s diagnosis and reconsideration of clinical factors that could be impeding successful therapy, such as concurrent medical conditions (e.g., thyroid disorder), comorbid psychiatric conditions (e.g., alcohol abuse), and psychosocial issues (e.g., marital stress).16... 

In a recent study, Elannery-Schroeder and Kendall (2000) compared group and individual CBT to a WLC in 37 children (ages 8-14 years) with GAD, SAD, and/ or SoP. Treatment outcome was evaluated using diagnostic interviews and child, parent, and teacher reports of anxiety and other measures of psychosocial functioning at post-treatment and 3-month follow-up. At post-treatment, significantly more children in the indi-... 

Particularly the evaluation of life events is unsatisfactory. Axis IV provides an opportunity to assess the pathogenic valence of a psychosocial stressor. According to DSM-III-R, however, the rating should be based on the clinician s assessment of the stress an average person in similar circumstances and with similar sociocultural values would experience from the particular psychosocial stressor [American Psychiatric Association 1987, p. 19). But the factor personality vulnerability is ignored and only absolute events are recorded. 

With respect to a specific and common clinical problem, advice to withdraw hypnotic medication should follow a careful evaluation of self-reported sleep patterns, psychological factors and psychosocial status. Ambulant monitoring can be helpful in patients who have encountered severe problems in effecting withdrawal. A careful psychiatric assessment should be made to ascertain whether the patient has clinically significant anxiety and/or depression. Both should be treated with a selective serotonin receptor inhibitor (SSRI) before withdrawal from the hypnotic is attempted. An optimal tapering schedule should be discussed with the patient some will attempt a rapid withdrawal over less than 8 weeks and others will require much longer. This is particularly so if previous attempts to withdraw have been unsuccessful. Carers, family and friends should be mobilized to help in withdrawal, should the patient wish this. Substitution of zolpidem may facilitate withdrawal but should be kept as a reserve strategy. 

Botkin JR, Croyle RT, Smith KR, Baty BJ, Lerman C, Goidgar DE, et al. A model protocol for evaluating the behavioral and psychosocial effects of BRCAl testing. J Natl Cancer Insti 1996 88 872-82. 

Selection criteria for patients who are candidates for home care are adapted to each environment, geographical area, and type of patient. These criteria can be divided into medical condition and psychosocial and family support. They will be described in each protocol of patients inclusion defined for each diagnosis. But some general environments should be evaluated in all cases home and family environment. 

Few studies have prospectively documented the degree of functional impairment before or after specific treatments or have evaluated the pharmacoeconomic differences in treatments for premenstrual and perimenopausal disorders. Data on the economic burden (i.e., health care utilization, related costs, and the loss of productivity) from different menstrual-related disorders are still lacking. Several PMDD studies have reported greater improvement in psychosocial functioning and work capacity with SRls compared with placebo. In all studies, the degree of functional impairment was substantial at baseline and similar to that seen in studies of major depression. The functional improvement correlated with the improvement in premenstrual symptoms and was evident by the second cycle of treatment. 

For MDD with severe anxiety, mirtazapine, TCAs, trazodone, and benzodiazepines should be considered as adjunctive therapy. If the patient is not at least moderately improved after 4-8 weeks, the treatment regimen should be reappraised. Compliance should be checked. It is important to consider pharmacokinetic/pharmacodynamic factors (this may require an evaluation of serum levels of the antidepressant medication), general medical comorbidities, and comorbid psychiatric disorders, including substance abuse and significant psychosocial problems. The initial therapeutic treatment dose should be gradually maximized. For partial responders, the trial should be extended by... 

---