Risk assessment depression

The developmental neurotoxicity guideline, accepted by OECD in 2007, has added the important aspect of behavioral effects of pre- and postnatal exposure to chemicals. This development arose from the notion that behavioral disorders in man such as anxiety, depression, phobias, autism, and attention deficit hyperactivity disorder, which appear to show increasing prevalences in western societies, may have a perinatal origin (4, 5). In the absence of causal inferences with respect to chemicals it seems nevertheless prudent to assess in a risk assessment whether such causal relations may exist. 

Also, the inclusion of EF and different biomarkers added significant prognostic information over TIMI and PREDICT scores. Recently, other markers, such as CRP, and different interleukins have been added to the risk assessment (Anguera et al, 2002 Zairis et al, 2002), as well as BNP (Bassan et al, 2005) and PAPP (Heeschen et al, 2004). Even the value of multiple biomarkers added to the value of quantitative ST-segment depression has been recently published (Westerhout et al, 2006). 

Assess for the safety of others and potential for violence. If accompanied by friends or family with whom the patient is living, ask them to remove from the home all guns, caustic chemicals, medications, and objects the person might use to harm self or others. Risk factors for suicide include severity of depression, feelings of hopelessness, comorbid personality disorder, and a history of a previous suicide attempt.19... 

Recommending maintenance therapy requires a careful assessment of the risks of recurrence weighed against the costs and benefits of prolonging treatment. Patients who have had three or more episodes of depression or patients who have had two particularly severe episodes should seriously be considered for long-term maintenance therapy. 

The cocaine addict most often presents during withdrawal after a binge of cocaine use. Cocaine withdrawal is not life threatening and does not require medical intervention in the same sense as alcohol or opiate withdrawal. It is, however, associated with a profound depression that can render the addict suicidal for 24-48 hours. The crashing cocaine addict should be assessed for suicide risk and, if indicated, the patient should be monitored in an emergency psychiatric setting or may require a brief 1-2 day inpatient psychiatric admission until the withdrawal resolves and the suicide risk is relieved. 

Geriatric Considerations - Summary Compared to placebo, duloxetine is effective for the treatent of depression and painful diabetic neuropathy Few head-to-head studies are available comparing duloxetine to other agents in the treatment of depression or painful neuropathy. Because this agent may increase urethral sphincter activity, it is now being assessed as an agent for the treatment of stress urinary incontinence. This same property may increase the risk of urinary retention, although this has not been well documented. Duloxetine has not been well studied with respect to falls. 

Major depression is a significant risk factor for suicide. The presence of suicidal ideation should be assessed initially and repeatedly over the course of treatment. In this respect, depressive disorders are a major health care problem, contributing to 70% of suicide-related deaths (with a 15% mortality risk associated with suicide in untreated recurrent major episodes). 

As regular psychiatric assessment is not always possible, the identification of easily detectable predictive factors of severe psychiatric disorders may help select which patients should undergo close psychiatric assessment. In 71 patients treated with interferon alfa alone or combined with ribavirin for chronic hepatitis C, female sex, scores on the MADRS at 4 months of treatment, sleep disorders, and prior antidepressant use were independent risk factors of suicidal behavior or depression (349). This study also suggested that prolonged follow-up is required, as 8% of patients still had suicidal behavior 6 months after the end of treatment. 

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