ITEMS IN AFP WITH KEYWORD:
Jul 01, 2021 Issue
Addressing Loneliness and Social Isolation in Older Adults [Curbside Consultation]
Social isolation and loneliness are increasingly recognized as complex clinical and public health problems, particularly in older adults, leading to adverse mental and physical health outcomes. The COVID-19 pandemic has led to physical distancing policies, which have exacerbated loneliness and social isolation.
Because an increasing percentage of patients are surviving to intensive care unit (ICU) discharge and require follow-up in the outpatient setting, family physicians should be prepared to provide ongoing care and screening for common post-ICU complications. Patients should be screened for physical and psychological complications, such as weakness, cognitive impairment, depression, anxiety, and posttraumatic stress disorder, and treated when indicated.
Physicians who complete suicide are much less likely to have sought mental health care compared with nonphysicians, most commonly because of barriers to access and stigma in the medical community.
Suicide is the second leading cause of death in people 10 to 34 years and the 10th leading cause of mortality among adults overall. National rates of suicide are increasing, and how people are attempting suicide is becoming more lethal. This article presents current data and recommendations to help physicians address this challenging clinical concern.
Bipolar disorders are common mental health conditions of variable severity. New diagnostic criteria and specifiers with attention on mixed features and anxious distress aid the physician in recognizing episode severity and prognosis. Physicians should consider bipolar disorder in any patient presenting with depression. Pharmacotherapy with mood stabilizers is a first-line treatment that should be continued indefinitely because of the risk of patient relapse. Active lifestyle approaches include good nutrition and sleep hygiene. Monotherapy with antidepressants is contraindicated during episodes with mixed features, manic episodes, and in bipolar I disorder.
Seasonal affective disorder is characterized by depressive symptoms that occur at a specific time of year, typically fall or winter, with full remission at other times of year. First-line therapy for seasonal affective disorder includes light therapy, antidepressants, and cognitive behavior therapy, alone or in combination. If seasonal affective disorder recurs, long-term treatment or preventive intervention is typically indicated. Bupropion appears to have the strongest evidence supporting long-term use.
Jul 1, 2020 Issue
A Primary Care Approach to Adverse Childhood Experiences [Curbside Consultation]
A 41-year-old long-time patient presented with concerns about irritability, depression, and anxiety after getting into another fight with her mother-in-law. The patient was concerned that her symptoms were getting worse, and she was worried about lacking control over her emotions and behavior.
Lithium is more effective at inducing a reduction of at least 50% on the validated Young Mania Rating Scale compared with placebo (number needed to treat [NNT] = 6; 95% CI, 5 to 8; six studies; n = 1,707).
Should benzodiazepeines continue to be prescribed during the initiation phase of selective serotonin reuptake inhibitors for acute relief of panic attacks? Find out more.
Life-long devotion and a mind-body mortality link between spouses.