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61. Guideline for concussion/mild traumatic brain injury & persistent symptoms - Mental Health Disorders

resulting from the injury. People with persistent symptoms may become isolated from others as they may be intolerant of or unable to engage in social interactions. Their injury status may disrupt their occupational status, leisure activities and interpersonal interactions. They may also incur losses (e.g., reduced quality of life and independence; lowered income or reduced educational attainment; changes in relationship functioning, etc.). When assessing and managing disorders of mental health post mTBI (...) severe mental health symptoms such as Major Depressive Disorder (MDD) and Post- Traumatic Stress Disorder (PTSD). 4 Depressive disorders following TBI are commonly associated with increased irritability and often comorbid with anxiety symptoms as well as with fatigue, sleep disturbances, cognitive dysfunction, decreased mobility, emotional processing deficits and anxiety syndromes. The latter include generalized anxiety, panic attacks, phobic disorders, and post-traumatic stress disorder (PTSD

2018 Ontario Neurotrauma Foundation

62. CRACKCast E151 – Antidepressants

/ ASA Supportive care: Fluids Cardiac monitor Observation for standard 6 hrs (longer if citalopram, escitalopram or bupropion) Consider cyproheptadine (in consultation w/ toxicologist) Treat hyperthermia Sedate Paralyse Intubate Cool Watch for rhabdo and hyperkalemia [8] What is the primary risk of toxicity in Bupropion? Drug class = norepinephrine/dopamine reuptake inhibitor used for depression, ADHD, and smoking cessation Seizures are the major toxicity However, known myocardial depressant can

2018 CandiEM

63. Treatment for Bipolar Disorder in Adults: A Systematic Review

episodes, some aim to reduce acute depression symptoms, and others aim to reduce acute symptoms, maintain relatively symptom-free periods, and prevent relapsing to acute episodes. Given the chronic, relapsing/remitting course of bipolar disorder and the need for maintenance treatment in many patients, drugs begun for an acute mood episode (including mania) are often carried forward into maintenance therapy. Nondrug psychosocial therapeutic approaches range from psychoeducational, cognitive behavioral (...) Treatment for Bipolar Disorder in Adults: A Systematic Review Comparative Effectiveness Review Number 208 Treatment for Bipolar Disorder in Adults: A Systematic Review eComparative Effectiveness Review Number 208 Treatment for Bipolar Disorder in Adults: A Systematic Review Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. 290-2012-00016-I Prepared by: Minnesota Evidence-based

2018 Effective Health Care Program (AHRQ)

64. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm Full Text available with Trip Pro

-making related to the care of patients with an abdominal aortic aneurysm (AAA) is complex. Aneurysms present with varying risks of rupture, and patient-specific factors influence anticipated life expectancy, operative risk, and need to intervene. Careful attention to the choice of operative strategy along with optimal treatment of medical comorbidities is critical to achieving excellent outcomes. Moreover, appropriate postoperative surveillance is necessary to minimize subsequent aneurysm-related (...) management of coronary artery disease 19 Pulmonary disease 19 Renal insufficiency 20 Diabetes mellitus 21 Hematologic disorders 21 Biomarkers and heritable risks for an AAA 22 Biomarkers for the presence and expansion of an aortic aneurysm 22 Genetic markers identifying risk of aortic aneurysm 22 Aneurysm imaging 22 Modalities for aneurysm imaging 22 Prediction of aneurysm expansion and rupture risk 23 Recommendations for aneurysm screening 24 Recommendations for aneurysm surveillance 25 Recommendations

2018 Society for Vascular Surgery

65. Management of Acute Myocardial Infarction in patients presenting with ST-segment elevation Full Text available with Trip Pro

be taken strongly into consideration to argue against an invasive coronary strategy. Unconscious patients admitted to critical care units after out-of-hospital cardiac arrest are at high risk for death, and neurologic deficits are common among those who survive. Targeted temperature management (also called therapeutic hypothermia), aiming for a constant temperature between 32 and 36 °C for at least 24 h, is indicated in patients who remain unconscious after resuscitation from cardiac arrest (...) (of presumed cardiac cause). , However, hypothermia conditions are associated with slow uptake, delayed onset of action, and diminished effects of oral antiplatelet agents (i.e. clopidogrel, ticagrelor, and prasugrel). Moreover, metabolic conversion of clopidogrel in the liver may be reduced in hypothermia conditions. Cooling should not delay primary PCI and can be started in parallel in the catheterization laboratory. Close attention to anticoagulation needs to be paid in patients reaching low

2017 European Society of Cardiology

66. Improving Quality of Life: Substance Use and Aging

. As this subgroup grows larger, there will be a significant impact on many aspects of our society, including a greater burden placed on our healthcare system. And that burden will be much heavier if the increasingly prevalent issue of substance use by older adults is not addressed. The issue is, however, difficult to comprehend fully. When most people think of someone with a substance use disorder, an older adult does not immediately come to mind. When an older adult suffers a fall or experiences declining (...) use, as we do in this report, is key to developing new and more tailored strategies for reducing the harms of alcohol and drugs on older adults. Since 2005, the series now known as Substance Use in Canada has highlighted alcohol- and drug-related issues that are in need of greater attention. For this seventh edition, we began with two questions: How can we help people age in a healthy way? and How can we ensure they have the supports they need to sustain a good quality of life in their later years

2018 Canadian Centre on Substance Abuse

67. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

inhibitors' (SSRIs') effects on platelets. Only 36% knew that SSRIs can lead to a bleeding disorder. Based on these results, the need for separate ASRA guidelines, specifically for interventional spine and pain procedures in patients on antiplatelets/anticoagulants, was self-evident. The Board of Directors of the ASRA recommended that the Regional Anesthesia and Pain Medicine appoint a committee to develop separate guidelines for pain interventions. The committee has an international representation (...) are at high risk of thromboembolic events. The procedure should be performed with imaging guidance with special attention to the lateral views to ensure that the needle is not advanced into the vicinity of the vascular structures in the neuroforamen. This is especially important with the use of large-gauge needles during RFA procedures. The Neurostimulation Appropriateness Consensus Committee recommendations formed by the International Neuromodulation Society also published specific measures to reduce

2018 American Society of Regional Anesthesia and Pain Medicine

68. Depression: Adult and Adolescent

health and substance use concerns by integrating behavioral health into primary care clinics. The goal of BHI is to create a welcoming environment for patients to address common problems— alcohol and substance use disorders as well as depression— with their primary care teams. A major element of BHI is transitioning primary care social workers to a new role—that of integrated behavioral health specialist—in which they will work as provider extenders to address patient needs without disrupting patient (...) , other mental health conditions, and life stressors to consider in ADOLESCENTS Mental health condition or life stressor Additional depression questions (ADQs) (on back of PHQ-9A) 1 Next steps ADHD ADQ #12: Are you having difficulty with school work? If yes, consider assessing for ADHD. Anxiety disorders, including generalized anxiety disorder, obsessive-compulsive disorder, and panic disorder GAD-2 ADQ #20: Over the last 2 weeks, how often have you been bothered by the following problems? • Feeling

2017 Kaiser Permanente Clinical Guidelines

69. Managing Chronic Non-Terminal Pain in Adults Including Prescribing Controlled Substances

, substance abuse, compensation status, psychiatric diagnosis and severe pain behaviors. Depressive disorders. Patients with chronic pain have rates of depression three to four times greater than that reported in the general population – as high as 50% or more. Major depressive disorder is present in about 1/3 of chronic pain patients. For cases of medically unexplained pain, the prevalence rate of major depression increases to 2/3. As pain is a common feature of depressive disorders, with 60-70 (...) . Post-traumatic stress disorder (PTSD) is an under- appreciated, but important part of the assessment of every chronic pain patient whose pain onset is associated with an accident or trauma, regardless of the severity of the inciting event. Nearly 30% of patients involved in a motor vehicle accident suffer PTSD when medical attention is required due to the accident. Patients who suffer an accident-induced pain problem, who meet criteria for PTSD, report more severe pain and higher levels

2017 University of Michigan Health System

70. HTA of smoking cessation interventions

in this review. In the mental health population group, efficacy data for cessation interventions were only retrieved for patients with schizophrenia, schizoaffective disorder and bipolar disorder. The only statistically significant evidence of a beneficial treatment effect was for bupropion when used as an adjunct to behavioural therapy plus NRT in a population with schizophrenia or schizoaffective disorder, where it was almost four times as effective as behavioural therapy plus NRT alone. The lack (...) treatment are rare. Bupropion increases the risk for seizures; a seizure rate of one in 1,000 is given in the product safety data. Bupropion is not recommended for use in patients with an increased risk of seizures, or in patients with a history of bipolar disorder as it may precipitate a manic episode. Nicotine crosses the placenta from mother to baby. The long-term fetal and neonatal effects of NRT are unclear; however, it is safer than continued smoking. No major congenital malformations associated

2017 Health Information and Quality Authority

71. Obesity: Scenario: Management

history: Enquire about that can contribute to overweight and obesity, or that may arise as a result of excess weight. Pay particular attention to symptoms of comorbidities that might not be recognized (for example sleep apnoea). Manage any comorbidities at the time they are identified. Do not delay treatment until the person has lost weight. Family history (for example family history of overweight and obesity, and comorbidities). Drug history — identify that might cause weight gain. Social history (...) consumption may include replacing alcoholic drinks with non-alcoholic, sugar-free drinks and increasing the number of alcohol-free days. For more information, see the CKS topic on . Improve their diet even if they do not lose weight. Do not use unduly restrictive and nutritionally unbalanced diets, because they are ineffective in the long term and can be harmful. Diets that are recommended for sustainable weight loss are: Those with a 600 kcal/day deficit (that is, they contain 600 kcal less than

2017 NICE Clinical Knowledge Summaries

72. Interventions to Prevent Age-Related Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer's-Type Dementia

Affairs Washington, DC Rod Corriveau, Ph.D. Program Director, Extramural Research Program National Institute of Neurological Disorders and Stroke Washington, DC Jonathan King, Ph.D. Program Director, Division of Behavioral and Social Research National Institute on Aging Washington, DC Lisa McGuire, Ph.D. Lead, Alzheimer’s Disease and Healthy Aging Program Centers for Disease Control & Prevention Atlanta, GA iv Claudia Moy, Ph.D. Program Director, Office of Clinical Research National Institute (...) of Neurological Disorders and Stroke Washington, DC Laurie Ryan, Ph.D. Chief, Dementias of Aging National Institute on Aging Washington, DC Jane Tilly, Dr.P.H., M.P.A. Brain Health and Dementia Programs Team Lead Administration for Community Living Washington, DC Molly Wagster, Ph.D. Chief, Behavioral and Systems Neuroscience Branch National Institute on Aging Washington, DC Peer Reviewers Prior to publication of the final evidence report, the EPC sought input from independent Peer Reviewers without financial

2017 Effective Health Care Program (AHRQ)

73. Interventions to Prevent Age-Related Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer's-Type Dementia

Affairs Washington, DC Rod Corriveau, Ph.D. Program Director, Extramural Research Program National Institute of Neurological Disorders and Stroke Washington, DC Jonathan King, Ph.D. Program Director, Division of Behavioral and Social Research National Institute on Aging Washington, DC Lisa McGuire, Ph.D. Lead, Alzheimer’s Disease and Healthy Aging Program Centers for Disease Control & Prevention Atlanta, GA iv Claudia Moy, Ph.D. Program Director, Office of Clinical Research National Institute (...) of Neurological Disorders and Stroke Washington, DC Laurie Ryan, Ph.D. Chief, Dementias of Aging National Institute on Aging Washington, DC Jane Tilly, Dr.P.H., M.P.A. Brain Health and Dementia Programs Team Lead Administration for Community Living Washington, DC Molly Wagster, Ph.D. Chief, Behavioral and Systems Neuroscience Branch National Institute on Aging Washington, DC Peer Reviewers Prior to publication of the final evidence report, the EPC sought input from independent Peer Reviewers without financial

2017 Effective Health Care Program (AHRQ)

74. Heart Disease and Stroke Statistics 2017 Update: A Report From the American Heart Association Full Text available with Trip Pro

Survey NHLBI National Heart, Lung, and Blood Institute NINDS National Institute of Neurological Disorders and Stroke PAD peripheral artery disease WHO World Health Organization YRBSS Youth Risk Behavior Surveillance System See Glossary (Chapter 29) for explanation of terms. Downloaded from http://ahajournals.org by on March 27, 2019e159 CLINICAL STATEMENTS AND GUIDELINES Circulation. 2017;135:e146–e603. DOI: 10.1161/CIR.0000000000000485 March 7, 2017 Heart Disease and Stroke Statistics—2017 Update (...) Behaviors 3. Smoking/Tobacco Use . . . . . . . . . . . . . . e183 4. Physical Inactivity . . . . . . . . . . . . . . . . e196 5. Nutrition . . . . . . . . . . . . . . . . . . . . . e214 6. Overweight and Obesity . . . . . . . . . . . . . e240 Health Factors and Other Risk Factors 7. Family History and Genetics . . . . . . . . . . . e263 8. High Blood Cholesterol and Other Lipids . . . . . e270 9. High Blood Pressure . . . . . . . . . . . . . . . e280 10. Diabetes Mellitus

2017 American Heart Association

75. Management of Posttraumatic Stress Disorder and Acute Stress Reaction

Management of Posttraumatic Stress Disorder and Acute Stress Reaction VA/DOD CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF POSTTRAUMATIC STRESS DISORDER AND ACUTE STRESS DISORDER Department of Veterans Affairs Department of Defense QUALIFYING STATEMENTS The Department of Veterans Affairs and the Department of Defense guidelines are based upon the best information available at the time of publication. They are designed to provide information and assist decision making. They are not intended (...) testing and/or therapeutic interventions within these guidelines does not guarantee coverage of civilian sector care. Additional information on current TRICARE benefits may be found at www.tricare.mil or by contacting your regional TRICARE Managed Care Support Contractor. Version 3.0 – 2017 VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder June 2017 Page 2 of 200 Prepared by: The Management of Posttraumatic Stress Disorder Work Group

2017 VA/DoD Clinical Practice Guidelines

76. Diagnosis and Treatment of Low Back Pain

. Recommendations # Recommendation Strength* Category† A. Diagnostic Approach 1. For patients with low back pain, we recommend that clinicians conduct a history and physical examination, that should include identifying and evaluating neurologic deficits (e.g., radiculopathy, neurogenic claudication), red flag symptoms associated with serious underlying pathology (e.g., malignancy, fracture, infection), and psychosocial factors. Strong for Reviewed, Amended 2. For patients with low back pain, we suggest (...) performing a mental health screening as part of the low back pain evaluation and taking results into consideration during selection of treatment. Weak for Reviewed, New-replaced 3. For patients with acute axial low back pain (i.e., localized, non-radiating), we recommend against routinely obtaining imaging studies or invasive diagnostic tests. Strong against Reviewed, Amended 4. For patients with low back pain, we recommend diagnostic imaging and appropriate laboratory testing when neurologic deficits

2017 VA/DoD Clinical Practice Guidelines

77. An update to the Greig Health Record: Preventive health care visits for children and adolescents aged 6 to 17 years ? Technical report

. These treatment approaches have been especially effective in children and youth known to be at-risk because of parental mental illness or their own conditions, such as attention deficit hyperactivity disorder (ADHD) or early-onset schizophrenia. However, the USPSTF reports limited ability to detect suicide risk in adolescents and insufficient evidence to evaluate the risks and benefits of screening. Children’s Mental Health Ontario provides evidence-based resources and guidelines for health care professionals (...) evidence of success of psychological and educational interventions for the prevention of the onset of depression in children and adolescents aged 5 to 19. With limited evidence on which to base recommendations for treatment, primary prevention is of crucial importance. Another review identifies modifiable and non-modifiable risk factors in children, along with some successful prevention strategies for anxiety disorders, eating disorders, substance abuse, disruptive behaviours and suicide

2016 Canadian Paediatric Society

78. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum

. They are divided into sections on risks of untreated illness in pregnancy; general principles of using drugs in the perinatal period; benefits and harms associated with individual drugs; and recommendations for the management of specific disorders. Keywords Antidepressants, antipsychotics, anxiolytics, birth defects, breastfeeding, child development, conception, fertility, hypnotics, mood stabilisers, neonatal problems, postpartum, pregnancy, pregnancy outcome, psychiatric illness, psychotropics (...) , UK. Email: r.h.mcallister-williams@ncl.ac.uk 699361 JOP0010.1177/0269881117699361Journal of PsychopharmacologyMcAllister-Williams et al. research-article2017 BAP Guidelines2 Journal of Psychopharmacology Introduction The British Association for Psychopharmacology (BAP) has published a series of evidence-based guidelines for the use of drugs in patients with psychiatric disorders with the emphasis on producing comprehensive, concise and useable guidance based on a review of the relevant evidence

2017 British Association for Psychopharmacology

79. Guidance on the clinical management of depressive and bipolar disorders, specifically focusing on diagnosis and treatment strategies

the DSM-IV diagnoses of dysthymia and chronic MDD. Disruptive mood dysregulation disorder (DMDD) is a new category in DSM-5 which is First published in Australian and New Zealand Journal of Psychiatry 2015, Vol. 49(12) 1-185. 9 Table 2. Features of bipolar disorders and depressive disorders (based on DSM-5). Episodes Depression Mania/Hypomania a Possible Psychosis Duration Severity of symptoms Duration Severity of symptoms BD I Mania +/– hypomania +/– depression 2 Weeks Marked Impairment Mania 7 days (...) develop MDD following bereavement benefit from the same treatment strategies. Dysthymia, which is now coded as persistent depressive disorder, reflects a more chronic illness, whereas chronic MDD is a persistent unremitting illness that perhaps reflects treatment non-response (Porter et al., 2013). f Disruptive Mood Dysregulation Disorder (DMDD) is a new category included in DSM-5 to describe children who have persistent irritability. Children with these symptom patterns are often found to go onto

2015 Royal Australian and New Zealand College of Psychiatrists

80. Addyi - Flibanserin

(USAN) names Addyi/Flibanserin Dosage forms / Strength Oral Tablet 100 mg Proposed Indication(s) Treatment of Acquired, Generalized Hypoactive Sexual Desire Disorder in Premenopausal Women Action Recommended: Complete Response 1. Introduction This is a summary review of the third submission by Sprout Pharmaceuticals (the Applicant) for flibanserin 100 mg taken at bedtime, intended for the treatment of acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women. Flibanserin (...) , a serotonin 1A agonist and serotonin 2A antagonist, is a new molecular entity that is not currently approved in any country for any indication. The application has received two Complete Response (CR) actions as FDA determined the overall benefit/risk profile of flibanserin was unfavorable. 2. Background 2.1 Hypoactive Sexual Desire Disorder From 1987 to 2013, HSDD was defined by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a distinct entity

2015 FDA - Drug Approval Package

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