DOCSLIB.ORG

First Episode Psychosis Assessment

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
First Episode Psychosis Assessment child & youth Mental Health Series First Episode Psychosis; Psychosis in Youth Sharman Robertson BSc MD FRCPC Date: February 25 2016 If you are connected by videoconference please mute your system and unmute to ask a question Please feel free to ask questions! By You will have had an opportunity to apply for professional credits or a certificate of attendance registering for today’s You will receive an email with a link to today’s online evaluation event… Visit our website to download slides You may and view archived events also want Sign-up to our distribution list to receive our event to… notifications Questions? [email protected] Speaker has nothing to disclose with regard to commercial support. Declaration of conflict Speaker does not plan to discuss unlabeled/ investigational uses of commercial product. Agenda • On Track First Episode Psychosis Program • Evolution of First Episode Psychosis Programs • Ontario Standards • Stress diathesis model • Clinical Features Psychosis in Youth • Differential Diagnosis • Treatment • Outcomes On Track • Recovery-based • Individuals aged 16-35 with first episode of psychosis (FEP) • Champlain District 1.3 million with satellites in Hawkesbury, Cornwall and Pembroke • Case management model • Interdisciplinary team • Follow for up to 3 years • Group, individual, family work Rationale of First Episode Programs • Early recognition of psychosis • Shorten DUP – Improve outcomes • Symptom resolution • Return to full function – Prevent relapse – Prevent • Cognitive decline • Treatment resistant symptoms • Loss of relationships • Loss of ability to be productive • Reduction of stigma • Rehabilitative model Long DUP • Longer DUP – Reduced treatment response – Poor functional outcome – Disrupted personal relationships – Increased legal involvement – Substance use – Disrupted school and work performance – Housing instability Ontario Perspective • Yearly incidence = 12 / 100,000 • Majority between ages of 14-35 years • First 3-5 years high risk for: – Suicide (2/3 of suicides) – Relapse – Hospitalization – Loss of social supports – Disruption of work, school, housing – Substance use – Legal problems Early Psychosis Intervention (EPI) Ontario • 1999: Making it Happen: Implementation Plan for Mental Health Reform- psychosis requires intensive care • 1999: Ontario Working Group for Psychosis advocated for EPI (clients, families and community mental health agencies) • 2004: MOHLTC announced EPI program funding 30 programs Early Intervention Ontario Network EPION • Formerly the Ontario Working Group • Ministry funded • Volunteer • Provides www.epion.ca – Networking – Research – Knowledge sharing – Conferences – Shapes policy – FEP advocacy Key Components • Early identification and facilitated access • Comprehensive assessment – Up to 3 months including treatment to establish dx – May lead to enrolment if criteria met • Treatment • Psychosocial supports • Family education and support • Public education • Research On Track Eligibility and Timelines • Age 16-35 years • < = 6 months of treatment for psychosis • Absence of severe substance use disorder, forensic history or established mood disorder • Contact client/family within 72 hours • In-person assessment within 2 weeks • 613-737-8069 Psychosis • Loss of touch with reality • Reduced ability to determine what is coming from within own thoughts and perceptions and what is happening in the environment • Not a diagnosis • Collection of signs and symptoms • Common end point for several mental illnesses Stress Diathesis Progression to Psychosis Neurochemistry: Dopamine • Dopamine (DA) hypothesis: – Too Much DA in certain brain areas • Efficacy of DA blocking medications • Psychotomimetic effect of stimulants – DA levels actually low in prefrontal cortex Serotonin: Modulates DA • 5HT-2 blockade: – reduces psychotic symptoms – Reduces side-effects caused by blocking DA – • Second generation anti-psychotics (SGA’s): – 5HT-2 blockers – Risperidone, olanzapine, seroquel – Older: clozapine Cortical Glutamate Regulates DA Neurons in 2 Possible Ways Direct action Indirect action as an as accelerator brake Cortex GLU GLU + + − GABA DA GLU = glutamate. Adapted from Tsapakis EM, et al. Adv Psychiatr Treat. 2002;8(3):189-197. Carlsson A, et al. Br J Psychiatry Suppl. 1999;(37):2-6. With Psychosis NMDA Receptors are under-firing Direct action as an accelerator Cortex DA is too low and we see: GLU -Lack of motivation, pleasure, depressed mood -Impaired ability to concentrate, pay attention remember -Impaired ability to plan, organize, use abstract concepts + NMDAR DA Hypofunctioning Adapted from Tsapakis EM, et al. Adv Psychiatr Treat. 2002;8(3):189-197. Citrome L. Curr Psychiatry Suppl. 2011;10(9):S10-S14. With psychosis there is no brake for DA in the mesolimbic area Indirect action as brake Cortex GLU + − GABA NMDAR Hypofunctioning DA DA is too high in the mesolimbic area - delusions and hallucinations Clinical Features Pre-pubertal Psychosis • Rare, less common than autistic spectrum disorder • Abnormal development: – Soft neurological S+S – LDs – Expressive/receptive language delays – Attachment issues – Autistic features – Reduced response to treatment Mental Status Examination • Appearance, self-care – Dressed for weather, clean, dishevelled, mannerisms, sunglasses, make-up, unusual costumes, body odour • Behaviour – Guarding, slowing, agitation, aggression, vigilance, responding to internal stimuli, grandiosity, mannerisms • AIMs/EPS – Dyskinetic movements of mouth, lips, face – Tremor, stiffness, lack of facial expression, restlessness, robotic gate • Affect – Flat, reduced, robotic, labile, hostile, euphoric, angry, perplexed, fearful, depressed, superficial Mental Status Examination • Mood – Numb, depressed (neuro-vegetative signs and symptoms), bored, swings, elated, irritable • Speech – Pressured, over-inclusive, prolongation of response latency, slow, muteness Mental Status Examination Thought form – Tangentiality: • Jumping from topic to unrelated topic – Circumstantiality: • Starting at one topic and speaking of partially related themes, over -inclusive of detail, eventually getting back to first point. – Loosening of associations: • Ideas are not related to each other and syntax of language is breaking down – Flight of ideas: • Rapid-fire thoughts that the person can not slow down – Poverty of thought: • Lack of output or devoid of content – Thought blocking – Prolongation of response latency Thought Form Disorders in Children Developmental stage of child is important. Normally thought form disorganized before the age of 7 years. Possible to detect thought form disorganization after this. Mental Status Examination • Thought content – Delusions Children - content involves animals, • Paranoid cartoons, super heros • Referential Adolescents - content similar to adults • Control • Religious • Pseudo-philosophical • Somatic • Grandiose • Erotomanic – Hallucinations • Auditory, visual, olfactory, senesthetic, gustatory Mental Status Examination – Hallucinations • Auditory, visual, olfactory, tactile, gustatory Children – Transient hallucinations possible during times of stress, loss. True hallucinations accompanied by LDs, attachment issues soft neuro S + S. Adolescents – Transient hallucinations seen with personality DO, panic attacks, trauma history. Mental Status Examination • Attention and concentration • Ability to use abstract concepts – Similarities and proverbs • Insight and judgement – Do they think they have an illness? – How do they explain their circumstances? – Does medication help? – What are their strategies to deal with symptoms? – What is their motivation to use strategies? Mental Status • Suicidal thinking – Passive vs. active – Plan – Association with delusions of control or impulses – Association with command hallucinations – Degree of control a person feels they have over the thoughts/impulses – Awareness of coping strategies – Ability to use coping strategies – Alliance with their team – Hopelessness – Emotional reaction to these thoughts • Calm and resolved vs. fearful of it actually happening Mental Status – Homicidal thinking • Past history of violence • Medication non-adherence • Substance abuse • Delusions of persecution or control – Know the delusional system • Association with command auditory hallucinations • Insight into this as a symptom • Emotional reaction to these thoughts – Fear and shame – Aggression – Flatness What Things Besides Schizophrenia Cause Psychosis? • Drug or alcohol induced psychosis • General medical conditions • Mood disorders • Schizophrenia spectrum disorders Substance and Alcohol Induced Psychosis • Withdrawal states; • Cannabis alcohol, anxiolytics, • Prescription drugs sedatives, GHB • Stimulants; – amphetamines, cocaine • Hallucinogens; LSD,PCP, ecstasy Can Drugs Cause Schizophrenia? • Certain drugs can mimic psychosis when a person is high • In a drug induced- psychosis symptoms are gone within one month after stopping the drug Can Drugs Cause Schizophrenia? • If symptoms last longer than one month something else is going on -possibly schizophrenia • If psychosis occurs with drug use that person’s nervous system is vulnerable to psychosis • Taking drugs at that point may lead to more psychosis!! General Medical Conditions • Rarely a cause of psychosis (<10%) • Seizure disorders • Genetic conditions; – Huntington’s, Wilsons disease – Velocardiofacial syndrome • Infections; encephalitis, meningitis, HIV/AIDs • Dementia Mood Disorders • Major Depressive Disorder • Bipolar disorder Schizophrenia
Load more

Recommended publications
  • Neuropsychological Aspects of Frontal Lobe Epilepsy
    Neuropsychological aspects of frontal lobe epilepsy. Dominic Upton, Doctor of Philosophy. Institute of Neurology. University of London. LONDON, WON 36G ROCKEFELLER MEOICAL LIBRARY INSTITUTE OF NEUROLOGY THE NATIONAL HOSPITAL QUEEN SQUARE, LONDON, WCIN 33G CLASS ACCN No. d a t e W c ProQuest Number: 10017771 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest. ProQuest 10017771 Published by ProQuest LLC(2016). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. Microform Edition © ProQuest LLC. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 Abstract. This study sought to increase our understanding of the neuropsychological consequences of frontal lobe epilepsy and surgery for this condition. In so doing, some suggestions were made on the role of the frontal lobes, and ways of assessing possible dysfunction in this area. The performance of a large group of subjects with clearly defined frontal lobe epilepsy (n=74), was examined on a comprehensive battery of neuropsychological measures. The performance of this group was compared to a control group of subjects with clearly defined temporal lobe epilepsy (n=57). There were few consistent group differences in test performance. Neither were there any strong relationships between test scores and epilepsy related variables.
    [Show full text]
  • Co-Morbidities and Dementia
    VOLUME 21 ISSUE 1 SPRING- SUMMER 2011 Published by the National Association of Professional Geriatric Care of Managers 3275 West Ina Road Suite 130 Tucson, Arizona Geriatric Care Management 85741 520.881.8008 / phone 520.325.7925 / fax www.caremanager.org Co-Morbidities and Dementia Guest Editor’s Message .............................................................................2 By Karen Knutson, MSN, MBA Dementia, Diabetes, Hypertension, and Alcohol Abuse: A Case Study of Medical Co-morbidities ....................................................3 By Karen Knutson, MSN, MBA Alzheimer’s Disease Co-morbidities ............................................................7 By M. Reza Bolouri, M.D. Frontal Lobe Disorders and Dementia.........................................................9 By Patricia Gross, Ph.D., ABPP-CN A Different Dementia: Different Challenges ...............................................13 By Sharon Mayfield, BSN of Geriatric Care Management Spring/Summer 2011 Guest Editor’s Message Coordinating the Complex Care of Clients with Dementia and Co-Morbidities By Karen Knutson, MSN, MBA, RN Care managers play a pivotal role in in psychiatric classification, co- options available for our clients? coordinating the care of their clients. morbidity does not necessarily imply Selected articles have been chosen As people live longer, the complexity the presence of multiple diseases, to provide more understanding of of life will continue and the increasing but rather an inability of a single the co-morbidities associated with prevalence of chronic disease will diagnosis to account for all of the dementia. Hopefully you will find pose many challenges for coordinating individual’s symptoms. new insights and approaches to such complex care. While the experts hash out integrate into your practice. In health care, co-morbidity is definitions of co-morbidity there The first article which I authored, defined in two different ways.
    [Show full text]
  • THE CLINICAL ASSESSMENT of the PATIENT with EARLY DEMENTIA S Cooper, J D W Greene V15
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.2005.081133 on 16 November 2005. Downloaded from THE CLINICAL ASSESSMENT OF THE PATIENT WITH EARLY DEMENTIA S Cooper, J D W Greene v15 J Neurol Neurosurg Psychiatry 2005;76(Suppl V):v15–v24. doi: 10.1136/jnnp.2005.081133 ementia is a clinical state characterised by a loss of function in at least two cognitive domains. When making a diagnosis of dementia, features to look for include memory Dimpairment and at least one of the following: aphasia, apraxia, agnosia and/or disturbances in executive functioning. To be significant the impairments should be severe enough to cause problems with social and occupational functioning and the decline must have occurred from a previously higher level. It is important to exclude delirium when considering such a diagnosis. When approaching the patient with a possible dementia, taking a careful history is paramount. Clues to the nature and aetiology of the disorder are often found following careful consultation with the patient and carer. A focused cognitive and physical examination is useful and the presence of specific features may aid in diagnosis. Certain investigations are mandatory and additional tests are recommended if the history and examination indicate particular aetiologies. It is useful when assessing a patient with cognitive impairment in the clinic to consider the following straightforward questions: c Is the patient demented? c If so, does the loss of function conform to a characteristic pattern? c Does the pattern of dementia conform to a particular pattern? c What is the likely disease process responsible for the dementia? An understanding of cognitive function and its anatomical correlates is necessary in order to ascertain which brain areas are affected.
    [Show full text]
  • Dementia and Aphasia in Motor Neuron Disease: an Underrecognised Association?
    J Neurol Neurosurg Psychiatry 1998;65:881–889 881 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.65.6.881 on 1 December 1998. Downloaded from Dementia and aphasia in motor neuron disease: an underrecognised association? Wojtek P Rakowicz, John R Hodges Abstract predominantly sporadic, cases have subse- Objectives—To determine the prevalence quently been found in western countries.6–9 and nature of global cognitive dysfunction The most common pattern of cognitive and language deficits in an unselected decline in MND is a progressive dementia of population based cohort of patients with the frontal lobe type.10 It is unclear whether this motor neuron disease (MND). MND-frontal lobe dementia syndrome consti- Methods——A battery of neuropsycho- tutes the extreme end of a range of disease or logical and language tests was adminis- alternatively whether it represents a separate tered to patients presenting consecutively nosological entity. Whereas some early studies overa3yearperiodtoaregional neurol- which looked for intermediate degrees of ogy service with a new diagnosis of cognitive dysfunction in clinically non- sporadic motor neuron disease. demented patients with MND found no evidence of widespread impairment,11 others Results—The 18 patients could be divided reported poor performance in isolated tests of on the basis of their performance into 12 13 three groups: Three patients were de- memory or concentration. The emerging picture is of consistent abnormalities on tests of mented and had impaired language func- so-called “frontal executive” function, most tion (group 1); two non-demented patients notably decreased verbal fluency, aVecting a had an aphasic syndrome characterised large proportion of non-demented patients with Y by word finding di culties and anomia MND.
    [Show full text]
  • Read the 2013 PSHA Journal
    1 PSHA JOURNAL ANNUAL PUBLICATION OF THE PENNSYLVANIA SPEECH-LANGUAGE-HEARING ASSOCIATION DECEMBER 2013 EDITION 2 JOURNAL IS AN ANNUAL PUBLICATION OF THE PENNSYLVANIA SPEECH-LANGUAGE-HEARING ASSOCIATION 700 McKnight Park Drive, Suite 708 Pittsburgh, PA 15237 412.366.9858 (Phone) 412.366.8804 (Fax) [email protected] THE PENNSYLVANIA SPEECH-LANGUAGE-HEARING ASSOCIATION (PSHA), FOUNDED IN 1960, IS A PROFESSIONAL ORGANIZATION OF SPEECH-LANGUAGE PATHOLOGISTS, AUDIOLOGISTS, AND TEACHERS OF THE HEARING-IMPAIRED. AS SUCH, PSHA: Serves as a liaison between the American Speech-Language-Hearing Association and its Pennsylvania members. Represents its’ members interests in legislative affairs. Recommends standards for training and practices. Provides information about effective services and programs and services in communication disorders and other related fields. Works to inform the public about the professions, careers, programs, and services in the field of communication disorders. Encourages basic scientific study of the process of individual human communication. Monitors state Licensure Board activities. 2013-2014 PSHA EXECUTIVE BOARD PRESIDENT: Kathleen Helfrich-Miller PRESIDENT-ELECT: Amy Goldman PAST PRESIDENT: Craig Coleman VICE-PRESIDENT – PROFESSIONAL PRACTICE (SPEECH-LANGUAGE PATHOLOGY): Susan Hough VICE-PRESIDENT – PROFESSIONAL PRACTICE (AUDIOLOGY/EDUCATION): Jennifer Rakers VICE-PRESIDENT – PROFESSIONAL PREPARATION/CONTINUING EDUCATION: Joan Luckhurst VICE-PRESIDENT – MEMBERSHIP/ETHICAL PRACTICES: Nancy Carlino VICE-PRESIDENT – PUBLIC INFORMATION/PROFESSIONAL COMMUNICATION: Eileen Cirelli VICE-PRESIDENT – CONVENTION PLANNING/PROGRAMMING: Mary Beth Mason-Baughman VICE-PRESIDENT – GOVERNMENTAL RELATIONS: Caterina Stalteri VICE-PRESIDENT – PUBLICATIONS/EDITOR: Cheryl Gunter SECRETARY: Emily Katzaman TREASURER: Hunter Manasco Ex Officio STUDENT REPRESENTATIVE: Kathryn Young BUSINESS MANAGER: Diane Yenerall ACCOUNT MANAGER: Amy Caye 3 JOURNAL EDITOR Cheryl D. Gunter, Ph.D.
    [Show full text]
  • Cultural Appropriateness of the Modified Checklist for Autism for Screening Autism In
    Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2021 Cultural Appropriateness of the Modified Checklist for utismA for Screening Autism in Ghana Eric Amoako Darquah Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Social and Behavioral Sciences Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Social and Behavioral Sciences This is to certify that the doctoral dissertation by Eric Darquah has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Peggy Gallaher, Committee Chairperson, Psychology Faculty Dr. John Agnew, Committee Member, Psychology Faculty Dr. Matthew Howren, University Reviewer, Psychology Faculty Chief Academic Officer and Provost Sue Subocz, Ph.D. Walden University 2021 Abstract Cultural Appropriateness of the Modified Checklist for Autism for Screening Autism in Ghana by Eric Darquah MS, Capella University, 2010 MA, Middlesex University, 2006 BEd, University of Cape Coast, 1999 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Psychology Walden University February 2021 Abstract Autism spectrum disorder (ASD) is a neurodevelopmental disorder in toddlers. The prevalence of this disorder continues to increase, necessitating an early screening tool to support early diagnosis and intervention. Although the Modified Checklist for Autism in Toddlers Revised (M-CHAT-R) has been cross-culturally effective for screening ASD, little research has been done on early screening for ASD characteristics in Ghana.
    [Show full text]
  • Does This Person Have ASD? New Zealand Autism Spectrum Disorder Guideline
    Does this person have ASD? New Zealand Autism Spectrum Disorder Guideline A resource to help identify autism spectrum disorder ________________________________ Citation: New Zealand Guidelines Group. 2010. What does ASD look like? A resource to help identify autism spectrum disorder. Wellington: New Zealand Guidelines Group. ISBN: (electronic): 978-1-877509-22-3 HP5011 Information in this resource is drawn from ‘New Zealand Autism Spectrum Disorder Guideline’ (NZ ASD Guideline). The guideline is available online at www.nzgg.org.nz – search term: autism. Contents � 1 Who is this for? page 1 2 What is autism spectrum disorder (ASD)? page 2 3 What are signs of possible ASD? page 6 4 What should I do if I suspect ASD? page 9 5 Some pointers for conducting page 11 an assessment 6 Associated conditions page 13 7 How can I support people going through page 14 the assessment process? 8 Why is diagnosis important? page 15 9 How to make a referral page 17 10 Notes for general practitioners page 19 11 The ASD referral process page 21 12 Appendix: Key signs for identifying page 23 ASD from the NZ ASD Guideline 13 Resources for further information page 29 14 Acknowledgements page 31 Who is this for? Who is this for? � 1 This resource is for health and education practitioners who make initial clinical assessments for ASD, and refer for specialist hospital assessment, if needed. Referrers may be doctors (usually GPs), Plunket or public health nurses, Resource Teachers: Learning and Behaviour (RTLBs), speech-language therapists or psychologists. It contains information on the basic signs and symptoms of ASD, and how to refer people for formal diagnosis when you suspect ASD.
    [Show full text]
  • Individuals with Autism Spectrum Disorders
    Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences 103 _____________________________ _____________________________ Individuals with Autism Spectrum Disorders Teaching, Language, and Screening BY FREDRIKA M. MIRANDA-LINNÉ ACTA UNIVERSITATIS UPSALIENSIS UPPSALA 2001 Dissertation for the Degree of Doctor of Philosophy in Clinical Psychology presented at Uppsala University in 2001 ABSTRACT Miranda-Linné, F. M. 2001. Individuals with Autism Spectrum Disorders: Teaching, Language, and Screening. Acta Universitatis Upsaliensis. Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences 103. 96 pp. Uppsala. ISBN 91-554-5047-4. The present dissertation on autism spectrum disorders (ASD) addressed several questions. First, the behavioral symptoms of speaking and mute individuals with ASD were compared on the Autism Behavior Checklist (ABC), a commonly used diagnostic instrument. In addition, questions about the construction of the ABC were investigated. In Study I it was found that although the two groups did not significantly differ on the total ABC score, the mute group demonstrated significantly more pathology on 21 of 57 items and 3 of 5 subscales. The speaking group obtained significantly higher scores on only 8 items and 1 subscale (Language). The appropriateness of providing greater pathology scores to speaking, rather than mute, individuals with ASD was called into question. In addition, it was speculated that the expressive language items are weighted too heavily, on both the Language subscale and the total score. Second, because the 57 items of the ABC were categorized into 5 subscales on a subjective basis, an empirical investigation of the factor structure of the ABC was performed. In Study II, a 5-factor model that contained 39 of the items accounted for 80% of the total variance in the checklist.
    [Show full text]
  • Speech Therapy Guidelines Toc526334655 Utilization Management Policy
    CLINICAL GUIDELINES Speech Therapy Version 1.0.2019 Clinical guidelines for medical necessity review of speech therapy services. © 2019 eviCore healthcare. All rights reserved. _____________________________________________________________________________________BridgeSpan Musculoskeletal Benefit Management Program: Speech Therapy Services V1.0.2019 Please note the following: CPT Copyright 2017 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. © 2019 eviCore healthcare. All rights reserved. Page 2 of 245 400 Buckwalter Place Boulevard, Bluffton, SC 29910 • (800) 918-8924 www.eviCore.com _____________________________________________________________________________________BridgeSpan Musculoskeletal Benefit Management Program: Speech Therapy Services V1.0.2019 Dear Provider, This document provides detailed descriptions of eviCore’s basic criteria for musculoskeletal management services. They have been carefully researched and are continually updated in order to be consistent with the most current evidence-based guidelines and recommendations for the provision of musculoskeletal management services from national and international medical societies and evidence-based medicine research centers. In addition, the criteria are supplemented by information published in peer reviewed literature. Our health plan clients review the development and application of these criteria. Every eviCore health plan client develops a unique list of CPT codes or diagnoses that are part of their musculoskeletal management program. Health Plan medical policy supersedes the eviCore criteria when there is conflict with the eviCore criteria and the health plan medical policy. If you are unsure of whether or not a specific health plan has made modifications to these basic criteria in their medical policy for musculoskeletal management services, please contact the plan or access the plan’s website for additional information. eviCore healthcare works hard to make your clinical review experience a pleasant one.
    [Show full text]
  • Integrated Mental Health Treatment Guidelines for Prescribers in Intellectual and Developmental Disabilities
    Integrated Mental Health Treatment Guidelines for Prescribers in Intellectual and Developmental Disabilities These guidelines were developed by the Center for START Services at the University of New Hampshire Institute on Disabilities/UCED with funding from the WITH Foundation. PI, Joan B. Beasley, PhD © 2021 Center for START Services, University of New Hampshire Institute on Disability/UCED Contents Editors & Contributors ................................................................................................................................................3 Introduction L. Jarrett Barnhill, MD, DFAPA, FAACAP, Joan B. Beasley, PhD, and Andrea Caoili, LCSW...........................5 Foreword: The Importance of Hope as an Essential Part of Patient Care Dan Tomasulo, PhD, MAPP, MFA.............................................................................................................................6 Fundamentals of Psychopharmacology L. Jarrett Barnhill, MD, DFAPA, FAACAP ...............................................................................................................8 1. The Lived Experience Perspective: Working with Patients and Supporters.........................................10 Communicating with Patients with IDD and Their Family Members Melanie Hecker, MPA, Susan Klick, and Beth Grosso, MSW ...........................................................................10 Considerations for Waiting Rooms Melanie Hecker, MPA, Susan Klick, and Beth Grosso, MSW............................................................................11
    [Show full text]
  • Apraxia of Speech: an Overview
    Neurocase (2005) 11, 427–432 Copyright © Taylor & Francis LLC ISSN: 1355-4795 print DOI: 10.1080/13554790500263529 ApraxiaNNCS of Speech: An overview JENNIFERApraxia Overview OGAR1,2, HILARY SLAMA1, NINA DRONKERS1,2, SERENA AMICI1 and MARIA LUISA GORNO-TEMPINI1 1UCSF Memory and Aging Center, San Francisco, CA, USA 2VA Northern California Health Care System, Martinez, CA, USA Apraxia of speech (AOS) is a motor speech disorder that can occur in the absence of aphasia or dysarthria. AOS has been the subject of some controversy since the disorder was first named and described by Darley and his Mayo Clinic colleagues in the 1960s. A recent revival of interest in AOS is due in part to the fact that it is often the first symptom of neurodegenerative diseases, such as primary progressive aphasia and corticobasal degeneration. This article will provide a brief review of terminology associated with AOS, its clinical hallmarks and neuroanatomical correlates. Current models of motor programming will also be addressed as they relate to AOS and finally, typical treatment strategies used in rehabilitating the articulation and prosody deficits associated with AOS will be summarized. Introduction with AOS. We will summarize the cognitive basis of AOS within current models of motor programming and review Apraxia of speech (AOS) has emerged as the term to describe modern approaches to treatment. a motor speech disorder characterized by an impaired ability to coordinate the sequential, articulatory movements neces- sary to produce speech sounds (Wertz et al., 1984). Confu- History of Terminology sion in the literature around AOS stems from the fact that terminology associated with this disorder has varied greatly.
    [Show full text]
  • Selective Mutism and Its Link to Sensory Processing Disorder
    UNIVERSITY OF GOTHENBURG DEPARTMENT OF PSYCHOLOGY More than Shyness: Selective Mutism and its Link to Sensory Processing Disorder Katarzyna Brimo Individual paper, 15 credits Bachelor thesis in Psychology PC1546 Spring 2016 Supervisors: Amelie Gamble Jennifer Strand More than Shyness: Selective Mutism and its Link to Sensory Processing Disorder Katarzyna Brimo Selective mutism (SM) is a childhood anxiety disorder. Since anxiety is related to Sensory Processing Disorder (SPD) the purpose of this study was to find out if sensory processing difficulties are present in children with SM. Clinical information was collected online from 147 caregivers and the data were complete for 122 subjects (ages 3-18). Short Sensory Profile (SSP) assessment was used to measure sensory reactivity in a group of children with SM. According to SSP definite sensory impairments were detected in 64 % of the children with SM, whereas probable sensory impairments were present in 24 % of the SM group. The highest rates of SPD were reported in three sections of SSP: taste/smell sensitivity, visual/auditory sensitivity and auditory filtering. Moreover, SPD was present at higher rate in children with SM compared to a group of typically developing children. The above findings suggest that a vast percentage of children with SM may be affected by SPD, regardless of other co-occurring diagnoses. This pioneering result has an implication for complementing the existing SM therapy methods with Sensory Integration training (SI) and/ or neurosensorimotor reflex integration techniques. “Anxiety can just as well express itself by muteness as by a scream” Søren Kierkegaard (1813- 1855) A second grade girl with selective mutism reaches the front of a lunch line.
    [Show full text]