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首页> 外文期刊>Journal of the American Academy of Nurse Practitioners. >Managing high-acuity-depressed adults in primary care.
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Managing high-acuity-depressed adults in primary care.

机译：在初级保健中管理高度感情的成年人。

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摘要

PURPOSE: To identify strategies for managing high-acuity-depressed adults in primary care settings. Patients who do not achieve remission with initial treatment, patients at risk for suicide, and patients with co-occurring substance use disorders are specifically addressed. DATA SOURCES: Scientific literature and evidence-based practice guidelines. CONCLUSION: Accurate diagnosis is best accomplished using screening instruments as an adjunct to a thorough history and assessment. The goal of interventions is remission of symptoms as opposed to a partial response. Patient preferences regarding choice of intervention must be considered. Initial pharmacotherapy must include adequate doses and a trial of adequate duration. Patients who do not respond to two medication trials are at risk for suicide and/or have a co-occurring substance use disorder may require: (a) a combination of medications coupled with psychotherapy; or (b) referral to mental health specialists to achieve the best outcomes. IMPLICATIONS FOR PRACTICE: High-acuity patients with mental health needs will continue to be seen in primary care settings. Through educational preparation and a patient-centered focus, advanced practice nurses in primary care settings are in an optimal position to set a high standard of care for complex mental health patients.
机译：目的：确定在初级保健环境中管理高敏感成年人的策略。未达到初始治疗的患者的患者，患者自杀的风险和共同发生的物质使用障碍的患者进行了专门寻址。数据来源：科学文学和基于证据的实践指南。结论：使用筛选器材作为彻底历史和评估的辅助来实现准确的诊断。干预措施的目标是缓解症状，而不是部分反应。必须考虑关于干预选择的患者偏好。初始药物疗法必须包括足够的剂量和适当持续时间的试验。没有反应两种药物试验的患者面临自杀的风险和/或有共同发生的物质使用障碍可能需要：（a）与心理治疗相结合的药物组合;或（b）转诊到心理健康专家，以实现最佳成果。对实践的影响：在初级保健环境中将继续在精神健康需求中进行高度敏锐的患者。通过教育准备和以患者为中心的重点，初级保健环境的高级实践护士处于最佳的位置，为复杂的心理健康患者设定高标准的护理。

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