@article{ref1,
title="Managing high-acuity-depressed adults in primary care",
journal="Journal of the American Academy of Nurse Practitioners",
year="2009",
author="Sobczak, Janet Ambrogne",
volume="21",
number="7",
pages="362-370",
abstract="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.<p /><p>Language: en</p>",
language="en",
issn="1041-2972",
doi="10.1111/j.1745-7599.2009.00422.x",
url="http://dx.doi.org/10.1111/j.1745-7599.2009.00422.x"
}