Decisional Capacity

Topics: Aid to capacity evaluation (ACE) | Capacity | Collaborative care | Decisional Capacity | Dispositional capacity | Free Articles | Medical incapacity hold | Surrogate decision-maker

CHPR: Can you start by telling us what criteria you use to assess capacity? Dr. Cheung: We generally look for evidence of capacity in four domains. These have become the standard criteria for assessing capacity, based on Dr. Paul Appelbaum’s work from many years ago (Appelbaum PS and Grisso T, N Engl J Med 1988;319(25):1635–1638). The domains are:

Prescribing to Children of Divorce

Topics: Collaborative care | custody agreement | Divorce | Free Articles | Medication | Separation

Each year in the US, there are about 1.04 million divorces, affecting about 800,000 children. Beyond that, 1.9 million cohabiting (and unmarried) couples break up each year, of whom 60% have children (www.census.gov/data/developers/data-sets/acs-1year.html). It may not be the divorce itself that is hard on children, but how the divorce is handled (ie, a

Perioperative Pain Management in Opioid Use Disorder

Topics: Buprenorphine | Collaborative care | Free Articles | Methadone | Opioid Use Disorder | Opioids | Pain

When your patients with opioid use disorder (OUD) develop pain due to medical illness or trauma, pain management can get tricky. When they seek pain control, they may be perceived as “drug seeking” in medical settings. Studies have shown that providing adequate pain management for these patients is a particular challenge (Department of Veterans Affa

Management of Opioid Withdrawal in the Emergency Setting

Topics: Collaborative care | Detoxification | Harm reduction | Opioid Use Disorder | Opioids | Withdrawal

Opioid withdrawal is being seen more frequently in emergency settings. From 2005 to 2014, it is estimated that the rate of US emergency department (ED) visits due to opioids doubled from 89.1 per 100,000 people to 177.7 per 100,000 (Agency for Healthcare Research and Quality, www.tinyurl.com/2xr8hp8h). For many patients, the ED is their only contact wit

Opioid Use Disorders and Serious Mental Illness

Topics: Addiction Treatment | Alcohol use disorder | Behavioral treatment | Bipolar Disorder | Buprenorphine | Co-occurring disorders | Collaborative care | Depression | Literacy | Medical Comorbidities | Methadone

CATR: Please tell us about your clinical focus. Dr. Gomez-Luna: My principal role is within an organization called Behavioral Health Care, a behavioral health organization in Connecticut that serves a wide array of populations, from children and adolescents all the way to late adulthood (www.bhcare.org). We provide clinical services to communities for

A New Way to Talk to Patients about Medication

Topics: Collaborative care | Medication adherence | Patient relationship | Psychiatric interviewing | Psychotherapy | Therapy with Med Management

TCPR: We all want to communicate better with patients, particularly around medications. You’ve lead workshops on this for several decades. Tell us about the model you developed out of that work. Dr. Shea: The Medication Interest Model (MIM) is a set of over 100 interview techniques that create shared decision making regarding all disease states from