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Functioning and well-being outcomes of patients with depression compared with chronic general medical illnesses. Treating depressed primary care patients improves their physical, mental, and social functioning.
National Institute of Mental Health treatment of Depression Collaborative Research Program.
Symptom profiles of depression among general medical service users compared with specialty mental health service users. Summary of the practice parameters for the assessment and treatment of children and adolescents with depressive disorders. Screening for depressive disorder in children and adolescents: validating the Center for Epidemiologic Studies Depression Scale for Children.
Screening for major depression disorders in medical inpatients with the Beck Depression Inventory for Primary Care. Development and validation of a geriatric depression screening scale: a preliminary report.
I strongly urge you to read the required papers for a given lecture before you come to that lecture. The class will cover the evolution, ecology, and conservation of marine plants, invertebrates, and vertebrates and a wide variety of marine habitats and ecosystems. In general, I will use the criteria below (Grading, grade inflation, and the meaning of grades at Carolina) by the faculty council to assign final grades.
Be skeptical, think critically, and try to synthesize seemingly disparate concepts and facts.
Keep separate lists of key facts, citations, terms, and concepts and cross-reference them to lectures. In February of 2000, the educational policy committee released a report on grade inflation at UNC Chapel Hill. Embrace the use of general principles while recognizing their limitations.A  Use the many caveats in ecology to predict when and where a principle or theory will and will not hold true.A  In other words, be aware of the context-specific nature of many ecological processes and general principles! Lincoln moved quickly to control the border states of Delaware, Kentucky, Maryland and Missouri a€“ slaves states that did not join the Confederacy. Using these advantages, General Winfield Scott developed a two-part strategy to defeat the South. When 35,000 inexperienced Union troops tried to capture the Confederate capital at Richmond, Virginia, they were badly defeated at the First Battle of Bull Run (Manassas, Virginia).
Confederate commander, General a€?Stonewalla€? Jackson earned his name at the battle by refusing to yield ground to the Union army. The a€?Anaconda Plana€? called for the North to strangle the southern economy by blocking all of her ports. In an attempt to break the (increasingly effective) blockade the South created the Virginia a€“ an ironclad ship that no wooden vessel could defeat. On March 8-9, 1862 the Union Monitor and the Confederate Virginia clashed off Hampton Roads, Virginia. On April 6, 1862 while pausing at Shiloh Church in Tennessee, Granta€™s forces were attacked by General Albert Sidney Johnstona€™s Confederate forces in what became the Battle of Shiloh (Pittsburg Landing, Tennessee).
On April 24, 1862 Admiral David Farragut led his fleet of 18 ships past the harbor defenses of New Orleans. If African-Americans were captured in battle the South would kill them or sell them into slavery.
In late 1862 and early 1862 Union forces tried to attack the Confederate capital at Richmond, Virginia by way of Fredericksburg. The Union was victorious and many northerners believed for the first time that the war could be won.
In the spring of 1864 General William Tecumseh Sherman led 100,000 Union troops south out of Tennessee.


After being trapped between General Sherman from the South and General Grant from the North, Robert E.
When 35,000 inexperienced Union troops tried to capture the Confederate capital at Richmond, Virginia, they were badly defeated at the First Battle of Bull Run (Manassas, Virginia).A  This unexpected defeat taught the Union that the Civil War would be a long one and would require a large army. The Uniona€™s western strategy in the West centered on control of the Mississippi River.A  Controlling the Mississippi would cut the Confederacya€™s western states off from the rest of the South. West of the Mississippi the Confederates attempted to take the border state of Missouri.A  Failing to take the federal arsenal at St. On November 19, 1863 President Lincoln came to dedicate the battlefield cemetery.A  He gave a short speech in which he reminded the nation that the war we being fought for liberty, equality and democracy.
Review your chapter outline, worksheets and quizzes.A  Take the on-line practice test and quizzes.
In case you can't make it to your TV to tune into ABC tomorrow, watch the "Scandal" season 4 full episode 7 online via a free live stream of ABC here! According to TV Guide, the official synopsis for tomorrow night's episode reads: "Olivia doubts Jake's guilt, so she seeks answers from Tom.
Don't forget to tune in to "Scandal" season 4, episode 7 tomorrow night, Thursday, November 6 at 10pm ET on ABC.
KpopStarz Is Looking For Enthusiastic Entertainment Contributors Reach Millions On The Web. Primary care physicians, not mental health professionals, treat the majority of patients with symptoms of depression.
It manifests as a combination of feelings of sadness, loneliness, irritability, worthlessness, hopelessness, agitation, and guilt, accompanied by an array of physical symptoms (Table 1).6 Recognizing depression in patients in a primary care setting may be particularly challenging because patients, especially men, rarely spontaneously describe emotional difficulties. Preventive Services Task Force (USPSTF) recently reviewed new evidence finding that patients fared best when physicians recognized the symptoms of depression and made sure that they received appropriate treatment.8 Based on this evidence, the USPSTF issued new depression screening recommendations last May, encouraging primary care physicians to routinely screen their adult patients for depression. Although each measure has a unique scoring system, higher scores consistently reflect more severe symptoms. If youa€™ve come to lecture and done the readings and you still dona€™t understand a concept, please come to either my or Natea€™s office hours with your questions. McClellan assembled a well-disciplined force of 100,000 called the a€?Army of the Potomaca€? and tried to attack Richmond again in the spring and summer of 1862. Lee - was always willing to take risks and make unpredictable moves to keep Union forces off balance. Lee finally surrendered what was left of his forces after being surrounded near Appomattox Courthouse, Virginia.
Sumter in Charleston, South Carolina.A  President Lincoln declared the South to be in a a€?state of rebelliona€? and called for 75,000 volunteers for the Union army to quash the rebellion. McClellan assembled a well-disciplined force of 100,000 called the a€?Army of the Potomaca€? and tried to attack Richmond again in the spring and summer of 1862.A  In the Seven Days Battle, General Robert E. LeeA  - was always willing to take risks and make unpredictable moves to keep Union forces off balance.A  After the Seven Days Battles, Lee decided to a€?go northa€?. Wagner, SC, the 54th Massachusetts Infantry Regiment, made up of free African-Americans, led a heroic charge.A  Half became casualties. After leaving Atlanta in ruins they tore through Georgia and South Carolina leaving massive destruction in their wake and decreasing the Southa€™s will to fight. Find out where to watch online a free live stream of the "Scandal" season 4, episode 7, titled "Baby Made A Mess." Spoilers reveal Olivia quizzes Fitz on Jake's wellbeing, now that he's been sent to a supermax prison known for mistreating its inmates. Persons who are depressed have feelings of sadness, loneliness, irritability, worthlessness, hopelessness, agitation, and guilt that may be accompanied by an array of physical symptoms.
All measures have a statistically predetermined cutoff score at which depression symptoms are considered significant. Once depression is diagnosed and treatment is initiated, repeated administration of these measures provides an excellent means of tracking response to pharmacotherapy or psychotherapy.Depression measures should be selected based on the patient population (Table 4). Leea€™s forces forced the Union to retreat from around Richmond.A  General Lee became a hero to the South ever after.


The Pediatric Symptom Checklist may serve as a general psychosocial screen for children and adolescents. Note: We wona€™t tell you what questions will be on the exams, but we can help you prepare for the exams by reviewing key ideas and details you find confusing. Identifying patients with depression can be difficult in busy primary care settings where time is limited, but certain depression screening measures may help physicians diagnose the disorder. An interview is necessary because many conditions have symptoms that are common to depression.
In adult patient populations, screening with the BDI, CES-D, or Zung measures is recommended in targeted, high-risk populations. Course readings will include review chapters and papers on general topics and more detailed cases studies from the primary scientific literature.
Patients who score above the predetermined cut-off levels on the screening measures should be interviewed more specifically for a diagnosis of a depressive disorder and treated within the primary care physician's scope of practice or referred to a mental health subspecialist as clinically indicated. In addition, screening measures do not address important diagnostic features such as duration of symptoms, degree of impairment, and comorbid psychiatric disorders. In postpartum women, the Edinburgh Postnatal Depression Scale is the preferred measure.The use of depression screening measures in elderly patients varies with their cognitive status and clinical presentation. Targeted screening in high-risk patients such as those with chronic diseases, pain, unexplained symptoms, stressful home environments, or social isolation, and those who are postnatal or elderly may provide an alternative approach to identifying patients with depression. An evaluation is critical in ruling out conditions that may present with symptoms of depression, such as hypothyroidism and pancreatic cancer. Use of the GDS is limited to cognitively intact or mildly impaired elderly patients and interviewer-administered instruments, such as the Cornell Scale for Depression in Dementia or the Hamilton Rating Scale, are preferable when cognitive deficits are present.
However, older patients with depression may also present with unexplained somatic symptoms and may deny sadness or loss of pleasure. The Center for Epidemiologic Studies Depression Scale for Children (CES-DC),15 the Center for Epidemiologic Studies Depression Scale (CES-D),16 the Beck Depression Inventory (BDI),17 and the Children's Depression Inventory (CDI) are alternatives for use in adolescents. Advantages of the BDI and CES-D include ease of scoring, low cost, and comparable psychometric properties.The screening measures for children and adolescents listed in Table 2 have been primarily used for research, and their clinical use in screening children and adolescents in primary care settings has not been established. Scoring of the Zung scale is slightly more difficult because the raw score must be converted using a table.The rightsholder did not grant rights to reproduce this item in electronic media. Edinburgh Postnatal Depression ScaleReprinted with permission from Cox JL, Chapman G, Murray D, Jones P. Edinburgh Postnatal Depression ScalePhysician instructions: Have the patient complete the scale by marking one answer for each question that comes closest to how she has felt in the past seven days, not just how she feels today.
Signs of depression that are more common in the elderly than in other populations include diminished self-care, irritability, and psychomotor retardation. Early diagnosis and treatment of depression in the elderly improve quality of life and functional status, and may help prevent premature death.When using screening instruments with elderly patients, it is important to consider their level of cognitive impairment along with visual deficits.
The validity of certain depression screening instruments is significantly decreased in patients with a Mini-Mental State Examination score of 15 or less.42A  Table 2 includes information on the BDI, CES-D, and Geriatric Depression Scale (GDS)22 specific to their use in persons older than 60 years. The GDS is unique in that it was specifically developed for use in geriatric patients, and it contains fewer somatic items. Geriatric Depression Scale–Short FormReprinted with permission from Sheikh JI, Yesavage JA. In cognitively intact patients older than 65 years, the GDS or one-item screen are currently the preferred instrument because the psychometric data on the BDI and CES-D are mixed in this population.44In patients who have cognitive deficits, interviewer-administered instruments such as the Cornell Scale for Depression in Dementia (Figure 4)24 or the Hamilton Rating Scale for Depression45 are preferred.
These instruments require more time to administer; however, they are more appropriate than self-report instruments for cognitively impaired patients.



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