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Because open- ended questions do not limit the patient to responding with a yes or no order nootropil 800 mg with visa useless id symptoms, they encour- age the patient to disclose more information purchase 800mg nootropil with amex 20 medications that cause memory loss. For example order nootropil 800mg visa treatment 1st degree burns, you can start the interview by asking an open-ended question, such as “How are you feeling today? For example, if you ask the patient a closed-ended question such as, “Do you take your medications as directed by your physician? Instead, if you ask the patient an open- ended question, such as “How are you taking this medication? By gathering more information with open-ended questioning, you may learn that there are dis- crepancies between how the patient is actually taking the medication and how it has been prescribed. Oftentimes, a patient answers, “Yes, I am taking it as directed,” but you then discover that this is not the case, perhaps as a result of dishonesty but more likely because the patient believes that he or she is taking the medication correctly. The use of open-ended questions enables you to gather more information from the patient and to be more complete and accurate in your assessment; this, in turn, leads to appropriate patient-specific care. Closed-ended questions do play a role in communicating with a patient; however, the use of close-ended questions should be specific to the information you want to col- lect. For example, if you would like to know whether the patient took his or her blood pressure medication in the morning to more accurately assess his or her blood pressure reading, you might ask, “Did you take your blood pressure medications this morning? For example, after asking an open-ended question such as “What symptoms communication skills 7 are you currently experiencing? These questions lead a patient to provide a response that he or she perceives to be the answer that the inter- viewer wants to hear. An example of a leading question is “You do not miss any doses of your medication, do you? Therefore, to obtain an accurate response to your questions, leading questions should be avoided. By allowing moments of silence after asking a question, the patient is able to reflect upon your question and provide a more thoughtful and accurate response. However, silence may also indicate that the patient has not understood your question. You can use nonver- bal cues to gauge each patient independently to determine the appropriate length of time to be silent and/or when to break the silence. In general, the silence should be long enough to provide the patient a chance to gather his or her thoughts but not so long as to make the patient feel uncomfortable. Although it may be necessary to learn the reasoning behind the patient’s choices and actions, the wording that you use may impact the response. For example, if you desire to learn why a patient is missing doses of hydrochlorothiazide, instead of asking “Why do you miss your doses? With the “why” method, the patient may feel the need to defend him- or herself, whereas 8 chapter 1 / the patient interview the “what” method allows the patient to reflect on his or her reasons without feeling as though you are offering judgment. This type of communication plays an important role in your interactions with your patients because it can be as powerful as the words that are spoken.

I chose radiation therapy because we thought it was the best choice for my situation generic nootropil 800 mg line treatment of gout. After talking with several doctors who specialize in prostate cancer cheap nootropil 800 mg mastercard medicine man 1992, we decided that surgery was the best choice for me buy 800 mg nootropil mastercard symptoms type 1 diabetes. And while it is good to have choices, this fact can make the decision hard to make. Yet, each choice has benefts (how treatment can help) and risks (problems treatment may cause). While you are waiting for treatment, you should meet with different doctors to learn about your treatment choices. Use this booklet to help you talk over treatment choices with your doctor before deciding which is best for you. After all, having prostate cancer and the treatment choice you make affect both of you. Its purpose is to help you learn about early-stage prostate cancer, diferent treatments, and the benefts and risks of each type of treatment. Most men will need more information than this booklet gives them to make a decision about treatment. For a list of groups that provide more information and support, please see the Ways to Learn More section on page 32. Also, see that section if you have prostate cancer that has spread beyond the prostate or that has returned after treatment. Semen is the milky fuid that carries sperm from the testicles through the penis during ejaculation. Te prostate surrounds part of the urethra, the tube that carries urine out of the bladder and through the penis. This means that it can take 10 to 30 years before a prostate tumor gets big enough to cause symptoms or for doctors to fnd it. Most men who have prostate cancer will die of something other than prostate cancer. Each has benefts (how treatments can help) and risks (problems treatment may cause). Te choice of treatment depends on many factors: n Your prostate cancer risk group. Doctors use details about your cancer to place you into a low-, medium-, or high-risk group. Having heart problems, diabetes, or other illnesses may affect your treatment options.

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When selecting your P-drugs you may need to revise some of the basic principles of pharmacology purchase 800 mg nootropil visa treatment of pneumonia, which are summarized in Annex 1 generic nootropil 800mg with amex medications that interact with grapefruit. How do you manage to choose the right drug for each patient in a relatively short time? P-drugs are the drugs you have chosen to prescribe regularly nootropil 800mg visa symptoms electrolyte imbalance, and with which you have become familiar. The P-drug concept is more than just the name of a pharmacological substance, it also includes the dosage form, dosage schedule and duration of treatment. P- drugs will differ from country to country, and between doctors, because of varying availability and cost of drugs, different national formularies and essential drugs lists, medical culture, and individual interpretation of information. And, as you use your P-drugs regularly, you will get to know their effects and side effects thoroughly, with obvious benefits to the patient. In general, the list of drugs registered for use in the country and the national list of essential drugs contain many more drugs than you are likely to use regularly. It is therefore useful to make your own selection from these lists, and to make this selection in a rational way. For these reasons they are a valuable tool for rational prescribing and you should consider them very carefully when choosing your P-drugs. P-drugs and P-treatment 19 Guide to Good Prescribing There is a difference between P-drugs and P-treatment. The concept of choosing a P-treatment was already introduced in the previous chapter. The process of choosing a P-drug is very similar and will be discussed in the following chapters. How not to compile your list of P-drugs Instead of compiling your own list, one of the most popular ways to make a list of P-drugs is just to copy it from clinical teachers, or from existing national or local treatment guidelines or formularies. While you can and should draw on expert opinion and consensus guidelines, you should always think for yourself. For example, if a recommended drug is contraindicated for a particular patient, you have to prescribe another drug. If you do not agree with a particular drug choice or treatment guideline in general, prepare your case and defend your choice with the committee that prepared it. F Through developing your own set of P-drugs you will learn how to handle pharmacological concepts and data. This will enable you to discriminate between major and minor pharmacological features of a drug, making it much easier for you to determine its therapeutic value. F Through compiling your own set of P-drugs you will know the alternatives when your P-drug choice cannot be used, for example because of serious side effects or contraindications, or when your P-drug is not available. With the experience gained in choosing your P-drugs you will more easily be able to select an alternative drug. F You will regularly receive information on new drugs, new side effects, new indications, etc.

However cheap 800 mg nootropil amex medications known to cause nightmares, affective symptoms (mood purchase cheapest nootropil and nootropil medications januvia, anxiety cheap nootropil 800 mg with amex medications reactions, anger) and somatic complaints also improved with low doses of haloperidol, perphenazine, and thio- thixene. An open-label trial of thioridazine (mean dose=92 mg/day) led to marked improve- ment in impulsive-behavioral symptoms, global symptom severity, and overall borderline psychopathology (78). Similar findings were reported for adolescents with borderline person- ality disorder treated with flupentixol (mean dose=3 mg/day) (77), with improvement in im- pulsivity, depression, and global functioning. Systematic, parallel studies that compared neuroleptics without a placebo control condition also reported a broad spectrum of efficacy. Subsequent double-blind, placebo-controlled trials also suggested a broad spectrum of effi- cacy for low-dose neuroleptics in the treatment of borderline personality disorder. Acute symp- tom severity improved in cognitive-perceptual, affective, and impulsive-behavioral symptom domains, although efficacy for schizotypal symptoms, psychoticism, anger, and hostility was most consistently noted. Treatment of Patients With Borderline Personality Disorder 63 Copyright 2010, American Psychiatric Association. Many of the double-blind, placebo-controlled studies of neuroleptics in borderline personal- ity disorder are noteworthy for biases in sample selection that strongly affected outcomes. In a study of patients with borderline or schizotypal personality disorder and at least one psychotic symptom (which biased the sample toward cognitive-perceptual symptoms), thiothixene (mean dose=8. Cowdry and Gardner (55) conducted a complex, placebo-controlled, four-drug crossover study in borderline personality disorder outpatients with trifluoperazine (mean dose=7. Pa- tients were required to meet criteria for hysteroid dysphoria and have a history of extensive behav- ioral dyscontrol, introducing a bias toward affective and impulsive-behavioral symptoms. Those patients who were able to keep taking trifluoperazine for 3 weeks or longer (7 of 12 patients) had improved mood, with significant improvement over placebo on physician ratings of depression, anxiety, rejection sensitivity, and suicidality. Soloff and colleagues (50, 51) studied acutely ill inpatients, comparing haloperidol with ami- triptyline and placebo in a 5-week trial. However, a second study by the same group (56) that used the same design but compared haloperidol with phenelzine and placebo failed to replicate the broad-spectrum efficacy of halo- peridol (mean dose=3. Efficacy for haloperidol was limited to hostile belligerence and impulsive-aggressive behaviors, and placebo effects were powerful. Patients in this study had milder symptoms, especially in the cognitive-perceptual and impulsive-behavioral symp- tom domains, than patients in the first study. Cornelius and colleagues (68) followed a subset of the aforementioned group who had re- sponded to haloperidol, phenelzine, or placebo for 16 weeks following acute treatment. Pa- tients’ intolerance of the medication, a high dropout rate, and nonadherence were decisive factors in this study. Further significant improvement with haloperidol treat- ment (compared with placebo) occurred only for irritability (with improvement for hostility that was not statistically significant). Depressive symptoms significantly worsened with halo- peridol treatment over time, which was attributed, in part, to the side effect of akinesia.