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This first-of-its-kind title addresses the failures of an often fragmented healthcare system in managing vulnerable patients with multiple, chronic, co-morbid conditions -- patients who are frequently unresponsive to the methods and approaches used to treat other patients with conditions that are less complicated. The book emphasizes a holistic evaluation to patient care that looks at the whole patient, providing comprehensive formulations that describe the interacting problems that afflict the patient, including elements that are barriers to effective treatment of active medical problems and barriers to recovery. The book begins by defining integrated care, discussing the types of patients who benefit from this approach and some of the models of care, including financing, barriers to acceptance, and advocacy for patients. The second section discusses the structural elements of integrated care, including the building of a team approach, issues of leadership, and role definition, as well as the authors'experiences in overcoming some of the problems. In the remaining sections, the book discusses major complicating features of the patients seen in integrative care settings, including a description of the kinds of problems, a model for formulation of patient cases, and successful approaches to treatment of these problems. Finally, some of the real-world applications where integrative care provides better outcomes is covered, including in terms of addictions, medically complex patients, and chronic pain patients. Integrative Medicine for Vulnerable Populations - A Clinical Guide to Working with Chronic and Comorbid Medical Disease, Mental Illness, and Addiction is a major contribution to the clinical literature and will be of great interest to health care professionals, administrators, policy stakeholders, and even interested patients and patient advocates.

This book is designed to give clinicians a practical guide to the detection, assessment and treatment of sleep disorders in patients with psychiatric illness in order to better treat both their sleep disorder and their psychiatric disorder. In addition to providing a thorough introduction to the major sleep disorders, it offers clear guidance on how to assess and manage these disorders in patients with a wide range of psychiatric conditions. The role of psychiatric medication and special considerations to be borne in mind when treating psychiatric patients are also addressed. Although it is aimed primarily at psychiatrists, this will also be a useful handbook for sleep clinics and general practitioners who frequently have to manage patients with both psychiatric and sleep disorders.

This book provides the readers with a series of complex cases that are organized by psychiatric disorder. Written by experts in the field, the cases offer insight on how to navigate care in delicate situations while considering preexisting medical conditions. Topics cover pharmacological concerns in women who are pregnant or nursing, working with dementia patients suffering from HIV, assessing and treating ADHD in special populations, monitoring medication use in patience recovering from Substance Use Disorder, and working with patients suffering from personality disorders. Each chapter offers guidance through the maze of classifications, clinical features, diagnosis and various complex interventions. The book also covers new information on the advances in research and management aspects. Complex Clinical Conundrums in Psychiatry is a valuable resource for psychiatrists, psychologists, family physicians, geriatricians, counselors, social workers, nurses, and all medical professionals working with complex psychiatric patients.

In comparison to the general population, people with schizophrenia and related disorders have poorer physical health and increased mortality. Whilst it is recognised that serious mental illnesses such as schizophrenia carry a reduced life expectancy, it is often assumed that suicide is the main cause of this disparity. In actuality, suicide accounts for no more than a third of the early mortality associated with schizophrenia: the vast majority is due to cardiovascular factors Physical Health and Schizophrenia offers a user-friendly guide to the physical health problems associated with schizophrenia and a clear overview of strategies and interventions to tackle these issues. Spanning eight chapters this resource covers the essential topics in a practical and easy-to-read format to suit the needs of busy clinicians. It also includes an appendix designed specifically for patients and carers, with practical tips on how to be actively involved in monitoring and managing physical health problems. Part of the Oxford Psychiatry Library series, Physical Health and Schizophrenia offers readers a fully up-to-date and valuable insight into this complex issue. With helpful key points at the start of each chapter and a clear layout, this is an essential resource for busy clinicians and researchers in any mental health field as well as those working in primary care.

This book provides up-to-date information on all aspects of the comorbidities that are associated with the headache disorders commonly seen in the primary care and hospital settings, including migraine, tension-type headache, and cluster headache. The coverage is wide ranging and encompasses all of the well-established comorbidities: cardio- and cerebrovascular disease, psychiatric conditions, epilepsy, sleep disorders, and various pain disorders, such as visceral pain, fibromyalgia, orofacial pain, and neuropathic pain. Individual chapters are also devoted to obesity and other metabolic comorbidities and to the comorbidities associated specifically with pediatric headaches. The information provided will assist readers in understanding the complex relationships between headache disorders and these various conditions and in delivering effective care that reflects the latest knowledge. The book is designed to meet the daily practice needs of general physicians, general neurologists, clinical psychologists, neurologists in training, and medical students. It is published as part of the series Headache, which is endorsed by the European Headache Federation – EHF.

The first edition of Comorbidities in Chronic Kidney Disease is focused on the main clinical syndromes associated with renal failure. Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are characterized by a wide spectrum of comorbidities, potentially complicating patients'clinical outcomes. In this volume, both editor and authors have planned a complete review of the main clinical syndromes associated with renal injury and failure. The first chapter is dedicated to epidemiological aspects of chronic kidney disease, and also introduces risk factors and associated comorbidities. Arterial hypertension and cardiovascular diseases are actually accountable as major risk factors for developing renal disease, and the next chapter is mainly focused on the latest trials in this field. The following chapter is dedicated to pathophysiology, diagnosis and treatment of dyslipidemia and atherosclerosis in patients with declined renal function. The subsequent chapter is exhaustively focused on the clinical features of secondary hyperparathyroidism and the disease's complications on kidneys, bone, vessels and heart, from early laboratory findings ‘to severe vascular and heart valvular calcifications. The section that succeeds reflects on secondary anemia and consequent cardiorenal anemia syndrome with particular attention on the latest treatment schedules. Coronary artery disease is also discussed, especially for those concerned with clinical features and laboratory diagnosis in chronic kidney disease patients with impaired clearance of coronary acute syndrome biomarkers. Cardiorenal syndrome and sudden cardiac death are well-established clinical aspects in CKD patients, and they are discussed both in terms of pathophsysiological and clinical features. The book finally ends with two sections on hepato-renal syndrome and contrast-induced nephropathy (CIN). CIN represents daily challenges for all nephrologists because due to the large amounts of instrumental diagnostic tests and an increasing number of chronic kidney disease patients involved. This volume could be appreciated both by nephrologists and all clinicians involved in chronic patients'management due to schematic and practical editing and form.

This clinical casebook presents a comprehensive review of common sleep problems in adolescents in a concise, easy-to-read format. Each chapter thoroughly addresses a unique sleep disorder in teenagers through illustrative cases, reviews of relevant literature, and pearls of wisdom for both the practicing sleep specialist and other practitioners involved in the care of adolescents. Early chapters address various sleep disorders in detail: parasomnias, narcolepsy, obstructive sleep apnea, and delayed sleep-wake phase disorder, providing clear treatment considerations. Later chapters address sleep when complicated by issues of major depression, PTSD, epilepsy, and Traumatic Brain Injury. In-depth discussions and differential diagnosis engage the reader, and offer a multitude of research-based and clinically guided recommendations for the evaluation and treatment of sleep disorders in the adolescent.An ideal, practical resource for clinicians at all levels, Sleep Disorders In Adolescents provides a valuable contribution to adolescent care.

A Clinician's Guide to Systemic Effects of Periodontal Diseases will serve as an ideal, easy-to-use reference for the practicing health professional. It summarizes the latest research on the systemic effects of periodontal diseases, discusses how the results of this research will impact on clinical practice, and aims to help the clinician to answer questions that may be posed by patients, medical colleagues, and the media. A central theme is the contribution of periodontal diseases to systemic inflammation but other mechanisms, such as systemic dissemination of oral pathogens, are also covered. A collaborative approach involving noted investigators in each field and medical colleagues ensures that all chapters are of clinical relevance from both a dental and a medical perspective. The book is also visually engaging, with numerous summary figures and graphics, bullet point tables, and highlight boxes identifying the most clinically significant points.

This book provides case studies accompanied by questions and commentaries for the specialist registrar in diabetes and endocrinology, to assist with problem-based learning during their training. The case studies range from the everyday to the rare and complicated, presenting a strong foundation for the specialist trainee to prepare them for their qualifying exams and, more importantly, for their future clinical consultations.

Over the past decade, research on the epidemiology, nature, and meaning of the comorbidity between trauma, PTSD, and substance abuse has burgeoned. Changes in the political and social climate of the United States during this time have brought with them new challenges. Changes in the definitions of both posttraumatic stress disorder (PTSD) and substance abuse have been proposed by those involved with diagnosing and treating people with these issues; some of these changes are expected to be reflected in future diagnostic systems. Trauma and Substance Abuse offers a broad overview of current trends in the field of co-occurring substance abuse and PTSD from both clinical and research perspectives. The goal of this volume, newly revised to include special settings, such as court systems and disasters, and special populations, such as veterans, is to clarify issues specific to trauma, PTSD, and substance abuse and to translate both quantitative and qualitative data into specific recommendations for clinicians, researchers, and administrators.

ABC of Multimorbidity is the first title to provide primary care practitioners with a practical approach to the complex issues of treating and managing patients with more than one morbidity.Ageing populations and earlier diagnosis of chronic conditions mean more people are living longer with multimorbidity. However, treatment guidelines are often designed for treatment in isolation of other morbidities. Multimorbidity management therefore requires a more patient centred approach and greater knowledge and coordination of existing services. Effective multimorbidity management both improves overall patient well-being and reduces the overall demand on health services.ABC of Multimorbidity examines how multimorbidities can be addressed within primary care, from the GP and family physician consultation through to the effective use of a range of health care services. It addresses complex issues such as polypharmacy, mental health, patient safety, patient involvement in self-management, and the role of the practitioner. It then provides guidance on how multimorbidities can be best treated and managed within primary care through specific interventions to improve outcomes.From an international, primary care editor and contributor team, ABC of Multimorbidity is a practical resource for general practitioners, family physicians, practice and specialist nurses, and others caring for multimorbid patients. It is also relevant for junior doctors, medical trainees and students.

Patients with advanced cancer may develop a number of clinical complications related to tumor progression or a variety of aggressive treatments. The majority of these patients are elderly, often with multiple co-morbidities that require appropriate assessment and management. In the palliative stage of their disease, patients undergo a progressive transition from active acute care to community-based hospice care. This transition requires modification in the diagnostic tests, monitoring procedures and pharmacological treatments to adjust them to the palliative and short-term nature of the care. Internal Medicine Issues in Palliative Cancer Care looks at internal medicine through a prognosis-based framework and provides a practical approach to maximizing comfort and quality of life while minimizing aggressive investigations and therapies for patients with life-limiting disease. Forty-six common internal medicine conditions are organized into nine clinical categories: pulmonary, cardiovascular, nephrologic and metabolic, gastrointestinal, hematologic, infectious, endocrine, rheumatologic, and neuro-psychiatric. This evidence-based resource is ideal for educating clinicians delivering palliative care to cancer patients in acute care facilities about complex internal medicine problems, decision-making regarding diagnostics and therapeutics which require a good understanding of state-of-the-art internal medicine and palliative care principles.

Depression is frequently associated with other psychiatric disorders and is often related to chronic health problems. Depressive symptoms are also common in chronically distressed close relationships and severe interpersonal difficulties in families and at work. The topic of depressive comorbidity is clearly very important, and while recent research in this area has been methodologically sophisticated, well presented, and inherently interesting, there has not been a comprehensive, academic resource that covers recent developments in this area. The Oxford Handbook of Depression and Comorbidity brings together scholarly contributions from world-class researchers to present a careful and empirically based review of depressive comorbidity. Cutting-edge chapters address theory, research, and practice, while capturing the diversity, evidence-base, and importance of depressive comorbidity. Specific topics include the comorbidity between depression and PTSD, alcohol use, and eating, anxiety, panic, bipolar, personality, and sleep disorders, as well as schizophrenia, suicide, cardiovascular disease, cancer, pain, obesity, intimate relationships, and many more. The Oxford Handbook of Depression and Comorbidity is a unique and much-needed resource that will be helpful to a broad range of researchers and practitioners including clinical and counseling psychologists, psychiatrists, marital and family therapists, social workers, and counselors working in mental-health and general health-care settings, as well as students in these areas.

Managing breathlessness is an important and often difficult task, especially when dealing with patients in their own homes. The causes of breathlessness may be physiological, pathological, or both; and patients may be suffering from more than one condition at the same time. This makes it a challenge to ensure that the best and most effective form of treatment is provided, according to each patient's particular needs. Written by experts in the field, Managing Breathlessness in the Community mainly focuses on four conditions (chronic obstructive pulmonary disease, heart failure, interstitial lung disease and pulmonary hypertension) in which breathlessness is a key and often distressing symptom. The authors also discuss common breathlessness management techniques that are relevant to all patients, regardless of their underlying condition. Aimed at community healthcare workers, this book applies the lessons of clinical research and practice to a wide range of breathlessness interventions, from activity and fitness to pharmacological treatments, rehabilitation, oxygen therapy and patient-specific support. It will be useful to the many practitioners who see breathless patients in their day-to-day practice and have a desire to improve the experience and clinical care that they receive.

Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality worldwide. By 2020, COPD is expected to be the fifth leading cause of disability and the third leading cause of death. COPD is associated with significant co-morbid illnesses including cardiovascular disease, pulmonary vascular disease, osteoporosis, depression and thoracic malignancies. In addition, COPD patients often have systemic manifestations of their disease, including peripheral muscle dysfunction, decreased activity levels and nutritional abnormalities, all of which contribute to poor functional status, decreased quality of life and increased health care utilization. Lack of recognition and understanding of the complex interactions of these common co-morbid conditions and systemic effects often contributes to sub-optimal care for patients with COPD. Comprehensive in covering the range of co-morbidities that often accompany COPD, Chronic Obstructive Pulmonary Disease: Co-Morbidities and Systemic Consequences provides a concise, evidence-based review of the problem and its systemic manifestations. All physicians interested in this growing disorder – from subspecialists to primary care providers –will find in this timely and informative title the practical, state-of-the art approaches needed to provide targeted, integrated care for patients with COPD.

Often considered the prototypic autoimmune disease, Lupus is characterized by protean manifestations and affects a wide range of organ systems. Despite widespread availability of anti nuclear antibody testing and other technological diagnostic advances, the diagnosis of lupus can be elusive, difficult, and inexact. Treatment of the disease can also be challenging. Advances in immunology and biotechnology have led to a burgeoning world of new therapies in development that offer patients the real possibility of new therapies and physicians and scientists novel insights into the pathogenesis of this complicated immunological disease. Lupus Erythematosus: Clinical Evaluation and Treatment summarizes the clinical aspects of lupus facing the general clinician in the 21st century. In this invaluable, practical book, the reader will find introductory chapters regarding general diagnostic and treatment principles, followed by chapters addressing the lupus-specific organ manifestations. Special topics regarding pregnancy and comorbidities are also presented. Written by highly experienced physicians with special expertise in lupus, Lupus Erythematosus: Clinical Evaluation and Treatment is an indispensable reference for the common and not so common problems affecting patients with lupus.

This important issue of Medical Clinics provides essential updates in heart failure. The following topics are covered: epidemiology, pathophysiology, and general approach for heart failure; symptoms, signs, diagnostic studies, and prognostic significance of systolic versus diastolic heart failure; the appropriate use of biomarkers; oral versus intravenous diuretic therapy; guideline-based therapy including RAAS blockade, beta-blockade, and aldosterone antagonist, appropriate use of AICD and biventricular pacing; role of ventricular assist device; pathophysiological consideration and management approaches in acute decompensated heart failure; pathophysiology and current approaches to cardiorenal syndrome; heart failure with other comorbidities including diabetes, obesity, anemia, and cancer; heart failure and atrial fibrillation; and the role of disease management strategies in heart failure.

“It takes my worries away…it helps me unwind when I'm tense…” Those with an anxiety disorder are at two to five times greater risk of having an alcohol or drug use disorder than those without an anxiety disorder. And although anxiety disorders are among the most common co-occurring conditions affecting people with substance issues, mainstream methods often fail to treat both halves of the picture. Anxiety and Substance Use Disorders: The Vicious Cycle of Comorbidity addresses this gap with dispatches from the frontlines of research and treatment. Thirty-four international experts offer findings, theories, and intervention strategies for this common form of dual disorder both across types of substances (alcohol, tobacco, street and prescription drugs) and the range of anxiety disorders (PTSD, social phobia, panic disorder, OCD) to give the reader comprehensive knowledge in a practical format. Informed by the reciprocal relationship between the two types of disorders (such as the contributions of substance abuse to anxiety-related symptoms), the book: Brings together neurobiological, psychosocial, and cognitive perspectives on its subject; Outlines theoretical models of co-occurring anxiety and substance abuse, its epidemiology, and etiology; Offers up-to-date research findings on the nature, origins, and treatment of specific combinations of substance use and anxiety disorders; Presents detailed reviews of emerging targeted treatment methods—including cognitive-behavioral, personality-based, and medical interventions—with latest data on their efficacy; Pinpoints future directions in understanding and treating the dually diagnosed. This integrative approach makes Anxiety and Substance Use Disorders: The Vicious Cycle of Comorbidity an important resource for all mental health professionals. It will also serve as an excellent clinical text.'The first of its kind in providing a critical review of theemerging literature addressing such co-morbid conditions, this book is an excellent step in providing researchers and clinicians with guidance in the understanding and treatment of this complicated presentation. Overall, the current volume will likely be instrumental in further advancing the field of co-occurring anxiety and substance use disorders.'-Lindsay S. Ham, Florida International University, Book Review Editor for Anxiety Disorders: A Quarterly Report, Association for Behavioral and Cognitive Therapies