| 1. |
Introduction and Themes |
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Overarching Themes |
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Mental Health and Mental Illness: A Public Health Approach |
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Mental Disorders are Disabling |
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Mental Health and Mental Illness: Points on a Continuum |
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Mind and Body are Inseparable |
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The Roots of Stigma |
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Separation of Treatment Systems |
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Public Attitudes About Mental Illness: 1950s to 1990s |
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Stigma and Seeking Help for Mental Disorders |
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Stigma and Paying for Mental Disorder Treatment |
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Reducing Stigma |
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The Science Base of the Report |
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Reliance on Scientific Evidence |
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Research Methods |
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Levels of Evidence |
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Overview of the Report’s Chapters |
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Chapter Conclusions |
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Chapter 2: The Fundamentals of Mental Health and Mental Illness |
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Chapter 3:
Children and Mental Health |
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Chapter 4:
Adults and Mental Health |
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Chapter
5: Older Adults and Mental Health |
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Chapter 6: Organization and Financing of Mental Health Services |
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Chapter 7: Confidentiality of Mental Health Information: Ethical, Legal, and
Policy Issues |
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Chapter 8: A Vision for the Future—Actions for Mental Health in the New
Millennium |
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Preparation of the Report |
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References |
| 2. |
The Fundamentals of Mental Health and Mental Illness |
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The Neuroscience of Mental Health |
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Complexity of the Brain I: Structural |
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Complexity of the Brain II: Neurochemical |
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Complexity of the Brain III: Plasticity |
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Imaging the Brain |
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Overview of Mental Illness |
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Manifestations of Mental Illness |
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Anxiety |
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Psychosis |
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Disturbance of mood |
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Disturbance of Cognition |
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Other Symptoms |
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Diagnosis of Mental Illness |
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Epidemiology of Mental Illness |
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Adults |
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Children and Adolescents |
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Older Adults |
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Future Directions for Epidemiology |
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Costs of Mental Illness |
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Overview
of Etiology |
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Biopsychosocial Model of Disease |
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Understanding Correlation, Causation, and Consequences |
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Biological Influences on Mental Health and Mental Illness |
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The Genetics of Behavior and Mental Illness |
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Infectious Influences |
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PANDAS |
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Psychosocial Influences on Mental Health and Mental Illness |
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Psychodynamic Theories |
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Behaviorism and Social Learning Theory |
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The Integrative Science of Mental Illness and Health |
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Overview of Development, Temperament, and Risk Factors |
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Physical Development |
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Theories of Psychological Development |
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Paiget: Cognitive Development Theory |
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Erik Erikson: Psychoanalytic Development Theory |
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John Bowlby: Attachment Theory of Development |
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Nature and Nurture: The Ultimate Synthesis |
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Overview of Prevention |
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Definitions of Prevention |
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Risk Factors and Protective Factors |
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Overview of Treatment |
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Introduction to Range of Treatments |
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Psychotherapy |
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Psychodynamic Therapy |
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Behavioral Therapy |
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Humanistic Therapy |
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Pharmacological Therapies |
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Mechanisms of Action |
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Complementary and Alternative Treatment |
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Issues in Treatment |
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Placebo Response |
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Benefits and Risks |
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Gap Between Efficacy and Effectiveness |
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Barriers to Seeking Help |
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Overview of Mental Health Services |
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Overall Patterns of Use |
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History of Mental Health Services |
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Overview of Cultural Diversity and Mental Health Services |
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Introduction to Cultural Diversity and Demographics |
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Coping Styles |
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Family and Community as Resources |
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Epidemiology and Utilization of Services |
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African Americans |
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Asian/Pacific Islanders |
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Hispanic Americans |
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Native Americans |
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Barriers to the Receipt of Treatment |
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Help-Seeking Behavior |
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Mistrust |
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Stigma |
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Cost |
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Clinician Bias |
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Improving Treatment for Minority Groups |
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Ethnopsychopharmacology |
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Minority-Oriented Services |
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Cultural Competence |
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Rural Mental Health Services |
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Overview of Consumer and Family Movements |
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Origins and Goals of Consumer Groups |
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Self-Help Groups |
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Accomplishments of Consumer Organizations |
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Family Advocacy |
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Overview of Recovery |
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Introduction and Definitions |
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Impact of the Recovery Concept |
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Conclusions |
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Mental Health and Mental Illness Across the Lifespan |
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References |
| 3. |
Children and Mental Health |
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Normal Development |
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Theories of Development |
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Development Viewed as a Series of Stages |
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Development Viewed as a Series of Stages |
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Behavioral Development |
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Social and Language Development |
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Parent-Child Relationships |
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Origins of Language |
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Relationships With Other Children |
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Temperament |
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Developmental Psychopathology |
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Current Developmental Theory Applied to Child Mental Health and Illness |
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Overview of Risk Factors and Prevention |
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Risk Factors |
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Biological Influences on Mental Disorders |
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Psychosocial Risk Factors |
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Family and Genetic Risk Factors |
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Effects of Parental Depression |
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Stressful Life Events |
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Childhood Maltreatment |
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Peer and Sibling Influences |
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Correlations and Interactions Among Risk Factors |
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Prevention |
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Project Head Start |
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Carolina Abecedarian Project |
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Infant Health and Development Program |
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Elmira Prenatal/Early Infancy Project |
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Primary Mental Health Project |
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Other Prevention Programs and Strategies |
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Overview of Mental Disorders in Children |
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General Categories of Mental Disorders of Children |
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Assessment and Diagnosis |
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Evaluation Process |
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Treatment Strategies |
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Psychotherapy |
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Psychopharmacology |
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Attention-Deficit/Hyperactivity Disorder |
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Prevalence |
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Causes |
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Treatment |
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Pharmacological Treatment |
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Psychostimulants |
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Dosing |
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Side Effects |
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Other Medications |
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Psychosocial Treatment |
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Behavioral Approaches |
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Cognitive-Behavioral Therapy |
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Psychoeducation |
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Multimodal Treatments |
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Treatment Controversies |
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Overprescription of Stimulants |
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Safety of Long-Term Stimulant Use |
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Depression and Suicide in Children and Adolescents |
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Conditions Associated With Depression |
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Prevalence |
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Major Depression |
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Dysthymic Disorder |
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Suicide |
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Course and Natural History |
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Causes |
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Family and Genetic Factors |
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Gender Differences |
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Biological Factors |
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Cognitive Factors |
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Risk Factors for Suicide and Suicidal Behavior |
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Consequences |
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Treatment |
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Depression |
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Psychosocial Interventions |
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Pharmacological Treatment |
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Bipolar Disorder |
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Pharmacological Treatment |
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Suicide |
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Psychotherapeutic Treatments |
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Psychopharmacological Treatments |
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Intervention After a Suicidal Death of a Relative, Friend, or
Acquaintance |
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Community-Based Suicide Prevention |
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Crisis Hotlines |
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Method Restriction |
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Media Counseling |
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Indirect Case-Finding Through Education |
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Direct Case-Finding |
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Aggressive Treatment of Mood Disorders |
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Air Force Suicide Prevention Program — A Community Approach |
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Other Mental Disorders in Children and Adolescents |
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Anxiety Disorders |
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Separation Anxiety Disorder |
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Generalized Anxiety Disorder |
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Social Phobia |
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Treatment of Anxiety |
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Obsessive-Compulsive Disorder |
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Autism |
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Treatment |
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Disruptive Disorders |
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Treatment |
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Substance Use Disorders in Adolescents |
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Eating Disorders |
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Services Interventions |
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Treatment Interventions |
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Outpatient Treatment |
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Partial Hospitalization/Day Treatment |
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Residential Treatment Centers |
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Inpatient Treatment |
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Newer Community-Based Interventions |
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Case Management |
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Team Approaches to Case Management |
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Home-Based Services |
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Family Preservation Programs Under the Child Welfare System |
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Multisystemic Therapy |
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Therapeutic Foster Care |
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Therapeutic Group Homes |
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Crisis Services |
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Service Delivery |
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Service Utilization |
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Utilization in Relation to Need |
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Early Termination of Treatment |
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Poverty and Utilization |
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Culture and Utilization |
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Service Systems and Financing |
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Private Sector |
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Public Sector |
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Children Served by the Public Sector |
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Managed Care in the Public Sector |
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Culturally Appropriate Social Support Services |
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Support and Assistance for Families |
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New Roles for Families in Systems of Care |
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Family Support |
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Family Support Groups |
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Practical Support |
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Integrated System Model |
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Effectiveness of Systems of Care |
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The Fort Bragg Study |
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The Stark County Study |
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Summary: Effectiveness of Systems of Care |
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Conclusions |
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References |
| 4. |
Adults and Mental Health |
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Chapter Overview |
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Mental Health in Adulthood |
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Personality Traits |
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Self-Esteem |
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Neuroticism |
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Avoidance |
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Impulsivity |
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Sociopathy |
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Stressful Life Events |
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Past Trauma and Child Sexual Abuse |
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Domestic Violence |
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Interventions for Stressful Life Events |
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Prevention of Mental Disorders |
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Anxiety Disorders |
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Types of Anxiety Disorders |
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Panic Attacks and Panic Disorder |
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Agoraphobia |
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Specific Phobias |
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Social Phobia |
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Generalized Anxiety Disorder |
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Obsessive-Compulsive Disorder |
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Acute and Post-Traumatic Stress Disorders |
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Etiology of Anxiety Disorders |
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Acute Stress Response |
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New Views About the Anatomical and Biochemical Basis of
Anxiety |
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Neurotransmitter Alterations |
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Psychological Views of Anxiety |
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Treatment of Anxiety Disorders |
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Counseling and Psychotherapy |
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Pharmacotherapy |
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Benzodiazepines |
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Antidepressants |
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Buspirone |
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Combinations of Psychotherapy and Pharmacotherapy |
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Mood Disorders |
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Complications and Comorbidities |
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Clinical Depression Versus Normal Sadness |
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Assessment: Diagnosis and Syndrome Severity |
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Major Depressive Disorder |
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Dysthymia |
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Bipolar Disorder |
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Cyclothymia |
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Differential Diagnosis |
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Etiology of Mood Disorders |
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Biologic Factors in Depression Monoamine Hypothesis |
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Evolving Views of Depression |
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Anxiety and Depression |
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Psychosocial and Genetic Factors in Depression |
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Stressful Life Events |
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Cognitive Factors |
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Temperament and Personality |
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Gender |
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Genetic Factors in Depression and Bipolar Disorder |
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Treatment of Mood Disorders |
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Stages of Therapy |
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Acute Phase Therapy |
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Continuation Phase Therapy |
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Maintenance Phase Therapies |
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Specific Treatments for Episodes of Depression and Mania |
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Treatment of Major Depressive Episodes |
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Pharmacotherapies |
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Alternate Pharmacotherapies |
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Augmentation Strategies |
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Psychotherapy and Counseling |
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Bipolar Depression |
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Pharmacotherapy, Psychosocial Therapy, and Multimodal Therapy |
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Preventing Relapse of Major Depressive Episodes |
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Treatment of Mania |
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Acute Phase Efficacy |
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Maintenance Treatment to Prevent Recurrences of Mania |
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Service Delivery for Mood Disorders |
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Schizophrenia |
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Overview |
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Cognitive Dysfunction |
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Functional Impairment |
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Cultural Variation |
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Prevalence |
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Prevalence of Comorbid Medical Illness |
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Course and Recovery |
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Gender and Age at Onset |
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Etiology of Schizophrenia |
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Interventions |
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Pharmacotherapy |
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Ethnopsychopharmacology |
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Psychosocial Treatments |
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Psychotherapy |
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Family Interventions |
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Psychosocial Rehabilitation and Skills Development |
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Coping and Self-Monitoring |
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Vocational Rehabilitation |
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Service Delivery |
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Case Management |
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Assertive Community Treatment |
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Psychosocial Rehabilitation Services |
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Inpatient Hospitalization and Community Alternatives for Crisis Care |
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Services for Substance Abuse and Severe Mental Illness |
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Other Services And Supports |
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Consumer Self-Help |
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Consumer-Operated Programs |
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Consumer Advocacy |
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Family Self-Help |
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Family Advocacy |
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Human Services |
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Housing |
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Income, Education, and Employment |
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Health Coverage |
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Integrating Service Systems |
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Conclusions |
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References |
| 5. |
Older Adults and Mental Health |
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Chapter Overview |
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Normal Life-Cycle Tasks |
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Cognitive Capacity With Aging |
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Change, Human Potential, and Creativity |
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Coping With Loss and Bereavement |
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Overview of Mental Disorders in Older Adults |
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Assessment and Diagnosis |
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Overview of Prevention |
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Primary Prevention |
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Prevention of Depression and Suicide |
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Treatment-Related Prevention |
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Prevention of Excess Disability |
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Prevention of Premature Institutionalization |
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Overview of Treatment |
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Pharmacological Treatment |
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Increased Risk of Side Effects |
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Polypharmacy |
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Treatment Compliance |
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Psychosocial Interventions |
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Gap Between Efficacy and Effectiveness |
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Depression in Older Adults |
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Diagnosis of Major and “Minor” Depression |
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Late-Onset Depression |
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Prevalence and Incidence |
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Barriers to Diagnosis and Treatment |
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Course |
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Interactions With Somatic Illness |
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Consequences of Depression |
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Cost |
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Etiology of Late-Onset Depression |
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Treatment of Depression in Older Adults |
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Pharmacological Treatment |
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Tricyclic Antidepressants |
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Selective Serotonin Reuptake Inhibitors and Other Newer Antidepressants |
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Multimodal Therapy |
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Course of Treatment |
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Electroconvulsive Therapy |
| |
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Psychosocial Treatment of Depression |
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Alzheimer’s Disease |
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Assessment and Diagnosis of Alzheimer’s Disease |
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Mild Cognitive Impairment |
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Behavioral Symptoms |
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Course |
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Prevalence and Incidence |
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Cost |
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Etiology of Alzheimer’s Disease |
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Biological Factors |
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Protective Factors |
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Histopathology |
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Role of Acetylcholine |
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Pharmacological Treatment of Alzheimer’s Disease |
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Acetylcholinesterase Inhibitors |
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Treatment of Behavioral Symptoms |
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Psychosocial Treatment of Alzheimer’s Disease Patients and Caregivers |
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Other Mental Disorders in Older Adults |
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Anxiety Disorders |
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Prevalence of Anxiety |
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Treatment of Anxiety |
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Schizophrenia in Late Life |
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Prevalence and Cost |
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Late-Onset Schizophrenia |
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Course and Recovery |
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Etiology of Late-Onset Schizophrenia |
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Treatment of Schizophrenia in Late Life |
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Alcohol and Substance Use Disorders in Older Adults |
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Epidemiology |
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Alcohol Abuse and Dependence |
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Misuse of Prescription and Over-the-Counter Medications |
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Illicit Drug Abuse and Dependence |
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Course |
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Treatment of Substance Abuse and Dependence |
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Service Delivery |
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Overview of Services |
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Service Settings and the New Landscape for Aging |
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Primary Care |
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Adult Day Centers and Other Community Care Settings |
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Nursing Homes |
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Services for Persons With Severe and Persistent Mental
Disorders |
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Financing Services for Older Adults |
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Increased Role of Managed Care |
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Carved-In Mental Health Services for Older Adults |
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Carved-Out Mental Health Services for Older Adults |
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Outcomes Under Managed Care |
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Other Services and Supports |
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Support and Self-Help Groups |
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Education and Health Promotion |
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Families and Caregivers |
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Communities and Social Services |
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Conclusions |
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References |
| 6. |
Organizing and Financing Mental Health Services |
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Overview of the Current Service System |
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The Structure of the U.S. Mental Health Service System |
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The Public and Private Sectors |
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Patterns of Use |
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Adults |
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Children and Adolescents |
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The Costs of Mental Illness |
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Indirect Costs |
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Direct Costs |
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Mental Health Spending |
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Spending by the Public and Private Sectors |
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|
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Trends in Spending |
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|
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Mental Health Compared With Total Health |
| |
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Financing and Managing Mental Health Care |
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|
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History of Financing and the Roots of Inequality |
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|
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Goals for Mental Health Insurance Coverage |
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|
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Patterns of Insurance Coverage for Mental Health Care |
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|
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Traditional Insurance and the Dynamics of Cost Containment |
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|
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Managed Care |
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|
|
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Major Types of Managed Care Plans |
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|
|
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The Ascent of Managed Care |
| |
|
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Dynamics of Cost Controls in Managed Care |
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|
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Managed Care Effects on Mental Health Services Access and Quality |
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|
|
Impact on Access to Services |
| |
|
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Impact on Quality of Care |
| |
|
Toward Parity in Coverage of Mental Health Care |
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|
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Benefit Restrictions and Parity |
| |
|
|
Legislative Trends Affecting Parity in Mental Health Insurance Coverage |
| |
|
Conclusions |
| |
|
Appendix 6-A: Quality and Consumers’ Rights |
| |
|
References |
| 7. |
Confidentiality of Mental Health Information |
| |
|
Chapter Overview |
| |
|
Ethical Issues About Confidentiality |
| |
|
Values Underlying Confidentiality |
| |
|
|
Reducing Stigma |
| |
|
|
Fostering Trust |
| |
|
|
Protecting Privacy |
| |
|
Research on Confidentiality and Mental Health Treatment |
| |
|
Current State of Confidentiality Law |
| |
|
|
Overview of State Confidentiality Laws |
| |
|
|
Exceptions to Confidentiality |
| |
|
|
|
Consent by the Person in Treatment |
| |
|
|
|
Disclosure to the Client |
| |
|
|
|
Disclosure to Other Providers |
| |
|
|
|
Disclosure to Payers |
| |
|
|
|
Disclosure of Information to Families |
| |
|
|
|
Oversight and Public Health Reporting |
| |
|
|
|
Research |
| |
|
|
|
Disclosure to Law Enforcement Agencies |
| |
|
|
|
Disclosure to Protect Third Parties |
| |
|
Federal Confidentiality Laws |
| |
|
Potential Problems With the Current Legal Framework |
| |
|
Summary |
| |
|
Conclusions |
| |
|
References |
| 8. |
A Vision for the Future |
| |
|
Continue To Build the Science Base |
| |
|
Overcome Stigma |
| |
|
Improve Public Awareness of Effective Treatment |
| |
|
Ensure the Supply of Mental Health Services and Providers |
| |
|
Ensure Delivery of State-of-the-Art Treatments |
| |
|
Tailor Treatment to Age, Gender, Race, and Culture |
| |
|
Facilitate Entry Into Treatment |
| |
|
Reduce Financial Barriers to Treatment |
| |
|
Conclusion |
| |
|
References |
| |
Post Test |
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