This review highlights for healthcare providers evidence and principles for practice, affecting women with the common mental health conditions, who want to avoid an unplanned pregnancy. Among the most prevalent and disabling chronic diseases affecting reproductive-aged women worldwide, depression and anxiety can contribute to adverse reproductive health outcomes, including an increased risk of unintended pregnancy and its health and social consequences. Effective contraception can be an important strategy to maintain and even improve mental health and well-being. Reproductive health clinicians play a critical role in providing and managing contraception to help women with mental health considerations achieve their desired fertility. This discussion reviews the literature on relationships between mental health and contraception and describes considerations for the clinical management of contraception among women with depression and anxiety. The issues related to contraceptive method effectiveness, adherence concerns, and mental health – specific contraceptive method safety and drug interaction considerations, clinical counseling and management strategies are also discussed. Given important gaps in current scientific knowledge of mental health and contraception, the Women’s Health and Education Center (WHEC) highlights areas for future research. Ultimately, mental health promotion may reduce adverse pregnancy-related outcomes, improve family-planning experiences, and help achieve reproductive goals for women, their families, and society.Read More

The purpose of this document is to begin to bridge the gap between clinicians' and patients' expectations of how psychosocial services should be used in response to distress screening. The Women's Health and Education Center (WHEC) supports professional organizations with the mission to improve survival and quality of life for cancer patients through standard-setting, prevention, research, education and the monitoring of comprehensive quality care. In 2014, the WHEC approved new standards to promote patient-centered care, an exciting shift driven by research over the past decade showing that patient-centered services improve outcomes. Patient-centered standards include the provision of treatment and survivorship plans, palliative care services, genetic services, navigation programs, and psychosocial distress screening. Given that the popularity of distress screening is increasing exponentially, and begins to bridge the gap between clinicians' and patients' expectations of how psychosocial services should be used in response to distress screening. Key findings and implications for service delivery were: 1) receptivity to referral is a separate issue from that of distress level, 2) strong preference among those who declined psycho-oncology referral to cope on their own emphasized the potential role of self-management interventions, and 3) low social support was a major theme among those accepting referral, suggesting that assessing family support might further contribute to identifying patients in need of additional psychological assessment. Additional studies are needed to further examine, on a large scale, patients' preferences for follow-up care after distress screening. Several different approaches to distress screening are discussed above, and additional studies should examine their comparative acceptability and efficacy.Read More

Dependence on opioids is associated with seri­ous morbidity and mortality, and advances in the understanding of the dependence have led to the development of effective treatments. A confusing aspect of the body of research on opi­ate abuse and dependence is the inconsistent use of important terminology that describes the nature and severity of involvement with therapeutic and illicit opiates. The purpose of this document is to provide the reader with a current, evidence-based overview of opiate abuse and dependence and its treatment. Topics covered in this review include the history and demographics of illicit and prescription opiate abuse; risk factors, background characteristics, and comorbid conditions of opiate abusers; the pharmacology of opiate drugs; the biological and behavioral characteristics of opiate dependence; and management of opiate dependence, including treatment of overdose, detoxification and with­drawal, agonist replacement therapy, and drug-free approaches. Additional areas of the course are devoted to the abuse liability of prescription opiates and the impact of abused opiates on the fetus.Read More

The admissions rates for treatment of methamphetamine-related disorders have ballooned alarmingly in some areas, particularly in rural or frontier areas, causing public health concerns. As a result, it is important that healthcare professionals have a solid knowledge of the effects and appropriate treatment of methamphetamine abuse and dependence. Various programs addressing substance abuse and methamphetamine abuse are also discussed. The Fellowship of Crystal Meth Anonymous works a Twelve Step program of recovery. Crystal Meth Anonymous is a fellowship of men and women who share their experience, strength and hope with each other, so they may solve their common problem and help others to recover from addiction to crystal meth. The only requirement for membership is a desire to stop using.Read More

Mind-altering substances all yield four basic types of disorders: Substance Dependence; Abuse; Intoxication, and Withdrawal. The etiology and pathophysiology of addictive behavior has been somewhat a mystery to the primary care physician. As such, patients with addiction issues are a particularly difficult group to treat in a coherent and comprehensive manner. The common pathways in reward circuitry that affect memory and learning, motivation, control, and decision making are also involved in the addictive process. It is hoped through these publications; the cycle of addiction can be better understood and managed. Citizens of this century have an ever-widening variety of mind-altering substances to use, but doing so still leads to a few basic sorts of problems with behavior, cognition, and physiological symptoms. These behaviors and alcohol abuse are discussed in this chapter.Read More

We experience illness on a physical level, but in order to be healed, we must understand where the true healing begins: with-in our hearts and minds. The purpose of this document is to explain methods to transform the minds of self-pity and anger, to work creatively with adversity, and to make our lives meaningful, no matter what state of health we are in. We hope this challenges us to open our hearts with compassion and wisdom. Spiritual cure is an understanding which allows us to begin to see illness and disease in a broader perspective. It directs the attention of mind to the special wisdom of cures that cause permanent healing to take place. Spiritual practices are not magical or miraculous but rather help a person to understand the real causes of health and happiness.Read More

Anxiety disorders are common in women, and cause substantial impairment in all spheres of functioning. Many effective treatment modalities offer hope and help to most sufferers and by asking specific questions to determine whether an anxiety disorder is a possibility, physicians will be able to make the appropriate diagnosis. Women are particularly vulnerable to such disorders, experiencing them twice as frequently as men. Situations related to gender, such as childbirth and domestic violence may increase the frequency of these problems. The purpose of this document is to outline a general framework for healthcare providers to diagnose and treat various types of anxiety disorders in women.Read More

Despite societal expectations that having a baby should be a completely joyful experience, many women are ambivalent about the birth experience. Some women are not prepared for the postpartum blues, nor are they aware of the risk of postpartum depression or psychosis. Women who unexpectedly develop postpartum blues may find her experiencing guilt, concern, or fear that having the baby was a mistake. These fears may worsen if the women's partner is not supportive and if there are no close relatives or friends to give emotional and physical assistance after delivery. The purpose of this document is to discuss the postpartum psychiatric disorders and to help primary care physicians to recognize and manage the emotional and psychiatric problems that can occur in the postpartum period.Read More

Crisis intervention provides a theory and treatment model that can be readily applied to helping patients with their psycho-social problems. Patients entering crisis treatment should expect that they will be treated immediately and recover from crisis. Patients can be treated while living in their natural environment, and should be able to return to normal life as soon as possible.  Mental health is a low priority in most countries around the world. Minimal research and resources have been invested in mental health at the national level. The document encourages mental health policy-makers to shift the responsibility to the primary care sector. Although professional training in mental health for primary care workers exists in many countries, it is not rigorously evaluated.Read More

It has been estimated that the prevalence of anorexia nervosa is 0.5% in high school and college-aged women and that 1% to 3% of young women meet criteria for the diagnosis of bulimia nervosa. In addition, many more women display evidence of milder forms of eating disorder behaviors. The first step in detecting the onset of an eating disorder is to be familiar with the diagnostic criteria for the major types of eating disorders, including: anorexia nervosa -- identified most simply by significant weight loss and a decrease in nutritional input; bulimia nervosa -- marked by binge and purge behavior with or without weight loss; and eating disorder not otherwise specified -- which is a category that includes patients with eating disorder behaviors and thoughts who do not meet all of the official criteria of anorexia nervosa or bulimia nervosa. Early detection and management of eating disorders are key factors in improving the course and outcome of the illness. The roles of the individual practitioner in the initial stages of management are to detect the presence of the eating disorder, to perform the initial evaluation, and to refer the patient to appropriate level of care. Coordination with the patient's family, primary care physician, nutritionist, and / or mental health provider is often necessary.Read More