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Abuse is a complex psychosocial problem that affects large numbers of adults as well as children throughout the world.

It is listed in the Diagnostic and Statistic Manual of Mental Disorders (DSM-IV-TR) Collaboration with patients and families To win the collaboration of patients and their families, those providing care need to elicit, negotiate and agree on a definition of the problem they are working on with each patient. They must then agree on the targets and goals for management and develop an individualised collaborative self management plan. This plan should be based on established cognitive behavioural principles and on the evidence relating to the management of the chronic condition. In order to implement collaborative care, patients and their families require access to the necessary information and services to enable them to play a full and informed role. The need for collaborative care in which patients play an active role has been highlighted in Britain with the development of the concept of the expert patient. Encouraging self care Active self care is critical to the optimal management of chronic illness. Interventions to optimise self care are based on cognitive behavioural principles. They start with an assessment of patients attitudes and beliefs about their illness and their chosen coping behaviours. This assessment then guides the provision of information, the resolution of misunderstandings and misinterpretations, and collaborative goal setting. These are agreed between patient and members of the healthcare team. The outcome of this initial assessment takes historical factors, such as a person s prior attempts, remain a risk factor even decades later. Having a serious head injury or neurological disease also raise risks. Other factors, especially those that affect teens, will be discussed in other chapters. The important thing to remember is that there is help.side effects include fever, headache, anemia, allergic reactions, and liver damage. Interactions Patients should always tell their doctor and dentist when they are taking barbiturates. Barbiturates should generally not be taken with other drugs used to treat mental disorders. There are a number of drugs that barbiturates should not be combined with because the barbiturates may increase the metabolism of these drugs and thus, reduce the amount of these drugs available to be of benefit. These drugs include oral corticosteroids such as predisolone, methylprednisolone, prednisone, or dexamethasone, estrogen and oral contraceptives, blood-thinning medications such as warfarin (Coumadin), the antibiotic doxycycline (Vibramycin), and anticonvulsants such as phenytoin (Dilantin). Barbiturates should not be combined with alcohol because the combination produces additive depressant effects in the central nervous system. Barbiturates may lower the amount of absorption of the vitamins D and K. Resources BOOKS

Consumer Reports Staff. Consumer Reports Complete Drug Reference. 2002 ed. Denver: Micromedex Thomson Healthcare, 2001. Ellsworth, Allan J., and others. Mosby s Medical DrugAbuse is a complex psychosoci al problem that affects large numbers of adults as well as children throughout the world. It is listed in the Diagnostic and Statistic Manual of Mental Disorders (DSM-IV-TR) under the heading of Other Conditions That May Be a Focus of Clinical Attention. Although abuse was first defined with regard to children when it first received sustained attention in the 1950s, clinicians and researchers now recognize that adults can suffer abuse in a number of different circumstances. Abuse refers to harmful or injurious tlude not only the direct costs of immediate medical and psychiatric treatment of abused people but also the indirect costs of learning difficulties, interrupted education, workplace absenteeism, and long-term health problems of abuse survivors.