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The Therapist s Guide to Psychopharmacology Working
with Patients Families and Physicians to Optimize Care
1st Edition Joellen Patterson Phd Digital Instant
Download
Author(s): JoEllen Patterson Phd, A. Ari Albala MD, Margaret E. McCahill
MD, Todd M. Edwards PhD LMFT
ISBN(s): 9781593853280, 1593853289
Edition: 1
File Details: PDF, 4.98 MB
Year: 2006
Language: english
 THE THERAPIST’S GUIDE
TO PSYCHOPHARMACOLOGY
 The Therapist’s Guide
to Psychopharmacology
WORKING WITH
PATIENTS, FAMILIES,
AND PHYSICIANS
TO OPTIMIZE CARE

JoEllen Patterson
A. Ari Albala
Margaret E. McCahill
Todd M. Edwards

THE GUILFORD PRESS

New York London
©2006 The Guilford Press
A Division of Guilford Publications, Inc.
72 Spring Street, New York, NY 10012
www.guilford.com

All rights reserved

No part of this book may be reproduced, translated, stored in a retrieval system, or

transmitted, in any form or by any means, electronic, mechanical, photocopying,
microfilming, recording, or otherwise, without written permission from the Pub-
lisher.
Printed in the United States of America
This book is printed on acid-free paper.

As with every work dealing with science, the contents of this book are subject
to evolving standards and advancements. Being apprised of such changes and
advancements is an important part of the informed consent to which patients
are entitled. In addition, any summary treatment of a subject so complicated
can omit details such as rare or newly discovered but unconfirmed contraindi-
cations. Because medications should only be administered according to the
most current guidelines available, practitioners are strongly reminded to con-
sult and review carefully the product information sheets that accompany each
drug administered, in light of the patient’s history.
The authors have checked with sources believed to be reliable in their efforts to
provide information that is complete and generally in accord with the stan-
dards of practice that are accepted at the time of publication. However, in view
of the possibility of human error or changes in medical sciences, neither the
authors, nor the editor and publisher, nor any other party who has been
involved in the preparation or publication of this work warrants that the infor-
mation contained herein is in every respect accurate or complete, and they are
not responsible for any errors or omissions or the results obtained from the use
of such information. Readers are encouraged to confirm the information con-
tained in this book with other sources.

Last digit is print number: 9 8 7 6 5 4 3 2 1

Library of Congress Cataloging-in-Publication Data

The therapist’s guide to psychopharmacology: working with patients, families, and
physicians to optimize care / JoEllen Patterson [et al.].
p. ; cm.
Includes bibliographical references and index.
ISBN-10: 1-59385-328-9 ISBN-13: 978-1-59385-328-0 (cloth: alk. paper)
1. Psychopharmacology. 2. Psychotropic drugs. 3. Psychotherapy.
I. Patterson, JoEllen.
[DNLM: 1. Mental Disorders-drug therapy. 2. Psychopharmacology-
methods. 3. Psychotropic Drugs-therapeutic use. 4. Referral and Consulta-
tion. WM 402 T3985 2006]
RC483.T454 2006
615′.78-dc22 2006021341
 For David.
For all that has been,
Thanks.
For all that shall be,
Yes.
(Dag Hammarskjold)
— J. E. P.

I dedicate this book to the memory of my parents,

Américo and Juanita, who showed me the love of learning;
to my wife, Barbara, who showed me the love of caring;
and to my children, Johanna, Keren, and David,
who every day show me what’s meaningful.
— A. A. A.

I dedicate this work to my wonderful children and their spouses;

my grandchildren, sister, brother, mother, and most especially
my dear husband. We are fortunate to have been blessed
with a deeply devoted and loving family, and I thank you all
for your work and commitment to keeping it that way.
—M. E. M.

I lovingly dedicate this book to my family, close and extended,

and especially to my wife, Kyle, and our children,
Grayson, Cole, and Quinn Edwards.
—T. M. E.
 About the Authors

JoEllen Patterson, PhD, is a Professor in the Marital and Family Ther-

apy Program at the University of San Diego. She is also an Associate
Clinical Professor of Family Medicine and Psychiatry at the Univer-
sity of California, San Diego School of Medicine. Besides receiving a
Rotary International Scholarship to work at Cambridge University, Dr.
Patterson has had two Fulbright Scholarships to work in Norway and
New Zealand. She serves on the editorial board for Family Systems and
Health and the Journal of Marital and Family Therapy. This is her third
book.

A. Ari Albala, MD, received his medical education at the University of

Chile and the University of Tel-Aviv, Israel, and completed a psychiatry
residency and a research fellowship at the University of Michigan. He is
currently Clinical Professor of Psychiatry at the University of California,
San Diego School of Medicine, Executive Medical Director at Paradise
Valley Hospital Behavioral Health Services, and Medical Director at Psy-
chiatric Centers at San Diego. Dr. Albala has received numerous distinc-
tions in his career as both an educator and practitioner, including a
Teaching Excellence Award from the University of California, San
Diego; an Education Award from the San Diego Psychiatric Society; and
the status of Distinguished Fellow of the American Psychiatric Associa-
tion.

vii
viii About the Authors

Margaret E. McCahill, MD, is a Health Sciences Clinical Professor of

Family Medicine and Psychiatry at the University of California, San
Diego (UCSD) School of Medicine. Dr. McCahill has practiced both
family medicine and psychiatry in the U.S. Public Health Service/Indian
Health Service, at a U.S. Naval Hospital, as a university faculty member,
and in a free clinic that serves the homeless. She is the Founding Director
of the UCSD Combined Family Medicine–Psychiatry Residency Training
Program and the Medical Director of St. Vincent de Paul Village in San
Diego, California. Dr. McCahill has received many teaching awards as a
teacher of resident physicians for more than 20 years, and she also pro-
vides classroom instruction and practicum supervision for mental health
care trainees in clinical social work, marital and family therapy, and clin-
ical psychology.

Todd M. Edwards, PhD, is an Associate Professor and Director of the

Marital and Family Therapy Program at the University of San Diego. He
is also a Voluntary Assistant Clinical Professor in the Department of
Family and Preventive Medicine at the University of California, San
Diego School of Medicine. Dr. Edwards received his doctorate in mar-
riage and family therapy from Virginia Tech and completed a medical
family therapy internship in the Department of Family Medicine at the
University of Rochester.
 Contents

Introduction 1

PART I. The Mind–Body Connection 11

CHAPTER 1. How the Brain Works 13

CHAPTER 2. How Psychotropic Drugs Work 23

PART II. Psychiatric Disorders and Their Treatment 29

CHAPTER 3. Mood Disorders 31

CHAPTER 4. Anxiety Disorders 79
CHAPTER 5. Schizophrenia and Other Psychoses 105
CHAPTER 6. Cognitive Disorders 128
CHAPTER 7. Alcoholism and Substance Abuse 144
CHAPTER 8. Special Populations and Situations 163

ix
x Contents

PART III. Creative Collaboration 207

CHAPTER 9. Focusing the Lens: The Referral Process 209

and Medication Evaluation
CHAPTER 10. Sharing Care: Building Successful 235
Collaborative Relationships
CHAPTER 11. Strengthening Bonds: Collaborating with the Family 248

APPENDIX A. How Drugs Are Developed 261

APPENDIX B. Future Trends 266

APPENDIX C. Professional Outreach 280

Glossary 283
References 291
Index 302
 Introduction

Several years ago, we were supervising student therapists working in

community clinics. During the students’ case presentations, they would
frequently mention, almost as an afterthought, that their patients were
taking medication X. Being therapists, we knew little about psychotropic
medication.1 It was not our domain, after all. Instead, we refocused the
discussion onto the “important” material—the topics we understood.
At that time, “important” material could include the patient’s diag-
nosis, family problems, stressors, previous mental health history, or ther-
apeutic relationships. As clinicians, however, we prided ourselves on not
being wedded to one particular model, theory, or treatment protocol. We
were open to almost all material, as long as it pertained to the patient’s
psychological or social experiences.
At the same time that we were ignoring information about psycho-
tropic medication usage or biological history, there were increasing ref-
erences to medications in daily life. Reading book reviews (notably
Listening to Prozac [Kramer, 1993]), having friends and family members
who began taking antidepressants, and having our own patients asking
about medication as a treatment option, we soon realized that psycho-
tropic medication was a burgeoning approach to treatment. And to stay
1
Terms in boldface type are included in the glossary at the end of the book.

1
2 Introduction

current, we had to gain a rudimentary knowledge about these medica-

tions and how they were used, as did our students (Patterson &
Magulac, 1994).

EMBRACING THE “BIO” IN BIOPSYCHOSOCIAL

While espousing the biopsychosocial model in our work as therapists in

medical settings, we did not have enough knowledge of human biology,
genetics, and neuroscience to consider our patients’ biological influences
and needs. Regardless of our knowledge or interest, neurobiological
research was creating a revolution by offering treatments for psychologi-
cal disorders that sometimes involved simply taking a pill every morn-
ing. These new treatments were less intrusive than traditional, weekly
psychotherapy, and they were frequently being delivered by primary care
physicians, not psychiatrists. In addition, new research suggested that
psychotherapy could affect biological systems such as the brain (Kandel,
1995, 1998, 2006). These combined research initiatives demonstrated
that cause and effect within the biopsychosocial model is a multidirec-
tional process.
The biopsychosocial model was originally created for physicians, to
help them have a more balanced view of patients’ needs. Engel (1980)
suggested that the biomedical model was flawed because it ignored the
patient’s context and even the patient him- or herself. Instead, Engel sug-
gested that the organized whole (the patient), as well as the component
parts (the patient’s brain, immune system, family, etc.), should be consid-
ered. According to systems theory, every unit is at the same time both a
whole and a part. Nothing exists in isolation. Thus, physicians must
take into account not only the patient’s physical body and the disease
but also the patient’s reported inner experiences (feelings, sensations,
memories) as well as his or her reported and observable behavior.
Similar to the physician’s myopic view, we as therapists were
equally short-sighted. We focused on our patients’ experiences and feel-
ings to the extent that we ignored their biological systems. Not acknowl-
edging or understanding the importance of these systems meant that we
ignored possible treatment options that targeted them—that is, we
failed to consider psychotropic medications. And by failing to consider
psychotropic medications in treatment, we were possibly failing our own
patients.
Realizing that our therapeutic knowledge had to expand if we were
going to truly follow a biopsychosocial model, we learned everything we
could about medications and started encouraging our students to do the
 Introduction 3

same. Textbooks for nonphysicians about psychotropic medications

were published (Beitman, Safer, Thase, Blinder, & Riba, 2003; Gitlin,
1996; Riba & Balon, 1999; Sammons & Schmidt, 2001). Courses about
neurobiology, medications, and genetics were added to mental health
training programs. A paradigm shift was occurring: the dissolving of
mind–body dualism.
However, this revolution in the academic mental health community
did not necessarily lead to better patient care. Although we could
explain the basic neurobiological mechanisms of medications, we could
not get our patients to keep taking them if their spouses did not like the
way the patients’ sex drive was affected, if the medications made the
patients gain weight, or if the medications were taken off an insurance
company’s reimbursed medications list. The books we collectively read
on combining psychotherapy and medications or simply educating
nonphysicians and patients about medications led us to believe that pro-
viding knowledge to mental health professionals would be enough to
create change. This assumption was not true. In addition, there was vir-
tually no communication between the prescribing physician—regardless
of his or her medical discipline—and the therapist. And family members,
who may be most affected by patients’ responses to medication, were
completely ignored. The impact of payors, employers, health care system
providers, and others was never mentioned along with the discussion of
the neuromechanisms of the medications. But these impediments were
the everyday challenges that we faced with our patients. Even if our
patients were open to the idea of medication, structural impediments,
especially the lack of communication between the prescribing physician
and the therapist, limited the medications’ effectiveness.
Engel (1980) had originally focused on the biological, psychologi-
cal, and social systems of his patients. But we were discovering that
other systems were also affecting the care we could offer. The organiza-
tional and financial structures of the health care systems, as well as the
divisions among the different mental health disciplines, meant that
patient care was often fragmented and uncoordinated.

THE COLLABORATIVE CARE MOVEMENT

At the same time that we were struggling with these issues, there was a
growing movement in health care that had as its goal the collaboration
of physicians and therapists in assessing, planning, and providing patient
care. A growing group of health professionals had been attempting to
repair both the fragmentation in health care services and the conceptual
4 Introduction

split between mind and body. In fact, there were already several organi-
zations and groups devoted to this model of care, especially in the
United States, Canada, the United Kingdom, and Australia.

Defining Collaborative Care

Collaborative care has many definitions. It does not refer to split care,
which usually implies that the physician treats the biological part of the
patient by prescribing medication, and the therapist does the rest.
Although split care may be attractive in terms of cost and ease for the
provider, it is inadequate care. Patients need their therapist and physi-
cian to communicate, particularly in the creation and maintenance of a
treatment plan.
Collaboration also differs from consultation. Consultation implies
an event rather than a process. It is possible that a psychiatrist, for
example, could conduct an evaluation and offer suggestions without
prescribing medication, which may negate the need for ongoing contact.
However, in most cases, the physician ideally becomes a treatment team
member, not simply a consultant who offers expert advice and disap-
pears.
One definition of collaboration is “the concurrent use of medical
and mental health services” (Roesler, Gavin, & Brenner, 1995). Al-
though this definition is absolutely correct, it obscures the diversity in
how collaborative treatment is delivered. Collaboration can include
phone calls, hallway discussions, exchanges of letters, participation by a
physician—primary care or otherwise—in part or all of a therapy ses-
sion, and meetings that involve all professionals, the patient, and his or
her family. Nor does this definition suggest the difficulty in practicing
collaboratively. Even with good intentions to “work together” and
“share care,” good collaboration is hard work.
Several excellent works on collaboration have been published
(Blount, 1998; Doherty & Baird, 1983; Seaburn, Lorenz, Gunn, Ga-
winski, & Mauksch, 1996). Doherty (1995) developed a model that
defines five levels of collaboration. The levels range from minimal col-
laboration, in which professionals work in different sites and rarely
communicate about a case, to close collaboration in a fully integrated
system, in which professionals from different disciplines practice in the
same site and hold team meetings regularly to discuss collaboration
issues. For most physicians and therapists, level 5 is more of a dream
than a reality. Because of the structure of health care today, most profes-
sionals probably practice at levels 1 or 2.
 Introduction 5

If levels 3 or 4 are not possible for therapists because of the location

of their practice, we advocate a model that is a modified version of level
2, which we call “close collaboration at a distance.” Such a model pro-
vides health care services that focus on coordinated assessment and
treatment by providers from different disciplines, so that all aspects
of the patient’s health—whether biological, psychological, spiritual, or
social—can be addressed. Successful collaborative care presumes shared
treatment planning and decision making by interdisciplinary teams.
Shared care over time and across disciplines results in comprehensive
care. Although the primary focus is on the integration of biomedical
problems and mental health problems, all variables related to the
patient’s quality of life are considered, most notably the patient’s family.
The importance of family in both treatment and the collaborative effort
is highlighted later in the text. Under the collaborative model, there are
regular interactions to discuss patients and an appreciation for each
other’s professional culture (Doherty, 1995).
Although lofty in its expectations, in practice this model provides
the best possible care for patients and their families. Sharing care also
decreases the isolation that therapists and physicians commonly experi-
ence, which can further complicate the work with complex patients.
Sharing responsibility for managing mental health crises, generating
fresh ideas, expressing frustration, and carrying the emotional burden of
serving these patients are only a few of the benefits that such care pro-
vides to the professional.

Collaborative Care: An Integrated Conceptualization

As clinicians, we were beginning to understand that a collaborative care
model addresses gaps and fragmentation in the health care delivery sys-
tem. It means that we do not have to know every fact about every system
that might affect the patient’s care. Instead of viewing ourselves as the
sole deliverers of treatment, we have become the purveyors of possibili-
ties in a system that extends beyond our own personal limitations, in
addition to offering the patient our clinical expertise.
All treatment options are equally plausible, regardless of whether
we can deliver the treatment ourselves. We might provide the treatment,
or we might serve as a conduit of information and resources so that our
patient can receive the best possible care. When psychotropic medica-
tions are used, we consider their impact beyond the patient’s biological
system. In a collaborative care model, it has become our job to under-
stand the impact that psychotropic medications could have on the
6 Introduction

patients and their families, at home or in their work environment, even

though as therapists we do not deliver the medication ourselves.

TRENDS IN MENTAL HEALTH CARE

We have also been reading about important trends in patient care such
as the following:

• The U.S. Surgeon General declared that ensuring that treatments

were available (minus problems of access) for patients with
depression was a more significant problem than developing more
efficacious treatment.
• There was a marked increase in the proportion of the population
who received outpatient treatment for mental health problems,
but this care was often provided by primary care physicians.
• There was greater involvement of physicians in patient mental
health care and greater use of psychotropic medications.
• Over one-half of all patients who were prescribed psychotropic
medications failed to complete the treatment course.
• With the exponential growth of the Internet, there was a dra-
matic increase in the use of self-help groups.
• Also, many patients used multiple venues to treat their mental
health problems—self-help groups, human services (school coun-
selors and ministers), primary care, and specialty mental health
services.
• In general, this care was uncoordinated (Kessler, Zhao, & Katz,
1999; Olfson et al., 2002).

It has become clear that training in collaborative care and the develop-
ment of supportive systems are essential initiatives if future patients are
going to receive optimal care. We have realized that we have to train our
students not only in traditional practice and technique but also in the
principles of collaborative care. We also have to play a part in building
support for collaborative care models within health care systems.

PREPARING THE NEXT GENERATION OF THERAPISTS

Despite our immersion in the collaborative care movement, we were

doing training as usual in our family therapy master’s program. That is,
we were training future therapists to work independently, using the tools
 Introduction 7

that we gave them, including theory and popular treatment techniques.

At best, working with other colleagues meant providing a referral for
some special treatment, such as psychological testing.
Eventually my colleagues and I realized that our training models
would no longer work. Using the ideals of the collaborative care move-
ment, we began creating new treatment goals. Believing that psycho-
tropic medication could be an essential treatment and that many of our
patients would be obtaining medication from their physicians, we con-
sidered what new knowledge future therapists (our students) would
need.
We began experimenting with collaborative care models of patient
care and thinking about how to train students in their use. The four of
us—two psychiatrists and two family therapists—began to share patient
care. That is, we began to provide joint clinical supervision to family
medicine residents and family therapy interns, and we began to teach
2
each other’s students.
This book is the result of our collective search for better ways to
care for patients with mental health problems. Its purpose is to provide
the information a non-MD therapist needs to know about psychotropic
medication and collaborative care. It is intended for nonprescribing cli-
nicians who work in mental health. We wrote it with two objectives in
mind: to give readers a basic sense of pharmacotherapy for various men-
tal health disorders, and, more important, to provide a conceptual
framework, a mind-set, and specific approaches for working in a collab-
orative care environment with medical professionals who do prescribe
psychotropics.
Many books about psychotropic medications have been written for
psychotherapists, and some recent books discuss split treatment models.
As clinicians we found that these books, although helpful, did not meet
our needs. We recognized that there are many effective treatments,
including combined therapy and medications. However, many of these
treatments never reach the people who need them most. We became
increasingly interested in the efficacy of the delivery of mental health ser-

2
For example, in a specific week, Dr. Albala and Dr. Patterson might exchange e-mails
about a shared patient, jointly conduct live supervision for family medicine residents who
are interviewing challenging patients; Dr. Albala might lecture to Dr. Patterson’s students
about basic antidepressant medication.
Dr. Edwards and Dr. McCahill might meet to talk about further developing treatment
protocols at the collaborative clinic they are developing and might engage in a problem-
solving session to figure out ways to help their homeless, indigent patients get access to
appropriate care, including medication.
8 Introduction

vices. What obstacles exist for the typical clinician and patient who seek
optimal treatment?
Our goal in this book is to provide basic scientific information
about psychotropic medications and, even more important, to offer
pragmatic advice on helping patients benefit from these medications.
Although there are many potential concerns, such as a family’s response
and insurance issues, we believe collaboration is the cornerstone of effi-
cacy.
There are many models of care in addition to the psychotherapist–
physician collaboration. For example, there is a movement to provide
psychologists with prescription-writing privileges. As reported by the
American Psychological Association (2002), New Mexico was the first
state to give psychologists prescription-writing privileges, followed by
Louisiana. Some psychiatrists suggest that it is cost-effective for the psy-
chiatrist to provide both medication and psychotherapy, thus eliminating
the need for a nonphysician provider. In addition, some patients do not
want therapy and simply seek medication from their primary care pro-
viders. Other patients would never consider medication and seek therapy
only. Finally, some people seek informal help only through Internet
searches or talking to a friend, member of the clergy, or human resources
employee.
This book does not focus on these other treatment modalities. It
simply focuses on a non-MD therapist and a physician working together
to care for their common patient. However, the non-MD therapist could
be a psychologist, a social worker, a marriage and family therapist, a
psychiatric nurse, or a counselor. When we refer to physicians, we could
mean a family physician, a psychiatrist, an internist, a pediatrician, or an
obstetrician–gynecologist. To simplify matters, we refer to “the thera-
pist” and “the physician” throughout this book. This book is primarily
intended for therapists who want to build collaborative relationships
and learn the biological information they need to communicate with
physicians.
In writing this book, we made a few assumptions:

1. We want this book to be theory-neutral. Each model and every

therapist makes unique contributions to the therapeutic process. You
might be an expert in cognitive-behavioral therapy, family systems the-
ory, interpersonal therapy, or another model; your expertise is a critical
component of healing. However, because we assume that you already
have expertise in some type of psychotherapy, that is not the focus of
this book.
 Introduction 9

2. Rather, we assume that you want to improve your collaborative

relationships with physicians. We suggest you can do this by knowing
more about psychotropic medications and how they work in the brain.
3. In addition to promoting more collaboration with physicians, we
also advocate for more family involvement in health care. We urge you
to think about not only your individual patient but also his or her fam-
ily. This need became strikingly clear to us when a seriously depressed
mother went to her primary care doctor because she “didn’t know what
else to do.” She had seen several mental health professionals during the
last year, yet none of their treatments had helped her. The physician
enlisted the aid of an on-site therapist, and they interviewed the patient
together. Fifteen minutes into the interview, it became clear that the
patient was a single mother of a 6-year-old and an 8-year-old. She tear-
fully reported that the 8-year-old had taken on all household responsibil-
ities: walking her younger brother to and from school, preparing all
meals, and doing all the shopping and other “parenting” responsibilities
that the mother could not do—given that she could not get out of bed
most days. The patient reported that she had never given this informa-
tion to any other health care professionals simply because none had
asked. Often, health care professionals are focused only on the individ-
ual patient who is present during the interview. As a result, they can miss
important information about other family members and the repercus-
sions of the problem throughout the entire family.
4. Some readers, particularly those already trained in neuroscience
and biological treatments, may find specific parts of this book too sim-
plistic. We have tried to write the book so that you can skip the parts
that are not helpful and turn instead to the sections that offer new infor-
mation. You may find the chapters on collaboration or the appendices
especially useful.
5. We assume that you are pressed for time, that the physicians you
work with are pressed for time, and that the payors (including employers
and insurance companies) want the patient to get better as quickly as
possible. The physicians you work with might have little knowledge or
interest in your contribution to the shared treatment—namely, the ther-
apy. They may even have little time or interest in working or communi-
cating with you. Although it is helpful if both professionals share a com-
mitment to collaborative care, it is not essential.
6. Biological treatments are changing at a rapid pace, and this book
can quickly become dated. Thus, we have tried to write in terms of gen-
eral ideas or principles. In general, we talk about classes of medications,
not specific drugs. In addition, we talk about the process of how drugs
10 Introduction

are created and tested. We know that you need to find your own meth-
ods of staying abreast of trends in psychopharmacology and collabora-
tive care. We hope this book serves as one foundation for the ongoing
process of learning about biology, neuroscience, psychotropic medica-
tions, and collaborative care.

We now narrow our focus to the information you need to effectively

collaborate with your medical colleagues. That information includes the
following:

• Basic neuroscience information on how the brain works and how

drugs affect the brain.
• The biomedical information that you need to understand about
psychotropic medications, one of the key treatments the physi-
cian might utilize. This is organized by specific disorders.
• An action plan for building collaboration: For example, we dis-
cuss what a therapist might consider when deciding to refer a
patient to a generalist physician or a psychiatrist. The basics ten-
ets of collaborative care are discussed (beyond collaborating
about the patient’s psychotropic medication). Whether you are
currently in a private practice or in a hospital-based interdisci-
plinary team, this section provides tools to enhance collabora-
tion.

We recognize that your professional experiences may be signifi-

cantly different from ours. But we surmise that you share some of our
frustrations as we try to provide excellent care in a rapidly changing
health care world. Your training may not have provided all of the tools
you need for optimal care, and you may be frustrated with the limits of
your work setting. We hope this book supplies some knowledge and
ways to help you overcome the limits you have faced in caring for your
patients.
Exploring the Variety of Random
Documents with Different Content
 Geography - Formula Sheet
Third 2021 - Center

Prepared by: Teaching Assistant Davis

Date: July 28, 2025

Chapter 1: Current trends and future directions

Learning Objective 1: Learning outcomes and objectives
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 2: Current trends and future directions
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Learning Objective 3: Problem-solving strategies and techniques
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 4: Assessment criteria and rubrics
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Learning Objective 5: Assessment criteria and rubrics
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice Problem 5: Statistical analysis and interpretation
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Definition: Fundamental concepts and principles
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Best practices and recommendations
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 8: Problem-solving strategies and techniques
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Study tips and learning strategies
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Exercise 2: Theoretical framework and methodology
Note: Current trends and future directions
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Learning outcomes and objectives
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 12: Learning outcomes and objectives
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 13: Diagram/Chart/Graph]
Definition: Historical development and evolution
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Assessment criteria and rubrics
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 15: Diagram/Chart/Graph]
Example 15: Literature review and discussion
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Study tips and learning strategies
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 17: Diagram/Chart/Graph]
Important: Fundamental concepts and principles
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 18: Diagram/Chart/Graph]
Remember: Statistical analysis and interpretation
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Research findings and conclusions
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Abstract 3: Experimental procedures and results
Example 20: Fundamental concepts and principles
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Remember: Experimental procedures and results
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Fundamental concepts and principles
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Learning outcomes and objectives
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Learning outcomes and objectives
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice Problem 25: Best practices and recommendations
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Historical development and evolution
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Current trends and future directions
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 28: Practical applications and examples
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 29: Fundamental concepts and principles
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Part 4: Study tips and learning strategies
Note: Assessment criteria and rubrics
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Critical analysis and evaluation
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice Problem 32: Fundamental concepts and principles
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Key Concept: Assessment criteria and rubrics
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Research findings and conclusions
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 35: Fundamental concepts and principles
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 36: Diagram/Chart/Graph]
Remember: Comparative analysis and synthesis
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Example 37: Literature review and discussion
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Literature review and discussion
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Study tips and learning strategies
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
[Figure 40: Diagram/Chart/Graph]
Chapter 5: Theoretical framework and methodology
Practice Problem 40: Study tips and learning strategies
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 41: Diagram/Chart/Graph]
Note: Case studies and real-world applications
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Study tips and learning strategies
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Statistical analysis and interpretation
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 44: Diagram/Chart/Graph]
Note: Best practices and recommendations
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Critical analysis and evaluation
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 46: Ethical considerations and implications
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Note: Research findings and conclusions
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 48: Critical analysis and evaluation
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Practice Problem 49: Assessment criteria and rubrics
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
[Figure 50: Diagram/Chart/Graph]
Introduction 6: Key terms and definitions
Important: Interdisciplinary approaches
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Ethical considerations and implications
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 52: Diagram/Chart/Graph]
Note: Ethical considerations and implications
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 53: Diagram/Chart/Graph]
Practice Problem 53: Critical analysis and evaluation
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
[Figure 54: Diagram/Chart/Graph]
Key Concept: Theoretical framework and methodology
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Statistical analysis and interpretation
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 56: Diagram/Chart/Graph]
Key Concept: Problem-solving strategies and techniques
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Experimental procedures and results
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 58: Literature review and discussion
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 59: Current trends and future directions
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Section 7: Comparative analysis and synthesis
Remember: Comparative analysis and synthesis
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Study tips and learning strategies
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Comparative analysis and synthesis
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 63: Diagram/Chart/Graph]
Example 63: Experimental procedures and results
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 64: Diagram/Chart/Graph]
Practice Problem 64: Fundamental concepts and principles
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Learning outcomes and objectives
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 66: Diagram/Chart/Graph]
Remember: Interdisciplinary approaches
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Key terms and definitions
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Learning outcomes and objectives
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Assessment criteria and rubrics
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 70: Diagram/Chart/Graph]
Quiz 8: Key terms and definitions
Practice Problem 70: Case studies and real-world applications
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 71: Diagram/Chart/Graph]
Practice Problem 71: Assessment criteria and rubrics
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Definition: Practical applications and examples
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 73: Diagram/Chart/Graph]
Note: Study tips and learning strategies
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 74: Critical analysis and evaluation
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 75: Diagram/Chart/Graph]
Practice Problem 75: Current trends and future directions
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 76: Diagram/Chart/Graph]
Practice Problem 76: Best practices and recommendations
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Literature review and discussion
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Fundamental concepts and principles
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Key terms and definitions
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 80: Diagram/Chart/Graph]
Lesson 9: Theoretical framework and methodology
Note: Theoretical framework and methodology
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Literature review and discussion
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 82: Research findings and conclusions
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 83: Case studies and real-world applications
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 84: Diagram/Chart/Graph]
Example 84: Learning outcomes and objectives
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 85: Diagram/Chart/Graph]
Note: Study tips and learning strategies
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Ethical considerations and implications
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 87: Theoretical framework and methodology
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Current trends and future directions
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Study tips and learning strategies
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Methodology 10: Comparative analysis and synthesis
Remember: Historical development and evolution
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Critical analysis and evaluation
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Theoretical framework and methodology
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Historical development and evolution
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 94: Diagram/Chart/Graph]
Important: Theoretical framework and methodology
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Comparative analysis and synthesis
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Comparative analysis and synthesis
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 97: Theoretical framework and methodology
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 98: Diagram/Chart/Graph]
Note: Critical analysis and evaluation
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Fundamental concepts and principles
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Topic 11: Literature review and discussion
Definition: Theoretical framework and methodology
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Key terms and definitions
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 102: Diagram/Chart/Graph]
Remember: Experimental procedures and results
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 103: Diagram/Chart/Graph]
Note: Theoretical framework and methodology
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
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