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To launch an application, double-click on the icon for the program. To move a folder or document, click on the icon, drag it to the destination (perhaps the desktop or another folder), and release the mouse button. To copy an item, do the same thing as in the move operation, but hold down the Option key. To delete items, click on them and drag them to the Trash.

The immediate goal of psychiatric evaluation is to assess the current suicidal risk and the need for hospitalization versus outpatient management The intent is less likely to be truly suicidal, for example, if small amounts of poison or drugs were ingested or scratching of wrists was superficial, if the act was performed in the vicinity of others or with early notification of others, or if the attempt was arranged so that early detection would be anticipated Alcohol, hopelessness, delusional thoughts, and complete or nearly complete loss of interest in life or ability to experience pleasure are all positively correlated with suicide attempts Other risk factors are previous attempts, a family history of suicide, medical or psychiatric illness (eg, anxiety, depression, psychosis), male sex, older age, contemplation of violent methods, a humiliating social stressor, and drug use (including long-term sedative or alcohol use), which contributes to impulsiveness or mood swings Successful treatment of the patient at risk for suicide cannot be achieved if the patient continues to abuse drugs The patient s current mood status is best evaluated by direct evaluation of plans and concerns about the future, personal reactions to the attempt, and thoughts about the reactions of others The patient s immediate resources should be assessed people who can be significantly involved (most important), family support, job situation, financial resources, etc If hospitalization is not indicated (eg, gestures, impulsive attempts; see above), the clinician must formulate and institute a treatment plan or make an adequate referral Medication should be dispensed in small amounts to at-risk patients Although TCAs and SSRIs are associated with an equal incidence of suicide attempts, the risk of successful suicide is higher with TCA overdose Guns and drugs should be removed from the patient s household Driving should be interdicted until the patient improves The problem is often worsened by the long-term complications of the suicide attempt, eg, brain damage due to hypoxia, peripheral neuropathies caused by staying for long periods in one position causing nerve compressions, and medical or surgical problems such as esophageal strictures and tendon dysfunctions The reasons for self-mutilation, most commonly wrist cutting (but also autocastration, autoamputation, and autoenucleation, which are associated with psychoses), may be very different from the reasons for a suicide attempt The initial treatment plan, however, should presume suicidal ideation, and conservative treatment should be initiated Sleep disturbances in the depressions are discussed below.

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Depression associated with reactive disorders usually does not call for drug therapy and can be managed by psychotherapy and the passage of time In severe cases particularly when vegetative signs are significant and symptoms have persisted for more than a few weeks antidepressant drug therapy is often effective Drug therapy is also suggested by a family history of major depression in first-degree relatives or a past history of prior episodes The antidepressant drugs may be conveniently classified into three groups: (1) the newer antidepressants, including the SSRIs and bupropion, venlafaxine, nefazodone, and mir-

Monitor acute treatment (every 1 2 weeks)

Assess response (week 6)1

Monitor treatment (every 1 2 weeks)

|

Assess response (week 12)1

of assessment (weeks 6 and 12) rest on very modest data It may be necessary to revise the treatment plan earlier for patients not responding at all

Figure 25 2 Overview of treatment for depression (Reproduced from Agency for Health Care Policy and Research: Depression in Primary Care Vol 2: Treatment of Major Depression United States Department of Health and Human Services, 1993)

At the most fundamental level, a C# application consists of source code. Source code is human-readable text written in a text editor. A text editor is like a word processor, but it puts no special characters into the file to support formatting, only the text. You could use any old text editor to write your code, but since you ll be using Visual Studio throughout this book, that s the best choice. Start up C# Express or Visual Studio. The first thing you ll see is the Start Page, which will look similar to Figure 1-2.

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