Essentials Of Psychiatry In Primary Care Behavioral Health In The Medical Setting

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Essentials of Psychiatry in Primary Care: Behavioral Health in the Medical Setting

Author : Robert C Smith
Publisher : McGraw Hill Professional
ISBN 13 : 1260116786
Total Pages : pages
Book Rating : 4.2/5 (61 download)

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Book Synopsis Essentials of Psychiatry in Primary Care: Behavioral Health in the Medical Setting by : Robert C Smith

Download or read book Essentials of Psychiatry in Primary Care: Behavioral Health in the Medical Setting written by Robert C Smith and published by McGraw Hill Professional. This book was released on 2019-07-22 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: An innovative psychiatry textbook that presents behavioral disorders from the perspective of what is seen in medical settings The goal of Essentials of Psychiatry in Primary Care is not to make psychiatrists out of medical clinicians, but rather, to help clinicians manage common behavioral conditions that most often present in a medical setting. Essentials of Psychiatry in Primary Care seeks to integrate medicine and psychiatry --- as the authors’ systems-based biopsychosocial model proposes. The book identifies physical symptoms as a common mode of presentation of mental health problems and describes how to integrate them with psychological symptoms to make diagnoses of mental disorders. Essentials of Psychiatry in Primary Care also details a behaviorally defined, evidence-based mental healthcare model that can be effectively used in a medical setting. The combined experiences in primary care of the authors --- who specialize in both general internal medicine and psychiatry --- provide the perfect background for a book of this nature. Having trained medical students, as well as internal and family medicine residents since 1986, their experience and research demonstrates the information they outline is effective and associated with improved mental and physical health outcomes. This is an invaluable reference for primary care physicians and clinicians.

Psychiatric and Mental Health Essentials in Primary Care

Author : Lee Ann Hoff
Publisher : Routledge
ISBN 13 : 1136890122
Total Pages : 304 pages
Book Rating : 4.1/5 (368 download)

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Book Synopsis Psychiatric and Mental Health Essentials in Primary Care by : Lee Ann Hoff

Download or read book Psychiatric and Mental Health Essentials in Primary Care written by Lee Ann Hoff and published by Routledge. This book was released on 2010-11-05 with total page 304 pages. Available in PDF, EPUB and Kindle. Book excerpt: Psychiatric and Mental Health Essentials in Primary Care addresses key mental health concepts and strategies for time-pressured practitioners in various healthcare settings serving diverse populations. It offers theoretically sound and succinct guidelines for compassionate, efficient, and effective service to people in emotional and physical pain and distress, capturing the essentials of mental health care delivered by primary care providers. The text provides a theoretical overview, discussing mental health assessment, crisis care basics, alternative therapies, and vulnerable groups such as children, adolescents and older people. It includes chapters that focus on the following topics in Primary Care Practice: Suicide and Violence Anxiety Mood disorders Schizophrenia Substance Abuse Chronic illness and mental health. This invaluable text is designed for primary care providers in either graduate student or practice roles across a range of primary care practice, including nurse practitioners and physician assistants.

Psychiatry for Primary Care Physicians

Author : Larry S. Goldman
Publisher : American Medical Association Press
ISBN 13 :
Total Pages : 512 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Psychiatry for Primary Care Physicians by : Larry S. Goldman

Download or read book Psychiatry for Primary Care Physicians written by Larry S. Goldman and published by American Medical Association Press. This book was released on 2004 with total page 512 pages. Available in PDF, EPUB and Kindle. Book excerpt: Guide helps primary care physicians treat the whole patient. As the main point of contact between patients and the medical system, primary care physicians represent the first line of defense in recognizing patients' mental health problems. But while an estimated 25 percent of primary care patients suffer from significant mental disorders, most primary care physicians are not prepared to deal with these types of problems. Psychiatry for Primary Care Physicians, Second Edition, provides a practical resource to integrate essential psychiatric care into the clinical primary care setting. This easy-to-use guide addresses the most common adult mental health problems in primary care, covering assessment, diagnosis, treatment, and prevention of psychiatric conditions. Logically organized by condition, each chapter is co-written by a psychiatrist and a practicing primary care physician so you get a specialist's knowledge tailored to your actual practice climate. Filled with tables, case studies, and checklists, most chapters cover relevant epidemiology, differential diagnosis, and referral issues. Special sections also explain various diagnostic models and screening tools. Building on the strengths that made the first edition a Brandon/Hill selection and one of DPI's "250 Best Books of the Year," Psychiatry for Primary Care Physicians, Second Edition, has added new chapters on psychological frameworks, development, emergencies in psychiatry, childhood disorders, women's health disorders, geropsychiatry, and resources in psychiatric care. This revised and updated second edition responds to the heightened awareness of the number of significant psychiatric conditions seen in primary care settings and the additional pressure on the primary care practitioner (PCP) to assess and manage them. Chapters cover relevant epidemiology, differential diagnosis, management strategies to be employed by the PCP, and specific criteria for patient refe

Caring for People with Mental Health and Substance Use Disorders in Primary Care Settings

Author : National Academies of Sciences, Engineering, and Medicine
Publisher : National Academies Press
ISBN 13 : 0309682681
Total Pages : 123 pages
Book Rating : 4.3/5 (96 download)

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Book Synopsis Caring for People with Mental Health and Substance Use Disorders in Primary Care Settings by : National Academies of Sciences, Engineering, and Medicine

Download or read book Caring for People with Mental Health and Substance Use Disorders in Primary Care Settings written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2021-01-30 with total page 123 pages. Available in PDF, EPUB and Kindle. Book excerpt: Behavioral health conditions, which include mental health and substance use disorders, affect approximately 20 percent of Americans. Of those with a substance use disorder, approximately 60 percent also have a mental health disorder. As many as 80 percent of patients with behavioral health conditions seek treatment in emergency rooms and primary care clinics, and between 60 and 70 percent of them are discharged without receiving behavioral health care services. More than two-thirds of primary care providers report that they are unable to connect patients with behavioral health providers because of a shortage of mental health providers and health insurance barriers. Part of the explanation for the lack of access to care lies in a historical legacy of discrimination and stigma that makes people reluctant to seek help and also led to segregated and inhumane services for those facing mental health and substance use disorders. In an effort to understanding the challenges and opportunities of providing essential components of care for people with mental health and substance use disorders in primary care settings, the National Academies of Sciences, Engineering, and Medicine's Forum on Mental Health and Substance Use Disorders convened three webinars held on June 3, July 29, and August 26, 2020. The webinars addressed efforts to define essential components of care for people with mental health and substance use disorders in the primary care setting for depression, alcohol use disorders, and opioid use disorders; opportunities to build the health care workforce and delivery models that incorporate those essential components of care; and financial incentives and payment structures to support the implementation of those care models, including value-based payment strategies and practice-level incentives. This publication summarizes the presentations and discussion of the webinars.

Psychiatry Essentials for Primary Care

Author :
Publisher : ACP Press
ISBN 13 : 1934465798
Total Pages : 290 pages
Book Rating : 4.9/5 (344 download)

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Book Synopsis Psychiatry Essentials for Primary Care by :

Download or read book Psychiatry Essentials for Primary Care written by and published by ACP Press. This book was released on with total page 290 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Integrated Behavioral Health in Primary Care

Author : Mary R. Talen
Publisher : Springer Science & Business Media
ISBN 13 : 1461468892
Total Pages : 354 pages
Book Rating : 4.4/5 (614 download)

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Book Synopsis Integrated Behavioral Health in Primary Care by : Mary R. Talen

Download or read book Integrated Behavioral Health in Primary Care written by Mary R. Talen and published by Springer Science & Business Media. This book was released on 2013-06-04 with total page 354 pages. Available in PDF, EPUB and Kindle. Book excerpt: Contributed by experts who’ve developed integrative healthcare initiatives with strengths in the areas of policy and principles, organizational systems, or clinical practice. These contributors will illustrate the concepts and describe the nuts and bolts of their integration initiatives. In the conclusion of each section, the editors will construct a template to systematically evaluate these essential elements. This template will organize the information to help stakeholders compare and contrast the strengths, resources, limitations and challenges of how each model meets the vision of integrative healthcare. In the concluding section the information in the preceding sections connects to provide a coherent synopsis of the common themes and practices, from the macro to micro levels of care, which foster successful integration of the medical and psychosocial systems.

Mental Disorders in Primary Care

Author : Andre F. Carvalho
Publisher : Oxford University Press
ISBN 13 : 0198746636
Total Pages : 385 pages
Book Rating : 4.1/5 (987 download)

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Book Synopsis Mental Disorders in Primary Care by : Andre F. Carvalho

Download or read book Mental Disorders in Primary Care written by Andre F. Carvalho and published by Oxford University Press. This book was released on 2017 with total page 385 pages. Available in PDF, EPUB and Kindle. Book excerpt: An invaluable guide to psychiatric presentation, diagnosis and treatment in a primary care setting.

Child and Adolescent Behavioral Health

Author : Edilma L. Yearwood
Publisher : John Wiley & Sons
ISBN 13 : 0813807867
Total Pages : 593 pages
Book Rating : 4.8/5 (138 download)

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Book Synopsis Child and Adolescent Behavioral Health by : Edilma L. Yearwood

Download or read book Child and Adolescent Behavioral Health written by Edilma L. Yearwood and published by John Wiley & Sons. This book was released on 2012-04-24 with total page 593 pages. Available in PDF, EPUB and Kindle. Book excerpt: As an increasing number of children and adolescents with psychiatric symptoms go unrecognized in our current healthcare system, the ability to identify and treat these issues in multiple healthcare settings has become vitally important. With access to primary care providers increasing and a shortage of child psychiatric providers, collaboration between psychiatric, pediatric and family advanced practice nurses is essential to improving care for this vulnerable population. Child and Adolescent Behavioral Health provides a practical reference to aid in this endeavour. Written and reviewed by over 70 nurse experts, it is a must-have reference for all practitioners caring for children and adolescents.

Primary Care Psychiatry

Author : Robert McCarron
Publisher : Lippincott Williams & Wilkins
ISBN 13 : 1496349229
Total Pages : 440 pages
Book Rating : 4.4/5 (963 download)

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Book Synopsis Primary Care Psychiatry by : Robert McCarron

Download or read book Primary Care Psychiatry written by Robert McCarron and published by Lippincott Williams & Wilkins. This book was released on 2018-10-12 with total page 440 pages. Available in PDF, EPUB and Kindle. Book excerpt: Publisher's Note: Products purchased from 3rd Party sellers are not guaranteed by the Publisher for quality, authenticity, or access to any online entitlements included with the product. Perfect for primary care physicians, nurse practitioners, and PAs, who are routinely confronted with behavioral health disorders among patients in a primary care setting, the second edition of this unique multimedia handbook—now affiliated with the Association of Medicine and Psychiatry—sits at the intersection of primary care and psychiatry. You’ll find much that is new: updated fundamentals on depression, anxiety, psychosis, substance, and eating disorders, as well as overviews on CBT, motivational therapy, and common pharmacological therapies. With contributors from the worlds of both psychiatry and primary care, you have a perfect package on how to integrate the two in order to deliver better mental health care for your patients.

Integrating Behavioral Health and Primary Care

Author : Robert E. Feinstein
Publisher : Oxford University Press
ISBN 13 : 0190276207
Total Pages : 593 pages
Book Rating : 4.1/5 (92 download)

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Book Synopsis Integrating Behavioral Health and Primary Care by : Robert E. Feinstein

Download or read book Integrating Behavioral Health and Primary Care written by Robert E. Feinstein and published by Oxford University Press. This book was released on 2017 with total page 593 pages. Available in PDF, EPUB and Kindle. Book excerpt: Integrated care incorporates behavioral and physical health services into primary care and specialty medical environments. Integrated care models are patient-centered; delivered by teams of medical professionals, utilize care coordination, and a population-based approach. This book is practical, office-based, and comfortably accessible to students, residents, faculty, and all mental health professionals, primary care and medical specialists. We examine and recommend applying collaborative care and other existing models of integrated care based on existing literature. When there is no literature supporting a specific approach, our experts offer their ideas and take an aspirational approach about how to manage and treat specific behavioral disorder or problems We assume the use of integrated team staffing including a primary care or specialist provider(s), front desk staff, medical assistant(s), nurse(s), nurse practitioners, behavioral health specialist(s), health coaches, consulting psychiatrist, and care coordinator(s)/manager(s).

Behavioral Medicine in Primary Care

Author : Mitchell D. Feldman
Publisher : McGraw-Hill/Appleton & Lange
ISBN 13 :
Total Pages : 414 pages
Book Rating : 4.3/5 (91 download)

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Book Synopsis Behavioral Medicine in Primary Care by : Mitchell D. Feldman

Download or read book Behavioral Medicine in Primary Care written by Mitchell D. Feldman and published by McGraw-Hill/Appleton & Lange. This book was released on 2003 with total page 414 pages. Available in PDF, EPUB and Kindle. Book excerpt: Use a Behavioral Medicine Approach to Improve Clinical Outcome "All primary care physicians, their residents, and students would benefit from the central message of this book: medical practice occurs in the context of the physician-patient relationship, and only by understanding, managing, and using that relationship in an ethical, supportive, and effective fashion can primary care practice be conducted appropriately. -- Journal of General Internal Medicine * "Cohesively edited...bolstered by clinical vignettes...well positioned as an introduction for the physician-teacher and physician-in-training to the demands of the expanding role of physician as therapist....[Other texts] are not directed at the physician-in-training, are not case based, and are not as useful as a quick reference." -- Annals of Internal Medicine * "An excellent resource...Our family practice residency program has recently adopted this text as the primary resource for our behavioral science curriculum and provides each resident with a copy. It would be similarly useful for internists, nurse practitioners, and other primary care practitioners in training...Primary care health psychologists, medical school faculty, and others needing a compact and useful reference in this area will find this book highly valuable." -- Annals of Behavioral Science & Medical Education * "Doctors Feldman and Christensen have done primary care practice a good and important service with the publication of their book. It remains for clinicians and teachers to open their minds and practices to the ideas within it." -- From the Foreword, by Steven A. Schroeder, MD * Of the first edition. Authored bynationally recognized experts, this outstanding reference offers essential behavioral insights and practical management strategies that will help clinicians and students build a strong relationship with their patients and ensure that they provide the best possible treatment for medical and psychiatric disorders. No other resource so effectively examines how behavior - from the standpoint of the clinician as well as the patient - affects treatment decisions and results. Features and Topics Covered: *New chapter on "Complementary & Alternative Medicine" *All chapters substantially revised and updated *Up-to-date information on psychopharmacologic treatment of psychiatric illnesses *Greater emphasis on evidence-based medicine *Practical approach to behavior change *Mental disorders as they commonly occur in medical practice *Issues in the relationship between provider and patient *Adherence to medical treatment *Care of the dying *Dealing with medical errors *Physician well-being *Clinical vignettes *Updated references and web resources

Integrated Care in Psychiatry

Author : Paul Summergrad
Publisher : Springer Science & Business
ISBN 13 : 1493906887
Total Pages : 235 pages
Book Rating : 4.4/5 (939 download)

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Book Synopsis Integrated Care in Psychiatry by : Paul Summergrad

Download or read book Integrated Care in Psychiatry written by Paul Summergrad and published by Springer Science & Business. This book was released on 2014-04-26 with total page 235 pages. Available in PDF, EPUB and Kindle. Book excerpt: Integrated Care in Psychiatry: Redefining the Role of Mental Health Professionals in the Medical Setting is a landmark title in the field, offering a clear, detailed, and cohesive call by leading experts for coordinated care for patients with concurrent psychiatric and medical conditions. The renowned editors and authors argue that what is slowly occurring, and greatly needed at a faster pace, is nothing less than a sea change in the way that psychiatric care will be delivered. The current, mostly segregated, medical and psychiatric model of care has led to the development of competing medical and psychiatric subcultures that have resulted in a lack of dialog among health providers, administrators, and payers – and thus in less than optimal patient outcomes. To remedy this problem, the book offers a practical, insightful road map to achieving the central tenet of health reform – truly coordinated, patient-centered care where the care experience for the patient, the medical care itself, and the cost outcomes improve as the system changes from fee-for-service to population-based health. An invaluable reference for all clinicians, policy makers, payers, administrators, and others interested in the debate surrounding healthcare systems, Integrated Care in Psychiatry: Redefining the Role of Mental Health Professionals in the Medical Setting is a major contribution to the literature and a gold standard resource.

Anxiety and Depression in Primary Care

Author : Sherina Mohd Sidik
Publisher : CRC Press
ISBN 13 : 1003809901
Total Pages : 204 pages
Book Rating : 4.0/5 (38 download)

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Book Synopsis Anxiety and Depression in Primary Care by : Sherina Mohd Sidik

Download or read book Anxiety and Depression in Primary Care written by Sherina Mohd Sidik and published by CRC Press. This book was released on 2024-01-02 with total page 204 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides practical information about depression and anxiety in primary care, with a focus on the approach in different countries and incorporating global ranges/prevalence, risk factors and health burden including that associated with COVID-19 and its pandemic. To ensure the challenges of a wide international primary care community are reflected fully, authors from different world regions – Africa, Asia Pacific, East Mediterranean, Europe, IberoAmericana-CIMF, North America and South Asia – have co-contributed to individual chapters on the detection and management of depression and anxiety in primary care in their own countries, including the screening tools used, how widely these tools are adopted and by whom, and current policies. As well as the medical model, it also presents the alternative viewpoint that feeling low or anxious is part of the human condition and the attention should be on supporting people in their journey through life, struggling to deal with the mainly social challenges they meet, rather than defining these problems as disorders or diseases requiring identification and treatment. Key Features: Explores the instruments used for the detection of depression and anxiety in primary care in various countries, and why and how these instruments are being used Describes the pharmaceutical and non-drug interventions for treating depression and anxiety in primary care and compares the similarities and differences in detecting and managing depression and anxiety in primary care among different countries Includes in-depth regional examples of how screening tools are used in practice and how policies can be established in the management of depression and anxiety in primary care Concludes with lessons learned from various countries and from different stakeholders with clear advice on what to do and, importantly, what not to do Addressing primary care detection and management of mental health issues across the globe, the book will be an invaluable practical aid for family medicine practitioners and the wider primary and community care teams and a useful reference for those involved in policy setting at regional and national levels including ministries of health.

The Primary Care Toolkit

Author : Larry James
Publisher : Springer Science & Business Media
ISBN 13 : 0387789715
Total Pages : 331 pages
Book Rating : 4.3/5 (877 download)

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Book Synopsis The Primary Care Toolkit by : Larry James

Download or read book The Primary Care Toolkit written by Larry James and published by Springer Science & Business Media. This book was released on 2008-12-16 with total page 331 pages. Available in PDF, EPUB and Kindle. Book excerpt: Integrated care is receiving a lot of attention from clinicians, administrators, policy makers, and researchers. Given the current healthcare crises in the United States, where costs, quality, and access to care are of particular concern, many are looking for new and better ways of delivering behavioral health services. Integrating behavioral health into primary care medical settings has been shown to: (1) produce healthier patients; (2) produce medical savings; (3) produce higher patient satisfaction; (4) leverage the primary care physician’s time so that they can be more productive; and (5) increase physician satisfaction. For these reasons this is an emerging paradigm with a lot of interest and momentum. For example, the President’s New Freedom Commission on Mental Health has recently endorsed redesigning the mental health system so that much of this is integrated into primary care medicine.

Behavioral Consultation and Primary Care

Author : Patricia J. Robinson
Publisher : Springer
ISBN 13 : 3319139541
Total Pages : 347 pages
Book Rating : 4.3/5 (191 download)

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Book Synopsis Behavioral Consultation and Primary Care by : Patricia J. Robinson

Download or read book Behavioral Consultation and Primary Care written by Patricia J. Robinson and published by Springer. This book was released on 2015-10-20 with total page 347 pages. Available in PDF, EPUB and Kindle. Book excerpt: “In this 2nd edition, Robinson and Reiter give us an updated blueprint for full integration of behavioral health and primary care in practice. They review the compelling rationale, but their real contribution is telling us exactly HOW to think about it and how to do it. This latest book is a must for anyone interested in population health and the nuts and bolts of full integration through using the Primary Care Behavioral Health Consultation model.” Susan H McDaniel Ph.D., 2016 President, American Psychological Association Professor, University of Rochester Medical Center The best-selling guide to integrating behavioral health services into primary care is now updated, expanded and better than ever! Integration is exploding in growth, and it is moving inexorably toward the model outlined here. To keep pace, this revised text is a must for primary care clinicians and administrators. It is also essential reading for graduate classes in a variety of disciplines, including social work, psychology, and medicine. This updated edition includes: · A refined presentation of the Primary Care Behavioral Health (PCBH) model · The latest terms, trends and innovations in primary care · Comprehensive strategies and resource lists for hiring and training new Behavioral Health Consultants (BHC) · Step-by-step guidance for implementing the PCBH model · A plethora of evolved practice tools, including new Core Competency Tools for BHCs and primary care providers · Sample interventions for behaviorally influenced problems · The use of “Third Wave” behavior therapies in primary care · Detailed program evaluation instructions and tools · The latest on financing integrated care · An entire chapter on understanding and addressing the prescription drug abuse epidemic · Experienced guidance on ethical issues in the PCBH model · Improved patient education handouts With all of the changes in health care, the potential for the Primary Care Behavioral Health (PCBH) model to improve primary care—and the health of the population—is greater than ever. This book should be the first read for anyone interested in realizing the potential of integration.

Clinical Reasoning for Physician Assistants, E-Book

Author : Robin D. Risling
Publisher : Elsevier Health Sciences
ISBN 13 : 0323775691
Total Pages : 338 pages
Book Rating : 4.3/5 (237 download)

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Book Synopsis Clinical Reasoning for Physician Assistants, E-Book by : Robin D. Risling

Download or read book Clinical Reasoning for Physician Assistants, E-Book written by Robin D. Risling and published by Elsevier Health Sciences. This book was released on 2023-03-20 with total page 338 pages. Available in PDF, EPUB and Kindle. Book excerpt: Use this all-new workbook to review for the PANCE and PANRE examinations with confidence—and develop the clinical reasoning skills you’ll use in everyday practice! Clinical Reasoning for Physician Assistants uniquely prepares you for success on certification and recertification examinations and in your future practice by teaching you to think like an experienced physician assistant and master what you need to know for safe, effective practice. Custom-tailored to physician assistant students and the PANCE and PANRE examination blueprints, this innovative resource provides robust preparation through multiple-choice questions and answers and real-world case studies that prepare you well for your career as a physician assistant. Part I introduces you to essential clinical reasoning skills for PANCE/PANRE success and safe clinical practice, and provides key test-taking skills. Part II contains 14 body system chapters with multiple-choice PANCE/PANRE practice questions organized according to the most current NCCPA PANCE content blueprint. After each chapter, an answer key with complete rationales is provided, along with an indication of the corresponding NCCPA task category. Part III presents 15 detailed, unfolding case studies that take you to the “next step in clinical reasoning for safe patient practice, with PANCE/PANRE-style questions throughout the cases for additional practice. These patient-centered cases integrate demographics, cultural aspects, ethics, and professional practice in decision making.

Primary Care Psychiatry Handbook

Author : Shawn Hersevoort
Publisher : LWW
ISBN 13 : 9781496366948
Total Pages : 0 pages
Book Rating : 4.3/5 (669 download)

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Book Synopsis Primary Care Psychiatry Handbook by : Shawn Hersevoort

Download or read book Primary Care Psychiatry Handbook written by Shawn Hersevoort and published by LWW. This book was released on 2018-12-10 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Written by a psychiatrist who works full-time in the primary care setting, Primary Care Psychiatry Handbook is a quick, practical guide to the key diagnostic and therapeutic information you need to offer optimal mental health care to your patients. Derived from Primary Care Psychiatry, 2nd Edition, this high-yield, point of care handbook uses quick-reference tables, key points, and more to help you answer the question, "What do I do right now?" Delivers precisely the information needed by primary care providers who need to quickly confirm a psychiatric diagnosis or treatment option. Helps you understand potential underlying mental health issues such as depression, which often go unrecognized and under-treated in the primary care setting. Features mnemonics, key points, up-to-date drug information, clinical notes, Abbreviations and acronyms, tables, full-color figures, and more - all designed for quick reference at the point of care. Features up to date information on each subject drawn from the most current academic, research, and organizational psychiatry sources. Enrich Your eBook Reading Experience Read directly on your preferred device(s), such as computer, tablet, or smartphone. Easily convert to audiobook, powering your content with natural language text-to-speech.