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A primary care practitioner can often manage gout without the patient having a consultation with a rheumatologist, but a consultation should be considered if the diagnosis is unclear, there is uncertainty as to whether or not to start uric acid-lowering medication, attacks continue to occur despite treatment, or possible medication side effects are making treatment difficult

More consistent focus throughout the day Reduced mental resistance when starting tasks Improved clarity and organization of thought Greater cognitive endurance Where This Fits in Mental Health Care NAD+ therapy is not a replacement for psychotherapy or medicationit is a supportive modality