Mx of Psych Disorders Flashcards
Tx of BPAD - Manic phase
General:
- Withdraw any medications with may contribute e.g. steroids, anti-depressants
- Calm environment
- Food and fluids
If they are already on mood stabiliser:
- Optimise their mood stabiliser
- Add an anti-psychotic
If they are not on any treatment:
- Give antipsychotic
- Give BDZ to help sleep
- Add in mood stabiliser later
Tx of BPAD - Depressive phase
- Tx with mood stablisers
Use of anti-depressants in BPAD patients
Must be avoided as they induce mania!
Long-term management of BPAD patients
- Long-term mood stabilisers
- Psychoeducation
- Social interventions e.g. family, housing etc
Management of depression
Mild depression
- Watch and wait
- Conservative management e.g. sleep hygiene
- Review in 2 weeks
Moderate-severe depression
- Antidepressants (SSRIs)
- If they are struggling with sleep and appetite, Mirtazipine is a good option
Management of schizophrenia
IMMEDIATE MANAGEMENT
- Start on an atypical antipsychotic (Risperidone)
- Benzodiazepine to help sleep
- Psychoeducation
MEDIUM-TERM MANAGEMENT
- Monitor for side-effects
- CBT
- Concordance therapy
- Social support e.g. housing
LONG-TERM MANAGEMENT
- Clozapine if needed
- Antidepressants can help for negative symptoms
When would you prescribe clozapine?
- When there is treatment-resistant scizophrenia
This is defined as:
- Schizophrenia which has not responded to 2 antipsychotics, which have been tried at the therapeutic dose for 6 weeks
GAD - management
- Assess symptoms with Beck Anxiety Inventory
- Assess severity with GAD-7
Mild anxiety, no functional impairment
- Self-help and psychoeducation
Moderate-severe anxiety
- CBT or SSRI
- Review patients <30 years in 1 week, due to risk of increased suicidality
Panic disorder - management
Aim: reduce the number of panic attacks, and ease symptoms
Primary care: SSRI or CBT
SSRI ineffective – prescribe TCA e.g. imipramine
Management of OCD
Mild - IAPTS (counselling/CBT)
Moderate - CBT or SSRI
Severe - SSRI and CBT
PTSD management
- SSRI and taking therapy (CBT or EMDR)
Personality disorder - mx
- Mainly psychological interventions
- Psychoeducation
- CBT
- DBT is useful in EUPD
- Medications may be useful
CAMHS disorders - management
- Depression - 3 months CBT, then fluoxetine if needed
- Anxiety - CBT/psychoeducation, then fluoxetine
School refusal/truancy/conduct disorders
- Psychotherapy
- Anger management for child
- Parenting programmes
Learning disabilities - management
ASSESSMENT
Level of intellectual function:
- Weschler Intelligence Scale for Children (WISC-IV) or Weschler Adult Intelligence Scale (WAIS)
Level of functional impairment:
- Adaptive Behavioural Assessment System (ABAS II)
ASSESS CAPACITY
MANAGEMENT
- Coordinated Care Programme
- They do the functional assessment, provide family with support and prescribe medications
- Family therapy
- Art therapy, music therapy etc
Post-partum psychiatry
- Baby blues - resolves
- PND - may need antidepressants (paroxetine best for breastfeeders)
- Puerperal psychosis - antipsychotic + admission to MBU
