Module 2 - management Flashcards
(24 cards)
Main treatment guidelines
RANZCP 2016
Goals of treatment
Prodromal Phase:
1. prevent transition to psychosis
2. reduce distress
3. treat co-morbs
Acute Phase:
- decrease vulnerability
- decrease impact of stressful events/ situations
- decrease distress/ disability
- minimise symptoms
- improve quality of life
- decrease risk
- increase communication/ coping skills
- enhance treatment
Pharmacological treatment options
antipyscotics
non-Pharmacological treatment options
- psychological
- physiological
- occupational
- educational
Should “at-risk” px take antipsychotics? why?
no. most at-risk pts do not convert to psycosis. risks outweigh bens.
what treatment does RANZCP recommend for “at-risk” pts?
cbt and/or family intervention
What are the 3 most prescribed antipsychotics in Australia?
Olanzapine
Quetiapine
Risperidone
What are 2 brand names for Olanzapine?
Zyprexa, Zyprexa Relprevv
What is the brand name for Quetiapine?
Seroquel
What are 2 brand names for Risperidone?
Risperdal, Risperdal Consta
Give 5 adjunctive pharmacological treatment.
- Anticonvulsants
- Mood stabalisers
- anticholinergics
- antidepressants
- benzos
RANZCP acute psychotic treatment guidelines
low-dose antipsychotic –> therapeutic dose (4 weeks with good adherence)
effective and tolerable? continue 1-2years
lack of efficacy/ poor tolerability? switch
How many patients experience treatment-resistant schizophrenia, how do you manage?
20-33% pts
Treatment:
Clozapine (only indicated for treatment-resistant due to cause of severe lack of WBCs)
High-dose antipsychotic
Combination therapy
What % of patients will relapse if they stop taking medication during the maintenance phase? And what % will relapse anyways?
50%. 20%
mental health services
inpatient services (full-time medical care, admitted)
outpatient services
describe a typical patient care journey
ED then psychiatric evaluation then;
discharged OR admitted for 10-14 days
discharged under community centre/ assigned case worker
under community:
case worker 1/wk
psychiatry registrar 1/fortnight
psychiatrist 1/month
once stable and compliant:
gp care (rarely initiates treatment independently)
Describe the unmet needs of adult patients
Negative symptoms, treated patients still have them.
Cognitive symptoms, remain prominent in patients life underlining positive and negative symptoms. Interfere with therapy and employment
Positive symptoms, some patients do not respond to any medication. lack of efficacy for ALL patients
What are some barriers to treatment
Patient non-adherence:
positive symptoms:
delusions
due to ‘not feeling sick’
negative symptoms:
memory
not sufficiently motivated
can’t plan for medication
cant save for medicaiton
cognitive symptoms:
e.g. poor sleep, missing morning does
side effects
substance abuse
Explain the pathways/ receptors involved in EPS s/e.
nigrostriatal DA pathway
Explain the pathways/ receptors involved in sedative s/e.
H1
Explain the pathways/ receptors involved in SD s/e.
5-HT
Explain the pathways/ receptors involved in WG s/e.
H1, 5-HT
What % of patients turn to substance abuse?
50%
What % of patients experience homelessness?
33%, 13% ‘rooflessness’
