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Year 3 Revision > Psych Treatment Pathways > Flashcards

Psych Treatment Pathways Flashcards

(59 cards)

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1
Q

Mild depression management

A

Antidepressants not indicated

Generally gets better by itself

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2
Q

Anorexia management guidance

A

MARSIPAN

Management of really sick patients with anorexia nervosa

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3
Q

Anorexia psychological management

A 
CBT and other psychological therapies
Dietician
Medical monitoring
Art/drama therapy
Family therapy
Inpatient for high risk (MHA)
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4
Q

Bulimia management

A

Guided self-help
CBT
SSRI

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5
Q

How long to continue anti-depressant after first episode of depression?

A

Continue for at least 6 months after full recovery without reducing dose

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6
Q

How long to continue anti-depressant after second episode of depression or more?

A

Continue for at least 1-2 years after full recovery without reducing dose

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7
Q

What is the first line antidepressant class you should prescribe?

A

SSRI

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8
Q

If SSRIs don’t work what should you do?

A 
Check they are taking them
Consider other diagnosis or factors
Increase dose
Swap
Combine e.g. SSRI and mirtazapine
Augment - antipsychotic or lithium first
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9
Q

How to start a patient on anti-depressants?

A

Do PHQ-9 rating before and after each trial

Review after 1-2 weeks

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10
Q

Acute mania first line management

A

Antipsychotics - olanzapine, quetiapine or risperidone

If patient already on maintenance therapy then max dose of this medication

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11
Q

Acute mania second line management

A

Lithium
Valproate
Carbamazepine
ECT

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12
Q

Acute mania symptom control

A

Benzos - agitation

Z-drugs - insomnia

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13
Q

When and what antidepressant should you prescribe in bipolar disorder?

A

Not without antimanic drug
Not in those with recent manic/hypomanic episode or rapid cycling
SSRI (esp fluoxetine)

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14
Q

Bipolar depression management

A

Antipsychotics first line (quetiapine, olanzapine, lurasidone)
Antidepressants alongside anti-spychotic, lithium or valproate
Lamotrigine
ECT
Lithium
(unsure about this flashcard take with pinch of salt)

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15
Q

Bipolar maintenance management

A 
Lithium gold-standard
Other options:
Antipsychotics
Lamotrigine (if primarily depressive)
Valproate (if primarily manic/hypomanic)
Psychoeducation
Other psychological therapies
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16
Q

ECT absolute contra-indications

A

MI within last 3 months
Recent CVA
Intracranial mass
Phaeochromocytoma

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17
Q

ECT relative contra-indications

A 
Angina
Congestive heart failure
Severe pulmonary disease
Severe osteoporosis
Pregnancy
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18
Q

ECT consent procedure

A

If capacity to consent is impaired need second opinion doctor
For life saving treatment second opinion approval is not needed

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19
Q

PTSD management (NICE guidelines)

A

CBT first line
Eye movement desensitisation and reprocessing (EMDR) second line

Medication can be combined with psychological therapies:
Venlafaxine or an SSRI
Antipsychotics e.g. risperidone for severe hyperarousal
Alternatives: prazosin, mood stabiliser

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20
Q

Generalised anxiety disorder management

A 
CBT
SSRIs (first line)
SNRIs (second line)
Pregabalin
Benzos (short term only)
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21
Q

Panic disorder management

A

CBT
SSRIs (first line)
SNRIs/tricyclics (second line)
Benzos (short term only)

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22
Q

Specific phobia management

A

Behavioural therapy (exposure)
Maybe add in CBT
SSRIs or SNRIs if required

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23
Q

Social phobia management

A

CBT
SSRI first line
SNRI second line
Benzos (short time only)

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24
Q

OCD management

Study These Flashcards
A

CBT (including response prevention)

SSRIs/clomipramine

25
Treatment pathway of depression in young people
``` Watchful waiting for 2 weeks Then group therapy or digital CBT for 2-3 months If unresponsive then individual CBT Then fluoxetine Then sertraline or citalopram ```
26
ICD-10 personality disorder criteria
Characteristic and enduring patterns of inner experience and behaviour deviate markedly from cultural norm Manifested in more than one of: cognition, affectivity, impulse control, interpersonal functioning Pervasive behaviour Personal distress and/or adverse impact on the social environment Stable Long duration Onset in late childhood/adolescence Cannot be explained as other mental health disorder
27
What personality disorders have little guidance on treatment?
``` Shizoid Paranoid Histrionic Dissocial Anankastic/obsessive-compulsive Avoidant ```
28
When to use low-dose antipsychotics in personality disorders
Reduce suspiciousness in cluster A (paranoid, schizoid and schizotypal) Can help with paranoid or hallucinations in borderline
29
When to use antidepressants in personality disorders
Help with mood and emotional difficulties in cluster B (dissocial, emotionally unstable, histrionic) SSRI can help impulsivity and aggression in borderline and dissocial Can reduce anxiety in cluster C (anankastic, avoidant and dependent)
30
Pharmacological management of difficulties with impulse control in personality disorder
SSRI
31
Pharmacological management of affective dysregulation in personality disorder
SSRI or mirtazapine
32
Pharmacological management of cognitive-perceptual symptoms in personality disorder
Low dose antipsychotic
33
Should you use drugs in management of interpersonal difficulties in personality disorder?
No
34
Avoidant PD management
Social skills training | Some evidence for antidepressants
35
Emotionally unstable personality disorder management
Dialectical behavioural therapy (ideal) Mentilisation based therapy Systems training for emotional predictability and problem solving (STEPPS) - CBT based
36
Hazardous drinking assessed using audit tool management
Deliver brief intervention
37
Harmful drinking assessed using audit tool management
Deliver brief intervention Deliver motivational enhancement therapy sessions Consider prescribing options
38
Possible alcohol dependence assessed using audit tool management
Comprehensive assessment
39
The 6 elements of brief intervention (FRAMES)
``` Feedback Responsibility Advice Menu Empathy Self-efficacy ```
40
Psychosocial interventions for alcohol relapse prevention
CBT Motivational enhancement therapy 12 step facilitation therapy (AA) Family and couple therapy
41
Drug to prevent alcohol withdrawal
Chlordiazepoxide
42
What are the 3 licensed to prevent relapse after successful alcohol withdrawal?
Acamprosate (corrects neurotransmitter imbalance) Naltrexone (blocks opioid receptors) Disulfiram
43
Drugs prescribed in opioid detox
Methadone Buprenorphine Lofexidine
44
Benefits of buprenorphine over methadone
Less risk of overdose Less sedative More likely to block the effect of using on top Longer effect (only needs to be taken every other day) Quicker titration (2-3 days) Easier to detox from Less stigma
45
Drawbacks of buprenorphine over methadone
Not indicated for patients using high doses of opioids (as only partial agonist can cause withdrawal) Can be misused (injected/snorted) Risk of induced withdrawal Less sedative
46
How do you decide between buprenorphine and methadone treatment?
Guided by preference of patient | Taking risk factors and previous treatments into account
47
Describe methadone induction and maintenance
``` Start with 10-30mg First week: increase by max 10mg/day or 30mg/week 5 days to steady state dose Usual effective dose 60-120mg No max dose ```
48
Describe buprenorphine induction and maintenance
Start with 4-8mg Second day up to 16mg Usual effective dose 12-16mg Max dose is 32mg/day normally
49
What is the right maintenance dose for opioid replacement?
Dose at which patient stops using and stops experiencing cravings Can be much higher than amount needed to suppress withdrawal
50
What should every patient on >100ml methadone receive?
An ECG to look at QTc
51
Pharmacological first line management for moderate and severe ADHD
Stimulants: Methylphenidate Dexamfetamine Lisdexamfetmine
52
Pharmacological second line management for moderate and severe ADHD
SNRI: | Atomoxetine
53
Pharmacological third line management for moderate and severe ADHD
Alpha agonist: Clonidine Guanfacine
54
Pharmacological 4th line management for moderate and severe ADHD
Antidepressents (imipramine) | Antipsychotics (risperidone)
55
When would you use drugs in autism?
For co-morbidity | Risperidone if severe aggression and significant self-injury.
56
Management of mild cognitive impairment
Repeat cognitive testing yearly (annual conversion rate 10-15%) May benefit from home based memory rehabilitation
57
When to use cholinesterase inhibitors in dementia
Alzheimers | Lew body/parkinson disease dementia (greater effect)
58
Pharmacological management of agitation in dementia
``` Antipsychotics Citalopram Memantine Analgesia Dextromethorphan (cough suppressant) ``` Trazodone for FTD
59
Pharmacological management of visual hallucinations in dementia
Cholinesterase inhibitors

Year 3 Revision (70 decks)

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