Psychiatric Counseling Points

Question 1

Explain the psychiatric indications of antipsychotics, antidepressants, mood stabilizers, anxiolytics and anticholinergics in lay language

Answer 1

Typically long term treatment
1. Antipsychotics = Thought organizer
2. Antidepressant = Improve mood/energy
3. Mood stabilizer = Better control of mood

Typically PRN
1. Anxiolytic = Relax
2. Hypnotic = Sleep
3. Anticholinergic = Relieves muscle side effects

Question 2

Counseling point for benzodiazepine

Answer 2

Tolerance for sedative effects can develop if using continuously for more than 1-2 weeks.

Inform doctor before stopping it if you are using it everyday

However, do not stop regular dosing if you are using it for panic disorder

Question 3

Counseling points for anxiolytics and hypnotics

Answer 3

Can be habit-forming if used daily

Question 4

Give reasons for poor adherence to antidepressants and what you should do

Answer 4

1. Intolerable ADR
2. Felt better and believed no need anymore Tx
3. Felt Tx was ineffective

Set realistic expectations
1. Management of ADRs
2. Continue Tx even after symptoms resolve
3. Delayed onset of action
4. Suicidality and contact emergency

Question 5

When does antidepressant induced mania and suicidality typically start after initiation?

Answer 5

Mania = Days to 2 weeks
Suicidality = 1 to 2 months

But any time can happen

Question 6

Explain how patients can manage antidepressant side effects

Answer 6

1. Drowsy: Bedtime ON dosing
2. Insomnia: Morning OM dosing
3. Lightheadedness: Rise up slowly
4. Stomach upset: Take after food
5. Sexual dysfunction: Treatable and reversible (Less with agomelatine, bupropion, mirtazapine)

Question 7

What to check with patients who are taking antipsychotics?

Answer 7

Indication: Check the reason for taking
- Thought organizer
- Mood stabilizer

Relate the medication to the symptoms the patient acknowledge
- Hallucinations: Do you hear voices when nobody is talking?
- Delusion: Do you fear that someone is trying to harm you?

Question 8

How should you convince patients to take their antipsychotics?

Answer 8

Find something about the condition the patient hates:
1. Re-hospitalization
2. Fear and suspicion
3. Voices

If patient is in complete denial,
1. Don’t argue with them about the indication
2. Justify maintenance through prevention of re-hospitalization

Question 9

Counsel patients on antipsychotic side effects that can be self-managed and referred to doctor

Answer 9

Self-managed:
- Sedative, orthostatic, anticholinergic, GI effect

Referral:
- Muscle side effects: Inform doctor if tremors or muscle stiffness affects use. In rare cases, if stiffness becomes severe with fever, see a doctor immediately
- Restlessness: Contact doctor immediately
- Blurred vision: Contact doctor immediately
- Infection (Fever, cough, sore throat): See doctor immediately (Clozapine)

Question 10

Convince your patient to take mood stabilizers

Answer 10

Focus on things they hate about the illness
1. Depression
2. Hospitalization
3. Legal and financial consequences

Question 11

Who should you take note of when giving mood stabilizers?

Answer 11

Females of childbearing age

Question 12

Explain how patients can manage lithium side effects

Answer 12

Stomach upset: After food
Thirst and urination: Sips but not excessive (Still keep 2L per day)
Tremors, nausea: See doctor if affecting you
Weight gain: Healthy lifestyle