8 Mental Health Flashcards
Main hypothesis about SCZ?
DA hypothesis - too much DA
Long term goals of SCZ treatment
Symptom control Prevent relapse and re-admission Ensure tolerability / safety Improve quality of life Improve social functioning Reduce cost
Widely used screaning tool for depression
PHQ-9 tool
What is the role of an advanced directive
e.g. if I become suicidal I would like to have ECT again
Challenges in clinical trials for psychiatry
Recruitment challenge
what is an appropriate outcome measure
length of time needed to follow up
Choice of antidepressant may be based on 4
Safefy Effectiveness Tolerabiltiy Cost - look at prevous medcation history
Mirtazapine is often combined because
s/e
Well tolerated, good cardiac safety
sedation and weight gain
At low doses venlafaxine acts as an
SSRI
At low doses venlafaxine acts as an
SSRI
problems with MAOI
dietary and co-prescription issues
Agomelatine is…
acts on melatonin receptors - new and place in therapy is not yet established
Social and environemtal stressors will not be removed by antidepressants
…
minimum time on antidepressants
6 moths
Discontinuation symptoms
flu-like insomnia nausea electric shock sensation vision disturbance axiety
Action for treatment resistant depression
Switch to another drug
Augment with:
Li, anti psychotic, thyroid hormones
Consider other diagnosis - bipoloar compnenet
Conventional wisdom is that all antipychotics are equal except
clozapine
Atypical vs typical side effects
Typical - movement disorders
Atypical - metabolic disorders
Problem with Clozapine
when to use
blood disorders
when other antipsychotics fail
Problem with Clozapine
when to use
blood disorders
when other antipsychotics fail
5 types of s/e patients should be informed about with antipsycotics
metabolic extrapyramidal cardiovascular hormonal other including unpleasant subjective experiences
at start of antipsychotic treatment select what dose
the lowest and titrate up
trial antipsychotic at optimum dose for how long?
4-6 weeks
5 questions to see if your antipscotic is a good choice
- is the drug choice logical
- has there been discussion in choice
- how will efficacy be monitored
- how will s/e be monitoered
- do benifits outweigh risks
5 questions to see if your antipscotic is a good choice
- is the drug choice logical
- has there been discussion in choice
- how will efficacy be monitored
- how will s/e be monitored
- do benefits outweigh risks
