Management of Psychiatric Illnesses - NICE Guidelines

Question 1

Emergency management of GAD and Panic Disorders

Answer 1

Benzodiazepines (2 to 4 weeks max)

Question 2

First Line management for panic disorders

Answer 2

CBT.

Question 3

An immediate problem of SSRIs in GAD management

Answer 3

Initially exacerbate anxiety symptoms

Question 4

Management of PTSD

Answer 4

Trauma-Focused CBT or EMDR

Question 5

First line drug treatment for PTSD

Answer 5

SSRIs

Question 6

What can be prescribed for nightmares relating to PTSD

Answer 6

Prazosin

Question 7

First Line intervention for OCD

Answer 7

Exposure and Response Prevention

Second Line: SSRIs and Clomipramine

Question 8

Treatment pathway for GAD

Answer 8

1. Non-therapeutic treatments (supportive counselling, psychoeducation FIRST)
2. Treat with SSRI, re-ass after 6-8 weeks and then increase dose and re-ass a 6-8 weeks later
3. Try SNRI’s or Mirtazipine
4. Refer to consultant psychiatrist (usually given low dose antipsychotics or pregabalin)

Question 9

What patient conditions contraindicate use of AChE inhibitors and memantine use in Dementia

Answer 9

Vascular Dementia
Vascular cognitive impairment

Only consider if they have comorbid Alzheimer’s

Question 10

First line management of Alzheimer’s

Answer 10

Donepezil, rivastigmine

Secondline: Memantine- USED ALONGISDE Donepezil, not on its own

Question 11

If someone’s Alzheimer’s deteriorates, what should happen to the Donepezil and Memantine prescribed to them

Answer 11

It should be continued as normal - DO NOT UNPRESCRIBE

Question 12

Firstline treatment of Lewy body and Parkinson’s disease dementia

Answer 12

Rivastigmine and Donepezil

Second Line: memantine

Question 13

When should haloperidol be given to people with Alzheimer’s or vascular dementia

Answer 13

Oney when the symptoms are severe and non-pharmacological treatments have failed

Question 14

First line parenteral feed in Anorexic patients

Answer 14

Nasogastric Tubes

Question 15

First line investigations for NMS

Answer 15

CK levels
Prolactin
FBC

Question 16

First line management of NMS

Answer 16

IV Fluids
Stop Antipsychotics

Oral -> IV BDZs

Cooling devices

ECT if it continues

Question 17

What antipsychotic has no affect on the QT interval

Answer 17

Aripiprazole

Question 18

How is Rapid Tranquillisation carried out

Answer 18

1. Consider non-pharmacological approaches first
2. ORAL Benzodiazepines

Then ‘as required’ antipsychotic than introducing a new one (usually oral haloperidol)

Then IM Lorazepam or IM Haloperidol AND Promethazine

Question 19

When should Lorazepam be avoided in rapid tranquillisation

Answer 19

Respiratory function problems

In combination with Clozapine

Question 20

What should be done before haloperidol is given at any therapeutic intervention (including rapid tranquillisation)

Answer 20

An ECG pre-treatment. If this is not possible, do not give unless absolutely necessary

Question 21

First line management of Serotonin Syndrome

Answer 21

Withdraw medication and supportive care ONLY

Question 22

First Line management of insomnia in children

Answer 22

Behaviour measure changes

Question 23

Criteria for Insomnia treatment in children

Answer 23

Behavioural measures -> Sleep Diaries -> Melatonin 3mg

Question 24

How to treat insomnia which is unlikely to resolve soon and causing distress

Answer 24

CBT

ONLY use hypnotics is acutely distressed

Question 25

How to treat insomnia which is causing distress and may resolve soon (e.g., the passing of a causative stressor)

Answer 25

Short course non-BDZ hypnotic (Zolpidem)

3-7 days

Question 26

Management of addiction cessation

Answer 26

1. Advice and offer leaflets
2. Then motivation support
3. Refer to Smoking Cessation Advisor for NRT or Vernicline

Question 27

Intervention for people with mild-moderate depression

Answer 27

Low-intensity psychosocial investigations; individual self guided help, group physical activity programme or computerised CBT

Group based CBT

then CBT OR SSRI