Psych Management Flashcards
Psychological therapies (for psych)?
Primary care: Counselling Psychoeducation (group/individual) CBT DBT - dialectical behavioural therapy (for personality disorders)
Secondary care: Group therapy Family therapy Psychoanalytic psychotherapy Refferal to CMHT
Examples for Bio-Psych-Social managment approach in psych?
Bio - DRUGS
Psych - CBT, Psychoeducation, Counselling, Group therapy, DBT (for personality disorders)
Social - Support (family/carer), Work/Education, Support with engagement/benefits
Referral to CMHT - community mental health team
Hypnotics? (3 classes)
Benzos - Lorazepam, diazepam, midazolam, chlordiazepoxide
Z-Drugs - zopiclone, zolpidem
Melatonin - (over 55s short term only)
Withdrawal effects - resp depression, seizures, irritability
Antidepressants? (5 classes) SEs for each pls
SSRIs - sertralline, fluoxetine, citalopram, paroxetine
SNRIs - venlafaxine, duoloxetine
TCAs - amytriptilline, clomipramine
MAOIs - phenalazine
NaSSA (tetracyclic / noradrenergic + specific serotonin antidepressant)
-Mirtazepine
SEs
SS/SNRIs - suicidility, sexual dysfunction, serotonin syndrome
NaSSA - weight gain/increased appetite
TCAs - sedation, cardiac arrhythmias, anticholinergic effects (dry mouth, urinary retention, long QT, blurred vision)
MAOIs - hypertensive crises linked to tyrosine in cheese/red wine/fish
Antipsychotics and SEs. 2 classes
Why clozapine of note?
Typical/1st gen - Haloperidol, Chlorpromazine
SEs - more EPSE + NMS + High prolactin
Atypical/2nd gen - Olanzapine, Risperidone, Quetiapine, Aripiprazole, Clozapine
SEs - more metabolic - DM, weight gain, lipids, NMS
HIGH PROLACTIN - tuberoinfundibular pathway
Aripiprazole = best SE profile
Clozapine - agranulocytosis, TDP, weight gain
Mood stabilisers? SEs/risks?
Lithium
SEs - tremor, confusion, weight gain, thyroid dysfunction, renal impairment. EBSTEINs ANOMALY
Antipsychotics - olanzapine
Anticonvulsants - sodium valproate, carbemazepine, lamotrigine
N.B - risk in pregnancy
EPSE mx?
Procycladine - acute dystonia/parkinsonism
Propanolol +/- cyproheptidine - akathisia
Tetrabenazine - tardive dyskinesia
NMS + Serotinin syndrome Mx?
NMS
- Bromocriptine
- Dantrolene (reduce muscle spasms)
SS
-Cyproheptidine (5HT-2a antagonist)
Alcohol Dependance Mx - NOT WITHDRAWAL
Acamposate
Disulfuram
Naltrexone
Support groups/CBT
Withdrawal Mx
Chlordiazepoxide
IV Pabrinex
(Thiamine - alcohol only?)
Opioid overdose acute Mx
Dependance Mx after?
Naloxone - IV/IM (opioid antagonist)
Methadone
Buprenorphrine
Delirium Mx?
AVOID sedation unless needed - haloperidol/olanzapine
Benzos - chlordiazepoxide - only if alcohol
Side-room, sleep hygeine, adequate lights, clock/calendar
GAD mx?
step1
education, stop smoking/drinking, exercise
time off work?
step2
guided-help, low intensity psych support, psychoeducational groups
step3
Meds
CBT / relaxation techniques - high intensity psych support
step4
psych referral
MEDS
1st line - Sertralline
2nd -TCA - clomipramine
Benzo = short term - if really hyper. Can use diazepam long-term
Panic Disorder Mx?
Step1
recognition + diagnosis
step2
Meds - same as Anxiety
CBT
step3 Review + consider alternative tx step4 review + referral step5 care in specialist MH service
Phobia Mx
Same as Anxiety Meds (+beta-blockers - to help wth autonomic arousal)
CBT - Graded Exposure therapy
OCD Mx
Same as anxiety!!!!
CBT - exposure !
PTSD Mx
CBT
EMDR - eye movement desentisation + reprocessing
Meds - 2nd Line
SSRI - sert
-target specf symps:
-anything goes!
antipsychs - for psych symptsom
Benzos/Beta-Bs - for anxiety +autonomic
Mirtazepine - sleep issues
Eating disorders. Specific for each bulaemia/anorxia
ED-CBT
MANTRA (anorexia specific)
SSRI - sert (bulaemia)
Depression Mx. Mild/Moderate/Severe? Meds - 1st/2nd/3rd line?
Mild
Lifestyle - sleep hygeine, meditation, yoga
Computerised CBT, IAPT
Mod
Meds + IAPT (CBT)
Severe
Psych ward
?ECT
Meds 1st line - SSRI 2nd - another SSRI 3rd - SNRI / NaSSA 4th - TCAs / MAOIs
Postnatal depression
CBT
Sertralline!!! all others excreted in breastmilk
Puerperal psychosis?
Hospital admission
Mood stabliser, ECT, antidepressant
Psychotic symptoms - antipsych/benzo
Bipolar?
Mood stabilisers - Lithium 1st line!
CBT
ECT - severe mania (as psychosis)
Dementia? Lewy body? Vascular dementia?
Cholinesterase inhibitors
- Donepazil
- Rivastigmine - in Lewy Body
Memantine - NMDA receptor antagonist
–> SEVERE alzheimers
Aspirin - vascular dementia (others don’t work unless mixed A+VD)
memory aids, instructions round house, label drawers, memory stimulating activites, helpers round house
Schizophrenia Mx? what types / symptoms do antipsychs not work?
CBT - 3rd person audit halluc
Meds:
1st line - Atypicals
2nd line - Typicals
3rd line - Clozapine
ECT - for Catatonic
Simple/Residual/-VE symps = antipsychs don’t work!
Personality disorders? Borderline/Cluster B
DBT - borderline/ B cluster
CBT
Meds - don’t cure!
Benzos - short term crisis
Mood stabilisers / atypicals - comorbs
Sleep disorders?
CBT
Sleep hygeine advice - limit coffe/alcohol/cigs, exercise, quiet/relax in evening. Less comp use/noise/light. reg sleep patterns
Meds
Z-drugs
Benzos - loraz
Malatonin - over 55s short term only
Violence Mx? Why use one over the other (both class + route of admin)
Monitoring?
Try oral first!!!
Haloperidol / olanzapine - don’t combine - long QT
Lorazepam - if ALREADY ON ANTIPSYCH
IM = if risk to others/already tried 2 doses
Monitor vitals - every 5-10mins for 1hour, then every 30mins
When to give ECT?
Severe depression (2core+4more)
Catatonic Schiz
Puerpural psychosis
Severe Mania
