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Year 3 Revision > Psych Treatment Pathways > Flashcards

Psych Treatment Pathways Flashcards

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

A

CBT (including response prevention)

SSRIs/clomipramine

25
Q

Treatment pathway of depression in young people

A 
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
Q

ICD-10 personality disorder criteria

A

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
Q

What personality disorders have little guidance on treatment?

A 
Shizoid
Paranoid
Histrionic
Dissocial
Anankastic/obsessive-compulsive
Avoidant
28
Q

When to use low-dose antipsychotics in personality disorders

A

Reduce suspiciousness in cluster A (paranoid, schizoid and schizotypal)
Can help with paranoid or hallucinations in borderline

29
Q

When to use antidepressants in personality disorders

A

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
Q

Pharmacological management of difficulties with impulse control in personality disorder

A

SSRI

31
Q

Pharmacological management of affective dysregulation in personality disorder

A

SSRI or mirtazapine

32
Q

Pharmacological management of cognitive-perceptual symptoms in personality disorder

A

Low dose antipsychotic

33
Q

Should you use drugs in management of interpersonal difficulties in personality disorder?

A

No

34
Q

Avoidant PD management

A

Social skills training

Some evidence for antidepressants

35
Q

Emotionally unstable personality disorder management

A

Dialectical behavioural therapy (ideal)
Mentilisation based therapy
Systems training for emotional predictability and problem solving (STEPPS) - CBT based

36
Q

Hazardous drinking assessed using audit tool management

A

Deliver brief intervention

37
Q

Harmful drinking assessed using audit tool management

A

Deliver brief intervention
Deliver motivational enhancement therapy sessions
Consider prescribing options

38
Q

Possible alcohol dependence assessed using audit tool management

A

Comprehensive assessment

39
Q

The 6 elements of brief intervention (FRAMES)

A 
Feedback
Responsibility
Advice
Menu
Empathy
Self-efficacy
40
Q

Psychosocial interventions for alcohol relapse prevention

A

CBT
Motivational enhancement therapy
12 step facilitation therapy (AA)
Family and couple therapy

41
Q

Drug to prevent alcohol withdrawal

A

Chlordiazepoxide

42
Q

What are the 3 licensed to prevent relapse after successful alcohol withdrawal?

A

Acamprosate (corrects neurotransmitter imbalance)
Naltrexone (blocks opioid receptors)
Disulfiram

43
Q

Drugs prescribed in opioid detox

A

Methadone
Buprenorphine
Lofexidine

44
Q

Benefits of buprenorphine over methadone

A

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
Q

Drawbacks of buprenorphine over methadone

A

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
Q

How do you decide between buprenorphine and methadone treatment?

A

Guided by preference of patient

Taking risk factors and previous treatments into account

47
Q

Describe methadone induction and maintenance

A 
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
Q

Describe buprenorphine induction and maintenance

A

Start with 4-8mg
Second day up to 16mg
Usual effective dose 12-16mg
Max dose is 32mg/day normally

49
Q

What is the right maintenance dose for opioid replacement?

A

Dose at which patient stops using and stops experiencing cravings
Can be much higher than amount needed to suppress withdrawal

50
Q

What should every patient on >100ml methadone receive?

A

An ECG to look at QTc

51
Q

Pharmacological first line management for moderate and severe ADHD

A

Stimulants:
Methylphenidate
Dexamfetamine
Lisdexamfetmine

52
Q

Pharmacological second line management for moderate and severe ADHD

A

SNRI:

Atomoxetine

53
Q

Pharmacological third line management for moderate and severe ADHD

A

Alpha agonist:
Clonidine
Guanfacine

54
Q

Pharmacological 4th line management for moderate and severe ADHD

A

Antidepressents (imipramine)

Antipsychotics (risperidone)

55
Q

When would you use drugs in autism?

A

For co-morbidity

Risperidone if severe aggression and significant self-injury.

56
Q

Management of mild cognitive impairment

A

Repeat cognitive testing yearly (annual conversion rate 10-15%)
May benefit from home based memory rehabilitation

57
Q

When to use cholinesterase inhibitors in dementia

A

Alzheimers

Lew body/parkinson disease dementia (greater effect)

58
Q

Pharmacological management of agitation in dementia

A 
Antipsychotics
Citalopram
Memantine
Analgesia
Dextromethorphan (cough suppressant)

Trazodone for FTD

59
Q

Pharmacological management of visual hallucinations in dementia

A

Cholinesterase inhibitors

Year 3 Revision (70 decks)

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