Psychiatry Flashcards
Management of PTSD (lasting more than 4 weeks) - 1st line
EMDR or trauma-focussed CBT
Management of PTSD (lasting more than 4 weeks) - 2nd line
Venlafaxine or SSRI
Lithium - routine monitoring
6-monthly: BMI + renal function + thyroid function
How long post-dose should you check Lithium levels
12 hours post-dose
How often must lithium levels be checked when initating or changing dose?
Weekly until stable, then 3-monthly
Section 2 - what is it used for
Admission for assessment
Up to 28 days
Section 3 purpose + length
Admission for treatment
Up to 6 months, can be renewed
Section 4
72hr assessment order
Section 5(2)
Patient voluntarily in hospital detained by doctor
For 72 hours
Section 5(4)
Nurse can detain patient who is voluntarily in hospital.
For 6 hours
Section 17a
Community Treatment Order
To recall patient to hospital if not complying with conditions in community
Section 135
Court order - allows police to break into property to remove person to place of safety
Section 136
Person in public place taken by police to place of safety
Up to 24 hours
DVLA requirements - mania/hypomania - new diagnosis or new episode
Must notify the DVLA + must not drive for at least 3 months
DVLA may consider licensing in stable hypomania/mania (<4 episodes/yr) if:
- Stable >=3m
- Adhering to treatment
- Medication not affecting driving
- Specialist agrees
DVLA - unstable hypomania/mania (>=4 episodes in 12 months) - licensing may be considered when:
- Stable >= 6m
- Adhering treatment
- No medication effects on driving
- Specialist agrees
Switching from citalopram, escitalopram, sertraline or paroxetine to another SSRI
Wean & withdraw 1st SSRI
Then start new SSRI
Switch from Fluoxetine > other SSRI
Withdraw fluoxetine
Leave 4-7 day gap
Start low-dose new SSRI
Switching from SSRI to TCA
Cross-taper
(Exception: fluoxetine)
Switching from citalopram, escitalopram, sertraline or paroxetine to venlafaxine
Cross-taper cautiously
Start venlafaxine 37.5 mg and slow increase
Switching from fluoxetine to venlafaxine
Withdraw Fluoxetine
Then start Venlafaxine 37.5 mg
Increase dose slowly