Psychiatry Treatment Guidance

Question 1

How long are people recommended to stay on an antidepressant after remission (different for elderly and recurrent depression) (BNF)?

Answer 1

6 months
12 months in elderly
2 years for recurrent depression

Question 2

When would you prescribe clozapine (NICE)?

Answer 2

If not responded adequately after sequential use of 2 different antipsychotic drugs at adequate doses. At least one of these should be a second generation (atypical) antipsychotic.

BNF states at least 6-8 weeks of each drug

Question 3

What can happen to clozapine levels if patient stops smoking and why, and what should you do?

Answer 3

Goes up
Smoking activates enzyme that breaks down clozapine (CYP1A2)
reduce dose

Question 4

Mild functional impairment OCD treatment 1st line

Answer 4

Low intensity CBT and exposure and response prevention (ERP)

Question 5

Mild functional impairment OCD treatment 2nd line

Answer 5

SSRI or more intensive CBT with ERP

Question 6

Moderate functional impairment OCD treatment

Answer 6

SSRI or more intensive CBT with ERP

Question 7

Severe functional impairment OCD treatment (e.g. over 3 hours a day)

Answer 7

Referral to secondary care
While awaiting assessment combined SSRI with CBT and ERP

Question 8

When should you use clomipramine in OCD?

Answer 8

Person prefers clomipramine
OR
Previous good response to it
OR
SSRI contraindicated

Question 9

What is the first line treatment for children and young people with anorexia?

Answer 9

Anorexia focused family therapy

Question 10

What is the second line treatment for children and young people with anorexia?

Answer 10

CBT

Question 11

NICE management guidelines to GAD (whole thing)

Answer 11

step 1: education about GAD + active monitoring
step 2: low-intensity psychological interventions (individual non-facilitated self-help or individual guided self-help or psychoeducational groups)
step 3: high-intensity psychological interventions (cognitive behavioural therapy or applied relaxation) or drug treatment (other flashcard)
step 4: highly specialist input e.g. Multi agency teams

Question 12

Drug treatment of GAD

Answer 12

Sertraline first line
If ineffective, another SSRI or SNRI
If cannot tolerate, then pregabalin

Question 13

Panic disorder drug management

Answer 13

CBT or drug treatment
Drug: SSRI first line, imipramine or clomipramine if contraindicated or no response after 12 weeks

Question 14

NICE first line management for less severe depression

Answer 14

Guided self-help
Antidepressants if that is the person’s preference

Question 15

Nice first line management for more severe depression

Answer 15

Combo of individual CBT and an SSRI