Template - management Flashcards
Introduction to initial management
Need to decide where the patient should be assessed
Is a mental health act assessment required
What should be considered in initial biological management? (6)
Medication ECT Pregnancy In the elderly Counselling regarding medication Immediate monitoring Lifestyle advice
What should be considered in initial medication management? (5)
Dose/frequency Side effect profile Contraindications Benefits for patient Psychoeducation (response, side effects, stopping medication)
When should ECT be considered? (7)
Catatonia, depressive stupor Severe, resistant depression Rapid short-term improvement Suicidal ideation Schizo-affective depression Mania not responding to drugs Post-partum affective psychosis
Subheadings for initial psychological management? (4)
Psychoeducation
Support for family and carers
Sign post sources of further information
Sign-post self help resources
Sources of further information for patients/families (2)
Leaflets
Charity websites - mind, infoline, legal-line
Sources of self-help (3)
Oxfordshire Mind - talking therapies, peer support, social support
Talking space - NHS, talking treatment and wellbeing activities
Low-intensity treatments - online CBT, self-help books
Initial social management (6)
Accommodation Support network Employment/education Coping/caring for themselves/others Sick note from work Mobility
Spiel for long-term management (4)
With regards to their longer term/ongoing management, a CPA should be utilised.
Referral to CMHT may be necessary, and the patient should be reviewed by a psychiatrist.
MDT should be held every 6 weeks, a plan should be drawn up and reviewed . Plan disseminated.
The patient should be allocated a care-coordinator, typically a CPN, who wiil be responsible for coordinating and organising all elements of the care plan and for the continued monitoring of the mental state and medication of the patient
Spiel for where patient should be managed long term (4)
Organised smooth transfer form inpatient care to the community
Interim period in day hospital may be necessary to facilitate activity scheduling, combat social isolate and maximise adherence.
Residential/supervised accommodation may be helpful to minimise risk of relapse
Then in the community review regularly in OP clinics under CMHT by psychiatrist and CPN, review medications: side effects, response, relapse
Monitoring by GP
Long term biological management (3)
Monitoring response, side effects and relapse
Consider reviewing diagnosis, adherence, dosage, treatment choice, combining therapy
Recovery and continuation therapy, withdrawal of medication
Long term psychological management (3)
Stepped care
Psychologically minded
CBT, IPT, counselling, EMDR, DBT, psychodynamic therapy
Support groups and charities
Long term social management (5)
Structured daily living
Social worker - accommodation, finances (benefits), legal advice
Occupational health - social skills, employment coaching, activity scheduling, work placements
Combat social isolation - recovery groups, Age UK, day centres
Family support - signposting to charities, may need support themselves, bereavement from suicide
Crisis team (5)
Educate family and carers Contacts Early warning symptoms Triggers Plan of action - liaison and referral pathways
