Treatment Flashcards
Depressive Disorders
Antidepressants
- *SSRIs (fluoxetine)
- SNRIs
- Bupropion
- TCAs
- Lithium
- MAOIs
Psychotherapy
- CBT
- IPT
- Insight oriented (psychoanalytic) therapy
ECT
- TMS
- VNS
- DCS
Surgery
Ketamine infusion
Alternative
- Exercise
- St. John’s Wort
- Ayurvedic meds
- Mediation
- S-adenosylmethionine
- Omega-3
- Gluten-free diet
- Probiotic supplements
- Cuentos, vision quest, walkabout
Panic Disorder
SSRIs - decrease amygdala activity
CBT - reduce phobic avoidance, decrease cognitive distortions
Eating Disorders
Weight restoration
Inpatient hospitalization (<75% ideal body weight)
Partial hospitalization (75-90% ideal body weight): group based, CBT, family therapy
Intensive outpatient: group therapy, family therapy
Anorexia Nervosa
Family therapy (treatment of choice for <18yo & living at home)
Psychoeducation
Self-help
Nutritional management
SSRIs (fluxoetine) (may be useful for depression or anxiety but not for AN alone)
Atypical antipsychotics (olanzapine decreases anxiety, insomnia, & body image distortions)
Benzos (decrease pre-meal anxiety)
Bulimia Nervosa
CBT IPT (CBT for BN) Family therapy Psychoeducation Self-help SSRIs (fluoxetine) (high-dose helpful, useful also if depression or anxiety comorbidity
Depression
Antidepressants - old: TCIs, MAOIs - new: SSRIs (fluoxetine & escitalopram in peds), SNRIs, SDRIs CBT IPT
Mania
Mood Stabilizers
- Lithium
- Anticonvulsants (valproate, carbamazepine, lamotrigine)
OR
Antipsychotics
Schizophrenia
Antipsychotics - old: Typicals - new: Atypicals Clozapine (blocks 5HT & DA) - first line, effective in treatment-resistant SCZ *no difference across meds about how good they are at reducing positive symptoms *none improve cognitive symptoms or reduce negative symptoms Psychosocial treatments - Psychoeducation - Psychotherapy - Case management - Family issues - Suicide prevention
Anxiety disorders (OCD, PTSD, GAD, phobias, PD)
Antidepressants +/- sedative for prevention
Anxiolytics (Benzos) for acute symptoms
BD
Polypharmacy Mood stabilizers - Lithium (mania) - Anticonvulsants (rapid cycling & mixed states) - Lamotrigine (bipolar depression) Atypical antipsychotics (acute mania, risperidone & aripiprazole in peds) Adjunctive meds - Atidepressants (ex. fluoxetine, treat bipolar depression) - Benzos (ex. clonazepam, initiate sleep, reduce agitation) - Anxiolytics (sleep aids) - Typical antipsychotics Psychotherapy - Psychoeducation - CBT - Interpersonal & social rhythms therapy - Family focused therapy - ECT
Delirium
Benzos - avoid unless suspect alcohol or benzo withdrawal Typical & Atypical antipsychotics (preoperative haloperidol, risperidone, olanzapine, quetiapine, aripiprazole) Orientation protocol Therapeutic activities Non-pharmacological sleep protocol Sleep-enhancement protocol Early mobilization protocol Vision protocol Hearing protocol Dehydration protocol Reduce polypharmacy
Separation Anxiety Disorder, Social Phobia, OCD, PTSD
SSRI
CBT
GAD
SSRI
SNRI
GAD
School Refusal
Benzos
ADHD
Stimulants (methylphenidate, mixed amphetamine salts) Atomoxetine Clonidine Guanfacine Bupropion
Smoking cessation
Bupropion
Oppositional Defiant Disorder (ODD) & Conduct Disorder (CD)
Behavioral therapy
Environmental interventions
Limit-setting & maintaining incentives
Autism & ASD
Atypical antipsychotics: risperidone
Behavioral treatments
Panic Disorder
Upregulate prefrontal cortex - SSRIs or other anti-depressants (not bupropion) - CBT Dampen amygdala hyperarousal - Benzos
GAD
Short-term benzos
Long-term antidepressants (esp SSRIs)
CBT
Buspirone (5HT agonist)
Specific Phobia
Behavioral approach
Social Anxiety Disorder
CBT (esp group)
SSRIs
Beta-blockers (for performance anxiety)
PTSD
Serotonergic antidepressants Exposure-based CBT Eye movement desensitization & reprocessing (EMDR) Mood stablizers Antipsychotics NOT Benzos
OCD
Serotonergic antidepressants
Exposure & response prevention
higher dose SSRIs
Psychosurgery (cingulotomy)
Body Dysmorphic Disorder
Exposure & response prevention
High dose SSRI
Personality Disorders (general principles)
Treat comorbidity
Maintain boundaries (esp for borderline personality disorder)
Avoid countertransference (be respectful & empathic)
Long-term treatment usually required
Get support
Psychotherapy
- CBT (most)
- Dialectical behavioral therapy (DBT) for borderline, reduces impulsivity
- psychodynamic psychotherapy (insight oriented therapy)
Cognitive-Perceptual Personality Disorders:
- suspicious / paranoid
- odd communication
- dissociation / hallucinations
Antipsychotics (neuroleptics)
Affective Personality Disorders:
- emotion dysregulation
- intense anger
SSRIs
Antipsychotics
Affective Personality Disorders:
- rejection sensitivity
- chronic emptiness
- social anxiety / avoidance
SSRIs
MAOIs
Impulsive-Behavioral Personality Disorders:
- sensation-seeking
- cognitive impulsivity
- aggressive
- binges (substances, sex)
- suicide / self-mutilation
SSRIs Lithium Antipsychotics MAOIs Anticonvulsants
