treatments Flashcards
management refeeding syndrome
Thiamine and vitamin B complex
Close monitoring of biochemistry: U&Es (potassium, magnesium and phosphate)
eating disorders medical management
Along with a weekly weight management and eating plan, consider these medications:
fluoxetine 60mg daily
olanzapine (improvement of obsessive symptoms and fixations, and controls the voice of anorexia)
Target Weight Gain per week for Anorexic Patients
0.5 kg per week
anxiety
SSRI
alternative SSRI or SNRI
Pregabalin
Do not use benzodiazepines except for short-term measures during a crisis
Do not offer antipsychotics for anxiety disorder in primary care
Referral to Psychiatry or Community Mental Health Team (CMHT)
indications for referral of anxiety to CMHT
Severe anxiety disorder with marked functional impairment and:
Risk of self-harm or suicide
Significant comorbidity (substance misuse, personality disorder, complex physical health problems)
Self-neglect
OR failure to respond to step 3 interventions
low intensity psychological interventions for GAD
individual non-facilitated self-help
Individual guided self-help
Psychoeducational groups
medical treatment of panic disorder
moderate- severe panic disorder
Psychological therapy (1-2 hrs CBT sessions weekly over 4 months)
First-line: SSRI (e.g. citalopram, sertraline, paroxetine, escitalopram)
Second-line: Tricyclic antidepressant (e.g. imipramine, clomipramine)
contraindications in panic disorder
Benzodiazepines (associated with a less good outcome in the long term and should not be prescribed)
Sedating antihistamines
Antipsychotics
treatment phobic anxiety disorders
Cognitive behavioural therapy
Exposure therapy
SSRI (e.g. Sertraline or Escitalopram) for 6 months
management of OCD
CBT
SSRIs
Often required at higher dose and longer durations >12 weeks to see a response and continued for 12 months to prevent relapse
Tricyclic antidepressant e.g. clomipramine
GAD7 levels
0-5 = Mild
6-10 = Moderate
11-15 = Moderately Severe
15-21 = Severe
treatment PTSD
Trauma-focused CBT
Eye Movement Desensitisation and Reprocessing (EMDR)
Drug therapy: SSRIs or Tricyclic Antidepressants (Beware risk of dependence with any sedatives)
management depression
Step 1: Recognition and Advice
Step 2: Active Monitoring and Low-Intensity Psychosocial Interventions
Step 3: SSRI or high intensity psychological intervention or combined treatment for mod- severe
Step4: severe and complex- refer to psych and possible in patient care. risk of self harm
for non responders -
increase level of support and dose OR switch to another antidepressant
Different SSRI
Another class (SNRI e.g. venlafaxine, TCA, MAOI)
Combining and Augmentation (In consultation with psychiatrist if primary care)
Antidepressant with Lithium, an antipsychotic (e.g. quetiapine, aripriprazole..) or another antidepressant (e.g. mirtazapine)
treatment of schizophrenia
minimum effective dose antipsychotic until remission
atypicals first then typicals
if dont work then switch
maintenance treatment after first episode should be at least 18 months
second line if treatment resistant (if two other antipsychotics have not been effective) - clozapine
Treatment of Acute Exacerbation or Recurrence of Schizophrenia- Atypical antipsychotics (e.g. Amisulpride, Olanzapine, Risperidone) OR low-potency typical antipsychotic (e.g. Chlorpromazine) for at least four weeks
Treatment for Relapse Prevention of Schizophrenia during Remission: For maintenance, give atypical antipsychotics (e.g. Amisulpride, Olanzapine, Risperidone) OR typical antipsychotic (e.g. Chlorpromazine) for a minimum of two years
Depot Antipsychotic in non compliance
treatment and signs of opioid overdose
Naloxone
Pinpoint pupils, Unconsciousness, Shallow breathing
treatment of opioid dependency
methadone
buprenorphine for less heavy opioid dependency or people reducing methodone
