general management principles- investigations & treatment modalities
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General Management principles- Investigations & Treatment Modalities. Dr Alok Rana Consultant Old Age Psychiatrist. Management. Assessment Formulation Investigation Treatment. Investigation. Traditional Bloods - PowerPoint PPT PresentationTRANSCRIPT
General Management principles-
Investigations & Treatment Modalities
Dr Alok Rana Consultant Old Age
Psychiatrist
ManagementO Assessment Formulation
O Investigation
O Treatment
Investigation
Traditional
OBloodsOScans: CT, special CTs,MRI, PET, fMRI,OECG
Other
OCollateral historyOCorroborationOPrevious notesOOther specialities
TreatmentO BioPsychoSocial
O - Formulation to identify what to treat
Holistic Approach:Whole personSymptomaticTreat the causePreventing the consequences
Biological/SomaticO Drug/Physical element based
treatment:O Routes:
- Oral- Injectibles- Patches- PR- long acting inestions or depots
Pharmacological Somatic Tt
O AnxiolyticsO AntidepressantsO Mood StabilisersO AntipsychoticsO Drugs for cognitive disorder O Drugs for addictionsO Hypnotics
Non Pharmacological Somatic Tt
O ECT: Electro Convulsive Therapy: Depression, Mania, Schizophrenia, Post partum psychosis
O PhototherapyO TMS: Transcranial Magnetic
StimulationO DBS: Deep Brain StimulationO Neurosurgery for psychiatric disorder
PsychologicalO Talking therapy:O Who delivers
O PsychologistsO PsychiatristsO CPNsO Other staff- trained
Psychological therapies
O CounsellingO Psychodynamic: Brief individual to
PsychoanalysisO CBT: for anxiety, depression, eating
disorder, schizophreniaO Family Therapy
Psychological therapiesO CATO DBTO Therapeutic CommunityO CST
Treatment by professions
O Rehabilitation techniques: OtsO Art therapyO AromatherapyO Dramatherapy
Social aspect of treatment
O Identify predisposing, precipitating & perpetuating factors
O Make formulationO Identify need:
housing/family/support/finances/O Social servicesO CAB
Illness based Somatic Psychological
O Depression:Mild to Mod
O AnxietyO Mania/BipolarO SchizophreniaO Psychosis/delusional
disorderO Dementia
O Mild DepressionO AnxietyO Eating disorderO Personality
disorderO Mild dementia
Factors to consider Pharmacological Treatment
Stages in life Drug Factors
O ChildrenO ElderlyO PregnancyO Breast feedingO Pharma ceuticals/
co-kinetics/dynamics
O Drug side effectsO Drug-drug
interactionO Timing &
frequencyO Mode of
administration
PrescribingO Establish and inform indication-
diagnosis/ symptom based/ treat the cause etc
O Discuss options and explainO Help patient to make an informed
decisionO Give information as leaflet if neededO Explain side effects, MOA,
contraindications, what to expect and how to seek help
Drugs – what to knowO MOAO IndicationsO DosesO Exception to
normal dosingO Side effects –
serious and other; early and late; warning signs.
O Half lifeO Metabolism siteO InteractionsO Know the individualO Red/Amber drugsO Hospital initiation
only drugsO Specialist
formulary drugs & costs.
LimitationsO Knowing your expertiseO Acknowledging your limitationsO Stepping over the boundaryO Ever-changing medicine – life long
learningO Joint working with other specialists
Early vs definite treatment
I believe in early I will treat only if I am confidant
O Better responseO Better prognosisO Quick recoveryO Less chronicityO Eg Early psychosis,
depression, mania
O Labelling & medico legal
O Unnecessary exposure & Side effects
O Consequence on career& personal life.
O Eg Schizophrenia, Bipolar, Dementia
Psychotropics
Anxiolytics:-Antidepressants:OTCAsOSSRIs (1st line)OMirtazapineOTrazodoneOSNRIs- BZD,
AntipsychoticsOTypical/FGA: Haloperidol, Chlorpromazine (S/E)OAtypical/SGA: Olanzapine, Risperidone, QuetiapineAripiprazoleClozapine
Psychotropics
Mood Stabilisers:OLithiumOSodium ValproateOCarbamazepineOOlanzapine
O Dementia medication:
O CHI medicationO DonepezilO RivastigmineO GalantamineNMDA Antagonist:Memantine
