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General Management principles- Investigations & Treatment Modalities

General Management principles- Investigations & Treatment Modalities. Dr Alok Rana Consultant Old Age Psychiatrist. Management. Assessment Formulation Investigation Treatment. Investigation. Traditional Bloods

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General Management principles- Investigations & Treatment Modalities

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  1. General Management principles- Investigations & Treatment Modalities Dr Alok Rana Consultant Old Age Psychiatrist

  2. Management • Assessment Formulation • Investigation • Treatment

  3. Investigation Traditional • Bloods • Scans: CT, special CTs,MRI, PET, fMRI, • ECG Other • Collateral history • Corroboration • Previous notes • Other specialities

  4. Treatment • BioPsychoSocial • - Formulation to identify what to treat Holistic Approach: Whole person Symptomatic Treat the cause Preventing the consequences

  5. Biological/Somatic • Drug/Physical element based treatment: • Routes: - Oral - Injectibles - Patches - PR - long acting inestions or depots

  6. Pharmacological Somatic Tt • Anxiolytics • Antidepressants • Mood Stabilisers • Antipsychotics • Drugs for cognitive disorder • Drugs for addictions • Hypnotics

  7. Non Pharmacological Somatic Tt • ECT: Electro Convulsive Therapy: Depression, Mania, Schizophrenia, Post partum psychosis • Phototherapy • TMS: Transcranial Magnetic Stimulation • DBS: Deep Brain Stimulation • Neurosurgery for psychiatric disorder

  8. Psychological • Talking therapy: • Who delivers • Psychologists • Psychiatrists • CPNs • Other staff- trained

  9. Psychological therapies • Counselling • Psychodynamic: Brief individual to Psychoanalysis • CBT: for anxiety, depression, eating disorder, schizophrenia • Family Therapy

  10. Psychological therapies • CAT • DBT • Therapeutic Community • CST

  11. Treatment by professions • Rehabilitation techniques: Ots • Art therapy • Aromatherapy • Dramatherapy

  12. Social aspect of treatment • Identify predisposing, precipitating & perpetuating factors • Make formulation • Identify need: housing/family/support/finances/ • Social services • CAB

  13. Illness based Psychological Depression:Mild to Mod Anxiety Mania/Bipolar Schizophrenia Psychosis/delusional disorder Dementia Mild Depression Anxiety Eating disorder Personality disorder Mild dementia Somatic

  14. Factors to consider Pharmacological Treatment Drug Factors Children Elderly Pregnancy Breast feeding Pharma ceuticals/ co-kinetics/dynamics Drug side effects Drug-drug interaction Timing & frequency Mode of administration Stages in life

  15. Prescribing • Establish and inform indication- diagnosis/ symptom based/ treat the cause etc • Discuss options and explain • Help patient to make an informed decision • Give information as leaflet if needed • Explain side effects, MOA, contraindications, what to expect and how to seek help

  16. Drugs – what to know • MOA • Indications • Doses • Exception to normal dosing • Side effects – serious and other; early and late; warning signs. • Half life • Metabolism site • Interactions • Know the individual • Red/Amber drugs • Hospital initiation only drugs • Specialist formulary drugs & costs.

  17. Limitations • Knowing your expertise • Acknowledging your limitations • Stepping over the boundary • Ever-changing medicine – life long learning • Joint working with other specialists

  18. Early vs definite treatment I will treat only if I am confidant Better response Better prognosis Quick recovery Less chronicity Eg Early psychosis, depression, mania Labelling & medico legal Unnecessary exposure & Side effects Consequence on career& personal life. Eg Schizophrenia, Bipolar, Dementia I believe in early

  19. Psychotropics Anxiolytics: -Antidepressants: • TCAs • SSRIs (1st line) • Mirtazapine • Trazodone • SNRIs - BZD, Antipsychotics • Typical/FGA: Haloperidol, Chlorpromazine (S/E) • Atypical/SGA: Olanzapine, Risperidone, Quetiapine Aripiprazole Clozapine

  20. Psychotropics Mood Stabilisers: • Lithium • Sodium Valproate • Carbamazepine • Olanzapine • Dementia medication: • CHI medication • Donepezil • Rivastigmine • Galantamine NMDA Antagonist: Memantine

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