General Management principles- Investigations

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General Management principles- Investigations
Treatment Modalities

• Dr Alok Rana
• Consultant Old Age Psychiatrist

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Management

• Assessment Formulation
• Investigation
• Treatment

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Investigation

• Other
• Collateral history
• Corroboration
• Previous notes
• Other specialities

• Traditional
• Bloods
• Scans CT, special CTs,MRI, PET, fMRI,
• ECG

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Treatment

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

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Biological/Somatic

• Drug/Physical element based treatment
• Routes
• - Oral
• - Injectibles
• - Patches
• - PR
• - long acting inestions or depots

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Pharmacological Somatic Tt

• Anxiolytics
• Antidepressants
• Mood Stabilisers
• Antipsychotics
• Drugs for cognitive disorder
• Drugs for addictions
• Hypnotics

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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

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Psychological

• Talking therapy
• Who delivers
• Psychologists
• Psychiatrists
• CPNs
• Other staff- trained

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Psychological therapies

• Counselling
• Psychodynamic Brief individual to Psychoanalysis
• CBT for anxiety, depression, eating disorder,
  schizophrenia
• Family Therapy

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Psychological therapies

• CAT
• DBT
• Therapeutic Community
• CST

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Treatment by professions

• Rehabilitation techniques Ots
• Art therapy
• Aromatherapy
• Dramatherapy

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Social aspect of treatment

• Identify predisposing, precipitating
  perpetuating factors
• Make formulation
• Identify need housing/family/support/finances/
• Social services
• CAB

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Illness based

• Psychological

• Somatic

• DepressionMild to Mod
• Anxiety
• Mania/Bipolar
• Schizophrenia
• Psychosis/delusional disorder
• Dementia

• Mild Depression
• Anxiety
• Eating disorder
• Personality disorder
• Mild dementia

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Factors to consider Pharmacological Treatment

• Drug Factors

• Stages in life

• Children
• Elderly
• Pregnancy
• Breast feeding
• Pharma ceuticals/ co-kinetics/dynamics

• Drug side effects
• Drug-drug interaction
• Timing frequency
• Mode of administration

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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

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Drugs what to know

• Half life
• Metabolism site
• Interactions
• Know the individual
• Red/Amber drugs
• Hospital initiation only drugs
• Specialist formulary drugs costs.

• MOA
• Indications
• Doses
• Exception to normal dosing
• Side effects serious and other early and late
  warning signs.

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Limitations

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

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Early vs definite treatment

• I will treat only if I am confidant

• I believe in early

• 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

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Psychotropics

• Antipsychotics
• Typical/FGA Haloperidol, Chlorpromazine (S/E)
• Atypical/SGA Olanzapine, Risperidone, Quetiapine
• Aripiprazole
• Clozapine

• Anxiolytics
• -Antidepressants
• TCAs
• SSRIs (1st line)
• Mirtazapine
• Trazodone
• SNRIs
• - BZD,

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Psychotropics

• Dementia medication
• CHI medication
• Donepezil
• Rivastigmine
• Galantamine
• NMDA Antagonist
• Memantine

• Mood Stabilisers
• Lithium
• Sodium Valproate
• Carbamazepine
• Olanzapine

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