General Management principlesInvestigations & Treatment
Modalities
Dr Alok Rana
Consultant Old Age Psychiatrist
Management
O Assessment
Formulation
O
Investigation
O
Treatment
Investigation
Traditional
Other
O Bloods
O Collateral history
O Scans: CT, special
O Corroboration
CTs,MRI, PET, fMRI,
O ECG
O Previous notes
O Other specialities
Treatment
O BioPsychoSocial
O - Formulation to identify what to treat
Holistic Approach:
Whole person
Symptomatic
Treat the cause
Preventing the consequences
Biological/Somatic
O Drug/Physical element based treatment:
O Routes:
- Oral
- Injectibles
- Patches
- PR
- long acting inestions or depots
Pharmacological Somatic Tt
O Anxiolytics
O Antidepressants
O Mood Stabilisers
O Antipsychotics
O Drugs for cognitive disorder
O Drugs for addictions
O Hypnotics
Non Pharmacological Somatic
Tt
O ECT: Electro Convulsive Therapy: Depression,
O
O
O
O
Mania, Schizophrenia, Post partum
psychosis
Phototherapy
TMS: Transcranial Magnetic Stimulation
DBS: Deep Brain Stimulation
Neurosurgery for psychiatric disorder
Psychological
O Talking therapy:
O Who delivers
O Psychologists
O Psychiatrists
O CPNs
O Other staff- trained
Psychological therapies
O Counselling
O Psychodynamic: Brief individual to
Psychoanalysis
O CBT: for anxiety, depression, eating disorder,
schizophrenia
O Family Therapy
Psychological therapies
O CAT
O DBT
O Therapeutic Community
O CST
Treatment by professions
O Rehabilitation techniques: Ots
O Art therapy
O Aromatherapy
O Dramatherapy
Social aspect of treatment
O Identify predisposing, precipitating &
O
O
O
O
perpetuating factors
Make formulation
Identify need:
housing/family/support/finances/
Social services
CAB
Illness based
Somatic
Psychological
O Depression:Mild to Mod O Mild Depression
O Anxiety
O Anxiety
O Mania/Bipolar
O Eating disorder
O Schizophrenia
O Personality disorder
O Psychosis/delusional
O Mild dementia
disorder
O Dementia
Factors to consider
Pharmacological Treatment
Stages in life
Drug Factors
O Children
O Drug side effects
O Elderly
O Drug-drug interaction
O Pregnancy
O Timing & frequency
O Breast feeding
O Mode of
O Pharma ceuticals/ co-
kinetics/dynamics
administration
Prescribing
O Establish and inform indication- diagnosis/
O
O
O
O
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
Drugs – what to know
O MOA
O Half life
O Indications
O Metabolism site
O Doses
O Interactions
O Exception to normal
O Know the individual
dosing
O Side effects –
serious and other;
early and late;
warning signs.
O Red/Amber drugs
O Hospital initiation
only drugs
O Specialist formulary
drugs & costs.
Limitations
O Knowing your expertise
O Acknowledging your limitations
O Stepping over the boundary
O Ever-changing medicine – life long learning
O Joint working with other specialists
Early vs definite treatment
I believe in early
I will treat only if I am
confidant
O Better response
O Labelling & medico legal
O Better prognosis
O Unnecessary exposure &
O Quick recovery
Side effects
O Consequence on
career& personal life.
O Eg Schizophrenia,
Bipolar, Dementia
O Less chronicity
O Eg Early psychosis,
depression, mania
Psychotropics
Anxiolytics:
-Antidepressants:
O TCAs
O SSRIs (1st line)
O Mirtazapine
O Trazodone
O SNRIs
- BZD,
Antipsychotics
O Typical/FGA: Haloperidol,
Chlorpromazine (S/E)
O Atypical/SGA:
Olanzapine, Risperidone,
Quetiapine
Aripiprazole
Clozapine
Psychotropics
Mood Stabilisers:
O Lithium
O Sodium Valproate
O Carbamazepine
O Olanzapine
O Dementia
medication:
O CHI medication
O Donepezil
O Rivastigmine
O Galantamine
NMDA Antagonist:
Memantine