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

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

General Management principles-

Investigations & Treatment Modalities

Dr Alok Rana Consultant Old Age

Psychiatrist

Page 2: General Management principles- Investigations & Treatment Modalities Dr Alok Rana Consultant Old Age Psychiatrist

ManagementO Assessment Formulation

O Investigation

O Treatment

Page 3: General Management principles- Investigations & Treatment Modalities Dr Alok Rana Consultant Old Age Psychiatrist

Investigation

Traditional

OBloodsOScans: CT, special CTs,MRI, PET, fMRI,OECG

Other

OCollateral historyOCorroborationOPrevious notesOOther specialities

Page 4: General Management principles- Investigations & Treatment Modalities Dr Alok Rana Consultant Old Age Psychiatrist

TreatmentO BioPsychoSocial

O - Formulation to identify what to treat

Holistic Approach:Whole personSymptomaticTreat the causePreventing the consequences

Page 5: General Management principles- Investigations & Treatment Modalities Dr Alok Rana Consultant Old Age Psychiatrist

Biological/SomaticO Drug/Physical element based

treatment:O Routes:

- Oral- Injectibles- Patches- PR- long acting inestions or depots

Page 6: General Management principles- Investigations & Treatment Modalities Dr Alok Rana Consultant Old Age Psychiatrist

Pharmacological Somatic Tt

O AnxiolyticsO AntidepressantsO Mood StabilisersO AntipsychoticsO Drugs for cognitive disorder O Drugs for addictionsO Hypnotics

Page 7: General Management principles- Investigations & Treatment Modalities Dr Alok Rana Consultant Old Age Psychiatrist

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

Page 8: General Management principles- Investigations & Treatment Modalities Dr Alok Rana Consultant Old Age Psychiatrist

PsychologicalO Talking therapy:O Who delivers

O PsychologistsO PsychiatristsO CPNsO Other staff- trained

Page 9: General Management principles- Investigations & Treatment Modalities Dr Alok Rana Consultant Old Age Psychiatrist

Psychological therapies

O CounsellingO Psychodynamic: Brief individual to

PsychoanalysisO CBT: for anxiety, depression, eating

disorder, schizophreniaO Family Therapy

Page 10: General Management principles- Investigations & Treatment Modalities Dr Alok Rana Consultant Old Age Psychiatrist

Psychological therapiesO CATO DBTO Therapeutic CommunityO CST

Page 11: General Management principles- Investigations & Treatment Modalities Dr Alok Rana Consultant Old Age Psychiatrist

Treatment by professions

O Rehabilitation techniques: OtsO Art therapyO AromatherapyO Dramatherapy

Page 12: General Management principles- Investigations & Treatment Modalities Dr Alok Rana Consultant Old Age Psychiatrist

Social aspect of treatment

O Identify predisposing, precipitating & perpetuating factors

O Make formulationO Identify need:

housing/family/support/finances/O Social servicesO CAB

Page 13: General Management principles- Investigations & Treatment Modalities Dr Alok Rana Consultant Old Age Psychiatrist

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

Page 14: General Management principles- Investigations & Treatment Modalities Dr Alok Rana Consultant Old Age Psychiatrist

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

Page 15: General Management principles- Investigations & Treatment Modalities Dr Alok Rana Consultant Old Age Psychiatrist

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

Page 16: General Management principles- Investigations & Treatment Modalities Dr Alok Rana Consultant Old Age Psychiatrist

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.

Page 17: General Management principles- Investigations & Treatment Modalities Dr Alok Rana Consultant Old Age Psychiatrist

LimitationsO Knowing your expertiseO Acknowledging your limitationsO Stepping over the boundaryO Ever-changing medicine – life long

learningO Joint working with other specialists

Page 18: General Management principles- Investigations & Treatment Modalities Dr Alok Rana Consultant Old Age Psychiatrist

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

Page 19: General Management principles- Investigations & Treatment Modalities Dr Alok Rana Consultant Old Age Psychiatrist

Psychotropics

Anxiolytics:-Antidepressants:OTCAsOSSRIs (1st line)OMirtazapineOTrazodoneOSNRIs- BZD,

AntipsychoticsOTypical/FGA: Haloperidol, Chlorpromazine (S/E)OAtypical/SGA: Olanzapine, Risperidone, QuetiapineAripiprazoleClozapine

Page 20: General Management principles- Investigations & Treatment Modalities Dr Alok Rana Consultant Old Age Psychiatrist

Psychotropics

Mood Stabilisers:OLithiumOSodium ValproateOCarbamazepineOOlanzapine

O Dementia medication:

O CHI medicationO DonepezilO RivastigmineO GalantamineNMDA Antagonist:Memantine

Page 21: General Management principles- Investigations & Treatment Modalities Dr Alok Rana Consultant Old Age Psychiatrist