psychiatry treatment

Get Started. It's Free
or sign up with your email address
Rocket clouds
psychiatry treatment by Mind Map: psychiatry treatment

1. Psychotherapy

1.1. time consuming

1.2. cognitive/behavioral therapies

1.2.1. directive and coach like, includes homework

1.2.2. manualized and time limited

1.2.3. examples Interpersonal psychotherapy ITP theory: connection between interpersonal context and mood disorder effective for major depression 12-16 weeks Cognitive behavioral therapy CBT theory: cognitive model, operant conditioning and classical conditioning very effective for major depression also for Dialectical behavioral therapy DBT behavioral therapy

1.3. group psychotherapy

1.4. family therapy

1.5. couples' therapy

2. Pharmacological treatment

2.1. general rules

2.1.1. indication: establish a diagnosis and identify target symptom to monitor therapy

2.1.2. start low and go slow

2.1.3. delayed response (3-6 weeks)

2.1.4. drug-drug interactions

2.1.5. informed consent

2.1.6. monitor

2.1.7. simplest regimen

2.2. antidepressants

2.2.1. Tricyclics (TCAs) very effective, but bad side effects antihistaminic anticholiniergic antiadrenergic lethal overdose QT interval types tertiary TCAs secondary TCAs

2.2.2. MAOIs prevent degenration of amines such as norepinephrine, domaine, and serotonin very effective for depression side effects serotonin syndrome Hypertensive crisis if taken with tyramine rich foods other

2.2.3. SSRIs selective block of serotonin reuptake works for depression and anxiety side effects GI upset sexual dysfunction insomnia fatigue sedation discontinuation syndrome examples fluoxetine Citalopram Escitalopram

2.2.4. SNRIs inhibit both serotonin and noradrenergic reuptake (like TCAs), but less side effects for depression, anxeity, and neuropathic pain (deloxitine) examples Venlafaxine Duloxetine

2.2.5. Novel antidepressants Mirtazapine different mechanism (augumintation for SSRI) less than 30 sedative more than 30 activating (give in the morning) weight gain increase lipids Buproprion acts on dope and norepi no weight gain or sexual or sedation or cardiac interactions may increase seazures at high doses NOT for anxiety (it causes it)

2.3. Mood stabilizers

2.3.1. lithium the only one that reduces suicide rate prophylaxis of mania and depression

2.3.2. anticonvulsants valproic acide good for mania not depression better tolerated carbamazepine first line for mania and its prophylaxis for rapid cyclers and mixed Lamotrigine also for neropathic pain do liver function

2.3.3. antipsychotics typicals high potency low potency atypicals serotonin-dopamine 2 antagonists examples side effects tradive dyskinesia (5% per year) Neuroleptic malignant syndrome extrapyramidal side effects

2.4. anxiolytics

2.4.1. buspirone 5HT1A agonist (independant of endogenous release of serotonin) 2 weeks to see results will not work for people used to benzo (no sedation)

2.4.2. benzodiazapines insomnia and anxeirty side effects somnolence cognitive deficits amnesia disinhibition tolerance and dependance examples Lorazepam Oxazepam Diazepam Triazolam

3. Electroconvulsive therapy (ECT)

3.1. indications

3.1.1. severe major depression

3.1.2. severe suicidality

3.1.3. severe psychosis

3.1.4. catatonia

3.1.5. malnutrition in depressive illness

3.2. side effects

3.2.1. cardiac ischemia

3.2.2. aspiration pneumonia

3.2.3. fracture

3.2.4. dental and tongue injuries

3.2.5. headache

3.2.6. nusea

3.2.7. myalgias

3.2.8. cognitive impairment acute confusion anterograde or retrograde amnesia