psychiatry treatment

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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

1.2.3.1. Interpersonal psychotherapy ITP

1.2.3.1.1. theory: connection between interpersonal context and mood disorder

1.2.3.1.2. effective for major depression

1.2.3.1.3. 12-16 weeks

1.2.3.2. Cognitive behavioral therapy CBT

1.2.3.2.1. theory: cognitive model, operant conditioning and classical conditioning

1.2.3.2.2. very effective for major depression

1.2.3.2.3. also for

1.2.3.3. Dialectical behavioral therapy DBT

1.2.3.4. 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)

2.2.1.1. very effective, but bad side effects

2.2.1.1.1. antihistaminic

2.2.1.1.2. anticholiniergic

2.2.1.1.3. antiadrenergic

2.2.1.1.4. lethal overdose

2.2.1.1.5. QT interval

2.2.1.2. types

2.2.1.2.1. tertiary TCAs

2.2.1.2.2. secondary TCAs

2.2.2. MAOIs

2.2.2.1. prevent degenration of amines such as norepinephrine, domaine, and serotonin

2.2.2.2. very effective for depression

2.2.2.3. side effects

2.2.2.3.1. serotonin syndrome

2.2.2.3.2. Hypertensive crisis if taken with tyramine rich foods

2.2.2.3.3. other

2.2.3. SSRIs

2.2.3.1. selective block of serotonin reuptake

2.2.3.2. works for depression and anxiety

2.2.3.3. side effects

2.2.3.3.1. GI upset

2.2.3.3.2. sexual dysfunction

2.2.3.3.3. insomnia

2.2.3.3.4. fatigue

2.2.3.3.5. sedation

2.2.3.3.6. discontinuation syndrome

2.2.3.4. examples

2.2.3.4.1. fluoxetine

2.2.3.4.2. Citalopram

2.2.3.4.3. Escitalopram

2.2.4. SNRIs

2.2.4.1. inhibit both serotonin and noradrenergic reuptake (like TCAs), but less side effects

2.2.4.2. for depression, anxeity, and neuropathic pain (deloxitine)

2.2.4.3. examples

2.2.4.3.1. Venlafaxine

2.2.4.3.2. Duloxetine

2.2.5. Novel antidepressants

2.2.5.1. Mirtazapine

2.2.5.1.1. different mechanism (augumintation for SSRI)

2.2.5.1.2. less than 30 sedative

2.2.5.1.3. more than 30 activating (give in the morning)

2.2.5.1.4. weight gain

2.2.5.1.5. increase lipids

2.2.5.2. Buproprion

2.2.5.2.1. acts on dope and norepi

2.2.5.2.2. no weight gain or sexual or sedation or cardiac interactions

2.2.5.2.3. may increase seazures at high doses

2.2.5.2.4. NOT for anxiety (it causes it)

2.3. Mood stabilizers

2.3.1. lithium

2.3.1.1. the only one that reduces suicide rate

2.3.1.2. prophylaxis of mania and depression

2.3.2. anticonvulsants

2.3.2.1. valproic acide

2.3.2.1.1. good for mania not depression

2.3.2.1.2. better tolerated

2.3.2.2. carbamazepine

2.3.2.2.1. first line for mania and its prophylaxis

2.3.2.2.2. for rapid cyclers and mixed

2.3.2.3. Lamotrigine

2.3.2.3.1. also for neropathic pain

2.3.2.3.2. do liver function

2.3.3. antipsychotics

2.3.3.1. typicals

2.3.3.1.1. high potency

2.3.3.1.2. low potency

2.3.3.2. atypicals

2.3.3.2.1. serotonin-dopamine 2 antagonists

2.3.3.2.2. examples

2.3.3.3. side effects

2.3.3.3.1. tradive dyskinesia (5% per year)

2.3.3.3.2. Neuroleptic malignant syndrome

2.3.3.3.3. extrapyramidal side effects

2.4. anxiolytics

2.4.1. buspirone

2.4.1.1. 5HT1A agonist (independant of endogenous release of serotonin)

2.4.1.2. 2 weeks to see results

2.4.1.3. will not work for people used to benzo (no sedation)

2.4.2. benzodiazapines

2.4.2.1. insomnia and anxeirty

2.4.2.2. side effects

2.4.2.2.1. somnolence

2.4.2.2.2. cognitive deficits

2.4.2.2.3. amnesia

2.4.2.2.4. disinhibition

2.4.2.2.5. tolerance and dependance

2.4.2.3. examples

2.4.2.3.1. Lorazepam

2.4.2.3.2. Oxazepam

2.4.2.3.3. Diazepam

2.4.2.3.4. 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

3.2.8.1. acute confusion

3.2.8.2. anterograde or retrograde amnesia