Download Psychiatric Treatment

ACUTE PSYCHOSIS
first episode of schizophrenic psychosis
atypical antipsychotic
or low-dose typical antipsychotic
If the first treatment fails
review compliance and tolerability
poor or no response over 6—8 weeks
switch to another drug
assess over a further 6 weeks
ACUTE PSYCHOSIS
patient with a previous history of schizophrenia experiences a relapse
adherence to treatment should be assessed thoroughly
social and psychological precipitants
If adherence to medication is doubtful
continue with the usual drug treatment + short-term sedative
If adherence is deemed satisfactory
switch to a different antipsychotic
assess over the following 6 weeks
If 6 weeks of this second antipsychotic treatment
proves ineffective
clozapine should be considered
ACUTE DISTURBED OR VIOLENT BEHAVIOUR
Try non-drug measures
quiet
privacy
talking down
Seclusion
Offer oral treatment
+ Lorazepam 1—2 mg
Risperidone 1—2 mg
Olanzapine 10 mg
Haloperidol 5 mg
Consider i.m. treatment
Olanzapine 5—10 mg
Haloperidol 5 mg
Lorazepam 1—2 mg
Consider i.v, treatment
Diazepam 10 mg over at Least 5 minutes
ACUTE DYSTONIA
Abrupt onset of muscle spasm
treatment
hours after commencing an
antipsychotic
should stop the antipsychotic
particularly after a typical
drug
give procyclidine 5—10 mg or
equivalent intramuscularly
can be very alarming
especially on first exposure
to antipsychotics
It is more common in the
young than tne old
it causes respiratory stridor
and tongue protrusion
it can induce panic
One should check for cyanosis, and
administer oxygen
and transfer to a medical unit as
required
ACUTE DYSTONIA
ACUTE DYSTONIA
ACUTE DYSTONIA
intense
extrapyramidal
rigidity
clouding of
consciousness
dystonias
diaphoresis
pyrexia
autonomic
dysfunction
Transfer to acute medical ward or intensive care unit
Monitor ECG
blood pressure
renal status
Cessation of neuroleptics
Bromocriptine 5—10 mg orally three times daily
if unable to swallow
Apomorphine infusion 1 mg/h s.c.
no response
Dantrolene sodium 50 mg twice daily maximum for 3 days
MORTALITY ASSOCIATED WITH NMS
autonomic
instability
(e.g. cardiac
arrest)
renal failure
due to
rhabdornyolysis
and myoglobinuria
Lower with
atypical
antipsychotics
Mortality: 12 -18 %
ECT
The National Institute for Health and Clinical Excellence (NICE) guidance on ECT
recommends that it be restricted to:
severe depressive illness,
catatonia,
prolonged or severe mania.
postpartum psychoses.
NMS
SEVERE DEPRESSIVE ILLNESS
treatment resistant
psychomotor retardation
psychotic features such as delusions and/or
hallucinations
life-saving if the patient is very acutely suicidal
fails to maintain adequate nutrition or hydration
SEVERE DEPRESSIVE ILLNESS
patient preference
past history of response to ECT
the need for a rapid response to treatment
the risks of other treatments exceed those for ECT
elderly who have not responded to drug treatments or have
suffered unpleasant side effects
Remission rates in clinical trials are 60—70 per cent
MANIA
prolonged or severe mania
the need for a speedy therapeutic response
as a safe alternative to high-dose medications
if patients have drug-resistant
'rapid cycling' mania
SCHIZOPHRENIA
catatonic excitement or
immobility
the patient cannot tolerate medications
failed to respond to adequate doses of
antipsychotics including clozapine
Thank you