Psychotropic Drug Therapy in Adults with Learning Disability. Steve Wilkinson
|
|
- Charlotte Hudson
- 6 years ago
- Views:
Transcription
1 Psychotropic Drug Therapy in Adults with Learning Disability Steve Wilkinson
2 Outline and Aims of the Session Drug use in learning disability Two distinct areas of drug therapy I. Treatment of common psychiatric disorders in the learning disabled population II. Treatment of behaviour disturbance (challenging behaviour) in adults with learning disability
3 Drug Use in Learning Disability All surveys show that use is common in learning disability 20-45% on psychotropic medication (Deb 2006) 1/3 on anti-epileptics 1/3 on antipsychotics Remainder on mixture of antidepressants and anxiolytics
4 Drug Use in Learning Disability For antipsychotics 22-45% in hospital patients 20% use in community patients 14-30% of psychotropic medication is for behaviour problems 36% Adults with LD on psychotropic's did not have a diagnosed mental illness (Clark 1990) 71% on antipsychotic did not have recorded severe mental illness (Faculty ID report 2016) Polypharmacy common Medication is used for mental illness, epilepsy, sleep problems, hyperactivity, and behavioural problems
5 Drug Use in Learning Disability Evidence for use not in learning disabled population Indications for use in psychiatric illness the same as non LD population Main difference of use is in the area of challenging behaviour Problems with drug use Consent and Capacity Best Interests Compliance Prominent side effects Communication difficulties Misidentified side effects
6 Drug Use in Learning Disability Diagnostic difficulties sometimes lead to a therapeutic trial of drugs Starting drug dosage may be smaller than the BNF norm Low and Slow Improvement is often rated by carers, their impression can alter outcomes
7 Drugs in Specific Psychiatric Disorders Schizophrenia Affective Disorder Mood Stabilisers Anxiety Disorder Dementia
8 Drug Treatment: Schizophrenia Antipsychotic drugs are the mainstay Large doses still common, polypharmacy, side effects missed and wide overlap into challenging behaviour Increasing pressure to use antipsychotics to treat only a diagnosed mental illness Increased use of the atypical antipsychotics unless good reason not to, Risperidone is the most commonly used. Mostly case reports and handful of RCT's (Deb, 2006) Risperidone or Olanzapine are usually considered first-line Amisulpride or Quetiapine are alternatives
9 Drug Treatment: Schizophrenia Risperidone, RCT evidence of decreased aggression, but linked with weight gain and somnolence Hyperprolactinaemia problem Clozapine, effective in learning disabled individuals with resistant schizophrenia. 79% responded (Antonacci and de Groot, 2000). Reduces seizure threshold Olanzapine, somnolence, increased appetite, weight gain, glucose intolerance Quetiapine, good choice in Parkinson's and movement disorders
10 Drug Treatment: Schizophrenia Tardive Dyskinesia in 45-50% of those with learning disability on typical antipsychotics 29% transient dyskinesia on stopping (Gualtieri,1986) TD irreversible more so in LD as in elderly compared to young adults Increased prevalence of NMS in learning disability, twice as common Mortality higher, fluid intake critical Akathisia often missed
11 Drug Treatment: Affective Disorder Verhoeven (2001), 60% effectiveness of Citalopram in learning disability Langee and Conion (1992), retrospective audit showed 36% response rate to antidepressants in severe and profound LD Only 20% response in those with hyperactivity and self-injurious behaviour,? Treating undiagnosed mood disorder 10% subjects with LD get worse when treated with antidepressants
12 Drug Treatment: Affective Disorder Which drug to use? Tricylic Antidepressants Poor sleep Significantly reduced body weight Cost or availability Associated enuresis SSRI s Danger of self harm Excessive weight (fluoxetine) Cardiac risks, angina, cardiac conduction defects Sedation problems Poorly controlled epilepsy Obsessional syndromes Others Trazodone-useful for sleep problems and epilepsy Venlafaxine-useful for obsessional symptoms
13 Drug Treatment: Mood Stabilisers Lithium is effective in mood disorders but can be difficult to manage in LD Blood monitoring can be difficult in the learning disabled Carers often unaware of side effects and changes with physical illness Valproate and Carbamazepine widely used Lamotrigine increasingly used Improvement may be linked to treating epilepsy
14 Drug Treatment: Anxiety Disorder CBT and environmental manipulation. Don t jump in with medication SSRI s widely used for anxiety disorders May need high doses and be used for 3 months to show response Short course of benzodiazepines Negative effect on cognition, withdrawal problems Buspirone low potency and long onset of action
15 Drug Treatment: Dementia Donepezil for Alzheimers type mild to moderate dementia Main clinical problem is targeting use in early illness MMSE inappropriate tool in LD DLD (formerly DMR) Memantine use in moderate to severe dementia, some positive effect seen clinically
16 Drug Use: Challenging Behaviour Wide use of psychotropic drugs in behaviour disorders Antipsychotics are commonly used Move from typical to atypical antipsychotics Aggressive behaviour is the strongest predictor for use of medication Used as both treatment and prophylaxis Lower the IQ the harder it is to distinguish between behaviour disorder and mental illness
17 Drug Use: Challenging Behaviour 10-15% of people with LD in contact with services have challenging behaviour 2/3rds of those identified were male 2/3rds were adolescents or young adults 50% living with families More demanding behaviours seen in those with profound intellectual disability (Emerson et al, 2001)
18 Drug Use: Challenging Behaviour Prudhoe Hospital in 1987 (24%) of the hospital patients were receiving antipsychotic medication The most frequent diagnosis was behaviour disorder in 48% of the patients 19% had affective disorder; 13% had schizophrenia Fifteen different antipsychotics were prescribed although Chlorpromazine and Thioridazine were most frequently prescribed (Wressell SE et al, 1990)
19 Drug Use: Challenging Behaviour Psychotropic drugs are often used for unlicensed indications in people with behavioural challenges in LD Reasons include the management of sleep disturbance, increased arousal and self-injurious behaviour, and behavioural change resulting from epilepsy and dementia A cross-sectional survey of psychotropic drug prescribing in in-patients with intellectual disability found that 46.4% were receiving at least one psychotropic for an unlicensed indication, most typically in an attempt to manage behavioural problems or to stabilise mood (Haw & Stubbs, 2005)
20 Drug Use: Challenging Behaviour Antipsychotics, typical and atypical Benzodiazepines Anticonvulsants, particularly Carbamazepine and Valproate Antidepressants including Tricyclic, SSRI s and Trazodone SSRI s no controlled studies of effectiveness Buspirone Amantadine Beta-blockers
21 Drug Use: Challenging Behaviour Naltrexone used in self injury % reduction in self-injurious behaviour (Sandman and Hetrick, 1995) Lithium, DBPCT 73% response rate in treatment of aggression (Craft, 1987 Tyrer S, 1984) Lithuim licensed for aggression and self injurious behaviour
22 Drug Use: Challenging Behaviour Antipsychotics very widely used but evidence-base for their use is poor Brylewski and Duggan (1999), reviewed over 500 citations for antipsychotics in challenging behaviour only 3 were sound RCT s. Uncertain evidence showing that antipsychotics benefit Trend to reduce antipsychotic drugs
23 Drug Use: Challenging Behaviour NACHBID Trial, Tyrer P et al, Lancet, 2008 Risperidone, Haloperidol and placebo in the treatment of aggressive and challenging behaviour in intellectual disability: randomised controlled trial
24
25 Drug Use: Challenging Behaviour Aggression declined dramatically with all three treatments by four weeks, with placebo showing the greatest reduction (79% vs 57% for combined drugs) The mean initial daily dosage for Risperidone was 1.07mg rising to 1.78mg, and Haloperidol 2.54mg rising to 2.94mg Adherence to prescribed medication was good Exclusion factors were high What we must conclude from our data is that the routine prescription of antipsychotic drugs early in the management of aggressive challenging behaviour, even in low dosage, should no longer be regarded as a satisfactory form of care
26 Drug Use: Challenging Behaviour Placebo/Hawthorn effect Trials in people with intellectual disability often reveal considerable improvement whenever a new treatment is tried The possible reasons for this include: Increased interest in the person being investigated A change in the environment in which the person is living Increased stimulation of the staff and positive changes in the care because of novelty Consequentially the drug is continued
27 Drug Use: Challenging Behaviour Withdrawal symptoms from antipsychotics include Dysphoria Nausea Vomiting Stomach pains Dizziness Tremor These symptoms have been found in volunteers In Learning Disability may be reasons for requests to continue Need motivated and well informed family and carers
28 Drug Use: Challenging Behaviour Effects of drug withdrawal Zuclopenthixol in adults with intellectual disabilities and aggressive behaviours: discontinuation study Of 49 patients responding to the treatment 39 took part in a randomised withdrawal trial. The placebo subgroup (20) showed more aggressive behaviour as indicated on the Modified Overt Aggression Scale than the continuing subgroup (19) This indicates that discontinuation of Zuclopenthixol in this population leads to an increase in aggressive behaviour. (Haessler, F et al. 2007)
29 Drug Use: Challenging Behaviour Thioridazine withdrawal In a population of 155 patients in Bristol, 18 patients were regularly taking Thioridazine at the time of the CSM directive. Only 3 of these patients had a diagnosis of schizophrenia. All 18 patients stopped Thioridazine following the Committee on Safety of Medicines' advice 7 experienced moderate or severe difficulties in the following three months (Davies, 2002)
30 Psychotropic Drug Prescribing for People With Intellectual Disability, Mental Health and/or Behaviours That Challenge: Practice Guidelines Faculty of Intellectual Disability- April 2016
31 Standards for Prescribing Indications for use clearly stated, along with off licence, high dose Consent to treatment or Best Interests (family/carer involvement) Monitor response 3 monthly along with side effects Review need to continue 3 monthly, maximum 6 monthly
32 Recommendations All initiations of psychotropic medications in people with intellectual disability should be by competent in the care of people with learning disability Secondary care initiation Prescribing seen as wider multi-disciplinary and holistic care plan Regular review A national audit of prescribing practice Use of standards by regulators and commissioners
33 Audit Tool Standards The indication(s) and rationale for prescribing the psychotropic drug should be clearly stated, including whether the prescribing is off-label, polypharmacy or high dose Key lines of enquiry Is the prescribing part of a wider multidisciplinary care plan? Is there documentation of the indication for prescribing? (This can include the diagnoses as well as the narrative account of the target symptoms.) If the prescription is only for behaviour that challenges, are the NICE guidelines being followed? (Psychological interventions have not produced a change within an agreed time period or treatment of coexisting mental and physical conditions have not led to a reduction or risk to the person or others is very severe and drugs are offered only with psychological or other interventions.) Is there off-label prescribing? If so, is the rationale explained? Is there polypharmacy? If so, is the rationale explained? Is there prescribing over British National Formulary maximum limits? If so, is the rationale explained? Audit standard rating Consent-to-treatment procedures (or best- interests decision- making processes) should be followed and documented Is there evidence of a capacity assessment? If the patient is deemed to lack capacity, is the best- interests process followed? Is there evidence that the patient s views about the drug treatment are being recorded? Is there evidence that the carers or family members views about the drug treatment are being recorded? If patient is detained (e.g. under the Mental Health Act 1983), are the legal requirements around consent to treatment satisfied? There should be regular monitoring of treatment response and side-effects (preferably every 3 months or less, at a minimum every 6 months) Review and evaluation of the need for continuation or discontinuation of the psychotropic drug should be undertaken on a regular basis (preferably every 3 months or less, at a minimum every 6 months) or whenever there is a request from patients, carers or other professionals Is there documentation about progress on the target symptoms for treatment? Is there evidence of objective evaluation of treatment response (e.g. use of standardised instruments)? Is there evidence of objective evaluation of side-effects (e.g. use of standardised instruments)? Is there evidence of objective evaluation of treatment response (e.g. use of standardised instruments)? Is there evidence of objective evaluation of side-effects (e.g. use of standardised instruments)? Is there evidence of regular review of the need for continuation or discontinuation of the drug? (This includes discussion of risks and benefits with the patient and/or carer.)
34 Drug Use: Challenging Behaviour Is there a need for long term medication for challenging behaviour? Identify, mental and physical health factors Treat these as priority Even if now well, if a history of affective disorder try a specific treatment for this Cyclical disturbance of behaviour, try a mood stabiliser
35 Drug Use: Challenging Behaviour Might epilepsy be a contributing factor? Is the EEG abnormal? If so, try an anticonvulsant Is the patent physically aggressive? If so, try Lithium Risperidone, Olanzapine, Carbamazepine or a -blocker Are there any signs of adrenergic over activity, such as tachycardia or tremor? If so, try a -blocker Is the patient s behaviour impulsive? If so, try an SSRI Is the patent self-injurious? If so, try an antipsychotic, SSRI or Lithium
36 Summary Try in all circumstances to work out why the person disturbed is behaving in an untoward way Alter the environment whenever possible if this is thought to contribute to the problem Too many people are on psychotropic medication If drugs are prescribed, use sparingly
37 Summary Have a good indication for use and be prepared to stop Most evidence for drug use on non LD population Beware of side effects being much more likely Low starting dose and increase very slowly and be proud to stop steve.wilkinson@danshell.co.uk
Professor Tony Holland, Department of Psychiatry, University of Cambridge
INFORMATION SHEET The Use of Medication for Challenging Behaviour Professor Tony Holland, Department of Psychiatry, University of Cambridge Introduction Challenging behaviours displayed by people with
More informationMedications for Anxiety & Behavior in Williams Syndrome. Disclosure of Potential Conflicts. None 9/22/2016. Evaluation
Medications for Anxiety & Behavior in Williams Syndrome Christopher J. McDougle, M.D. Director, Lurie Center for Autism Professor of Psychiatry and Pediatrics Massachusetts General Hospital and MassGeneral
More informationProfessor Tony Holland, Department of Psychiatry, University of Cambridge
INFORMATION SHEET The Use of Medication in the Treatment of Challenging Behaviour Professor Tony Holland, Department of Psychiatry, University of Cambridge Introduction The use of medication is but one
More informationIntroduction to Drug Treatment
Introduction to Drug Treatment LPT Gondar Mental Health Group www.le.ac.uk Introduction to Psychiatric Drugs Drugs and Neurotransmitters 5 Classes of Psychotropic medications Mechanism of action Clinical
More informationESSENTIAL SHARED CAR E AGREEMENT FOR
E093 ESSENTIAL SHARED CARE AGREEMENT FOR Risperidone, Olanzapine, Quetiapine, Aripiprazole, or Amisulpride for Behavioural indications in People with Learning Disability (LD) Referral Criteria In some
More informationPRESCRIBING GUIDELINES
The Maudsley The South London and Maudsley NHS Foundation Trust & Oxleas NHS Foundation Trust PRESCRIBING GUIDELINES 10th Edition David Taylor Carol Paton Shitij Kapur informa healthcare Contents Authors
More informationESSENTIAL SHARED CARE AGREEMENT FOR Risperidone, Olanzapine, Quetiapine, Aripiprazole, or Amisulpride for Behavioural indications in DNLD
Ref No: E050 ESSENTIAL SHARED CARE AGREEMENT FOR Risperidone, Olanzapine, Quetiapine, Aripiprazole, or Amisulpride for Behavioural indications in DNLD Please complete the following details: Patient s name,
More informationPsychotropic Strategies Handout Package
Psychotropic Strategies Handout Package Psychotropic Strategies Learning Objectives Utilize all clinical information available Assess the patient s overall condition this is essential Basic Principles
More informationSiGMA/ MMHSCT GUIDELINES FOR ANTIPSYCHOTIC DRUG TREATMENT OF SCHIZOPHRENIA. [compatible with NICE guidance]
SiGMA/ MMHSCT GUIDELINES FOR ANTIPSYCHOTIC DRUG TREATMENT OF SCHIZOPHRENIA [compatible with NICE guidance] Medicines Management Committee August 2002 For review August 2003 Rationale The SiGMA algorithm
More informationDEMENTIA and BPSD in PARKINSON'S DISEASE. DR. T. JOHNSON. NOVEMBER 2017.
DEMENTIA and BPSD in PARKINSON'S DISEASE. DR. T. JOHNSON. NOVEMBER 2017. Introduction. Parkinson's disease (PD) has been considered largely as a motor disorder. It has been increasingly recognized that
More informationPregnancy. General Principles of Prescribing in Pregnancy (The Maudsley, 12 th Edition)
Pregnancy General Principles of Prescribing in Pregnancy (The Maudsley, 12 th Edition) In all women of child bearing potential Always discuss the possibility of pregnancy; half of all pregnancies are unplanned
More informationMERSEY CARE NHS TRUST HOW WE MANAGE MEDICINES. MM11 - High-Dose Antipsychotic Use Guidelines (local guideline) KEY ISSUES
MERSEY CARE NHS TRUST HOW WE MANAGE MEDICINES MM11 - High-Dose Antipsychotic Use Guidelines (local guideline) Medicines Management Services aim to ensure that (i) Service users receive their medicines
More informationDEMENTIA AND MEDICATION
DEMENTIA AND MEDICATION Dr. Siobhan Ni Bhriain, MRCP, MRCPsych. Clinical Director, Tallaght and SJH MHS, Consultant Old Age Psychiatrist, Chair, DSIDC Steering Committee. SUMMARY OF TODAY S TALK Dementia-definition,
More informationSECTION 9 : MANAGEMENT OF MOVEMENT DISORDERS AND EXTRAPYRAMIDAL SIDE EFFECTS
SECTION 9 : MANAGEMENT OF MOVEMENT DISORDERS AND EXTRAPYRAMIDAL SIDE EFFECTS Formulary and Prescribing Guidelines 9.1 Introduction Movement disorders and extrapyramidal side effects can manifest in the
More informationManaging Behavioural Problems in Patients with Learning Disabilities
Managing Behavioural Problems in Patients with Learning Disabilities Some people with a learning disability display behaviour that challenges. Although such behaviour is a challenge to services, family
More informationAntipsychotic Medications
TRAIL: Team Review of EVIDENCE REVIEW & RECOMMENDATIONS FOR LTC Behavioural and psychological symptoms of dementia (BPSD) refer to the non-cognitive symptoms of disturbed perception, thought content, mood
More informationPsychotropics in Learning Disabilities: Systematic reviews. Professor Shoumitro Deb FRCPsych, MD University of Birmingham
Psychotropics in Learning Disabilities: Systematic reviews Professor Shoumitro Deb FRCPsych, MD University of Birmingham HTA EVIDENCE CATEGORIES Type I: RCTs/ Meta analysis Type II: Other controlled studies
More informationUse of antipsychotic medication in people with a learning disability
POMH-UK Topic 9a baseline report Use of antipsychotic medication in people with a learning disability September 2009 Prepared by the Prescribing Observatory for Mental Health-UK for Coventry and Warwickshire
More informationGuidance on Consent to Treatment Documentation for Medication Patient s Detained under the Mental Health Act
Guidance on Consent to Treatment Documentation for Medication Patient s Detained under the Mental Health Act This guidance is intended for Coventry and Warwickshire Partnership Trust staff to use when
More informationPsychopharmacology. Psychopharmacology. Hamish McAllister-Williams Reader in Clinical. Department of Psychiatry, RVI
Regional Affective Disorders Service Psychopharmacology Northumberland, Tyne and Wear NHS Trust Hamish McAllister-Williams Reader in Clinical Psychopharmacology Department of Psychiatry, RVI Intro NOT
More informationDr Keith Ganasen Department of Psychiatry UCT
Dr Keith Ganasen Department of Psychiatry UCT A. Significantly subaverage intellectual functioning: an IQ of approximately 70 or below on an individually administered IQ test B. Concurrent deficits or
More informationConduct Disorder in Children and Young People (CYP 5-18 years of age) RISPERIDONE Effective Shared Care Agreement (ESCA)
E102 Conduct Disorder in Children and Young People (CYP 5-18 years of age) RISPERIDONE Effective Shared Care Agreement (ESCA) Patient details Name: Date of birth: NHS number: Contact details Specialist:
More informationDrugs used to relieve behavioural and psychological symptoms in dementia
alzheimers.org.uk Drugs used to relieve behavioural and psychological symptoms in dementia People with dementia may develop behavioural and psychological symptoms including restlessness, aggression, delusions,
More informationBorderline personality disorder: what role for medication?
Borderline personality disorder: what role for medication? Mike Crawford Imperial College London CNWL NHS Foundation Trust m.crawford@imperial.ac.uk Licensed medication for PD Jane, 34, moderately severe
More informationDocument Title Pharmacological Management of Generalised Anxiety Disorder
Document Title Pharmacological Management of Generalised Anxiety Disorder Document Description Document Type Policy Service Application Trust Wide Version 1.1 Policy Reference no. POL 201 Lead Author(s)
More informationCognitive enhancers PINCH ME. Anticholinergic burden BPSD. Agitation, Aggression and antipsychotics
Cognitive enhancers PINCH ME Anticholinergic burden BPSD Agitation, Aggression and antipsychotics 2 types Cholinesterase inhibitors licensed for mild to moderate AD Donepezil Galantamine Rivastigmine also
More informationTreatment Options for Bipolar Disorder Contents
Keeping Your Balance Treatment Options for Bipolar Disorder Contents Medication Treatment for Bipolar Disorder 2 Page Medication Record 5 Psychosocial Treatments for Bipolar Disorder 6 Module Summary 8
More informationHigh Dose Antipsychotic Therapy (HDAT) guideline
Document level: Trustwide (TW) Code: MP18 Issue number: 2 High Dose Antipsychotic Therapy (HDAT) guideline Lead executive Medical Director Author and contact number Lead Clinical Pharmacist 01625 663 857
More informationSHARED CARE GUIDELINE
SHARED CARE GUIDELINE Shared Care Guideline for the prescribing and monitoring of antipsychotics for the treatment of Neurodevelopmental Disorders in children and adolescents. Scope: Version 1 Pennine
More informationPsychotropic Medication Use in Dementia
Psychotropic Medication Use in Dementia Marie A DeWitt, MD Diplomate of the American Board of Psychiatry and Neurology, Specialization in Psychiatry & Subspecialization in Geriatric Psychiatry Staff Physician,
More informationPediatric Psychopharmacology
Pediatric Psychopharmacology General issues to consider. Pharmacokinetic differences Availability of Clinical Data Psychiatric Disorders can be common in childhood. Early intervention may prevent disorders
More informationIntroduction to psychotropic medications JAYNE CAMPBELL
Introduction to psychotropic medications JAYNE CAMPBELL Introduction Psychotropic medications are prescription drugs that are commonly used to control some symptoms associated with many different types
More informationObjectives. Epidemiology. Diagnosis 3/27/2013. Identify positive and negative symptoms used for diagnosis of schizophrenia
Objectives Identify positive and negative symptoms used for diagnosis of schizophrenia Mohamed Sallout, Pharm D. Pharmacist Resident St. Luke s Magic Valley Regional Medical Center List medications used
More informationSHARED CARE GUIDELINE
SHARED CARE GUIDELINE Title: Shared Care Guideline for the prescribing and monitoring of Antipsychotics for the treatment of Schizophrenia and psychotic symptoms in children and adolescents Scope: Pennine
More informationPrescribing medications for people with a personality disorder A service evaluation of a community mental health team
Prescribing medications for people with a personality disorder A service evaluation of a community mental health team Dr Umama Khan, Consultant Psychiatrist Dr Venkatesh Ballagere, Specialist Registrar
More informationThe Maudsley Prescribing Guidelines in
The Maudsley Prescribing Guidelines in 11th Edition David Taylor Director of Pharmacy and Pathology South London and Maudsley NHS Foundation Trust; Professor King's College London, London, UK Paton Chief
More informationTHIOTHIXENE. THERAPEUTICS Brands Navane see index for additional brand names. Generic? Yes
THIOTHIXENE THERAPEUTICS Brands Navane see index for additional brand names Generic? Yes Class Conventional antipsychotic (neuroleptic, thioxanthene, dopamine 2 antagonist) Commonly Prescribed for (bold
More informationChanges in Therapeutic Concepts. De-mystifying psychiatric drugs. Models of drug action
De-mystifying psychiatric drugs Joanna Moncrieff, UCL, NELFT, CPN, September 2012 Models of drug action Disease centred model Drug centred model Drugs correct an abnormal brain state Drugs as disease treatments
More informationBehavioral and Psychological Symptoms of dementia (BPSD)
Behavioral and Psychological Symptoms of dementia (BPSD) Chris Collins - Old Age Psychiatrist, Christchurch chris.collins@cdhb.health.nz Approaching BPSD: the right mindset Assessment Non-drug management
More informationSafe transfer of prescribing guidance
Safe transfer of prescribing guidance TEWV Prescriber Summary Application required before prescribing Products requiring an application, before prescribing, using the single application form Unlicensed
More informationPsychiatric and Behavioral Symptoms in Alzheimer s and Other Dementias. Aaron H. Kaufman, MD
Psychiatric and Behavioral Symptoms in Alzheimer s and Other Dementias Aaron H. Kaufman, MD Psychiatric and Behavioral Symptoms in Alzheimer s and Other Dementias Aaron H. Kaufman, M.D. Health Sciences
More informationChoosing and delivering ering interventions entions for
Choosing and delivering ering interventions entions for psychosis and schizophrenia in adults bring together everything NICE says on a topic in an interactive flowchart. are interactive and designed to
More informationNew Medications in Early Psychosis
New Medications in Early Psychosis Jean Starling Department of Psychological Medicine, the Children s Hospital at Westmead Department of Psychological Medicine and Department of Paediatrics and Child Health,
More informationPharmacological Treatment of Behavioural and Psychological Symptoms of Dementia (BPSD) Gurdeep K Major St. Charles Hospital
Pharmacological Treatment of Behavioural and Psychological Symptoms of Dementia (BPSD) Gurdeep K Major St. Charles Hospital with thanks to Jonathan Cavan for his input Aims Define BPSD and common symptoms
More informationThe Deprescribing of Psychotropic Medication in Service Users (Patients) with Learning Disability
The Deprescribing of Psychotropic Medication in Service Users (Patients) with Learning Disability Danielle Adams Principal Clinical Pharmacist Pharmacy and Medicines Optimisation Team HPFT July 2017 1
More informationMental Health Pathway
Mental Health Pathway Triggers for Mental Health Pathway Information for professionals Consider mainstream Mental Health Services (Green light Toolkit) Clinical Interface Protocol Clinical Assessment Information
More informationToo Many Meds? How to Prevent Polypharmacy in People with Intellectual/Developmental Disabilities
Too Many Meds? How to Prevent Polypharmacy in People with Intellectual/Developmental Disabilities One definition of polypharmacy is using more medications than is medically necessary. However, it can be
More informationPORT, 2009 Spain, 2009 Malaysia, 2009 Singapore, 2009 BAP, 2011 WFSBP, 2012 SIGN, 2013 Harvard NICE RANZCP, 2016
Appendix 3. Comparison of recommendations from clinical practice guidelines. Data extracted in relation to key health questions that are relevant to a clinician adopting an algorithmic approach to the
More informationResubmission. Scottish Medicines Consortium
Scottish Medicines Consortium Resubmission aripiprazole 5mg, 10mg, 15mg, 0mg tablets; 10mg, 15mg orodispersible tablets; 1mg/mL oral solution (Abilify ) No. (498/08) Bristol-Myers Squibb Pharmaceuticals
More informationThe treatment of bipolar disorder in adults, children and adolescents
DRAFT FOR CONSULTATION The treatment of bipolar disorder in adults, children and adolescents The paragraphs in the draft are numbered for the purposes of consultation. The final version will not contain
More informationPreferred Prescribing Choices of Antipsychotic Drugs (APD) in Adults for Schizophrenia and Other Psychoses
Preferred Prescribing Choices of Antipsychotic Drugs (APD) in Adults for Schizophrenia and Other Psychoses HPFT Medicines Formulary lists the APDs that have been approved for use, however, it does not
More informationPsychosis and Agitation in Dementia
Psychosis and Agitation in Dementia Dilip V. Jeste, MD Estelle & Edgar Levi Chair in Aging, Director, Stein Institute for Research on Aging, Distinguished Professor of Psychiatry & Neurosciences, University
More informationFormulary and Clinical Guideline Document Pharmacy Department Medicines Management Services
Formulary and Clinical Guideline Document Pharmacy Department Medicines Management Services DRIVING AND MENTAL HEALTH CONDITIONS AND TREATMENTS General information Driving while impaired by a physical
More informationMental illness A Broad Overview. Dr H Pathmanandam March 2017
Mental illness A Broad Overview Dr H Pathmanandam March 2017 Introduction Mental disorders are common in primary and secondary care Many are not recognised and not treated Some receive unnecessary or inappropriate
More informationThings You Might Not Know About Psychotropic Medications But Wish You Did
Things You Might Not Know About Psychotropic Medications But Wish You Did John E. Dunne, MD December 3, 2016 PAL Conference Conflicts of Interest None to report I am employed by Seattle Children s and
More informationOptimal Management of Challenging Behaviours in Dementia: An Update on Pharmacologic and Non-Pharmacologic Approaches
Optimal Management of Challenging Behaviours in Dementia: An Update on Pharmacologic and Non-Pharmacologic Approaches Andrea Iaboni, MD, DPhil, FRCPC Toronto Rehab Institute, UHN Learning objectives Recognize
More informationFormulary and Prescribing Guidelines
Formulary and Prescribing Guidelines SECTION 3: TREATMENT OF BIPOLAR AFFECTIVE DISORDER This section provides information regarding the pharmacological management of Bipolar affective disorder in secondary
More informationAntidepressants: Prof. Riyadh Al_Azzawi F.R.C.Psych
Antidepressants: Prof. Riyadh Al_Azzawi F.R.C.Psych A. Heterocyclic antidepressants: (tricyclic and tetracyclic ), e.g.amitryptaline,imipramine. B. Monoamine oxidase inhibitors(m.a.o.i), e.g.phenelzine.
More informationSwitching antipsychotics: Basing practice on pharmacology & pharmacokinetics
Switching antipsychotics: Basing practice on pharmacology & pharmacokinetics John Donoghue Liverpool L imagination est plus important que le savoir Albert Einstein Switching Antipsychotics: Objectives
More informationT2/T3/S62/CT012 Aide Memoire
Correct way to fill out MHA forms T2/T3/S62/CTO12 SH CP 224 T2/T3/S62/CT012 Aide Memoire Version: 2 Summary: An Aide Memoire to completing or requesting a T2/T3/S62/CT012 Keywords: Target Audience: T2,
More informationRelationship Between Mental Health Problems and Challenging Behaviour in People with Intellectual Disabilities
Relationship Between Mental Health Problems and Challenging Behaviour in People with Intellectual Disabilities Dr Vikram Palanisamy MD Psych, Dip in Clinical Psych, MRC Psych CCT in Intellectual Disability
More information4/2/13 COMMON CLASSES OF MEDICATIONS. Child & Adolescent Behavioral Medicine & Medication Therapies. Behavioral Medicine & Medication Therapies
Child & Adolescent Behavioral Medicine & Medication Therapies Brian J Cowles, PharmD Associate Professor of Pharmacy Practice Albany College of Pharmacy & Health Sciences; Vermont Campus Behavioral Medicine
More informationS H A R E D P R E S C R I B I N G G U I D E L I N E
S H A R E D P R E S C R I B I N G G U I D E L I N E Introduction This shared prescribing guideline for the second generation antipsychotic medications listed above has been developed with due consideration
More informationGREATER MANCHESTER INTERFACE PRESCRIBING GROUP
GREATER MANCHESTER INTERFACE PRESCRIBING GROUP On behalf of the GREATER MANCHESTER MEDICINES MANAGEMENT GROUP SHARED CARE GUIDELINE FOR THE PRESCRIBING OF SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)
More informationPrescribing antipsychotics for children and adolescents
POMH-UK Topic 10a baseline report Prescribing antipsychotics for children and adolescents September 2010 Prepared by the Prescribing Observatory for Mental Health-UK for Coventry and Warwickshire Partnership
More informationDosing & Administration
Dosing & Administration REAL LIFE. REAL RESULTS. INDICATION INVEGA SUSTENNA (paliperidone palmitate) is indicated for the treatment of: Schizophrenia. Schizoaffective disorder as monotherapy and as an
More informationPromoting and Monitoring Evidenced-Based Antipsychotic Prescribing Practices in Children and Adolescents: Florida Medicaid Initiatives
Promoting and Monitoring Evidenced-Based Antipsychotic Prescribing Practices in Children and Adolescents: Florida Medicaid Initiatives Mary Elizabeth Jones, Pharm BSc, RPh Senior Pharmacist AHCA Pharmacy
More informationasenapine 5mg, 10mg sublingual tablet (Sycrest ) SMC No. (762/12) Lundbeck Ltd
asenapine 5mg, 10mg sublingual tablet (Sycrest ) SMC No. (762/12) Lundbeck Ltd 10 February 2012 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS
More informationESSENTIAL SHARED CARE AGREEMENT FOR Risperidone, Olanzapine, Quetiapine, Aripiprazole, Amisulpride (South Staffordshire Only)
E099 ESSENTIAL SHARED CARE AGREEMENT FOR Risperidone, Olanzapine, Quetiapine, Aripiprazole, Amisulpride (South Staffordshire Only) NOTE: Please complete details on P1 &3 Send one copy to GP, Patient and
More informationMentoring Session: Participant Cases
Handout for the Neuroscience Education Institute (NEI) online activity: Mentoring Session: Participant Cases The Case: 55-year-old patient with depression and anxiety The Question: What to do when antidepressants
More informationPharmacological Treatment of Anxiety & Depressive Disorders
Pharmacological Treatment of Anxiety & Depressive Disorders Dr Gary Jackson (MB BCh FRCPsych) Consultant Psychiatrist The Priory Hospital Chelmsford Wellesley Hospital Southend-on-Sea Medical Secretary:
More informationDepression in adults: treatment and management
1 2 3 4 Depression in adults: treatment and management 5 6 7 8 Appendix V3: recommendations that have been deleted of changed from 2009 guideline Depression in adults: Appendix V3 1 of 22 1 Recommendations
More informationUse of Anti-Psychotic Agents in Irish Long Term Care Residents with Dementia
Use of Anti-Psychotic Agents in Irish Long Term Care Residents with Dementia Aine Leen, Kieran Walsh, David O Sullivan, Denis O Mahony, Stephen Byrne, Margaret Bermingham Pharmaceutical Care Research Group,
More informationMEDICATIONS IN MANAGING DIFFICULT BEHAVIORS
MEDICATIONS IN MANAGING DIFFICULT BEHAVIORS A REALITY CHECK reality check Noun informal an occasion on which one is reminded of the state of things in the real world. ROBERT LACOSTE, MD MEDICAL DIRECTOR,
More informationA systematic review of atypical antipsychotic drugs in schizophrenia. Atypical antipsychotic drugs in schizophrenia
A systematic review of atypical antipsychotic drugs in schizophrenia Atypical antipsychotic drugs in schizophrenia A-M Bagnall 1 * S Gilbody 3 L Jones 1 L Davies 4 L Ginnelly 2 D Torgerson 2 R Lewis 1
More informationMental Health Medicines Management Pilot. Community Pharmacy. High Dose Antipsychotic Screening, Education & Advice Service
Mental Health Medicines Management Pilot Community Pharmacy High Dose Antipsychotic Screening, Education & Advice Service Approved Version 1 Date of First Issue Review Date Date of Issue Author / Contact
More informationPERPHENAZINE. THERAPEUTICS Brands Trilafon see index for additional brand names. Generic? Yes
PERPHENAZINE THERAPEUTICS Brands Trilafon see index for additional brand names Generic? Yes Class Neuroscience-based Nomenclature: dopamine receptor antagonist (D-RAn) Conventional antipsychotic (neuroleptic,
More informationFormulary and Clinical Guideline Document Pharmacy Department Medicines Management Services
Formulary and Clinical Guideline Document Pharmacy Department Medicines Management Services VIOLENCE, AGGRESSION OR SEVERE BEHAVIOURAL DISTURBANCE Introduction During an acute episode or illness, some
More informationPiecing the Puzzle Together: Pharmacologic Approaches to Behavioral Management in Autism Spectrum Disorder
Piecing the Puzzle Together: Pharmacologic Approaches to Behavioral Management in Autism Spectrum Disorder Hannah Sauer, PharmD PGY1 Pediatric Pharmacy Resident Mayo Clinic 2015 MFMER slide-1 Objectives
More informationPATIENT INFORMATION LEAFLET ZOXADON TABLETS RANGE
SCHEDULING STATUS: S5 PROPRIETARY NAME, STRENGTH AND PHARMACEUTICAL FORM: ZOXADON 0,5 mg: Each tablet contains 0,5 mg risperidone. ZOXADON 1 mg: Each tablet contains 1 mg risperidone. ZOXADON 2 mg: Each
More informationPSYCHOTROPIC SOLUTIONS
PSYCHOTROPIC SOLUTIONS A proactive approach to antipsychotic medication management A Quality Use of Medicines initiative by Choice Aged Care Copyright 2018 Key Senate Committee Recommendations: All RACF
More informationHearts and Minds An ECG Update. Tuesday 18 th November The Met Hotel, Leeds
Hearts and Minds An ECG Update Tuesday 18 th November The Met Hotel, Leeds Ashleigh Bradley Specialist Clinical Pharmacist for Mental Health and Lithium Clinic Airedale NHS Foundation Trust Introduction
More informationPsychiatric Illness. In the medical arena psychiatry is a fairly recent field A challenging field Numerous diagnosis
Psychiatric Illness In the medical arena psychiatry is a fairly recent field A challenging field Numerous diagnosis 12,000,000 children infants through 18 y/o nation wide 5,000,000 suffer severely Serious
More informationPerinatal Mental Health: Prescribing Guidance for Trust Prescribers and GPs
Perinatal Mental Health: Prescribing Guidance for Trust Prescribers and GPs (Version 3 January 2015) Principal Author: Dr Jenny Cooke Consultant Psychiatrist, Brighton & Hove Perinatal Mental Health Service
More informationDRUG THERAPY CHOICES FOR THE DEMENTED PATIENT Past, Present and Future
DRUG THERAPY CHOICES FOR THE DEMENTED PATIENT Past, Present and Future Daniel S. Sitar Professor Emeritus University of Manitoba Email: Daniel.Sitar@umanitoba.ca March 6, 2018 INTRODUCTION EPIDEMIOLOGY
More information-Guidelines for the discontinuation of oral antipsychotics in patients with BPSD within the primary care setting Summary- Quetiapine
-Guidelines for the discontinuation of oral antipsychotics in patients with BPSD within the primary care setting Summary- Quetiapine An independent report Time for action 1 by Professor Sube Banerjee looked
More informationAlison Charleston 1 st September 2016
Alison Charleston 1 st September 2016 Clinical features of Parkinson s disease Differential diagnosis Management of the motor features Non-motor and neuropsychiatric aspects 100-200 per 100,000 prevalence
More informationAlpha-2 Agonists. Antipsychotics
Table 5: Randomized Controlled Trials of Psychotropic Medications in Children and Adolescents with ASD Agent Study Target Symptoms Dose Demographics Significant Side Clonidine Guanfacine Jaselskis et al.,
More informationGuidelines MANAGEMENT OF MAJOR DEPRESSIVE DISORDER (MDD)
MANAGEMENT OF MAJOR DEPRESSIVE DISORDER (MDD) Guidelines CH Lim, B Baizury, on behalf of Development Group Clinical Practice Guidelines Management of Major Depressive Disorder A. Introduction Major depressive
More informationAn Overview on the Use of Psychotropic Medications
An Overview on the Use of Psychotropic Medications Marilyn B. Benoit, M.D. Chief Clinical Officer SVP, Clinical & Professional Affairs Classes of Medications Antidepressants Anti-anxiety Mood stabilizers
More informationSHARED CARE GUIDELINE FOR THE MANAGEMENT OF PATIENTS ON NALTREXONE FOR OPIOID DEPENDENCE
SHARED CARE GUIDELINE FOR THE MANAGEMENT OF PATIENTS ON NALTREXONE FOR OPIOID DEPENDENCE INDICATION Naltrexone is a pure opiate antagonist licensed as an adjunctive prophylactic therapy in the maintenance
More information6/22/2012. Co-morbidity - when two or more conditions occur together. The two conditions may or may not be causally related.
Autism Spectrum Disorders and Co-existing Mental Health Issues By Dr. Karen Berkman Objective To present an overview of common psychiatric conditions that occur in persons with autism spectrum disorders
More informationCommunity Pharmacy Dementia Audit
Community Pharmacy Dementia Audit Introduction To comply with the NHS contractual requirements associated with the Clinical Governance Essential Service, pharmacy contractors must perform an annual practice
More informationFrom MCI to Dementia DR YU- MIN LIN GERIATRICIAN AUG 2018
From MCI to Dementia DR YU- MIN LIN GERIATRICIAN AUG 2018 Overview What is dementia? Common causes Normal cognitive decline Abnormal decline and mild cognitive impairment How do we manage dementia Can
More informationDr. Ken Courtenay FRCPsych MRCGP Consultant Psychiatrist in Intellectual Disability. London UK
Dr. Ken Courtenay FRCPsych MRCGP (k.courtenay@ucl.ac.uk) Consultant Psychiatrist in Intellectual Disability London UK EAMHID Zagreb 27.4.2018 Overuse of Medication in People with ID Clinical Background
More informationPSYCHOTROPIC SOLUTIONS
PSYCHOTROPIC SOLUTIONS A proactive approach to antipsychotic medication management A Quality Use of Medicines initiative by Choice Aged Care Copyright 2018 Hello everyone. Today we will be discussing the
More informationSHARED CARE GUIDELINE FOR THE MANAGEMENT OF PATIENTS ON NALTREXONE FOR ALCOHOL DEPENDENCE INDICATION
SHARED CARE GUIDELINE FOR THE MANAGEMENT OF PATIENTS ON NALTREXONE FOR ALCOHOL DEPENDENCE INDICATION Naltrexone is used as part of a comprehensive programme of treatment against alcoholism to reduce the
More informationAnti-Depressant Medications
Anti-Depressant Medications A Introduction: This topic may be a little bit underestimated here in Jordan, while in western countries it has more significance. The function of anti-depressants is to change
More information