Guidelines in the Treatment of Major Depressive Disorder
|
|
- Warren McCormick
- 6 years ago
- Views:
Transcription
1 Guidelines in the Treatment of Major Depressive Disorder ational Center for Mental Health ueve de Febrero St., Mandaluyong City Telephone o.: Website:
2 ational Center for Mental Health ueve de Febrero St., Mandaluyong City Telephone o.: Website: Organizational Structure OIC, Medical Center Chief II Chief, Medical and Professional Staff (Hospital Service) Chief, Medical and Professional Staff (Community Service) Treatment Protocol Committee Beverly A. Azucena, MD, DPBP, FPPA, MMHoA Beverly A. Azucena, MD, DPBP, FPPA, MMHoA Venus S. Arain, MD, DPBP, FPPA (Life), MHA Bernard B. Argamosa, MD, DSBPP Agnes Joy L. Casiño, MD Joeffrey D. Cruzada, MD, DPBP, FPPA Teresa Rosalie D. Del Valle, MD, DPBP, FPPA, MMHoA Victor C. Vinluan Jr., MD, DPBP, FPPA (Life), MHA l Sign up and open your clinic to the world. 77
3 Algorithm for Major Depressive Disorder 1 Major Depressive Disorder 2 Patient's History (Physical exam, neurological exam, mental status exam, laboratory exam) 3 Does the patient satisfy the DSM 5/ ICD 10 for MDD? 4 Manage patient 5 Is hospitalization indicated? 6 Patient for admission 7 8 Perform alternative diagnosis Out-patient / ER Go to B 9 Management Pharmacotherapy Anti-depressant (Table 2) Antipsychotics (Table 1) Benzodiazepines on-pharmacotherapy Go to A Figure 1 78
4 1 Re-assessment (2-4 weeks) A Mental and physical status Management of adverse/side effects of antipsychotic/antidepressants 2 3 Is patient showing improvement? Continue treatment accordingly 4 Increase dosage of antidepressants 5 6 Is response to treatment adequate after 2 months? Continue treatment accordingly 7 Shift to other class of antidepressants Is response good? Patient continue treatment regime & regular checkup Is response to treatment adequate? Continue treatment accordingly Combination of two antidepressants Patient for admission Go to B Figure 2 l Sign up and open your clinic to the world. 79
5 B 1 4 Patient admitted 3 Is patient manifesting signs & symptoms of psychosis and warrants admission Out-patient 2 MAAGEMET: Pharmacotherapy - see Table 1 & Table 2 With psychosis Rapid neuroleptization olanzapine, risperidone, haloperidol orodispersible tablet or IM inj * closely monitor vital signs Antipsychotics Antidepressants Benzodiazepines Without psychosis Antidepressants Benzodiazepines on-pharmcotherapy 5 Is there a good response? 6 Re-assess 3-14 days Mental & physical status Manage adverse/side effects of medication 7 Refer to mental health facility for possible ECT 8 Does the condition improved during short-term hospitalization? 9 Discharge Continue medication Follow up within 2 weeks 10 Continue treatment in hospital setting until patient improves 80
6 Guidelines in the Treatment of Major Depressive Disorder I. Definition Major Depressive Disorder (MDD) is characterized by a major depressive episode lasting for at least two weeks, without a history of manic, mixed or hypomanic episode. It leads to a significant disruption in one's important areas of functioning such as social/occupational/academic, interpersonal and selfcare. It goes beyond the normal feelings of sadness or grief, with symptoms ranging from appetite and weight changes, sleep disruption, lack of energy, guilt feelings and recurring suicide ideations. MDD carries an extended impact in the society as a whole. The diagnosis of a major depressive disorder requires careful and insightful understanding of the disease process, using mental status evaluations as guided by the American Psychiatric Association's (APA) Diagnostic and Statistical Manual (DSM 5). Although several laboratory examinations are used in patient with depression, these are only done to have a baseline data and that there is no laboratory/ancillary procedure that would definitely point to such a diagnosis. It is important to monitor the treatment course of an individual with MDD, including possible drug interactions and adverse events, because such findings can lead to poor compliance and treatment outcome. II. Epidemiology Among the mood disorders, MDD has the highest lifetime prevalence of almost 17% among psychiatric disorders. Across countries and cultures, there is a twofold greater prevalence of MDD in women than in men which can be explained by a multiplicity of factors such as hormonal differences, effects of childbirth and different psychosocial stressors. The mean age of onset for MDD is about 40 years old, with more than half having an onset between 20 to 50 years old. There is an increased risk of occurrence in individuals without close interpersonal relationships, divorced or separated and can occur with other psychiatric disorders such as substance abuse and anxiety disorders. III. Etiology a. Genetic Factors: umerous studies involving families, adoption and twin studies have long established the genetic basis for mood disorders. The risk of developing a mood disorder ranges from 10-25% for one parent with a disorder, with the risk doubling for both parents afflicted. MDD is the most common form of mood disorder among families with bipolar probands. Major Depressive Disorder b. Biochemical Factors: The involvement of several neurotransmitters, particularly the monoamines (norepinephrine, dopamine, serotonin and histamine), have long been the center of researches regarding major depression. Pharmacologic interventions all aim to target the prominent dysfunctions in these neurotransmitter system. Of the biogenic amines, norepinephrine and serotonin have been implicated the most in the pathophysiology of depression. Other neurotransmitter disturbances include the Acetylcholine, Gamma Amino Butyric Acid (GABA), glutamate and glycine systems which are postulated to have an effect in the evolution of depression. c. europathology: The advent of non-invasive modalities such as Computed axial tomography (CAT) and Magnetic Resonance Imaging have demonstrated an increased frequency of abnormal hyperintensities in sobcortical regions of the the brain. Ventricular enlargement, cortical atrophy and sulcal widening have also been reported. Positron Emission tomography (PET) finding in depression is decreased anterior brain metabolism, more pronounced on the left side. d. Psychosocial and Psychodynamic Factors: It is strongly believed that stressful life events precede first, rather than subsequent, episodes of mood disorders. The most compelling data indicate that the life event most often associated with the development of depression is losing a parent before age 11 and the environmental stressor most often associated with the onset of depression is the loss of a spouse, followed by unemployment and excessive guilt. The psychodynamic theme involving depression is known as the classic view of depression which involves 4 key points: a. disturbances in the infant and mother relationship during the first 18 mos of life predisposes one to vulnerability to depression; b. depression can be linked to a real or imagined object loss; c. introjections as a defense mechanism; d. because the love object is regarded with ambivalence, feelings of anger are directed towards the self. IV. Signs and Symptoms People with depressive illnesses do not all experience the same symptoms. The severity, frequency, and duration of symptoms vary depending on the individual and his or her particular illness. Although depression may occur only one time during your life, usually people have multiple episodes of depression. During these episodes, symptoms occur most of the day, nearly every day. l Sign up and open your clinic to the world. 81
7 DSM 5: An individual diagnosed with major depressive disorder needs to meet all of the following criteria: Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. ote: Do not include symptoms that are clearly attributable to another medical condition. o Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (ote: In children and adolescents, can be irritable mood.) o Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation). o Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly everyday. (ote: In children, consider failure to make expected weight gain.) o Insomnia or hypersomnia nearly every day. o Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down). o Fatigue or loss of energy nearly every day. o Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick). o Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others. o Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. B. The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning. C. The episode is not attributable to the physiological effects of a substance or to another medical condition. D. The occurrence of the major depressive episode is not better explained by schizo-affective, schizophrenia, schizophreniform, delusional disorder or other specified and unspecified schizophrenia spectrum and other psychotic disorders. E. There has never been a manic or a hypomanic episode. Specify if: With anxious distress With mixed features With melancholic features With atypical features With mood-congruent psychotic features With mood-incongruent psychotic features With catatonia With peripartum onset With seasonal pattern V. Management The management of patients with MDD involves a holistic approach which integrates a bio-psychosocial framework. The treatment plan involves two general phases: A. Acute Phase This phase constitutes the first 3 to 6 months of treatment with the general goal of controlling the depressive and psychotic symptoms, if present. Table 1A: Convention/typical antipsychotics Acute dose Maintenance dose Haloperidol Chlorpromazine Table 1B: Atypical antipsychotics Acute dose Maintenance dose Risperidone Olanzapine Clozapine Quetiapine Amisulpride Aripiprazole Table 2: Mood stabilizers Acute dose Maintenance dose Lamotrigine Week 1 & 2: 25 mg PO mg/day in 24 hrly divided doses Week 3 & 4: 50 mg PO 24 hrly Week 5: 100 mg PO 24 hrly or divided doses Lithium carbonate 400 mg - 2 g PO in divided doses for 1 st 5-7 days 1.2 g PO 6-8 hrly Carbamazepine 400 mg/day in divided mg/day PO doses in divided doses Max dose: 1600 mg/day Valproic acid mg/day mg/day (valproate, Max dose: 2.5 g/day Max dose: 3000 sodium valproate) mg/day Valproate 750 mg/day mg/day semisodium Max dose: 60 mg/kg/day (divalproex a) 82
8 This can be done in an out-patient or in-patient setting, if warranted. Hospitalization maybe indicated if the patient is potentially and/or imminently destructive to self and others, lack or absence of satisfactory family support, in severe crises and in patients with diagnostic dilemma. B. Maintenance Phase: This phase involves the next 3-6 months after the acute phase with the prevention of recurrences as the greatest challenge of every clinician. This phase also involves the steady re-integration of the patient to the society and return to premorbid functioning. 1. Pharmacotherapy Selective serotonin reuptake inhibitors (SSRI) Serotonin norephinephrine reuptake inhibitors (SRI) Antipsychotics Benzodiazepines 2. on Pharmacological Behavior therapy Cognitive-behavioral therapy (CBT) Family therapy Group psychotherapy Interpersonal psychotherapy Interpersonal therapy Psychodynamic psychotherapy Supportive psychotherapy 3. Combination of medications and psychotherapy 4. Complementary and alternative therapy l Sign up and open your clinic to the world. 83
9 Index of Drugs Related to the Guideline This index lists the products of interest and/or their therapeutic classifications related to the guideline. This index is not part of the guideline. For the doctor's convenience, brands available in the PPD references are listed under each of the classes. For drug information, refer to the PPD references (PPD, PPD Pocket Version, PPD Tabs, and www. TheFilipinoDoctor.com). ATIPSCHOTICS Atypical Antipsychotics Asenapine Saphris Aripiprazole Abdin Abilify Clozapine Clopax Clopixene Leponex irva Olanzapine Epilanz-10 Olavex 5/Olavex 10 Olazin Olzadin Zyprexa Zyprexa Zydis Paliperidone Invega Invega Sustenna Quetiapine Quekline Queppin Seroquel Seroquel XR Risperidone Renuvie Residon Respixl Riscare Risdin Risperdal Risperdal Consta Risperdal Quicklet Zysda Benzamides Amisulpride Amiabel Solian Butyrophenones Haloperidol Haldol Haldol Decanoas Serenace Zuredel Phenothiazines Fluphenazine Sydepres Chlorpromazine Zycloran Thioxanthenes Flupentixol Fluanxol Fluanxol Depot Other Antipsychotics Lithium carbonate Litcab Quilonium - R ATIDEPRESSATS Selective Serotonin Reuptake Inhibitors (SSRIs) Fluoxetine Adep Drafzin Motivest Prodinl Sertraline Deperin Exulten Zolodin Zoloft Escitalopram Escinal Escivex 5/Escivex 10 Jovia Lexapro Mentumir Zescita Dapoxetine Priligy Paroxetine Seroxat orepinephrine- Reuptake Inhibitors Duloxetine Cymbalta Benzodiazepines Midazolam Midazolex Sedacum Clorazepate Tranxene Anticonvulsants Carbamazepine Carbilepp Tegretol Zynaps Divalproex Depakote ER / Depakote Sprinkle Epival Zystal Lamotrigine Lamictal Motrigine Zyglia Valproic acid Depacon Depakene Syrup Valpros 84
Bipolar Disorder. Guidelines in the Treatment of. National Center for Mental Health
Guidelines in the Treatment of Bipolar Disorder ational Center for Mental Health ueve de Febrero St., Mandaluyong City Telephone o.: 53-900 Website: http://www.ncmh.gov.ph ational Center for Mental Health
More informationAdult Depression - Clinical Practice Guideline
1 Adult Depression - Clinical Practice Guideline 05/2018 Diagnosis and Screening Diagnostic criteria o Please refer to Attachment A Screening o The United States Preventative Services Task Force (USPSTF)
More informationDepression. University of Illinois at Chicago College of Nursing
Depression University of Illinois at Chicago College of Nursing 1 Learning Objectives Upon completion of this session, participants will be better able to: 1. Recognize depression, its symptoms and behaviors
More informationMeasure #106 (NQF 0103): Adult Major Depressive Disorder (MDD): Comprehensive Depression Evaluation: Diagnosis and Severity
Measure #106 (NQF 0103): Adult Major Depressive Disorder (MDD): Comprehensive Depression Evaluation: Diagnosis and Severity 2014 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY DESCRIPTION: Percentage
More informationBipolar Disorder 4/6/2014. Bipolar Disorder. Symptoms of Depression. Mania. Depression
Bipolar Disorder J. H. Atkinson, M.D. Professor of Psychiatry HIV Neurobehavioral Research Programs University of California, San Diego KETHEA, Athens Slides courtesy of John Kelsoe, M.D. Bipolar Disorder
More informationAre All Older Adults Depressed? Common Mental Health Disorders in Older Adults
Are All Older Adults Depressed? Common Mental Health Disorders in Older Adults Cherie Simpson, PhD, APRN, CNS-BC Myth vs Fact All old people get depressed. Depression in late life is more enduring and
More informationJudges Reference Table for the March 2016 Psychotropic Medication Utilization Parameters for Foster Children
Judges Reference Table for the Psychotropic Medication Utilization Parameters for Foster Children Stimulants for treatment of ADHD Preschool (Ages 3-5 years) Child (Ages 6-12 years) Adolescent (Ages 13-17
More informationReview of Psychotrophic Medications. (An approved North Carolina Division of Health Services Regulation Continuing Education Course)
Review of Psychotrophic Medications (An approved North Carolina Division of Health Services Regulation Continuing Education Course) Common Psychiatric Disorders *Schizophrenia *Depression *Bipolar Disorder
More informationA Brief Overview of Psychiatric Pharmacotherapy. Joel V. Oberstar, M.D. Chief Executive Officer
A Brief Overview of Psychiatric Pharmacotherapy Joel V. Oberstar, M.D. Chief Executive Officer Disclosures Some medications discussed are not approved by the FDA for use in the population discussed/described.
More informationDSM5: How to Understand It and How to Help
DSM5: How to Understand It and How to Help Introduction: The DSM5 is a foreign language! Three Questions: I. The first was, What the key assumptions made to determine the organization of the DSM5? A. Mental
More informationHealthyPlace s Introductory Guide to Bipolar Disorder. By Natasha Tracy
HealthyPlace s Introductory Guide to Bipolar Disorder By Natasha Tracy 1 Index Introduction Chapter One Bipolar Disorder Basics Chapter Two Bipolar Disorder Diagnosis Chapter Three Treatment of Bipolar
More informationDepression major depressive disorder. Some terms: Major Depressive Disorder: Major Depressive Disorder:
Depression major depressive disorder Oldest recognized disorder: melancholia It is a positive and active anguish, a sort of psychical neuralgia wholly unknown to normal life. - William James "I am now
More informationOffice Practice Coding Assistance - Overview
Office Practice Coding Assistance - Overview Three office coding assistance resources are provided in the STABLE Resource Toolkit. Depression & Bipolar Coding Reference: n Provides ICD9CM and DSM-IV-TR
More informationTreat mood, cognition, and behavioral disturbances associated with psychological disorders. Most are not used recreationally or abused
Psychiatric Drugs Psychiatric Drugs Treat mood, cognition, and behavioral disturbances associated with psychological disorders Psychotropic in nature Most are not used recreationally or abused Benzodiazepines
More informationYour journal: how can it help you?
Journal Your journal: how can it help you? By monitoring your mood along with other symptoms like sleep, you and your treatment team will be better able to follow the evolution of your symptoms and therefore
More informationRunning head: DEPRESSIVE DISORDERS 1
Running head: DEPRESSIVE DISORDERS 1 Depressive Disorders: DSM-5 Name: Institution: DEPRESSIVE DISORDERS 2 Abstract The 2013 update to DSM-5 saw revisions of the psychiatric nomenclature, diagnostic criteria,
More informationDepressive and Bipolar Disorders
Depressive and Bipolar Disorders Symptoms Associated with Depressive and Bipolar Disorders Characteristics of mood symptoms Affects a person s well being, school, work, or social functioning Continues
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 informationPSYCHIATRIC DRUGS. Mr. D.Raju, M.pharm, Lecturer
PSYCHIATRIC DRUGS Mr. D.Raju, M.pharm, Lecturer PSYCHIATRIC DRUGS Treat mood, cognition, and behavioral disturbances associated with psychological disorders Psychotropic in nature Most are not used recreationally
More informationPSYCH 235 Introduction to Abnormal Psychology. Agenda/Overview. Mood Disorders. Chapter 11 Mood/Bipolar and Related disorders & Suicide
PSYCH 235 Introduction to Abnormal Psychology Chapter 11 Mood/Bipolar and Related disorders & Suicide 1 Agenda/Overview Mood disorders Major depression Persistent Depressive Disorder (Dysthymia) Bipolar
More informationClass: Treatment with Medication:
Class: As we have not finished all the material covering disorders, I wanted to give you and overview of some disorders we have not had a chance to discuss. I feel you are well prepared in different types
More informationPsychiatric Medication Guide
Psychiatric Medication Guide F O R : N E O N P R I M A R Y H E A L T H C A R E P R O V I D E R S B Y : M I C H E L L E R O M E R O, D O M A Y, 2 0 1 3 Anti-depressants TCA s & MAOI s (Tricyclic Antidepressants
More informationClinical Guideline for the Management of Bipolar Disorder in Adults
Clinical Guideline for the Management of Bipolar Disorder in Adults Goal: To improve the quality of life of adults with bipolar disorder Identification and Treatment of Bipolar Disorder Criteria for Diagnosis:
More informationDepression Workshop 26 January 2007
Depression Workshop 26 January 2007 Leslie G Walker Professor of Cancer Rehabilitation Donald M Sharp Senior Lecturer in Behavioural Oncology Mary B Walker Senior Clinical and Research Nurse Specialist
More informationBipolar Disorder Clinical Practice Guideline Summary for Primary Care
Bipolar Disorder Clinical Practice Guideline Summary for Primary Care DIAGNOSIS AND CLINICAL ASSESSMENT Bipolar Disorder is categorized by extreme mood cycling; manifested by periods of euphoria, grandiosity,
More informationChild & Adolescent Psychiatry (a brief overview)
Child & Adolescent Psychiatry (a brief overview) Lance Feldman, MD, FAPA, MBA, BSN Vice Chair Clinical Affairs, Department of Psychiatry Affiliate Clinical Assistant Professor, University of South Carolina
More informationMedications and Children Disorders
Mental Health Comprehensive Services Providing Family Stability and Developing Life Coping Skills Medications and Children Disorders Psychiatric medications can be an effective part of the treatment for
More informationMental Illness. Doreen L. Rasp, APN, FNP, PMHNP Advanced Behavioral Counseling
Mental Illness Doreen L. Rasp, APN, FNP, PMHNP Advanced Behavioral Counseling Moodiness Changing Bodies Narcissism Self-Esteem Ignorant Naïve Insecure Self-Centered Independent Adolescence Disorders Affecting
More informationDepression: Assessment and Treatment For Older Adults
Tool on Depression: Assessment and Treatment For Older Adults Based on: National Guidelines for Seniors Mental Health: the Assessment and Treatment of Depression Available on line: www.ccsmh.ca www.nicenet.ca
More informationCriteria for Child Psychiatrist on the Use of Selected Psychotropic Medications in Children & Adolescents
Criteria for Child Psychiatrist on the Use of Selected Psychotropic Medications in Children & Adolescents DRUG NAME INDICATIONS / ACCEPTABLE USES PRIOR STIMULANT/ADHD DRUGS Daytrana (methylphenidate) ADHD
More informationMood Disorders.
Mood Disorders Shamim Nejad, MD Medical Director, Psycho-Oncology Services Swedish Cancer Institute Swedish Medical Center Seattle, Washington Shamim.Nejad@swedish.org Disclosures Neither I nor my spouse/partner
More informationMedically Accepted Indications for Pediatric Use of Psychotropic Medications by
Key: White Background: Medically Accepted Indication Yellow Backgroun: Medically Accepted Indication Status Not Ascertained Orange Background: Pediatric Indication cited, but not supported Red Background:
More informationGuilt Suicidality. Depression Co-Occurs with Medical Illness The rate of major depression among those with medical illness is significant.
1-800-PSYCH If you are obsessive-compulsive, dial 1 repeatedly If you are paranoid-delusional, dial 2 and wait, your call is being traced If you are schizophrenic, a little voice will tell you what number
More informationENTITLEMENT ELIGIBILITY GUIDELINE DEPRESSIVE DISORDERS
ENTITLEMENT ELIGIBILITY GUIDELINE DEPRESSIVE DISORDERS MPC 03000 ICD-9 296.2, 296.3, 300.4, 311 ICD-10 F32, F33, F34.1 DEFINITION Depressive Disorders is a category of conditions in the Diagnostic and
More informationIntegrated Health and Well-Being
Integrated Health and Well-Being CF Physical Health Health and Well-Being Mental Health 1 Depression A Continuum Normal Mood Lowering Abnormal Mood Lowering Abnormal Mood Lowering and Loss of Functioning
More informationAntidepressants. Dr Malek Zihlif
Antidepressants The optimal use of antidepressant required a clear understanding of their mechanism of action, pharmacokinetics, potential drug interaction and the deferential diagnosis of psychiatric
More informationDSM-5 Criteria: Major Depressive Disorder
DSM-5 Criteria: Major Depressive Disorder Box 3. Major Depressive Episode: DSM-5 Diagnosis: Major Depressive Disorder Five (or more) of the following symptoms have been present during the same 2-week period
More informationDepressive, Bipolar and Related Disorders
Depressive, Bipolar and Related Disorders Robert Kelly, MD Assistant Professor of Psychiatry Weill Cornell Medical College White Plains, New York Lecture available at www.robertkelly.us Financial Conflicts
More informationENTITLEMENT ELIGIBILITY GUIDELINE DEPRESSIVE DISORDERS
ENTITLEMENT ELIGIBILITY GUIDELINE DEPRESSIVE DISORDERS MPC 03000 ICD-9 296.2, 296.3, 300.4, 311 ICD-10 F32, F33, F34.1 DEFINITION DEPRESSIVE DISORDERS Depressive Disorders include: Major Depressive Disorder
More informationComprehensive Quick Reference Handout on Pediatric Bipolar Disorder By Jessica Tomasula
Comprehensive Quick Reference Handout on Pediatric Bipolar Disorder By Jessica Tomasula Official Name Bipolar Disorder; also referred to as Manic Depression Definitions (DSM-IV-TR, 2000) Bipolar I Disorder
More informationDiagnosis & Management of Major Depression: A Review of What s Old and New. Cerrone Cohen, MD
Diagnosis & Management of Major Depression: A Review of What s Old and New Cerrone Cohen, MD Why You re Treating So Much Mental Health 59% of Psychiatrists Are Over the Age of 55 AAMC 2014 Physician specialty
More informationSchedule FDA & literature based indications
Psychotropic Medication List Recommended dosages are intended to serve only as a guide for children. Recommended doses are literature based. Clinicians should consult package insert of medications for
More informationAffective Disorders.
Affective Disorders http://www.bristol.ac.uk/medicalschool/hippocrates/psychethics/ Affective Disorders Depression Mania / Hypomania Bipolar mood disorder Recurrent depression Persistent mood disorders
More informationMental Health Nursing: Mood Disorders. By Mary B. Knutson, RN, MS, FCP
Mental Health Nursing: Mood Disorders By Mary B. Knutson, RN, MS, FCP A Definition of Mood Prolonged emotional state that influences the person s whole personality and life functioning Adaptive Functions
More informationDISEASES AND DISORDERS
DISEASES AND DISORDERS 13. The mood (affective) disorders 99 14. The psychotic disorders: schizophrenia 105 15. The anxiety and somatoform disorders 111 16. Dementia and delirium 117 17. Alcohol and substance-related
More informationCLASSIFICATION & EPIDEMIOLOGY
DEPRESSION IN ELDERLY CLASSIFICATION & EPIDEMIOLOGY NIH Consensuses on Depression in Late Life Elderly depressive disorders are underdiagnosed and undertreated. Only 11% of depressed patients in primary
More informationDEPRESSION IN ELDERLY CLASSIFICATION & EPIDEMIOLOGY
DEPRESSION IN ELDERLY CLASSIFICATION & EPIDEMIOLOGY NIH Consensuses on Depression in Late Life Elderly depressive disorders are underdiagnosed and undertreated. Only 11% of depressed patients in primary
More informationSteps for Initiating Electroconvulsive Therapy Treatment
Steps for Initiating Electroconvulsive Therapy Treatment PSYCHIATRISTS CAN REFER PATIENTS FOR ECT TREATMENT AT EL CAMINO HOSPITAL BY CALLING THE ECT NURSE COORDINATOR AT 650-962-5795. Once the referral
More informationdepression and anxiety in later life clinical challenges and creative research
2 nd Annual MARC Symposium Critical Themes in Ageing Melbourne, 10 th August 2018 depression and anxiety in later life clinical challenges and creative research Nicola T Lautenschlager, MD, FRANZCP Professor
More informationRichard Heidenfelder M.D. Child, Adolescent and Adult Psychiatry 447 9th Ave San Diego, CA
*We are not accepting any New Patients who are currently taking any controlled pain medications *We are *Note: not completion accepting of the any following New Patients paperwork who and Initial are Screening
More informationKEY MESSAGES. It is often under-recognised and 30-50% of MDD cases in primary care and medical settings are not detected.
KEY MESSAGES Major depressive disorder (MDD) is a significant mental health problem that disrupts a person s mood and affects his psychosocial and occupational functioning. It is often under-recognised
More informationNew Patient Questionnaire
4 Embarcadero Center, Suite 1400, San Francisco, CA 94111 (415) 926-7774 phone; (415) 591-7760 office@sanfranciscopsych.com New Patient Questionnaire Thank you for trusting San Francisco Psychiatry with
More informationCHILD & ADOLESCENT PSYCHIATRY ALERTS, VOLUME XIV, 2012 INDEX
A Adderall Counterfeit, 31 addiction, internet CBT, 55 ADHD Adjunctive Guanfacine, 11 Counterfeit Adderall, 31 Developmental Trajectory and Risk Factors, 5 Dopamine Transporter Alterations, 14 Extended-Release
More informationPrepared by: Elizabeth Vicens-Fernandez, LMHC, Ph.D.
Prepared by: Elizabeth Vicens-Fernandez, LMHC, Ph.D. Sources: National Institute of Mental Health (NIMH), the National Alliance on Mental Illness (NAMI), and from the American Psychological Association
More informationMood Disorders. Mood Disorders: Part 1. Mood Disorders And Primary Care. Mood Disorders. Mood Disorders and Primary Care
Mood Disorders Mood Disorders: Part 1 Cynthia L. Gauss, MD Inova Fairfax Hospital VCU School of Medicine Group of clinical conditions involving loss of control over mood states: depression, elation, irritability,
More informationPharmacy Medical Necessity Guidelines: Antipsychotic Medications
Pharmacy Medical Necessity Guidelines: Antipsychotic Medications Effective: July. 1, 2016 Prior Authorization Required Type of Review Care Management Not Covered Type of Review Clinical Review Pharmacy
More informationPSYCHIATRY INTAKE FORM
Please complete all information on this form. PSYCHIATRY INTAKE FORM Name Date Date of Birth Primary Care Physician Current Therapist/Counselor What are the problem(s) for which you are seeking help? 1.
More informationMOOD (AFFECTIVE) DISORDERS and ANXIETY DISORDERS
MOOD (AFFECTIVE) DISORDERS and ANXIETY DISORDERS Shelley Klipp AS91 Spring 2010 TIP 42 Pages 226-231 and 369-379 DSM IV-TR APA 2000 Co-Occurring Substance Abuse and Mental Disorders by John Smith Types
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 informationDepression & Anxiety in Adolescents
Depression & Anxiety in Adolescents Objectives 1) Review diagnosis of anxiety and depression in adolescents 2) Provide overview of evidence-based treatment options 3) Increase provider comfort level with
More informationGoal: To recognize and differentiate abnormal reactions involving depressed and manic moods
Goal: To recognize and differentiate abnormal reactions involving depressed and manic moods Moods versus emotions DSM-IV mood disorders are now two separate categories in DSM-5 Depressive disorders Bipolar
More informationMental Health Intake Form
Current Symptoms Checklist: (check once for any symptoms present, twice for major symptoms) ( ) ( ) Depressed mood ( ) ( ) Racing thoughts ( ) ( ) Excessive worry ( ) ( ) Unable to enjoy activities ( )
More informationA Basic Approach to Mood and Anxiety Disorders in the Elderly
A Basic Approach to Mood and Anxiety Disorders in the Elderly November 1 2013 Sarah Colman MD FRCPC Clinical Fellow, Geriatric Psychiatry Mount Sinai Hospital, University of Toronto Disclosure No conflict
More informationAntipsychotics. Something Old, Something New, Something Used to Treat the Blues
Antipsychotics Something Old, Something New, Something Used to Treat the Blues Objectives To provide an overview of the key differences between first and second generation agents To an overview the newer
More informationApril 2016 Prepared By: Kimberly D. Griego, PharmD, CGP
April 2016 Prepared By: Kimberly D. Griego, PharmD, CGP Bipolar disorder (BD), also referred to as manic-depression, presents with dramatic swings in a person s mood and energy level, which affects their
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 informationTOP APS DRUGS TRAZODONE BRAND NAMES: OLEPTRO, DESYREL (DIVIDOSE) & TRIALODINE
trazodone TOP APS DRUGS TRAZODONE BRAND NAMES: OLEPTRO, DESYREL (DIVIDOSE) & TRIALODINE Pharmacodynamics study of what a drug does to the body Studies show that trazodone selectively inhibits neuronal
More informationFamily Medicine Forum November 10, 2017 Montreal., Quebec. Jon Davine, CCFP, FRCP(C) Associate Professor, McMaster University
APPROACH TO DEPRESSION IN PRIMARY CARE Family Medicine Forum November 10, 2017 Montreal., Quebec. Jon Davine, CCFP, FRCP(C) Associate Professor, McMaster University DISCLOSURE Speaker/Presenter Disclosure
More informationNational Center for Mental Health
National Center for Mental Health 9 de Febrero St., Mandaluyong City Telephone No.: 531-9001 (c/o Dr. Vinluan) Organizational Structure Medical Center Chief II Chief, Medical and Professional Staff (Hospital
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 informationMood Disorders for Care Coordinators
Mood Disorders for Care Coordinators David A Harrison, MD, PhD Assistant Professor, Dept of Psychiatry & Behavioral Sciences University of Washington School of Medicine Introduction 1 of 3 Mood disorders
More informationJohn E. Kraus, M.D., Ph.D.
John E. Kraus, M.D., Ph.D. Chief, Adult Psychiatry, Dorothea Dix Hospital, Raleigh, NC Assistant Professor/Associate Director of Residency Training, Dept. of Psychiatry, UNC Hospitals, Chapel Hill, NC
More informationNational Center for Mental Health
National Center for Mental Health 9 de Febrero St., Mandaluyong City Telephone No.: 531-91 Organizational Structure Medical Center Chief II Chief, Medical and Professional Staff (Hospital Service) Chief,
More informationDepression in the Eldery Handout Package
Depression in the Eldery Handout Package Depression in the Elderly 1 Learning Objectives Upon completion of this module, you should be able to: 1. State the prevalence and describe the consequences of
More informationPractice Parameter for the Assessment and Treatment of Children and Adolescents with Bipolar Disorder,
Practice Parameter for the Assessment and Treatment of Children and Adolescents with Bipolar Disorder, Journal of the Academy of Child and Adolescent Psychiatry, 1997 Primary Authors: Jon McClellan MD
More informationKelly Godecke, MD Department of Psychiatry University of Utah
Kelly Godecke, MD Department of Psychiatry University of Utah Epidemiology and Impact -module 2 session 1 overview of mood disorders Diagnostic Criteria of Bipolar Disorders Medications Used in Bipolar
More informationManual of Clinical Psychopharmacology
Manual of Clinical Psychopharmacology Fourth Edition Alan F. Schatzberg, M.D. Kenneth T. Norris, Jr., Professor and Chairman, Department of Psychiatry and Behavioral Sciences, Stanford University School
More informationAiming for recovery for patients with severe or persistent depression a view from secondary care. Chrisvan Koen
Aiming for recovery for patients with severe or persistent depression a view from secondary care Chrisvan Koen Kent and Medway NHS and Social care Partnership trust Persistent depressive disorder F34 Persistent
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 informationSome newer, investigational approaches to treating refractory major depression are being used.
CREATED EXCLUSIVELY FOR FINANCIAL PROFESSIONALS Rx FOR SUCCESS Depression and Anxiety Disorders Mood and anxiety disorders are common, and the mortality risk is due primarily to suicide, cardiovascular
More informationIndex. Note: Page numbers of article titles are in boldface type. A ADHD. See Attention-deficit/hyperactivity disorder (ADHD) b-adrenergic blockers
Note: Page numbers of article titles are in boldface type. A ADHD. See Attention-deficit/hyperactivity disorder (ADHD) a-adrenergic blockers for PTSD, 798 b-adrenergic blockers for PTSD, 798 Adrenergic
More informationDEPRESSION. Dr. Jonathan Haverkampf, M.D.
Dr., M.D. Depression is one of the most common medical conditions, which can interfere with a person s quality of life, relationships and ability to work significantly. Fortunately, there are a number
More informationDEPRESSION. Men and women of all ages, races, and economic levels can have depression. It occurs more often in women.
DEPRESSION The exact cause of depression is not known. Many researchers believe it is caused by chemical imbalances in the brain, which may be hereditary or caused by events in a person's life. Some types
More informationGuide to Psychiatric Medications for Children and Adolescents
Guide to Psychiatric Medications for Children and Adolescents by Glenn S. Hirsch, M.D. The following guide includes most of the medications used to treat child and adolescent mental disorders. It lists
More informationChapter 6 Mood Disorders and Suicide An Overview of Mood Disorders
Page 1 Extremes in Normal Mood Chapter 6 Mood Disorders and Suicide An Overview of Mood Disorders Nature of depression Nature of mania and hypomania Types of DSM-IV Depressive Disorders Major depressive
More information4. Definition, clinical diagnosis and diagnostic criteria
4. Definition, clinical diagnosis and diagnostic criteria 4.1. Definition Major depression is a mood disorder consisting of a set of symptoms, which include a predominance of the affective type (pathological
More information4/29/2015. Dr. Carman Gill Wednesday, April 29th
Dr. Carman Gill Wednesday, April 29th 1 Impacted diagnoses Major changes and rationale Special considerations Implications for counselors A sustained condition of prolonged emotional dejection, sadness,
More informationDepression in Late Life
Depression in Late Life Robert Madan MD FRCPC Geriatric Psychiatrist Key Learnings Robert Madan MD FRCPC Key Learnings By the end of the session, participants will be able to List the symptoms of depression
More informationREXULTI (brexpiprazole) oral tablet
REXULTI (brexpiprazole) oral tablet Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Pharmacy
More informationPsychiatry in Primary Care: What is the Role of Pharmacist?
Psychiatry in Primary Care: What is the Role of Pharmacist? Benjamin Chavez, PharmD, BCPP, BCACP Clinical Associate Professor Director of Behavioral Health Pharmacy Services January 12, 2019 Disclosure
More informationWomen And Bipolar Spectrum Disorders
Women And Bipolar Spectrum Disorders Introduction While bipolar disorder is a mental illness that affects both men and women, clinicians who provide care for female patients with bipolar disorder must
More informationA Primer on Psychotropic Medications. Michael Flaum, MD
The Iowa Mental Health System and Employment for Individuals with Psychiatric Conditions Iowa Vocational Rehabilitation Services Conference Des Moines, IA, September 18, 2006 A Primer on Psychotropic Medications
More informationSeasonal Affective Disorder: Diagnostic Issues
CHAPTER 1 Seasonal Affective Disorder: Diagnostic Issues Definition and diagnostic criteria Prevalence and burden Screening Clinical features Differential diagnosis Variants of SAD Further reading 1 Definition
More informationContemporary Psychiatric-Mental Health Nursing. Psychopharmacology. Psychopharmacology - continued. Chapter 7 The Science of Psychopharmacology
Contemporary Psychiatric-Mental Health Nursing Chapter 7 The Science of Psychopharmacology Psychopharmacology A primary treatment mode of psychiatric-mental health nursing care Psychopharmacology - continued
More informationChronic Condition Toolbook: Major Depressive Disorder. Focusing on Depression and Its Symptoms
Chronic Condition Toolbook: Major Depressive Disorder Focusing on Depression and Its Symptoms Table of Contents Focusing on Major Depressive Disorder... 1 Major Depressive Disorder Algorithm... 2 The Importance
More informationJonathan Haverkampf BIPOLAR DISORDR BIPOLAR DISORDER. Dr. Jonathan Haverkampf, M.D.
BIPOLAR DISORDER Dr., M.D. Abstract - Bipolar disorder is a condition affecting an individual s affective states (mood). The different flavors of bipolar disorder have in common that there are alterations
More informationDrugs for Emotional and Mood Disorders Chapter 16
Drugs for Emotional and Mood Disorders Chapter 16 NCLEX-RN Review Question 1 Choices Please note Question #1 at the end of Ch 16 pg 202 & Key pg 805 answer is #4 1. Psychomotor symptoms 2. Tachycardia,
More informationPsychiatry curbside: Answers to a primary care doctor s top mental health questions
Psychiatry curbside: Answers to a primary care doctor s top mental health questions April 27, 2018 Laurel Ralston, DO Psychiatrist, Taussig Cancer Institute Objectives Review current diagnostic and prescribing
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 information