Drugs used to Treat Antipsychotic-Induced Weight-Gain (Mnemonic)
FORMAT-B
- Fluoxetine
- Orlistat
- Reboxetine
- Metformin, methylcellulose, melatonin
- Topiramate
- Bupropion
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> A complete assessment is mandatory before starting treatment
For
people with first-episode psychosis offer:
●
oral antipsychotic
medication with
● psychological interventions (family intervention and individual CBT.)
Advise
people who want to try psychological interventions alone that these therapies are more
effective when delivered with antipsychotic medication.
If the person still wants to try psychological interventions alone:
It is also mandatory to assess and monitor the physical health of the patients before commencing antipsychotics and during treatment.
Especially
And
other baseline investigations
These recommendations are based on the Maudsley Prescribing Guidelines 2018, according to which, depression is treatment refractory when it does not respond to sequential trials of three different antidepressants as recommended in their algorithms.
In the first three steps below, we have enlisted the recommended pharmacological treatment options for an episode of depression. subsequently, we list the options for treatment-refractory depression. Maudsley Prescribing Guidelines focus on the pharmacological treatment options and algorithms, never nevertheless, they acknowledge the important role of non-pharmacological interventions in its treatment and recommend considering one of the appropriate options like cognitive behaviour therapy and/or behavioural activation and other factors identified as being responsible for resistance.
SSRIs
Sertraline is recommended first-line per NICE Stepped Care Model
Second-line
MAOIs, Mirtazapine, Imipramine, Clomipramine,
Venlafaxine
Gabapentin, Inositol, Pindolol as augmentation
CBT, Anxiety management
Reassurance
Self-help and psychoeducation
à Pure self-help, guided self-help, group
psychoeducation
Relaxation therapy
à applied relaxation, progressive
muscle relaxation, deep breathing exercises
Cognitive behavior therapy
Exercise
While on psychotherapy, short-term
Psychotherapy ineffective,
Psychotherapies not available
Selective Serotonin Reuptake Inhibitors
àThese and SNRIs may initially
exacerbate symptoms; a lower starting dose is often required. Fluoxetine and sertraline
are preferred options. Sertraline
is the most tolerable
and cost effective, recommended as first choice by NICE. Fluoxetine
is most effective choice.
Effexor (venlafaxine) SR up to 225 mg/day
Dulan/Duron (duloxetine) up to 60 mg/day
pregabalin 150–600 mg/day
Agoviz (agomelatine) 25
mg 2 x nocte
Agoviz (agomelatine) 25
mg 4 x nocte
Busron (buspirone) 5 mg
1 x TDS
Steer (buspirone) 10
mg 2 x TDS
Atarax (hydroxyzine) 25
mg 1 x BD
Atarax (hydroxyzine) 25 mg 1+ 1 + 2
Qusel (quetiapine)
Tofranil (imipramine)
Clomixet (clomipramine)
Ramargon (mirtazapine)
Beta-blockers for somatic symptoms, Vortioxetine
2.5–10 mg
Tricyclic with olanzapine or quetiapine
SSRI/SNRI
Ketamine-IV (0.5 mg/kg IV over 40
minutes),
à
rapidly effective, by the anesthetist
High-dose venlafaxine à
200 mg/d,
à
NICE recommended, monitor BP
Electroconvulsive therapy
à effective,
stigmatized
Add risperidone 0.5-3 mg/d,
à
weak evidence, hypotension
Add Triiodothyronine 20–50 μg/d,
à reasonable evidence, monitor
TFTs
Lamotrigine, 100, 200, 400 mg/d,
à best tolerated, risk of rash
SSRI+ buspirone 60 mg/d,
à research-supported, dizziness
at a high dose.
Supportive psychotherapy, CBT, interpersonal therapy, marital/couple therapy, dynamic psychotherapy, behavioral activation
SRI/ Mirtazapine
à A generic SRI; use
mirtazapine if sleep needed
SSRI/non-SRI
à
Most evidence is for a switch to vortioxetine
Mirtazapine, vortioxetine, agomelatine
à if not already trialed
What interventions are safe and effective for the management of alcohol withdrawal, including treatment for alcohol withdrawal seizures and prevention and treatment for acute Wernicke's encephalopathy?
Alcohol withdrawal can be uncomfortable and occasionally life-threatening. Pharmacological management of alcohol withdrawal is an essential component of alcohol dependence. Benzodiazepines (BZDs), non-sedating anticonvulsants, and antipsychotics are commonly used in the treatment of alcohol withdrawal.
Given that they are all potentially toxic medications, what is the evidence that the benefits of their use justify the risks? Which is more effective?
Below, I summarize the WHO 2012 Guidelines to treat Alcohol Withdrawal that explains the answers to these questions.
ICD-11 Criteria for Gambling Disorder (6C50) A collection of dice Foundation URI : http://id.who.int/icd/entity/1041487064 6C50 Gambling d...