Approach to Psychiatry Management new.pptx

Bio-psycho-social approach to psychiatry management

1. Approach to Psychiatry Management (Bio-Psycho-Social Model) Nur ‘Athira binti Faisal Sabri

2. George Engel Reverse dehumanization of medicine & disempowerment of patients “Illness is the result of interplay of biological psychological & social factors plus individual health-related behaviors” Brings more empathy &compassion into medical practice

3. Bio Psycho Social Predisposing: not a causing factor, but makes a person susceptible to mental disorder Genetics vulnerability Personality trait ( eg . Poor self esteem) Disorganized attachment Precipitating: factor that contributes to the mental disorder Poor sleep, substance use Stress loss of significant relationship Perpetuating: factor that maintains the mental health ongoing / prolonged Substance abuse rumination Poor access to treatment Protective: prevent recurrence Adequate diet & sleep High self esteem Strong support, access to treatment

4. Biological

5. Antidepressant Central inhibition of input from brain to salivary gland -> dry mouth

6. Typical Antidepressant MOA SSRI Antagonist SERT (serotonin transporter) Agonist on other serotonin receptors SNRI Antagonist SERT & NAT (serotonin & NA transporter) Agonist on other serotonin receptors TCA Antagonist SERT, NAT, a1, muscarinic receptor MAOI Inhibit MAO Atypical Antidepressant MOA Nassa (Mirtazapine) Antagonist a2, H1, 5HT2A/2C/3, Agonist 5HT1 MASA ( Agomelatine ) Agonist MT1/2, Antagonist 5HT2C MSM ( Vortioxetine ) Antagonist SERT & 5HT3/7, Agonist 5HT1A NDRI (Bupropion) Antagonist NAT & DAT

7. Serotonin Syndrome & Management Mental Status change (confusion, agitation) Muscle tone abnormality (myoclonus, hyperreflexia ) Hyperactive Autonomic Nervous System (fever, shiver, tremor, diaphoresis, diarrhea, incoordination)

8. Serotonin Discontinuation Syndrome

9. Antipsychotic High potency Acts more on D2 receptors Low potency Acts more on other receptors % of dopamine receptor occupancy

10. Dopamine Pathways What happens in schizophrenia? Effect of antipsychotic Mesocortical Low dopamine  negative symptoms Worsen negative sx Mesolimbic High dopamine  Positive symptoms Decrease positive sx Nigrostriatal - Causes EPS Tubuloinfundibular - Increase prolactin

11. TYPICAL AP Action Effect D2 Antagonist EPS, Hyperprolactinemia , Decrease libido Anti Alpha 1 Adrenergic orthostatic hypotension Anti Muscarinic blurred vision, dry mouth, urinary retention Anti Histamine (H1) sedation , weight gain Others NMS, Torsades de Pointes, Seizure, Corneal (CPZ) & Retinal ( Thioridazine ) Deposits High potency Acts more on D2 receptors Low potency Acts more on other receptors

12. ATYPICAL AP Action Effect All of the above (same as typical) 5HT2a, c Antagonist Hyperglycemia, Dyslipidemia, Weight gain (Especially –pines) Others Movement disorder & Torsades De Pointes ( Especially – dones ) Neutropenia/ Agranulocytosis (Clozapine)

13. Clozapine

14. Benzodiazepine

15. MOA

16. Mood Stabilizers Lithium

17. Other Mood Stabilizers

18. Psychotherapy Psychoeducation Supportive Psychotherapy Family & Couple Therapy Problem Solving Therapy Skills Training Psychodynamic Cognitive Behaviour Therapy Acceptance & Commitment Therapy (ACT)

19. 1. Psychoeducation

20. 2. Supportive Psychotherapy Most impaired Least impaired Psychoanalytic Psychotherapy Continuum Disorganized behavior, disorganized thinking impaired ability to form relationship Limited intelligence / education, severe borderline PD Addressing conscious conflicts Intact, think clearly & realistically, accurate perceptions, able to form relationships OCPD, dependent PD, avoidant PD, dysthymia, panic d/o, adjustment d/o Address unconscious & conscious conflicts

21. 3. Family therapy

22. 4. Couples / Marital Therapy

23. 5. Problem Solving Therapy

24. 6. Social Skills Training

25. 7. Psychodynamic Psychodynamic therapy  involves the interpretation of mental and emotional processes rather than focusing on behavior ( Strupp , Butler, & Rosser, 1988).  Psychodynamic therapists  attempt to help clients find patterns in their emotions, thoughts, and beliefs in order to gain insight into their current self.

26. 8. CBT

27. 9. ACT

28. Social Occupational Therapy Clinical Assessment Intervention Prevention & Promotion Programmes Social Welfare Officer

29. Reference Kaplan & Saddock Textbook of Psychiatry Psychiatry lecture notes Gautam Gulati 11 th edition NCBI Antidepressant discontinuation syndrome by Matthew Gabriel  and  Verinder Sharma , MBBS The Mausdley Textbook