Brief psychiatric treatment

Treatment:

1- GAD :

⁃ Psychotherapy
⁃ Medications :
⁃ Paroxetine + sertraline : SSRI
⁃ venlafaxine : SNRI
⁃ Buspirone : Serotonin receptor Agonist
⁃ Benzodiazepines:
⁃ Lorazepam
⁃ Diazepam
⁃ Clonazepam
⁃ Alprazolam

2- panic attacks and panic disorder :

⁃ Psychotherapy ( first choice )
⁃ SSRI
⁃ SNRI
⁃ Benzodiazepines

3-Schezofreniform :

⁃ similar to an acute exacerbation of schizophrenia

⁃ Psychotic symptoms treated by a 3- to 6-month course of antipsychotic drugs (e.g., Risperidone)

⁃ Hospitalization if needed

⁃ Psychotherapy family (provide education for the family)

⁃ ECT may be indicated for some patients, esp. catatonic or depressed features

4- ASD :

⁃ Behavioral treatment
⁃ Family Eductional treatment
⁃ Medication if needed ( to treat Comorbidity )

5- Delusion Disorder:

⁃ Psychotherapy (Very effective due to false believes)
⁃ Antipsychotic medications:
⁃ – Risperidone – Olanzapine – Quetiapine – Haloperidol

6-Brief psychotic disorder :

⁃ Hospitalization
⁃ Antipsychotic drugs (For psychosis)
⁃ benzodiazepines (For agitation)
⁃ Psychotherapy

7- Bipolar :

⁃ Mania/Hypomania :
⁃ Lithium ,1st line
⁃ Anticonvulsants:
⁃ Valproic acid ,1st line
⁃ Carbamazepine , 2nd line
⁃ Atypical antipsychotics
⁃ risperidone, olanzapine, quetiapine. 1st line

⁃ Depression:
⁃ Lithium ,1st line
⁃ Lamotrigine ( Anticonvulsant )
⁃ Quetiapine.

⁃ Electroconvulsive Therapy (ECT) : If the patient has manic episode or bipolar depressive episode, and not responding to first and second lines then ECT is very effective.

8- Seasonal pattern: light therapy. 1st line

⁃ Bupropion first line evidence in prevention of winter disorders + fluoxetine
⁃ CBT for seasonal MDD is as effective as light therapy or combined therapy
⁃ light therapy second line for non-seasonal adjunct
⁃ Sleep deprivation third line adjunct for seasonal

9- MDD :

⁃ Mild : PSYCHOTHERAPY
⁃ Cognitive Behavioral Therapy (CBT)
⁃ Interpersonal Psychotherapy (IPT)
⁃ Behavioural activation (BA)
⁃ Mindfulness-based cognitive therapy (MBCT)

⁃ Moderate to severe :
⁃ SSRI :
⁃ Fluoxetine
⁃ Paroxetine
⁃ Sertraline
⁃ Fluvoxamine
⁃ Citalopram
⁃ EsCitalopram
⁃ SNRI :
⁃ Venlafaxine
⁃ DesVenlafaxine
⁃ Duloxetine
⁃ NDRI :
⁃ bupropion

1 episode of depression we treat him for 1 year,
If 2 Episodes we treat him for 5 years,
If 3 Episodes or more we treat him for life,
If 1 episode + suicidal thoughts we treat him for life.

10-Alcohol Use Disorders :

Medications :
⁃ Acamprosate : effective , reduce alcohol cravings and withdrawal symptoms.
⁃ Naltrexone : opioid antagonist. reduce cravings and pleasurable effects.
⁃ Disulfiram : block Acetaldehyde Dehydrogenase Causes severe Negative effects when alcohol is consumed.
Psychotherapy

11- Opioid Use Disorders :

Medications
Psychotherapy

12- Wernicke’s encephalopathy : ( Ataxia, Nystagmus, Ophthalmoplegia )
⁃ Reversible with treatment
⁃ thiamine 100mg.

13-ADHD :

⁃ Pharmacological treatments:
⁃ First-line: Stimulants e.g., methylphenidate compounds ( concerta , retalin ) , dextroamphetamine, and mixed amphetamine salts.
⁃ Second-line choice: Atomoxetine, a norepinephrine reuptake inhibitor.
⁃ Alpha-2 agonists (e.g., clonidine, guanfacine) can be used instead of or as adjunctive therapy to stimulants
⁃ Bupropion

⁃ Nonpharmacological treatments:
⁃ Behavior modification techniques and social skills training.
⁃ Educational interventions (i.e., classroom modifications).
⁃ Parental psychoeducation.

14-PANDA :
⁃
⁃ ibuprofen for 2 weeks + order ASO titter 2 WEEKS
⁃ antibiotics ( usually amoxiclavulinic acid)2 MONTHS
⁃ refer to psychiatry clinic or give SSRI ( it’s an emergency ) 2 YEARS

15- OCD :

⁃ First line of psychological treatment is CBT : 16 sessions, twice weekly, 20 to 120 minutes, over 8 weeks
⁃ SSRI : Escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
⁃ TCA, clomipramine.
⁃ atypical antipsychotics.