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Summary management in psychiatric diseases
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management in diseases related to psychiatry
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Class notes Introduction to business Oxford Handbook of Psychiatry
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1000-PLUS-PSYCHIATRY-MCQ-book
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child and adolescent psychiatry
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Chapter 8Management
41
, Chapter 8: Management
Introduction
Management can be divided into biological, psychological and social.
Tailor the management to the individual case rather than giving a general management plan which could
apply to any case.
Look at what medications the person is already prescribed and consider modifying the mediation to manage the
depression/elation/psychosis, etc.
It is important not to just write “antidepressant/mood stabiliser/antipsychotic” under the biological management if
the person is already prescribed these medications.
Do not consider electroconvulsive therapy (ECT) unless all other management strategies have failed and
there is a clear indication for this treatment.
Example of a management plan
General points
o “I would involve the multidisciplinary team in the management of this patient. I would inform his GP of the
management plan. I would try to involve the family/partner in the management” (consent needed from the
patient).
o Consider the most suitable location for management at the current time (e.g. inpatient, outpatient, day
hospital). If inpatient treatment is required, consider if the patient can be admitted voluntarily or if there is a
requirement for admission under the Mental Health Act 2001.
o If admission is needed, decide on level of observation required (e.g. 1:1 nursing, 15 minute observations or
general observations), if the person can have leave off the ward (accompanied or unaccompanied leave?)
AND if the person can have their day clothes (or if they should remain in night clothes).
o A key worker (staff member) should be assigned to the patient.
o The patient’s care plan should be prepared considering MDT input (the care plan should be discussed with the
patient).
Biological
o If the patient is admitted to an inpatient psychiatric unit, ward nursing staff are involved in regular monitoring
the mental state of the patient and monitoring their medication compliance. In the community (when the
patient is at home), a community mental health nurse can be involved in undertaking domiciliary visits (home
visits) to monitor the mental state of the patient and their medication compliance.
o Depressed person
Person with a history of depression who is currently stable: continue the antidepressant
and mood stabiliser (if prescribed) at the current dose while continuing to monitor their mental state,
response to the medication and for the possibility of emergence of side effects.
Depressed person who is not prescribed an antidepressant: consider introducing a selective
serotonin reuptake inhibitor (SSRI) such as fluoxetine and titrating the dose according to effect,
while monitoring for any side effects to this agent.
Depressed person who is already prescribed fluoxetine (or other antidepressant): titrate the
dose upwards according to effect (to the BNF maximum dose if required), while monitoring the
person for any side effects to this agent.
Depressed person who is already prescribed the BNF maximum dose of fluoxetine (or other
antidepressant), is compliant with the medication and has received an adequate therapeutic
trial: consider switching to a different antidepressant (e.g. sertraline or venlafaxine), adding a mood
stabiliser such as lithium or adding a second antidepressant (e.g. an SSRI plus mirtazapine, or an
SSRI plus venlafaxine).
o Hypomanic/manic person
Person with a history of mania/hypomania who is currently stable: maintain the mood
stabiliser at the current dose while continuing to monitor their mental state, response to the medication
and for the possibility of emergence of side effects.
Person with acute mania/hypomania: stop any prescribed antidepressant and start/increase the dose of
an antipsychotic (e.g. olanzapine). Consider adding a short-term benzodiazepine (e.g. lorazepam or
clonazepam).
o Psychotic person
Person with a history of psychosis who is currently stable: continue the antipsychotic at the current
dose while continuing to monitor their mental state, response to the medication and for the possibility of
emergence of side effects.
Psychotic person who is not prescribed an antipsychotic: start an antipsychotic such as olanzapine and
titrate the dose upwards according to effect while monitoring for any side effects to this agent.
Psychotic person who is already prescribed olanzapine (or other antipsychotic): titrate the
dose upwards according to effect (to the BNF maximum dose if required), while monitoring the
person for any side effects to this agent.
Psychotic person who is already prescribed the BNF maximum dose of olanzapine (or other
antipsychotic) and has received a therapeutic trial: consider switching to a different antipsychotic
such as risperidone.
42
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