The easy way to understanding of Depression and Psychosis. This slide is used for Medic Training.

1. MENTAL HEALTH
MHGAP 2.0
DEPRESSION
PSYCHOSIS
DAY 2
CME FOR MEDICS
BY
DR. ARKAR, CLINICAL CONSULTANT, MAE TAO CLINIC
30.8.2017

2. MCQ
• AMITRIPTYLLINE
A. AMITRIPTYLLINE CAN BE USED IN CARDIOVASCULAR DISEASE
B. AMITRIPTYLLINE IS DRUG OF CHOICE FOR DEPRESSIVE PATIENTS WITH SUICIDAL
IDEATION.
C. OVERDOSE CAN LEAD TO HYPOTENSION, COMA, OR DEATH.
D. MINIMUM EFFECTIVE DOSE IN ADULT IS 25 MG/DAY.

3. MCQ
• ONE OF DIAGNOSIS POINTS FOR DEPRESSION IS
A. NO NEED TO SLEEP
B. ALL DEPRESSIVE PATIENT HAS WEIGHT LOSS
C. MARKEDLY NO INTEREST IN OR PLEASURE FROM ACTIVITIES
D. LOSS OF NORMAL SOCIAL INHIBITIONS

4. MCQ
• PSYCHOSIS
A. BIPOLAR DISORDER (MANIC-DEPRESSIVE ILLNESS) IS NOT PSYCHOSIS.
B. PSYCHOTIC PATIENTS KNOW THEMSELVES THAT THEY ARE MENTALLY SICK.
C. HAVE TO START ANTIPSYCHOTIC MEDICATION IMMEDIATELY.
D. INJECTION IS ROUTE OF CHOICE FOR EVERYONE AS PSYCHOTIC PATIENTS ARE NOT
GOOD IN ADHERENCE.

5. DEPRESSION

6. DEPRESSION

7. DEPRESSION

8. DEPRESSION

9. DEPRESSION

10. DEPRESSION

11. DEPRESSION

12. DEPRESSION

13. DEPRESSION

14. DEPRESSION

15. PSYCHOSOCIAL INTERVENTION
• C A T M A P
- PSYCHOEDUCATION: DEPRESSION IS COMMON, IS NOT MEANT LAZY, AVOID (-
)VE ATTITUDES OF OTHERS AS IT IS NOT #, NO SHARE WILLPOWER, UNJUSTIFIED
THOUGHTS OF HOPELESSNESS WILL BE PROGNOSTIC FACTOR, SELF-
HARM/SUICIDE IS COMMON.
- M & A: PLEASURE, WALK, ACTIVE, APPETITE, FRIENDS, FAMILY,
COMMUNITY/SOCIAL ACTIVITIES,

16. PSYCHOSOCIAL INTERVENTION

17. PHARMACOLOGICAL INTERVENTION
• ANTI-DEPRESSANTS ARE NOT ADDICTIVE.
• TREATMENT COURSE: AT LEAST 9 TO 12 MONTHS (CAN STOP SYMPTOMS FREE
FOR 9-12 MONTHS)
• START WITH ONLY ONE MEDICATION AT THE LOWEST STARTING DOSE.
• STOP ANTI-DEPRESSANT WHEN PATIENT HAS MANIA SYMPTOMS.
• INCREASE SUICIDAL IDEATION ESPECIALLY IN ADOLESCENTS AND YOUNG
ADULT.

18. PHARMACOLOGICAL INTERVENTION
IN
SPECIAL POPULATION
• ADOLESCENTS
• FLUOXETINE IS DRUG OF CHOICE. IF NOT AVAILABLE > AMITRIPTYLLINE
• PREGNANT AND BREAST FEEDING MOTHER
• AVOID, IF POSSIBLE.
• IF NO RESPONSE TO PSYCHOSOCIAL INTERVENTION, START LOWEST EFFECTIVE DOSE.
• AVOID – FLUOXETINE
• OLDER ADULT
• AVOID – AMITRIPTYLLINE IF POSSIBLE
• CVS DISEASE
• AVOID AMITRIPTYLINE
• ADULT WITH SUICIDE IDEATION
• FLUOXETINE

19. DRUG OF CHOICES
TCA SSRI
Contraindication:
Avoid in CVS patients, Hyperthoroidism, Urinary
retention, bipolar, glaucoma
Overdose can lead to seizures, cardiac
arrhythmias, hypotension, coma or, death
Cautions:
Use in patients with history of seizures.

20. PSYCHOSIS

21. PSYCHOSIS

22. PSYCHOSIS

23. PSYCHOSIS

24. PSYCHOSIS

25. PSYCHOSOCIAL INTERVENTION
• C A T M A P
• EXPLAIN PSYCHOSIS AND BIPOLAR CAN BE TREATED.
• CLARIFY CLARIFY MISCONCEPTIONS ABOUT PSYCHOSIS AND BIPOLAR.
• AVOID ALCOHOL AND OTHER SUBSTANCES
• AVOID CRITICISM
• GIVE PATIENT FREEDOM OF MOVEMENT
• AVOID LONG TERM HOSPITALIZATION

26. PHARMACOLOGICAL INTERVENTION
• START ANTIPSYCHOTIC DRUGS ASAP. ONE DRUG AT THE SAME TIME, WITH
LOWEST DOSE.
• EFFECTIVE DOSE WILL BE REACHED 4 – 6 WEEKS.
• STOP ANTIDEPRESSANTS IN BIPOLAR.
• SHORT TERM DIAZEPAM (2 – 4 WEEKS) CAN BE USED FOR AGITATED PATIENTS.
• CONTINUE TREATMENT AT LEAST 2 YEARS AFTER LAST BIPOLAR EPISODE.
• CONTINUE TREATMENT AT LEAST 1 YEAR AFTER LAST PSYCHOTIC EPISODE.

27. PHARMACOLOGICAL INTERVENTION

28. PHARMACOLOGICAL INTERVENTION

29. PHARMACOLOGICAL INTERVENTION

30. PHARMACOLOGIC
AL INTERVENTION

31. APPROACH TO AGITATED
AND/OR AGGRESSIVE PATIENTS