Psychiatry

Anxiety Disorders areNotoriously Undertreated

Anxiety Disorders are Notoriously Undertreated

Anxiety disorders are the most prevalent psychiatric disorders and are associated with a high burden of illness. With a 12-month prevalence of 10.3%, specific (isolated) phobias are the most common anxiety disorders, although persons suffering from isolated phobias rarely seek treatment. Panic disorder with or without agoraphobia is the next most common type with a prevalence of 6.0%, followed by social anxiety disorder (also called social phobia; 2.7%) and generalised anxiety disorder (GAD; 2.2%). Alprazolam is the most commonly prescribed psychotropic medication for anxiety and panic disorders in the US.

Modern Medicine – Issue 4 2024

August 16, 2024 by Psychiatry

Managing Depression
Using a clinical practice guideline approach

Managing Depression: Using a clinical practice guideline approach

The 2020 update of the Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders provides a new framework for managing depressive disorders that moves beyond the stepped care approach. This framework is based around three key components: actions, such as lifestyle modification and patient education; choices in pharmacological treatment that include the patient’s preferences; and potential alternative treatments.

Modern Medicine – Issue 2 2023

April 6, 2023 by Psychiatry

Managing Major Depressive Disorder

Managing Major Depressive Disorder

Major depressive disorder (MDD) or Major Affective Disorder is a severe psychiatric disorder affecting over 200 million people worldwide. The lifetime depression risk is 15–18% and is higher in women than men.1 Aetiologically, while societal and environmental factors play a significant role in the psychosocial development of depression, underlying biological and genetic factors are also key drivers, and the two interact via epigenetic mechanisms.

Modern Medicine – Issue 1 2022

February 9, 2022 by Psychiatry

Clinical Practice Guidelines for the Assessment and Management of ADHD

Clinical Practice Guidelines for the Assessment and Management of ADHD

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders. ADHD affects around 5 % – 7 % of school-aged children. It is a neurodevelopmental disorder that runs a chronic course and causes significant impairments across various domains of everyday functioning, such as peer and social functioning, academic functioning and occupational functioning across the lifespan. Besides the patient, ADHD also has significant negative impact on the caregivers. This is a shortened version of the original article.

Modern Medicine – Issue 4 2021

August 11, 2021 by Psychiatry

Schizophrenia The GP’s crucial management role

Schizophrenia The GP’s crucial management role

Early recognition and referral are key in managing schizophrenia and related psychoses. Management should occur within a framework of autonomy and self-determination and, where possible, with family or carer inclusion. Pharmacological and psychosocial treatments improve outcomes, including quality of life, for people affected by schizophrenia. Antipsychotic, mood stabiliser and antidepressant medications may all be indicated in treating psychoses.

Modern Medicine – Issue 3 2020

May 21, 2020 by CNS Psychiatry

Emotional Blunting and Depression | Symptom or Side Effect?

Emotional Blunting and Depression | Symptom or Side Effect? – MM1609

When treating a patient for depression, doctors need to provide relief from the depressive symptoms, restore functioning, enhance quality of life and develop relapse prevention strategies. The main focus is on the reduction of depression symptoms. Emotional blunting, or the inability to experience usual emotions can be a side effect of many antidepressants. This emotional blunting can have a profound impact on the patient’s quality of life. It needs to be distinguished from residual depressive symptoms and if distressing the patient, may warrant a change of treatment.

Modern Medicine – September 2016

October 6, 2016 by Depression Psychiatry

Adult Depression A step-by-step guide to treatment

Adult Depression A step-by-step guide to treatment – MM1605

A stepwise approach to the early detection and management of depression, guided by severity of presentation and treatment response, encourages more timely access to evidence-based treatments, including easily accessed and destigmatising e-mental health interventions. Evidence-based treatments range from e-mental health apps, psychological therapy and medication to neurostimulation.

With the overall similarities in efficacy of antidepressants, the most important considerations when initiating pharmacotherapy are tolerability and safety. For patients with difficult-to-treat depression, an algorithmic management approach with steps that include increasing the antidepressant dose, switching antidepressants, augmenting with a non-antidepressant treatment and combining antidepressants improves the chance of patient recovery. Neurostimulatory treatments such as electroconvulsive therapy and repetitive transcranial magnetic stimulation have an expanding role in the evidence based treatment of severe depression.

Modern Medicine – May 2016

May 31, 2016 by CNS Depression Psychiatry

Insight Linked to Meds Adherence in Schizophrenia

Insight Linked to Meds Adherence in Schizophrenia – MM1603

The first episode of a psychotic disorder typically occurs in late adolescence
or young adulthood, a critical time of development with respect to personality,
social role, education, and vocation. The first few years of psychosis appear to
be a critical period during which intervention needs to be initiated before the
consequences of psychosis become more severe. Early intervention is therefore
crucial in maximising outcomes.

Medication attitudes, insight and characteristics of support have been
identified as important determinants of adherence to medication,2 with poor
insight being linked to poor outcome of psychosis in multiple ways. The negative influence of poor insight has been demonstrated in relation to quality of life, rehospitalisation, poor treatment adherence and poor outcome of psychosis

Modern Medicine – March 2016

March 18, 2016 by Psychiatry Schizophrenia

Diabetes and Mental Illness Challenges and practical progress

Diabetes and Mental Illness Challenges and practical progress – MM1603

Severe mental illnesses are associated with premature death and accelerated
cardiometabolic disease. Diabetes contributes substantially to the health burden in severe mental illness, with glycaemic, lipid and hypertension control often below the targets accepted as standard of care. Treatment disparities and unmet health needs are common and contribute to poorer health outcomes.

Screening for diabetes with measurement of fasting glucose levels and/or
HbA1c should be undertaken every six months in people with severe mental
illness. If weight gain occurs in this group, lifestyle strategies to prevent diabetes should be undertaken, with support and follow up.

People with severe mental illness and diabetes should be considered as a
‘special needs’ group, requiring longer, more frequent appointments with regula follow up. Assumptions should not be made about a patient’s healthy behaviour literacy, access to healthy food and food preparation facilities and knowledge and skill sets necessary to prepare healthy meals. People with severe mental illness and diabetes may require supported training in these areas.

Modern Medicine – March 2016

March 18, 2016 by Diabetes Psychiatry
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