Tiêu đề psych-2-3c-ocd-and-trauma-related-disorders-treatment.pdf ✅

Page 1 of 2 PSYCHIATRY 2 OCD and Trauma Related Disorders: TREATMENT Dr. Los Baños 2.3c Aug. 21, 2014 Bautista, Cruz, Gillera, Janolo, Merilles Sources: Kaplan 10 th ed., old trans, and lecture ppt OOBSESSIVE COMPULSIVE DISORDER PRINCIPLES IN OCD TREATMENT:  Initial effects seen after 4-6 weeks of treatment, Maximal therapeutic benefit after 8 - 16 weeks STANDARD APPROACH:  Start with an SSRI or clomipramine(second line)  Move to other pharmacological strategies if the serotonin- specific drugs not effective SSRI SECOND LINE: TRICYCLIC ANTIDEPRESSANT OTHER DRUGS  Valproate Depakene  Lithium Eskalith  Carbamazepine Tegretol  Venlafaxine Effexor  Pindolol Visken  MAOIs (phenelzine) Nardil  Buspirone BuSpar  Clonazepam Klonopil PHARMACOTHERAPY, BEHAVIOR THERAPY, OR A COMBINATION  Effective in significantly reducing OCD symptoms SSRI’S + BEHAVIORAL THERAPY  Best clinical outcome  Beneficial effects of meds are longer lasting with behavior therapy EXPOSURE OR RESPONSE PREVENTION  Principal behavioral approaches in OCD  For excoriation (skin-picking) disorder SUPPORTIVE PSYCHOTHERAPY  With continuous and regular contact with an interested, sympathetic, and encouraging professional, patients may be able to function by virtue of this help, without which their symptoms would incapacitate them. FAMILY THERAPY  Often useful in supporting the family, helping reduce marital discord resulting from the disorder, and building a treatment alliance with the family members for the good of the patient. POST-TRAUMATIC STRESS DISORDER/ ACUTE STRESS DISORDER SSRI  Considered first-line treatments for PTSD owing to their efficacy, tolerability, and safety ratings. TRICYCLIC DRUGS  Alternative  IMIPRAMINE (Tofranil) and AMITRIPTYLINE (Elavil) - Both unavailable in the Phil. OTHER DRUGS  MAOIs( phenelzine) Nardil  Carbamazepine Tegretol  Valproate Depakene  RIMAs  Clonidine Catapres  Propanolol Inderal PSYCHODYNAMIC PSYCHOTHERAPY  Reconstruction of the traumatic events with associated abreaction and catharsis may be therapeutic in some cases  But psychotherapy must be individualized because reexperiencing the trauma overwhelms some patients.  Psychotherapeutic interventions for PTSD: behavior therapy, cognitive therapy, and hypnosis. EXPOSURE THERAPY  Patient reexperiences the traumatic event through imaging techniques or in vivo exposure.  Exposures can be intense, as in implosive therapy, or graded, as in systematic desensitization. METHODS OF STRESS MANAGEMENT  Include relaxation techniques and cognitive approaches to coping with stress. Fluoxetine HCl (Prozac 20) 20 mg /capsule #7 Sig: take 1-3 cap once a day for 1 week. (OCD: 20-60 mg/day) Refill: none Warning: watch out for anxiety, nervousness, insomnia, nervousness, fatigue, tremor, lightheadedness and sweating. Paroxetine HCl (Seroxat) 20 mg /tab #7 Sig: Take 2 tabs daily. Start w/ 1tab/day, and may be increased weekly in 10-mg increments. Max: 60mg daily. Refill: None Warning: increased cholesterol level, decreased appetite, blurred vision,insomnia, agitation, abnormal dreams including nightmares, dizziness, tremor and headaches. Clomipramine (Anafranil) 25mg/tab #7 Sig (Children& Adolescents): take 1 tab once a day. (during the 1ST 2 weeks, increase dose up to 3mg/kg or 100 mg, then up to 3mg/kg or 200mg) Refill: None Warning: Before initiating treatment, hypokalemia should be treated. Watch out for the following: drowsiness, fatigue, restlessness, tremor, increased appetite, dry mouth, sweating, constipation, visual disturbances, dizziness, headache, nausea, and weight gain. Paroxetine HCl (Seroxat) 20 mg /tab #7 Sig: Take 1 tab daily; may be increased in 10mg increments weekly. Refill: None Warning: increased cholesterol level, decreased appetite, blurred vision, insomnia, agitation, abnormal dreams including nightmares, dizziness, tremor and headaches. Outline of topics: I. Obsessive Compulsive Disorder II. Post Traumatic Stress Disorder and Acute Stress Disorder III. Reactive Attachment Disorder IV. Adjustment Disoders