Pharmacological Interventions Behavioural and Depression: 42% - PowerPoint PPT Presentation

Pharmacological Interventions

Behavioural and Depression: 42% Psychological Agitation: 35% Anxiety: 35% Irritability: 30% Delusions: 22% Symptoms of Aberrant motor behaviour: 25% Sleep Disturbance: 14% Disinhibition: 12% Hallucinations: 8.5% Dementia – 90%

PAIN Higher 50% of people prevalence living with than in dementia cancer at end of life

THINK DELIRIUM

Cognitive symptoms of dementia: 100%

Golden rules 1. Speak to family. 2. What does the patient with dementia want? 3. Advanced decisions. 4. Advanced statements. 5. Legal framework for drug administration. 6. Low and slow. 7. Titrate to effect. 8. Consider all side effects / contraindications. 9. Speak to family.

Nociceptive pain • Regular paracetamol. • Remove stimulus – Think constipation, GORD, wind. • NSAIDS + PPI. • Opiates.

Neuropathic pain • SNRI • Amitriptyline • Pregabalin

Golden rules 1. Speak to family. 2. What does the patient with dementia want? 3. Advanced decisions. 4. Advanced statements. 5. Legal framework for drug administration. 6. Low and slow. 7. Titrate to effect. 8. Consider all side effects / contraindications. 9.Speak to family.

• SSRI – Sertraline, Fluoxetine, Citalopram. • Mirtazapine – positive side effect profile. • Trazadone – agitation, hypnotic. • Venlafaxine / Duloxetine.

Selective serotonin reuptake inhibitor Mirtazapine Pregabalin*

Antipsychotics • When and what to prescribe….. • Treat the symptom not the behviour

Antipsychotics Risperidone - ? The safe (er) option? • Olanzapine – The all rounder. • Aripiprazole – Cardiologists friend • Amisulpride – Diabetologists friend • Haloperidol – The junior doctors friend • Quetiapine – Neurologists friend •

IM antipsychotics • Convenience vs drug • Rule 2 • Legal framework

Golden rules 1. Speak to family. 2. What does the patient with dementia want? 3. Advanced decisions. 4. Advanced statements. 5. Legal framework for drug administration. 6. Low and slow. 7. Titrate to effect. 8. Consider all side effects / contraindications. 9. Speak to family.

Psychotic symptoms in Parkinson’s disease Can dopaminergic medication be reduced? • Rivastigmine • Quetiapine • ?Clozapine? •

Sleep / wake reversal

• Melatonin 10mg– mixed evidence, Sleep wake cycle cochrane, no effect and low side effects. • Trazadone 50mg-100mg – improved time to sleep and time asleep • Ramelteon 8mg – no effects and poor evidence base.

• Acetylcholinesterase inhibitors* • Memantine* • Trazadone

georgecrowther@nhs.net

Pharmacological Interventions Behavioural and Depression: 42% - PowerPoint PPT Presentation

Pharmacological Interventions Behavioural and Depression: 42% Psychological Agitation: 35% Anxiety: 35% Irritability: 30% Delusions: 22% Symptoms of Aberrant motor behaviour: 25% Sleep Disturbance: 14% Disinhibition: 12% Hallucinations:

Non pharmacological Modulation of Neurotransmitters Brief Review of Neurochemistry

ONTOP: Can Non-Pharmacological Interventions be recommended to prevent or reduce critical

Refractory Cough: non pharmacological interventions Dr Surinder Birring MD Consultant Respiratory

What do we know about brief interventions to increase physical activity? A systematic review of

Chris Wagstaff September 2016 A bag costs 5p, but thats not the point! 2 Stick doesnt

Interventions into the Community: Learning from ADSSP Grantees Katie Maslow Visiting Scholar

Pharmacological Management Of Pharmacological Management Of Alcohol Use Disorders Alcohol Use

What is really behavioural in behavioural health policy? Matteo M Galizzi

Causal Discovery from Interventions Brady Neal causalcourse.com Structural Interventions

ENHANCING BEHAVIOURAL INSIGHTS TO CREATE SUSTAINBLE BEHAVIOURAL CHANGE AT WORK Date: 16 TH APRIL

Applying Behavioural Insights to Public Policy Simon Ruda Outline 1. What are behavioural

Lexico-grammatical Features of the Behavioural Process 1 L U C Y C H R I S P I N C A R D I F F

Bisimilarity and Behavioural Equivalences Lus Soares Barbosa HASLab - INESC TEC Universidade

EED INTERVENTIONS 3.0 Produced by: Kidane, L.; Osterman, A.; Babigumira, J. EED Interventions |

1 How Good Are Long-Term Confusion Assessment Method Care Nurses at Screening? (CAM) (Inouye et

BFFF Birmingham Roger Martin-Fagg behavioural economist Mainstream vv Behavioural Economists

Overview Treatment Goals First Episode Optimizing Treatment in Schizophrenia:

Early Identification and Treatment of Psychosis: Potential Promise and Pitfalls October 14, 2013

Douglas F. Steenblock, MD Relevant to the content of this educational activity, I do not have any

Antipsychotic Potpourri Monica Ott, MD Assistant professor of clinical medicine Department of

The Basics of Psychoactive/Psychotropic Medications Tina Sanchez, RN, SMQT New Mexico Department

MEDICATION USE AND ALZHEIMERS DISEASE - MEDALZ STUDY Sirpa Hartikainen Professor of Geriatric

Why and how we reduced the use of anti-psychotic medication from 30% to 5 % in two residential

Summary of the Ultimate authority over ASHP professional policies ______________________________