Category Archives: Psychiatry

Depression management

Some interesting points in this BMJ article about depression management: For mild depression (symptoms fairly manageable), appropriate routes for initial treatment include active monitoring (seeing them at intervals and discussing problems), exercise, and guided self-help. If this isn’t helping, other … Continue reading

Posted in Credits 2019, Psychiatry | Leave a comment

Management of an acutely disturbed person in the community

This BMJ article dealt with the management of someone presenting in an acutely disturbed/psychotic state: Above all, try to de-escalate the situation, and call for help quickly using, if possible, a silent messaging system. Be calm and sympathetic. Use non-threatening … Continue reading

Posted in Credits 2019, Psychiatry | Leave a comment

Mirtazapine + SSRIs

I’ve occasionally seen Mirtazapine used as an add-on to SSRIs in resistant depression. An RCT recently showed that adding Mirtazapine to an SSRI or SNRI in resistant depression works no better than adding placebo. That said, the definition of ‘resistant’ … Continue reading

Posted in Credits 2019, Medication, Psychiatry | Leave a comment

Dementia: NICE guidance update

I was pleased to see a summary of the new NICE guidance on dementia in the BMJ, since dementia accounts for a significant proportion of my work at the local care home. However, it turned out to be a mixture … Continue reading

Posted in Credits 2018, Dementia | Leave a comment

Management of psychotropic drugs during pregnancy

Good news – it seems that many of the problems initially thought to be related to taking antidepressants during pregnancy (cardiac problems, autism) are, in fact, probably due to risk factors related to the underlying illness. Since psychiatric illness is … Continue reading

Posted in Credits 2016, Medication, Medication in pregnancy, Pregnancy and Childbirth, Psychiatry | Leave a comment

Random prescribing points

Statins: Fluvastatin, simvastatin and atorvastatin are predominantly lipid-soluble, whereas pravastatin and rosuvastatin are predominantly water-soluble. Therefore, if a patient gets SEs on a lipid-soluble statin, it’s worth trying water-soluble.   Remember that the cut-offs for stopping are liver enzymes >3x … Continue reading

Posted in BMJ, Cardiovascular, Credits 2013, Gastroenterology, Medication, Prescriber, Psychiatry | Leave a comment

Assessment of pain in dementia

There are now scales for assessing pain in patients too demented to communicate. They rely on observation of behaviour over at least 5 minutes. PAINAD (Pain Assessment in Advanced Dementia) OPBAI (Observational Pain Behaviour Assessment Instrument) PADE (Pain Assessment in … Continue reading

Posted in Credits 2012, Elderly Medicine, Pain control, Psychiatry | Leave a comment