CH 16 MENTAL HEALTH CONDITIONS NATIONAL DEPARTMENT OF HEALTH AFFORDABLE MEDICINES ESSENTIAL MEDICINES PROGRAMME Midazolam buccal and IM added Lorazepam IM not added adults ID: 776668
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PRIMARY HEALTHCARE 2014Updates to the 2008 PHC STG & EML
CH 16: MENTAL HEALTH CONDITIONS
NATIONAL DEPARTMENT OF HEALTH
AFFORDABLE MEDICINES
ESSENTIAL MEDICINES PROGRAMME
Slide2Midazolam, buccal and IM: addedLorazepam, IM: not added (adults), deleted (children)Haloperidol, IM: retainedPromethazine, IM: retainedRapid tranquilisation is not supported by robust data – to obtain study consent in this setting where patients are disturbed is challenging.Most recommendations are based on clinical experience, theoretical considerations & research data.4 TREC studies investigated parenteral medicines in “real life” emergency settings.Lorazepam’s efficaciousness is supported by TREC II study & is standard of care .However, combining TREC1 and TRECII studies suggests that midazolam 7.5–15 mg sedates more rapidly than lorazepam. A limitation in TRECI: mean dose of haloperidol was lower than in other TREC studies.
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Slide3EvidenceEfficacy: Meta-analysis of benzodiazepines: Insufficient data to support or refute the use of benzodiazepines (alone or in combination with antipsychotics). Analysis included TREC studies on lorazepam & midazolam.Safety: Meta-analysis of benzodiazepines : Single case of side effect-respiratory depression associated with midazolam; successfully treated with flumazenil.Respiratory depression is a class effect of benzodiazepines.Flumazenil is not essential as an antidote - patient can be manually ventilated.Benzodiazepines safer option as adverse effects (extrapyramidal side effects; dystonia & QT prolongation) associated with antipsychotics.
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Pragmatic implications
Lorazepam is standard of care. However, lorazepam requires to be refrigerated under lock & key.As benzodiazepines has a class effect in this setting; a single benzodiazepine was recommended that fulfils most indications throughout the PHC book. Midazolam: Recommended for status epilepticus at primary level (buccally for paediatrics & IM for adults), supported by good quality evidence (Refer to implementation slides for Trauma chapter). Buccal midazolam observed to be efficacious in psychiatric emergency setting for psychiatric agitation.
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Slide5Step up approach: NICE Guidelines recommends a step up approach in the short-term management of the disturbed patient: Prevalence: Patients commonly present with aggression & acute psychosis at primary level.
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SEDATION: Parental therapy has little advantage vs. oral preparations.
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Slide6PriceLorazepam was not awarded on contract on the current or previous tender cycle.Supply reported to be erratic. Reference price is not available. (A market analysis showed that lorazepam does not appear to be a reimbursable item on a number of National Healthcare Funds [including Australia (Pharmaceutical Benefit Scheme), New Zealand (PHARMAC), Turkey (Ex-Factory), Brazil (Maximum Price to Government]).
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PRICE SOURCELORAZEPAM INJDIAZEPAM INJMIDAZOLAM INJAustralia PBSNot listed10mg/2mlNot listedNew ZealandNot listed10mg/2ml1mg/mlTurkeyNot listedNot listedNot listedBrazilNot listed5mg/ml , 10mg/ml5mg/ml, 1mg/ml, 2mg/mlMSH price guideNot listedNot listed1mg/ml, 5mg/ml
Listing of product prices for
lorazepam
, diazepam, midazolam and
clonazepam
Injections
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Recommendation
Sedation algorithm describing step up therapy:
The sedation algorithm was inserted in the following sections:
16.1 Aggressive disruptive behaviour in adults 16.6.2 Bipolar disorder 16.7.1 Acute psychosis 16.8.2 Substance-induced psychosis
ALWAYS MONITOR VITAL SIGNS OF SEDATED PATIENT
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Rationale:
Recent expert consensus recommends non-coercive approaches including non-pharmacological calming techniques & oral preparations to promote patient collaboration, when safe to do so.Benzodiazepines safer option due to adverse effects (extrapyramidal side effects; dystonia & QT prolongation) associated with antipsychotics.Lorazepam requires refrigeration under lock & key.Availability issues regarding lorazepam - supply erratic, locally & globally.Midazolam recommended for the management of status epilepticus in adults and paediatrics with midazolam.Level of Evidence: II, III Systematic review of low quality evidence, RCTs, Guidelines(Refer to the medicine review of midazolam in rapid tranquillisation)
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Slide9NEW STGS
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SECTION
CONDITIONMEDICINE MANAGEMENT16.4.1ACUTELY DISTURBED CHILD OR ADOLESCENT AWAITING PSYCHIATRIC EVALUATIONYes16.5ACUTE DYSTONIC REACTIONYes16.6.1.1SUICIDE RISK ASSESMENTNo – referral16.6.2BIPOLAR DISORDERYes16.7.1ACUTE PSYCHOSISYes16.7.2CHRONIC PSYCHOSISYes16.8.1SUBSTANCE USE DISORDERSYes16.8.2SUBSTANCE-INDUCED MOOD DISORDERYes16.8.3SUBSTANCE-INDUCED PSYCHOSISYes16.8.4ALCOHOL WITHDRAWAL (UNCOMPLICATED)Yes
Rationale:
STGs were added to the PHC book for clarity.
To provide guidance on additional conditions that commonly present at primary level of care – with referral to secondary level of care as required.
Slide10Midazolam: addedHaloperidol: addedOrphenadrine: addedAligned with the Paediatric Hospital level STG, 2013; SAMF 2012; Section 16.6: Acute dystonic reactions & rationale for considering midazolam in the PHC book (see slide # 8).STG recommends switching to haloperidol, rather than administering an additional dose of benzodiazepine - in clinical practice the side effect of paradoxical disinhibition associated with benzodiazepines is often not considered.Level of Evidence: III Expert opinion, Guidelines
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16.4.1 ACUTELY DISTURBED CHILD OR ADOLESCENT AWAITING FURTHER EVALUATION
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Slide1116.5 ACUTE DYSTONIC REACTION
Biperiden, IM/IV: addedPromethazine, IM: addedSTG developed to provide guidance on management of acute dystonia.Aligned with Adult Hospital level STG, 2012 & Paediatric Hospital level STG, 2013.Promethazine for use in children: Due to global shortage of biperiden, promethazine was considered for children (extrapolated from adult data & dose as per sedation indication).
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16.5.2 BIPOLAR DISORDER
Diazepam, oral: addedMidazolam, buccal & IM: addedHaloperidol, IM: addedPromethazine, IM: addedAligned with the Adult Hospital level STG.Sedation algorithm included in the STG.Level of Evidence: II, III Systematic review of low quality evidence, Guidelines
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Slide132008 PHC STG: Psychosis divided into “Acute psychosis” & “Chronic psychosis”.Diazepam, oral: addedHaloperidol, oral: moved to chronic psychosis STGMidazolam, buccal & IM: addedLorazepam, IM: deletedHaloperidol, IM: retainedPromethazine, IM: addedChlorpromazine, oral: moved to chronic psychosis STGZuclophenthixol acetate, IM: amendedFluphenazine decanoate, IM: moved to chronic psychosis STGZuclopenthixol decanoate, IM: moved to chronic psychosis STGAligned with the Adult Hospital level STG, 2012. Sedation algorithm included in the STG.Directions for use of zuclopenthixol acetate, IM amended to align with SAMF 10th edition, 2012.Level of Evidence: II, III Systematic review of low quality evidence, Guidelines
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16.7.1 ACUTE PSYCHOSIS
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Slide14Schizophrenia where a less sedating agent is requiredHaloperidol, oral: dose amendedRisperidone, oral: addedEvidence: Meta-analysis: Risperidone had better overall efficacy vs. first-generation antipsychotic (FGAs) medicines, −0.13 (−0.22 to −0.05, p=0.002). NNT for 1 additional responder was 15 (9 to 36) for risperidone.Relapse significantly better with risperidone vs. FGAs, RR 0.74 (0.63 to 0.87), NNT: 11 (7 to33). Extrapyramidal side effects (EPSE) associated with risperidone vs. FGAs were less, RR (95% CI): 0.61 (0.52 to 0.72).Risperidone RCTs reviewed in the analysis were industry-sponsored. Exclusion of these studies reduced risperidone effect size in the primary analysis (overall symptoms) to -0.04, which was not significantly different from FGAs.
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Slide15Price: (Refer to the costing analysis report for details, which included a sensitivity analysis)Cost effectiveness analysis compared haloperidol, 4–6 mg to risperidone, 3–20 mg, for schizophrenia, based on the meta-analysis by Leucht et al (2009). Adverse effect of EPSE was costed, assuming that the percentage of patients requiring an anticholinergic was 45.8% for haloperidol vs. 30.8% for risperidone. The calculated ICERs across the dose range and sensitivity analyses indicated that risperidone was affordable (comparing haloperidol to risperidone):
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16.7.2 CHRONIC PSYCHOSIS
EffectICERSensitivity analysis (lower limit)Sensitivity analysis (upper limit)i. Overall efficacyR8.64 to R117.63R5.40 to R73.52R21.60 to R294.07ii. One additional responder-R16.20 to -R220.56-R9.72 to –R132.33-R38.89 to –R529.33iii. Relapse improved- R11.88 to –R161.74-R7.56 to –R102.93-R35.65 to –R485.22
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Slide16Other considerationsRisperidone associated with more weight gain vs. haloperidol 1.7 (0.9 to 2.4); p < 0.0001.Meta-analyses included older studies that used higher doses of FGAs resulting in definitive EPSE. However, EPSE also associated with second generation antipsychotics (SGAs), that is dose-dependent. Tardive dyskinesia associated with antipsychotics is often diagnosed late, & the condition is mostly irreversible.The condition commonly presents at primary level, warranting continuous availability of an agent.
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Slide17RecommendationsRationale: Anticholinergics are toxic & switching from low dose FGA to SGA preferred to adding an anticholinergic (to manage EPSE associated with FGAs). Haloperidol was as efficacious as risperidone for management of chronic schizophrenia.Although haloperidol is associated with a higher incidence of EPSE, risperidone is associated with a higher incidence of weight gain and metabolic complications/syndrome. Both agents are affordable & available on the current contract. The condition commonly presents at primary level & warrants continuous availability of an agent.Level of Evidence: I Meta-analysis
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Haloperidol, oral 5 mg as first line option.If associated side-effects occur with haloperidol, switch to risperidone rather than adding an anticholinergic.A note be included that anticholinergic therapy not be routinely added to antipsychotics to prevent EPSE.
16.7.2 CHRONIC PSYCHOSIS
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Slide18Schizophrenia where a more sedating agent is required:Chlorpromazine: amendedChlorpromazine 100 mg is the gold standard & reported to be more sedating than haloperidol. New patients would not be initiated on chlorpromazine at primary level of care.Those patients stabilised on chlorpromazine should continue therapy. Maximum maintenance dose was amended to 800 mg daily.Level of Evidence: III Expert opinion, Guidelines
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Slide19Long-term therapy:Fluphenazine decanoate: amendedFlupenthixol decanoate: amendedZuclopenthixol decanoate: amendedDoses were aligned with the SAMF 10th edition, 2012.Guidance provided on the weaning off of oral antispsychotics when changing to a depot preparation.Guidance on the addition of oral risperidone 2 mg for break through episodes whilst on the long acting depot.Level of Evidence: III Guidelines
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Slide20Long-term therapy (cont’d):Risperidone: addedGuidance provided on the addition of oral risperidone 2 mg for break through episodes whilst on long acting depot.For acute dystonic reaction:Biperiden, IM: deletedText was amended with cross referral to Section 16.5 Acute dystonic reaction.Level of Evidence: III Expert opinion, Guidelines
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Slide21Scope of the primary healthcare worker: Probably not in the scope of the primary healthcare practitioner to manage substance related disorders according to the DSM V criteria - possibly too complex.However, alcohol withdrawal should be considered, as this commonly presents at primary level of care.Level of evidence: III Expert opinion
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16.8 SUBSTANCE RELATED DISORDERS
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Slide22Diazepam, oral: addedDiazepam, IV: addedDSM V has combined substance abuse & substance dependent (substance-induced) disorders under substance use disorders.Guidelines: The STG includes a statement to refer to National Policy guidelines on detoxification of psychoactive substances.Aligned with Adult Hospital level STG, 2012 & National Policy guidelines on detoxification of psychoactive substances.STG describes general management with benzodiazepines and referral to secondary level.
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16.8.1 SUBSTANCE USE DISORDERS
Level of Evidence: III Guidelines
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Slide23Diazepam, oral: addedMidazolam, buccal & IM: addedHaloperidol, IM: addedPromethazine, IM: addedAligned with Adult Hospital level STG, 2012 & National Policy guidelines on detoxification of psychoactive substances.Sedation algorithm included in the STG.
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16.8.2 SUBSTANCE-INDUCED PSYCHOSIS
Level of Evidence: III Guidelines
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Slide24Thiamine, oral: addedDiazepam, oral: addedAligned with the Adult Hospital level STG, 2012.However, dose of thiamine, oral was amended to 300 mg daily x 14 days.As recommended by the British Association of Psychopharmacology guidelines (2013). Cochrane review: Evidence from RCTs insufficient to guide clinicians in determining the dose, frequency, route or duration of thiamine treatment for prophylaxis against or treatment of Wernicke syndrome due to alcohol abuse.Available data of low quality: 100 mg daily is insufficient. Level of Evidence: III Guidelines, low quality RCTs
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16.8.4 ALCOHOL WITHDRAWAL (UNCOMPLICATED)
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Slide25AMENDMENTS
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Slide26Diazepam, oral: addedMidazolam, buccal & IM: addedHaloperidol, IM: addedPromethazine, IM: addedSedation algorithm included in the STG.Biperiden for acute dystonia: Although a S21 application had been utilised to circumvent local supply issues, there is a global shortage of biperiden. As parenteral atropine has no supporting data in this clinical setting; promethazine, IM, retained for acute dystonia induced by antipsychotics.Level of Evidence: II, III Systematic review of low quality evidence, Guidelines
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16.1 AGGRESSIVE DISRUPTIVE BEHAVIOUR IN ADULTS
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Slide27Diazepam, oral: addedCitalopram, oral: addedFluoxetine, oral: not addedAligned with the Adult Hospital level STG, 2012.Short course of benzodiazepines (5-10 days) considered for the acute management of anxiety. Some doctors at primary level would be able to diagnose chronic anxiety, managed with SSRIs - SSRIs are considered safer & less sedating than tricyclic antidepressants.Level of Evidence: III Guidelines
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Slide28Diazepam, oral: addedAligned with the Adult Hospital level STG, 2012.Short course of benzodiazepines (5-10 days) considered for the acute management of anxiety. Level of Evidence: III Guidelines
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Slide29Fluoxetine: not addedCitalopram: addedGuidelines supports SSRIs as 1st line pharmacotherapy - chronic management of GAD in adults.Paucity of robust data comparing various SSRIs for GAD. RCTs generally show comparable efficacy & selection further guided by side effect profile of specific SSRIs. 1 small RCT (n=34) showed that by 8 weeks, for the treatment of anxiety disorders in the elderly (≥ 60 years of age): 65% [(11/17); 95% CI 42 to 87%] in the citalopram group vs. 24% [(4/17); 95% CI 3 to 44%] the placebo group.Lack of available data to support fluoxetine in preventing relapse of generalised anxiety disorders (chronic management of anxiety).RCT by Allgulander et al (2004): Remission rate (Hamilton anxiety scale ≤ 7) higher with sertraline vs. placebo, (37% vs. 23%, p=0.006) at 12 weeks analysis & endpoint analysis with the last observation carried forward (31% vs. 18%, p=0.002). Response rates (Clinical Global Impression ≤ 2) higher for sertraline (63%) vs. placebo (37%).Sertraline was better tolerated vs. placebo.
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Level of Evidence: III, Guidelines, Low quality RCT
16.2 ANXIETY AND STRESS AND RELATED DISORDERS IN ADULTS
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Slide30Price: Current contract price for citalopram cheaper than sertraline.
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BASED ON
WHO/ATC DDD (MG):Sertraline: 50 mgCitalopram: 20 mg
16.2 ANXIETY AND STRESS AND RELATED DISORDERS IN ADULTS
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Slide3116.6.1 MAJOR DEPRESSIVE DISORDER
Availability: Fluoxetine, oral is currently only available as a 20 mg capsule on tender; and doses of 10 mg per day would not be possible. Fluoxetine & not amitryptilline considered for the elderly in this clinical setting.
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Level of Evidence: III Expert opinion
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Slide3216.6.1 MAJOR DEPRESSIVE DISORDER
Duration of SSRI therapy:The duration of 9 months appears to be consistent with the literature. Guidelines recommend a continuation phase of therapy ranging from 6 months to 9 months:American Psychiatric Association (2010): 4 - 9 months.NICE 2009: 6 months.NEJM 2005: 6 - 9 months.Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2000 British Association for Psychopharmacology guidelines: 6 to 9 months.Texas Medication Algorithm Project 1999: 6 to 9 months.Recommendation: Continuation phase of SSRI therapy for a period of 6 months, once a patient has been stabilised.Rationale: This pragmatic approach consistent with most guidelines.Level of Evidence: III Guidelines
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Which of the following can be considered as appropriate primary health care management of chronic anxiety in an adult patient? Fluoxetine, oral, Initial dose: 20mg, increased to 40mg if there is only a partial response after weeks. If no response after 4 weeks, refer patient to secondary level Tricyclic antidepressants, e.g. Amitriptyline, oral, at bedtime. Initial dose: 25mg per day. Increase by 25 mg per day at 3–5 day intervals to a maximum dose of 150 mg per day.Citalopram, oral (Doctor initiated). Initiate at 10 mg daily for the 1st week. Then increase to 20 mg daily.
CASE STUDY
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Fluoxetine, oral, Initial dose: 20mg, increased to 40mg if there is only a partial response after weeks. If no response after 4 weeks, refer patient to secondary level Tricyclic antidepressants, e.g. Amitriptyline, oral, at bedtime. Initial dose: 25mg per day. Increase by 25 mg per day at 3–5 day intervals to a maximum dose of 150 mg per day.Citalopram, oral. Initiate at 10 mg daily for the 1st week. Then increase to 20 mg daily.Note: Citalopram must be doctor initiated.
CASE STUDY: SOLUTION
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Slide35SlideRef #ReferenceRAPID TRANQUILISATION IN PSYCHIATRY21TREC I: TREC Collaborative Group. Rapid tranquillisation for agitated patients in emergency psychiatric rooms: a randomised trial of midazolam versus haloperidol plus promethazine. BMJ. 2003 Sep 27;327(7417):708-13. http://www.ncbi.nlm.nih.gov/pubmed/14512476TREC II: Alexander J, Tharyan P, Adams C, John T, Mol C, Philip J. Rapid tranquillisation of violent or agitated patients in a psychiatric emergencysetting. Pragmatic randomised trial of intramuscular lorazepam v. haloperidol plus promethazine. Br J Psychiatry. 2004 Jul;185:63-9. http://www.ncbi.nlm.nih.gov/pubmed/15231557TREC III: Huf G, Coutinho ES, Adams CE; TREC Collaborative Group. Rapid tranquillisationin psychiatric emergency settings in Brazil: pragmatic randomisedcontrolledtrial of intramuscular haloperidol versus intramuscular haloperidol plus promethazine. BMJ. 2007 Oct 27;335(7625):869. http://www.ncbi.nlm.nih.gov/pubmed/17954515TREC IV: Raveendran NS, Tharyan P, Alexander J, Adams CE; TREC-India II Collaborative Group. Rapid tranquillisation in psychiatric emergency settings in India: pragmatic randomised controlled trial of intramuscular olanzapine versus intramuscular haloperidol plus promethazine. BMJ. 2007 Oct 27;335(7625):865. http://www.ncbi.nlm.nih.gov/pubmed/1795451432Gillies D, Sampson S, Beck A, Rathbone J. Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database Syst Rev. 2013 Apr 30;4:CD003079. http://www.ncbi.nlm.nih.gov/pubmed/23633309Alexander J, Tharyan P, Adams C, John T, Mol C, Philip J. Rapid tranquillisation of violent or agitated patients in a psychiatric emergency setting. Pragmatic randomised trial of intramuscular lorazepam v. haloperidol plus promethazine. Br J Psychiatry. 2004 Jul;185:63-9.TREC Collaborative Group. Rapid tranquillisation for agitated patients in emergency psychiatric rooms: a randomised trial of midazolam versus haloperidol plus promethazine. BMJ. 2003 Sep 27;327(7417):708-13.SAMF 2012, 10th edition.43MIDAZOLAM Taylor D, Okocha C, Paton C, Smith S, Connolly A. Buccal midazolam for agitation on psychiatric intensive care wards. Int J Psychiatry ClinPract.2008;12(4):309-11. http://www.ncbi.nlm.nih.gov/pubmed/2493772054Taylor D, Okocha C, Paton C, Smith S, Connolly A. Buccal midazolam for agitation on psychiatric intensive care wards. Int J Psychiatry ClinPract.2008;12(4):309-11. http://www.ncbi.nlm.nih.gov/pubmed/24937720
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Slide36SlideRef #ReferenceRAPID TRANQUILISATION IN PSYCHIATRY85Wilson MP, Pepper D, Currier GW, Holloman GH Jr, Feifel D. The psychopharmacology of agitation: consensus statement of the american association for emergency psychiatry project Beta psychopharmacology workgroup. West J Emerg Med. 2012 Feb;13(1):26-34. http://www.ncbi.nlm.nih.gov/pubmed/22461918 NICE. The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments, NICE clinical guideline 25, February 2005. Available at: www.nice.org.uk/cg25 16.4 MENTAL HEALTH CONDITIONS IN CHILDREN AND ADOLESCENTS106MIDAZOLAMPaediatric Hospital level STG, 2013.SAMF 10th edition, 2012.Section 16.6: Acute dystonic reactions 106HALOPERIDOLPaediatric Hospital level STG, 2013.SAMF 10th edition, 2012.Section 16.6: Acute dystonic reactions 106ORPHENADRINEPaediatric Hospital level STG, 2013.SAMF 10th edition, 2012.Section 16.6: Acute dystonic reactions 16.5 ACUTE DYSTONIC REACTION117BIPERIDENAdult Hospital level STG ,2012.Paediatric Hospital level STG, 2013.SAMF 10th edition, 2012.117PROMETHAZINEAdult Hospital level STG ,2012.Paediatric Hospital level STG, 2013.SAMF 10th edition, 2012.
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Slide37SlideRef #Reference16.7.1 ACUTE PSYCHOSIS138DIAZEPAMGillies D, Sampson S, Beck A, Rathbone J. Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database Syst Rev. 2013 Apr 30;4:CD003079.NICE clinical guideline 25: The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments.Leucht S, Heres S, Kissling W, Davis JM.Evidence-based pharmacotherapy of schizophrenia.Int J Neuropsychopharmacol. 2011 Mar;14(2):269-84.Wilson MP, Pepper D, Currier GW, Holloman GH Jr, Feifel D. The psychopharmacology of agitation: consensus statement of the american association for emergency psychiatry project Beta psychopharmacology workgroup. West J Emerg Med. 2012 Feb;13(1):26-34.Adult Hospital level STG, 2012.138MIDAZOLAMGillies D, Sampson S, Beck A, Rathbone J. Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database Syst Rev. 2013 Apr 30;4:CD003079.TREC I: TREC Collaborative Group. Rapid tranquillisation for agitated patients in emergency psychiatric rooms: a randomised trial of midazolam versus haloperidol plus promethazine. BMJ. 2003 Sep 27;327(7417):708-13. TREC II: Alexander J, Tharyan P, Adams C, John T, Mol C, Philip J. Rapidtranquillisation of violent or agitated patients in a psychiatric emergencysetting. Pragmatic randomised trial of intramuscular lorazepam v. haloperidol plus promethazine. Br J Psychiatry. 2004 Jul;185:63-9.TREC III: Huf G, Coutinho ES, Adams CE; TREC Collaborative Group. Rapid tranquillisationin psychiatric emergency settings in Brazil: pragmatic randomisedcontrolledtrial of intramuscular haloperidol versus intramuscular haloperidol pluspromethazine. BMJ. 2007 Oct 27;335(7625):869.NICE clinical guideline 25: The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments.Leucht S, Heres S, Kissling W, Davis JM.Evidence-based pharmacotherapy of schizophrenia.Int J Neuropsychopharmacol. 2011 Mar;14(2):269-84.Wilson MP, Pepper D, Currier GW, Holloman GH Jr, Feifel D. The psychopharmacology of agitation: consensus statement of the american association for emergency psychiatry project Beta psychopharmacology workgroup. West J Emerg Med. 2012 Feb;13(1):26-34.Adult Hospital level STG, 2012.
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Slide38SlideRef #Reference16.7.1 ACUTE PSYCHOSIS138LORAZEPAMGillies D, Sampson S, Beck A, Rathbone J. Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database Syst Rev. 2013 Apr 30;4:CD003079.NICE clinical guideline 25: The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments.Leucht S, Heres S, Kissling W, Davis JM.Evidence-based pharmacotherapy of schizophrenia.Int J Neuropsychopharmacol. 2011 Mar;14(2):269-84.Wilson MP, Pepper D, Currier GW, Holloman GH Jr, Feifel D. The psychopharmacology of agitation: consensus statement of the american association for emergency psychiatry project Beta psychopharmacology workgroup. West J Emerg Med. 2012 Feb;13(1):26-34.Adult Hospital level STG, 2012.16.7.2 CHRONIC PSYCHOSIS138HALOPERIDOLGillies D, Sampson S, Beck A, Rathbone J. Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database Syst Rev. 2013 Apr 30;4:CD003079.TREC I: TREC Collaborative Group. Rapid tranquillisation for agitated patients in emergency psychiatric rooms: a randomised trial of midazolam versus haloperidol plus promethazine. BMJ. 2003 Sep 27;327(7417):708-13. TREC II: Alexander J, Tharyan P, Adams C, John T, Mol C, Philip J. Rapidtranquillisation of violent or agitated patients in a psychiatric emergencysetting. Pragmatic randomised trial of intramuscular lorazepam v. haloperidol plus promethazine. Br J Psychiatry. 2004 Jul;185:63-9.TREC III: Huf G, Coutinho ES, Adams CE; TREC Collaborative Group. Rapid tranquillisationin psychiatric emergency settings in Brazil: pragmatic randomisedcontrolledtrial of intramuscular haloperidol versus intramuscular haloperidol pluspromethazine. BMJ. 2007 Oct 27;335(7625):869.NICE clinical guideline 25: The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments.Leucht S, Heres S, Kissling W, Davis JM.Evidence-based pharmacotherapy of schizophrenia.Int J Neuropsychopharmacol. 2011 Mar;14(2):269-84.Wilson MP, Pepper D, Currier GW, Holloman GH Jr, Feifel D. The psychopharmacology of agitation: consensus statement of the american association for emergency psychiatry project Beta psychopharmacology workgroup. West J Emerg Med. 2012 Feb;13(1):26-34.Adult Hospital level STG, 2012.
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Slide39SlideRef #Reference16.7.1 ACUTE PSYCHOSIS138PROMETHAZINEGillies D, Sampson S, Beck A, Rathbone J. Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database Syst Rev. 2013 Apr 30;4:CD003079.TREC I: TREC Collaborative Group. Rapid tranquillisation for agitated patients in emergency psychiatric rooms: a randomised trial of midazolam versus haloperidol plus promethazine. BMJ. 2003 Sep 27;327(7417):708-13. TREC II: Alexander J, Tharyan P, Adams C, John T, Mol C, Philip J. Rapidtranquillisation of violent or agitated patients in a psychiatric emergencysetting. Pragmatic randomised trial of intramuscular lorazepam v. haloperidol plus promethazine. Br J Psychiatry. 2004 Jul;185:63-9.TREC III: Huf G, Coutinho ES, Adams CE; TREC Collaborative Group. Rapid tranquillisationin psychiatric emergency settings in Brazil: pragmatic randomisedcontrolledtrial of intramuscular haloperidol versus intramuscular haloperidol pluspromethazine. BMJ. 2007 Oct 27;335(7625):869.NICE clinical guideline 25: The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments.Leucht S, Heres S, Kissling W, Davis JM.Evidence-based pharmacotherapy of schizophrenia.Int J Neuropsychopharmacol. 2011 Mar;14(2):269-84.Wilson MP, Pepper D, Currier GW, Holloman GH Jr, Feifel D. The psychopharmacology of agitation: consensus statement of the american association for emergency psychiatry project Beta psychopharmacology workgroup. West J Emerg Med. 2012 Feb;13(1):26-34.Adult Hospital level STG, 2012.138ZUCLOPHENTHIXOL ACETATEGillies D, Sampson S, Beck A, Rathbone J. Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database Syst Rev. 2013 Apr 30;4:CD003079.NICE clinical guideline 25: The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments.Leucht S, Heres S, Kissling W, Davis JM.Evidence-based pharmacotherapy of schizophrenia.Int J Neuropsychopharmacol. 2011 Mar;14(2):269-84.Wilson MP, Pepper D, Currier GW, Holloman GH Jr, Feifel D. The psychopharmacology of agitation: consensus statement of the american association for emergency psychiatry project Beta psychopharmacology workgroup. West J Emerg Med. 2012 Feb;13(1):26-34.Adult Hospital level STG, 2012.
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Slide40SlideRef #Reference16.7.2 CHRONIC PSYCHOSIS138CHLORPROMAZINEGillies D, Sampson S, Beck A, Rathbone J. Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database Syst Rev. 2013 Apr 30;4:CD003079.NICE clinical guideline 25: The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments.Leucht S, Heres S, Kissling W, Davis JM.Evidence-based pharmacotherapy of schizophrenia.Int J Neuropsychopharmacol. 2011 Mar;14(2):269-84.Wilson MP, Pepper D, Currier GW, Holloman GH Jr, Feifel D. The psychopharmacology of agitation: consensus statement of the american association for emergency psychiatry project Beta psychopharmacology workgroup. West J Emerg Med. 2012 Feb;13(1):26-34.Adult Hospital level STG, 2012.138ZUCLOPHENTHIXOL DECONATEGillies D, Sampson S, Beck A, Rathbone J. Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database Syst Rev. 2013 Apr 30;4:CD003079.NICE clinical guideline 25: The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments.Leucht S, Heres S, Kissling W, Davis JM.Evidence-based pharmacotherapy of schizophrenia.Int J Neuropsychopharmacol. 2011 Mar;14(2):269-84.Wilson MP, Pepper D, Currier GW, Holloman GH Jr, Feifel D. The psychopharmacology of agitation: consensus statement of the american association for emergency psychiatry project Beta psychopharmacology workgroup. West J Emerg Med. 2012 Feb;13(1):26-34.Adult Hospital level STG, 2012.138FLUPHENAZINE DECANOATE Gillies D, Sampson S, Beck A, Rathbone J. Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database Syst Rev. 2013 Apr 30;4:CD003079.NICE clinical guideline 25: The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments.Leucht S, Heres S, Kissling W, Davis JM.Evidence-based pharmacotherapy of schizophrenia.Int J Neuropsychopharmacol. 2011 Mar;14(2):269-84.Wilson MP, Pepper D, Currier GW, Holloman GH Jr, Feifel D. The psychopharmacology of agitation: consensus statement of the american association for emergency psychiatry project Beta psychopharmacology workgroup. West J Emerg Med. 2012 Feb;13(1):26-34.Adult Hospital level STG, 2012.
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Slide41SlideRef #Reference16.7.2 CHRONIC PSYCHOSIS159Gillies D, Sampson S, Beck A, Rathbone J. Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database Syst Rev. 2013 Apr 30;4:CD003079.TREC I: TREC Collaborative Group. Rapid tranquillisation for agitated patients in emergency psychiatric rooms: a randomised trial of midazolam versus haloperidol plus promethazine. BMJ. 2003 Sep 27;327(7417):708-13. TREC II: Alexander J, Tharyan P, Adams C, John T, Mol C, Philip J. Rapid tranquillisation of violent or agitated patients in a psychiatric emergencysetting. Pragmatic randomised trial of intramuscular lorazepam v. haloperidol plus promethazine. Br J Psychiatry. 2004 Jul;185:63-9.Promethazine, IM: Huf G, Coutinho ES, Adams CE; TREC Collaborative Group. Rapid tranquillisationin psychiatric emergency settings in Brazil: pragmatic randomisedcontrolledtrial of intramuscular haloperidol versus intramuscular haloperidol plus promethazine. BMJ. 2007 Oct 27;335(7625):869. http://www.ncbi.nlm.nih.gov/pubmed/17954515NICE clinical guideline 25: The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments.Leucht S, Heres S, Kissling W, Davis JM.Evidence-based pharmacotherapy of schizophrenia.Int J Neuropsychopharmacol. 2011 Mar;14(2):269-84.Wilson MP, Pepper D, Currier GW, Holloman GH Jr, Feifel D. The psychopharmacology of agitation: consensus statement of the american association for emergency psychiatry project Beta psychopharmacology workgroup. West J Emerg Med. 2012 Feb;13(1):26-34.Adult Hospital level STG, 2012.SAMF 10th edition, 2012.1610Leucht S, Corves C, Arbter D, Engel RR, Li C, Davis JM. Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Lancet. 2009 Jan 3;373(9657):31-41. http://www.ncbi.nlm.nih.gov/pubmed/19058842Crespo-Facorro B, Pérez-Iglesias R, Mata I, Ramirez-Bonilla M, Martínez-Garcia O, Pardo-Garcia G, Caseiro O, Pelayo-Terán JM, Vázquez-Barquero JL. Effectiveness of haloperidol, risperidone and olanzapine in the treatment of first-episode non-affective psychosis: results of a randomized, flexible-dose, open-label 1-year follow-up comparison. J Psychopharmacol. 2011 Jun;25(6):744-54. http://www.ncbi.nlm.nih.gov/pubmed/212929221610Leucht S, Corves C, Arbter D, Engel RR, Li C, Davis JM. Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Lancet. 2009 Jan 3;373(9657):31-41. http://www.ncbi.nlm.nih.gov/pubmed/190588421711Leucht S, Corves C, Arbter D, Engel RR, Li C, Davis JM. Second-generation versus first-generation antipsychotic drugs for schizophrenia: a meta-analysis. Lancet. 2009 Jan 3;373(9657):31-41. http://www.ncbi.nlm.nih.gov/pubmed/19058842
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Slide42SlideRef #Reference 16.7 PSYCHOSIS1812CHLORPROMAZINESAMF 10th edition, 2012.1913FLUPHENAZINE DECANOATESAMF 10th edition, 20121913FLUPENTHIXOL DECANOATE SAMF 10th edition, 20121913ZUCLOPENTHIXOL DECANOATESAMF 10th edition, 20122014RISPERIDONESAMF 10th edition, 20122014BIPERIDENSAMF 10th edition, 201216.8 SUBSTANCE RELATED DISORDERS2115Substance use disorder defined as per the DSM V criteria as the presence of 2 of 11 criteria; and further clustered in four groups: Impaired control; Social impairment; Risky use; Pharmacologic dependence.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th edition. Available at: http://www.dsm5.org/Pages/Default.aspx16.8.1 SUBSTANCE USE DISORDERS2216DIAZEPAMAmerican Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th edition. Available at: http://www.dsm5.org/Pages/Default.aspxAdult Hospital level STG, 2012.National Department of Health. National Policy guidelines on detoxification of psychoactive substances.
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Slide43SlideRef #Reference16.8.2 SUBSTANCE-INDUCED PSYCHOSIS2317DIAZEPAM American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th edition. Available at: http://www.dsm5.org/Pages/Default.aspxAdult Hospital level STG, 2012.National Department of Health. National Policy guidelines on detoxification of psychoactive substances.2317MIDAZOLAMAmerican Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th edition. Available at: http://www.dsm5.org/Pages/Default.aspxAdult Hospital level STG, 2012.National Department of Health. National Policy guidelines on detoxification of psychoactive substances.2317HALOPERIDOLAmerican Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th edition. Available at: http://www.dsm5.org/Pages/Default.aspxAdult Hospital level STG, 2012.National Department of Health. National Policy guidelines on detoxification of psychoactive substances.2317PROMETHAZINEAmerican Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th edition. Available at: http://www.dsm5.org/Pages/Default.aspxAdult Hospital level STG, 2012.National Department of Health. National Policy guidelines on detoxification of psychoactive substances.
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Slide44SlideRef #Reference16.8.4 ALCOHOL WITHDRAWAL (UNCOMPLICATED)2418THIAMINELingford-Hughes AR, Welch S, Peters L, Nutt DJ; British Association for Psychopharmacology, Expert Reviewers Group. BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP. J Psychopharmacol. 2012 Jul;26(7):899-952. http://www.ncbi.nlm.nih.gov/pubmed/22628390Day E, Bentham PW, Callaghan R, Kuruvilla T, George S. Thiamine for prevention and treatment of Wernicke-Korsakoff Syndrome in people who abuse alcohol. Cochrane Database Syst Rev. 2013 Jul 1;7:CD004033. http://www.ncbi.nlm.nih.gov/pubmed/23818100Ambrose ML, Bowden SC, Wehan G. Thiamine treatment and working memory function of alcohol dependent people: preliminary findings. Alcohol Clin Exp Res 2001; 25: 112–16. http://www.ncbi.nlm.nih.gov/pubmed/11198705 Cook CC. Prevention and treatment of Wernicke-Korsakoff Syndrome. Alcohol Alcohol Suppl 2000; 35: 19–20. http://www.ncbi.nlm.nih.gov/pubmed/11304070Thomson AD, Cook CCH, Touquet R, Henry JA. The Royal College of Physicians report on alcohol: guidelines for managing Wernicke’s encephalopathy in the accident and emergency department. Alcohol Alcohol Suppl 2002; 37: 513–21. http://www.ncbi.nlm.nih.gov/pubmed/12414541 Cook CCH, Hallwood PM, Thomson AD. B-vitamin deficiency and neuro-psychiatric syndromes in alcohol misuse. Alcohol Alcohol Suppl 1998; 33: 317–36. http://www.ncbi.nlm.nih.gov/pubmed/9719389Sechi G, Serra A. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007 May;6(5):442-55. Review. http://www.ncbi.nlm.nih.gov/pubmed/174340992418DIAZEPAMLingford-Hughes AR, Welch S, Peters L, Nutt DJ; British Association for Psychopharmacology, Expert Reviewers Group. BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP. J Psychopharmacol. 2012 Jul;26(7):899-952. http://www.ncbi.nlm.nih.gov/pubmed/22628390Cook CC. Prevention and treatment of Wernicke-Korsakoff Syndrome. Alcohol Alcohol Suppl 2000; 35: 19–20. http://www.ncbi.nlm.nih.gov/pubmed/11304070Thomson AD, Cook CCH, Touquet R, Henry JA. The Royal College of Physicians report on alcohol: guidelines for managing Wernicke’s encephalopathy in the accident and emergency department. Alcohol Alcohol Suppl 2002; 37: 513–21. http://www.ncbi.nlm.nih.gov/pubmed/12414541Sechi G, Serra A. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol. 2007 May;6(5):442-55. Review. http://www.ncbi.nlm.nih.gov/pubmed/17434099
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Slide45SlideRef #Reference16.1 AGGRESSIVE DISRUPTIVE BEHAVIOUR IN ADULTS2619DIAZEPAMGillies D, Sampson S, Beck A, Rathbone J. Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database Syst Rev. 2013 Apr 30;4:CD003079.NICE clinical guideline 25: The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments.Leucht S, Heres S, Kissling W, Davis JM.Evidence-based pharmacotherapy of schizophrenia.Int J Neuropsychopharmacol. 2011 Mar;14(2):269-84.Wilson MP, Pepper D, Currier GW, Holloman GH Jr, Feifel D. The psychopharmacology of agitation: consensus statement of the american association for emergency psychiatry project Beta psychopharmacology workgroup. West J Emerg Med. 2012 Feb;13(1):26-34.Adult Hospital level STG, 2012.16.1 AGGRESSIVE DISRUPTIVE BEHAVIOUR IN ADULTS2619MIDAZOLAM Gillies D, Sampson S, Beck A, Rathbone J. Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database Syst Rev. 2013 Apr 30;4:CD003079.TREC I: TREC Collaborative Group. Rapid tranquillisation for agitated patients in emergency psychiatric rooms: a randomised trial of midazolam versus haloperidol plus promethazine. BMJ. 2003 Sep 27;327(7417):708-13. TREC II: Alexander J, Tharyan P, Adams C, John T, Mol C, Philip J. Rapidtranquillisation of violent or agitated patients in a psychiatric emergencysetting. Pragmatic randomised trial of intramuscular lorazepam v. haloperidol plus promethazine. Br J Psychiatry. 2004 Jul;185:63-9.TREC III: Huf G, Coutinho ES, Adams CE; TREC Collaborative Group. Rapid tranquillisationin psychiatric emergency settings in Brazil: pragmatic randomised controlled trial of intramuscular haloperidol versus intramuscular haloperidol pluspromethazine. BMJ. 2007 Oct 27;335(7625):869. http://www.ncbi.nlm.nih.gov/pubmed/17954515NICE clinical guideline 25: The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments.Leucht S, Heres S, Kissling W, Davis JM.Evidence-based pharmacotherapy of schizophrenia.Int J Neuropsychopharmacol. 2011 Mar;14(2):269-84.Wilson MP, Pepper D, Currier GW, Holloman GH Jr, Feifel D. The psychopharmacology of agitation: consensus statement of the american association for emergency psychiatry project Beta psychopharmacology workgroup. West J Emerg Med. 2012 Feb;13(1):26-34.Adult Hospital level STG, 2012.
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Slide46SlideRef #Reference16.1 AGGRESSIVE DISRUPTIVE BEHAVIOUR IN ADULTS2619HALOPERIDOL Gillies D, Sampson S, Beck A, Rathbone J. Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database Syst Rev. 2013 Apr 30;4:CD003079.TREC I: TREC Collaborative Group. Rapid tranquillisation for agitated patients in emergency psychiatric rooms: a randomised trial of midazolam versus haloperidol plus promethazine. BMJ. 2003 Sep 27;327(7417):708-13. TREC II: Alexander J, Tharyan P, Adams C, John T, Mol C, Philip J. Rapidtranquillisation of violent or agitated patients in a psychiatric emergencysetting. Pragmatic randomised trial of intramuscular lorazepam v. haloperidol plus promethazine. Br J Psychiatry. 2004 Jul;185:63-9.TREC III: Huf G, Coutinho ES, Adams CE; TREC Collaborative Group. Rapid tranquillisationin psychiatric emergency settings in Brazil: pragmatic randomised controlled trial of intramuscular haloperidol versus intramuscular haloperidol pluspromethazine. BMJ. 2007 Oct 27;335(7625):869. http://www.ncbi.nlm.nih.gov/pubmed/17954515NICE clinical guideline 25: The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments.Leucht S, Heres S, Kissling W, Davis JM.Evidence-based pharmacotherapy of schizophrenia.Int J Neuropsychopharmacol. 2011 Mar;14(2):269-84.Wilson MP, Pepper D, Currier GW, Holloman GH Jr, Feifel D. The psychopharmacology of agitation: consensus statement of the american association for emergency psychiatry project Beta psychopharmacology workgroup. West J Emerg Med. 2012 Feb;13(1):26-34.Adult Hospital level STG, 2012.
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Slide47SlideRef #Reference16.1 AGGRESSIVE DISRUPTIVE BEHAVIOUR IN ADULTS2619PROMETHAZINEGillies D, Sampson S, Beck A, Rathbone J. Benzodiazepines for psychosis-induced aggression or agitation. Cochrane Database Syst Rev. 2013 Apr 30;4:CD003079.TREC I: TREC Collaborative Group. Rapid tranquillisation for agitated patients in emergency psychiatric rooms: a randomised trial of midazolam versus haloperidol plus promethazine. BMJ. 2003 Sep 27;327(7417):708-13. TREC II: Alexander J, Tharyan P, Adams C, John T, Mol C, Philip J. Rapidtranquillisation of violent or agitated patients in a psychiatric emergencysetting. Pragmatic randomised trial of intramuscular lorazepam v. haloperidol plus promethazine. Br J Psychiatry. 2004 Jul;185:63-9.TREC III: Huf G, Coutinho ES, Adams CE; TREC Collaborative Group. Rapid tranquillisationin psychiatric emergency settings in Brazil: pragmatic randomised controlled trial of intramuscular haloperidol versus intramuscular haloperidol pluspromethazine. BMJ. 2007 Oct 27;335(7625):869. http://www.ncbi.nlm.nih.gov/pubmed/17954515NICE clinical guideline 25: The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments.Leucht S, Heres S, Kissling W, Davis JM.Evidence-based pharmacotherapy of schizophrenia.Int J Neuropsychopharmacol. 2011 Mar;14(2):269-84.Wilson MP, Pepper D, Currier GW, Holloman GH Jr, Feifel D. The psychopharmacology of agitation: consensus statement of the american association for emergency psychiatry project Beta psychopharmacology workgroup. West J Emerg Med. 2012 Feb;13(1):26-34.Adult Hospital level STG, 2012.16.2 ANXIETY AND STRESS AND RELATED DISORDERS IN ADULTS2720DIAZEPAMAdult Hospital level STG, 2012.Batelaan NM, Van Balkom AJ, Stein DJ. Evidence-based pharmacotherapy of panic disorder: an update. Int J Neuropsychopharmacol. 2012 Apr;15(3):403-15. http://www.ncbi.nlm.nih.gov/pubmed/21733234Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA, Christmas DM, Davies S, Fineberg N, Lidbetter N, MaliziaA, McCrone P, Nabarro D, O'Neill C, Scott J, van der Wee N, Wittchen HU. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. J Psychopharmacol. 2014 May;28(5):403-39 http://www.ncbi.nlm.nih.gov/pubmed/24713617
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Slide48SlideRef #Reference16.2 ANXIETY AND STRESS AND RELATED DISORDERS IN ADULTS2720CITALOPRAMAdult Hospital level STG, 2012.Batelaan NM, Van Balkom AJ, Stein DJ. Evidence-based pharmacotherapy of panic disorder: an update. Int J Neuropsychopharmacol. 2012 Apr;15(3):403-15. http://www.ncbi.nlm.nih.gov/pubmed/21733234Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA, Christmas DM, Davies S, Fineberg N, Lidbetter N, MaliziaA, McCrone P, Nabarro D, O'Neill C, Scott J, van der Wee N, Wittchen HU. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. J Psychopharmacol. 2014 May;28(5):403-39 http://www.ncbi.nlm.nih.gov/pubmed/247136172720FLUOXETINEAdult Hospital level STG, 2012.Batelaan NM, Van Balkom AJ, Stein DJ. Evidence-based pharmacotherapy of panic disorder: an update. Int J Neuropsychopharmacol. 2012 Apr;15(3):403-15. http://www.ncbi.nlm.nih.gov/pubmed/21733234Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA, Christmas DM, Davies S, Fineberg N, Lidbetter N, MaliziaA, McCrone P, Nabarro D, O'Neill C, Scott J, van der Wee N, Wittchen HU. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. J Psychopharmacol. 2014 May;28(5):403-39 http://www.ncbi.nlm.nih.gov/pubmed/247136172821DIAZEPAMAdult Hospital level STG, 2012.Batelaan NM, Van Balkom AJ, Stein DJ. Evidence-based pharmacotherapy of panic disorder: an update. Int J Neuropsychopharmacol. 2012 Apr;15(3):403-15. http://www.ncbi.nlm.nih.gov/pubmed/21733234Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA, Christmas DM, Davies S, Fineberg N, Lidbetter N, MaliziaA, McCrone P, Nabarro D, O'Neill C, Scott J, van der Wee N, Wittchen HU. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. J Psychopharmacol. 2014 May;28(5):403-39 http://www.ncbi.nlm.nih.gov/pubmed/24713617
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Slide49SlideRef #Reference16.2 ANXIETY AND STRESS AND RELATED DISORDERS IN ADULTS2922SSRIS FOR CHRONIC ANXIETY:NICE. NICE clinical guideline CG113: Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults: Management in primary, secondary and community care, January 2011. http://www.nice.org.uk/guidance/cg113Bereza BG, Machado M, Ravindran AV, Einarson TR. Evidence-based review of clinical outcomes of guideline-recommended pharmacotherapies for generalized anxiety disorder. Can J Psychiatry. 2012 Aug;57(8):470-8.Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA,Christmas DM, Davies S, Fineberg N, Lidbetter N, Malizia A, McCrone P, Nabarro D, O'Neill C, Scott J, van der Wee N, Wittchen HU. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. J Psychopharmacol. 2014 May;28(5):403-39.2922FLUOXETINE:Baldwin D, Woods R, Lawson R, Taylor D. Efficacy of drug treatments for generalised anxiety disorder: systematic review and meta-analysis. BMJ. 2011 Mar 11;342:d1199.3023Contract circular HP09-2014SD16.6 MOOD DISORDERS 3225DURATION OF SSRI THERAPY:American Psychiatric Association (APA). Practice guideline for the treatment of patients with major depressive disorder. 3rd ed. Arlington (VA): American Psychiatric Association (APA); 2010 Oct. http://www.guideline.gov/content.aspx?id=24158NICE clinical guideline 90. [Internet] Depression in adults. [Issued: October 2009; cited February 2014]. Available at: www.guidance.nice.org.uk/cg90 Malani AK, Ammar H. Medical management of depression. N Engl J Med. 2006 Feb 9;354(6):646-8; author reply 646-8. http://www.ncbi.nlm.nih.gov/pubmed/16470956Anderson IM, Ferrier IN, Baldwin RC, Cowen PJ, Howard L, Lewis G, Matthews K, McAllister-Williams RH, Peveler RC, Scott J, Tylee A. Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 2000 British Association for Psychopharmacology guidelines. J Psychopharmacol. 2008 Jun;22(4):343-96. http://www.ncbi.nlm.nih.gov/pubmed/18413657Crismon ML, Trivedi M, Pigott TA, Rush AJ, Hirschfeld RM, Kahn DA, DeBattista C, Nelson JC, Nierenberg AA, Sackeim HA, Thase ME. The Texas Medication Algorithm Project: report of the Texas Consensus Conference Panel on Medication Treatment of Major Depressive Disorder. J Clin Psychiatry. 1999 Mar;60(3):142-56. http://www.ncbi.nlm.nih.gov/pubmed/10192589
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