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Practical steps: Major Depressive Disorder Bipolar Disorder

Practical steps: Major Depressive Disorder Bipolar Disorder. Dr. Tariq Hassan MRCPsych Forensic Division Department of Psychiatry Queen’s University. Objectives. At the end of the 60 min interactive presentation, the family physician resident will be able to :

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Practical steps: Major Depressive Disorder Bipolar Disorder

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  1. Practical steps:Major Depressive DisorderBipolar Disorder Dr. Tariq Hassan MRCPsych Forensic Division Department of Psychiatry Queen’s University

  2. Objectives • At the end of the 60 min interactive presentation, the family physician resident will be able to : 1. Identify a pathway to treating common mood disorders in your family medicine office 2. Identify important areas in the CANMAT guidelines for the common mood disorders

  3. Format • 25 min - Major Depressive Disorder • 25 min - Bipolar Disorder • 10 min – Questions and discussion

  4. Case Study - MDD • John is a 54 yr old man brought to your family medicine office by his sister. She is concerned that he has not been ‘his usual self’. John is the youngest of 3 siblings and for the last 5 years has been living with and caring for his mother who suffers from dementia.

  5. Computerized CBT • Living life to the full http://www.llttf.com/ • Mood Gym http://moodgym.anu.edu.au/

  6. Case study - BD • Mary is a 35 yr old receptionist currently on leave where she was working in a busy law firm. She has come to your family medicine office with her husband who is concerned that ‘she just can’t switch off’.

  7. Pre-Lithium checklist • Informed consent • Education leaflets • Baseline thyroid (TSH) and Kidney (BUN and creatinine) functions • ECG: patients>40 with cardiac hx • Pregnancy • Drug interactions : NSAID, ACE inhibitors, and thiazide diuretics

  8. Lithium maintenance • Next blood test for Lithium levels as well as Thyroid and Renal function after 9-12 hrs of first dose • Then after 2-3/ week till maintenance dose • Then every 3-6 months • More frequent if changing the dose • Lithium level 0.8-1.2 mmol/L (<1 in elderly)

  9. Lithium maintenance • Mild-moderate toxic reactions 1.5-2mmol/L: • Persistent diarrhea • Severe nausea • Ataxia • Coarse tremor • Stop or reduce dose (after 24 hr cessation)

  10. Lithium maintenance • Lithium level > 2 mmol/L • Stop Lithium • HOSPITAL

  11. Key learning points • A good history captures high yield areas • PHQ-9 does not replace a good history • If not sure don’t diagnose – THE GYPSY DIAGNOSIS • Provisional Diagnosis - OK • If not sure treat the symptoms , reassess and modify, then come to a diagnosis

  12. Questions Discussion Comments Thank you !

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