Treatment Modalities

1. Treatment Modalities 蔡雅如 財團法人天主教耕莘醫院 精神科主治醫師

2. Treatment Approach • Biological • Psychological • Social

3. Treatment Modalities • Acute Ward：急診、強制住院 • Chronic Ward • Half-way House:安康之家 • Rehabilitation Center:日間病房、社區復健中心

4. Anti-psychotics • First Generation Anti-psychotics • Second Generation Anti-psychotics

5. FGA(1/2)

6. FGA(2/2)

7. SGA(2/2)

8. Anti-psychotics • Second generation anti-psychotics • Clozapine • Risperidone • Olanzapine (Zyprexa) • Quetiapine (Seroquel) • Sertindole • Ziprasidone(Geodon) • Ami-sulpride(Solian) • Aripiprazole (Abilify)

9. EPS • EPS: extra-pyramidal syndrome • Akathisia • Tremor • Parkinsonian-like signs • Tardive Dyskinesia

10. Anti-parkinson Drugs • Amantadine(PK-Merz) • Biperiden(Akineton) • Trihexyphenidyl (Artane) • Carbidopa/Levodopa(Sinemet)

11. Sedative-Hypnotics

12. 長效BZD 與短效BZD

13. Sedative-Hypnotics • Zolpidem(Stilnox) • Zpiclone(Imovane) • Buspirone • Beta-blocker(Inderal, Propranool)

14. Anti-depressants(1/2)

15. Anti-depressants(2/2)

16. Mood Stabilizer • Lithium • Carbamazepine (CBZ) • Valproic acid (VPA) • Lamotrigine • Topiramate(TPM) • Clonazepam(Rivotril) • Verapramil • Thyroid hormone • SGA

17. Multiaxial Evaluation Report Form • Axis I consists of all mental disorders except those listed under Axis II, and other conditions that may be a focus of clinical attention. • Axis II consists of personality disorders and mental retardation. The habitual use of a particular defense mechanism can be indicated on Axis II.

18. Multiaxial Evaluation Report Form • Axis III lists any physical disorder or general medical condition that is present in addition to the mental disorder. • The identified physical condition may be • causative (e.g., hepatic failure causing delirium), interactive (e.g., gastritis secondary to alcohol dependence), • an effect (e.g., dementia and human immunodeficiency virus [HIV]-related pneumonia), • or unrelated to the mental disorder.

19. Multiaxial Evaluation Report Form • Axis IV is used to code psychosocial and environmental problems that contribute significantly to the development or the exacerbation of the current disorder • The evaluation of stressors is based on the clinician's assessment of the stress that an average person with similar sociocultural values and circumstances would experience from psychosocial stressors.

20. Multiaxial Evaluation Report Form • Axis V is the Global Assessment of Functioning (GAF) scale with which the clinician judges the patient's overall level of functioning during a particular time period (e.g., the patient's level of functioning at the time of the evaluation or the patient's highest level of functioning for at least a few months during the past year). • Functioning is conceptualized as a composite of three major areas: social functioning, occupational functioning, and psychological functioning. • The GAF scale, based on a continuum of severity, is a 100-point scale with 100 representing the highest level of functioning in all areas.

21. Team Work • Psychiatrist • Nurse • Psychologist • Social worker • Occupational worker

22. Thank you for your attention