Prescribing psychotropics in physical illness
Psychotropic medications are serious treatments for serious illnesses. Whilst often effective in the medically fit population, they frequently produce disappointing efficacy outcomes in the medically unwell. Their use is also made more difficult by wide-ranging side effects which may complicate management or worsen symptoms or disease pathology of physical illnesses. Medical illnesses themselves may impact on the pharmacokinetics and pharmacodymanics of psychiatric medications, with implications for their effectiveness and safe use.
The availability of information to guide the clinician through drug choice for these patients is limited; research trials frequently exclude the medically unwell, guidelines are written for those without comorbidity, and where policies do exist, they do not account for the multimorbidity frequently seen in real-world practice. Further, prescribing and management of psychotropic medicines in non-mental health specialist settings may be fraught with practical difficulties, including access to medication and experience with its use.
This course will discuss choice of antidepressant in patients with heart failure, including those with comorbid conditions such as cardiac disease and diabetes. The evidence base for the safe and effective use of antidepressants in the cardiac patient will be discussed, as well as drug interactions, relative contraindications, and management of side effects.
We will address the difficulties of using antidepressants in patients with gastrointestinal problems, including inflammatory bowel diseases. Particular attention will be paid to the relative likelihood of various drug options to cause, contribute to or even ameliorate pre-existing gastric symptoms. The use of antidepressants to treat neuropathic pain will be discussed, and how to separately manage depression in patients already taking antidepressants for this purpose.
Pharmacological measures for the management of agitation and aggression in the non-mental health hospital setting will be explored. The impact of differences in staff skill mix, medication availability, physical health monitoring and available administration routes on safe and effective drug choice will be considered.
The key issues surrounding prescribing of psychotropics for patients with kidney disease will be discussed. We will further examine the complexities of prescribing safely and effectively for patients who require dialysis, including pharmacokinetic principles, the use of depots, and how to manage episodic agitation whilst on the machine.
The vast majority of medicines used in mental conditions are largely metabolised and cleared by the liver. We will look at how liver impairment, both acute and chronic, may affect prescribing choice. We will also address how to manage psychotropic-induced liver damage.
Finally, this course will look at administration of psychotropics via non-oral routes. The practical implications of conditions such as short bowel and high-output stomas will be covered, as well as treatment options for those patients who cannot take medication orally. We will discuss the availability of various treatment options and the practicalities of using unlicensed medicines or routes in the acute hospital setting.
This course is suitable for clinical pharmacists or doctors who want to enhance their skills in safely and effectively prescribing psychotropics for patients with physical comorbidities, including:
- Pharmacists working in physical or mental health settings
- Mental health liaison pharmacists
- Doctors working in liaison departments
|Describe antidepressant treatment options for patients with heart failure and comorbid physical health problems||Select antidepressants appropriate for use in patients with inflammatory bowel disease||Understand the benefits and disadvantages for different pharmacological strategies for treatment of the agitated patient in acute hospital settings|
|Safely manage psychotropic use for patients undergoing renal dialysis||Understand changes in drug handling in patients with liver disease||Evaluate treatment options for patients unable to take medicines orally|
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