Psych Pharm
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Created by Bennett Waxse, UTSW, updated 5/26/2016
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More med school reference docs here
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ClassPsychotherapy or OtherDisease1st-line ℞2nd-line ℞Circumstantce-Specific ℞Avoid
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Psychoticsuportive, psychoeducationSchizophreniform/iaAAP APclozapine
(refractory, SI)
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SchizoaffectiveAAP APLithium, VPA, carb
(Bipolar)
SSRI
(depression)
ECT
(depression)
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Brief Psychotic DisorderAAP APBDZ
(agitation)
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supportive, groupDelusional Disorder
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MoodCBT
ECT (SI, elderly, catatonia)
MDDSSRISNRITCAs, MAOIsbuproprion
(to avoid sexual dysfunction)
mirtazapine
(insomnia and wt loss)
perphenazine
(w/ psychotic features)
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cognitive, interpersonalPersistent Depressive DisorderSSRISNRITCAs, MAOIs
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Premenstrual Dysphoric DisorderSSRI
(daily, luteal)
OCPs may help
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supportive, family, group
ECT (mania)
Bipolar I/IILithiumVPA, carbamazepine
(rapid cycling, mixed)
+ lorazepam
(keep calm acutely)
AAP
(acute mania or depression)
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Cyclothymic DisorderLithiumVPA, carbamazepineAAP
(acute mania or depression)
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CBTDisruptive Mood Dysregulation DisorderOnly for cormorbidities
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AnxietyCBT (psychodynamic)Panic Disorder, Agoraphobiasertraline, citalopram, escitalopramTCAsBDZ
(immediate Tx)
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CBTSpecific / Social PhobiaSSRI
(if debilitating)
SNRI
(if debilitating)
BDZ (augment, performance-subtype)propranolol, atenolol
(performance anxiety)
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CBTGADSSRISNRIBDZ
(short-term)
buspirone
(adjunct)
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CBT, familySelective Mutism, Separation AnxietySSRI
(for anxiety)
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OCDCBT (graded ERP)OCDsertraline, paroxetine, fluvoxamine, fluoxetine (high dose)clomipraminerisperidone
(3rd-line)
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CBTBody Dysmorphic DisorderSSRIPlastic surgery
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CBT (specialized)Hoarding DisorderSSRI
(if OCD Sx)
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CBTTrichotillomaniaSSRIAAPN-acetylcysteine
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StressCBT (ERP, cognitive processing, supportive/psychodynamic)PTSDsertraline, citalopramvenlafaxineprazosin
(nightmares)
AAP
(severe)
BDZ
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CBT (ERP, cognitive processing, supportive/psychodynamic)Acute Stress Disorder
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CBT (supportive, group)Adjustment DisorderOnly for cormorbidities
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Substancebehavioral counseling, 12-step, CBT, motivationSubstance Use DisorderMedically-assisted withdrawal, meds to ↓ craving
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Alcohol Withdrawalchlordiazepoxide, lorazepam, diazepamlorazepam, oxazepam, temazepam (liver dysfxn)
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Delirium Tremenslorazepam gttthiamine, FA, MV, lytes, IVF AP
(severe agitation)
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AAAlcohol Use Disordernaltrexoneacamprosatedisulfiram or topiramate
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Cocaine IntoxicationBDZ
(agitation)
haloperidol
(severe agitation)
Sx support
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Benzodiazepine ODflumazenillavage
(if 4-6 hrs ago)
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Barb ODalkalinize urine
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Benzodiazepine Withdrawaltaper
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Opiod ODnaloxonenaltrexone
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NAOpiod Withdrawal (moderate)clonidineNSAIDs
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NAOpiod Withdrawal (severe)buprenorphinemethadonebuprenorphine + naloxone (UD)methadone
(UD)
naltrexone
(UD if dedicated)
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NCDDeliriumTx underlying disorderhaloperidol
(agitation, aggression)
BDZ (disinhibition)
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Caregiver supportAlzheimer'sdonepezil, rivastigmine, galantaminememantine AP
(agitation, aggression)
AP
(black box warning)
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Caregiver supportVascular Dimentiamanage risk factors AP
(agitation, aggression)
AP
(black box warning)
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Lewy Body Diseasedonepezil, rivastigmine, g...
(cognition)
olanzapine, quetiapine, risperidone (psychosis)levodopa-carbidopa
(Parkinsonism)
AAP
(neuroleptic sensitivity)
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Parkinson'slevodopa-carbidopa vs dopamine agonistsdonepezil
(cognition)
↓ levodopa → quetiapine, clozapine (fewest motor Sx)
(psychosis)
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Frontotemporal DegenerationSSRItrazodone
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HIVHAARTstimulants
(fatigue, apathy)
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Huntington'stetrabenazineAAP
(psychosis)
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supportive, group, senior centerPseudodimentiaLow-dose SSRInortriptylinemirtazapineECTTertiary TCAs
(higher antichold SE)
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KidsB-mod (social skills, classroom intervention, family education)ADHDstimulantsatomoxetineclonidine, guanfacine
(3rd-line)
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behavioral therapy, psychoeducationASDrisperidone, aripiprazole (disruptive behavior)stimulants
(hyperacitivty)
clonidine, guanfacine
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psychoeducationTourette's Disorderguanfacine > clonidine
(if impairing)
haloperidol, risperidone, pimozide (severe)
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B-mod (parent-child interaction therapy)ODDOnly for cormorbidities
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B-mod, family-/community-based therapyConduct DisorderOnly for cormorbidities
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B-mod, PMTEnuresisDDAVP
(refractory or diurnal)
imipramine
(refractory or diurnal)
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bowel retraining, behavioral program, toileting routineEncopresisstool softener
(if 2/2 constipation)
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Dissoc.supportive, CBT, hypnotherapyDissociative AmnesiaOnly for cormorbidities
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psychodynamic, CBT, hypnotherapyDepersonalization / DerealizationOnly for cormorbidities
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safety, stability, Sx reduction, identify integrationDissociative Identity DisorderOnly for cormorbiditiesprazosin
(nightmares)
naltrexone
(self-mutilation)
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Eatingfamily (Maudsley), supervised wt gainAnorexia NervosaOnly for cormorbiditiesSSRI
(depression, anxiety)
bupropion
(↓ Sz threshold)
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CBT, nutritional counselingBulimiaSSRIbupropion
(↓ Sz threshold)
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CBT, individualBinge-Eating Disorderstimulants
(↓ appetite)
topiramate
(↓ wt)
orlistat
(↓ pancreatic lipase)
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Sleepsleep hygiene, CBTInsomnia DisorderBDZ (short-term)zolpidem, eszopiclone, zaleplontrazodone
(elderly, depressive Sx)
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Primary Insomnia (Travel)BDZ
(not groggy like trazodone/diphen)
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scheduled nappingHypersomnolence Disordermodafinilstimulantsatomoxetine
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wt loss, exercise, surgeryObstructive Sleep Apnea HypopneaBiPAP, CPAP
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scheduled napping, sleep hygiene, no shift workNarcolepsymodafinilamphetamine, methylphenidate
(daytime sleepiness)
Na Oxybate
(cataplexy)
TCA, SSRI, SNRI
(cataplexy)
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Sleep in elderlytrazodoneBDZDiphenhydramine
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education, reassurance, safe environmentNon-REM Sleep Arousal Disorderlow-dose BDZ
(refractory)
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reassurance, imagery rehersal therapyNightmare DisorderNot indicated
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environmental safetyREM Sleep Behavior DisorderD/C offending medclonazepam
(if needed)
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Restless LegDA agonistBDZFe
(if deficient)
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sexsex therapy, CBT, hypnotherapy, group therapySexual Dysfunctionsildenafil, alprostadil
(erectile dysfunction)
SSRI, TCA
(premature ejaculation)
T, vaginal E2
(hypoactive desire)
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PharmMAOI Hypertensive Crisisα-blocker (phentolamine)
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Serotonin SyndromeBDZ
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Acute dystonia↓ dosediphenhydramine > benztropine
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AP-induced akathisia↓ dosepropranololBDZ
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EPS↓ dosebenztropine, diphenhydramineamantadine
(anticholinergic toxicity)
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Tardive Dyskinesiad/c offending drug clozapine, quetiapine
(optional)
benztropine
(tardive dystonia)
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D/C MedsNMSdantrolenebromocriptine
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