Treatment Modalities

Treatment Modalities

蔡雅如財團法人天主教耕莘醫院

精神科主治醫師

Treatment Approach

Biological Psychological Social

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

Anti-psychotics

First Generation Anti-psychotics Second Generation Anti-psychotics

FGA(1/2)

抗精神病劑 抗精神病效力的對等量 (mg)Phenothiazines

Aliphatic groups Chlorpromazine 100 Triflupromazine 25-50 Piperazine groups Perpherazine 8 Trifluoperazine 5 Fluphenazine 2 Acetophenazine 25 Piperidine groups Thioridazine 100 Mesoridazine 50

FGA(2/2)

抗精神病劑 抗精神病效力的對等量 (mg)Thioxanthenes

Aliphatic groups Chlorprothixene 50 Piperazine groups Thiothixene 4Dibenzoxazepines

Loxapine 15Dihydroindole

Molindone 15Butyrophenones

Haloperidol 2 Droperidol 1Diphenylbutylpiperidine

Pimozide 1-2註：此表出自於： Shen WW ， Keio Journal of Medicine ， 1994 ，有重印許准。原表中兩藥， clozapine(CLZ) 及 risperidone (RIS) ，是屬於非典型抗精神病劑，因此不放在此表中。

SGA(2/2)

抗精神病劑 上市年代 抗精神效力的對等量 (mg)

血泌乳素增加

Clozapine 1990 50 不會Risperidone 1994 1-2 會Olanzapine 1996 2-3? 不會Quetiapine 1997 50-100 不會Sertindole 1996 ＊ 2-3? 不會Ziprasidone 2000 ? ?

( ＊不在美國市場，但在歐洲上市，後來於 1998 年廠商自動由全球市場撤銷。此表節譯於： Shen WW ， Comprehensive Psychiatry ， 1999 。 )

Anti-psychotics

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

EPS

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

Anti-parkinson Drugs

Amantadine(PK-Merz) Biperiden(Akineton) Trihexyphenidyl (Artane) Carbidopa/Levodopa(Sinemet)

Sedative-Hypnotics

長效 BZD 與短效 BZD

長效 BZD 代謝半衰期長的 BZD 叫做長效 (long-acting) 的 BZD ，它們有 (Shen 1991) ：˙Diazepam 50-150 小時 (Valium)˙Prazepam 30-120 小時˙Chlorazepate 50-100 小時˙Flurazepam 24-100 小時˙Nitrazepam 24-36 小時短效 BZD 短效 (short-acting) BZD 的代謝半衰期比較短，它們有 (Shen 1991) ：˙Lorazepam 10-18 小時 (Ativan)˙Oxazepam 4-10 小時˙Temazepam 5-8 小時˙Alprazolam 12-15 小時 (Xanax)˙Triazolam 3-5 小時

Sedative-Hypnotics

Zolpidem(Stilnox) Zpiclone(Imovane) Buspirone Beta-blocker(Inderal, Propranool)

Anti-depressants(1/2)

a. 單胺再吸收抑制抗憂鬱劑 (monoamine reuptake inhibitors) ˙ 選擇性血清素及去甲基腎上腺素再吸收抑制劑 (SNRIs) → 三環抗憂鬱劑 (TCAs) ，如 imipramine(Tofranil) → 四環抗憂鬱劑 (tetracyclic) ，如 maprotiline(Ludiomil) → 二環抗憂鬱劑 (bicyclic) ，如 venlafaxine(Efexor) ˙ 選擇性血清素再吸收抑制劑 (SSRIs) ，如 fluoxetine(Prozac),

Paroxetine(Seroxat),Sertraline(Zoloft), Fluvoxamine(Luvox), Citalopram(Cipram)

˙ 去甲基腎上腺素及多巴胺再吸收抑制劑 (NaDRI) ，如 bupropion(Wellbutrin)

˙ 選擇性去甲基腎上腺素再吸收抑制劑 (SNaRI) ，如 reboxetine

Anti-depressants(2/2)

b. 單胺氧化酵素抑制抗憂鬱劑 (MAOIs)

˙ 傳統的單胺氧化酵素抑制劑 (traditional MAOIs) ，如 phenelzine

˙ 可逆性 A型單胺氧化酵素抑制劑 (RIMA) ，如 moclobemide(Aurorix)

c. 單胺受體調整劑 (monoamine receptor modulators)

˙ 血清素調整劑，如 trazodone(mesyrel)

˙ 血清素及去甲基腎上腺素調整劑，如 mirtazapine(Remeron)

Mood Stabilizer

Lithium Carbamazepine (CBZ) Valproic acid (VPA) Lamotrigine Topiramate(TPM) Clonazepam(Rivotril) Verapramil Thyroid hormone SGA

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.

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.

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.

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.

Team Work

Psychiatrist Nurse Psychologist Social worker Occupational worker

Thank you for your attention