Algorithms for Mental Health Conditions Hunter Hansen, PsyD, MSCP Certificate in Integrated Primary Care Fairleigh Dickinson University

Goal To develop a strategy of care based on clinical impression, guidelines of treatment, algorithms, and treatment response

Objectives Algorithms for integrated biopsychosocial treatment of mental disorders are reviewed special emphasis on those that are particularly prevalent in community health settings: affective,anxiety, and ADHD disorders. Practical thresholds for referral to specialty mental health care are explored.

BHpC vs Specialty MH

Primary Care Motto Trying to Treat What We Can, Referring Out What Doesn’t Respond or Fit “This person has a lot of insight and would be great for traditional therapy” “She has psychotherapy for 3 years and wants to start again- let’s refer out” “He was on Seroquel monotherapy before, so let’s just do that” “She really needs to talk to someone”

Trends in Community Care Misdiagnosis Under dosage of treatment Over reliance on medications Klinkman, M. S. (2003). The role of algorithms in the detection and treatment of depression in primary care. Journal of Clinical Psychiatry, 64(Suppl2), 19-23.

Analysis of your Clinic What are the common mental health conditions that you treat? What systems are in place to evaluate outcomes for these conditions? What informs the practice of mental health care in your clinic?

☤ ☹ ☏ ✔ Ψ Algorithm of Care Integrated Care Model Registry Specialty Referrals Registry ☏ ✔ screening & monitoring tools evidence based/ guidelines/algorithms for psychotropics Algorithm of Care ☹ Ψ condition/population specific approaches evidence & guideline based psychosocial interventions Integrated Care Model

Sources for Algorithms and Guidelines guidance.nice.org.uk/Topic/MentalHealthBehavioural guidelines.gov American Psychiatric Association- psych.org American Psychological Association (coming soon)- apa.org

National Institute for Health and Clinical Excellence Completed guidelines Alcohol dependence and harmful alcohol use Alcohol-use disorders: physical complications Antenatal and postnatal mental health Antisocial personality disorder Anxiety Attention deficit hyperactivity disorder (ADHD) Bipolar disorder Borderline personality disorder (BPD) Dementia Depression (replaced by CG90) Depression in adults (update) Depression in children and young people Depression with a chronic physical health problem Drug misuse: opioid detoxification Drug misuse: psychosocial interventions Eating disorders Medicines adherence Nocturnal enuresis - the management of bedwetting in children and young people Obsessive compulsive disorder (OCD) and body dismorphic disorder (BDD) Post-traumatic stress disorder (PTSD) Pregnancy and complex social factors Schizophrenia (replaced by CG82) Schizophrenia (update) Self-harm Violence When to suspect child maltreatment nice.org.uk Guidelines in development Alcohol dependence and harmful alcohol use Autism - management of autism in children and young people Autism spectrum disorders in children and young people Autistic spectrum conditions in adults Common mental health disorders Conduct disorders in children and young people Psychosis with substance misuse Schizophrenia up to 18 years of age Self-harm (longer term management) Social phobia

Checklist Screening Diagnosis & Individualized Treatment Plan EBT/Guidelines/Algorithms ->Treatments Available In Clinic Referrals Available to Patient Registry Condition? Treatment Response Condition Specific Measuring Program for Quality of Care

ConDitions 25% Adults have MH dx, 10% of Children Affective (Mood) Disorders 9.5% (MDD ; Anxiety Disorders 18% ADHD 4% http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml#Intro

Affective Disorders MDD Dysthymia Bipolar

MDD Screening- case finding and/or screening in suspected population who what where when why Diagnosis & Individualized Treatment Plan special population (e.g peds, gero, OB)? EBTs, guidelines, algorithms list EBT/Guidelines/Algorithms ->Treatments Available In Clinic Referrals Available to Patient Registry Condition? Treatment Response Condition Specific Measuring Program for Quality of Care

Anxiety Disorders Generalized Anxiety Disorder Obsessive-Compulsive Disorder (OCD) Panic Disorder Post-Traumatic Stress Disorder (PTSD) Social Phobia (or Social Anxiety Disorder)

Attention Deficit Hyperactivity Disorder (ADHD) Types: Predominantly hyperactive-impulsive Predominantly inattentive Combined hyperactive-impulsive and inattentive Rule Outs Sleep Disorders Learning Disabilities PTSD/Depression/ODD Seizures

ADHD Screening- case finding and/or screening in suspected population who what where when why Diagnosis & Individualized Treatment Plan special population (e.g peds, gero, OB)? EBTs, guidelines, algorithms list EBT/Guidelines/Algorithms ->Treatments Available In Clinic Referrals Available to Patient Registry Condition? Treatment Response Condition Specific Measuring Program for Quality of Care

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