4.4.1 Treatment goals and prescribing

4.4.1 Treatment goals and prescribing

Establishing Goals of Treatment

Establishing goals of treatment in psychiatry involves collaboration between the patient and the clinician to determine the desired outcomes of psychiatric treatment. Some common goals of treatment in psychiatry include:

These goals can vary depending on the specific needs and circumstances of each individual patient and may change over time as treatment progresses.

Rational Prescribing

Rational prescribing refers to the responsible and appropriate use of medications in the treatment of mental health conditions. It involves taking into consideration various factors such as the patient’s symptoms, medical history, current medications, and potential side effects before choosing and prescribing medication.

The principles of rational prescribing in psychiatry include:

Rational prescribing is important in ensuring that patients receive safe and effective treatment while avoiding unnecessary or harmful medications. It also helps to promote patient adherence and improve outcomes in the long term.

In the context of specific psychiatric diagnoses (disorders and severities of disorder):

In psychiatric treatment, the goals of treatment and the principles of rational prescribing are crucial in ensuring safe, effective, and individualized care for patients with mental health disorders.

  1. Major Depressive Disorder (MDD): MDD is a common mental health disorder characterized by persistent feelings of sadness, hopelessness, and a lack of interest in activities that the individual once enjoyed. The goals of treatment for MDD include reducing symptoms of depression, improving mood, and enhancing overall functioning. Antidepressant medication, psychotherapy, or a combination of both may be used for treatment.

In terms of principles of rational prescribing, it is important to consider the individual needs and preferences of the patient when choosing a medication. For example, some patients may prefer a medication with a lower risk of side effects, while others may prioritize a faster onset of action. The clinician should also be aware of the patient’s medical history, including any prior treatment for depression or other medical conditions that may affect the patient’s response to the medication.

  1. Schizophrenia: Schizophrenia is a severe mental health disorder characterized by symptoms such as delusions, hallucinations, and disordered thinking. The goals of treatment for schizophrenia include managing these symptoms and improving the patient’s overall functioning. Antipsychotic medication is the mainstay of treatment, but psychotherapy may also be used.

In terms of principles of rational prescribing, the clinician should consider the individual needs and preferences of the patient when choosing an antipsychotic medication. Some patients may prefer a medication with a lower risk of side effects, while others may prioritize a faster onset of action. The clinician should also be aware of the patient’s medical history, including any prior treatment for schizophrenia or other medical conditions that may affect the patient’s response to the medication.

  1. Bipolar Disorder: Bipolar disorder is a mental health disorder characterized by episodes of mania or hypomania and depression. The goals of treatment for bipolar disorder include managing mood swings, preventing episodes of mania or depression, and improving the patient’s overall functioning. Mood stabilizers and/or antipsychotic medications may be used for treatment.

In summary, establishing goals of treatment and following the principles of rational prescribing are crucial in ensuring safe, effective, and individualized care for patients with psychiatric disorders. The goals of treatment vary depending on the specific disorder, and the clinician should consider the individual needs and preferences of the patient when choosing a medication. Close monitoring of the patient’s response to treatment is also important in ensuring the safety and effectiveness of treatment, and adjustments may need to be made if the patient is not responding well to the initial treatment plan. Additionally, the use of multiple medications should be avoided unless absolutely necessary, as this can increase the risk of side effects and interactions (Kirsh, 2005).

In the context of phases of illness (acute/subacute/maintenance):

The goals of treatment and principles of rational prescribing may vary depending on the phase of illness in which the patient with a psychiatric disorder is. Let’s examine how these may differ for each phase of illness:

  1. Acute phase: In the acute phase, the primary goal of treatment is to rapidly alleviate symptoms and prevent harm to the patient or others. This may involve hospitalization, the use of psychotropics or other medications, or other emergency interventions. The principles of rational prescribing during this phase include choosing a medication that is effective in treating the specific symptoms the patient is experiencing and ensuring that the medication is started at an appropriate dose and titrated as needed to achieve the desired effect.
  2. Subacute phase: In the subacute phase, the goals of treatment are similar to those in the acute phase but may be less intensive. The focus may shift to stabilizing the patient’s symptoms, preventing relapse, and improving overall functioning. The principles of rational prescribing during this phase include considering the patient’s response to previous treatments, choosing a medication that is well tolerated, and ensuring that the patient is monitored for adverse effects and potential interactions between medications.
  3. Maintenance phase: In the maintenance phase, the goal of treatment is to prevent relapse and maintain the patient’s stability. The principles of rational prescribing during this phase include considering the patient’s past response to treatment, continuing to monitor the patient for adverse effects and potential drug interactions, and considering the patient’s overall functioning and goals for their treatment.

In summary, the goals of treatment and principles of rational prescribing may vary depending on the phase of illness in which the patient with a psychiatric disorder. During the acute phase, the primary focus is on rapid symptom relief and preventing harm. During the subacute phase, the focus shifts to stabilizing symptoms and improving overall functioning. In the maintenance phase, the goal is to prevent relapse and maintain stability. In each phase, the clinician should consider the individual needs and preferences of the patient and closely monitor their response to treatment.

In the context of physical health status/co-prescribed medications:

The physical health status and co-prescribed medications of a patient with a psychiatric disorder can significantly impact the goals of treatment and principles of rational prescribing. Here’s how:

  1. Physical health status: A patient’s physical health status, including any co-occurring medical conditions, can impact the choice of medication and the dose that is appropriate. For example, a patient with liver or kidney disease may not be able to metabolize certain medications effectively, and the clinician may need to choose a different medication or adjust the dose accordingly.
  2. Co-prescribed medications: The presence of other medications being taken by the patient can also impact the choice of psychotropic medication and the dose that is appropriate. For example, certain medications can interact with psychotropics, leading to adverse effects or decreased effectiveness of the treatment. The clinician should consider the potential for drug interactions when choosing a medication and should closely monitor the patient for any adverse effects.

In summary, the physical health status and co-prescribed medications of a patient with a psychiatric disorder can have a significant impact on the goals of treatment and principles of rational prescribing. The clinician should consider the individual needs and preferences of the patient, as well as any co-occurring medical conditions or medications when choosing a medication and adjusting the dose (Chan, 2000).

In the context of age:

Age can play a significant role in the goals of treatment and principles of rational prescribing for patients with psychiatric disorders. Here’s how:

  1. Pediatric populations: In children and adolescents, the goals of treatment often include rapid symptom relief, improvement in overall functioning, and minimizing potential long-term adverse effects. The principles of rational prescribing in this population include considering the child’s developmental stage, choosing a medication that is well tolerated and effective in treating the specific symptoms, and monitoring for any potential adverse effects or drug interactions.
  2. Geriatric populations: In older adults, the goals of treatment may include managing symptoms and improving overall functioning while also considering potential adverse effects that may be more common in this population, such as cognitive impairment or falls. The principles of rational prescribing in this population include choosing a medication that is well tolerated, considering the potential for drug interactions with other medications the patient may be taking, and monitoring for any adverse effects.

In conclusion, age can play a significant role in the goals of treatment and principles of rational prescribing for patients with psychiatric disorders. In pediatric populations, the focus is on rapid symptom relief, improvement in overall functioning, and minimizing potential long-term adverse effects. In geriatric populations, the focus is on managing symptoms and improving overall functioning while considering potential adverse effects that may be more common in this population. The clinician should consider the individual needs and preferences of the patient, as well as the patient’s age when choosing a medication and adjusting the dose (Jeste, 2011).

Tailored Prescribing and the Individual Risk-Benefit Appraisal

Tailored prescribing and the individual risk-benefit appraisal are important considerations in the goals of treatment and principles of rational prescribing for patients with psychiatric disorders.

  1. Tailored prescribing: Tailored prescribing refers to the individualized approach to medication selection and dosing based on the unique needs and preferences of each patient. This approach takes into account factors such as the patient’s specific symptoms, physical health status, co-prescribed medications, age, and other individual considerations. The goal of tailored prescribing is to provide the patient with the most effective and safe treatment, while also considering the individual patient’s needs and preferences.
  2. Individual risk-benefit appraisal: The individual risk-benefit appraisal is the process of weighing the potential benefits of a medication against its potential risks, based on the specific needs and circumstances of each patient. This appraisal involves considering the patient’s symptoms, the potential adverse effects of the medication, and the patient’s ability to tolerate these adverse effects. The goal of the individual risk-benefit appraisal is to ensure that the patient receives the most effective treatment while minimizing the potential for harm.

In conclusion, tailored prescribing and the individual risk-benefit appraisal are important considerations in the goals of treatment and principles of rational prescribing for patients with psychiatric disorders. The goal of these approaches is to provide the patient with the most effective and safe treatment, while also considering the individual patient’s needs and preferences. The clinician should take into account the patient’s unique needs and circumstances when choosing a medication and adjusting the dose, and should closely monitor the patient’s response to treatment to ensure the safety and effectiveness of the treatment.

References:

(1) Chan, W. K., & Cheung, E. F. (2000). Clinical pharmacokinetics of psychotropics. Clinical Pharmacokinetics, 39(5), 347-373.

(2) Jeste, D. V., Palmer, B. W., & Rettiganti, M. (2011). Geriatric psychiatry: The interface between neurology and psychiatry in the elderly. Neuropsychiatry, 1(2), 129-141.

(3) Kirsh, B., & Mulsant, B. H. (2005). The future of psychopharmacotherapy for major mental illness. Current Opinion in Psychiatry, 18(5), 451-456.