tailieunhanh - Early detection and management of mental disorders - part 4

. Nếu có thể, cho bệnh nhân và gia đình tham gia vào các quyết định lựa chọn một thuốc chống loạn thần, tuy nhiên. . . . Sử dụng cuốn tiểu thuyết hoặc "" không điển hình, các thuốc chống loạn thần thế hệ thứ hai là điều trị đầu tiên [14,41,57]. . Thông báo cho bệnh nhân và gia đình về những mục tiêu của điều trị chống loạn thần. | THE MANAGEMENT OF EARLY PSYCHOSIS 85 TABLE Principles in the use of antipsychotic medication in early psychosis 3 If possible let the patient and family participate in the decision to choose an antipsychotic however. Use novel or atypical second-generation antipsychotics as first-line treatment 14 41 57 . Inform the patient and family about the goals of the antipsychotic treatment. Inform about the acute and long-term side effects and possible impairment of subjective well-being. Monitor side effects closely especially extrapyramidal symptoms subjective dysphoria weight gain and cognitive dysfunction. Give repeated psychoeducation about efficacy tolerability and safety of the antipsychotic. Avoid polypharmacy with antipsychotics. Use of more than one antipsychotic should generally be avoided but concurrent use of a benzodiazepine in the short term and antidepressant or mood stabilizer in the long term is commonly necessary and beneficial. Avoid multiple or indeterminate prescriptions. Use the minimal effective dose to minimize side effects. Do not change dose or type of medication impulsively. Wait for at least 3 weeks to assess the response to a given dose or medication change. Use for appropriate duration for example 1-2 years for antipsychotics . Discontinue gradually 4-6 months . Follow up after discontinuation especially in first 3-6 months . Medication Adherence and Route of Administration A patient s initial experience of medication can have a powerful influence on short-term and long-term adherence to treatment 3 . Nonadherence can be considered the norm rather than the exception 58 . Adherence is influenced by several factors including attitudes towards illness insight concerns about the effects of medication. An investment in addressing these issues in the early stages of treatment can have a worthwhile long-term impact. Administering medication can be considered as a process of negotiation between clinicians the patient and the family. Identifying .