Psych clinical reference/textbook ?

[JustPlainBill]

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Noticed that I'm seeing a lot more psych patients -- I no longer have a psych NP on site so the management is falling to me; It's been a while since I've done anything except garden variety depression; Does anyone have a good clinical reference to brush up/freshen up psych skills -- preferably one that includes considerations with each medication?

 

[simpler2]

Noticed that I'm seeing a lot more psych patients -- I no longer have a psych NP on site so the management is falling to me; It's been a while since I've done anything except garden variety depression; Does anyone have a good clinical reference to brush up/freshen up psych skills -- preferably one that includes considerations with each medication?

If you have access to up to date, the articles for individual psychiatric diseases provide easy to follow and comprehensive medication management. I would encourage looking up articles pertinent to the population where you patient lives (pediatric depression, geriatric bipolar, etc.) as these are also great for med management.

For diagnosis, I find the spiral bound desk reference to the diagnostic criteria from DSM-5 accessible. Psychiatric diagnostic interviewing is a skill that takes practice to develop efficiency like most outpatient based skills.

The trickier part is the significant amount of off label Rx use that occurs in psych. Up to date covers some of this (e.g. prazosin in PTSD, clonidine for opiate withdrawal, ...) but not all (probably wont find things like gabapentin/pregabalin for anxiety readily).

 

[clausewitz2]

Uptodate psych articles are not very good quality, for the most part.if you are looking for a succinct guide to psych methods with lots of practical tips and uses, I would suggest Stahl's Prescriber's Guide or the Maudsley Prescribing g Guidelines in Psychiatry. Maudsley is definitely the better resource for many reasons, but is also a British resource and so makes some reference to drugs that are not available in this country, whereas Stahl is strictly American in what it covers and so may be more practical for you.

 

[Ironspy]

Uptodate psych articles are not very good quality, for the most part.if you are looking for a succinct guide to psych methods with lots of practical tips and uses, I would suggest Stahl's Prescriber's Guide or the Maudsley Prescribing g Guidelines in Psychiatry. Maudsley is definitely the better resource for many reasons, but is also a British resource and so makes some reference to drugs that are not available in this country, whereas Stahl is strictly American in what it covers and so may be more practical for you.

I'll second the stahl's prescribers guide recommendation

 

[northernpsy]

Uptodate psych articles are not very good quality, for the most part.if you are looking for a succinct guide to psych methods with lots of practical tips and uses, I would suggest Stahl's Prescriber's Guide or the Maudsley Prescribing g Guidelines in Psychiatry. Maudsley is definitely the better resource for many reasons, but is also a British resource and so makes some reference to drugs that are not available in this country, whereas Stahl is strictly American in what it covers and so may be more practical for you.

As a psychiatrist, I approve this message.

 

[AFMD]

The trickier part is the significant amount of off label Rx use that occurs in psych. Up to date covers some of this (e.g. prazosin in PTSD, clonidine for opiate withdrawal, ...) but not all (probably wont find things like gabapentin/pregabalin for anxiety readily).

Is there any other issue with off label meds? We use them all the time. Should I be doing some sort of special documentation or having the patient sign a release?

 

[SilentCool]

Medical marijauna is the best off-label drug evah.

 

[simpler2]

Is there any other issue with off label meds? We use them all the time. Should I be doing some sort of special documentation or having the patient sign a release?

Off label simply is the title for treatment used for indications without FDA "approval". There are off label uses for medications with evidence far greater than some of the "on label" uses out there. You certainly DO NOT need to have any sort of special consent signed for "off label" medication use that is beyond your normal prescribing/clinical practice. I probably shouldn't have even placed warning about Up to Date not covering the off label uses. I went back and reviewed and noticed that they were included in any article I searched.

 

[simpler2]

Uptodate psych articles are not very good quality, for the most part.if you are looking for a succinct guide to psych methods with lots of practical tips and uses, I would suggest Stahl's Prescriber's Guide or the Maudsley Prescribing g Guidelines in Psychiatry. Maudsley is definitely the better resource for many reasons, but is also a British resource and so makes some reference to drugs that are not available in this country, whereas Stahl is strictly American in what it covers and so may be more practical for you.

I'm willing to defend Uptodate as I find this a much more accessible and practical resource for the primary care provider needing to address mental health prescription management. Stahl's is arranged by medication so you would need to know what you are prescribing for it to serve a purpose. I'm not sure that Maudsley would be a reasonable quick resource. The OP appears to be looking for a resource to apply in primary care, not to study for boards.

Though not perfect, Uptodate is electronic, searchable and organized by diagnosis/symptoms. In daily primary care clinic, such features are a must. Dynamed would serve similar function. Most primary care sites already offer UTD or dynamed for their providers and both are updated regularly...paper based references have some issues with both cost and maintenance of relevance.

 

[clausewitz2]

I'm willing to defend Uptodate as I find this a much more accessible and practical resource for the primary care provider needing to address mental health prescription management. Stahl's is arranged by medication so you would need to know what you are prescribing for it to serve a purpose. I'm not sure that Maudsley would be a reasonable quick resource. The OP appears to be looking for a resource to apply in primary care, not to study for boards.

Though not perfect, Uptodate is electronic, searchable and organized by diagnosis/symptoms. In daily primary care clinic, such features are a must. Dynamed would serve similar function. Most primary care sites already offer UTD or dynamed for their providers and both are updated regularly...paper based references have some issues with both cost and maintenance of relevance.

Maudsley is organized by indication and has handy tables of medicines with ideas about typical dosing, at least in the most recent editions. Agree that reading the articles in depth is probably not ideal for a primary care setting.

Stahl's does have the issue of being organized by med, but the section on each med is fairly extensive in terms of considerations and even better, that information is organized in a standardized format and address relevant questions.

 

[Bacchus]

If you make templates for GAD-7, PHQ2-->9, MDQ and DSM-V ADHD Symptoms (Children/Adult) you'll cover most psych you're going to see.

Depression with insomnia? I use trazodone initially

Anxiety/Depression +/- insomnia? I use an SSRI

ADHD? I try to do Straterra or Wellbutrin and if need to then go to a stimulant

Bipolar? I do depakote. I don't want to deal with lithium (personal preference).

If there's some racing thoughts with anxiety/depression or mild anger I'll add abilify.

Questionable cases I talk with our LPC/send for an intake.

 

[TableMD]

If you make templates for GAD-7, PHQ2-->9, MDQ and DSM-V ADHD Symptoms (Children/Adult) you'll cover most psych you're going to see.

Depression with insomnia? I use trazodone initially

Anxiety/Depression +/- insomnia? I use an SSRI

ADHD? I try to do Straterra or Wellbutrin and if need to then go to a stimulant

Bipolar? I do depakote. I don't want to deal with lithium (personal preference).

If there's some racing thoughts with anxiety/depression or mild anger I'll add abilify.

Questionable cases I talk with our LPC/send for an intake.

Hey I think Lamictal is very solid for Bipolar, from my limited experience...