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Psychiatry

Welcome to the psychiatry category for physicians and pharmacists. This category has links to a wide range of psychiatry online resources such as clinical and prescribing guidelines for mental health disorders e.g. depression, schizophrenia and bipolar.

British Association for Psychopharmacology Consensus Guidelines

Source: bap.org.uk
Clinical Resource: Guidelines
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Last Checked: 20/06/13 Link Error: Report It

 

American Psychiatric Association Practice Guidelines

Source: psych.org
Clinical Resource: Guidelines
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Last Checked: 20/08/15 Link Error: Report It

 

American Academy of Child & Adolescent Psychiatry Practice Parameters

Source: aacap.org
Clinical Resource: Practice Parameters
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Last Checked: 19/08/15 Link Error: Report It

 

National Institute for Health and Care Excellence (NICE) Guidance > Mental health and behavioural conditions

Source: nice.org.uk
Clinical Resource: Guidance
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Last Checked: 18/05/15 Link Error: Report It

 

European College of Neuropsychopharmacology Guidelines

Source: ecnp.eu
Clinical Resource: Guidelines
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Last Checked: 19/03/13 Link Error: Report It

 

The Psychological Toolkit

The Psychological Toolkit is a collection of practical resources available for GPs to assist in the management of mood disorders in their clinical work. Comprised of five sections, the materials include fact sheets for GPs and patients, questionnaires to assist GPs in the assessment of depression, charts to assist with treatment protocols, tools for self-monitoring, and exercises for patients.

Source: blackdoginstitute.org.au
Clinical Resource: Toolkit
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Last Checked: 20/06/13 Link Error: Report It

 

Research tools

The Mood Disorders Unit (MDU) research team at the Black Dog Institute has been responsible for developing a number of rating scales, including the:

  • CORE Rating Scale for Psychomotor Retardation
  • Parental Bonding Instrument (PBI)
  • Intimate Bond Instrument (IBM)
  • Measure of Parental Style (MOPS)
  • Depression in the Medically Ill (DMI-10 and DMI-18)
  • Bipolar Disorder Screening Tool
  • Life Skills Profile (LSP)
  • Temperament and Personality Questionnaire (T&P)
  • Brief Measure of Worry Severity (BMWS)
  • Antenatal Risk Questionnaire (ANRQ)
  • Postnatal Risk Questionnaire (PNRQ)
  • Adult Measure of Behavioural Inhibition (AMBI) & Retrospective Measure of Behavioural Inhibition (RMBI)
  • Workplace Wellbeing Questionnaire
Source: blackdoginstitute.org.au
Clinical Resource: Tools
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Last Checked: 20/06/13 Link Error: Report It

 

Mood Disorders Psychopharmacology Unit

Source: mdpu.ca
Clinical Resource: Rating Scales
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Last Checked: 20/06/13 Link Error: Report It

 

Diagnostic & Treatment Scales

Source: medicaidmentalhealth.org
Clinical Resource: Diagnostic and Treatment Scales
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Last Checked: 19/08/15 Link Error: Report It

 

Mental health and behavioural conditions - CLEAR: clinical enquiry and response service

The CLEAR service is delivered by a team of information professionals based at Healthcare Improvement Scotland and NHS Greater Glasgow and Clyde.

CLEAR aims to provide clinicians with summarised evidence relating to aetiology, diagnosis, prognosis and treatment queries about patient care.

Source: knowledge.scot.nhs.uk
Clinical Resource: Evidence Based Answers to Clinical Questions
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Last Checked: 22/04/13 Link Error: Report It

 

BestBETs
Psychiatry

BETs were developed in the Emergency Department of Manchester Royal Infirmary, UK, to provide rapid evidence-based answers to real-life clinical questions, using a systematic approach to reviewing the literature. BETs take into account the shortcomings of much current evidence, allowing physicians to make the best of what there is.

Source: bestbets.org
Clinical Resource: Evidence Based Answers to Clinical Questions
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Last Checked: 20/06/13 Link Error: Report It

 

The Cochrane Collaboration
Cochrane Reviews - Mental Health

The Cochrane Collaboration is an international, non-profit, independent organisation, established to ensure that up-to-date, accurate information about the effects of healthcare interventions is readily available worldwide. It produces and disseminates systematic reviews of healthcare interventions, and promotes the search for evidence in the form of clinical trials and other studies of the effects of interventions.

Source: cochrane.org
Clinical Resource: Systematic Reviews
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Last Checked: 13/07/15 Link Error: Report It

 

Bandolier Knowledge
Mental Health

In these pages are collected the stories from Bandolier relating to mental health problems.

Source: bandolier.org.uk
Clinical Resource: Evidence Based Abstracts
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Last Checked: 13/06/17 Link Error: Report It

 

Western Australian Psychotropic Drugs Committee

WAPDC was established in 1998 with the purpose of providing guidance and advice on the use of psycho-pharmacological agents.

Source: watag.org.au
Clinical Resource: Various
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Last Checked: 20/06/13 Link Error: Report It

 

Psychotropics

The Lundbeck Institute is pleased to present Psychotropics Online, a comprehensive guide to CNS compounds and products.

Source: psychotropics.dk
Clinical Resource: Database
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Last Checked: 20/06/13 Link Error: Report It

 

Canadian Quick Reference Guide to Psychiatric Medication

Please note, P450 & Special Considerations sections are designed to contain helpful clinical information, and are not designed to be comprehensive. Medication interactions mediated by P450 enzyme sub-systems can be derived from the P450 information sections of the guide. Selected other clinically significant medication interactions are referred to in the Special Considerations columns.

Source: mdpu.ca
Clinical Resource: Reference Guide
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Last Checked: 20/06/13 Link Error: Report It

 

2010 Guide to Psychiatric Drug Interactions

Similar to the 2006 version, this educational review focuses on neuropsychiatric medications but also covers all other drugs to the extent that they interact with psychiatric medications. It emphasizes the role of pharmacologic principles to guide the safe and effective use of multiple medications when such use is necessary. Consistent with these principles, this review presents tables outlining major pharmacodynamic and pharmacokinetic mechanisms mediating DDIs relevant to the patient on psychiatric medications.

Source: primarypsychiatry.com
Clinical Resource: Journal Article
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Last Checked: 20/06/13 Link Error: Report It

 

Potentially hazardous drug interactions with psychotropics

Of the many interactions with psychotropic drugs, a minority are potentially hazardous. Most interactions are pharmacodynamic, resulting from augmented or antagonistic actions at a receptor or from different mechanisms in the same tissue. Most important pharmacokinetic interactions are due to effects on metabolism or renal excretion.

Source: apt.rcpsych.org
Clinical Resource: Journal Article
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Last Checked: 20/06/13 Link Error: Report It

 

Psychiatric Medications and HIV Antiretrovirals: A Guide to Interactions for Clinicians

This convenient guide is designed to provide guidance for minimizing drug interactions and more severe reactions among patients being treated with psychiatric medications in conjunction with antiretrovirals.

Source: nynjaetc.org
Clinical Resource: Guide
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Last Checked: 20/05/14 Link Error: Report It

 

Clinical Significance of Pharmacokinetic Interactions Between Antiepileptic and Psychotropic Drugs

The purpose of this article is to provide a concise overview of pharmacokinetic interactions between psychotropic agents and antiepileptic drugs (AEDs).

Source: eu.wiley.com
Clinical Resource: Journal Article
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Last Checked: 17/02/14 Link Error: Report It

 

Guidance on the recommended psychotropic agents for use in pregnancy and lactation
Cheshire and Wirral Partnership NHS Foundation Trust

Source: cwp.nhs.uk
Clinical Resource: Guidance
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Last Checked: 07/05/14 Link Error: Report It

 

Exposure to Psychotropic Medications and Other Substances during Pregnancy and Lactation: A Handbook for Health Care Providers

Our goal with this publication is to help primary care physicians, psychiatrists, pharmacists, obstetricians, midwives, public health nurses and nurse practitioners provide the best advice, information and care to women who are taking psychotropic medications or other substances during pregnancy and postpartum. Medications and other substances discussed in this handbook have been chosen because of their psychotropic qualities: they all affect brain chemistry and functioning. Drugs and substances that are not psychotropic, that are not used during pregnancy, or about whose effects there is not enough documented evidence (e.g., herbal remedies) are not included.

Source: knowledgex.camh.net
Clinical Resource: Handbook
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Last Checked: 07/05/14 Link Error: Report It

 

Management of Hyponatremia: Focus on Psychiatric Patients

Hyponatremia caused by SIADH is due to increased release of antidiuretic hormone (ADH). SIADH has been associated with many drugs often used in psychiatric patients, including nicotine, barbiturates, carbamazepine, antipsychotics, and antidepressants.

Source: uspharmacist.com
Clinical Resource: Journal Article
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Last Checked: 19/10/15 Link Error: Report It

 

Glaucoma Associated With therapies for Psychiatric disorders

The most common psychiatric conditions in the elderly are anxiety, severe cognitive impairment, and mood disorders (depression or bipolar disorder). Unfortunately, some psychiatric treatments, both medical and electroconvulsive therapy (ECT), can cause glaucoma, and glaucoma therapy such as timolol, brimonidine, and pilocarpine can cause psychiatric symptoms. This article provides an overview of the relationship between glaucoma and psychiatric treatments.

Source: bmctoday.com
Clinical Resource: Publication
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Last Checked: 19/05/14 Link Error: Report It

 

Polypharmacy: causes and consequences

Learning outcomes:

By the end of this module, we hope you will gain:

  • an understanding of the concept of polypharmacy
  • specific clinical and non-clinical factors associated with polypharmacy
  • clinical knowledge in applying polypharmacy with reference to specific mental disorders in the context of existing guidelines
  • an understanding of the balance between benefits and adverse effects from using multiple medications.
Source: psychiatrycpd.org
Clinical Resource: CE / CPD / Learning
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Last Checked: 20/06/13 Link Error: Report It

 

Benzodiazepines: How They Work and How to Withdraw
(aka The Ashton Manual)

This monograph contains information about the effects that benzodiazepines have on the brain and body and how these actions are exerted. Detailed suggestions on how to withdraw after long-term use and individual tapering schedules for different benzodiazepines are provided. Withdrawal symptoms, acute and protracted, are described along with an explanation of why they may occur and how to cope with them.

  • Contents Page
  • Introduction
  • Chapter I: The benzodiazepines: what they do in the body
  • Chapter II: How to withdraw from benzodiazepines after long-term use
  • Chapter II: Slow withdrawal schedules
  • Chapter III: Benzodiazepines withdrawal symptoms, acute & protacted
Source: benzo.org.uk
Clinical Resource: Manual
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Last Checked: 20/06/13 Link Error: Report It

 

Benzodiazepine equivalents

Source: sahealth.sa.gov.au
Clinical Resource: Conversion Chart
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Last Checked: 28/11/16 Link Error: Report It

 

Calculating equivalent doses of oral benzodiazepines

Benzodiazepines are the most commonly used anxiolytics and hypnotics. There are major differences in potency between different benzodiazepines and this difference in potency is important when switching from one benzodiazepine to another.

Source: sussexpartnership.nhs.uk
Clinical Resource: Document
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Last Checked: 28/11/16 Link Error: Report It

 

Material to support appropriate prescribing of hypnotics and anxiolytics across Wales

This educational pack aims to support the appropriate prescribing of hypnotics and anxiolytics across Wales by providing key health professionals with a practical approach for the initiation and review of hypnotic and anxiolytic prescribing. It includes examples of support material which can be used or adapted for this purpose.

Source: awmsg.org
Clinical Resource: Educational Pack
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Last Checked: 24/07/13 Link Error: Report It

 

Seminars in Old Age Psychiatry
Edited by Rob Butler and Brice Pitt

Contents

  1. Assessment
  2. Epidemiology
  3. Delirium
  4. Alzheimer's disease
  5. Vascular and other dementias
  6. Management of dementia
  7. Depression
  8. Mania
  9. Anxiety disorders and other neuroses
  10. Late paraphrenia
  11. Personality disorders and alcohol dependence
  12. Imaging
  13. Services
  14. Liaison
  15. Residential and nursing homes
  16. Pharmacological treatments
  17. Psychological treatments
  18. Carers
  19. Law
  20. Research
  21. Patient management problems
Source: rcpsych.ac.uk
Clinical Resource: Textbook
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Last Checked: 24/11/14 Link Error: Report It

 

Scottish Intercollegiate Guidelines Network (SIGN) Guideline > Management of Perinatal Mood Disorders

Source: sign.ac.uk
Clinical Resource: Guideline
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Last Checked: 18/05/15 Link Error: Report It

 

The Royal College of Psychiatrists College Report on the Use of Licensed Medicines for Unlicensed Applications in Psychiatric Practice

Source: rcpsych.ac.uk
Clinical Resource: Report
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Last Checked: 24/11/14 Link Error: Report It

 

What legal and pharmaceutical issues should be considered when administering medicines covertly?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

This Medicines Q&A discusses some of the legal issues that need to be considered before medicines are given covertly.

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

Depression

The resources which are available for this therapeutic topic can be accessed via the menu on the left-hand side of the page. The e-learning home page suggests ways in which you may like to use the wide variety of e-learning materials.

Source: webarchive.org.uk
Clinical Resource: e-Learning
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Last Checked: 24/04/15 Link Error: Report It

 

Scottish Intercollegiate Guidelines Network (SIGN) Guideline > Non-Pharmaceutical Management of Depression

Source: sign.ac.uk
Clinical Resource: Guideline
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Last Checked: 18/05/15 Link Error: Report It

 

Geriatric Depression Scale

Source: bpac.org.nz
Clinical Resource: Calculator
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Last Checked: 17/05/13 Link Error: Report It

 

Citalopram Drug Interaction: Prolonged QT and Risk of Arrhythmia

The interaction between citalopram and omeprazole or esomeprazole has the potential to significantly increase citalopram serum levels, prolong the QT interval and increase risk of TdP. Avoid this combination if possible.

Source: usask.ca
Clinical Resource: Drug Information Services Newsletter
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Last Checked: 18/03/13 Link Error: Report It

 

Escitalopram or citalopram for depression in primary care?

Several independent reviews of randomised controlled trials (RCTs) have concluded that the benefits of escitalopram over other antidepressants are small and unlikely to be clinically significant.

Source: webarchive.org.uk
Clinical Resource: National Prescribing Centre Publication
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Last Checked: 24/04/15 Link Error: Report It

 

What is the most appropriate antidepressant to use in ischaemic heart disease?

Patients with ischaemic heart disease (IHD) have a higher frequency of major depressive disorder than patients without cardiac disease. Patients who have had a recent myocardial infarction (MI) are also at increased risk of developing depression, which is a cause of increased morbidity and mortality.

Source: elmmb.nhs.uk
Clinical Resource: Medicines and Prescribing Bulletin
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Last Checked: 22/04/13 Link Error: Report It

 

Antidepressants for depression in stage 3–5 chronic kidney disease: a systematic review of pharmacokinetics, efficacy and safety with recommendations by European Renal Best Practice (ERBP)

Source: european-renal-best-practice.org
Clinical Resource: Guidance
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Last Checked: 17/02/14 Link Error: Report It

 

Antidepressant Drugs: Indications and Guidelines for Use in Epilepsy

Epilepsy patients who are diagnosed with clinical depression are often not treated with antidepressant drugs. There are a number of arguments for avoiding antidepressants in a person with active epilepsy; but there also are irrational worries. On the patient’s side, there is often the fundamental problem that a diagnosis of depression cannot be accepted because psychiatric disorders are seen as even more stigmatizing than epilepsy. However, for the physician, who most often has little or no psychiatric training, there is often an inappropriate fear of using antidepressants because of proconvulsive properties and of kinetic and dynamic interactions with antiepileptic drugs (AEDs).

Source: eu.wiley.com
Clinical Resource: Journal Article
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Last Checked: 16/05/13 Link Error: Report It

 

Antidepressant-induced seizures

The incidence of antidepressant induced seizures ranges from 0.1–4.0%, with the greatest risk being in patients with identifiable risk factors, as listed below. The mechanisms by which antidepressants cause seizures are unclear.

Source: auspharmlist.net.au
Clinical Resource: Pharmacy E-Bulletin
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Last Checked: 16/05/13 Link Error: Report It

 

Antidepressant Use in Pregnancy

This bulletin aims to discuss the potential risks associated with the use of the following antidepressants in pregnancy: selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs) and serotonin noradrenaline reuptake inhibitor (SNRIs).

Source: druginformation.co.nz
Clinical Resource: Drug Information Service Bulletin
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Last Checked: 07/05/14 Link Error: Report It

 

Neonatal outcomes after antidepressant use in the third trimester of pregnancy

This bulletin will focus on neonatal outcomes after third trimester use of therapeutic doses of the same antidepressants.

Source: druginformation.co.nz
Clinical Resource: Drug Information Service Bulletin
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Last Checked: 07/05/14 Link Error: Report It

 

Anti-depressant use in the post-partum period

Source: breastfeeding.ie
Clinical Resource: Factsheet
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Last Checked: 19/10/15 Link Error: Report It

 

Antidepressants in Pregnancy & Breastfeeding - Deliver Safe Choices

Women who are currently prescribed antidepressants and planning a family should be given the option of preconceptual counselling. Discuss treatment preference, efficacy, tolerability and the risks of taking medication.

Source: saferx.co.nz
Clinical Resource: Bulletin
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Last Checked: 07/05/14 Link Error: Report It

 

Antidepressants and Breastfeeding

Parental perception of the risk associated with breastfeeding during maternal drug use may lead to non–compliance with drug therapy or unnecessary cessation of breastfeeding. Given the prevalence of post-natal depression, and the benefits of breastfeeding for the baby (and mother), it is essential to have access to accurate and useful data when making decisions around antidepressant use during breastfeeding.

Source: druginformation.co.nz
Clinical Resource: Drug Information Service Bulletin
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Last Checked: 07/05/14 Link Error: Report It

 

Sexual dysfunction & antidepressants – part one

When considering whether sexual dysfunction is a result of antidepressant therapy, other causes and or contributing factors should be taken into account.

Sexual dysfunction & antidepressants – part two

There are a number of strategies that have been suggested for managing antidepressant induced sexual dysfunction as follows.

Source: auspharmlist.net.au
Clinical Resource: Pharmacy E-Bulletins
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Last Checked: 18/06/13 Link Error: Report It

 

Antidepressant-induced sexual dysfunction

Depression and sexual dysfunction are both common in the general population. When they co-exist they have the potential to impact negatively on each other in a bidirectional manner. Medication used to treat depression may cause additional problems with the sexual response cycle; although no drug is completely innocent, serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) are most frequently implicated in antidepressant-induced sexual dysfunction.

Source: safpj.co.za
Clinical Resource: Journal Article
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Last Checked: 18/06/13 Link Error: Report It

 

Which antidepressants are available in lactose-free formulations?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

Lactose is widely used in pharmaceutical formulations as a diluent or carrier. The dose of lactose in most pharmaceuticals is usually less than 2g per day and is unlikely to cause symptoms except in cases of severe lactose intolerance.

Source: sps.nhs.uk
Clinical Resource: Medicines Question and Answer
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Last Checked: 22/09/16 Link Error: Report It

 

Herbs for mental illness: Effectiveness and interaction with conventional medicines

The herbal remedies discussed in this article are those commonly used for psychiatric conditions. Their effectiveness and potential for adverse side effects and interactions are assessed.

Source: jfponline.com
Clinical Resource: Journal Article
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Last Checked: 24/02/14 Link Error: Report It

 

Herbal remedies for depression and anxiety

In this article, I will review the evidence for or against herbal remedies as treatments for depression and anxiety.

Source: apt.rcpsych.org
Clinical Resource: Journal Article
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Last Checked: 24/02/14 Link Error: Report It

 

St John’s wort (Hypericum perforatum): drug interactions and clinical outcomes

The aim of this work is to identify the medicines which interact with the herbal remedy St John’s wort (SJW), and the mechanisms responsible.

Source: eu.wiley.com
Clinical Resource: Journal Article
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Last Checked: 24/02/14 Link Error: Report It

 

Herb-medicine interactions: St John’s wort (Hypericum perforatum)
Useful information for pharmacists

This information sheet identifies the principal interacting medicines and explains the basis of the interactions. It may be used, together with other information sources, as a basis to provide advice to patients.

Source: nes.scot.nhs.uk
Clinical Resource: Information Sheet
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Last Checked: 24/02/14 Link Error: Report It

 

Complementary Corner: St John’s Wort and Serotonin Syndrome

A single cup of Healtheries “Be Happy” tea and two days of citalopram treatment has been associated with a case of serotonin syndrome resulting in hospitalisation.

Source: medsafe.govt.nz
Clinical Resource: Prescriber Update Article
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Last Checked: 24/02/14 Link Error: Report It

 

What to do if an initial antidepressant fails?

To provide family physicians with practical ways of managing depressed patients responding insufficiently to initial antidepressant treatment.

Source: cfp.ca
Clinical Resource: Journal Article
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Last Checked: 20/06/13 Link Error: Report It

 

Switching Antidepressants

The goal of this switching table is to offer a guide for physician and pharmacist in switching antidepressants. The table should be clear, easy to use and contains the most important information. Therefore, the table only contains the most commonly used antidepressants.

Source: wiki.psychiatrienet.nl
Clinical Resource: Table
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Last Checked: 28/11/16 Link Error: Report It

 

A Guide to Switching Antidepressants

Source: nes.scot.nhs.uk
Clinical Resource: Table
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Last Checked: 28/11/16 Link Error: Report It

 

Stopping Antidepressants - The Antidepressant Discontinuation Syndrome

Discontinuation symptoms may occur after stopping many drugs including antidepressants. ‘Discontinuation syndrome’ is the preferred term since ‘withdrawal syndrome’ implies addiction. Symptoms can often be explained in terms of receptor rebound - e.g. an antidepressant with potent anticholinergic side effects may cause diarrhoea, headache, nausea, vomiting, and restlessness on discontinuation.

Source: nes.scot.nhs.uk
Clinical Resource: Educational Resource
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Last Checked: 20/06/13 Link Error: Report It

 

Switching and stopping antidepressants

Switching from one antidepressant to another is frequently indicated due to an inadequate treatment response or unacceptable adverse effects. All antidepressant switches must be carried out cautiously and under close observation.

Source: nps.org.au
Clinical Resource: Journal Article
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Last Checked: 08/08/16 Link Error: Report It

 

Stopping medicines - antidepressants

Discontinuation symptoms have been reported with all the different classes of antidepressants, including tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and the other antidepressants, such as mirtazepine and venlafaxine.

Source: wemerec.org
Clinical Resource: Medicines Resource Centre E-Note
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Last Checked: 20/06/13 Link Error: Report It

 

Drug-induced depression

Drug-induced depression can vary from minor mood changes, to more severe mood changes with sleep disturbances and loss of appetite. In its most severe form, it can include suicidal ideation.

Source: adr.org.uk
Clinical Resource: Factsheet
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Last Checked: 20/06/13 Link Error: Report It

 

SSRIs and bleeding disorders

The selective serotonin re-uptake inhibitors (SSRIs) (e.g. fluoxetine, paroxetine, citalopram) have been associated with a variety of bleeding disorders and these started to be reported soon after their introduction. Reported reactions have ranged from mild spontaneous bleeding such as bruising or epistaxis to serious conditions including GI haemorrhage, genitourinary bleeding, intracranial haemorrhage and increased bleeding during surgery.

Source: bpac.org.nz
Clinical Resource: Journal Article
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Last Checked: 20/06/13 Link Error: Report It

 

Tramadol and Serotonin Syndrome

Reports continue to appear describing serotonin syndrome following combined use of tramadol (Ultram) with selective serotonin reuptake inhibitors (SSRIs) or selective serotonin/norepinephrine reuptake inhibitors (SNRIs). Because serotonin syndrome can be serious and is often difficult to detect, it is important for health professionals to be alert for this reaction.

Source: hanstenandhorn.com
Clinical Resource: Journal Article
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Last Checked: 22/08/12 Link Error: Report It

 

Tramadol: Seizures, Serotonin Syndrome, and Coadministered Antidepressants

In this edition of The Interface, we discuss two potential adverse events related to this commonly prescribed analgesic—seizures and serotonin syndrome.

Source: nih.gov
Clinical Resource: Journal Article
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Last Checked: 07/04/14 Link Error: Report It

 

Serotonin Syndrome

Serotonin Syndrome results from an acute hyperserotonergic state. The patient does not develop serotonin syndrome by natural processes alone. Abnormally elevated concentrations of serotonin and clinical signs and symptoms of serotonin syndrome develop because of drug induced serotonin augmentation.

Source: utah.edu
Clinical Resource: Poison Control Centre Newsletter
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Last Checked: 21/08/15 Link Error: Report It

 

Recognition and treatment of serotonin syndrome

This case report explains the syndrome’s pathogenesis, diagnosis, and management. Physicians are encouraged to consider the possibility of serotonin syndrome in patients who use serotonergic medications and present with autonomic changes, mental status changes, and neurological hyperexcitability.

Source: cfp.ca
Clinical Resource: Journal Article
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Last Checked: 20/06/13 Link Error: Report It

 

Neuroleptic Malignant Syndrome Information Service

NMSIS serves as an international resource center for knowledge on neuroleptic malignant syndrome in addition to other heat-related disorders and drug side effects by:

  1. developing educational support programs
  2. supporting clinical and new product research and development
  3. implementing updated web-based and published materials
  4. providing evidence-based informational and consultative services
Source: nmsis.org
Clinical Resource: Various
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Last Checked: 20/06/13 Link Error: Report It

 

Scottish Intercollegiate Guidelines Network (SIGN) Guideline > Management of Schizophrenia

Source: sign.ac.uk
Clinical Resource: Guideline
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Last Checked: 18/05/15 Link Error: Report It

 

Schizophrenia

The resources which are available for this therapeutic topic can be accessed via the menu on the left-hand side of the page. The e-learning home page suggests ways in which you may like to use the wide variety of e-learning materials.

Source: webarchive.org.uk
Clinical Resource: e-Learning
Register to Access Content: No

Last Checked: 24/04/15 Link Error: Report It

 

Schizophrenia: A Review

Schizophrenia is a debilitating mental illness that affects 1 percent of the population in all cultures. It affects equal numbers of men and women, but the onset is often later in women than in men. Schizophrenia is characterized by positive and negative symptoms. Positive symptoms include hallucinations, voices that converse with or about the patient, and delusions that are often paranoid. Negative symptoms include flattened affect, loss of a sense of pleasure, loss of will or drive, and social withdrawal.

Source: aafp.org
Clinical Resource: Journal Article
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Last Checked: 20/06/13 Link Error: Report It

 

The acutely psychotic patient
Assessment and initial management

This article aims to update the GP about the initial management of the acutely psychotic patient.

Source: racgp.org.au
Clinical Resource: Journal Article
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Last Checked: 20/06/13 Link Error: Report It

 

Guidance on the Administration to Adults of Oil-based Depot and other Long-Acting Intramuscular Antipsychotic Injections 3rd Edition

Written by Graham Alexander, Worcestershire Health and Care NHS Trust; Kathleen Greenway, Oxford Brooks University; David Pratt, Northumberland Tyne and Wear NHS Foundation Trust; Alan Pollard, Worcestershire Health and Care NHS Trust; Susan Stocks, Derbyshire Healthcare NHS Foundation Trust.

3rd edition revised and edited by Jacquie White, lecturer in Mental Health Nursing and University Teaching Fellow, of University of Hull and Celia Feetam of Aston University, Birmingham.

This document sets out evidence based guidance on the administration to adults of oil-based depot and other long-acting intramuscular antipsychotic injections which may be adopted by healthcare professionals as a framework for best practice

Source: cmhp.org.uk
Clinical Resource: Guidance
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Last Checked: 20/06/13 Link Error: Report It

 

The Royal College of Psychiatrists Consensus Statement On High-Dose Antipsychotic Medication

Source: rcpsych.ac.uk
Clinical Resource: Report
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Last Checked: 24/11/14 Link Error: Report It

 

Treatment with Multiple Antipsychotic Medications

A patient will be deemed to have treatment resistance once the patient has failed two separate treatments with antipsychotic medications, including a first generation and a second generation antipsychotic. Once a patient has failed two antipsychotic medications, a second medication is often added to an initial medication in order to increase efficacy.

Source: uwyo.edu
Clinical Resource: Newsletter
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Last Checked: 20/06/13 Link Error: Report It

 

Off-Label Use of Atypical Antipsychotic Drugs: An Update

This report covers the following off-label uses of atypical antipsychotic medications: anxiety, ADHD, dementia and severe geriatric agitation, major depressive disorder (MDD), eating disorders, insomnia, OCD, PTSD, personality disorders, substance abuse, and Tourette’s syndrome

Source: effectivehealthcare.ahrq.gov
Clinical Resource: Report
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Last Checked: 20/06/13 Link Error: Report It

 

American College of Neuropsychopharmacology White Paper: Update on Use of Antipsychotic Drugs in Elderly Persons with Dementia

The goal of this White Paper is to review relevant issues and make clinical and research recommendations regarding the treatment of elderly dementia patients with psychosis and/or agitation. The role of shared decision making and caution in using pharmacotherapy for these patients is stressed.

Source: acnp.org
Clinical Resource: Task Force Report
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Last Checked: 20/06/13 Link Error: Report It

 

Dementia - Behavioural and Psychological Symptoms (BPSD), Use of Antipsychotics
Pan Mersey Area Prescribing Committee Guideline

Source: panmerseyapc.nhs.uk
Clinical Resource: Guideline
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Last Checked: 08/08/16 Link Error: Report It

 

Antipsychotics in Dementia

This Best Practice Guide focuses on the rational and safe use of antipsychotics in people with dementia. Their place in therapy for symptoms associated with dementia is very limited and use is short-term for most people.

The focus of this guide is on the treatment of behavioural and psychological symptoms of dementia (BPSD). These prescribing principles are common to all indications for the use of antipsychotics.

This guide is intended as a resource for all those involved in the care of patients with dementia. It reflects the important culture of shared care and decision making involving doctors, nurses, pharmacists, caregivers, relatives and the patient.

Source: bpac.org.nz
Clinical Resource: Guide
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Last Checked: 20/06/13 Link Error: Report It

 

Guidance for Antipsychotic Use and Withdrawal in Dementia
Ipswich and East Suffolk Clinical Commissioning Group

Source: ipswichandeastsuffolkccg.nhs.uk
Clinical Resource: Guidance
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Last Checked: 19/08/15 Link Error: Report It

 

Management of women with psychosis during pregnancy

In the first of a series of reviews focusing on the management of women with psychiatric and neurological conditions during pregnancy, Dr Howard and Dr Seneviratne discuss the many issues surrounding the care of women with psychotic disorders during pregnancy and postpartum, including risks to the mother and fetus, use of antipsychotic medication and child protection issues.

Source: eu.wiley.com
Clinical Resource: Journal Article
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Last Checked: 07/05/14 Link Error: Report It

 

Switching Antipsychotics

The goal of this switching table is to offer a guide for physician and pharmacist in switching antipsychotics. The table should be clear, easy to use and contain the most important information. Therefore, the table only contains the most common or special antipsychotics. There is also a group ‘rest AP’, containing antipsychotics with the same switching advice.

Source: wiki.psychiatrienet.nl
Clinical Resource: Table
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Last Checked: 28/11/16 Link Error: Report It

 

Q: Are there any general recommendations for switching from one antipsychotic agent to another?

A: It is frequently necessary to convert patients from one type of drug therapy to alternative agents within the same therapeutic category. This commonly occurs with drugs such as antidepressants, benzodiazepines, anticonvulsants, etc. In the case of antipsychotic medications, this issue must be carefully addressed. There are a number of reasons for switching patients from one antipsychotic compound to another.

Source: duq.edu
Clinical Resource: Pharmaceutical Information Centre Publication
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Last Checked: 28/11/16 Link Error: Report It

 

Stopping medicines - antipsychotics

There may be several reasons for stopping an antipsychotic:

  • Inadequate response.
  • Adverse effects.
Source: wemerec.org
Clinical Resource: Medicines Resource Centre E-Note
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Last Checked: 20/06/13 Link Error: Report It

 

Haloperidol IM and oral equivalent doses

Source: hpft.nhs.uk
Clinical Resource: Table
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Last Checked: 28/11/16 Link Error: Report It

 

Factors influencing clozapine plasma concentrations

The use of therapeutic drug monitoring for clozapine is indicated in various situations, including poor compliance, inadequate response to treatment, presence of significant adverse effects, the presence of specific disease states (especially hepatic disease) and where there may be drug interactions.

Source: auspharmlist.net.au
Clinical Resource: Pharmacy E-Bulletin
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Last Checked: 17/02/14 Link Error: Report It

 

Atypical Antipsychotics

Antipsychotic medications have traditionally been used in the treatment of schizophrenia and schizoaffective disorders. They differ from the older “typical” antipsychotics (phenothiazines and butryophenones) in that they have improved efficacy, especially in the treatment of negative symptoms, and reduced incidence of extrapyramidal reactions. The differences in activity at dopamine receptors and serotonin receptors contribute to their improved efficacy and side-effect profile.

Source: utah.edu
Clinical Resource: Poison Control Centre Newsletter
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Last Checked: 21/08/15 Link Error: Report It

 

Atypical Antipsychotics and Metabolic Abnormalities

This article will focus on the type of metabolic abnormalities that can be associated with AAPs as well as recommended monitoring and management strategies.

Source: oregonstate.edu
Clinical Resource: Newsletter
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Last Checked: 19/08/15 Link Error: Report It

 

Diabetes, Psychiatric Disorders, and the Metabolic Effects of Antipsychotic Medications

This article will review the atypical, or second-generation, antipsychotics and their current uses. The relationship between diabetes and two of the most frequent indications for the use of these medications (schizophrenia and behavioral and psychological symptoms of dementia) will be examined. Additionally, this article will explore the complex association between antipsychotic medications and obesity, hyperglycemia, and dyslipidemias.

Source: diabetesjournals.org
Clinical Resource: Journal Article
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Last Checked: 20/06/13 Link Error: Report It

 

Schizophrenia, Glycemia and Antipsychotic Medications: An Expert Consensus Review

A working group of Canadian psychiatrists and endocrinologists met to discuss and provide recommendations for the re-emerging and controversial issue of glycemic control in schizophrenia and its possible relationship to antipsychotic drug therapy.The recommendations are based on expert opinion and consensus, on current Canadian guidelines for the treatment of schizophrenia and the management of diabetes mellitus, and on a review of the available data.

Source: diabetes.ca
Clinical Resource: Journal Article
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Last Checked: 19/08/15 Link Error: Report It

 

Atypical antipsychotic-induced blood dyscrasias and other adverse effects

A summary of recent information regarding atypical antipsychotic-induced blood dyscrasias is outlined below.

Source: druginformation.co.nz
Clinical Resource: Drug Information Service Bulletin
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Last Checked: 20/06/13 Link Error: Report It

 

Guidance on the Treatment of Antipsychotic Induced Hyperprolactinaemia in Adults
Sussex Partnership NHS Foundation Trust

Source: sussexpartnership.nhs.uk
Clinical Resource: Guideline
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Last Checked: 19/10/15 Link Error: Report It

 

Scottish Intercollegiate Guidelines Network (SIGN) Guideline > Bipolar Affective Disorder

Source: sign.ac.uk
Clinical Resource: Guideline
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Last Checked: 18/05/15 Link Error: Report It

 

 

Bipolar

The resources which are available for this therapeutic topic can be accessed via the menu on the left-hand side of the page. The e-learning home page suggests ways in which you may like to use the wide variety of e-learning materials.

Source: webarchive.org.uk
Clinical Resource: e-Learning
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Last Checked: 24/04/15 Link Error: Report It

 

Drug Combinations for Bipolar Spectrum Disorders: Evidence-Based Prescribing or Prescribing-Based Evidence?

Treatment of bipolar spectrum disorders today is a hot topic, with many new agents now available and many new combinations being touted. However clinical practice may not always be “in synch” with clinical research, since the treatment of bipolar spectrum disorders with monotherapies as well as with combinations of drugs may now be the least evidence-based area of psychopharmacology practice.

Source: psychiatrist.com
Clinical Resource: Journal Article
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Last Checked: 21/08/15 Link Error: Report It

 

Lithium in Bipolar Disorder. From the book "Handbook of Bipolar Disorder", Section IV, Chapter 19.

  1. Introduction
  2. Historical Background
  3. Clinical Effects and Indications
  4. Adverse effects of lithium treatment
  5. Special Situations
  6. Management of Lithium Treatment
  7. Putative Mechanisms of Action
  8. Summary
Source: mdco.ca
Clinical Resource: Handbook
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Last Checked: 19/08/15 Link Error: Report It

 

Lithium in General Practice

In this article we provide an overview and guidance on the management of patients taking lithium.

Source: bpac.org.nz
Clinical Resource: Journal Article
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Last Checked: 20/06/13 Link Error: Report It

 

Lithium

Lithium has a narrow therapeutic-index. The therapeutic concentration for bipolar depression is 0.6-1.2 mEq/L. Toxicity can occur at concentrations >1.5 mEq/L. Most poisonings are a result of altered kinetics (change in dosing or elimination) in patients taking lithium chronically. The clinical presentation of lithium toxicity is loosely correlated with serum drug concentrations in patients who develop toxicity after chronic administration.

Source: utah.edu
Clinical Resource: Poison Control Centre Newsletter
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Last Checked: 21/08/15 Link Error: Report It

 

Preventing lithium intoxication

Lithium is one of the most frequently used drugs for treating mood disorders. Because lithium has a narrow therapeutic index and wide therapeutic indications, intoxication continues to be an important issue in lithium therapy. Patients are put at risk of lithium intoxication, the toxicity produced by excessive doses of lithium, when they attend physicians who are unaware of potential interactions with other drugs and of comorbid disorders.

Source: cfp.ca
Clinical Resource: Journal Article
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Last Checked: 20/06/13 Link Error: Report It

 

Clinical aspects of delirium

Two comprehensive reviews (Inouye, 2006; Young and Inouye, 2007) have recently been published and this article draws on these as well as guidelines produced in 2006 by the British Geriatrics Society and the Royal College of Physicians of London and other reference material, in order to provide an overview of delirium targeted at a general audience with an aim to provide practical management advice.

Source: rcpe.ac.uk
Clinical Resource: Journal Article
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Last Checked: 20/06/13 Link Error: Report It

 

 

Anxiety

The resources which are available for this therapeutic topic can be accessed via the menu on the left-hand side of the page. The e-learning home page suggests ways in which you may like to use the wide variety of e-learning materials.

Source: webarchive.org.uk
Clinical Resource: e-Learning
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Last Checked: 24/04/15 Link Error: Report It

 

American Academy of Sleep Medicine Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults

Source: aasmnet.org
Clinical Resource: Guideline
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Last Checked: 20/06/13 Link Error: Report It

 

Insomnia

The resources which are available for this therapeutic topic can be accessed via the menu on the left-hand side of the page. The e-learning home page suggests ways in which you may like to use the wide variety of e-learning materials.

Source: webarchive.org.uk
Clinical Resource: e-Learning
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Last Checked: 24/04/15 Link Error: Report It

 

Insomnia: guide to diagnosis and recommended management

Insomnia is a major cause of distress due to fatigue and poor daytime performance. In our Drug review the authors discuss how to distinguish insomnia from other sleep disorders and the available treatment options and their properties, followed by an analysis of prescription data.

Source: eu.wiley.com
Clinical Resource: Journal Article
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Last Checked: 20/06/13 Link Error: Report It

 

Oral Nonprescription Treatment for Insomnia: An Evaluation of Products With Limited Evidence

Source: aasmnet.org
Clinical Resource: Review Article
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Last Checked: 20/06/13 Link Error: Report It

 

Comorbidity of mental disorders and substance use: A brief guide for the primary care clinician
Drug and Alcohol Services South Australia 2008

Source: sahealth.sa.gov.au
Clinical Resource: Guideline
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Last Checked: 28/01/14 Link Error: Report It

 

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