In this section, I present some ad-hoc thoughts mainly on clinical management issues. There is no attempt to offer a comprehensive guide to Psychiaty. There is plenty of academic information readily available that provides such a service. <\/p>\n\n\n\n
During my professional lifetime, Psychiatry has\nfundamentally remained a clinically descriptive specialty and in truth, special\ninvestigations have rarely helped in diagnosis. Somewhat ritually, we arrange\nhaematology, urea & electrolytes, liver function tests and thyroid function;\noccasionally there are some incidental abnormalities.<\/p>\n\n\n\n
There are a few drugs we use that require close\nmonitoring but these are very much specialist use only. Apart from Lithium level\nand thyroid function, special pathological investigations have little practical\nuse in the management of routine psychiatric disorders.<\/p>\n\n\n\n
Treatment resistant depression is one of the\nmost serious clinical situations referred to me and, I expect most other\npsychiatrists, because there is everything to play for. Get it right, recovery is the prize; if not, catastrophe.<\/p>\n\n\n\n
Medication almost always has a critically\nimportant part to play with this group of patients. Invariably, they have tried two or more\nwithout success; until recently, I have had to impress on the patient and their\nfamilies the critical importance of working through the medication in a\nmethodical fashion, hoping that eventually an effective anti-depressant will be\nfound for them.<\/p>\n\n\n\n
Genetic testing does not improve the efficacy of medication of course; what it does is ensure that we don\u2019t prescribe something that is going to be ineffective because of the patients’ biological make-up.\u00a0 It also can explain why previous prescriptions and treatment plans have not been helpful and under these circumstances, the patient finds it reassuring, because they now have an explanation for why they are no better.<\/p>\n\n\n\n
Testing at the moment is relatively expensive, but\nwhenever I have suggested it to the family, they have been happy to pay for\nit. Remarkably, the results have always\ninformed prescribing which puts me in the fortunate position of only suggesting\nthe medication to which they are likely to respond; and for the most part, they\ndo.<\/p>\n\n\n\n
I am confident that soon every patient, who is described as treatment resistant, will have genetic testing.\u00a0 It is a simple investigation and in my experience, with every single patient, it has facilitated effective management, enhanced the instillation of hope and saved lives.<\/p>\n","protected":false},"excerpt":{"rendered":"
In this section, I present some ad-hoc thoughts mainly on clinical management issues. There is no attempt to offer a comprehensive guide to Psychiaty. There is plenty of academic information readily available that provides such a service. Some thoughts about the management of Depression and the use of genetic testing. During my professional lifetime, Psychiatry … Continue reading “Clinical Information”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":2,"menu_order":2,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-472","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.drandrewmacaulay.org\/index.php?rest_route=\/wp\/v2\/pages\/472","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.drandrewmacaulay.org\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.drandrewmacaulay.org\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.drandrewmacaulay.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.drandrewmacaulay.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=472"}],"version-history":[{"count":4,"href":"https:\/\/www.drandrewmacaulay.org\/index.php?rest_route=\/wp\/v2\/pages\/472\/revisions"}],"predecessor-version":[{"id":493,"href":"https:\/\/www.drandrewmacaulay.org\/index.php?rest_route=\/wp\/v2\/pages\/472\/revisions\/493"}],"up":[{"embeddable":true,"href":"https:\/\/www.drandrewmacaulay.org\/index.php?rest_route=\/wp\/v2\/pages\/2"}],"wp:attachment":[{"href":"https:\/\/www.drandrewmacaulay.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=472"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}