1. Algorithms for Mental Health Conditions
Hunter Hansen, PsyD, MSCP
Certificate in Integrated Primary Care
Fairleigh Dickinson University

2. Goal
To develop a strategy of care based on clinical impression, guidelines of treatment, algorithms, and treatment response

3. Objectives
Algorithms for integrated biopsychosocial treatment of mental disorders are reviewed
special emphasis on those that are particularly prevalent in community health settings: affective,anxiety, and ADHD disorders.
Practical thresholds for referral to specialty mental health care are explored.

4. BHpC vs Specialty MH

5. Primary Care Motto
Trying to Treat What We Can, Referring Out What Doesn’t Respond or Fit
“This person has a lot of insight and would be great for traditional therapy”
“She has psychotherapy for 3 years and wants to start again- let’s refer out”
“He was on Seroquel monotherapy before, so let’s just do that”
“She really needs to talk to someone”

6. Trends in Community Care
Misdiagnosis
Under dosage of treatment
Over reliance on medications
Klinkman, M. S. (2003). The role of algorithms in the detection and treatment of depression in primary care. Journal of Clinical Psychiatry, 64(Suppl2),

7. Analysis of your Clinic
What are the common mental health conditions that you treat?
What systems are in place to evaluate outcomes for these conditions?
What informs the practice of mental health care in your clinic?

8. ☤ ☹ ☏ ✔ Ψ Algorithm of Care Integrated Care Model Registry
Specialty Referrals
Registry ☏ ✔
screening & monitoring tools
evidence based/ guidelines/algorithms for psychotropics
Algorithm of Care ☹ Ψ
condition/population specific approaches
evidence & guideline based psychosocial interventions
Integrated Care Model

9. Sources for Algorithms and Guidelines
guidance.nice.org.uk/Topic/MentalHealthBehavioural
guidelines.gov
American Psychiatric Association- psych.org
American Psychological Association (coming soon)- apa.org

10. National Institute for Health and Clinical Excellence
Completed guidelines
Alcohol dependence and harmful alcohol use
Alcohol-use disorders: physical complications
Antenatal and postnatal mental health
Antisocial personality disorder
Anxiety
Attention deficit hyperactivity disorder (ADHD)
Bipolar disorder
Borderline personality disorder (BPD)
Dementia
Depression (replaced by CG90)
Depression in adults (update)
Depression in children and young people
Depression with a chronic physical health problem
Drug misuse: opioid detoxification
Drug misuse: psychosocial interventions
Eating disorders
Medicines adherence
Nocturnal enuresis - the management of bedwetting in children and young people
Obsessive compulsive disorder (OCD) and body dismorphic disorder (BDD)
Post-traumatic stress disorder (PTSD)
Pregnancy and complex social factors
Schizophrenia (replaced by CG82)
Schizophrenia (update)
Self-harm
Violence
When to suspect child maltreatment
nice.org.uk
Guidelines in development
Alcohol dependence and harmful alcohol use
Autism - management of autism in children and young people
Autism spectrum disorders in children and young people
Autistic spectrum conditions in adults
Common mental health disorders
Conduct disorders in children and young people
Psychosis with substance misuse
Schizophrenia up to 18 years of age
Self-harm (longer term management)
Social phobia

11. Checklist Screening Diagnosis & Individualized Treatment Plan
EBT/Guidelines/Algorithms ->Treatments Available In Clinic
Referrals Available to Patient
Registry Condition?
Treatment Response
Condition Specific Measuring Program for Quality of Care

12. ConDitions 25% Adults have MH dx, 10% of Children
Affective (Mood) Disorders 9.5% (MDD ;
Anxiety Disorders 18%
ADHD 4%

13. Affective Disorders
MDD
Dysthymia
Bipolar

14. MDD Screening- case finding and/or screening in suspected population
who what where when why
Diagnosis & Individualized Treatment Plan
special population (e.g peds, gero, OB)?
EBTs, guidelines, algorithms
list
EBT/Guidelines/Algorithms ->Treatments Available In Clinic
Referrals Available to Patient
Registry Condition?
Treatment Response
Condition Specific Measuring Program for Quality of Care

16. Anxiety Disorders Generalized Anxiety Disorder
Obsessive-Compulsive Disorder (OCD)
Panic Disorder
Post-Traumatic Stress Disorder (PTSD)
Social Phobia (or Social Anxiety Disorder)

18. Attention Deficit Hyperactivity Disorder (ADHD)
Types:
Predominantly hyperactive-impulsive
Predominantly inattentive
Combined hyperactive-impulsive and inattentive
Rule Outs
Sleep Disorders
Learning Disabilities
PTSD/Depression/ODD
Seizures

19. ADHD Screening- case finding and/or screening in suspected population
who what where when why
Diagnosis & Individualized Treatment Plan
special population (e.g peds, gero, OB)?
EBTs, guidelines, algorithms
list
EBT/Guidelines/Algorithms ->Treatments Available In Clinic
Referrals Available to Patient
Registry Condition?
Treatment Response
Condition Specific Measuring Program for Quality of Care

21. INSTITUTE FOR CLINICAL SYSTEMS IMPROVEMENT