Assessment
These are the approved guidelines published by the South African Society of Psychiatrists to provide an overview on treatment and management of commonly diagnosed psychiatric illnesses. The guidelines include consensus recommendations, based on peer contribution and using the international evidence based guidelines that are suitable for the local South African health service.
Please note that parts of this guideline may be out of date, an update will be published as soon as it is available.
Diagnostic
A detailed clinical history, mental state and careful physical examinations must inform a diagnosis made rigorously in terms of the DSM-IV-TR, satisfying, in particular, criterion A of the disorder.[7] Clinically indicated special investigations (bedside, serological and drug screening) should support the exclusion of other biological causes of psychosis, and screening for HIV, syphilis and psychoactive substances is recommended in the South African context.
Brain imaging (computed tomography (CT) or magnetic resonance imaging (MRI)) and electroencephalography (EEG) are recommended in first-episode patients, when the clinical picture is atypical, and when there are abnormal findings on routine examination.[4]
Pre-treatment
Clinically indicated baseline investigations prior to initiating antipsychotic treatment are directed by the clinical process and choice of initial drug therapy, and include body mass index (BMI) and waist : hip ratio (cardiovascular (CV) risk), fasting blood glucose and lipogram (metabolic risk), and full blood count and liver function tests (depending on drug selection).
A baseline electrocardiogram (ECG) is indicated before treatment if required by the product’s package insert. If there is a personal history of CV disease or evidence of CV risk on physical examination, an ECG should be considered for inpatients.[6]