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Guideline

Update of the Mental Health Gap Action Programme (mhGAP) guidelines for mental, neurological and substance use disorders, 2015

Year of Publication
2015
Issuing Institution
World Health Organization
Links
WHO IRIS,WHO IRIS

Recommendations

30 included recommendations

Treatment for moderate-severe depressive disorder . As first-line therapy, health care providers may select psychological treatments (such as behavioural activation [BA], cognitive behavioural therapy [CBT], or interpersonal psychotherapy [IPT]) or antidepressant medication (such as selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]). They should keep in mind the possible adverse effects associated with antidepressant medications, the ability to deliver either intervention (in terms of expertise, and/or treatment availability), and individual preferences.

Status
Retired

Recommended in favor

Conditional

Health care providers can offer different treatment formats of WHO’s recommended, structured psychological interventions for adults and older adolescents with depressive disorder. These include behavioural activation, cognitive behavioural therapy (CBT), interpersonal psychotherapy (IPT), problem-solving treatment as an adjunct treatment (e.g. in combination with antidepressants). Different treatment formats for consideration include (a) individual and/or group face-to-face psychological treatments delivered by professionals and supervised lay therapists, as well as (b) self-help psychological treatment. While face-to-face psychological treatment or guided self-help psychological treatment are likely to have better outcomes than unguided self-help, the latter may be suitable for those people who either (a) do not have access to face-to-face psychological treatment or guided self-help psychological treatment or (b) are not willing to access such treatments

Status
Retired

Recommended in favor

Conditional

(Antipsychotics and mood stabilizers (lithium, valproate, or carbamazepine) for maintenance treatment of bipolar disorder) Lithium or valproate or certain second-generation antipsychotics (aripiprazole, olanzapine, paliperidone extended release, quetiapine, and risperidone long acting injection release) can be offered for the maintenance treatment of bipolar disorder. If treatment with one of these agents is not feasible, first-generation antipsychotics or carbamazepine may be used. Maintenance treatment should be offered in primary health care settings under supervision of a specialist.

Status
Retired

Recommended in favor

Conditional

(Psychosis including schizophrenia and bipolar disorder) Recovery-oriented psychosocial interventions (e.g. life skills and social skills training) to enhance independent living skills can be offered for people with psychotic disorders (including schizophrenia and bipolar disorder) and for their families and/or caregivers. Facilitation of assisted living, independent living and supported housing that is culturally and contextually appropriate may be considered as an option for people with psychotic disorders (including schizophrenia and bipolar disorder). Careful consideration should be given to the functional capacity and the need for stability and support when advising and facilitating optimal housing arrangements

Status
Retired

Recommended in favor

Conditional

(Psychosis including schizophrenia and bipolar disorder) Recovery-oriented strategies enhancing vocational and economic inclusion (e.g. supported employment) can be offered for people with psychosis (including schizophrenia and bipolar disorder). Such strategies should be contextualised to their social and cultural environment, using formal and non-formal recovery-oriented interventions that may be available, and using a multisectoral approach.

Status
Updated

Recommended in favor

Conditional

(Psychosis including schizophrenia and bipolar disorder) Second-generation antipsychotics (with the exception of clozapine which is indicated for treatment resistant psychosis) can be offered for the treatment of psychotic disorders (including schizophrenia). There is no clinically relevant advantage of one second-generation antipsychotic over others and choice should be based on availability, cost, patient preferences and possible adverse effects associated with each medication.

Status
Retired

Recommended in favor

Conditional

(Psychosis including schizophrenia and bipolar disorder) In adolescents with psychotic disorders (including schizophrenia and bipolar disorder), certain second-generation antipsychotic medications (aripiprazole, olanzapine, quetiapine, risperidone, ziprasidone) can be offered as a treatment option under supervision of a specialist. If treatment with one of the above agents is not feasible, first-generation antipsychotics (haloperidol, chlorpromazine, perphenazine, molindone) may be used under supervision of a specialist

Status
Retired

Recommended in favor

Conditional

(Epilepsy) When intravenous access is not available for the control of acute seizures in adults, non- parenteral routes of benzodiazepine administrations should be used. Options include rectal diazepam, buccal or intranasal midazolam, rectal or intranasal lorazepam. The preference may be guided by availability, expertise and social preference. Some benzodiazepines (lorazepam or midazolam) may be given by intramuscular route, which requires additional expertise. Intramuscular administration of diazepam is not recommended because of erratic absorption.

Status
Updated

Recommended in favor

Strong

In adults with established status epilepticus, i.e. seizures persisting after two doses of benzodiazepines, either intravenous valproic acid, intravenous phenobarbital or intravenous phenytoin can be used with appropriate monitoring. Intravenous valproic acid is preferred over intravenous phenobarbital or intravenous phenytoin because of its superior risk-benefit profile. The choice of these medications depends on local resource settings, including availability and facilities for monitoring. Where intravenous infusion may not be feasible, intramuscular phenobarbital remains an option, with appropriate monitoring. Phenytoin and valproic acid should not be given intramuscularly.

Status
Retired

Recommended in favor

Conditional

In comparison with enzyme-inducing anti-epileptic medications (phenobarbital, phenytoin, carbamazepine) or valproic acid, newer generation anti-epileptic medications that are not hepatically metabolized (i.e. leviteracetam, lacosamide, topiramate, gabapentin and pregabalin) may be preferred to use in people with HIV on certain antiretroviral medications (protease inhibitors or non-nucleoside reversetranscriptase inhibitors). If the treatment with newer generation anti-epileptic medications is not feasible, valproic acid is preferred over the enzyme-inducing anti-epileptic medications (phenobarbital, phenytoin, and carbamazepine). In all cases, close monitoring of HIV viral load and regular clinical monitoring is required. If resources are available, antiepileptic medication levels should be monitored.

Status
Updated

Recommended in favor

Conditional

Cholinesterase inhibitors and memantine may be offered for people with dementia in non-specialist health settings. Non-specialists need to be trained and supervised to ensure competence in diagnosis and monitoring. The use of cholinesterase inhibitors should be focused upon those with mild to moderate Alzheimer's disease, where the majority of evidence is available. Memantine may be considered for those with moderate to severe Alzheimer’s disease and vascular dementia. Memantine should not be prescribed for Lewy Body dementia.

Status
Updated

Recommended in favor

Conditional

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