Affective disorders Flashcards
what are the important questions to ask about suicide?
have you thought about giving up, life is not worth living, committing suicide?
how often?
have you tried?
have you made any plans?
do you have access to any of these?
is there anything stopping you?
is there anyone around you that have committed suicide?
what are the important questions to ask about self harm?
are you thinking about self harm?
how often do you think about it?
have you tried? when was the most recent?
how do you do it? do you have access to that?
do you know anyone who harm themselves?
does anyone tell you to do it (command hallucinations)
do you feel safe at the moment?
what are the principles of treatment for the big D?
mild depression = psychotherapy
moderate dep = psychotherapy + adjunct pharmacological therapy
moderate to severe dep = pharmacotherapy is more effective than psychotherapy
how long does anti-depressants take to act?
takes at least 1 -2 weeks usually, and full benefit may not occur for 4 - 6 weeks in some cases
what are the initial first line treatment of depression?
SSRI (citalopram/escitalopram, fluoxetine/paroxetine)
SNRI (duloxetine, venlafaxine, desvenlafaxine)
Mirtazapine
what anti-depressants should not be used w/ children under the age of 8
SSRI - increased suicidal ideation esp amongst adolescence
TCA - due to adverse effect profile
diagnostic criterion for MDD
duration of more than 2 weeks of:
(2 cardinal symptoms) anhedonia, depressed mood
(3 themes of thought) worthlessness, guilt, suicidal/hopelessness
(4 basic function changes) sleep, appetite, concenctration/attention, sex
what are some psychotherapy techniques that can be used for depression?
psychoeducation about their condition mantaining therapeutic relationship between patient and doctor activity scheduling CBT anger and assertion training problem solving skills mindfulness
what are some risk factors for suicide risk/
age 45 and older white males prior history of poor physical health poor social supports prior suicide attempt comorbid use of drugs or alcohol recent severe loss detailed plan for suicide, pattern of chronic self-destructiveness, psychotic symptomology
what is the acute treatment of bipolar depression?
cannot give anti-depressants alone, have to use mood stabilizer and withdraw anti-depressants upon remission (within 1 - 2 months)
antidepressants + mood stabilizer
quetiapine
if refractory: change anti-dep, psychotherapy, ECT
what is the acute treatment for mania?
olanzapine 5mg oral, nocte, increasing to 10mg at night
OR
risperidone
what are the prophylactic treatment for mania?
lithium 125 - 500 mg oral, twice daily, two weeks. dose adjust to serum concentration
2nd gen antipsychotics: olanzapine, risperidone, paliiperidone, quetiapine, amipriprazole
lamotrigine
carbamazepine
valproate
main side effects of lithium
nephrogenic diabetes insipidus
lithium toxicity - old, dehydrated, renal impairment, polypharmacy
cognitive slowing
hypothyroidism
common non significant side effect of lithium
fine tremor
metallic taste
gi effect: diarrhoea, n/v, reduced appetite
what are the effects of lithium toxicity according to the doses?
mild (1.5 -2): nystagmus, ataxia, diarrhoea, n/v, dizziness, slurred speech
moderate (2-2.5): n/v, anorexia, blurred vision, clonic limb movements, convulsions, delirium
severe (>2.5) generalized convulsions, oliguria, renal failure