Alternative Treatments for Mood Disorders

Question 1

What can anti-psychotics be used for in bipolar disorder?

Answer 1

Treatment and prophylaxis of both manic/hypomanic and depressed states in bipolar disorder

Question 2

When can anti-psychotics be used in unipolar depression?

Answer 2

Combined with an anti-depressant in unipolar depression with or without psychotic symptoms

Question 3

What are some possible side effects of atypical anti-psychotics?

Answer 3

Sedation, weight gain, metabolic syndrome, constipation and prolonged QT syndrome

Question 4

What tests must be done before starting an atypical anti-psychotic?

Answer 4

BP, weight, lipids, glucose, ECG, FBC, Us and Es and LFTs

Question 5

After starting an atypical anti-psychotic, how often should all the relevant tests be done?

Answer 5

At 1 months, and then yearly thereafter

Question 6

Which type of anti-psychotic is used more commonly in mood disorders?

Answer 6

Atypical

Question 7

What is the main mechanism of action of anti-psychotic drugs?

Answer 7

D2 receptor blockade

Question 8

What are some side effects of typical anti-psychotic drugs?

Answer 8

EPSE, sedation, dizziness, long QT syndrome, hyperprolactinaemia

Question 9

How often is ECT usually given?

Answer 9

Twice a week

Question 10

Is unilateral or bilateral ECT more common?

Answer 10

Bilateral

Question 11

If unilateral ECT is given, what side is it on?

Answer 11

The non-dominant side, so usually right

Question 12

In ECT, a dose of electricity is titrated for each patient to achieve what?

Answer 12

A seizure which typically lasts 15-20 seconds

Question 13

How quickly do patients ‘recover’ following ECT?

Answer 13

Within minutes

Question 14

66% of people will usually complain of a side effect following ECT. What is important about this?

Answer 14

The side effect will usually be mild and self-limiting and respond to symptomatic treatment

Question 15

What type of memory loss can occur following ECT?

Answer 15

Short term memory loss, most accentuated for the time closest to treatment

Question 16

Does memory loss as a result of ECT recover?

Answer 16

Usually, though a minority cases are persistent

Question 17

If a person’s capacity is impaired, what is needed before ECT can go ahead?

Answer 17

A second opinion from an independent secondary doctor

Question 18

Is a second opinion needed for life saving ECT?

Answer 18

No

Question 19

Can you give ECT to a person who has capacity and is refusing treatment, but is detained under the mental health act?

Answer 19

No

Question 20

Which type of ECT is more likely to cause cognitive issues?

Answer 20

Bilateral

Question 21

Which type of ECT is faster and more effective?

Answer 21

Bilateral

Question 22

What are the absolute contra-indications to ECT?

Answer 22

Recent MI or cerebrovascular event within the last 3 months, intracranial mass lesion or phaeochromocytoma

Question 23

What are the relative contra-indications to ECT?

Answer 23

Angina or congestive heart failure, severe pulmonary disease, severe osteoporosis, pregnancy