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Psychiatry > CBT and ECT > Flashcards

CBT and ECT Flashcards

1
Q

Elements of CBT

A

Developing a therapeutic relationship
Empathetic and collaborative
Socratic questioning
Time-limited
Agenda-setting/goals
Formulation
Homework
Relapse Prevention

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2
Q

CBT and anxiety disorders

A
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3
Q

CBT Anxiety Model

A
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4
Q

NICE Guidelines for Anxiety, PTSD and OCD

A

CBT for all anxiety disorders

Social anxiety disorder = CBT/short-term psychodynamic
PTSD = ‘reliving’ trauma, CBT/EMDR (eye movement desensitisation and reprocessing)
OCD = CBT incorporates Exposure and Response Prevention (ERP)

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5
Q

NICE guidelines for eating disorders

A

Bulimia nervosa = CBT/IPT
Anorexia nervosa = in-patient weight get progressive (CBT, IPT, CAT)

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6
Q

NICE Guidelines PD

A 
Borderline = schema focussed CBT, DBT, mentalisation
Anti-social = group based CBT
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6
Q

NICE Guidelines PD

A 
Borderline = schema focussed CBT, DBT, mentalisation
Anti-social = group based CBT
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7
Q

NICE guidelines for schizophrenia

A

CBT and family therapy

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8
Q

Cognitive Distortions

A

Mental filter
All or nothing thinking
Over-generalising
Disqualifying the positive
Magnification (catastrophising) + minimisation
Jumping to conclusions
Emotional reasoning
Should/must
Labelling
Personalisation

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9
Q

Third wave CBT (mindfulness based CBT) seeks to evaluate and change…

A

thought process (rather than thought content)

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10
Q

Definition of ECT and indications

A

ECT is defined as “passage of a small electric current through the brain with a view to inducing a generalised fit which is therapeutic”.

Indications:

  • severe depressive illness = only in life-threatening situation i.e. poor oral intake, acutely suicidal, or tx resistant depressive illness
  • uncontrolled mania
  • catatonia = increased resting muscle tone not present on active or passive movement
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11
Q

Can patients refuse ECT?

A

Informal patients with capacity- need to complete a written consent form

Patient might lack capacity to consent but not objecting to treatment- Mental capacity Act

Those under MHA ‘section’ and have capacity- they need to complete a specific consent form.

Those refusing treatment- emergency sections of the MHA. (after first 2 treatments need to be authorised by a SOAD

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12
Q

Modified ECT procedure

A

Modified as using anaesthetic and muscle relaxant

Routine physical examination for all patients

Investigations:

  • Bloods (FBC, U&E’s, LFTs, Sickle test for specific ethnic groups)
  • ECG - for all pts >50 yrs of age; <50 if medical indication
  • CXR- for all pts >55 yrs of age, <55 only if medical history indicates

Medication review:

  • Medications increase seizure threshold: Benzodiazepines, Anticonvulsants
  • Medications reduce seizure threshold: antipsychotics, TCAs, Lithium

Not food or drink 8 hours prior to the procedure.

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13
Q

Side effects of ECT

A

Risk of anaesthetic = MI, arrhythmia, aspiration pneumonia, prolonged apnoea, malignant hyperthermia, broken teeth, death (1 in 50k)

Risks from ECT:

  • common = confusion, muscle pain, headache, nausea
  • effect on cognition (10%) = retrograde/anterograde memory (immediately before and after ECT), most patients recover at 6 months
  • very rare to have LT complications
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14
Q

Bilateral vs unilateral ECT

A

Bilateral = 2 electrodes placed over 2 hemispheres

  • effective at threshold, more efficacious, quicker
  • cognitive side effects, language problems or visuospatial orientation problems, more AUTOBIOGRAPHICAL MEMORY LESS

Unilateral = 2 electrodes placed over the non-dominant hemisphere

  • fewer cognitive side effects
  • technically difficult, not as effective, not effective at threshold, slower action
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15
Q

Does ECT work?

Contraindications? high risk patients

A

8/10 patients respond to ECT

Equal/better than antidepressants, likely best in combination, often fewer s/e cf antidepressants and quicker acting

no absolute contraindications

higher risk patients:

  • heart disease/stroke
  • raised ICP
  • risk of cerebral bleeding (HTN, stroke etc.)
  • pacemake, pregnant women, epilepsy
16
Q

How does ECT work?

A

specific mode of action unknown

17
Q

How many times will they need ECT?

A

Most patients require 2 ECT sessions a week

On average will require 6-12 sessions

Can be delivered to both inpatients and outpatients

ECT is ‘prescribed’ by a psychiatrist and is reviewed after each session

18
Q

TMS

A

Electromagnets placed on the scalp in order to induce an electrical current in the cortex.

Has been included into NICE guidelines since 2015 but not widely used.

NICE concluded ‘no major safety concerns’

Evidence suggests might be effective in short term and there is variable clinical response.

19
Q

Which of the following best describes risks associated with ECT?

A.ECT is more likely to cause memory loss after 6 months than immediately after treatment.

B.Bilateral ECT is more likely to cause autobiographical memory loss than Unilateral ECT

C.Low dose ECT is more likely to cause retrograde amnesia than high dose ECT

D.Simulated ECT causes the same amount of anterograde memory loss as Bilateral ECT

E.Lithium reduces the risk of ECT–associated memory loss

A

B

20
Q

Which of the following is NICE indication for ECT?

A.Maintenance treatment for schizophrenia.

B.Serotonin syndrome

C.Catalepsy

D.Uncontrolled Mania

E.First episode of psychosis

A

D

Severe depressive illness: only if there is a life threateningsituation i.e. poor oral intake, acutely suicidal or if the depressive illness is treatment resistant.

Uncontrolled mania

Catatonia: this is a motor symptom of schizophrenia, in which there is increased resting muscle tone which is not present on active or passive movement.

21
Q

Which of the following patients would most benefit from ECT?

A.Someone who believes they are dead, so there is no point taking medication.

B.Someone who has not experienced benefit from two antidepressants.

C.Someone who is not eating and drinking.

D.Someone who benefitted from ECT in the past.

A

C

Psychiatry (11 decks)

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