ECT & CBT Flashcards
What are the indications for ECT?
Catatonia Severe manic episodes Schizophrenia Severe life-threatening depression Rapid, short-term improvement of severe symptoms after a trial of other treatments
What are the contraindications of ECT?
PMH (physical illness should be treated as far as possible)
Consider CV & resp problems due to risk of GA & ECT
Pregnancy-caution with ECT, more of a CI for giving a GA
Medications: Fluoxetine can prolong seizures, benzos & tranquilisers make it more
Difficult to induce a seizure so higher electrical current will be needed.
Children <12years old with depression
What is the pathophysiology of ECT?
2/week Tx approx 12 in total
Given under GA, an electrical current is sent through the brain to trigger an epileptic seizure to relieve the symptoms of some mental health problems. Thought to change patterns of blood flow in the brain.
What are the 2 ways ECT can be given?
Bilateral ECT: One electrode on each temple to stimulate the whole brain
Unilateral ECT: Both electrodes are placed on one temple so only one side of the brain is stimulated
What are the adverse effects of ECT?
Memory loss (short-term but can be very significant)
Immediate: Drowsiness, confusion, headache, nausea, aching muscles, loss of appetite
Long-term: Apathy, loss of creativity, drive & energy, difficulty concentrating, loss of emotional responses, difficulty learning new information
What are the advantages of ECT?
- When it works, it works quickly
- Can prevent death & lift suicidal feelings (from depression)
- Can help postnatal depression & lift feelings quickly
What are the disadvantages of ECT?
- Even if it has worked, effects don’t often last long
- Can’t address any underlying despair/life problems or prevent future depression
- Some find it overwhelmingly negative and feel worse after treatment
What are the outcomes of a post-ECT assessment?
No more treatment required if serious side effects seen (memory loss)
Have a positive response so that more treatment is unnecessary
What are the post-treatment instructions for outpatients of ECT?
Accompanied home & have someone with you for 24hours
Not drive during course of treatment
Not drink alcohol for at least 24hours
Not sign any legal documents for at least 24hours
What are the indications for CBT?
- Anxiety and depression: Particularly recommended by NICE
- Panic attacks
- Bipolar disorder
- Borderline personality disorder
- Depression
- Eating disorders
- OCD & PTSD
- Schizophrenia
- Phobias
- Psychosis
- Other: anger management, insomnia, sexual & relationship issues, drug/alcohol problems
- Physical problems: Chronic fatigue syndrome, chronic pain, habits
How can CBT be delivered?
Online, individually, self-help books, in a group
What is CBT?
Defining problem- how thoughts, beliefs, attitudes affect feelings & behaviour Defining goals Structured Mapping out & identifying patterns of problematic thing Here & now Uses hwk Collaberative Socratic questioning Feedback Summarising Monitoring Challenging unhelpful thoughts- Coping skills Overcoming avoidance, acceptance Relapse prevention
What is IPT?
Time limited
Structured psychotherapy Moderate- Severe depression
Symptoms understood as a response to current difficulties in our everyday interactions
Focuses: Conflicts, life changes, grief, loss, relationship problems
What is Behavioural activation?
Treatment involves getting people to act according to a plan rather than how they feel
Simple goals to start
What is the stepped care model?
Tier 1: GP
Tier 2: PCMHW
Tier 3: CMHT
Tier 4: Home Tx or In-patient
When is a referral to secondary care made?
Signif risk of self-harm, dangers to others, psychotic symptoms, severe agitation
Signif depression w/functional impairment persists despite adequate Tx in primary care
Additional community support
Indication for specialist Tx
What are the defence mechanisms?
Denial Projection Dissociation Somatisation Regression Repression Displacement Humour Altruism
What are the components of sleep hygiene?
Avoid sleeping during the day Avoid caffeine Avoid OH- (affects REM) Regular exercise Bedtime routine Expectation (how many hours per night)
How is CBT used in depression?
Behavioural activation
More depressed less you do & vice versa
Act according to plan rather than home they feel
How is CBT used in anxiety?
Need to address maintaining behaviours
Overcome avoidancee
OCD: Exposure & response
PTSD: Process the trauma
What are the social treatment options?
Address gaps
Financial support: Help w/benefits, signpost to CAB
Meaningful activities outside the home: Volutary work, befriending services, mental health groups
Exercise
Family & carer support
What types of psychotherapy are available?
CBT: Most disorders
GP: Supportive therapy
Group therapy
Systemic therapy: Usually seeing the whole family rather than just the individual Eating disorders, Children, Schizophrenia
IPT
Counselling: Be specific about the type, mostly voluntary
Psychodynamic & exploratory therapies: personality disorders
Integrated therapies
What are NICE recommended therapies?
Art therapy= Schizophrenia
Motivational interviewing= Addiction
Simple phobias= Behavioural therapy
