Explanations - Treatments Flashcards
1
Q
ECT - What is ECT?
A
What is ECT?
- A treatment used for certain mental health conditions. Consists of giving an anaesthetic and muscle relaxant then passing a small electrical current across the brain in order to induce a seizure
- The goal is to induce a seizure that lasts less that 20 seconds
- We start at a low dose of electricity and work our way up till we find the level that causes a seizure, after this we only use the dose just above this threshold.
- Because of the anaesthesia and muscle relaxant the patient only trembles a little bit and does not risk hurting themselves, we mostly judge the seizure by the EEG that records the electrical activity of the brain.
2
Q
Lithium - What is Lithium?
A
What is Lithium?
- A metal salt used as a drug to treat mental illnesses for over 50 years.
3
Q
Clozapine Treatment - What else does the patient need to know?
A
- Are there any physical contraindications - : myselodysplasia, blood dyscrasia, uncontrolled epilepsy, diabetes, liver problems, kidney problems, glaucoma, prostate problems.
- Pt needs counselling of need for blood tests and reporting of fever sore throat infections asap.
- No doubling of missed dose and if missed for > 48hrs then will need to restart at 12.5mg.
4
Q
Acetylcholinesterase Inhibitors (Donepezil, Galantamine, Rivastigmine) - What Are They?
A
What is (Donepezil, Galantamine, Rivastigmine)?
- It is a type of antidementia drug called an acetylcholinesterase inhibitor. It works to stop the breakdown of a chemical called acetycholine in the brain.
5
Q
Depot Medication - Why give depot medication?
A
- We know medication is very helpful in reducing psychotic symptoms and the impairment the cause people.
- 40-60% of patients with Schizophrenia are non-compliant reasons include: limited insight, limited benefit, side effects, poor communication from medical team, pressure from family and friends.
- Unfortunately stopping medication associated with high risk of relapse (and admission), 60-70% in one year, 85% in 2 years vs (10-30% of those on active medication).
- With depot medication is slowly released into body over weeks, means more stable dosage and patients do not have to think about taking medication. Results in increased compliance and reduced risk of relapse.
6
Q
ECT - What Else Does the Patient Need to Know?
A
- Treatment only continues as long as patients need
- Patient muct either make an informed decision or be deemed to be unable to under the MHA, in which case a second opinion is needed, sometimes in emergencies this might be skipped temporarily.
- It is not permenantly effective, the effects fade after some time. Recovery can be maintained pharmacologically but some people requre top-up courses in the future
- Let me give you some leaflet sot read about this
7
Q
ECT - How is it Given?
A
- Patient is anaethetised and given a muscle relaxant, an airway will be put in to help them breathe. They will be monitored throughout.
- Jewelerry is removed and a block is put in their mouth so they don’t bite their tongue.
- Current is applied by electrodes held to the head. Usually given bilaterally but can be given on one side only.
- Given as 6-12 treatments, usually 2 times a week
8
Q
ECT - What are the Side Effects?
A
- Common short term side effects include: headache, nausa, feeling muzzy, feeling upset. Mostly this is due to the drugs used by the anaesthetist. Usually go away shortly after with a refreshment and some reassurance.
- Some people get some amnesia about recent events before and after the treatment
- Older people may be more confused for 2-3 hours, this can be improved by changing the way we give it
- Long term - up to a third of people complain of long term amnesia - islands of memory lost. These usually resolve after ECT treatment is finished although some people feel it persists - unclear if this is due to mental illness or ECT.
- The more ECT someone has the more likely they are to get amnesia
- There is no evidence of structural changes to the brain.
- The risk of serious injury or death is 1:50,000 - most of the risks are due to the anaesthesia
9
Q
ECT - What do We Know About its Efficacy?
A
- Its effectiveness has been well establised - over 70% chance of helping overall
10
Q
ECT - Why do we use it? What is it used for?
A
- ECT has been used for many decades now and is proven to be effective for mental health conditions when other treatments have failed or can’t be used
- Most commonly used for severe or treatment resistant depression, sometimes used for other conditions including catatonia and mania.
11
Q
Lithium - What else does the patient need to know?
A
- Before starting we’ll need to do a work-up including weight, blood tests and ECG
- Lithium levels need to be kept in range, if the concentration rises this can have dangerous side effects that can lead to death. Signs are severe tremor, severe tummy upset and sickness, staggering, slurred speech. Need to be aware of drinking plent of fluid and increase more if dehydration e.g. D+V, a lot of exercise or hot weather.
- See GP or A+E urgently if you do have any symptoms like this.
- Really important you are consistent with dose and blood tests, need to take for at least 3 years ideally.
- Stopping must occur slowly over at least a month.
- Are you planning on having children? If not are you on adequate contraception?
12
Q
Lithium - How is it taken?
A
- It is usually taken once a day at night
- Lithium levels in the blood have to be kept in a certain range - too low and it will not work, too high and it will have damaging effects
- We start at a dose of 400mg and then check levels after 5 days (12 hours after dose) and increase if needed rechecking after 5 days again until correct dose - levels found. Once levels are stable for 2 weeks we then check monthly and then 3 monthly.
13
Q
Lithium - What are the side effects?
A
- Common side effects include nausea, diarrhoea, fine tremor and a metallic taste in the mouth. In early stages about a third of people get thirstier and go to the toilet more often. Some people experience weight gain, swelling of their ankles, worsening acne and hair loss.
- Long term some people get issues with their thyroid - 1/5 hypothyroid - more common in women. Others get kidney impairment (10-20%) which is usually reversible, 1% will develope serious kidney failure over 10 years.
- Risk of both reduced by regular blood test monitoring - once dose stable lithium levels and thyroid function usually checked every 3 months, renal function every 6 months.
14
Q
Lithium - What is its efficacy?
A
- Most effective in reducing manic episodes - can reduce risk of relapses in BPAD by 30-40%.
- In treatment resistent depression works in about 50% of people, response usually seen after 2 weeks.
- Also reduces risk of suicide by 80% in both BPAD and depression
15
Q
Lithium - Why do we use it? What illnesses is it used in?
A
- Most commonly used to treat bipolar disorder although it can also be used to increase the efficacy of antidepressants when patients are depressed.
