Lectures - depression

Question 1

what is the NNT for depression? is it any good?

Answer 1

4-5

very good

Question 2

risk factors for atypical depression?

Answer 2

female

young age

Question 3

a patient comes in with mania. 6 years ago they were treated for depression. ddx?

Answer 3

bipolar!

this is a classical presentation! there has to be full recovery in-between

Question 4

what is the mean age of onset for bpad?

which social class?

Answer 4

18 bpad 1
20 bpad 2

higher social classes

Question 5

what is the abc of CBT?

Answer 5

an event -> thoughts -> emotions

Question 6

what are the indications for ECT according to nice?

Answer 6

1. severe life threatening depression ; poor oral intake, suicidal, treatment resistant
2. severe life threatening mania
3. catatonic schizophrenia

Question 7

what are the indications for ECT according to nice?

Answer 7

1. severe life threatening depression ; poor oral intake, suicidal, treatment resistant
2. severe life threatening/ uncontrolled mania
3. catatonic schizophrenia

Question 8

what do you say when patient asks you of risks associated with ect?

Answer 8

risk is mainly associated with the anaesthetic
1 in 50,000 risk of the following;

arrthymias, broken teeth, heart attack

risk from ect:
80% complain of: confusion, headache, muscle pain
10% retro and anterograde amnesia - gets better by 6 months

Question 9

difference between bilateral vs unilateral ect?

Answer 9

bilateral;
2 electrodes on opposite sides
effective at lower threshold, more effective, quicker
bad ; increased risk of side effects: confusion, orientation

unilateral;
2 electrodes on same side
not as effective, higher doses required to elecit the seizure response

Question 10

effectiveness of ect?

Answer 10

80% response

Question 11

how does ect work - if you had to explain to a patient?

Answer 11

patient anaesthetised - put to sleep
given muscle relaxant 
eeg monitors put on
shocked for 15-25 seconds
till a generalised tonic-clonic. seizure seen or actiivity on eeg
stopped.

2 sessions for week and will. be reviewed weekly to see if its working. max 12 sessions/ 6 weeks.
average 6-12 weeks of sessions.

Question 12

which is 1st line antidepressant to prescribe in moderate-severe depression diagnosis?

Answer 12

sertraline

Question 13

if patient wants to know what an ssri is or how it works how will you explain?

Answer 13

serotonin is chemical in brain that you dont have enough of if your depressed

drug blocks pumps in brain so you have more of serotonin so you feel better

Question 14

what is the main difference between SSRIs?

Answer 14

1/2 life

Question 15

what are the 4 classic anti-cholinergic effects?

Answer 15

dry mouth
blurry vision
constipation
urinary retention

Question 16

what is the tyramine reaction ?

Answer 16

tyramine causes;

vasoconstriction and tachycardia -> hypertensive crisis -> stroke or death or flushing

Question 17

what is the MOA of mirtazapine / NaSSA?

Answer 17

blocks pre-synaptic alpha 2 adrenergic receptors

Question 18

what examination would you do when suspecting serotonin syndrome?

Answer 18

Neuro examination;

confusion/ altered mental state
neuromuscular changes: eg mycolonus, hypertonia
autonomic dysfunction; eg hypertension

Question 19

complications of serotonin syndrome?

Answer 19

rhabdomyolysis - > renal failure

metabolic acidosis

seizures

DIC

Question 20

management of serotonin syndrome?

Answer 20

stop causative meds
ABCDE approach - renal care, fluids etc

cyproheptadine - antihistamine with additional anticholinergic, antiserotonergic

Question 21

which is the only antidepressant licenced to treat kids?

Answer 21

fluoxetine

Question 22

ssris are more effective than tea, true or false?

Answer 22

false

efficacy is the same