Lectures - depression Flashcards
what is the NNT for depression? is it any good?
4-5
very good
risk factors for atypical depression?
female
young age
a patient comes in with mania. 6 years ago they were treated for depression. ddx?
bipolar!
this is a classical presentation! there has to be full recovery in-between
what is the mean age of onset for bpad?
which social class?
18 bpad 1
20 bpad 2
higher social classes
what is the abc of CBT?
an event -> thoughts -> emotions
what are the indications for ECT according to nice?
- severe life threatening depression ; poor oral intake, suicidal, treatment resistant
- severe life threatening mania
- catatonic schizophrenia
what are the indications for ECT according to nice?
- severe life threatening depression ; poor oral intake, suicidal, treatment resistant
- severe life threatening/ uncontrolled mania
- catatonic schizophrenia
what do you say when patient asks you of risks associated with ect?
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
difference between bilateral vs unilateral ect?
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
effectiveness of ect?
80% response
how does ect work - if you had to explain to a patient?
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.
which is 1st line antidepressant to prescribe in moderate-severe depression diagnosis?
sertraline
if patient wants to know what an ssri is or how it works how will you explain?
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
what is the main difference between SSRIs?
1/2 life
what are the 4 classic anti-cholinergic effects?
dry mouth
blurry vision
constipation
urinary retention
what is the tyramine reaction ?
tyramine causes;
vasoconstriction and tachycardia -> hypertensive crisis -> stroke or death or flushing
what is the MOA of mirtazapine / NaSSA?
blocks pre-synaptic alpha 2 adrenergic receptors
what examination would you do when suspecting serotonin syndrome?
Neuro examination;
confusion/ altered mental state
neuromuscular changes: eg mycolonus, hypertonia
autonomic dysfunction; eg hypertension
complications of serotonin syndrome?
rhabdomyolysis - > renal failure
metabolic acidosis
seizures
DIC
management of serotonin syndrome?
stop causative meds
ABCDE approach - renal care, fluids etc
cyproheptadine - antihistamine with additional anticholinergic, antiserotonergic
which is the only antidepressant licenced to treat kids?
fluoxetine
ssris are more effective than tea, true or false?
false
efficacy is the same
