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Mental Health > Management of Mental Health > Flashcards

Management of Mental Health Flashcards

1
Q

What are the principles of psychotherapy?

A 
Develop therapeutic relationship
Listen to patient's concerns
Empathetic approach
Provide info, support, advice
Allow expression of emotion
Encourage self-help
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2
Q

What are the most commonly used forms of psychotherapy?

A

CBT

Psychodynamic psychotherapy

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3
Q

What are the types of psychological therapies?

A

Type A - psychological treatment as an integral part of mental health care

Type B - eclectic psychological therapy and counseling

Type C - formal psychotherapies e.g. CBT, psychoanalytic/psychodynamic therapies, systemic and family therapy

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4
Q

What is transference?

A

Unconscious transfer of feelings and attitudes from the past into the therapist

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5
Q

What is psychotherapy?

A

The systematic use of a relationship between a patient and a therapist, as opposed to physical and social methods, to produce changes in feelings, cognition and behaviour.

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6
Q

What are common characteristics of all psychotherapies?

A

Intense confiding relationship with a helpful person
Rationale containing explanation of the patient’s distress
Provision of new information about the nature and origins of the patient’s problems and ways of dealing with them
Development of hope in the patient that they will be helped
Opportunities to experience success during treatment, enabling increased sense of mastery
Facilitation of emotional arousal

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7
Q

What are the principles of psychodynamic psychotherapy?

A

Less freq treatment - once or twice weekly sessions, may be brief from 4 months to a year.

Focuses of unconscious and past experience to determine current behaviour. Talk about childhood relationships, reveal unconscious psych.

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8
Q

What are the principles of psychoanalytic psychotherapy?

A

Regular sessions
Unconscious patterns brought into awareness, view of changing these
Verbalise thoughts through free association, fantasy and dreams.

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9
Q

What are the basic principles of CBT?

A

Based on learning theory, exposure to reduce avoidance and permit habituation.
Behavioural techniques for anxiety, OCD, PTSD.

Addresses role of dysfunctional thoughts and beliefs, very structured, problem orientated and time limited therapy.

Very active, homework to complete e.g. experimenting with new behaviours, identifying negative thoughts

Between 5-20 weekly sessions, last 1 hour

Can be individual, group, self help via books or computers

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10
Q

What are examples of behavioural therapies?

A

Relaxation training - for stress related and anxiety disorders

Systemic desensitisation - for phobic anxiety disorders, gradually exposed to hierarchy of anxiety-producing situations

Flooding - rapid exposure to phobic object without any attempt to reduce anxiety prior, continue exposure until diminishes

Exposure and response prevention - for OCD and phobias, repeatedly exposed but prevented from performing compulsive actions.

Behavioural activation - for depressive illness, making realistic and achievable plans to carry out activities, then gradually increasing amount of activity

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11
Q

What is the rationale for psychodynamic therapy?

A

Based upon the idea that childhood experiences, past unresolved conflicts and previous relationships influence individuals current situation

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12
Q

What is psychoeducation?

A

Delivery of information to help cope with mental illness
Inform of causes, health services to help them, self help
May be in groups or individually

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13
Q

What is counselling?

A

Relief of distress
Active dialogue between councillor and client
For e.g. adjustment disorder, mild depression, grief, trauma, prior to decision making
Helps client find own solutions to problems, whilst being supported to do so and being guided by appropriate advice

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14
Q

What is supportive psychotherapy?

A

Psychological support for those with chronic or disabling mental illness
Helps people cope
Listening, reassurance, providing explanation, guidance

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15
Q

What is problem solving therapy?

A

Structured combination of counselling and CBT

Learn to actively deal with life problems, select a solution and review its effect.

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16
Q

What is interpersonal therapy?

A

Used to treat depression and eating disorders.
Focus is on interpersonal problems e.g. bereavement, relationship difficulties
Overlap with CBT and psychodynamic therapy

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17
Q

What is EMDR?

A

Eye movement desensitisation and reprocessing
Recalling emotionally traumatic material whilst focusing on an external stimulus, stimulates both sides of the brain e.g. following finger side to side

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18
Q

What is DBT?

A

Dialect behavioural therapy
For those with borderline PD
CBT and group skills training for alternative coping strategies rather than self harm when faced with emotional instability

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19
Q

What is CAT?

A

Cognitive analytic therapy

Combines cognitive theories and psychoanalytic approaches to an integrated therapy

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20
Q

What are the forms of psychotherapies?

A

Individual
Couples
Family
Group - offers support network for those with similar difficulties

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21
Q

What is the rationale for antidepressants?

A 
Moderate to severe depressive episodes and dysthymia
Anxiety, panic attacks
OCD
Chronic pain
EDs
PTSD
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22
Q

What is the basis of the function of antidepressants?

A

The monoamine hypothesis

Enhances the activity of monoamine neurotransmitters noradrenaline and serotonin

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23
Q

What are the classes of antidepressants?

A

SSRIs
SNRIs - serotonin and noradrenaline reuptake inhibitor
TCA - tricyclic antidepressant
MAOI - monoamine oxidase inhibitor
NARI - noradrenaline reuptake inhibitor
SARI - serotonin antagonist and reuptake inhibitor
NASSA - noradrenaline serotonin specific antidepressant

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24
Q

What is the action of MAOIs?

A

Prevent breakdown of dopamine, noradrenaline and serotonin.

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25
Q

What do TCAs do?

A

Block reuptake of serotonin and noradrenaline in synaptic cleft?

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26
Q

What are examples of SSRIs?

A

Citalopram, fluoxetine, sertraline

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27
Q

What are the indications for SSRIs?

A 
Depression
Panic disorder - citalopram
Social phobia - paroxetine
BN - fluoxetine
GAD - paroxetine
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28
Q

What is the mechanism of action of SSRIs?

A

Inhibit reuptake of serotonin from the synaptic cleft into the pre-synaptic neurones
SSRIs increase concentration of serotonin in the synaptic cleft

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29
Q

What are the side effects of SSRIs?

A 
Nausea, dyspepsia, bloating
STRESS
Sweating, tremor, rashes
Extrapyramidal side effects
Sexual dysfunction
Somnolence
Stopping SSRIs - chills, insomnia, anxiety, restless
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30
Q

What are the cautions of SSRIs?

A

History of mania, epilepsy
Cardiac disease, glaucoma
Diabetes
GI bleeding, hepatic impairment, renal impairment

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31
Q

What are the contraindications of SSRIs?

A

Mania

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32
Q

What are some common doses of SSRIs?

A

Sertraline - 50-200mg/day

Fluoxetine - 20-60mg/day

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33
Q

What is the route for SSRIs?

A

Oral

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34
Q

What are examples of SNRIs?

A

Venlafaxine 75mg a day

Duloxetine 60-120mg/day

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35
Q

What is the indication for SNRIs?

A

Second or third line in treatment of depression and anxiety disorders
More rapid onset and more effective

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36
Q

What is the mechanism of action of SNRIs?

A

Prevent reuptake of NA and serotonin but do not block cholinergic receptors and therefore many anti-cholinergic side effects

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37
Q

What are the side effects of SNRIs?

A 
Nausea
Dry mouth
Headache
Dizziness
Sexual dysfunction
Hypertension
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38
Q

What are the cautions to SNRIs?

A

Similar to SSRIs

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39
Q

What are the contraindications of SNRIs?

A

Conditions associated with high risk of cardiac arrhythmias, uncontrolled hypertension

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40
Q

What are NASSAs?

A

Noradrenaline-serotonin specific antidepressants e.g. Mirtazapine

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41
Q

What are the indications for NASSAs?

A

Second line depressed patients
Who would benefit from weight gain
Suffer from insomnia

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42
Q

What is the mechanism of action of mirtazapine?

A

Weak noradrenaline reuptake inhibiting effect
Anti-histaminergic properties and is an alpha 1 and 2 blocker
Therefore increases appetite and is a sedative

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43
Q

What are the side effects of mirtazapine?

A 
Increase in appetite
Weight gain, dry mouth
Postural hypotension
Oedema, drowsiness, fatigue
Tremor, dizziness, abnormal dreams
Anxiety, arthralgia, myalgia
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44
Q

Who is mirtazapine cautioned in?

A 
Elderly, cardiac disorders
Hypotension, urinary retention
Susceptibility to glaucoma
History of seizures, blood disorders
Pregnancy and breast feeding
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45
Q

What are NARIs?

A

Noradrenaline reuptake inhibitors

Reboxetine

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46
Q

What is the indication for NARIs?

A

Second or third line for major depression

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47
Q

What is the mechanism of action for NARIs?

A

Highly specific noradrenaline reuptake inhibitor

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48
Q

What are the side effects of NARIs?

A 
Nausea, dry mouth
Constipation
Anorexia, tachycardia
Palpitations
Vasodilatation
Postural hypotension
Headache, dizziness, chills
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49
Q

Who are NARIs cautioned in?

A 
Cardiovascular disease
Epilepsy
Bipolar disorder
Urinary retention
Pregnancy
Avoid abrupt withdrawal
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50
Q

What are SARIs?

A

Trazodone

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51
Q

What are the indications for trazodone?

A

Depressive illness
Particularly where sedation is required
Anxiety, dementia with agitation, insomnia

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52
Q

What are important warning for prescribing SSRIs?

A

Do not co-prescribe NSAIDs, but if you have to give a PPI as well.

Do not co-prescribe SSRIs and heparin/warfarin

Do not stop SSRIs suddenly, dose gradually reduced over 4 week period - but not necessary with fluoextine

Do not prescribe citalopram in congenital long QT syndrome/

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53
Q

Who should SNRIs not be used in?

A

Those with cardiac disease and uncontrolled hypertension

BP measurement should be taken before starting venlafaxine, and monitored regularly after.

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54
Q

What are some examples of tricyclic antidepressants?

A

Amitriptyline, clomipramine

Nortiptyline

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55
Q

What are the indications for TCA?

A

Depressive illness
Nocturnal enuresis
Neuropathic pain
Migraine prophylaxis

56
Q

What is the mechanism of action of TCAs?

A

Inhibit reuptake of adrenaline and serotonin in the synaptic clef
Also have affinity for cholinergic receptors and serotonin receptors - contributes to side effects.

57
Q

What are the side effects of TCAs?

A

Anticholinergic - dry mouth, constipation, urinary retention, blurred vision
CV - arrhythmias, postural hypotension, tachycardia, syncope, sweating
Hypersensitivity reactions - urticarial, photosensitivity
Psychiatric - hypomania, mania, confusion
Metabolic - appetite, weight gain
Endocrine
Neurological - convulsions, movement disorders
Headache, sexual dysfunction, tremor

58
Q

When are TCAs cautioned?

A 
Cardiac disease
History of epilepsy
Breastfeeding, pregnancy
Elderly
Hepatic impairment
Thyroid disease
Phaeochromocytoma
Hx mania
Concurrent ECT
59
Q

When are TCAs contraindicated?

A 
Recent MI
Arrhythmias, heart block
Mania
Severe liver disease
Agranulocytosis
60
Q

What is an example of TCA dosage?

A

Amitriptyline 50-200mg/day

61
Q

What is the route of TCAs?

A

Oral - tablet or solution

62
Q

What are examples of MAOIs?

A

Irreversible - phenelzine

Reversible - moclobemide

63
Q

What are the indications for MAOIs?

A

Third line depression
Atypical or treatment resistant
Social phobia

64
Q

What is the mechanism of action?

A

Inactive monoamine oxidase enzymes that oxidise monoamine neurotransmitters

65
Q

What are the side effects of MAOIs?

A 
CV - postural HTN, arrhythmias
Neuro - drowsy, insomnia
GI - appetite, weight gain
Sexual - anorgasmia
Hepatic 
Hypertensive reactions with tyramine containing foods
66
Q

When are MAOIs cautioned?

A

Avoid in agitated or excited patients, or give with a sedative for up to 2-3 wks
Thyrotoxicosis
Hepatic impairment
Pregnancy, breast feeding
If changing to another antidepressant, need a washout period of up to 6 weeks

67
Q

What foods should be avoided with MAOIs?

A

Tyramine rich foods as MAOIs also metabolise tyramine.
Cheese, pickled herring, liver, Bovril, Oxo, marmite, some red wine.
Can cause hypertensive crisis - headache, palpations, fever, convulsions, risk of coma.

68
Q

What are examples of typical antipsychotics?

A

Haloperidol
Chlorpromazine
Zuclopenthixol

69
Q

What are examples of atypical antipsychotics?

A 
Olanzapine
Risperidone
Quetiapine
Aripiprazole
Clozapine
70
Q

What is the indication for antipsychotics?

A

Mainstay of treatment for schizophrenia, for delusions and hallucinations.

71
Q

What are the indications for clozapine?

A

Third line treatment for schizophrenia

Should only be prescribed after failing to respond to two other antipsychotics - treatment resistant schizophrenia

72
Q

What is the mechanism of action of antipsychotics?

A

Reduce abnormal transmission of dopamine through blocking dopamine receptors
Atypicals have a specific dopaminergic action blocking D2 receptors and serotonergic effects

73
Q

How is a first-episode schizophrenia treated with antipsychotics?

A

Agree on choice
Titrate to minimum effective dose, adjust
Assess over 2-3 weeks
Continue if working
Change if not, consider depot if not compliant
Not effective - clozapine

74
Q

What are some of the additional side effects of antipsychotics?

A

Have an affinity for muscarinic, 5HT, histaminergic and adrenergic receptors

Have extrapyramidal side effects

Anti-muscarinic - can’t see (blurred vision) can’t wee (urinary retention) can’t spit (dry mouth) can’t shit (constipation)

Anti-histaminergic - sedation and weight gain

Anti-adrenergic - postural hypotension, tachycardia, ejaculatory failure

Increase in prolactin
Neuroleptic malignant syndrome
Prolonged QT interval

75
Q

What are the specific side effects of clozapine?

A

Hypersalivation - patients may wake up with their pillows soaking with saliva

Agranulocytosis

76
Q

What are the EPSEs?

A

Parkinsonism - bradykinesia, rigidity, coarse tremor, masked facies, shuffling gait

Akathisia - unpleasant feeling of restlessness - reduce dose and give propranolol

Dystonia - acute painful spasms of neck, jaw and eye muscles, occurs within days

Tardive dyskinesia - late onset, choreoathetoid abnormal involuntary movements, chewing and pouting of the jaw

77
Q

What are the cautions of antipsychotics?

A 
CV disease - ecg
Parkinson's - exacerbated
Epilepsy
Depression
Myasthenia gravis
78
Q

What are the contraindications of antipsychotics?

A

Comatose states
CNS depression
Phaeochromocytoma

79
Q

What needs to be monitored whilst taking antipsychotics?

A

FBC, U&Es, LFTs - at start then annually
Clozapine needs WBC weekly for 18 weeks

Fasting blood glucose

Blood lipids - baseline, 3 months then yearly

ECG before initiating
Advised for haloperidol
Mandatory for pimozide
Check for long QT

BP
Prolactin
Weight
Physical health

Creatine phosphokinase - baseline CK, then measure if neuroleptic malignant syndrome is suspected

80
Q

How should antipsychotics be stopped?

A

Continue for 1-2 years following an episode of psychosis, even up to 5 years to prevent relapse

Taper medication over period of approx 3 weeks, relapse rate in first 6 months after abrupt withdrawal is double

81
Q

What is the route of antipsychotics?

A

Oral
Short acting IM injection
Depot injection every 1-4 weeks

Dose increases only take place after 1-2 weeks of assessment if poor/no response

82
Q

What is the difference between typical and atypical antipsychotics?

A

Typical - more extrapyramidal side effects, metabolic syndrome less likely, weight gain less likely
Less likely to cause Type 2 diabetes, stroke in elderly, tardive dyskinesia, high prolactin levels.

83
Q

What is it important not to do when prescribing antipsychotics?

A

Do not use loading dose
Do not routinely initiate regular combined antipsychotics
Do not prescribe without significant cardiovascular hx
Do not stop abruptly

84
Q

What are mood stabilisers?

A

Prevent depression and mania in bipolar affective disorder and schizoaffective disorder.

Atypical antipsychotics have a rapid onset of action compared to mood stabilisers so can be used in acute severe manic episodes.

85
Q

What is the treatment guideline of acute mania or hypomania?

A

Stop antidepressant
Is the patient taking antimanic medication?

No - consider an antipsychotic if symptoms severe or mood stabiliser - valproate if not childbearing.

If taking antipsychotic, check compliance and dose, consider increasing dose, add mood stabiliser.

86
Q

What are the indications for lithium?

A

First line bipolar affective

Also effective in acute manic episode and as an adjunctive treatment for depression.

87
Q

What is the mechanism of action of lithium?

A

Some evidence bipolar patients have a raised intracellular conc of sodium and calcium, and lithium can decrease these, as lithium handled in similar way to sodium.

Decreased activity of sodium dependent messenger systems.

88
Q

What are the side effects of taking lithium?

A

GI disturbances

LITHIUM
Leucocytosis
Impaired renal function
Tremor - fine
Teratogenic
Thirst - polydipsia
Hypothyroidism
Increased weight, fluid retent
Urine increase
Metalic taste
89
Q

What are the signs of lithium toxicity?

A 
TOXIC
Tremor - coarse
Oliguric renal failure
AtaXia
Increased reflexes
Convulsions/coma

Toxic levels >1.5mmol/L
Therapeutic levels - 0.4-1.0

90
Q

What are the contraindications and cautions of lithium?

A

Avoid in renal failure
Avoid in preg, breastfeeding as teratogenic

Caution with QT prolongation, epilepsy and diuretic therapy

Contraindicated in untreated hypothyroidism, Addison’s, Brugada syndrome

91
Q

When should lithium levels be monitored?

A

Before treatment started - U&Es, eGFR, TFT, pregnancy status, baseline ECG.

Levels monitored 12 hours following first dose, then weekly until therapeutic level stable for 4 weeks.
Then check every 3 months.

U&Es checked every 6 months.
TFTs every 12 months.

92
Q

What should you not do when prescribing lithium?

A

Do not prescribe unless specialist.
Do not give to women of childbearing age.
Do not give in severe renal failure.

Do not prescribe NSAIDs, diuretics, ACEi without careful thought.

Do not withdraw lithium abruptly as can precipitate relapse

93
Q

How can lithium toxicity be enhanced?

A

4Ds
Dehydration
Drugs - ACEi, NSAIDs, diuretics
Depletion of sodium

94
Q

What is the management of lithium toxicity?

A

Stop immediately
High intake of fluid provided, including IV NaCl therapy to stimulate osmotic diuresis
In most severe cases, renal dialysis may be needed

95
Q

What are the indications for sodium valproate?

A

Comparable efficacy to lithium as a mood stabiliser
If lithium is ineffective or unsuitable
Can be used with lithium for rapid cycling

96
Q

What is the mechanism of sodium valproate?

A

Inhibits catabolism of GABA

Decreases turnover of arachidonic acid and activates extracellular signal-regulated kinase

97
Q

What are the side effects of sodium valproate?

A

GI disturbances
VALPROATE

Very fat - weight gain
Aggression
LFTs rise
Platelets low
Reversible hair loss
Oedema
Ataxia
Tremor/tiredness/teratogenic
Emesis
98
Q

What are the contraindications for sodium valproate?

A

Avoid in pregnancy - can cause neural tube defects
Hepatic dysfunction
Porphyria

99
Q

What is the route and dosage of sodium valproate?

A

250-500mg, titrated upwards

Oral, IV only used for epilepsy

100
Q

What is the indication for carbamazepine?

A

Mania not first line
Prophylaxis of bipolar affective disorder if unresponsive to lithium
Alcohol withdrawal

101
Q

What is the mechanism of action of carbamezapine?

A

Blocks voltage dependent sodium channels, inhibits repetitive neuronal firing
Decreases glutamate release and turnover of dopamine and noradrenaline

102
Q

What are the side effects of carbamezapine?

A

GI disturbances, dermatitis, dizziness, hyponatraemia, blood disorders e.g. leucopenia, thrombocytopenia

103
Q

What are the contraindications of carbamezapine?

A

Caution in cardiac disease and blood disorders

Contraindicated in AV conduction abnormalities and acute porphyria (metabolic disorder causes nervous symptoms)

Avoid in pregnancy

Potent enzyme inducer so e.g. COCP metabolised faster

104
Q

What are the indications for lamotrigine?

A

Used to treat bipolar depression

Does not treat or prevent manic episodes

105
Q

What is the mechanism of action of lamotrigine?

A

Inhibition of sodium and calcium channels in presynaptic neurones and subsequent stabilisation of neuronal membrane

106
Q

What are the SEs of lamotrigine?

A

GI disturbances, rash, headache, tremor

107
Q

What are the contraindications of lamotrigine?

A

Combination of lamotrigine and carbamezapine may cause neurotoxicity

108
Q

What monitoring is required on lamotrigine?

A

LFTs, FBC and U&Es prior to starting

Do not routinely measure plasma levels unless evidence of ineffectiveness, poor adherence or toxicity.

109
Q

What is the dosage of lamotrigine?

A

Must be initiated very gradually beginning at 25mg daily.

Avoid abrupt withdrawal unless serious stevens johnson rash

110
Q

What drugs can be used as hypnotics?

A

Benzodiazepines
Low dose amitriptyline
Zopiclone, Zolpidem, Zaleplon

111
Q

What are examples of benzos?

A

Long acting >24 hours - diazepam, nitrazepam, clonazepam

Short acting <12 hours - lorazepam, midazolam

112
Q

What are the indications for benzos?

A

Insomnia, short term use
Anxiety disorders - panic disorder, phobic anxiety disorder, short term relief
Delirium tremens and alcohol detoxification
Acute psychosis
Violent behaviour

113
Q

What is the mechanism of action of benzos?

A

Enhance effect of inhibitory neurotransmitters, increase frequency of Cl channels

114
Q

What are the SEs of benzos?

A 
Drowsiness
Light headedness
Confusion and ataxia
Amnesia
Paradoxical inc in agitation
Muscle weakness
Respiratory depression
115
Q

What are the cautions and contraindications of benzos?

A

Respiratory depression and hepatic impairment

116
Q

What are the common routes for benzos?

A

PO

IM, IV and PR if non compliant and status epilepticus

117
Q

What are the clinical features of a benzo overdose?

A 
Ataxia
Dysarthria
Nystagmus
Coma
Respiratory depression
A-E approach, IV flumazenil
118
Q

What is benzodiazepine withdrawal syndrome?

A

May develop at any time up to 3 weeks after stopping a long acting benzodiazepine
May occur within a day in the case of a short acting one

Effects include insomnia, anxiety, loss of appetite, tremor, muscle twitching, sweating, tinnitus, perceptual disturbances
Seizures - rare

119
Q

What is discontinuation syndrome?

A

Antidepressants are not addictive but they can be difficult to stop
Syndrome characterised by sweating, shakes, agitation, insomnia, headaches, irritability, nausea, vomiting, paraesthesia, clonus

120
Q

What can be used to treat extra pyramidal side effects?

A

If too much acetylcholine in relation to dopamine and cannot increase dopamine activity - use acetylcholine receptor antagonists e.g.
procyclidine, benzatropine, trihexphenidyl

121
Q

What beta blockers are used as an anxiolytic?

A

Act by reducing autonomic nervous sytem activation
Propranolol
Dangerous in overdose, contraindicated in asthma

122
Q

What is pregabalin?

A

Binds to voltage gated calcium channels, reduces neuronal activity - CNS depressant

Used in anxiety, neuropathic pain and epilepsy

Causes sedation and weight gain

123
Q

What is buspirone?

A

Non sedating anxiolytic that can be used for GAD
Does not cause dependence, but its anxiolytic effect develops more slowly

Side effects include nausea, headache, light headedness, dizziness

124
Q

What are the Z drugs?

A

Zopiclone, zolpidem, zaleplon

Work like benzos, enhance GABA transmission, mainly used as hypnotics as have shorter half lives.

125
Q

What should you not do when prescribing anxiolytics and hypnotics?

A

Use readily
Prescribe benzos long term - should not be prescribed for more than 2-4 weeks
Withdraw anxiolytics abruptly
Do not forget alternatives - antidepressants have secondary anxiolytic effects and are safer for long term use

126
Q

What is ECT?

A

Passage of small electrical current through the brain to induce a therapeutic modified epileptic seizure

GA given, muscle relaxant e.g. suzamethonium give

Bilateral with electrodes on each side, or non dominant cerebral hemisphere - unilateral ECT

6-12 treatment sessions delivered twice a week

127
Q

What basic observational changes are noticed in ECT?

A

EEG changes - seizure
Pulse and BP rise
Cerebral blood flow increases by 200%

128
Q

What is the seizure threshold?

A

The minimum electrical stimulus required to induce a seizure, used in calculating the electrical current dose.

129
Q

What drugs raise the seizure threshold?

A

Anaesthetic drugs, anticonvulsants, benzodiazepines, barbiturates

130
Q

What drugs decrease the seizure threshold?

A

Antipsychotics
Antidepressants
Lithium

131
Q

What are the main indications for ECT?

A

Euphoric, Catatonic, Tearful

Prolonged or severe mania
Catatonia
Severe depression - treatment resistant, suicidal ideation or serious risk to others, life threatening e.g. will not eat or drink

132
Q

How is consent given for ECT?

A

Written informed consent

For patients detained under MHA - requires independent second opinion

133
Q

What are the short term side effects of ECT?

A

PC DAMS

Peripheral nerve palsies
Cardiac arrhythmias, confusion
Dental and oral trauma
Anaesthetic risks - laryngospasm, sore throat, N+V
Muscular aches, headaches
Short term memory impairment, status epilepticus

134
Q

What are the long term side effects of ECT?

A

Anterograde and retrograde amnesia

Deficit is greater in those who receive bilateral ECT vs unilateral

135
Q

What can ECT precipitate in bipolar?

A

A manic episode

136
Q

What are the contraindications to ECT?

A 
MI < 3 months
Major unstable fracture
Aneurysm - cerebral
Raised ICP e.g. intracranial bleed, SOL - the only absolute contraindication
Stroke <1 month ago, 
history of status epilepticus
Severe anaesthetic risk

Mental Health (15 decks)

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