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Psychiatry > Management of Mood Disorder > Flashcards

Management of Mood Disorder Flashcards

1
Q

what are the four scales used to assess progress in mood disorders

A

inventory of depressive symptomatology self report 30 (IDS-30-SR): patient rated, very detailed

quick inventory of depressive symptomatology self report (QIDS): shorter more simple questions

hospital anxiety and depression scale: 14 items, easy to complete

montgomery- asberg rating scale (MADRAS): 10 items, observers rated, objective (good if patient cant communicate/ complete form/ lacks insight)

(can also use symptom diaries)

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2
Q

are antidepressants addictive

A

no

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3
Q

are antidepressant effective

A

yes

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4
Q

does continued antidepressant use reduce relapse rates

A

yes

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5
Q

this isnt a question by If someone has responded to a particular type of drug (e.g. SSRI), stick to that class

A

:)

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6
Q

what is sertraline and what is it good for

A

SSRI

has good cardiac safety - give if patient has/ is prone to heart problems (old)

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7
Q

what is mirtazapine and what is it good for

A 
atypical antidepressant (mixed receptor effect)
promote sleep and appetite/ weight gain
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8
Q

what is venlafaxine and what is it good/ bad for

A

SNRI

high rate of adverse effects but may be slightly more effective

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9
Q

what are the top 4 antidepressants

A

escitalopram (SSRI)
sertraline (SSRI)
mirtazapine (atypical)
venlafaxine (SNRI)

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10
Q

what should you consider if antidepressents dont work

A 
concordance 
right diagnosis? 
substance missuse 
physical illness
address other predisposing, precipitating and prolonging factors
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11
Q

what pharmacological changes can you make if an antidepressant doesnt work

A

increase dose
swap
combine- SSRI/SNRI plus mirtazapine (atypical)
augment- antipsychotic/ lithium first

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12
Q

what are the features of good antidepressant prescribing

A

Get ratings of depressive symptoms before and after each trial (e.g. PHQ-9)
Warn patients about possible side effects and the probability that they will be transient
Review after 1-2 weeks
Ensure adequate dose for adequate time

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13
Q

how do you prevent depression relapse after first episode

A

continue antidepressant for at least 6 months after full recovery without reducing dose

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14
Q

how do you prevent depression relapse after second episode/ more

A

continue antidepressant for at least 1-2 years after full recover without reducing dose

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15
Q

what is the treatment principles for acute mania/hypomania

A

maximise antimanic dose if patient already on them
stop antidepressants
combination therapy may be required
hospital admission likely to be required in mania
medication should be oral if possible

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16
Q

what is the treatment for acute mania

A

1st line= antipsychotic: olanzapine, quetiapine or risperidone

other options: lithium, valproate, carbamazepine, ECT

benzodiazepines/ Z drugs for symptoms control (agitation and insomnia)

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17
Q

what are the principles of treating acute bipolar depression

A

antidepressants should not be prescribed without an antimanic drug
avoid antidepressants in those with a recent manic/ hypomanic episode or history of rapid cycling
SSRIs (esp fluoxetine) are preferable

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18
Q

what is rapid cycling

A

at least 4 episodes per year (bi polar disorder)

19
Q

what treatment for acute bipolar depression

A

antipsychotic 1st line: quetiapne, olanzapine

antidepressants can be used alongside antipsychotic, lithium or valproate to prevent mania

lamotrigine (needs to be titrated)

ECT

lithium

20
Q

what is gold standard for long term bipolar maintenance

A

lithium

21
Q

what are the other options (other than lithium) for bipolar maintenance

A

antipsychotics,
lamotrigine (if primarily depression),
valproate (if primarily manic/ hypomanic)

psychoeducation important
psychological therapies

22
Q

what do you need to measure when prescribing lithium

A 
lithium levels in blood 
U&Es
ECGs
TFTs
calcium
23
Q

what do you need to consider in prescribing for the elderly

A

want to preserve cognition
prevent falls- least sedative/ postural hypotension causing (mirtazopine)
sodium (SSRIs and SNRIs lower sodium) (mirtazopine good at not doing this aswell)
polypharmacy- lithium cannot be given with an NSAID or an ACEi)
start slow and titrate up

24
Q

what does ECT do

A 
induces seizures 
causes release of NTs
and causes brain growth 
anticonvulsant effects 
reduces hyper-connectivity
25
Q

what is patient given during ECT

A

under GA and given a muscle relaxant

given medazolam if seizure lasts too long

26
Q

what is ECT used to treat

A 
#1 depression 
bipolar disorder, mania, catatonia
27
Q

how is ECT given

A

twice weekly
80% bilateral
seizures last 15-30 seconds
recovery is within minutes

28
Q

what are the absolute and relative contraindications to ECT

A 
absolute: 
recent MI (last 3 months), recent cerebrovascular accident, intracranial mass lesion, phaeochromocytoma

relative:
angina, congestive HF, severe pulmonary disease, severe osteoporosis, pregnancy

29
Q

what most likely causes death in ECT

A

very rare

cardio/ pulmonary complications

30
Q

what are the side effects of ECT

A

usually mild, self limiting and respond to symptomatic treatment

  • HA
  • memory problems (short term, time before treatment, small number have permanent memory loss)
  • cognitive problems
  • muscle aches
  • confusion
  • nausea
31
Q

in pyschological therapies what are examples of thinking errors

A

Overgeneralising
Rules from isolated incidents then applied in all cases
Dichotomous thinking
“all or nothing” or “black and white thinking”

Selective abstraction
Focus on one –ve detail; colours entire experience

Personalisation- Relate external events to self without cause (or little cause)
Minimisation or magnification- overestimate magnitude of undesirable events (or opposite)

Arbitrary evidence- Draw a conclusion in context of no evidence or contrary evidence

Emotional Reasoning-I feel bad/guilty/therefore I am bad/have something to feel guilty about

Shoulds and musts

32
Q

what are examples of pyschological therapies

A

behavioural activation (more you do the better youll feel- meaningful activities)

cognitive behavioural analysis system of pyschotherapy (impact of three people on your life)

interpersonal therapy

acceptance and commitment therapy

psychoeducation

33
Q

what are the risks associated with mood disorders

A 
suicide 
financial difficulties 
driving
aggression 
sexual disinhibition 
self harm 
neglection of personal health 
vulnerable to exploitation
34
Q

what symptoms are SNRIs good for

A

biological symptoms- anergia, sleep, libido

35
Q

why are tricyclics unpopular

A

anticholinergic side effects

risk of overdose

36
Q

what is the order of prescribing antidepressants

A

fluoxetine 1st line (SSRI) (only licensed antidepressant for young people)
other SSRI
after 2 SSRIs SNRI
then tricyclic

37
Q

what is a bad quality of fluoxetine

A

long half life, if coming off because of SEs will have them for ages after

38
Q

when should you start to feel effects of antidepressants

A

within 10 days/ 2 weeks

max effect at 4 weeks

39
Q

what is the maximum dose of fluoxetine

A

60 mg

if <18 then 20 mg

40
Q

what are points of good sleep hygiene

A

routine- always go to bed at same time, avoid caffeine, alcohol, cigarettes, hot chocolate

41
Q

what can you combine antidepressants with to treat depression

A

SSRI/ tricyclic + SNRI

or antidepressant with atypical antipsychotic

42
Q

what is the last resort treatment for depression

A

ECT

43
Q

if lithium is not tolerated for bi polar what else can given

A

Antipsychotics (quetiapine, olanzapine (significant weight gain), lurasidone, aripiprazole),
anticonvulsants:
lamotrigine (if primarily depression), valproate (if primarily manic/hypomanic- but teratogenic), carbamazepine

Psychiatry (27 decks)

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