Management of Mood Disorders Flashcards
what apps can you recommend to patients to keep record of their mood?
mood tracker
daylio
patient has been on an old-fashioned antidepressant in the past and responded well but nowadays there is newer antidepressants to prescribe; what should you give them?
the old-fashioned antidepressant
why are SSRIs prescribed over other antidepressants?
safer in overdose
less side effects
best all round SSRI?
escitalopram
what drug is good for patients who have insomnia and are underweight?
mirtazapine
why is sertraline a good SSRI?
good cardiac safety profile
easy dose titration
well tolerated
why might a drug not be working for depression?
substance misuse compliance wrong diagnosis physical illness do they need more time?
what should be done if medication doesnt work for a patient?
increase dose
switch
combine
augment with an antipsychotic/lithium (careful in older pts)
most common antidepressant combination?
SSRI or SNRI + mirtazapine
why is mirtazapine good as a combo drug with an SNRI?
SNRIs can make you feel sick and mirtazapine can act as an antiemetic
when should you review a patient after starting an antidepressant?
1-2 weeks
how would you safety net with antidepressants?
warn the patient about side effects
tell them they will go away but if they cant tolerate them they should let you know
how long should you keep a patient on an antidepressant if theyre doing well and are in remission from a depressive episode?
6 months
first line and second line treatment for acute mania?
- anti-psychotics eg olanzapine, quetiapine, risperidone
2. anti-psychotic + lithium or valproate
benzodiazepines are helpful in acute mania for what symptoms?
agitation
insomnia
antidepressants should not be prescribed without an antimanic drug in a bipolar patient T or F
T
when should you avoid antidepressants in a bipolar patients?
recent hypomanic episode
rapid cycling
what antidepressant is best for bipolar depression?
SSRI eg fluoxetine
bipolar depression 1st line drug
antipsychotic - quetiapine, olanzapine, lurasidone
a patient on lithium should have what bloods checked
LI level U+E ECG TFTs Ca
valproate is better for depressive/hypomania symptoms in bipolar disorder
hypomania
lamotrigine is better for depressive/hypomania symptoms in bipolar disorder?
depressive symptoms
long term bipolar disorder is primarily managed with what drug?
lithium
acute bipolar depression is primarily managed with what drug?
SSRI eg fluoxetine
acute hypomania/mania is primarily managed with what drug?
antipsychotics
ECT is first line for…
very severe depression
pregnant patients if they are intolerant to non-teratogenic drugs
ECT is usually given how often per week?
twice
__lateral ECT is more commonly used
bilateral
absolute contraindications to ECT
MI in last 3 months
recent CVA
intracranial mass lesion
phaeochromocytoma
relative contraindications to ECT
pregnancy severe osteoporosis severe pulmonary disease CCF angina
main side effect of ECT?
short term headache
memory/cognitive problems
how does ECT work in the brain?
modulates monoamines
anticonvulsant effect
increases neurones
how can anxiety present?
poor memory and low mood
somatic symptoms eg palpitations
describe disinhibited behaviour
actions which seem tactless, rude or even offensive
what is depersonalisation
a state in which one’s thoughts and feelings seem unreal or not to belong to oneself.
what is derealisation?
detached from everything that is going on ie not real
what symptoms are associated with psychotic mania?
grandiose delusions
hallucination
how do hallucinations differ from delusions
hallucinations are to do with the senses
a delusion is a fixed, abnormal belief that the patient isnt open to discuss with you ie grandiose/persecutory
what are nihilistic delusions? what condition do they present in?
youre rotting and are dead inside
depression
patient with hypomania and depression is what type of BPAD?
bipolar 2
define dysthymia
low mood but not low enough to be diagnosed as depression
define cyclothymia
low mood that doesnt have biological symptoms of depression eg low energy
they function well
contraindications to lithium
renal/hepatic impairment
non-compliant
signs of lithium toxicity?
vomiting diarrhoea tremor loss of consciousness ataxia hyperthyroidism
lithium substitutes?
lamotrigine
valproate
