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3 Psychiatry > Management of Mood Disorders > Flashcards

Management of Mood Disorders Flashcards

1
Q

what apps can you recommend to patients to keep record of their mood?

A

mood tracker

daylio

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2
Q

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?

A

the old-fashioned antidepressant

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3
Q

why are SSRIs prescribed over other antidepressants?

A

safer in overdose

less side effects

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4
Q

best all round SSRI?

A

escitalopram

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5
Q

what drug is good for patients who have insomnia and are underweight?

A

mirtazapine

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6
Q

why is sertraline a good SSRI?

A

good cardiac safety profile
easy dose titration
well tolerated

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7
Q

why might a drug not be working for depression?

A 
substance misuse
compliance
wrong diagnosis
physical illness
do they need more time?
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8
Q

what should be done if medication doesnt work for a patient?

A

increase dose
switch
combine
augment with an antipsychotic/lithium (careful in older pts)

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9
Q

most common antidepressant combination?

A

SSRI or SNRI + mirtazapine

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10
Q

why is mirtazapine good as a combo drug with an SNRI?

A

SNRIs can make you feel sick and mirtazapine can act as an antiemetic

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11
Q

when should you review a patient after starting an antidepressant?

A

1-2 weeks

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12
Q

how would you safety net with antidepressants?

A

warn the patient about side effects

tell them they will go away but if they cant tolerate them they should let you know

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13
Q

how long should you keep a patient on an antidepressant if theyre doing well and are in remission from a depressive episode?

A

6 months

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14
Q

first line and second line treatment for acute mania?

A
  1. anti-psychotics eg olanzapine, quetiapine, risperidone

2. anti-psychotic + lithium or valproate

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15
Q

benzodiazepines are helpful in acute mania for what symptoms?

A

agitation

insomnia

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16
Q

antidepressants should not be prescribed without an antimanic drug in a bipolar patient T or F

A

T

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17
Q

when should you avoid antidepressants in a bipolar patients?

A

recent hypomanic episode

rapid cycling

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18
Q

what antidepressant is best for bipolar depression?

A

SSRI eg fluoxetine

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19
Q

bipolar depression 1st line drug

A

antipsychotic - quetiapine, olanzapine, lurasidone

20
Q

a patient on lithium should have what bloods checked

A 
LI level
U+E
ECG
TFTs
Ca
21
Q

valproate is better for depressive/hypomania symptoms in bipolar disorder

A

hypomania

22
Q

lamotrigine is better for depressive/hypomania symptoms in bipolar disorder?

A

depressive symptoms

23
Q

long term bipolar disorder is primarily managed with what drug?

A

lithium

24
Q

acute bipolar depression is primarily managed with what drug?

A

SSRI eg fluoxetine

25
Q

acute hypomania/mania is primarily managed with what drug?

A

antipsychotics

26
Q

ECT is first line for…

A

very severe depression

pregnant patients if they are intolerant to non-teratogenic drugs

27
Q

ECT is usually given how often per week?

A

twice

28
Q

__lateral ECT is more commonly used

A

bilateral

29
Q

absolute contraindications to ECT

A

MI in last 3 months
recent CVA
intracranial mass lesion
phaeochromocytoma

30
Q

relative contraindications to ECT

A 
pregnancy
severe osteoporosis
severe pulmonary disease
CCF
angina
31
Q

main side effect of ECT?

A

short term headache

memory/cognitive problems

32
Q

how does ECT work in the brain?

A

modulates monoamines
anticonvulsant effect
increases neurones

33
Q

how can anxiety present?

A

poor memory and low mood

somatic symptoms eg palpitations

34
Q

describe disinhibited behaviour

A

actions which seem tactless, rude or even offensive

35
Q

what is depersonalisation

A

a state in which one’s thoughts and feelings seem unreal or not to belong to oneself.

36
Q

what is derealisation?

A

detached from everything that is going on ie not real

37
Q

what symptoms are associated with psychotic mania?

A

grandiose delusions

hallucination

38
Q

how do hallucinations differ from delusions

A

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

39
Q

what are nihilistic delusions? what condition do they present in?

A

youre rotting and are dead inside

depression

40
Q

patient with hypomania and depression is what type of BPAD?

A

bipolar 2

41
Q

define dysthymia

A

low mood but not low enough to be diagnosed as depression

42
Q

define cyclothymia

A

low mood that doesnt have biological symptoms of depression eg low energy
they function well

43
Q

contraindications to lithium

A

renal/hepatic impairment

non-compliant

44
Q

signs of lithium toxicity?

A 
vomiting 
diarrhoea
tremor 
loss of consciousness
ataxia
hyperthyroidism
45
Q

lithium substitutes?

A

lamotrigine

valproate

3 Psychiatry (28 decks)

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