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Psychiatry > Management of Mood Disorders > Flashcards

Management of Mood Disorders Flashcards

1
Q

In IDS-30-SR, energy levels can be graded from 0-3. Outline this.

A

0 - there is no change in my usual level of energy
1 - I get tired more easily than usual
2 - I have to make a big effort to start and finish my usual daily activities (shopping, homework, cooking, going to work)
3 - I really cannot carry out most of my normal daily activities because I just don’t have the energy

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2
Q

What is QIDS?

A

Quick inventory of depressive symtoms

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3
Q

Outline the different categories of symptoms of QIDS.

A
  • Sleep
  • Sadness
  • Appetite
  • Weight
  • Concentration
  • View of self
  • Suicidal thoughts
  • General interests
  • Energy
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4
Q

What scale is used for those in hospital?

A

Depression and Anxiety Scale

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5
Q

Continuing treatment of depression reduces the risk of relapse by __%

A

70%

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6
Q

How long do the treatment affects of antidepressants last?

A

36 months

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7
Q

The longer you take an antidepressant, the less likely you are to relapse

A

T

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8
Q

What drug class is usually first line in treating depression?

A

SSRI’s

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9
Q

Name the top 4 antidepressants.

A
  • Escitalopram
  • Sertaline
  • Mitrazapine
  • Venlafaxine
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10
Q

What does Mirtazapine promote that most other antidepressants don’t?

A

Promotes sleep and appetite/weight gain

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11
Q

What is good about Sertaline?

A
  • Good cardiac safety profile

* Allows for good dose titration

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12
Q

Describe Venlafaxine.

A
  • Shows a dose-response relationship but has more side effects
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13
Q

If 1 antidepressant is not working, what could you do?

A

COMBINE - SSRI/SNRI plus mirtazapine

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14
Q

If an antidepressant is not working, what are all the things you should consider?

A
  • Medication concordance
  • Is the diagnosis right?
  • Substance misuse
  • Physical illness
  • Address any other predisposing, precipitating and prolonging factors
  • Dose increase
  • Swap
  • Combine- most common is SSRI/SNRI plus mirtazapine
  • Augment- antipsychotic or lithium first
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15
Q

Venlafaxine is an example of an SNRI

A

T

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16
Q

What should always be done before starting someone on an antidepressant?

A

** Get ratings of depressive symptoms before and after starting each drug **

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17
Q

After starting someone on an antidepressant, when should you review them?

A

1-2 weeks

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18
Q

What should you warn patients about before starting them on an antidepressant?

A

Side effects

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19
Q

After someone has a relapse of their depression, they should take an antidepressant for at least _ months after the episode

A

6

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20
Q

Antidepressants are not associated with addiction

A

T

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21
Q

Continue medication for at least 6 months after someone has a relapse

A

T

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22
Q

How is acute mania in bipolar disorder treated?

A
  • Increase anti-manic drug dose

* Stop antidepressant

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23
Q

What antipsychotics are the first line for an acute manic episode in bipolar?

A
  • Olanzapine
  • Quetiapine
  • Risperidone
24
Q

Aside from antipsychotics, what else can be used to manage an acute manic episode in bipolar?

A
  • Lithium
  • Valproate
  • Carbamazepine
  • ECT
25
Q

What symptoms are BZD’s and Z drugs useful for in an acute manic episode in bipolar?

A
  • Agitation

* Insomnia

26
Q

What should you always prescribe with an antidepressant in someone with an acute depressive episode in bipolar?

A

Antipsychotic

27
Q

What antidepressant should be prescribed in someone with an acute depressive episode in bipolar?

A

SSRI’s (particularly Fluoxetine)

28
Q

Describe the management of bipolar depression.

A

1st line – Antipsychotics

  • Quetiapine
  • Olanzapine
  • Lurasidone

+ Antidepressants (to prevent mania)

  • Lithium
  • Valproate
29
Q

Lithium is gold standard for long term bipolar management

A

T

30
Q

Outline how bipolar is managed long term.

A

LITHIUM +

  • Lamotrigine if primarily depressive
  • Valproate if primarily manic/hypomanic
31
Q

How is ECT usually given?

A

Bitemporal

32
Q

How does ECT work?

A

A dose of electricity is titrated for each patient to achieve a seizure typically lasting 15-20 seconds

33
Q

ECT is usually given once weekly

A

F - twice weekly

34
Q

In which 4 situations should you NEVER give a patient ECT?

A
  • Recent MI (within the last 3 months)
  • Recent cerebrovascular accident
  • Intracranial mass lesion
  • Phaeochromocytoma
35
Q

In which 5 situations should you be cautious about giving a patient ECT?

A
  • Angina
  • Congestive heart failure
  • Severe pulmonary disease
  • Osteoporosis
  • Pregnancy
36
Q

** The most common side effect of ECT is headaches ** - after this there is ….

A
  • Memory problems
  • Cognitive problems
  • Muscle aches
  • Confusion
  • N+V
37
Q

Short term memory impairment around the time of the course of ECT is uncommon

A

F - this is common

38
Q

Memory loss is worst from the time period surrounding their ECT treatment

A

T

39
Q

Memory loss after ECT recovers gradually

A

T

40
Q

In a small number of patients, ECT can result in permanent memory loss

A

T :(

41
Q

Patients with severe depression often have impaired cognitive function and memory from the depression and not the ECT

A

T

42
Q

In Scotland you cannot give ECT to a person who has capacity and who is refusing the treatment, even if detained under the Mental Health (Care and Treatment) (Scotland) Act 2003

A

T

43
Q

If capacity to give consent is impaired then an independent second opinion doctor is then required before ECT can go ahead (T3 form)

A

T

44
Q

For life saving ECT treatment, a second opinion from a doctor is still needed

A

F - this is not required

45
Q

63% of patients overall (and 86% of most severe) showed improvement of at least a 50% reduction in MADRS scores by the end of ECT treatment

A

T

46
Q

Outline some reasons why ECT works by altering the CNS.

A
  • Modulation of monoamines
  • Potent anticonvulsant
  • Effects the second messenger system
  • Reduced hyperconnectivity in the frontal and limbic circuits
  • Boosts neuronal survival
  • Promotes production of new neuronal processes in areas involving cognitive and emotional function
47
Q

Give examples of psychotherapy (other than medication) which can be used to treat patients with depression/bipolar.

A
  • CBT
  • Behavioural activation
  • Interpersonal therapy
  • Psychoeducation
  • Cognitive behavioural analytic system of psychotherapy
48
Q

Someone with mental health issues will often have alterations in what 4 domains?

A
  • Thinking
  • Physical symptoms
  • Behaviour
  • Feelings
49
Q

What 3 things can CBT help to alter to improve someones QoL?

A
  • Thinking
  • Behaviour
  • Feelings
50
Q

Overgeneralising?

A

Rules from isolated incidents then applied in all cases

51
Q

Dichotomous Thinking?

A

‘all or nothing’ or ‘black and white’ thinking

52
Q

Selective Abstraction

A

Focusing on one negative detail of a whole experience

53
Q

Selective Abstraction?

A

Focusing on one negative detail of a whole experience

54
Q

Personalisation?

A

Relate external events to self without cause (or little cause)

55
Q

Minimisation/Magnification?

A
  • Overestimate magnitude of undesirable events

* Underestimate magnitude of desirable events

56
Q

Arbitrary Evidence?

A

Draw a conclusion in context of no evidence of contrary evidence

57
Q

Emotional reasoning?

A

I feel bad/guilty therefore I must be bad/ have something to feel guilty about

Psychiatry (31 decks)

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