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PSYCHIATRY > Management of Mood Disorders > Flashcards

Management of Mood Disorders Flashcards

1
Q

What scales can be used to assess patients mood to say that treatment is working?

A
  • Inventory of Depressive Symptomatology (IDS 30 Qs)
  • Quick Inventory of Depressive Symptomatology (QIDS 16 Qs)
  • Hospital Anxiety and Depression Scale 14 Qs
  • Montgomery-Asberg Rating Scale (MADRS) - 10 item observer rated scale
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2
Q

Why is it useful for people to use a mood diary?

A

Allows doctor to see how patient has been over the past months/weeks NOT just on the day of the consultation

Also allows patient to log their symptoms and exercise

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3
Q

What apps and websites can patients use to log their mood diary?

A

Medhelp.com survey
Daylio (App)
Bipolar Disorder Research Network- weekly QIDS and Altman surveys

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4
Q

What myths about antidepressants are held by the population?

A
  • overprescribing
  • addictive
  • dont work - exercise/ eating well is better
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5
Q

All antidepressant drugs are favoured more than placebo on Forest Plot. TRUE/FALSE?

A

TRUE

=> they DO work

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6
Q

How effective are antidepressants for maintenance treatment versus acute treatments?

A

More effective for maintenance

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7
Q

Lithium is very effective for bipolar maintenance treatment. TRUE/FALSE?

A

TRUE

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8
Q

Relapse rate with antidepressants decreases. TRUE/FALSE?

A

TRUE

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9
Q

Why have SSRI antidepressants become more widely prescribed?

A

GPs more likely to prescribe them
Stigma for patients has decreased
side effect profile lower than other antidepressants

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10
Q

Why is sertraline used in older patients?

A

Cardiac safety

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11
Q

What are the main 2 side effects of mirtazapine, and why may they not be suitable for some depressive patients?

A

Sedation and weight gain

may not be suitable if patient is already excessively eating/sleeping

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12
Q

Why are venlafaxine and mirtazapine often given in combination?

A

Acute depression treatment

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13
Q

What questions should you be asking if medication is not working for a patient?

A
  • Medication concordance?
  • diagnosis right?
  • Substance misuse
  • Physical illness
  • Address any other predisposing, precipitating and prolonging factors
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14
Q

What can doctors DO if the medication they have prescribed is not working?

A

Dose increase
Swap
Combine- most common is SSRI/SNRI plus mirtazapine
Augment- antipsychotic or lithium first

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15
Q

What should be done when starting a patient on a new antidepressant?

A
  • Get ratings of depressive symptoms before and after trial of medication
  • Warn patients about possible side effects
  • Review after 1-2 weeks
  • Change after 4-6 weeks
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16
Q

How long should an antidepressant be continued after the first major depressive episode ?

A

At least 6 months after full recovery

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17
Q

How long should treatment be continued after two or more major depressive episodes?

A

At least 1-2 years after full recovery without reducing dose

some patients may require lifelong

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18
Q

What are the main principles of acute hypomania/mania treatment?

A
  • Increase to anti-manic dose if patient already on maintenance treatment
  • Antidepressants should be discontinued
  • Combination therapy
  • Hospital admission if mania
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19
Q

What antipsychotics are first line in anti-mania prescribing?

A

olanzapine, quetiapine or risperidone

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20
Q

What agents other than antipsychotics can be used in acute mania prescribing?

A

lithium
valproate
carbamazepine
ECT

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21
Q

Medication should be oral if possible in acute mania prescribing. TRUE/FALSE?

A

TRUE

BUT if patient is detained under mental health act then IM medication may be needed

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22
Q

When are benzodiazepines used in acute mania?

A

For symptom control e.g. agitation and insomnia

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23
Q

What are the main 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 (particularly fluoxetine) preferable to other classes
24
Q

Lithium is gold standard long term treatment for bipolar maintenance. TRUE/FALSE?

A

TRUE

25
Q

What is meant by the recovery model?

A

Helping patients to make the most of life regardless of whether their mental health problems are present/absent

26
Q

What seasons show a peak in mood disorders?

A

Spring and Autumn

27
Q

What is meant by Rapid Cycling and what medication is best used to treat this?

A

4 different mood episodes in one year

SSRIs useful - escitalopram = purest form of SSRI

28
Q

What should be monitored when a patient is on lithium?

A 
Lithium levels
U&Es 
ECG
TFTs (check pt is not hypothyroid)
Ca2+ (check pt is not hypoparathyroid)
Check patient is not dehydrated
29
Q

Name some of the common side effects of lithium

A

GI upset
Metallic taste
Tremor
Exacerbation of skin conditions

30
Q

Why should tricyclics possibly be avoided in older patients?

A

Can decrease cognition

ALSO cause sedation (can precipitate falls)

31
Q

What SSRI should be used if a patient is prone to falling?

A

Mirtazapine

as other SSRIs can cause postural hypotension

32
Q

What types of drugs should lithium NOT be combined with?

A

NSAIDs

ACEi

33
Q

What is electroconvulsive therapy?

A

Electrical shockwaves administered to brain whilst patient is under general anaesthetic and a muscle relaxant

Causes a 20-30 second seizure

Aims to decrease overactivity between limbic system and areas of the prefrontal cortex

34
Q

What can be used to reverse an ECT seizure that continues for too long?

A

Midazolam

35
Q

What condition is ECT used to treat most?

A

Recurrent Depressive Disorder without Psychosis

36
Q

How often are patients usually treated with ECT?

A

Twice a week

6-12 sessions usually required for full effect

37
Q

Is ECT conducted unilaterally or bilaterally?

A

Usually always bilaterally

38
Q

When is ECT deemed to be “safer” than medications?

A

In an acute scenario where waiting on medications to work would take too long

39
Q

ECT can cause cognitive side effects. TRUE/FALSE?

A

TRUE

  • short term
  • closer to time of treatment
40
Q

How is a patient monitored during ECT?

A

EEG (to see start and end of seizure)

ECG

41
Q

What are the ABSOLUTE contraindications for ECT?

A
  • Recent MI (within last 3 months)
  • Recent cerebrovascular accident
  • Intracranial mass lesion
  • Phaeochromocytoma
42
Q

What other contraindications may be considered for ECT?

A
  • Angina
  • Congestive heart failure
  • Severe pulmonary disease
  • Severe osteoporosis
  • Pregnancy
43
Q

2/3 of patients experience at least 1 mild physical side effect after ECT. TRUE/FALSE?

A

TRUE

e.g. headache, memory loss etc

44
Q

Give examples of “thinking errors” which Cognitive Behavioural Therapy attempts to overcome?

A
  • Overgeneralising
  • Dichotomous thinking (black and white thinking)
  • Selective abstraction (Focus on one –ve detail)
  • Personalisation (Relate events to self)
  • Minimisation or magnification
  • Arbitrary evidence
  • Emotional Reasoning (I feel bad/guilty)
45
Q

What is meant by “dysfunctional assumptions” which CBT attempts to overcome?

A
  • Pt feels that accepting help makes them look weak

- “If i cant do something perfectly, why attempt it at all?”

46
Q

What is the aim of Cognitive behavioural analysis system of psychotherapy (CBASP)?

A

Talking therapy like CBT

  • Uses influential people to help patient learn from experiences with these people
  • Situational analysis where patient was stressed/ upset, revisit and plan how patient would achieve their desired outcome
47
Q

What is discussed during Interpersonal Therapy?

A

Focus on patients relationships

- if older, patient may have struggled with children leaving home

48
Q

What is the aim of acceptance and commitment therapy?

A

Acceptance of unpleasant thoughts coming

Learning how to stand back and observe/ analyse these thoughts?

49
Q

What should be considered when doing a risk assessment of a patient?

A 
Suicide
Self harm
financial difficulty
neglect
not seeking attention for physical health problems
inappropriate sexual behaviour
50
Q

Why may patients who experience mania need a power of attorney?

A

Financial needs - incase they end up manically spending money

51
Q

What are the predisposing factors for most mood disorders?

aka things from previously in life that may NOW play a part

A

Genetics
Disrupted parental attachments
Chronic health problems during childhood
Trauma as a child

52
Q

What are the precipitating factors of mood disorders?

aka current factors which contribute to patients mood

A

Recent trauma
stress (moving house, changing job)
New medications
Sleep disturbance (night shift)

53
Q

What prolonging factors can affect mood disorders?

aka things which occur during depressive episode that can make it last longer

A
  • Distress whilst staying on ward
  • detained under mental health act
  • substance misuse during depressive episode
54
Q

Who and what can act as support for patients with mood disorders?

A

Friends and family
Religion
Enjoyable activities

55
Q

ECT can be given in an outpatient setting. TRUE/FALSE?

A

TRUE

- especially for patients requiring maintenance therapy but do not need admission to hospital

PSYCHIATRY (35 decks)

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