Management of Mood disorders Flashcards
How do you know treatment is working?
4 Scales often used:
- IDS-30-SR
- QIDS
- Hospital Anxiety and Depression Scale
- MADRS
Which scale is said to be Objective?
- MADRS
- it is performed completed by an observer
How are way patients can keep track of their own conditions?
- medhelp.com (allows pts to record their symptoms ) IN FULL DETAIL
- DAYLIO is simpler
Are anti-depressants addictive?
- unlike benzodiazepines, they are NOT addictive
- but they do make the patient feel really good after taking it, it cause people to continue the meds for a long time
How effective are psychiatric drugs?
- as effective as other drug treatments in medicine
Which is the most effective form of treatment?
- LITHIUM
- HIGH quality CBT
Does prolonging antidepressant rx have an affect on relapse?
- continuing rx reduces chance of relapse by 70%
- the LONGER you take them the GREATER the reduction in relapse
What is NNT?
- It is known as no. of pts, needed to treat
- If the NNT is4.3, for every 5 patients 1 will stay well
What to do is the pt is said to respond to a particular drug so well,?
-GIVE THE medication AGAIN
What is a more widely used ANTI-DEPRESSANT compared to the rest of the classes available?
- the use of SSRIs over TCAs have peaked beyond the recently
What antii-depressant has a good CARDIAC SAFETY porfile?
Setraline
Which anti-depressant promotes SLEEP, appetite and wgt gain?
MIRTAZAPINE
What drug is given adjunct with WITH SSRIs to reduce the rate of their ADVERSE effects?
- MIRTAZAPINE
What medication should be considered for an elderly patient with a renal problem?
LITHIUM OR ANTI-PSYCHOTIC?
—-anti-psychotics are best for renanl pts.
How is drug effectiveness monitored in a patient?
- by giving ratings to the depressive symptoms before and after EACH trial
(PHQ-9) - review after 1-2weeks
How to prevent relapse after the 1st episode?
- continue anti-depressant rx for at least 6 MONTHS.
How to prevent relapse after the 2 nd episode of more?
- by continuing ANT-DEPRESSANT for at least 1-2 YEARS (and no dose reduction)
How to further instil the promise of no relapse?
- lifelong treatment (some may need)
- consider PSYCHOLOGICAL therapies
- discuss LIFESTYLE factors
How would the management change is a chronically depressed person has an episode of MANIA / hypomania?
- maximise ANTI-MANIC dose (if pt was already on anti-depressants)
- discontinue ANTI-DEPRESSANTS
- may need combination therapy
- may require HOSPITAL admission, if the patient has MANIA
What anti-psychotics can be given for ACUTE mania?
- Olanzapine
- Quetiapine
- Risperidone
What other rx options should also be considered?
- Lithium
- Valproate
- Carbamazepine
- ECT
- preferably done oral (IM only if oral is redused)
What could be given to treat Agitation and Insomnia?
- agitat—-Benzos
- Z-drugs—InSOMNIA
What are 3 principles to be remembered for the treatment of Acute Bipolar Depression?
- anti-depressants should NOT be prescribed without an antimanic drug
- avoid anti-depressants in those with a recent MANIC/hypomanic episode
- SSRIs is prefered—esp. FLUOXETINE
What could be given ALONGSIDE an anti-psychotic to prevent mania?
Lithium, valproate or antipsychotic
What are the principles when prescribing for Bipolar Depression?
- Antipsychotics are first line
- If poor response, then add Lithium or Valproate
- Lamotigrine may be used but TAKE time
- ect
Best antipsychotics?
quetiapine,
olanzapine
What is the GOLD standard for long term rx of Bipolar d.o?
- LITHIUM
What kind of group sessions are proven to be beneficial for Bipolar pts?
Psychoeducation
WHat is Lamotigrine and valproate primarily for?
- LAMOTIGRINE (mainly for DEPRESSION)
- Valproate (mainly for MANIC/HYPOMANIC)
When on lithium what should be constantly monitored?
- U&E, Calcium Lvels, TFT levels, ECG, monitor blood lithium levels
Why is it crucial to remain hydrated when on lithium?
- dehydration will impair the excretion of lithium from the kidneys.
- may cause lithium toxicity
Wi=hich anti-depressant is said to increase the risk of FALLS?
mirtazapine
What are the 2 kinds of ECT? (4)
- BIPOLAR (more commonly used+ more effective); MORE LIKELY to result in COGNITIVE problems)
- UNIPOLAR (hard to administer)
When is ECT c/i? (8)
- with recent MI
- recent CEREBROVASCULAR accident
- intracranial mass lesion
- pheochromocytoma
- angina pectoris
- CHF
- severe PULMONARY disease
- severe osteoporosis
- pregnancy
Name the top 4 s/es of ECT?
- Headache
- Memory problems and confusion
- cognitive problems
- muscle aches
What are the cognitive S/Es from ECT?
- memory problems (some have permanent loss; others / inability to create no new problems)
What is required if a patient is incapable of giving consent?
- an independent second opinion doctor is required for ect to go ahead
What law is enforced regarding MENTAL health and ECT ?
- you CANNOT give ECT to a person who HAS capacity and who is REFUSING treatment
How efficient is ECT?
50% reduction in MADRS score by end of the TREATMENT
What are pschological therapies?
- CBT
- Behavioural Activiation (the more you do, the better you feel)
- CBASP (cognitive behvav. analysis syste)
- Interpersonal therapy
- Acceptance and commitment therapy
What are the risks of MOOD disorders?
- suicidal thoughts
- financial diffi.
- self-harm
- isolation
- disinhibition
- unable to care for themselves
What is the worst OPIOD medication in kids?
TRAMADOL
