Management of Mood disorders Flashcards

1
Q

How do you know treatment is working?

A

4 Scales often used:

  1. IDS-30-SR
  2. QIDS
  3. Hospital Anxiety and Depression Scale
  4. MADRS
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2
Q

Which scale is said to be Objective?

A
  • MADRS

- it is performed completed by an observer

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3
Q

How are way patients can keep track of their own conditions?

A
  • medhelp.com (allows pts to record their symptoms ) IN FULL DETAIL
  • DAYLIO is simpler
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4
Q

Are anti-depressants addictive?

A
  • 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

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5
Q

How effective are psychiatric drugs?

A
  • as effective as other drug treatments in medicine
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6
Q

Which is the most effective form of treatment?

A
  • LITHIUM

- HIGH quality CBT

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7
Q

Does prolonging antidepressant rx have an affect on relapse?

A
  • continuing rx reduces chance of relapse by 70%

- the LONGER you take them the GREATER the reduction in relapse

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8
Q

What is NNT?

A
  • It is known as no. of pts, needed to treat

- If the NNT is4.3, for every 5 patients 1 will stay well

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9
Q

What to do is the pt is said to respond to a particular drug so well,?

A

-GIVE THE medication AGAIN

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10
Q

What is a more widely used ANTI-DEPRESSANT compared to the rest of the classes available?

A
  • the use of SSRIs over TCAs have peaked beyond the recently
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11
Q

What antii-depressant has a good CARDIAC SAFETY porfile?

A

Setraline

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12
Q

Which anti-depressant promotes SLEEP, appetite and wgt gain?

A

MIRTAZAPINE

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13
Q

What drug is given adjunct with WITH SSRIs to reduce the rate of their ADVERSE effects?

A
  • MIRTAZAPINE
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14
Q

What medication should be considered for an elderly patient with a renal problem?
LITHIUM OR ANTI-PSYCHOTIC?

A

—-anti-psychotics are best for renanl pts.

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15
Q

How is drug effectiveness monitored in a patient?

A
  • by giving ratings to the depressive symptoms before and after EACH trial
    (PHQ-9)
  • review after 1-2weeks
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16
Q

How to prevent relapse after the 1st episode?

A
  • continue anti-depressant rx for at least 6 MONTHS.
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17
Q

How to prevent relapse after the 2 nd episode of more?

A
  • by continuing ANT-DEPRESSANT for at least 1-2 YEARS (and no dose reduction)
18
Q

How to further instil the promise of no relapse?

A
  • lifelong treatment (some may need)
  • consider PSYCHOLOGICAL therapies
  • discuss LIFESTYLE factors
19
Q

How would the management change is a chronically depressed person has an episode of MANIA / hypomania?

A
  • 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
20
Q

What anti-psychotics can be given for ACUTE mania?

A
  • Olanzapine
  • Quetiapine
  • Risperidone
21
Q

What other rx options should also be considered?

A
  • Lithium
  • Valproate
  • Carbamazepine
  • ECT
  • preferably done oral (IM only if oral is redused)
22
Q

What could be given to treat Agitation and Insomnia?

A
  • agitat—-Benzos

- Z-drugs—InSOMNIA

23
Q

What are 3 principles to be remembered for the treatment of Acute Bipolar Depression?

A
  • 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
24
Q

What could be given ALONGSIDE an anti-psychotic to prevent mania?

A

Lithium, valproate or antipsychotic

25
What are the principles when prescribing for Bipolar Depression?
1. Antipsychotics are first line 2. If poor response, then add Lithium or Valproate 3. Lamotigrine may be used but TAKE time 4. ect
26
Best antipsychotics?
quetiapine, | olanzapine
27
What is the GOLD standard for long term rx of Bipolar d.o?
- LITHIUM
28
What kind of group sessions are proven to be beneficial for Bipolar pts?
Psychoeducation
29
WHat is Lamotigrine and valproate primarily for?
- LAMOTIGRINE (mainly for DEPRESSION) | - Valproate (mainly for MANIC/HYPOMANIC)
30
When on lithium what should be constantly monitored?
- U&E, Calcium Lvels, TFT levels, ECG, monitor blood lithium levels
31
Why is it crucial to remain hydrated when on lithium?
- dehydration will impair the excretion of lithium from the kidneys. - may cause lithium toxicity
32
Wi=hich anti-depressant is said to increase the risk of FALLS?
mirtazapine
33
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)
34
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
35
Name the top 4 s/es of ECT?
- Headache - Memory problems and confusion - cognitive problems - muscle aches
36
What are the cognitive S/Es from ECT?
- memory problems (some have permanent loss; others / inability to create no new problems)
37
What is required if a patient is incapable of giving consent?
- an independent second opinion doctor is required for ect to go ahead
38
What law is enforced regarding MENTAL health and ECT ?
- you CANNOT give ECT to a person who HAS capacity and who is REFUSING treatment
39
How efficient is ECT?
50% reduction in MADRS score by end of the TREATMENT
40
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
41
What are the risks of MOOD disorders?
- suicidal thoughts - financial diffi. - self-harm - isolation - disinhibition - unable to care for themselves
42
What is the worst OPIOD medication in kids?
TRAMADOL