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NEUROLOGY > Management of Mood disorders > Flashcards

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
Q

What are the principles when prescribing for Bipolar Depression?

A
  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
Q

Best antipsychotics?

A

quetiapine,

olanzapine

27
Q

What is the GOLD standard for long term rx of Bipolar d.o?

A
  • LITHIUM
28
Q

What kind of group sessions are proven to be beneficial for Bipolar pts?

A

Psychoeducation

29
Q

WHat is Lamotigrine and valproate primarily for?

A
  • LAMOTIGRINE (mainly for DEPRESSION)

- Valproate (mainly for MANIC/HYPOMANIC)

30
Q

When on lithium what should be constantly monitored?

A
  • U&E, Calcium Lvels, TFT levels, ECG, monitor blood lithium levels
31
Q

Why is it crucial to remain hydrated when on lithium?

A
  • dehydration will impair the excretion of lithium from the kidneys.
  • may cause lithium toxicity
32
Q

Wi=hich anti-depressant is said to increase the risk of FALLS?

A

mirtazapine

33
Q

What are the 2 kinds of ECT? (4)

A
  • BIPOLAR (more commonly used+ more effective); MORE LIKELY to result in COGNITIVE problems)
  • UNIPOLAR (hard to administer)
34
Q

When is ECT c/i? (8)

A
  • with recent MI
  • recent CEREBROVASCULAR accident
  • intracranial mass lesion
  • pheochromocytoma
  • angina pectoris
  • CHF
  • severe PULMONARY disease
  • severe osteoporosis
  • pregnancy
35
Q

Name the top 4 s/es of ECT?

A
  • Headache
  • Memory problems and confusion
  • cognitive problems
  • muscle aches
36
Q

What are the cognitive S/Es from ECT?

A
  • memory problems (some have permanent loss; others / inability to create no new problems)
37
Q

What is required if a patient is incapable of giving consent?

A
  • an independent second opinion doctor is required for ect to go ahead
38
Q

What law is enforced regarding MENTAL health and ECT ?

A
  • you CANNOT give ECT to a person who HAS capacity and who is REFUSING treatment
39
Q

How efficient is ECT?

A

50% reduction in MADRS score by end of the TREATMENT

40
Q

What are pschological therapies?

A
  • CBT
  • Behavioural Activiation (the more you do, the better you feel)
  • CBASP (cognitive behvav. analysis syste)
  • Interpersonal therapy
  • Acceptance and commitment therapy
41
Q

What are the risks of MOOD disorders?

A
  • suicidal thoughts
  • financial diffi.
  • self-harm
  • isolation
  • disinhibition
  • unable to care for themselves
42
Q

What is the worst OPIOD medication in kids?

A

TRAMADOL

NEUROLOGY (36 decks)

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