Management of Mood Disorders

Question 1

What are some rating scales used to assess mood?

Answer 1

IDS, QIDS, HADS, MADRS

Question 2

What is the IDS?

Answer 2

Self report of 30 questions = very detailed, patient rates each question, subjective

Question 3

What is the QIDS?

Answer 3

Shorter version of the IDS = only asks about sleep, sadness, appetite, eight, concentration, view of self, suicide, energy and general interest

Question 4

What is the HADS?

Answer 4

14 item self rated scale = easy to complete and administer

Question 5

What is the MADRS?

Answer 5

10 item observer rated scale = highly sensitive to change

Question 6

What are mood diaries useful for?

Answer 6

Identifying peaks and troughs in mood

Tracking overall mood progression

Question 7

What are some evidence in support of antidepressants?

Answer 7

Reduce odds of relapse by 70%

For every 5 patients treated, 1 will stay well

Question 8

What are the top 4 antidepressants recommended?

Answer 8

Escitalopram = probably best all round SSRI
Sertraline = well established, good cardiac profile
Mirtazapine = promotes sleep and appetite
Venlafaxine

Question 9

What should you do if an antidepressant doesn’t work?

Answer 9

Increase dose, swap for another antidepressant, combine drugs, augment

Question 10

What should you do when starting a patient on an antidepressant?

Answer 10

Get ratings of depressive symptoms before and after each trial
Warn patient about side effects
Review after 1-2 weeks

Question 11

How is the first episode of relapse managed?

Answer 11

Continue antidepressant for at least 6 months after full recovery without reducing dose

Question 12

How are second and subsequent relapses managed?

Answer 12

Continue antidepressant for at least 1-2 years after full recovery without reducing dose

Question 13

What medication should be stopped in a patient having an acute manic episode?

Answer 13

Stop antidepressants

Question 14

What is the first line treatment for acute mania?

Answer 14

Antipsychotics = olanzapine, quetiapine, ripendone

Question 15

What are some features of treating acute mania?

Answer 15

Other options = lithium, valproate, ECT, carbamazepine
Oral medication if possible = IM medication if needed
Benzodiazepines or Z-drugs can be used for symptom control

Question 16

How is acute bipolar depression treated?

Answer 16

SSRIs, especially fluoxetine, are preferred
Antipsychotic first line = quetiapine, olanzapine
Lamotrigine can be used but not acutely = takes time to titrate

Question 17

What must be done if you are giving an antidepressant to a patient suffering from acute bipolar depression?

Answer 17

Must give it with an antimanic

Question 18

What are some features of bipolar disorder maintenance therapy?

Answer 18

Lithium is gold standard
Psychoeducation very important
Lamotrigine if primarily depression
Valproate if primarily manic

Question 19

What are some features of prescribing for older people?

Answer 19

Tricyclics can cause cognitive impairment
Fall risk increases when starting medication or increasing dose = SSRIs reduce sodium causing falls
Try to give monotherapy and start on half dose

Question 20

What common class of drug can lithium not be prescribed alongside?

Answer 20

ACE inhibitors

Question 21

What is ECT most commonly given for?

Answer 21

Recurrent depressive disorder without psychosis

Question 22

How is ECT given?

Answer 22

Twice weekly = most patients are inpatients, receive bitemporal ECT, always under general anaesthetic with muscle relaxant, seizures usually last 15-30s

Question 23

How common are side effects from ECT?

Answer 23

CV and pulmonary complications are most likely cause of death
66% complain of at least 1 side effect = headache is most common
64% experience some form of memory problems = usually autobiographical memory loss

Question 24

What are the main effects of ECT on the CNS?

Answer 24

Modulation of monoamines
Potent anticonvulsant effects
2nd messenger system effect
Bolsters neuronal survival
Reduces hyperconnectivity in frontal and limbic circuits

Question 25

What is the most common psychological therapy used to treat mood disorders?

Answer 25

Cognitive behaviour therapy

Question 26

What are some examples of negative automatic thoughts?

Answer 26

Overgeneralising, minimisation, dichotomous thinking, arbitrary evidence, selective abstraction

Question 27

What occurs in behavioural activation?

Answer 27

Gradually increase amount of meaningful activity the patient is involved in

Question 28

What are some features of CBASP?

Answer 28

Includes past events and looks at patient’s whole history = explore what patient has learned from relationships, used to treat depression

Question 29

What is the purpose of acceptance and commitment therapy?

Answer 29

To teach the patient how to accept unpleasant thoughts and dismiss them

Question 30

What is the aim of psychoeducation?

Answer 30

Teach patient to understand their illness and their own experience of this

Question 31

What are some of the risks associated with mood disorders?

Answer 31

Self harm and suicide, unemployment and money struggles, overspending, reckless behaviour, neglecting children, isolation