Mood Disorders Management Flashcards
Name top 4 drugs for Mood Disorders.
- Escitalopram (all round SSRI)
- Sertraline (good CARDIAC profile)
- Mirtazapine (promotes SLEEP, APPETITE and WGT gain)
- Venlafaxine- high rate of S.Es—slightly more effective
Most common combination for MOOD DISORDERS?
SSRI/SNRI + Mirtazapine
—–to augment, give LITHIUM or antipsychotic first
What should be known to the pt BEFORE giving anti-depressants?
- RATINGS of depressive symptoms should be taken (BEFORE and after each trial= PHQ-9)
- warn pts of S.E
- review after 1-2 weeks
- ensure adequate dose
How to prevent relapse in 1st episode?
- continue anti-depressant for at least 6 months AFTER full recovery without reducing dose
How to prevent relapse if its the 2nd episode (or more) ?
- continue anti-depressant for at least 1-2 YEARS AFTER full recovery WITHOUT reducing the dose
WHat should be discontinued during an acute MANIC episode/ hypomania?
- antidepressants
If mania is suspect, what should be considered?
- Hospital admission may be required
What should be adjusted when a pt has an acute manic episode?
- MAXIMISE anti-manic dose if pt is already on maintenance rx
Name 1st line rx of acute MANIA/ hypomania?
- Olanzapine
- Quetiapine
- Risperidone
- Haloperidol
Add Li if 2 anti-psychotics don’t work
-Add Valproate if Li doensn’t work
What is given to rx acute bipolar DEPRESSION?
- SSRIs
Fluoxetine
Give 2 principles when prescribing drugs for Acute Bipolar Depression.
- antidepressants should NOT be prescribed without an anti-manic drug
- Avoid anti-depressants in those with a RECENT MANIC/ hypoMANIC episode
Rx of Bipolar depression?
- olanzapime/ dusperdone, QUETIAPINE
- Lithium and/or by valproate og the psrt dies
How often is ECT given?
- TWICE weekly in the UK
Name the 2 methods ECT can be performed.
- Bilateral and Unilateral
Which one is harder to administer
unilateral
Which ect is likely to result in cognitive problems?
B.L
Name the ABSOLUTE Contrindications to ECT
recent MI (last 3 months)
recent Cerebrovascular accident
intracranial mass lesion
phaeochromocytoma
What are the relative C.Is?
- angina pectoris
- CHF
- Severe pulmonary disease
- severe osteoporosis
- pregnancy
Most likely cause of death by ECT?
Complications of the Pulmonary and Cardiovascular
How SAFE is ect?
- risk of NOT treating is GREATER
- mortality rate of 1 in 80,000
- in SOME, mortality and morbidity rates from ECT is LESS than with some anti-depressant meds
Name the top 5 side effects of ECT?
- 65% complain of AT LEAST one s.e:
headache/ memory problems/ cognitive problems/ muscle aches/ confusion
What is the MAIN cognitive impairment from ECT?
How bad is it?
- Memory impairment (loss is accentuated for the time period CLOSEST to their rx)
- —memory RECOVERS gradually (within 2 months)
Is the ability of picking up new info affected with ECT rx?
NO
—it shouldn’t be
- however; small no. of patients experience PERMANENT and PERSISTENT memory loss
1/3 of ECT rx are performed involuntarily…what is required before performing a procedure on a patient with no capacity?
- impaired capacity= independent SECOND opinion doctor
—-but for a life saving rx- no need 2nd opnion
Can you give ECT to someone with capacity and is refusing?
NO
- even if he/she os detained
How effective is ECT?
- 63% showed OVERALL improvement in MADRS scores (50% in scores)
How does ECT bring about altercations in the CNS?
- unclear mechanism
- said to:
- modulate monoamines
- potent anticonvulsant efx
- second messenger affected
- bolsters neuronal SURVIVAL
- reduced hyperconnectivity in FRONTAL and limbic circuits
- promotes prodn of new neuronal processes
List examples of THINKING errors.
- MINIMISATION/ MAGNIFICATION
- Arbitrary evidence
- Emotional reasoning
- Shoulds and Musts
- Dichotomous thinking
- selective abstraction
- personalisation
- overgeneralising
What is meant by selective abstraction?
- focus’s on one (-)ve detail
