Non-pharm

Question 1

What is CBT?

Answer 1

Cognitive Behavioral Therapy

Blended model of cognitive therapy and behavioral therapy

Question 2

What is cognitive therapy?

Answer 2

Focuses on persons thoughts and beliefs and how they influence a person’s mood and actions

Question 3

What is the goal of cognitive therapy?

Answer 3

To change a person’s thinking to be more adaptive and healthy to situtations

Question 4

What is behavioral therapy?

Answer 4

Focuses on persons actions

Question 5

What is the goal of behavioral therapy?

Answer 5

To change unhealthy behavior patterns

Question 6

What is CBT based on?

Answer 6

Foundation that thoughts, feelings, and behavior are inter-related and impact each other

Question 7

What do CBT treatments focus on?

Answer 7

Changing specific thoughts, feelings, or behaviors

Question 8

How is the patient involved in CBT?

Answer 8

Requires the patient to be actively involved in the process

Question 9

What types of people does CBT typically work for?

Answer 9

Works best for highly motivated/goal oriented individuals

Question 10

Which disorders can use combo medications?

Answer 10

MDD
Anxiety
Bipolar
Schizophrenia

Question 11

What disorders can use monotherapy as treatment?

Answer 11

MDD

Anxiety

Question 12

Which disorders do not use medications acutely?

Answer 12

Bipolar
Schizophrenia
But once person’s mood has stabilized, can be receptive to CBT

Question 13

What is ECT?

Answer 13

Electroconvulsive therapy

Procedure where a seizure is induced to reset neurotransmitters and catacholamines

Question 14

What are indications for ECT?

Answer 14

Severe, or treatment resistant MDD or bipolar disorder

Question 15

What are some clinical considerations that favor the use of ECT?

Answer 15

H/o tx resistance
Need for rapid treatment response
Severity of illness

Question 16

Has ECT been approved during pregnancy?

Answer 16

Yes

Question 17

What are the procedures for ECT?

Answer 17

General anesthesia and a muscle relaxant prior to stimulation

Question 18

How many treatments are needed for ECT?

Answer 18

6-12 treatments

Question 19

What is the efficacy rate of ECT treatments in uncomplicated cases of severe major depression?

Answer 19

80%

Question 20

What are SEs of ECT?

Answer 20

HA, muscle soreness, nausea and confusion

Possible memory deficits

Question 21

What does rTMS stand for?

Answer 21

Repetitive Transcranial Magnetic Stimulation

Question 22

What is the indication for rTMS?

Answer 22

Approved for MDD who have failed at least one antidepressant medication

Question 23

How is rTMS performed?

Answer 23

Noninvasive and relatively painless application of pulsed electromagnetic fields via coil to modulate electrical activity in the brain

Question 24

How does rTMS work?

Answer 24

Activates the neurons through effects on neurotransmitter systems, neurotrophic factors, regional blood flow, and cortical excitability

Question 25

Does rTMS require anesthesia?

Answer 25

No

Question 26

What are the side effects of rTMS?

Answer 26

``` Mild and transient Discomfort at the site Discomfort of muscles at scalp, jaw or face Tension HA Inadvertent seizures (rare) ```

Question 27

Is ECT or rTMS more effective?

Answer 27

ECT

Question 28

Are relapse rates of ECT high or low?

Answer 28

High

Question 29

What is the maintenance treatment following ECT?

Answer 29

Antidepressants

Question 30

Why would a patient need maintenance ECT?

Answer 30

To reduce sx return

Question 31

What are the relative CIs for ECT?

Answer 31

``` Brain tumor w/increased intracranial pressure Recent cerebral hemorrhage or stroke Unstable CVD MI Arrhythmias Retinal detachment Pheochomocytoma High anesthesia risk Adolescents/children ```