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Psychiatry > Physical/psychological treatments > Flashcards

Physical/psychological treatments Flashcards

1
Q

How does ECT work?

A

Neurochemical theories: Chanes in receptor expression of D2 and 5-HT2 receptors

Neuroendocrine theories: Restores diurnal rhythm of HPA axis, plus enhances production + release of several neuroendocrine substances (e.g. oxytocin)

Neuro + synaptogenesis: Increase in BDNF and synaptic remodelling seen in animal data

Connectivity: Changes in connectivity between dorsolateral prefrontal cortex and subgeniculate cortex

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2
Q

Indications for ECT

A

Severe depression: Stupor, life-threatening, treatment-refractory

Moderate depression: Prolonged, resistant to multiple drugs + psychotherapy

Mania + psychosis: Prolonged/severe

Catatonia/NMS

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3
Q

Physiological effects of ECT

A

Raised pressures: Intraocular, intragastric, hypertension

Dental: Supraphysiological bite

Cardiac: Emergent arrhythmias

Endocrine: ACTH, cortisol, glucagon release –> may affect blood sugar

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4
Q

Efficacy of ECT

A

High remission rates, but short-lived (approx 2w) –> need to include supplemental management after course of CBT

90-95% for puerperal psychosis

80-85% for unipolar depression

80% catatonia

70-75% bipolar

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5
Q

Side effects of ECT

A
  • Immediate:
    • Headache
    • Nausea
    • Muscle ache
    • Confusion/disorientation
  • Longer-term
    • Antero- + retrograde amnesia for duration of treatment + following month
    • Deficits in autobiographical memory up to 6mo before treatment (RARER, 15-20%)
  • Rare but severe:
    • Emergent hypomania
    • Bone/dental/jaw injury
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6
Q

Length of ECT treatment

A

Twice a week, usually for 6-12 sessions (3-6w)

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7
Q

Consent and capacity frameworks for ECT

A

Voluntary:

  • Capacitous –> need consent
  • Lacks capacity –> need assent

Detained:

  • Capacitous –> need consent (c.f. pharma treatments)
  • Lacks capacity –> needs SOAD (no 3-month rule)
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8
Q

Contraindications for ECT

A

No absolutes, but several cautions

Cerebral: Raised ICP, cerebral haemmorhage, stroke, aneurysm, glaucoma/raised IOP

Cardiac: Recent MI, arrhythmia, phaeochromocytoma, malignant hypertension

Unstable COPD/chest infexion

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9
Q

Principles of rTMS

A

Repetitive transcranial magnetic stimulation

Pulses of strong magnetic field applied to excite/inhibit cortical pyramidal cells in a more localised fashion compared to ECT (esp dorsolateral prefrontal cortex)

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10
Q

Timecourse of rTMS treatment

A

45-min sessions (may be optimised with shorter, theta-burst rTMS)

5x per week

For 4-6 weeks

Presents logistical barrier

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11
Q

Efficacy of rTMS

A

For treatment-resistant depression: 1:1:1 recovery/partial recovery/no effect

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12
Q

Side effects of rTMS

A

Headache, facial discomfort

Syncope occasionally

Rarely seizure induction

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13
Q

Contraindications for rTMS

A

Epilepsy, stroke, brain tumour

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14
Q

Three levels of cognition in CBT model

A

Automatic thoughts: Rapid images/verbal interpretations of events –> often taken as true although not necessarily correct

Dysfunctional assumptions:‘Rules’ for behaving and interacting with world

Core beliefs: Absolute statements about self, others, world that shape how we view the world

These are explored in the formulation of CBT

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15
Q

Common negative cognitive biases

A

All-or-nothing thinking

Catastrophising

Overgeneralising

Disqualifying positives/focusing on negatives

Labeling/jumping to conclusions

Personalisation

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16
Q

Rationale behind CBT

A

Cognition, emotion, behaviour, and physical sensations co-exist and influence each other

Influencing cognition/learned behaviorus –> influence on emotions/physical sensations leading to improvement

17
Q

Principles/tools of CBT

A
  1. Thought diaries: Allow breakdown of unhelpful thinking patterns + identification of trends/core beliefs
  2. Socratic questioning: Challenging cognition w/ support of therapist as collaborator (not as expert) –> pt reaches own conclusions
  3. Behavioural experiments: Desensitisation by breaking link between thought and conclusion
18
Q

Stepped care model for psychological treatment

A

Step 1: Assessment, psychoeducation, monitoring, possible referral to IAPT (i.e. Talking Space for steps 2-4)

Step 2: Low-intensity CBT e.g. computer-based, guided self-help, group CBT, motivational interviewing

Step 3: Individual CBT, counselling, IPT

Step 4: Intensive, specialist CBT/IPT/DBT/CAT

19
Q

Four areas of focus of interpersonal therapy

A

One of:

  • Grief
  • Managing transitions
  • Interpersonal deficits (social impoverishment)
  • Interpersonal disputes
20
Q

What is DBT?

A

Dialectical behaviour therapy

Used for BPD patients

Skills in coping with emotional distress and problem-solving, allow more adaptive responses

21
Q

Techniques of DBT

A
  • Individual:
    • Validation of emotions
    • Identifying maladaptive behaviorus + their triggers
    • Reinforcing adaptive behaviours
  • Group:
    • Mindfulness techniques
    • Emotional modulation techniques
    • Interpersonal skills: e.g. communication, conflict resolution
    • Distress tolerance skills: Self-soothing, distraction
  • Other:
    • Telephone between sessions for ‘real-life’ application
    • Therapist support groups
22
Q

Uses of motivational interviewing

A

Substance abuse

Risky behaviour in adolescents

Smoking/substance use in pregnancy

Behavioural change desired (e.g. in ED)

23
Q

Role of supportive psychotherapy

A

Recent onset problems: Short-term support to weather transitions/adjustment

Mild depression (Esp if one episode, trigger known)

Mild-moderate anxiety

24
Q

Techniques in systemic family therapy

A

60-90min every 2-4 weeks

One therapist + reflective team behind one-way screen, or two therapists reflecting in front of family

Highlight strengths, share ideas, find solutions

Concerned with:

  • Power distribution within system
  • Communication
  • Attachment
  • Intergenerational scripts/roles

Psychiatry (20 decks)

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