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1. Psychiatric services > Physical treatments in psychiatry > Flashcards

Physical treatments in psychiatry Flashcards

1
Q

Absolute contraindications to ECT

A

None

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2
Q

ECT should be considered for treatment of severe depression where

A

The patient requests it
A rapid response is required (e.g. if the patient is not eating or drinking)
Other treatments have been unsuccessful

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3
Q

Conditions ECT may be considered for

A

Depression
Mania
Schizophrenia
Catatonia
Parkinson’s disease
NMS
Intractable seizure disorders

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4
Q

Times ECT may be considered in mania

A

Life threatening physical exhaustion
Prolonged and severe mania with lack of response to all other appropriate drug treatments

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5
Q

Times ECT may be considered in schizophrenia

A

Fourth line treatment after use of two antipsychotics and clozapine

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6
Q

Times ECT may be considered in catatonia

A

When treatment with a benzodiazepine has been ineffective

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7
Q

Cardiac relative contraindications to ECT

A

MI within 3 months
Uncontrolled heart failure
Arrhythmias

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8
Q

Neurological relative contraindications to ECT

A

Stroke within 1 month
Raised ICP
Intracerebral haemorrhage

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9
Q

Haematological relative contraindication to ECT

A

DVT until treated with anticoagulant

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10
Q

Proportion of patients undergoing ECT who experience significant memory loss

A

1/3

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11
Q

Three most common early side effects from ECT

A

Headache (48%)
Temporary confusion (27%)
Nausea/vomiting (9%)

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12
Q

Cognitive impairment seen in bilateral compared to unilateral ECT

A

Greater in bilateral ECT

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13
Q

Efficacy of bilateral compared to unilateral ECT

A

Bilateral more effective

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14
Q

Difference in efficacy between brief pulse and sinewave ECT

A

None

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15
Q

Types of memory loss seen with ECT

A

Anterograde amnesia
Retrograde amnesia

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16
Q

Differences between timing of anterograde vs. retrograde amnesia associated with ECT

A

Anterograde amnesia worse during ECT then resolves rapidly afterwards
Retrograde amnesia resolves very gradually after the final ECT treatment

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17
Q

Structural brain damage caused by ECT

A

None

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18
Q

Effect of ECT on IQ

A

None

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19
Q

Effect of ECT on executive functioning

A

None

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20
Q

Mortality for ECT

A

No different than general anaesthesia for minor surgery (2:100,000)

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21
Q

Percentage of ECT responders who relapse within 12 months

A

51.1%

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22
Q

Percentage of ECT responders who relapse within 6 months

A

37.7%

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23
Q

Antidepressant group with the largest evidence base in post-ECT relapse prevention

A

TCA

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24
Q

Optimal frequency and length of initial ECT treatment

A

Twice weekly for 6-12 sessions total

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25
Number of ECT treatments after which improvement is unlikely if no improvement has been seen
6
26
Frequency of memory assessment needed during ECT
After every session
27
Electrode placement in bilateral ECT
Both temples 4cm above and perpendicular to the midpoint of a line between the lateral angle of the eye and the EAM
28
Electrode placement in unilateral ECT
One electrode on the temple 4cm above and perpendicular to the midpoint of a line between the lateral angle of the eye and the EAM One electrode over the parietal surface of the scalp over the non-dominant hemisphere
29
Motor seizure definition of an effective ECT treatment
Motor seizure lasting at least 20 seconds
30
Four phases of a typical ECT induction EEG
Build up Spike and wave activity Low voltage slow waves Suppression of activity
31
Typical length of a typical ECT induction EEG
35-130 seconds
32
Definition of continuation ECT
A course of ECT that begins after the initial course Lasts up to 6 months Aims to prevent relapse of the episode
33
Definition of maintenance ECT
A course of ECT that begins after continuation ECT ends at 6 months Aims to prevent recurrence of the episode
34
Reasons to consider continuation/maintenance ECT
Initial illness responded well Early relapse despite adequate continuation drug treatment Patient cannot tolerate continuation drug treatment Able to be performed safely (likely as an outpatient)
35
Reasons to consider using bilateral ECT
Speed and completeness of response are a priority Unilateral ECT has failed Previous ECT has produced a good response without significant memory impairment Difficult to determine hemispheric dominance
36
Reasons to consider using unilateral ECT
Minimising memory impairment is a priority Speed of treatment is less of a priority Previous good response
37
Interaction between ECT and lithium
May increase cognitive side effects of ECT May increase likelihood of neurotoxic effects of lithium
38
Conditions transcranial magnetic stimulation may be used for
Migraine Depression
39
Type of transcranial magnetic stimulation used in depression
Repetitive pulse transcranial magnetic stimulation (rTMS)
40
Developed the first device which used magnetic fields to produce stimulation of a targeted brain region
Anthony Barker
41
Number needed to treat for TMS for depression which has not responded to a trial of antidepressants
4
42
Timing of rTMS
30-40 minutes a day for at least 4 consecutive weeks
43
Positioning of the magnetic coil in TMS
Right or left (usually left) dorsolateral prefrontal cortex
44
Cognitive effects of TMS
None
45
Anaesthetic required for TMS
None
46
Short term efficacy of ECT compared to TMS for depression
ECT more effective especially in psychotic depression
47
Side effects of TMS
Discomfort at the site of application Transient headaches Transient facial muscle twitching Theoretical risk of seizures
48
Criteria for psychosurgery
Severe mood disorder or OCD which has been resistant to all other reasonable evidence based treatments tried adequately Patient is competent and gives informed consent
49
Method used in psychosurgery where pre-operative MRI is used to establish target co-ordinates
Stereotactic method
50
Methods of producing targeted lesions in psychosurgery
Radio-frequency thermocoagulation Gamma radiation
51
Psychosurgery where a lesion is made beneath the head of each caudate nucleus
Subcaudate tractotomy
52
Psychosurgery where a lesion is made bilaterally within the cingulate bundle
Anterior cingulotomy
53
Psychosurgery where a lesion is made beneath the head of each caudate nucleus and bilaterally within the cingulate bundle
Limbic leucotomy
54
Psychosurgeries combined in a limbic leucotomy
Subcaudate tractotomy Anterior cingulotomy
55
Side effects associated with older methods of psychosurgery
Personality change Epilepsy Amotivation
56
Percentage of patients undergoing modern psychosurgery who experience short term confusion
10%
57
Percentage of patients undergoing modern psychosurgery who experience personality change or social functioning issues
2-8%
58
Percentage of patients undergoing modern psychosurgery who experience seizures
<1%
59
Percentage of patients undergoing modern psychosurgery who experience weight gain
10%
60
Percentage of patients who experience significant improvement with psychosurgery
50-70%
61
Conditions most amenable to improvement with psychosurgery
OCD Chronic intractable major depressive disorder
62
Conditions which DBS has been shown to be therapeutic for
Parkinson's Disease Essential tremor Tourette's disorder Dystonia
63
Conditions for which DBS is being evaluated
Major depression OCD Chronic pain
64
Area of the brain DBS is aimed for treatment of OCD
Internal capsule
65
Most common complication of DBS
Infection
66
Risk of intracranial haemorrhage following DBS surgery
0-4.5%
67
Neuropsychiatric side effects of DBS
Depression Anxiety Mania Impulsivity Speech and language difficulties Decreased cognition Postural instability and falls
68
Contraindications to rTMS
Epilepsy Organic brain pathology Sleep deprivation Active alcohol dependence Use of drugs which reduce the seizure threshold Severe or recent heart disease Surgically placed magnetic material e.g. pacemaker, cochlear implant
69
Difference in efficacy between ECT performed once a week, twice a week, or three times a week
None
70
Difference in efficacy of higher vs. lower electrical stimuli for patients with depression
Higher electrical stimulus leads to greater reduction in symptoms
71
Decade in which ECT was invented
1930s
72
Medication shown to reduce recovery time and confusion following ECT
Donepezil
73
Maximum frequency of ECT
Twice weekly
74
Doctor who popularised transorbital leucotomy
Freeman

1. Psychiatric services (6 decks)

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