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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
Q

Number of ECT treatments after which improvement is unlikely if no improvement has been seen

A

6

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26
Q

Frequency of memory assessment needed during ECT

A

After every session

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27
Q

Electrode placement in bilateral ECT

A

Both temples
4cm above and perpendicular to the midpoint of a line between the lateral angle of the eye and the EAM

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28
Q

Electrode placement in unilateral ECT

A

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

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29
Q

Motor seizure definition of an effective ECT treatment

A

Motor seizure lasting at least 20 seconds

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30
Q

Four phases of a typical ECT induction EEG

A

Build up
Spike and wave activity
Low voltage slow waves
Suppression of activity

31
Q

Typical length of a typical ECT induction EEG

A

35-130 seconds

32
Q

Definition of continuation ECT

A

A course of ECT that begins after the initial course
Lasts up to 6 months
Aims to prevent relapse of the episode

33
Q

Definition of maintenance ECT

A

A course of ECT that begins after continuation ECT ends at 6 months
Aims to prevent recurrence of the episode

34
Q

Reasons to consider continuation/maintenance ECT

A

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
Q

Reasons to consider using bilateral ECT

A

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
Q

Reasons to consider using unilateral ECT

A

Minimising memory impairment is a priority
Speed of treatment is less of a priority
Previous good response

37
Q

Interaction between ECT and lithium

A

May increase cognitive side effects of ECT
May increase likelihood of neurotoxic effects of lithium

38
Q

Conditions transcranial magnetic stimulation may be used for

A

Migraine
Depression

39
Q

Type of transcranial magnetic stimulation used in depression

A

Repetitive pulse transcranial magnetic stimulation (rTMS)

40
Q

Developed the first device which used magnetic fields to produce stimulation of a targeted brain region

A

Anthony Barker

41
Q

Number needed to treat for TMS for depression which has not responded to a trial of antidepressants

A

4

42
Q

Timing of rTMS

A

30-40 minutes a day for at least 4 consecutive weeks

43
Q

Positioning of the magnetic coil in TMS

A

Right or left (usually left) dorsolateral prefrontal cortex

44
Q

Cognitive effects of TMS

A

None

45
Q

Anaesthetic required for TMS

A

None

46
Q

Short term efficacy of ECT compared to TMS for depression

A

ECT more effective especially in psychotic depression

47
Q

Side effects of TMS

A

Discomfort at the site of application
Transient headaches
Transient facial muscle twitching
Theoretical risk of seizures

48
Q

Criteria for psychosurgery

A

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
Q

Method used in psychosurgery where pre-operative MRI is used to establish target co-ordinates

A

Stereotactic method

50
Q

Methods of producing targeted lesions in psychosurgery

A

Radio-frequency thermocoagulation
Gamma radiation

51
Q

Psychosurgery where a lesion is made beneath the head of each caudate nucleus

A

Subcaudate tractotomy

52
Q

Psychosurgery where a lesion is made bilaterally within the cingulate bundle

A

Anterior cingulotomy

53
Q

Psychosurgery where a lesion is made beneath the head of each caudate nucleus and bilaterally within the cingulate bundle

A

Limbic leucotomy

54
Q

Psychosurgeries combined in a limbic leucotomy

A

Subcaudate tractotomy
Anterior cingulotomy

55
Q

Side effects associated with older methods of psychosurgery

A

Personality change
Epilepsy
Amotivation

56
Q

Percentage of patients undergoing modern psychosurgery who experience short term confusion

A

10%

57
Q

Percentage of patients undergoing modern psychosurgery who experience personality change or social functioning issues

A

2-8%

58
Q

Percentage of patients undergoing modern psychosurgery who experience seizures

A

<1%

59
Q

Percentage of patients undergoing modern psychosurgery who experience weight gain

A

10%

60
Q

Percentage of patients who experience significant improvement with psychosurgery

A

50-70%

61
Q

Conditions most amenable to improvement with psychosurgery

A

OCD
Chronic intractable major depressive disorder

62
Q

Conditions which DBS has been shown to be therapeutic for

A

Parkinson’s Disease
Essential tremor
Tourette’s disorder
Dystonia

63
Q

Conditions for which DBS is being evaluated

A

Major depression
OCD
Chronic pain

64
Q

Area of the brain DBS is aimed for treatment of OCD

A

Internal capsule

65
Q

Most common complication of DBS

A

Infection

66
Q

Risk of intracranial haemorrhage following DBS surgery

A

0-4.5%

67
Q

Neuropsychiatric side effects of DBS

A

Depression
Anxiety
Mania
Impulsivity
Speech and language difficulties
Decreased cognition
Postural instability and falls

68
Q

Contraindications to rTMS

A

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
Q

Difference in efficacy between ECT performed once a week, twice a week, or three times a week

A

None

70
Q

Difference in efficacy of higher vs. lower electrical stimuli for patients with depression

A

Higher electrical stimulus leads to greater reduction in symptoms

71
Q

Decade in which ECT was invented

A

1930s

72
Q

Medication shown to reduce recovery time and confusion following ECT

A

Donepezil

73
Q

Maximum frequency of ECT

A

Twice weekly

74
Q

Doctor who popularised transorbital leucotomy

A

Freeman

1. Psychiatric services (6 decks)

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