physiologic therapies (329 E1)

Question 1

what is the first line treatment for seasonal affective disorder (SAD)

Answer 1

phototherapy / light therapy

Question 2

phototherapy / light therapy

Answer 2

efficacy due to influence of life on melatonin, multiple rounds per week - usually in the morning
do not look directly into the light

Question 3

phototherapy / light therapy SE

Answer 3

headache & jitteriness/mania

Question 4

electroconvulsive therapy (ETC)

Answer 4

-noninvasive
-the most effective depression treatment
-primary treatment in severe malnut, exhaustion, & dehydration d/t lengthy depression
-psychotic illnesses is 2nd most common indication
-safer than meds w/ certain medical conditions
-other indications: delusional depression, failure of previous meds & schizophrenia w/ catatonia

Question 5

how does ECT work

Answer 5

-under anesthesia & with a muscle relaxant, ECT is the application of electricity to temporal regions of the brain to induce a brief seizure
-unilateral or bilateral
-2 to 3 treatments per week for a total of 6-12 treatments

Question 6

ECT risks & adverse reactions

Answer 6

-stress on heart at seizure onset and up to 10 mins post (assess & mgt in htn, CHF, arrhyth)
-stresses the brain as a result of inc cerebral oxygen, blood flow and intracranial pressure
-confused and disoriented for several hours, must reorient frequently
-retrograde amnesia loss of memory of events leading up to and including the treatment

Question 7

transcranial magnetic stimulation (TMS)

Answer 7

-noninvasive
-MRI
-presence of metal is only contraindication

Question 8

TMS adverse reactions

Answer 8

-headache and lightheadedness
-no neurological deficits or memory problems
-seizures rarely
-most are mild and include scalp tingling and discomfort at admin site

Question 9

vagus nerve stimulation

Answer 9

-invasive procedure
-originally used to treat epilepsy
-decreases seizures and improves mood
-used for treatment resistant depression
-electrical stimulation boosts the level of neurotransitters

Question 10

vagus nerve stimulation side effects

Answer 10

-voice alterations
-neck pain, cough, paresthesia and dyspnea (that decrease w/ time)

Question 11

deep brain stimulation

Answer 11

-more invasive then VNS
-surgically implanted electrodes directly into the brain
-treatment for parkinson’s disease and now being investigated as an effective treatment in depression
-stimulates regions identified as under active in depression

Question 12

deep brain stim SE

Answer 12

high risk of infection

Question 13

exercise alters

Answer 13

levels of serotonin, dopamine and norepinephrine

Question 14

St.John’s wort

Answer 14

-flower processed into tea or tablets
-thought to inc serotonin, norepi and dopamine
-useful in mild to moderate depression

Question 15

ginseng

Answer 15

stress and fatigue

Question 16

valerian root or chamomile

Answer 16

insomnia, depression and stress/anxiety

Question 17

samE

Answer 17

depression