Physiological treatments

Question 1

First line for SAD

Answer 1

phototherapy

Question 2

how to use phototherapy

Answer 2

Off to side for 30-40min, 2-3x/w esp fall and winter

Question 3

How does phototherapy work

Answer 3

stimulates pineal gland and 5-ht to influence melatonin

Question 4

SE of phototherapy

Answer 4

HA, jittery (n/v, sedate, sweat, eye strain rare), can trig mania (screen for bipolar)

Question 5

ECT

Answer 5

noninvasive tx for refractory dep (and dep with malnut, exhaustion, and dehydration), also delusional dep and schiz with catatonia

Question 6

Adv of ECT

Answer 6

safer than some meds and can avoid polypharm

Question 7

Why does ECT have a bad rap

Answer 7

used to do w/o paralytics and got fractures even w/ pt restrained

Question 8

ECT process

Answer 8

anesthesia with muscle relaxant, electricity to 1 unilat or bilat temporal region to induce brief sx (1 sec or less shock, 30-60 sec sz)
- 2-3x/w for 6-12 tx

Question 9

Benefits of ECT

Answer 9

may inc cerebral BF, neurogenesis, release 5-ht, stress hormones
- can inc appetite, sleep, mood

Question 10

ECT NC

Answer 10

Must reorient after frequently (confused for several hours—retrograde amnesia)
- wake up 15 min after

Question 11

Risks of ECT

Answer 11

• heart stress at sz onset and for 10 min after
• not great for HTN, CHF, cardiac arrhythmia
• stress brain (inc cerebral oxy, BF, ICP)
• retrograde amnesia leading up to and during tx

Question 12

Transcranial magnetic stimulation (TMS)

Answer 12

MRI-strength magnetic pulses stim focal areas (often PFC) of cerebral cortex with electrodes
- non invasive
- electromagnetic on scalp gives short magnetic pulses to activate neurons

Question 13

ECT CI

Answer 13

brain tumor or subdural hematoma

Question 14

TMS frequency

Answer 14

outpt, 30 min 5d/w 4-6w

Question 15

CI for TMS

Answer 15

metal; bullet, brain stimulator

Question 16

Adverse rxn for TMS

Answer 16

HA, lightheaded, tight jaw or scalp ctx, tapping on head
- no memory or neuro deficits, sz rare, most mild scalp tingle or uncomfort on site

Question 17

Vagus nerve stimulator

Answer 17

pacemaker placed in chest to stim vagus nerve in neck
- for partial onset epilepsy and tx resistant dep to inc NTs thru limbic sys activation

Question 18

Vagus nerve stim SE

Answer 18

voice alter (hoarse), neck pain ,cough, paresthesia, dyspnea that dec with time
- can get infected

Question 19

Deep brain stimulation

Answer 19

• rare and invasive
• implant electrodes in brain (often basal ganglia) and run down to pulse generator in chest
• tx Park’s and testing w/ dep
• stim underactive regions

Question 20

alternate therapties

Answer 20

pet, aroma (stim ANS), acupuncture (sub use and craving)

Question 21

Exercise as MH tx

Answer 21

• dampens HPA axis (overactive with dep)
• alters Nor, Dp, 5-ht
• dep and anx, inc mood, biopsychosocial fxn esp if outside

Question 22

NC for herbal tx

Answer 22

not FDA reg so concentrations vary

Question 23

St. John wort affects…

Answer 23

inc 5-ht, dp, nor in mild-mod dep

Question 24

ginseng affects…

Answer 24

stress and fatigue

Question 25

valerian and chamomile affects…

Answer 25

dep, stress/anx, insomnia

Question 26

SamE affects…

Answer 26

dep