somatic psychiatric tx

Question 1

How many tx of ECT are typically needed? What is therapeutic about ECT?

Answer 1

Seizure is what is therapeutic about ECT

most pts need 6-12 tx

Question 2

Indications of for ECT

Answer 2

• severe uinipolar or bipolar depression (esp. melancholic and psychotic subtypes)
• intractable mania
• intractable psychosis of shchizoaffective disorder or schizophrenia (may need 12-20 tx)
• Parkinson’s disease
• Catatonia

Question 3

What anesthetics/paralytics are usually used for ECT

Answer 3

anesthetic- thiopental or methohexital (or propofal)

paralytic- succinylcholine

Question 4

What maintenance therapy is typically used after ECT

Answer 4

either maintenance ECT (once/month) or pharm (best evidence for Li + nortryptiline)

Question 5

How long does ECT seizure last

Answer 5

must last 25-30 s; most procedures last 45-90 s

Question 6

What are risk factors for cognitive impairments in ECT? What about efficacy?

Answer 6

-bilateral usually has more cog deficits than unilateral
-High current often more cog deficits than low current
Bilateral and high current ECT are also more effective.
High dose unilateral ECT is usually good compromise for pts who are sensitive to cognitive deficits of ECT

Question 7

What is deep brain stimulation?

Answer 7

• experimental tx for OCD and tx-resistant depression

- stereotactic stimulation of area 25

Question 8

What area of the brain is supposedly dysfunctional in depression?

Answer 8

underactive left prefrontal cortex

Question 9

What area of the brain is supposedly dysfunctional in anxiety

Answer 9

overactive right pre-frontal cortex

Question 10

What is a chemical similarity between ECT and antidepressants?

Answer 10

-down-regulation of beta-adrenergic receptors