The Management of Mood Disorders Flashcards

1
Q

when is the inventory of depressive symptomatology - self report 30 (IDS-30-SR) often used?

A

treatment resistant illness
bipolar depression
motivated patients who have energy to fill it in

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2
Q

what does IDS-30-SR ask about?

A

energy levels

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3
Q

what does quick inventory or depressive symptomatology self report 16 (QIDS) ask about?

A
sleep 
sadness
appetite
weight
concentration
view of self 
suicidal thoughts 
general interest 
energy
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4
Q

who often uses hospital anxiety and depression scale?

A

nurses

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5
Q

who is montgomery-aberg rating scale (MADRS) useful for?

A

those who cant communicate or too unwell to communicate

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6
Q

what is thought to be the best all round SSRI?

A

escitalopram

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7
Q

what antidepressant has good cardiac safety profile and allows easy dose titration?

A

sertraline

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8
Q

what antidepressant promotes sleep and appetite / weight gain?

A

mirtazapine

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9
Q

what antidepressant is associated with a higher rate of adverse effects but shows a dose-response relationship and may be slightly more effective?

A

venlafaxine

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10
Q

first episode - how long should you continue antidepressant for after full recovery without reducing dose?

A

6 months

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11
Q

second episode - how long should you continue antidepressant for after full recovery without reducing dose?

A

1-2 years

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12
Q

mania vs hypomania?

A

hypomania - mania without psychotic symptoms

can also have mania without psychotic symptoms if complete loss of function

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13
Q

what are first line antipsychotic medications for acute mania?

A

olanzapine
quetiapine
risperidone

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14
Q

what are other options for acute mania?

A

lithium
valproate
carbamazepine
ECT

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15
Q

medication for acute mania should be oral if possible but what method of administration may be needed?

A

IM

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16
Q

what symptoms in acute mania can benzodiazepines or Z-drugs control?

A

agitation

insomnia

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17
Q

what is first line in long term control of bipolar?

A

lithium

18
Q

in acute bipolar depression, antidepressants should not be prescribed without what type of drug?

A

antimanic

19
Q

when in acute bipolar depression should you avoid antidepressants?

A

those with recent manic / hypomanic episode or history of rapid cycling

20
Q

what antidepressants are often used in acute bipolar depression?

A

SSRIs (particularly fluoxetine)

21
Q

what other drugs are options for bipolar maintenance (other than lithium)?

A

antipsychotics
lamotrigine (if primarily depression)
valproate (if primarily manic / hypomanic)

22
Q

what must you consider when an older patient presents with a mood disorder?

A

cognitive impairment (ie dementia)

23
Q

lithium cannot be given with NSAID or ACE inhibitor - true or false?

A

true

24
Q

how does ECT work?

A

induce seizure for 15-20 seconds

25
Q

what is the most common condition ECT is used for?

A

recurrent depressive disorder without psychosis (44%)

26
Q

how often is ECT usually given?

A

twice weekly

27
Q

most patients are outpatient at time of treatment - true or false?

A

false - mostly inpatients

28
Q

how quick is recovery from ECT?

A

within minutes

29
Q

what is more common - bilateral and unilateral ECT?

A

bilateral

30
Q

what is advantage and disadvantage of bilateral ECT?

A

quicker and more effective

but more likely to result in cognitive problems

31
Q

what is advantage and disadvantage of unilateral?

A

lower dose needed and research suggests high dose unilateral is just as effective as bilateral

but more difficult to administer

32
Q

how do you know seizure is finished?

A

EEG

33
Q

what are the absolute contraindications to ECT?

A

recent MI (within 3 months)
recent cerebrovascular accident
intracranial mass lesion
pheochromocytoma

34
Q

what are relative contraindications to ECT?

A
angina 
congestive heart failure
severe pulmonary disease
severe osteoporosis 
pregnancy
35
Q

what is the mortality of ECT?

A

1 per 80,000 - very safe

36
Q

what are the most common cause of death from ECT?

A

CV and pulmonary complications

37
Q

are physical side effects (eg headache) from ECT common?

A

yes - at least 66%

usually mild and self limiting

38
Q

what is most common cognitive side effect of ECT?

A

short term memory impairment which in most patients, recovers gradually

39
Q

in scotland, you cannot give ECT to someone who has capacity and is refusing even if detained under mental health act - true or false?

A

true

40
Q

what are the main effects of ECT on CNS?

A

modulation of monoamines
potent anticonvulsant effects
second messenger system effect
reduces hyper-connectivity in frontal and limbic circuits
bolsters neuronal survival
promotes production of new neuronal processes in areas involving cognitive and emotional function

41
Q

what are other examples of other forms of psychotherapy?

A

behavioural activation

cognitive behavioural analysis system of psychotherapy (CBASP)

interpersonal therapy

acceptable and commitment therapy

psychoeducation