The Management of Mood Disorders Flashcards
when is the inventory of depressive symptomatology - self report 30 (IDS-30-SR) often used?
treatment resistant illness
bipolar depression
motivated patients who have energy to fill it in
what does IDS-30-SR ask about?
energy levels
what does quick inventory or depressive symptomatology self report 16 (QIDS) ask about?
sleep sadness appetite weight concentration view of self suicidal thoughts general interest energy
who often uses hospital anxiety and depression scale?
nurses
who is montgomery-aberg rating scale (MADRS) useful for?
those who cant communicate or too unwell to communicate
what is thought to be the best all round SSRI?
escitalopram
what antidepressant has good cardiac safety profile and allows easy dose titration?
sertraline
what antidepressant promotes sleep and appetite / weight gain?
mirtazapine
what antidepressant is associated with a higher rate of adverse effects but shows a dose-response relationship and may be slightly more effective?
venlafaxine
first episode - how long should you continue antidepressant for after full recovery without reducing dose?
6 months
second episode - how long should you continue antidepressant for after full recovery without reducing dose?
1-2 years
mania vs hypomania?
hypomania - mania without psychotic symptoms
can also have mania without psychotic symptoms if complete loss of function
what are first line antipsychotic medications for acute mania?
olanzapine
quetiapine
risperidone
what are other options for acute mania?
lithium
valproate
carbamazepine
ECT
medication for acute mania should be oral if possible but what method of administration may be needed?
IM
what symptoms in acute mania can benzodiazepines or Z-drugs control?
agitation
insomnia
what is first line in long term control of bipolar?
lithium
in acute bipolar depression, antidepressants should not be prescribed without what type of drug?
antimanic
when in acute bipolar depression should you avoid antidepressants?
those with recent manic / hypomanic episode or history of rapid cycling
what antidepressants are often used in acute bipolar depression?
SSRIs (particularly fluoxetine)
what other drugs are options for bipolar maintenance (other than lithium)?
antipsychotics
lamotrigine (if primarily depression)
valproate (if primarily manic / hypomanic)
what must you consider when an older patient presents with a mood disorder?
cognitive impairment (ie dementia)
lithium cannot be given with NSAID or ACE inhibitor - true or false?
true
how does ECT work?
induce seizure for 15-20 seconds
what is the most common condition ECT is used for?
recurrent depressive disorder without psychosis (44%)
how often is ECT usually given?
twice weekly
most patients are outpatient at time of treatment - true or false?
false - mostly inpatients
how quick is recovery from ECT?
within minutes
what is more common - bilateral and unilateral ECT?
bilateral
what is advantage and disadvantage of bilateral ECT?
quicker and more effective
but more likely to result in cognitive problems
what is advantage and disadvantage of unilateral?
lower dose needed and research suggests high dose unilateral is just as effective as bilateral
but more difficult to administer
how do you know seizure is finished?
EEG
what are the absolute contraindications to ECT?
recent MI (within 3 months)
recent cerebrovascular accident
intracranial mass lesion
pheochromocytoma
what are relative contraindications to ECT?
angina congestive heart failure severe pulmonary disease severe osteoporosis pregnancy
what is the mortality of ECT?
1 per 80,000 - very safe
what are the most common cause of death from ECT?
CV and pulmonary complications
are physical side effects (eg headache) from ECT common?
yes - at least 66%
usually mild and self limiting
what is most common cognitive side effect of ECT?
short term memory impairment which in most patients, recovers gradually
in scotland, you cannot give ECT to someone who has capacity and is refusing even if detained under mental health act - true or false?
true
what are the main effects of ECT on CNS?
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
what are other examples of other forms of psychotherapy?
behavioural activation
cognitive behavioural analysis system of psychotherapy (CBASP)
interpersonal therapy
acceptable and commitment therapy
psychoeducation
