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PSC 168 > Chapter 9: Treatment of Mood Disorders > Flashcards

Chapter 9: Treatment of Mood Disorders Flashcards

1
Q

What is electroconvulsive therapy used to treat?

A

Severe depression not responding to meds

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2
Q

How is modern ECT like a surgical procedure?

A
  • Anesthesia and muscle relaxants
  • Oxygen to reduce memory loss
  • Heart monitor, EEG monitoring, etc.
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3
Q

During what time period was ECT overused?

A

1940s-mid 1960s

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4
Q

Describe the levels and duration of the ECT shocks.

A
  • Levels = 12-65 volts

- Duration < 1/2 sec

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5
Q

How long do ECT convulsions last?

A

Several mins

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6
Q

How many treatments is ECT?

A

At least 6-10

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7
Q

What is the relapse rate of ECT?

A

60%

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8
Q

What are the common and less common side effects of ECT?

A
  • Common = severe headaches, memory loss for events surrounding ECT
  • Less common = irretrievable loss of long-term memories
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9
Q

How does transcranial magnetic stimulation work?

A

Electromagnetic coil is held against patient’s scalp that emits powerful magnetic pulses to alter brain activity

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10
Q

What is TMS used to treat?

A

Treatment-resistant depression mostly

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11
Q

What is VNS used to treat?

A

Treatment-resistant depression

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12
Q

What is vagus nerve stimulation? How does it work?

A

-Surgical implantation of a pulse generator in left upper chest –> wires go from upper chest into the neck and send mild pulses every 5 mins to left vagus nerve –> to the brain areas involved in regulation of mood, motivation, sleep, appetite, etc.

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13
Q

What are some side effects of VNS?

A

Voice alteration or hoarseness

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14
Q

What is light therapy used to treat?

A

Seasonal Affective DIsorder

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15
Q

What equipment does light therapy require?

A

Light boxes (at least 10K lux)

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16
Q

When did tricyclics start becoming available?

A

Mid 1960s

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17
Q

What are tricyclics? What do they treat?

A
  • Mostly norepinephrine reuptake inhibitors

- Treat mood disorders

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18
Q

What are the side effects of Tricyclics?

A
  • Weight gain
  • Sedation
  • Constipation
  • Dry mouth
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19
Q

What does SSRI stand for?

A

Serotonin Selective Reuptake Inhibitors

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20
Q

When did SSRIs become available in the U.S.?

A

1989

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21
Q

How do SSRIs work?

A

By blocking serotonin reuptake so it stays in the system

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22
Q

What are the advantages of SSRIs over tricyclics?

A
  • Generally fewer side effects
  • Less dangerous in overdose
  • Less interaction w/ alcohol
  • Faster action that tricyclics (2-3 weeks vs. 5-6 weeks)
  • More effective for OCD
  • More effective for sensitivity to rejection
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23
Q

What are the side effects of SSRIs?

A
  • Sexual = delayed orgasm, decreased desire or arousal
  • Headaches and GI probs
  • Zombie-like feeling
  • Elevated suicide risk b/c very activating
  • Increased energy before mood & negative thoughts improve
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24
Q

When did MAO inhibitors become available?

A

1960s

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25
Q

How do MAO inhibitors work?

A
  • Block enzymes at synapses that degrade excess NT at synapses
  • Increase norepinephrine, serotonin, dopamine
26
Q

What are the problems associated w/ MAO inhibitors?

A
  • Block same enzymes in live and intestines –> causes tyramine build up
  • Danger of hypertensive crisis (stroke, heart attack)
  • Food restrictions
  • Dangerous interactions w/ most other medications
27
Q

What does SNRI stand for?

A

Serotonin-Norepinephrin Reuptake Inhibitors

28
Q

How do SNRIs work?

A

Block reuptake of both norepinephrine and serotonin

29
Q

What does NDRI stand for?

A

Norepinephrine-Dopamine Reuptake Inhibitors

30
Q

How do NDRIs work?

A

Blocks reuptake of mostly dopamine and also norepinephrine

31
Q

What are the effects of NDRIs?

A
  • Very activating
  • No weight gain
  • No decrease in sexual functioning
32
Q

What conditions are NDRIs helpful with?

A
  • ADHD

- Former stimulant abusers

33
Q

What conditions are NDRIs not used for?

A
  • Anxiety
  • Panic
  • OCD
34
Q

What are mood stabilizers used for?

A

Mostly to prevent mania

35
Q

What other meds can mood stabilizers be combined with?

A
  • Antidepressants

- Antipsychotics

36
Q

How long does it take for mood stabilizers to kick in?

A

Require weeks to build up to therapeutic blood levels

37
Q

How long has lithium been available?

A

1950s

38
Q

How does lithium work?

A
  • Affects the flow of sodium through nerve & muscle cells

- Interferes w/ relay and amplification of neuronal messages

39
Q

What are the restrictions of lithium?

A
  • Requires build up in system
  • Narrow therapeutic range
  • Regular blood draws required
40
Q

What are the side effects of lithium?

A
  • Fine hand tremors
  • Short-term memory impairment
  • Weight gain
  • Possible sedation
  • Kidney toxicity
  • Flu-like symptoms, lack of coordination, confusion
41
Q

When are anticonvulsants preferred?

A
  • For rapid cycling or mixed episodes

- If history of head injury of drug use

42
Q

Describe the anticonvulsant Depakote. Side effects?

A
  • Requires blood draws

- Side effects = sedation, weight gain, danger of liver damage, diabetes

43
Q

Describe the anticonvulsant Tegretol. Side effects?

A
  • Requires blood draws
  • Good for explosive anger probs
  • Side effects = tremor, sedation, increased liver enzymes
44
Q

Describe the anticonvulsant Trileptal. Side effects?

A
  • No blood draws required

- Some sedation

45
Q

Describe Lamictal. Side effects? Medication of choice for? Less helpful for?

A
  • No blood draws required
  • No weight gain or sedation
  • Need to start at low dose and titrate up to avoid skin rash
  • Med of choice for bipolar depression and rapid cycling
  • Less helpful to prevent severe mania by itself
46
Q

What are the 3 medication groups for mood disorders?

A
  • Antidepressants
  • Mood stabilizers
  • Newer antipsychotics
47
Q

What do newer antipsychotics do?

A
  • Treat psychosis in both manic and depressive episodes
  • Bring down mania quickly
  • Have some mood-stabilizing properties
  • Used w/ antidepressants for depression
48
Q

Explain humanistic-existential therapy and how it works.

A
  • Focus on finding meaning and purpose in life
  • Discover one’s strengths and talents
  • Overcome alienation and develop true self
49
Q

Explain behavioral therapy and how it works.

A
  • Change behaviors to change feelings
  • Change reward structure in everyday life
  • Chart progress
50
Q

Explain cognitive therapy and how it works.

A

-Change maladaptive, irrational thoughts to change negative feelings

51
Q

What is the most common form of psychotherapy for depression today?

A

Cognitive therapy

52
Q

What does Aaron Beck’s cognitive therapy of depression treat?

A
  • Cognitive triad = negative thoughts about self, world, future
  • Maladaptive cognitive schemas and errors in logic (magnification, minimization, overgeneralization)
53
Q

How is lack of sleep a trigger for bipolar episodes?

A
  • Irregular wake-sleep hrs
  • Working irregular shifts
  • Travel to diff time zones
  • Caffeine and other stimulant drugs
54
Q

How is caffein a trigger for bipolar episodes?

A

Interferes w/ sleep and triggers manic states

55
Q

How are antidepressants a trigger for bipolar episodes?

A

Manic switch on antidepressants w/o mood stabilizers

56
Q

How is anesthesia a trigger for bipolar episodes?

A
  • Can trigger mania

- Throws off internal clock

57
Q

How are life events a trigger for bipolar episodes?

A
  • Anything interfering w/ sleep, increasing stress and excitement
  • Sad events often trigger mania, not depression
58
Q

How is medication a trigger for bipolar episodes?

A

Side effects put client at risk for non-compliance

59
Q

What are the initial goals for individual therapy for bipolar disorder?

A
  • Accept diagnosis and work through denial
  • Accept life-long disorder requiring meds
  • Work through grief over lost life opportunities
  • Help client accept new “slower” self
  • Deal w/ embarrassment about mania
  • Help clean up the aftermath of mania
60
Q

What are the goals of individual therapy for bipolar disorder during therapy?

A
  • Monitor moods, provide feedback
  • Identify risk factors and triggers
  • Stay in touch w/ fam
  • Emphasize medication compliance
  • Help w/ decision making
61
Q

What are the goals for family counseling for bipolar disorder?

A
  • Recognize that mani is an illness
  • Recognize signs and triggers for mood changes
  • Help fam deal w/ consequences of mania
  • Help solve power struggle about medication compliance
  • Develop action plan to intervene early
62
Q

Individuals with bipolar I disorder do well when?

A
  • Meds are effective
  • Good judgment and insight
  • No comorbid psychological disorders
  • No comorbid substance abuse
  • Supportive friends and fam
  • Keep regular sleep-wake cycle
  • Suitable job or meaningful volunteer work
  • Manage time well and avoid stress

PSC 168 (18 decks)

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