Chapter 9: Treatment of Mood Disorders Flashcards Preview

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Flashcards in Chapter 9: Treatment of Mood Disorders Deck (62):
1

What is electroconvulsive therapy used to treat?

Severe depression not responding to meds

2

How is modern ECT like a surgical procedure?

-Anesthesia and muscle relaxants
-Oxygen to reduce memory loss
-Heart monitor, EEG monitoring, etc.

3

During what time period was ECT overused?

1940s-mid 1960s

4

Describe the levels and duration of the ECT shocks.

-Levels = 12-65 volts
-Duration < 1/2 sec

5

How long do ECT convulsions last?

Several mins

6

How many treatments is ECT?

At least 6-10

7

What is the relapse rate of ECT?

60%

8

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

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

9

How does transcranial magnetic stimulation work?

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

10

What is TMS used to treat?

Treatment-resistant depression mostly

11

What is VNS used to treat?

Treatment-resistant depression

12

What is vagus nerve stimulation? How does it work?

-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.

13

What are some side effects of VNS?

Voice alteration or hoarseness

14

What is light therapy used to treat?

Seasonal Affective DIsorder

15

What equipment does light therapy require?

Light boxes (at least 10K lux)

16

When did tricyclics start becoming available?

Mid 1960s

17

What are tricyclics? What do they treat?

-Mostly norepinephrine reuptake inhibitors
-Treat mood disorders

18

What are the side effects of Tricyclics?

-Weight gain
-Sedation
-Constipation
-Dry mouth

19

What does SSRI stand for?

Serotonin Selective Reuptake Inhibitors

20

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

1989

21

How do SSRIs work?

By blocking serotonin reuptake so it stays in the system

22

What are the advantages of SSRIs over tricyclics?

-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

23

What are the side effects of SSRIs?

-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

24

When did MAO inhibitors become available?

1960s

25

How do MAO inhibitors work?

-Block enzymes at synapses that degrade excess NT at synapses
-Increase norepinephrine, serotonin, dopamine

26

What are the problems associated w/ MAO inhibitors?

-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

What does SNRI stand for?

Serotonin-Norepinephrin Reuptake Inhibitors

28

How do SNRIs work?

Block reuptake of both norepinephrine and serotonin

29

What does NDRI stand for?

Norepinephrine-Dopamine Reuptake Inhibitors

30

How do NDRIs work?

Blocks reuptake of mostly dopamine and also norepinephrine

31

What are the effects of NDRIs?

-Very activating
-No weight gain
-No decrease in sexual functioning

32

What conditions are NDRIs helpful with?

-ADHD
-Former stimulant abusers

33

What conditions are NDRIs not used for?

-Anxiety
-Panic
-OCD

34

What are mood stabilizers used for?

Mostly to prevent mania

35

What other meds can mood stabilizers be combined with?

-Antidepressants
-Antipsychotics

36

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

Require weeks to build up to therapeutic blood levels

37

How long has lithium been available?

1950s

38

How does lithium work?

-Affects the flow of sodium through nerve & muscle cells
-Interferes w/ relay and amplification of neuronal messages

39

What are the restrictions of lithium?

-Requires build up in system
-Narrow therapeutic range
-Regular blood draws required

40

What are the side effects of lithium?

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

41

When are anticonvulsants preferred?

-For rapid cycling or mixed episodes
-If history of head injury of drug use

42

Describe the anticonvulsant Depakote. Side effects?

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

43

Describe the anticonvulsant Tegretol. Side effects?

-Requires blood draws
-Good for explosive anger probs
-Side effects = tremor, sedation, increased liver enzymes

44

Describe the anticonvulsant Trileptal. Side effects?

-No blood draws required
-Some sedation

45

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

-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

What are the 3 medication groups for mood disorders?

-Antidepressants
-Mood stabilizers
-Newer antipsychotics

47

What do newer antipsychotics do?

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

48

Explain humanistic-existential therapy and how it works.

-Focus on finding meaning and purpose in life
-Discover one's strengths and talents
-Overcome alienation and develop true self

49

Explain behavioral therapy and how it works.

-Change behaviors to change feelings
-Change reward structure in everyday life
-Chart progress

50

Explain cognitive therapy and how it works.

-Change maladaptive, irrational thoughts to change negative feelings

51

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

Cognitive therapy

52

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

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

53

How is lack of sleep a trigger for bipolar episodes?

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

54

How is caffein a trigger for bipolar episodes?

Interferes w/ sleep and triggers manic states

55

How are antidepressants a trigger for bipolar episodes?

Manic switch on antidepressants w/o mood stabilizers

56

How is anesthesia a trigger for bipolar episodes?

-Can trigger mania
-Throws off internal clock

57

How are life events a trigger for bipolar episodes?

-Anything interfering w/ sleep, increasing stress and excitement
-Sad events often trigger mania, not depression

58

How is medication a trigger for bipolar episodes?

Side effects put client at risk for non-compliance

59

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

-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

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

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

61

What are the goals for family counseling for bipolar disorder?

-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

Individuals with bipolar I disorder do well when?

-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