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Therapeutics > Depression (Other Decks) > Flashcards

Depression (Other Decks) Flashcards

1
Q

What is the purpose of the MHSA?

A

assist people suffering from serious mental illness in receiving treatment

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2
Q

What is MHSA involuntary treatment?

A

Where a person needs hospitalization for a mental disorder but it is not possible for them to be admitted voluntarily

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3
Q

3 methods for initiating a psychiatric exam which may lead to involuntary hospitalization

A

Physician
Peace Officer
Provincial Court Judge

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4
Q

What is a caveat about involuntary patient admittence?

A

Non-mental health treatment cannot be authorized

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5
Q

What is Form A of the MHSA?

A

Certificate of Physician or Prescribed Health Professional that Psychiatric Examination is Required

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6
Q

What is Form G of the MHSA form?

A

Certificate of Medical Practitioners for Compulsory Admission of a Person to a Mental Health Centre

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7
Q

What is the field of psychiatry in terms of mental health diagnosis?

A

Symptoms are cross-referenced to a diagnostic/classification manual containing 100s of potential syndromes, and 1 or more diagnostic labels are applied

  • DSM-V
  • ICD
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8
Q

What is current practice of psychiatry for most clinicians

A

Symptom-based classification systems

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9
Q

What is DSM – five?

A

Manual that is used to establish diagnosis

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10
Q

How many symptoms need to result in change in functioning for major depressive disorder diagnosis

A

5+

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11
Q

What is the issues with DSM-5?

A

Defines illness too close to “normal” leading to over diagnosis (e.g. ADHD)

over simplification

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12
Q

What are the 4 components of a mental status exam?

A

General Observations
Thinking
Emotion
Cognition

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13
Q

What are some tools used to measure MDD?

A

Ham-D, PHQ-9, BDI

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14
Q

What is the limitations of current psychotropic nomenclature?

A

Outdated
Does not support clinical decision making
Inconsistent with other areas of medicine
May confuse patients
Negatively contributes to stigma

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15
Q

What is the nbN initiative?

A
  • Based on contemporary scientific knowledge
  • Help clinicians make informed choices when working out the next ‘pharmacological step’
  • System of naming that does not conflict with the actual use of medications
  • Be future-proof to accommodate new compounds
  • Help patients understand and accepta prescribed treatment for a condition
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16
Q

What does the acronym ALGEE stand for?

A
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17
Q

Where does MDD fall on the mood spectrum?

A

Persistently and abnormally low mood, characterized by feelings of sadness, emptiness or irritability, and accompanied by other somatic or cognitive changes that significantly affect the individual’s capacity to function

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18
Q

When is onset of MDD usually?

A

Late 20s, but can occur at any age

Generally see a sharp increase between ages 12-16

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19
Q

What are the risk factors of MDD?

A
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20
Q

What does the acronym SIG: E. CAPS mean?

A
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21
Q

What is Peristent depressive disorder?

A
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22
Q

What is Substance/Medication Induced Depressive Episode?

A
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23
Q

What is the acronym Sig: E Caps used in?

A

Diagnosis of MDD and PHQ-9, Describes the symptoms of depression

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24
Q

What are the suicide risk factors?

A
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25
Q

In mild psychological treatment what treatment recommendations should be

A

Psychological alone, but active guidelines should be involved

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26
Q

Moderate and Severe MDD should be treated?

A

With both psychotherapy and pharmacological

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27
Q

What is the value of psychological treatments?

A

Seems to work about as well as antidepressants especially in less severe cases

Has no side effects associated with this treatment

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28
Q

Best evidence-base psychological treatments is from?

A
  • ***cognitive behavioural therapy (CBT)

(The ones below are not as much)
* behavioural activation (BA)
* interpersonal psychotherapy (IPT)
* Mindfulness-based cognitive therapy (MBCT)

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29
Q

What is Transcranial Magnetic Stimulation TMS therapy?

A

Used for refractory depression where the magnetic fields are used to stimulate nerve cells in regions of the brain involved in mood regulation and depression

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30
Q

How long is TMS?

A

4-6 weeks

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31
Q

What is the primary evidence of TMS?

A

TMS is effective but unclear how long the benefits lasts

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32
Q

What is ECT?

A

Electroconvulsive Therapy

Used for severe depression

Is effective in 80-90% of patients

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33
Q

How many treatments are their with ECT?

A

6-12

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34
Q

What is the time taken for response to ECT?

A

10-14 days

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35
Q

What is the acute treatment of symptom remission of MDD?

A

8-12 weeks Where remission is

HAM-D score <7 and PHQ-9 <7

Response HAMD and PHQ-9 less then 50%

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36
Q

What is maintenance treatment used for with MDD?

A

Prevent recurrence of mood episode

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37
Q

What is important for managing psych conditions?

A
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38
Q

What are the two landmark papers for MDD treatment?

A
39
Q

What does the Cipriana 2018 paper show?

A

Concluded that basicaly all antidepressants have equal efficacy

40
Q

What does the NICE 2022 paper recognize?

A

Initial treatment for less severe MDD should be SSRI

41
Q

What does the BAP 2015 paper tell us?

A

Choose antidepressants that are tolerated

42
Q

What does the Star*D trial tell us?

A
43
Q

What is the general response to antidepressant treatment?

A

First treatment 30% remission

Usually 40-60% symptom resposne rate

44
Q

What occurs when the NMDA receptors are inhibited?

A
45
Q

What occurs when the opioid receptors are activated?

A
46
Q

What occurs when the AMPA receptors are activated?

A
47
Q

What is the chronic stress theory?

A
48
Q

With the usage of ketamine which racemic version has been approved as nasal spray for TRD?

A

S-ketamine or Esketamine

49
Q

What is one issue with with injecting ketamine with naltrexone?

A

They saw smaller reductions in depressive symptoms when given together. Hence trial was ended earlier and naltrexone is not recommended to be used together

50
Q

What are the adverse reactions seen with ketamine when given at TRD doses?

A

Dissociation
Dizziness
Increase blood pressure
Possible blood in urine

51
Q

Which antidepressants in order have more nausea associated with them?

A
52
Q

How do we manage GI adverse effects with Antidepressants?

A

Divide doses if possible, If SSRI decrease dose

Take medication with a small amount of food

Take ginger contianing food

53
Q

With respect to diarrhea ADE is it temporary?

A
54
Q

With respect to management of Diarrhea what can be done?

A
55
Q

Which antidepressant is associated with higher rates of constipation?

A

paroxetine and also common with TCAs

56
Q

What is the management of constipation caused by antidepressants?

A
57
Q

During what period does suicidality may occur when taking antidepressants?

A

First 4-8 weeks of therapy

58
Q

Which age groups do we generally see an increase in suicide ideation when starting antidepressants?

A

<24

59
Q

If someone is first starting an antidepressant what management can be done with respect to suicidality? With respect to kids too?

A
60
Q

For those who develop suicidality during treatment what should be considered?

A

Dose reduciton, switching, discontinuing offending agent

61
Q

With respect to sexual dysfunction which drug class has the highest risk?

A

SSRIs
TCAs
SNRIs

62
Q

Which drug has the lowest risk of sexual dysfunction?

A

Bupropion

63
Q

What is the management for ADE with respect to sexual dysfunction?

A
  1. No intervention
  2. Reduce
  3. Drug holidays
  4. Using medications to augment sexual side effects such as bupropion or mirtazipine, sildenafil or tadalafil
  5. Switching
64
Q

Which medication classes have higher risk of QT prolongation?

A

TCAs and anything that is dosed out of therapeutic range

65
Q

What is baseline QTC?

A

360-400ms

66
Q

What is serotonin syndrome?

A
67
Q

What causes serotonin syndrome?

A
68
Q

What should serotonin syndrome be treated as?

A

Life threatening and requires medical aid

69
Q

Which drugs cause the worst AE with respect to discontinuation syndrome?

A

Venlafaxine and paroxetine

70
Q

Who is at high risk for discontinuation syndrome?

A

Those who have been on tx for >6-8 weeks

71
Q

What does the finish mnemonic stand for?

A
72
Q

What does the finish mnemonic relate to?

A

discontinuation syndrome

73
Q

When does discontinuation syndrome usually start?

A

24-72 hours after medication stop

74
Q

How do we prevent discontinuation syndrome?

A

Taper dose down for 2-4 weeks

75
Q

Which drug would you be able to full stop without taper?

A

Fluoxetine

76
Q

If discontinuation syndrome occurs what should be considered?

A
77
Q

If symptoms of MDD persist after 6-8 weeks what should an adequate

A

-Switch to alternate first line agents
-Augment with an alternate mechanism
antidepressant SGA or psychotherapy

78
Q

What are the reasons for nonresponse to therapy?

A
79
Q

How do we categorize treatment resistant depression?

A

Lack of improvement or <20% reduction in depression score after two or more antidepressant trials

80
Q

What are the options for TRD?

A

May switch antidepressant
May choose to use augmentation therapy
Combining antidepressants

81
Q

What are the augmentation therapies people with TRD can try?

A
82
Q

What medications are usually combined with TRD?

A
83
Q

How do we go about SSRI/SNRI within class direct switch?

A
84
Q

When would be consider cross-tapering AD?

A
85
Q

What is the MAOIs washout period?

A
86
Q

What medicaitons are considered first line for adjunct medication options?

A

Aripiprazole, quetiapine, risperiodone

87
Q

With respect to lithium when should we begin to see a response?

A

3-4 weeks,

If patient responds continue the combo for 6-9 monhts

88
Q

Using Triiodothyronine or T3 what does this do?

A

Improves and accelerates antidepressant effects.

89
Q

Why is T3 sometimes preferred over lithium?

A

Better tolerance

90
Q

Which medications should be avoided in depression in childrem/adolescents?

A

SNRI and TCA

91
Q

Which drug class is 1st line in pregnancy?

A

SSRIs, most data for sertraline, citalopram, escitalopram

92
Q

What is the neuroplasticity hypothesis?

A

Altered cell growth and adaptation
Chronic stress leading to redevelopment of hippocampus

93
Q
A

Therapeutics (10 decks)

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