What drugs can cause low mood?
CCBs, steroids, antipsychotics, buproprion, champix, levodopa, OCP, beta blockers, anticonvulsants…
What are 2 smoking cessation drugs?
Bupropion and verenicline
What are the differentials for low mood?
Depression Dementia Secondary to drugs (e.g. steroids) Mental health: schizophrenia, BPAD, anxiety, eating dirsoder substance misuse Anaemia PD Cushing's ...
Give some RFs for depression
Substance misuse chronic illness Existing psyhciatric disorder Hx of depression Victim of abuse ...
Give some RFs for suicide
Male Single/divorced/widowed Hx of suicide or self-harm Age 40-60 Unemploued Psychiatric mental health problem Chronic illness Living alone Substance misuse...
What is the treatment for sub threshold or mild depression?
Low intensity psychological therapies:
- Individualised guided self-help
- computer CBT
- Group CBT
In mild-moderate depression which fails low intensity psychological therapies, what can be used?
Antidepressant OR high intensity psychological therapy
E.G. CBT, interpersonal therapy, behavioural couple therapy [if relationship problems]
In moderate-severe depression what can be offered?
COMBO: Antidepressant AND high intensity psychological therapy
Give some examples of low intensity psychological therapies
- Individualised guided self-help
- computer CBT
- Group CBT
Give some examples of high intensity psychological therapies
CBT, interpersonal therapy, behavioural couple therapy [if relationship problems]
If pt’s decline intervention what can be offered?
Counselling
How do pt’s access low-intend. psych therapy
IAPT: improving access to psychological therapy
Who should be involved in the management if there is a suicide risk?
Crisis team
How long should antidepressants be used after symptoms have stopped? why?
6mths - prevent relapse
What are the screening tools for depression?
PHQ-9
HAD scale (hospital anxiety and depression scale)
What warrants the use of PHQ-9?
+ve screening questions:
- ‘in last month hopeless, down, depressed?’
- ‘In last month little interest or pleasure in doing things?’
What is the PHQ-9 useful for?
Severity of depression
Give 2 alcohol screening questionairres?
CAGE
AUDIT (alcohol use disorders identification test)
If AUDIT suggests alcohol dependence, what can be used to assess the severity of alcohol dependence?
SADQ-C
What indicates ECT in depression?
1st line if psychotic severe depression
If all treatments fail for moderate-severe depression
Emergency: risk to pt (e.g. not eating, suicide…)
What affect do TCAs/SSRIs/SNRIs have on an ECG?
Prolong QT interval
What drug should you avoid if someone is on SSRIs? why?
MAO inhibitors (causes serotonin syndrome)
What type of MAO-inhibitors are there? What are they used in?
MAO-A (depression)
MAO-B (PD)
Give an example of an MAO-A inhibitor?
Isocarboxazid
Give an example of a SNRI?
Venlafaxine
What drugs might cause serotonin syndrome in combination with MAO-inhibitors?
SSRIs and TCAs
What drugs might cause hypertensive crisis in combination with MAO-inhibitors?
sympathetogics (E.g. adrenaline, NAd…)
Give a drug that can be used to treat serotonin syndrome?
Cyproheptadine or chlorpromazine (both serotonin antagonists)
What drug can be used to treat neuroleptic malignant syndrome?
Dantrolene (muscle relaxant)
Bromocriptine (dopamine agonist)
What is the difference between serotonin syndrome and NMS in terms of onset?
NMS - gradual onset
SS - acute onset
How do patients access psychological therapies?
IAPT (improving access to psychological therapies)
What are the 3 broad symptoms experienced in serotonin syndrome?
Autonomic hyperactivity
Altered mental status
Neuromuscular excitation (e.g. myoclonus)
What causes hypertensive crisis with MAO-I’s?
Sympathetogenics (NAd)
and tyramine containing substances (e.g. cheese and red wine)