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Psychiatry > Management of Mood Disorder > Flashcards

Management of Mood Disorder Flashcards

(43 cards)

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1
Q

what are the four scales used to assess progress in mood disorders

A

inventory of depressive symptomatology self report 30 (IDS-30-SR): patient rated, very detailed

quick inventory of depressive symptomatology self report (QIDS): shorter more simple questions

hospital anxiety and depression scale: 14 items, easy to complete

montgomery- asberg rating scale (MADRAS): 10 items, observers rated, objective (good if patient cant communicate/ complete form/ lacks insight)

(can also use symptom diaries)

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2
Q

are antidepressants addictive

A

no

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3
Q

are antidepressant effective

A

yes

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4
Q

does continued antidepressant use reduce relapse rates

A

yes

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5
Q

this isnt a question by If someone has responded to a particular type of drug (e.g. SSRI), stick to that class

A

:)

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6
Q

what is sertraline and what is it good for

A

SSRI

has good cardiac safety - give if patient has/ is prone to heart problems (old)

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7
Q

what is mirtazapine and what is it good for

A 
atypical antidepressant (mixed receptor effect)
promote sleep and appetite/ weight gain
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8
Q

what is venlafaxine and what is it good/ bad for

A

SNRI

high rate of adverse effects but may be slightly more effective

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9
Q

what are the top 4 antidepressants

A

escitalopram (SSRI)
sertraline (SSRI)
mirtazapine (atypical)
venlafaxine (SNRI)

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10
Q

what should you consider if antidepressents dont work

A 
concordance 
right diagnosis? 
substance missuse 
physical illness
address other predisposing, precipitating and prolonging factors
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11
Q

what pharmacological changes can you make if an antidepressant doesnt work

A

increase dose
swap
combine- SSRI/SNRI plus mirtazapine (atypical)
augment- antipsychotic/ lithium first

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12
Q

what are the features of good antidepressant prescribing

A

Get ratings of depressive symptoms before and after each trial (e.g. PHQ-9)
Warn patients about possible side effects and the probability that they will be transient
Review after 1-2 weeks
Ensure adequate dose for adequate time

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13
Q

how do you prevent depression relapse after first episode

A

continue antidepressant for at least 6 months after full recovery without reducing dose

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14
Q

how do you prevent depression relapse after second episode/ more

A

continue antidepressant for at least 1-2 years after full recover without reducing dose

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15
Q

what is the treatment principles for acute mania/hypomania

A

maximise antimanic dose if patient already on them
stop antidepressants
combination therapy may be required
hospital admission likely to be required in mania
medication should be oral if possible

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16
Q

what is the treatment for acute mania

A

1st line= antipsychotic: olanzapine, quetiapine or risperidone

other options: lithium, valproate, carbamazepine, ECT

benzodiazepines/ Z drugs for symptoms control (agitation and insomnia)

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17
Q

what are the principles of treating acute bipolar depression

A

antidepressants should not be prescribed without an antimanic drug
avoid antidepressants in those with a recent manic/ hypomanic episode or history of rapid cycling
SSRIs (esp fluoxetine) are preferable

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18
Q

what is rapid cycling

Study These Flashcards
A

at least 4 episodes per year (bi polar disorder)

19
Q

what treatment for acute bipolar depression

Study These Flashcards
A

antipsychotic 1st line: quetiapne, olanzapine

antidepressants can be used alongside antipsychotic, lithium or valproate to prevent mania

lamotrigine (needs to be titrated)

ECT

lithium

20
Q

what is gold standard for long term bipolar maintenance

21
Q

what are the other options (other than lithium) for bipolar maintenance

Study These Flashcards
A

antipsychotics,
lamotrigine (if primarily depression),
valproate (if primarily manic/ hypomanic)

psychoeducation important
psychological therapies

22
Q

what do you need to measure when prescribing lithium

Study These Flashcards
A 
lithium levels in blood 
U&Es
ECGs
TFTs
calcium
23
Q

what do you need to consider in prescribing for the elderly

Study These Flashcards
A

want to preserve cognition
prevent falls- least sedative/ postural hypotension causing (mirtazopine)
sodium (SSRIs and SNRIs lower sodium) (mirtazopine good at not doing this aswell)
polypharmacy- lithium cannot be given with an NSAID or an ACEi)
start slow and titrate up

24
Q

what does ECT do

Study These Flashcards
A 
induces seizures 
causes release of NTs
and causes brain growth 
anticonvulsant effects 
reduces hyper-connectivity
25
what is patient given during ECT
under GA and given a muscle relaxant | given medazolam if seizure lasts too long
26
what is ECT used to treat
``` #1 depression bipolar disorder, mania, catatonia ```
27
how is ECT given
twice weekly 80% bilateral seizures last 15-30 seconds recovery is within minutes
28
what are the absolute and relative contraindications to ECT
``` absolute: recent MI (last 3 months), recent cerebrovascular accident, intracranial mass lesion, phaeochromocytoma ``` relative: angina, congestive HF, severe pulmonary disease, severe osteoporosis, pregnancy
29
what most likely causes death in ECT
very rare | cardio/ pulmonary complications
30
what are the side effects of ECT
usually mild, self limiting and respond to symptomatic treatment - HA - memory problems (short term, time before treatment, small number have permanent memory loss) - cognitive problems - muscle aches - confusion - nausea
31
in pyschological therapies what are examples of thinking errors
Overgeneralising Rules from isolated incidents then applied in all cases Dichotomous thinking “all or nothing” or “black and white thinking” Selective abstraction Focus on one –ve detail; colours entire experience Personalisation- Relate external events to self without cause (or little cause) Minimisation or magnification- overestimate magnitude of undesirable events (or opposite) Arbitrary evidence- Draw a conclusion in context of no evidence or contrary evidence Emotional Reasoning-I feel bad/guilty/therefore I am bad/have something to feel guilty about Shoulds and musts
32
what are examples of pyschological therapies
behavioural activation (more you do the better youll feel- meaningful activities) cognitive behavioural analysis system of pyschotherapy (impact of three people on your life) interpersonal therapy acceptance and commitment therapy psychoeducation
33
what are the risks associated with mood disorders
``` suicide financial difficulties driving aggression sexual disinhibition self harm neglection of personal health vulnerable to exploitation ```
34
what symptoms are SNRIs good for
biological symptoms- anergia, sleep, libido
35
why are tricyclics unpopular
anticholinergic side effects | risk of overdose
36
what is the order of prescribing antidepressants
fluoxetine 1st line (SSRI) (only licensed antidepressant for young people) other SSRI after 2 SSRIs SNRI then tricyclic
37
what is a bad quality of fluoxetine
long half life, if coming off because of SEs will have them for ages after
38
when should you start to feel effects of antidepressants
within 10 days/ 2 weeks | max effect at 4 weeks
39
what is the maximum dose of fluoxetine
60 mg | if <18 then 20 mg
40
what are points of good sleep hygiene
routine- always go to bed at same time, avoid caffeine, alcohol, cigarettes, hot chocolate
41
what can you combine antidepressants with to treat depression
SSRI/ tricyclic + SNRI | or antidepressant with atypical antipsychotic
42
what is the last resort treatment for depression
ECT
43
if lithium is not tolerated for bi polar what else can given
Antipsychotics (quetiapine, olanzapine (significant weight gain), lurasidone, aripiprazole), anticonvulsants: lamotrigine (if primarily depression), valproate (if primarily manic/hypomanic- but teratogenic), carbamazepine

Psychiatry (27 decks)

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