Management of Mood Disorders

Question 1

what apps can you recommend to patients to keep record of their mood?

Answer 1

mood tracker

daylio

Question 2

patient has been on an old-fashioned antidepressant in the past and responded well but nowadays there is newer antidepressants to prescribe; what should you give them?

Answer 2

the old-fashioned antidepressant

Question 3

why are SSRIs prescribed over other antidepressants?

Answer 3

safer in overdose

less side effects

Question 4

best all round SSRI?

Answer 4

escitalopram

Question 5

what drug is good for patients who have insomnia and are underweight?

Answer 5

mirtazapine

Question 6

why is sertraline a good SSRI?

Answer 6

good cardiac safety profile
easy dose titration
well tolerated

Question 7

why might a drug not be working for depression?

Answer 7

substance misuse
compliance
wrong diagnosis
physical illness
do they need more time?

Question 8

what should be done if medication doesnt work for a patient?

Answer 8

increase dose
switch
combine
augment with an antipsychotic/lithium (careful in older pts)

Question 9

most common antidepressant combination?

Answer 9

SSRI or SNRI + mirtazapine

Question 10

why is mirtazapine good as a combo drug with an SNRI?

Answer 10

SNRIs can make you feel sick and mirtazapine can act as an antiemetic

Question 11

when should you review a patient after starting an antidepressant?

Answer 11

1-2 weeks

Question 12

how would you safety net with antidepressants?

Answer 12

warn the patient about side effects

tell them they will go away but if they cant tolerate them they should let you know

Question 13

how long should you keep a patient on an antidepressant if theyre doing well and are in remission from a depressive episode?

Answer 13

6 months

Question 14

first line and second line treatment for acute mania?

Answer 14

1. anti-psychotics eg olanzapine, quetiapine, risperidone

2. anti-psychotic + lithium or valproate

Question 15

benzodiazepines are helpful in acute mania for what symptoms?

Answer 15

agitation

insomnia

Question 16

antidepressants should not be prescribed without an antimanic drug in a bipolar patient T or F

Answer 16

T

Question 17

when should you avoid antidepressants in a bipolar patients?

Answer 17

recent hypomanic episode

rapid cycling

Question 18

what antidepressant is best for bipolar depression?

Answer 18

SSRI eg fluoxetine

Question 19

bipolar depression 1st line drug

Answer 19

antipsychotic - quetiapine, olanzapine, lurasidone

Question 20

a patient on lithium should have what bloods checked

Answer 20

LI level
U+E
ECG
TFTs
Ca

Question 21

valproate is better for depressive/hypomania symptoms in bipolar disorder

Answer 21

hypomania

Question 22

lamotrigine is better for depressive/hypomania symptoms in bipolar disorder?

Answer 22

depressive symptoms

Question 23

long term bipolar disorder is primarily managed with what drug?

Answer 23

lithium

Question 24

acute bipolar depression is primarily managed with what drug?

Answer 24

SSRI eg fluoxetine

Question 25

acute hypomania/mania is primarily managed with what drug?

Answer 25

antipsychotics

Question 26

ECT is first line for...

Answer 26

very severe depression | pregnant patients if they are intolerant to non-teratogenic drugs

Question 27

ECT is usually given how often per week?

Answer 27

twice

Question 28

__lateral ECT is more commonly used

Answer 28

bilateral

Question 29

absolute contraindications to ECT

Answer 29

MI in last 3 months recent CVA intracranial mass lesion phaeochromocytoma

Question 30

relative contraindications to ECT

Answer 30

``` pregnancy severe osteoporosis severe pulmonary disease CCF angina ```

Question 31

main side effect of ECT?

Answer 31

short term headache | memory/cognitive problems

Question 32

how does ECT work in the brain?

Answer 32

modulates monoamines anticonvulsant effect increases neurones

Question 33

how can anxiety present?

Answer 33

poor memory and low mood | somatic symptoms eg palpitations

Question 34

describe disinhibited behaviour

Answer 34

actions which seem tactless, rude or even offensive

Question 35

what is depersonalisation

Answer 35

a state in which one's thoughts and feelings seem unreal or not to belong to oneself.

Question 36

what is derealisation?

Answer 36

detached from everything that is going on ie not real

Question 37

what symptoms are associated with psychotic mania?

Answer 37

grandiose delusions | hallucination

Question 38

how do hallucinations differ from delusions

Answer 38

hallucinations are to do with the senses | a delusion is a fixed, abnormal belief that the patient isnt open to discuss with you ie grandiose/persecutory

Question 39

what are nihilistic delusions? what condition do they present in?

Answer 39

youre rotting and are dead inside | depression

Question 40

patient with hypomania and depression is what type of BPAD?

Answer 40

bipolar 2

Question 41

define dysthymia

Answer 41

low mood but not low enough to be diagnosed as depression

Question 42

define cyclothymia

Answer 42

low mood that doesnt have biological symptoms of depression eg low energy they function well

Question 43

contraindications to lithium

Answer 43

renal/hepatic impairment | non-compliant

Question 44

signs of lithium toxicity?

Answer 44

``` vomiting diarrhoea tremor loss of consciousness ataxia hyperthyroidism ```

Question 45

lithium substitutes?

Answer 45

lamotrigine | valproate