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PSYCHIATRY > Mood Disorders Management > Flashcards

Mood Disorders Management Flashcards

1
Q

Name top 4 drugs for Mood Disorders.

A
  1. Escitalopram (all round SSRI)
  2. Sertraline (good CARDIAC profile)
  3. Mirtazapine (promotes SLEEP, APPETITE and WGT gain)
  4. Venlafaxine- high rate of S.Es—slightly more effective
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2
Q

Most common combination for MOOD DISORDERS?

A

SSRI/SNRI + Mirtazapine

—–to augment, give LITHIUM or antipsychotic first

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3
Q

What should be known to the pt BEFORE giving anti-depressants?

A
  • RATINGS of depressive symptoms should be taken (BEFORE and after each trial= PHQ-9)
  • warn pts of S.E
  • review after 1-2 weeks
  • ensure adequate dose
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4
Q

How to prevent relapse in 1st episode?

A
  • continue anti-depressant for at least 6 months AFTER full recovery without reducing dose
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5
Q

How to prevent relapse if its the 2nd episode (or more) ?

A
  • continue anti-depressant for at least 1-2 YEARS AFTER full recovery WITHOUT reducing the dose
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6
Q

WHat should be discontinued during an acute MANIC episode/ hypomania?

A
  • antidepressants
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7
Q

If mania is suspect, what should be considered?

A
  • Hospital admission may be required
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8
Q

What should be adjusted when a pt has an acute manic episode?

A
  • MAXIMISE anti-manic dose if pt is already on maintenance rx
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9
Q

Name 1st line rx of acute MANIA/ hypomania?

A
  • Olanzapine
  • Quetiapine
  • Risperidone
  • Haloperidol

Add Li if 2 anti-psychotics don’t work

-Add Valproate if Li doensn’t work

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10
Q

What is given to rx acute bipolar DEPRESSION?

A
  • SSRIs

Fluoxetine

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11
Q

Give 2 principles when prescribing drugs for Acute Bipolar Depression.

A
  1. antidepressants should NOT be prescribed without an anti-manic drug
  2. Avoid anti-depressants in those with a RECENT MANIC/ hypoMANIC episode
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12
Q

Rx of Bipolar depression?

A
  • olanzapime/ dusperdone, QUETIAPINE

- Lithium and/or by valproate og the psrt dies

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13
Q

How often is ECT given?

A
  • TWICE weekly in the UK
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14
Q

Name the 2 methods ECT can be performed.

A
  • Bilateral and Unilateral
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15
Q

Which one is harder to administer

A

unilateral

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16
Q

Which ect is likely to result in cognitive problems?

A

B.L

17
Q

Name the ABSOLUTE Contrindications to ECT

A

recent MI (last 3 months)
recent Cerebrovascular accident
intracranial mass lesion
phaeochromocytoma

18
Q

What are the relative C.Is?

A
  • angina pectoris
  • CHF
  • Severe pulmonary disease
  • severe osteoporosis
  • pregnancy
19
Q

Most likely cause of death by ECT?

A

Complications of the Pulmonary and Cardiovascular

20
Q

How SAFE is ect?

A
  • risk of NOT treating is GREATER
  • mortality rate of 1 in 80,000
  • in SOME, mortality and morbidity rates from ECT is LESS than with some anti-depressant meds
21
Q

Name the top 5 side effects of ECT?

A
  • 65% complain of AT LEAST one s.e:

headache/ memory problems/ cognitive problems/ muscle aches/ confusion

22
Q

What is the MAIN cognitive impairment from ECT?

How bad is it?

A
  • Memory impairment (loss is accentuated for the time period CLOSEST to their rx)
  • —memory RECOVERS gradually (within 2 months)
23
Q

Is the ability of picking up new info affected with ECT rx?

A

NO
—it shouldn’t be

  • however; small no. of patients experience PERMANENT and PERSISTENT memory loss
24
Q

1/3 of ECT rx are performed involuntarily…what is required before performing a procedure on a patient with no capacity?

A
  • impaired capacity= independent SECOND opinion doctor

—-but for a life saving rx- no need 2nd opnion

25
Q

Can you give ECT to someone with capacity and is refusing?

A

NO

- even if he/she os detained

26
Q

How effective is ECT?

A
  • 63% showed OVERALL improvement in MADRS scores (50% in scores)
27
Q

How does ECT bring about altercations in the CNS?

A
  • unclear mechanism
  • said to:
  • modulate monoamines
  • potent anticonvulsant efx
  • second messenger affected
  • bolsters neuronal SURVIVAL
  • reduced hyperconnectivity in FRONTAL and limbic circuits
  • promotes prodn of new neuronal processes
28
Q

List examples of THINKING errors.

A
  1. MINIMISATION/ MAGNIFICATION
  2. Arbitrary evidence
  3. Emotional reasoning
  4. Shoulds and Musts
  5. Dichotomous thinking
  6. selective abstraction
  7. personalisation
  8. overgeneralising
29
Q

What is meant by selective abstraction?

A
  • focus’s on one (-)ve detail

PSYCHIATRY (32 decks)

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