The Management of Mood Disorders

Question 1

when is the inventory of depressive symptomatology - self report 30 (IDS-30-SR) often used?

Answer 1

treatment resistant illness
bipolar depression
motivated patients who have energy to fill it in

Question 2

what does IDS-30-SR ask about?

Answer 2

energy levels

Question 3

what does quick inventory or depressive symptomatology self report 16 (QIDS) ask about?

Answer 3

sleep 
sadness
appetite
weight
concentration
view of self 
suicidal thoughts 
general interest 
energy

Question 4

who often uses hospital anxiety and depression scale?

Answer 4

nurses

Question 5

who is montgomery-aberg rating scale (MADRS) useful for?

Answer 5

those who cant communicate or too unwell to communicate

Question 6

what is thought to be the best all round SSRI?

Answer 6

escitalopram

Question 7

what antidepressant has good cardiac safety profile and allows easy dose titration?

Answer 7

sertraline

Question 8

what antidepressant promotes sleep and appetite / weight gain?

Answer 8

mirtazapine

Question 9

what antidepressant is associated with a higher rate of adverse effects but shows a dose-response relationship and may be slightly more effective?

Answer 9

venlafaxine

Question 10

first episode - how long should you continue antidepressant for after full recovery without reducing dose?

Answer 10

6 months

Question 11

second episode - how long should you continue antidepressant for after full recovery without reducing dose?

Answer 11

1-2 years

Question 12

mania vs hypomania?

Answer 12

hypomania - mania without psychotic symptoms

can also have mania without psychotic symptoms if complete loss of function

Question 13

what are first line antipsychotic medications for acute mania?

Answer 13

olanzapine
quetiapine
risperidone

Question 14

what are other options for acute mania?

Answer 14

lithium
valproate
carbamazepine
ECT

Question 15

medication for acute mania should be oral if possible but what method of administration may be needed?

Answer 15

IM

Question 16

what symptoms in acute mania can benzodiazepines or Z-drugs control?

Answer 16

agitation

insomnia

Question 17

what is first line in long term control of bipolar?

Answer 17

lithium

Question 18

in acute bipolar depression, antidepressants should not be prescribed without what type of drug?

Answer 18

antimanic

Question 19

when in acute bipolar depression should you avoid antidepressants?

Answer 19

those with recent manic / hypomanic episode or history of rapid cycling

Question 20

what antidepressants are often used in acute bipolar depression?

Answer 20

SSRIs (particularly fluoxetine)

Question 21

what other drugs are options for bipolar maintenance (other than lithium)?

Answer 21

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

Question 22

what must you consider when an older patient presents with a mood disorder?

Answer 22

cognitive impairment (ie dementia)

Question 23

lithium cannot be given with NSAID or ACE inhibitor - true or false?

Answer 23

true

Question 24

how does ECT work?

Answer 24

induce seizure for 15-20 seconds

Question 25

what is the most common condition ECT is used for?

Answer 25

recurrent depressive disorder without psychosis (44%)

Question 26

how often is ECT usually given?

Answer 26

twice weekly

Question 27

most patients are outpatient at time of treatment - true or false?

Answer 27

false - mostly inpatients

Question 28

how quick is recovery from ECT?

Answer 28

within minutes

Question 29

what is more common - bilateral and unilateral ECT?

Answer 29

bilateral

Question 30

what is advantage and disadvantage of bilateral ECT?

Answer 30

quicker and more effective but more likely to result in cognitive problems

Question 31

what is advantage and disadvantage of unilateral?

Answer 31

lower dose needed and research suggests high dose unilateral is just as effective as bilateral but more difficult to administer

Question 32

how do you know seizure is finished?

Answer 32

EEG

Question 33

what are the absolute contraindications to ECT?

Answer 33

recent MI (within 3 months) recent cerebrovascular accident intracranial mass lesion pheochromocytoma

Question 34

what are relative contraindications to ECT?

Answer 34

``` angina congestive heart failure severe pulmonary disease severe osteoporosis pregnancy ```

Question 35

what is the mortality of ECT?

Answer 35

1 per 80,000 - very safe

Question 36

what are the most common cause of death from ECT?

Answer 36

CV and pulmonary complications

Question 37

are physical side effects (eg headache) from ECT common?

Answer 37

yes - at least 66% | usually mild and self limiting

Question 38

what is most common cognitive side effect of ECT?

Answer 38

short term memory impairment which in most patients, recovers gradually

Question 39

in scotland, you cannot give ECT to someone who has capacity and is refusing even if detained under mental health act - true or false?

Answer 39

true

Question 40

what are the main effects of ECT on CNS?

Answer 40

modulation of monoamines potent anticonvulsant effects second messenger system effect reduces hyper-connectivity in frontal and limbic circuits bolsters neuronal survival promotes production of new neuronal processes in areas involving cognitive and emotional function

Question 41

what are other examples of other forms of psychotherapy?

Answer 41

behavioural activation cognitive behavioural analysis system of psychotherapy (CBASP) interpersonal therapy acceptable and commitment therapy psychoeducation