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NSB Lectures > Treatment of Affective Disorder > Flashcards

Treatment of Affective Disorder Flashcards

1
Q

Why do Ps not always tell you the they are depressed?

A

Still lots of stigma surrounding mental health

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2
Q

When should you screen for depression?

A

Past Hx of depression
Significant physical illness
Risk of depression is significant - childbirth, postnatal, elderly, social isolation
Unexplained physical symptoms

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3
Q

What do we do for all Ps with depression?

A

Psychoeducation
Sleep hygiene advice
Actively monitor them

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4
Q

How do we treat mild-moderate depression?

A

Psychosocial and psychological interventions

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5
Q

How do we treat mild-moderate depression that does not respond to Rx?

A

Antidepressants + high intensity psychology

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6
Q

How do we treat severe or v severe depression?

A

Antidepressants
High intensity psychology
Specialist referral - crisis team - admission

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7
Q

What do we do for Ps in severe depression with high suicidal risk?

A

Urgent specialist referral + admission (detain if necessary)

Consider ECT

Antipsychotic medication if needed

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8
Q

What is psychoeducation?

A

Talking to P about their difficulties and trying to find ways to improve day-to-day things which will help - inc. relationships, exercise, die, and sleep

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9
Q

What are low intensity psychological interventions for depression?

A

Computerised CBT
Self help books
Group CBT

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10
Q

What are high intensity psychological interventions for depression?

A

Individual CBT
Other individual therapies

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11
Q

How does CBT work’?

A

Explores cognition behind the behaviour - collaborates with the P and gets P to complete tasks in order to better understand their behaviour and beliefs and change them

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12
Q

What do most antidepressants work on?

A

Monoamine neurotransmission - act to increase the amount of NT at the synapse

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13
Q

What are the monoamines involved in mood?

A

Serotonin
Noradrenaline
Dopamine

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14
Q

Why is it thought that antidepressants take so long to work?

A

Believed to be due to alterations in gene expression (down-regulation of receptors) and promotion of neurogenesis (in which monoamines may play a role)

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15
Q

Which parts of the brain are thought to have improved neurogenesis by increased monoamines?

A

Hippocampus
Prefrontal cortex

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16
Q

What is the response rate for Ps on antidepressants?

A

50% (compared to 30% on placebo)

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17
Q

How long do you have to continue antidepressants for? Why?

A

6 months
High rate of relapse if stopped before then

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18
Q

What do response rates for antidepressants tells us?

A

That we need to also have psychosocial and psychological treatments in connection with antidepressants

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19
Q

Name 5 antidepressant drug classes

A

SSRIs
SNRIs
TCAs
MAOIs
Monoamine receptor antagonists

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20
Q

Which is the first line antidepressant drug that we use?

A

SSRIs

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21
Q

How do SSRIs work?

A

Increase the amount of serotonin in the synapse by blocking its reuptake

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22
Q

What are the common side effects of SSRIs?

A

Nausea
Loss of appetite
Sexual dysfunction
Insomnia
Agitation
Anxiety
Headaches

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23
Q

What do you need to be careful about with SSRIs?

A

Can cause hyponatremia - be careful in older Ps or those with low Na.

Use with NSAIDs can increase chances of GI bleeds - need to prescribe PPI as well

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24
Q

What side effects to SNRIs have?

A

Similar to SSRIs

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25
Q

What do you need to be careful about with prescribing SNRIs?

A

Hypertension - SNRIs can cause an increase in BP

Are toxic in overdose

26
Q

How do TCAs work?

A

Block monoamine reuptake - inc levels of serotonin and Nor in the cleft (and slightly more dopamine)

27
Q

What are the problems with TCAs?

A

Adverse effects - are toxic in overdose - have interactions with there medications

Can have cardiotoxic effects

28
Q

What are TCAs sometimes used for?

A

Neuropathic pain

29
Q

What are the side effects of TCAs?

A

Sedation
Confusion
Loss of motor coordination
Anticholinergic effects
Cardiotoxicity

30
Q

What are anticholinergic effects?

A

Dry mouth
Blurred vision
Constipation
Urinary retention

31
Q

How do MAOIs work?

A

Inhibit monoamine oxidase from breaking down MAs in the cleft - thus increasing levels of 5HT, NOR & Dopa

32
Q

What is the cheese reaction?

A

Tyramine in cheese is normally metabolised by MAO in gut - MAOIs block this - can cause sympathomimetic effects, hypertensive crisis & intercranial haemorrhage

33
Q

What is it important to remember about MAOIs?

A

They cannot be prescribed with other antidepressants - is potential for interactions with them

34
Q

Why is it important to engage with active monitoring when first prescribing SSRIs and SNRIs?

A

Is evidence for increased suicidal thoughts and acts - esp in children, adolescents and young adults.

35
Q

What do you need to beware of when prescribing antidepressants, especially to older Ps?

A

Hyponatremia

36
Q

What can hyponatremia cause?

A

Delirium, seizures & death

37
Q

What are the withdrawal symptoms of antidepressants?

A

Diziness
Anxiety
Insomina & vivid reams
General malaise
Irritability
Headache
Electric shocks in arms and legs
Low mood, suicidal thoughts
Agitation

38
Q

Does the fact that antidepressants have withdrawal symptoms mean they are addictive?

A

No - is the act there is a temporary deficiency of synaptic serotonin due to down-regulated receptors which need time to adjust.

39
Q

How do you reduce antidepressants?

A

25% every 2-4 weeks

40
Q

What is lithium used for?

A

As an add on to antidepressants when they dont work.

41
Q

What do you need to be aware of with lithium?

A

Has a narrow therapeutic window - monitoring required.

Can also have drug interactions

42
Q

What are the early side effects of lithium?

A

Polyuria, tremor, dry mouth, metallic taste, weakness & fatigue

43
Q

What are the late side effects of lithium?

A

Tremor, nephrogenic diabetes insipidus, goitre, hypothyroidism, weight gain, GI symptoms, sedation, ECG changes, CKD

44
Q

How often should you monitor lithium?

A

Frequently whilst establishing correct dose - then 6 monthly.

45
Q

What should you check when P is on lithium?

A

Lithium level, renal function (U&E, eGFR), thyroid function tests

46
Q

When is ECT used?

A

Severe depression when life is threatened AND there is a lack of response to the treatments

47
Q

What is the general approach to managing bipolar disorder?

A

Treat acute mood episodes (e.g. depression or mania)
Maintain treatment to promote mood stability
Aim to prevent relapse

48
Q

Why is it important to treat acute mania?

A

High death rate in mania

49
Q

What do we do for manic Ps?

A

Stop antidepressants. If not on treatment - use antipsychotic. If on treatment - check compliance and considering adding/changing antipsychotic.

50
Q

Which drug can be used as an adjunctive treatment for bipolar disorder? Why?

A

Benzodiazepines

Reduce overactivity, restore sleep

51
Q

Which treatment is first line for maintenance treatment of bipolar disorder?

A

Lithium

52
Q

Which drug is most commonly used as an anticonvulsant in bipolar disorder?

A

Sodium valporate

53
Q

What is the downside of using lithium and anticonvulsants in treating mania in bipolar disorder?

A

They are slower acting than antipsychotics

54
Q

What pharmacological treatments are used in bipolar disorder?

A

Lithium
Anticonvulsants (sodium valproate)
Antipsychotics

55
Q

How is depression managed in bipolar disorder?

A

In a similar way to unipolar depression -
- Psychological & Psychosocial
- Antidepressants - often combined with mood stabiliser (lithium, valproate, antipsychotics)

56
Q

When treating depression in bipolar depression, what do you need to be aware of?

A

Risk of manic switch - can tip P into hypomania / manic state

57
Q

Which drug is first line for treating the MANIA of bipolar disorder?

A

Antipsychotics
Manic Ps need urgent treatment

58
Q

How do we treat depressive episodes of bipolar?

A

Same as unipolar
Careful not to tip into mania
Antidepressant + mood stabiliser (lithium/valporate/antipsychotic)

59
Q

What is the MAINTENANCE treatment for bipolar to prevent further episodes?

A

Lithium first line
Sodium valproate second line
Antipsychotics

Prevent relapse - needs multidisciplinary support

60
Q

Name 2 drugs which are being consider for future treatment of depressive disorders.

A

Ketamine (NMDA blocker - rapid antidepressant)

Psilocybin (5HT agonist)

NSB Lectures (48 decks)

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