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55 Cards in this Set
- Front
- Back
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What percentage of women and men have recurrent depressive disorder? |
Women: 10-25% Men: 5-12% Ratio = F:M @ 2:1 |
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What is the prevalence of Bipolar? |
1% 1:1 M:F |
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What percentage of the population have cyclothymia? |
0.5-1% |
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In what percentage of the population does Dysthymia occur? |
3-6% F:M = 2-3:1 |
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What is the monoamine theory |
The suggestion that depression is due to a shortage of noradrenaline, serotonin and dopamine |
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Risk factors in developing depression |
Bio: Genetics Psychosocial: High expressed emotion and criticism in family. PD Adverse life events - divorce, job loss, bereavement, childhood abuse and social adversity. |
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List some vulnerability factors for developing depression in women |
>3 children under 14 at home, not working outside of home, lack of confiding relationship and loss of mother before age of 11. |
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What percentage of patients experience chronic and relapsing depression? |
60% |
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What is the lifetime risk of a 1st degree relative of a patient with bipolar? |
10% |
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What social factors may influence bipolar? |
Life events and stress may provoke the first manic or hypomanic episode. No personality traits associated. |
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What is the prognosis for bipolar? |
Typically 8-10 episodes in a lifetime. 90% of patients experiencing manic episode will go on to experience more.
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What is rapid cycling bipolar? |
>4 episodes in 1 year - associated with poor prognosis |
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What percentage of patients suffering from Mania have 1st rank symptoms? |
10% |
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What are the 5 categories of conditions that cause a low mood? |
Neurological Endocrine Infections Others - malignancy, SLE, RA, renal failure Drugs |
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What is the lifetime risk of suicide in a patient with depression? Schizophrenia? Alcohol misuse? |
15% 10% 3-4% |
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Run through the process of problem solving. What is this management for? |
Self harm 1. List current problems 2. Choose one problem 3. Come up with some solutions 4. Evaluate solutions and choose best option 5. Try and put in to practice 6. Evaluate results 7. Repeat until all problems are solved |
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How might you manage the initial detox from alcohol? |
High doses of drugs with alcohol cross tolerance e.g. diazepam or lorazepam for 5-7 days tapered down with daily thiamine doses. |
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How would you maintain alcohol abstinence in patients? |
Disulfiram (Antabuse) - Block alcohol oxidation --> accumulation of acetaldehyde --> anxiety, flushing, headaches and choking sensation within 20mins of drinking. Motivational interviewing CBT Group therapy AA - 12 step programme Social support |
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Prognosis of alcohol dependence? |
High functioning people >65% 1 year abstinence following treatment. |
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What are good prognostic indicators of abstinence? |
Stable relationship, employment, stable living conditions, good insight, good motivation, good social support |
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What is lofexidine used in? |
Alleviating the symptoms of opioid withdrawal. It is a central acting alpha adrenoceptor agonist reducing sympathetic flow. |
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What might be offered to patients who are severely dependent? |
Maintenance opiates such as methodone |
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What could be used in patients who are moderately opioid dependent? |
Sublingual buprenorphine - a partial opioid agonist. |
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What is naltrexone used for? |
Once a patient has been detoxified to block the euphoric effects of opiate use. |
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What psychological interventions are available for substance misuse? |
CBT Motivational interviewing Group therapy Social support |
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What symptoms does BZD withdrawal cause? |
hallucinations, convulsions and delirium. |
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How can you manage BZD withdrawal? |
Convert pts from short acting BZD e.g. lorazepam to longer acting e.g. Diazepam |
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What are the indications for lithium use? |
Acute mania Bipolar disorder prophylaxis Treatment resistant depression (lithium augmentation) Adjunct to antipsychotics in schizoaffective disorder, schizophrenia and aggression/impulsivity |
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What are the indications of valproate use? |
Epilepsy Acute mania Bipolar prophylaxis |
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What are the indications of carbamazepine use? |
Epilepsy Bipolar prophylaxis if not responsive to lithium Rapid cycling bipolar Treatment resistant mania Depression Schizophrenia Trigeminal neuralgia Impulse control disorders |
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What decreases the clearance of lithium? |
Renal insufficiency Na+ depletion |
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What drugs increase lithium levels? |
Diuretics NSAIDs ACEIs |
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What are the contraindications to lithium therapy? |
Pregnancy Renal insufficiency Thyroid disease Cardiac conditions Neuro conditions |
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What is ebstein's anomaly? |
Abnormal tricuspid Cardiac defects - VSD and ASD |
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What are the side effects of carbamazapine? |
Increased appetite --> weight gain Ankle swelling Hair loss Nausea and vomiting Tremor Haem abnormalities Deranged LFTs Teratogenic
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What are the side effects of valproate? |
Nausea and vomiting Skin rashes Blurred or double vision Ataxia Drowsiness Fatigue Hyponatraemia Fluid retention Haem abnormalities Deranged LFTs |
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Which is the least teratogenic mood stabiliser? |
Lamotrigine - risk of cleft palate or lip if given in 1st trimester. |
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Why do you need to titrate the dose of lamotrigine? |
To prevent SJS |
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What are the indications for ECT? |
Severe depression Treatment resistant depression Life threatening depression Treatment resistant mania Catatonia |
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How many sessions would a patient have? |
2-3 a week for 4-12 sessions |
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MOA of ECT? |
Modulation of neurotransmitter functioning Changes in regional blood flow Modulation of neuronal connectivity Alteration of neuronal structures including hippocampus |
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List some relative contraindications to ECT |
Raised ICP Intracranial aneurysm Hx of cerebral haemorrhage MI within 3 months Aortic aneurysm Uncontrolled cardiac arrhythmias Decomp cardiac failure Acute resp infection DVT |
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Absolute ECT contraindication? |
Cochlear implant |
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What are the indications for the use of antidepressants? |
Depression - mod and severe Anxiety Neuropathic pain Insomnia Bulimia nervosa Impulsivity Migraines Chronic fatigue syndrome IBS OCD - Sertraline Narcolepsy |
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Name some SSRIs |
Fluoxetine Paroxetine Citalopram Sertraline Fluvoxamine Escitalopram |
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SSRI S/E |
Nausea Insomnia Apathy and fatigue Weight gain Reduced sex drive Sweating May have increased suicidal ideation and initiation in initiation. Takes 4-6 weeks for effect |
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Name the SNRIs |
Venlafaxine Duloxetine |
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Name some TCA |
Amitriptyline Imipramine Dosulepin Lofepramine - less toxic in overdose Clomipramine
1st line in pregnancy |
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What are the S/E of TCAs? |
Antimuscarinic effects Dry mouth Blurred vision Constipation Urinary retention Other: Sedation, weight gain, dizziness, hypotension, delirium, sexual dysfunc |
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Which antidepressant is associated with fewer sexual S/E? |
SNRIs |
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What antidepressant is used in treatment resistant depression? |
Mirtazapine - also used to treat anxiety |
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What percentage of patients respond to first medication? |
70% |
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How long should treatment continue beyond treatment resolution? |
6 months |
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What withdrawal effects may ensue following antidepressant discontinuation? |
Dizziness Tingling Nausea Vomiting Sweating Anxiety Shaking Tapering dose over 4 weeks should prevent this |
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How would you manage acute mania? |
Olanzapine - 10mg PO then regularly Valproate |
