define/etiology/patho
etiology/patho
Treatment for MDD/ECT
ECT
ECT
100

Treatment Resistive Depression according FDA

Pt with MDD and doesn't respond to 2 or more antidepressant.

Treatment must begin given with adequate doses for adequate duration and pt must adhere to treatment 

100

Chronic ________ may contribute to TRD

stress

100

Antipsychotics approved for MDD

Aripiprazole/Abilify

Brexpiprazole/Rexulti

Cariprazine/ Vraylar

Extended release quetiapine/Seroquel

olanzapine-fluoxetine combination/Symbyax 

100

ECT 1st developed in Rome for pts with ___________


ECT is best used for ___________ &_____________

schizophrenia


psychomotor retardation & psychosis (95% rate)


100

Appropriate use for ECT

TRD

Bipolar with depressed or manic features

Catatonia

Schizophrenia

Psychotic episode that is refractory to antipsychotic agents

Pregnant females

Agitation& aggression in older adults with dementia

200

CMS is concerned with 

response vs remission

200

TRD changes the fxn of the ______ __________

HPA Axis

200

additional FDA approval for TRD

Esketamine

Electroconvulsive Therapy (ECT)

Repetitive Transcranial Magnetic Stimulation (rTMS)

Vagus Nerve Stimulation (VNS)


200

Explain the process of ECT & typical schedule


Pt under general anesthesia, administer muscle relaxer

electrodes placed on the head, seizures are  monitored by EEG while stimulus is applied

seizures are generally 30-90 minutes

Scheule: 2-3 days per week for 3-4 weeks

10-12 treatments during initial course

maintenance ECT tx maybe required with occasional tune up


200

Process for preparing the pt for ECT

Informed consent

medical clearance

cardiac clearance for risk factors

Anesthesia clearance

review and adjust medications accordingly

NPO prior night before and until procedure. COMMUNICATE with staff 

300

______ % dx with MDD will develop TRD

30%

300

Chronis stress leads to ________ because depressive sx become more challenging to treat

 TRD

300

additional treatment sans (without) FDA approval 

dextromethrphan-buprion (don't sepate from placebo in clinical trial

Ketamine infusions

Manetic Resonance therapy (MeRT)

Lithium( reduced suicide risj

MAOIs

Psilocybin and other hallucinogens

300

The typical range of current for ECT is ____ to ______

Voltage is __________ future treatments depending on ________ and _________ of seizure


70-120 (approximately 100)


adjusted, duration & quality

300

Medication considerations for ECT remember:

1. MOA for meds-they can suppress or exaggerate sx

2. Lithium should be avoided d/t delirium, prolonged seizure, and higher risk for toxicity

3 MAOIs & TCAs + HTNsive Crisis

4. Buproprion- reduces seizure threshold

5. Benzos-taper or stop they decrease quality of seizure (may need Flumazenil prior but not ideal)

6. antiepileptics-suppress seizures

7. FGA-d/t anticholinergic effects similar to aesthesia

8. Clozapine-reduce dose assoc. with dose dependent reduction in seizure threshold. 

400

_______ & ________ chemistry play a role in the etiology /pathology of TRD

genetics & brain

400

Strategies  used to treat TRD

 increase current dose of meds

change agents with in class

adding another antidepressant type

add an antipsychotic or mood stabilizer

explore non-pharm interventions(therapy)

GOAL- stay on label

typically 6-8weeks



400

Method of therapy in which a current is passed through the brain with the intention of causing a brief controlled seizure

Electroconvulsive Therapy (ECT)

400

The quality of the seizure is captured by_______


Current is applied using which two approaches?

EEG


Unilateral (front o back) or bilateral (temple to temple ***** may adjust placement depending on results


GOOD QUALITY SEIZURE NEEDED FOR GOOD OUTCOME

400

Side effects from ECT

1.confusion-few mins-hours rarely last servel days or longer

2. memory loss: antegrade amnesia  (right before tx, impaired immediate recall ), Retrograde amnesia (trouble remembering events yrs, months, or weeks before treatment) tend to improve in a few moths

Psychical SE: Nausea, lethargy, h/a, jaw pain, and myalgias


500

The risk is _________ in medical pts

higher

500

Other considerations for TRD

reevaluate DX

borderline Personality disorder?

malingering? 

psychotherapy-meds sometimes not enough

address underlying physical health issues

500

The thought of ECT is to.........

reset the brain fxn, impacting most NTs systems

(increasing DA, 5HT, GABA, NE, and Glutamine)

500

ECT is most effective tx for MDD which is __________ as high as pharmacological intervention

twice

500

Contraindications for ECT 

No absolure contraindications

aneurysm, space occupying leisions, intracanial process/tumor/increased ICP

CVA/brain hemmorraghe

cardiac concerns

retinal detachment

cochlear implants (?)

recent MI

any condition or clinical scenario that would contraindication to anesthia