Psych Vivas · Psychopharmacology — augmentation in mood and psychosis
Augmentation strategies — consultant viva
Fellowship viva covering augment vs switch, mood augmenters with doses/monitoring, and clozapine-resistant pathways.
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Target exams
FRANZCPMRCPsychABPNMD-DNB
Prompt
Examiner places cards: STAR*D, Crossley lithium, Nierenberg T3, Nelson atypical AP, VAST-D, Popova esketamine, Kane clozapine, TRRIP, Petrides ECT, Wagner meta-review, PASS mnemonic.
Station structure
Time: 8–10 minutes. Depth: consultant teaching registrar. Expect crisp taxonomy (augment/switch/combo), pseudo-resistance, named trials with doses/monitoring, and psychosis pathway that puts clozapine before chaotic dual AP and ECT for CRS.[1][2][6][7]
References9ShowHide
- [1]Rush AJ, Trivedi MH, Wisniewski SR, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report Am J Psychiatry, 2006.PMID 17074942
- [2]Crossley NA, Bauer M Acceleration and augmentation of antidepressants with lithium for depressive disorders: two meta-analyses of randomized, placebo-controlled trials J Clin Psychiatry, 2007.PMID 17592920
- [3]Nierenberg AA, Fava M, Trivedi MH, et al. A comparison of lithium and T(3) augmentation following two failed medication treatments for depression: a STAR*D report Am J Psychiatry, 2006.PMID 16946176
- [4]Nelson JC, Papakostas GI Atypical antipsychotic augmentation in major depressive disorder: a meta-analysis of placebo-controlled randomized trials Am J Psychiatry, 2009.PMID 19687129
- [5]Mohamed S, Johnson GR, Chen P, et al. Effect of Antidepressant Switching vs Augmentation on Remission Among Patients With Major Depressive Disorder Unresponsive to Antidepressant Treatment: The VAST-D Randomized Clinical Trial JAMA, 2017.PMID 28697253
- [6]Petrides G, Malur C, Braga RJ, et al. Electroconvulsive therapy augmentation in clozapine-resistant schizophrenia: a prospective, randomized study Am J Psychiatry, 2015.PMID 25157964
- [7]Kane J, Honigfeld G, Singer J, et al. Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine. Arch Gen Psychiatry, 1988.PMID 3046553
- [8]Howes OD, McCutcheon R, Agid O, et al. Treatment-Resistant Schizophrenia: Treatment Response and Resistance in Psychosis (TRRIP) Working Group Consensus Guidelines on Diagnosis and Terminology Am J Psychiatry, 2017.PMID 27919182
- [9]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.