Day 1 - Psych Part 1 Mood, Anxiety Flashcards Preview

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Flashcards in Day 1 - Psych Part 1 Mood, Anxiety Deck (27):
1

Neurotransmitter changes: (1) Anxiety disorders (2) Depression (3) Mania (4) Alzheimer's (5) Huntington's (6) Schizophrenia (7) Parkinson's disease

(1) Inc. NE, Dec. Serotonin & GABA (2) Dec. NE, Dopamine, & Serotonin (3) Inc. NE & Serotonin (4) Dec. ACh (not give anticholinergics) (5) Dec. ACh & GABA (think: Choreiform) (6) Inc. Dopamine (7) Dec. Dopamine, Inc. ACh

2

Pathological grief/bereavement criteria

(1) Depression criteria met for at least 2 weeks, after first 2 months following loss (2) Generalized feelings of hopelessness/helplessness/worthlessness/guilt (3) Suicideal ideation (4) Distressing feelings not diminish intensity by 6 mo. (5) Inability to move on, trust others, & re-engage in life by 6 mo.

3

Med conditions assoc. w/ severe depression

(1) Hypothyroidism (2) Hyperparathyroidism (3) Parkinson's disease (4) Stroke, especially ACA (5) CNS Neoplasms (6) Pancreatic cancer

4

Meds known for causing sx of depression

(1) Sedatives - Alcohol, Benzos, Antihistamines (2) Stimulant withdrawal (3) Methyldopa (antihypertensive, used in pregnancy) (4) 1st gen. antipsychotics (e.g., Haloperidol) (5) Metoclopramide/Perchlorperazine (6) Glucocorticoids (steroids - mania, insomnia, also) (7) Insufficient thyroid replacement, causing hypothyroidism (8) Alpha-Interferon (tx viral hepatitis, depression is contraindication)

5

Suicidal risk factors - scale used

SAD PERSONS: (1) Sex (men) (2) Age (younger than 19, older than 45) (3) Depression (4) Prior attempts (5) Ethanol (6) Rational thought process (psychotic/irrational) (7) Support lacking (8) Organized plan (9) No spouse (10) Sickness; Also schizophrenia & owning hand gun

6

Sx of atypical depression; Meds

Hypersomnia, psychomotor retardation, hyperphagia (& weight gain), hypersensitivity to rejection; MAO Inhibitors work better than TCAs, SSRIs also work

7

Cause & 1st line tx for seasonal affective disorder

Depression in winter months, lack of exposure to light; Tx w/ light phototherapy; SSRIs & bupropion may also be useful

8

Name antidepressants in following categories: (1) SSRIs (2) TCAs (3) MAO Inhibitors (4) NDRI (5) SNRI (6) Tetracyclics

(1) Fluoxetine, Fluvoxamine, Sertraline, Paroxetine, Citalopram, Escitalopram (2) Imipramine, Amitriptyline, Desipramine, Nortriptyline, Clomipramine, Doxepin (3) Phenelzine, Selegiline, Tranylcypromine (4) Bupropion (5) Venlafaxine, Duloxetine, Milnacipran, Nefazodone (SARI?) (6) Mirtazipine, Trazodone

9

Drugs not taken w/ SSRIs due to risk of serotonin syndrome

(1) Other SSRIs (2) SNRIs (3) MAOIs (4) St. John's wort (5) Tryptophan (6) Drugs - cocaine, amphetamine, ecstasy (7) L-Dopa/Dopamine

10

Serotonin syndrome p/w

Mental status changes: anxiety, agitation, delirium, restlessness, disorientation; Autonomic excitation: diaphoresis, tachycardia, hypertension, vomiting, hyperthermia, diarrhea; Neuromuscular hyperactivity - tremor, rigidity, hyperreflexia; Ocular clonus (slow continuous horizontal eye movements), Spontaneous or inducible clonus at ankle, Babinski b/l

11

Serotonin syndrome Tx

D/c serotonin agents; Supportive care, normal vital signs, Sedate w/ benzos; High temp - sedation, intubation, & mechanical cooling; Paralysis relieves hyperthermia (caused by muscle movement); No need for antipyretics; If agitation despite Benzos, use Serotonin antagonist (i.e., Cyproheptadine); After resolution, assess need to resume serotinergic agent

12

Serotonin withdrawal syndrome p/w; Worse offenders; Tx

Dizziness, nausea, fautigue, muscle ache, chills, irritability; Paroxetine & Venlafaxine; Switch to SSRIs w/ long half-life, like Fluoxetine

13

Name SNRIs generic (brands only FYI); For those not used for tx of depression, give use

Venlafaxine (Effexor), Desvenlafaxine (Pristiq), Duloxetine (Cymbalta), Nefazodone (Serzone), Milnacipran (Savella) - fibromyalgia only, Sibutramine (Meridia) - weight loss only

14

Eval. prior to TCAs in children

Screen PMH for heart disease, palpitations, syncope, and near-syncope (since TCAs can cause arrhythmias); FH for sudden death prior to age 40, long QT syndrome, arrhythmias, hypertrophic cardiomyopathy; EKG prior to initiation & again once optimized

15

Sx of TCA overdose

Cardiotoxicity (tachycardia, hypotension, conduction abnormalities); CNS toxicity (sedation, obtundation, coma, seizures); Anticholinergic (mydriasis, xerostomia, ileus, urinary retention, dementia/confusion)

16

Best TCA for elderly & why

Nortriptyline (over amitriptyline), since less anticholinergic side effects

17

TCA overdose mgt

ABCs; Activated charcoal, Continuous cardiac monitoring for at least 6 hrs, Frequent neuro checks, EKG, Electrolytes, TCA level, Gastric lavage in acute phase, IVF if hypotension; Most important - prolong QRS give sodium bicarb & if seizures give Benzos (maybe Barbs or Propofol - NOT phenytoin for toxin induced seizures)

18

Foods w/ tyramine; Assoc. conditions

Fermented, aged, smoked, pickled, spoiled; Cheese, beers, wine, miso soup, avocados, brown bananas, etc. ; MAOi hypertensive crisis & migraine

19

Bupropion contraind in which pt pops

Lower threshold of seizure, so avoided in pts w/ eating disorders (anorexia/bulimia), history of seizure disorder, & any other seizure risk (MAOi in last 14 days, withdrawing from alcohol or sedatives like benzos)

20

ECT indications

(1) Severe depression refractory to antidepressants (2) Depression w/ sychotic feat. (3) Severe suicidality (4) Depression w/ catatonic stupor (5) Depression w/ food refusal, leading to nutritional deficiency (6) Situations where rapid antidepressant response required (7) Previous good response to ECT (8) Medical conditions prevent use of antidepressants (e.g., elderly on lots of meds) (9) Bipolar disorder or mania (10) Schizophrenia psychosis

21

s/e of Lithium use in tx of bipolar disorder

(1) CNS depression & tremor (2) Thyroid changes (hypo/hyper, or goiter with euthyroid) (3) Nephrogenic DI (reversible w/ discontinuation - polydipsia, polyuria) (4) GI - n/v, diarrhea, metallic taste changes, weight gain

22

Tx for nephrogenic DI 2/2 Li toxicity

Hydrochlorothiazide & Amiloride (added for Li, closing Na channels)

23

Depression mgt in pt with bipolar disorder

Mild: Li or Lamotrigine alone; Moderate: second mood stabilizer (Lamotrigine) or atypical antipsychotic (Olanazipine, Risperidone, or Quetiapine); Lamotrigine has significant drug intx w/ Valproic acid and Lamotrigine; Adding antidepressant to mood stabilizer not shown to be effective; Severe depression - try other mood stabilizers or ETC

24

Dx criteria for adjustment disorder w/ depressed mood

(1) Clinically significant behavioral or emotional reactions causing significant distress or social/occupational impairment (2) Sx develop in response to identifiable psychosocial stressor, other than bereavement (3) Sx begin w/i 3 mo. of stressor (4) Sx disappear w/i 6 months of disapperance of stressor

25

MDD vs. Adjustment disorder w/ depressed mood

Adjustment disorder w/ depressed mood occurs w/i 3 mo. of identifiable stressor & disappears within 6 mo. of disappearance of stressor; Not meet MDD criteria

26

Acute stress disorder v. PTSD

Acute stress disorder: sx last less than 4 weeks; PTSD: sx lasting longer than 6 mo.

27

Tx for PTSD

Psychotherapy & SSRIs first-line; Other antidepressants may be used; Benzos avoided; Mood stabilizers; Alpha blockers improves nightmares; Atypical antipsychotics if refractory to other therapies

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