Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

PSYCH EOR > GAD, ADD, Depression > Flashcards

GAD, ADD, Depression Flashcards

(67 cards)

Start Studying
1
Q

Dx GAD

A

Excessive anxiety/worry more days than not x6 months + ≥3:

  • Restlessness
  • Easily fatigued
  • Difficulty concentrating
  • Difficulty falling/staying asleep
  • Irritability
  • Muscle tension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

pathophys of GAD

A

Decreased GABA receptor density. Inc glutamate

Decreased 5-HT

CO2 serum concentration sensitivity (panic)

Increased amygdala activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

tx of acute phase anxiety

A

Start SSRIs, TCAs

+/-BZD if necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

pphx anxiety tx

A

SSRIs, SNRIs

buspirone

pregabalin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

name first and second line tx for anxiety

tx timelines

A

SSRIs for 12 weeks then switch to another for at least 6 mos.

  • Fluoxetine may have best response and remission outcomes.
  • Sertraline best tolerability outcomes.

Venlafaxine second line (dose 75mg or less)

  • Venlafaxine and paroxetine may have worst comparative outcomes.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

SSRIs for GAD w/

best response and remission outcomes.

best tolerability outcomes.

may have worst comparative outcomes.

A

Fluoxetine may have best response and remission outcomes.

Sertraline best tolerability outcomes.

Venlafaxine and paroxetine may have worst comparative outcomes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Indication & MOI of Buspirone

advantages & disadvantages

A

indicated for GAD

5HT1A partial agonist

Advantages:

  • Almost as effective as benzos for GAD
  • No sedation, cognitive impairment, respiratory depression, dependence or withdrawal
  • Lacks abuse potential

Disadvantages:

  • Onset of effect ~2 weeks, but can take 6 weeks for full effect (similar to the antidepressants)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

name an antiepiletic to consider w/ GAD

A

Pregabalin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Name the atypical antipsychotic you could use in GAD (unlikely)

A

Quetiapine –> monotherapy may be beneficial in non refractory GAD

greater discontinuations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

define panic attack

A

Period of intense fear in which 4 of the following symptoms develop abruptly and reached a peak within minutes.

  • Palpitations
  • Sweating
  • Trembling
  • Shortness of breath or smothering
  • Feeling of choking
  • Chest pain
  • Nausea
  • Dizzy or lightheadedness
  • Chills or heat sensations
  • Paresthesias
  • Derealization or depersonalization
  • Fear of losing control
  • Fear of dying – peaks at 10-15mins and disappears in 30 mins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

define panic disorder

A

YOU CHANGE YOUR LIFE

At least one of the attacks has been followed by 1 month of one of the following

  • Persistent concern about having additional attacks
  • Worry about the implication of the attack
  • Significant change in behavior related to the attacks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

first line for panic disorder

A

Antidepressants - high dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how to dose SSRIs for pt with panic disorder

A

Need to start low and increase dose slowly – takes a while to get to therapeutic dose

  • SSRIs can precipitate a panic attack if initially dosed too high.
  • Goal dose is at high end of dosing range.

treat for at least 8 weeks (and probably 12).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

name drugs to consider for a pt w/ panic attacks

A

SSRIs and SNRIs

TCAs

BZDs for the first 4-6 weeks of treatment only.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what type of benzos are indicated for panic attacks

A

Alprazolam

lorazepam

High potency, short acting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

type of BZD indicated for GAD vs Panic disorders

A

GAD - low potency, low acting

Panic - High potency, short acting (Alprazolam, lorazepam.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the most common comorbidity assoc w/ GAD & PD

A

MDD

At least half of GAD patients will develop MDD.

30-60% of Panic patients will develop MDD.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

•Highest risk of admission due to OD in Medicaid patients when compared to other BZDs.

A

Alprazolam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

name fast onset BZDs

A
  • Triazolam
  • Alprazolam
  • Loprazolam
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what drug would you give to a pt who is tapering off BZD and feeling withdrawl si/sx?

A

Pregabalin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

describe how to taper BZDs

A

Empower patient.

  • Most research has been done in median age > 60 yo
  • offer to anyone >64 or to anyone prescribed for >4wks

_Slow reduction 3-6 month_s with decreases of 1/8 to 1/4 dose qweek/q2week/monthly dose

Along with initiation of an SSRI/SNRI for anxiety maintenance (if appropriate)

Melatonin for sleep*

Pregabalin with withdrawal/anxiety symptoms**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

who should we offer BZD tapering to

A

over 64 or

anyone prescribed for >4wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

si/sx of protracted BZD withdrawl

A

May last for up to a year after drug cessation

  • Anxiety
  • Insomnia
  • Depression

Weakness, muscle pain, tremor, irritable bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

signs of rapid BZD withdrawl

A

Tremors

Anxiety

Perceptual disturbances

Dysphoria

Psychosis

Seizures

Insomnia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
explain role of atypical antipsychotics in GAD and PD
_For panic disorder:_ * NO monotherapy --\> adjunct to SSRIs. _For GAD_: NOT RECOMMENDED * atypicals shown to have more side effects with little benefit when added to SSRIs- * _Quetiapine_ monotherapy has positive efficacy data but poor tolerability
26
name other adjuct tx for anxiet & PD
Hydroxyzine propranolol clonidine
27
describe neurobiology of ADD
_Blocking NE alpha2 receptors_ results in ADHD like behavior. * Dysfunction in _prefrontal-striatal neural circuits_ * _Reductions in synaptic DA_, --\> enhanced DA reuptake & i_ncreased catabolism_. * _Low prefrontal cortex NE._ P50 suppression deficiency. * Deficiency in the ability to suppress reaction to an auditory stimuli. Delayed brain maturation.
28
describe delayed brain maturation in ADD
Delayed Cortical thickness & surface area. Approximately a 2-3 year delay in children. * 18 yo the differences not significant.
29
list 2 office questionaires to help dx ADD
ADHD-RS SNAP-IV
30
name notable findings on ADHD-RS
2. Fidgets with hands or feet or squirms in seat. 5. Does not seem to listen when spoken to directly. 10. Is “on the go” or acts as if “driven by a motor.” 12. Talks excessively.
31
name notable findings in the SNAP-IV
**LETI** 3. Often does not seem to _listen_ when spoken to directly 21. Often loses _temper_ 32. Often is _excitable_, impulsive 54. Often is _irritable_
32
MOI of stimulats used to tx ADD
_methylphenidate_: block the reuptake of dopamine and norepinephrine. * _dexmethylphenidate_ has less NE effects potentially resulting in better tolerability. _amphetamines_: Also inhibits MAO and may have direct stimulatory effects on alpha and beta receptors. INC DA
33
what ADD meds are you concerned as they are metabolized through 2D6 pathway which is not?
dextroamphetamine/ mixed amphetamine salts/ lisdexamfetamine Atomoxetine methylphenidate is NOT!
34
what med should you never give to someone w/ ADD & a tic disorder
dextroamphetamine/ mixed amphetamine salts/ lisdexamfetamine
35
med of choice for ADD + anxiety sx
atomoxetine
36
med of choice ADD + SUD
atomoxetine
37
MOI of Atomoxetine indication??
blocks the reuptake of NE. * This results in benefits on both alpha 2 receptors and small increases in DA Not as good as stimulant ADD
38
Useful adjunct to stimulants.
Guanfacine
39
MOI of Guanfacine
Alpha 2 agonist --\> This results in strengthening the relevant connections for attention. * Compared to DA enhancement which weakens irrelevant connections. * Lower NE --\> reduce BP
40
adverse effects of Guanfacine
Decrease in BP and pulse sedation/somnolence/fatigue
41
\_\_\_\_, compared to guanfacine, is less specific and will stimulate alpha \_\_, __ and __ receptors resulting
**Clonidine**, compared to guanfacine, is less specific and will stimulate alpha **2a, b and c** receptors resulting
42
adverse effects of clonidine
in more sedation & greater decrease in BP. shorter half life requiring increased frequency in dosing.
43
which stimulant is better to give someone w/ ADD + seizure
methylphenidate
44
define MDE
**5 or more** of the below symptoms for _2 weeks and_ which _cause significant impairment in social, academic and occupational functioning._ * **–\*depressed mood** * **–\*lack of enjoyment in pleasurable activities** * –changes in weight * –changes in sleep * –psychomotor agitation or retardation * –fatigue or lack of energy * –feelings of worthlessness or excessive guilt * –decreased concentration * –thoughts of suicide
45
define persistent depressive disorder
Depressed mood for _more days than not for a_t _least 2 years._ _+ 2 o_r more of the following: * -poor appetite or overeating * -insomnia or hypersomnia * -low energy or fatigue * -low self-esteem * -poor concentration or difficulty making decisions * -feelings of hopelessness
46
what disorder is important to r/o when evaluating a depressed pt what should tou ask them
bipolar any mania??
47
# define beravement adjustment disorder
* Bereavement - depressive symptoms which occur after the loss of a loved one. * Adjustment disorder - development of emotional and/or behavioral symptoms within 3 months after an identifiable stressor.
48
T/F in tx depression: All classes are equally efficacious
TRUE
49
in depression: ## Footnote \_\_\_\_the most useful when considering tolerability, efficacy and benefits. \_\_\_\_\_ and\_\_\_\_ had slightly better efficacy than the other reviewed antidepressants.1
* **Sertraline** the most useful when considering tolerability, efficacy and benefits. * **Escitalopram** and **mirtazapine** had slightly better efficacy than the other reviewed antidepressants.1
50
what are the serotonin targets we want to agonize/antagonize in tx depresion
**5-HT1a agonism** **5-HT2 antagonism** * seems to lower anxiety and promote the 5-HT1a agonistic effect.
51
list steps to follow in regards to Nonresponse to initial antidepressant
1. 4-8 weeks of treatment. \<25% reduction in sx then inc dose 2. If no response then switch to another antidepressant. (different type 3. After 2 trials then consider the patient to be treatment resistant. 4. Switching to a third antidepressant monotherapy. (SSRI --\> SSRI --\> SNRI) 5. add adjuvant non antidepressive (esketamine, atypical, lithium) 6. COMBO therapy --\> (SSR+ Bup or SSRI/SNRI + mirtazapine)
52
name approriate combo therapy for depression what pt would you use each combo w/??
SSRI along with _bupropion_. --\> ↑ dopamine (NE) * Drowsy all day / no energy SSRI or SNRI with _mirtazapine_. --\> ↑ serotonin & NE through alpha 2 blockade * Can't fall asleep – (hypnotic)
53
Combining an SSRI, SNRI or TCA with an\_\_\_ is not recommended.
Combining an SSRI, SNRI or TCA with an **MAOI** is not recommended.
54
post partum depression first line second line third line
_First line_: psychotherapy _Second line Pharm:_ * Citalopram * escitalopram * sertraline _Third Line:_ Brexanolone IV * Acts as allopregnanolone * Neuroactive steroid that drops dramatically after childbirth * Has positive GABAA modulatory effects (pass out)
55
name Non-Prescription Strategies for post partum dep
* SAMe * Folic Acid
56
Non-Pharmacologic Therapies for dep
Electroconvulsive Therapy (ECT). Repetitive Transcranial Magnetic Stimulation (rTMS). – noninvasive Deep Brain Stimulation (DBS). - used for Parkinson’s Disease. Vagus Nerve Stimulation (VNS). - used for seizure disorder.
57
Patient Education Message for antidep
* Take medication daily (as prescribed). * Antidepressants need to be taken 2-4 weeks before noticeable effects will occur. * Patients need to continue taking the antidepressant even if they start to feel better. * Patients should not stop taking the antidepressant without talking to a clinician. * Patients should be given specific instructions on how to resolve questions regarding their treatment (e.g. a contact person/case manager)
58
tx depression in kids
* Fluoxetine -- \>8 y/o (FIRST LINE) * Escitalopram --- \>12 y/o (SECOND LINE) * Venlafaxine after 2 failed attempts
59
tx dep in pregnancy & BF
**PREGNANCY**: No med preferred * If need med -- _fluoxetine_ * _Bupropion_ -- useful but does not help w/ anxiety BREASFEEDING * _Sertraline_ & _paroxetine_ negligible in milk
60
if prescribing atypical antipsychotic which would you choose bc of least side effects and least likely to cause movement disorder?
Aripiprazole
61
Aripiprazole is used in what case?
Adjunct/ add-on therapy for refractory depression (+SSRI or SNRI)
62
name adjuctive meds you can add on for depression
_Selegiline transdermal patch_ _Esketamine_ – nasal inhalation _Brexanolone_ _Atypical antipsychotics:_ * Aripiprazole – fewer side effects * Olanzapine w/ fluoxetine * Quetiapine
63
indication & adverse effects Brexanolone
PPD LOC/sedation/syncope (DEC O2)
64
indication / MOI / Adverse effects: Esketamine
add-on for **depression** **MOI** * NMDA glutamate receptor antagonist * Block reuptake of serotonin, NE, & DA * 5-HT 1 agonist * Opiate receptor agonist (mild) **Adverse Effects** * Dissociation - outer body experience (buzzed) * INC HR/BP
65
indication / MOI / adverse effects ## Footnote Selegiline transdermal patch
adjuct for **depression** **MOI:** CNS (selective) monoaminoxidase inhibitors (MAOI) * Works in the CNS but does not affect GI located monoamine oxidase (MO). * Avoidance of GI located (MO) allows the GI tract to still break down dietary tyramine before it is allowed into the blood stream. **Adverse Effects:** * Hypertensive crisis at high doses 2° to ­ GI tyramine absorption (dietary restrictions) * Too much DA (bc too much tyramine) * Skin irritation * Xerostomia * Diarrhea
66
what drug Mimics allopregnanolone (positive GABA effects)
Brexanolone PPD
67
tx follow up algorithm for starting pt on antidepresant s
Meet with pt after _10-14 days_ --\> assess _tolerability_ and safety/suicidal thoughts. --\> Kids every week Meet in _4 weeks to assess efficacy_. --\> Should be feeling better Meet _2-4 weeks later to measure maximal respons_e * (6-8 weeks of a therapeutic dose). Meet e_very month for next 4-9 months_ during _continuation phase_. (up to 1 year) * if more then 2 episodes take medication forever

PSYCH EOR (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions