Mental health Flashcards
(107 cards)
1
Q
Generalized anxiety disorder:
- excessive worrying occurring _______ over a period of ______
- impairs functioning in _______
A
- more days than not
- over a period of 6 or more months
- impairs functioning in social, work, home environment
2
Q
Generalized anxiety disorder:
Examples of medical conditions with similar symptoms:
Examples of substances with similar symptoms:
A
hyperthyroidism, pheochromocytoma, hyperparathyroidism; tumour, hypoglycemia, Cushing’s, epilepsy
Substances:
-caffeine, albuterol, levothyroxine, decongestants, substance withdrawal
3
Q
Generalized anxiety disorder:
Two specific areas to assess during history
Two specific ROS for physical exam
A
- safety risk every visit
- substances
- CVS
- thyroid
4
Q
Generalized anxiety disorder:
First line treatment drug class and example
A
SSRI
Fluoxetine (Prozac), paroxetine (Paxil), Sertraline (Zoloft), Escitalopram, Citalopram (Celexa), Venlafaxine (Effexor)
5
Q
Generalized anxiety disorder:
Patient education points
- meds:
- lifestyle:
A
- medications can take 4-6 weeks to take effect
- should not stop meds abruptly, need gradual taper if stopping
- self-calming: deep breathing, mindfulness, relaxation
- sleep hygiene
- management of stress and triggers (caffeine, nicotine, stimulants)
- smoking cessation
- exercise
- avoid ETOH with benzos
6
Q
Generalized anxiety disorder:
Prescribing benzos: limit use to prevent ______
Two considerations for safe prescribing of benzos:
A
-tolerance, dependence, side effects (sedation, confusion)
- Check Pharmanet every time
- Pt education re: concurrent use of alcohol and/or opioids
7
Q
Generalized anxiety disorder:
Follow up in ________
Assess ______ during every follow up
A
- f/u in 1-2 weeks
- safety assessment (suicide risk) every visit
8
Q
ADHD
Symptoms of persistent _____, _____ and/or _______
Negatively affects:
A
- hyperactivity (speech/motor)
- impulsivity (risk taking, impatience)
- inattention (daydreaming, doesn’t finish tasks, concentration)
Poor school performance
Poor peer relationships
9
Q
ADHD
Risk factors: (3 categories)
A
ADHD Risk factors
- family hx
- environmental exposure (lead, organophosphates)
- perinatal (hypoxia, maternal smoking/substance use, prolonged labour, low birth weight)
10
Q
ADHD
History components:
A
- duration of symptoms
- settings in which symptoms are present (home/school/work)
- complete developmental hx: prenatal and perinatal events, motor/language/social milestones, behaviour
- substance use
- Family, social, school, lifestyle (sleep, exercise, screen time)
- Academic progress: report cards
- Meds: theophylline, prednisone, albuterol
11
Q
ADHD
Physical exam:
-special focus on:
-focused exam on 4 systems:
A
wt and ht (especially for children, side effects of anorexia and growth suppression for meds)
CVS, resp, thyroid, neuro exam
12
Q
ADHD
First line management drug class and example
A
Stimulants
Methylphenidate (Ritalin), Dextroamphetamine (Dexedrine), Amphetamine-dextroamphetamine (Adderall)
13
Q
ADHD
Precaution with prescribing of stimulants
A
- assess CV risk (family hx)
- monitor BP and HR
Caution with:
-hx of substance use, anxiety, renal impairment, epilepsy (monitor plasma level of meds), Raynaud’s, family hx of Tourettes (can worsen tics)
14
Q
ADHD
Contraindications to prescribing stimulants
A
- MAOIs
- glaucoma
- hx of mania/psychosis
- untreated hypertension or symptomatic CVD
- untreated hyperthyroidism
15
Q
ADHD
Common side effects of stimulants
A
- appetite suppression
- insomnia
- growth suppression
16
Q
ADHD
Pt education
A
- Promoting structured life/home: priorities, reminders, timers/apps for deadlines
- Classroom/work management
- Regular exercise (mod to large effect on core symptoms)
- Psychoeducation for parents
17
Q
ADHD Rx
Recommended options if concurrent/hx of substance use:
Recommended options if co-morbid depression
A
Substance use:
-Vyvanse, Bupropion, Strattera
Co-morbid depression:
-Bupropion, Venlafaxine
18
Q
ADHD
Follow up in ____
What to review in follow up:
A
F/U in 2-4 weeks
- sleep
- compliance with meds
- side effects
- BP and HR
- ht and wt
19
Q
GAD
Common somatic symptoms
A
dizziness GI upset/nausea chest pain/SOB fatigue sweating chronic headaches
20
Q
What are the 5 stages of grief?
A
- denial
- anger
- bargaining
- depression
- acceptance
21
Q
Acute grief reaction
Specific areas to assess during visit:
Diagnostic tools:
A
SWIGECAPS
- personal hx of moment of loss
- relationship to deceased
- significant anniversary dates
- substance use
- supports
- safety risk assessment
Mental health exam
GAD-7 , PHQ-9
22
Q
What is the first line treatment for acute grief reaction?
A
- acute grief will resolve on its own without intervention
- encourage supports from family, friends, community resources
- psychotherapy NOT routinely recommended if no underlying MH conditions
- prescriptions are NOT routinely recommended
23
Q
Intimate partner violence
- what is the key risk factor?
- other risk factors?
A
key risk: female gender :(
BIPOC pregnancy history of violence (childhood, family of origin) lack of social supports poverty
24
Q
Intimate partner violence often presents with chronic physical somatic concerns such as:
(3 broad systems)
A
- neuro (headaches, dizziness)
- GI (IBS, ulcers)
- GU (STIs, UTIs, unwanted pregnancies, pelvic pain)
25
Health consequences of insomnia:
Increased risk of CVD, HTN, depression, anxiety
Affects mental functioning, efficiency
Cause of accidents
26
Insomnia
What drug classes can cause insomnia?
- steroids
- methylphenidate
- ephedrine
- decongestants
- bronchodilators
- thyroid
- MAOIs
- weight loss/diet pills
27
Chronic insomnia (defined by DSM-5) is associated with ______ and impairment of ______ lasting ____ months for _____ nights/week despite ________
- associated with distress
- impairs daytime functioning
- lasts 3+ months
- 3+ nights/week
- despite adequate opportunity for sleep
28
What do you assess for with insomnia history?
- thorough history of sleep issue: sleep diary for 1-2 weeks
- sleep hygiene
- meal and exercise time
- trouble falling asleep vs staying asleep vs early morning wakening
- substance use
- stressors
- snoring and apneic periods (collateral from partner)
- CVS: orthopnea, PND, nocturnal angina
29
Insomnia
Always screen for: (3 conditions)
In geriatrics, assess for (3 conditions)
- OSA
- Depression (PHQ-9)
- Anxiety (GAD-7)
Geriatrics:
- depression
- chronic pain
- polypharmacy
30
What is the first line treatment for acute and chronic insomnia?
CBT-I
31
When prescribing medications for insomnia, limit to _____ (time) with ______
1-2 weeks (no more than 1 month)
| NO refills
32
Zopiclone
- drug class
- MOA
- usual dose
* limit rx to _____ days
- most common side effects
- cognitive side effects
- precautions:
- avoid use in:
Drug class: non-BZD hypnotic
MOA: GABA agonist (reduces sleep latency, increases sleep duration, decrease wakening)
Usual dose: 3.75-7.5 mg
*limit rx to 7-10 days
Side effects: bitter taste, daytime sedation
```
Anterograde amnesia (must be able to have a full night's sleep)
Impaired daytime functioning (driving impaired x 11 hours)
```
Precautions: risk of tolerance and dependence, can induce complex sleep behaviours
Avoid use in: elderly, severe resp impairment (sleep apnea), myasthenia gravis, hx of complex sleep behaviours
33
Doxepin
- drug class
- MOA
- indication
- usual dose
* timing with food?
- most common side effects
- cognitive side effects
- precautions:
- contraindications:
Drug class: TCA, H1 receptor antagonist
MOA: inhibits reuptake of serotonin and norepinephrine in CNS
Indication: only for sleep maintenance
Usual dose: 3-6 mg 30 min before bedtime
-avoid within 3 hours of meals
Side effects: dry mouth, sedation, constipation, nausea, URTI
Cognitive: no impact
*minimal risk of tolerance and dependence
Contraindications: glaucoma, urinary retention, use of MAO-I x 14 days prior, acute CHF/MI
34
Trazodone
- drug class
- MOA
- usual dose
- benefits (less risk of ______ and ______)
- common side effects: (3)
- precautions:
Drug class: antidepressant
MOA: inhibits re-uptake of serotonin, also blocks H1 and alpha-1 adrenergic receptors
Usual dose: 25-100 mg
Benefits: short half life (less risk morning hangover), less risk of tolerance/dependence
Side effects: sedation, orthostatic hypotension (risk of falls), cardiac arrhythmias (serious), rare priaprism
Precautions: prolonged QT (be careful if existing cardiac condition), CYP, serotonin syndrome
always monitor suicide risk with antidepressants
35
PTSD
Predisposing risk factors:
Risk factors:
- age at trauma
- poor psychosocial support
- previous history of trauma
- general childhood adversity
- lower education, lower SES
- hx of other MH conditions
36
PTSD is often comorbid with:
- MH conditions: (3)
- Physical conditions: (7)
- depression (high risk of suicide)
- anxiety
- substance use
Physical:
- somatic symptoms
- obesity
- dyslipidemia
- HTN
- DM
- dementia
- IBS
37
What are the 5 cardinal symptoms of PTSD?
Symptoms must be present for _______ (length of time)
- traumatic event: must be extreme
- intrusive symptoms: re-experiencing memories that are recurrent, involuntary, intrusive and distressing
- avoidance of people/places/things that remind of trauma
- negative mood and thoughts associated with trauma
- chronic hyperarousal
Symptoms must be present for over one month
38
What are the 2 thought patterns seen in dissociative PTSD?
Dissociative PTSD is linked to high rate of _____ and ______
- depersonalization "this body is not mine"
- derealization "this world is not real"
High rate of impairment, comorbidity and suicide
39
PTSD
What broad types of pts are at high risk and should be screened?
- victims of sexual assault
- military in combat zones
- survivors of disasters
40
PTSD can be screened using a validated screening tool
Also assess for these 3 S's
- suicide risk/safety
- substance
- sleep
41
What is first line treatment for PTSD?
Trauma focused psychotherapy (first)
| SSRI or SNRI
42
Give an example of first line pharmacotherapy option for PTSD
```
Drug class:
MOA:
Initial dose:
Precautions: (3)
Contraindications:
```
Sertraline (Zoloft)
Drug class: SSRI antidepressant
MOA: assists with intrusive thoughts, flashbacks, irritability, anger
Dosing: Sertraline 50 mg OD initial dose
Precautions: activation of mania/hypomania (if bipolar), serotonin syndrome, prolonged QT
Contraindications: use of MAOIs x 14 days
Common adverse reactions: nausea, diarrhea, dry mouth, insomnia, dizziness, sexual dysfunction (ejaculatory delay, orgasm disturbance, ED, ↓ libido)
Monitoring: will take 6-8 weeks to achieve full benefit
43
What are some common side effects with SERTRALINE?
What is one aspect to counsel pts about with sertraline re: effect?
Common adverse reactions: nausea, diarrhea, dry mouth, insomnia, dizziness, sexual dysfunction (ejaculatory delay, orgasm disturbance, ED, ↓ libido)
-will take 2-4 weeks for initial effect, 6-8 weeks to achieve full benefit
44
PTSD
What is an adjunct therapy used for sleep disturbance/nightmares?
What is an adjunct therapy used for concurrent BPD?
Sleep: Prazosin (minipress) - alpha-adrenergic blocker
BPD: DBT
45
PTSD
Medications, once stabilized, should continue for ________ to prevent relapse/recurrence
Always assess for these 3 at follow up visits
6-12 months
Mood
Suicide/safety
Substance use
46
GAD
What are the two questions to ask during GAD-2 screen?
Over the last 2 weeks, how often have you been bothered by the following problems:
1. Feeling nervous, anxious or on edge
2. Not being able to stop or control worrying
47
Grief
Prolonged/complicated grief persists for ________ (time) after the loss
6-12 months
48
What are some risk factors for chronic insomnia?
Predisposing risk factors:
- age (30-59)
- Substances: ETOH, tolerance to hypnotic meds, stimulants (caffeine, nicotine, amphetamines, hallucinogens)
- women with fibromyalgia and menopause
49
What OTC and Rx medications commonly contribute to sleep disorders?
Medications:
| -steroids, methylphenidate, ephedrine, decongestants, bronchodilators, thyroid meds, MAOIs, weight loss/diet pills
50
Insomnia:
Early morning wakening is defined as:
waking up (termination of sleep) 30+ minutes before desired wake up time
51
Alcohol use disorder
Binge drinking definition for
-males: ___ drinks on at least ____ in last _____ days
-females ____drinks on at least _____ in last _____ days
Heavy ETOH use = binge drinking on ___ days in last 30 days
- males 5+ drinks on at least 1 day in last 30 days
- females 4+ drinks on at least 1 day in last 30 days
Heavy ETOH: binge drinking on 5+ days in last 30 days
52
Canada Low Risk Drinking Guidelines
Risky drinking is defined as:
males: __ drinks/day or ___ drinks/week
females: ___ drinks/day or ___ drinks/week
Males: 3+ drinks/day or 15+ drinks/week
Females: 2+ drinks/day or 10+ drinks/week
53
How often should adults and youth be screened for alcohol use?
annually
54
What does CAGE stand for?
Cut down
Annoyed
Guilty
Eye-opener
55
What are some signs and symptoms of ETOH withdrawal?
n/v, tachycardia, diaphoresis, anxiety, agitation, tremors, dizziness, hallucinations (tactile, auditory, visual), paresthesia, piloerection, rhinorrhea, tremors
(think about what is asked on CIWA)
56
What is the AST: ALT ratio that signifies significant ETOH use?
>2:1 AST: ALT
57
What are the two first line treatment options for alcohol use disorder?
- mechanism of action?
- treatment goal?
- contraindications
NALTREXONE
- opiate receptor antagonist
- goal of reduction OR abstinence
- contraindicated with opiate use, acute liver failure/hepatitis
ACAMPROSATE
- MoA r/t GABA and glutamate
- goal of abstinence
- contraindicated with breastfeeding and severe renal impairment
58
What are the 3 multivitamins to supplement with ETOH use disorder?
Thiamine 100 mg
Folic acid 1 mg
B6 2 mg
59
OCD
define obsession and compulsion
obsession: unwanted persistent intrusive thoughts/impulses
compulsion: unwanted repetitive act that neutralizes/prevents discomfort
60
What are the 4 core features of Borderline Personality Disorder?
- RELATEDNESS: instability of interpersonal relationships
- self image: unstable
- AFFECT: labile, angry, efforts to avoid abandonment
- BEHAVIOUR: marked impulsivity, suicidality/threats
61
What are common MH co-morbidities that exist with BPD?
| PESANS
```
PTSD
Eating disorder
Substance use disorder
Antisocial personality disorder
Narcissistic personality disorder
Schizotypal personality disorder
```
62
Borderline personality disorder
describe 3 examples of behaviour dysregulation
- impulsivity
- suicidality (8-12% will die by suicide)
- self-harm behaviour
63
Borderline personality disorder
describe 3 examples of affective dysregulation
- labile affect
- excess anger
- efforts to avoid rea/imagined abandonment
64
Borderline personality disorder
describe 3 examples of impaired relationships
- unstable relationship with others (intense, splitting)
- chronic emptiness
- transient identity disturbance (paranoid ideation/dissociative symptoms)
65
What is the ideal treatment strategy when working with people with borderline personality disorder?
- communication
- collaboration between clinicians
- clear boundaries re: relationship and behaviours
- set limits
- encourage pts to take responsibility for actions and problems
66
What is the first line psychotherapy strategy for borderline personality disorder?
-what does it focus on?
DBT
-dialectical behaviour therapy
focus on increase coping skills and helping with emotional regulation
67
Schizophrenia affects a person's _____, _____ and ______
cognition
perception (distorted)
affect (inappropriate/blunted)
68
What are some risk factors for development of schizophrenia?
-living in urban area
-immigration
-late winter/early spring birth??
-advanced paternal age at conception
-inflammatory conditions (eg celiac, interstitial cystitis, thyrotoxicosis)
SUBSTANCE use: cannabis and nicotine
69
What is the criteria for duration of symptoms for diagnosis of schizophrenia?
6 months of poor functioning with one month of active symptoms
70
# Define
- hallucination
| - illusion
Hallucination:
- can occur in any sensory modality
- sensory perceptions in ABSENCE of corresponding external stimulus
Illusions:
-distortion of an actual stimulus
ie misinterpretation of external stimulus (common with drug induced)
71
What is a delusion?
-examples of delusion?
Delusion: fixed false belief
• Being followed or monitored
• Being plotted against
• Having special abilities or "powers"
• Certain songs or comments are specifically directed toward oneself or communicating a hidden message
• Being controlled by forces or other individuals
• Having one's thoughts broadcast so others can hear them
Can seem 100% real to person
72
What are some prodromal and soft signs of PSYCHOSIS?
Prodromal:
- social withdrawal
- reduced concentration
- attention
- depressed mood
- sleep disturbance
- anxiety -suspiciousness
- skipping school or work
- irritability
Soft signs: -Unusually intense affect
- vagueness
- very mild thought disorder
- Preoccupation with incident from distant past
- Expectation of familiarity from interviewer
- latency or thought blocking
- odd statements or beliefs
73
Schizophrenia:
define negative symptoms
-give examples
Negative symptoms: reduction in normal function
* Blunted affect
* Emotional withdrawal
* Poor rapport
* Passivity
* Apathetic social withdrawal
* Difficulty in abstract thinking
* Lack of spontaneity
* Stereotyped thinking
* Alogia (reduced fluency or poverty of speech)
* Avolition (lack of motivation)
* Anhedonia (lack of pleasure)
* Attentional impairment
74
Schizophrenia
-examples of positive symptoms
* Delusions
* Hallucinations
* Distortions in communication
* Disorganized speech
* Disorganized behavior
* Catatonic behavior
* Agitation
75
Schizophrenia
-what is the drug class (first line) for treatment? examples?
-Atypical anti-pyschotics
```
eg
Quetiapine (seroquel)
Aripriprazole (Abilify)
Palpiperidone (Invega)
Clozapine (clozaril)
```
76
Atypical antipsychotics:
-3 common side effects
Clozapine has risk of ______ and _____
-monitoring?
- metabolic syndrome
- weight gain
- prolonged QTc
Clozapine:
- cardiac complications
- blood dyscrasis
- monthly CBCs and regular metabolic monitoring
77
OUD
Tolerance is defined as either:
- need for:
- diminished effect with:
- increased amt of opioids to achieve intoxication/desired effect
- Diminished effect with continued use of same amt of opioid
78
OUD
Withdrawal manifests as either:
- characteristic:
- same/related:
- characteristic opioid withdrawal syndrome
| - same/related substance to relieve/avoid withdrawal symptoms
79
What question do you ask all patients to screen for opioid use disorder?
"how many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons?"
80
Signs and symptoms of opioid withdrawal
```
• Flu-like symptoms
• Runny nose
• Nausea, vomiting, diarrhea, stomach cramps
• Restlessness
• Yawning
• Pupil dilation
• Tremors/shaking
• Anxiety, irritability
Strong desire to use opioids
```
81
Opioid use disorder
Questions to ask during detailed substance use history
- current and past use of ETOH, stimulants, BZD, opioids, sedatives, Rx meds
- amt, frequency, route of use
- past treatment history with OAT
- past withdrawal management
- past treatment interventions (A+D counselling, support groups)
- past residential treatment
- length of sobriety
- history of OD
82
Opioid use disorder
Baseline labs?
- CBC, Cr, LFT, HIV, HBV/HCV, syphilis, GC/CT
- preg test
Lab UDS:
*need to explicitly ask for fentanyl and synthetic opioids (buprenorphine, oxy, HM)
83
Requirements for home induction for suboxone?
- ability to store meds safely, -reliable caregiver at home (esp for youth)
- previous provider experience with suboxone
- barriers to office induction
84
What do you assess for in follow up visits for OUD?
* Cravings
* Withdrawal symptoms
* med side effects, adherence
* ongoing opioid use? last use
* Other substances (focus on sedatives - ETOH, BZD)
* Sleep
* Mood/anxiety
* home/social stability
* Safe storage of medications
85
What are some clinical situations where you would REFER to addictions specialist for OUD management?
* pregnant/breastfeeding
* concurrent chronic pain, complex comorbidities
* switching from another type of OAT
* previous unsuccessful inductions
* youth
* complex polysubstance use
86
Name some harm reduction strategies for prevention of overdose in OUD
- take home naloxone
- harm reduction supplies
- access to supervised injection sites
- safer supply
- testing drugs
- education on safer use: smoking/intranasal instead of IVDU, not using alone
- connecting to overdose outreach team
- Lifeguard app
87
Signs and symptoms of opioid overdose
```
Opioid overdose:
• Respiratory depression (RR<10-12/min is best clinical predictor of opioid intoxication)
• Gurgling/snoring
• Minimally responsive --> unresponsive
• Constricted pupils
• Slow erratic HR
• Cyanosis and cool/clammy skin
```
Atypical opioid overdose:
* chest wall rigidity
* dyskinesia
88
Suboxone
-ratio of buprenorphine:naloxone?
- drug class?
- indication?
- MOA? (full vs partial agonist?)
Subxone
4:1 buprenorphine: naloxone
- opioid agonist therapy
- first line treatment for OUD in adults and youth 12+
buprenorphine is PARTIAL opioid agonist --> helps withdrawal and cravings, no euphoria
naloxone: prevents diversion to IVDU
89
Suboxone
Common side effects
- Headache
- n/v, constipation, abdo pain
- insomnia
- sweating
90
Suboxone
- contraindications
- precautions
CONTRAINDICATIONS:
- severe resp depression
- delirium tremens
- acute ETOH
- severe liver failure
PRECAUTIONS
- concurrent sedatives (risk of resp depression)
- need to be in moderate to severe withdrawal before taking first dose to avoid PRECIPITATED withdrawal
91
GAD
what neurotransmitters (3) are thought to be involved?
norepinephrine
serotonin
GABA
92
GAD
predisposing risk factors?
- non-white
- single
- poverty
- overanxious/shy as a child
- excess worrying
- early childhood trauma
93
GAD panic disorder
- panic attacks that occur:
- rapid onset:
- most common physical symptom:
occur unexpectedly without clear trigger
- rapid onset of intense fear (peak 10 min)
- palpitations
94
GAD
common somatic symptoms:
```
dizziness
GI upset/nausea
chest pain/SOB
chronic headaches
poor sleep
fatigue
```
95
GAD
What are the 2 questions to ask during GAD-2 screen?
over last 2 weeks, how often have you
- felt nervous/anxious/on edge?
- not able to stop/control worrying?
96
Personality disorders
Cluster A: "weird"
- paranoid (suspicious)
- schizoid (detached)
- schizotypal (magical thinking)
97
Personality disorders
Cluster B: "wild"
- antisocial (no regard for others, no remorse)
- borderline (unstable emotions and relationships)
- histrionic (attention seeking)
- narcissistic (ego, grandiose)
98
Personality disorders
Cluster C: "worried"
- avoidant (avoid conflict)
- dependent (clingy)
- obsessive compulsive (perfection)
99
Broad signs and symptoms that you may be dealing with personality disorder
"it's you, not me"
- Frequent mood swings
- Angry outbursts
- Difficulty making friends
- Attention-seeking
- Externalizing/blaming the world
- Ego-syntonic ("nothing's wrong with me")
100
Risk factors for depression?
- prior major depression
- stress
- trauma/childhood adversity
- family hx mood disorder
- SDOH
- chronic medical conditions (next Q)
101
Medical conditions assoc with depression?
- Neuro:
- Pain:
- Resp:
- Endo:
- Autoimmune:
- Neuro: MS, Parkinson's, CVA, migraines, dementia, epilepsy
- Pain: chronic pain, fibromyalgia, chronic fatigue, cancer
- Resp: asthma, COPD
- Endo: thyroid (hypo and hyper), DM
- Autoimmune: SLE, RA
102
Depression
Diagnostic workup?
PHQ-9
TSH, B12, preg test
other MH syndromes: anxiety, bipolar, psychosis, alcohol, substance use
review meds
103
What is the definition of dysthymia aka persistent depressive disorder
dysphoria and __________ occurring _________ lasting _______
dysphoria and at least 2 other depressive symptoms occurring on more days than not, lasting 2 or more years
104
Depression
first line treatment?
SSRI
Psychotherapy
self management
105
What score on PHQ-9 indicates major depression?
What score indicates full remission?
score 10+
remission: <5
106
Depression
- when will people start to notice improvement with meds? full benefit?
- how long should people continue on rx?
improvement in 1-2 weeks
full benefit 4-8 weeks
stay on meds for minimum of 6 months after full remission
107
Depression
What are the 2 quick questions to use in screen?
MOOD AND ANHEDONIA
in the last month:
have you lost interest/pleasure in things you usually like to do?
have you felt sad/low/depressed/hopeless?
