Psychology #1 Flashcards by Tyler Cichowski

Risk factors for Major Depressive Disorder

Female, 20’s, poor socioeconomic status, family history

How well did you know this?

Not at all

Perfectly

Pathophysiology of Major Depressive Disorder

Alteration of neurotransmitters (serotonin, epinephrine, norepinephrine, histamaine, dopamine, and acetylcholine)

How well did you know this?

Not at all

Perfectly

What screening methods are used for MDD

PHQ-2 and then, if positive, PHQ-9

How well did you know this?

Not at all

Perfectly

What are the diagnostic criteria for MDD?

5 or more symptoms for most days for 2 or more weeks. Must include anhedonia or depressive mood
-fatigue, insomnia, sleep changes, weight change, concentration issues, guilt, suicidal thoughts, worthlessness feelings (SIGEMCAPS)

How well did you know this?

Not at all

Perfectly

What must be true about the symptoms in MDD to diagnose it as MDD?

It MUST cause significant distress and must not be related to substance use

How well did you know this?

Not at all

Perfectly

When should you consider treatment for a patient with MDD?

If PHQ-9 score is 10 or more

How well did you know this?

Not at all

Perfectly

Treatment for MDD

1) Psychotherapy: CBT, interpersonal, or supportive therapy)
2) SSRI’s are first line
3) SNRI, TCA, Bupropion
4) Electroconvulsive therapy if no response to medication

How well did you know this?

Not at all

Perfectly

What is seasonal affective disorder?

Presence of depressive symptoms at the same time each year

-Treamtent with SSRI’s, light therapy, Bupropion

How well did you know this?

Not at all

Perfectly

What is atypical depression?

Normal depressive symptoms, but improved mood with positive events

How well did you know this?

Not at all

Perfectly

Name the SSRI’s and how long do they take to reach maximum efficacy?

Sertraline, Fluoxetine, Paroxetine, Citalopram, Escitalopram

4-6 weeks for maximum efficacy

How well did you know this?

Not at all

Perfectly

Which SSRI has a longer half life?

Fluoxetine

How well did you know this?

Not at all

Perfectly

Adverse effects of SSRI’s include…

-GI, sexual dysfunction, insomnia, increased suicidality

How well did you know this?

Not at all

Perfectly

What is one thing to be remembered when prescribing Citalopram (who is it contraindicated in?)

Those with long QT syndrome

How well did you know this?

Not at all

Perfectly

SNRI’s inhibit the uptake of ______, ____, and ______. These drugs are….

Serotonin, norepinephrine, dopamine

Duloxetine, Venlafaxine, Desvenlafaxine

How well did you know this?

Not at all

Perfectly

Which SNRI is given if the patient has severe fatigue or neuropathy pain syndromes?

Duloxetine

How well did you know this?

Not at all

Perfectly

What is one advantage of Bupropion?

Less GI, sexual side effects than SSRI and SNRI

How well did you know this?

Not at all

Perfectly

Bupropion also aids in _______, but has some adverse effects including…

Smoking cessation

Seizures (lowers threshold). Therefore, avoid abrupt withdrawal!

How well did you know this?

Not at all

Perfectly

Another atypical antidepressant, Mirtazapine, inhibits which two neurotransmitters. It also has a benefit of

Inhibits serotonin and norepinephrine

-Fewer sexual side effects

How well did you know this?

Not at all

Perfectly

Although Mirtazapine works quicker than SSRI’s (it takes 2-3 weeks), it has some adverse effects that include…

Weight gain, constipation, dry mouth, sedation

How well did you know this?

Not at all

Perfectly

Name 4 TCA’s and what is the MC side effect of them?

Doxepin, Amitriptyline, Nortriptyline, Imipramine

Anticholinergic (MC)

How well did you know this?

Not at all

Perfectly

What are the three signs of TCA overdose and what can be given for the first symptom?

-Cardiotoxicity (wide complex tachycardia)
-Coma
-Convulsions (Seizures)

-Give sodium bicarbonate for cardiotoxicity

How well did you know this?

Not at all

Perfectly

Which TCA should be given for treatment of enuresis in kids?

Imipramine

How well did you know this?

Not at all

Perfectly

The most serotonin specific TCA and what can it also be used as treatment for.

Clomipramine

OCD

How well did you know this?

Not at all

Perfectly

MAO’s are drugs such as Phenelzine, Isocarboxazid and Tranylcypromine. Name two adverse effects or cautionary things to remember with these drugs.

-Orthostatic hypotension (MC)
-Hypertensive crisis (after eating foods high in tyramine such as aged cheese, red wine, beer, meats, chocolate)

How well did you know this?

Not at all

Perfectly

Serotonin Receptor Antagonists and Agonists include two common drugs such as

Trazodone and Nefazodone

Serotonin Receptor Antagonists and Agonists are useful for _______, but some common side effects are ____ and _____

Insomnia Sedation and Priapism

When does serotonin syndrome occur?

MC occurs after 24 hours after initiating or change in serotonergic drug dose

Symptoms of serotonin syndrome

-Cognitive: agitation, AMS, confusion -Autonomic instability: hyperthermia, diaphoresis, tachycardia, BP changes -Nausea, vomiting, diarrhea -Clonus, hypertonia, tremor, akithisia -Mydriasis, dry mouth, flushed skin

Treatment for serotonin syndrome (mild)

Prompt discontinuation of offending drug(s) Supportive, IVF, oxygen, Benzos

Treatment for serotonin syndrome (moderate)

As above + Cyproheptadine

What is persistent depressive disorder?

Depressed mood for most days for 2 years or more (in adults) and at least 1 year in kids/adolescents

Treatment for persistent depressive disorder

Pharmacotherapy (SSRI) + Psychotherapy most effective

What is cyclothymic disorder?

At least 2 years of prolonged, milder elevations and milder depressions (do not meet criteria of hypomanic or depression)

Treatment for cyclothymic disorder

Lithium, Valproic Acid -Alternatives: 2nd generation antipsychotics (Risperidone, Olanzapine, Quetiapine, Ziprasidone)

What is adjustment disorder and how long does it usually take to resolve?

Emotional or behavioral symptoms in response to stressor within 3 months of stressor onset Resolves within 6 months usually

Treatment for adjustment disorder

Psychotherapy

What are the 5 stages of grief

-Denial, anger, bargaining, depression, acceptance

What are signs of abnormal grief?

If it lasts longer than 1 year or if she has suicidal ideation

What are some differences between grief and MDD?

Grief: intermittent MDD: Consistent symptoms Grief: self esteem preserved MDD: Feeling of worthlessness

What are the criteria for Bipolar 1 Disorder?

At least 1 manic episode -Abnormal, elevated, expansive, irritated mood for at least 1 week impairs function -thinking: flight of ideas, grandiose, racing -behavior: hyperactivity, pressured speech, no sleep, hypersexuality

Treatment for Bipolar I Disorder

Lithium (first line) -Alternatives: Valproic acid, 2nd gen antipsychotics -Psychotherapy

What is one benefit of Lithium as treatment?

It reduces suicide risk as well

What are the criteria for Bipolar II Disorder?

History of 1 major depressive episode + 1 hypomanic episode -Patient has never had a manic episode!

What is hypomania?

Abnormal elevated mood < 1 week, doesn't need hospitalization and doesn't impair function at all

Treatment for Bipolar II Disorder

Lithium or 2nd gen antipsychotics -Psychotherapy as well

Lithium alters neuronal sodium transport. What are some adverse effects of this medication.

Hypothyroidism Hyperparathyroidism Hypercalcemia Hypermagnesemia

Prior to starting Lithium, what are some labs that should be obtained?

ECG, Beta-HCG, TSH, CBC Monitor every 4-8 weeks

Contraindications and cautions to using Lithium

Do not use in pregnancy - associated with Ebstein's Anomaly Do not use in severe renal disease Do not use with NSAIDs. Can raise Lithium levels in the blood too high.

Generalized anxiety disorder is anxiety or worry for at least _______ and the anxiety is out of proportion to the event. What should you screen with?

At least 6 months GAD-7 (score of 10 or more is positive)

Treatment for GAD (acute and long-term)

Benzos for short-term (risk of dependence) SSRI (first-line) but takes 4-6 weeks to reach efficacy CBT, Psychotherapy

What are two positives about Buspirone?

Does not cause sedation and does not have abuse potential

What is the diagnostic criteria for panic disorder?

Recurrent, unexpected panic attacks (2 or more) that are often followed by concern about future attacks, persistent worry about attacks, and maladaptive behavior related to attacks

Treatment for panic disorder

SSRI + CBT

What is the usual time frame for a panic attack?

Peaks within 10 minutes and never lasts longer than 1 hour

Pathophysiology of a panic attack

Sympathetic system overdrive

Treatment for an acute panic attack

Benzos

What should you do BEFORE diagnosing a panic attack or treating it as a panic attack?

Rule out life threatening conditions such as a heart attack or thyrotoxicosis

What is agoraphobia?

Intense fear of being in places where escape is difficult (crowds, public transportation, out of the home)

Diagnostic criteria for agoraphobia

Symptoms last longer than 6 months and cause social or occupational impairment

Treatment for agoraphobia

SSRI + CBT

Treatment for a specific phobia

Exposure + desensitization Short-term Benzos can be used in some patients

MC type of phobia

Social phobia (public speaking)

Treatment for social phobia

Psychotherapy (initially) SSRIs Situational: Propanolol 30-60 min prior to event

What is the difference between obsessions and compulsions?

Obsessions: recurrent or persistent thoughts Compulsions: repetitive behaviors that cause distress, impairment, or are time-consuming

OCD is ego-dystonic/ego-syntonic?

Ego-dystonic (inconsistent with personal beliefs)

Which neurotransmitter is generally involved with OCD?

Serotonin

What are the four patterns in OCD?

1) Contamination 2) Pathologic Doubt 3) Symmetry/Precision 4) Intrusive obsessive thoughts with compulsion

Treatment for OCD

CBT + Pharmacotherapy --SSRI (first line) --TCA's (Clomipramine)

Which TCA can be used for OCD and why?

Clomipramine because it is the most serotonin specific

Psychology #1 Flashcards

(69 cards)