Flashcards in Psychopharmacology Deck (22):
With equal or greater to what score on the PHQ9 should you start treating?
Equal to less than what score on the PHQ9 suggests remission of depressive symptoms?
If depression lasts at least 2 years, what do you call it? Why is it important to make the distinction between it an MDD?
persistent depressive disorder - it's important to differentiate because it will take longer to treat than MDD
What is the first step in deciding how you hsould treat a depression?
you have to determine if it's recurrent vs persistent vs refractory
What is the difference between recurrent and refractory?
recurrent got better on drugs and then relapsed
refractory never responded to any drugs
What happens during the first week of antidepressant trx?
1. decreased anxiety
2. improvement in sleep
3. improvement in appetite
What happens during the first 1-3 weeks of antidepressant trx?
increased activity, sex drive, self-care and memory
thinking and movements normalize
sleeping and eating patterns normalize
What happens during the 2-4 weeks of treatment with antidepressants?
1. relief of depressed mood
2. less hopeless/helpless
3. less thoughts of suicide
If a patient fails her first antidepressant treatment (even with the optimized dose/duration), what should you do?
1. add psychotherapy
2. lithium augmentation
3. 2nd generation antipsychotic augmentation
4. T3 augmentation
5. Switch to another antidepressant
What are the risks for T3 augmentaiton?
if the person's thyroid is normal, the risks are for cardiac arrhythmias and osteopenia
What are 3 second generation antipsychotics you can use for augmentation with an antidepressant? Which two were found to not be effective
olanzapine (esp combo with fluoxetine)
risperidone - not effective
ziprasidone - not effective
Which was the first 2nd gen antipsychotic to be approved for adjunctive therapy for MDD?
what are the side effects of abilify (aripirazole)?
akathisia (restlessness), weight gain
What three things should you consider for metabolic monitoring when giving 2nd gen antipsychotic augmentation?
1. weight gain
What 5 things should you consider for neurological monitoring when giving a 2nd gen antipsychotic?
4. tardive dyskinesia
5. neuroleptic malignant syndrome?
What are the risks for second gen antipsychotic augmentation in GENERAL?
3. prolonged QT interval
6. sudden death risk in elderly
What are the first line treatments for bipolar 1 depression?
1. quetiapine (antipsychotic)
2. lamotrigine (but taper up slowly)
3. olanzapine/fluoxetine combo
5. lamotrigine + lithium
6. combo mood stabilizer and AD
Although there is no FDA approved treatment for borderlien perseonality disorder, what are some drugs you can give off label?
1. aripiprazole (anger, psychosis, inpulsivity, depression, anxiety, interpersonal problems)
2. olanzapine (anger, psychosis, anxiety)
3. divalproex (anger, dep, IP)
4. lamotrigine (anger impulsivity)
5. topiramate (impulsivity IP)
What is the first line treatment for PTSD?
cognitive behavioral therapy plus SSRIs (sertraline, paroxetine, fluoxetine)
What are 3 augmentation strategies for PTSD treatment?
1. give an alpha1 or 2 agonist to target the nightmares (like clonidine or trazodone)
2. 2nd gen antipsychotic to treat psychosis and avoidance (like aripiprazole)
3. anticonvulsants for the nightmares and the arousal (depakote)
How do you manage opioid-induced hyperalgesia syndrome?
1. withdraw the opioid
2. give methadone or buprenorphine to ease decrease
3. reduction of glial activation?
4. treat secondary withdrawal symptoms with corticosteroids and or clonidine