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25 Cards in this Set

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Major Depression defined
lasting 2 or more weeks
5/8 symptoms
fatigue
change in wgt appetite
dysphoria or apathy
in/hypersomnia
worthless/guilty, inability to make decision, suicide ideation
Dysthymic disorder defined
depressed mood for two or more years, at lease two sypmtoms
change in appetitie, in/hypersomnia. fatigue, poor concentration, decision difficulty, hopeless
adjustment disorder defined
must have a identifiable event. difficulty adjusting, symptoms occure within 3 months of event.
acute less than 6 months duration
depressed, hopeless, tearfull
chronic greater than 6 months
Medical conditions associated with depression
mi, ca, ms, hiv, cva, iddm parkinsons
diagnostic labs to abtain when questioning depression diagnosis
cbc w diff
lytes, rft, lft, glucose, tsh, b12, tox screen
A screening tool for depression
SIG E CAPS
sleep, intersts, guilt, energy concentration, appetitie, psychomotor suicidality
What are three other screening tools besides the sig e caps
zung self rating
beck depression inventory
CES-D
risk factors for suicide
sad person
sex , age, depression, previous attempts,ETOH, rational thinking decline, social support absent, organized plan, no significant other, sickness
what are some suicide interventions
identify/reestablish social network
relieve isolation
remove lethal weapons
encourage expression of anger
no final decisions during crises
only give 2-3 days of medication with f/u plan
The objectives of depression management are
ensure safety
control symptoms
restore functioning
Principles of pharmacologic management
Identify target symptoms
effect takes 4-6 weeks
treat for 8- 12 months minimum
start low titrate up
watch for drug drug interactions
What are the advantages of tca's and an example of one
Imipramine.
low cost, qd dosing, good efficacy, good for adjucntive tx for chronic pain.
Disadvantages of TCA's
SE: sedation, htn, anticholinergic
Drug interactions
hypomania
Describe SSRIs
Paxil, Celexa, Zoloft, lexapro, prozac
first choice, safety in overdose, can start at theraputic dose, tolerability,
SSRI side effects include
nausea, agitation, sexual dysfunction,
serotonin syndrome: flu-like myalgias, anxiety, irritability, insomnia,
SARI's examples and effects
Trazadone, sezone,
wide theraputic index
improves sleep
minimal sexual effects
* risk of priapism
SSARB example and effects
remeron
safety in overdose
no GI or sexual effect
decrease anxiety, improves sleep,
adverse,, am sleepy, wght gain.
anxiety is pathological if
diaproportionate
sustained over time
impairs functioning
unrelated to identifiable event
Generalized anxiety disorder characteristics
excessive worry
lasting 6 months or more
interferes with functioning
characteristics of Panic Disorder
Discrete episodes
no prodrome,
sudden onset, peak intensity about 10 min.
paresthesias, shills. glushes. sob. cp, nausea
assessment of anxiety disorder includes
muscle aches, fatigue, rapid speech, hand wringing, tense, anxious, worried, goal directed, forgetful, indecisive, limited insight.
Labs. cbc w diff, chemistry, tsh b12, tox screen
Screening tool for axiety disorder
Becks anxiety inventory at baseline and periodically
NOn-pharmocologic treatment of anxiety disorder
behvior therapy
systemic desensittization
exposure therapy
relaxation therapies
biofeedback
cog-behav therapy
interpersonal therapy
self help groups
pharmacological management of anxiety disorders inclde
Benxodiazepines;never xanax
Nonbenzodiazapines.. buspar
SSRI Paxil Zoloft First line for chronic anxiety
what is the mnemonic for mania
SIG DAM PT
sleep, irritability, grandiosity, distractability,
appetite, mood, psychomotor, talkative