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68 Cards in this Set
- Front
- Back
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What is the one thing that is most important to diagnose a psychiatric dz?
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timeline!
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When is it appropriate to treat a psychiatric patient?
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Treatment can begin at any stage of a disease - timelines for actual diagnosis do not need to be made
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Why should we not give anti-depressant to a bipolar patient?
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90% of the time bipolars are in a DOWN stage (depressed) - if we give them antidepressant we put them into a manic state the patient may commit suicide
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What is meant by the "DOWNS"?
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Depressive mood disorders
EVERYTHING is slowed down: mentation, movements, HR, GI, fatigue |
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What is the end ruslt of all patients with the "DOWNS"?
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Suicide - as soon as they get enough energy to kill themselves
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What are the 5 stages of grief?
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Denial, Anger, Bargaining, Guilt, Acceptance
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How long does normal grief usually take?
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95% usually takes 5 years
5% takes > 5 years |
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What is the best treatment for grief?
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Empathy!
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What is the definition of melancholy? Does the patient need treatment?
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Deep sadness, but patient is functional
Tx: No meds needed |
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What is the definition of Dysthymia?
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2 years of sadness
Patient is functional |
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What is the definition of Cyclothymia?
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Patient is sad but has cycles of near normal mood for 2 years
Patient is functional No meds needed |
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What is the definition of mania?
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Increased ATP, fight/flight ideas, no sleep, spend money, grandiose ideas
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What are the signs/symptoms of Bipolar type I?
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Major Depression > 2 weeks
Mania > 1 week |
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What are the signs/symptoms of Bipolar type II?
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Major Depression > 2 weeks
Hypomania < 5 days (minor sx) |
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What is the treatment of Bipolar Type I patient? Bipolar Type II patient?
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Type I - Admit so they won't kill themselves while manic
Type II - Treat outpatient - use mood stabilizer |
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What diseases are associated with bipolar dz?
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OCD and ADHD
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What are the 2 signs that define Major Depression?
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Anhedonia
Failure to Function |
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What other signs may be present in Major Depression?
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SIGECAPS: Sleep inc/dec, Interest dec, Guilt inc, Energy dec, Concentration dec, Appetite inc/dec, Psychomotor retardation inc, Suicide
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What treatments are used for depression?
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Increase catecholamines: Serotonin, Epi, NE
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What are the big NO-NO's of prescribing psych meds?
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1. NEVER prescribe SSRI and MAOI
2. NEVER prescribe two drugs from the same class |
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What receptors does NE bind?
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alpha1, alpha2, Beta1
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What receptors does Serotonin bind?
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5HT; sympathetic in CNS, parasympathetic in PNS
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What receptors does Epi bind?
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alpha1, alpha2, Beta1, Beta2
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What is the function of alpha1? Beta 2?
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alpha 1 vasoconstricts, Beta 2 vasodilates - this is important for use of vasodilators and vasoconstrictors
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How long does it take catecholamine levels to return to normal once patient takes SSRI?
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4 weeks
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How long does it take for the patient to feel better once SSRI have been started?
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6-8 weeks
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What are the signs seen on X-ray for an Alzheimer's patient?
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cortical atrophy
basal ganglia atrophy hippocampus atrophy |
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What are the stats for patient response to SSRI? What is the only drug that can improve those stats?
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30% remission, 30% relapse, 40% inconclusive
Add Buproprion --> 40% remission |
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What drug is a 2nd line drug for antidepression? How does it function?
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Tricyclic antidepressants, blocks reuptake of catecholamines (inc 5HT, NE, Epi)
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What are the side effects of TCAs?
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Strongly anticholinergic, blocks alpha one receptors (orthostatic hypotension), Blocks AV conduction in the heart (see QRS widening or long QT on EKG)
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What should be given to patient if they overdose on TCAs?
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NaHCO3 to balance the acid of the drug
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What are the TCAs?
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Imipramine,Amitryptaline, Clomipramine, Desipramine, Nortryptaline
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Which TCA drug can be used as a 2nd line treatment for bed wetting?
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Imipramine
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Which TCA drug can be used as a treatment for chronic pain?
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Amitryptaline
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Which TCA drug can be used as a 2nd line for OCD?
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Clomipramine
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Which TCA drug has the least side effects?
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Desipramine
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Which TCA drug is best for elderly? Why?
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Nortryptaline - least alpha1 symptoms
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What is the mecahnism of action of SSRIs?
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Block reuptake of serotonin only (increase 5HT)
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What are the side effects of serotonin?
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Anorgasmia
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What are the indications for starting a patient on SSRIs?
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Depression, OCD, Chronic Panic, Post-traumatic stress disorder, Phobia, Eating Disorders, PMDD
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What drugs are SSRIs?
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Fluoxetine, Sertraline, Luvoxetine, Paroxetine, Citalopram, Escitalopram
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Which SSRI has been on the market the longest?
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Fluoxetine - Prozac
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Which SSRI is the only one to be approved in teenagers?
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Paroxetine
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Which SSRIs are used for stroke patients who are depressed?
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Citalopram and Escitalopram
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What is PMDD?
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PMS symptoms that extend beyond bleeding and patient becomes depressed
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When is a depressed patient most at risk of commiting suicide?
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During the first 90 days of therapy - this is why we must talk to our patients to gauge their suicidal intentions
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What class of drugs is 2nd line TCAs? How do they work?
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Heterocyclics
They block reuptake of catecholamines (inc NE, 5HT, Epi) |
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What drugs are heterocyclics?
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Nefazadone, Trazadone, Duolexetine, Amoxapine, Venlafaxine, Buproprion
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Which HCAs are SNRIs?
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Nefazadone and Duoloxetine
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Which HCA requires daily BP monitoring?
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Duoloxetine
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What are the added benefits of Buproprion as an HCA?
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Smoking cessation, no anorgasmia (can exchange for SSRI)
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What is the major side effect of Buproprion? In which patients is this drug contraindicated?
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Seizure - don't use in pt with electrolyte abnormalities, epileptics
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What are MAOIs used for? Which drugs are MAOIs?
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2nd line antidepressants: Tranylcypramine, isocarboxazid, Phenylxine, Selegyline
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Which MAOIs inhibit MAO-A? Which catecholamines do they increase?
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Tranylcypramine, Isocarboxazid, Phenylxine - increase NE, and Epi
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Which MAOI inhibits MAO-B? Which catecholamines are increased? What is its special use?
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Selegyline, increase dopamine - use for Parkinson's
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What is the benefit of Electroconvulsive Therapy?
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Can be used in acute situations, resets patient's mind, may be used during pregnancy
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What is the 1st line drug for smoking cessation?
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veranicline (stimulates nicotine receptors)
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What is the most common side effect of ECT?
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Anterograde memory loss (forget things that happened just prior to treatment)
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Which HCAs are SNRIs?
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Nefazadone and Duoloxetine
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Which HCA requires daily BP monitoring?
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Duoloxetine
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What are the added benefits of Buproprion as an HCA?
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Smoking cessation, no anorgasmia (can exchange for SSRI)
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What is the major side effect of Buproprion? In which patients is this drug contraindicated?
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Seizure - don't use in pt with electrolyte abnormalities, epileptics
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What are MAOIs used for? Which drugs are MAOIs?
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2nd line antidepressants: Tranylcypramine, isocarboxazid, Phenylxine, Selegyline
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Which MAOIs inhibit MAO-A? Which catecholamines do they increase?
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Tranylcypramine, Isocarboxazid, Phenylxine - increase NE, and Epi
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Which MAOI inhibits MAO-B? Which catecholamines are increased? What is its special use?
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Selegyline, increase dopamine - use for Parkinson's
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What is the benefit of Electroconvulsive Therapy?
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Can be used in acute situations, resets patient's mind, may be used during pregnancy
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What is the 1st line drug for smoking cessation?
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veranicline (stimulates nicotine receptors)
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What is the most common side effect of ECT?
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Anterograde memory loss (forget things that happened just prior to treatment)
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