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44 Cards in this Set

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Suicide gesture: defn
any act of self-harm in which there is either a low degree of lethality or the motive of the victim is not specifically to die
Suicide attempt: defn
any act of self-harm which has been thought out with a reasonable degree of lethality in which the intent of the victim is death.
What are the risk factors for suicide?
SAD PEOPLES

Sex
Age
Depression
Professions
Ethnicity
Organic factors
Personality Disorders
Loss
EtOH and drugs
Schizophrenia
Peak age for men vs women completing suicide
Men: 45
Women: 55
Most common dx in those who attempt and complete suicide
Depression
Suicide risk increases, decreases as SES increases
Increases
WHat is the suicide rate for male vs female physicians when compared to general population?
males: 2-3x
females: 5x
Most frequent method of completed suicide in physicians
lethal drug OD
What race has the highest risk of suicide?
whites
Low levels of ________ are associated with violent suicide attempts
CSF 5-HIAA (5HT metabolite)
T/F Most people who commit suicide have a serious illness at time of death (terminal illness generally like cancer etc)
T
What is the personality disorder with greatest risk of suicide?
Antisocial Personality Disorder
Lifetime risk of suicide for alcoholic patients is ____ the rate of general population
120x
When are patients with schizophrenia at highest risk of suicide?
During the early stages of active illness or during relapse.
What are the stages of grief expressed in crisis?
1) Denial
2) Anger
3) Bargaining
4) Depression
5) Acceptance
What are interventions with individuals in crisis?
Recognition of the stage of crisis response.

"normalize" the response of the individual, NOT minimize.

Empathic response is helpful.
How many patients see their primary care physicians in the month preceding their suicide?
2/3 (almost half in the week before!!)
How many patients are prescribed a psychotropic med by their primary care physicians preceding their suicide?
2/3. Most it's a hypnotic
Nearly all antidepressant treatments over time result in down-regulation of _____ and _____ receptors
post synaptic β adrenergic receptors;

presynaptic 5HT<sub>1a</sub> receptors.
What are the original tricyclic antidepressants? (2)
imipramine

desipramine
tricyclic antidepressants: MOA
block reuptake of NE and/or 5HT.

what are the tertiary amines?
imipramine, amitriptyline
Bupropion MOA
DA reuptake inhibition
What are the secondary amines?
desipramine and nortriptyline
What are the tertiary amines?
imipramine and amitriptyline
What are the side effects of the tertiary amines and why?
More sedating because they block 5HT reuptake in addition to NE reuptake.
Antidepressants with pronounced antimuscarinic effects
tricyclics
What does fluoxetine inhibit?
CYP2D6
T/F SSRIs may not be as effective as tricyclics for severe depression
T
Why are tricyclics useful in genetic bedwetting?
Genetic bedwetting is due to delayed NS development. TCAs reduced REM sleep, because bedwetting occurs during REM sleep.
Onset of full therapeutic action of all antidepressants is delayed for ____weeks
3-4
How do women respond differently to antidepressants than men?
Women are prescribed antidepressants more, but Women have more adverse side effects and they may be less effective.
What is serotonin syndrome?
True psych emergency where there is clonus, hyperthermia, and muscular hypertonicity.
What is the SSRI discontinuation syndrome?
FINISH

Flu like syndrome
Insomnia
Nausea
Imbalance
Sensory disturbances
Hyperarousal
What are the most common side effects of tricyclics?
Due to anticholinergic effects. Act similar to atropine.

Dry mouth, constipation, diziness, blurred vision, tachycardia, urinary retention.
CV side effects can occur with which drugs?
tricyclic antidepressants.

Patients with existing CV illness are particularly susceptible.
Effective antidote for CV side effects occuring from TCA OD
physostigmine (AChEi)
How are MAO inhibitors thought to exert therapeutic effects?
by increasing the levels of synaptic NE and/or 5HT by irreversibly inhibiting one of enzymes responsible for metabolizing monoamines
MAO inhibitors may be most effective in what type of depression?
Those with atypical or anergic features.
What is tranylcypromine?
MAOI
What is imipramine?
Tertiary amine - tricyclic
What is desipramine?
Secondary amine - tricyclic
There is also some evidence that (what race?) may obtain higher blood levels and have higher incidence of side effects
non-Caucasians
Symptoms of drug interaction with MAOIs
Hypertension
Tachycardia
Diaphoresis