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44 Cards in this Set
- Front
- Back
Suicide gesture: defn
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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
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Suicide attempt: defn
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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.
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What are the risk factors for suicide?
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SAD PEOPLES
Sex Age Depression Professions Ethnicity Organic factors Personality Disorders Loss EtOH and drugs Schizophrenia |
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Peak age for men vs women completing suicide
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Men: 45
Women: 55 |
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Most common dx in those who attempt and complete suicide
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Depression
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Suicide risk increases, decreases as SES increases
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Increases
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WHat is the suicide rate for male vs female physicians when compared to general population?
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males: 2-3x
females: 5x |
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Most frequent method of completed suicide in physicians
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lethal drug OD
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What race has the highest risk of suicide?
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whites
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Low levels of ________ are associated with violent suicide attempts
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CSF 5-HIAA (5HT metabolite)
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T/F Most people who commit suicide have a serious illness at time of death (terminal illness generally like cancer etc)
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T
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What is the personality disorder with greatest risk of suicide?
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Antisocial Personality Disorder
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Lifetime risk of suicide for alcoholic patients is ____ the rate of general population
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120x
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When are patients with schizophrenia at highest risk of suicide?
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During the early stages of active illness or during relapse.
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What are the stages of grief expressed in crisis?
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1) Denial
2) Anger 3) Bargaining 4) Depression 5) Acceptance |
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What are interventions with individuals in crisis?
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Recognition of the stage of crisis response.
"normalize" the response of the individual, NOT minimize. Empathic response is helpful. |
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How many patients see their primary care physicians in the month preceding their suicide?
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2/3 (almost half in the week before!!)
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How many patients are prescribed a psychotropic med by their primary care physicians preceding their suicide?
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2/3. Most it's a hypnotic
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Nearly all antidepressant treatments over time result in down-regulation of _____ and _____ receptors
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post synaptic β adrenergic receptors;
presynaptic 5HT<sub>1a</sub> receptors. |
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What are the original tricyclic antidepressants? (2)
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imipramine
desipramine |
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tricyclic antidepressants: MOA
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block reuptake of NE and/or 5HT.
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what are the tertiary amines?
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imipramine, amitriptyline
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Bupropion MOA
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DA reuptake inhibition
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What are the secondary amines?
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desipramine and nortriptyline
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What are the tertiary amines?
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imipramine and amitriptyline
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What are the side effects of the tertiary amines and why?
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More sedating because they block 5HT reuptake in addition to NE reuptake.
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Antidepressants with pronounced antimuscarinic effects
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tricyclics
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What does fluoxetine inhibit?
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CYP2D6
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T/F SSRIs may not be as effective as tricyclics for severe depression
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T
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Why are tricyclics useful in genetic bedwetting?
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Genetic bedwetting is due to delayed NS development. TCAs reduced REM sleep, because bedwetting occurs during REM sleep.
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Onset of full therapeutic action of all antidepressants is delayed for ____weeks
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3-4
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How do women respond differently to antidepressants than men?
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Women are prescribed antidepressants more, but Women have more adverse side effects and they may be less effective.
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What is serotonin syndrome?
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True psych emergency where there is clonus, hyperthermia, and muscular hypertonicity.
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What is the SSRI discontinuation syndrome?
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FINISH
Flu like syndrome Insomnia Nausea Imbalance Sensory disturbances Hyperarousal |
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What are the most common side effects of tricyclics?
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Due to anticholinergic effects. Act similar to atropine.
Dry mouth, constipation, diziness, blurred vision, tachycardia, urinary retention. |
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CV side effects can occur with which drugs?
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tricyclic antidepressants.
Patients with existing CV illness are particularly susceptible. |
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Effective antidote for CV side effects occuring from TCA OD
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physostigmine (AChEi)
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How are MAO inhibitors thought to exert therapeutic effects?
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by increasing the levels of synaptic NE and/or 5HT by irreversibly inhibiting one of enzymes responsible for metabolizing monoamines
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MAO inhibitors may be most effective in what type of depression?
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Those with atypical or anergic features.
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What is tranylcypromine?
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MAOI
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What is imipramine?
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Tertiary amine - tricyclic
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What is desipramine?
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Secondary amine - tricyclic
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There is also some evidence that (what race?) may obtain higher blood levels and have higher incidence of side effects
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non-Caucasians
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Symptoms of drug interaction with MAOIs
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Hypertension
Tachycardia Diaphoresis |