03 - 65 yo F with insomnia

Question 1

elderly patients with hyperthyroidism usually dont present with which of the usual symptoms?

Answer 1

• tachycardia

- weight loss

Question 2

what is the most common cause of suicide in the elderly?

Answer 2

drug overdose

Question 3

what is the SIGECAPS mnemonic for depression?

Answer 3

Sleep 
Interest (loss of) 
Guilt 
Energy 
Concentration 
Appetite 
Psychomotor retardation 
Suicidal ideation

Question 4

for a diagnosis of major depression you need a minimum of ___ / 9 criteria for a minimum of ____ weeks

Answer 4

• 5

- 2

Question 5

what are the side effects of SSRIs / SNRIs?

Answer 5

• headache
• sleep disturbances (drowsiness, insomnia)
• GI (nausea, diarrhea)
• sexual dysfunction
• hyponatremia
• serotonin syndrome (lethargy, restlessness, hypertonicity, rhabdomyolosis, renal failure)
• GI bleeding

Question 6

what is a major side effect of citalopram and escitalopram?

Answer 6

QT prolongation especially in the face of hypokalemia and hypomagnesemia

Question 7

what are the only evidence based criteria for efficacy for primary insomnia in the elderly?

Answer 7

• sleep restriction / compression

- multi-component CBT

Question 8

what is sleep restriction therapy?

Answer 8

• pt told to reduce sleep / in bed time to avg number of hours pt has actually been able to sleep over the last 2 weeks
• as sleep efficiency increases, time allowed in bed gradually increases by 15-20 minute intervals approximately once every 5 days until optimal sleep is obtained

Question 9

what is sleep compression?

Answer 9

• pt is counseled to decrease amount of time spent in bed gradually to match total sleep time rather than making an immediate substantial change

Question 10

in a first episode of depression, it is recommended that the patient take medication for _______ months

Answer 10

9-12

Question 11

recurrent episodes of depression require treatment with medication for _______

Answer 11

2-3 years

Question 12

what is the most likely antidepressant medication to cause discontinuation syndrome? why?

Answer 12

• paroxetine (Paxil)

- short half life

Question 13

what is the main side effect of citalopram?

Answer 13

QT prolongation

Question 14

which antidepressant is approved for GAD?

Answer 14

escitalopram