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05 Psych > 11 Mood disorders and related drugs > Flashcards

11 Mood disorders and related drugs Flashcards

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0
Q

Depression dagnosis and treatment ratios

A

50% undagnosed
25% untreated
25% Treated

60- 80% improve if treated

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1
Q

Mood disorder epidemiology etc

A
  • 4th in disability adjusted life years
  • same cost as heart disease
  • Low recognition rate
  • Highly treatable
  • 5% prevalence for dysthymic disorder and MDD
  • functional impairment exceeds: DM, HTN, Arthritis, Back problems, GI
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2
Q

Depression presentation

A 
Multiple Somatic complaints
Anxiety
"nerves, headaches" mex
"Weakness, imbalance"chinese
"heartbroken" hopi
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3
Q

Symptom and psychiatric rates

A

Greater number of symptoms associated with prevalance of psychiatric disorders.

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4
Q

Major depressive episode

A

5 symptoms at least two weeks with depressed moos or ahedonia

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5
Q

Depression criteria

A
  • 2 weeks or more
  • SIGECAPS 5 of 9
  • clinically significant distress
  • Not substance or medical condition
  • not bereavement
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6
Q

PH9 scoring

A

several days-1pt
More than 1/2 - 2pt
Every day - 3pt

5-9 stable
10-14dysthymia or mild depression TX?
15-19 MDD TX
>20 SEVERE MDD- TX meds and psychotherapy

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7
Q

Suicide red flags

A

ISPATHWARM

ideation
substance abuse
purposeless
anxiety 
trapped
hopelessness
Withdrawl
anger
recklessness
mood swings
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8
Q

Bereavement stages

A

Stage 1: shock
*numbness, unreality - crying abdominal pang/empptiness, sighing, tightness in throat- thoughts of denial or disbelief

Stage 2: Preocupation
*guilt, anger, sadness- weakness, anorexia, insomnia, fatigue- dreams and thoughts of deceased- ahedonia and introversion

Stage 3:Resolution
*Thinks of past with pleasure- regains interest, new relationships formed

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9
Q

TCAs

A

Imipramine, Amitryptyline, Desipramine, Nortryptyline, Doxepin, Clomipramine, Maprotilene, Amoxapine, protriptyline, trimipramine

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10
Q

SSRIs

A

Fluoxetine, sertraline, paroxetine, citalopram, fluvoxamine, escitalopram

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11
Q

SSRI SE

A 
HA/dizziness
N,D,Constipation
Somnolence/insomnia
Sweating/tremor/dry mouth
Anxiety/restlessness
Sexual drive
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12
Q

Atypical antidepressants

A

Buproprion, trazodone, nefazodone, venlaflaxine, mirtazapine, duloxetine, alprazolam

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13
Q

MAOi

A 
Phenelzine
Isocarboxazid
Tranylcypramine
selegiline 
RIMA
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14
Q

Additional treatments

A 
Lithium
Psychotherapy
ECT
Vagal nerve stimulation
Transcranial Magnetic stim
Deep brain stim
*St john's wort, Sam-E, Reboxetine
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15
Q

Depression outcomes

A 
Response
Remission
Relapse
Recovery
Recurrence
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16
Q

Bipolar general info

A

2.6% 1 year prevalence
1% lifetime prevalence
4.4% lifetime rate in us
15% suicide rateq

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17
Q

Manic episode

A

*Distinct period >1 week
*Elevated or expansive mood (abnormal and persistent)
*Irritable mood
*Severe
Traits:
*Grandiosity
*Decreased need for sleep
*Hyperverbal/pressured speech
*Flight of ideas
*distractability
*Psychomotor agitation and goal seeking actvity
*Pleasurable activity with painful consequences

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18
Q

Mania Stage 1

A
  • increased Psychomotor activity and increased rate of speech
  • Labile mood/euphoria
  • Grandiosity
  • Tagential but coherant thoughts
  • Sexual preocupation, religion, spending, letter writing,
  • High but not out of control
19
Q

Mania Stage 2

A
  • Pressured speech, ^ psychomotor activity
  • Dysphoric mood/depression
  • Hostility/anger
  • Explosive/assultive behavior
  • Flight of ideas
  • Delusional preoccupations
20
Q

Stage3 mania

A
  • Desperate/panic stricken
  • Loose associations
  • bizzare idiosyncratic delusions
  • hallucinations
  • disorientation
  • ideas of reference
21
Q

NE pathways

A

Loccus ceruleans to cerebellum and around limbic system

22
Q

Serotonin pathways

A

Raphe nucleus to limbic, cingulate gyrus, basal ganglia, and neocortex

23
Q

Mirtazapine MOA

A

alpha 2, 5ht2, 5ht3 antagonist- antagonizes presynapic receptors

24
Q

SSRIs

A
  • Fluoxetine, paroxetine, sertraline, citalopram, escitalopram,
  • Less acute tox than TCA MAOI
  • Similar in effectiveness to TCAs
  • nausea, insomnia, sexual dysfunction
  • Serotonin rxn if mixed with MAOIs - hyperthemia, muscle rigidity, CV collapse
25
Q

SSRI withdrawl

A

Dz/Lightheaded, Vertigo/faint, shock like, paresthesia, anxiety, diarrhea, fatigue, gait instability, HA, insomnia, irritability, NV, tremor, visual disturbances

26
Q

SSRI usage

A 
MDD,
OCD (high dose
SAD
PTSD
GAD
PMS
Hot flashes
27
Q

Fluoxetine*

A
  • Affects meetabolism
  • 7 day halflife on active metabolite
  • Sustained release formulation available
28
Q

Sertraline*

A

Shorter half life than fluoxetine
Less metabolism interaction
*OCD, PTSD, Panic attacks

29
Q

Paroxetine*

A

Same but hot flashes as well

30
Q

Fluvoxamine

A

OCD

31
Q

SNRIs

A

*Venlafaxine- Anxiety and depression
*Duloxetine- MDD/anxiety, Fibromyalgia (care with liver DZ)
Minacipran-fibromyalgia and MDD

32
Q

Buproprion***

A

Atypical

  • DNRI
  • Tobacco cessation, SAD
  • No weight gain or sexual dysfunction
33
Q

Mirtazapine***

A

Atypical
Blocks presynaptic alpha2, 5ht2, 5HT3, H2 antagonist
*increases appetite

34
Q

Trazodone

A

Atypical
Weak SSRI
*Sedating and used for insomnia
*CV SE, TrazaBONE

35
Q

Vortioxetine

A

Atypical
MDD
SSRI-like + 5ht1 and 5HT3

37
Q

TCA effects

A
  • Decreased REM and Stage 3/4 sleep
  • Prominant anticholinergic
  • dry mouth, blurred vision, urinary retention
  • sedation
  • orthostatic
  • cardiac abnormalities (increased NE—> palp, lengthened QRS, T wave abnormalities)
38
Q

TCA OD

A 
Hyperpyrexia- exceptionally high fever
BP changes
Cardiac conduction abnormalities
Seizures
coma

Tx- Supportive with 3 days of observation (long t1/2)

39
Q

TCA Drug interactions

A

Guanethidine- blocks uptake
Sympathomimetics
Absorption and metabolism of other drugs

40
Q

TCA indications

A

MDD
Enuresis in kids- imipramine
Chronic pain-amitryptyline
OCD-Clomipramine and SSRIs

41
Q

MAOi

A

Phenelzine***, Tranylcypromine - MDD, Narcolepsy

  • Improves depressed mood
  • Corrects depression sleep disorders
  • Stimulation in normals
  • Lowers BP- orthostasis
  • Tox–> Agitation, hallucinations, hyperpyrexia convusions, BP changes
42
Q

Tyramine

A

MAO inhibs stop breakdown

Causes NE release and hypertensive crisis

43
Q

Refractory depression

A
  • Antipsychotic augmentation
  • Olanzapine
  • Aripriprazole
  • Quietapine
  • Ketamine-experimental
  • Physiological
  • ECT
  • TMS (transcranial magnetic)
  • DBS (deep brain stimulation)
44
Q

St. John’s wort

A

MAOi
Might help with mild depression
3A4 induction - inhibits Birth control, Aids drugs, cyclosporine

57
Q

TCA drugs and mechanisms.

A

Imipramine, Amitryptyline

Block serotonin and NE reuptake

05 Psych (8 decks)

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