Anhydonia or depressed mood for at least 2 wks PLUS 4 or more: - fatigue/low energy - insomnia or hypersomnia - loss/inc in appetite/weight change - psychomotor retardation or agitation - suicidal ideation - guilt or feelings of worthlessness Every psychiatrist uses- SIG E CAPS Minor depression have 2-4, or fewer than 5 SIG E CAPS(some pts have >4 but not present most of day nearly everyday

5 psychiatric Disorders Flashcards by Susan Johnston

Depression screen

Pick one. All have pros and cons.

Eval Hx, PE, labs to r/o med condition that mimics depression

How well did you know this?

Not at all

Perfectly

Common side effects of SSRI

Decreased libido and weight gain

How well did you know this?

Not at all

Perfectly

64 yo pt w low energy inc appetite and wt gain. Did depression screen. How else should she be evaluated?

Lab studies with TSH

Hypothyroidism is so common in women >50

How well did you know this?

Not at all

Perfectly

Initial eval depression

CBC
Electrolytes 
Glucose
BUN Creatinine, liver enzymes
TSH (esp females > 50)
Serum B12 and folate
EKG. Dysthymia

How well did you know this?

Not at all

Perfectly

How do we diagnose?

DSM 5 Depression
MDD is unipolar
Bipolar is mania and depression

How well did you know this?

Not at all

Perfectly

Anhedonia

Anythingthat made u happy before doesnt anymore (for atleast 2 wks)

How well did you know this?

Not at all

Perfectly

MDD DX

Anhydonia or depressed mood for at least 2 wks PLUS 4 or more:

fatigue/low energy
insomnia or hypersomnia
loss/inc in appetite/weight change
psychomotor retardation or agitation
suicidal ideation
guilt or feelings of worthlessness

Every psychiatrist uses- SIG E CAPS
Minor depression have 2-4, or fewer than 5 SIG E CAPS(some pts have >4 but not present most of day nearly everyday

How well did you know this?

Not at all

Perfectly

Every psychiatrist uses- SIG E CAPS for MDD Dx

S. Sleep issues. Time go to bed and wake up
I interest. Anhydonia
G. Guilt or worthlessness. Dont care if live or die
E energy. Low and they steal yours!
C concentration difficulties. Nothing sticks
A. Appetite. Get their wt every single visit
S. Suicidality

5 or more check=. Depression!

How well did you know this?

Not at all

Perfectly

Classic sleep disorder found in depressed pts

Early morning wakening

How well did you know this?

Not at all

Perfectly

What 3 neurotransmitters control mood?

Serotonin- produces happiness, deep breath, enjoy life

Dopamine and norepinephrine- makes u worry, increase vigilance and motivation/concentration

How well did you know this?

Not at all

Perfectly

Explain how neurotransmitters work with SSRIs and Stratera

SSRI. Selective serotonin reuptake inhibitor. Serotonin betters mood

Stratera- selective norepinephrin reuptake inhibitor. Norepinephrine increases focus and concentration

How well did you know this?

Not at all

Perfectly

DSM V. Four subtypes of depression

Melancholic- Mr. wilson! Exam- *elderly. 25-30% pts
Atypical- women>men. Mult suicide attempts, inter personal rejection sensitivity “nobody likes me”
Anxious depression-40-50% pts. Older, unemployed, restless, agitated, ruminate, difficult to tx
Psychotic depression-15-20% MDD pts.- smallest grp. Fxnal impairment. Diff to Tx. Refer

How well did you know this?

Not at all

Perfectly

DSM V. Depressive subgrps

Seasonal affective disorder. Bupropion, light therapy

Postpartum depression/psychosis: w in 4 wks of delivery (most PP mood changes resolve w in 10 d). 13% of preg women. Edinburgh PP dep scale

How well did you know this?

Not at all

Perfectly

Exam!

Depression vs normal grief

Normal grief:
Comes in waves w thoughts of the loss
Decreases intensity over time
* no specific window of time- e body diff

Bereavement does not include:
Persistent depressed mood
Pervasive unhappiness
Self critical/ pessimistic rumination
Suicidal thoughts
Feelings of worthlessness

How well did you know this?

Not at all

Perfectly

Pharmocology of depression
First gen- 2. Safety a problem
Second gen- safer
Atypical antipsychotics

1st. MAOIS, TCAs
2nd. SSRI. SNRIs
Atypical antipsychotics Zyprexa, Seroquel, Risperdal, Abilify

How well did you know this?

Not at all

Perfectly

Which drug for minor depressive disorder should be avoided in the elderly?
Name root letters from this class

TCAs!!! Bc of anticholinergic effects- dry mouth. Blurred vision. Constipation. Urinary retention. Tachycardia. Confusion. Delirium. - in elderly: confusion. Memory impairment, hallucinations

Tri, ipr, oxepin

Doxepin. Amitriptyline. Nortriptyline. Clomipramine. Desipramine. Imipramine

How well did you know this?

Not at all

Perfectly

Pt needs depression med and is elderly. Which one should be avoided?

Sertraline
Paroxetine
Bupropion
Desipramine

Desipramine. No TCAs w elderly- anticholinergic

SSRI mnemonics

A parrot serves citrus fruit
Paroxitine. Sertraline citalopram/escitalopram, fluoxetine

Effective for sadness, panic, and compulsions
Escitalopram. Fluoxetine. Sertraline. Paroxitine. Citalopram

SSRI. Acronymn for adverse effects

S S S

Stomach upset
Sexual dysfunction
Serotonin syndrome

But generally safe

MAOI drugs for depression mnemonic

Tranys use funnels

Tranylcypromine. Phenelzine

If a depressed pt becomes suicidal and consumes 30 d of her antidepressant med, which one likely to result in death?

Paroxitine
Sertraline
Amitriptyline
Fluoxetine

TCA!!!! (Tri, ipr, oxepin). **Very dangerous!!

Amitriptyline no!

Atypical antipsychotics mnemonic

Rich clumsy old queens are fat

Risperidone- Risperdol
Clozapine- clozaril. (Dont confuse w Benzo Clonazepam-Klonipin)
Olanzapine- zyprexa
Quetiapine- Seroquel
Aripiprazole- Abilify

Fat is to link these w s.e.- wt gain!!!!

Which atypical antidepressent has a great side effect profile?

Bupropion (Wellbutrin)

Works with Dopamine
No serotonin so no libido and wt gain issues!

No wt gain, drowsiness, orthostatic hypotension, or sex dysfxn!

Watch B/P - may go up early in course

How long is pharm mngt in depression necessary?

Should cont 4-12 m after sxs relieved

Or, if 2 or more episodes, consider 15m-2yrs

Also w therapy

Highest suicide risk

Elderly male with gun in home

3 suicide screen questions

1. R u thinking of hurtin urself? 2. If yes do u hv plan? 3. If yes. Do u hv means? Risk factors Prior attempt Dual dx Inc age. Male gender

Suicide mngt

Estab. Safe enviroment Negotiate do not harm contract Provide resources, suicide hotline

A pt w depression has begun cycling and has manic episodes 1 wk after starting Fluoxetine. What is causing sxs? Drug dgug interaction Adverse drug effect Bipolar disorder Serotonin syndrome

Bipolar!

If bipolar is treated as unipolar

MUCH worse! Mood switches Cycling- goes back n forth quickly Agitated states

Tx for bipolar

Refer! Just make sure u dont treat them for unipolar! Need mood stabilizer- Lithium Atypical antipsychotic or combo. Plus antidepressant Or ECT

Pharm mngt for Anxiety

Benzodiazepines Buspirone (Buspar). An anioxolitic psychotropic Antidepressants ssri. Tcas Beta blockers

Benzos end in What schedule?

Lam or pam Sched 4 Work grt if used well- but cause dependance

Name brand names of benzos

Valium Xanax Atavan Ambien

What drug best for exam anxiety?

Beta blocker Good for when u need to keep ur wits about u (Benzo not good) Also good for tremors and palpitations (adrenergic excess) Propranolol 10 mg

Which med is associated w lowest rate of sex dysfxn when used in a pt being treated for depression? Paroxetine Buproprion Duloxetine Venlafaxine

Buproprion. Only one that is not a SSRI

With depression dx, what other disease should be screened for? Diabetes Hypertension Arrhythmias Bipolar disorder

Bipolar- ask and document!!!!

Exam****. Herb ???s What herb is communly used to treat depression? Echinacea Black Cohosh St. John's wart Milk thistle

St. John's wart The herb that gives herbs a bad name bc many drug-drug interactions A "3a4" inhibitor- it prevents cytochrome P450 system from metabolizing drugs. Can cause an acceleration of drug metabolism- so other drugs pt is taking have decreased potency Ex. People on HIV antiviral drugs took St. john's wart and their viral load shot way up bc herb decreased efficacy of antiviral....

A patient takes alprazolam prn for anxiety. She started taking St. john's wart for depression. What effect will this have? No effect will be realized Increased potency of alprazolam Decreased potency of alprazolam Increased effect of St. John's wart

Decreased potency of alprazolam bc St. john's wart metabolizes other drugs very rapidly so u need them again quickly Ie. Like a wart growing over something so it covers it up and can't work....

A pt is taking fluoxetine for depression. She develops a cough and takes dextromethorphan OTC. What is she at inc risk for? Hepatotoxicity Serotonin syndrome Suicide Manis

Serotonin syndrome Serotonin can't be metabolized- sxs- sleepy, irritable, or coma or cardiac arrest Lawsuit with college girl that died from being given something for tremors in hosp and she was on a SSRI and she got 108d fever and cardiac arrest

An NP student has severe test anxiety. What med could he take to relieve his anxiety prior to the exam? 50 mg Sertraline (Zoloft) for 6-8 wks prior to exam Low dose alprazolam 45 min before exam Propanolol 60 min before exam 200 mg Sertraline daily for 6-8 wks before exam

Propanolol 60 min before exam. Only one 10 mg dose -will last

If the test anxiety NP student took Alprazolam(benzo) before exam and slept through it and subsequently failed, what could happen legally to you as the prescriber? ``` You could be sued for negligence You could be sued You could be sued for malpractice You are not responsible for legally for his exam failure Y ```

*this- You could be sued for malpractice- "professional" negligence is malpractice You could be sued for negligence.- no this is not for professionals You could be sued You are not responsible for legally for his exam failure