ch 13 mental health

Question 1

major depressive disorder diagnosis

Answer 1

5 or more of these sx’s in same 2 week period:

SIGECAPS
-Sleep: insomnia/hypersomnia, can’t STAY asleep
-Interest (depressed mood (marked diurnal variation, loss of interest or pleasure , irritability common in teens/children ***mandatory needed for dx
-guilt (feeling worthless)
-Energy (fatigue)
-concentration (diminished ability to think clearly or make decisions; feeling “stuck”)
-appetite: weight changes (inc or dec), loss of food enjoyment
-psychomotor (retardation or agitation: slow movement/thinking)
-Suicide (recurrent thoughts of death, passive thoughts with no plan is common)

Question 2

if sus for depression, always ask

Answer 2

if have thoughts about suicide or intent, and ask WHY, and always document everything!

Question 3

generalized anxiety disorder (GAD) diagnosis

Answer 3

3 or more of these sx’s on most days, for 6 or more months:

WATCHERS
-Worry: disproportionate to daily concerns, continue worry even if resolved
-Anxiety: mental and physical hyper vigilance
-Tension: muscle tension, GI upset others
-Concentration: “mind racing”
-Hyperarousal: irritability
-Energy loss: fatigue, chronically tired even enough rest/sleep
-Restlessness: “keyed up”
-Sleep disturbances

Question 4

screening tool for depression

Answer 4

PHQ-9 depression screening tool

Question 5

screening tool for anxiety

Answer 5

GAD -7

Question 6

overlapping sx’s of depression and GAD

Answer 6

depression: depressed, anhedonia/less pleasure, appetite disturbances, worthlessness, suicidal ideation
both: sleep disturbances, psychomotor agitation, diff concentration, irritability, fatigue
GAD: palpitation, muscle tension, sweating, dry mouth, nausea

Question 7

treatment goal of Depression and GAD

Answer 7

elimination of sx’s of dep and anxiety and restoration psychosocial and occupational function

Question 8

when stopping antidepressants…

Answer 8

-tapering meds over 6 or more weeks if tx cesssation desired to avoid antidepressant discontinuation syndrome.
-monitor for mood disorder relapse

Question 9

ask a pt with depression/anxiety (in choosing a therapeutic agent)…

Answer 9

what is the most bothersome symptom you have?
-vegetative sx’s: alt sleep, hypersomina, low libido, altered appetite, unexplained fatigue, psychomotor retardation, alt concentration, GI disturbance) present?
-energized or anxious

Question 10

what is SSRI good for?

Answer 10

best for lifting and smoothing mood
-most to least energizing: fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil)
-don’t want to give an energizing med that is super anxious; no sedating med for down pt

Question 11

what is SNRI good for?

Answer 11

lifting and smoothing mood PLUS increasing focus
-Venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq)
-helpful in anxious and/or resistant depression, potentially energizing

Question 12

what is SDRI good for?

Answer 12

selective dopamine reuptake inhibitor
-bupropion (Wellbutrin), potentially energizing, helpful as add on with SSRI with incomplete treatment response or solo agent

Question 13

what are anxiolytics good for?

Answer 13

alleviating hypervigilance a/s with anxiety, but use does not decrease worry
-benzodiazpeines, buspirone (BuSpar)

Question 14

most common adverse effects with psychotrophic med:

Answer 14

-sexual: anorgasmia (can’t orgasm), ED, alt libido (20-40%)
-FDA warning: inc suicidal thinking/behavior in those under 24 years old; reduced risk in adults 65 and older

Question 15

avoid this SSRI and med class in older adults

Answer 15

paroxetine (most sedating)
fluxoetine (longest half life)
TCA

Question 16

which SSRI has a dose limitation due to QT prolongation (increase risk ventricular dysrythmias, v tach, v fib, torsades de pointes)?

Answer 16

citalopram (Celexa)

Question 17

which SSRI has the LEAST drug interaction potential aka best one to use on someone on multiple meds?

Answer 17

escitalopram

Question 18

which SSRI has longest half life?

Answer 18

fluoxetine - avoid in older adults

Question 19

which SSRI has the most drug interaction potential?

Answer 19

fluoxetine most then paroxetine

Question 20

how long does it take for SSRI’s to take effect?

Answer 20

4-6 weeks

Question 21

antidepressant discontinuation syndrome

Answer 21

when SSRI, SNRI, TCA taken for 6 weeks or more then rapidly stopped.
-lasts ~1 week
-need to taper off med over 6 weeks to avoid this
bothersome but not life-threatening

F.I.N.I.S.H.H. (TCA only when taking full therapeutic dose (not a 1 time dose))
-Flu-like sx’s
-Insomnia
-Nausea
-Imbalance (dizziness, difficulty with coordination)
-Sensory disturbances (nightmares)
-Hyperarousal (anxiety/agitation)
-Headache

Question 22

which SSRI for a pt with major depressive disorder with anxious affect and on lots of meds?

Answer 22

escitalopram (0 drug interactions and not activating)

Question 23

2nd gen antipychotics (olanzapine/Zyprexa)

Answer 23

weight gain!!!
-worsening insulin resistance

Question 24

which provides the most accurate info on assessing for alcohol use disorder?

Answer 24

CAGE questionnaire is the MOST helpful way

Question 25

CAGE questionnaire

Answer 25

-Have you ever felt you ought to CUT down on drinking?
-Have people ANNOYED you by criticizing your drinking?
-Have you ever felt bad or GUILTY about your drinking?
-Have you ever had a drinking 1st thing in the morning to steady your nerves or get rid of a hangover *EYE opener

2 or more: positive

Question 26

DSM 5 criteria for substance use disorder

Answer 26

2 or more within past 12 months:
-substance use in larger amounts or over longer period than intended
-desired to cut down and/or has tried unsuccessfully in the past
-excessive time spent obtaining substance, using substance, or recovering from its effects
-craving
-can’t maintain major role obligations
-continued substance use despite recurrent social or interpersonal problems due to drug
-important social, job, recreational activities are given up or reduced due to drug
-tolerance = need more to feel it, diminished effect with same amount
-withdrawal: set of characteristic withdrawal sx’s, same or other substances taken to avoid withdrawal

Question 27

Codependence

Answer 27

-behavior of family members and friends that are strongly affected by the person’s substance use so they enable to avoid conflict
-they enable these behavior
-makes excuses for the person with SUD to protect the person with SUD
-provide funds