ch 13 mental health Flashcards
major depressive disorder diagnosis
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)
if sus for depression, always ask
if have thoughts about suicide or intent, and ask WHY, and always document everything!
generalized anxiety disorder (GAD) diagnosis
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
screening tool for depression
PHQ-9 depression screening tool
screening tool for anxiety
GAD -7
overlapping sx’s of depression and GAD
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
treatment goal of Depression and GAD
elimination of sx’s of dep and anxiety and restoration psychosocial and occupational function
when stopping antidepressants…
-tapering meds over 6 or more weeks if tx cesssation desired to avoid antidepressant discontinuation syndrome.
-monitor for mood disorder relapse
ask a pt with depression/anxiety (in choosing a therapeutic agent)…
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
what is SSRI good for?
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
what is SNRI good for?
lifting and smoothing mood PLUS increasing focus
-Venlafaxine (Effexor), duloxetine (Cymbalta), desvenlafaxine (Pristiq)
-helpful in anxious and/or resistant depression, potentially energizing
what is SDRI good for?
selective dopamine reuptake inhibitor
-bupropion (Wellbutrin), potentially energizing, helpful as add on with SSRI with incomplete treatment response or solo agent
what are anxiolytics good for?
alleviating hypervigilance a/s with anxiety, but use does not decrease worry
-benzodiazpeines, buspirone (BuSpar)
most common adverse effects with psychotrophic med:
-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
avoid this SSRI and med class in older adults
paroxetine (most sedating)
fluxoetine (longest half life)
TCA
which SSRI has a dose limitation due to QT prolongation (increase risk ventricular dysrythmias, v tach, v fib, torsades de pointes)?
citalopram (Celexa)
which SSRI has the LEAST drug interaction potential aka best one to use on someone on multiple meds?
escitalopram
which SSRI has longest half life?
fluoxetine - avoid in older adults
which SSRI has the most drug interaction potential?
fluoxetine most then paroxetine
how long does it take for SSRI’s to take effect?
4-6 weeks
antidepressant discontinuation syndrome
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
which SSRI for a pt with major depressive disorder with anxious affect and on lots of meds?
escitalopram (0 drug interactions and not activating)
2nd gen antipychotics (olanzapine/Zyprexa)
weight gain!!!
-worsening insulin resistance
which provides the most accurate info on assessing for alcohol use disorder?
CAGE questionnaire is the MOST helpful way
CAGE questionnaire
-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
DSM 5 criteria for substance use disorder
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
Codependence
-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
