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Reasoning in mental health 2 > Class 3 > Flashcards

Class 3 Flashcards

1
Q

CBT for SAD

A

exposure (rehearsals: start with simple things then work your way up/ flooding) + restructuring and challenging maladaptive thoughts: when people have negative emotions = negative thoughts, vicious cycle. Thoughts: I’m not good enough, people don’t lie me, I’m weak and people can see that. Pretend survey. Talk to a friend/ coworker.

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2
Q

How to chose Rx

A

Family members? Taken? Side effects? Half life (manic switch)?

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3
Q

1st line SAD

A

SSRI: escitalopram(Cipralex), fluvoxamine + CR, paroxetine + CR, sertraline
SNRI: Venlafaxine XR
Pregabalin

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4
Q

Side effects SSRI

A

: no, diarrhea, headache, insomnia, irritability, increased anxiety, somnolence (2 weeks), long term: weight gain, sexual dysfunction. GI, heart problems, manic symptoms, bipolar in the family

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5
Q

Which SSRIs are associated with less weight gain

A

• fluoxetine, citalopram and sertraline associated with less weight gain than paroxetine.

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6
Q

Which SSRI is associated with more sexual side effects and more withdrawal symptoms

A

paroxetine

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7
Q

Which SSRI is associated with more diarrhea

A

sertraline

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8
Q

Which SSRI is associated with less withdrawal symptoms

A

fluoxetine

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9
Q

Which SSRI to use if patient also has pain

A

paroxetine and duloxetine

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10
Q

Which class of antidepressants increases chances of GI bleeding

A

SSRI

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11
Q

Which classes of antidepressants are associated with QTc prolongation

A

Tricyclic and tetracyclic antidepressants and selective serotonin reuptake inhibitors.
SNRIs have a better side effect profile

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12
Q

Risk factors for QT prolongation

A 
Heart disease or cardiac abnormalities 
Over 65
Female 
Electrolyte abnormalities (hypoCa/Mg) 
Bradycardia 
Genetic factors/ congenital QT syndrome
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13
Q

Antidepressants with higher risk of QTc prolongation

A

citalopram, escitalopram, venlafaxine, mirtazapine, amitriptyline, imipramine, nortriptyline, clomipramine, trimipramine, desipramine, maprotiline, mirtazapine

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14
Q

2n line SAD

A

Benzo: clonazepam, alprzolam, bramazepam:
Antidep: citalopram (celexa), phenlazine
Anticonvuls: gabapentin

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15
Q

Why use benzos SAD

A

single presentation, try medication before, 2 weeks away, help with exposure.

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16
Q

Side effects benzos

A

sedation, dizziness, weakness, ataxia, decreased motor performance, DEPENDANCE, WITHDRAWAL.

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17
Q

Side effects MAOIs

A

Dry mouth, Nausea, diarrhea or constipation, Headache, Drowsiness, Insomnia, Dizziness or lightheadedness. MAOIscan cause dangerous interactions with certain foods and beverages. You’ll need to avoid foods containing high levels of tyramine ― an amino acid that regulates blood pressure

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18
Q

Side effects gabapentin

A

GI, weight gain, somnolence, tremor, rash, toxic epidermal necrolysis

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19
Q

SAD performance only Rx

A

Propanolol, Tenormin; block beta adrenergic receptor activity

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20
Q

SSRIs: onset, full response, titrage dose

A

2-8 weeks onset of symptom relief. Full response: 12 weeks. Titrage dose: every 1-2 weeks.

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21
Q

Aggravating factors SAD

A

general stress, big life events, depression

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22
Q

signs of relapse SAD

A

morbid state, start avoiding more, difficulty sleeping, low mood, isolation, low energy, trouble concentrating

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23
Q

Goal of therapy

A

you can learn to tolerate and cope with the things you’re afraid of, better than you think you can, not be so frightened of your fear, more confidence in your ability to get through it

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24
Q

Tolerability of therapy

A

it’s going to be hard, work on your part, what you do outside of therapy.

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25
Q

Prevent relapse

A

“booster shots”

26
Q

Treatment plan

A

Treatment plan: If a treatment relationship is to be established (structure, frequency, goal, expectations of engagement), recommended treatment + options (medication risks + benefits), referrals, psychosocial interventions, consent for collaboration with specialist/ primary care physician, safety planning + contact information.
Algorithm of steps.

27
Q

Sudden onset of panic attacks

A

investigate cardio more

28
Q

Therapy for panic disorder

A

CBT: exposure + restructuring and challenging maladaptive thoughts. exposure to physical symptoms that they’re afraid of. Create panic symptoms: make them run up and down flight of stairs, breathe into a paper bag, spin on a chair, wear a bunch of layers of clothes, breathe through a straw. Can also do situational exposures. Cognitive therapy: identify anxious thoughts.
Noninvasive brain stimulation using a radioelectric asymmetric conveyor, aerobic exercise, capnometry respiratory training

29
Q

Main difference in CBT across dx

A

type of exposure.

30
Q

2 parts in exposure

A

: Do the thing you’re afraid+ don’t do the thing you usually do to cope

31
Q

1st line medication for panic disorder

A

SSRI: citalopram + CR, fluoxetine, fluvoxamine, paroxetine + CR, sertraline. SNRI: venlafaxine XR

32
Q

2nd line medication for panic disorder

A

TCAs: clomipramine, imipramine
other antidep: reboxetine, mirtazapine
benzos: alprazolam, clonazepam, lorazepam, diazepam.

33
Q

side effects TCAs

A

Drowsiness, Blurred vision, Constipation
Dry mouth, Drop in blood pressure when moving from sitting to standing, which can cause lightheadedness, Urine retention. Disorientation or confusion, particularly in older people when the dosage is too high, Increased or irregular heart rate, More-frequent seizures in people who have seizures

34
Q

What to verify before initiating medication

A

SUD, heart condition

35
Q

How to initiate antidepressants

A

Start low (symptoms of anxiety), go slow, increase every 1-2 weeks

36
Q

What to do if the person has depression and panic disorder

A

1st line for panic and 1st line for depression: sertraline, Venlafaxine XR, Paxil, Luvox, celexa

37
Q

Acceptance and commitment therapy

A

changing the way you think about your thinking/ feelings, people must commitment to behaviors that are consistent with their values.

38
Q

CBT for GAD

A

expose to worst case scenario: write out a script/ tell stories, future predictions: anxious because they’re thinking through every option, really afraid of not knowing: expose to uncertainty, help to learn how to tolerate uncertainty ex: write an email and not double checking for punctuation/ go to a restaurant, order whatever without looking, Like worrying because makes them feel prepared: challenge that belief, come up with ways to test that: don’t prepare for something (behavioral experiments) other have negative beliefs about worry: worry about worrying: certain amount of worry is healthy= know that that thing matters to you. Dysfunctional vs functional worry. Problem solving strategies

39
Q

other non pharmacological for GAD

A

acupuncture, aerobic exercise, relaxation techniques: muscle relaxtion(muscles tension, restlessness).

40
Q

1st line GAD

A

Agomelatine, duloxetine, excitalopram, paroxetine + CR, pregabalin, sertraline, venlafaxine XR

41
Q

2nd line GAD

A

Benzo: alprazolam, bromazepam, diazepam, lorazepam

TCAs and other antidepressants: imipramine, bupropion XL, vortioxetine, Seroquel XR, burspirone, hydroxyzine

42
Q

Buspirone mecanism

A

partial agonist of 5-HT1a receptor

43
Q

how long GAD take Rx

A

1-2 years, may be all their lives.

44
Q

Why not prescribe bentos

A

Dependence, withdrawal. SUD, over 65. crutch

45
Q

CBT for OCD

A

ERP: exposure and response prevention: count less numbers. Pill counter: what are you thinking, count them once and out that in the bottle, how did that feel. Wait 2 minutes, 5 minutes, 10 minutes. Do it again. Show me how you wash your hands. Practice washing and then not wasking their hands. Touch something contaminated. Contaminate another person.

46
Q

other therapy for OCD

A

aceptance and commitment therapy (not taking thoughts so seriously), modular cognitive therapy (OCD beliefs, doubts), organizational training, mindfulness, bibliotherapy, RTMS, surgery

47
Q

What’s special about prescribing for OCD

A

higher doses of antidepressants

48
Q

1st line OCD

A

SSRI: escitalopram, fluoxetine, fluvoxamine, sertraline

49
Q

2nd line OCD

A

clomipramine, citalopram, mirtazapine, venlafaxine XR

50
Q

Adj in OCD

A
  1. Abilify, Risperdal
  2. memantine, Seroquel, topiramate
  3. Zyprexa, ziprasidone, Haldol, mirtazapine, amisulpride, lamotrigine, pregabalin, celecoxib, granisetron, ketamine IV, ondansetron, N-acetylcysteine, riluzole
51
Q

When to use antipsychotics in OCD

A

when they’re using magical thinking, don’t sleep well very anxious

52
Q

What patient factors in OCD affect the response rates to treatment?

A

insight, family that accomadates behaviors, pt’s motivation, how the person understands their own problems

53
Q

Aggravating factors OCD

A

more symptomatic when under more stress, triggers

54
Q

Signs of relapse OCD

A

re-emergence of obsessions, compulsions, that’s an OCD thought

55
Q

What is the general risk of suicide in patients with anxiety related disorders?

A

1.7-2.5 times more at risk for a suicide attempt. Social anxiety and panic disorder, the risk id 20 times higher than the general population.

56
Q

how does the presence of a co-morbid mood disorder affect the suicide risk?

A

Increases the risk. More agitated = more desperate, looking for a way out = suicide

57
Q

Therapy adjustment disorder

A

CBT: coping mechanisms. Relaxation, meditation, mindfulness, deep breathing, sleep, eating, exercise, pleasant activities, validating. Depathologize.

58
Q

NP for someone with adjustment disorder

A

mental health assessment, leave of absence, health promotion/ prevention initiate treatment plan, follow up, safety plan.

59
Q

Selective mutism looking defiant

A

protective mechanism: don’t hurt me

60
Q

Selective mutism therapy

A

CBT
External reinforcement: rewards: encouragements, small rewards, stars on a chart, time limited. Tell teacher. Explore what her concerns are. General coping statements: it’s going to be okay. Storybooks, fear thermometer.
Opportunities to talk to strangers in non threatening environments: going to the movies, go buy the ticket.

61
Q

scales to monitor improvement

A

clinical global impression

hamilton anxiety scale

62
Q

specific phobias treatment

A

CBT, pharmaco not really recommended

Reasoning in mental health 2 (6 decks)

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