CV and Psych Flashcards
_____% of adult population has a mental disorder
_____% of people with mental disorders have medical conditions
____% of people with medical conditions
______% of adults with medical ocnditions have mental disorders
25%
68%
58%
29%
What happens to Cardiac risk factors in pts with depression. What about post-MI mortatlity?
doubles.. much higher CV risk
associated with increased mortality post-MI
Depression has etiologies of increased morbidity and mortality.
Behavioral risk include:
Physiologic risk factors include:
• Behavioral risk factors – Treatment non-adherence – Lifestyle factors – Personality types (A and D) • Physiologic risk factors – Autonomic nervous system dysfunction – Inflammation/Platelet reactivity – Hypothalamic pituitary adrenal (HPA) axis dysregulation
The link between beta-blockers and depression started with numerous case reports – There was a specific concern for the more \_\_\_\_\_\_\_ ones that more readily cross the blood-brain barrier Should people stop taking B Blockers?
lipophilic
No, styematic studies failed to find increased rates of depression:
W/ beta-blockers we do see:
– Drowsiness, fatigue, lethargy, and sleep disorders
What drugs will increase lithium concentrations (lithium is classic med for bipolar)
anti HTNs like
Thiazide diuretics
Loop diuretics and ACEi have varied risk of lithuim toxicity
How does thiazide cause lithium toxicity?
Thiazide diuretics increase lithium levels
– Due to their site of action on the distal tubal which causes a compensatory proximal tubular reabsorption of sodium and lithium
– Lithium levels are often increased by 20% to 40%
What things are we more concerned with then ACEi and loop diuretics causing lithium toxicity?
– Patient factors such as volume status, renal
function, polypharmacy, and other medical
comorbidities are often more important
predisposing factors of lithium toxicity than these medications
A young patient you are seeing been on an Paroxetine, an SSRI, for some time to regulate her depression. She is 30 years old and has hypertension. A classmate recommends because she is you, a selective Bblocker like Metoprolol would be excellent. Do you agree?
– Metoprolol is extensively metabolized via 2D6 and Paroxetine, an inhibitor of 2D6, has been shown to effect metoprolol metabolism
• 2x increase in both maximum plasma
concentration and terminal elimination half-life
• Decrease in exercise heart rate and SBP
You are seeing a pt for hypertension that is on Mirtazapine to help with anxiety and depression. What type of drugs to tx his hypertension would be a bad mix with Mirtazapine as it is an alpha-2 antagonist?
Clonidine is antiHTN by acting on central alpha-2 receptors; at high doses, mirtazapine competes and may displace clonidine thus lose the antiHTN effect
Woman at funeral.. horrible substernal chest pain and SOB
• Vitals– T 99.0, BP 106/50 mmHg, HR 112 bpm, RR 32/min, POx 89% on room air.
Physical Examinations
– Diaphoretic
– Jugular venous distension
– Crackles in the bilateral basilar lung fields
Physical Examinations
– Diaphoretic
– Jugular venous distension
– Crackles in the bilateral basilar lung fields
NEXT STEP?
– Administered O2, ASA, NTG, beta-blocker and diuretic
Take urgently to cardiac catheterization
Funeral woman before was taken to cath lab and we get results:
– All coronary arteries were patent with no marked obstruction
– The LV had a large, severely hypokinetic
to akinetic segment
– All other myocardial segments contracted normally
– The estimated ejection fraction was 25%
Dx?
Takotsubo cardiomyopathy
–> pt can have full recover
Mortality Rates and Schizophrenia • Standardized mortality ratio – All cause mortality rate: • Natural cause: • Unnatural cause: Main trend in mortality rates of schizophrenics
2.58 (so 2.5xs higher mortality then normal)
2.41
7.50
Mortality rates are INCREASING
What trend do we see with modifiable CVD risk factors in patients with Schizophrenia and Bipolar?
very much elevated, especially schizophrenics:
much higher for smoking in both, as well as obesity and metabolic syndrome
The diagnosis of schizophrenia associated with 34% increase risk of mortality following MI… why is this?
Suboptimal medical care; many pts with schizophrenia aren’t getting treated for the diesases they have such as: dyslipidemia, HTN and DM
describes a group of cardiometabolic risk factors associated with insulin resistance
Metabolic Syndrome
Metabolic syndrome is much higher in which populations of people according to the CATIE study
mental illness we see a double in metabolic sydrome, even more so in women with mental illness
What are some general etiologic concerns in pts with schizophrenia
General etiology concerns – Schizophrenia • Suspicion • Stigma • Negative symptoms • Executive dysfunction • Medications – Lifestyle • Sedentary lifestyle • Lack of regular physical activity • Poor food intake • Substance use • High rates of smoking
Olanzipine is used to tx bipolar and schizophrenia and has what concerning side effect?
weight gain; increased metabolic syndrome
What is the correlation between obesity, mental illness and medication
obesity is 2x more common in mental ill…
Clinical course of weight gain
– Weight gain tends to slow after the first year of treatment
– Longer-term progressive increases have been reported
• Risk factors for antipsychotic-induced
weight gain
– Demographic risk factors
- Younger age
- Lower initial BMI
- Personal or family history of obesity
- Non-white ethnic background
- Cannabis use
• Risk factors for antipsychotic-induced
weight gain
– Clinical risk factors:
- Choice of antipsychotic
* First episode psychosis/Previous antipsychotic exposure
