depression and anxiety Flashcards
how to diagnose depression
more than 5 symptoms during 2 weeks at least loss of interest must be present: weight changes insomnia fatigue worthlessness suicidal ideation indecisiveness impaired thinking retardation
exclusion for depression
manic or hypomanic episode
depressive episode not explained schizophrenia, delusion or psychotic disorder
monoamine oxidase inhibtors
discontinued due to interaction with foodstuffs and medicines
inhibit MAO and tyramine breakdown
SSRIs
fluoxetine
better side effects
inhibit serotonin re-uptake
side effects of SSRIs
anxiety drowsiness insomnia sexual dysfunction Nausea drug interactions
serotonin syndromme
confusion
tremor
clonus, hyperreflexis, rigidity
fever, sweating, tachycardia and tachypnoea and diarrhoea
difference between the two types of bipolar
Bipolar type 1 is defined as the occurrence of at least one manic or mixed (full mania and full depression simultaneously) episode. Patients with bipolar disorder 1 typically experience major depressive episodes as well, although this is not necessary for bipolar 1 diagnosis.
Bipolar type 2 disorder is defined as an illness course consisting of one of more major depressive episodes and at least one hypomanic episode.
symptoms of manic episode
elevated mood inflated self esteem increased goal directed activity risk taking distractible flight of ideas
when to refer to psychiatrist
suicidal ideation
severe depression
impairment of daily functioning
if poor response to intervention
management for bipolar mood disorder
mood stabilizer- lithium plus anti-depressant
anti-convulsant less effective
sodium valproate contra-indicated in pregnancy
lithium adverse effects, toxicity and drug interactions
Lithium toxicity
- neurotoxic (convulsions, ataxia), nephrotoxic (80% renal elimination), thyrotoxic
Adverse effects
- neutrophilia, weight gain, polydipsia and polyuria, not teratogenic
. NSAIDS (anti-prostaglandins reduce bloodsupply to the kidneys, lithium is renally excreted), thiazide diuretics, ACE-I, may increase the risk of toxicity.
when should we montor lithium and what else should we monitor annually
Narrow therapeutic index
- requires therapeutic drug monitoring (TDM) 6-monthly - annual serum creatinine and TSH
anxiety signs and symptoms
Feeling nervous Having a sense of impending danger, panic or doom Palpitations Hyperventilation Sweating Tremor Feeling weak or tired Trouble concentrating or thinking about anything other than the present worry/overthinking
anxiety management
Benzodiazepines
- mainstay in the past, yet high dependency rate - role in acute setting, not chronic - relatively safe in overdose - CNS depressant - contra-indicated with alcohol use
indications of benzos
ALL will terminate seizures (status epilepticus)
Other indications (other than anxiety and seizures) include:
Treatment of alcohol withdrawal states / delirium tremens
Muscle spasms
Tetanus
Acute psychotic states
Serotonin syndrome
In overdose
Respiratory depression
Coma
Flumazenil
Antidote
Shorter half life than benzodiazepines
Can be used for diagnosis of benzodiazepine OD
