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PSYCH EOR > Depression, Bipolar and Anxiety 36% > Flashcards

Depression, Bipolar and Anxiety 36% Flashcards

1
Q

Define GAD

A

chronic excessive worry >6 months + 3 or more of the following symptoms: (MISC RF)

  • restlessness
  • fatigue
  • concentration problems
  • irritability
  • muscle tension
  • sleep disturbance for 6 months or more
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2
Q

define panic disorder

A

anxiety disorder marked by unpredictable minutes-long episodes of intense dread in which a person experiences terror +

  • accompanying chest pain
  • choking
  • or other frightening sensations.

>2 panic attacks w/ sx lasting >1 mo and woried about another attack

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3
Q

A group of anxiety disorders involving a pathological fear of a specific object or situation

A

Phobia

•Symptoms 10-15min prior to specific stress event

•6+ months of fear/anxiety about an object/situation

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4
Q

define panic attack

A

•Episode of intense fear or discomfort that develops abruptly; usually peaks within 10min, last <60min

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5
Q

Panic Disorder Criteria: + si/sx

A

Recurrent, unexpected panic attacks

2+ attacks x1 month and 1+ criteria sx

4/13 physical symptoms

Si/Sx

  • persistent concern/worry of another attack
  • worry of losing control during attack
  • maladaptive behavior
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6
Q

define agorphobia

Tx?

A

Fear of going into places where you may not be able to escape

SSRI, CBT, or both

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7
Q

defien Social Phobia/ Anxiety

A

6+ months of intense fear of social situation or performance where you can be scrutinized

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8
Q

tx of phobic disorders

1st line

2nd line

triggers

agoraphobia

A

1st line: CBT/exposure therapy

2nd line: SSRI, Benzos

Specific, predictable trigger: Benzos

Agoraphobia: SSRI & CBT

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9
Q

tx of

panic attacks

panic disorder

acute panic attacks

A

Panic Attacks: Benzos (Lorazepam, Alprazolam)

Panic Disorder

  • SSRI (Paroxetine, Sertraline, Fluoxetine)
  • CBT

Acute Attacks: Benzos

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10
Q

Tx of GAD

A

SSRIs (Paroxetine, Escitalopram)

SNRI (Venlafaxine)

Benzos

Buspirone

•CBT x6-12 months

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11
Q

35-year-old female with a complaint of worry which she cannot control for the last year. She tells you that her symptoms daily consisting of sleep disturbances, difficulty concentrating, and irritability. She reports her symptoms started around age 17 but have worsened.

Dx??

Tx options

A

GAD: persistent and excessive worry pertaining to multiple events or domains that continues for 6 months or more

Treatment

  • SSRIs: Paroxetine and escitalopram; SNRIs: Venlafaxine
  • Buspirone is also effective; the starting dose is 5 mg PO bid or tid. However, buspirone can take at least 2 weeks before it begins to help
  • BZD (short-term use), BBs
  • Psychotherapy
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12
Q

26-year-old first-year PA student with a medical history significant for GERD comes to your office because of frequent episodes of palpitations. The palpitations are sudden in onset and are accompanied by sweating and a sense that she is going to “pass out.” The episodes typically last no more than 10 minutes, and although the patient feels as if she may pass out, she never has. The episodes first appeared when she started PA school and have increased in frequency to the point where she is afraid to attend lectures out of fear of having an “attack.”

Dx??

Tx??

A

Panic Disorder

Treatment

  • SSRIs: Paroxetine, Sertraline, Fluoxetine
  • Benzodiazepines: for acute attacks (watch for abuse)
  • CBT (relaxation, desensitization, examining behavior consequences)
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13
Q

a lab technician calls to tell you that a 22-year-old man you have sent for a blood draw is very anxious. He says he is terrified of having his blood drawn and almost faints at the sight of the needle.

A

Phobia - Same as panic disorder – symptoms begin 10-15 minutes prior to stress event except in this case it is a specific stress event (i.e flying, blood, social situations, spiders etc. etc.)

Treatment

  • Exposure therapy (first line), teach to relax and try to understand/overcome the fear
  • SSRI + CBT
  • Benzodiazepines (i.e prior to flying)
  • Treat agoraphobia just as GAD with SSRIs and CBT
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14
Q

Name indication and MOA of Buspirone

A

Add on for anxiety

5HT-1a receptor agonist

•dopamine receptors

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15
Q

Hydroxyzine (Vistaril, Atarax) DDI & CI

A

DDI :

  • Potassium
  • MAOIs
  • CNS depressants

CI

  • Allergy
  • 1st trimester prego
  • *only use po route
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16
Q

CI for BZDs

A
  • Pregnancy
  • Allergy
  • Myasthenia gravis
  • Glaucoma
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17
Q

Tx optiosn for Bipolar

A

Lithium - (1st line)

Valproate (Depakote enteric coated) *increase GABA

Lamotrigine – *inhibit glutamate

Carbamazepine

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18
Q

side effect we are concerned for w/ Lithium

A

Ebstein anomaly is a rare heart defect in which the tricuspid valve — isn’t formed properly

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19
Q

Carbamazepine side effects

A

Nausea, rash, pruritis,

hyponatremia, fluid retention

leukopenia

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20
Q

when tx Bipolar what medications do you need LFTs?

Renal labs?

A

LFTS- valporate, carbamazepine, lamotrigine

Renal - Lithium

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21
Q

•SJS, TEN need to be watched for when starting what bipolar medications?

A

lamotrigine

carba

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22
Q

acute and long term effects of lithium

A

Acute: GI, tremor, thirst, polyuria, weight gain, loose stools

Long term: LITH-PA

  • Leukocytosis
  • insipidus (renal)
  • tremor
  • hypothyroidism
  • parathyroid
  • arrhythmia
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23
Q

what bipolar med is CI in pregnancy and safest in preg

A

safest - lamictal

CI - lithium, valporate, carba

24
Q

Differentiate b/w Bipolar 1 and Bipolar 2

A

Bipolar 1 – (mania > Depression)

  • manic episodes alternating with depression; psychosis during manic episodes

Bipolar 2 - (depression > Mania)

  • Low-level mania with profound depression; no psychosis
    *
25
27-year-old man accompanied by his girlfriend. In the office, he seems to be running from topic to topic without a clear message. His speech is pressured. The patient’s girlfriend reports that he took steroids recently for a bad sinus infection and since he started them, his behavior has been abnormal. After discontinuing the medication, he has still been having symptoms. He has not had a normal night of sleep for the past ten days, and he just bought a new sports car though he has no need for one or the money to afford it. She also reports that she has caught him with multiple other women in the past few days, though they were in a committed relationship Dx?? Txx?
Bipolar 1 Tx: * Lithium (first line ) * Acute mania: Lithium, valproate, SGAs (olanzapine, aripiprazole), carbamazepine * Mania maintenance: SGAs, Gabapentin, lamotrigine (Lamictal) * If agitation add antipsychotics (haloperidol, risperidone) or benzodiazepines
26
Tx of: ## Footnote Acute mania: Mania maintenance: If agitation
**Acute mania:** * Lithium * valproate * SGAs (olanzapine, aripiprazole) * carbamazepine **Mania maintenance:** SGAs, Gabapentin, lamotrigine (Lamictal) **If agitation** * add antipsychotics (haloperidol, risperidone) or benzodiazepines
27
SGAs used to tx acute mania
olanzapine, aripiprazole
28
19-year-old male who has had bouts of sadness for the course of 1 year in which he says that oftentimes cannot even get out of bed so he tells his parents he is ill. Jim states that he recently felt so energized that he could not keep his thoughts straight and jumped from one idea to another. During this energized state, he did become irritable and others stated that he was louder than usual and wondered if he took something that increased his energy. During the week of high energy, he maxed out two of his credit cards and is not sure how he will pay them off before he goes to school in the fall. It was only a week later that he became so depressed that he did not find any pleasure in anything he did, was so tired he did not want to get out of bed which has continued to be a struggle today. Dx? Tx??
**Bipolar 2** **Treatment:** * Lithium First line * Depressive episodes- * SSRIs * quetiapine * or olanzapine + fluoxetine
29
24-year-old male with c/o episodes of depression alternating with times of increased energy, restlessness, and decreased sleep for 2 years. dx??
**Cyclothymic disorder** Alternating hypomanic episodes with a long-standing low mood state (dysthymia)
30
tx of cyclothymic disorder
_Lithium_ first line _Anticonvulsant medications,_ (valproate and carbamazepine,) _Psychotherapy_
31
define MDD
**5 or more SIEGECAPS for≥ 2 weeks** nearly every day and at _least one of the symptoms is depressed mood or anhedonia_ * **Sadness** * **Interest/anhedonia** * Guilt * Energy * Concentration * Appetite * Psychomotor activity * Suicidal
32
define PDD
Chronic depression - **depressive symptoms for \> 2 years** * _never been without the depressive symptoms in for more than 2 months at a time._ * _never been a manic episode_ or a hypomanic episode
33
tx MDD
SSRIs are the first line treatment * Continue to increase dosage q3–4wk until symptoms in remission. * Full medication effect is complete in 4–6 weeks. Augmentation with 2nd medication may be necessary. * See within 2–4 weeks of starting medication and q2wk until improvement, then monthly to monitor medication changes
34
tx PDD
SSRIs and other antidepressants Psychotherapy Physical exercise
35
Repeated episodes of significant depression and related symptoms during the week before menstruation??
Premenstrual dysphoric disorder
36
Tx Premenstrual dysphoric disorder
Treatment: * _SSRIs_ first-line treatment (fluoxetine, sertraline, paroxetine, escitalopram) * can be used continuously or instituted the week prior to menses. * _Birth control_, low-dose estrogen, * _SNRIs_ venlafaxine * (GnRH) -
37
MDD Substypes and Tx (4)
**Seasonal**: depressive sx at the same time each year, MC winter * **TX**: SSRI, light therapy, Bupropion **Atypical**: mood reactivity with depression (improve in response to positive events) * **TX**: MAOI Inhibitors (**A/B**: Nardil, Parnate, Marplan; **B only**: Selegiline) **Melancholia**: anhedonia (inability to find pleasure in things), lack of mood reactivity, depression, severe weight loss/loss of appetite, excessive guilt, psychomotor agitation, or retardation & sleep disturbance (increased REM time and reduced sleep). _Sleep disturbances may lead to early morning awakening or mood that is worse in the morning_ **Catatonic**: motor immobility, stupor, extreme withdrawal
38
# define types of bipolar: mania hypomania mixed rapid
* **Mania**: abnormal or persistently elevated, expansive or irritable mood for at least **1 WEEK** * **Hypomania**: mania sx for **4 DAYS**; no impairment * **Mixed**: criteria for one and 3+ sx of other * **Rapid**: 4+ ep/yr
39
Dx??? Tx?? ## Footnote Fear of going into places where you may not be able to escape •**6+ months of fear/anxiety about 2+ scenarios**
Agoraphobia Tx: SSRI, CBT, or both
40
# define social anxiety Tx? performance anxiety Tx?
**6+ months** of intense fear of social situation or performance where you can be scrutinized Tx: CBT, SSRI/SNRI or both _Performance_: Beta Blockers
41
# define phobic disorders tx?? (1st, 2md, triggers, agoraphobia)
•Symptoms 10-15min prior to specific stress event **•6+ months** of fear/anxiety about an object/situation Tx 1st line: **CBT/exposure therapy** 2nd line: SSRI, Benzos _Specific, predictable trigger_: Benzos _Agoraphobia_: SSRI & CBT
42
define Bipolar 2
**\>1 hypomanic episod**e w/ **at least 1 depressive episode** where **sx last \>4 days**
43
define bipolar 1
**1 manic episode** (hospitalization) and **\>3 sx** going on for **\>1 wk** **(DIG FAST)** * Distractibility * insomnia * grandiosity * flight of ideas * activity (increased) * Speech (rapid/pressured) * thoughtlessness
44
# define adjustmnt disorder tx
occurs w/in 3 mo of stimuli and resolves w/in 6 mo tx: psychotherpay
45
SSRI w/ longest 1/2 life
fluoxetine
46
SSRI also tx OCD
fluvoxamine
47
most sedating SSRI
paroxetine
48
Bupripion is CI in what disorders?? Why
anorexia, bullemia, epilepsy -- dec Sz thershold
49
common side effect of trazodone
priapism
50
tyramine induced HTN crisis is a concern w/ what class od meds?
MAOI (segelline)
51
class of meds that is cardiotoxic and prolong QTc
TCA
52
TI of Lithium is it cleared renally or hepatically?
0.6-1.2 renally
53
valporic acid TI CI in?? monitor???
60-120 pregnancy - NTD LTFs- spike in transaminases
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PSYCH EOR (8 decks)

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