EM Psych 5: Depression Flashcards

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1
Q

most common mental health complaints presenting to the ED

A

Mood disorders, which include depressive disorders and bipolar disorders (50%)

behind anxiety and substance use disorders (about 25% each)

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2
Q

most common mental health disorder overall

A

Anxiety

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3
Q

Criteria for MDD diagnosis

A

The patient needs to have at least 5 out of 9 symptoms for 2 weeks; one symptom has to be depressed mood or anhedonia

Symptoms cannot be due to substance abuse or a medical condition.

Symptoms must be significant enough to impair normal functioning

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4
Q

two simple questions to screen for depression

A
  1. During the past month, have you been bothered by feeling down, depressed, or hopeless?
  2. During the past month, have you been bothered by little interest or pleasure in doing things?
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5
Q

the most important part of the evaluation of depression is

A

the assessment of suicide risk

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6
Q

remarks on antidepressant therapy

A

Antidepressants take about 2-3 weeks to have clinical effects and may initially place a patient at increased risk of suicide.

Ideally, ED antidepressant prescriptions should be discussed with the follow-up practictioner and should include an arranged visit within a week

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7
Q

Black box warning for SSRIs

A

Antidepressants may increase suicide risk in patients <25 years old

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8
Q

Examples of SSRIs

A

Citalopram
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertralinee

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9
Q

Examples of SNRIs

A

Duloxetine
Venlafaxine
Desvenlafaxine

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10
Q

Examples of atypical antidepressants

A

Bupoprion
Mirtazapine
Trazodone

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11
Q

Examples of heterocyclics

A

Amitriptyline
Nortriptyline

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12
Q

Examples of drugs that may trigger serotonin syndrome

A

Metoclopramide
Ecstasy, Cocaine
Tramadol
Ondansetron
Dextromethorphan
St John’s wort

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13
Q

Treatment of serotonin syndrome

A

Discontinuing the affecting agents
Benzodiazepines
Supportive care

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14
Q

Remarks on Bupoprion

A

a dopamine reuptake inhibitor
also used for smoking cessation

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15
Q

Remarks on Trazodone

A

a serotonin antagonist and reuptake inhibitor
more sedating than other depressants with less anticholinergic effects
commonly used as a sleep aid

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16
Q

Remarks on Mirtazapine

A

related to the heterocyclic antidepressants
tends to cause weight gain
has a more rapid onset of action of about 1 week

17
Q

remarks on heterocyclic antidepressants

A

low therapeutic index
side effects are mainly anticholinergic related and cardiotoxic, including prolonged QTc interval and AV block

18
Q

remarks on MAO inhibitors

A

Monoamine oxidase inhibitors - rarely used first line in treating depression because of potentially lethal drug-drug and dietary interactions

Monoamine oxidase inhibitors block oxidative deamination of tyramine and may precipitate a sometimes FATAL hypertensive crisis when certain drugs (or tyramine-containing foods) are co-ingested:
- sympathomimetic amines
- levodopa
- narcotics
- heterocyclic antidepressants

19
Q

Disposition of the depressed patient

A

based on the assessment of:
-harm to self or others
-ability to care for one’s self
-level of supportive environement at home
-complicating medical or substance abuse problems

Any combination of the above may require psychiatric consultation for admission evaluation

20
Q

commonly prescribed for chronic or neurogenic pain

A

Amitriptyline