Mental Health Flashcards
excessive anxiety that occurs more days than not about a wide variety of events or activities
CM: 3 or more: restlessness or feeling on edge, easy fatigability, difficulty concentrating, irritability, muscle tension, sleep disturbance.
GAD
Screening for GAD?
approved med tx?
GAD-7
Buspirone approved for GAD only. May exacerbate depression
screening for social anxiety disorder
SPIN (Social Phobia INventory), MiniSPIN screening tool (3 items)
1st line tx for separation anxiety
SSRIs and SNRIs → first line
Takes 6 weeks for effect
AE: HA, restlessness, increased anxiety, nausea, fatigue, and dizziness.
SE: weight gain and sexual dysfunction
Do not stop taking abruptly
Serotonin syndrome: mental status changes, autonomic instability, and neuromuscular changes
Other drugs to tx separation anxiety? (not 1st line)
Benzodiazepines use with caution; long term use not recommended
Best for short term use in conjunction with SSRIs or SNRIs for management of acute sx
Dependence and tolerance results from long term use
Tricyclic antidepressants (tCA=cardiac arrhythmia)→ high risk of cardiac dysrhythmias. CI for patients with SI
if > 6 years old pt can start on _____
if > 7 years old pt can start on _____
if > 8 years old they can take ___
What can kids not take for anxiety/ depression?!
if > 6 years old pt can start on zoloft
if > 7 years old pt can start on prozac
if > 8 years old they can take lexapro
- DO NOT PUT PEDIATRICS ON PAXIL!!!
Screening kids for anxiety/ depression?
STIAC (Spielberger State-Trait Anxiety Inventory for Children)–> 9-12yrs
S
CARED (Screen for Child Anxiety Related Disorders) → 8-18 yrs
depressed mood or anhedonia (loss of interest or sense of pleasure) AND 4 of the following: unintended change in weight, sleep disturbance, psychomotor agitation or retardation, fatigue, feelings of worthlessness or guilt, inability to concentrate, and recurrent thoughts of death or suicide.
Major depressive episode
: at least 1 week of mood abnormally elevated, expansive, or irritable AND at least 3 of the following: inflated self-esteem (grandiosity), decreased need for sleep without fatigue, pressured speech, racing thoughts, distractibility, psychomotor agitation, and excessive involvement in pleasure-seeking activities
manic episode
sx of both major depressive and manic episodes nearly every day for a week or more.
mixed episode
sx of manic episode that are shorter duration and less severe
Hypomanic episode
How to screen for manic episodes?
PHQ-2, PHQ-9. GDS (geriatric depression scale). All females 35-45 and all males >55; GAD-7; Mood Disorder Questionnaire; CAGE
Diagnostic labs for manic episodes?
Tx?
Diag: TSH, CBC, B12, CMP and Mag. ECG if over 40. UDS with patient permission
Tx: patients must return on medication for 6-12mos after return to baseline. Counseling, education, support groups
Favored for safety, cost, and SE profile. Risk of sexual dysfunction (70%) and serotonin syndrome. Titration of dose often required.
Fluoxetine (Prozac) 20-40mg/day Paroxetine (Paxil) 20-60mg/day Sertraline (Zoloft) 50-250 mg/day Citalopram (Celexa) 20-60 mg/day Escitalopram (Lexapro) 10-20 mg/day
SSRI
good for anxiety and chronic pain. SE: can elevate BP
Duloxetine (Cymbalta) 30-120 mg/day
Venlafaxine (Effexor) 75-225 mg/day (XR); 37.5- 75 mg bid to tid
Desvenlafaxine (Pristiq) 50mg/day → almost identical to venlafaxine
Levomilnacipran (Fetzima) 30-120 mg/day
SNRI
atypical antidepressant
100mg bid to tid→ also helps pt sleep; Can cause prolonged erection
Trazodone 150-375 mg/hs (Oleptro)
atypical antidepressant
helpful in pts not eating and losing weight
Mirtazapine (Remeron)
atypical antidepressant
helps pts stop smoking, eat less, and improves sex. CI seizure disorder or eating disorder
Bupropion (Wellbutrin) 150-200mg bid (SR); 150-450 mg/day (XL)
not commonly used d/t SE (high risk of fatal OD, no reversal)
Doxepin → can be helpful with sleep. Usually reserved when exhausted all other classes
Amitriptyline Amoxapine Desipramine (Norpramin) Doxepin Imipramine (Tofranil) Nortriptyline (Pamelor) Protriptyline Trimipramine
TCAs
rarely used d/t many drug-drug and drug-food interactions
Cheese, wine, pickles, decongestants, herbs
Isocarboxazid (Marplan)
Phenelzine (Nardil)
Selegiline (Emsam)
Tranylcypromine (Parnate)
MAOIs
will give pt more energy
dopamine
stabilizing; insomnia; anxiety; hyperactive
Norepinephrine & Serotonin
OK antidepressants in pregnancy
not ok=?
zoloft and prozac
DO NOT USE PAXIL
teratogenic
how to dose the elderly with SSRIs ?
low dose - anxiety dose
