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FNPII Test 3 > Mental Health > Flashcards

Mental Health Flashcards

1
Q

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.

A

GAD

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2
Q

Screening for GAD?

approved med tx?

A

GAD-7

Buspirone approved for GAD only. May exacerbate depression

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3
Q

screening for social anxiety disorder

A

SPIN (Social Phobia INventory), MiniSPIN screening tool (3 items)

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4
Q

1st line tx for separation anxiety

A

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

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5
Q

Other drugs to tx separation anxiety? (not 1st line)

A

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

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6
Q

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?!

A

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!!!
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7
Q

Screening kids for anxiety/ depression?

A

STIAC (Spielberger State-Trait Anxiety Inventory for Children)–> 9-12yrs
S
CARED (Screen for Child Anxiety Related Disorders) → 8-18 yrs

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8
Q

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.

A

Major depressive episode

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9
Q

: 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

A

manic episode

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10
Q

sx of both major depressive and manic episodes nearly every day for a week or more.

A

mixed episode

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11
Q

sx of manic episode that are shorter duration and less severe

A

Hypomanic episode

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12
Q

How to screen for manic episodes?

A

PHQ-2, PHQ-9. GDS (geriatric depression scale). All females 35-45 and all males >55; GAD-7; Mood Disorder Questionnaire; CAGE

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13
Q

Diagnostic labs for manic episodes?

Tx?

A

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

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14
Q

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
A

SSRI

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15
Q

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

A

SNRI

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16
Q

atypical antidepressant

100mg bid to tid→ also helps pt sleep; Can cause prolonged erection

A

Trazodone 150-375 mg/hs (Oleptro)

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17
Q

atypical antidepressant

helpful in pts not eating and losing weight

A

Mirtazapine (Remeron)

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18
Q

atypical antidepressant

helps pts stop smoking, eat less, and improves sex. CI seizure disorder or eating disorder

A

Bupropion (Wellbutrin) 150-200mg bid (SR); 150-450 mg/day (XL)

19
Q

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
A

TCAs

20
Q

rarely used d/t many drug-drug and drug-food interactions
Cheese, wine, pickles, decongestants, herbs

Isocarboxazid (Marplan)
Phenelzine (Nardil)
Selegiline (Emsam)
Tranylcypromine (Parnate)

A

MAOIs

21
Q

will give pt more energy

A

dopamine

22
Q

stabilizing; insomnia; anxiety; hyperactive

A

Norepinephrine & Serotonin

23
Q

OK antidepressants in pregnancy

not ok=?

A

zoloft and prozac

DO NOT USE PAXIL
teratogenic

24
Q

how to dose the elderly with SSRIs ?

A

low dose - anxiety dose

25
Q

when to screen kids/adolescents for anxiety/ depression?

A

screen at every wellness visit starting at age 12- use peds specific tools (no PHQ-2)
Diag: cbc, pregnancy test, Epstein-barr titers, thyroid panel, LFTs, UA, drug screen

26
Q

Tx kids over 12 for depression/ anxiety

A

combine CBT with SSRI

Fluoxetine 10-40 mg/day
Citalopram 20-40 mg/day
Sertraline 12.5-200 mg/day
Black box warning for increased suicide, but do not avoid treated depressed kids with meds

27
Q

Hypomania, mania, depression, and a craving for carbohydrates. r/t both unipolar and bipolar depression. Symptoms change with seasons (noted in fall and worsens in winter) sx remit as season changes

A

SAD

28
Q

Diag tests for SAD?

A

CMP, CBC w/ diff, thyroid function tests, 24-hour free cortisol, vitamin B12, and folic acid.

29
Q

nonpahrm tx for SAD?

A

light therapy (artificial light daily), regular exercise, adequate sleep, stress reduction, and relaxation

30
Q

pharm tx for sad?

A

Fluoxetine (Prozac) or other SSRI along with nonpharm tx

31
Q

occurs w/in 1 week of menstruation and lasts until a few days after menstruation

A

premenstrual dysphoric disorder

32
Q

chronic (2yrs or more) low level depression

A

Dysthymia

33
Q

diagnosing sleep disorders?

A

thorough history with sleep log for 1-2 weeks (including naps). BMI (OSA)
Actigraphy (wrist-worn monitor that estimates sleep-wake patterns)
Polysomnography → OSA
Epworth Sleepiness Scale

34
Q

Pharm drugs to tx sleep disorders?

A

Sleep hygiene, relaxation techniques; drugs come with risk
Benzodiazepine RA→ tx both onset and maintenance. Zolpidem (Ambien) and eszopiclone. Zaleplon.
benzodiazepine → Triazolam 0.25mg; temazepam 7.5-15mg. May develop tolerance, OD, confusion
Orexin RA→ suvorexant→ sleep maintenance
Melatonin agonist→ ramelteon (Rozerem)
Antidepressants → may make patients feel hungover/groggy
Trazodone 25-50 mg/hs
Doxepin (Silenor) 3-6 mg/hs→ heterocyclic antidepressant
Amitriptyline 10-25 mg/hs
Lunesta
Sonata

35
Q

OTC drugs to help sleep?

A

Antihistamines → benadryl or unisom: do not use over 65yo; dry mouth
Supplements: Melatonin and Valerian

36
Q

Tx Children with circadian rhythm disorders:

A

Awaken the child 15mins earlier each morning

Keep regular routines of sleeping, eating, and activities.

37
Q

What meds to not give suicidal children?

A

TCAs (tricyclic antidepressants)

38
Q

What med not to give for suicial pts?

A

NO paroxetine (3x increase suicide risk)

39
Q

__________ often increases during the first month of tx → emergence : increase in energy levels while feelings of hopelessness and helplessness remain

A

Suicidal ideation

40
Q

repetitive, fast, unconscious movements or vocalizations. Persists more than one year

A

Tourette syndrome

41
Q

diag tests for tic disorders?

A

Hgb, ferritin, renal function, hepatic function, thyroid function, and substance use.

42
Q

How to tx tic disorders?

A

psychotherapy- comprehensive behavioral intervention for tics (CBIT)
Mod - severe: SSRIs, atypical antipsychotics (risperidone), and antihypertensives (clonidine)

43
Q

when is separation anxiety normal?

A

7 months- preschool

44
Q

what to screen for in kids with night terrors?

A

OSA

FNPII Test 3 (7 decks)

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