mental health

Question 1

MDD

Answer 1

• > 5 symptoms in the same 2week period
• SIDECAPS
• Sleep
• Interest - symtoms must include marked diurnal depression, and/or loss of interest or pleaseure
• Guilt - felling of worhtless
• Energy - fatigue
• Concentration impaired
• Appetite change
• Psycomotor - retardation or agitation
• Suicide

PHQ-9 Depression screeingn tool

Question 2

GAD

Answer 2

• > 3 of the following on mst days of the last 6 months
• WATCHERS
• Worry
• Anxiety
• Concentration difficulty
• Hyperarousal
• Energy loss
• Restlessness
• sleep disturbance

GAD-7 screening tool

Question 3

Choosing therapudic agaent for depression/anxiety

Answer 3

What are most bothersome symptoms ? Vegatative vs, energized or anxious
* SSRI - best on mood lift and smoothing mood: listed most to least energizing
1. Fluoxetine (prozac)
2. sertraline (zoloft)
3. citalopram (celexa)
4. escitalopram (lexapro)
5. paroxitine (paxil)
* SNRI - best effect on lifting/smoothing mood, + increasing focus (helpful in anxious and/or resistant depression, potentially energizing
1. venlafaxine (effexor)
2. duloxetine (cymbalta)
3. desvenlafaxine (pristiq)
* SDRI (selective dopamine reuptake inhibitor - best on improving mood when insufficient response with SSRI or as solo
1. buproprion ( Wellbutrin)
* Anxiolytics - helpful in alleviating hypervigilance
* benzodiazepines
* busparone

Question 4

SSRI 1/2 lives

Answer 4

1. Paroxitine Paxil 21 hrs - most sedating
2. Setraline (Zoloft) 26 hrs
3. Escitaloprm (Lexapro) 27-32hrs - no CYP450 isoenzyme inhibition
4. Citalopram (Celexa) 33hrs - potential for abnormal rhythms in higher doses
5. Fluoxetine - 84 hrs, metabolite 7-15 days - most drug interaction potential, most energizing

Question 5

Antidepressant discontinuation syndrome

Answer 5

• typically noted when SSRI, SNRI, TCA taken for >6 weeks then rapidly discontinued
• lasts <7days
• bithersome, not life threatening
• FINISH
• Flu-like symptoms
• Insomnia
• Nausea
• Imbalance
• Sensory disturbance (nightmares)
• Hyperarousal, Headache

Question 6

2nd gen antipsycotic metabolic risk factors

Answer 6

Weight gain, diabetes risk and dyslipidema
* check baseline labs and repeat 12wks and anually
* Greatest risk with Olanzapine (Zyprexa, and Clozapine (clozaril)