Mental Health Flashcards
s/s of serotonin syndrome
fever, muscular rigidity, mental status changes, hyperreflexia, shivering
life-threatening idiopathic reaction from typical and atypical antipsychotics
malignant neuroleptic syndrome
typical and atypical antipsychotics affect this neurotransmitter
dopamine
s/s of malignant neuroleptic syndrome
fever, muscular rigidity, mental status changes, urinary incontinence, changes in BP
The Baker Act
allows 72 hours of involuntary detention for eval and trx of those who are at high risk of suicide
A questionnaire used to evaluate an individual for dementia and confusion
MMSE
adverse effects of atypical antipsychotics
weight gain and DM2
olanzapine (Zyprexa)
atypical antipsychotic
Rispiradone (Risperdal)
atypical antipsychotic
Quetapine (Seroquel)
atypical antipsychotic
Haloperidol (Haldol)
typical antipsychotic
chlorpromazine
typical antipsychotic
adverse effects of typical antipsychotics
elevated lipids
Black box warning for typical antipsychotics
high risk of death to frail elderly
carbamezapine (Tegretol)
anticonvulsant
Lamotragine (Lamictal)
anticonvulsant
adverse effect of Lamictal
SJS
black box warning for SSRIs
high risk of suicide ideation, esp in those less than 24
bupropion (Wellbutrin)
atypical antidepressant
bupropion (Wellbutrin) is contraindicated in
those with hx of seizures, anorexia, bulimia
venlaxafine (Effexor)
SNRI
duloxetine (Cymbalta)
SNRI
adverse effects of SNRI
can precipitate acute narrow-angle glaucoma
Do not combine these SSRIs with this medication as it may increase risk of serotonin syndrome
MAOIs
antidepressant that is category X
TCA
SSRI with the longest half life
fluoxetine (Prozac)
This SNRI can trx both depression and neuropathic pain
Duloxetine (Cymbalta)
side effects of SSRI
weight gain, sexual dysfunction, insomnia
SSRIs can induce
manic phase in bipolar patients
imipramine (Tofranil)
TCA
amitriptyline (Elavil)
TCA
nortryptyline (Norpramine)
TCA
Phenelzine (Nardil)
MAOIs
tranylcypromine (Parnate)
MAOIs
Wait until ____ before initiating SSRI or TRCA therapy after use of MAOIs
2 weeks
Avoid eating these foods with MAOI
high tyramine foods: beer, chianti wine, aged cheese, fava beans
Do not discontinue benzos abruptly because it increase risk of
seizures
ultra short acting benzo
IV midazolam (versed)
medium acting benzo
alprazolam (xanax), lorazepam (Ativan)
long-acting benzo
diazepam (valium), clonazepam (Klonopin), temazepam (Restoril)
Depression is due to dysfunction of the neurotransmitters
norepinephrine and serotonin
diminished interest or pleasure in all of most activities
anhedonia
rule these out before making a diagnosis of depression
anemia, hypothyroidism, B12 deficiency, daibetes
Patients taking SSRI with sexual dysfunction
add bupropion
drug interactions with St. John’s wort
oral contraceptives, SSRI, TCA, MAOI
drug interactions with kava kava and valerian root
benzo, hypnotics
examples of MMSE
date, location, repeat 3 listed things, count backwards, spell “WORLD” backwards, write a sentence, copy figure
impaired MMSE score
less than 24
decreases the effectiveness of digoxin
st. john’s wort
adverse effects of antipsychotics
extrapyramidal symptoms: pill-rolling, shuffling gait, bradykinesia, akinesia
inability to initiate movement; can be an adverse effect of antipsychotics
akinesia
a strong inner feeling to move, unable to stay still; can be an adverse effect of antipsychotics
akathisia
involuntary movements of the lips (smacking), tongue, face, trunk, and extremities
tardive dyskinesia
alcohol limit guidelines for americans
women: 1 drink/day; men: 2 drinks/day
binge drinking is
more than 5 drinks on a single occasion in males (4 in females)
lone elevation of this is a possible sign of alcohol abuse
GGT
lab with alcoholic hepatitis
AST is double the level of ALT
CAGE questionaire
C: Do you feel the need to CUT down?
A: Are you ANNOYED when people make comments about your drinking?
G: Do you feel GUILTY about your drinking?
E: Do you need to drink EARLY in the morning?
(positive if more than 2/4)
Meds for alcoholics
disulfiram (Antabuse), Naltrexone (Vivitrol)
side effect of Antabuse
severe N/V, headache
s/s of Korsakoff’s syndrome
confusion, coma, hypotension
trx for Korsakoff’s syndrome
high dose thiamine (B1)
chronic insomnia is for
more than 3 weeks
s/s of anorexia
xerosis, lanugo, peripheral edema, amenorrhea
anorexic patients are at high risk of
osteoporosis
SSRI with highest side effect of erectile dysfunction
Paxil
complications of anorexia
hypotension, bradycardia, mitral valve prolapse
s/s of bulimia
normal weight, hypotension, tachycardia, parotid gland swelling, erosion of tooth enamel.
bulimia is associated with
diabetes
first line medication for bulimia
fluoxetine (Prozac)
an illness fabricated by the parent
Munchausen by proxy
the reason for hypoactive sexual disorder
low testosterone
PDE5 inhibitors
sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis)
contraindication of those taking PDE5 inhibitors with
nitrates
education about Viagra and Levitra
have rapid onset of action and work for a short period of time. best to take on empty stomach; avoid with high fat meal
education about tadalafil (Cialis)
long half life; no diet limitations
undesirable physical events or experiences that occur during entry in sleep.
parasomnias
cocaine is a
stimulant
GAD are symptoms of anxiety for more than
6 months
s/s of GAD
restlessness, fatigue, difficulty concentrating, irritability, sleep disturbance
problem with discontinuing benzo
rebound insomnia
side effects of SSRIs in older adults
hyponatremia, bleeding, osteoporosis, serotonin syndrome
TCA carry a high risk of
cardiac dysrythmias
s/s of anxiety in adolescents
anger and disobedience
s/s of panic disorder
symptoms peak in 10 min with palpitations, sweating, trembling, SOB, nausea, lightheadness
first line trx for OCD
exposure and response prevention (CBT)
inability to interpret sensory information
agnosia
inability to perform purposeful action
apraxia
progressive cognitive decline, common in those greater than 60
alzheimer’s dementia
fluctuating cognition associated with parkinsonism, hallucinations and delusions, gait difficulties, and falls.
Lewy body dementia
trx for mild dementia
cholinesterase inhibitors
donepezil (Aricept)
cholinesterase inhibitors
rivastigmine (Exelon)
cholinesterase inhibitors
for moderate to severe dementia
cholinesterase inhibitors, memantine (Namenda), or antipsychotics
Neurologic complication of illness and/or medication, especially common in older patients, manifested by new confusion and impaired attention.
delirium
impairment of effective social and communication skills
autism
s/s of major depressive disorder
symptoms for more than 2 weeks: feeling or worthlessness, depressed mood, loss of interest, weight change, sleep pattern change
Major depressive disorder is associated with low levels of
serotonin
Major depressive disorder in children is characterized as
irritability
dosage for escitalopram (Lexapro)
5-20 mg
dosage for citalopram (Celexa)
10-60 mg
dosage for sertraline (Zoloft)
50-200 mg
dosage for paroxetine (Paxil)
20-60 mg
dosage for fluoxetine (Prozac)
10-80 mg
SSRI that can be used for also for premenstrual dysphoric disorder
fluoxetine (Prozac)
dosage for duloxetine (Cymbalta)
20-60 mg
dosage for venlaxafine (Effexor)
75-375 mg
dosage for bupropion (Wellbutrin)
200-450 mg
defined by one or more manic or mixed episodes during a patient’s lifetime
Bipolar I
at least one major depressive episode are met in addition to at least one hypomanic episode.
Bipolar II
lab to do before starting on TCA
EKG
At least of these symptoms are needed to diagnose with depression
SIG E CAPS: Sleep issues Interests Guilt or worthlessness Energy Concentration difficulties Appetite Psychomotor agitation or irritation Suicidality
Anticipatory guidance about SSRI therapy in young to middle age adult
takes 2-4 weeks to see improvement and 6-12 weeks to have relief of symptoms
Anticipatory guidance about SSRI therapy in older adult
takes 4-8 weeks to see improvement and 12-16 weeks to have relief of symptoms
SSRIs can increase risk of
bleeding, especially if on ASA or blood thinners
TCA side effects in elderly
confusion, hallucinations
benzos with highest rate of addiction
those with shortest half life: xanax and ativan
GABA and serotonin affect
wellbeing, calmness
norepinephrine and dopamine affect
productivity, ambition, concentration
