Mental Health Flashcards
normal M and W alcohol intake per day
M : 2 drinks a day
W: 1 drink a day
what lab value could indicate alcohol abuse
elevated Gamma Glutamyl Transaminases w/ or w/o ALT AST elevation
With chronic alcohol abuse what labs would you see elevated
> 100 MCV due to def in folate
Hypertriglyceremia
Thrombocytopenia - increased risk of bleeding
what can you tx DT’s from alchol with
benzos ( librium and valium)
Wernicke- Korsakoffs Dementia
permanent damage to the brain and spinal cord due to chronic alchol and VITAMIN def of thiamine and B1
tx: give high doses of thiamine and B vitamins
CAGE test
evaluation to see if someoone may have a alcohol problem two or more is a +
Cut down
Annoyed
Gulity
Early in AM
DX of Anorexia
restriction of energy intake resulting in low body weight w/intense fear of gaining weight/ being fat. Low body weight BMI < 18.5
Complications of eating disorders
osteoporosis, stress fractures, bradycardia, CHF, arythmias from vit K depletion, sz
What is the tx plan for ADHD
- behavioral therapy
2. Amphetemines
side affects of amphetamines
anorexia, insominia, poor growth, tics
What is atomoxetine
non-stimulent for ADHD, check LFT’s and there is an increase risk of SI
who is most at risk for SI
older men with multiple comordities
major depression dx
presence for two weeks: sad mood, diminished interest, ( anhedomia), PLUS presence of at least 5 of the following
- decreased energy
- poor self image
- poor cognition
- sleep too much or too little
- change in appitiete
- weight change
- diminshed interest
minor depression
Presence of 2-4 symtpoms of depression ( including depressed mood or loss of pleasure)
what do you need to do when dx depression
- labs to r/o other causes
- assess current SI risk
- first line SSRI’s
What are examples of SSRI’s
Fluoxetine, Paroxetine, Escitalopram, Citopram, Sertraline
Fluoxetine
Prozac , longest half life, dont need to wean off
Paroxetine
Paxil. shortest half life, wean off slowly, high risk of erticle dysfunction
Indications for SSRI’s , s/e, follow up,
depression. OCD, GAD, SAD, Panic
insomina, sexual dysfunction, anorexia
follow up 2 weeks after start
what are the contraindications for SSRI’s
MAOI w/thin 2 weeks, triptans, TCA’s, Eldeprl
What is the FDA black box warning on the SSRI’s
increase risk of SI in people up to 23
What is the best depression medication for the elderly
SSRI’s Celexa (citalopram), Lexapro (ecitalopram), Zoloft (sertaline)
What interactions do MAOI’s have
food interactions ( aged-cheese, red wine, beer, fermnated foods)
why are TCA’s not first line for depression
increased risk of successful SI from an overdose ( fatal arrythmias
Atypical Antidepressants indications and contraindiactions
Wellbutrin
depression, smoking cessation, seasonal effective disorder
avoid w. hx of sz and head injuries
What two medications for smoking cessation?
Zyban and Chantix
pt can still smoke w/ med but needs to be less
follow up in 2 weeks
SNRI’s names, indication, contraindication,
For depression and GAD
Cymbalta, Effexor, Chantix
dont use w/ people with HTN or glaucoma
what is an anti-anxiety medication?
buspar must be taken daily
What is short term insomnia or transient
adjustment, stress related,
sympt < 3 months,
expect when the stressor resolves it will too
Sleep Terms :
sleep-onset and early awakening
chronic insomia
s: difficulty initiaing sleep
e: wakes up after an hour or too
chronic: sympts occur at least 3 x week for 3 months or longer
Primary insomonia
not drug related related to stress, travel, shift work
Secondarcy insomonia
related to medication or disease
What is the first line therapy for insomonia
Sleep hygiene
Meds for insomonia
antihistamines - benedrly
Kava kava, melatonin
perscription Restoril
What are signs of abuse
- delay in seeking tx
- Pattern of injuries not consistent
- Injurues on trunk vs extremities
- preg and elderly ( if new onset STD)
Type 1 Bipolar vs Type 2
- full blown manic episodes
2. hypomanic (milder symptoms)
Bipolar TX
Lithem, depakote ( check TSH as it can cause hypothyroidism )
PTSD TX
- pyschotherapy
- Meds ( Zoloft and Paxil) SSRI
- Eye movement desensitiation and reprocessing)
