Mood disorder

Question 1

test with high sensitivity test is the ability of the test to identify the dx

Answer 1

is the ability of the test to identify the dx

Question 2

SSRI’s

Answer 2

inhibit transporter making more Neurotransmitter available in the synaptic cleft

Question 3

depression associated symptoms

Answer 3

SIG E Caps
-S sleep issue (too much or less)
-I interest
-G guilt or worthlessness
-E energy
-C concentration difficulty
-A appetite
-P psychomotor agitation or irritation
- S suicidal

Question 4

exercise

Answer 4

enhances neurotransmitter

Question 4

depression screening

Answer 4

PH-Q9

Question 4

serotonin, Gaba

Answer 4

well-being
calmness
impulsivity
aggression
sleep
sex drive
appetite

Question 4

Indication for Labs

Answer 4

1st episode
precipitation unclear
severe depression
older age

Question 4

specificity

Answer 4

ability to test to rule out the problem

Question 4

Norepinephrine and dopamine

Answer 4

enhance
concentration, ambition. productivity

Question 5

stress

Answer 5

reduce neurotransmitter

Question 5

sensitivity

Answer 5

test highly sensitive
ability to test to identify the problem you are screening for depression

Question 6

Bipolar disorder

Answer 6

patient should always screen for BD before starting an SSRI because SSRI can precipitate a maniac episode in pt with BD

Question 7

BD symptom

Answer 7

insomnia
delusions
multiple social problems
hyperactive
mood swings
anxious. Irritable.
impulse control problem
paranoid
low energy
unable to focus
substance abuse
alcohol abuse
legal problem
relationship issue

Question 8

Mild to moderate depression treatment

Answer 8

psychotherapy
medication
combination most effective

Question 9

Depression treatment

Answer 9

1st line-SSRI
Increased risk of CYP450 liver enzyme effects
caution with elders, drug to drug interaction. benzo
-fluoxetine (prozac)
-paroxetine
-fluvoxamine
Greatest weigh loss but GI side effect

Less risk of CYP 450 liver enzyme effects
Safer in elders, fewer side effects
-sertraline (zoloft)
-citalopram (celexa)
-Escitalopram (Lexapro)

Question 10

Pregnancy and breastfeeding_ SSRI

Answer 10

pregnancy
Highest risk
-fluoxetine and paroxetine
Lowest risk -
-Escitalopram
Breastfeeding
Highest risk citalopram

Question 11

NB

Answer 11

Any woman at childbearing age should always be screened for pregnancy before starting a medication for depression

Question 12

Most common SSRI side effects

Answer 12

GI tract
Diarrhea
n/v
sexual dysfunction
somnolence
weight gain

Question 13

how to minimize side effect

Answer 13

start low and go slow

Question 14

depression treatment and older adult

Answer 14

Citalopram, escitalopram and sertraline

Question 15

Why are TCA’s risky in older adult

Answer 15

arrhythmias, cognitive changes, overdose risk as little as 1 week supply

Question 16

What antidepressant class is on the beers list

Answer 16

TCA’s

avoid paroxetine (anticholinergic effect like TCA’s) and fluoxetine (prolonged side effects and long half-life) in elders

Question 17

Abruptly stop SSRI symptoms

Answer 17

Anxiety
Dizziness
flulike symptoms

Question 18

withdrawal symptom all psych med

Answer 18

6+ taking med
if stopped or rapidly reduced
consider fluoxetine low dose because has longest half-life to minimize withdrawal symptoms

Question 19

serotonin syndrome

Answer 19

caused by excess serotonin
symptom
rapid HR, confusion, restlessness, agitation, and headache. nausea. vomiting.tremors,shivering

Question 20

severe symptoms

Answer 20

seizure, high fever, syncope, irregular HR
send to ER
consider cyproheptadine to block the serotine production

Question 21

name and anti-anxiety medication listed in the beers criteria

Answer 21

Benzodiazepine
alprazolam (Xanax®)
lorzepam (Ativan®),
diazepam (Valium®)
Clonazepam (Klonopin®)

Question 22

TCA

Answer 22

tricyclic antidepressants

Amitriptyline.
Amoxapine.
Desipramine (Norpramin)
Doxepin.
Imipramine (Tofranil)
Nortriptyline (Pamelor)
Protriptyline.
Trimipramine.