Mood Disorders Flashcards
Older people who have lost a spouse, plan to use a gun or other lethal weapon, history of attempted suicide or family history of suicide, mental illness such as depression or bipolar disorder, history of sexual emotional or physical abuse, terminal illness, chronic illness, chronic pain, alcohol abuse, substance-abuse, are all riskFactors for what
Suicide
Mood cycles between mania and depression
Bipolar disorder
Labile moods, euphoria, talkativeness, flight of ideas, grandiosity, and less need for sleep are symptoms of what
Manic symptoms of bipolar disorder
Classic manic episodes is what type of bipolar disorder
Type one
Hypomanic episodes is what type of bipolar
Type two
Occurs from high levels of serotonin accumulating in the body due to the introduction of a new drug and an increase in the dose
Acute serotonin syndrome
Sudden onset of high fever, muscular rigidity, mental status changes, hyperreflexia, uncontrolled shivering, mydriasis (dilated pupils) Are all signs of
A cute serotonin syndrome
What increases the risk of serotonin syndrome
Combining to drugs that block serotonin such as SSRI, MAOI, and TCA.
How long do you need to wait if switching to another drug affecting serotonin
Two weeks because it is potentially life-threatening reaction
Rare life-threatening idiopathic reaction from typical and atypical antipsychotics
Malignant neuroleptic syndrome
Allows 72 hours of involuntary detention for evaluation and treatment of persons who are considered at very high risk for suicide or hurting others
The Baker act
A multiple-choice self report inventory for evaluating depression. Based on the theory that negative conditions about the self and the world in general can cause depression
Beck depression inventory
The diagnostic manual for mental and emotional disorders by the American a Psychiatric Association
DSM-V
A questionnaire that is used to evaluate and individual for confusion and dementia
Mini mental state exam
A 30 item questionnaire that is used to assess depression in the elderly
Geriatric Depression scale
What is the most common side effect of SSRI
Weight gain
Nine questions used to screen and monitor response to treatment
PH Q9
If a patient has a positive screen for depression what do you do next
Order lab studies: T-SHIRT Urine drug screens Fasting blood glucose B12 Folate EKG prior to medication administration
What kind of psycho tropic medication can prolong QT interval’s in older adults
SSRI
What is another word for depressed mood
Dysphoria
What is another word for loss of interest or pleasure in most or all activities
Anhedonia
What acronym do you use For diagnosing depression
SIG: E Caps
Need five or more to diagnose major depression
What does Sig: E Caps stand for
Sleep issues Interests (loss) Guilt (or worthlessness) Energy (no energy) Concentration difficulties Appetite Psychomotor agitation Suicidality
What medication the class is considered first line and a patient who has major depressive disorder her
SNRI
What are some examples of an SNRI
Prestique, Effexor, Cymbalta
If 2 to 4 of the symptoms for depression Are present then the patient has
Mild to moderate depressive disorder
What medication class is considered first line in adults who has mild to moderate depressive disorder
SSRI
Sertraline (Zoloft), Escitalopram (Lexapro), Fluoxetine (Prozac) are all
SSRI
When an antidepressant medication is initiated when will the patient start seeing results
Usually observe some improvement within 2 to 4 weeks. If not, then increase dose
When starting an antidepressant medication when should a patient see a full relief of symptoms
6 to 12 weeks if not, switch, augment
An 85-year-old patient was diagnosed with moderate depression. What medication classes considered first line
SSRI
In an older adult with depression how long does it take for there to be an improvement with medication
There should be some improvement in 4-6 weeks
In how many weeks will an older adult see a complete relief of symptoms after taking medications for depression
12 to 16 weeks
Parkinsonism, anorexia, sinus bradycardia, hyponatremia, bleeding and fragility are all side effects of
SSRI
What is the first line treatment for moderate depression in the older adult and younger adults
SSRI
What is the Beers list
Geriatric guide to prescribing. Tells what drugs stay away from in older adults
What is almost twice as high in the elderly, and highest in white males
Suicide rates
What type of antidepressant is deadly with suicide overdose
TCA
Amytriptiline
Which SSRI has the longest half life and may last up to four weeks
Prozac
Which SSRI has the shortest half-life
Paxil
Which SSRI has fewer drug interactions compare to others
Celexa
Which SSRI can also treat neuropathic pain
Cymbalta
Loss of libido, erectile dysfunction, women with sexual dysfunction, anorexia and insomnia are side effects of
SSRI
What antidepressant should be avoided in anorexic patients and undernourished elderly
SSRI
What is a common side effect of Paxil
Erectile dysfunction
For how many days should SSRI be avoided after taking a MAOI
14 days
Can SSRI induce mania in bipolar patients
Yes
If a patient is on a TCA can they take an SSRI
No
Phenelzine (Nardil) and tranylcypromine (Parnate) are rarely used and what type of antidepressants
MAOI
If taking an MAOI what foods should be avoided
Beer, Chianti wine, some aged cheeses, and favs beans
What medication is indicated for anxiety disorders, panic disorder, and insomnia
Benzodiazepine
What type of benzodiazepine is used for severe alcohol withdrawal and seizures
Diazepam or Valium
Are you able to Discontinue benzodiazepines abruptly? Why?
No because it causes seizures. Wean slowly
Midazolam (Versed), triazolam (Halcion), Pam suffix are all
Benzodiazepine