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Psychosocial Disorders > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

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

A

Suicide

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2
Q

Mood cycles between mania and depression

A

Bipolar disorder

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3
Q

Labile moods, euphoria, talkativeness, flight of ideas, grandiosity, and less need for sleep are symptoms of what

A

Manic symptoms of bipolar disorder

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4
Q

Classic manic episodes is what type of bipolar disorder

A

Type one

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5
Q

Hypomanic episodes is what type of bipolar

A

Type two

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6
Q

Occurs from high levels of serotonin accumulating in the body due to the introduction of a new drug and an increase in the dose

A

Acute serotonin syndrome

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7
Q

Sudden onset of high fever, muscular rigidity, mental status changes, hyperreflexia, uncontrolled shivering, mydriasis (dilated pupils) Are all signs of

A

A cute serotonin syndrome

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8
Q

What increases the risk of serotonin syndrome

A

Combining to drugs that block serotonin such as SSRI, MAOI, and TCA.

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9
Q

How long do you need to wait if switching to another drug affecting serotonin

A

Two weeks because it is potentially life-threatening reaction

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10
Q

Rare life-threatening idiopathic reaction from typical and atypical antipsychotics

A

Malignant neuroleptic syndrome

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11
Q

Allows 72 hours of involuntary detention for evaluation and treatment of persons who are considered at very high risk for suicide or hurting others

A

The Baker act

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12
Q

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

A

Beck depression inventory

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13
Q

The diagnostic manual for mental and emotional disorders by the American a Psychiatric Association

A

DSM-V

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14
Q

A questionnaire that is used to evaluate and individual for confusion and dementia

A

Mini mental state exam

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15
Q

A 30 item questionnaire that is used to assess depression in the elderly

A

Geriatric Depression scale

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16
Q

What is the most common side effect of SSRI

A

Weight gain

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17
Q

Nine questions used to screen and monitor response to treatment

A

PH Q9

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18
Q

If a patient has a positive screen for depression what do you do next

A 
Order lab studies:
T-SHIRT
Urine drug screens
Fasting blood glucose
B12
Folate
EKG prior to medication administration
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19
Q

What kind of psycho tropic medication can prolong QT interval’s in older adults

A

SSRI

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20
Q

What is another word for depressed mood

A

Dysphoria

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21
Q

What is another word for loss of interest or pleasure in most or all activities

A

Anhedonia

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22
Q

What acronym do you use For diagnosing depression

A

SIG: E Caps

Need five or more to diagnose major depression

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23
Q

What does Sig: E Caps stand for

A 
Sleep issues
Interests (loss)
Guilt (or worthlessness)
Energy (no energy)
Concentration difficulties 
Appetite 
Psychomotor agitation 
Suicidality
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24
Q

What medication the class is considered first line and a patient who has major depressive disorder her

A

SNRI

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25
Q

What are some examples of an SNRI

A

Prestique, Effexor, Cymbalta

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26
Q

If 2 to 4 of the symptoms for depression Are present then the patient has

A

Mild to moderate depressive disorder

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27
Q

What medication class is considered first line in adults who has mild to moderate depressive disorder

A

SSRI

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28
Q

Sertraline (Zoloft), Escitalopram (Lexapro), Fluoxetine (Prozac) are all

A

SSRI

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29
Q

When an antidepressant medication is initiated when will the patient start seeing results

A

Usually observe some improvement within 2 to 4 weeks. If not, then increase dose

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30
Q

When starting an antidepressant medication when should a patient see a full relief of symptoms

A

6 to 12 weeks if not, switch, augment

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31
Q

An 85-year-old patient was diagnosed with moderate depression. What medication classes considered first line

A

SSRI

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32
Q

In an older adult with depression how long does it take for there to be an improvement with medication

A

There should be some improvement in 4-6 weeks

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33
Q

In how many weeks will an older adult see a complete relief of symptoms after taking medications for depression

A

12 to 16 weeks

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34
Q

Parkinsonism, anorexia, sinus bradycardia, hyponatremia, bleeding and fragility are all side effects of

A

SSRI

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35
Q

What is the first line treatment for moderate depression in the older adult and younger adults

A

SSRI

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36
Q

What is the Beers list

A

Geriatric guide to prescribing. Tells what drugs stay away from in older adults

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37
Q

What is almost twice as high in the elderly, and highest in white males

A

Suicide rates

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38
Q

What type of antidepressant is deadly with suicide overdose

A

TCA

Amytriptiline

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39
Q

Which SSRI has the longest half life and may last up to four weeks

A

Prozac

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40
Q

Which SSRI has the shortest half-life

A

Paxil

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41
Q

Which SSRI has fewer drug interactions compare to others

A

Celexa

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42
Q

Which SSRI can also treat neuropathic pain

A

Cymbalta

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43
Q

Loss of libido, erectile dysfunction, women with sexual dysfunction, anorexia and insomnia are side effects of

A

SSRI

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44
Q

What antidepressant should be avoided in anorexic patients and undernourished elderly

A

SSRI

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45
Q

What is a common side effect of Paxil

A

Erectile dysfunction

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46
Q

For how many days should SSRI be avoided after taking a MAOI

A

14 days

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47
Q

Can SSRI induce mania in bipolar patients

A

Yes

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48
Q

If a patient is on a TCA can they take an SSRI

A

No

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49
Q

Phenelzine (Nardil) and tranylcypromine (Parnate) are rarely used and what type of antidepressants

A

MAOI

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50
Q

If taking an MAOI what foods should be avoided

A

Beer, Chianti wine, some aged cheeses, and favs beans

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51
Q

What medication is indicated for anxiety disorders, panic disorder, and insomnia

A

Benzodiazepine

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52
Q

What type of benzodiazepine is used for severe alcohol withdrawal and seizures

A

Diazepam or Valium

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53
Q

Are you able to Discontinue benzodiazepines abruptly? Why?

A

No because it causes seizures. Wean slowly

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54
Q

Midazolam (Versed), triazolam (Halcion), Pam suffix are all

A

Benzodiazepine

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55
Q

What benzodiazepine should be avoided in the elderly

A

Diazepam i.e. Valium, Librium, tenazepam (Restoril), and clonazepam (Klonopin) Because they are all long acting

56
Q

What type of medication for depression has an increased risk of suicidal thinking and behavior in children, Adolescents , and young adults

A

SSRI

57
Q

If a patient is on an SSRI and experiences sexual dysfunction what should be added to the prescription

A

Bupropion (Wellbutrin)

58
Q

If a patient is depressed and wants to quit smoking what medication can be given

A

Bupropion (Zyban)

59
Q

If a depressed patient has post herpatic neuralgia and chronic pain, what antidepressant can be considered

A

TCA

60
Q

If a patient is depressed and has stress urinary incontinence what antidepressant medication can be considered

A

TCA

61
Q

What type of medication lead to an increased risk of obesity, type two diabetes, hyperlipidemia, metabolic syndrome, and hypothyroidism

A

Antipsychotics

62
Q

What herbal supplement is used for depression, menopausal symptoms

A

St. John’s wort

63
Q

What herb drug interactions occur with johns wort

A

Indinavir, cyclosporine, oral contraceptives, SSRI, TCA

64
Q

What is kava kava and or valerian root used for

A

Anxiety and insomnia. Do not mix with benzo diazepam’s, hypnotics were any central nervous system depressants

65
Q

Asking the patient to spell the word world backwards is part of which examination

A

Mini mental state exam

66
Q

Delusions and paranoia such as disorganized speech and behavior are symptoms of

A

Psychotic symptoms

67
Q

When do psychotic symptoms usually occur in life and what is the peak incidence of Age

A

Onset is usually around the second decade and peak incidence is between 16 and 30 years of age

68
Q

Extrapyramidal symptoms, pull rolling, shuffling gait, and bradykinesia are all adverse effects of

A

Antipsychotics

69
Q

Inability to initiate movement

A

Akinesia

Adverse effect of antipsychotic

70
Q

Hey strong inner feelings to move, unable to stay still

A

Akathesia

Adverse effects of antipsychotic

71
Q

Bradykinesia when initiating activities or actions that require successive steps such as buttoning a shirt

A

Adverse effect of antipsychotic

72
Q

Involuntary movements of the lips, tongue, face, trunk and extremities i.e. more common in schizophrenics

A

Tardive dyskinesia. Adverse affects of antipsychotics

73
Q

Antipsychotics, TCA, decongestants, antihistamines all have what type of the effect

A

Anticholinergic

74
Q

BPH, narrow angle glaucoma, pre-existing heart disease need to be careful with

A

Drugs that have an anti-cholinergic effect

75
Q

What is sad cub mnemonic for anti-cholinergic side effects

A

Sedation, anorexia, dry mouth, confusion, constipation, urinary retention, BPH

76
Q

Elevated blood level greater than what number is illegal for driving

A

0.08%

77
Q

How many ounces is one beer

A

12 ounces

78
Q

How many ounces is one glass of wine

A

5 ounces

79
Q

How many ounces is a shot of alcohol

A

1.5 ounces

80
Q

How many drinks per day can women have

A

One

81
Q

How many drinks per day can a man have

A

Two drinks per day

82
Q

What lab test would show a possible sign of occult alcohol abuse

A

GGT

83
Q

What is the AST/ALT ratio associated with alcohol abuse

A

2 to 1

84
Q

What type of anemia do alcoholics have

A

Macrocytic

85
Q

What is the screening test for alcohol abuse

A

Cage test

86
Q

Sudden onset of confusion, delusions, transient auditory, tactile or visual hallucinations, tachycardia, hypertension, hand tremors, disturbed psycho motor behavior and grand mal seizures or symptoms of what

A

Acute delirium tremens

87
Q

How do you treat acute delirium tremens

A

Medical emergency refer to the ED

88
Q

What is the treatment plan for alcoholics

A

Benzodiazepines such as Librium or Valium and antipsychotics if needed such as Haldol. Vitamins such as thiamine 100 mg, folate 1 mg PO daily and multivitamins with high caloric intake. Refer to Alcoholics Anonymous, therapist or recovery program. Avoid prescribing recovering alcoholic addict drugs with abuse potential such as narcotics or any medication that contains alcohol such as cough syrup.

89
Q

What medications help alcoholics

A

Antabuse which causes severe nausea and vomiting, and headache. Vivitrol decreases alcohol cravings

90
Q

A complication from chronic alcohol abuse. A neurologic disorder with signs that include hypotension , visual impairment, and coma. Signs include mental confusion, ataxia, stupor, coma, and hypotension. Treated with high dose parenteral vitamins especially thiamine.

A

Korsakoff syndrome

91
Q

A type of amnesia. Problems with acquiring and learning new information and retrieving older information. Symptoms include confabulation, disorientation, attention deficit’s and visual impairment

A

Korsakoffs amnesic syndrome

92
Q

What causes Korsakoffs amnesic syndrome

A

Chronic thiamine deficiency damages the brain permanently

93
Q

Depression, severe anxiety, GERD, female gender, illicit drug use, musculoskeletal illness, pain, chronic health problems, shiftwork, alcohol, caffeine and nicotine are all risk factors for

A

Insomnia

94
Q

SSRI, cardiac, blood pressure, allergy, steroids can cause

A

Insomnia

95
Q

Insomnia not caused by disease, mental illness, or environmental factors is called

A

Primary insomnia

96
Q

Insomnia caused by disease or environmental factors is called

A

Secondary insomnia

97
Q

How do you treat insomnia

A

Sleep hygiene, avoid caffeine tobacco and heavy meals before bedtime, get out of there in 30 minutes if not asleep and use bed only for sex and sleep.

98
Q

What medications treat insomnia

A

Benadryl but do not use in the elderly.
Benzodiazepines such as Xanax, and non-benzo hypnotics such as ambien or lunesta (do not take if unable to get from 7-8 hours of sleeping time).

99
Q

What are some complementary alternative treatments for insomnia

A

Kava Kava avoid mixing with alcohol, tranquilizers, Hypnotics as it will increase sedation. Do not give Valerian root or herbal supplements to children and lactating pregnant women. Melatonin, chamomile tea and meditation

100
Q

Can a patient smoke with a nicotine patch on

A

No patient will overdose with nicotine

101
Q

What does nicotine overdose cause

A

Acute myocardial infarction, hypertension, and agitation

102
Q

What antidepressant decreases smoking cravings

A

Bupropion (Zyban)

103
Q

What is A laboratory sign of occult alcohol abuse

A

Lone GGT elevation

104
Q

AST/ALT Ratio of what number is more likely an alcoholism

A

2.0 or higher

105
Q

What causes Korsakoff’s syndrome

A

Chronic thiamine deficiency

106
Q

Can you mix nicotine patches and nicotine gum

A

No

107
Q

Can a patient smoke while on Zyban?

A

Yes

108
Q

How often do you discuss smoking cessation with patients

A

At every visit

109
Q

Marked weight loss i.e. greater than 15% of body weight, Lanugo, amenorrhea for 3 months or longer, are all signs of

A

Anorexia nervosa

110
Q

What are some complications of anorexia nervosa

A

Osteopenia/osteoporosis due to prolonged estrogen depletion from amenorrhea and low calcium intake. Higher risks of stress factors. Peripheral edema, and cardiac complications such as arrhythmias, cardiomyopathy, and hypokalemia.

111
Q

What antidepressant medication is contra indicated for anorexic or bulimic patience because it increases the seizure threshold

A

Bupropion (Wellbutrin)

112
Q

What type of antidepressant has a common side effect of erectile dysfunction

A

Paroxetine (Paxil)

113
Q

Does Paroxetine have a long or short half life compared with other SSRIs?

A

Short half-life so patients need to be weaned. Do not discontinue abruptly. It is FDA category D

114
Q

If an elderly patient is depressed what medication should be prescribed even if they are on multiple medications

A

Citalopram i.e. Celexa because it has less drug interactions than other SSRI

115
Q

What medication can be used for hepatic neuralgia and migraine headache prophylaxis

A

TCA

116
Q

What type of bipolar disorder consists of manic episodes, nearly always hypomania, major depression

A

Bipolar one

117
Q

What type of bipolar disorder is more prevalent and has at least one hypomanic disorder, absence of media, and major depression

A

Bipolar II

118
Q

What medications are used to treat mania or hypomania

A

Lithium, anticonvulsants, antipsychotics, and benzodiazepines to treat insomnia, agitation, anxiety.

119
Q

What medications are used to treat bipolar disorder

A

Mood stabilizer, atypical antipsychoticor combo, plus antidepressant or ECT

120
Q

Generalized anxiety disorder is caused by excessive worry that causes significant distress, impairment and a occurs on more days than not for at least how many months

A

For at least six months

121
Q

How do you treat generalized anxiety disorder

A

SSRI, and give a limited duration of a benzo diazepine until the SSRI kicks in. No refills.

122
Q

How do you treat situational and anxiety

A

Benzodiazepine for short term

123
Q

The most common side effects of lithium therapy is

A

Nephrogenic diabetes insipidus

124
Q

The most common mental disorder in older adults is

A

Anxiety

125
Q

What is a common side effect of trazodone i.e. tricyclic antidepressant

A

Drowsiness

126
Q

What type of antidepressant has an anti-cholinergic reaction

A

TCA

127
Q

Hey patient reports that she takes kava kava regularly for anxiety with good results. What should be evaluated

A

Liver function studies

128
Q

If a patient is taking valproate what labs must be monitored in this patient

A

Valproate levels, platelet count, liver function studies

129
Q

What tool diagnoses ADHD

A

DSM five

130
Q

What geriatric condition is characterized by Production and physical or mental capacity sufficient to interfere with managing day-to-day tasks

A

Functional impairment

131
Q

What occurs in depression, Parkinson’s disease, orAlzheimer’s disease

A

Flat affect

132
Q

What type of medication is used for OCD

A

Antidepressants such as Paxil

133
Q

The CAGE, MAST, and AUDIT questionnaires to detect a problem drinking should be used

A

As supplements to the standard patient history

134
Q

What is the most frequent cause of death in patients with anorexia nervosa

A

Cardiac arrest

135
Q

A significant barrier to treatment of depression in the elderly population is

A

The believe that depression is an inevitable part of aging

136
Q

The intervention known it to be most effective in the treatment of severe depression, with or without psychosis is

A

ECT

137
Q

The type of assessment found to be most effective when screening for domestic violence is

A

Routine questioning about abuse

Psychosocial Disorders (2 decks)

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