Psych/Behavioral Health #2 Flashcards
Most common adverse effects of TCA’s (Amitriptyline, Nortriptyline, Clomipramine)
Anticholinergic effects: dry mouth, constipation, tachycardia, orthostatic hypotension
- Weight gain, prolonged QT interval
- Sedation, lowers seizure threshold, SIADH
What are the three indications of overdose of TCA’s?
3C’s
- Cardiotoxicity: wide complex tachycardia
- Convulsions (seizures)
- Coma
What can be used for treatment for cardio toxicity of TCA’s?
Sodium bicarbonate
What TCA is most useful in obsessive compulsive disorder because it is the most serotonin specific?
Clomipramine
When should you use MAO inhibitors for treatment?
Refractory depression or refractory anxiety disorders
Adverse effects of MAO inhibitors?
- Orthostatic hypotension (MC)
- Hypertensive crisis after ingesting foods high in tyramine (aged, smoked cheese or meats, red wine, beer, chocolates)
True or False: If MAO inhibitors are combined with SSRI’s, increased risk of serotonin syndrome?
True
Adverse effects of Trazodone
Sedation (MC)
Priapism
What is serotonin syndrome?
Life-threatening syndrome due to increased serotonergic activity in the CNS
Serotonin syndrome MC occurs ______ hours with initiation or change in serotonergic drugs such as SSRI’s, SNRI’s, TCA’s, and MAO’s.
within 24 hours (usually 6 hours)
Symptoms of serotonin syndrome
- AMS, agitation, hallucinations
- Hyperthermia, diaphoresis, blood pressure changes
- nausea, vomiting, diarrhea
- clonus, hypertonia (increased DTR), tremor
- Mydriasis, dry mucus membranes, flushed skin
Treatment for serotonin syndrome
- Prompt discontinuation of drugs
- IVF, oxygen, Benzodiazepines
- Cyproheptadine
What is the strongest risk factor for Bipolar 1 disorder?
Family history (10x more likely if 1st degree relative has it)
What is the only requirement for Bipolar 1 Disorder?
At least 1 manic or mixed episode (elevated expansive or irritable mood at least 1 week with marked impairment of social/occupational function
At least 3: mood (euphoria, labile), thinking (racing, flight of ideas, disorganized, spending sprees), behavior (physical hyperactivity, pressured speech, impulsivity, risk taking)
First-line treatment for Bipolar 1 Disorder
Lithium (also decreases suicide risk)
For acute mania, what is the treatment?
Antipsychotics (Risperidone or Olanzapine > Haloperidol) or mood stabilizers (Lithium) are most effective
Adverse effects of Lithium
- Hypothyroidism, Nephrogenic Diabetes Insipidus, Hyperparathyroidism
- Hypercalcemia
- Hypermagnesemia
When should levels be checked after starting Lithium therapy?
Prior to starting, get ECG, thyroid function, CBC, and beta-HCG
- Check levels after 5 days, then every 2-3 days until therapeutic
- Plasma levels checked every 4-8 weeks
Lithium is toxic in pregnancy and may be associated with ______ if taken during the first-trimester
Ebstein’s Anomaly
What is Ebstein’s Anomaly?
Tricuspid valve in the wrong direction and the valve’s leaflets are malformed.
When should Lithium NOT be used?
With NSAIDs, ACEi, or Thiazide Diuretics
What is Bipolar II Disorder?
History of at least 1 major depressive disorder + at least 1 hypomanic episode
What is a hypomanic episode?
Elevated, expansive, or irritable mood < 1 week and does not require hospitalization or have marked impairment of social or occupational function
Treatment for Bipolar II Disorder?
Lithium (first line) or Atypical Antipsychotics (Risperidone, Olanzapine, Ziprasidone, Quetiapine)
What is persistent depressive disorder (Dysthymia)
Chronic depressed mood for at least 2 years in adults (1 year in children) that last most of the day, more days than not
-Patient is NOT symptom free for > 2 months at a time
Treatment for persistent depressive disorder
-Psychotherapy + SSRI/SNRI/TCA/MAO
Cyclothymic Disorder is
At least 2 years of prolonged, milder elevations and depressions in mood that DO NOT meet criteria for full hypomanic episodes of major depressive episodes
Treatment for cyclothymic disorder
Lithium or Atypical Antipsychotics
When does PMS occur?
Luteal phase of the menstrual cycle
What is premenstrual dysphoric disorder?
Severe PMS with functional impairment where anger, irritability, and internal tension are prominent
Name some symptoms of PMDD
- Bloating and fatigue (MC)
- Breast swelling or pain
- Headache
- Changes in bowel habits
- Irritability (MC)
- Anxiety, hostility, libido changes
- food cravings
- Poor concentration
- noise sensitivity
- Loss of motor senses
What is the diagnostic criteria for PMDD (what is the normal occurrence of the symptoms)?
Symptoms occurring 1-2 weeks before menses (luteal phase) relieved within 2-3 days of the onset of menses, plus at least 7 symptom free days during follicular phase
Management of PMDD
- Lifestyle modifications: stress reduction, exercise (most beneficial). Caffeine, alcohol, smoking, salt reduction. NSAIDs, vitamin B6 and E
- SSRI’s: first line for emotional symptoms
- Oral contraceptives: Must contain Drospirenone if they do not want to take SSRI’s
What is the single strongest predictive factor for suicide?
Previous attempt
Conduct disorder is
persistent pattern of behaviors that deviate sharply from the age-appropriate norms and violates the rights of others and animals
Conduct disorder may progress to
Antisocial personality disorder
What are some symptoms of conduct disorder?
- Aggression to humans and animals
- Destruction of property
- Serious violation of rules
- Deceitfulness or theft
- MUST BE < 18 years old
Treatment for conduct disorder
- Behavioral modification
- Community and family involvement
- parent management training (enforcing rules, setting limits)
What are some indications of a good prognosis of a patient with conduct disorder?
- Positive relationship with at least 1 parent
- Adolescent onset of symptoms
- Female gender
- High IQ
- Good academic performance
What is oppositional defiant disorder?
Child who is generally defiant towards authority but NOT associate with physical aggression, violating others’ rights, or breaking laws
Symptoms of ODD
- Angry or irritable mood
- Argumentative or defiant behavior
- Vindictiveness (spiteful)
Treatment for ODD
-Psychotherapy: behavioral modification therapy, teaching parents child management, problem-solving skills, etc.
