Psychiatry Flashcards
What is the diagnostic criteria for major depressive disorders?
Any 5 of the 9 following, 1 of the 5 which must include either depressed mood of anhedonia (loss of interest), for at least 2 weeks or more:
SIG E CAPS:
- Sleep disturbances: hypersomnia or insomnia
- Loss of interest: anhedonia
- Guilt/Feeling of worthlessness
- Energy loss and fatigue
- Concentration loss/problems
- Appetite changes/Weight changes
- Psychomotor retardation/agitation
- Suicidal ideation
- Depressed mood
What are the risks of suicide?
SAD PERSONS
- S: Sex (Male)
- A: Age (45y)
- D: Depression
- P: Previous attempts
- E: Ethanol/Drug abuse
- R: Loss of Rational Thinking
- S: Sicknesses (chronic medical illnesses)
- O: Organized plan
- N: No social support
- S: Stated future intent
What is dysthymia?
Milder form of depression lasting at least 2 years
= Persistent depressive disorder
What are the indications for electroconvulsive therapy?
- Major depressive disorder refractory to other treatment
- Pregnant women with major depressive disorder
- Acute suicidality when immediate response is needed
- Depression with psychotic features
- Catatonia
What are the side effects of electroconvulsive therapy?
- Disorientation
- Partial anterograde/retrograde amnesia
- Headache
> > Usually resolves fully in 6 months
What is the physiology of electroconvulsive therapy?
Induction of a relatively controlled seizure in a patient under GENERAL anaestheia
How long does postpartum blues usually last?
Usually resolves within 10 days of onset
When is the typical onset of postpartum mood disturbances?
Within 4 weeks of delivery
What characterizes postpartum psychosis?
- Hallucinations
- Delusions
- Confusion
- Unusual behaviour
- Homicidal/Suicidal ideations/attempts
Usually lasts from days to 4-6 weeks
» May need inpatient care
» Assessment for child safety
Which class of drug is fluoxetine?
SSRI: Selective serotonin reuptake inhibitors
Which class of drug is paroxetine?
SSRI: selective serotonin reuptake inhibitor
Which class of drug is sertraline?
SSRI: selective serotonin reuptake inhibitor
Which class of drug is citalopram?
SSRI: selective serotonin reuptake inhibitor
Which class of drug is duloxetine?
SNRI: serotonin-norepinephrine reuptake inhibitor
Which class of drug is venlafaxine?
SNRI: serotonin-norepinephrine reuptake inhibitor
Which class of drug is milnacipran?
SNRI: serotonin-norepinephrine reuptake inhibitor
Which class of drug is amitriptyline?
TCA: tricyclic anti-depressant
Which class of drug is nortriptyline?
TCA: tricyclic anti-depressant
Which class of drug is imipramine?
TCA: tricyclic anti-depressant
Which class of drug is desipramine?
TCA: tricyclic anti-depressant
Which class of drug is doxepin?
TCA: tricyclic anti-depressant
Which class of drug is amoxapine?
TCA: tricyclic anti-depressant
Which class of drug is selegiline?
MAOI: monoamine oxidase inhibitor
Which class of drug is tranylcypromine?
MAOI: monoamine oxidase inhibitor
Which class of drug is isocarboxazid?
MAOI: monoamine oxidase inhibitor
Which class of drug is phenelzine?
MAOI: monoamine oxidase inhibitor
Name 4 examples of SSRIs.
- Fluoxetine
- Paroxetine
- Sertraline
- Citalopram
Name 3 examples of SNRIs.
- Venlafaxine
- Duloxetine
- Milnacipran
Name 6 examples of TCAs.
- Amitriptyline
- Nortriptyline
- Imipramine
- Desipramine
- Clomipramine
- Doxepin
- Amoxapine
Name 4 examples of MAOIs.
- Tranylcypromine
- Phenelzine
- Isocarboxazid
- Selegiline
Which class of drug is clomipramine?
SNRI: serotonin-noradrenaline reuptake inhibitor
Name 3 atypical antidepressants.
- Bupropion
- Mirtazapine
- Trazodone
What are the indications for SSRIs?
- Depression
- Generalized anxiety disorder
- Panic disorder
- OCD
- Bulimia
- Social phobia
- PTSD
What are the side effects of SSRIs?
Sexual dysfunction
Serotonin syndrome - Mental status changes: delirium, disorientation, anxiety - Autonomic instability >> Hyperthermia >> Cardiovascular collapse >> Flushing >> Diarrhea - Neuromuscular changes >> Hyperreflexia >> Myoclonus
What are the drugs associated with serotonin syndrome?
- SSRIs
- SNRIs
- MAOIs
- Cocaine
- Amphetamines
- Tryptophan
- St. John’s Wort
- Kava Kava
What are the indications for SNRIs?
- Depression
- Generalized anxiety disorder
- Panic disorder
- Diabetic peripheral neuropathy (duloxetine)
- Fibromyalgia (milnacipran)
What are the presenting features of TCA toxicity?
THREE Cs:
- Convulsion
- Coma
- Cardiotoxicity (Arrhythmias)
+ Respiratory depression
+ Hyperpyrexia
+ Confusion and hallucinations
How do we treat TCA toxicity?
NaHCO3 for urine ion trapping effect ONLY IF the patient is suffering from cardiotoxicity
How do we treat TCA toxicity?
NaHCO3 for urine ion trapping effect ONLY IF the patient is suffering from cardiotoxicity
What are the indications for MAOIs?
- ATYPICAL depression
- Anxiety
- Hypochondriasis
What are the side effects of MAOIs?
- Hypertensive crisis (with ingestion of tyramine)
- Tachycardia
- CNS stimulation
What are some drugs that are contraindicated in a patient taking MAOIs?
- SSRIs
- SNRIs
- TCAs
- Tryptophan
- Cocaine
- Amphetamine
- St. John’s Worst
- Mepiridine
- Dextromethorphan
> > To prevent precipitating serotonin syndrome (mental status changes, autonomic instability and neuromuscular abnormalities)
What are some drugs that are contraindicated in a patient taking MAOIs?
- SSRIs
- SNRIs
- TCAs
- Tryptophan
- Cocaine
- Amphetamine
- St. John’s Worst
- Mepiridine
- Dextromethorphan
> > To prevent precipitating serotonin syndrome (mental status changes, autonomic instability and neuromuscular abnormalities)
What is the mechanism of action of bupropion?
Inhibits reuptake of:
- Norepinephrine
- Dopamine
What are the indications for bupropion?
- Depression
- Smoking cessation
What are the side effects of bupropion?
- Stimulant effects
- Headaches
- Seizures
NO SEXUAL SIDE EFFECTS (VS. SSRIs)
What is the mechanism of action of mirtazapine?
- a2-antagonist: increases NE and 5-HT release
- 5HT2 and 5HT3 receptor antagonist
What are the side effects of mirtazapine?
- Sedation
- Increased appetite
- Weight gain
- Dry mouth
> > Anti-histaminergic effects
What is the mechanism of action of trazodone?
Antagonist of 5-HT2 and a1-adrenergic receptors
What are the indications for trazodone?
- INSOMNIA
- Depression: requires a large dose
What are the side effects of trazodone?
- Sedation
- Priapism
- Sedation
- Postural hypotension
