Psychiatry Flashcards
Diagnostic criteria for Major Depressive Syndrome
at least 5 for 2 or more weeks.
- Sleep changes
- Interest lost (anhedonia)
- Guilty increase
- Energy loss
- Concentration disrupted
- Appetite change (increase/decrease)
- Psychomotor changes (agitation)
- Suicidal Ideation
Major risk factors for suicide
Psychiatric d/o, Feeling of hopelessness, IMpulsive. Old age, male sex, access to firearm, previous attempts.
What medical illness can mimic depression?
Hypothyroidism, Hyperparathyroidism, Parkinson’s, Stroke, HIV, Cancer
Citalopram
Fluoxetine
Sertraline
Paroxetine
SSRI
- Block synaptic uptake of serotonin.
- require 2-4wk before effective.
- ADR
- sex dysfunction
- insomnia
- weight gain
- serotonin syndrome (dilated pupils, myoclonus, Hyperthermia, tachycardia, hyperreflexia)
Desvenlafaxine
Duloxetine
Milnacipran
Venlafaxine
SNRI
- Block persynaptic uptake of Serotonin and NE
- ADR
- sex dysfunction
- nausea
- HTN (venlafaxine)
Bupropion
NDRI
- Block dopamine and NE uptake
- ADR
- insomnia
- weight loss
- no sexual dysfunction
- Lowers seizure threshold and not approved for use in seizure or malnutrition disorders.
Mirtazapine
Alpha2-antagonist
- Block alpha2, causing increase NE levels
- ADR
- sedation
- weight gain
- increased appetite.
Trazodone
Nefazodone
Vilazodone
Serotonin modulators.
- Varying effects of signaling molecules
- ADR
- sedation
- Priapism
Amitriptyline
Clomipramine
Imipramine
Nortriptyline
Tricyclic antidepressants.
- Use
- Enuresis
- Neuropathic pain.
- ADR
- the C’s
- Convulsion
- Cardiotoxicity
- Coma (AMS)
Tranylcypromine
Phenelzine
Selegiline
MAOI
- Block MAO enzyme. Leading to high levels of NE, dopamine, Serotonin
- ADR
- HTN crisis
- excessive consumption of tyramine containing foods (wine, cheese..)
- HTN crisis
Features of serotonin Syndrome
- AMS
- (anxiety, agitation, delirium, restlessness).
- Excitation
- diaphoresis, tachycardia, hyperthermia, HTN
- Myoclonus, rigidity, tremor
- Ocular clonus
- slow, continuous horizontal eye movements.
Treatment for Serotonin Syndrome
- Stop all offending agents.
- Supportive care.
- Benzos for sedation.
- > 41.1 temperature
- sedation, paralysis, ET tube, mechanical cooling.
- cyproheptadine
- if benzos do not control agitation.
How do you manage a TCA overdose?
Cardiotoxicity, CNS toxicity, antiCholinergic sxms.
- Cardiac monitor for 6+ hours. F/u w/ psych eval.
- QRS > 100msec = sodium bicarb.
- HoTN = IVF and norepinephrine if needed.
- Agitation/seizures = benzos.
- do not use phenytoin.
Symptoms of mania
DIGFAST
- Distractibility
- Insomnia w/o fatigue
- Grandiosity
- Flight of Ideas
- Activity/agitation constantly
- Speech rapid
- Taking high risk behavior.
Symptoms of psychosis
- Delusion
- Hallucinations
- Disorganized thoughts
- circumstantiality
- Tangential
- Loose association
- Word salad
- Neologism
