Psychology #1 Flashcards
Risk factors for Major Depressive Disorder
Female, 20’s, poor socioeconomic status, family history
Pathophysiology of Major Depressive Disorder
Alteration of neurotransmitters (serotonin, epinephrine, norepinephrine, histamaine, dopamine, and acetylcholine)
What screening methods are used for MDD
PHQ-2 and then, if positive, PHQ-9
What are the diagnostic criteria for MDD?
5 or more symptoms for most days for 2 or more weeks. Must include anhedonia or depressive mood
-fatigue, insomnia, sleep changes, weight change, concentration issues, guilt, suicidal thoughts, worthlessness feelings (SIGEMCAPS)
What must be true about the symptoms in MDD to diagnose it as MDD?
It MUST cause significant distress and must not be related to substance use
When should you consider treatment for a patient with MDD?
If PHQ-9 score is 10 or more
Treatment for MDD
1) Psychotherapy: CBT, interpersonal, or supportive therapy)
2) SSRI’s are first line
3) SNRI, TCA, Bupropion
4) Electroconvulsive therapy if no response to medication
What is seasonal affective disorder?
Presence of depressive symptoms at the same time each year
-Treamtent with SSRI’s, light therapy, Bupropion
What is atypical depression?
Normal depressive symptoms, but improved mood with positive events
Name the SSRI’s and how long do they take to reach maximum efficacy?
Sertraline, Fluoxetine, Paroxetine, Citalopram, Escitalopram
4-6 weeks for maximum efficacy
Which SSRI has a longer half life?
Fluoxetine
Adverse effects of SSRI’s include…
-GI, sexual dysfunction, insomnia, increased suicidality
What is one thing to be remembered when prescribing Citalopram (who is it contraindicated in?)
Those with long QT syndrome
SNRI’s inhibit the uptake of ______, ____, and ______. These drugs are….
Serotonin, norepinephrine, dopamine
Duloxetine, Venlafaxine, Desvenlafaxine
Which SNRI is given if the patient has severe fatigue or neuropathy pain syndromes?
Duloxetine
What is one advantage of Bupropion?
Less GI, sexual side effects than SSRI and SNRI
Bupropion also aids in _______, but has some adverse effects including…
Smoking cessation
Seizures (lowers threshold). Therefore, avoid abrupt withdrawal!
Another atypical antidepressant, Mirtazapine, inhibits which two neurotransmitters. It also has a benefit of
Inhibits serotonin and norepinephrine
-Fewer sexual side effects
Although Mirtazapine works quicker than SSRI’s (it takes 2-3 weeks), it has some adverse effects that include…
Weight gain, constipation, dry mouth, sedation
Name 4 TCA’s and what is the MC side effect of them?
Doxepin, Amitriptyline, Nortriptyline, Imipramine
Anticholinergic (MC)
What are the three signs of TCA overdose and what can be given for the first symptom?
-Cardiotoxicity (wide complex tachycardia)
-Coma
-Convulsions (Seizures)
-Give sodium bicarbonate for cardiotoxicity
Which TCA should be given for treatment of enuresis in kids?
Imipramine
The most serotonin specific TCA and what can it also be used as treatment for.
Clomipramine
OCD
MAO’s are drugs such as Phenelzine, Isocarboxazid and Tranylcypromine. Name two adverse effects or cautionary things to remember with these drugs.
-Orthostatic hypotension (MC)
-Hypertensive crisis (after eating foods high in tyramine such as aged cheese, red wine, beer, meats, chocolate)
Serotonin Receptor Antagonists and Agonists include two common drugs such as
Trazodone and Nefazodone
Serotonin Receptor Antagonists and Agonists are useful for _______, but some common side effects are ____ and _____
Insomnia
Sedation and Priapism
When does serotonin syndrome occur?
MC occurs after 24 hours after initiating or change in serotonergic drug dose
Symptoms of serotonin syndrome
-Cognitive: agitation, AMS, confusion
-Autonomic instability: hyperthermia, diaphoresis, tachycardia, BP changes
-Nausea, vomiting, diarrhea
-Clonus, hypertonia, tremor, akithisia
-Mydriasis, dry mouth, flushed skin
Treatment for serotonin syndrome (mild)
Prompt discontinuation of offending drug(s)
Supportive, IVF, oxygen, Benzos
Treatment for serotonin syndrome (moderate)
As above + Cyproheptadine
What is persistent depressive disorder?
Depressed mood for most days for 2 years or more (in adults) and at least 1 year in kids/adolescents
Treatment for persistent depressive disorder
Pharmacotherapy (SSRI) + Psychotherapy most effective
What is cyclothymic disorder?
At least 2 years of prolonged, milder elevations and milder depressions (do not meet criteria of hypomanic or depression)
Treatment for cyclothymic disorder
Lithium, Valproic Acid
-Alternatives: 2nd generation antipsychotics (Risperidone, Olanzapine, Quetiapine, Ziprasidone)
What is adjustment disorder and how long does it usually take to resolve?
Emotional or behavioral symptoms in response to stressor within 3 months of stressor onset
Resolves within 6 months usually
Treatment for adjustment disorder
Psychotherapy
What are the 5 stages of grief
-Denial, anger, bargaining, depression, acceptance
What are signs of abnormal grief?
If it lasts longer than 1 year or if she has suicidal ideation
What are some differences between grief and MDD?
Grief: intermittent
MDD: Consistent symptoms
Grief: self esteem preserved
MDD: Feeling of worthlessness
What are the criteria for Bipolar 1 Disorder?
At least 1 manic episode
-Abnormal, elevated, expansive, irritated mood for at least 1 week impairs function
-thinking: flight of ideas, grandiose, racing
-behavior: hyperactivity, pressured speech, no sleep, hypersexuality
Treatment for Bipolar I Disorder
Lithium (first line)
-Alternatives: Valproic acid, 2nd gen antipsychotics
-Psychotherapy
What is one benefit of Lithium as treatment?
It reduces suicide risk as well
What are the criteria for Bipolar II Disorder?
History of 1 major depressive episode + 1 hypomanic episode
-Patient has never had a manic episode!
What is hypomania?
Abnormal elevated mood < 1 week, doesn’t need hospitalization and doesn’t impair function at all
Treatment for Bipolar II Disorder
Lithium or 2nd gen antipsychotics
-Psychotherapy as well
Lithium alters neuronal sodium transport. What are some adverse effects of this medication.
Hypothyroidism
Hyperparathyroidism
Hypercalcemia
Hypermagnesemia
Prior to starting Lithium, what are some labs that should be obtained?
ECG, Beta-HCG, TSH, CBC
Monitor every 4-8 weeks
Contraindications and cautions to using Lithium
Do not use in pregnancy - associated with Ebstein’s Anomaly
Do not use in severe renal disease
Do not use with NSAIDs. Can raise Lithium levels in the blood too high.
Generalized anxiety disorder is anxiety or worry for at least _______ and the anxiety is out of proportion to the event. What should you screen with?
At least 6 months
GAD-7 (score of 10 or more is positive)
Treatment for GAD (acute and long-term)
Benzos for short-term (risk of dependence)
SSRI (first-line) but takes 4-6 weeks to reach efficacy
CBT, Psychotherapy
What are two positives about Buspirone?
Does not cause sedation and does not have abuse potential
What is the diagnostic criteria for panic disorder?
Recurrent, unexpected panic attacks (2 or more) that are often followed by concern about future attacks, persistent worry about attacks, and maladaptive behavior related to attacks
Treatment for panic disorder
SSRI + CBT
What is the usual time frame for a panic attack?
Peaks within 10 minutes and never lasts longer than 1 hour
Pathophysiology of a panic attack
Sympathetic system overdrive
Treatment for an acute panic attack
Benzos
What should you do BEFORE diagnosing a panic attack or treating it as a panic attack?
Rule out life threatening conditions such as a heart attack or thyrotoxicosis
What is agoraphobia?
Intense fear of being in places where escape is difficult (crowds, public transportation, out of the home)
Diagnostic criteria for agoraphobia
Symptoms last longer than 6 months and cause social or occupational impairment
Treatment for agoraphobia
SSRI + CBT
Treatment for a specific phobia
Exposure + desensitization
Short-term Benzos can be used in some patients
MC type of phobia
Social phobia (public speaking)
Treatment for social phobia
Psychotherapy (initially)
SSRIs
Situational: Propanolol 30-60 min prior to event
What is the difference between obsessions and compulsions?
Obsessions: recurrent or persistent thoughts
Compulsions: repetitive behaviors that cause distress, impairment, or are time-consuming
OCD is ego-dystonic/ego-syntonic?
Ego-dystonic (inconsistent with personal beliefs)
Which neurotransmitter is generally involved with OCD?
Serotonin
What are the four patterns in OCD?
1) Contamination
2) Pathologic Doubt
3) Symmetry/Precision
4) Intrusive obsessive thoughts with compulsion
Treatment for OCD
CBT + Pharmacotherapy
–SSRI (first line)
–TCA’s (Clomipramine)
Which TCA can be used for OCD and why?
Clomipramine because it is the most serotonin specific
