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Year 3- Psychiatry > Psychopharmacological Treatments of Affective and Anxiety Disorders > Flashcards

Psychopharmacological Treatments of Affective and Anxiety Disorders Flashcards

1
Q

How long after starting antidepressants does the patient start to notice an effect?

A

2-4wks

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2
Q

If a patient is on antidepressants, how long do they have to trial a drug for without changes before changing the type?

A

2 months

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3
Q

Which conditions may be treated with antidepressants

A

Unipolar and bipolar depression
Organic mood disorders
Schizoaffective disorder
Anxiety disorders including OCD, panic, social phobia
PTSD

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4
Q

List some of the different antidepressant types.

A

Selective Serotonin Reuptake Inhibitors (SSRIs)
Tricyclics (TCAs)
Monoamine Oxidase Inhibitors (MAOIs)
Serotonin/Noradrenaline Reuptake Inhibitors (SNRIs)

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5
Q

How do SSRI’s work?

A

Block presynpatic seratonin reuptake

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6
Q

Which conditions do SSRI’s treat?

A

Anxiety
Depression

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7
Q
A
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8
Q

Side effects of SSRIs?

A

GI upset
Sexual dysfunction
Anxiety
Restlessness
Nervousness
Insomnia
Fatigue or sedation
Dizziness

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9
Q

What is important to note about starting SSRIs?

A

Symptoms get worse before they get better
Typically for 2-10 days

This is due to a thing called activation syndrome. Can cause nausea and anxiousness.

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10
Q

Which change may be seen on ECG in a patient taking tricyclics?

A

QT lengthening

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11
Q

What are the two types of tricyclics?

A

Secondary
Tertiary

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12
Q

Which type of antidepressant is lethal in overdose?

A

Tricyclics

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13
Q

Which antidepressant is rarely used but very effective for resistant depression?

A

Monoamine Oxidase Inhibitors (MAOIs)

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14
Q

Side effects of Monoamine Oxidase Inhibitors (MAOIs)?

A

Hypotension
Sleep disturbance
Sexual dysfunction
Sedation
Dry mouth

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15
Q

Monoamine Oxidase Inhibitors (MAOIs) can cause a hypertensive crisis when taken with foods rich in what?

A

Tyramine

->cheese

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16
Q

Symptoms of serotonin syndrome?

A

Abdominal pain, diarrhea, sweats, tachycardia, HTN, myoclonus, irritability, delirium. Can lead to hyperpyrexia, cardiovascular shock and death

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17
Q

How do you reduce risks of serotonin syndrome>

A

Wait 2 weeks before switching from an SSRI to an MAOI

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18
Q

When are Serotonin/Norepinephrine reuptake inhibitors (SNRIs) used?

A

Anxiety
Depression
Possibly neuropathic pain

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19
Q
A
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20
Q

How do Serotonin/Norepinephrine reuptake inhibitors (SNRIs) work?

A

Inhibit both serotonin and noradrenergic reuptake like the TCAS but without the antihistamine, antiadrenergic or anticholinergic side effects

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21
Q

List some Serotonin/Norepinephrine reuptake inhibitors (SNRIs).

A

Venlafaxine
Duloxetine
Vortioxetine

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22
Q

List some SSRIs.

A

Fluoxetine (Prozac)
Sertraline

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23
Q

List some tricyclics.

A

Desipramine
Notrtriptyline

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24
Q

Susie has a depressive episode with no history of hypomania or mania. She has depressed mood, not eating, psychomotor retardation and poor sleep with early morning wakening. What agent would you like to use for her?
Establish dx: Major depressive disorder
Target symptoms: depression, poor appetite, psychomotor retardation and insomnia

Medication?

A

SSRI

so either Citalopram, Fluoxetine or Sertraline.

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25
Q

Bob is a 55 year old diabetic man with mild hypertnesion and painful diabetic neuropathy who has had previous depressive episodes and one suicide attempt. He meets criteria currently for a major depressive episode with some anxiety. He has been treated with paroxetine, sertraline and mirtazepine. His depression was improved slightly with each of these meds but never remitted.

What would you like to treat him with?

A

Has already tried two SRRIs so best choice would be Duloxetine as targets neuropathic pain, depression and anxiety

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26
Q

What is the treatment for treatment resistant depression?

A
  1. Combo of antidepressants e.g. SSRI or SNRI with Mirtazapine
  2. Adjunctive treatment with lithium
  3. Adjunctive treatment with atypical antipsychotic e.g. Quetiapine, Olanzapine or Aripiprazole
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27
Q

What are the treatment options for treatment resistant anxiety?

A
  1. High dose SSRI first
  2. Combination of antidepressants e.g. SSRI or SNRI with Mirtazapine

3.Adjunctive treatment with atypical antipsychotic e.g. Quetiapine, Olanzapine or risperidone

  1. Adjunctive treatment with Pregabalin or buspirone
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28
Q

Why is diazepam not good for treatment resistant anxiety?

A

Does not treat underlying cause

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29
Q

Prophylaxis is important for antidepressant medication.

After one episode of depression, how long should the patient continue their meds?

A

6mths-1yr

30
Q

Prophylaxis is important for antidepressant medication.

After two episodes of depression, how long should the patient continue their meds?

A

2yrs

31
Q

Prophylaxis is important for antidepressant medication.

After three episodes of depression, how long should the patient continue their meds?

A

Lifelong

->generally well tolerated so okay to take long-term

32
Q

What are some of the conditions treated with mood stabilisers?

A

Bipolar
Cyclothymia
Schizoaffective,

33
Q

What are some of the types of mood stabilisers?

A

Lithium
Anticonvulsants
Antipsychotics

34
Q

What is the only medication that reduces suicide rate?

A

Lithium

35
Q
A
36
Q

What are some of the factors which predict a good response to lithium treatment?

A

Prior long-term response or family member with good response
Classic pure mania
Mania is followed by depression

37
Q

What is lithium effective in the prophylaxis of?

A

Both mania and depressive episodes of bipolar affective disorder

38
Q

What tests need to be done before commencing someone on lithium?

A

Baseline U&Es and TSH
Pregnancy test in females

39
Q

Side effects of lithium?

A

GI upset e.g. reduced appetite, nausea/vomiting, diarrhoea

Thyroid abnormalities

Hair loss

Acne

Polyuria/polydipsia

40
Q

Valproic acid, an anticonvulsant, is as effective as Lithium in mania prophylaxis but is not as effective in depression prophylaxis. It is better tolerated than lithium.

What are some of the factors which predict a good response?

A

Rapid cycling patients (females>males)
Comorbid substance issues
Mixed patients
Patients with comorbid anxiety disorders

41
Q

Which tests need to be done before starting a patient on Valproic acid?

A

LFTs
Pregnancy test
FBC

42
Q

Why should Valproic acid be avoided completely in women of child bearing age?

A

Can cause neural tube defects

43
Q

Side effects of Valproic acid?

A

Thrombocytopenia and platelet dysfunction

Nausea, vomiting, weight gain

Sedation, tremor

Increased risk of neural tube defect

Hair loss

44
Q

What is the first line agent for acute mania and mania prophylaxis?

A

Carbamazepine (Tegretol)

45
Q

Lithium can be toxic.

What are some of the symptoms of mild lithium toxicity?

A

Vomiting
Diarrhoea
Ataxia
Dizziness
Slurred speech
Nystagmus

46
Q

Lithium can be toxic.

What are some of the symptoms of moderate lithium toxicity?

A

Nausea
Vomiting
Anorexia
Blurred vision
Clonic limb movements
Convulsions
Delirium
Syncope

47
Q

Lithium can be toxic.

What are some of the symptoms of severe lithium toxicity?

A

Generalized convulsions
Oliguria
Renal failure

48
Q

Before starting a patient on Carbamazepine (Tegretol), which tests need to be done?

A

Baseline liver function tests, FBC and an ECG

49
Q

Side effects of Carbamazepine (Tegretol)?

A

Rash- most common SE seen
Nausea, vomiting, diarrhea
Sedation, dizziness, ataxia, confusion
AV conduction delays
Aplastic anemia and agranulocytosis
Water retention
Drug-drug interactions

50
Q

Lamotrigine ( Lamictal) is another type of anticonvulsant. What can it also be used for?

A

Neuropathic / chronic pain

51
Q

Tests before starting Lamotrigine ( Lamictal)?

A

LFTs

52
Q

Side effects of Lamotrigine ( Lamictal)?

A

Necrotising fasciitis
Nausea/vomiting
Sedation, dizziness, ataxia and confusion
Stevens Johnson’s Syndrome.

-> The character/severity of the rash is not a good predictor of severity of reaction. Therefore, if ANY rash develops, discontinue use immediately.

53
Q

If a patient on

A
54
Q

47 yo woman hospitalized with her first episode of mania. She has no previous history of a depressive episode. She has no drug or ETOH history and has no medical issues. What medication would you like to start?

A

Lithium

->likely over child bearing age but check pregnancy test beforehand.

55
Q

Conditions which are treated with antipsychotics?

A

Schizophrenia
Schizoaffective disorder
Bipolar disorder- for mood stabilization and/or when psychotic features are present
Psychotic depression
Augmenting agent in treatment resistant anxiety disorders

56
Q

Adverse effects of antipsychotics?

A

Tardive Dyskinesia (TD)-involuntary muscle movements that may not resolve with drug discontinuation
Neuroleptic Malignant Syndrome (NMS): Characterized by severe muscle rigidity, fever, altered mental status, autonomic instability, elevated WBC, CPK and LFTs.
Extrapyramidal side effects (EPS): Acute dystonia, Parkinson syndrome,
Akathisia be aware increased risk of suicide

57
Q

What are there reduced levels of in Parkinson’s?

A

Dopamine

58
Q

What are the two types of antipsychotic drugs?

A

Typicals
Atypicals

59
Q
A
60
Q
A
61
Q

Give some examples of typical antipsychotic drugs?

A

Fluphenazine, Haloperidol, Pimozide.

62
Q

Give some examples of atypical antipsychotic drugs.

A

SDAs:
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Aripiprazole (Abilify)

63
Q

Schizophrenia is a chronic illness
Roughly 1/3 don’t respond to first line treatment
Treatment resistance defined as poor response to 2 first line antipsychotics at at adequate dose for 8 weeks

What is used in this case?

A

Clozapine

64
Q

21 yo AA male with symptoms consistent with schizophrenia is admitted because of profound psychotic sx. He is treatment naïve. You plan to start an antipsychotic- what baseline blood work would you obtain?

A

Fasting lipid profile
Fasting blood sugar
Lfts
WBC

65
Q

Which conditions are anxiolytics used to treat?

A

Panic disorder
Generalized Anxiety disorder
Substance-related disorders and their withdrawal Insomnias and parasomnias

66
Q

Which other drugs are anxiolytics combined with to treat anxiety?

A

SSRIS or SNRIs

67
Q

List some anxiolytics drugs.

A

Buspirone (Buspar)
Benzodiazapines

68
Q

As well as anxiety, which other conditions can Benzodiazapines treat?

A

Insomnia and parainsomia

69
Q

Side effects of Benzodiazapines?

A

Somnolence- drowsiness or strong desire to fall asleep
Cognitive deficits
Amnesia
Disinhibition
Tolerance
Dependence

70
Q

What is the most common psychotic symptom>

A

Lack of insight

->bad as this means patients often don’t take their medications as they don’t realise they are ill.

71
Q
A

Year 3- Psychiatry (12 decks)

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