Pyschotherapy and Psychopharm Flashcards
4 types of therapy
- individual (supportive, insight oriented)
- behavior (desensitization, substitution, hypnosis)
- cognitive
- social (marital, AA)
therapy to maintain defense mechanisms for improved function?
Indicated for?
Supportive
adjustment disorders, acute emotional crises
therapy to breakdown unconscious maladaptive defense mechanisms?
indicated for?
insight-oriented
depression, anxiety, somatoform/dissociative/personality, neuroses, trauma
indications for cognitive therapy?
major depression, self-defeating attitudes
3 classes of psychopharm
- antidepressants / mood stabilizers
- anti-psychotics
- anxiolytics / hypnotic
3 types of neurotransmitter targets of psychopharm
- monoamines (norepinephrine, dopamine, serotonin, acetylcholine, histamine)
- amino acids (GABA)
- glutamic acid
4 categories of antidepressants
Their mechanism
Their side effects
Which is most commonly used?
- SSRIs / SSNRIs
reuptake inhibition of 5HT / 5HT-NE
GI, sexual - TCA
reuptake reduction of NE and 5-HT
anti-adrenergic - cardiac arrhythmias / orthostatic HoTN, anticholinergic, anti-histamine - weight gain; coma / convulsion / cardiotox - MAOI
breakdown inhibition
HTN crisis if coupled w tyramine (wine, cheese, liver, smoked foods) - avoid unless atypical depression (overeating, oversleeping, irritability), orthostatic HoTN, somnolence, weight gain - Miscellaneous
SSRIs
3 commonly used mood stabilizers
Their side effects
- Li - tremor, NDI, acne, hypothyroidism, cardiac arrythmias, weight gain, edema, leukocytosis, cleared renally thus avoid if low GFR
- Valproate - thrombocytopenia, pancreatitis, hair loss, NT defects
- Carbamazepine -slurring, transaminitis, craniofacial defects in newborn, agranulocytosis
1st gen antipsychotics
Mechanism?
Most effective for?
Side effects? - CNS, anticholinergic, CV, endocrine, metabolic
- blocks central DA receptors
- reducing pos symptoms of schizophrenia - hallucination and delusions
- CNS: EPS (acute dystonia, akathisia, Parkinsonian), Tardive Dyskinesia, sedation, NMS (rigidity, autonomic dysregulation - tx w dantrolene / bromocriptine)
- anticholinergic: hot as hare (increased temp), read as beet (flushing), blind as bat (mydriasis), dry as bone (dry mouth, no sweating), mad as hatter (delirium); opposite of DUMBBELSS (diarrhea, urination, miosis, bronchospasm, bradycardia, excitation, lacrimation, salivation, sweating)
- CV: a-blockade -> orthostatic HoTN, QT elongation
- Endocrine: hyperPRL -> gynecomastia, galactorrhea, sexual dysfunction
- Metabolic: weight gain
2nd gen (atypical) antipsychotics How diff from 1st gen?
Less likely to have CNS side effects
Anxiolytics / hypnotics
mech?
side effects?
withdrawal consequence?
binds GABA receptors
sedation, behavioral disinhibition, psychomotor impairment, cognitive impairment, ataxia; addictive
seizure -> death
Stimulants
mech?
indication?
increases NE, DA activity
ADHD
tx for OCD
SSRI (fluoxetine, sertraline, paroxetine, fluovaxamine), clomipramine
TCA that causes EPS and NMS?
amoxapine (metabolite of loxapine, a 1st gen anti-psychotic)
TCA w most favorable side effect profile?
desipramine