Quiz 2 Flashcards
Anafranil, Elavil, Ludiomil, Norpramin, Tofranil
Tricyclic Antidepressants
Prozac, Luvox, Zoloft
SSRIs (selective serotonin reuptake inhibitors
Effexor, Wellbutrin
Heterocyclic Antidepressants
Nardil, Parnate, Marplan
MAOIs (monoamine oxidase inhibitors)
Steps for treatment with antidepressants
1) start with SSRI low dose, 4-5 weeks 2) add other meds if necessary MAOI or lithium or nonbenxo anxiety 3) psychotic features present, add antipsychotic 4) check for compliance, alcohol use 5) be aware of side effects “washout period”
Biochemical effects of lithium
1) increse serotonin 2) enhance serotonin release 3) increase rate of synthesis of norepinephrine in depressed pts 4) decrease rate of synthesis in norepinephrine in manic pts 5) blks postsynaptic dopamine receptors sensitivity 6) has effect on G proteins
Valproate
anti-convulsant. Best known. Helpful in rapid cycling, atypical features and mixed mood. Not for use in pregnancy
Carbamazephine
Anti-convulsant. widespread use as mood stabilizer. Not FDA approved. Decrease white blood cell count, drug interactions high
Lamotrigine
Anti-convulsant. New generation, approved for bipolar. Toxic rash. May be safer during pregnancy
Gabapentin
Anti-convulsant. Bipolar disorder. primarily as adjunctive treatment. Not approved. Not during pregnancy
Topiramate
Anti-convulsant. Not FDA approved. does not cause weight gain. Not during pregnancy
Mania treatment protocol
1) Start with FDA approved medications, if psychotic symptoms present, add antipsychotic. Typically hospitalized. 5-15 days needed before eval. 2) choose alternative FDA approve med if pt doesn’t respond well 3) if monotherapy fails, try two-combination med. Try all two combination until exhausted 4) three drug combination. from ea main category (lithium, anticonvulsant, atypical antipsychotic). Consider ECT or clozapine at this stage 5) reassess diagnosis, comorbid conditions, compliance.
Mixed mood treatment protocol
1) Valproate/olanzephine first line treatment (mixed mood respond better to antivonvulsants/atypical antipsychotic over lithium)
2) if monotherapy fails, try with another med
3) two drug combination
4) three drug combination
Ativan, klonopin, valium, xanaz
Benzodiazepine (common name)
Abilify, Risperdal, Seroquel
Atypical Antipsychotics
Haldol, Mellaril, Moban, Navane, Prolizin, Stelazine, Thorazine (ine)
Typical/Conventional Antipsychotic
Benefits of atypical antipsychotic medications
1) minimal EPS (dystonia, parkinsonism, tardive)
2) efficacy for positive symptoms
3) improved efficacy for negative symptoms
4) improved cognition and mood
Referral Guide
Grief –> depression
Early morning awakening, serious weight loss, anhedonia, agitation
Referral Guide
Depression –> vegitative symptoms
sleep disturbance, appetite disturbance, fatigue, decreased sex drive, agitation, psychomotor retardation, anhedonia
Referral Guide
Depression –> atypical symptoms
pronounced fatigue, hypersomnia, increased appetite/weight gain, rejection sensitivity, reactive dysphoria
Referral Guide
Dysthymia with sustained symptoms
low energy, anhedonia
Referral Guide
Other
Daily functioning markedly impaired
Severe suicidal impulses/psychotic symptoms
Major depression/dysthymia fails to respond to psychotherapy
Treatment of OCD
Standard psychotherapy is ineffective
Behavioral techniques: exposure and response prevention
o Gradual exposure to anxiety provoking stimuli
o Response prevention helps patient avoid rituals
o Effective in 75-80% of patients
o 20-25 sessions
Medication treatment
o Selective 5-HT antidepressants (clomipramine, fluoxetine, sertraline, etc)
o Higher dosage than that to treat depression
o 50-65% efficient
o if patients stop using medication, 95% chance relapse rate
Combined behavioral and pharmacologic treatments are best
Positive symptoms in schizophrenia
Hallucinations, delusions, agitation, floridly bizarre behavior
First rank-symptoms -thought broadcasting, experiences of alienation, experiences of influence, complete auditory hallucinations, delusional perceptions
Negative symptoms in schizophrenia
Anhedonia, apathy, blunted affect, poverty of thought, feelings of emptiness, amotivational states
