Quiz 2

Question 1

Anafranil, Elavil, Ludiomil, Norpramin, Tofranil

Answer 1

Tricyclic Antidepressants

Question 2

Prozac, Luvox, Zoloft

Answer 2

SSRIs (selective serotonin reuptake inhibitors

Question 3

Effexor, Wellbutrin

Answer 3

Heterocyclic Antidepressants

Question 4

Nardil, Parnate, Marplan

Answer 4

MAOIs (monoamine oxidase inhibitors)

Question 5

Steps for treatment with antidepressants

Answer 5

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”

Question 6

Biochemical effects of lithium

Answer 6

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

Question 7

Valproate

Answer 7

anti-convulsant. Best known. Helpful in rapid cycling, atypical features and mixed mood. Not for use in pregnancy

Question 8

Carbamazephine

Answer 8

Anti-convulsant. widespread use as mood stabilizer. Not FDA approved. Decrease white blood cell count, drug interactions high

Question 9

Lamotrigine

Answer 9

Anti-convulsant. New generation, approved for bipolar. Toxic rash. May be safer during pregnancy

Question 10

Gabapentin

Answer 10

Anti-convulsant. Bipolar disorder. primarily as adjunctive treatment. Not approved. Not during pregnancy

Question 11

Topiramate

Answer 11

Anti-convulsant. Not FDA approved. does not cause weight gain. Not during pregnancy

Question 12

Mania treatment protocol

Answer 12

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.

Question 13

Mixed mood treatment protocol

Answer 13

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

Question 14

Ativan, klonopin, valium, xanaz

Answer 14

Benzodiazepine (common name)

Question 15

Abilify, Risperdal, Seroquel

Answer 15

Atypical Antipsychotics

Question 16

Haldol, Mellaril, Moban, Navane, Prolizin, Stelazine, Thorazine (ine)

Answer 16

Typical/Conventional Antipsychotic

Question 17

Benefits of atypical antipsychotic medications

Answer 17

1) minimal EPS (dystonia, parkinsonism, tardive)
2) efficacy for positive symptoms
3) improved efficacy for negative symptoms
4) improved cognition and mood

Question 18

Referral Guide

Grief –> depression

Answer 18

Early morning awakening, serious weight loss, anhedonia, agitation

Question 19

Referral Guide

Depression –> vegitative symptoms

Answer 19

sleep disturbance, appetite disturbance, fatigue, decreased sex drive, agitation, psychomotor retardation, anhedonia

Question 20

Referral Guide

Depression –> atypical symptoms

Answer 20

pronounced fatigue, hypersomnia, increased appetite/weight gain, rejection sensitivity, reactive dysphoria

Question 21

Referral Guide

Dysthymia with sustained symptoms

Answer 21

low energy, anhedonia

Question 22

Referral Guide

Other

Answer 22

Daily functioning markedly impaired
Severe suicidal impulses/psychotic symptoms
Major depression/dysthymia fails to respond to psychotherapy

Question 23

Treatment of OCD

Answer 23

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

Question 24

Positive symptoms in schizophrenia

Answer 24

Hallucinations, delusions, agitation, floridly bizarre behavior

First rank-symptoms -thought broadcasting, experiences of alienation, experiences of influence, complete auditory hallucinations, delusional perceptions

Question 25

Negative symptoms in schizophrenia

Answer 25

Anhedonia, apathy, blunted affect, poverty of thought, feelings of emptiness, amotivational states