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Psychiatry Studying > review points > Flashcards

review points Flashcards

1
Q

What are the first-line treatments for mild-mod depression in pregnancy?

A

CBT (I)

IPT (I)

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2
Q

What are the second-line treatments for mild-mod depression in pregnancy?

A

Citalopram (III)
Escitalopram (III)
Sertraline (III)
[the same as during breastfeeding]

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3
Q

What are the third-line treatments for mild-mod depression in pregnancy?

A

(all drugs are level III or IV)
Fluoxetine
Fluvoxamine

Duloxetine
Venlafaxine
Desvenlafaxine

Bupropion
Mirtazapine

TCAs (not clomipramine)

ECT (III)

Exercise, acupuncture, bright-light (II) Other therapies (IV)

Combo SSRI + CBT/IPT (IV)

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4
Q

First line treatments in depression w/ breastfeeding

A

CBT or IPT (I)

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5
Q

Second line treatments in depression w/ breastfeeding

A

Citalopram (II)
Escitalopram (II)
Sertraline (II)
[the same as during pregnancy]

SSRI + CBT/IPT (II)

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6
Q

Third line treatments in depression w/ breastfeeding

A

Fluoxetine (II)
Fluvoxamine (II)
Paroxetine (II)
TCAs (not doxepin) (II)

Duloxetine (III)
Desvenlafaxine (III)
Venlafaxine (III)

Mirtazapine (III)
Bupropion (III)

ECT (III)

Other: therapies, bright light, exercise, acupuncture, behavioural activation

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7
Q

First line treatment for peri-menopausal depression

A

Desvenlafaxine (I)

CBT (II)

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8
Q

Second line treatment for peri-menopausal depression

A

transdermal estradiol (II)

citalopram (III)
escitalopram (III)

duloxetine (III)
venlafaxine (III)

mirtazapine (III)
quetiapine (III)

fluoxetine, sertraline, paroxetine, nortryptiline and Omega3 FAs (IV)

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9
Q

Third line treatment for peri-menopausal depression

A

mindfulness cbt, supportive

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10
Q

First line in LLD (CANMAT)

A

Duloxetine (I)
Mirtazapine (I)
Nortriptyline (I)

Citalopram (II)
Escitalopram (II)
Sertraline (II)

Duloxetine (II)
Desvenlafaxine (II)
Venlafaxine (II)

Voritoxetine (II)

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11
Q

Second line in LLD

A 
Nortriptyline (I)
Moclobemide (II)
Phenelzine (II)
Trazodone (II)
Quetiapine (II)
Bupropion (III)
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12
Q

Augmentation in LLD

A

Augmentation is considered second line:
Aripiprazole (I)
Lithium (I)
Methylphenidate (II)

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13
Q

In the CANMAT guidelines, which antidepressants have evidence for superior efficacy based on meta-analysis

A

Escitalopram
Citalopram
Sertraline
[same as meds for pregnancy and breastfeeding depression!]

Venlafaxine

Mirtazapine

Agomelatine

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14
Q 
CANMAT first line ADs (15 tot)
There are: 
- 6 SSRIs
- 4 SNRIs
- 5 other
A 
Citalopram
Escitalopram
Fluoxetine
Sertraline
Paroxetine
Fluvoxamine

Duloxetine
Desvenlafaxine
Venlafaxine
Milnacipran

Vortioxetine 
Mirtazapine
Bupropion
Agomelatine
Milanserin
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15
Q

CANMAT first line adjuncts (3)

A

Aripiprazole (I)
Quetiapine (I)
Risperidone (I)

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16
Q

CANMAT second line adjuncts (7)

A

Brexipip (I)
Olanzapine (I)

Bupropion (II)
Mirtaz (II)

Lithium (II)
Modafinil (II)
T3 (II)

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17
Q

Varenicline MOA

A

Partial agonist at α4β2 nAChR

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18
Q

Bupropion MOA

A

Noradrenaline and dopamine reuptake inhibitor
Dose: 150-300 mg daily
Cyp 2D6 inhibitor

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19
Q

Which patients need long-term depression treatment?

A

Patients with:

  • frequent, recurrent episodes
  • severe episodes (psychosis, severe impairment, suicidality)
  • chronic episodes
  • presence of co-morbid psychiatric or other medical conditions
  • presence of residual symptoms
  • difficult-to-treat episodes
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20
Q

What are the risk factors for chronic or recurrent depressive episodes?

A
  • Earlier age of onset
  • Greater number of previous episodes
  • Severity of the initial episode (defined by the presence of a greater number of symptoms, suicidal ideation, or psychomotor agitation)
  • Disruptions of the sleep-wake cycle
  • Presence of comorbid psychopathology (particularly persistent depressive disorder/dysthymia)
  • Family history of psychiatric illness
  • Presence of negative cognitions
  • High neuroticism
  • Poor social support
  • Stressful life events
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21
Q

Indications for ECT

A
  • acute SI (I)
  • psychotic features (I)
  • treatment-resistant depression (I)
  • medication intolerance (III)
  • catatonic features (III)
  • prior response to ECT (III)
  • rapidly deteriorating physical health (III)
  • pregnancy for any of the above (III)
  • patient preference (IV)
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22
Q

What are the first-line medication treatments for panic disorder?

A

(all the SSRIs and venlafaxine)
escitalopram, citalopram, fluoxetine, sertraline, paroxetine, fluvoxamine

Recall: CBT»pharmacoptherapy BUT CBT+pharmacotherapy is superior to either alone

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23
Q

What are the second-line medication treatments for panic disorder?

A

Clomipramine + imipramine
alprazolam, clonazepam, diazepam, lorazepam
mirtazapine
reboxetine

24
Q

What are the second-line adjuncts for panic disorder?

A

2nd line: alprazolam, clonazepam

25
Q

What medications are explicitly NOT recommended in panic disorder?

A

buspirone
trazodone
propranolol
tiagabine

26
Q

What are the first-line medications for SAD?

A

escitalopram, sertraline, paroxetine, fluvoxamine
(NO citalopram or fluoxetine)
venlafaxine
pregabalin

Recall: CBT is considered first line for SAD and in most cases CBT is as effective as CBT+pharmacotherapy

27
Q

What are the second-line medications for SAD?

A

citalopram
alprazolam, bromazepam, clonazepam
gabapentin
phenelzine

28
Q

What are the adjuncts for SAD?

A

aripiprazole, risperidone
paroxetine
buspirone

29
Q

What are the first-line medications for GAD?

A

escitalopram, paroxetine, sertraline
duloxetine, venlafaxine
pregabalin
agomelatine

Recall: CBT = pharmacotherapy, combination only recommended if one alone fails

30
Q

What are the second-line medications for GAD?

A 
alprazolam, bromazepam, diazepam, lorazepam
vortioxetine
bupropion
buspirone
quetiapine
hydroxyzine
31
Q

What are the adjuncts for GAD?

A

pregabalin

32
Q

What are the first-line treatments for BPAD I depression?

A 
quetiapine (I)
lithium (II)
lamotrigine (II)
lurasidone (II) 
lamotrigine + any (II)
lurasidone + li/val (I)
33
Q

What are the second-line treatments for BPAD I depression?

A 
cariprazine (I)
valproic acid (II)
adj SSRI/bupropion (I)
olanzapine + fluoxetine (II)
ECT (IV)
34
Q

What are the first-line treatments for BPAD mania?

A 
lithium
epival
asenapine +/- li/val
aripiprazole +/- li/val
risperidone +/- li/val
quetiapine +/- li/val
paliperidone
cariprazine
  • all level I evidence except asenapine and aripiprazole combos (level II)
35
Q

What are the second-line treatments for BPAD mania?

A 
lithium + epival
olanzapine +/- li/val
haldol
ziprasidone
carbamazepine
ECT
36
Q

What are the first-line treatments for BPAD I maintenance?

A 
lithium (I)
epival (I)
lamotrigine (I)
quetiapine (I) 
quetiapine + li/val (I)
aripirazole +/- li/val (II)
asenapine (II)
37
Q

What are the second-line treatments for BPAD I maintenance?

A 
olanzapine (I)
risperidone LAI (I) 
risperidone LAI adj. (II) 
lurasidone + li/val (III) 
ziprasidone + li/val (II)
carbamazepine (II)
paliperidone (II)
38
Q

What are the first-line treatments for BPAD II depression?

A

quetiapine (I)

39
Q

What are the second-line treatments for BPAD II depression?

A 
lithium (II)
lamotrigine (II)
venlafaxine (II)
sertraline (II)
bupropion adj (II)
ECT (III)
40
Q

What are the first-line treatments for BPAD II maintenance?

A

quetiapine (I)
lithium (II)
lamotrigine (II)

41
Q

What are the second-line treatments for BPAD II maintenance?

A

venlafaxine (II)

42
Q

CANMAT recommends lithium for BPAD when:

A 
classic grandiose mania
few prior episodes
mania -> depression -> euthymia course
family history of BPAD
family history of lithium response
43
Q

CANMAT recommends valproic acid for BPAD when:

A

dysphoric mania, predominant irritable/dysphoric mood
multiple prior episodes
comorbid substance abuse
history of head trauma

44
Q

CANMAT recommendation for mixed-feature treatment:

A

atypical antipsychotics +/- divalproex, combination typically required.
specifically asenapine, aripiprazole, olanzapine and ziprasidone

45
Q

CANMAT recommendation for BPAD w/ anxious distress:

A

quetiapine
olanzapine with lithium or fluoxetine
lurasidone with lithium

46
Q

CANMAT recommendation for BPAD rapid cycling:

A 
lithium
divalproex
olanzapine
quetiapine
NOT lamotrigine
47
Q

Which mood stabilizers affect OCP levels?

A

carbamazepine
lamotrigine
topiramate

48
Q

What is the effect of lamotrigine and OCP?

A

they reduce the efficacy of each other (CANMAT pg 131)

49
Q

Preferred choice of meds in BPAD for breastfeeding as per CANMAT:

A

olanzapine

quetiapine

50
Q

Risk factors for BPAD in pediatric depression:

A 
family history (+)
early age of onset (+)
psychotic symptoms (+)

cyclothymia
emotional/behavioural dysregulation
subthreshold manic symptoms
atypical depression

51
Q

First-line treatments for mania in children:

A 
First line:
lithium (I)
risperidone (I) - consider with ADHD
quetiapine (II)
aripirazole (II)
asenapine (II)
52
Q

Second-line treatments for mania in children:

A 
olanzapine (II)
lurasidone (II)
quetiapine adj (III)
53
Q

First-line treatments for BPAD depression in children:

A

lurasidone (II)

54
Q

Second-line treatments for BPAD depression in children:

A

lamotrigine (IV)

lithium (IV)

55
Q

First-line treatments for BPAD maintenance in children:

A

lithium
epival
aripirazole

Psychiatry Studying (11 decks)

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