Schneiderhan- Tx for Psychiatric Conditions Flashcards
What are the characteristics of MDD?
- 5 + sx for 2 wks and changes from prior fxns
- Depressed mood, loss of pleasure and interest
- No other med conditions/disorders
- No manic/hypermanic episodes
What are the characteristics of PDD?
- 2 yrs feeling depressed, most of day/daily, “whole life”
- > 2 sx
- No medical conditions/PDs
- No manic/hypomanic episodes
What do you use to evaluate depression and what is indicative of treatment/remission?
PHQ-9
Treat if scores > 10
Response >5 pt reduction
What is the difference between persistent, recurrent and refractory depression?
Persistent- chronic depression (YYY)
Recurrent- meds worked, were stopped, now depression is back (YYY)
Refractory- doesn’t respond to drugs (YYN)
What is the criteria for determining the type of depression?
Adequate medical trial
Adherence
Response–leads to reduced score on PHQ-9
During what week of treatment is their relief from depressed mood, feelings of hopelessness, and suicidal thoughts?
Week 2-4
What is first line treatment for resistant depression?
- Psychotherapy
- Li Augmentation- between TCA and citalopram
- T3 Augmentation
- 2nd Gen AP Augmentation
- Switching Antidepressants
What is T3 augmentation and what are the risk factors?
2x more likely to respond, has advantage over Li
Cardiac factors and osteopenia
What are the drugs used for 2nd gen AP augmentation?
- Aripiprazole- akathesia restlessness, wght gain (2 mg-> 10 mg)
- Olanzapine/fluoxetine- wght gain, diabetes
- Quetiapine- inhibits NE transport (300 mg)
- Risperidone/Ziprasidone (not good)
What two types of monitoring should occur when giving 2nd gen AP?
- Metabolic: wght gain, diabetes, hyperlipidemia
2. Neuro: dystonia, parkinsons, akathesia, dyskinesia
What are the most successful anti-depressants to siwtch to?
SSRI–> SSRI/SNRI
Venlaflaxine/paroxetine
What is the 2nd line treatment for resistant depression?
- Augmentation: Busprione/Pindolol/psychostimulants (none are significant)
- Combining anti-depressants: Mirtazapine and Despiramine both illicit signals
What are the characteristics of bipolar disorder in someone who is currently depressed?
- 4-7 d elevated/irritable mood and increased activity
- > 3 sx, >4 if they are only irritable
What drugs can you use to treat Bipolar?
1st line:
- quetiapine
- lamotrigine
- olanzapine/fluoxetine
- Li
- lamotrigine + Li
- Mood stabilizer + AD
What are the characteristics of bipolar?
Instability in relationships, self image and impulsivity plus >5 of the following sx:
- avoiding abandonment
- impulsivity in >2 areas
- suicidal/self inj. behaviour
- Short term mood changes
- chronic emptiness
- stress-paranoia
How do you treat bipolar?
Sx reduction only, meds not FDA approved:
- Aripiprazole
- Olanzapine
- Divalproex
- Lamotrigine
- Topiramate
What are the characteristics of PTSD?
Exposure to injury/death/vilence
- intrusion sx > 2
- avoidance
- alt in mood/cog and arousal/activity
- NOT d/t medical conditions
What is first line tx for PTSD?
sertraline
paroxetine
fluoxetine
What is 2nd line tx for PTSD?
venlaflaxine
mirtazapine/nefazodone
TCA (impiramine/amitryptiline)
How can you augment PTSD treatment?
- Alpha 1 antag/alpha 2 ag to target re-experiencing (severe nightmares)
- prazosin, clonidine, trazodone - SGA to target psychosis/avoidance or first line tx resistance
- olanzapine, quetiapine, risperidone, siprasidone, aripiprazole - Anticonvulsants for re-experiencing, arousal
- divalproex, carbamazepine, topiramate, lamotrigine
What can be used to treat opioid induced hyperalgesia?
- opioid w/drawal
- methadone/pubrenorphine
- decreased glial activation
- secondary w/drawal sx (corticosteroids, clonidine)
How do you treat fibromyalgia?
- Duloxetine
- milnaciprain
- pregabulin–CHF, obesity, confusion, wg, edema
