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Behavioral Health II > Schneiderhan- Tx for Psychiatric Conditions > Flashcards

Schneiderhan- Tx for Psychiatric Conditions Flashcards

1
Q

What are the characteristics of MDD?

A
  • 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
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2
Q

What are the characteristics of PDD?

A
  • 2 yrs feeling depressed, most of day/daily, “whole life”
  • > 2 sx
  • No medical conditions/PDs
  • No manic/hypomanic episodes
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3
Q

What do you use to evaluate depression and what is indicative of treatment/remission?

A

PHQ-9
Treat if scores > 10
Response >5 pt reduction

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4
Q

What is the difference between persistent, recurrent and refractory depression?

A

Persistent- chronic depression (YYY)
Recurrent- meds worked, were stopped, now depression is back (YYY)
Refractory- doesn’t respond to drugs (YYN)

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5
Q

What is the criteria for determining the type of depression?

A

Adequate medical trial
Adherence
Response–leads to reduced score on PHQ-9

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6
Q

During what week of treatment is their relief from depressed mood, feelings of hopelessness, and suicidal thoughts?

A

Week 2-4

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7
Q

What is first line treatment for resistant depression?

A
  1. Psychotherapy
  2. Li Augmentation- between TCA and citalopram
  3. T3 Augmentation
  4. 2nd Gen AP Augmentation
  5. Switching Antidepressants
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8
Q

What is T3 augmentation and what are the risk factors?

A

2x more likely to respond, has advantage over Li

Cardiac factors and osteopenia

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9
Q

What are the drugs used for 2nd gen AP augmentation?

A
  1. Aripiprazole- akathesia restlessness, wght gain (2 mg-> 10 mg)
  2. Olanzapine/fluoxetine- wght gain, diabetes
  3. Quetiapine- inhibits NE transport (300 mg)
  4. Risperidone/Ziprasidone (not good)
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10
Q

What two types of monitoring should occur when giving 2nd gen AP?

A
  1. Metabolic: wght gain, diabetes, hyperlipidemia

2. Neuro: dystonia, parkinsons, akathesia, dyskinesia

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11
Q

What are the most successful anti-depressants to siwtch to?

A

SSRI–> SSRI/SNRI

Venlaflaxine/paroxetine

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12
Q

What is the 2nd line treatment for resistant depression?

A
  1. Augmentation: Busprione/Pindolol/psychostimulants (none are significant)
  2. Combining anti-depressants: Mirtazapine and Despiramine both illicit signals
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13
Q

What are the characteristics of bipolar disorder in someone who is currently depressed?

A
  • 4-7 d elevated/irritable mood and increased activity

- > 3 sx, >4 if they are only irritable

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14
Q

What drugs can you use to treat Bipolar?

A

1st line:

  1. quetiapine
  2. lamotrigine
  3. olanzapine/fluoxetine
  4. Li
  5. lamotrigine + Li
  6. Mood stabilizer + AD
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15
Q

What are the characteristics of bipolar?

A

Instability in relationships, self image and impulsivity plus >5 of the following sx:

  1. avoiding abandonment
  2. impulsivity in >2 areas
  3. suicidal/self inj. behaviour
  4. Short term mood changes
  5. chronic emptiness
  6. stress-paranoia
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16
Q

How do you treat bipolar?

A

Sx reduction only, meds not FDA approved:

  1. Aripiprazole
  2. Olanzapine
  3. Divalproex
  4. Lamotrigine
  5. Topiramate
17
Q

What are the characteristics of PTSD?

A

Exposure to injury/death/vilence

  1. intrusion sx > 2
  2. avoidance
  3. alt in mood/cog and arousal/activity
  4. NOT d/t medical conditions
18
Q

What is first line tx for PTSD?

A

sertraline
paroxetine
fluoxetine

19
Q

What is 2nd line tx for PTSD?

A

venlaflaxine
mirtazapine/nefazodone
TCA (impiramine/amitryptiline)

20
Q

How can you augment PTSD treatment?

A
  1. Alpha 1 antag/alpha 2 ag to target re-experiencing (severe nightmares)
    - prazosin, clonidine, trazodone
  2. SGA to target psychosis/avoidance or first line tx resistance
    - olanzapine, quetiapine, risperidone, siprasidone, aripiprazole
  3. Anticonvulsants for re-experiencing, arousal
    - divalproex, carbamazepine, topiramate, lamotrigine
21
Q

What can be used to treat opioid induced hyperalgesia?

A
  1. opioid w/drawal
  2. methadone/pubrenorphine
  3. decreased glial activation
  4. secondary w/drawal sx (corticosteroids, clonidine)
22
Q

How do you treat fibromyalgia?

A
  1. Duloxetine
  2. milnaciprain
  3. pregabulin–CHF, obesity, confusion, wg, edema

Behavioral Health II (20 decks)

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