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MJ-Disciplines Exam 2 > Treatments > Flashcards

Treatments Flashcards

1
Q

What is the first line treatment for OCD?

A
  • Cognitive Behavioral therapy alone OR
  • SSRI alone OR
  • Tricyclic antidepressent alone OR
      • Tricyclic antidepressant (Clomipramine AKA Anafranil)–> inhibits reuptake of serotonin and norepinephrine
  • CBT + SSRI (Sertraline, Fluoxetine) OR
  • CBT +Tricyclic antidepressent (Clomipramine)

*consider tapering off meds after 1-2 yrs*

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2
Q

What is the first line tx for Body Dysmorphic disorder?

A

1st line tx is one of the following alone or CBT in combo with either SSRI or Tricyclic antidepressent:

  1. CBT
  2. SSRI (Escitalopram, Sertraline, Fluoxetine)
  3. Tricyclic antidepressent (Clomipramine)
  4. OR CBT+ SSRI or Tricyclic antidepressent

*considering tapering off meds after 1-2 years

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3
Q

T/F the first line tx for Body dysmorphic disorder is the same as for OCD?

A

TRUE

(except you DO NOT give Escitalapram in OCD)

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4
Q
A
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5
Q

What is the first line tx for Hoarding disorder?

A

Cognitive Behavioral Therapy

  • Typically comprised of 26 sessions spread out over a yr
  • Most have at least modest reduction in sxs
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6
Q

What do you do if a patient with hoarding disorder fails CBT (1st line therapy)

A

Screen for comorbid conditions and tx those

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7
Q

What is 2nd line tx for Hoarding Disorder and why would you give the 2nd line?

A
  • SSRI :
    • Sertraline (Zoloft)
    • Fluoxetine (Prozac)

Give SSRI if there is poor response, resistance or lack of access to CBT

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8
Q

What is first line tx for Trichotillomania?

A

Cognitive Behavioral Therapy

*not enough evidence regarding pharmacotherapy

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9
Q

What are the 3 primary elements of treating escoriation disorder?

A
  1. Optimization of patients mental state (CBT)
  2. Pharmacologic therapies (SSRI, Dermatologic therapies)
  3. Nonpharmacologic therapies (Laser therapy to reduce scarring, specialized bandages)
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10
Q

What are pharmacologic therapies used to tx excoriation disorder?

A
  • SSRI:
    • Sertraline (Zoloft)
    • Fluoxetine (Prozac)- often used in peds but advise about black box SI warnings
  • Dermatologic therapies may include:
    • Topical or oral abx
    • Topical corticosteroids
    • Acne focused therapy
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11
Q

What are nonpharmacologic therapies used to tx Excoriation Disorder?

A
  • Laser therapy to reduce scarring
  • Specialized bandages to assist w/ wound healing
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12
Q

What are elements of acute treatment of eating disorders?

A
  1. Acute medical stabilization
    • hospitalization
    • in-patient EDO tx center
    • Outpatient intensive therapy EDO tx center
  2. Nutritional and Fluid/electrolyte stabilization
    • Break binge-purge cycle in BN
    • Correct starvation state in AN
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13
Q

During acute treatment of Anorexia Nervosa, what is important to monitor and what is considered safe weight gain?

A

Correct starvation state:

  • Monitor closely to prevent gastric dilation and CHF
  • Weight gain of 0.16kg/day or 0.45-1.36kg/week considered safe
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14
Q

What are the 3 elements of chronic treatment of eating disorders?

A
  1. Medical and nutritional support/surveillance
    • Education about proper nutrition and risks of chronic dieting and/or purging
  2. Mental health tx (long term, family therapy often helpful)
  3. Interprofessional team approach is optimal
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15
Q

What is pharmacotherapy for eating disorders?

A

SSRI Antidepressants

  • Fluoxetine (studied the most)
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16
Q

What pharmacotherapy should be especially considered in Bulemia Nervosa because it reduces frequency of binging and purging

A

SSRI antidepressants (Fluoxetine)

Both for depressed and non-depressed patients

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17
Q

What pharmacotherapy should be considerend in Nutritionally stable Anorexia Nervosa?

A

SSRI Antidepressants (Fluoxetine)

  • moderate obsessive-compulsive behaviors
  • may need higher dose than average
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18
Q

The following are considerations for tx of ____ to _____ depression? (what severity)

  1. Benefits equally from psychotherapy or medication
  2. Exercise therapy may be appropriate; close follow up warranted
A

Mild to moderate

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19
Q

What 2 groups of meds should be used to initiate tx of Depressive Disorder?

A
  • 1st line-
    • SSRI (citalopram, escitalopram, fluoxetine, paroxetine, sertraline) OR
    • SNRI (venlafaxine, desvenlafaxine, duloxetine)
  • Mirtazapine and bupropion may also be appropriate
20
Q

What should a patient with Depressive Disorder be prescribed if they fail SSRI and SNRI?

A

Atypical antidepressants

  • bupropion (Wellbutrin)
  • mirtazapine (Remeron)
  • nefazodone and trazodone (Desyrel)
22
Q

Depressive Disorder: What treatment actions should be done at week 2 follow up?

A
  • Check patient compliance to medication usage
  • Assess for adherence, side effects, SI, pt response
  • Adjust as appropriate, medication and dosage
23
Q

Depressive Disorder: What treatment actions should be done at week 4?

A
  • Re-check patient compliance to medication usage
  • assess for adherence, side effects, SI and pt response
24
Q

Depressive Disorder: What treatment actions should be done at week 6?

A

Adjust, as appropriate, medication and dosage

25
Depressive Disorder: What treatment actions should be done at week 7-12?
* Monthly communication w/ patient * Patients appointments every 3rd or 4th week * Further medication or medication dosage adjustments * Goal: Remission
26
In a patient with Depressive Disorder, when should a provider consider switching medication?
1. Partial response * 1st maximize dose of intial agent as tolerated * switch to another med or add second drug as needed
27
Depressive Disorder= What should a provider do if partial response continues?
* Add psychotherapy * Change antidepressants * Augment with bupropion, mirtazapine, nontraditional agent Combo therapy may offer benefits over withdrawing 1 drug and starting another
28
How long to maintain pharmacologic therapy for Depressive disorder for the first episode
tx may take 1 to several months until remission Continue for another 6-12 months
29
How long to maintain pharmacologic therapy for Depressive disorder for multiple episodes of depression?
Even longer duration of therapy may be beneficial 15 months-3 years
30
How long to maintain pharmacologic therapy for patiehts \>70y/o with Depressive Disorder who respond to an SSRI?
Consider treating for 2 yrs to prevent recurrence
31
What are the 3 psychotherapy interventions used to tx Depressive Disorder?
1. Cognitive Behavioral Therapy 2. Interpersonal Therapy Problem solving Therapy
32
How is cyclothymia best managed?
with psychotherapy
33
What 3 drug categories are used to tx Bipolar Disorder
1. Mood stabilizers **(Lithium)** 2. Anticonvulsants 3. Antipsychotics
34
Which medication is used in Bipolar Disorder that is used for prophylaxis and tx of manic episodes?
Lithium (a mood stabilizer)
35
Which anticonvulsant should be used in patients with Bipolar Disorder who have not had clinical response to lithium and who have rapid-cycling bipolar d/o
Carbamazepine (Tegretol, Equetro)
36
Which anticonvulsants have proven effectiveness in treating mania, can be used alone or in combo w/ lithium and is useful for rapid cycling bipolar d/o?
Valproate sodium, valproic acid, divalproex sodium (Depakene, Depakote, Depakote ER, Depacon, Stavzor)
37
Which antipsychotic is indicated for acute tx of manic (immediated release and extended release) or mixed (XR) episodes that are associated with **bipolar I disorder?**
Antipsychotics- * Quetiapine (Seroquel) \*can be used as monotherapy or adjunctively w/ agents such as lithium or divalproex
38
Which antipsychotic is indicated for short-term treatment of acute manic or mixed episodes that are associated with bipolar I disorder
Antipsychotics: * Risperidone (RIsperdal) \* can be used alone or in combination with lithium or valproate \*can be used in adults and adolescents aged 10-17 years with bipolar I disorder
39
Overview of bipolar tx
40
What medications should be used to tx the manic phase of bipolar disorder?
1. Mood stabilizer * Lithium * divalproex (Depakote) * carbamazepine (Tegretol) AND/OR 1. Atypical antipsychotic * risperidone (Risperdal) * quetiapine (Seroquel)
41
What medications could be used to tx the depressed phase of Bipolar Disorder
* Mood stabilizer AND/OR * Atypical Antipsychotic AND/OR * Antidepressent
42
Maintenance treatment for Bipolar Disorder (2)
1. Mood stabilizer (Lithium) 2. Atypical antipsychotic
43
What are the 3 main suicide treatment components?
1. Screen for and tx underlying psychiatric disorders aggressively 2. Psychotherapy 3. Safety plan
44
What are 3 main underlying pschiatric disorders that should be treated in a suicidal patient and what do you treat them with?
1. Unipolar major depression or bipolar disorder * maintenance tx w/ lithium 2. Unipolar major depression * Double SSRI dosage (can reduce suicide by 25%) * Electroconvulsive therapy 3. Psychotic disorders * Olanzapine (Zyprexa)
45
What psychotherapy should be used in suicide treatment?
Cognitive behavioral therapy
46
What are two 1st line treatments for PTSD?
Trauma focused psychotherapy 1. Prolonged exposure therapy 2. Eye movement desensitization and reprocessing (EMDR)
47
What are 2 pharmacotherapy options as tx for PTSD?
1. **SSRIs** 2. **Prazosin (Minipress)** 30-60 min before bedtime * Alpha 1 blocker (usually for HTN) * significant sleep disturbances (nightmares) * this is off label use

MJ-Disciplines Exam 2 (8 decks)

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