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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)
21
Q
A
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
Q

Depressive Disorder: What treatment actions should be done at week 7-12?

A
  • Monthly communication w/ patient
  • Patients appointments every 3rd or 4th week
  • Further medication or medication dosage adjustments
  • Goal: Remission
26
Q

In a patient with Depressive Disorder, when should a provider consider switching medication?

A
  1. Partial response
    • 1st maximize dose of intial agent as tolerated
    • switch to another med or add second drug as needed
27
Q

Depressive Disorder= What should a provider do if partial response continues?

A
  • Add psychotherapy
  • Change antidepressants
  • Augment with bupropion, mirtazapine, nontraditional agent

Combo therapy may offer benefits over withdrawing 1 drug and starting another

28
Q

How long to maintain pharmacologic therapy for Depressive disorder for the first episode

A

tx may take 1 to several months until remission

Continue for another 6-12 months

29
Q

How long to maintain pharmacologic therapy for Depressive disorder for multiple episodes of depression?

A

Even longer duration of therapy may be beneficial

15 months-3 years

30
Q

How long to maintain pharmacologic therapy for patiehts >70y/o with Depressive Disorder who respond to an SSRI?

A

Consider treating for 2 yrs to prevent recurrence

31
Q

What are the 3 psychotherapy interventions used to tx Depressive Disorder?

A
  1. Cognitive Behavioral Therapy
  2. Interpersonal Therapy

Problem solving Therapy

32
Q

How is cyclothymia best managed?

A

with psychotherapy

33
Q

What 3 drug categories are used to tx Bipolar Disorder

A
  1. Mood stabilizers (Lithium)
  2. Anticonvulsants
  3. Antipsychotics
34
Q

Which medication is used in Bipolar Disorder that is used for prophylaxis and tx of manic episodes?

A

Lithium (a mood stabilizer)

35
Q

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

A

Carbamazepine (Tegretol, Equetro)

36
Q

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?

A

Valproate sodium, valproic acid, divalproex sodium (Depakene, Depakote, Depakote ER, Depacon, Stavzor)

37
Q

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?

A

Antipsychotics-

  • Quetiapine (Seroquel)

*can be used as monotherapy or adjunctively w/ agents such as lithium or divalproex

38
Q

Which antipsychotic is indicated for short-term treatment of acute manic or mixed episodes that are associated with bipolar I disorder

A

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
Q

Overview of bipolar tx

A
40
Q

What medications should be used to tx the manic phase of bipolar disorder?

A
  1. Mood stabilizer
    • Lithium
    • divalproex (Depakote)
    • carbamazepine (Tegretol)

AND/OR

  1. Atypical antipsychotic
    • risperidone (Risperdal)
    • quetiapine (Seroquel)
41
Q

What medications could be used to tx the depressed phase of Bipolar Disorder

A
  • Mood stabilizer

AND/OR

  • Atypical Antipsychotic

AND/OR

  • Antidepressent
42
Q

Maintenance treatment for Bipolar Disorder (2)

A
  1. Mood stabilizer (Lithium)
  2. Atypical antipsychotic
43
Q

What are the 3 main suicide treatment components?

A
  1. Screen for and tx underlying psychiatric disorders aggressively
  2. Psychotherapy
  3. Safety plan
44
Q

What are 3 main underlying pschiatric disorders that should be treated in a suicidal patient and what do you treat them with?

A
  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
Q

What psychotherapy should be used in suicide treatment?

A

Cognitive behavioral therapy

46
Q

What are two 1st line treatments for PTSD?

A

Trauma focused psychotherapy

  1. Prolonged exposure therapy
  2. Eye movement desensitization and reprocessing (EMDR)
47
Q

What are 2 pharmacotherapy options as tx for PTSD?

A
  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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