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Social Behavioral Mike Rose > Treatments Week 3 > Flashcards

Treatments Week 3 Flashcards

1
Q

SUD and Bipolar

A

Lithium, Valproate, and Carbamezepine

CBT also effective in both disorders. Integrated group therapy has best outcomes.

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2
Q

Schizophrenia

A

Domamine antaonists: Haloperidol/Fluphenazine
Serotonin/DA antagonists: Clozaril (clozapine), risperidone, etc.

Naltrexone for alcohol dependence and Schizophrenia

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3
Q

GAD and Alcohol SUD

A

Buspirone

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4
Q

Social Anxiety Disorder and Alcohol SUD

A

Paroxetine (Small study)

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5
Q

PTSD and SUD

A

Group therapy integrating CBT for SUD and PTSD. Emphasis on seeking safety.

Sertraline helpful for cluster 1 ( early onset PTSD late onset SUD) Neutral for cluster 2 and contraindicated cluster 3 (early onset/severe SUD, and later-onset PTSD)

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6
Q

ADHD and SUD

A

No controlled trials

Conventional wisdom is to avoid psychostimulants.

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7
Q

Methylphenidate

A

First line for ADHD. Mildest

Short acting = Ritalin
Long acting = concerta

Risks: Cardiovascular; Anxiety/Depression; Pschosis/Mania (very rare)

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8
Q

Dextroamphetamine Sulfate (Dexedrine)

A

Other First line for ADHD. More potent amphetamine w/ 2-6 hour half life.

Risks: Cardiovascular; Anxiety/Depression; Pschosis/Mania (very rare)

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9
Q

Amphetamine and Dextroamphetamine (Adderall)

A

Potent and longest acting. Works by stimulating DA release and blocking reuptake.

Indications: ADHD, treatment resistant MDD adjunct, lethargy, trouble concentrating, poor motivation

Side effects: activation, anxiety
dangerous - dependence, arrythmias, psyfdchosis/Mania (very rare)

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10
Q

Atomoxetine (strattera)

A

Selective NE reuptake inhibitor. Second line for ADHD. First line for ADHD and Anxiety

A.E. = nausea, agitation

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11
Q

SSRIs

A

First line depression. Also used vs. anxiety disorders. Fluoxetine, Sertraline, etc.

Mechanism. Selectively block 5HT reuptake.

Safe

60% respond but only 30% remission. (50% of people get 50% better according to Baldes)

Most common side effect is sexual dysfunction (60-70%) along with GI, agitation/sedation

Other dangerous side effects: platelet dysfunction, drug interactions (CYP2D6), seizure, serotonin syndrome, suicide (questionable)

  • Can be effectively augmented with 3 drugs:
    1. ) Buspirone (Anxiolytic)
    2. ) Mirtazapine (atypical antidepressant)
    3. ) Buproprion (atypical antidepressant)
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12
Q

Mirtazapine (Remeron)

A

Blocks 5HT2 and 5HT3 (gut = anti-emetic) and alpha-2 autoreceptor antagonist. Net effect is increased synaptic NE and 5HT.

Indications: MDD, anxiety disorders

Side effects: sedation, weight gain (ideal use is in small elderly people who struggle to sleep.

Less sexual dysfunciton than SSRIs (13%)

Also can be used as cheaper version of Ondansetron (zofran)

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13
Q

SNRI

A

Block 5HT and NE (i.e. venlafaxine)

More energy/agitation, but still has sexual dysfunction.

Better for anxiety + depression according to Dr. Schultz.

(Baldes thinks slightly more effective.)

Most common side effect is sexual dysfunction (60-70%) along with GI, agitation/sedation. Hypertension, tachycardia. Discontinuation syndrome (must taper –> can be very dangerous.)

Other dangerous side effects: platelet dysfunction, drug interactions (CYP2D6), seizure, serotonin syndrome, suicide (questionable)

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14
Q

Buproprion

A

(Wellbutrin)

NE and DA specific blocker. Little to no sexual side effects.

Less help with anxiety except in smokers

Efficacy: Useful mostly as adjunct for residual symptoms.

Side effects: headache, hypertension, irritability, increased anxiety.

Dangerous = drug interactions CYP2D6 inhibitor, and seizures

Special uses: smoking cessation, ADHD, Reversal of sexual side effects.

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15
Q

Buspirone

A

Anxiolytic. Partial agonist of 5HT; less sexual side effects. Mild/moderate control of 5HT

Placebo effect/ mild effect. Rarely works for patients who have used benzos in the past.

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16
Q

Tricyclics

A

Imipramine

Mechanism: “shotgun drugs” increase synaptic 5HT and NE

Indications: MDD, anxiety, chronic (neuropathic) pain, fibromyalgia, and insomnia.

More efficacious than SSRIs or SNRIs. 80% respond with more side effects.

Side effects: Dry mouth, sedation, constipation.

Dangerous: drug interactions (CYP2D6, seizure, arrthymias, and lethal in overdose (one week prescriptions).

17
Q

Exposure therapy

A

Education about common reactions to trauma, breathing retraining, and repeated exposure to the past trauma in graduated doses.

The goal is for the traumatic event to be remembered without anxiety or panic resulting

18
Q

Cognitive Therapy

A

Separating the intrusive thoughts from the associated anxiety they produce

19
Q

Stress Inoculation Training

A

Variant of exposure therapy that teaches client to relax.

20
Q

Monoamine oxidase inhibitors

A

Archetypal agent: phynelzine

Mechanism: Inhibit MAO thus increase synaptic serotoning, NE, and DA.

Indications: MDD (treatment resistant), anxiety

Efficacy: More efficacious than SSRIs and SNRIs, or TCAs

Side effects: sedation, weight gain

Dangerous - med interactions, food interactions (tyramine), hypertensive crisis, and serotonin syndrome.

21
Q

Aripiprazole

A

Abilify. Atypical Antipsychotic that is the best in its class for antidepressant usage.

Mechanism: block post synaptic 5HT and partial agonist of post synaptic DA receptor. (different than other atypical antipsychotics!

Indications: Schizophrenia, bipolar, MDD (treatment resistant adjunct)

Efficacy: useful in combination of SSRI or SNRI

Side effects: sedation, weight gain, parkinsonian side effects.

22
Q

Lithium

A

Mechanism: enhance 5HT neurotransmission?

Indications: Bipolar, treament resistant MDD adjunct, mood stabilizer

Efficacy: Useful in combination with SSRI and SNRI (Baldes yes other guy no)

Side effects: sedation, weight gain, tremor

dangerous - toxicity (thiazide diuretics increase levels)

23
Q

Thyroid hormone (cytomel/triiodothyronine)

A

Mechanism: stimulate gene transcription

Indications: treatments resistant MDD adjunct; mood instability

Efficacy: Useful in combination with SSRI or SNRI (Baldes yes, other guy no)

Side effects: activation

Dangerous: hyperthyroidism (monitor levels)

24
Q

Ketamine

A

NMDA receptor antagonist. Increases BDNF to enhance neurogenesis

Indications: MDD -treatment resistant and severe (experimental), anesthesia

Efficacy: highly effective, very rapid onset

Side effects: sedation
dangerous - hallucinations, dissociation

25
Q

Electroconvulsive Therapy

A

Very effective for severe depressionl, refractory mania, and catatonia. Can be life saving, but stigmatized currently (biggest hurry)

Causes massive neurotransmitter release

26
Q

Transcranial magnetic stimulation

A

Stimulates dorsolater PFC. Not covered by insuarance

27
Q

Deep brain stimulation

A

Surgical implantation of simulator in the subcallosal cingulate gyrus.

Growing evidence indicating this for refractory depression

Social Behavioral Mike Rose (6 decks)

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