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PPT > WK1 Mental health > Flashcards

WK1 Mental health Flashcards

1
Q

first line medicaiton for GAD

A

SSRI -Sertraline

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2
Q

why are SSRIs and SNRIs used

A

best combination of efficacy and safety -less serious SE

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3
Q

escitalopram=

A

SSRI

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4
Q

paroxetine=

A

SSRI

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5
Q

SNRI=

A

serotonin and noradrenaline reuptake inhibitor

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6
Q

depression treatment with SSRIs initiation –>

A

start low go slow

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7
Q

average clinically meaniful action for SSRI

A

4 weeks

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8
Q

how long should the initial therapeutic SSRI/SNRI dose be continued for

A

4 - 6 weeks

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9
Q

how should an SSRI be increased

A

in 1-2 week increments until sufficient improvement or maximum dose tolerated

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10
Q

how do SSRIs work

A

inhibit neuronal reuptake of serotonin from synpatic cleft increasing its avalibility for neurotransmission

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11
Q

common SSRI side effects (4)

A
  • GI upset
  • appetite and weight change
  • hypersensitivity reactions incl skin rash
  • sexual dysfunction
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12
Q

other important SE of SSRIs (6)

A
  • suicidal thoughts
  • hyponatraemia
  • lower seizure threshold
  • prolong OT interval
  • serotonin syndrome
  • GI bleed
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13
Q

how long should a patient experiencing a good clinical response stay on antidepressants for GAD

A

12 months

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14
Q

SSRIs overdose risk compared to TCA and MAOIs

A

much less

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15
Q

venlafaxine=

A

SNRI

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16
Q

SNRI vs SSRI for overdose

A

SNRI have a greater risk of significant toxicity in overdose

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17
Q

symptoms of SSRI overdose

A
  • CNS features (tremor, agitation, fatigue, coma)
  • CVS features (tachycardia, hypotension, HTN, prolonged QT etc)
  • Rhabdomyolysis
  • serotonin syndrome
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18
Q

serotonin syndrome=

A

clinical combination of;

  • autonomic instability
  • mental status change
  • increased neuromuscular tone
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19
Q

what typically causes serotonin syndrome

A

combining two or more serotonergic medications

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20
Q

when does serotonin syndrome occur

A

several days to one week after addition of new agent / dose increase

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21
Q

3 most likely to cause serotonin syndrome

A

sertraline
paroxetine
fluvoamine

22
Q

clinical findings of serotonin syndrome (8)

A 
muscle clonus
ocular clonus 
agitation 
diaphoresis 
tremor 
hyperreflexia 
muscle rigidity 
hyperthermia
23
Q

severe serotonin syndrome can present with (5)

A 
acute hyperthermia 
HTN 
tachycardia 
agitated delirium 
muscle rigidity
24
Q

without intervention serotonin syndrome can result in (7)

A 
rhabdomyolysis
metabolic acidocis, 
renal failure '
seizures 
disseminated intravascular coagulation 
shock
25
Q

treatment of seizures from overdose

A

benzodiazepines

26
Q

serotonin antagonist (can be used in severe serotonin syndrome)

A

cyproheptadine

27
Q

prolonged OT interval after SSRI ingestion management

A

serial ECGs

28
Q

treatment of acute stress disorder

A

BDZ

29
Q

when does acute stress disorder become PTSD

A

> 4 weeks

30
Q

mirtazapine=

A

TCA

31
Q

antidepressant treatment for PTSD if

A
  • preference for drug treatment
  • refusal of specialist psychological therapies
  • delayed referral
32
Q

main treatment for PTSD

A

specialist mental health services for trauma focused psychological treatment

33
Q

antidepressants used in PTSD = (2)

A

paroxetine

mirtazapine

34
Q

prevalence of alcohol dependancy in UK

A

3.6%

35
Q

% of admitted patients with alcohol use problems

A

40%

36
Q

pharmacological support for alcoholics

A

IV thiamine

Chlordiazepoxide

37
Q

which BDZ are preferred in alcohol withdrawal

A

long-acting BDZ (e.g Diazepam)

38
Q

BDZ effect on GABA-A

A

increasing opening frequency of GABA-A receptor potentiating neurotransmission

39
Q

what ion does GABA increase the influx of into the neuron

A

Cl-

40
Q

useful effect of BDZ (6)

A 
sedation 
sleep induction 
anterograde amnesia 
anticonvulsant 
anxiolytic 
reduces muscle tone
41
Q

indication for BDZ

A

short term relief (2-4 weeks) of anxiety that is disabling or causing unacceptable distress

42
Q

when can BDZ be used to treat insomnia

A

when its severe, disabling, or causing extreme distress

43
Q

rapid withdrawal of BDZ can be

A

life threatening

44
Q

symptoms of BDZ withdrawal (6)

A 
tremors 
anxiety 
perceptual disturbances 
dysphoria 
psychosis 
seizures
45
Q

onset of withdrawal from BDZ

A

24-28 hrs –> 3 weeks (depending on half-life)

46
Q

how long do the symptoms of BDZ withdrawal last

A

1-2 weeks

47
Q

treatment of BDZ withdrawal

A

IV diazepam titrated to effect tapered gradually over months once symptoms controlled

48
Q

symptoms of alcohol withdrawal start how long after stopping drinking

A

6-12 hours

49
Q

peak incidence of seizures after stopping drinking

A

36 hours

50
Q

peak incidence of delirium tremens after stopping alcohol

A

48-72

PPT (8 decks)

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