Rasmussen: Mental Health Exam 2 Latest Version(2024]

• Rare: seizures, increased anxiety/insomnia Serotonin antagonist and reuptake inhibitors - Buspirone (BuSpar) LONG TERM THERAPY Serotonin antagonist and reuptake inhibitors Side Effects - • Anxiety, nausea, headache, dizziness • Useful augmenting drug for antidepressants; mainly used to treat anxiety SNRIs- severe depression, MDD - Duloxetine (Cymbalta) venlafaxine (Effexor) desvenlafaxine (Pristiq) TCA (Tricyclic's) - Amitriptyline (Elavil) clomipramine (Anafranil) desipramine (Norpramin) doxepin (Sinequan) imipramine (Tofranil) maprotiline (Ludiomil) nortriptyline (Pamelor) protriptyline (Vivactil) trimipramine (Surmontil) amoxapine (Asendin) TCA Side Effects - Dry mouth, constipation, bladder problems, sexual problems, blurred vision, drowsiness MAOIs- second line treatment and only to depressions that are resistant to other medications and treatments - Isocarboxazid (Marplan)*, phenelzine (Nardil)* tranylcypromine (Parnate) selegiline (Eldepryl) MAOI Side Effects - High risk of hypertensive crisis; cerebral hemorrhage or death if take with food high in tyramine TCA teachings - o Improvement in mood may take 7-28 days; 6-8 weeks for full effect o Drowsiness, dizziness, and hypotension usually subside after few weeks o Alcohol can block effects o Take full dose at bedtime if possible o Suddenly stopping can cause nausea, altered heartbeat, nightmares, cold sweats (in 2-4 days) symptoms and interventions for serotonin syndrome - ▪ Hyperactivity/restlessness ▪ Tachycardia (CV shock) ▪ Fever (hyperpyrexia) ▪ Elevated blood pressure ▪ Altered mental status (delirium) ▪ Irrationality/mood swings/hostility ▪ Seizures (status epilepticus) ▪ Myoclonus/incoordination/tonic rigidity ▪ Abdominal pain/bloating/diarrhea ▪ Apnea (death) SSRI teaching - o May cause sexual dysfunction or lack of sex drive o Many cause insomnia, anxiety, nervousness o No OTC without notifying HCP o Avoid alcohol o Liver and renal function tests performed routinely, blood counts periodically o Report to a physician: ▪ Increase in depression or suicidal thoughts, rash or hives, rapid heartbeat, sore throat, difficulty urinating, fever/malaise, anorexia/weight loss, unusual bleeding, initiation of hyperactive behavior, severe headache Drugs that interact with MAOI - o OTC for cold, allergies, congestion o TCAs o Narcotics o Anti-hypertensives o Amine precursors (levodopa) o Sedatives o General anesthetics o Stimulants common adverse reactions to and toxic effects of MAOI - ▪ Hypotension ▪ Sedation, weakness, fatigues ▪ Insomnia ▪ Changes in cardia rhythm ▪ Muscle cramps ▪ Anorgasmia or sexual impotence ▪ Urinary hesitancy or constipation ▪ Weight gain Toxic effects (hypertensive crisis)- go to ED immediately - ▪ Flushing; cold, clammy skin ▪ Tachycardia ▪ Severe nosebleeds, dilated pupils ▪ Chest pain, stroke, coma, death ▪ Nausea and vomiting ▪ Severe headache ▪ Stiff, sore neck foods that can interact with MAOIs - Avocados, fermented soybean, sauerkraut, large amounts of bananas, figs, aged meats, liver, fermented meats, cheese, yeast extracts, beer, wine, soups, soy sauce, protein dairy supplements, chocolate, ginseng, caffeinated beverages. BIPOLAR COMMUNICATION: Hypomania - • Talks and jokes incessantly, is "life of the party," and gets irritated when not the center of attention • Treats everyone with familiarity and confidentiality; often borders on crude • Talk is often sexual-can reach obscene, inappropriate propositions to total strangers • Talk is fresh; flits from one topic to the next; marked by pressure of speech BIPOLAR COMMUNICATION: Acute mania - • May change suddenly from laughing to anger or depression (labile) • Becomes inappropriately demanding of people's attention, and intrusive nature repels others • Speech may be marked by profanities and crude sexual remarks to everyone • Speech marked by flight of ideas, may have clang association BIPOLAR COMMUNICATION: Extreme delirious mania - • Totally out of touch with reality • Most likely has clang association BIPOLAR MOOD: Hypomania - • Persistently elevated, expansive, or irritable mood