> incidence and prevalence Psychiatric Disorders
• 1/5 americans experience in year
> major depressive disorder (MDD)
• 1/25 adults live with serious mental illness
• loss of interest in previously enjoyed things
• 50% of chronic mental illness before 14years
& generalized anxiety disorder (GAD)
• diagnostic: symptoms most of day nearly
every day for minimun of 2 weeks
• excessive anxiety and worry about several events or
activities •
↳ manifestations
• frequenty diagnoses 45-59, 1/2 experience depression - lack of interest, appetite, energy
• diagnostic: chronic worry/anxiety interferes with - substance use, sleep disturbances, SI
daily activities/relationships for majority of days for •↳ treatment
6 months - nonpharm: CBT, electroconvulsive therapy,
↳• manifestations phototherapy
- apprehenshion, anxiety, tension, fatigue, sleep S SSRIs - fluoxetine
disturbances • therapeutic uses
↳• treatment - MDD/depressive disorders, panic/GAD, bipolar,
- nonpharm: CBT, mediation, relaxation social anxiety
>
benzodiazepines - alprazolam • complications
• therapeutic uses - sexual dysfunction: anorgasmia, impotence,
- GAD, panic disorder, seizures, insomnia, muscle decrease libido
spasms, EtOH withdrawal anesthesia - CNS stimulation: agitation, anxiety, inability
• complications to sleep
- CNS depression, anterograde amnesia - weight loss/gain, SI, bruxism
- toxicity, withdrawal effects - serotonic syndrome (2-72hr), withdrawal
syndrome
- paradoxical response
• contraindications
• contraindications
- potential fetal harm, ok lactation
- pregnancy/lactation
- TCAs, MAOIs
- sleep apnea, respiratory depression
- BBW: SI
- short term use
• interactions
• interactions
- TCAs, MAOIs, st. johns wort
- CNS depressants
- warfarin, NSAIDs, anticoagulants
- grapefruit juice, oral contraceptives > SNRIs - venlafaxine
> atypical anxiolytics - busprione
• therapeutic uses
• therapeutic uses
- MDD, GAD, social anxiety, panic disorder pain
- GAD, panic disorder, social anxiety, bruxism (clench
teeth) • complications
• complications - nausea, anorexia, weight loss, headache
- dizziness, nausea, headache, agitation, - insomnia, anxiety, SI, dizziness
lightheadedness - HTN, tachycardia, sexual dysfunction
- constipation, SI - serotonic syndrome, withdrawal
• contraindications • contraindications
- not est. in pregnancy/lactation - pregnancy/lactation
- not within 14 days of MAOIs - taper slowy when discnt
• interactions - BBW: SI
- erythromycin, ketoconazole, st. johns wort, • interactions
grapefruit juice - MAOIs, NSAIDs, anticoagulants, st. johns wort
- CNS depresssants - CNS depressants
• 1/5 americans experience in year
> major depressive disorder (MDD)
• 1/25 adults live with serious mental illness
• loss of interest in previously enjoyed things
• 50% of chronic mental illness before 14years
& generalized anxiety disorder (GAD)
• diagnostic: symptoms most of day nearly
every day for minimun of 2 weeks
• excessive anxiety and worry about several events or
activities •
↳ manifestations
• frequenty diagnoses 45-59, 1/2 experience depression - lack of interest, appetite, energy
• diagnostic: chronic worry/anxiety interferes with - substance use, sleep disturbances, SI
daily activities/relationships for majority of days for •↳ treatment
6 months - nonpharm: CBT, electroconvulsive therapy,
↳• manifestations phototherapy
- apprehenshion, anxiety, tension, fatigue, sleep S SSRIs - fluoxetine
disturbances • therapeutic uses
↳• treatment - MDD/depressive disorders, panic/GAD, bipolar,
- nonpharm: CBT, mediation, relaxation social anxiety
>
benzodiazepines - alprazolam • complications
• therapeutic uses - sexual dysfunction: anorgasmia, impotence,
- GAD, panic disorder, seizures, insomnia, muscle decrease libido
spasms, EtOH withdrawal anesthesia - CNS stimulation: agitation, anxiety, inability
• complications to sleep
- CNS depression, anterograde amnesia - weight loss/gain, SI, bruxism
- toxicity, withdrawal effects - serotonic syndrome (2-72hr), withdrawal
syndrome
- paradoxical response
• contraindications
• contraindications
- potential fetal harm, ok lactation
- pregnancy/lactation
- TCAs, MAOIs
- sleep apnea, respiratory depression
- BBW: SI
- short term use
• interactions
• interactions
- TCAs, MAOIs, st. johns wort
- CNS depressants
- warfarin, NSAIDs, anticoagulants
- grapefruit juice, oral contraceptives > SNRIs - venlafaxine
> atypical anxiolytics - busprione
• therapeutic uses
• therapeutic uses
- MDD, GAD, social anxiety, panic disorder pain
- GAD, panic disorder, social anxiety, bruxism (clench
teeth) • complications
• complications - nausea, anorexia, weight loss, headache
- dizziness, nausea, headache, agitation, - insomnia, anxiety, SI, dizziness
lightheadedness - HTN, tachycardia, sexual dysfunction
- constipation, SI - serotonic syndrome, withdrawal
• contraindications • contraindications
- not est. in pregnancy/lactation - pregnancy/lactation
- not within 14 days of MAOIs - taper slowy when discnt
• interactions - BBW: SI
- erythromycin, ketoconazole, st. johns wort, • interactions
grapefruit juice - MAOIs, NSAIDs, anticoagulants, st. johns wort
- CNS depresssants - CNS depressants
