Psychiatric Disorders Practice Study Exam

Phq-9 (patient health questionnaire) - -dx: any population Assesses severity of depression, 12: major depressive disorder Domain: body structure and fxn Major depressive disorder - - Dsm5 criteria symptoms x2 weeks: Fatigue or loss of energy/interest Insomnia or hypersomnia Loss/increase in appetite; poor appetite Weight change Psychomotor retardation or agitation Suicidal ideation Guilt or feelings of worthlessness Loss of attention span - -if four or more of these symptoms=depressed mood Red flag signs - -hallucinations Delusions Suicidal Homicidal Extreme self-care deficit Adverse effect after medications prescribed Depression is known as - -unipolar Maois inhibitors Nardil Parmate - - Ssri's why start on this - -best for mood stabilization Ex of ssri's - -lexapro Paxil Melancholic depression - -is a type of major depressive disorder that is characterized by a loss of pleasure in most or all activities, psychomotor retardation, weight loss, guilt, and insomnia Accounts for 30% of depression Psychiatric Psychiatric Psychiatric Atypical depression - -differs from classical forms. Characterized my mood reactivity (being able to experience improved mood in response to positive stimuli), reversed vegatative symtpoms (hyperphagia, hypersomnia). Leaden paralysis (heavy feeling in arms and legs), long-standing interpersonal rejection sensitivty Tx: cbt and ssris are first line. Mao inhibitors work but are second line due to increased side effects. Tx of *melancholic* depression? - -ssris (first line for depression in general) Tca's Seasonal affective disorder - -controversial disorder in which a person experiences depression during winter months and improved mood during spring. Can be treated using phototherapy, using bright light and high levels of negative ions. Tx of seasonal affective disorder - -tx: light therapy and wellbutrin Postpartum depression - -occurs 4 weeks after delivery and up to one year after delivery, 13% of women affected Side effects for tca's - -- are mostly due to anticholinergic effects Dry mouth, blurred vision, constipation, urinary retention, tachycardia, confusion, delirium In elderly: confusion, memory impairment, hallucinations Citalopram, escitalopram Fluoxetine Paroxetine Sertraline Fluvoxamine These drugs are belong in what category? - -ssri's Ssri's are used to treat what? - -ocd and anxiety Bupropion (wellbutrin ) - -good choice due to decrease in side effects No weight gain, no drowsiness, no orthostatic hypotension, no sexual dysfunction Management: Length of treatment: 4-12 months- more severe 15 months top 5 years Make sure patient is also seeking counseling/ therapy When assessing patient look for: Racing thoughts Sustained periods of high energy No sleep but not tired Risk taking behaviors Psychiatric Psychiatric All indicative of what disorder? - -bipolar Bipolar treatment? - -antipsychotics for acute treatment of mania; lithium; mood stabilizer, atypical antipsychotic or combo, plus antidepressant. S/s of lithium toxicity - -gi symptoms, tremulous, dystonia, ataxia, aloc. Motor tension Autonomic hyperactivity Increased vigilance Are all s/s of what? - -anxiety Rule out organic causes (otc medications, drugs, caffeine) for what disorder? - -anxiety disorder Anxiety management - -benzodiazepines- biggest problem is dependence- For rapid specific treatment Buspirone- (buspar) Antidepressants- ssri's and tca'a Beta blockers- for transient anxiety like stage fright Munchausen syndrome - -repeated fabrication of disease symptoms for the purpose of gaining medical attention Munchausen proxy syndrome - -repeated fabrication of disease symptoms for the purpose of gaining medical attention By proxy - parent, usually mother, exaggerates, fabricates or induces medical complaints for their preschool child Contraindications with buspar (bupripone) - -seizures Tca and maois - -help with panic attacks but not for generalized anxiety Safest anti depressant-ssri - -fast symptoms response and Duloxetine or cymbalta - -ok for brea