PHARM Exam 2: Psychiatric Disorders

1 in 5

__ experience the consequences of a psychiatric disorder in a year

1 in 25

__ adults live with serious mental illness

50%

__ of all chronic mental illnesses begin before 14 years of age

75%

__ of chronic mental illnesses begin before 24 years of age

30%

__ of people with a physical disorder have a coexisting psychiatric disorder

50%

__ of people with a substance use disorder have a coexisting psychiatric disorder

generalized anxiety disorder (GAD)

characterized by excessive anxiety and worry about several events or activities 

most frequently diagnosed in ages 45-59*

diagnostic criteria: chronic and excessive worry/anxiety that interferes with daily activities and relationships for the majority of days for at least 6 months 

about ½ of all people with GAD experience depression

GAD manifestations

apprehension

anxiety

tension

autonomic hyperactivity 

fatigue 

inability to concentrate 

sleep disturbances

GAD treatment nonpharmacologic

cognitive-behavioral therapy (CBT)

meditation/mindfulness

relaxation techniques

supportive care

emergency stabilization

GAD treatment pharmacologic

benzos: alprazolam

atypical anxiolytics: buspirone

selective serotonin reuptake inhibitors (SSRIs): paroxetine, sertraline, citalopram, fluoxetine

alprazolam therapeutic uses

GAD, panic disorder, seizures, insomnia, muscle spasms, alcohol withdrawal, induction of anesthesia

alprazolam complications

CNS depression

anterograde amnesia

toxicity

paradoxical response

withdrawal effects

alprazolam precautions

not safe in pregnancy/lactation

sleep apnea, respiratory depression

short-term use

alprazolam interactions

CNS depressants 

grapefuit juice, oral contraceptives

buspirone therapeutic uses

GAD, panic disorder, social anxiety, disorder, bruxism*

buspirone complications

dizziness, nausea, HA, agitation, lightheadedness

constipation

SI

buspirone precautions

safely not established in pregnancy/lactation

do not given within 14 days of MAOIs

buspirone interactions

erythromycin, ketoconazole, St. Johns wort, grapefruit juice

CNS depressants

major depressive disorder (MDD)

affected individuals experience a loss of interest in previously enjoyed activities

wide range of manifestations based on the degree of illness and access to resources/response to therapies

diagnostic criteria: presence of symptoms most the day nearly every day for a minimum of 2 week that interfere with activites such as work or functioning 

various subclassifications based on symptom patterns

MDD manifestations

lack of interest in activities

lack of appetite

inability to concentrate

decision-making difficulties

feelings of worthlessness

lack of energy

decreased motor skills

depressive disorders nonpharmacologic treatment

CBT

problem-solving therapy

phototherapy

electroconvulsive therapy

supportive care

emergency stabilization

depressive disorders pharmacologic treatment

SSRIs: fluoxetine, citalopram, escitalopram, paroxetine, sertraline

serotonin/norepinephrine reuptake inhibitors (SNRIs): venlafaxine, duloxetine

tricyclic antidepressants (TCAs): amitriptyline

monoamine oxidase inhibitors (MAOIs): phenelzine, isocarboxazid

velafaxine therapeutic uses

MDD, GAD, social anxiety disorder, panic disorder, pain

velafaxine complications

nausea, anorexia, weight loss

HA, insomnia, anxiety

HTN, tachycardia

SI

dizziness, blurred vision

withdrawal syndrome and serotonin syndrome

sexual dysfunction

velafaxine precautions

avoid in pregnancy/lactation

taper slowly when discontinuing to avoid withdrawal syndrome 

BBW: SI

velafaxine interactions

MAOIs

NSAIDs, anticoagulants

CNS depressants

St. John’s wort

amitriptyline therapeutic uses

depression, depressive episodes of bipolar disorders, neuropathic pain, anxiety disorders

amitriptyline complications

orthostatic hypotension

anticholinergic effects

sedation

toxicity: dyshythmias, confusion, agitation, seizures, coma, death

decreased seizure threshold

diaphoresis

amitriptyline precautions

caution in pregnancy/lactation

seizure disorders

MI history 

BBW: SI

amitriptyline interactions

MAOIs, St John’s wort

antihistamines, anticholinergics

CNS depressants

cardiac agents

phenelzine therapeutic uses

depression, panic disorder, GAD

phenelzine complications

CNS stimulation

orthostatic hypotension

hypertensive crisis

liver damage/disease

phenelzine precautions

caution in pregnancy/lactation

contraindicated: SSRIs, heart failure, cardiovascular disease

BBW: SI

phenelzine interactions

TCAs, SSRIs

antihypertensives

tyramine-rich foods: aged cheese, pepperoni, salami, avocados, figs, bananas, beers, wines

bipolar disorder

mood disorder with depressive components

lifetime prevalence of nearly 2.5% for bipolar disorders worldwide

median age of onset is 25 years

females more likely to be affected

often undiagnosed for 10 years after onset of symptoms

highs(euphoria) and lows (depression)

bipolar I

1+ manic episodes

mood: elevated, expansive, irritable

• alternating with depressive episodes

mood swings often interfere with daily living 

flight of ideas

episodes begin suddenly and can last up to a few months

bipolar II

major depressive episode

at least 1 hypomanic or less severe episode of mania

• present for > 4 days 

bipolar nonpharmacologic treatment

CBT

meditation/mindfulness

relaxation techniques

supportive care

emergency stabilization

bipolar pharmacologic treatment 

AEDs: valproic acid, carbamazepine, lamotrigine

antipsychotics

anxiolytics

antidepressants

mood stabilizer: lithium 

lamotrigine therapeutic uses

action: treatment and prevention of relapse of mania and depressive episodes

lamotrigine complications

double and blurred vision

dizziness 

headache 

NV

serious skin rashes: Stevens-Johnson’s syndrome 

• withhold if rash occurs

lamotrigine precautions

liver disorders

pregnancy C: cleft palate 

lamotrigine interactions

carbamazepine, phenytoin, and phenobarbital: promote liver enzymes- decrease lamotrigine efficacy

valproic acid: inhibits metabolism, increases half-life of __

oral contraceptives: decreases progestin level, estrogen reduces level of __

lithium therapeutic uses

bipolar disorders

lithium complications

GI, NVD, abdominal pain

fine hand tremors

polyuria, thirst

weight gain

renal toxicity

goiter, hypothyroidism

dyshythmias, hypotension, electrolyte imbalances

• maintain fluid and stable sodium intake

toxicity 

lithium precautions

avoid use in pregnancy

caution: renal disorders, heart disease, sodium depletion, hypovolemia, schizophrenia, thyroid disease, seizures, diabetes

BBW: toxicity

lithium interactions

diuretics, antihypertensives

NSAIDs

anticholinergics

SSRIs, antipsychotics

lithium toxicity

lithium has a narrow therapeutic range; serum lithium levels must be monitored consistently

lithium levels exceeding 2 mEq/L

there is no antidote; discontinue drug, hydrate, and potentially EXTRIP protocol 

schizophrenia

chronic debilitating psychotic disorder and results in marked impairment of functioning

affects thoughts, feelings, perceptions, and overall behavior while interfering with filtering of environmental stimuli

onset: 16-30 years

more prevalent in males

risk factors: childhood trauma, malnutrition, long-term cannabis use, vit D deficiency, retroviruses, chronic amphetamine use, first-degree relative

schizophrenia nonpharmacologic treatment

CBT

group therapy

community-based treatment

supportive care

emergency stabilization

schizophrenia pharmacologic treatment

antipsychotics

• first-gen (conventional)

  • chlorpromazine

  • haloperidol

• second-gen (atypical)

  • risperidone, olanzapine, quetiapine

chlorpromazine therapeutic uses

acute and chronic psychotic disorders, schizophrenia, mania, tourette syndrome, agitation, NV

chlorpromazine complications

extrapyramidal symptoms (EPS)

• acute dystonia: spasms

• parkinsonism: bradykinesia, rigidity, ataxia, drooling, tremors

• tardive dyskinesia: lip-smacking, speech disturbances

neuroleptic malignant syndrome (NMS)

• sudden high-grade fever, blood pressure changes, dysrhythmias, muscle rigiditym change in consciousness

seizures

sexual dysfunction

agranulocytosis: low WBCs

chlorpromazine precautions

caution in pregnancy

BBW: death in elderly patients with dementia-related disorders

chlorpromazine interactions

anticholinergics

CNS depressants

levodopa

risperidone therapeutic uses

schizophrenia disorders, psychotic episodes, bipolar disorders, impulsive disorders

risperidone complications

diabetes

weight gain

hypercholesterolemia

orthostatic hypotension

anticholinergic effects

agitation, dizziness, sedation, mild EPS

sexual dysfunction

risperidone precautions

caution in pregnancy

BBW: death in elderly patients with dementia-related disorders

risperidone interactions

CNS depressants

antipsychotics

levodopa

anticholinergics