Psych Mental Health Flashcards

Flashcards for reviewing key vocabulary and concepts in psych mental health, based on a lecture transcript.

Major Depressive Disorder (MDD)

Requires one of two key symptoms: a sad depressed mood or the loss of pleasure or interest in things once enjoyed.

sides for depressive distress

symptoms of depression: Sleep disturbances, decreased interest, guilt, decreased energy, decreased concentration, appetite changes, psychomotor symptoms, and suicidal ideation.

Patient Health Questionnaire (PHQ-2)

Initial screening tool for depression, comprised of two questions related to the two main symptoms of depression.

PHQ-9

The questionnaire that is completed if there is a positive result on the PHQ-2, which asks about additional symptoms of depression.

Suicidal Ideation Assessment

Involves directly asking patients about their plan and method. A specific and detailed plan requires referral to the emergency department.

First-Line Medication Classes for MDD

Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs).

SSRIs Safe for Older Adults

Zoloft and Lexapro, due to their low side effect profiles.

SSRI to Avoid in Older Adults

Fluoxetine, due to its long half-life.

Most Sedating SSRI

Paxil.

SSRI Typically Avoided in Patients with Anxiety

Prozac, as nervousness is a known side effect.

First-Line Medication for Pediatric Patients with Depression

Prozac (when therapy has not helped).

SNRIs and Hypertension

SNRIs are not ideal for patients with uncontrolled hypertension because they cause an increase in blood pressure due to their effects on norepinephrine.

Timeframe for SSRI/SNRI Effects

Four to six weeks to see notable effects.

Common Side Effects of SSRIs and SNRIs

GI issues, sexual dysfunction, and potential weight gain.

Duration of SSRI/SNRI Treatment

Typically continued for at least six to twelve months after symptoms are under control.

Tricyclic Antidepressants

Not first-line agents due to notable side effects, including weight gain and ECG changes. To be avoided in older adults due to anticholinergic side effects.

Wellbutrin

A norepinephrine dopamine reuptake inhibitor used for MDD, smoking cessation, and seasonal affective disorder. Commonly used off-label for ADHD.

Wellbutrin Avoidance

Should be avoided in patients with anxiety and insomnia, as it may worsen symptoms due to stimulating effects.

Wellbutrin and SSRI Therapy

Can help reduce low libido or sexual dysfunction.

St. John's Wort Contraindications

Cannot be used concurrently with serotonin medications like SSRIs and SNRIs due to the increased risk of serotonin syndrome.

Serotonin Syndrome Symptoms

Shivering, seizures, tremors, tachycardia, agitation. Requires prompt referral to the emergency department.

WATCHERS

Mnemonic for anxiety symptoms: Worry, anxiety, tension, concentration difficulty, hyperarousal, energy loss, restlessness, and sleep disturbance.

Generalized Anxiety Disorder Diagnosis

Symptoms must be excessive, difficult to control, cause functional impairment, and have lasted for at least six months.

GAD-2

Screening tool to assess for potential anxiety disorder. A total score of three or greater would warrant follow-up with the GAD-7.

First-Line Medications for Generalized Anxiety Disorder

SSRI and SNRI drug classes.

Buspirone

A common adjunct anxiety medication that is not a controlled substance and can be dosed as needed or on a consistent basis.

Benzodiazepines

An option for situational anxiety (e.g., fear of flying) or short-term use as a bridge until other medications start working. High risk for dependence and CNS depression.

Post Traumatic Stress Disorder (PTSD) Key Signs and Symptoms

Nightmares, flashbacks, and hypervigilance.

First-Line Treatments for PTSD

Medication and cognitive behavioral therapy. SSRIs are typically preferred.

Initial Treatment for Insomnia

Patient education about sleep hygiene followed by cognitive behavioral therapy.

Non-Benzodiazepine Receptor Agonists (e.g., Ambien)

Effective for insomnia but can cause CNS depression and carry a black box warning for complex sleep behaviors like sleep driving.

Mania Symptoms

Hardly sleeping, impulsive purchases, racing thoughts, and extreme excitement.

First-Line Medication for Bipolar Disorder

Lithium, a mood stabilizer.

Lithium Therapeutic Range

Narrow therapeutic range of 0.6 to 1.2. Levels of 1.5 or greater put the patient at risk for lithium toxicity.

Symptoms of Lithium Toxicity

Nausea, vomiting, tremors, hyperactive reflexes, confusion, and vision changes.

Monitoring with Long-Term Lithium Use

The thyroid gland needs close monitoring, as long-term use can lead to hypothyroidism.

Metabolic Side Effects of Antipsychotics

Weight gain, hyperglycemia, and hyperlipidemia.

CYP450 Enzymes

Majority of medications are metabolized in the liver via this group of enzymes, and many psych mental health medications are metabolized by the CYP3A4 enzyme, which can create some significant drug interactions.

St. John's Wort and CYP3A4

A known inducer of the CYP3A4 system, which means that it can decrease the efficacy of other drugs like warfarin or digoxin that also use that same enzyme.

CYP2C19 Enzyme

The activity can vary significantly across various populations, affecting how they metabolize certain medications such as SSRIs.