Psych Mental Health Flashcards

Major Depressive Disorder (MDD)

• Diagnosis requires one of two key symptoms:

  • Sad, depressed mood

  • Loss of pleasure or interest in previously enjoyed activities

Mnemonic for Depression Symptoms: SITCH CAPS

• Sleep disturbances

• Decreased interest

• Guilt

• Decreased energy

• Decreased concentration

• Appetite changes

• Psychomotor symptoms

• Suicidal ideation

Initial Screening Tool: PHQ-2

• Two questions focusing on the main symptoms of depression.

• Positive result leads to the full PHQ-9 assessment.

Assessing Suicidal Ideation

• Directly ask patients about thoughts of self-harm.

• Inquire about a specific plan.

  • If a detailed plan exists, refer to the emergency department.

First-Line Medications for MDD

• Selective Serotonin Reuptake Inhibitors (SSRIs)

• Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

SSRIs: Key Points

• Safe for older adults (low side effect profile):

  • Zoloft (sertraline)

  • Lexapro (escitalopram)

• Avoid in older adults (long half-life):

  • Fluoxetine (Prozac)

• Most sedating SSRI:

  • Paroxetine (Paxil)

• Avoid in patients with anxiety:

  • Fluoxetine (Prozac) - may cause nervousness.

• First-line for pediatric depression (when therapy fails):

  • Fluoxetine (Prozac)

SNRIs: Key Points

• Commonly used options:

  • Cymbalta (duloxetine)

  • Effexor (venlafaxine)

• Side effects comparable to SSRIs, but SNRIs can increase blood pressure due to norepinephrine effects.

  • Not ideal for patients with uncontrolled hypertension.

SSRI/SNRI: Patient Education

• Onset of noticeable effects: 4-6 weeks.

  • If no relief after 4-6 weeks: Increase dose or investigate other conditions.

• Common side effects: GI issues, sexual dysfunction, potential weight gain.

  • GI effects usually subside after a few weeks.

• Treatment duration: Typically 6-12 months after symptoms are under control.

Other Antidepressant Drug Classes

• Tricyclic Antidepressants (TCAs) (e.g., nortriptyline):

  • Not first-line agents due to notable side effects.

  • Side effects: Weight gain, ECG changes.

  • Avoid in older adults due to anticholinergic side effects.

• Norepinephrine-Dopamine Reuptake Inhibitor (NDRI) - Wellbutrin (bupropion):

  • Uses: MDD, smoking cessation, seasonal affective disorder, and off-label for ADHD.

  • Avoid in patients with anxiety and insomnia (may worsen symptoms).

  • Can reduce sexual dysfunction when added to SSRI therapy.

Herbal Supplements: St. John's Wort

• Avoid with serotonin medications (SSRIs/SNRIs) due to increased risk of serotonin syndrome.

• Serotonin syndrome signs/symptoms: Shivering, seizures, tremors, tachycardia, agitation.

  • Emergency requiring immediate referral.

Anxiety

Mnemonic for Anxiety Symptoms: WATCHERS

• Worry

• Anxiety

• Tension

• Concentration difficulty

• Hyperarousal

• Energy loss

• Restlessness

• Sleep disturbance

Generalized Anxiety Disorder (GAD)

• Symptoms must be:

  • Excessive

  • Difficult to control

  • Cause functional impairment

  • Last at least six months

Screening Tool: GAD-2

• A score of 3 or greater warrants follow-up with the GAD-7.

First-Line Medications for GAD

• SSRIs and SNRIs.

Adjunct Anxiety Medication

• Buspirone (Buspar): Not a controlled substance. Can be dosed as needed or consistently

Benzodiazepines

• For situational anxiety (e.g., fear of flying) or short-term bridge therapy.

• Caution advised due to serious side effects (CNS depression) and risk of dependence.

Post-Traumatic Stress Disorder (PTSD)

• Develops in response to a traumatic event or experience.

• Key symptoms: Nightmares, flashbacks, hypervigilance.

• Management: Medication and cognitive behavioral therapy (both first-line).

• Preferred Medication Class: SSRIs.

Insomnia

• Characterized by difficulty falling asleep, staying asleep, or both.

• Leads to daytime sleepiness and impairment.

• Initial Treatment: Patient education about sleep hygiene, followed by cognitive behavioral therapy.

• Medications:

  • Over-the-counter (OTC): Benadryl, melatonin.

  • FDA-approved medications (use cautiously due to side effects).

  • Non-benzodiazepine receptor agonists (e.g., Ambien): Can cause CNS depression and complex sleep behaviors (sleep driving).

Bipolar Disorder

• Characterized by extreme mood episodes.

• Mania (Bipolar I):

  • Reduced sleep, impulsive purchases, racing thoughts, extreme excitement.

• Followed by low mood symptoms.

• First-Line Medication: Lithium (mood stabilizer).

  • Prescribed by mental health clinicians.

  • Narrow therapeutic range: 0.6 - 1.2

  • Levels
    less 1.5 indicate risk of toxicity.

• Lithium Toxicity Symptoms: Nausea, vomiting, tremors, hyperactive reflexes, confusion, vision changes.

• Monitor thyroid gland (long-term use can lead to hypothyroidism).

Antipsychotics

• Used for schizophrenia, mood disorders, treatment-resistant depression.

• Not prescribed by primary care clinicians.

• Typical (First Generation): Haldol (haloperidol).

• Atypical (Second Generation): Zyprexa (olanzapine), Seroquel (quetiapine).

• Metabolic Side Effects: Weight gain, hyperglycemia, hyperlipidemia (monitor regularly).

Pharmacodynamics

• Majority of medications metabolized in the liver via cytochrome P450 (CYP450) enzymes.

• Many psych medications are metabolized by CYP3A4, leading to potential drug interactions.

  • St. John's Wort: CYP3A4 inducer (decreases efficacy of drugs like warfarin, digoxin).

• CYP2C19 enzyme activity varies across populations, affecting metabolism of SSRIs.

  • Genetic variants in some Asian populations may cause different metabolism, effectiveness, or side effects.

• Asian patients may have cytochrome p450 2C19 poor metabolizer genes causing certain SSRIs like escitalopram (lexapro) to not work. They may require higher dosing or different meds