What is the role of the primary care provider in mental health? - CORRECT ANWER- Screen for mental health issues
- Improve outcomes and reduce health
... [Show More] care costs
- Assess and give care to mild-moderate disorders or patients with stable severe mental disorders
- From strong links with mental health specialty care for complex cases
Sharing patient info (ex: meds used)
about PHQ2
- what does it screen for, what are the questions, scoring - CORRECT ANWER- Screens for MDD
- It is the first two questions of the PHQ9
- In the last two week, have you been feeling these (not at all, several days, more than half the day, nearly everyday):
- Little interest or pleasure in doing things?
- Feeling down, depressed, or hopeless?
Scoring:
A single yes or score >3 (out of 0-6) = possible clinical depression ⇒ due the PHQ9
If the pt screens (+) ⇒ continue to eval with the PHQ9
about PHQ9
- what its used for, questions, scoring - CORRECT ANWERUsed for screening, diagnosing, and treating
- It asks about functioning impairments which is needed for the DSM-based diagnosis
Includes asking about suicide or hurting self
Scoring:
0-27 available
0-4: Minimal/none
Monitor; may not require treatment
5-9: Mild
Use clinical judgment; follow-up in one month
10-14: Moderate
Use clinical judgment; may need meds if functionally impaired
15-19: Moderately Severe
Warrants active treatment with psychotherapy, meds, or combo
20-27: Severe
Warrants active treatment with psychotherapy, meds, or combo
What is the appropriate initiation dose for fluoxetine for adults and geriatric adults? - CORRECT ANWER20mg PO once daily in the AM
- May ↑ daily dose after several weeks if inadequate response
- Full therapeutic effect may be delayed 4 weeks or longer
- Max dose: 80mg/day
What labs would be appropriate to draw if you initiate fluoxetine in a geriatric patient? - CORRECT ANWERSodium levels
- Baseline screening & after 3-4 weeks in high-risk patients (> 65yrs, previous hx of antidepressant-induced hyponatremia, low body weight, concomitant use of thiazides or other hyponatremia-inducing agents)
- monitor regularly in the elderly
What are potential side effects of SSRI medications?
- what are the common SSRIs, LEAP of them, and zoloft AE - CORRECT ANWERCommon SSRIs:
Lexapro, celexa, paxil, zoloft, prozac
L = decreased libido and sleep
E = Neutral effect on energy
A = neural effect on addiction
P = celexa may stop working after awhile (increase or switch)
Zoloft AE:
Insomnia, somnolence, fatigue, abnormal ejaculation, suicidal thoughts
What are characteristics of major depressive disorder or MDD? 9 - CORRECT ANWERDiagnostics need 5 or more of the following:
- SS occur more days than not in a 2 week period
- SS cause significant impairment in any realm of functioning
- Depressed mood
- Loss of interest
- Significant unintended ▲ in weight or appetite
- Significant ▲ sleep
- ▲ psychomotor activity (restlessness)
- Fatigue, loss of energy
- Worthlessness, guilt
What is serotonin syndrome? - CORRECT ANWER- Increased serotonergic activity in the CNS
- Can be due to therapeutic med use, inadvertent drug interactions, or self-OD
Serotonin in the Body:
CNS: Modulates attention, behavior, and thermoregulation
PNS: Regulates GI motility, vasoconstriction, uterine contraction, and bronchoconstriction, promotes PLT aggregation
PE of serotonin syndrome 11 - CORRECT ANWER- Hyperthermia, flushed skin, diaphoresis
- Agitation
- Slow, continuous, horizontal eye movements (ocular clonus)
- Dilated pupils
- Tremor, akathisia
- Deep tendon hyperreflexia (common)
- Inducible or spontaneous muscle clonus (common)
- Muscle rigidity
- Bilateral babinski
- Dry mucus membranes
- Increased bowel sounds
What is discontinuation syndrome (from SSRIs)?
"FINISH" - CORRECT ANWER2-3 days after stopping SSRIs abruptly
F: flu-like SS
I: insomnia
N: nausea
I: imbalance
S: sensory disturbances
H: hyperarousal
Bupropion
- MOA
- BENFITS
AE
CONTRA - CORRECT ANWERMOA
- act to inhibit reuptake of NE, dopamine, and serotonin
BENFIT
- Depression
- Smoking cessation
- Seasonal affective disorder
- Treat sexual dysfunction relative to SSRI therapy
AE
- weight loss
- increases libido ⇒ combine with SSRI
- can cause seizures by lowering the seizure threshold
CONTRA
- History of seizures
- Do not prescribe to pts with psych disorders ⇒ ↑ risk for delusions or hallucinations
RF for ETOH abuse 4 - CORRECT ANWERYounger adults (18-29 yrs)
Men > women
Native americans
Genetics (low response to ETOH), environment (peer influences), specific personality traits (impulsivity, extroversion), cognitive fxn
What are predisposing factors impacting the likelihood of someone developing a SA issue? - CORRECT ANWERPredisposing Factors:
- Unhealthy use of one substance increases the likelihood of unhealthy use of other substances
- Family history
- Social history
- Partner or friends with SA, living in a community with poverty, violence, and/or high ETOH/drug use
Use of:
- Caffeine, tobacco, ETOH, prescription meds, marijuana, illicit drugs
- Mental health disorders
- Highest in personality disorders
What is withdrawal - CORRECT ANWERprocess of removal of the drug of dependence from the body
SS of substance abuse withdrawal 3 - CORRECT ANWERCan last days to weeks
- NVD
- Flu-like SS: lacrimation, rhinorrhea, diaphoresis, shivering, piloerection
- SNS/CNS Arousal: mydriasis, mild HTN and tachy, anxiety, irritability, insomnia, agitation, restless leg, general restlessness, tremor, low grade temp
Which medications are central nervous system sedatives? - CORRECT ANWERInclude sedatives, tranquilizers, hypnotics
- Good for treating anxiety, panic, acute stress reactions, sleep disorders
Examples:
Benzos:
- Diazepam (valium), clonazepam (klonopin), alprazolam (xanax)
Non-Benzo Sedative Hypnotics
- Zolpidem (ambien)
Barbiturates
- Mephobarbital
Initiation Strategies for Antidepressants: - CORRECT ANWERAntidepressants are considered equivalent in efficacy for depression
Decide on med by:
- History of response [Show Less]