Psychiatric Disorders

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

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

which group of psych meds can cause obesity and DM type II

Atypical antipsychotics Olanzaine- (Zyprexa) Risperiodone (Risperdal) Quetiapine (Seroquel)

a 38 year old patient diagnosed with bipolar disease has taken lithium for many months. His mood has stabilized. He was told to report frequent urination while taking lithium. What might be the underlying cause of his frequent urination? A.) Blood sugar elevations B.) Diabetes insipidus C.)UTI D.) Elevated Lithium

B.) Diabetes insipidus

A 79 year old female lost her husband of 55 years fours days ago. She presents today with her daughter because she believes that she is going crazy. She reports that she often hears his voice though she realizes that he has died. She has not slept well since his death and hasn't eaten very much. She has taken her usual medications for hypertension, osteoporosis, osteoarthritis, and hypothyroidism. She has no history of psych illness. How should the NP manage this? a.) Prescribe a bento for relief of anxiety b.) Tell her that this is a normal response and that it will resolve. c.) Encourage her daughter to consider assisted living placement. d.) Prescribe an antidepressant and follow up in 1-2 weeks.

B.) Tell her that this is a normal response and that it will resolve.

An adolescent female patient with anorexia nervosa must exhibit 4 criteria for diagnosis. Which Criterion listed below is NOT part of the diagnostic criteria? a.)Intense fear of weight gain b.) weight below 90% of ideal body weight c.) Severe body image disturbance d.)Absence of menstrual cycle

B.) weight below 90% of ideal body weight

When assessing patient look for: Racing thoughts Sustained periods of high energy No sleep but not tired Risk taking behaviors all indicative of what disorder?

BIPOLAR

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

Which depressed patient below has characteristics that are risk factors for suicide? A.) 34 year old female recently married B.) 46 year old Hispanic who is jobless C.) a 78 year old male recently widowed D.) 60 year old dentist nearing retirement

C.) a 78 year old male recently widowed

a patient with an eating disorder may concomitantly exhibit: a.) thyroid disease b.) sleep disorders c.) anxiety disorders d.) liver disease

C.) anxiety disorders

Which SSRi has the fewest Drug drug interactions

Citalopram (Celexa) Escitaprolam (Lexapro)

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.

PHQ-9 (Patient Health Questionnaire)

Dx: Any population Assesses severity of depression, >12: Major depressive disorder Domain: Body Structure and Fxn

S/S of lithium toxicity

GI symptoms, tremulous, dystonia, ataxia, ALOC.

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

Red flag signs

Hallucinations Delusions Suicidal Homicidal Extreme self-care deficit Adverse effect after medications prescribed

SSRI and SNRI side effects

Insomnia, agitation, headache, weight loss, sexual dysfunction, serotonin syndrome

can you give cymbalta to uncontrolled HTN?

NO-

SSRI's are used to treat what?

OCD and anxiety

postpartum depression

Occurs 4 weeks after delivery and up to one year after delivery, 13% of women affected

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

Citalopram, escitalopram Fluoxetine Paroxetine Sertraline Fluvoxamine these drugs are belong in what category?

SSRI's

Tx of *melancholic* depression?

SSRIs (first line for depression in general) TCA's

Hydroxyzine (Vistaril)

Safe for a patient with anxiety and emphysema because of anticholinergic effects

Amitryptiline class

TCA

Tx of Seasonal Affective Disorder

Tx: light therapy and Wellbutrin

Depression is known as

Unipolar

taking this med at bedtime

a common side effect of trazadone may be alleviated by: a.) taking this med with food b.) taking this med at bedtime c.) drinking a big glass of water with each dose. d.) Eating increased fiber while taking this med.

Which of the following characterizes bulimia nervosa? a.) Binge eating b.) purging c.) food restriction d.) concern over body weight

a.) Binge eating

A NP suspects that a patient is abusing ethanol. what lab values would support this suspicion? a.) Elevated alk phos b.)Decreased TSH, macrocytosis c.) Elevated ALT, AST, and GGT d.) Elevated AST, alk phos

a.) Elevated ALT, AST and GGT

which findings suggest that a patient may be abusing alcohol? a.) macrocytosis, tremulousness, hypertension b.) Rhinophyma, hypotension, peripheral neuropathy C.)Telangiectasis, flat affect, thyroid dysfunction d.) Hepatosplenomegaly, murmur, osteoarthritis

a.) Macrocytosis, tremulousness, hypertension

Bipolar Treatment?

antipsychotics for acute treatment of mania; Lithium; Mood stabilizer, atypical antipsychotic or combo, plus antidepressant.

The most common co morbidity associates with Depression is?

anxiety

A patient is taking a generic version of a selective serotonin reuptake inhibitor. She reports intermittent nausea and mild headache daily since she started this med 5 days ago. How should the NP respond? a.)Brand name meds may help the side effects resolve. b.) These are typical complaints of patients who take SSRIs c.) This sounds like a viral syndrome. Continue the SSRI d.)These symptoms are common in patients with depression.

b.) These are typical complaints of patients who take SSRI's.

In patients who exhibit depression, selective serotonin reuptake inhibitor (SSRIs) are commonly chosen as a medication for treatment. SSRI's are often chose because they: a.) are more efficacious than other drug classes b.) are safer than other medications for depression c.) require fewer lab tests for follow-up d.) help patients reach normal states more quickly

b.) are safer than other meds for depression

within 6 months of treatment, patients who are treated for depression wth SSRI often exhibit: a.) insomnia b.) weight gain c.) increased libido d.) hyperglycemia

b.) weight gain- weight gain is common among men and women who take SSRI's snd TCA's because they stimulate appetite

SSRI's why start on this

best for mood stabilization

a 19 year old college student with anorexia is being treated as an outpatient. Today she is bradycardia and occasionally has orthostatic hypotension. What might accompany today's findings? a.) Insomnia b.) Sleep apnea c.) amenorrhea d.) Intermittent tachycardia

c.) amenorrhea

a 69 year old female with feelings of anhedonia for the last month. What should be part of the nurse practitioners assessment?

depression

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.

safest anti depressant-SSRI

fast symptoms response and

TCA and MAOIs

help with panic attacks but not for generalized anxiety

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

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

EX of SSRI's

lexapro paxil

duloxetine or Cymbalta

ok for breastfeeding mother

which patient is the most likely to exhibit depression related to his illness. A patient with?

parkinsons disease

MAOI inhibitors side effects

postural hypotension (feeling faint upon standing due to decreased blood flow to the brain), high blood pressure, fainting, abnormal heart rhythm, dizziness, headache, drowsiness, insomnia, anxiety, constipation, nausea, diarrhea, sexual dysfunction, weight gain or weight loss, and edema. Seizures, rash, blurred vision, and hepatitis are infrequently associated with MAOIs.

Tricyclic Antidepressants (TCAs)

sedation, dry mouth, blurred vision, constipation, urinary retention, and increased pressure in the eye. They are also associated with hypertension, abnormal heart rhythms, anxiety, insomnia, seizures, headache, rash, nausea, and vomiting, abdominal cramps, weight loss, and sexual dysfunction. Tricyclic antidepressants rarely cause liver failure.

contraindications with Buspar (BUpripone)

seizures