Mayberry Topics (Exam 1)
Most anxiety disorder, expect for OCD, are approximately twice as common in?
Females than in males
In regard to GAD, excessive anxiety and worry about a number of events and activities must occur for a period of?
at least 6 months or more
Does a panic attack only occur in Panic Disorder?q
No. It will occur in the context of different anxiety disorders as well
In regards to PD, most patients who seek treatment have developed _______________________________
- this is the fear of not being in control
intrusive and unwanted
the response to an obsession
In regards to OCD, the obsessions or compulsions must at least take up ___________ amount of your day, or cause distress or impairment.
In OCD, approximately how many patients will also develop MDD?
In regards to PTSD, you must have a symptom from each of the 4 clusters. The duration of the disturbance is more than ___________________.
(Not one isolated epsidoe)
Suicide risk for ___________ is comparable to that seen in MDD.
Anxiety disorders are generally _____________ in nature, but the symptoms tend to wax and wane.
_________________ is first line treatment in mild OCD.
CBT (Cognitive Behavioral Therapy)
Benzos are not recommended for use in which disorder?
(it is also typically not used in OCD)
Lorazepam and Oxazepam are different because?
They do not undergo oxidation, only CONJUGATION
Oxidation may be impaired by which 3 things?
- liver disease
- drug interactions
BZD concentration will be higher if you have these things
BZD that have very long half lives will?
- be less likely for withdrawal
- have a risk of accumulation in the body
Best choice of BZD therapy for elderly?
In regards to BZD, ______________ doses are generally used to treat panic disorder. While ____________ doses are generally used for GAD.
Withdrawal is more likely to happen with?
- higher doses of BZD
- longer duration of BZD
A more SEVERE withdrawal is likely to happen with?
- a short half life medication (ex: xanax)
Is Buspirone effective in PD?
(this medication is only effective for GAD)
MOA of Buspirone?
5-HT1A partial agonist
Maximum dosage of Busprione?
60 mg per day
BZD will generally reduce _____________ symptoms, more than __________________ symptoms.
(somatic symptoms are the physical symptoms)
Should Buspirone be given PRN or routinely?
Place in therapy for Buspirone in the treatment of GAD?
(Antidepressants (Paroxetine, Venlafaxine XR, and Duloxetine) are 1st line)
Which drug has a risk of hepatotoxicity?
Which agents have shown to be promising in adjunctive therapy for GAD?
Second Generation Antipsychotics
BZD for treatment of Panic Disorder
there is a relatively rapid response (within 1-2 weeks)
First line therapy for PD?
(paroxetine, sertraline, fluoxetine, venlafaxine XR)
Which agents are considered INEFFECTIVE for treatment of PD?
Second line therapy for SAD?
When do you see a response onset with BZD in treatment of SAD?
(the two agents are xanax and klonopin)
What is first line therapy for SAD?
(paroxetine, sertraline, fluvoxamine)
With antidepressant therapy for treatment of SAD.....
symptoms will improve after several weeks, but the maximum effects will take about 12 weeks.
Which class of medications are NOT effective in SAD?
What should be used to treat OCD?
SSRIs and clomipramine
Which SSRI is only used to treat OCD?
In regards to OCD, if you use paxil and it doesnt work.... what should you do next?
Switch to another SSRI like fluoxetine
FDA approved treatments for OCD
When should clomipramine be used for OCD?
After two or three failed SSRI trials
2nd line for OCD?
venlafaxine and mirtazapine
Adequate trial for OCD?
at least 8-12 weeks at maximum recommended doses
Which class of medications is first line for PTSD?
SSRIs (sertraline and paxil)
If you see that a patient is also taking PRAZOSIN with their antidepressant, they most likely have?
Can BZD be used in PTSD?
PTSD has a ___________ substance abuse comorbidity
In regards to PTSD...
- some improvement may be noted within the first 2 weeks
- graded improvement continues over 8-12 weeks
Which class of medications is considered 2nd line for PTSD?
How long should you tell a patient with anxiety that they will have to take their medication?
"at least one year"
In regards to discontinuation of therapy for anxiety disorders....
should be GRADUAL
If you discontinue BZD abruptly....
there is a possibility of withdrawal
In MDD, there is a high risk of psychiatric comorbidity, especially for?
- anxiety disorders
- substance abuse disorders
Is MDD more common in males or females?
twice as common in females
Average age of onset for MDD is mid ______________ to mid _____________.
Can stressors cause depression?
Do stressors always cause depression? Is depression always causes by stressors?
Depression is characterized by
decreased NE and 5-HT
Do antidepressants start working immediately?
No, there is a delay in clinical effects
Depressed patients will often have _____________ TFTs
Depressed patients may have an ___________________ HPA axis
Do psychotic symptoms ever occur with MDD?
According to DSM-5...
___________ or more of the 9 symptoms must be present during the same 2 week period
1 of which 2 symptoms MUST be present for MDD?
- depressed mood (either feelings or tearful)
- anhedonia (diminished interest)
What is required for a MDD diagnosis?
significant impairment to daily living or significant distress
How long does an untreated major depressive episode typically last?
6 months or longer
How many MDD episodes will FULLY recover?
(the other 1/3 will have a partial or no response)
Psychotherapy is a treatment option for...
mild to moderate depression
(may be used with or without antidepressant)
What treatment is superior for MDD?
combination of psychotherapy with pharmacotherapy
The onset of benefits of psychotherapy for MDD tend to be more _____________________ than that from medication
ECT therapy for MDD
- HIGH response rates (70-90%)
- RAPID onset (within first week or two)
- adverse effects include: confusion and memory problems
Supplements or exercise may be efficacious as __________________ treatment with antidepressants
Sexual dysfunction is caused by
(or an increase in serotonin)
increased NE causes
increased blood pressure
increase DOPAMINE causes
precipitation of psychosis
Which serotonin receptor will cause weight gain when it is ANTAGONIZED?
Irreversible inhibition caused by MAOIs will take how long to overcome?
The MAOI, EMSAM
- lowest dose can be used without diet restrictions
- higher doses = diet restrictions still apply
- drug-drug interactions still apply at ALL doses
TCAs will block the reuptake pump for
NE and 5-HT
Do TCAs block the dirty receptors?
Can overdoses be fatal with TCAs?
What is the lethal dose of TCA for a young adult?
What is a main symptoms of TCA toxicity?