Mayberry Topics (Exam 1)

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1

Most anxiety disorder, expect for OCD, are approximately twice as common in?

Females than in males

2

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

3

Does a panic attack only occur in Panic Disorder?q

No. It will occur in the context of different anxiety disorders as well

4

In regards to PD, most patients who seek treatment have developed _______________________________

agoraphobia

- this is the fear of not being in control

5

Obsessions are?

intrusive and unwanted

6

Compulsions are?

the response to an obsession

7

In regards to OCD, the obsessions or compulsions must at least take up ___________ amount of your day, or cause distress or impairment.

1 hour

8

In OCD, approximately how many patients will also develop MDD?

2/3

9

In regards to PTSD, you must have a symptom from each of the 4 clusters. The duration of the disturbance is more than ___________________.

1 month

(Not one isolated epsidoe)

10

Suicide risk for ___________ is comparable to that seen in MDD.

PTSD

11

Anxiety disorders are generally _____________ in nature, but the symptoms tend to wax and wane.

chronic

12

_________________ is first line treatment in mild OCD.

CBT (Cognitive Behavioral Therapy)

13

Benzos are not recommended for use in which disorder?

PTSD

(it is also typically not used in OCD)

14

Lorazepam and Oxazepam are different because?

They do not undergo oxidation, only CONJUGATION

15

Oxidation may be impaired by which 3 things?

  • aging
  • liver disease
  • drug interactions

BZD concentration will be higher if you have these things

16

BZD that have very long half lives will?

  • be less likely for withdrawal
  • have a risk of accumulation in the body
17

Best choice of BZD therapy for elderly?

Lorazepam

18

In regards to BZD, ______________ doses are generally used to treat panic disorder. While ____________ doses are generally used for GAD.

higher; lower

19

Withdrawal is more likely to happen with?

  • higher doses of BZD
  • longer duration of BZD
20

A more SEVERE withdrawal is likely to happen with?

  • a short half life medication (ex: xanax)
21

Is Buspirone effective in PD?

No

(this medication is only effective for GAD)

22

MOA of Buspirone?

5-HT1A partial agonist

23

Maximum dosage of Busprione?

60 mg per day

24

BZD will generally reduce _____________ symptoms, more than __________________ symptoms.

somatic; psychic

(somatic symptoms are the physical symptoms)

25

Should Buspirone be given PRN or routinely?

routinely

26

Place in therapy for Buspirone in the treatment of GAD?

Second line

(Antidepressants (Paroxetine, Venlafaxine XR, and Duloxetine) are 1st line)

27

Which drug has a risk of hepatotoxicity?

Nefazodone

28

Which agents have shown to be promising in adjunctive therapy for GAD?

Second Generation Antipsychotics

29

BZD for treatment of Panic Disorder

there is a relatively rapid response (within 1-2 weeks)

30

First line therapy for PD?

antidepressants

(paroxetine, sertraline, fluoxetine, venlafaxine XR)

31

Which agents are considered INEFFECTIVE for treatment of PD?

  • buspirone
  • bupropion
  • trazodone
32

Second line therapy for SAD?

Benzodiazepines

33

When do you see a response onset with BZD in treatment of SAD?

2 weeks

(the two agents are xanax and klonopin)

34

What is first line therapy for SAD?

antidepressants

(paroxetine, sertraline, fluvoxamine)

35

With antidepressant therapy for treatment of SAD.....

symptoms will improve after several weeks, but the maximum effects will take about 12 weeks.

36

Which class of medications are NOT effective in SAD?

TCAs

37

What should be used to treat OCD?

SSRIs and clomipramine

38

Which SSRI is only used to treat OCD?

Fluvoxamine

39

In regards to OCD, if you use paxil and it doesnt work.... what should you do next?

Switch to another SSRI like fluoxetine

40

FDA approved treatments for OCD

  • clomipramine
  • fluoxetine
  • sertraline
  • paroxetine
  • fluvoxamine
41

When should clomipramine be used for OCD?

After two or three failed SSRI trials

42

2nd line for OCD?

venlafaxine and mirtazapine

43

Adequate trial for OCD?

at least 8-12 weeks at maximum recommended doses

44

Which class of medications is first line for PTSD?

SSRIs (sertraline and paxil)

& venlafaxine

45

If you see that a patient is also taking PRAZOSIN with their antidepressant, they most likely have?

PTSD

46

Can BZD be used in PTSD?

No

47

PTSD has a ___________ substance abuse comorbidity

high

48

In regards to PTSD...

  • some improvement may be noted within the first 2 weeks
  • graded improvement continues over 8-12 weeks
49

Which class of medications is considered 2nd line for PTSD?

TCAs

50

How long should you tell a patient with anxiety that they will have to take their medication?

"at least one year"

51

In regards to discontinuation of therapy for anxiety disorders....

should be GRADUAL

52

If you discontinue BZD abruptly....

there is a possibility of withdrawal

53

In MDD, there is a high risk of psychiatric comorbidity, especially for?

  • anxiety disorders
  • substance abuse disorders
54

Is MDD more common in males or females?

twice as common in females

55

Average age of onset for MDD is mid ______________ to mid _____________.

20's-30's

56

Can stressors cause depression?

Yes

57

Do stressors always cause depression? Is depression always causes by stressors?

NO; NO

58

Depression is characterized by

decreased NE and 5-HT

59

Do antidepressants start working immediately?

No, there is a delay in clinical effects

60

Depressed patients will often have _____________ TFTs

abnormal

61

Depressed patients may have an ___________________ HPA axis

overactive

62

Do psychotic symptoms ever occur with MDD?

Yes, sometimes

63

According to DSM-5...

___________ or more of the 9 symptoms must be present during the same 2 week period

5

64

1 of which 2 symptoms MUST be present for MDD?

  • depressed mood (either feelings or tearful)
  • anhedonia (diminished interest)
65

What is required for a MDD diagnosis?

significant impairment to daily living or significant distress

66

How long does an untreated major depressive episode typically last?

6 months or longer

67

How many MDD episodes will FULLY recover?

2/3

(the other 1/3 will have a partial or no response)

68

Psychotherapy is a treatment option for...

mild to moderate depression

(may be used with or without antidepressant)

69

What treatment is superior for MDD?

combination of psychotherapy with pharmacotherapy

70

The onset of benefits of psychotherapy for MDD tend to be more _____________________ than that from medication

gradual

71

ECT therapy for MDD

  • HIGH response rates (70-90%)
  • RAPID onset (within first week or two)
  • adverse effects include: confusion and memory problems
72

Supplements or exercise may be efficacious as __________________ treatment with antidepressants

adjunctive

73

Sexual dysfunction is caused by

5-HT2A agonism

(or an increase in serotonin)

74

increased NE causes

increased blood pressure

75

increase DOPAMINE causes

precipitation of psychosis

76

Which serotonin receptor will cause weight gain when it is ANTAGONIZED?

5-HT2C

77

Irreversible inhibition caused by MAOIs will take how long to overcome?

2 weeks

78

The MAOI, EMSAM

  • patch
  • lowest dose can be used without diet restrictions
  • higher doses = diet restrictions still apply
  • drug-drug interactions still apply at ALL doses
79

TCAs will block the reuptake pump for

NE and 5-HT

80

Do TCAs block the dirty receptors?

Yes

81

Can overdoses be fatal with TCAs?

Yes

82

What is the lethal dose of TCA for a young adult?

30 mg/kg

83

What is a main symptoms of TCA toxicity?

cardiac arrhythmias