Depression
Cognitive behavioral therapy (CBT)
Interpersonal therapy (IT)
Time-limited focused psychotherapy
Behavior therapy
Group therapy
What is therapeutic index for lithium?
0.6-1.2 mEq/L
What is first line treatment for anxiety?
Therapy
When are medications appropriate for treating PTSD?
Treat symptoms or comorbidities
Current medications to treat schizophrenia primarily affect what neurotransmitter?
dopamine
What medication class is considered first-line to use for MDD?
SSRIs
Thyroid
Kidneys
Name a technique to treat a specific phobia.
Systematic desensitization
Flooding
What comorbidities and symptoms of PTSD are appropriate to treat with medication?
Depression and anxiety:
SSRI: fluoxetine, sertraline, paroxetine
SNRI: venlafaxine
Hyperarousal/intrusive symptoms: Clonidine, prazosin
Hyperarousal/panic: propranolol
Name a second generation antipsychotic medication (atypical neuroleptic).
Quetiapine (Seroquel)
Paliperidone (Invega)—available as LAI
Clozapine (Clozaril)
Lurasidone (Latuda)
Olanzapine (Zyprexa)
Risperidone (Risperdal)
Ziprasidone (Geodon)
Lloperidone (Fanapt)
Asenapine (Saphris)
Name an SSRI.
What is the black box warning for this medication class?
Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil)
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluvoxamine (Luvox)
You are providing teaching for a patient starting lamotrigine. What serious side effect must you include teaching for?
Stevens-Johnsons syndrome
What class of medications is first-line pharmacotherapy for anxiety?
SSRIs
What therapy modalities are used to treat PTSD?
CBT, EMDR
You are working with a patient with schizophrenia who has a severe needle phobia. What SGA would you question and why?
clozapine
Required frequent lab monitoring when starting med.
Name a common SE of SSRIs.
Name a serious SE of SSRIs.
Common: GI Upset, Agitation, Anxiety, Sleep disturbance, Tremor, Sexual dysfunction (anorgasmia), Tension headache
Serious: Serotonin Syndrome: abdominal pain, diarrhea, sweating, fever, tachycardia, hypertension, delirium, myoclonus, increased motor activity, irritability, hostility, mood changes.
True/False: Lab monitoring is required for carbamazepine and valproate?
What class medication are these?
True.
Anticonvulsants.
True/False: Benzodiazepines are never appropriate for treatment of anxiety.
False.
When are they appropriate?
Name a grounding technique and a stressor disorder it can be used for.
deep breathing, stomping feet, exercising, touching fabric on chair, take a shower, etc.
depersonalization/derealization disorders
You are working with a patient with schizophrenia who is having challenges taking pills every day. What might your recommend/request from patient's prescriber?
Switch to LAI
Washout period with other medications.
S/S of hypertensive crisis. What is reversal med?
Dietary restrictions.
You are completing your NPW on a patient on the Aspen unit. You see the following medications prescribed for a patient diagnosed with bipolar disorder. Is this regimen appropriate?
aripiprazole 15 mg daily
alprazolam 1 mg PRN TID, agitation
Yes. SGAs can be used to treat bipolar disorder--aripiprazole approved as a monotherapy.
Benzos can be used short-term to manage mania. Agitation can be part of patient's manic symptoms.
Why do we try to avoid use of tricyclic antidepressants (TCAs) in treating anxiety and/or depression?
Increased risk for death with overdose.
True/False: You do not need to re-orient a person with a dissociative disorder as it will confuse them.
False. Re-orientation is important to reconnect patient with reality.
When might you give a patient an SGA or FGA outside the psychiatric setting?
What are your considerations if an SGA is ordered for this purpose?