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Dx: Major Depressive Disorder
4/8 for 2 weeks with depressed mood or anhedonia: Sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicide
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Atypical Major Depressive Disorder
Increased sleep and appetite
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Dx: Neurotic Depression
Chronic mild to moderate anxiety and depression
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Dx: GAD
- Excessive anxiety/worry for at least 6 months 3/6: restless, easily fatigued, difficulty concentrating, irritable, muscle tension, insomnia
- Dx: PTSD
- Re-experience in at least 1 way (Intrusive recollection, flashbacks, nightmares, physiological distress or physical response to cues resembling event) Avoidance in at least 3 ways (avoiding thoughts, feelings, conversations, activities, people, places associated with events, inability to recall part of trauma, decreased interest in activities, estrangement, restricted affect, sense of shortened life)
- Increased arousal in at least 2 ways (sleep disturbance, irritability/angry outbursts, hypervigilance, exaggerated startling, decreased concentration)
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Complex PTSD
PTSD criteria and affective disregulation, poor impulse control, dissociation, somatization, self-destructive activities, preoccupation with perpetrator
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Dx: OCD
Obsessions: Intrusive/Inappropriate/Interfering, not real-life problems, attempts made to ignore or neutralize, recognized as product of self Compulsions: Repetitive behaviors or mental acts in response to obsessions aimed at preventing or reducing distress, not realistically connected
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Dx: Bipolar Type I
3/7 with euphoria or 4/7 with irritability for at least 1 week: Distractability, Insomnia, Grandiose, Flight of Ideas, Activities, Speech, Thoughtlessness -Mania because of disfunction
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Dx: Bipolar Type II
- 3/7 with euphoria or 4/7 with irritability for at least 1 week:
- Distractability, Insomnia, Grandiose, Flight of Ideas, Activities, Speech, Thoughtlessness -Hypomania because no disfunction, also need depressive episode (4/8 SIGECAPS)
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Dx: Schizophrenia
2 or more for 1 month psychosis symptoms: Delusions (if bizarre no other symptoms needed), hallucinations, disordered speech, disturbance of behavior, negative symptoms -Disfunction-Over at least a 6 month period -Not schizoaffective, mood, substance, medical
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Dx: Schizophreniform
Psychosis/schizophrenia symptoms for 1-6 months
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Dx: Schizoaffective
Psychosis and mania/depression/mixed where psychosis persists with stable mood for 2 weeks; mood disorder prominent longitudinally
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Dx: Delusional disorder
Non-bizarre delusions for 1 month with otherwise intact functioning
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Dx: Brief psychotic disorder
Psychotic for less than 1 month - self-resolves
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Dx: Shared psychosis
- Shared delusion with close contact
- Dx: Conversion disorder
- Caused by hypofunction in dominant hemisphere 1 or more symptoms indicating neurological disorder, with related psychological factors, not feigned or fully explained by medicine that causes distress or impairment (not pain or sexual dysfunction)
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Dx: Somatization disorder
Starting before 30 and lasting several years -4 pain symptoms, 2 GI, 1 sexual and 1 pseudoneurological
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Dx: Hypochondriasis
Preoccupation with fears of having (or thinking one has) a serious disease based on misinterpretation of physical signs, causing stress/impairment and lasting at least 6 months, with inability to be reassured
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Dx: Pain disorder
Pain causing distress or impairment that cannot fully be explained that has psychological factors
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Dx: Body dysmorphic disorder
Preoccupation with imagined (or exaggerated) defect leading to distress or impairment
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MOA: MAOI
Block MAO from breaking down catacholamines, A - NE, Epi, 5HTB � Dopamine
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SE: MAOI
Hypertensive crisis (with sympathomimetics or tyramine)
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CI: MAOI
CHF, liver disease, pheochromocytoma
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MOA: TCA
Inhibition of re-uptake of NE (5HT)
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SE: TCA
Anticholinergic (dry mouth), weight gain, sedation, orthostasis, prolonged QRS Serotonergic (sexual dysfunction)
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Overdose: TCA
Alkalinize serum
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MOA: SSRI
Inhibition of re-uptake of 5HT
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Paroxetine
SSRI (Class D)
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SE: SSRI
Nausea, sexual dysfunction, sleep, extrapyramidal, hyponatremia, QT prolongation, Anti-platelet, CYP2D6 Inhibition
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CI: SSRI
Tamoxifen (CYP2D6 Inhibition)
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MOA: SNRI
Inhibit re-uptake of 5HT and NE (some dopamine)
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SE: SNRI
Nausea, sexual dysfunction, sleep, extrapyramidal, hyponatremia, QT prolongation, antiplatelet effects, increase in BP and HR
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MOA: Buproprion
Inhibit re-uptake of dopamine (NE)
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SE: Buproprion
Nausea, tremor, agitation, insomnia, psychosis, seizures
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Zyban
Buproprion derivative for smoking cessation
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MOA: Mirtazapine
Tetracyclic; Inhibition of alpha-2 (increased 5HT, NE)
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SE: Mirtazapine
Sedation, dizziness, weight gain, orthostasis, constipation, dry mouth, agranulocytosis
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MOA: Trazadone
Serotonergic
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SE: Trazadone
- Sedation
- Beta blockers
- B1 - HR, lipolysis, renin
- B2 - Smooth muscle relaxation, tremor reduction
- Don't impair cognitive function
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MOA: Propranolol
Non-selective beta blocker
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MOA: Atenolol, metopropol
B1 Inhibition
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MOA: Benzodiazepines
Open more GABA channels A1 � sedation A2/3 � Anxiolysis A4 - Muscle relaxation
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SE: Benzodiazepines
Dependence, tolerance, withdrawal, abuse
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Chlordiazepoxide
Benzodiazepine (short)
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Diazepam
Benzodiazepine (short)
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Alprazolam
Benzodiazepine (long)
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Lorazepam
Benzodiazepine (long)
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MOA: Benzodiazepine-like drugs
GABA A1 - Sedation (short acting)
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Zolpidem
Benzodiazepine-like drug (sedation)
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MOA: Barbituates
Increase lenght of GABA channel opening
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SE: Barbituates
Tolerance, linear kinetics (overdose), drug interactions
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Flumazenil
Emergency treatment for benzodiazepine overdose
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MOA: Flumazenil
Neutral ligand for GABA receptors (competitive inhibition)
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MOA: Buspirone
5HT receptor partial agonist (anxiolytic)
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Trazodone
Helps people fall asleep and stay asleep, less potential for abuse
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MOA: Lithium
Alters sodium transport, decreases inositol recirculation
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SE: Lithium
Narrow therapeutic window Initial - nausea, fatigue Persistant - tremor, edema, weight gain, polydipsia/polyurea (antagonism of ADH receptors), nephrotoxicity, thyroid, confusion, ataxia, leukocytosis, skin, arrhythmias
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Drug interactions: Li
Drugs that Increase Li: ACE inhibitors, Thiazide diuretics, NSAIDS Drugs that decrease Li - K-sparing diuretics
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MOA: Valproate
Increases GABA
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SE: Valproate
Narrow therapeutic window Sedation, tremor, weight gain, nausea, diarrhea, alopecia, neural tube defects, increased LFTs, platelet disfunction, pancreatitis, agranulocytosis
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MOA: Carbamazepine
Na channel modulation
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SE: Carbamazepine
Narrow therapeutic window Enzyme induction and toxicity, GI, CNS, leukopenia, thrombocytopenia, edema, rashes, hyponatremia (increased ADH)
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MOA: Lamotrignine
Decreased glutamate and aspartate
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SE: Lamotrignine
CNS, severe rashes
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MOA: Typical Antipsychotics
D2 blockade (positive psychotic symptoms)
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Chlorpromazine
Typical Antipsychotic
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Haloperidol
Typical antipsychotic
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SE: Typical antipsychotics
Extrapyramidal symptoms, prolactin, sexual dysfunction, orthostasis, QT prolongation, Acute dystonic rxn, tardive kinesis, neuroleptic malignant syndrome
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MOA: Atypical antipsychotics
5HT (D2) blockade
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Clozapine
Atypical antipsychotic
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SE: Atypical antipsychotics
Hypotension, weight gain, dizziness, increased LFTs, increased glucose, increased lipids
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SE: Clozapine
Agranulocytosis
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