Change in appetite, insomnia, loss of interest/pleasure, fatigue, felling worthlessness & hopelessness, decreased sex drive, decreased ability to concentrate,feeling sad, withdrawl from society, irratibility, thoughts of death/suicide.

Must present with 5+ symptoms in a two week period

Two different neurotransmitters are resposible for function of mood

Depression: Decrease NE(norepi) &

5HT(seratonin)

Manic Episode: Increase NE & 5HT

Acute Phase: 6-10wks, remission

Continuation Phase: 4-9months, prevent relapse

Maintenance: 12-36months, prevent recurrence

Phenylzine, tranylcypromine

-hardley used because of toxicity & drug/food interations

-MOA: MAO-an enzyme that breaks down NE an 5HT 

MAO inhibitors prevent break down and result in an increase in NE, 5HT, and DA

Orthostatic hypotension, weight gain, sex dysfx, hypertensive crisis

avoid foods that contain tyramine during therapy and 14 days after d/c-- wine, beers, cheeses

wait 2 weeks after d/c MAOI to start a new anti-depressant

MOA: The inhibit the reuptake of NE and 5HT into the neuronal nerve endings

Results seen upon administration

Not first line due to toxicity in OD

-Neuropathetic Pain

-Migrain prophy

-Persistant sigultus(hiccups)

-Noctournal enuresis (bedwetting)

Sedation, anticholergenic effects(dry mouth, constipation, urinary retention, blurred vision)

Increased CNS Activity(restlessness, tremors, convulsions, mania)

Selective only to 5HT

First line of MDD and anxiety due to efficacy, tolerability and safer than TCA in OD

Side Effects: Hyponatremia, GI bleeds, seizures, Serotonin Syndrome, QT prologation

Medical Emergency

Constellation of SXs- delerium, tachycardia, diarrhea, hyperactive bowel movements, tremor, shivering, clonus(involuntary muscle contrations and relaxations)

Medication that increase risk: SSRIs, SNRIs, TCAs, Tramadol, Methadone, Meperidine

Serotonin and NE reuptake inhibitors(SNRIs)

Inhibits both 5HT and NE reuptake, dose related increases in diastolic BP

(Be careful in patients who have HTN)

Serotonin and NE reuptake inhibitors(SNRIs)

Inhibits 5HT and NE reuptake

 Active metabolite of venlafaxine

 Inform pt that they may see an empty shell in stool

SNRIs

Inhibits 5HT and NE reuptake

First SNRI approved for fibromyalgia and diabetic peripheal neuropathy

Avoid if alcohol use is chronic-hepatotoxicity

may cause constipation

SNRI

FDA approved for fibromyalgia NOT depression

Constipation, insomnia, hot flush, hyperhidrosis, and dry mouth

Atypical Antidepressant

NE and DA reuptake

Used for smoking cessation

Possible sex dysfx and weight gain

Avoid use in those with seizures(lowers seizure threshold)

Atypical Antidepressant

Alpha-2 adrenergic antagonist(increases 5HT and NE release)

May cause weight gain

No sex dysfx Used for sedation at low doses

do not use with clonidine, rebound HTN

Atypical antidepressant

Black box warning for liver failure

Atypical Antidepressant

Adjunct to AD for insomnia

May cause priapism(constant erection)

Herbal Supplement

Not regulated by FDA

Hypericum

Plenty of water at meal times

Photosensitivity

Major DDI- Warfarin, SSRIs, TCAs

Sequenced Treatment Alternatives to Relieve Depression

only 33% of pts respond to their first trial of AD

Titrate dose to its max as tolerated

Treat pt for at least 8 weeks before stopping

Increase NE→ excitement

Characterized by periods of hyperactivity and excitement combined with excessive elevation of mood.

usually really talkative but thoughts and ideas are more often unrealistic

Characterized by a period of time(lasting at least a week) in which the criteria are met both for a manic episode and for Major depressive episode nearly every day.

The individule experiences rapidly alternating moods accompanied by symptoms of a manic episode and a major depressive episode.

MOA: Decreases Excitability of nerve tissues

Decreases release of NE at nerve ending

Increasing the reuptake of NE anf 5HT

Similar to Na, so body uses Li as if Na

Be careful w/pts who are Na depleted b/c they can retain Li

MOA: Not known but works with GABA

Clinical Uses: Mania, seizures, and migraines

Counseling Tips: N/V, Abd pain, HA, Thrombocytopenia(dose related)

MOA: Not known

CLinical Uses: Bipolar I, acute manic and mixed episodes, Nerve pain, Epilepsy

Counseling tips: Dizziness, lightheadedness, blurred vision, Hematologic issues (CBC)

MOA: Not known but may decrease glutamate release

Clinical Uses: Bipolar I, Epilepsy

Counceling tips: Rash, N/V, dizziness, somnolence, rhinitis, Steven-John syndrome(flesh falling off)

Must start Low and Slow

Normal Levels: 0.6- 0.8

IN Li concentration <1.5 (fine hand tremors, GI upset, Polydipsia, Muscle weakness

In Li conc is 1.5-2.5 slurres speech, confusion, sedation, dizziness

If Li conc >2.5 seizures,coma, cardiovascular collapse, death

is one of the most complex and challenging of psychiatric disorders

A psychotic condition in which individuals usually are withdrawn, behavior is inapproriate and highly unpredicatable.

presents as a heterogeneous syndrome of disorganized and bizarre thoughts, delusions, hallucinations, inappropriate affect, and impaired psychosocial functioning.

Must have 2 or more symptoms for at lease one month: Bizzare Delusions, Hallucinations, Agitation, Loose Associations, Social Withdrawn

Positive Symptoms: hallucinations, delusions, and conceptual disorganization

Negative Symptoms: Apathy, Social Withdrawal, Blunted affect, poverty of speech(Alogia), Avolition(inability to initiate and persistin goal related activities), and Anhedonia(Lack of interest in activities).

Phenothiazine

-Chlorpromazine(Thorazine)

-Thioridazine(Mellaril)

Butyrophenones

-Haloperidol(Haldol)

-Thiothixene(Navane)

MOA: Bases on DA hypothesis: too much DA in brain, blockade of CNS DA receptors resulting in inhibition of dopamine-medicated effects

Side Effects: NOt only affecting DA receptors but many others as well(Histamine, Alpha-1, Musculrenic, 5HT)

Agents with higher degree of blocking DA receptor cause EPS problems

-Haloperidol

Dystonic Reactions:

Torticollis 

movement of neck to one side

Akathisia 

inability to stay still

Parkinsonism

Tardive Dyskinesia

slow onset of involuntary and repetative movements

First line agents in the TX for schizophrenia

Work on the negative symptomsof schizophrenia

Moderate to high D₂ antagonism and high 5HT_2A antagonism

but also affect other receptors

Clozapine- prototypic drug

last line- causes agranulocytosis(failure of the bone marrow to make enough white blood
cells)

Risperidone, Olanazapine, Quetiapine, Aripiprazole, Asenapine-- causes a lot of drooling.Glycopyrolate is used to treat the drooling.

Sedation, EPS, anticholinergic, orthostasis(orthostatic hypotention), weight gain, and prolactin

Diabetes mellitus, dyslipidemia

Hypoesthesia- loss of sensation in the mouth

An emotional state caused by perception of real or percieved danger that threatens an individuals security

Can produce uncomfortable and potentially debilitating psychological and/or physiological state

most frequent mental disorder

Generalized anxiety disorder

Panic disorder

Social anxiety disorder

Specific phobia

PTSD

OCD

Excessive anxiety, fatigue, poor coping abilities, on edge, muscle tension, worries that are difficult to control, irritability, restlessness, loss of appetite, sleep disturbance

Pt has more botherd days that normal

Unexpected panic attacks that are intense, terrifying fear

Last 20-30 min

Misdiagnosed due to panic symptoms mimicking several medical conditions

Fears of being humiliated or embarrassed

Some feared situations like addressing a group of people, speaking in public, and using public toilets

Symptoms: blushing, sweating, trembling

Fear of an object or situation

Avoidance

Agoraphobia- place or situation which may be difficult to escape

Exposure to traumatic event

Veterans of war

poorly recongnized

 Recurrent disturbing dreams of the event, insomnia, angry outburst, sense of forshortened future

Variety of sxs on presentation to MD

Secretive

Obsession- recurrent, persistant idea, thought, impulse that produces anxiety

Compulsion- repetitive behavior or mental act

most effective and safe

rapid relief of acute sxs

MOA: Potentiates the inhibitory effect of GABA which results in reduce neuronal excitability

Xanax(alprazolam)

Ativan(lorazepam)

Restoril(temazepam)

Halcion(triazolam)

Librium(chlordiazepoxide)

Klonopin(clonazepam)

Valium(diazepam)

Dalmane (flurazepam)

Drowsiness

Dizziness

Physical and physiological dependence

Long term effects: memory loss

TX for OD: Flumazenil- used to reverse effects of BZD overdose

Drug Class: Azapirones

Similar in efficasy to Benzo's but there are advantages and disadvatages to the use of Buspar

MOA: Suppresses serotonergic activity while enhancing noradrenergic and dopaminergic cell firing

Slow onset of action

Needs to be taken continuously on a routine regimen, not as needed

Full theraputic effect in 3-4 weeks

No abuse potential

Not affected by alcohol

Has anti-convulsant and skeletal muscle relaxant properties

No sedation

Herbal Supplement

TX: Anxiety and insomnia

MOA: Similar to BZDs, Inhibits the breakdown of GABA

DDI: MAOIs

Affects about 50% of US population and some point during life.

Hypnotic- used to induce and maintain sleep

OTC

Antipressants- TCA(amitriptyline and doxepine), mirtazapine, and trazodone

Melatonin receptor agonist

Bind to GABA receptor complex sites, leading to enhancement of GABA activity in the CNS

Benzodiazepines- "pams"

nonbenzodiazepams- "Z" drugs

Chronic condition characterized by widespread pain in muscles and joints and abnormal bodily tenderness

more common in women

only 3 FDA approved agents to treat- Cymbalta, Lyrica, and Savella

is one of the most common childhood disorders and can continue through adolescence and adulthood.

onset is typically by the age of 3

caused by genes, enviromental factors, brain injuries, sugar, and food additives

Adderall, Concerta, Focalin, Vyvanse, Ritalin

Daytrana patch(total wear time should not exceed 9 hours)

Strattera

Occurs within descrete areas of the brain

Simple: Consciousness is fully preserved

Complex: Consciousness is impaired, "Automatisms" (lip-smacking)

Arise from both sides of the cerebral hemispheres simultanelously

Atonic

Tonic/Clonic- most common, "Grand Mal"

Myoclonic- a sudden and brief muscle contraction

Absence-"Petite Mal"

life threatning seizures

in an emergencey

DOC: IV Diazepam(Valium)