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Ha Vu D.O. Meier Clinics Ha Vu D.O. Meier Clinics

Ha Vu D.O. Meier Clinics - PowerPoint Presentation

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Ha Vu D.O. Meier Clinics - PPT Presentation

Board Certified in General Psychiatry Board Certified in Consult Liaison Psychiatry Disclosure I Ha VU do not have relationships with commercial interests Horror Stories of Antidepressants ID: 909017

psychotic anxiety social mood anxiety psychotic mood social bipolar eating antidepressant ocd ptsd panic depression misc subs mdd psychiatric

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Slide1

Ha Vu D.O.

Meier Clinics

Board Certified in General Psychiatry

Board Certified in Consult Liaison Psychiatry

Slide2

Disclosure

I, Ha VU, do not have relationship(s) with commercial interests.

Slide3

Horror Stories of Antidepressants

Slide4

Objectives:

Approximate the gap of mental health perspectives:

Highlight common mental health illnesses

Highlight some common characteristics of “antidepressant”

Slide5

Doctor Visit

HPI: 18

y.o

. single CF, lives with family, home-schooled, works at restaurant, presented to clinic for worsening of depression and anxiety past few months, no clear precipitating factor. No previous psych

eval

/treatment

+ Panic: episodes of SOB, sweats, palpitation, crying, fear, lasting 10 min

+ Generalized Anxiety: “worrier”, affects sleep.

+

Emetophobia

: fear of vomiting situations -> poor appetite, weight loss.

+ Depression symptoms:

1.

Depressed

mood

2. Markedly

diminished interest

or pleasure in all

3.

Social isolation

4. Feelings of worthlessness or

guilt,

burdance

to family

5. Diminished ability to think or

concentrate

.

+ Social anxiety

History otherwise negative.

Appearance: overly anxious. Underweight. Pleasant.

Slide6

Psychotic D/O:

Mood D/O

:

Anxiety D/O:

Misc.

Subs

antipsychotic

antidepressant

Mood

stablizer

antidepressant

anxiolytic

antidepressant

stimulant

Psychotropic Meds

MDD

Bipolar D/O

G.A.D.

Panic D/O

OCD

Social phobia

PTSD

Schizophrenia

Schizophreniform

Brief Psychotic

Schizoaffective

Eating D/O

ADD/ADHD

PSYCHIATRIC DISORDERS

Slide7

Psychotic D/O:

Mood D/O

:

Anxiety D/O:

Misc.

Subs

MDD

Bipolar D/O

G.A.D.

Panic D/O

OCD

Social phobia

PTSD

Schizophrenia

Schizophreniform

Brief Psychotic

Schizoaffective

Eating D/O

ADD/ADHD

PSYCHIATRIC DISORDERS

HPI: 18

y.o

. single CF, lives with family, home-schooled, works at restaurant, presented to clinic for worsening of depression and anxiety past few months, no clear precipitating factor. No previous psych

eval

/treatment

+ Panic: episodes of SOB, sweats, palpitation, crying, fear, lasting 10 min

+ Generalized Anxiety: “worrier”, affects sleep.

+

Emetophobia

: fear of vomiting situations -> poor appetite, weight loss.

+ Depression: low mood, diminished interest, Social isolation, guilt, concentration

+ Social anxiety

Slide8

Key Neurotransmitters

Serotonin

Norepinephrine

Dopamine

Slide9

Antidepressants

SSRI

Citalopram

(

Celexa

)

Escitalopram

(

Lexapro

)

Fluoxetine

(Prozac) Fluvoxamine (

Luvox)Paroxetine (Paxil)Sertraline (Zoloft)

SNRIDuloxetine

(Cymbalta)Venlafaxine

(Effexor)Desvenlaxine

(Pristiq)Levomilnacipran (Fetzima)

NDRI

Bupropion (Wellbutrin)MISC.Trazadone

(Desyrel)Mirtazapine

(Remeron)Vilazodone (

Viibryd)Vortioxetine (

Trintellix)

ADVERSE EFFECTS:

USE

:

Depression, Bipolar, GAD, OCD, Social, PTSD, SAD, Eating , Impulse

CLASSIFICATION :

Anticholinergic

: dry mouth, blurred vision, constipation, urinary retention

Antihistamine: sedation, weight gain

Alpha 1 blockage: Orthostatic

hypotention, sedation, sexual dysfunction

Serotonergic: GI (nausea, diarrhea), insomnia, agitation, headache,

sx dysfx

Discontinuation: dizziness, fatigue, nausea, shock-like (paxil)

Slide10

Older Antidepressants

TCA

Amitriptyline

(

Elavil

)

Clomipramine

(

Anafranil

)

Desipramine

(Norpramin)

Doxepin (Sinequan, Adapin,

Silenor)Imipramine (

Tofranil)Nortriptyline (Aventyl

, Pamelor)Protriptyline

(Vivactil)Trimipramine (Surmontil)

ADVERSE EFFECTS

…additionally… MAOI

Phenelzine (Nardil)

Tranylcypromine (Parnate)

Selegiline (Ensam)

CLASSIFICATION

:

USE:

Unipolar

, Bipolar, GAD, OCD, PTSD, SAD, Eating d/o, Impulse control

TCA may slow cardiac conduction, prolongation of the QT interval, SZ

MAOI increases risk for hypertensive crisis if foods with high

tyramine or sympathomimetic

drugs are consumed

Slide11

Psychotic D/O:

Mood D/O

:

Anxiety D/O:

Misc.

Subs

antipsychotic

antidepressant

Mood

stablizer

antidpressant

anxiolytic

antidepressant

stimulant

Psychotropic Meds

MDD

Bipolar D/O

G.A.D.

Panic D/O

OCD

Social phobia

PTSD

Acute Stress

Schizophrenia

Schizophreniform

Brief Psychotic

Schizoaffective

Eating D/O

ADD/ADHD

PSYCHIATRIC DISORDERS

Slide12

Anxiolytics

*

Buspirone

(

BuSpar

):

BENZODIAZAPINE

Oxezepam

(

Serax

)

Alprazolam

(Xanax)Triazolam (

Halcion)Lorazepam (

Ativan)Clonazepam (

Klonopin)Clorazepate (Tranxene

)Diazepam (Valium)Chlordiazepoxide (Librium)Halazepam (

paxipam)

ADVERSE EFFECTS:Use

:

Anxiety, insomnia, SZ, alcohol detox, adjunct for psychotic agitation

Sedation, cognitive dysfunction (amnesia), ataxia, slurred speech

Respiratory depression at high doses or if combined with alcohol, or w

resp d/o

Indicated for GAD

Slide13

Case Study II

HPI: 37

y.o

. CM, previously worked in customer service, switched to sale past year. Presented with distraction, unable to complete tasks, “racing thoughts”.

Appearance: overweight, anxious.

Vitals: 145/100

Psychotic D/O:

Mood D/O

:

Anxiety D/O:

Misc.

Subs

MDD

Bipolar D/O

G.A.D.

Panic D/O

OCD

Social phobia

PTSD

Acute Stress

Schizophrenia

Schizophreniform

Brief Psychotic

Schizoaffective

Eating D/O

ADD/ADHD

Diagnosis?

Treatment?

Slide14

Psychotic D/O:

Mood D/O

:

Anxiety D/O:

Misc.

Subs

antipsychotic

antidepressant

Mood

stablizer

antidpressant

anxiolytic

antidepressant

stimulant

Psychotropic Meds

MDD

Bipolar D/O

G.A.D.

Panic D/O

OCD

Social phobia

PTSD

Acute Stress

Schizophrenia

Schizophreniform

Brief Psychotic

Schizoaffective

Eating D/O

ADD/ADHD

PSYCHIATRIC DISORDERS

Slide15

Objectives:

Approximate the gap of mental health perspectives:

Highlight common mental health illnesses

Highlight some common characteristics of “antidepressant”

Horror Stories of Antidepressants

Ha Vu D.O.

Meier Clinics

Board Certified in General Psychiatry

Board Certified in Consult Liaison Psychiatry

Slide16

Reference

Lieberman, Jeffrey A. “Handbook of Psychiatric Drugs.” John Wiley & Sons. 2006

Hahn, Rhoda K. “Psychiatry on Call.” Current Clinical Strategies Publishing. 2008.

Procyshyn, Ric

M. “Clinical Handbook of Psychotropic Drugs.” 2015