What is the role of the primary care provider in mental health? - ANSWER - Screen for
mental health issues
- Improve outcomes and reduce health care costs
- Assess and give care to mild-moderate disorders or patients with stable severe mental dis-
orders
- From strong links with mental health specialty care for complex cases
Sharing patient info (ex: meds used)
about PHQ2
- what does it screen for, what are the questions, scoring - ANSWER - Screens for MDD
- It is the first two questions of the PHQ9
- In the last two week, have you been feeling these (not at all, several days, more than half
the day, nearly everyday):
- Little interest or pleasure in doing things?
- Feeling down, depressed, or hopeless?
Scoring:
A single yes or score >3 (out of 0-6) = possible clinical depression ⇒ due the PHQ9
If the pt screens (+) ⇒ continue to eval with the PHQ9
about PHQ9
- what its used for, questions, scoring - ANSWER Used for screening, diagnosing, and
treating
1
,- It asks about functioning impairments which is needed for the DSM-based diagnosis
Includes asking about suicide or hurting self
Scoring:
0-27 available
0-4: Minimal/none
Monitor; may not require treatment
5-9: Mild
Use clinical judgment; follow-up in one month
10-14: Moderate
Use clinical judgment; may need meds if functionally impaired
15-19: Moderately Severe
Warrants active treatment with psychotherapy, meds, or combo
20-27: Severe
Warrants active treatment with psychotherapy, meds, or combo
What is the appropriate initiation dose for fluoxetine for adults and geriatric adults? - AN-
SWER 20mg PO once daily in the AM
- May ↑ daily dose after several weeks if inadequate response
- Full therapeutic effect may be delayed 4 weeks or longer
- Max dose: 80mg/day
What labs would be appropriate to draw if you initiate fluoxetine in a geriatric patient? - AN-
SWER Sodium levels
- Baseline screening & after 3-4 weeks in high-risk patients (> 65yrs, previous hx of antide-
pressant-induced hyponatremia, low body weight, concomitant use of thiazides or other hy-
ponatremia-inducing agents)
- monitor regularly in the elderly
2
, What are potential side effects of SSRI medications?
- what are the common SSRIs, LEAP of them, and zoloft AE - ANSWER Common SSRIs:
Lexapro, celexa, paxil, zoloft, prozac
L = decreased libido and sleep
E = Neutral effect on energy
A = neural effect on addiction
P = celexa may stop working after awhile (increase or switch)
Zoloft AE:
Insomnia, somnolence, fatigue, abnormal ejaculation, suicidal thoughts
What are characteristics of major depressive disorder or MDD? 9 - ANSWER Diagnostics
need 5 or more of the following:
- SS occur more days than not in a 2 week period
- SS cause significant impairment in any realm of functioning
- Depressed mood
- Loss of interest
- Significant unintended ▲ in weight or appetite
- Significant ▲ sleep
- ▲ psychomotor activity (restlessness)
- Fatigue, loss of energy
- Worthlessness, guilt
What is serotonin syndrome? - ANSWER - Increased serotonergic activity in the CNS
- Can be due to therapeutic med use, inadvertent drug interactions, or self-OD
Serotonin in the Body:
3
mental health issues
- Improve outcomes and reduce health care costs
- Assess and give care to mild-moderate disorders or patients with stable severe mental dis-
orders
- From strong links with mental health specialty care for complex cases
Sharing patient info (ex: meds used)
about PHQ2
- what does it screen for, what are the questions, scoring - ANSWER - Screens for MDD
- It is the first two questions of the PHQ9
- In the last two week, have you been feeling these (not at all, several days, more than half
the day, nearly everyday):
- Little interest or pleasure in doing things?
- Feeling down, depressed, or hopeless?
Scoring:
A single yes or score >3 (out of 0-6) = possible clinical depression ⇒ due the PHQ9
If the pt screens (+) ⇒ continue to eval with the PHQ9
about PHQ9
- what its used for, questions, scoring - ANSWER Used for screening, diagnosing, and
treating
1
,- It asks about functioning impairments which is needed for the DSM-based diagnosis
Includes asking about suicide or hurting self
Scoring:
0-27 available
0-4: Minimal/none
Monitor; may not require treatment
5-9: Mild
Use clinical judgment; follow-up in one month
10-14: Moderate
Use clinical judgment; may need meds if functionally impaired
15-19: Moderately Severe
Warrants active treatment with psychotherapy, meds, or combo
20-27: Severe
Warrants active treatment with psychotherapy, meds, or combo
What is the appropriate initiation dose for fluoxetine for adults and geriatric adults? - AN-
SWER 20mg PO once daily in the AM
- May ↑ daily dose after several weeks if inadequate response
- Full therapeutic effect may be delayed 4 weeks or longer
- Max dose: 80mg/day
What labs would be appropriate to draw if you initiate fluoxetine in a geriatric patient? - AN-
SWER Sodium levels
- Baseline screening & after 3-4 weeks in high-risk patients (> 65yrs, previous hx of antide-
pressant-induced hyponatremia, low body weight, concomitant use of thiazides or other hy-
ponatremia-inducing agents)
- monitor regularly in the elderly
2
, What are potential side effects of SSRI medications?
- what are the common SSRIs, LEAP of them, and zoloft AE - ANSWER Common SSRIs:
Lexapro, celexa, paxil, zoloft, prozac
L = decreased libido and sleep
E = Neutral effect on energy
A = neural effect on addiction
P = celexa may stop working after awhile (increase or switch)
Zoloft AE:
Insomnia, somnolence, fatigue, abnormal ejaculation, suicidal thoughts
What are characteristics of major depressive disorder or MDD? 9 - ANSWER Diagnostics
need 5 or more of the following:
- SS occur more days than not in a 2 week period
- SS cause significant impairment in any realm of functioning
- Depressed mood
- Loss of interest
- Significant unintended ▲ in weight or appetite
- Significant ▲ sleep
- ▲ psychomotor activity (restlessness)
- Fatigue, loss of energy
- Worthlessness, guilt
What is serotonin syndrome? - ANSWER - Increased serotonergic activity in the CNS
- Can be due to therapeutic med use, inadvertent drug interactions, or self-OD
Serotonin in the Body:
3
