1. What is the role of the primary care provider in mental health?: - 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 disorders
- From strong links with mental health specialty care for
complex cases Sharing patient info (ex: meds used)
2. about PHQ2
- what does it screen for, what are the questions, scoring: - 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 Ò due
,the PHQ9
If the pt screens (+) Ò continue to eval with the PHQ9
3. about PHQ9
- what its used for, questions, scoring: Used for screening,
diagnosing, and treating
- It asks about functioning impairments which is needed for the DSM-
based diagno- sis
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
, 4. What is the appropriate initiation dose for fluoxetine for adults and
geriatric adults?: 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
5.What labs would be appropriate to draw if you initiate fluoxetine in a
geriatric patient?: Sodium levels
- Baseline screening & after 3-4 weeks in high-risk patients (> 65yrs,
previous
hx of antidepressant-induced hyponatremia, low body weight,
concomitant use of thiazides or other hyponatremia-inducing agents)
- monitor regularly in the elderly
6. What are potential side effects of SSRI medications?
- what are the common SSRIs, LEAP of them, and zoloft AE: Common SSRIs
Lexapro, celexa, paxil, zoloft, prozac
L = decreased libido and
sleep E = Neutral effect on
energy
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