10 - Depression & Anxiety Flashcards
Which 2 traits distinguish MDD and dysthymia?
- Severity
2. Duration
It can take up to ___ weeks for anti-depressants to take effect.
4
List 3 symptoms of generalized anxiety disorder.
- Apprehension
- Motor tension
- Autonomic overactivity
What is trichotillomania?
Irresistible urge to pull hair
Schizophrenia is ___ common than bipolar disorder.
More
What is the effect of an enlarged amygdala (re: anxiety disorders)?
Cognitive bias (i.e., heightened acuity) to perceived threats
List 2 behaviours that negatively reinforce anxiety disorders.
- Avoidance
2. Escape
What are the 2 pathways for processing fear?
- Amygdala
2. Cerebral cortex
What is agoraphobia?
Fear of crowds/large open spaces/situations perceived as difficult to escape
Which piece of legislation allows 2 registered medical practitioners to detain a high-risk psychiatric patient for assessment at a hospital?
Mental Health Act of 1983
According to the World Health Organization, what is the most common cause of disability?
Depression
List 2 areas of the brain whose activity is inhibited by GABA.
- Amygdala
2. Prefrontal cortex
What percentage of anxiety disorders are experienced concurrently with depression?
60%
In anxiety disorders, the ___ of the brain is larger, causing patients to develop a cognitive bias when responding to perceived threats.
Amygdala
___ GABA can cause anxiety.
Reduced
Repeated pairing of neutral stimulus with noxious stimulus can trigger an anxious response. What is this process called?
Conditioning
Remember: Little Albert
Define dysfunctional assumptions.
Unhelpful “if, then” thoughts that cause distress
Example: “If I fail my ETA, then I will have to sell my body.”
Females are ___ likely to be diagnosed with depression.
More
According to the Mental Health Act of 1983, how many registered medical practitioners must agree to detain a high-risk psychiatric patient for assessment at a hospital?
2
Order the following mental illnesses from most to least common.
- Anxiety
- Bipolar disorder
- Schizophrenia
- Depression
Depression
Anxiety
Schizophrenia
Bipolar disorder
List 3 neurotransmitters linked to depressive symptoms.
- Noradrenaline
- Serotonin
- Dopamine
A patient feels anxious most days and struggles to remember the last time they felt relaxed. No additional symptoms are presented. What is the likely diagnosis?
Generalized anxiety disorder (GAD)
According to the Mental Health Act of 1983, a psychiatric patient may be detained for assessment at a hospital if they pose a risk to the health and safety of others or ___.
Themselves
How would a panic disorder present?
Recurrent attacks of sudden, severe anxiety
List 2 situations where you would refer a depression patient to specialist services.
- Attempted interventions ineffective
2. High risk of self-harm
Compare panic disorders and phobias.
Panic disorders: no specific trigger (i.e., unpredictable)
Phobias: predictable trigger
Why might anti-depressants make things worse?
Side effects can be severe and counterintuitive (although they often lessen with time)
OCD onset is usually ___ in life.
Early
Compare panic disorders and GAD.
Panic disorders: episodic
GAD: chronic
Compare the GAD-2 and GAD-7 scales.
GAD-2: identifies anxiety
GAD-7: assesses the severity of anxiety
Compare fear reaction of the amygdala and cerebral cortex.
Amygdala: fast, unconscious (i.e., fight, flight, or freeze)
Cerebral cortex: slow, conscious
What structural changes happen to the brain in cases of depression?
Excess cortisol shrinks HIPPOCAMPUS and PREFRONTAL CORTEX
How do twin studies indicate that depression has a psychological/social component?
Twins raised in different environments have different levels of mental health
Depressive symptoms are NOT triggered by low levels of neurotransmitters. Rather, there can be excessive ___ of neurotransmitters to the presynaptic nerve ending.
Reuptake
Are social phobias more common in women or men?
Men
What is anhedonia?
Loss of interest/enjoyment in previously enjoyable activities
Chronically high cortisol levels ___ depressive symptoms.
Aggravate
What are the 2 main categories of depression?
- Major depressive disorder
2. Dysthymia
Define negative automatic thought (NAT).
Involuntary thought that aligns with a negative schema/core belief
Example: “The ETA is in 3 weeks? I will fail.”
Generalized anxiety disorder (GAD) causes overactivity of the ___ nervous system.
Autonomic
List 2 neurotransmitter deficiencies that can cause anxiety.
- GABA
2. Serotonin
How would chronic stress lead to depression? (Hint: hormone-related.)
Raises cortisol, which stimulates depressive symptoms
What is the key treatment target for anxiety disorders?
Maladaptive behaviours
Compare specific phobias and social phobias.
Specific: fear of specific things or situations
Social: fear of social situations
Which neurotransmitter is linked to mood?
Serotonin
Define schema/core belief.
Abstract framework that serves as a guide to action
Example: “I NEED to get 12/12 on my ETA.”
Describe deep brain stimulation (DBS).
Electrodes are implanted in the brain and a neurostrimulator (visualise: brain pacemaker) sends electric currents through them
Compare cognitive behavioural therapy (CBT) and mindfulness-based cognitive therapy (MBCT).
CBT: focus is on MODIFYING interpretations of events
MBCT: focus is on DISCONNECTING interpretations from events
What is the most common disorder contributing to suicide?
Depression
Why might a patient with depression present with poor decision-making, concentration, and memory?
High cortisol levels in the brain shrink the prefrontal cortex and hippocampus, which are associated with such functions
List 2 difficulties that can arise when trying to diagnose a patient with depression.
- Unsure if symptoms caused by depression or something else
- Reluctance to open up due to embarrassment or stigma
Which scale would you use to IDENTIFY anxiety? (Hint: not measuring severity.)
GAD-2
A long-term effect of high cortisol levels in the brain is the reduction of regions regulating mood. List 2 such regions.
- Hippocampus
2. Prefrontal cortex
Males are ___ likely to die by suicide than females.
More
Are specific phobias more common in women or men?
Women
List 6 potential causes of anxiety disorders.
- Trauma
- Conditioning
- Catastrophic thinking
- Long-term stress
- Genetics (30-40% accountability)
- Neurotransmitters (reduced GABA and serotonin)
A patient scores less than 3 on the GAD-2, but you are still concerned. What question would you ask to screen for an anxiety disorder?
“Do you find yourself avoiding places or activities and does this cause you problems?”
OCD is anxiety induced by fear that not doing things a certain way will cause harm. It is characterized by OBSESSIONS and COMPULSIONS. Compare the two.
Obsessions: intrusive thoughts
Compulsions: repetitive activities that reduce anxiety
List 3 situations in which symptoms of depression may be confused with another condition.
- Chronic fatigue syndrome
- Hypothyroidism
- Anemia
What is the minimum duration of major depressive disorder?
> 2 weeks
What compulsions (re: OCD)?
Repetitive activities that reduce anxiety
Which neurotransmitter is linked to reward-seeking?
Dopamine
Which questionnaire screens for depression?
PHQ9
What is the most effective buffer against depression?
Social support
The ___ guidelines outline a stepped approach to depression treatment.
NICE
Generalized anxiety disorder (GAD) causes ___ of the autonomic nervous system.
Overactivity
The ___ model attributes disease outcomes to the interaction between biological, psychological, and social factors.
BIOPSYCHOSOCIAL
How does disconfirming evidence reduce anxiety?
Shows that the situation/thing is not actually harmful, making it more tolerable
Which protein is a blood test marker for inflammation?
C-reactive protein (CRP)
How might neurotransmitters cause depressive symptoms?
Too much reuptake of neurotransmitters to the presynaptic nerve ending lessens their concentration in the synapse
What are the 3 components of Beck’s cognitive theory of depression?
- Negative view of the SELF
- Negative view of the WORLD
- Negative view of the FUTURE
During a psychiatric interview, you discover that for the past 2 weeks, a patient has exhibited low mood, low energy, and anhedonia. What is the next step in management?
Get patient to complete a PHQ9 survey
Anxiety disorders are ___ commonly diagnosed in women.
More
List 5 types of anxiety disorders.
- Generalized anxiety disorder (GAD)
- Obsessive compulsive disorder (OCD)
- Post-traumatic stress disorder (PTSD)
- Panic disorders
- Phobias
Compare the common sense model and cognitive model.
Common sense model: event -> emotion
Cognitive model: event -> INTERPRETATION -> emotion
GABA ___ activity of the amygdala and prefrontal cortex.
Inhibits
How does electroconvulsive therapy (ECT) work?
Seizures are electrically induced to provide relief from mental disorders
What are the 3 core symptoms of depression?
- Depressed MOOD
- Reduced ENERGY
- Loss of INTEREST/ENJOYMENT
What are the 2 most common types of antidepressants?
- SSRI’s (selective serotonin reuptake inhibitors)
2. SNRI’s (selective noradrenaline reuptake inhibitors)
Which scale would you use to assess the SEVERITY of anxiety? (Hint: assume you have already identified it.)
GAD-7
What is a phobia?
Fear evoked by a clearly-defined situation or object
Which neurotransmitter is linked to stress response?
Noradrenaline
Anxiety disorders are ___ likely to be chronic than episodic.
More
