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Clinical Problem Solving > 10 - Depression & Anxiety > Flashcards

10 - Depression & Anxiety Flashcards

1
Q

Which 2 traits distinguish MDD and dysthymia?

A
  1. Severity

2. Duration

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2
Q

It can take up to ___ weeks for anti-depressants to take effect.

A

4

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3
Q

List 3 symptoms of generalized anxiety disorder.

A
  1. Apprehension
  2. Motor tension
  3. Autonomic overactivity
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4
Q

What is trichotillomania?

A

Irresistible urge to pull hair

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5
Q

Schizophrenia is ___ common than bipolar disorder.

A

More

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6
Q

What is the effect of an enlarged amygdala (re: anxiety disorders)?

A

Cognitive bias (i.e., heightened acuity) to perceived threats

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7
Q

List 2 behaviours that negatively reinforce anxiety disorders.

A
  1. Avoidance

2. Escape

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8
Q

What are the 2 pathways for processing fear?

A
  1. Amygdala

2. Cerebral cortex

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9
Q

What is agoraphobia?

A

Fear of crowds/large open spaces/situations perceived as difficult to escape

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10
Q

Which piece of legislation allows 2 registered medical practitioners to detain a high-risk psychiatric patient for assessment at a hospital?

A

Mental Health Act of 1983

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11
Q

According to the World Health Organization, what is the most common cause of disability?

A

Depression

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12
Q

List 2 areas of the brain whose activity is inhibited by GABA.

A
  1. Amygdala

2. Prefrontal cortex

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13
Q

What percentage of anxiety disorders are experienced concurrently with depression?

A

60%

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14
Q

In anxiety disorders, the ___ of the brain is larger, causing patients to develop a cognitive bias when responding to perceived threats.

A

Amygdala

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15
Q

___ GABA can cause anxiety.

A

Reduced

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16
Q

Repeated pairing of neutral stimulus with noxious stimulus can trigger an anxious response. What is this process called?

A

Conditioning

Remember: Little Albert

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17
Q

Define dysfunctional assumptions.

A

Unhelpful “if, then” thoughts that cause distress

Example: “If I fail my ETA, then I will have to sell my body.”

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18
Q

Females are ___ likely to be diagnosed with depression.

A

More

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19
Q

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?

A

2

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20
Q

Order the following mental illnesses from most to least common.

  1. Anxiety
  2. Bipolar disorder
  3. Schizophrenia
  4. Depression
A

Depression
Anxiety
Schizophrenia
Bipolar disorder

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21
Q

List 3 neurotransmitters linked to depressive symptoms.

A
  1. Noradrenaline
  2. Serotonin
  3. Dopamine
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22
Q

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?

A

Generalized anxiety disorder (GAD)

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23
Q

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 ___.

A

Themselves

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24
Q

How would a panic disorder present?

A

Recurrent attacks of sudden, severe anxiety

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25
Q

List 2 situations where you would refer a depression patient to specialist services.

A
  1. Attempted interventions ineffective

2. High risk of self-harm

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26
Q

Compare panic disorders and phobias.

A

Panic disorders: no specific trigger (i.e., unpredictable)

Phobias: predictable trigger

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27
Q

Why might anti-depressants make things worse?

A

Side effects can be severe and counterintuitive (although they often lessen with time)

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28
Q

OCD onset is usually ___ in life.

A

Early

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29
Q

Compare panic disorders and GAD.

A

Panic disorders: episodic

GAD: chronic

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30
Q

Compare the GAD-2 and GAD-7 scales.

A

GAD-2: identifies anxiety

GAD-7: assesses the severity of anxiety

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31
Q

Compare fear reaction of the amygdala and cerebral cortex.

A

Amygdala: fast, unconscious (i.e., fight, flight, or freeze)

Cerebral cortex: slow, conscious

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32
Q

What structural changes happen to the brain in cases of depression?

A

Excess cortisol shrinks HIPPOCAMPUS and PREFRONTAL CORTEX

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33
Q

How do twin studies indicate that depression has a psychological/social component?

A

Twins raised in different environments have different levels of mental health

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34
Q

Depressive symptoms are NOT triggered by low levels of neurotransmitters. Rather, there can be excessive ___ of neurotransmitters to the presynaptic nerve ending.

A

Reuptake

35
Q

Are social phobias more common in women or men?

A

Men

36
Q

What is anhedonia?

A

Loss of interest/enjoyment in previously enjoyable activities

37
Q

Chronically high cortisol levels ___ depressive symptoms.

A

Aggravate

38
Q

What are the 2 main categories of depression?

A
  1. Major depressive disorder

2. Dysthymia

39
Q

Define negative automatic thought (NAT).

A

Involuntary thought that aligns with a negative schema/core belief
Example: “The ETA is in 3 weeks? I will fail.”

40
Q

Generalized anxiety disorder (GAD) causes overactivity of the ___ nervous system.

A

Autonomic

41
Q

List 2 neurotransmitter deficiencies that can cause anxiety.

A
  1. GABA

2. Serotonin

42
Q

How would chronic stress lead to depression? (Hint: hormone-related.)

A

Raises cortisol, which stimulates depressive symptoms

43
Q

What is the key treatment target for anxiety disorders?

A

Maladaptive behaviours

44
Q

Compare specific phobias and social phobias.

A

Specific: fear of specific things or situations
Social: fear of social situations

45
Q

Which neurotransmitter is linked to mood?

A

Serotonin

46
Q

Define schema/core belief.

A

Abstract framework that serves as a guide to action

Example: “I NEED to get 12/12 on my ETA.”

47
Q

Describe deep brain stimulation (DBS).

A

Electrodes are implanted in the brain and a neurostrimulator (visualise: brain pacemaker) sends electric currents through them

48
Q

Compare cognitive behavioural therapy (CBT) and mindfulness-based cognitive therapy (MBCT).

A

CBT: focus is on MODIFYING interpretations of events
MBCT: focus is on DISCONNECTING interpretations from events

49
Q

What is the most common disorder contributing to suicide?

A

Depression

50
Q

Why might a patient with depression present with poor decision-making, concentration, and memory?

A

High cortisol levels in the brain shrink the prefrontal cortex and hippocampus, which are associated with such functions

51
Q

List 2 difficulties that can arise when trying to diagnose a patient with depression.

A
  1. Unsure if symptoms caused by depression or something else
  2. Reluctance to open up due to embarrassment or stigma
52
Q

Which scale would you use to IDENTIFY anxiety? (Hint: not measuring severity.)

A

GAD-2

53
Q

A long-term effect of high cortisol levels in the brain is the reduction of regions regulating mood. List 2 such regions.

A
  1. Hippocampus

2. Prefrontal cortex

54
Q

Males are ___ likely to die by suicide than females.

A

More

55
Q

Are specific phobias more common in women or men?

A

Women

56
Q

List 6 potential causes of anxiety disorders.

A
  1. Trauma
  2. Conditioning
  3. Catastrophic thinking
  4. Long-term stress
  5. Genetics (30-40% accountability)
  6. Neurotransmitters (reduced GABA and serotonin)
57
Q

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?

A

“Do you find yourself avoiding places or activities and does this cause you problems?”

58
Q

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.

A

Obsessions: intrusive thoughts
Compulsions: repetitive activities that reduce anxiety

59
Q

List 3 situations in which symptoms of depression may be confused with another condition.

A
  1. Chronic fatigue syndrome
  2. Hypothyroidism
  3. Anemia
60
Q

What is the minimum duration of major depressive disorder?

A

> 2 weeks

61
Q

What compulsions (re: OCD)?

A

Repetitive activities that reduce anxiety

62
Q

Which neurotransmitter is linked to reward-seeking?

A

Dopamine

63
Q

Which questionnaire screens for depression?

A

PHQ9

64
Q

What is the most effective buffer against depression?

A

Social support

65
Q

The ___ guidelines outline a stepped approach to depression treatment.

A

NICE

66
Q

Generalized anxiety disorder (GAD) causes ___ of the autonomic nervous system.

A

Overactivity

67
Q

The ___ model attributes disease outcomes to the interaction between biological, psychological, and social factors.

A

BIOPSYCHOSOCIAL

68
Q

How does disconfirming evidence reduce anxiety?

A

Shows that the situation/thing is not actually harmful, making it more tolerable

69
Q

Which protein is a blood test marker for inflammation?

A

C-reactive protein (CRP)

70
Q

How might neurotransmitters cause depressive symptoms?

A

Too much reuptake of neurotransmitters to the presynaptic nerve ending lessens their concentration in the synapse

71
Q

What are the 3 components of Beck’s cognitive theory of depression?

A
  1. Negative view of the SELF
  2. Negative view of the WORLD
  3. Negative view of the FUTURE
72
Q

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?

A

Get patient to complete a PHQ9 survey

73
Q

Anxiety disorders are ___ commonly diagnosed in women.

A

More

74
Q

List 5 types of anxiety disorders.

A
  1. Generalized anxiety disorder (GAD)
  2. Obsessive compulsive disorder (OCD)
  3. Post-traumatic stress disorder (PTSD)
  4. Panic disorders
  5. Phobias
75
Q

Compare the common sense model and cognitive model.

A

Common sense model: event -> emotion

Cognitive model: event -> INTERPRETATION -> emotion

76
Q

GABA ___ activity of the amygdala and prefrontal cortex.

A

Inhibits

77
Q

How does electroconvulsive therapy (ECT) work?

A

Seizures are electrically induced to provide relief from mental disorders

78
Q

What are the 3 core symptoms of depression?

A
  1. Depressed MOOD
  2. Reduced ENERGY
  3. Loss of INTEREST/ENJOYMENT
79
Q

What are the 2 most common types of antidepressants?

A
  1. SSRI’s (selective serotonin reuptake inhibitors)

2. SNRI’s (selective noradrenaline reuptake inhibitors)

80
Q

Which scale would you use to assess the SEVERITY of anxiety? (Hint: assume you have already identified it.)

A

GAD-7

81
Q

What is a phobia?

A

Fear evoked by a clearly-defined situation or object

82
Q

Which neurotransmitter is linked to stress response?

A

Noradrenaline

83
Q

Anxiety disorders are ___ likely to be chronic than episodic.

A

More

Clinical Problem Solving (10 decks)

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