Affective Disorders Flashcards
Difference between yellow people and blue people
Serotonin transporter is like recycling device. has 2 genes. The long version is associated with resilience. If you have short alleles you are a blue person.
The genes you get determine your susceptibility to:
depression
If you grew up in benign childhood, the gene difference is lost. When your a parent…do a good job. Avoid physical discipline and reinforce the behavior you do want. This wipes out gene _____
difference
Who gets depressed when stressed men or women?
The men with 2 short alleles.
What is depression
SIG E CAPS: 5 or more s/x for more than 2 weeks
- Sleep
- Interests
- Guilt
- Energy
- Cognition
- Appetite
- Psychomotor
- Suicidal ideation
Subginual cingulate/Anterior cingulate gyrus comes up in studies of _____
depression; signals catemine responder
Nucleus cumins region is stimulated using DBS
know this
Where does depression come from
- biological: genetics
- environmental: childhood experience
- psychodynamic: repressed drives
- Psychological: automatic thoughts, mood congruent cognitions
- social: inescapable stress; stuck in a cage with a social superior, epigenetic changes
What is neuroplasticity
Tug of war between good and bad guys. About trophic (feed) and atrophic factors
Hippocampus is called hippocampus because it looks like a
seahorse
If you stay depressed, you get a hippoampal volume loss which is from neuron ____ and ____ loss
hippocampal; atrophy and neuron loss
What is neurogenesis
Active process of making new neurons. 6 weeks of daily restraint: cell number decreases by 13% and cell layer volume decreases by 5%
What is the molecular basis of depression
ask about this
Anti depressants promote _____
BDNF
stress methylates DNA and these epigenetic changes can be transmitted to human offspring. If your mom was stressed during pregnancy it makes you prone to stress before you are _____
born
2 short versions is not necessarily bad, your brain is more plastic and more responsible to react to _____
environment
What about alzheimers
Lithium is used to prevent it.
What is lifetime prevalence of depression
20%
what is the 12 month prevalence
6-9%
what is the prevalence of anxiety in a 12 month prevalence
18.1 %
What is the percentage of people with severe depression
4.3%
People who suffer from major depressive disorder fluctuate with their mood. People with dysthymic disorder are usually at a level ____. People with bipolar disorder 1 have ____episodes. People with bipolar disorder 2 have hypomanic episodes.
3; manic
Describe major depressive disorder
Episodes last more than 2 weeks with greater than 5 SIG E CAPS.
Dysthmia is chronic ___. Someone ends up with this gets this from alcoholism. Also awful childhoods
depression
Describe Bipolar 1 Disorder
- Lasts more than 7 days
- Have manic episodes
- 3, 4 DIGFAST
Describe Bipolar II Disorder
- Lasts more than 4 days
- 3, 4 DIGFAST
- hypermanic; less intense
When you give antidepressants to someone, they don’t get manic. Its possible to have manic and depressive symptoms at the ____time. When you give someone antidepressants you get the induction of ____states
same; mix
Mood experts think that the mechanism of antidepressants inducing suicides because antidepressants induce mix states not manic episodes. People want to get away from it, is by committing ____
suicide
What are some things that cause depression
- Medical problems:
- Thryoid
- New medical problem
- After age 30 w/o precipitating factor - Medications
- Interfereon, steroids
- new
What is depression associated with
- Risk factor for stroke, MI, Alzheimer’s
- Poorer outcomes after MI
- Poorer outcome in CHF
- Poorer outcome after orthopedic surgery
What are atrophic factors:
- glutamate
2. cortisol
What are trophic factors
- BDNF
2. bcl-2
When you put DBS you put dampening frequency to dial down area. Too little activity in Brodman area 25 is associated with hypomania. Too much is associated with _____
depression
T/F TMS increases BDNF
True
Beta blockers is a depressagenic medication. T/F
False
Interferons get it for Hepatitis C and is depressagenic. T/F
True
How do you treat major depression
Depends on severity:
1. Patient preference
2. Psychotherapy as effective as meds (access and $ is a problem)
3.
How do you quanitfy depression
PHQ-9; Max score is 27; Have to be ateast over 9 to be given an antidepressant
What are three different ways to treat major depressive disorder
- Psychotherapies
- Medication
- “Natural”
What are the different types of psychotherapies
- Psychodynamic
- CBT
- Interpersonal
- Supportive
- Mish-mash
What are the med’s prescribed for people who have major depressive disorder
- Bupropion/Wellbutrin
- SRIs: prozac, and zoloft
- SNRIs
what are 3 main meds given for major depressive disorder
- bupropion (weight neutral)
- fluoxetine/Prozac
- Sertraline/Zoloft
Why isn’t bupropion as frequently prescribed for major depression
ask
What is the STARD trial
ask
What is the Natural way of treating Major depressive disorder
- fish oil
- st johns wort
- yoga
- light therapy
- Vitamin D
- an amazing array
- what I’m selling (inducing belief)
- what I utterly believe in
What are not so natural ways of treating major depressive disorder
- Electroconvulsive therapy (ECT) -causes a seizure to happen every couple of seconds. Benefit lasts a long time
- Transcranial magnetic stimulation (TMS)
- Deep brain stimulation
How do you treat dysthymia
- Try up to 3 different things
2. Psychotherapy
How do you treat bipolar disorder 1
- diagnose
- mood stabilizers
- not AD’s
How do you diagnose bipolar disorder 1
DIGFAST; find it in history of mania….incredible level of energy
What does DIGFAST stand for
- distractability
- insomnia
- grandiosity
- flight of ideas
- activity (increased)
- speech (pressured)
- thoughtlessness
MDQ is for mood disorder (questionnaire) and a handy way not to miss something and walk you through _____
DIGFAST
Describe mania
A distinct period of persisently elevated, expansive, or irritable mood lasting throughout at least 7 days
What are the non medication options for “mood stabilizers”
- sleep regularity
- “dark therapy”
- avoid substance use
- pt/family “concordance”
What is dark therapy
put in dark room from 6 pm to 8 am…then went to 10 hours of darkness.
what are standard mood stabilizers
- lithium
- valproate/divalproex/depakote
- carbamazepine/tegretol
- Lamotrigine (not antimanic)
What are the atypical antipsychotics used for mood stabilizers
- olanzapine/zyprexa
- risperidone/invega
- quietiapine/seroquel
- aripiprazole/abilify
- ziprasidone/geodon
what is the perfect medication for bipolar II disorder
lemotragine
Describe hypomania
- increased activity
- increased energy
- increased optimism
- increased talkativeness
- decreased sleep
- increased self confidence
