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ADELE-Noodles of Neurology > Anxiety and depression > Flashcards

Anxiety and depression Flashcards

1
Q

What percentage of women develop depression after having a baby?

A

10%

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2
Q

What percentage of mental disorders start before age 14?

A

50%

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3
Q

Before what age have 50% of mood disorders started?

A

age 30

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4
Q

What stops people with depression presenting?

A 
Lack of insight
Low self-worth
Overwhelming thought
Pride
Stigma
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5
Q

What is the diagnostic critera for depression?

A 
Should last 2+ weeks
No hypomanic/manic symptoms sufficient to meet the criteria at any time in their life
2/3 of the following must be present
1- Depressed mood
2-Loss of interest of pleasure
3-Decreased energy
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6
Q

Aside from the 3 diagnostic symtpoms what are some other symptoms that those with depression may present with?

A 
Loss of confidence
Guilt
Suicidal behaviours
Inability to concentrate
Agitation
Sleep disturbances
Change In appetite with marked wt loss
Decreased libido
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7
Q

What are the hallucinations like in depression?

A

Auditory, second person and derogatory

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8
Q

Who is high risk for suicide?

A 
S-Suicide plans or ideas of self-harm
U-Unexplained guilt or worthlessness
I-Inability to function
C-Concentration impaired
I-Impaired appetite
D-Decreased sleep/early waking
E-Energy low/unaccountable fatigue
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9
Q

What is somatic syndrome?

A

Lack of emotional response
depression worse in mornings
wt loss
loss of libido

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10
Q

What is atypical depression?

A 
Mood reactivity
Wt gain
Hypersomnia
Leaden paralysis
Interpersonal rejection sensitivity
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11
Q

Which group is psychotic depression more common in?

A

Elderly

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12
Q

Anxiety is more like if what?

A

Alcohol/drug disorder

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13
Q

What are the biological symptoms of anxiety?

A 
Sweating
Trembling/shaking
Muscle tension
Faint
Difficulty breathing
Chest pain
N + abdo distress
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14
Q

What are the behavioural symptoms of anxiety?

A 
Avoidance of certain triggers
Exaggerated response
Difficulty sleeping
Excessive alcohol/drugs
Inability to relax
Always at GP
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15
Q

What are the cognitive symptoms of anxiety?

A

Fear of losing control
Derealisation and depersonalisation
Hypervigilance
Worrying about everything

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16
Q

What is the amygdala?

A

Emotional filter of brain assessing is sensory material (via thalamus) required a stress/fear response

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17
Q

What is the amygdala modified by?

A

Later received cortically processed signal (Act fast, think later) from adrenal gland

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18
Q

Why circuit are fear symptoms due to?

A

Fear symptoms due to amygdala centred circuit

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19
Q

What circuit are worry symptoms due to?

A

Cortico-striatal-thalamic-cortical circuit

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20
Q

What is generalised anxiety disorder?

A

Generalised, not fixed on one thing in particular

free floating, “meta worry”

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21
Q

What is the treatment for GAD?

A

CBT
SSRI’s/SNRI’s
Pregabalin
Benzodiazapaines (short term only)

22
Q

How long should it take for treatment to take effect in GAD?

A

Up to 12wks to assess efficacy

absence of effect within 4wks-response unlikely

23
Q

What is panic disorder?

A

Recurrent, intermittent, severe when it happens, unpredictable

24
Q

What are the dominant symptoms of panic disorder?

A

Hyperventilation
Palpation
Marked anxiety

25
Q

What is panic disorder triggered by neurobiologically?

A

A build up of lactate/ increase in CO2

26
Q

If someone with panic disorder was measured with PET scans where would there be increased metabolism?

A

Parahippocampal gyrus

27
Q

What is the treatment for panic disorder?

A

1-Self-help
2-CBT
3-SSRI’s/SNRI’s (longstanding/no benefit from CBT)
4-Tricyclics

28
Q

Why are benzodiazepines not used with panic disorder?

A

They are associated with less good long term outcomes

29
Q

What is social phobia?

A

The fear of social scrutiny, fear being embarrassed or humiliated

30
Q

Neurobiological what is there in social phobia?

A

Increased bilateral activation of amydala

31
Q

What is agoraphobia?

A

Fear of going out (being in busy places with people)

32
Q

What are the potential treatments for social phobia?

A

CBT
SSRIs/SNRIs (review at 12wks)
MAOI (moclobemide)
Benzodiazepines (short term only)

33
Q

What is a specific fear?

A

A marked, persistent fear that is excessive/unreasonable

Caused by the presence/anticipation of specific object

34
Q

Treatment for specific fear?

A

Behavioural therapy
+CBT if necessary
SNRIs/SSRIs if required

35
Q

What is OCD?

A

Recurrent obsessive intrusive thoughts and/or compulsive acts

36
Q

OCD is ego-dystonic. What does this mean?

A

It is in conflict with a persons ideal self-image

37
Q

What percentage of those with OCD have at least one major depressive episode?

A

60-90%

38
Q

What are the significant co-morbidities with OCD?

A

Schizophrenia
Tourette’s
Other tic disorders
Eating disorders

39
Q

Treatment of OCD

A

1-CBT/ERP
2- More intense psychological intervention / SSRIs
3- Consider ^ in dose after 4-6wks
4- Clomipramine
5-Augmentation with antipsychotic/clomipramine + citalopram

40
Q

Which two other substances work on the same receptor as benzodiazepines?

A

Barbiturates

Alcohol

41
Q

Name 3 benzodiazepines

A

Diazepam
Klonopin
Lorazepam

42
Q

What is the indication for benzodiazepines?

A 
Acute treatment of extreme anxiety
Hypnosis
Alcohol withdrawl
Mania
Delirium
Rapid tranquillisation
Status epilepticus
43
Q

What is the mode of action of benzodiazepines?

A

They bind at a separate location to GABA and enhance the effect of GABA (therefore increasing inhibition)

44
Q

What type of receptor is GABA?

A

Inhibitory inotropic receptor

45
Q

What is the pharmacological effect of benzodiazepines?

A 
Reduce anxiety and aggression
Hypnosis/sedation
Muscle relaxant
Anticonvulsant effect
Antegrade amnesia
46
Q

Why are benzodiazepines considered fairly safe in overdose?

A

They are unlikely to cause overdose

47
Q

TRUE/FALSE

Chronic treatment with benzodiazepines decreases response to GABA

A

TRUE

48
Q

If there is rapid withdrawal of benzodiazepines then it can look similar to DT. Gimme some symptoms

A 
Confusion
Psychosis
Convulsions
Tachycardia
Sweating 
Agitation
Hypertension
Tremor
49
Q

How do you withdraw benzodiazepines?

A

1-Transfer patient to equivalent daily dose of diazepam/chlordiazepoxide
2-Reduce dose every 2-3wks in steps of 2-2.5g
Time taken to withdraw can vary from4wks to a year+

50
Q

How do antidepressants generally increase serotonin?

A

By blocking the serotonin transporter

51
Q

What type of symptoms are B-Blockers best for?

A

Somatic symptoms e.g. palpitations, tremor

ADELE-Noodles of Neurology (38 decks)

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