Anxiety and depression Flashcards
What percentage of women develop depression after having a baby?
10%
What percentage of mental disorders start before age 14?
50%
Before what age have 50% of mood disorders started?
age 30
What stops people with depression presenting?
Lack of insight Low self-worth Overwhelming thought Pride Stigma
What is the diagnostic critera for depression?
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
Aside from the 3 diagnostic symtpoms what are some other symptoms that those with depression may present with?
Loss of confidence Guilt Suicidal behaviours Inability to concentrate Agitation Sleep disturbances Change In appetite with marked wt loss Decreased libido
What are the hallucinations like in depression?
Auditory, second person and derogatory
Who is high risk for suicide?
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
What is somatic syndrome?
Lack of emotional response
depression worse in mornings
wt loss
loss of libido
What is atypical depression?
Mood reactivity Wt gain Hypersomnia Leaden paralysis Interpersonal rejection sensitivity
Which group is psychotic depression more common in?
Elderly
Anxiety is more like if what?
Alcohol/drug disorder
What are the biological symptoms of anxiety?
Sweating Trembling/shaking Muscle tension Faint Difficulty breathing Chest pain N + abdo distress
What are the behavioural symptoms of anxiety?
Avoidance of certain triggers Exaggerated response Difficulty sleeping Excessive alcohol/drugs Inability to relax Always at GP
What are the cognitive symptoms of anxiety?
Fear of losing control
Derealisation and depersonalisation
Hypervigilance
Worrying about everything
What is the amygdala?
Emotional filter of brain assessing is sensory material (via thalamus) required a stress/fear response
What is the amygdala modified by?
Later received cortically processed signal (Act fast, think later) from adrenal gland
Why circuit are fear symptoms due to?
Fear symptoms due to amygdala centred circuit
What circuit are worry symptoms due to?
Cortico-striatal-thalamic-cortical circuit
What is generalised anxiety disorder?
Generalised, not fixed on one thing in particular
free floating, “meta worry”
What is the treatment for GAD?
CBT
SSRI’s/SNRI’s
Pregabalin
Benzodiazapaines (short term only)
How long should it take for treatment to take effect in GAD?
Up to 12wks to assess efficacy
absence of effect within 4wks-response unlikely
What is panic disorder?
Recurrent, intermittent, severe when it happens, unpredictable
What are the dominant symptoms of panic disorder?
Hyperventilation
Palpation
Marked anxiety
What is panic disorder triggered by neurobiologically?
A build up of lactate/ increase in CO2
If someone with panic disorder was measured with PET scans where would there be increased metabolism?
Parahippocampal gyrus
What is the treatment for panic disorder?
1-Self-help
2-CBT
3-SSRI’s/SNRI’s (longstanding/no benefit from CBT)
4-Tricyclics
Why are benzodiazepines not used with panic disorder?
They are associated with less good long term outcomes
What is social phobia?
The fear of social scrutiny, fear being embarrassed or humiliated
Neurobiological what is there in social phobia?
Increased bilateral activation of amydala
What is agoraphobia?
Fear of going out (being in busy places with people)
What are the potential treatments for social phobia?
CBT
SSRIs/SNRIs (review at 12wks)
MAOI (moclobemide)
Benzodiazepines (short term only)
What is a specific fear?
A marked, persistent fear that is excessive/unreasonable
Caused by the presence/anticipation of specific object
Treatment for specific fear?
Behavioural therapy
+CBT if necessary
SNRIs/SSRIs if required
What is OCD?
Recurrent obsessive intrusive thoughts and/or compulsive acts
OCD is ego-dystonic. What does this mean?
It is in conflict with a persons ideal self-image
What percentage of those with OCD have at least one major depressive episode?
60-90%
What are the significant co-morbidities with OCD?
Schizophrenia
Tourette’s
Other tic disorders
Eating disorders
Treatment of OCD
1-CBT/ERP
2- More intense psychological intervention / SSRIs
3- Consider ^ in dose after 4-6wks
4- Clomipramine
5-Augmentation with antipsychotic/clomipramine + citalopram
Which two other substances work on the same receptor as benzodiazepines?
Barbiturates
Alcohol
Name 3 benzodiazepines
Diazepam
Klonopin
Lorazepam
What is the indication for benzodiazepines?
Acute treatment of extreme anxiety Hypnosis Alcohol withdrawl Mania Delirium Rapid tranquillisation Status epilepticus
What is the mode of action of benzodiazepines?
They bind at a separate location to GABA and enhance the effect of GABA (therefore increasing inhibition)
What type of receptor is GABA?
Inhibitory inotropic receptor
What is the pharmacological effect of benzodiazepines?
Reduce anxiety and aggression Hypnosis/sedation Muscle relaxant Anticonvulsant effect Antegrade amnesia
Why are benzodiazepines considered fairly safe in overdose?
They are unlikely to cause overdose
TRUE/FALSE
Chronic treatment with benzodiazepines decreases response to GABA
TRUE
If there is rapid withdrawal of benzodiazepines then it can look similar to DT. Gimme some symptoms
Confusion Psychosis Convulsions Tachycardia Sweating Agitation Hypertension Tremor
How do you withdraw benzodiazepines?
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+
How do antidepressants generally increase serotonin?
By blocking the serotonin transporter
What type of symptoms are B-Blockers best for?
Somatic symptoms e.g. palpitations, tremor
