Anxiety/Depression

Question 1

ACH

Answer 1

Excitatory or inhibitory depending on area of the brain. Underactivity is seen in alzheimer’s disease

Question 2

Dopamine (DA)

Answer 2

Usually excitatory. Motivation, thought and emotional regulation. Overactivity in schizophrenia

Question 3

Norepinephrine(NE)
and epinephrine (E)

Answer 3

Excitatory or inhibitory, depending on area. Underactivity involved in some depression

Question 4

Serotonin (5-HT)

Answer 4

Regulation of attention and complex cognitive function. Underactivity involved in depression and OCD

Question 5

Gamma-Aminobutyric acid (GABA), glutamate, aspartate, glycine

Answer 5

GABA and glycine are inhibitory, glutamate is excitatory. Implicated in anxiety disorders

Question 6

Bipolar disorder is characterized by episodes of elation and irritability (______) with episodes of ______

Answer 6

mania, depression

Question 7

What are things that you see in patients with mania?

Answer 7

decreased need for food and sleep, labile mood, irritability, racing thoughts, high distractibility, rapid and pressured speech, inflated self-esteem, excessive involvement with pleasurable activities

Question 8

The severity of mania can range from ________ (mood fluctuates between mild elation and depression) to severe _________

Answer 8

cyclothymia, delusional mania

Question 9

In bipolar disorder, rapid cycling occurs when an individual has _____ or more shifts in moods from normal with a ____ year period

Answer 9

4, 1

Question 10

Bipolar I has recurrent episodes of _______ and _____

Answer 10

mania and depression

Question 11

Bipolar I

Answer 11

Can be separated by months or years
Most severe form of the disorder
Can be accompanied by delusional beliefs or hallucinations
Can require hospitalization and impair daily functioning

Question 12

Bipolar II

Answer 12

hypomania and depression
Less severe forms of mania
Elevated mood, no delusions

Question 13

What is kindling?

Answer 13

phenomenon in which a stressor creates an electrophysiologic vulnerability to future stressful events by causing long-lasting changes in neuronal function.
changes permanently how the body responds to physical and emotional stress

Question 14

What is Major Depression characterized by?

Answer 14

“Depression Is Worth Studiously Memorizing Extremely Grueling Criteria. Sorry”
Depressed Mood, Interest, Weight, Sleep, Motor Activity, Energy, Guilt, Concentration, Suicide.

Question 15

Persistent depressive disorder (dysthymia)

Answer 15

Milder depressive symptoms that have been present for at least 2 years. Only 2 criteria (instead of 5) are required for diagnosis

Question 16

Premenstrual dysphoric disorder (PMDD)

Answer 16

Depressive symptoms begin during the luteal phase of the menstrual cycle and terminate around the onset of menses

Question 17

Disruptive mood dysregulation disorder (DMDD)

Answer 17

Chronic, severe, persistent irritability
Diagnosis has to be made between 6-18
Moves between sad and angry. Never manic.

Question 18

What is the Biogenic amine hypothesis?(depression)

Answer 18

deficiencies or norepi and serotonin is to be the patho for depression. There is decreased dopamine activity in depression and increased activity in mania.
There has to be more to it though because these medications take at least 6 weeks to work even though levels of serotonin and norepinephrine are increased immediately when the medication is taken.

Question 19

What is the Hypothalamic-pituitary-adrenal axis disturbance theory?

Answer 19

Normally, cortisol levels are flat from late in the afternoon until a few hours before dawn when they rise
In depressed persons, cortisol levels spike erratically over the 24 hours of the day
Cortisol levels return to normal pattern when depression has resolved

Question 20

What is Circadian rhythm dysfunction?

Answer 20

Alteration in the sleep-wake cycle is common in many mental illnesses. Persons with depression often have dream pressure sleep. They fall into light and dream-state sleep early, and reach stage 4 sleep only late in the sleep cycle.
Resolves after resolution of depression
Mania is often precipitated in bipolar depression when sleep is disturbed (pulling an “all-nighter”)

Question 21

Anxiety Disorders

Answer 21

-affects more women
-Intensity of disability experienced by the person living with anxiety varies widely
-Characterized by increased fearfulness that sometimes is intense
-Core issue is that symptoms occur without a precipitating potentially dangerous event

Question 22

Anxiety disorders occurs with activation of the ______ cascade through the _______ axis

Answer 22

sympathetic, HPA

Question 23

Anxiety disorders are different than normal feelings of situational nervousness. They involve overwhelming feelings of:

Answer 23

panic and fear or obsession, and often include physical manifestations of abdominal discomfort, palpitations, tachycardia and muscle tension.

Question 24

What neurotransmitters are involved in the patho of anxiety ?

Answer 24

GABA and norepinephrine, and serotonin

Question 25

What is the overlying theory of what causes anxiety symptoms?

Answer 25

amygdala > triggers medulla oblongata and hypothalamus which are responsible for FF and sympathetic nervous system > send messages to heart and lungs that its time to FF > but when a person doesnt have to FF they end up hyperventilating and tachy > epi which raises BP and blood sugar

Question 26

Separation anxiety

Answer 26

Excessive distress/ worry about separation, refusal to leave home or have attachment(s) leave home, nightmares about separation, complaints of physical symptoms when separation is anticipated or occurs most common in children normal for children to some degree

Question 27

Selective Mutism

Answer 27

Failure to speak in social situations where speaking is expected despite being able to speak in other situations. Most commonly effects young children

Question 28

Specific Phobia

Answer 28

Irrational fears of specific objects, places, situations or activities

Question 29

Social phobia (social anxiety disorder)

Answer 29

The irrational fear of humiliation or embarrassment in social settings

Question 30

What is panic disorder characterized by?

Answer 30

1. neurologic symptoms (dizziness or lightheadedness, paresthesias, fainting), 2. cardiac symptoms (tachycardia, chest pain, feeling of smothering or choking, SOB) 3. psychological symptoms (feeling of impending doom, fear of dying, sense of unreality).

Question 31

Panic attacks are unexpected and not related to external events, they last _______ minutes and up to ____ hr

Answer 31

15-30, 1hr

Question 32

T/F Panic order is an ABRUPT surge of intense fear or intense discomfort

Answer 32

True

Question 33

Agoraphobia

Answer 33

Fear of being unable to get out of a place or situation quickly in the event of a panic attack Often a complication of panic disorder

Question 34

Generalized Anxiety Disorder

Answer 34

Prolonged (more than 6 months) excessive worry that is not easily controlled by the person. Worry about life circumstances such as health, finances, social acceptance, job performance

Question 35

What are characteristics of GAD?

Answer 35

feeling restless, fatigued, difficulty concentrating, irritability, muscle tension, poor sleep. Causes significant distress or impairment in social, occupational or other important area of functioning

Question 36

Obsessive-Compulsive Disorder

Answer 36

characterized by: 1. obsessions - repeated thoughts 2. compulsion- repeated acts Pts. usually recognize that the rituals are unreasonable Men=Women

Question 37

Post-Traumatic Stress Disorde

Answer 37

Chronic activation of stress response as a result of experiencing a potentially life-threatening event. War/combat, major weather related disasters, airplane crashes, terrorist bombings, rape, child abuse or other catastrophic event can precipitate the disorder.

Question 38

Post-Traumatic Stress Disorder characterized by states of

Answer 38

intrusion, avoidance and hyperarousal 1. intrusion- "flashbacks" 2. avoidance 3. hyperarousal- increased irritability, difficulty in concentration, an exaggerated startle reflex, increased vigilance and concern over safety

Question 39

Pathophysiology of Anxiety Disorders

Answer 39

Most anxiety disorders have a familial and/or genetic link Decreases in dopamine are theorized to play a role in phobic disorders Serotonin and norepinephrine are implicated in anxiety because of the efficacy of drugs that work on the neurotransmitters It is way more complicated than “the levels are too high or too low.” We really don’t understand it. GABA is the major inhibitory neurotransmitter. The function of GABA is to slow or calm things down Benzodiazepines increase the efficacy of GABA