Chapter 6 Flashcards
How are psychiatric disorders diagnosed?
on the presence or absence of subjective symptoms.
The Diagnostic and statistical manual of mental disorders (5th edition) DSM-V, has the dx criteria and classification of all psychiatric disorders.
A psychiatric attending physician statement contains five axes, noting the presence of absence of a diagnosis. What are these 5 axis’?
Axis 1- lists major psychiatric illness
Axis 2- for personality disorders
Axis 3- general medical conditions
Axis 4- psychosocial and environmental problems
Axis 5- a global assessment of function called the GAF score.
Define the term “mood” and provide examples of mood disorders
its a conscious state of mind or prevailing emotion or feeling.
- depression
- Dysthymia
- bipolar disorders 1 & 2
- cyclothymia.
There are undefined genetic components to certain mood disorders. Which has the strongest genetic component?
bipolar-
What is comorbidity?
when a disorder occurs together with specific linked impairments
What are diseases that are commonly associated with depression
heart disease cancer CNS endocrine disease connective tissue disease
What is the most common mood disorder?
who is most effected
depression
Women- linked to genetic predisposition
median age of onset 34, 20% in teenages
Depression is characterized by what 3 main sxs?
- loss of energy
- loss of ability to experience pleasure (anhedonia)
- loss of sexual desire
Without tx, what is the average duration of a MDD? (major depressive disorder)
8 mo.
50% recover in first year
70% in 5 yrs
85% in 15
When does Depression typically occur?
after a major life event, dx of medical condition, loss of loved one, divorce, loss of employment, bankruptcy or
situational
What is Dysthymia?
the presence of chronic depressive sxs for 2+ urs that are not severe enough to be dxed as a MDD.
What are treatment options for depression?
- psychotherapy
- electroconvulsive therapy (ECT)
- medications
What is psychotherapy?
the use of verbal and non-verbal communication to deal with depressive and other psychiatric disorders. There are two kinds
1) individual psychotherapy (IPT)
2) cognitive behavior therapy (CBT)
What is IPT?
uses skills of empathy, sensitivity, and listening accurately to intervene, give helpful and corrective information during patient session. This is mean to enhance the patients social functioning
What is CBT?
users principle of focusing on thoughts, emotions, and behaviors present at a specific time to appropriately intervene during patient encounter sessions. Goal is to help develop more +Ve and constructive tools to assess pt’s capabilities and circumstances.
What is ECT?
effective for tx severe depression resistant to medications.
Medications for depression can be divided into 6 various groups depending upon what 3 characteristics?
- chemical structure
- physiological effects
- proposed method of action
How to anti-depressants work?
It is difficult to predict which Rx will work for which pt’s and is quite a gamble. The exert benifical effects by affecting various transmitters.
Note anti-depressent use goes beyond just a MDD disorder.
There are 6 main groups of antidepressant medications, what are they and their features?
- TCA- tricyclic antidepresant- effective depression tx with undesirable side effects,
- phenylpiperaines, trazodone and nefazodine- sedating, used at night for sleep
- SSRI- frequently used- side effects +
- bupropion- not serotonin effectine, used when SSRIs fail.
- venlafazine- a phenethylamine, both SSRI and SNRI actions- fast onset, good for old people
- MAOI- monoamine oxidase inhibitors- increase levels of NE, Serotonin, Dopa= highly effective, but sig risk of HTN crisis, with specific foods. Last used
Depression treatment is recommended for how long
6-9 months, if there is MDD recurrances, long-term Rx is recommended.
What are the increased mortality risks for depression?
accdients, suicides, and adverse effects on other illnesses, ie heart disease, cancer, stoke, DM, and others.
What test is used to measure the severity of depression?
Beck Depression Inventory (BDI).
- self administered
- 21 items rated 0-4 depending how severe the sxs are. score are added together for a total score.
How would one characterize Bipolar Disorder?
characterized by depression and period of mania.
mania is distractibility, rapid flight of ideas, excessive involvement in pleasurable activities, loss of economic and social judgement and impaired social function.
There are two kinds of bipolar disorders. Define Bipolar 1.
makes by episodes of major depression and mania. Occurs equally in males and females
There are two kinds of bipolar disorders. Define Bipolar 2.
at least two major depression episodes and hypomanic episodes.
-more common in female.
How is Cyclothymia characterized?
fluctuating periods of depressive and hypomanic sxs for at least 2 yrs, with the sxs not meeting the criteria for a major depressive episode or mania episode.
What the treatment options for bipolar disorder?
lithium is the most common Rx
mild side effects, including hypothyroidism.
other medications used are Valproate, oxcabazepine and carbamazepine.
tx is usually life long.
What are common comorbidities for bipolar disorder?
OCD panic disorder eating disorder schizo ETOH abuse/ substance abuse