class 5-6 (mood & affect A-B)

Question 1

what is an emotion

Answer 1

a short-lived feeling about something specific
-emotions tell us about our mood

Question 2

what is a mood

Answer 2

a mood is long-lasting (hours->dayys) & much more diffuse
-it is subjective

Question 3

what is affect

Answer 3

the observable expression of a mood

Question 4

depression in children/teenagers

Answer 4

-increased focus on this in recent years but most do not get the tx they need
-people dont believe them or they dont know how to express themselves
-presents differently in every case, may not have “common cues”
-stigma of teenagers being “moody”, lasts weeks->months

Question 5

depression in older adults

Answer 5

-often misdiagnosed as one of the 3 D’s
-increased stigma
-generational differences + substance use = decreased change of a diagnosis

Question 6

what is the risk assessment for suicide

Answer 6

SAD PERSONS scale

Question 7

postpartum depression

Answer 7

starts in 1st month->1 year
-long lasting and requires treatment
-normalized after birth due to: changes in hormones, societal factors, stigma

Question 8

baby blues

Answer 8

starts 3-4 days after birth & lifts on its own
-“acute version” of PDD, same criteria for Dx

Question 9

risk factors for PPD

Answer 9

Hx depression
previous PPD
stressors (i.e. financial, marital, etc)
-unplanned pregnancy
-little to no support

Question 10

treatment for PPD

Answer 10

CBT
supportive counselling
anti-depressant
ECT

Question 11

edinburgh postnatal depression scale (EPDS)

Answer 11

-assists HCP to assess for ppd
-consists of 10 short statements->takes 5 mins
-based on previous 7 days
-has to be completed in it’s entirety
-if pt answers “yes” to thoughts of harm question: automatically referred regardless of other answers

Question 12

disruptive mood dysregulation disorder

Answer 12

-irritability, anger, & frequent intense temper outbursts (verbal & behavioural, acts like this most of the day everyday)
-experience significant problems at home, in school (high rate of suspension), & with peers
-can occur with other disorders associated with irritability such as ADHD & anxiety
-dx: 3+ outbursts within a week & behaviour ongoing for 12 months

Question 13

treatments for distruptive mood dysregulation disorder

Answer 13

CBT
DBT
individual/group/family therapy
meds for behaviours (no med for dx): stimulants, antidepressants, antipsychotics

Question 14

persistent depressive disorder

Answer 14

-social distress
-they’ve “always felt this way”
-early teen onset
-chronic

Question 15

premenstrual dysphoric disorder

Answer 15

occurs last week pre-menstrual period
-2-6% effected
-depressive symptoms

Question 16

dysthymia/persistent depressive disorder

Answer 16

milder but more chronic than MDD
-2+ years of s&s
-affects social experiences “i’ve always felt like this”
-can be associated with other illnesses the person is experiencing
-duration &severity of symptoms are different from depression

Question 17

major depressive disorder

Answer 17

-one of the most common mental disorders
-severe depressive mood symptoms: interferes with relationships, funtional status, employment
-persistent for min 2w, acute episode can last up to 5-6 months, chronic can last >2yr
-acute episode 50% chance of reoccurance during 1st yr of dx
-hallucinations/delusions can occur in severe cases
-can be related to physical illness ex:thyroid disorder
-NO HISTORY OF MANIA/HYPOMANIA

Question 18

depression is characterized by:

Answer 18

-sadness
-loss of interest or pleasure
-feelings of guilt
-low self-worth
-disturbed sleep or appetite
-tiredness
-poor concentration

Question 19

MDD S2IGECAPS meaning:

Answer 19

S-sadness (depressed mood)
S-sleep disturbance
I-interest reduced (anhedonia)
G-guilt and self blame
E-energy loss and fatigue (anergia)
C-concentration problems
A-appetite changes
P-psychmotor changes
S-suicidal thoughts
-must have at least 5 for at least 2 weeks

Question 20

psychotic features of depression

Answer 20

delusions, disorganized thoughts, hallucinations (usually auditory)

Question 21

melancholic features of depression

Answer 21

severe endogenous depression r/t internal (biological, cognitive, etc) stressor vs external one

Question 22

atypical features of depression

Answer 22

overeating, oversleeping, anxiety (usually seen in younger generations)

Question 23

catatonic features of depression

Answer 23

unresponsive, extreme psychmotor paralysis

Question 24

seasonal (SAD) fall/winter features of depression

Answer 24

“normal mood” during spring/summer, decrease mood during cold dark years, responds well to light therapy

Question 25

how depression presents in men: mood

Answer 25

anger, aggressiveness, anxiousness, restlessness

Question 26

how depression presents in men: emotional

Answer 26

feeling empty, sad, hopeless

Question 27

how depression presents in men: behavioral

Answer 27

feeling tired easily, drinking excessively, using drugs, engaging in high-risk activities

Question 28

how depression presents in men: sexual

Answer 28

reduced sexual desire, lack of sexual performance

Question 29

how depression presents in men: cognitive

Answer 29

inability to concentrate, difficulty completing tasks, delayed responses during conversations

Question 30

how depression presents in men: sleep

Answer 30

insomnia, restless sleep, excessive sleepiness

Question 31

how depression presents in men: physical

Answer 31

fatigue, pains, headache, digestive problems

Question 32

how depression presents in women: mood

Answer 32

iriitability

Question 33

how depression presents in women: emotional

Answer 33

feeling sad or empty, anxious or hopeless

Question 34

how depression presents in women: behavioral

Answer 34

withdrawing from social engagements, thoughts of suicide

Question 35

how depression presents in women: cognitive

Answer 35

thinking or talking more slowly

Question 36

how depression presents in women: sleep

Answer 36

waking early, sleeping too much

Question 37

how depression presents in women: physical

Answer 37

decreased energy, increased fatigue, changes in appetite, increased cramps

Question 38

how depression presents LQBTQ community

Answer 38

-lack of research
-most often associated with what factors impact on the presentation of depression

Question 39

depression: presentation in children & teens

Answer 39

-irritable, sad, withdrawn, or bored most of the time
-does not take pleasure in things he or she used to enjoy
-weight loss or gain
-sleep changes: too much or too little
-feel hopeless, worthless, or guilty
-trouble concentrating, thinking, or making decisions
-think about death or suicide a lot

Question 40

depression: presentation in older adults

Answer 40

-loss of interest in activities they used to enjoy
-express feelings of worthlessness or sadness
-unusual outbursts of crying, agitation, or anger, or shows little emotion
-sleep changes
-change in eating patterns
-complains about physical symptoms that do not have a cause
-lack of energy
-confused, difficulty concentrating, remembering things, making decisions, following through with plans
-spends more time alone
-talks about suicide

Question 41

what are some things that have a causal relationship with depression

Answer 41

-family hx
-hormones
-difficult life or traumatic events
-increased stress
-chronic illness
-addictive behaviours and patterns
-societal trends
-medications (birth control, beta blockers, PPI’s, steroids, sedatives, anticonvulsants)
-cultural or religious considerations (lack or words to describe deoression)

Question 42

examples of other mental health screening tools for depression

Answer 42

mood disorder questionnaire
patient health questionnaire (PHQ-9)
edinburgh postnatal depression scale(EPDS)

Question 43

assessment of depression in older adults

Answer 43

-explore predisposing and precipitating factors
-S2IGECAPS
-the geriatric depression scale “yes or no q’s”
-brief assessment schedule for the elderly (BASDEC) “true or false q’s”
-following a positive screening->complete bio-psycho-social assessment should be conducted

Question 44

Recommendations for prevention and Treatment of depression in Older Adults

Answer 44

-a variety of interventions focused on reducing social isolation and/or loneliness
-social prescribing
-stepped care approach
-higher levels of physical activity
-instilling hope and positive thinking as therapeutic tools

Question 45

top treatments for depression

Answer 45

cognitive behavioural therapy (CBT)
interpersonal therapy
behavioural activiation (similar to social prescribing, deliberate practicing a behaviour to get a positive emotional response

Question 45

what do antidepressants target?

Answer 45

CNS and neurotransmitters

Question 46

what do antidepressants address

Answer 46

anergia
anadonia
fatigue
sleep/appetite disturbances

Question 47

what factors to consider when choosing antidepressants

Answer 47

side effects, current medications, contraindications, affordability, patient preference

Question 48

commonly prescribed SSRI’s

Answer 48

-citalopram (Celexa)
-escitalopram (Lexapro)
-fluoxetine (Prozac)
-fluvoxamine (Luvox)
-Paroxetine (Paxil)
-sertraline (Zoloft)

Question 49

SSRI common adverse reactions

Answer 49

-sexual dysfunction
-decreased appetite
-sedation
-sweating
-bruising

Question 50

SSRI rare reactions

Answer 50

-bleeding
-hyponatremia
-serotonin syndrome (combination of mental status changes & neuromuscular changes)

Question 51

what is seen in serotonin syndrome

Answer 51

increased BP
delirium
sweating
aggitation
abdominal pain
mental status changes

Question 52

common SNRI’s

Answer 52

-duloxetine (Cymbalta)
-venlafaxine (Effexor)

Question 53

common adverse effects of SNRI’s

Answer 53

nervousness
asthenia (physical weakness/energy)
-increase in BP
-hyponatremia

Question 54

rare reactions with SNRI’s

Answer 54

induction of hypomania

Question 55

common prescribed serotonin modulator and reuptake inhibitors

Answer 55

-nefazodone (serzone)
-trazodone (desyrel)

Question 56

serotonin modulator and reuptake inhibitors adverse reactions

Answer 56

-dyspepsia
-memory impairment
-ataxia
-parethesia
-asthenia
-increased cough
-edema
-incoordination
-hypotension
-syncope

Question 57

rare adverse reactions of serotonin modulator and reuptake inhibitors

Answer 57

induction of hypomania
postural hypotension
priapism
hepatic failure requiring liver transplant and/or death

Question 58

common norepinephrine and dopamine reuptake inhibitor (NDRI)

Answer 58

bupropion (Wellbutrin)

Question 59

adverse reactions for NDRI’s

Answer 59

-dry mouth
-constipation
-weight loss
-anorexia
-insomnia
-dizziness
-headache
-agitation
-anxiety
-tremors
-tinnitus
-rash
-hypertension

Question 60

rare adverse reactions in NDRI’s

Answer 60

seizures
hypomania (pts’s with bipolar disorder)

Question 61

commonly prescribed TCA’s

Answer 61

-amitriptyline (Elavil)
-Clomipramine (Anafranil)
-Doxepin (Sinequan)
-Desipramine (Norapramin)
-Imipramine (Tofranil)

Question 62

adverse reactions of TCA’s

Answer 62

-blurred vision
-urinary retention
-heartburn
-unusual taste in mouth
-weakness
-nervousness
-restlessness
-photosensitivity
-rash and itching
-application site reactions (topical doxepin)

Question 63

important points about TCA’s

Answer 63

-very effective with non-delusional depression
-increase monitoring with dose adjustion: low n slow

Question 64

rare adverse reactions of TCA’s

Answer 64

-paralytic ileus*
-hyperthermia*
-lowered seizure threshold orthostatic hypotension
-sudden death arrhythmias
-QT prolongation
-hepatic failure
-increased intraocular pressure
-rare induction of mania