class 5-6 (mood & affect A-B) Flashcards
what is an emotion
a short-lived feeling about something specific
-emotions tell us about our mood
what is a mood
a mood is long-lasting (hours->dayys) & much more diffuse
-it is subjective
what is affect
the observable expression of a mood
depression in children/teenagers
-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
depression in older adults
-often misdiagnosed as one of the 3 D’s
-increased stigma
-generational differences + substance use = decreased change of a diagnosis
what is the risk assessment for suicide
SAD PERSONS scale
postpartum depression
starts in 1st month->1 year
-long lasting and requires treatment
-normalized after birth due to: changes in hormones, societal factors, stigma
baby blues
starts 3-4 days after birth & lifts on its own
-“acute version” of PDD, same criteria for Dx
risk factors for PPD
Hx depression
previous PPD
stressors (i.e. financial, marital, etc)
-unplanned pregnancy
-little to no support
treatment for PPD
CBT
supportive counselling
anti-depressant
ECT
edinburgh postnatal depression scale (EPDS)
-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
disruptive mood dysregulation disorder
-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
treatments for distruptive mood dysregulation disorder
CBT
DBT
individual/group/family therapy
meds for behaviours (no med for dx): stimulants, antidepressants, antipsychotics
persistent depressive disorder
-social distress
-they’ve “always felt this way”
-early teen onset
-chronic
premenstrual dysphoric disorder
occurs last week pre-menstrual period
-2-6% effected
-depressive symptoms
dysthymia/persistent depressive disorder
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
major depressive disorder
-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
depression is characterized by:
-sadness
-loss of interest or pleasure
-feelings of guilt
-low self-worth
-disturbed sleep or appetite
-tiredness
-poor concentration
MDD S2IGECAPS meaning:
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
psychotic features of depression
delusions, disorganized thoughts, hallucinations (usually auditory)
melancholic features of depression
severe endogenous depression r/t internal (biological, cognitive, etc) stressor vs external one
atypical features of depression
overeating, oversleeping, anxiety (usually seen in younger generations)
catatonic features of depression
unresponsive, extreme psychmotor paralysis
seasonal (SAD) fall/winter features of depression
“normal mood” during spring/summer, decrease mood during cold dark years, responds well to light therapy
how depression presents in men: mood
anger, aggressiveness, anxiousness, restlessness
how depression presents in men: emotional
feeling empty, sad, hopeless
how depression presents in men: behavioral
feeling tired easily, drinking excessively, using drugs, engaging in high-risk activities
how depression presents in men: sexual
reduced sexual desire, lack of sexual performance
how depression presents in men: cognitive
inability to concentrate, difficulty completing tasks, delayed responses during conversations
how depression presents in men: sleep
insomnia, restless sleep, excessive sleepiness
how depression presents in men: physical
fatigue, pains, headache, digestive problems
how depression presents in women: mood
iriitability
how depression presents in women: emotional
feeling sad or empty, anxious or hopeless
how depression presents in women: behavioral
withdrawing from social engagements, thoughts of suicide
how depression presents in women: cognitive
thinking or talking more slowly
how depression presents in women: sleep
waking early, sleeping too much
how depression presents in women: physical
decreased energy, increased fatigue, changes in appetite, increased cramps
how depression presents LQBTQ community
-lack of research
-most often associated with what factors impact on the presentation of depression
depression: presentation in children & teens
-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
depression: presentation in older adults
-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
what are some things that have a causal relationship with depression
-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)
examples of other mental health screening tools for depression
mood disorder questionnaire
patient health questionnaire (PHQ-9)
edinburgh postnatal depression scale(EPDS)
assessment of depression in older adults
-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
Recommendations for prevention and Treatment of depression in Older Adults
-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
top treatments for depression
cognitive behavioural therapy (CBT)
interpersonal therapy
behavioural activiation (similar to social prescribing, deliberate practicing a behaviour to get a positive emotional response
what do antidepressants target?
CNS and neurotransmitters
what do antidepressants address
anergia
anadonia
fatigue
sleep/appetite disturbances
what factors to consider when choosing antidepressants
side effects, current medications, contraindications, affordability, patient preference
commonly prescribed SSRI’s
-citalopram (Celexa)
-escitalopram (Lexapro)
-fluoxetine (Prozac)
-fluvoxamine (Luvox)
-Paroxetine (Paxil)
-sertraline (Zoloft)
SSRI common adverse reactions
-sexual dysfunction
-decreased appetite
-sedation
-sweating
-bruising
SSRI rare reactions
-bleeding
-hyponatremia
-serotonin syndrome (combination of mental status changes & neuromuscular changes)
what is seen in serotonin syndrome
increased BP
delirium
sweating
aggitation
abdominal pain
mental status changes
common SNRI’s
-duloxetine (Cymbalta)
-venlafaxine (Effexor)
common adverse effects of SNRI’s
nervousness
asthenia (physical weakness/energy)
-increase in BP
-hyponatremia
rare reactions with SNRI’s
induction of hypomania
common prescribed serotonin modulator and reuptake inhibitors
-nefazodone (serzone)
-trazodone (desyrel)
serotonin modulator and reuptake inhibitors adverse reactions
-dyspepsia
-memory impairment
-ataxia
-parethesia
-asthenia
-increased cough
-edema
-incoordination
-hypotension
-syncope
rare adverse reactions of serotonin modulator and reuptake inhibitors
induction of hypomania
postural hypotension
priapism
hepatic failure requiring liver transplant and/or death
common norepinephrine and dopamine reuptake inhibitor (NDRI)
bupropion (Wellbutrin)
adverse reactions for NDRI’s
-dry mouth
-constipation
-weight loss
-anorexia
-insomnia
-dizziness
-headache
-agitation
-anxiety
-tremors
-tinnitus
-rash
-hypertension
rare adverse reactions in NDRI’s
seizures
hypomania (pts’s with bipolar disorder)
commonly prescribed TCA’s
-amitriptyline (Elavil)
-Clomipramine (Anafranil)
-Doxepin (Sinequan)
-Desipramine (Norapramin)
-Imipramine (Tofranil)
adverse reactions of TCA’s
-blurred vision
-urinary retention
-heartburn
-unusual taste in mouth
-weakness
-nervousness
-restlessness
-photosensitivity
-rash and itching
-application site reactions (topical doxepin)
important points about TCA’s
-very effective with non-delusional depression
-increase monitoring with dose adjustion: low n slow
rare adverse reactions of TCA’s
-paralytic ileus*
-hyperthermia*
-lowered seizure threshold orthostatic hypotension
-sudden death arrhythmias
-QT prolongation
-hepatic failure
-increased intraocular pressure
-rare induction of mania
