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NMSP Exam 3 > Clinical Approach To Mood Disorders Dr. Hill > Flashcards

Clinical Approach To Mood Disorders Dr. Hill Flashcards

1
Q

Depression causes what neurotransmitters to change

A
  1. NE (decreases) B-adrenergic R downregulated
  2. Dopamine (decreases), it increases in mania
  3. 5-HT (decreased, SSRIs drugs helps with this)
  4. GABA : lower in depression (drugs for anxiety)
  5. Glutamate : NMDA involved (is low)
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2
Q

Major event that commonly causes depression

A

Death of parent or grandparent before 11yo

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3
Q

DSM 5 guide

A

Assesing with mood disorders

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4
Q

Major Depressive Episode

A

2 week period at least
(At least 5 of the listed criteria)
- sleep, apetite, feelinf on self, focus, feeling down, psychomotor retardating, suicidal thoughts
= total score says how severe it is

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5
Q

PHQ2

A

Depending on how pt scores you go in and do PHQ9 and then depending on that you clinically examine pt for depression

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6
Q

Major Depressive Disorder

A

Many depressive episodes with no manic, hypomanic or mixed episodes (mixed depression and mania)
= delusions
= anxious
= melancholic (not sleeping, eating)
= catatonic ( pt is frozen due to psychomotor slowing)

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7
Q

Major Depressive Disorder what should you rule out

A
  1. Substance obuse
  2. Medical condition (DM, thyroid problems)
  3. Normal Grief (bereavement) can last 2 years (Denial, anger, bargaining, depression, acceptance)
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8
Q

Grief vs depression

A

Grief comes in waves , not anti-depressant drugs needed just therapy
= no delusions or such features of depression

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9
Q

Major Depressive Disorder TX

A
  1. Hospitilization if severe enough
  2. TCA , MAO inhibitors (not used as much, first to come), SSRIs and Mirtazapine(can cause weight gain), Trazodone (for sleep), Bupropion (adolecents with no anxiety worried about weight gain),
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10
Q

Major Depressive Disorder for hard to tx how do you tx

A
  1. Electroconvulsive Therapy (ECT)= shock therapy inducing brief seizure during under anesthetic, very safe and no contraindications (can have some short term memory loss) , 9-12 treatments
  2. Transcranial Magnetic Stimulation = new tx with magnetic field stimulating neural pathways (in doctors office) (50% - 75% effective as ECG)
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11
Q

Transcranial Magnetic Stimulation (TMS) location it is done

Given with what anesthetic

A

On the DLPFC (LEFT and at times right Dorsolateral Prefrontal cortex = where depression lies)
= none

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12
Q

ECT what anesthetic is given

A

Succinylcholin

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13
Q

Newer treatments for Major Depressive Disorder

A
  1. Katamine = anesthetic antigonist to NMDA (similar to PCP)
  2. Can be obused
  3. 4-6 infusions about 45min-60min
    = good imporvement
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14
Q

Spravato

A

Nasal spray approved Ketamine
= need to be taken at clinic, monitor vitals and stuff (cant drive home)
= rapid acting
= only for treatments resistant problems

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15
Q

Pshycodelics and Major Depressive Disorder

A

Psilocybin from muschrooms is an example (is like serotonin, given with psychologist or doctor)
= future of treating depression (Very effective however not socially accepted)
= breakthrough treatment (depression, OCD, alchohol and tobacco, end of life anxiety)

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16
Q

Keep in mind when prescribing drugs

A

That a lot of good drugs are not FDA approved due to not high money value of them and therefore they focus on drugs that are worth higher money

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17
Q

Things about attempting suicide that shows its is needing to be taken seriously

A
  1. Cuts that need sutures
  2. Repeated attmepts
  3. Not telling anyone
  4. Substance abuse
  5. Their children are better off without them
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18
Q

If you feel suicde risk outweights protective factors what do you do

A

Even if you have the gut feeling of the risk = affidavits of patient’s attempt documented (has to be held at psychiatric floor for at least 9 hours)

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19
Q

Persistent Depressive Disorder (Dysthymia)

A

Low to moderate depression constant for at least 2 years

= no not severe enough for Major Depressive Episode

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20
Q

Double Depression

A

Major depression + Persistant Depressive Disorder

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21
Q

Persistent Depressive Disorder (Dysthymia) TX

A

Cognitive Behavioral Therapy first and then add Drugs if needed (SSRIs, SNRIs, MOAIs)
= hard to treat

22
Q

Seasonal Depression

A

Major Depression (middle fall/september) then imporves march/april
(Eat more, sleep more, fatgued)
= TX light therapy**, labuterine

23
Q

Premenstrual Dysphoric Disorder (PMDD)

A

Mood instability like anxiety depression, irritablity, sleep problems 1 week before menses
TX : Exercise, diet, relaxation therapy yoga, SSRIs(Sertraline, Fluoxetine) 2 weeks before menses

24
Q

Bipolar Manic Episode is what

A

Lasts at least 1 week with at least 3 of the following:

  1. Inflated self esteem/ grandiosity (think they are invincible), belive they can do anything*****, shopping sprees major
  2. Dont need to sleep
  3. Have so many racing thoughts and ideas and really talketive all the time hard to interrupt
  4. Very distracted non connecting thoughts (HYPER ADHD)
  5. If they start painting 1 door they then do all doors and neighboors door (increased goal oriented)
  6. Excessive involvement in pleasurable activites
25
Q

A bipolar pt needs what

A

At least 1 manic episode

26
Q

Antidepression meds can cause what if misdiagnosed

A

Manic episode

27
Q

Hypomania Episode

A

Less severe then mania episode (lasts 4 days or more) and must not include psychotic features (no social occupational impariment)
= cleaning house middle of night
= annoying people
= very hyper

28
Q

Mania epidose what can you find in patient

A
  1. Preg
  2. Bankrupt
  3. Jail
    = all same week
29
Q

Bipolar 1 Disorder
DX
SX

A
  1. Only 1 manic or mixed episode needed to diagnose
  2. Major depression can present first, worse prognosis then Major depression
  3. Dellusins can happen
    = in episodes
30
Q

Bipolar 2 Disorder
DX
SX

A
  1. At least 1 major depressive episode and 1 hypomania episode needed, NO Mania episodes
  2. More prevalent then type 1
31
Q

Bipolar type 1 TX

A

Mood stabilizers **

  1. Lithium
  2. Valproic Acid
  3. Carbamazepine
32
Q

Cyclothymic Disorders

A

Intermittent hypomanic periods (2 years , repeated episodes of hypomania, depression not severe enough for major depressive disorder
1. Cycle from hypomania to moderate depression

33
Q

Cyclothymic Disorders TX

A
  1. Mood stabilizer

2. Life style changes to keep stress and caos out from thier lives

34
Q

Substance related problems can look like

A

Mood disorder

35
Q

Anxiety Disorders SX

A
  1. Worry / apprehension
  2. Sense of doom
  3. Hypervigilance
  4. Focus problems
  5. Derealization (out of touch from world around them)
  6. Headache, dizzy, palpitations, restless, SOB, sweating, dry mouth
36
Q

Anxiety Disorders Signs

A 
Cool clammy skin , sweaty 
Tachy
Flushing
Hyperreflex, tremor
Fidgity
37
Q

Anxiety Disorders can be casued by what that needs to be checked

A

Medical condition

Medications

38
Q

Panic Attacks

A

1 and 2 present always

  1. Recurrent unexpected panic attack
  2. 1 attack followed by a month or longer of fear from more attacks, behavior change due to the attacks, change behavior to avoid attacks,
  3. scared to leave house (due to maybe getting an attack = agoraphobia)
39
Q

Panic Attack DX

A 
Peak at 10min lasts 25min-3min
= intense fear and discomfort
= palpitations, sweating, CP, SOB, shaking, dizzy, hot flash, chills
= feel like an MI
= can happen in the middle of night
40
Q

Anxiety Disorders prevalence and risk

A
  1. Women, 25yo average age , strong genetic component

2. Suicide due to feeling completley worn out and overwhelmed

41
Q

Agoraphobia

A

Afraid of environment where they cant exit if they have an attack
= afraid to leave home or be in public

42
Q

Social Phobia what and ABCD DX

A

= uncomfortable being around anyone FOR 6 OR MORE MONTH**, usually come in grade school
= shake hand and its sweaty
A : feel like they will screw up when bein around others and talking, feel like they are being judge, can use drugs or alcohol before meeting others
B : exposure to feared situation causes anxiety
C : person knows this fear is unreasonable
D : feared situation is avoided or endured with intense anxiety and distress

43
Q

Generalized Anxiety Disorder SX

A 
For more then 6MONTHS**** for most of day and more days then not
1. Restlessness, on edge
2. Easily fatigued
3. Focus problemss
4. Irritability
5. Muscle tension
6. Sleep problems 
= affects life
44
Q

OCD Obsessions what is is and Examples

A

Recurrent persistant thoughts, impulses, imagening things or images causing anxiety
= not worring about real life issues
= attempts to ignor or suppress thoughts
= person knows this is from their mind
1. Fear of dirt, germs
2. Feeling responsibel for something bad
3. Unexeptable religious thoughts

45
Q

OCD Compulsions what is it and examples

A

= repetitive behaviors or menta acts the person needs to do
= they do for reduced anxiety and disress, or prevent a dreaded event
1. Excressive cleaning
2. Rechecking and ordering some things in like a ritual way
3. Counting , repeated counting activity
4. Some are unobservable mental rituals

46
Q

OCD is related to what

A
  1. Hair pulling (Trichotillomania), skin picking (Excoriation)
  2. Hoarding
  3. Substance mediacrtion caused
  4. Strep throat in children can cause OCD later
47
Q

OCD vs OCPD

A

OCPD dont know they have a problem

48
Q

TX anxiety disorders

A
  1. Psychotherapy***** (EDUCATE them about the condition, this is something youre NOT, just something you have)
  2. Psychodynamic psychotherapy (Froyian)
  3. CBT**
49
Q

Good drugs for anxiety

A

SSRIs**
SNRIs**
TCAs
Benzodiazapines = Lorazapam (ER panic attack) = short term (Zanex)

Buspirone
Beta-blocker = very good for social anxiety, performance anxiety, public speaking anxeity, can help with PTSD nighmares —- >Prezosen

50
Q

DEPRESSION PNEUMOINC

A 
SIG E CAPS 
S : sleep lack
I : Interest decrease
G : Guilt
E : energy low
C : Consentration probs
A : appetite low or high
P : Psychomotor decrease
S : Suicidal thoughts can happen
51
Q

Manic pneumoina

A 
DIG FAST 
D : Distracted
I : Inflated self esteem, + Impulsive ****
G : Grandiosity****
F : flight ideas (racing thoughts)
A : Activity high (agitation)
S : Speech pressured
T : thoughtlessness
52
Q

PEARLS for CLINICAL PRACTICE

A
  1. Rule out medication, medical condition, substance obuse causing any SXS or problems (esp in pts with no previous depression PMH or family history)
  2. 50% with 1 episode will not have another one, 50% with one will have another one
  3. More episodes of depression the more likely they need to be on meds for a long time many years
  4. TX that was successful in past and then didnt work anymore in a pt that is trying to find a working medication has HIGH chance that going back to that medication what worked in the past will work now
  5. SSRI ** 1st line tx for anxiety and depression, (bupropion, venlafaxine, mirtazaine)

NMSP Exam 3 (13 decks)

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