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10. NMSP Exam 1 > Clinical Approach to Mood Disorders (Hill) > Flashcards

Clinical Approach to Mood Disorders (Hill) Flashcards

1
Q

norepinephrine role in depression

A

down-regulate beta receptors; noradrenergic function abnormal in depression

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2
Q

dopamine role in depression/mania

A
  • decreased in depression

- increased in mania

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3
Q

5-HT role in depression

A

decreased in depression

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4
Q

general action GABA (gamma-aminobutyric acid)

A

inhibitory neurotransmitter

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5
Q

general action glutamate & its receptor & one specific disease it’s involved in

A

excitatory neurotransmitter, NMDA, involved in dementia

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6
Q

Major depressive episode definition

A

At least five of the following for a TWO WEEK period with at least one of either 1) depressed mood or 2) loss of interest or pleasure:

  • depressed mood most of the day, nearly every day
  • anhedonia in most or all activities
  • significant weight loss/gain
  • insomnia/hypersomnia
  • psychomotor agitation or retardation
  • fatigue or loss of energy
  • feelings of worthlessness or excessive guilt
  • diminished ability to think or concentrate
  • recurrent thoughts of death or suicide
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7
Q

major depressive disorder definition

A

diagnosis requires the presence of one or more major depressive episodes and the ABSENCE of any manic, hypomanic, or mixed episodes

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8
Q

Use of electroconvulsive therapy (ECT)

A

used for treatment resistant depression

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9
Q

Side effects ECT

A

short term memory loss common, long term memory loss rare

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10
Q

MOA ECT

A

induces a seizure to “reset” brain

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11
Q

Contraindications ECT and Tx response

A

no absolute contraindications; 75-80% Tx response

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12
Q

Ketamine indication

A

used for major depressive disorder

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13
Q

MOA ketamine

A

NMDA antagonist (N-methyl-D-aspartate); produces dissociative anesthesia

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14
Q

Describe Spravato (esketamine)

A
  • nasal spray of ketamine
  • used for treatment resistant depression
  • rapid acting
  • expensive!
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15
Q

define persistent depressive disorder (dysthymia)

A
  • depressed mood for MOST OF THE DAY (at least 2 YEARS for adults, and 1 YEAR for children) that has not been severe enough to meet criteria for major depressive episode
  • during 2 years, cannot be w/o Sx for >2 month at a time
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16
Q

treatment persistent depressive disorder

A
  • pharmacology (SSRI, SNRI, MAOIs)

- cognitive behavioral therapy

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17
Q

definition depression with seasonal pattern

A
  • essential feature is the onset and remission of major depressive episodes at characteristic times of the year, often with the change of seasons
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18
Q

treatment depression with seasonal pattern

A

light therapy

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19
Q

define premenstrual dysphoric disorder

A

mood instability with anxiety, depression, irritability the week before menses

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20
Q

treatment PMDD

A
  • exercise, diet, relaxation therapy

- SSRIs (treat during cycle or 2 weeks preceding menses)

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21
Q

etiology depression (3)

A
  • genetics
  • neurochemical
  • psychosocial factors/stressors
22
Q

treatment major depressive disorder

A
  • hospitalization
  • somatic therapies (pharmaceuticals)
  • electroconvulsive therapy
  • transcranial magnetic stimulation
  • ketamine
23
Q

manic episode definition

A

abnormally and persistently elevated, expansive, or irritable mood lasting AT LEAST 1 WEEK and with at least 3 of the following during the mood disturbance:

  • inflated self-esteem or grandiosity
  • decreased need for sleep
  • pressured speech
  • flight of ideas/racing thoughts
  • distractibility
  • increased goal-oriented behavior
  • excessive involvement in pleasurable activities
24
Q

hypomanic episode definition

A

similar to manic episode but is less severe. Episodes only need to last 4 days and must not include psychotic features (no social/occupational impairment)

25
Q

bipolar I disorder criteria

A
  • at least one manic or mixed episode necessary to diagnose
  • major depressive episode not necessary for diagnosis, but is usually the first episode to present
  • can be psychotic episode
26
Q

bipolar II disorder criteria

A
  • patients have had at least ONE major depressive episode and ONE hypomanic episode in the absence of any manic or mixed episodes
  • more prevalent than bipolar I disorder
27
Q

1st line treatment bipolar disorders

A

mood stabilizers:

  • lithium
  • valproic acid (depakote)
28
Q

cyclothymic disorder definition

A
  • dysthymic disorder with intermittent hypomanic periods
  • patient who, over the last 2 YEARS (1 year for children), experiences repeated episodes of hypomania and depression (not severe enough to meet criteria for MDD)
29
Q

treatment cyclothymic disorder

A
  • mood stabilizing drugs
  • supportive psychotherapy
  • antidepressants frequently precipitate manic symptoms
30
Q

psychological symptoms anxiety

A
  • apprehension
  • sense of doom or panic
  • hypervigilence
  • difficulty concentrating
  • derealization (world seems strange)
31
Q

somatic symptoms anxiety

A
  • headache
  • dizziness
  • lightheaded
  • palpitations
  • lump in throat/dry mouth
  • restlessness
  • SOB
32
Q

physical signs of anxiety

A
  • diaphoresis, clammy skin
  • tachycardia
  • flushing
  • hyperreflexia, tremor
  • fidgeting
33
Q

panic disorder definition

A

Both:

1) recurrent unexpected panic attacks
2) at least ONE ATTACK followed by 1 MONTH or more of one or more:
- persistent concern about additional attacks
- worry about implications of attack
- significant change in behavior related to the attacks

34
Q

panic attack definition

A

a discrete period of intense fear or discomfort, in which four or more of the [physical/somatic/psychological Sx of anxiety] develop abruptly and reached PEAK WITHIN 10 MINUTES and usually lasts <25 minutes

35
Q

What group of people is most affected by panic disorders?

A
  • women’s 2-3x more likely to be affected

- average age of presentation is 25 y/o

36
Q

agoraphobia definition

A

anxiety about being in situations from which escape might be difficult/embarrassing or for which help may not be available in the event of panic

37
Q

generalized anxiety disorder definition

A

excessive anxiety and worry (apprehensive expectation) OCCURRING MORE DAYS THAN NOT for at least 6 MONTHS, FOR MOST OF THE DAY, about a number of events or activities; it is difficult to control the worry

38
Q

diagnostic criteria GAD

A

anxiety and worry are associated with at least 3 persisting for more days than not of the past 6 months:

  • restlessness or feeling on edge
  • easily fatigued
  • difficulty concentrating
  • irritability
  • muscle tension
  • sleep disturbance
39
Q

obsessions definition

A
  • recurrent and persistent thoughts, impulses, or images experienced as intrusive and inappropriate and causing marked anxiety or distress
  • person attempts for ignore or suppress these thoughts
  • person recognizes them as a product of his/her own mind
40
Q

compulsions definition

A
  • repetitive behaviors or mental acts that the person feels drive to perform
  • aimed at preventing or reducing distress or preventing some dreaded event/situation
41
Q

obsessive-compulsive disorder general definition

A
  • person has recognized the obsessions or compulsions are unreasonable
  • obsessions and compulsions caused marked distress, are time consuming (>1 hour/day) and interfere with functioning
42
Q

Difference between OCD and obsessive-compulsive personality disorder

A

OCPD patients don’t perceive they have a problem

43
Q

phobia definition

A

marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation

44
Q

arachnophobia definition

A

fear of spiders

45
Q

iatrophobia definition

A

fear of doctors

46
Q

acrophobia

A

fear of heights

47
Q

treatment for anxiety

A
  • supportive therapy
  • psychodynamic psychotherapy
  • cognitive behavioral therapy
  • psychopharmacology
48
Q

Pneumonic for dysthymia

A

CHASES

  • concentration: poor
  • hopelessness
  • appetite: poor
  • insomnia
  • energy: low
  • self-esteem: low
49
Q

What should be ruled out if the patient doesn’t have a h/o depression?

A

underlying substance, medication, or medical condition causing depression

50
Q

In recurrent episodes of mood disorder, what is best treatment?

A

the treatment that was successful in previous episodes

51
Q

first line treatments for major depressive disorder

A

SSRIs, bupropion, venlafaxine, mirtazapine

10. NMSP Exam 1 (20 decks)

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