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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
bipolar I disorder criteria
- 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
bipolar II disorder criteria
- 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
1st line treatment bipolar disorders
mood stabilizers: - lithium - valproic acid (depakote)
28
cyclothymic disorder definition
- 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
treatment cyclothymic disorder
- mood stabilizing drugs - supportive psychotherapy * antidepressants frequently precipitate manic symptoms
30
psychological symptoms anxiety
- apprehension - sense of doom or panic - hypervigilence - difficulty concentrating - derealization (world seems strange)
31
somatic symptoms anxiety
- headache - dizziness - lightheaded - palpitations - lump in throat/dry mouth - restlessness - SOB
32
physical signs of anxiety
- diaphoresis, clammy skin - tachycardia - flushing - hyperreflexia, tremor - fidgeting
33
panic disorder definition
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
panic attack definition
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
What group of people is most affected by panic disorders?
- women's 2-3x more likely to be affected | - average age of presentation is 25 y/o
36
agoraphobia definition
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
generalized anxiety disorder definition
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
diagnostic criteria GAD
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
obsessions definition
- 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
compulsions definition
- 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
obsessive-compulsive disorder general definition
- 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
Difference between OCD and obsessive-compulsive personality disorder
OCPD patients don't perceive they have a problem
43
phobia definition
marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation
44
arachnophobia definition
fear of spiders
45
iatrophobia definition
fear of doctors
46
acrophobia
fear of heights
47
treatment for anxiety
- supportive therapy - psychodynamic psychotherapy - cognitive behavioral therapy - psychopharmacology
48
Pneumonic for dysthymia
CHASES - concentration: poor - hopelessness - appetite: poor - insomnia - energy: low - self-esteem: low
49
What should be ruled out if the patient doesn't have a h/o depression?
underlying substance, medication, or medical condition causing depression
50
In recurrent episodes of mood disorder, what is best treatment?
the treatment that was successful in previous episodes
51
first line treatments for major depressive disorder
SSRIs, bupropion, venlafaxine, mirtazapine

10. NMSP Exam 1 (20 decks)

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