[CLMD] Mood Disorders [Hill] Flashcards
What are the (5) major neurotransmitters involved in mood disorders?
Norepinephrine
Dopamine
5-HT
GABA
Glutamate
What are the relative levels of dopamine during
(Depression)
and
(Mania)
Depression = Dopamine is LOW
Mania = Dopamine is HIGH
What are the levels of 5-HT during depression?
5-HT is LOW in depression
What is the major excitatory neurotransmitter of the CNS?
What is the major inhibitory neurotransmitter of the CNS?
Excitatory = Glutamate
Inhibitory = GABA
What is the definition of a major depressive episode?
At least (5) of the following for a 2-week period with at least one either (1) depressed mood or (2) loss of interest or pleasure
What is the gold standard questionaaire that is used in nearly every primary care office to assess for depression?
Patient Health Questionnaire (PHQ-9)
What is required for the diagnosis of major depressive disorder?
Diagnosis requires the presence of one or more major depressive episodes and the ABSENCE of any manic,hypomanic or mixed episodes
What are associated features with major depressive disorder (6)?
Psychotic
Anxious distress
Melancholic
Catatonic
Peripartum onset
Mixed features
What are the (5) stages of grieving?
Denial –> Anger –> Bargaining –> Depression –> Acceptance
What are some major categories of treatments for major depressive disorder??
Pharmacologic
Electroconvulsive therapy (ECT)
Transcranial magnetic stimulation
What is electroconvulsive therapy used for?
What is it?
Treatment resistant depression
Induces a seizure
Efficacy of electroconvulsive therapy (ECT)?
75-80% treatment response
What drug therapy has shown a 50% reduction in suicidal thoughts within 24 hours of major depressive disorder patients?
Ketamine
What is spravato?
Spravato aka esketamine
Nasal spray formulation of ketamine
Rapid acting and expensive
What is the name of the disorder related to this description:
Depressed mood for most of the day for at least 2 years in duration for adults and 1 year for children that has not been severe enough to meet criteria for a major depressive episode
Persistent depressive disorder (Dysthymia)
What is double depression?
Double depression = Dysthymic disorder + Major depression can occur simultaneously
What is depression w/ seasonal pattern?
Onset and remission of major depressive episodes at characteristic times of the year
Sleep more and eat more; fatigued
Light therapy is effective
What is premenstrual dysphoric disorder (PMDD)?
Mood instability w/ anxiety, depression, irritability
Occur the week before menses
Treatment includes : (Exercise, diet, relaxation thearpy, SSRIs)
Define a manic episode
Abnormally and persistently elevated, expansive or irritable mood lasting at least 1 week with at least three of the following:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative
- Flight of ideas/racing thoughts
- Distractibility
- Increased goal-oriented behavior
- Excessive involvement iin pleasureable activities
What is a hypomanic episode?
Similar to manic episode but it is less severe
Episodes only need to last 4 days and must not include psychotic features
No social/occupational impairment
What is bipolar I disorder?
Single manic episode is necessary to diagnose
At least one manic or mixed episode
Can be psychotic episode, delusions and/or hallucinations
Define bipolar II disorder?
Prevalence?
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
What are the 1st line agents to treat bipolar disorders?
Mood stabilizers:
Lithium
Valproic Acid
What is cyclothymic disorder?
Characterized as dysthymic disorder w/ intermittent hypomanic periods
Patient who over the last 2 years experiences repeated episodes of hypomania and depression (not severe enough to meet criteria for major depressive disorder)
What is separation anxiety disorder?
Recurrent excessive stress when anticipating or experiencing separation from major attachment figures or home
Describe a panic attack
A discrete period of intense fear or discomfort, in which four or more of the following developed abruptly and reached peak within 10 min and usually last <25 min
- Palpitations
- Sweating
- Trembling/Shaking
- Sensations of SOB
- Chest pain/discomfort
- Feeling dizzy
- Fear of losing control
- Paresthesia
- Chills or hot flashes
What is agoraphobia?
Anxiety about being in situations from which escape may be difficult or embarrassing or for which help may not be available in the event of panic
Define social phobia (social anxiety disorder)
The fear, anxiety or avoidance is persistent
Typically lasting 6 or more months
Define generalized anxiety disorder
Excessive anxiety and worry occuring more days than not for at least 6 months for MOST OF THE DAY about a number of events or activities
Define obsessions
Recurrent and persistent THOUGHTS, impulses or images experienced as intrusive and inappropriate and causing marked anxiety or distress
Define compulsions
Repetitive behaviors or mental acts that the person feels drive to perform
What are a few obsessive compulsive RELATED disorders?
Hoarding
Trichotillomania (hair pulling)
Excoriation disorder (skin picking)
Substance-medication induced OCD
What is the difference b/w OCD and Obsessive compulsive personality disorder (OCPD)?
OCPD = they don’t perceive they have a problem
OCD = they know their compulsions and obsessions are not reasonable (most of the time)
What are examples of obsessions?
Contamination
Safety/harm
Unwanted acts of aggression
Unacceptable sexual or religious thoughts
Need for symmetry or exactness
What are examples of compulsions?
Excessive cleaning
Checking, ordering and arranging rituals
Counting
Define phobia
Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation
What are examples of anxiety treatments?
Psychotherapy (supportive therapy, psychodynamic, cognitive behavioral therapy)
Psychopharmacology (SSRIs, SNRIs, TCAs, MAOIs, Buspirone, Benzos, Antipsychotics)
What is the pneumonic for depression?
SIG E CAPS
Sleep-lack of
Interest-anhedonia
Guilt
Energy -lack of
Concentration - difficulty
Appetite - decreased or increased
Psychomotor- decreased
Suicidal ideation
What is the pneumonic for manic?
DIG FAST
Distractability
Inflated self esteem/impulsive
Grandiosity
Flight of ideas
Activity
Speech pressured
Thoughtlessness
What is the pneumonic for dysthymic?
CHASES
Concentration-poor
Hopelessness
Appetite-poor
Sleep- Insomnia
Energy-low
Self-esteem low
