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PATHOPHYSIOLOGY > Depression > Flashcards

Depression Flashcards

1
Q

What are disorders of emotions (Including: mania and depression) called?

A

Mood Disorders

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2
Q

These disorders are underdiagnosed and undertreated, not very often.

True or False?

A

False

These disorders are highly underdiagnosed and undertreated

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3
Q

What is among the leading causes of disability worldwide?

A

Depression

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4
Q

8% of adults experience what at some point of their lives?

A

major depressive episodes

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5
Q

What is the cause of death in ~15% of individuals with Major Depressive Disorder (MDD)?

A

Suicide

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6
Q

Depression is twice as prevalent in men or women?

A

Women

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7
Q

Depression is twice as prevalent in women than men.

Why is this?

A

Women are more likely to recognize mental health issues and go to their doctor

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8
Q

Neurological basis for the increased prevalence is very well known.

True or False?

A

False

unknown

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9
Q

Depression is twice as prevalent in women than men

It is thought that the reason for this is that women are more likely to recognize mental health issues and go to their doctor.

Neurological basis for the increased prevalence is unknown but
hypotheses include differences in what three things in the brain?

A

hormonal statuses, stress systems, or sexual differences in the brain

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10
Q

Who are less likely to see help for depression, men or women?

A

men

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11
Q

Depression is often masked in men.

True or False?

A

True

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12
Q

Why is depression is often masked in men?

A

Due to somatic complaints (For example, somatic complaints include: migraines, back pain, or irritable bowel syndrome. Therefore, often not recognized as depression.)

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13
Q

Prevalence of bipolar disorder or manic depression is approximately 1% and _______________ ________________ between men and women.

A

equally distributed

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14
Q

Mood disorders are disorders of emotion including what two things?

A

mania and depression

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15
Q

Depressive disorders can be divided into what two categories?

A

MDD (depressed mood or loss of interest/pleasure) and Dysthymia (persistent mild depressive disorder)

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16
Q

Depressive disorders can be divided into two categories. What is characteristic of MDD (major depressive disorder)?

A

depressed mood or loss of interest/pleasure

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17
Q

Depressive disorders can be divided into two categories. What is characteristic of Dysthymia?

A

persistent depressive disorder

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18
Q

Criteria for Depression includes the simultaneous presence of ________ or more symptoms (at least one of the symptoms have to be depressed mood OR loss of interest/pleasure) during a ____-___________, period and represent a __________ from previous functioning.

A

Five, 2-week, change

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19
Q

What are symptoms of depression?

A 
o Depressed Mood
o Anhedonia (loss of interest/pleasure)
o Changes in weight/appetite
o Insomnia or hypersomnia
o Psychomotor agitation or retardation
o Fatigue or loss of energy
o Feeling of worthlessness or excessive guilt
o Diminished ability to think or concentrate, or indecisiveness
o Thoughts of death or suicidal ideation
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20
Q

Common comorbid diagnosis with depression include what 4 things?

A

diabetes, heart disease, autoimmune disorders, and pain

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21
Q

What are these known as:

disruptive mood dysregulation disorder

premenstrual dysphoric disorder

substance/medicationinduced depressive disorder

specified and unspecified depressive disorders

A

Other Depressive Disorders

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22
Q

The following are examples of risk factors of depression:

  • Childhood emotional, physical, and sexual abuse
  • Prior episode of depression
  • Family history of depressive disorder

True or False?

A

true

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23
Q

What are three examples of risk factors for depression?

A

Childhood emotional, physical, and sexual abuse, Prior episode of depression, Family history of depressive disorder, Lack of social support, Stressful life event,
Current substance abuse, Economic difficulties

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24
Q

The etiology of depression involves only one factor.

True or False?

A

False (it is multifactoral)

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25
Q

Which ones are NOT a part of the dynamic interplay for the multifactorial etiology of depression:

  • Genetic predisposition
  • Environment
  • Stressors
  • Chronic Disease
  • Life History
  • Obesity
  • Development
  • Biological Challenges (Changes)
A

Stressors, Chronic Disease, and Obesity

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26
Q

Much of the research for the etiology of Depression has focused on what?

A

deficits in neurotransmitter systems

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27
Q

It is believed that Major Depressive Disorders (MDD) arises from this complex interaction of what two things?

A

genes and environmental factors

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28
Q

For the pathophysiology of mental illness we are talking about what happens inside the brain, that portion of the central nervous system that is contained within the ________________.

A

cranium

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29
Q

Doing the math, there are ___________ _____________ neurons or nerve cells and _______-_______ _________________ neuroglia, which support the nerve cells in the brain.

A

1000 trillion, 10-50 trillion

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30
Q

The brain has a mass of about ___________ in adults.

A

3 lbs (1300 grams)

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31
Q

On average, each neuron forms how many synapses with other neurons?

A

1000 synapses

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32
Q

The total number of synapses is about a thousand trillion which is larger than the number of stars in the galaxy.

True or False?

A

True

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33
Q

What Genetic-Environment Interaction is more common amongst first degree relatives than the general population?

A

MDD (Major Depressive Disorders)

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34
Q

Studies suggest a ___________ component to the etiology of mood disorders.

A

hereditary

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35
Q

Heritability for depression has been estimated from twin studies as 31-42% with a ________________ _____________ of environmental effects unique to individuals of 58-67%

A

substantial contribution

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36
Q

Scientists have identified a gene or series of genes that cause depression.

True or False?

A

False (Scientists have not identified a gene or series of genes that cause depression)

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37
Q

What are the certain variations called that increase the risk for depression?

A

polymorphisms (variations in genes)

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38
Q

Genes can predispose individuals to Major Depressive Disorders (MDD)?

True or False?

A

True

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39
Q

What can help:

  • control the metabolism of neurotransmitters and their receptors
  • the numbers of particular types of neurons and their synaptic connections
  • the intracellular transduction of neuronal signals,
  • the speed with which all of these can change in response to environmental stressors
A

Genes

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40
Q

What is the most studied in Major Depressive Disorders (MDD)?

A

Serotonin Transporter Gene

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41
Q

The Serotonin Transporter Gene contains a polymorphism that gives rise to what?

A

two different alleles (long and short)

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42
Q

Serotonin Transporter Gene is the most studied in Major Depressive Disorders (MDD)

People usually have two copies of each gene in their DNA, therefore, a person can be __________________ for the short allele or the long allele, or _________________ (one short and one long)

A

homozygous and heterozygous

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43
Q

Serotonin Transporter Gene is the most studied in Major Depressive Disorders (MDD).

The short allele slows down the synthesis of what? (What does this do?)

A

the serotonin transporter (this reduces the speed with which serotonin neurons can adapt to changes in their stimulation)

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44
Q

What is is one of the neurotransmitters implicated in depression?

A

Serotonin

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45
Q

The short allele of the serotonin transporter gene does what?

A

slows down the synthesis of the serotonin transporter (leading to a dysregulation of serotonin)

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46
Q

What is a growth factor that plays an important role in birth, survival and maturation of brain cells during development?

A

BDNF (brain-derived neurotrophic factor)

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47
Q

Brain Derived Neurotrophic Factor is a ________ found in _________ concentrations in the brain

A

protein and high

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48
Q

Brain Derived Neurotrophic Factor is important for what two things?

A

neuronal cell growth and the synaptic changes that occur through a person’s life

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49
Q

Brain Derived Neurotrophic Factor is important for what two things?

A

neuronal cell growth and the synaptic changes that occur through a person’s life

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50
Q

What activates DNA binding factors that stimulate gene transcription of genes involved in serotonin function (such as the serotonin transporter and tryptophan hydrolase, the serotonin synthesizing enzyme)?

A

BDNF (brain-derived neurotrophic factor)

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51
Q

Do people diagnosed with MDD have higher or lower levels of BDNF?

A

lower

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52
Q

What are the two alleles in gene that codes for BDNF?

A

Val and met

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53
Q

People with met allele increases or decreases a person’s vulnerability to depression?

A

increases

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54
Q

A common polymorphism in the gene that codes for BDNF produces alleles called “VAL” and “MET”. This polymorphism affects what two things?

A

the intracellular transport and secretion of BDNF

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55
Q

People with the Met allele have a _________ hippocampus at birth, hippocampal _________ activity at rest, hippocampal _________ activation during learning, and ________ hippocampus-dependant memory function

A

small, hypo, hyper, and poor

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56
Q

Why is the hippocampus significant to depression?

A

it modulates the cognitive aspects of depression

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57
Q

Hippocampus is significant to depression because it modulates the cognitive aspects of depression. What two things does this cause?

A

Memory impairments and feelings of hopelessness (guilt, doom, and suicidality)

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58
Q

Studies found that having the ______ allele AND the ___________ allele of the serotonin transporter and psychosocial stress, increases vulnerability to depression

A

Met and short

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59
Q

Studies found low or high levels of BDNF in the hippocampus and prefrontal cortex of symptomatic depressed patients?

A

low levels

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60
Q

Serum studies have shown that serum levels of BDNF are abnormally low in patients with what condition?

A

MDD (major depressive disorder)

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61
Q

While, depression is diagnosed based on symptoms, it is important for scientists to know about __________ so that they can find a way to __________ these levels when treating patients with depression

A

BDNF and increase

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62
Q

Theories suggests that major depression is caused by what two things in the CNS concentrations of neurotransmitters?

A

a deficiency or dysregulation

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63
Q

What two systems modulate many areas of feeling, thinking, and behaving and are implicated in depression?

A

Noradrenergic and serotonergic

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64
Q

Nerve cells communicate by what type of signals?

A

electrochemical signals

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65
Q

Nerve cells communicate by electrochemical signals which cross the paint at which two neurons meet called what?

A

the synapse

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66
Q

Neurotransmitters are released from the what terminal of the neuron?

A

axonal terminal (presynaptic cell)

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67
Q

Neurotransmitters are released from the axonal terminal of one neuron (presynaptic cell), crosses the synapse, and then binds to receptors on the postsynaptic cells causing what?

A

excitatory or inhibitory action

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68
Q

Order the four steps in neuro transmission?

A. Storage and release of the transmitter
B. Binding of the transmitter to receptors on the postsynaptic membrane
C. Removal of the transmitter from the synaptic cleft
D. Synthesis of a transmitter substance

A

D, A, B, C

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69
Q

What are typically stored in the vesicles in the presynaptic axonal terminal and released by the process of exocytosis?

A

Neurotransmitters

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70
Q

Neurotransmitters are typically stored in the vesicles in the presynaptic axonal terminal and released by what process?

A

exocytosis

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71
Q

Where are Neurotransmitters typically synthesized?

A

the presynaptic neuron

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72
Q

Communication between the two neurons begins with what?

A

a nerve impulse (that stimulates presynaptic neuron)

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73
Q

Communication between the two neurons begins with a nerve impulse that stimulates presynaptic neuron followed by movement of the _________________ _________________ to the cell membrane and release of the neurotransmitter into the _____________ ____________.

A

synaptic vesicle and synaptic cleft

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74
Q

What is the second step in neurotransmission?

A

receptor binding

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75
Q

Neurotransmitter moves across the synaptic cleft and binds to receptors where?

A

on the postsynaptic neuron

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76
Q

The action of neurotransmitter is determined by the type of receptor (excitatory or inhibitory).

True or False?

A

True

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77
Q

Binding to an excitatory receptor will result in what?

A

the opening of an ion channel

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78
Q

Many presynaptic neurons also have receptors to which a neurotransmitter does what?

A

binds

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79
Q

Presynaptic receptors function in a positive feedback manner to speed up further release.

True or False?

A

False (Presynaptic receptors function in a negative feedback manner to inhibit further release)

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80
Q

What is the third step in neurotransmission?

A

Neurotransmitter Removal

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81
Q

Precise control of synaptic function relies on the rapid removal of the neurotransmitter from where?

A

the receptor site

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82
Q

A released neurotransmitter can do what three things?

A

Be taken back up into the neuron (reuptake), Diffuse out of the synaptic cleft, andBe broken down by enzymes into inactive substances or metabolites

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83
Q

Which hypothesis suggests that decreased levels of serotonin and NE in the synaptic cleft (due to decreased presynaptic release OR decreased postsynaptic sensitivity) is the underlying pathologic process in depression?

A

Biogenic Amine Hypothesis

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84
Q

The Biogenic Amine Hypothesis suggests that decreased levels of ____________ and ________________ in the synaptic cleft (due to decreased presynaptic release OR decreased postsynaptic sensitivity) is the underlying pathologic process in depression

A

serotonin and NE

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85
Q

The Biogenic Amine Hypothesis suggests that decreased levels of serotonin and NE in the synaptic cleft is the underlying pathologic process in depression. What two things could this be due to?

A

Decreased presynaptic release or decreased postsynaptic sensitivity

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86
Q

Reduction in serotonin may result in depression however, how may it also occur?

A

With a reduction of serotonin synthesis.

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87
Q

Serotonin levels can be depleted by decreasing the level of ________________ (this is a precursor to serotonin)

A

tryptophan

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88
Q

Research has prove that lowering serotonin factors does not induce depression in all people, therefore supporting the genetic and environmental factors.

True or False?

A

True

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89
Q

What other activity has also been implicated in mood disorders?

A

Dopamine

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90
Q

In times of depression and in mania, is dopamine activity increased or decreased?

A

decreased

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91
Q

Effects of genetics, environment, and deficiencies/ dysregulation in the CNS concentrations of neurotransmitters causes what in many areas of the brain?

A

anatomic changes

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92
Q

What is the part of the cerebral cortex that is the outermost part of the brain?

A

prefrontal cortex

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93
Q

What part of the brain is most evolved?

A

cerebral cortex

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94
Q

What is the chief administrator of the brain and is responsible for planning, problem solving, intellectual insight, judgement, and expression of emotion?

A

Prefrontal Cortex

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95
Q

In times of depression, the prefrontal cortex is reduced and less active because of a decrease in the neurotransmission of serotonin, NE, and alterations in the neurotransmission of dopamine in this area.

True or False?

A

True

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96
Q

In times of depression, there is a decrease in what in the prefrontal cortex?

A

BDNF (brain-derived neurotrophic factor)

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97
Q

In times of depression, why does a decrease in neurotransmitter activity lead to a decrease in neuronal volume?

A

Pruning occurs (pathways are not being used, density of pathways decrease)

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98
Q

What type of brain imagery includes:

  • Variable brain tissue uptake of an infused radioactive substance
  • Subs can be infused to study neurotransmitter receptor activity or concentration in the brain
A

PET scan (positron emission tomography)

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99
Q

What type of brain imagery helps to diagnose structural abnormalities of the brain and can distinguish between grey and white matter?

A

MRI (magnetic resonance imaging)

100
Q

What type of brain matter includes myelinated axons surrounded by multilayered lipid and protein covering which electrically insulates the axon of a neutron and increases speed of nerve impulse conduction?

A

white matter

101
Q

What type of brain matter contains neuronal cell bodies, dendrites, unmyelinated axons, axon terminals, and neuroganglia?

A

grey matter

102
Q

What part of the brain integrates and interprets somatic or bodily, visual, and auditory information that is critical for recognition of the familiar/appropriate interpretation of and response to social contexts?

A

temporal lobe

103
Q

Part of an appropriate social response is the accurate interpretation of emotions and the ability to response with the socially appropriate level of emotionality and language.

Where is this information integrated?

A

temporal lobe

104
Q

In short, what is the temporal lobe responsible for?

A

the modulation and fine-tuning of emotion appropriate to level of intensity

105
Q

The temporal lobe is responsible for planning, problem solving, intellectual insight, judgement, and expression of emotion.

True or False?

What differs that from prefrontal cortex?

A

true

  • pre frontal cortex Contains functional areas for reward, motivation, higher cognitive processes (executive functions), motor planning and execution and regulating the expression of emotion
106
Q

Parts of which system (it controls emotional behaviour), are housed in the temporal lobe?

A

the limbic system

107
Q

In cases of depression, PET/MRI studies show decreased functioning in which two lobes?

A

frontal and temporal lobes

108
Q

In cases of depression, the dysregulation of which three neurotransmitters are the culprits in frontal and temporal lobe?

A

serotonin, dopamine, and NE

109
Q

Where is the amygdala located in the brain?

A

medial temporal lobe (in the primitive part of our brain )

110
Q

The amygdala receives neuronal signals from which two lobes of the cortex?

A

temporal and occipital lobes

111
Q

The amygdala communicates with the _____________________ and other parts of the limbic system

A

hypothalamus

112
Q

The amygdala helps a person relate to the surrounding environment and pattern what?

A

appropriate behaviour

113
Q

What part of the brain is important in emotional function and regulation, the modulation of affective responses in social settings, sexual arousal, aggression, and fear responses?

A

Amygdala

114
Q

The amygdala tends to have increased or decreased blood flow and oxygen consumption during depression?

A

increased

115
Q

What two areas of the brain are important in emotional memory?

A

Striatum and amygdala (and related brain areas)

116
Q

What is a decreased drive and reward for pleasurable activities called?

A

anhedonia

117
Q

Striatum and amygdala and related brain areas are important in emotional memory.

They are believed to mediate the anhedonia (decreased drive and reward for pleasurable activities), anxiety, and reduced motivation symptoms of depression.

True or False?

A

True

118
Q

What two things are involved in the development of mood disorders?

A

limbic system and basal ganglia

119
Q

What is a part of the limbic system which is a primitive area deep in our brain that regulates our emotional behaviours?

A

Amygdala

120
Q

What system includes the hippocampus, parahippocampal gyrus, cingulate gyrus, amygdala, and the fornix (bridge like structure which connects the hippocampus with the hypothalamus)?

A

Limbic System

121
Q

Higher and lower brain centres communicate with the limbic system to do what?

A

connect thoughts and autonomic nervous system responses to emotions

122
Q

Neurological disorders of the limbic system and basal ganglia are also involved in what?

A

development of mood disorders

123
Q

What two things mediate cognitive aspects of depression including memory impairments and feelings of worthlessness, hopelessness, guilt, doom, and suicidality?

A

Neocortex and hippocampus

124
Q

The dysregulation and neuroanatomical changes in the hypothalamus are believed to be responsible for what?

A

the neurovegetative symptoms of depression

125
Q

The dysregulation and neuroanatomical changes in the hypothalamus are believed to be responsible for what three neurovegetative symptoms of depression?

A

too much or too little sleep, appetite and energy, and loss of interest in sex (and other pleasurable activities)

126
Q

What are the three active neurotransmitters in the limbic system area?

A

serotonin, NE, dopamine

127
Q

Serotonin, NE, and dopamine are the active neurotransmitters in the limbic system.

Their dysregulation (they are no longer able to do their jobs well)
is the cause of over activity of what part of the limbic system?
A

the amygdala

128
Q

Serotonin, NE, and dopamine are the active neurotransmitters in the limbic system.
Their dysregulation is the cause of over activity of the amygdala.
This results in an overall abnormality of connectivity within the limbic system and causes what three symptoms?

A

emotional liability, irritability, and suicidality

129
Q

Major Depressive Disorder is associated with multiple endocrine alterations particularly in what?

A

HPA axis

130
Q

Stress is perceived by the ___________ of the brain and transmitted to the deeper regions of the ____________________ , where ____________ is released onto _____________ receptors

A

cortex, hypothalamus, CRF, pituitary

131
Q

Within the HPA, the stimulus results in the secretion of what into plasma?

A

corticotrophin

132
Q

Within the HPA, the stimulus results in the secretion of corticotrophin into plasma leading to stimulation of corticotrophin receptors where?

A

adrenal cortex

133
Q

Within the HPA, the stimulus results in the secretion of corticotrophin into plasma, stimulation of corticotrophin receptors in the adrenal cortex, and release of what into the blood?

A

cortisol

134
Q

What two stress hormones are involved in depression?

A

cortisol and CRF

135
Q

Patients with depression have elevated or diminished cortisol levels in plasma and cerebrospinal fluid?

A

elevated

136
Q

Patients with depression have elevated cortisol levels in plasma and cerebrospinal fluid and increased levels of what two things?

A

CRF messenger RNA and protein in limbic brain regions

137
Q

The sensitivity of the hypothalamus to feedback signals (for the shutdown of CRF release) is about half in severely depressed patients.

True or False?

A

True

138
Q

Disturbances in the function of the HPA axis in depression cause cortisol levels to spike erratically throughout the day.

True or False?

A

True

139
Q

In the non-depressed person, serum BDNF levels lower with exposure to stress.

True or False?

A

False (In the non-depressed person, serum BDNF levels do not lower with exposure to stress)

140
Q

In people with MDD, stress activates what two things?

A

amygdala and NE systems

141
Q

In people with MDD, stress activates the amygdala and NE systems causing symptoms of increased ________________ and ____________.

A

vigilance and fear

142
Q

In people with MDD, stress activates the amygdala and NE systems causing symptoms of increased vigilance and fear.

People had an exaggerated stress response and increased levels of what two things in the plasma?

A

CRF and NE in the plasma

143
Q

People exposed to childhood stress had an exaggerated or diminished stress response as adults?

A

exaggerated

144
Q

In the depressed person, cortisol levels never really return to the normal pattern when depression resolves.

True or False?

A

False (In the depressed person, cortisol levels return to the normal pattern as depression resolves)

145
Q

Depression has NO effect on thyroid function.

True or False?

A

False

5-10% of persons with depression when tested have a decreased thyroid function

146
Q

Depressed patients with decreased thyroid function are given what in order to reverse this process and speed up the ability to metabolize and respond to treatment with antidepressant medications?

A

thyroid replacement therapy

147
Q

Alteration in what is common in many mental illnesses including depression, and often is one of the prodromal or early warning signs of relapse?

A

the sleep-wake cycle

148
Q

Research has shown that normal sleep cycle is often reversed in depressed individuals where the person reaches deep sleep earlier or later in the cycle?

A

earlier

149
Q

What hormone, produced by the pineal gland, helps to regulate the sleep-wake cycle?

A

Melatonin

150
Q

When does the pineal gland synthesizes and release melatonin?

A

at night

151
Q

The rhythm of the sleep wake cycle is regulated by what?

A

the circadian clock

152
Q

The circadian rhythm’s function is to provide a temporal organization for physiologic processes and behaviours to promote what?

A

effective adaptation to our environment

153
Q

The circadian rhythm’s function is to provide a temporal organization for physiologic processes and behaviours to promote effective adaptation to our environment

This involves regular cycles of sleep and waking and body functions such as what two things, based on changes in the 24-hour light-dark solar day?

A

temperature regulation and hormone secretion

154
Q

Research has shown that some patients with depression have circadian abnormalities of what four things?

A

mood, sleep, temperature, and neuroendocrine secretion

Research has shown that some patients with depression have circadian abnormalities of what four things?

155
Q

The sleep cycle usually reverses instantly to normal, after the resolution of depression.

True or False?

A

False

It may take weeks to months

156
Q

It is important for patients with depression to attempt to normalize the sleep-wake cycle by doing what two interventions?

A

sedative medication and teach sleep-hygiene techniques

157
Q

What signals the brain and serve as mediators between immune and nerve cells?

A

Cytokines

158
Q

The dysregulation of cytokines (these signal the brain and serve as mediators between immune and nerve cells) can result in adverse effects and may manifest as what?

A

symptoms of MDD (and related disorders)

159
Q

Research shows that depression is rare in infectious and autoimmune diseases.

True or False?

A

False

Research shows that depression is common in infectious and autoimmune diseases

160
Q

Exposure to cytokines induces depressive symptoms and cytokine secretion is increased or decreased in MDD?

A

Increased

161
Q

Antidepressants have anti-inflammatory effects and have been used to treat what?

A

chronic pain

162
Q

Depression is often masked as physical illnesses and it is believed that what type of pain can be associated with depression?

A

physical pain

163
Q

Depression is often masked as physical illnesses and it is believed that physical pain can be associated with depression

________________ is a pain-modulating neurotransmitter and the release of _________________ is centrally mediated by ______________.

A

Serotonin, endorphins, serotonin

164
Q

The decrease in availability and action of serotonin at the nerve synapse may be manifested as what?

A

increased subjective experiences of pain (and complaints of physical symptoms of which may be indicative of a depressive illness)

165
Q

It is believed that a way a person interprets their environment and thinks about themselves can induce and perpetuate what?

A

depressive symptoms

166
Q

What type of environmental factor involves distorted negative beliefs and thoughts about the self, the environment, and the future that can induce and perpetuate depressive symptoms?

A

Psychodynamic Factors

167
Q

Psychodynamic Factors involves distorted negative beliefs and thoughts about what three things?

A

the self, the environment, and the future

168
Q

What type of environmental factor involves a severe reduction in rewarding activities or an increase in unpleasant events in one’s life that result in depression and a further restriction of activity, decreasing the likelihood of experiencing pleasurable activities and intensifying a mood disturbance?

A

Behavioural factors

169
Q

Psychodynamic Factors involves a severe reduction in rewarding activities or an increase in unpleasant events in one’s life that result in depression and a further restriction of activity, decreasing the likelihood of what?

A

experiencing pleasurable activities (and intensifying a mood disturbance)

170
Q

What type of environmental factor involves loss of a parent or lack of emotional adequate parenting that may delay or prohibit the realization of appropriate developmental milestones?

A

Developmental Factors

171
Q

Developmental Factors involves what that may delay or prohibit the realization of appropriate developmental milestones?

A

loss of a parent or lack of emotional adequate parenting

172
Q

What type of environmental factor involves a disruption in family dynamics involving maladaptive circular patterns in family interactions that contribute to the onset of depression in family members?

A

Family Distress

173
Q

Family Distress involves a disruption in family dynamics involving what?

A

maladaptive circular patterns in family interactions (that contribute to the onset of depression in family members)

174
Q

What type of environmental factor involves adverse or traumatic life events especially that involve the loss of an important human relationship or role in life that is followed by a depression?

A

Social Factors

175
Q

Social Factors involve traumatic life events that include the loss of an important human relationship or role.

True or False?

A

True

176
Q

Antidepressants may increase what two things, which are dysregulated at the synapse?

A

synaptic sprouting or rewiring of connections

177
Q

What can occur when connections between nerve cells are not used, nerve cells atrophy and volume decreases?

A

Synaptic pruning

178
Q

With pharmacological treatment, the synaptic connections are used and formed and again and the _________ ____________ in the areas implicated in depressions increases.

A

brain volume

179
Q

Antidepressant medications are used to treat what?

A

depression

180
Q

Antidepressant medications effect occur instantaneously.

True or False?

A

False

Their antidepressant effects occur only after chronic administration of days to weeks

181
Q

Antidepressant medications normalize levels of what three neurotransmitters in the brain and their neurotransmission at the synapse?

A

serotonin, dopamine, and NE

182
Q

Antidepressants increase levels of ___________ and affect ____________ ___________ by increasing the activity of neurotransmitters in the synapse and nerve cell volume .

A

BDNF and synaptic plasticity

183
Q

Antidepressant response takes days to weeks because it requires what?

A

sufficient time for the levels of BDNF to gradually rise (and exert synaptic and nerve cell sprouting)

184
Q

What type of antidepressant drugs inhibits the reuptake of serotonin?

A

SSRIs (selective serotonin reuptake inhibitors)

185
Q

Put the Selective serotonin reuptake inhibitors (SSRIs) steps in order:

A: reuptake of serotonin results in less serotonin being released

B: serotonin binds to its postsynaptic receptor

C: SSRIs block the reuptake of serotonin and therefore more will be available in the synaptic cleft

D: serotonin binds to its presynaptic receptor

E: Serotonin/5-HT is released into the synapse

F: SSRIs block the reuptake of serotonin and therefore more will be available in the synaptic cleft

A

E, B, D, A, F

186
Q

What type of antidepressant drugs blocks the degradation of NE and serotonin?

A

MAOIs (monoamine oxidase inhibitors)

187
Q

Put the Monoamine oxidase inhibitors (MAOIs) steps in order:

A: monoamine is inhibited and NE is not broken down as quickly and therefore its action is prolonged

B: NE binds with its postsynaptic receptor

C: action of NE is terminated by the enzymes monoamine oxidase and catecholamine 0-methyltransferase

D: NE is released into the synapse

A

D, B, C, A

188
Q

What type of antidepressant drugs inhibit the uptake of NE and serotonin into the presynaptic terminal allowing NE and serotonin to accumulate in the synapse and thus enhance their action?

A

TCAs (tricyclic antidepressants)

189
Q

What type of therapeutic effect do MAOI have on the neurotransmitters?

A

Increase NE, serotonin, and dopamine

190
Q

What type of side effects do MAOI have?

A

orthostatic hypotension, headache, insomnia, diarrhea

191
Q

What type of therapeutic effect do TCAs have on the neurotransmitters?

A

Increase NE, serotonin, and dopamine

192
Q

What type of side effects do TCAs have?

A

Anticholinergic effects, sweating, sedation, orthostatic hypotension

193
Q

What type of therapeutic effect do SSRIs have on the neurotransmitters?

A

increase serotonin

194
Q

What type of side effects do SSRIs have?

A

nervousness, insomnia, sexual dysfunction, weight gain

195
Q

What type of antidepressant drugs block the reuptake of serotonin and NE?

A

SNRIs (serotonin-norepinephrine reuptake inhibitors)

196
Q

Which antidepressant drugs interact with all other antidepressant drugs?

A

MAOIs (monoamine oxidase inhibitors)

197
Q

Non-pharmacological therapies are believed to work similarly to antidepressant medications, promoting increased what?

A

connectivity at the synapse and nerve cell growth

198
Q

What is the procedure called that electrically stimulates a generalized seizure?

A

ECT (electroconvulsive therapy)

199
Q

Electroconvulsive Therapy (ECT) has a 70-90% effective treatment rate for depression and over 1 million people in the world receive ECT.

True or False?

A

True

200
Q

ECT is given under a general anesthetic with complete muscle relaxation because the _________ _________________ of the seizure does not contribute to the therapeutic effects of the treatment.

A

motor component

201
Q

During ECT, a brief electrical current is passed through the brain to produce a generalized seizure last 25-150 seconds
Does the patient feel the stimulus or recall the procedure?

A

No

202
Q

On average, how many ECT treatments are given at 2-day intervals over a period of 2-4 weeks?

A

6-8

203
Q

The exact mechanism of the antidepressant action of ECT remains unclear.

True or False?

A

True

204
Q

The exact mechanism of the antidepressant action of ECT remains unclear.
However, it is known to down regulate (occurs when there are excess chemical messengers and the # of active receptors decreases)
______________________________ in much the same way as antidepressant medications, therefore lowering the stress response?

A

B-adrenergic receptors

205
Q

ECT produces an up-regulation (Up-regulation occurs when there is a deficiency in the messenger) in
which neurotransmitter?

A

Serotonin

206
Q

ECT produces an up-regulation in serotonin.

There is less serotonin so the number of active receptors for serotonin increases or decreases?

A

increases

207
Q

ECT increases the influx of _____________ in the brain and has effects on second messenger systems.

A

calcium

208
Q

ECT increases the influx of calcium in the brain and has effects on second messenger systems.

First messengers in depression are what?

A

neurotransmitters

209
Q

ECT increases the influx of calcium in the brain and has effects on second messenger systems.

Second messengers are involved in converting the chemical signal into a physiological one that does what?

A

moves the nerve impulse across the nerve cell and onto the next nerve cell

210
Q

ECT has also been shown to down-regulate levels of BDNF.

True or False?

A

False (ECT has also been shown to up-regulate levels of BDNF)

211
Q

After symptoms have improved after ECT, what are used to prevent relapse?

A

antidepressant medications

212
Q

Why is the use of ECT is limited by invasive nature?

A

Due to the requirement of the general anesthetic and risk of retrograde amnesia

213
Q

ECT is only indicated in patients whose depression is what?

A

resistant to conventional treatments

214
Q

What type of non-pharmacological treatment for depression uses artificial light to influence the production of melatonin and the function of the catecholamine systems?

A

phototherapy (light therapy)

215
Q

In Phototherapy, artificial light is believed to trigger what?

A

a shift in the patient’s circadian rhythm (to an earlier time)

216
Q

In Phototherapy, exposure to the light source has produced improvement and relief of depressive symptoms for significant numbers of who?

A

seasonally depressed individuals

217
Q

Phototherapy produces no change for individuals who are not seasonally depressed.

True or False?

A

True

218
Q

What type of non-pharmacological treatment for depression includes vagal nerve stimulation, deep brain stimulation, and transcranial magnetic stimulation?

A

Neurostimulation

219
Q

In Neurostimulation, the techniques are considered treatments for cases of depression that do not respond to medication or ECT.

True or False?

A

True

220
Q

In Neurostimulation, what uses an implanted stimulator that sends electric impulses to the left vagus nerve in the neck via a lead wire implanted under the skin?

A

Vagal Nerve Stimulation (VNS)

221
Q

In Neurostimulation, Vagal Nerve Stimulation (VNS) uses an implanted stimulator that sends electric impulses to the left vagus nerve in the neck via a lead wire implanted under the skin.

VNS has antidepressant properties via its effects on what part of the brain?

A

locus ceruleus (area in the brain stem from which NE neurons originate)

222
Q

What type of non-pharmacological treatment for depression includes implantation of electrodes which are connected to a surgically implanted impulse generator that delivers electrical stimulation to the ventral striatum which has been found to have functional dysregulation in depression?

A

deep brain stimulation (DBS)

223
Q

In deep brain stimulation, the implantation of electrodes which are connected to a surgically implanted impulse generator that delivers electrical stimulation to the ventral striatum which has been found to have functional dysregulation in depression.

Ventral striatum is connectionally associated with the _______ structures.

A

limbic

224
Q

What type of non-pharmacological treatment for depression involves stimulation of the dorsolateral prefrontal cortex by using weak electric currents which are induced in the tissue by rapidly changing magnetic fields or electromagnetic induction.

A

TMS (transcranial magnetic stimulation)

225
Q

In Transcranial Magnetic Stimulation, brain activity can be triggered in the prefrontal cortex which has decreased volume and activity in depression.

True or False?

A

True

226
Q

In Transcranial Magnetic Stimulation, Vagal nerve and transcranial magnetic stimulation have not been approved in Canada for the treatment of MDD.

True or False?

A

False

Vagal nerve and transcranial magnetic stimulation have been approved in Canada for the treatment of MDD

227
Q

What type of non-pharmacological treatment for depression helps to reduce the stressors that trigger episodes
by reducing stressors and negative thinking?

A

Psychotherapy

228
Q

In psychotherapy, the abnormal activity of the neurotransmitters indicated in depression and the stress response can be reduced, aiding in a more normal functioning of BDNF, neurotransmission, neuroendocrine abnormalities, and reduction and/or prevention of the neuroanatomical changes of depression.

True or False?

A

True

229
Q

What type of psychotherapy treatment for depression is focused on identifying, analyzing and ultimately changing the habitually inflexible and negative cognition about oneself, others, and the world that occurs with depression?

A

CBT (cognitive behavioral therapy)

230
Q

The use of cognitive therapy in the acute phase of treatment + medication has grown in the past few years and may be considered first line treatment for who?

A

mildly to moderately depressed outpatients

231
Q

A psychotherapeutic approach may be especially helpful for patients with what two things?

A

history of childhood adversity or recent stress

232
Q

In cases of depression, the nurse must recognize when patient may be depressed and recognize the importance of early detection and intervention that can prevent the neuroanatomical changes in the brain from further what?

A

deterioration

233
Q

In cases of depression, the nurse must recognize the importance of helping patients to manage stress and to focus on prevention of risk factors for depression.

True or False?

A

True

234
Q

Tutorial Question

Depression is best defined as:

A: A disorder characterized by disturbances in speech and thought +/- hallucinations

B: A disorder characterized by disturbances in mood

C:A disorder characterized by intense episodes of fearfulness

D:A disorder characterized by episodes of irritability, elation, and racing thoughts

A

B

235
Q

Tutorial Question

5+ symptoms present during the same ___-________ _________________ and represents a change from previous functioning.

  1. depressed mood
  2. markedly diminished interest or pleasure in activities
  3. significant weight loss (not dieting) or weight gain, or change in appetite
  4. insomnia or hypersomnia
  5. psychomotor agitation or retardation
  6. fatigue or loss of energy
  7. feelings of worthlessness or guilt
  8. diminished ability to think or concentrate (indecisiveness)
  9. thoughts of death, suicidal ideation/attempt
A

2-week period

236
Q

Tutorial Question

Which of the following is a co-morbidity often observed with depression?

A: Chronic pain
B: Diabetes mellitus
C: Heart disease
D: Autoimmune disease
E: All of the above
A

E

237
Q

Tutorial Question

Which clinical manifestation of depression is correctly matched to the CNS structure that is thought to be involved?

Clinical Manifestation:
A: Lack of sleep
B: Anhedonia
C: Lack of insight
D: Memory loss
E: Loss of appetite

CNS Structure:

  1. Amygdala
  2. Prefrontal cortex
  3. Hippocampus
  4. Pineal gland
  5. Hypothalamus
A

A4, B1, C2, D3, E5

238
Q

Tutorial Question

Alterations in which of the following endocrine hormones accounts for the increase in body weight observed in some depressive patients?

A: Catecholamines
B: Thyroid hormone
C: Cortisol
D: Melatonin
E: Dopamine
A

B

239
Q

Tutorial Question

Risk Factors for Depression

  • Childhood emotional, physical and/or sexual abuse(s)
  • Prior episode(s) of depression
  • Family history of depressive disorder
  • Lack of social support
  • Stressful life event
    Current substance abuse
  • Economic difficulties

True or False?

A

True

240
Q

Tutorial Question

Which of the following statements concerning depression is TRUE?

A: Reductions in 5-HT signaling alone are not always sufficient to cause depression
B: ~10% of Canadians suffer from depression, however, 90% of these will commit suicide
C: The prevalence of depression in females is 2x greater than in males as testosterone is thought to be neuro-protective
D: Monozygotic twins have an equal occurrence of depression, suggesting that genetics plays a large role in the etiology

A

A

241
Q

Tutorial Question

The etiology of depression is multi-factorial. What makes up 60-70% and what makes up 30-40%?

A

environment and genetic pre-disposition

242
Q

Tutorial Question

Structural/Functional changes associated with Depression.

Which part of the brain shows a reduction in neuronal cell volume?

A

prefrontal cortex

243
Q

Tutorial Question

Structural/Functional changes associated with Depression.

Which part of the brain shows a reduction in neuronal volume. Memory, emotion, and behavioural responses?

A

Limbic system (hippocampus, amygdala)

244
Q

Tutorial Question

Structural/Functional changes associated with Depression.

Which part of the brain shows elevated cortisol levels. Heightened response to stress -> impairment of hippocampal function?

A

HPA-axis

245
Q

Tutorial Question

How do SSRIs help to treat the symptoms of depression?

A: By increasing synaptic levels of 5-HT
B: By increasing synaptic levels of NE, DA, & 5-HT
C: By increasing synaptic levels of NE & DA
D: By increasing synaptic levels of 5-HT & NE
E: By increasing synaptic levels of NE

A

A

246
Q

Tutorial Question

When are Vagal Nerve Stimulation and TMS considered in the management of patients with severe depression?

A: Only when a decrease in neuronal volume is confirmed by diagnostic imaging
B: Before aggressive pharmacotherapy and or invasive ECT is considered
C: After NT levels have been normalized through the use of pharmaceuticals
D: When conventional treatments and ECT have “epically” failed

A

D

PATHOPHYSIOLOGY (9 decks)

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