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clinical mental health > Depression And Anxiety > Flashcards

Depression And Anxiety Flashcards

0
Q

Depression

A

Core symptoms
- Absence of positive affect, diminished interest or pleasure
- depressed/Low mood
Emotional, cognitive, physical & behavioural symptoms

Significant unintentional weigh loss or gain
Sleep disturbance (too much or less)
Agitation or psychomotor retardation noticed by others
Reduce concentration
Recurrent thought of death
Fatigue or loss of energy

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1
Q

Depression and anxiety

A

Syndrome which is a combination of symptoms that occur at the same time

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2
Q

Cognitive theory of vicious cycle

A

Thoughts-it’s not worth trying
Emotion -sad, hopeless
Physical- agitation, poor sleep
Behaviour - avoid social interaction

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3
Q

Suicide and self harm risk

A

Depressed people have 4 times more risk of suicide than general population

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4
Q

Deliberate self-harm (DSH)

A

Separate suicidal behaviour
Chronic disorder
Intentionally injuring of one’s own body without apparent intent to die
–>separate from suicide ideation

Due to impulsive compulsive to harm themselves without feeling capable of resisting these

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5
Q

Anxiety disorder

A

Where anxiety is out of proportion to the actual risk and is constant or intrusive enough to cause significant disability

Symptoms share similarity with depression but more physical symptom

Fight or flight response ( autonomic system) adrenaline and cortisol

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6
Q

Types of anxiety disorder

A 
Panic disorder 
General anxiety disorder 
Specific phobia 
Obsessive compulsive disorder 
Post traumatic stress disorder
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7
Q

Specific phobia

A 
Anxiety restricted to phobia 
Autonomic system(physical) 
Avoidance
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8
Q

Agoraphobia

A

Fear of market place/crowded place
Fear of leaving the house, taking tube, entering the shop/crowd, public place

Avoidance of crowd

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9
Q

Social phobia

A

Fear of judgement by others
Avoidance of social contact
Low self-esteem

Avoidance of social contact

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10
Q

Obsessive compulsive disorder

A

Recurrent obsessional thoughts and/or compulsive acts

Obsessive and intrusive thoughts are distressing and unwanted idea/image

The more they try to get rid of this thoughts, the more it occurs in their mind –> anxiety

Compulsive acts are for reducing the anxiety and it repeated so many times that become rituals

Intrusive thoughts-anxiety- compulsive acts- feel better- reduce anxiety- compulsive acts ritualized

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11
Q

Post traumatic stress disorder

A

Delayed response to stressful events

  • reliving/re-experiencing the event (can smell, hear, see the event)
  • responding to trigger (avoid trigger) -flashback
  • anxiety over recurrence (constantly on alert)
  • emotional numbing (to avoid/protect the emotional reaction)
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12
Q

Difference from PTSD

A

Acute stress response (last only hours up to a day) / agitation, confusion etc

Chronic stress response (stress hormone keep releasing and affect emotion and physical)

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13
Q

Epidemiology of depression

A

Most common in 45-64y.o
Women are twice more likely to have depression than men in same age
1 in 10 women experience symptoms of depression after having baby (postpartum depression)

Gender difference emerge after puberty (age 12y.o)

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14
Q

Risk factor of depression

A

Women (2:1)
Most common is 32/45-64
Black, minority ethnic group
Previous history /family history of depression
Significant physical lines - pain and disability
Other mental health problem (dementia, schizophrenia)

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15
Q

Epidemiology of anxiety disorder

A

Phobia (agoraphobia +social phobia) is the most common one

GAD is second most common one

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16
Q

Risk factor for anxiety disorder

A

Female (simple phobia, agoraphobia, GAD)

No gender difference in social phobia, panic disorder , OCD

Divorced/widow
Highest in 25-44yo
 lowest in more than 65 yo
People with disability 
Unemployment 
Black, minority ethnic group
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17
Q

Mixed Depression and anxiety

A

66%of those with depressive disorder also have anxiety, worry or panic

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18
Q

Prognosis of depression

A

Episode =6-8 months

Under 20 or over 65 has higher risk of relapse

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19
Q

Biological risk factor

A 
HPA axis 
Nicotine , cannabis 
Lack of Physical activity 
Genetic predisposition 
biochemical imbalance
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20
Q

Psychological risk factor

A

Entrenched negative thinking style
Negative memory bias
Decreased perceived coping (less self esteem)
Other mental health problems

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21
Q

Social risk factor

A 
Negative Life events 
Social network and support 
Financial difficulties/ unemployment 
Childhood environment (abuse, neglect, bullying) 
War
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22
Q

Cause of depression and anxiety - bio psychosocial model

A

Stress- life events, chronic difficulty
Interpretation- ability to cope with difficulty
Biological - activated HPA axis (hypothalamic-pituitary-adrenal)

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23
Q

Types of depressive disorders

A

Major depression: severe symptoms that interfere social functioning

Persistent depressive disorder: depressed mood that last at least 2 years. They can have episode of major depression along with period of less severe symptoms that last 2 years

Psychotic depression: severe/major depression + some psychosis

Postpartum depression:10-15% of women experience

Seasonal affective disorder:onset of depression during the winter

Bipolar disorder/manic -depressive disorder: less common than major depression or persistent depressive disorder

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24
Q

Popular antidepressants

A

SSRI and SNRI(serotonin and norepinephrine reuptake inhibitor)

  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)

Tricyclics - older antidepressant
Serious side effect of heart condition

MAOIs (monoamine oxidase inhibitor)oldest antidepressant– shouldn’t be taken with SSRI, food restriction,

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25
Q

Psychotherapy for depression

A 
CBT 
Interpersonal therapy (IPT)
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26
Q

Electro convulsive therapy (ECT)

A

Side effect of confusing, memory loss, disorientation that usually last short term.
Usually 6-12 treatments

Newer treatment
-Transcranial magnetic stimulation -stimulation to left dorsalateral prefrontal cortex

-Deep brain stimulation -brain peacemaker stimulating subcallosal area

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27
Q

Behavioural therapy for anxiety disorder

A

CBT

Exposure therapy

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28
Q

What to include when taking history ?

A 
Presenting problem 
-nature of the problem
-recent example 
Development of problem 
-onset
-course 
Early life experience/predisposing factor 
Recent trigger 
Risk 
Maintaining factor 
-biological, social, psychological, environmental, systematic 
Goal
Previous treatment 
Engagement in current treatment plan 
Resource and strength ( when they were coping with stress)
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29
Q

How to take history

A

Principle of funnelling

-start from open question and the narrow down to closed question

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30
Q

Formulation of -4 “P”s model

A
  1. Predisposing factor (what makes the person vulnerable)
  2. precipitants (trigger)
  3. Perpetuating factor (what keeps the symptom)
  4. Protective factor
31
Q

CBT

A 
Focus on present issues 
Structures and active 
Time limited 
Interacting system 
Important of empiricism

Focus on 5 interacting system

  • cognition
  • behaviour
  • emotion
  • physiological
  • environmental
32
Q

Cognition of CBT

A
  1. Core belief: deeply held unconditional belief about self, world and others ( I’m weak, I’m unlovable)
  2. dysfunctional assumptions, rules, conditional belief (if I cannot pass the exam, I’m a loser, I must always pass the exams)
  3. negative automatic thoughts
33
Q

Cognitive model

A 
Early life experience 
Core belief
Assumption and rule 
Critical incident 
Belief/rule activated 
Negative automatic thoughts
-emotion, physiology, behaviour
34
Q

2 neural pathway for anxiety

A

Subcortical pathway

Cortical pathway

35
Q

Subcortical fear pathway

A

Include sensory cortices, dorsal thalamus, amygdala, and physical response system

  • fast, sensitive without significant conscious evaluation
  • lead to immediate arousal and avoidance response
36
Q

Cortical fear pathway

A

Include significant cortical networks involved in

  • executive working memory
  • affective appraisal system

Heavy involvement of the prefrontal cortex in addition to subcortical structure

Slower, evaluative, subjective to more conscious control

37
Q

Neurotransmitter for anxiety

A

GABA : main inhibitory neurotransmitter reducing anxiety, arousal, muscle tone, alertness, cognitive function

  • -benzodiazepines (vallium); bind GABA to receptors
  • –alcohol does it too

Serotonin

38
Q

Beck cognitive model -depression

A

Provides both;
developmental account
>interaction between life-events and vulnerability in terms of developing a depresogenic cognitive structure

And cognitive account
>that explains how low mood is maintained by interpretation of ongoing experience

39
Q

Cause of depression & anxiety - biopsychosocial model

A

Stress; life events, chronic difficulty
Interpretation; ability to cope with difficulties
Biological; activates HPA axis

40
Q

Anxiety

A 
An emotional prediction of danger 
Normal reaction 
Not just an arousal 
Anxiety involves the activation of the fight or flight system 
Mainly learnt
41
Q

Anxiety and arousal are same ?

A

Anxiety involves increased physiological arousal and activation of the fight or flight system

Increased heart rate, blood pressure, adrenaline, muscle tone

Arousal =excitement or pleasure
Anxiety= unpleasant

Anxiety includes arousal but not just arousal

42
Q

Classic conditioning

A

Anxiety becomes associated with an originally non-threatening stimuli due to co-occurrence with anxiety-inducing situation

  • ie you experience violence when ur partner is drunk
    • smell of alcohol = anxiety
43
Q

Operant conditioning

A

After a behaviour, the outcome can encourage or discourage the future use of the behaviour

Anxiety can act as “punishment” to decrease doing something
Or a “reinforcer” if the behaviour leads to an escape from anxiety to increase

Ie, checking the light switch to reduce anxiety about house burning

44
Q

Extinction

A

The association between stimuli and anxiety fade over time as;

The newly anxiety-provoking stimuli appears enough times without original anxiety-provoking event (ie smell of alcohol is no longer accompanied by violence)

Or behaviour is no longer reinforce

45
Q

Cognitive for anxiety

A

Anxiety can be triggered by our understanding of the situation even if it’s completely new

46
Q

Psychological treatment for anxiety

A

Anxiety is maintained because people use coping strategies that are effective for short term at the expense of maintaining the problem in the long term

  • general treatment principle
  • -adjustment of unhelpful belief and appraisal
  • -extinction of anxiety through exposure
  • -breaking down maladaptive coping
47
Q

Adjustment of belief and appraisal

A

This can involve teaching (psychoeducation)

And testing out (behavioural experiments, data gathering)

48
Q

Extinction through exposure

A

Anxiety will fade through sustained exposure to feared situation when danger does not occur

Graded exposure: the person draws up a hierarchy of situations and how much anxiety they cause

Is exposed to each and stays long enough for anxiety to fade before moving on to the next step

Can start with imagination, cues and then the actual situation

49
Q

Breaking down maladaptive coping

A

Maladaptive coping strategies are those that prevent sufficient exposure to feared situation or updating of appraisals

Ie dog phobia-avoid park

50
Q

Two main neural pathways to fear

A

Subcortical pathway

Cortical pathway

Both pass through the amygdala

51
Q

Subcortical fear pathway

A

Include sensory cortices, dorsal thalamus, amygdala and physical response systems

Fast, sensitive, without significant conscious evaluation

Leads to immediate arousal and avoidance response

52
Q

Cortical fear pathway

A

Includes significant cortical networks involved in
>executive working memory
>affective appraisal system

Heavy involvement of the prefrontal cortex in addition to subcortical structures

Slower, evaluative, subjective to more conscious control

53
Q

Neurotransmitter system

A

As anxiety is so complex, many neurotransmitter system have been implicated

Research has focus on two
>GABA
>serotonin

54
Q

GABA

A

Main inhibitory neurotransmitter, important in reducing neural excitability

Increase in GABA function tends to reduce&raquo_space;anxiety, arousal, muscle tone,alertness, cognitive function

Fast acting system, effects felt in minutes to hours

55
Q

Direct GABA modulating drugs

A

Typically bind to GABA or GABA receptor

  • benzodiazepines
  • barbituates
  • alcohol
  • GHB
56
Q

Serotonin

A

Released by the raphe nuclei in brainstorm but affect virtually whole of brain

Gradual level changes leads to slower modulation of other brain circuits, particularly those involved in emotion

14 different serotonergic receptors

57
Q

Serotonergic drugs in anxiety

A

Most antidepressants affect serotonin system and have anxiolytic (anti-anxiety) effects

Selective serotonin reuptake inhibitors (SSRIs) tend to prevent serotonin from being re-absorbed and so increase its level

Most well known fluoxetine or Prozac

58
Q

Depression: some key concept

A

Cognitive theory of depression aim to explain
»development of depressive thinking style
»immediate cognition -how thinking style biases judgments to maintain poor mood

Serotonin and HPA -axis among the most studied biological aspects of depression

59
Q

Depression: Beck Cognitive Model

A

> > thoughts- moment to moment interpretation

> > cognitive bias -ways of processing information that focus us on negative aspects and conclusion

> > dysfunctional schemas-core network of attitudes and beliefs about the self that can be activated by negative events

60
Q

Beck mode : developmental aspect

A

Adverse developmental experience

Dysfunctional attitudes (schema); cognitive vulnerability

Activation by stressful events

Pervasive negative cognitive bias: depression

61
Q

Beck model: cognitive aspect

A

When the dysfunctional schema are activated by negative daily events it leads to negative interpretation bias and a drop in mood

If this repeatedly happens, there is a shift into a depressive mode which affects, emotion, cognitive and behaviour (depressive episode)

As this happens more often, smaller negative events are needed to re-start an episode

62
Q

Behavioural Activation Therapy

A

Attempts to address the negative cycle whereby:

Depressed people reduced short-term distress by avoiding activities that promote long-term well-being

63
Q

Behavioural activation approach

A

Graded approach to initiating activities based on perceived effort

  • monitor activity and mood
  • identify positive behaviour
  • ranking from the least to most difficult
  • set weekly goals and monitor progress

Effective but trial quality low

64
Q

Mindfulness-based CBT

A

Based on practicing and applying techniques from mindfulness meditation to disengage with negative thoughts and emotions

Initial trials have found it reduces relapse in people who have had three or more episodes of depression

65
Q

Does low serotonin cause depression ?

A

No, but changes to the serotonin system likely play a role in maintaining depressive state

Imaging has shown no consistent difference in serotonin receptor

Tryptophan depletion does not induce depression

But evidence that serotonin transport gene (5-HTTLPR) moderates the relationship between stress and depression

66
Q

Newer theories

A

Reduced production of new neurones (neuro genesis) in the hippocampus

Role of body’s response to inflammation (cytokines) as a trigger

67
Q

Depression syndrome

A

Seasonal affective disorder
Psychotic depression
Major depressive disorder
Postpartum depression

68
Q

Negative automatic thoughts (NAT)

A

Streak of thinking/commentary
Common to all of us
Often barely aware of NATs
With training can bring these thoughts into consciousness
Can learn to challenge NAT and thereby reduce distress

69
Q

Assumption/rule in CBT

A

Conditional beliefs/rules that guide action

“If…..then….”
-If I get lower than 60%, I’m a failure

“Should” and “must”
-I should always work hard

70
Q

Core belief

A

Deeply held unconditional beliefs about self, world and others

Usually arising from early life experience
May be reinforced by later experience

71
Q

Emotional symptoms of anxiety

A 
Apprehension or dread 
Trouble concentrating 
Feeling tense and jumpy 
Anticipating the worst 
Irritability 
Restlessness 
Watching for signs of danger 
Feeling like your mine's gone blank
72
Q

Physical symptoms of anxiety

A 
Pounding heart 
Sweating 
Stomach upset or dizziness 
Frequent urination or diarrhea 
Shortness of breath
Tremors and twitches 
Muscle tension 
Headache
Fatigue 
Insomnia
73
Q

Self-help for anxiety attack and anxiety disorder

A 
Write down your worries 
Creat an anxiety worry period 
Accept uncertainty 
Practice relaxation technique 
Reduce alcohol and nicotine 
Exercise 
Sleep
74
Q

DSM IV

A

Depressed mood and/ or loss of interest or pleasure in life activity for at least 2 weeks and at least 5 of the following

Core symptoms :
Depressed mood most of the day
Diminished interest or pleasure in all or most activity

Significant unintentional weight loss or gain
Insomnia / sleep too much
Agitation or psychomotor retardation noticed by others
Fatigue or loss of energy
Feeling of worthlessness or excessive guilt
Diminished ability to think or concentrate or decide
Recurrent thought of death

clinical mental health (12 decks)

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