DEPRESSION AND BPD Flashcards
It stands for a complex of disturbed feelings (called mood, or affective, disorder)-which may include aspects of despair, hopelessness, sense of worthlessness, and thoughts of selfharm- associated with decreased energy and libido, loss of interest in personal affairs, impaired concentration, various abnormalities of behavior and appearance, and prominent physical complaints
DEPRESSION
As a purely phenomenological observation, an
abnormally elevated mood, or ______ is about one-third
as frequent as depression
mania,
_____ and ______ disorder are the names given to milder forms of mania and bipolar disorder, respectively.
Hypomania
cyclothymic
The DSM classifications also acknowledge the existence of a __________ in which attributes of depression and schizophrenia are combined
mixed schizoaffective state
__________is a particularly frequent somatic manifestation of depression
Chronic pain
_______used for the treatment of multiple sclerosis
and hepatitis, and the _______ may also evoke
a depressive reaction
beta-interferons
phenothiazines
depressed mood may
also emerge during the tapering-off period of _______
medication or during their initial use (a hypomanic
state is more common).
corticosteroid
Patients with psychotic depression with hallucinations and delusions usually have ______infarcts
right temporoparietal infarcts
With regard t o emotional reactions in degenerative
brain diseases, Parkinson disease is complicated by a
depressive reaction in approximately _____
one-quarter of
cases
Another hazard in Parkinson and
in Lewy-body disease is the tendency for L-dopa itself
to provoke a depression in a limited number of patients,
sometimes with ________, ________, _____
suicidal tendencies, paranoid ideation,
and psychotic episodes.
The main risk
for depression during pregnancy is a______
history of previous
depressions.
the essential diagnostic criteria of
endogenous depression ("major depressive syndrome")
consist of a dysphoric mood or loss of interest or pleasure in all usual activities (including sexual activity) in combination with at least four of the following seven symptoms:
1. 2. 3. 4. 5. 6. 7.
(1) disturbance of appetite and change in weight;
(2) sleep disorder; (3) psychomotor retardation or agitation;
(4) decreased energy and fatigue; (5) self-reproach,
feelings of worthlessness or guilt; (6) indecisiveness,
complaints of memory loss and difficulty in concentrating;
and (7) thoughts of death or suicide or actual suicide
attempts.
T or F
In Depressive psychosis
The delusions are generally congruent with the
patient’s mood and are not as fixed or bizarre as those of
schizophrenia or paranoia
T
In Depressive psychosis
_______, when they occur, are usually
transitory, vocal, and vaguely accusatory; their presence
should always raise the possibility of an associated structural
brain disease, drug intoxication, or alcoholic auditory
hallucinosis.
Hallucinations
the illness takes the form of a depressive stupor;
the patient becomes mute, indifferent to nutritional needs,
and neglectful even of bowel and bladder functions (anergic
depression). The condition in this extreme form is a
_________
catatonic depression
________is a disorder of mood consisting of
prolonged episodes of depression, interrupted by, or
coexistent with episodes of mania
Bipolar disease
bipolar psychosis has been divided into two subtypes: the ________ in which only an endogenous depressive illness occurs, and a ______, in which one or more bouts of mania occur with or without depression
unipolar group,
bipolar group
There has been an arbitrary
further subdivision of bipolar I to denote at least one episode
of _______, and bipolar II when the process entails
an episode of _______.
full mania
hypomania
In addition, there are _______, in which
symptoms of both depression and mania occur within a
single episode of the illness.
A so-called _________
form of bipolar disease has also been recognized in which four or more circumscribed episodes occur in a year
mixed affective states
“rapid-cycling”
The __________ is, in most ways, the opposite of the
depressed state, being characterized by a flight of ideas,
motor and speech hyperactivity, and an increased appetite and sex urgE
manic state
The
manic individual appears to possess great drive and
confidence yet lacks the ability to ______
carry out plans.
In its most advanced form, a condition
described as __________” the patient becomes
totally incoherent and altogether disorganized in behavior.
At this stage visual and auditory hallucinations and
paranoid delusions may be rampant
“delirious mania,
______ describes a milder degree of the disorder
but this term is also used loosely to depict behavior in
a normally functioning individual who is unusually
energetic and active
Hypomania
First attacks of either depression or mania last an
average of _________ if untreated, although the duration
varies greatly.
6 months
Variables that are predictive
of an unfavorable outcome in Mania are high degrees of ________, ___________, ________
anxiety, strongly positive family history of a similar psychiatric illness, and presence of depression-provoking circumstances
Hypometabolism in the________ cortex is among the
most consistent findings in depression
left frontal
Also prominent in many studies
are metabolic changes in the _______ and ________ related parts of the medial limbic system, and
the hippocampus
cingulate and orbitofrontal
cortices,
On histologic level, several studies have shown a
depletion of and changes in the _____________ in both depression
and stress,
pyramidal neurons of
the CA3 region of the hippocampus
depressed
patients and their first-degree relatives, as well as healthy
individuals, develop a depressed mood after dietary
depletion of the monoamine precursor tryptophan and
concentrations of 3-methoxy-4-hydroxyphenylglycol
(MHPG), a metabolite of ________
norepinephrine
5-hydroxyindoleacetic
acid (5-HIAA), a deaminated metabolite of _______, is
reduced in the cerebrospinal fluid of depressed patients
serotonin
It had been found
several decades ago that the parenteral administration of
1 to 2 mg of dexamethasone _______ serum cortisol
secretion while the patient was ill with endogenous
depression, but did so after recovery
failed to suppress
The failure of dexamethasone suppression has been
attributed to hyperactivity in the hypothalamic pituitary
axis and a corresponding increase in secretion
of ________, _______ and ______
corticotropin-releasing hormone, adrenocorticotropic
hormone (ACTH), and glucocorticoids
Among patients with primary depressive
disorders, ____________ were
found to have occurred more frequently in the months
preceding the onset of depression than in matched control
groups.
life events of a stressful nature
I n the management o f bipolar and depressive disease, sixmain categories of drugs are in general use- 1 2 3 4 5 6
the tricyclic antidepressants, "atypical" or nontricyclic group of compounds, the MAO inhibitors, serotonin agonists (reuptake inhibitors), antiepileptic drugs, and lithium
____________ has a
tendency to produce insomnia and weight loss, making
it particularly useful in the treatment of depressions that
are characterized by overeating and hypersomnia
Fluoxetine
Patients with anorexia, insomnia, and high
levels of anxiety may do better with a more sedating
medication, such as _______
amitriptyline
The tricyclic antidepressants comprise amitriptyline,
imipramine, desipramine, doxepin, clomipramine, and
trimipramine, and the closely related drugs nortriptyline
and protriptyline. Among this group, most psychiatrists
start with________ or _______ because of their
relative safety.
imipramine or amitriptyline
The therapeutic effect of tricyclic medication
is generally not evident for _______ after treatment
has been initiated, and it is important that this be
explained to the patient and family.
2 to 4 weeks
Caution should be exercised in elderly patients with
cardiac disorders of all types because of the possibility of
causing heart block or arrhythmia. For such patients, the
serotonin drugs or one of a newer group of nontricyclic
antidepressant drugs-________ and _______-may
be preferable, but the latter causes orthostatic hypotension and sedation in doses required for consistent antidepression effects.
bupropion and trazodone
If one of the SSRI or tricyclic and related drugs,
given in full doses for _________ does not produce
the desired effect, or, as often happens, if the patient is
intolerant of the given drug, another one from an alternative group, e.g., an MAO inhibitor, may be tried.
4 to 6 weeks,
