Depression, Anxiety, and Dementia Flashcards
Define mood
Sustained emotion that impacts our perception of the world and how we function in it
What neurotransmitters are involved in the neurobiology hypothesis?
Norepinephrine, dopamine, and seratonin
Conditions associated with major depressive disorder?
Neuro disorders, cancers, autoimmune, CV conditions
Risk factors for depression
previous depression, family history, lack of social support, stressful life event current substance use, medical comorbidity
When do you need medication for depression?
Suicidal, loss of function, impacts daily life
DSM 5 requirements for depression
Need 5
- Depressed mood or or loss of interest and pleasure
- Weight loss or gain
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Fatigue or loss of energy
- Worthlessness or guilt
- Diminished ability to think or concentrate
- Reucurrent thought of death
Differential diagnosis of major depressive disorder?
Major depression with psychotic feature, bipolar disorder, dysthymic disorder, cyclothymic disorder, seasonal affective disorder, adjustment disorder with depressed mood, post part depression
What does SIG E CAPS
Sleep changes, interest lost, guilt, energy, cognition, appetite, psychomotor, suicide
Best treatment for depression?
Medication and psychotherapy
SSRIs medications
fluoxetine ( prozac)
Citlaopram (celexa)
Escitalopram (lexapro)
Paroxetine (paxil)
SSRI side effects?
motor restlessness, anxity and agitiation, insomnia, sedation sexual dysfunction, serotnin syndrome
What should you do for SSRi side effects?
Take them at night
TCA side effects?
Anticholinergic and sedative side effects
Major problem of TCA?
Cardiovascular toxicity with over dose
Atypical Antidepressants?
SNRI
Venlafaxine (effexor), duloxetine (cymbalta), nefazodone (serzone)
When do you stop antidepressants?
6-9 months after depression symptoms
First line drug for depression?
SSRIs
Differential diagnosis of anxiety
Hypo/hyperthryoid, mitral valve disorders, TBI, B12 deficiency, CNS disorders, OTC abuse of mediations, electrolyte imbalances
What rules out anxiety?
- History does not fit (no significant life stressors or family history)
- later in life
- states that happened at same time as headache or decrease in cognitive function
What is Adjustment disorder?
Development in response to identifiable stress with distress that is out of proportion to the severity that might influent function.
Generalized anxiety disorder
> 6 months, excessive anxiety and worry with or without panic attacks
Panic Disroder
> 1 month, persistent worry, maladaptive behavior
Acute Stress Disorder and PTSD?
Length of time with PTSD longer than a month, with multiple systemic affected
What should you screen for with anxiety?
Depression and substance abuse. Always screen for all three at the same time.
Most common complaint for anxiety?
Insomnia
First line drug for anxiety?
SSRIs
Who do SNRIs work best for with anxiety?
Those with chronic pain, non-specific
Who are benzos best for?
Short term solution that does not call for significant impairment of functionality (i.e. speech, plane ride)
Who shouldn’t bento’s be prescribed for?
The elderly
Who is BuSpar good for?
Chronic anxiety without abuse potential
Differential Diagnosis for dementias?
B12, folate, thyroid disease, neurosyphilis, organ failure, HIV, stroke, Huntington’s, delirium, UTI
Most common type of dementia?
Alzheimers
When should you start treatment for alzheimer’s?
As soon as possible
Vascular dementia?
Sudden or gradual onset with patchy, focal neurological deficits from stroke, TIA, DM, MI and CAD (risk factors)
What is Pick’s disease?
Like FT dementia, but early onset and familial tendencies
Lewi body Dementia?
Usually with Parkinson’s dementia, occurs quickly, with neuroleptic sensitivity
frontotemporal Dementia
Usually less than 60 y.o. with decline in interpersonal conduct and emotional blunting
What shouldn’t you prescribe with dementias?
Antipsychotics
Who can help differentiate the different dementias?
Neuropsychologist
What score suggests a problem on MMSE?
25 and less suggests organic disease (book says 27)
