Depression - Nametz Flashcards
What is the most genetically concordant psychiatric condition?
Bipolar disorder
75-100%
What are the signs of depression caused by biogenic amines?
Caused by low norepinephrine, low dopamine and low serotonin.
In MRI scan: smaller hippocampus
Overactive hypothalamic-pituitary-adrenal axis
Seen in a dexamethasone suppression test
What are the types of depression?
– adjustment diisorder
– bereavement
– major depressive disorder
– dystthymiia
– bipolar disorder (often begins as depressed state)
– substance induced depression
– depression secondary to a medical
disorder (before condition is known)
• Premenstrual dysphoric disorder (during luteal period, resolves once menses begins)
• Postpartum Depression
• Post psychotic Depression (after recover and realize what happened)
• Brief depressive disorder (<2 weeks)
• Minor depressive disorder
(att lleastt 2 weeks,, butt fewer tthan 5 iittems of MDD, never psychotic or anhydric)
What are the symptoms that meet the first criteria for a major depressive episode?
(9)
At lleastt one
of tthe sympttoms iis eiitther ((1)) depressed mood or ((2)) lloss of iintterestt or plleasure- anhydonia
– 1 Depressed mood mostt of tthe day,, nearlly every day
– 2 Marked diimiiniished iintterestt or plleasure iin allll,, or allmostt allll,, acttiiviittiies
mostt of tthe day,, nearlly every day
– 3 Siigniifiicantt weiightt lloss ((when nott diiettiing)) or weiightt gaiin,, or decrease
or iincrease iin appettiitte nearlly every day
– 4 Insomniia or hypersomniia nearlly every day (hypersomnia and weightgain are atypical)
– 5 Psychomottor agiittattiion or rettardattiion nearlly every day ((nott merelly subjjecttiive feelliings of resttllessness or beiing sllowed down))
– 6 Fattiigue or lloss of energy nearlly every day
– 7 Feelliings of wortthllessness or excessiive or iinappropriiatte guiilltt ((whiich
may be dellusiionall)) nearlly every day ((nott merelly sellf–reproach or feelliings of guiilltt aboutt beiing siick))
– 8 Diimiiniished abiilliitty tto tthiink or concenttratte,, or iindeciisiiveness,, nearlly every day
– 9 Recurrentt tthoughtts of deatth ((nott merelly fear of dyiing)),, recurrentt suiiciidall iideattiion,, or a suiiciide attttemptt..
What are the criteria for a major depressive episode?
(4)
A. Fiive ((or more)) of tthe follllowiing sympttoms have been presentt duriing tthe same
2–week periiod and representt a change from previious functtiioniing
• B The symptoms cause clinically significant distress or
impairment in social, occupational, or other important
areas of functioning.
• C The symptoms are not due to the direct physiologic
effects of a substance or a general medical condition.
• D The symptoms do not meet criteria for a Mixed
Episode (Bipolar) and are not better accounted for by
Bereavement.
What are the symptoms in the second criteria for dysthymic disorder?
– 1 poor appetite or overeating
– 2 insomnia or hypersomnia
– 3 low energy or fatigue
– 4 low self-esteem
– 5 poor concentration or difficulty making
decision
– 6 feelings of hopelessness
What are the criteria for dysthymic disorder?
• A Depressed mood mostt off tthe day,, nearlly
every day,, ffor att lleastt 2 years ((iin adollescentts
1 year))
• B Presence off ttwo or more of the symptoms (does NOT include anhydonia)
During the 2-year period the person has never been without the symptoms in Criteria A and B for more than 2 months at a time.
• C The symptoms are not due to the direct physiologic effects of a substance or a general medical condition.
• D No Major Depressive Episode during the first 2 years of disturbance which is not better accounted for by chronic MDD, or MDD in partial remission.
• E No history of manic, hypomanic or mixed episode
• F Not occur exclusively during chronic psychotic disorder, such as Schizophrenia or Delusional disorder
• G Not due to direct psychological effect of a substance abuse or a general medical condition
What is the difference between depression in dementia and pseudodementia?
Pseudodementia:
Attention and concentration preserved
“Don’t know” answers
Orientation tests answered “don’t know”
Recent and remote memory impaired equally
Variability in performance on tasks of similar difficulty
Dementia:
Faulty attention and concentration
Near-miss answers
Mistakenly answered orientation tests
Recent memory more impaired
Consistently poor performance on tasks of similar difficulty
What are the classes of antidepressive treatments?
Tricyclic Antidepressants
SSRI (Specific serotonin/norepinephrine reuptake inhibitors)
SSRI (serotonin only)
MAO (monoamine oxidase) inhibitors
RIMA (Reversible Inhibitors of MAO
Mirtazabine (alpha-presynaptic auto- and hetero- receptors inhibitor and 5HT2 and 5HT3-postsynaptic blocker
Bupropion (Norepinephrine/dopamine reuptake inhibitor)
Trazodone and nefazodone (Serotonin reuptake inhibitor/serotonin antagonist)
What are the effects blockage of each group of receptors?
M1 (anticholinergic receptor): blockage causes somnolescence and overeating
Alpha-1 receptors: blockagte causes orthostatic hypotension and tachycardia
SRI and NRI: block without other receptors
What are types of Tricyclic Antidepressants (TCA’s), what do they block, and what are their side effects?
Amitriptyline, Imipramine , Desipramine
, Clomipramine
Serotonin/norepinephrine reuptake
inhibitor, M1, H1, α1 blocker.
Muscarinic:
dry mouth
constipation
urinary retention
blurred vision
dizziness
memory disturbance
tachycardia
Histaminergic:
sedation
weight gain
drowsiness
α1-adrenergic:
drowsiness
dizziness
postural hypotension
reflex tachycardia
What are SSRIs, what side effects are related?
fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, escitalopram
Stimulation of:
5-HT(2A):
Behavioral activation, insomnia, anxiety, sexual dysfunction (delayed ejaculation and anorgasmia)
5-HT(2C)
Irritability, decreased appetite
5-HT(3)
Nausea, headache and emesis
What are side effects associated with noradrenaline receptor stimulation?
Tachycardia, tremor, agitation/activation
Blood pressure effects and sweating
What are SNRIs and what are its side effects?
(venlafaxine, milnacipran,
duloxetine) Specific
serotonin/norepinephrine reuptake inhibitor
- Urinary retention
- Arterial hypertension
- Weight loss
- Weight gain
- Increased tendency of sweating
- Headache
- Constipation
- Reduced salivation
- Nausea
- Orthostatic dizziness
- Palpitations
- Tremor
