Depressive, Bipolar and related disorders Flashcards
withdrawal and discontinuation syndrome with antidepressants
- physical symptoms (dizziness, diarrhea, insomnia)
- psychological symptoms (anxiety, agitaiton, confusion)
- titrate dose to prevent this
when does bipolar disorder develop
- late teens or early adulthood
- moslty before 25
what should be monitored when taking SSRIs
- thyroid function
- side effects
- therapuetic effects
- watch for suicideal thoughts, hypomania, disinhibition
what needs to happen to be diagnosed with disorder
- affects daily activities and QOL
what needs to be monitored when on lithium
- lithium levels in the blood (0.8-1.2)
what is the leading helath problem of 21st centery
- depressive disorder
what is prefrontal cortex responsible for (neuroanatomical)
congnition
- decision making
what is it called when major depressive episode and dysthymic overlap
double depression
what do you monitor for when on carbamazepine
- agranulocytosis
- SJS
what do SSRIs do:
- increase serotonergic activity
- decrease action of presynaptic reuptake pump
- allows neurotransmitters to stay in synapse
what diagnostics for persisitant depressive disorder
- 2 or more symptoms for a year
what criteria is needed to be diagnosed with MDD
- 5 or more symptoms for 2 week span
Volproates (anticonvulsants) monitoring
- thrombocytopenia
- extensive hepatic excretion
TCAs monitoring:
- cardiac screening
- serum potassium
TCAs MOA
block reuptake of serotonin and norepineprhine
SNRIs treat depression by:
- inhibiting reuptakes of serotonin and norepineprhine
- increased stimulation of post-synaptic receptors
side effects of TCAs
- orthostaic hypotension
- diaphoresis
- sedation
- cardiac toxicity
- seizures
serotonin modulators side effects
- nausea
- fatigue
- dry mouth
- constipation
- weakness
serotonin modulators MOA
- impacts serotonin, modulate one or more serotonin receptors and inhibit reuptake of serotonin
S/E of SNRIs
- nausea
- dizziness
- diaphoresis -
- increased BP/HR
S/E of lithium carbonate
- tremor, polyuria, polydispsia, weight gain, diarrhea
risk factors
- prior episodes
- family history
- lack social support
- stress
- economic difficulties
remission
- minimal to no symptoms for more than 2 months
relapse
- a return to fully symptomatic state during remission
recurrence
- appearance of new episode during recovery (not same as before)
recovery
- extended period of remission 6-12 months or more
psychotherapuetic apporaches
- CBT - bring in positive
- interpersoanl psychotherapy (imporve social)
psychosocial factors
- cognitive
- interpersonal
- learned helplessness
- attachment
protective factors
- low risk family history
- engagment
- resilience
neurotranmistter affetcing depression
- low levels of serotinin
- low levels of nor-epinephrine and dopmaine
neuroanatomical
- low activity in dorsolateral prefrontal cortex and high limbic system
mood stabilizer treatment
- used to treat symptoms of mania
mood disorders
- bipolar
- depression
monitoring of SNRIs
- check baseline BP/HR
- height and weight in kids
MAOIs MAO
- block monoamine oxidase in synaptic cleft
- not first or second line treatment
major depression is considered:
- persistant and reaccuring
lithium carbonate (mood stabilizer) MOA
- lithium reduces excitatory (dopamine and glutamate) and increases inhibitory (GABA) neurotransmission
if SSRIs dont work then what?
- use SNRIs
hormonal disturbances in depression
- hypothyroidsim
goals for use of mood stabilizers
- rapid relief of mania
- prevent reaccurnece
- imporve functioning and QOL
ECT treatment
- for clients who do not respond to medications
dysthymic disorder
- mild, chronic form of MDD
- eating, sleeping are effected
- low energy
- cant make decisions
DSM-5 diagnostic for hypomania episodes
- abnormal behvaiors, persistently elevated, irritbale for 4 days
- less severe than full mania on daily functioning
DSM-5 criteria for manic episodes
- elevated, expansive, irritable mood, high energy lasting a week
- 3 or more symptoms
- elevated form normal behaviors
cytothymia contains:
- dysthymia and hypomania
common treatment options for major depression
- psychotherapuetic approaches
- psychopharmacologic approaches
- electroconvulsive therapy
cognitive theory
- negative veiw of self
- stressors
catatonic sympotms
- lack of movement, stoned face, non-responsive to stimuli
carbamazepine (anticonvulsant) S/E
- dizziness,
- drowsiness
- ataxia
- nausea, vomiting
Bipolar II criteria
- starts with major depressive episode
- has hypomania episodes
bipolar I disorder
- combination of full manic episodes and depressive disorder
- more severe mania episodes
- mania starts first
- depressive episodes usually occur
bipolar disorder
- brain disorder causing shifts in mood, energy, activity levels, and ability to carry out daily tasks
biological fatcors of depression
- neurotransmitter
- homronal disturbances
neuroanatomical
atypical antidepressants (buproprion) MOA
- change elvels of neurotransmitters (dopamine, serotonin, norepinephrine)
- effecting chnages in brain chemisrty and communication in brain nerve cell
atypical antidepressant monitoring and side effects
- weight and BP/HR
- dry mouth, nausea, dizziness, anxiety, seizure risk
antidepressants
- 1st generation (old)
- 2nd generation (new)
anticonvulsants S/E
- nausea, vomiting
- headache
- dizziness
- increased appetite
anticonvulsants (mood stabilizers) MOA
- enhances GABA and stabilization fo sodium channels/prevention of neuronal firing
anhedonia
- negative symptoms with lack of pleasure
additonal lithium monitoring
- BUN, Cr, thyroid hormones and CBC
- kidney damage
- dry skin, constipation
A/E of MAOIs
- dizziness, fatigue
- serotonin syndrome
- hypertensive crisis
2nd generation first line of choice
- SSRIs
