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NMSP Exam 3 > Depressive Disorders, Anxiety Disorders, and Bipolar and Related Disorders > Flashcards

Depressive Disorders, Anxiety Disorders, and Bipolar and Related Disorders Flashcards

1
Q

What are some genetic causes of major depressive disorder?

A
  • Family studies: 10-25% of patients with mood disorders have a first degree relative with a mood disorder and 50% of patients with Bipolar disorder have a first degree relative with a mood disorder
  • Adoption studies
  • Linkage studies
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2
Q

How can norepinephrine cause major depressive disorder?

A
  • Down regulate beta adrenergic receptors; noradrenergic function abnormal in depression
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3
Q

How can dopamine cause major depressive disorder?

A
  • Decreased in depression and increased in mania
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4
Q

How can 5-HT cause major depressive disorder?

A
  • Decreased in depression (SSRIs proved effective as anti-depressants
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5
Q

How can GABA cause major depressive disorder?

A
  • Inhibitory neurotransmitter: reduced in patients with depression
  • Site of action for anxiolytic agents, benzodiazepines enhance GABA activity
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6
Q

How can glutamate cause major depressive disorder?

A
  • Excitatory neurotransmitter
  • Implicated in dementia
  • Glutamate receptor, NMDA involved in current antidepressant studies
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7
Q

What are some psychosocial factors/stressors that could cause major depressive disorder?

A
  • Often proceed first mood episode than subsequent episodes
  • Death of a parent before age 11
  • Death of a spouse or child
  • Unemployment
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8
Q

What constitutes a major depressive episode?

A

At least 5 of the following for 2 weeks with at least either depressed mood or loss of interest or pleasure

  1. Depressed mood most of the day, nearly every day
  2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day nearly every day
  3. Significant weight loss or weight gain when not dieting
  4. Insomnia or hypersomnia nearly every day
  5. Psychomotor agitation or retardation nearly every day
  6. Fatigue or loss of energy nearly every day
  7. Feelings of worthlessness or excessive guilt
  8. Diminished ability to think or concentrate
  9. Recurrent thoughts of death or suicide
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9
Q

How is the diagnosis of major depressive disorder made?

A
  • Requires the presence of one or more major depressive episodes and the absence of any manic, hypomanic, or mixed episodes
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10
Q

What are some associated features of major depressive disoder?

A
  • Psychotic: hallucinations, delusions
  • Anxious distress
  • Melancholic
  • Catatonic
  • Peripartum onset: during pregnancy or 4 weeks after
  • Mixed features: manic/hypomanic symptoms
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11
Q

What is the treatment for major depressive disorder?

A
  • Hospitalization

- Somatic therapies like TCAs, SSRIs, MOAs, Trazodone, bupropion, SNRIs, Mirtazapin

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12
Q

How was electroconvulsive therapy used for major depressive disorder?

A
  • Used for treatment resistant depression
  • First used in italy in 1938
  • Short term memory loss common
  • Induces a seizure
  • Safe and effective
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13
Q

How can transcranial magnetic stimulation used for major depressive disorder?

A
  • Relatively newer treatment
  • Magnetic field stimulates neuronal pathways
  • Thought at first to be almost as effective as ECT
  • Can be done in doctor’s office
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14
Q

How is ketamine used to treat major depressive disorder?

A
  • Produces dissociative anesthesia
  • NMDA antagonist
  • Overdose may lead to panic attacks and aggressive behavior; rarely seizures, increased ICP, and cardiac arrest
  • Very similar in chemical makeup to PCP, but is shorter acting and less toxic
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15
Q

What is the off label use for ketamine?

A
  • Treatment resistant depression

- Administered by psychiatrist

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16
Q

What is Spravato?

A
  • FDA approved on March 5 for treatment resistant depression
  • Nasal spray
  • Rapid acting
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17
Q

What is persistent depressive disorder?

A
  • Depressed mood for most of the day (at least 2 years in duration for adults and 1 year for children) that has not been severe enough to meet criteria for major depressive episode
  • During 2 years, cannot be without symptoms for more than 2 months at a time (is continuous)
  • Patients must have never have met criteria for manic episode, mixed episode, or hypomanic episode
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18
Q

What is the treatment of persistent depressive/dysthymic disorder?

A
  • Can be more difficult to treat
  • Pharmacology (SSRIs, SNRIs, and MOAIs)
  • Cognitive behavioral therapy
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19
Q

What is an essential feature of depression with seasonal pattern?

A
  • Essential feature is the onset and remission of major depressive episodes at characteristic times of the year
  • Often with the change of the seasons
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20
Q

What was depression with seasonal pattern formerly called?

A
  • Seasonal Affective Disorder (SAD)
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21
Q

When do most episodes of depression with seasonal pattern usually occur?

A
  • Begin in fall or winter and will remit in summer
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22
Q

What does someone with depression with seasonal pattern usually look like? Treatment?

A
  • Sleep more and eat more; fatigued

- Light therapy

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23
Q

What is premenstrual dysphoric disorder (PMDD) look like?

A
  • Mood instability with anxiety, depression, irritability, sleep disturbances
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24
Q

When does PMDD occur?

A
  • The week before menses
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25
Q

What is the treatment for PMDD?

A
  • Exercise, diet, relaxation therapy

- SSRIs

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26
Q

What is a manic episode?

A
  • Abnormally and persistently elevated, expansive, or irritable mood lasting at least one week with at least three mood disturbances and increased energy
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27
Q

What mood disturbances are needed to diagnose a manic epidsode?

A
  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • More talkative
  • Flight of ideas/racing thoughts
  • Distractibility
  • Increased goal-oriented behavior
  • Excessive involvement in pleasurable activities
28
Q

What is a hypomanic episode?

A
  • Similar to manic episode but is less severe
  • Episodes only need to last 4 days and must not include psychotic features
  • No social/occupational impairment
29
Q

What is bipolar I disorder?

A
  • Single manic episode is necessary to diagnose
  • At least one manic or mixed episode
  • Major depressive episode not required for diagnosis
  • Can be psychotic episode
  • Worse prognosis than MDD
30
Q

What is bipolar II disorder?

A
  • Patients have had at least one major depressive episode and one hypomanic episode in the absence of any manic or mixed episodes
31
Q

Which bipolar disorder is more prevalent?

A
  • Bipolar II
32
Q

What is the treatment for bipolar disorders?

A
  • Mood stabilizers (lithium and valproic acid)
  • Carbamazepine
  • Second generation antipsychotics
  • Lamotrigine
  • Antidepressants can precipitate manic symptoms
33
Q

What is cyclothymic disorder?

A
  • Characterized as dysthymic disorder with intermittent hypomanic periods
34
Q

How is the diagnosis made for cyclothymic disorder?

A
  • A patient who, over the last 2 years, experiences repeated episodes of hypomania and depression (not severe enough to meet criteria for major depressive disorder)
35
Q

What is the treatment for cyclothymic disorder?

A
  • Mood stabilizing drugs

- Supportive psychotherapy

36
Q

What are some psychological symptoms with anxiety disorders?

A
  • Apprehension, worry
  • Sense of doom or panic
  • Hypervigilance
  • Difficulty concentrating
  • Derealization
37
Q

What are some somatic symptoms with anxiety disorders?

A
  • Headache
  • Dizziness
  • Lightheaded
  • Palpitations
  • Lump in throat
  • Restlessness
  • SOB
  • Dry mouth
  • Sweating
38
Q

What are some physical signs with anxiety signs?

A
  • Diaphoresis, cool/clammy skin
  • Tachycardia
  • Flushing
  • Hyperreflexia, tremor
  • Fidgeting
39
Q

What is involved in generalized anxiety?

A
  • Involved worry about actual circumstances, events, or conflicts
  • Often accompanies panic anxiety
  • Symptoms of generalized anxiety fluctuate more than those of panic anxiety
40
Q

What are some diagnostic categories of anxiety?

A
  • Separation anxiety disorder
  • Panic disorder
  • Agoraphobia
  • Generalized anxiety disorder
  • OCD
  • Specific phobias/social phobias
  • PTSD
41
Q

What are some qualities of separation anxiety disorder?

A
  • Recurrent excessive stress when anticipating or experiencing separation from major attachment figures or home
  • Persistent and excessive worry about losing major attachment figures or harm to them
  • In response to fear of separation from an attachment figure
  • Excessive worry about experiencing a negative event
  • Refusal to go out, such as from home, to school, or to work
  • Fear of being alone or without major attachment figures at home or in other settings
  • Reluctance or refusal to sleep away from home or to go to sleep
  • Repeated nightmares involving the theme of separation
  • Repeated complaints of physical symptoms when separation from major attachment figures occurs or is anticipated
42
Q

What are some qualities of some panic disorder?

A
  • Recurrent unexpected panic attacks
  • At least one attack followed by one month or longer of one or more:
    1. persistent concern about additional attacks
    2. worry about the implications of the attack or its consequences
    3. significant change in behavior related to the attacks
43
Q

What could be present in panic disorder?

A
  • Agoraphobia
44
Q

What is a panic attack?

A
  • A discrete period of intense fear or discomfort, in which four or more of the following developed abruptly and reached peak within 10 minutes and usually last greater than 25 minutes
45
Q

What are some symptoms of a panic attack?

A
  • Palpitations
  • Sweating
  • Trembling/shaking
  • Sensations of SOB
  • Chest pain or discomfort
  • Feeling dizzy/unsteady/lightheaded
  • Fear of losing control or going crazy or dying
  • Paresthesias
  • Chills or Hot flashes
46
Q

Who is more likely to be affected by panic disorder?

A
  • Women

- Average age is 25 years old

47
Q

What is panic disorder most likely associated with?

A
  • Lifetime history of suicidal ideation
  • Suicide attempts
  • Has a strong genetic component
48
Q

What is agoraphobia?

A
  • Anxiety about being in situations from which escape might be difficult of embarrassing or for which help may not be available in the event of panic
49
Q

What is an example of agoraphobia?

A
  • Being away from home
  • Sitting in the middle of a row in the movie theater
  • Being in an elevator
  • Traveling in a plane
50
Q

What is agoraphobia associated with?

A
  • Panic disorder
51
Q

What is social phobia (social anxiety disorder)?

A
  • Fear, anxiety, or avoidance is persistent, typically lasting or more months
52
Q

What are some qualities of social phobia?

A
  • Persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others
  • Exposure to the feared situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed Panic attack
  • Person recognizes that this fear is unreasonable or excessive
  • Feared situations are avoided or else are endured with intense anxiety and distress
53
Q

What is generalized anxiety disorder?

A
  • Excessive anxiety and worry, occurring more days than not for at least 6 months, for most of the day, about a number of events or activities
54
Q

What physical symptoms are associated with generalized anxiety disorder?

A
  • Restlessness or feeling on edge
  • Easily fatigued
  • Difficulty concentrating
  • Irritability
  • Muscle tension
  • Sleep disturbance
55
Q

What is a part of OCD and related disorders?

A
  • Can have either obsessions or compulsions
56
Q

What are some obsessions seen in OCD?

A
  • Recurrent and persistent thoughts, impulses or images experienced as intrusive and inappropriate and causing marked anxiety or distress
  • Not simply excessive worries about real life issues
  • Person attempts to ignore or suppress these thoughts
  • Person recognizes them as a product of their own mind
57
Q

What are some compulsions seen in OCD?

A
  • Repetitive behaviors or mental acts that the person feels drive to perform
  • Aimed at preventing or reducing distress or preventing some dreaded event/situation
58
Q

What are some OCD related disorders?

A
  • Hoarding disorder
  • Trichotillomania (hair pulling)
  • Excoriation disorder (skin picking)
  • Substance medication induced obsessive-compulsive and related disorder
  • Obsessive-compulsive and related disorder due to another medical condition
59
Q

What is the difference between OCD and OCPD (obsessive-compulsive personality disorder)?

A
  • OCPD: they do not think they have a problem

- OCD: they know their compulsions and obsessions are not reasonable

60
Q

What are some specific types of obsessions?

A
  • Contamination
  • Safety/harm
  • Unwanted acts of aggression
  • Unacceptable sexual or religious thoughts
  • Need for symmetry or exactness
  • Excessive cleaning
  • Checking, ordering and arranging rituals
  • Counting; repeating routine activities
  • Some are unobservable mental rituals
61
Q

What are some specific phobias?

A
  • Arachnophobia - fear of spiders
  • Iatrophobia - fear of doctors
  • Acrophobia - fear of heights
62
Q

What are some psychotherapy treatments for anxiety?

A
  • Supportive therapy
  • Psychodynamic psychotherapy
  • Cognitive behavioral therapy
63
Q

What are some psychopharmacology treatments for anxiety?

A
  • SSRIs
  • SNRIs
  • TCAs
  • MOAIs
  • Buspirone
  • Benzodiazepines
  • Antipsychotics
64
Q

What is a helpful pneumonic for depression?

A
  • SIG E CAPS
65
Q

What does SIG E CAPS stand for?

A
  • Sleep (lack of)
  • Interest (anhedonia)
  • Guilt
  • Energy (lack of)
  • Concentration (difficulty)
  • Appetite (decreased or increased)
  • Psychomotor (decreased)
  • Suicidal ideation
66
Q

What is a helpful pneumonic for manic?

A
  • DIG FAST
67
Q

What does DIG FAST stand for?

A
  • Distractibility
  • Inflated self esteem/impulsive
  • Grandiosity
  • Flight of ideas (racing thoughts)
  • Activity (increased)/Agitation
  • Speech-pressured
  • Thoughtlessness

NMSP Exam 3 (18 decks)

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