E3 Depression, Anxiety, Addiction Flashcards
Dopamine
-Attention
-Motivation
-Pleasure
-Reward
-Focus
-Energy/motivation
-Learning
-Antianxiety
Norepinephrine
-Alertness
-Energy
Serotonin (5HT)
-Obsessions
-Compulsions
-Happiness
-Sleep
GABA
Relaxation
Dopamine deficit
Parkinson-like symptoms
-Slow reaction time
-Anergia (abnormal lack of energy)
-Anhedonia “please center” dysfuntion
Serotonin deficit
OCD-like symptoms
-Obsessive thoughts
-compulsive behavior
-Impulsivity
-Suicide
-Aggression
-Susceptibility to “cue triggers”
GABA dysfunction is associated with
anxiety disorders especially panic disorders
High levels of Norepinephrine associated with
Anxiety, stress, hyperactivity
Low levels of Norepinephrine associated with
Lack of energy, focus, motivation
Depression is most common in
Unmarried Caucasian Women
Those with depression have a 64% greater risk of developing
coronary artery disease
Diagnosis of Depression requires
the presence of multiple symptoms that are intense enough to cause distress and to persistently impair psychosocial functioning
Depressive symptoms
-Loss of interest or pleasure
-Fatigue
-Restlessness, irritability
-Impaired concentration
-Low self-esteem
-Negative thinking
-Sleep disturbances
-Appetite disturbances
Depression treatment
-Medications (weeks to see results)
-Psychotherapy: talk therapy
-Cognitive behavioral therapy
-Pyschoeducation & support groups
-Brain stimulation therapy (last resort)
Panic disorder is characterized by two important psychological symptoms :
Anticipatory anxiety: fearful expectation of panic anxiety onset
Avoidance anxiety: personal strategies used to increase feeling of control and decrease the risk of panic anxiety
Overwhelming stress can induce circulating stress hormones which stimulate ______
glutamate
What is panic?
-Unexpected episodes
-Out of proportion to events going on around patient
What is Panic attacks?
Recurrent uncomfortable episodes with sudden onset with symptoms
-Heart palpitations
-Chest pain
-SOA/smothering
-Dizziness
-Nausea
-Fear of losing control
-Tingling in hands
-Flushing or chills
-VS change
Treatment of Panic disorders
-Cognitive behavioral therapy: reduce fearful thinking & cognitive/ physical stress response
-Anti-depressants: SSRI, SNRI, TCA, MAO inhibitors
-Benzodiazepines (for panic attack)
What is generalized anxiety disorder?
-Chronic condition
-Anxiety >6 months
-Excessive, uncontrolled, unrealistic worry
-Accompanied by muscle tension, autonomic hyperactivity, exaggerated startle, difficulty concentrating
Risk factors for generalized anxiety disorder?
- Excessive use of certain substances
- Childhood abuse or family trauma
- Genetics (fam hx)
Treatment of generalized anxiety disorder?
-Cognitive behavioral therapy
-Antidepressants: SNRIs & SSRIs
-Buspirone
-Benzodiazapines
What are the 3 core symptoms of PTSD?
- Hyper-arousal
- Avoidance of reminders
- Re-experiencing the events
What is PTSD?
Chronic activation of the stress response in relation to exposure to potentially life-threatening event
PTSD is characterized by
vivid flashbacks, nightmares, emotional blunting, irritability, exaggerated startle
memory, sleep, and depression probs very common
What are the top 4 causes of PTSD in men and women?
Men: Rape, combat exposure, childhood neglect, childhood physical abuse
Women: Rape, sexual molestation, physical attack, being threatened with a weapon
PTSD treament
-Psychotherapy: trauma focused, exposure therapy, Cognitive behavioral therapy
-EMDR: eye movement desensitization and reprocessing
-SSRIs (Paroxetine & sertraline)
-SNRIs (venlafaxine)
Social anxiety disorder
-Intense fear of being criticized by others
-Persistent fear of humiliation
-Withdrawn
What is the causes of social anxiety disorder?
-Inherited traits
-Brain structure: amygdala plays role in the fear response
-Environment: learned behavior
Treatment of Social anxiety
-Cognitive behavioral therapy
-SSRI (paroxetine & sertraline)
-Benzos
-Propranolol: 1-2 hour before activity (B-blocker to slow down anxiety before activity)
Obsessive compulsive disorder
-Repetitive unwanted thoughts/ obsessions
-Repeated activities/ rituals
-Time consuming, may be distressing to individual, friends, family members
OCD treatment
VERY difficult to treat
-SSRI: Fluxetine, fluvoxamine. sertraline, paroxetine, citalopram, escitalopram
-Clomipramine: TCA (second line)
-Deep brain stimulation
-EMDR
-Transcranial magnetic stimulation
Addiction is a _____
disease
Rewarding effects of drugs come from large and rapid upsurges of ______
dopamine
-Mimics regular pleasure response but greatly exceeds it
Addiction is associated with deficits in the _______
prefrontal cortex
What factors increase risk of substance use disorder?
- Aggressive behavior in childhood
- Lack of parental supervision
- Poor social skills
- Drug experimentation
- Availability of drugs at schools
What factors decrease risk of substance used disorder?
- Good self control
- Parental monitoring & support
- Positive relationships
- Good grades
- School ani-drug policies
Treatment of substance use disorder
-No single treatment is appropriate for everyone
-Therapy is crucial
-Cognitive behavioral therapy
-Contingency management: positive reinforcement
-Motivation enhancement therapy
-Family therapy
-12-step facilitation programs
-Treatment must address the whole person
Treatment programs test patients for presence of other diseases associated with substance use disorder: (4)
- HIV/AIDS
- Hepatitis B & C
- Tuberculosis
- Endocarditis (bacteria in blood stream gets lodged in heart valves)
Methadone MOA
Synthetic opioid analgesics, mu-agonist
Methadone side effects
-Light headed
-Hives
-Chest pain
-Tachycardia
-Hallucinations
-Confusion
Abuse potential of methadone?
Pts can be addicted to methadone and it can be abused, but the potential is much lower
-Traditionally pts get their methadone once a day from a ‘methadone clinic’
MOA of Buprenorphine & Naloxone
Buprenorphine: partial opioid agonist (helps block receptors to prevent craving)
Naloxone: Opioid antagonist, block opioid receptors
Buprenorphine & Naloxone Side effects
-Headache
-Opioid withdrawal symptoms, anxiety, insomnia, sweating, depression, constipation, nausea
Abuse potential of Buprenorphine & Naloxone
Still has the potential for abuse, but less than methadone and buprenorphine alone
Buprenorphine & Naloxone is available
sublingual and buccal
(works very quickly)
Opioid withdrawal begins ______ following last dose. Peaks at _______ and Last _____
12-24 hrs
72 hrs
5-10 days
S/S of opioid withdrawal
-Flu-like symptoms
-N/V/D
-Stomach cramping
-Goosebumps
-Depression
-Drug cravings
-Anxiety
-Sweating
-Muscle aches
-Fever
Treatment of opioid withdrawal?
Supportive (Tylenol or antidiarrheals)
Buprenorphine & Naloxone
Benzos & Alcohol both act on _______, therefore the withdrawal symptoms are treated the same
GABA receptors
Both alcohol and benzo withdrawal have dangerous symptoms that can _____
lead to death
S/S of Alcohol and Benzo withdrawal
-Sleep disturbances
-Dry retching
-Irritability
-Nausea
-Increased tension
-Wt loss
-Anxiety
-Palpitations
-Panic attacks
-Headache
-Sweating
-Muscle aches
-Difficulty concentrating
-Perceptual changes
What are the dangerous symptoms of Benzo & Alcohol withdrawal?
-Seizures
-Hallucinations
-Delirium tremens
-Wernicke’s Encephalopathy
What is Wernickes encephalopathy?
- Encephalopathy: profound disorientation, indifference, inattention
- Oculmotor dysfunction (nystagmus, lateral rectus palsy, conjugate gaze palsy)
- Gait ataxia
What is delirium tremens?
-Hallucinations
-Disorientation
-Tachycardia
-Hypertension
-Fever
-Agitation
-Diaphoresis
Benzodiazepine onset, peak, duration
Onset: 6-12 hrs
Peak: Around 2 weeks
Duration: Months to a year
Alcohol withdrawal timeline
Stage 1: 8 hrs, Anxiety, Insomnia, Nausea, Abdominal pain
Stage 2: 1-3 days: High BP & Temp
Stage 3: 1 wk, Hallucinations, fever, seizure, agitation
Alcohol and Benzo withdrawal treatment
Benzodiazepine taper
-helps prevent seizures & DT severity
Those with alcohol withdrawal also requires _____
Vitamin supplementation especially Vit B1 (thiamine)
