Introduction to Psychiatry: Depression and Anxiety

Question 1

What is a psychiatrist?

Answer 1

a physical who specializes int he diagnosis and treatment of mental disorders

Question 2

What are 4 methods that psychiatrist use to treat patients?

Answer 2

1. psychotherapy –> couch/freud/psychoanalysis
2. psychopharmacology –> drugs
3. Somatic therapies –> ECT, TMS, light therapy… everything else but drugs and talking
4. lifestyle modifications –> getting enough sleep, working out etc..

Question 3

How does the DSM-5 describe mental disorders?

Answer 3

that its characterized by clinically significant disturbance in an individual’s cognition, emotion regulation or behaviour that reflects a dysfunction in the psychological, biological or developmental process underlying mental function

basically theres something wrong with your brain thats causing changes in how u think, feel and behave

Question 4

what are mental disorders usually associated with?

Answer 4

significant distress, or disability in social, occupational, or other important activities

Question 5

What is NOT considered to be a mental disorder?

Answer 5

an expectable or culturally approved response to a common stressor or loss is NOT a mental disorder

socially deviant behaviour and conflicts that are primarily between the individual and society are not mental disorders unless the deviance results from a dysfunction in the individual

i.e. grieving is NOT a mental disorder.. if you have a belief that isn’t in par with social norms but is still normal like aliens exist that doesn’t mean u have a mental disorder

Question 6

what are two methods of diagnosis of mental disorders?

Answer 6

1. the identification of the nature of an illness or problem by examination of the symptoms
2. the distinctive characterization in precise terms of a genus, species or phenomenon

Question 7

What is considered to be “normal” in mental disorders?

Answer 7

the normal curve doesn’t work in mental disorders because it works well identifying things like height but not emotions

identifying whats normal is a problem in diagnosing mental disorders because u don’t have anything to really compare it to

Question 8

What are psychotherapies?

Answer 8

involve addressing an individuals thoughts, behaviours and emotions and relationships through developing insight (awareness for urself), changing cognitions and changing behaviours (what freud used)

Question 9

What are some pharmacotherapy treatments of psychiatric disorders?

Answer 9

include drugs that are SYMPTOM specific and not DIAGNOSIS specific

Question 10

What are somatic therapies?

Answer 10

they involve stimulating neural circuits like DBS, ECT..etc..

Question 11

What is the DSM-5 Criteria for Major Depressive Episode (MDE)?

Answer 11

at least five of below must be present in 2 WEEK period and either 1 or 2 must be included

1. depressed mood
2. diminished interest or pleasure (anhedonia)
3. unintentional weight gain or less
4. sleep disturbance
5. psychomotor agitation or retardation
6. fatigue, lethargy lack of energy
7. feelings of guilt or worthlessness
8. trouble concentrating or thinking
9. recurrent thoughts of suicide

Question 12

what must the symptoms have in order to be classified as MDD?

Answer 12

• they must be disruptive enough to impair normal function and not be in the context of other disorders like bipolar disorder or schizo

and not be due to a substance
and must occur most days in 2 weeks time

Question 13

What is the course major of MDD?

Answer 13

average onset is 25-30

onset may be sudden or gradual

MDD is a recurrent illness and if u get it once and not treat it then theres a high chance u will get a second episode and so forth

Question 14

Is MDD due to nature or nurture?

Answer 14

its 2-3X more prevalent in first degree biological relative

• twin and adoption studies show 20-30% of monozygotic twins are NOT concordant for MDD
• there must be an environmental element as well

Question 15

What are anatomic aspects of major depression in the brain?

Answer 15

the brain regions that are most effect is medial prefrontal cortex (shrinks), hypothalamus and hypothalamic-pituitary-adrenal-axis (associated with abnormal HPA axis.. always releasing hormones cortisol and epinephrine and they;re always under stress), and reduced sized hippocampus

theres also reduced volumes in the brains of individuals with depression which likely reflects impaired neurogenesis

• depression is not beginning it causes physical damage over ones brain

the longer its untreated, the more damage is done

Question 16

What is the lifetime prevalence of MDD in woman vs. men?

Answer 16

17% total with 10-20% woman and 5-10% men

Question 17

What is the biogenic (monoamine) hypothesis of depression

Answer 17

depression is the result of functional deficiency of norE and or 5HT at specific synapses in the CNS

Question 18

What are antidepressant treatments and their side effects and outcomes?

Answer 18

• they decrease symptoms of depression
• studies shown that all antidepressants work the same and have the same outcome

at 67% chance of picking the right AD

things to look out for:
side effects and cost

Question 19

How are AD’s supposed to be taken?

Answer 19

• initial treatment for at least one year after remission to reduce rates of relapse
• higher rates of relapse if medication stopped early
• some individuals end up on it longer if they have repeated episodes
• the increased rate of suicide while taking AD is because mood is the last area that it helps. It initially starts by giving you a lot of energy but still with a low mood so that makes you have suicidal thoughts but not go through with it

Question 20

what are MAO inhibitors?

Answer 20

they inhibit monoamine oxidase, allowing the amine neurotransmitters to accumulate within the nerve terminal
- these have aversive side effects and are not commonly perscribed

Question 21

what are Tricyclic Antidepressants TCA’s

Answer 21

they inhibit active reuptake of NA and 5HT back into nerve terminals, resulting in an increased functional availabillity of these neurotransmitter amines at central receptors

these can be sedating

Question 22

What are selective serotonin reuptake inhibitors?

Answer 22

strong inhibitors of 5-ht and unlike TCA’s they and their metabolites have little effect on NA reuptake into the terminals

this has less side effects

Question 23

what are serotonin- norepinephrine reuptake inhibitors?

Answer 23

inhibit reuptake of 5-ht and NA from the synaptic cleft

it doesn’t cause sedation or harsh side effects

Question 24

what are other uses of antidepressants?

Answer 24

like for anxiety, eating disorders, personality disorders, and chronic pain syndromes

not just limited to depression

Question 25

what is ECT?

Answer 25

electroconvulsive therapy is an effective treatment for severe depression

mode of action is unknown
- used for treatment resistant depression, and depression with psychotic or suicidal features

believed to stimulate

ECT can only be given in conjunction with AD’s and antipsychotics

it only raises mood for 4-6 months and then medication is needed for maintenance

some individuals receive ongoing maintenance ECT

Question 26

what is anxiety?

Answer 26

anxiety itself is a normal adaptive response to perceived threats or danger

anxiety is a disorder when it results in impairment in someones life and causes significant personal distress and loss of function

Question 27

what is the 12 month prevalence rate for having anxiety disorder?

Answer 27

18%

Question 28

what is panic disorder?

Answer 28

unpredictable, and recurrent attacks of panic characterized by upsetting physical symptoms such as tachycardia, chest pain, sweating, tremor, nausea, and overwhelming sensations of fear or loss of control

Question 29

What are social anxiety disorders?

Answer 29

extreme nd persistent anxiety about social situations and social interactions with people bc they think they will get embarrassed

Question 30

what is specific phobias?

Answer 30

clinically significant anxiety provoked by exposure to a specific feared object or situation often leading to a avoidance behavior

Question 31

what is generalized anxiety disorder?

Answer 31

excessive anxiety and worry occurring most days for more than 6 months, with symptoms of motor tension, autonomic hyperactivity, apprehensive expectation, vigilance and scanning

Question 32

what is the neurochemical bases of anxiety disorders?

Answer 32

thought to be due to overactivity of neural circuits involved in fight or flight/freeze behaviour mostly involve serotonergic and noradrenergic synapses

Question 33

what is the anatomical aspects of anxiety?

Answer 33

limbic system is involved

thalamus –> interpreting sights and sounds
amygdala –> triggers fear response and send sit to hypothalamus and pit to com cup with hormones
hippocampus –> stores raw information about senses along with emotional tone and links memories with emotional states
locus ceruleus –> receives signals from amygdala and sends signals via norE to the rest of the body to trigger a classic sympathetic fight or flight fear response

Question 34

What are some treatments for anxiety disorders?

Answer 34

combinations of CBT and medications are often used

medications include: antidepressants, benzodiazepines and beta blocekrs

Question 35

what is the mechanism of action of benzodiazepines?

Answer 35

they interact with binding sites on GABA-A receptor and potentiate GABA mediated increase in chloride permeability

its a complete depressant and its similar to alcohol and it makes you addicted

Question 36

what are the dependance rates on benzoD?

Answer 36

psychological dependence develops up to 25%

withdrawal effects can occur when u stop treatment and these include anxiety and insomnia but can be seizures and hallucinations as well

Question 37

what are some difficulties in studying psychiatric disorders? (5)

Answer 37

1. comorbidity
2. numerous brain regions and non neural systems are involved
3. multiple neurochemical systems involved
4. disorders appear to be polygenic
5. inadequate animal models

Question 38

What is the value of a mental health diagnosis?

Answer 38

1. provides common language for clinicians
2. many disorders implied prognosis
3. guides treatment decisions
4. may provide reassurance to the patient