Introduction to Psychiatry: Depression and Anxiety Flashcards
What is a psychiatrist?
a physical who specializes int he diagnosis and treatment of mental disorders
What are 4 methods that psychiatrist use to treat patients?
- psychotherapy –> couch/freud/psychoanalysis
- psychopharmacology –> drugs
- Somatic therapies –> ECT, TMS, light therapy… everything else but drugs and talking
- lifestyle modifications –> getting enough sleep, working out etc..
How does the DSM-5 describe mental disorders?
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
what are mental disorders usually associated with?
significant distress, or disability in social, occupational, or other important activities
What is NOT considered to be a mental disorder?
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
what are two methods of diagnosis of mental disorders?
- the identification of the nature of an illness or problem by examination of the symptoms
- the distinctive characterization in precise terms of a genus, species or phenomenon
What is considered to be “normal” in mental disorders?
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
What are psychotherapies?
involve addressing an individuals thoughts, behaviours and emotions and relationships through developing insight (awareness for urself), changing cognitions and changing behaviours (what freud used)
What are some pharmacotherapy treatments of psychiatric disorders?
include drugs that are SYMPTOM specific and not DIAGNOSIS specific
What are somatic therapies?
they involve stimulating neural circuits like DBS, ECT..etc..
What is the DSM-5 Criteria for Major Depressive Episode (MDE)?
at least five of below must be present in 2 WEEK period and either 1 or 2 must be included
- depressed mood
- diminished interest or pleasure (anhedonia)
- unintentional weight gain or less
- sleep disturbance
- psychomotor agitation or retardation
- fatigue, lethargy lack of energy
- feelings of guilt or worthlessness
- trouble concentrating or thinking
- recurrent thoughts of suicide
what must the symptoms have in order to be classified as MDD?
- 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
What is the course major of MDD?
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
Is MDD due to nature or nurture?
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
What are anatomic aspects of major depression in the brain?
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
What is the lifetime prevalence of MDD in woman vs. men?
17% total with 10-20% woman and 5-10% men
What is the biogenic (monoamine) hypothesis of depression
depression is the result of functional deficiency of norE and or 5HT at specific synapses in the CNS
What are antidepressant treatments and their side effects and outcomes?
- 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
How are AD’s supposed to be taken?
- 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
what are MAO inhibitors?
they inhibit monoamine oxidase, allowing the amine neurotransmitters to accumulate within the nerve terminal
- these have aversive side effects and are not commonly perscribed
what are Tricyclic Antidepressants TCA’s
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
What are selective serotonin reuptake inhibitors?
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
what are serotonin- norepinephrine reuptake inhibitors?
inhibit reuptake of 5-ht and NA from the synaptic cleft
it doesn’t cause sedation or harsh side effects
what are other uses of antidepressants?
like for anxiety, eating disorders, personality disorders, and chronic pain syndromes
not just limited to depression
what is ECT?
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
what is anxiety?
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
what is the 12 month prevalence rate for having anxiety disorder?
18%
what is panic disorder?
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
What are social anxiety disorders?
extreme nd persistent anxiety about social situations and social interactions with people bc they think they will get embarrassed
what is specific phobias?
clinically significant anxiety provoked by exposure to a specific feared object or situation often leading to a avoidance behavior
what is generalized anxiety disorder?
excessive anxiety and worry occurring most days for more than 6 months, with symptoms of motor tension, autonomic hyperactivity, apprehensive expectation, vigilance and scanning
what is the neurochemical bases of anxiety disorders?
thought to be due to overactivity of neural circuits involved in fight or flight/freeze behaviour mostly involve serotonergic and noradrenergic synapses
what is the anatomical aspects of anxiety?
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
What are some treatments for anxiety disorders?
combinations of CBT and medications are often used
medications include: antidepressants, benzodiazepines and beta blocekrs
what is the mechanism of action of benzodiazepines?
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
what are the dependance rates on benzoD?
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
what are some difficulties in studying psychiatric disorders? (5)
- comorbidity
- numerous brain regions and non neural systems are involved
- multiple neurochemical systems involved
- disorders appear to be polygenic
- inadequate animal models
What is the value of a mental health diagnosis?
- provides common language for clinicians
- many disorders implied prognosis
- guides treatment decisions
- may provide reassurance to the patient
