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Mood Disorders 3/10 > ISMH Mood Disorders 3rd of October > Flashcards

ISMH Mood Disorders 3rd of October Flashcards

1
Q

Anxiety

A

Panic disorder
GAD
OCD
Agoraphobia

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2
Q

Affective

A

Major Depression
Bipolar Disorder
Dysthymia

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3
Q

Psychoses

A

Schizophrenia
Schizoaffective

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4
Q

What are the two types of affective mood disorder?

A

Only depressive symptoms
Oscillation between depression and manic symptoms (Bipolar Disorder)

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5
Q

Depression Symptoms

A

Flattened mood
Sadness
Feelings of worthlessness and guilt
Withdrawal from others
Changes in sleep and appetite

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6
Q

Mania Symptoms

A

Abnormally elevated mood
Intense elation or irritability
Hyperactivity, talkativeness, distractibility

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7
Q

DSM-5 Criteria

A

Depressed mood OR loss of interest or pleasure (anhedonia)
Minimum period of 2 weeks
Not due to normal bereavement
2. Plus any 5 of these symptoms

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8
Q

Clinical Depression Symptoms

A

S Sleep
I Interest
G: Guilt
E Energy
C Concentration
A Appetite
P Psychomotor retardation
S Suicidality

5 needed to fulfill DSM-5

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9
Q

Physical Symptoms

A

Vague Aches and pains
Headaches
Sleep Disturbances
Fatigue
Back Pain
Significant change in appetite (weight loss/gain)

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10
Q

Somatic consequences of MDD

A

Mortality
Heart Disease
Cancer
Disability
Diabetes
Cognitive Impairment
Obesity

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11
Q

which gender is depression more common in?

A

Women

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12
Q

Can depression manifest in children?

A

Yes. shows up as stomach and headaches

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13
Q

Does depression have co-morbidities?

A

2/3 of those with MDD will also meet criteria for anxiety disorder at some point

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14
Q

What is bipolar disorder?

A

Usually involve episodes of depression alternating with mania
Mania - States of intense elation or irritability
Mixed episode - Symptoms of both mania and depression in the same week

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15
Q

What is Hypomania?

A

Symptoms of mania but less intense
Four or more days of elevated mood
Doesn’t interfere with functioning
Hypomania alone is not a DSM diagnostic category

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16
Q

What is the DSM-5 criteria for Manic and Hypomanic episodes?

A

Elevated, expansive, or irritable mood
PLUS 3 of the following (4 if mood is irritable):
- Psychomotor agitation or increase in goal-directed behavior
- Excessive talking or pressured speech
- Flights of ideas; racing thoughts
- Reduced need for sleep
- Grandiosity or inflated self esteem
- Easily distractible
- Excessive involvement in pleasurable activities with negative consequences
e.g., unprotected sexual activity, spending sprees

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17
Q

Criteria for manic episode specifically?

A

Symptoms last for 1 week OR require hospitalization
Symptoms cause significant distress or functional impairment

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18
Q

Criteria for hypomanic episode specifically?

A

Symptoms last at least 4 days
Clear changes in functioning but impairment is not marked

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19
Q

What is Seasonal Affective disorder?

A

Episodes happen regularly at a particular time of year

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20
Q

Postpartum onset?

A

Within 4 weeks of giving birth

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21
Q

Anhedonia? (Melancholic)

A

Inability to experience pleasure

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22
Q

Is there a genetic predisposition for MDD?

A

Yes.
- MDD clusters within families
- First-degree relatives of patients with MDD  threefold increased risk of MDD
- Heritability approximately 35%
- Genetic overlap between MDD and other psychiatric disorders (schizophrenia; bipolar disorder).

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23
Q

What depression symptoms does 5HT mediate

A

Sex
Appetite
Aggression

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24
Q

What depression symptoms does noradrenaline mediate

A

Concentration
Interest
Motivation

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25
Q

What symptoms does both 5HT and noradrenaline mediate?

A

Depressed Mood
Anxiety
Irritability
Thought process
Vague aches and pains

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26
Q

what does low levels of NA and 5HT cause?

A

MDD

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27
Q

What does high levels of NA and low levels of 5HT cause?

A

Mania

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28
Q

Three main classes of drugs

A

Tricyclic antidepressants (TCAs)
Selective NA/5HT reuptake inhibitors (SS/NRIs)
Monoamine Oxidase Inhibitors (MAOIs)

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29
Q

What is the aim of antidepressants?

A
  • Strategy is to increase extracellular levels of these neurotransmitters in the brain,
  • with varying degrees of selectivity for particular neurotransmitter systems
  • selectivity determines degree of side effects.
30
Q

Examples of Tricyclic Antidepressants

A

Clomipramine
Amitriptyline
Doxepin
Imipramine
Desipramine

-pramine

31
Q

Uses of TCAs

A

Depression
Migraine prophylaxis
Neuropathic pain
Obsessive compulsive disorder (Clomipramine)
Enuresis
Panic disorder
Sleep disorders
Attention deficit / hyperactivity disorder

32
Q

Preferred uses of TCAs

A

Depression with
Pain
Fibromyalgia
Migraine
insomnia

33
Q

Least preferred uses of TCAs

A

Patients in whom anticholinergic effects would be problematic
Overweight patients
Suicidal patients
Cardiac patients
Patients with dementia

34
Q

Adverse effects of TCAs

A
  • Antagonist activity at mACh receptors, histamine H1 receptors and 𝛼1-adrenoceptors.
  • The antagonist activity at mACh receptors results in atropine-like side effects
  • The antagonist activity at histamine H1 receptors causes weight gain, drowsiness and sedation.
  • The antagonist activity at 𝛼1-adrenoceptors can produce postural hypotension, syncope in some patients and sedation.
  • The incidence of these side effects varies with different TCAs. Therefore, TCAs with excessive sedative properties, such as amitriptyline and doxepin, should be avoided in the elderly, who should be prescribed TCAs with less sedative properties such as imipramine or nortriptyline.
35
Q

What happens during TCA overdose?

A

Confusion, convulsions, tachycardia, hypotension, ventricular arrhythmias.
Ventricular arrhythmias - death

36
Q

Treatment of TCA overdose

A
  • removal of the remaining drug in the stomach
  • anticonvulsant agent (diazepam)
  • antiarrhythmic drugs and further cardiac support to prevent or treat ventricular arrhythmias.
37
Q

When are SSRIs given

A
  • 4–6 weeks before a clinically significant antidepressant effect is observed
  • during this time, side effects may dissuade patient compliance - importance of patient counselling by pharmacists.
38
Q

advantages of SSRIs over TCAs or MAOIs

A
  • generally better tolerated
  • possess less anticholinergic and cardiovascular side effects
  • low acute toxicity in overdose.
  • most widely prescribed antidepressants worldwide
39
Q

Examples of SSRIs

A

Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
Fluvoxamine (Luvox)
Citalopram (Celexa)
Escitalopram (Lexapro)

40
Q

Uses of SSRIs

A

Depression
Social phobia
Panic disorder
Obsessive compulsive disorder
Bulimia Nervosa
Post Traumatic Stress Disorder
Pre Menstrual Dysphoric Disorder (Sarafem)

41
Q

Least preferred use of SSRI

A

Patients with sexual dysfunction
Patients with nocturnal myoclonus
Patients with consistent agitation
Patients with consistent insomnia

42
Q

Adverse effects of SSRI

A
  • Gastrointestinal
  • Nausea, vomiting, diarrhea
  • Sexual dysfunction
  • Some anticholinergic side effects, especially with paroxetine
  • Headache
  • insomnia
  • Long-term weight gain
  • Occasional aggressive and violent behaviours.
  • Fatigue
  • Akathisia (an inability to remain still) and dystonic reactions
    5HT can reduce DA levels
43
Q

What are the symptoms associated with discontinuation/withdrawal of SSRI

A

Usually after prolonged treatment
- dizziness,
- nausea,
- headache,
- fatigue,
- flu-like symptoms,
- agitation,
- impaired concentration,
- paraesthesia
- sensations of electric shocks,
- vivid dreaming
- anxiety.

44
Q

What causes serotonin syndrome?

A
  • Occurs when several serotonergic drugs combined
  • Often involves MAOI’s as one of the drugs
  • Other serotonergic drugs implicated
    SSRI’s
    TCA’s
    Serotonin releasing agents (i.e. MDMA or “ecstasy”)
    Dextromethorphan, meperidine, others
45
Q

Serotonin Syndrome symptoms?

A
  • Altered mental status – confusion, agitation
  • Autonomic dysfunction – diaphoresis, tachycardia, BP changes, fever
  • Neuromusucular abnormalities – clonus
46
Q

How do you avoid Serotonin Syndrome?

A

Allow 2 weeks between MAOI and other antidepressant administration
- 5 weeks for fluoxetine

47
Q

do SSRIs cause suicide?

A

Yes. major risk factor for suicide in children, adolescents and young adults.
WHY:
Discontinuation or withdrawal symptom with an increased risk of suicidal ideation if dose missed.

48
Q

What SSRIs increase risk of suicide?

A

SSRIs with short half-lives

49
Q

how to avoid suicide risk of SSRIs?

A
  • Avoid SSRIs with short half lives
  • SSRIs not to be prescribed in children and young adults (apart from fluoxetine which has a long half-life)
50
Q

When should SNRIs be given?

A

4-6 weeks before a clinical effect is observed.

51
Q

How do SNRIs work?

A

Selectively inhibit NA transporters and block the reuptake of noradrenaline

Indirectly increase 5-HT release by an action at presynaptic 𝛼1-adrenoceptors on 5-HT neurones.

52
Q

Main NRI available in the UK

A

Reboxetine

53
Q

Adverse effects of SNRIs

A

mild atropine-like effects,
tachycardia,
postural hypotension and
sexual dysfunction.

54
Q

Examples of SNRIs

A

Duloxetine
Venlafaxine - can cause sustained increases in blood pressure in some patients.

Inhibit the reuptake of both 5-HT and NA.

The SNRIs are usually used as a second-line treatment for patients who do not respond well to SSRIs.

55
Q

how do SNRIs work?

A

Inhibit the reuptake of both 5-HT and NA.
Similar side-effect profile to SSRIs

56
Q

what is Lithium carbonate used for?

A

Widely used in the past for first-line therapy but generally superseded by antipsychotics.

57
Q

what is the onset of action for lithium?

A

Slow onset of action (6-12 months)
- more useful as prophylaxis therapy than treatment of acute phase.

58
Q

Uses of Lithium carbonate?

A
  • Prophylaxis and treatment of mania
  • Prophylaxis of bipolar disorder (manic-depression)
  • Concomitant anti-depressant treatment in patients with
  • incomplete response to treatment for depression in bipolar disorder.
  • Augmenting agent in treatment resistant depression.
59
Q

Lithium pharmacology?

A
  • small monovalent cation
  • used therapeutically in its salt form.
  • Related to sodium functionally
    mechanism of action is unclear
60
Q

What does lithium affect?

A

Affects electrolytes and ion transport (Na+)
Affects release of neurotransmitters (5HT, NA, DA)
Affects second messengers and enzymes that mediate neurotransmitter function.

61
Q

what is the pharmacotherapy available for Bipolar Conditions

A
  1. Antipsychotic drugs (olanzapine; quetiapine; risperidone)
    First line treatment (NICE guidelines)
  2. Lithium carbonate
  3. Carbamazepine
  4. Valproate
  5. Benzodiazepines (only for acute treatment)
62
Q

Trazodone (Serotonin antagonist and reuptake inhibitor)

A
  • antagonist at 5-HT1A and 5-HT2 receptors and inhibits the reuptake of 5-HT.
  • Antagonist at 5-HT1A autoreceptors  increase the release of 5-HT
  • Inhibition of 5-HT reuptake will further enhance the postsynaptic effects of 5-HT.
63
Q

Adverse effects of Trazodone?

A

Its main adverse effects include postural hypotension, sedation and weight gain.

64
Q

Bupropion (Noradrenergic and dopamine reuptake inhibitors) mechanism of action?

A

main mechanism of action is to inhibit dopamine and noradrenaline transporters and, thereby, block the reuptake of DA and NA

65
Q

adverse effects of bupropion?

A

The main adverse effects of bupropion include
- nausea,
- constipation,
- epigastric distress,
- dry mouth agitation
- insomnia.

More serious, but rare, side effects that can occur are the risk of seizures or the induction of psychosis.

66
Q

When are monoamine oxidase inhibitors used? (MOAs)

A

Used in patients with atypical MDD/ anxiety

67
Q

Examples of MOAs

A

Phenelzine (Nardil)
Tranylcypromine (Parnate)

68
Q

Cautions to note with MOAs?

A

Hypertensive crisis can occur when combined with high tyramine foods or sympathomimetics

Aged cheeses, sour cream, wines, beer, canned or processed meats, fermented foods, coffee, chocolate

Amphetamines, ephedrine, other decongestants

69
Q

MAOI Side effects?

A

Atropine-like side effects,
- postural hypotension,
- hyperphagia
- weight gain.

70
Q

What are the problems with the irreversible MAOIs?

A

The irreversible MAOIs can cause liver damage, and are contraindicated in patients with hepatic impairments.

71
Q

What is the most important factor to consider with MAOI use?

A

The most important factor that limits the use of the MAOIs is their potentially fatal interaction with specific foods types that are rich in certain amines, especially tyramine, such as cheese (with the exception of Cottage cheese), yeast products, processed meats, beef liver, broad beans and beer.

They can interact with the MAOIs to cause a hypertensive crisis.

Mood Disorders 3/10 (1 decks)

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