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BD > Lecture 11 > Flashcards

Lecture 11 Flashcards

1
Q

What is mood?

A

Overall state of emotion at a given time
Influenced by internal and external factors

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2
Q

What is a mood disorder?

A

Condition that affects a person’s everyday emotional state/mood
AKA affective disorders

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3
Q

How many adults 18+ have a mood disorder?

A

1 in 4

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4
Q

What NT regulate mood?

A

Serotonin
Norepinephrine
Dopamine

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5
Q

What are the types of depressive disorders?

A

Major depressive disorder
Dysthymia/Persistent Depressive Disorder
Seasonal Affective Disorder
Premenstrual Dysphoric Disorder (PMDD)
Disruptive Mood Dysregulation Disorder

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6
Q

What are the types of bipolar disorder?

A

Bipolar I disorder
Bipolar 2 disorder (cyclothymia included)

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7
Q

What are the most recognized systems for psychiatric diagnosis?

A

DSM
ICD(International Statistical Classifications of Diseases and Related Health Problems)

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8
Q

What does the DSM require for all psychiatric conditions?

A

Criteria based diagnostic that requires 3 conditions…
Not caused by the direct effects of any drug or external exposure
Not caused by effects of a medical condition
Significant impairment of social functioning, occupational functioning, or both.

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9
Q

What percentage of people in the US have a MDD their lifetime? past 12months?

A

21%
10%

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10
Q

Who are more likely to have a MDD?

A

MC younger population (average age 30)
Rates higher in (25-44yo)
Low socioeconomic status
2-3x more in women

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11
Q

What race is the highest to have a MDD? lowest?

A

Native Americans
Asians/Pacific Islanders

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12
Q

What are some genetics/biological facts that increase the risk of MDD?

A

NT expression sensitivity (serotonin, norepinephrine, glutamate, GABA, dopamine)
Response to antidepressants
FH of depression or alcoholism

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13
Q

What are some life events that increase the risk of MDD?

A

Adversity or loss of loved one, job, or relationship
Early childhood trauma
Postpartum period

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14
Q

What are some medications that increase the risk of MDD?

A

Glucocorticoids
Interferons

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15
Q

What personalities increase the risk of MDD?

A

Low self-esteem
Sensitive to stressors
Insecure or worried
Dependent or unassertive
Introverted

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16
Q

What social factors increase the risk of MDD?

A

Lack of close relationships
Close individuals with depression
Maladaptive learned behaviors from close individuals

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17
Q

What medical conditions are increase the risk for MDD?

A

Neurologic
Infectious
Cardiac
Endocrine
Cancer
Inflammatory

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18
Q

How do you diagnose MDD according to the DSM?

A

Depressed mood or anhedonia for >2weeks and >4 conditions (on another card)

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19
Q

What are the conditions of the DSM criteria for MDD?

A

SIG E CAPS
Sleep disturbances
Interested decreased (anhedonia)
Guilt and/or feeling of worthlessness
Energy decreased
Concentration problems
Appteite/weight changes
Psychometer agitation or retardation
Suicidal ideation

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20
Q

What are the subtypes of MDD?

A

Catatonic (psychomotor disturbances)
Anxiety
Mixed (insomnia, racing thoughts, increase energy)
Psychotic (hallucinations, delusions)
Seasonal
Atypical (reactivity to pleasurable stimuli)
Melancholic
Peripartum

CAMPSAMP

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21
Q

How does a MDD present?

A

At least one major depressive episode that can last over days to weeks (average time 20weeks)

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22
Q

When is there the highest risk of recurrence for a major depressive episode?

A

Within the first few months following episodes resolution

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23
Q

What are the rates of recurrence of a major depressive episode in 1 year? lifetime??

A

40%
85%

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24
Q

What are some differentials of MDD?

A

Other mood disorders
Medication SE
General medical disorders
Substance use/abuse

NOT bereavement

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25
Q

What are the types of screening for MDD?

A

Two question screen (PHQ-2)
Pt health questionnaire-9 (PHQ-9)
Zung self-rated depression scale

26
Q

What are the non-pharmacological management for MDD?

A

Psychotherapy
Electroconvulsive(ECT)
Vagal nerve stimulation
Transcranial Magnetic stimulation (TMS)

27
Q

What are the pharmacological management for MDD?

A

Supplements
Herbals
Antidepressants

28
Q

What are the goals of MDD treatment?

A

Maintain pt safety
Full remission of symptoms
Return to baseline functions

29
Q

What is the preferred treatment for MDD? Whats the MC?

A

Pharmacotherapy AND psychotherapy
MC is just pharmacotherapy

30
Q

What are a characteristics of a pt to be considered for outpatient treatment in MDD?

A

Mild/moderate depression

No suicidal/homicidal ideation or behavior
No psychotic features
Minimal to no aggressiveness
Intact judgement
Able to perform basic ADL and maintain adequate nutritional/hydration status

31
Q

What are the characteristics of a pt to be considered for inpt treatment in MDD?

A

Severe depression

Suicidal/homicidal ideation or behavior with specific plan or intent
Psychosis
Catatonia
Impaired judgement that puts patient/others at risk for harm
Grossly impaired functioning affecting ability to care for self

32
Q

What are non-pharmacologic treatments for MDD?

A

Psychotherapy (CBT, interpersonal therapy)
Relaxation techniques
Exercise
Behavioral activation
Other(massage therapy, spirituality, yoga, acupuncture)

33
Q

How does ECT work?

A

Small electric current to induce cerebral seizure while patient is under general anesthesia

34
Q

What is indicated for ECT?

A

Severe, refractory depression
Severe suicidality, severe psychosis, catatonia, malnutrition d/t food refusal secondary to depressive illness

35
Q

What is the most effective treatment for severe MDD?

A

ECT

36
Q

What are SE of ECT?

A

Generally safe

Cardiopulmonary
HA
Nausea
Transiet cognitive impairment
Muscle aches

37
Q

How does a vagal nerve stimulation work?

A

Device implanted in chest wall and connected to one(left) vagus nerve

38
Q

What is indicated for vagal nerve stimulation?

A

Refractory epilepsy
Refractory depression(questionable efficacy)

39
Q

How does TMS work?

A

Metal coil with magnetic field is placed against scalp to induce depolarization of neurons in a focal area
Output use without sedation or anesthesia

40
Q

What is indicated for TMS?

A

Treatment-refractory depression

41
Q

What is CI for TMS?

A

High seizure risk
Incompatible implants(metallic, electrical, cochlear)

42
Q

What are the SE of TMS?

A

Seizures
HA
Scalp pain
Transient hearing loss

43
Q

What are the supplements that could be used to treat MDD?

A

S-Adenosylmethionine (SAMe): raise dopamine levels
5-Hydroxytryptophan (5-HTP): precursor of serotonin
Omega-3 Fatty Acids

44
Q

What herbals can be used for treating MDD?

A

St. John’s wort(increase serotonin, possibly noes and dopamine levels)
Saffron
Ginkgo biloba: improve mood for pts being treated for memory loss, increase sensitivity of serotonin

45
Q

What herbs or supplements can increase the risk of bleeding?

A

Omega-3. Ginkgo biloba

46
Q

When do you usually see improvement after taking oral antidepressants?

A

As soon as week 1, but can take up to 4-6 weeks

47
Q

How long should. a pt be on antidepressants?

A

6+months after s/s improvement and then you gradual titrate down

48
Q

What are the types of antidepressants?

A

SSRI: paroxetine, escitalopram
SNRI: venlafaxine
Serotonin Modulators: mirtazapine, vortioxetine
TCAs: amitriptyline

49
Q

What are the first gen antidepressant classes?

A

MAOIs
TCAs
TeCAs
Litium
Antipsychotics

50
Q

What are the 2nd gen antidepressant classes?

A

SSRIs
SNRIs
Atypical antidepressants
Serotonin modulators
Ketamine/Esketamine

51
Q

What is the MC class of antidepressants?

A

2nd gen antidepressants

52
Q

What do most SSRIs have a half life of?

A

24hours

53
Q

What medication is usually best used to titrate off an SSRI?

A

Prozac

54
Q

What causes serotonin syndrome?

A

Increased serotongeric activity
Usually when starting medications or dosing changes

55
Q

What are the S/S of serotonin syndrome?

A

Diarrhea
Increased bowel sounds
Agitation
Hyperreflexia
Dry mucous membranes
Autonomic instability
Hyperthermia
HTN
Tremor
Clonus
Seizures
Death

56
Q

How do we diagnose serotonin syndrome?

A

Clinically

57
Q

How do you treat serotonin syndrome?

A

Supportive care
D/C serotonergic medications
Sedation with benzodiazepines
Normalize vitals and hydration status

58
Q

How do you treat serotonin syndrome?

A

Supportive care
D/C serotonergic medications
Sedation with benzodiazepines
Normalize vitals and hydration status

59
Q

What SSRIs do you not take if a pt is on tamoxifen(breast cancer med)

A

Fluoxetine and Paroxetine

60
Q

What are usually first-line for MDD?

A

SSRIs

61
Q

What do most SSRIs have a half life of?

A

24hours

BD (6 decks)

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