Mental Health Introduction: Depression Flashcards
Test I Review
1
Q
Individuals who remain in good mental health are able to find ways to deal with stressors and exhibit these qualities. Persons, who over time, cannot cope with stressors in their daily life, and show these qualities end-up physically or emotional ill.
Criteria for mental health include: (7)
A
- Ability to be flexible
- Ability to be successful
- Ability to form close relationships
- Ability to make appropriate judgments
- Ability to solve problems
- Ability to cope with daily stresses
- Ability to have a positive sense of self
2
Q
Treats to mental health or the definition of mental illness include: (5)
A
- Impairment of a person’s ability to think
- Impairment of a person’s ability to feel
- Impairment of a person’s ability to make sound judgments
- Difficulty or inability to cope with reality
- Difficulty or inability to form strong personal relationships
3
Q
CAUSES OF MENTAL HEALTH
The cause is still under investigation. One theory holds that it is due to:(2)
A
- Organic or Physical Causes (NATURE).
2. Inorganic or Emotional Causes (NURTURE)
4
Q
Cause of Mental Health
- psychobiologic theory – related to genetic, physical or neurochemical malfunction in the brain
A
- Organic or Physical Causes (NATURE).
5
Q
Cause of Mental Health
- The psychoanalytic theory by Sigmund Freud et al. related to ineffective parenting.
A
- Inorganic or Emotional Causes (NURTURE)
6
Q
Diagnosis for Mental Illness
A
The diagnostic tool used is the
“Diagnostic and Statistical Manual of Mental Disorders-I Text Revision DSM 5”
7
Q
Neurotransmitters (NT) (10)
A
- Acetylcholine:
- Norepinephrine and Epinephrine
- Epinephrine
- Dopamine
- Gamma-aminobutyric acid (GABA)
- Glutamate (glutamic acid)
- Serotonin
- Histamine
- Substance P
- Encephalin and Endorphins
8
Q
Neurotransmitter
• Communicates between nerves and muscles, is broken down by acetycholinesterase.
• Found in many parts of the brain, is excitatory or inhibitory, involved with memory.
A
- Acetylcholine
9
Q
Neurotransmitter
- catecholamines released in areas of the brain such as the limbic system.
A
- Norepinephrine and Epinephrine
10
Q
Neurotransmitter
- found in several areas of CNS and in the sympathetic division of ANS.
- function is excitatory or inhibitory.
A
- Epinephrine
11
Q
Neurotransmitter
- Found in high concentration in the brain; also present in autonomic system, is related to coordination of impulses and responses both motor and intellectual. Mostly inhibitor;
- involved in emotions/moods and in regulation motor control
A
- Dopamine
12
Q
Neurotransmitter
- Found in the brain, inhibits nerve activity; is important in preventing overexcitibility or stimulation such as seizure activity. It is the most common inhibitory neurotransmitter in the brain.
A
- Gamma-aminobutyric acid (GABA)
13
Q
Neurotransmitter
- found in the CNS, excitatory, most common excitatory NT in the CNS.
A
- Glutamate (glutamic acid)
14
Q
Neurotransmitter
- Important in arousal and sleep as well as in preventing depression and promoting motivation;
- Found in several regions of CNS, including the limbic system, it mostly inhibitory; involved in emotion/moods.
A
- Serotonin
15
Q
Neurotransmitter
- found in the brain; mostly excitatory; involved in emotions and regulation of body temperature and water balance
A
- Histamine
16
Q
Neurotransmitter
- found in the brain, spinal cord, sensory pain pathways and GIT; mostly excitatory; transmits pain information.
A
- Substance P
17
Q
Neurotransmitter
- found in several regions of CNS, retina, intestinal tract; mostly excitatory, act like opiates to block pain
A
- Encephalin and Endorphins
18
Q
What drug blocks the uptake of dopamine?
A
Cocaine
19
Q
What drug inhibits the uptake of serotonin?
A
Prozac
20
Q
Norepinephrine, dopamine, epinephrine and serotonin are broken down by (a) or by (b).
A
a. monoamine oxidase (MAO)
b. catechol-o-methyl transferase (COMT)
21
Q
Controls the arousal and awareness of stimuli, contains the sleep centre, When levels of serotonin becomes high here, the system shuts down and sleep occurs.
A
1 Reticular Activating System (RAS)
22
Q
_____ contains high levels of NE, E, and serotonin. It is responsible for expressions of emotion (anger, pleasure, stress, motivation, and so on).
- Drug therapy aimed at alleviating emotional disorders such as depression and anxiety often involve attempting to alter the levels of NE, E and serotonin.
A
Limbic system
23
Q
Drug therapy aimed at alleviating emotional disorders such as depression and anxiety often involve attempting to alter the levels of ___.(3)
A
NE, E and serotonin.
24
Q
Depressive disorders include:(6)
A
- Major depressive disorder
- Disruptive mood dysregulation disorder
- Persistent depressive disorder (Dysthymia)
- Premenstrual dysphoric disorder
- Substance/medication-induced depressive disorder
- Other specified and unspecified depressive disorders.
25
All of these disorders are characterised by the presence of: (4)
1. sadness
2. feeling of emptiness
3. irritable mood
4. somatic and cognitive changes that significantly affects the individual’s capability to function normally
26
Each disorder differs from the others in terms of(3)
* duration
* timing
* presumed aetiology
27
Refers to an emotional feeling or mood expressed by client’s outward appearance.
Affect
28
When a person’s mood goes from beyond the normal “ups and downs".
Affective disorders
29
Alteration in mood that is expressed by feeling of sadness, despair and pessimism
- Low levels of NE&Serotonin
Depression
30
The most common type of depressive disorder.
Major depressive disorder (MDD)
31
The least common depressive disorder.
Substance/ Medication-induced depressive
32
Risk of depressive disorder varies by ____ (7).
Age, gender, social class, ethnicity, culture, marital status and season of the year.
33
True or false?
| Incidence of depressive disorder tends to be higher in women than men (ratio almost 2:1).
True
34
During their lifetime, about __% of women and __% of men become depressed.
21%
| 13%
35
Between age ____ women experience more depression than men.
10-43 years old and above 65.
36
Between ___ the rates are almost the same for men and women.
44-65 years old
37
About __% of adolescents have a depressive disorder by age 18
11%
38
_____ is the leading cause of disability among Americans age 15-44.
Major depression
39
Low _______ is associated with higher risk of depression
Socioeconomic status
40
True or False?
| In Ethnicity/Culture, no consistent pattern in depression has yet emerge.
True
41
True or False?
| No consistent association in depression found between depressive disorders and marital status.
True
42
Two prevalent seasons for depression: (2)
(1) March to May (Spring) and
| 2) September to November (Autumn
43
Note that the suicide rates tend to follow these seasonal pattern with a large peak (highest rate) in what season?
Spring
44
Another sucide peak (with a lower rate) in what month?
October
45
The ____ of depressive disorder is still unclear. A number of theories exist but no clear single evidence exists to suppose a cause.
Aetiology
46
Predisposing factors associated with affective disorders include: (4)
Genetics, psychosocial factors (divorce, death of close relative or friend), physical stress (illness, infection, childbirth) and personality traits.
47
Combinations of psychosocial, physical stress and personality traits also appear to affect the ___ and possibly lead to ____.
CNS; affective disorder.
48
Evidence Supporting Predisposing Factors:(5)
1. Genetic role
2. Biochemical Influence
3. Neuroendocrine disturbance
4. Physiological Influence
5. Psychosocial Theory:
49
Evidence Supporting Predisposing Factor
- twin studies show link between monozygotic twins and depressive disorders
- family studies show increase risk of depressive disorder in offspring of family with a positive history of major depressive disorder
- adoption studies suggest biological children of parent with mood disorder are at greater risk of developing mood disorder
1. Genetic role
50
Evidence Supporting Predisposing Factor
- depressive illness may be related to deficiency of norepinephrine, serotonin and dopamine in specific regions of the brain. There is also the possibility of low acetylcholine contributing to depression. The role these neurotransmitters play is still unknown but increase their level appears to relieve symptoms.
2. Biochemical Influence
51
Evidence Supporting Predisposing Factor
1. Hypothalamic - Pituitary-Adrenocortical axis malfunction
2. Hypothalamic - Pituitary- Thyroid axis malfunction
3. Neuroendocrine disturbance
52
Evidence Supporting Predisposing Factor
- Substances (that alter the physiology of the body appear to play a role in depression.
For example, a number of drugs given as monotherapy (or in combination with others) are associated depression.)
• Neurological disorders (as a result of cardiovascular accidents, brain tumour in the temporal lobe, degenerative diseases such as Alzheimer’s, Parkinson’s and Huntington’s)
• Electrolyte imbalance (in the case of excessively high levels of sodium bicarbonate or calcium
• Hormonal disturbances as seen in Cushing’s and Addison diseases)
• Nutritional deficiency (as seem in deficiencies of Vitamin B1, Vitamin B12, niacin, folic acid and many of the macro minerals)
4. Physiological Influence
53
Evidence Supporting Predisposing Factor
• Freud postulated that loss of love object by death or otherwise may trigger depression.
• Seligman postulated that learned helplessness particularly after repeated failure may cause the individual to abandon attempts at success and become depressed
5. Psychosocial Theory:
54
Neuroendocrine disturbance
| - causing increased secretion of cortisol which seem to induce depression
Hypothalamic - Pituitary-Adrenocortical axis malfunction
55
Neuroendocrine disturbance
| - causing decrease TSH and low TSH is associated with depression.
Hypothalamic - Pituitary- Thyroid axis malfunction
56
He postulated that learned helplessness particularly after repeated failure may cause the individual to abandon attempts at success and become depressed
Seligman
57
He postulated that loss of love object by death or otherwise may trigger depression
Freud
58
TYPES OF DEPRESSIVE DISORDER (6)
1. Major depressive disorder (MDD)
2. Persistent Depressive Disorder (Dysthymia)
3. Premenstrual Dysphoric Disorder
4. Substance/Medication-Induced Depressive Disorder
5. Disruptive Mood Dysregulation Disorder (DMDD)
6. Depressive Disorder associated with Peripartum Onset (PDD)
59
Type of Depressive Disorder
- Characterised by discrete episodes of at least 2 weeks’ duration involving very clear changes in affect, cognition and neurological state; loss of interest or pleasure in activities; social impairment and occupational dysfunction.
- There is an absence of a history of manic behaviour and absence of other factors that may be attributed to depression, such as medication or a medical condition.
- The diagnosis is specified according to whether it is a single episode or recurrent episodes. The degree of severity is also specified whether it is mild, moderate or severe.
- Note that bereavement may cause great suffering but it is not believe to cause this.
1. Major depressive disorder (MDD)
60
Type of Depressive Disorder
- Its a chronic form of depression where the mood disturbance continues for at least 2 years in adults or 1 year in children. It has the same characteristics of MDD but is somewhat milder.
- It has no evidence of psychotic symptoms; its main feature is chronically depressed mood or irritability for most of a day, for most days in 2 years.
2. Persistent Depressive Disorder (Dysthymia)
61
Type of Depressive Disorder
- This category has marked depressed mood, excessive anxiety, mood swings, and decreased interest in activities during the week prior to menses. The mood improves shortly after the onset of menstruation and gradual returns to normal in a week after menses.
3. Premenstrual Dysphoric Disorder
62
Type of Depressive Disorder
- Symptoms seen are the direct physiological effect of substance/ medication. These symptoms substance/medication cause clinically significant distress or impairment in social, occupational or other areas of normal function. The depressive disorder is associated with intoxication or withdrawal from the substances/medication.
4. Substance/Medication-Induced Depressive Disorder
63
Type of Depressive Disorder
- This disorder is characterised by severe recurrent outbursts of verbal rages and physical aggression toward people and property. The temper outbursts are grossly out of proportion to the provocation.
- This disorder cannot be attributed substance/medication, neurological or physiological causes.
- This is mostly seen in children
5. Disruptive Mood Dysregulation Disorder (DMDD)
64
Type of Depressive Disorder
- This is a type of Major depressive disorder where the mood symptoms occur during pregnancy or in the 4 weeks following the delivery.
6. Depressive Disorder associated with Peripartum Onset (PDD)
65
Onset mood episodes can be present in the patient with or without psychosi
Peripartum
66
- Mood episodes with psychotic features is characterized by hallucination to kill the infant or delusions that the infant is possessed. But psychotic symptoms can occur in severe postpartum episode without the present of hallucination and delusion
- Studies show that mood and anxiety during pregnancy (a.k.a. Baby blues) increase the risk of postpartum major depressive episodes.
Postpartum
67
True or False?
Some psychiatrists treat affective conditions as due to biologic factors (NE, E, and serotonin). Some psychiatrists treat the condition as due to both biologic and psychosocial factors.
True
68
CLASSES OF ANTI-DEPRESSANTS(5)
```
A. Tricyclic anti-depressants (TCAs)
B. Heterocyclics
C. Monoamine Oxidase Inhibitors (MAOIs)
D. Selective Serotonin Re-uptake Inhibitors (SSRIs)
E. Miscellaneous Antidepressants
```
69
Class of Anti Depressant
- block the reuptake of NE and serotonin.
- Inhibition of the uptake of NE and serotonin leads to increased levels of neurotransmitters (NE and serotonin) in the synaptic cleft.
• Well absorbed orally
• Have onset 2-3 weeks
• It is metabolized mainly by the liver and excreted by the kidneys. The liver metabolizes some of it to form active metabolites.
• The following agent and adult dose are the more commonly used drugs:
A. Tricyclic anti-depressants (TCAs)
70
An enzyme found in nerve cells
| - metabolizes the monoamines NE and serotonin within the nerve cell.
MAO
71
Agents of TCAs (6)
1. amitriptyline (Elavil) (50-300 mg)
2. nortriptyline (Aventyl, Pamelor) (30-100 mg)
3. clomipramine (Anafrnil) (25-250 mg)
4. trimipramine Surmontil) (50-300 mg)
5. imipramine (P) (Tofranil) (30-300 mg) 6. desipramine (Norpramin) (25-300 mg)
72
Assessment in TCAs
- A thorough history of medical condition of patient is vital:
• Contraindication/caution:
• Conditions that may be aggravated by TCA include asthma, blood disorder, GI and cardiovascular disorders.
• Alcohol or CNS depressants may potentiate any CNS depressant effects of TCA .
• Assess for drug allergy.
• Assess pts. from the start of therapy and monitor throughout therapy for suicidal behaviour.
• Check ECG, complete blood counts, BP, pulse, hepatic and renal functions.
73
Contraindication/cautions for TCAs
pts. in acute recovery phase of myocardial infarction,
pts with prostatic hypertrophy, urinary retention, narrow-angle glaucoma or increased intraocular pressure
pts. with hyperthyroid condition,
pts. with a history of seizure.
74
Side effects of TCAs (5)
1. Altered thought process
2. CNS effects (blurred vision, confusion, tremors, hypotension, drowsiness)
3. Dry mouth, nausea, headache
4. Skin photosensitivity
5. Anticholinergic effects
75
When giving TCAs, monitor for:(6)
1. At appropriate interval monitor BP, pulse, suicide risk, ECG
2. Manifestation of overdose of TCAs include: CNS abnormality and CVS abnormality.
76
Evaluation for treatment of TCAs (4)
Effectiveness of therapy marked by
1. more participation in activities,
2. initiating social activities,
3. taken more interest in personal appearance, 4. normal vital signs.
77
HETEROCYCLICS (4)
1. amoxapine (Ascendin) - inhibits the reuptake of NE and dopamine
2. bupropion (Wellbutrin) - weakly blocks the reuptake of NE, dopamine and serotonin
3. maprotiline (Ludiomil) - similar action to TCAs
4. trazodone (Desyrel) - blocks serotonin reuptake and alter serotonin receptors
78
Heterocyclic.
| - inhibits the reuptake of NE and dopamine
1. amoxapine (Ascendin
79
Heterocyclic.
| - eakly blocks the reuptake of NE, dopamine and serotonin
2. bupropion (Wellbutrin)
80
Heterocyclic.
| - similar action to TCAs
3. maprotiline (Ludiomil)
81
Heterocyclic.
| - blocks serotonin reuptake and alter serotonin receptors
4. trazodone (Desyrel)
82
These agents have fewer long-term side effects than the TCAs.
Heterocyclics
83
- the second or third -line antidepressant for treatment of depression that does not respond to other safer drugs.
- Prevents the uptake and breakdown of NE/Serotonin
- Irreversibly inhibit E, dopamine and 5HT allowing them to accumulate in synaptic clefts and neuronal stage vesicles, causing increased stimulation of the postsynaptic receptors and relief of depression
MAO INHIBITORS
84
MAOIs are rarely used because they require a specific diet to prevent toxicity; diet must be free of?
Tyramine
85
What is the major adverse reaction of MAOIs which may be very fatal? is the occurrence of a sudden very severe hypertension which may be fatal.
Sudden very severe hypertension
86
MAOIS effect may be toxic to the liver, may also cause? (4)
Dizziness, mania, blurred vision and GI problems
87
MAOI agents
1. isocarboxazid (Marplan) (20-60 mg)
2. Phenelzine (Nardil) (45-90 mg)
3. Tranylcypromine (Parnate) (30-60 mg)
4. Selegiline Transdermal
5. System (Emsam)
88
Contraindications of MAOIs (5)
1. Active alcoholism
2. Congestive heart failure
3. Pheochromocytoma
4. Severe hepatic impairment
5. Renal impairment
89
Cautions for MAOIs (3)
1. Cardiac disease (e.g., ischemia) and
2. cardiac dysrhythmias,
3. hypertension
90
MAO interaction with ___ may lead to hypertension and cardiac dysrhythmias
Caffeine
91
MAO alcohol interaction may lead to ______
CNS depression
92
When taking MAOIs, monitor for(4)
1. BP, ECG and observe for orthostatic hypotension
2. Weigh pt biweekly and assess for pedal oedema
3. Periodic liver function test should be performed.
4. Suicidal tendencies
93
Health teaching for taking MAOIs
Do not give tyramine –containing food and beverages until 3 weeks after meds. end
94
Adverse Effects of MAOIs(5)
1. Sleep disturbance
2. Weakness
3. Blurred vision,
4. severe orthostatic hypotension
5. Fluid volume excess (oedema)
95
Evaluation for treatment using MAOIs (2)
1. Improvement in behaviour and communication
| 2. No adverse CNS and Cardiovascular symptoms.
96
- Newest group of antidepressants (#1)
- Are safer than and as effective as the other anti-depressants
- Block the uptake of Serotonin with little to no effect on NE
- Increase levels in the synaptic cleft causes the antidepressant effect
- Drugs under this caption are used to treat depression and a few (fluoxetine and fluvoxamine (Luvox) are used to treat obsessive- compulsive behaviour.
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI’s)
97
Agents of SSRIs (5)
1. fluoxetine (Prozac, Sarafem) 920-80)
2. paroxeline (Paxil) (10-50 mg)
3. seratraline (zoloft) (25-200 mg)
4. citalopram (Celexa) (20-40 mg)
5. escitalopram (Lexapro) (10-20 mg)
98
SSRI drug
| - prototype drug, used to treat depression and obsessive-compulsive disorders
1. fluoxetine (Prozac, Sarafem) 920-80
99
SSRI drug
- is a weak inhibitor of the liver’s P450 enzyme system, has a long half-life and therefore require administration once/day
4. citalopram (Celexa) (20-40 mg)
100
Adverse effect of SSRIs
Anorexia and weightloss
101
SSRIs are usually administered ____, serum peak level vary depending to the drug.
PO
102
True or False
| Concurrent use of SSRIs with MAOIs, contraindicated not recommended
True
103
SSRIs are metabolized by the ___ and excreted via ____ and ____.
liver; urine & feces
104
SEROTONIN AND NOREPINEPHRINE REUPTAKE INHIBITOR Agents (3)
1. Desvenlafaxine (Pristiq) (50-400 mg)
2. Duloxetine (Cymbata) (40-60 mg)
3. Venlafaxine (Effexor) (75-375 mg)
105
A type of antidepressant medication that increases the levels of both serotonin and norepinephrine by inhibiting their reabsorption (reuptake) into cells in the brain. Although the precise mechanism of action isn't clear, it's thought that these higher levels enhance neurotransmission — the sending of nerve impulses — and so improve and elevate mood. Medications in this group of antidepressants are sometimes called dual reuptake inhibitors.
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
106
The sending of nerve impulses
Neurotransmission
107
Other term for SNRIs
Dual reuptake inhibitors.
108
SNRI agents (2)
- Duloxetine (Cymbalta)
| - Venlafaxine (Effexor, Effexor XR) - have extended release form
109
All SNRIs have the same general mechanism of action and side effects. However, individual SNRIs have some different ______. That means you may respond differently to a certain SNRI or have different side effects with a different SNRI. For instance, you may have unpleasant side effects with one SNRI but not another.
Pharmacological characteristics
110
Side effects of SNRIs include: (14)
1. Nausea &Vomiting
2. Dizziness
3. Sleeping Problems (Insomnia, Sleepiness, Trouble sleeping, Abnormal dreams)
4. Constipation
5. Sweating
6. Dry mouth
7. Yawning
8. Tremor
9. Gas
10. Anxiety
11. Agitation
12. Abnormal vision(blurred vision/double vision)
13. Headache S
14. Sexual dysfunction
111
Nausea is less common with the _____ form of SNRIs.
extended-release
112
When using SNRIs, monitor for:(6)
1. Cardiac effects
2. Excess sedation,
3. Orthostatic hypotension
4. Nausea
5. headache and
6. malaise
113
First line anti-depressant medications (12)
* Bupropion Fluvoxamine
* Citalopram Mirtazapine
* Desvenlafaxine Moclobemide
* Duloxetine Paroxetine
* Escitalopram Sertraline
* Fluoxetine Venlafaxine
114
Second line anti-depressant medications
* Quetiapine
| * Tricyclic antidepressants
115
Third line anti-depressant medications
• Monoamine oxidase inhibitors (MAOIs)
116
2 Neurons cant touch, thus they are connected via:
Neurotransmitter
117
3 Methods of Neurotransmitter Reuptake
1st System
2nd System
3rd System
118
System which puts the neurotransmitter back to the vesicle in the pre-synaptic neuron.
1st System
119
System which reuptakes and breaks down neurotransmitters in the presynaptic neuron.
2nd System
120
System which reuptakes, breaks down and puts NE to blood vessels.
3rd System
121
Anti-depressants that block the 1st system
SSRIs & Tricyclics
122
Anti-depressants that block the 2nd system
MAOIs
123
Anti-depressants that block the 3rd system
COMT
124
Origin of Serotonin
Ralph Nuclei in the Brainstem
125
Origin of Norepinephrine
Locus Cereleus
126
Parts of the Brain that is affected by Depression(6)
1. Hippocampus
2. Amygdala
3. Hypothalamus
4. Other limbis structures
5. Frontal Cortex
6. Cerebellum
127
Part of the Brain that is affected by Depression
| - Memory impairments, feelings of worthlessness, hopelessness and guilt
1. Hippocampus
128
Part of the Brain that is affected by Depression
| - Anhedonia, anxiety, reduced motivation
2. Amygdala
129
Part of the Brain that is affected by Depression
| - Increased or decreased sleep and appetite,decreased energy and libido
3. Hypothalamus
130
Part of the Brain that is affected by Depression
| - emotional alterations
4. Other limbis structures
131
Part of the Brain that is affected by Depression
| - Depressed mood, problems concentrating
5. Frontal Cortex
132
Part of the Brain that is affected by Depression
| - Psychomotor retardation/agitation
6. Cerebellum
133
In depression, we want the NE to stay in the _____
Synaptic cleft
