Module 14b - Part 2 Flashcards by Dallas Toon

For a diagnosis, at least _____ of some massive list must occur for at least __ weeks.

5 symptoms

2 weeks

How well did you know this?

Not at all

Perfectly

Depression is classified into two major types, what are they?

Exogenous

Endogenous

How well did you know this?

Not at all

Perfectly

_________ depression is triggered by external stimuli, whereas _________ depression may or may not be related to external events

Exogenous

Endogenous

How well did you know this?

Not at all

Perfectly

Prolonged grieving coupled with excessive guilt.

Pathological grief

How well did you know this?

Not at all

Perfectly

What treatment modality is more effective to treat pathological grief?

Psychotherapy > drugs

How well did you know this?

Not at all

Perfectly

Prolonged depression following failure or rejection. Common symptoms include hypersomnia and hyperphagia.

Adjustment disorder

How well did you know this?

Not at all

Perfectly

What is the most effective treatment modality for treating adjustment disorder?

Psychotherapy > drugs

How well did you know this?

Not at all

Perfectly

What are the two depression types within exogenous depression?
What treatment modality is best for exogenous depression?

Pathological grief
Adjustment disorder
Psychotherapy

How well did you know this?

Not at all

Perfectly

What are the different depressive types within endogenous depression?

Major depression
Severe depression
Atypical depression
Dysthymia
Seasonal Affective Disorder
Postpartum depression
Bipolar disorder

How well did you know this?

Not at all

Perfectly

Common symptoms include anhedonia and lack of response to positive stimuli. Symptoms are usually worse in the morning, and insomnia and weight loss are also typical.

Major depression

How well did you know this?

Not at all

Perfectly

Similar symptoms to major depression with the addition of severe suicidal ideation and psychoses

Severe depression

How well did you know this?

Not at all

Perfectly

The patient’s mood is regularly low but symptoms are not as severe as major depression.

Dysthymia

How well did you know this?

Not at all

Perfectly

Mild or moderate symptoms of depression related to the lack of sunlight. Usually only affects people in the winter months.

Seasonal affective disorder

How well did you know this?

Not at all

Perfectly

Alternating periods of elevated or irritable mood and periods of depression

Bipolar disorder

How well did you know this?

Not at all

Perfectly

Moderate to severe depression in women after they given birth. Usually occurs within ___ months of delivery but may occur __ year after birth.

Postpartum depression

w/in 3 months - 1 year

How well did you know this?

Not at all

Perfectly

Similar symptoms to major depression but patients also have the atypical symptoms of hypersomnia and hyperphagia. Patients are usually obese.

Atypical depression

How well did you know this?

Not at all

Perfectly

This endogenous depressive type responds better to psychotherapy than drugs.

Dysthymia

How well did you know this?

Not at all

Perfectly

Describe the major hypothesis for the biochemical basis of depression.

Monoamine hypothesis

States that altered monoamine release, receptor sensitivity, or postsynaptic function lead to symptoms of depression

How well did you know this?

Not at all

Perfectly

Why is the efficacy of antidepressants difficult to assess?

Since it takes months for effects to occur

How well did you know this?

Not at all

Perfectly

Results from placebo controlled CTs also suggests that as much as 40% of the effects of antidepressants may be due to the _______ ________.

placebo effect

How well did you know this?

Not at all

Perfectly

Antidepressant drugs mediate their effects by one of two major mechanisms. What are they?

Inhibiting monoamine reuptake

Inhibiting monoamine metabolism

How well did you know this?

Not at all

Perfectly

What are the four major classes of drugs used to treat depression?

TCAs
SSRIs
MAOIs
SSRIs/NSRIs

How well did you know this?

Not at all

Perfectly

What is the mechanism of action of TCAs?

Prevent the reuptake of both serotonin and NE

How well did you know this?

Not at all

Perfectly

What are the adverse effects of TCAs?

ASS WOD (Think TCA = techoic ass+ids [acids] —> ASS workout of the day)

Anticholinergic effects
Sedation
Orthostatic hypotension
Decreased seizure threshold
Cardiac toxicity
Weight gain
Sexual dysfunction

How well did you know this?

Not at all

Perfectly

Describe the mechanism of action of SSRIs.

Block the reuptake of serotonin.

Why would SSRIs be used over TCAS if they only block serotonin, rather than serotonin and NE?

Thought to have similar efficacy to TCAs, but the incidence of side effects is lower

Most commonly used treatment of depression and most commonly used in major depression.

SSRIs

What are the adverse effects of SSRIs?

``` IWSS (i [don't] want Serotonin Syndrome) Insomnia Weight gain Sexual dysfunction Serotonin syndrome ```

Increased serotonin transmission can result in agitation, confusion, anxiety, hallucinations and incoordination. Symptoms may occur within __ days of initial therapy and disappear when the drug is stopped.

Serotonin syndrome | 3

Same mechanism of action as TCAs.

SNRIs - selective serotonin/NE reuptake inhibitors

What is the main advantage of SNRIs?

Faster onset of action

What are the adverse effects of SNRIs?

NDS (sNris --> Nintendo DS) | Nausea, diastolic HTN, sexual dysfunction

Enzyme that inactivates monoamine NTs.

Mononamine oxidase

What are the two major types of MAO, and what do each oxidize?

MAO-A - serotonin and NE | MOA-B - dopamine

MAO inhibitors inactivate which MAO subtype?

Both - non-selective

MAO inhihbitors are useful in the treatment of these depression types.

Atypical and Dysthymia (the weird ones)

MAO inhibitors mediate their effects by inhibiting the metabolism of monoamines in the __-_______ neuron.

pre-synaptic

What are the adverse effects of MAO inhibitors?

HI AOA (HI American Orthopedic Association) Hypertensive crisis (tyramine containing foods) Insomnia Agitation Orthostatic hypotension Anxiety

Severe illness characterized by recurrent fluctuations between episodes of mania and depression

Bipolar disorder

What are the three major groups of drugs used to treat bipolar disorder?

Mood stabilizers Antipsychotics Antidepressants

What are the benefits of patients using mood stabilizers to treat bipolar disorder.

1 - Relieve symptoms during manic OR depressive episodes 2 - Prevent recurrence of manic or depressive episodes 3 - Do not worsen symptoms of mania or depression and do not alter the rate of cycling

The primary drugs used as mood stabilizers.

``` Lithium Valproic acid (anti-epileptic) ```

Although the mechanism of action of lithium is not clear, what do we believe it does?

Alter the uptake and release of glutamate | Block the binding of serotonin

Lithium has a ______ therapeutic range and plasma concentrations may be altered by _____.

narrow | sodium

Drugs that increase sodium loss from the body (i.e. ______) increase lithium concentrations and produce toxicity. These toxic effects are?

diuretics Gi upset, tremor, sedation, hypotension GTSH (Toxic - Thyroid stimulating hormone Gone)

Used in bipolar disorder acutely to control symptoms during manic episodes and long term to stabilize mood.

Antipsychotics

Why are antipsychotics even used to treat bipolar disorder, and which type is preferrable?

Show a benefit even in patient's without psychotic symptoms | Atypical antipsychotics are preferred due to the lower incidence of EPS

Used to treat depressive episodes of bipolar disorder. Always used in conjunction with _____ _______.

antidepressants | mood stabilizers

Why are antidepressants not used alone in the treatment of bipolar disorder?

Thought that they may precipitate manic episodes

``` Which of the following is best in the treatment for bipolar disorder? A) TCAs B) SSRIs C) SNRIs D) All of the above ```

D - there is no evidence for which antidepressant works best

Patient is overwhelmed with uncontrollable worrying. The hallmark is an unrealistic or excessive worry about several activities that lasts 6 months or longer

GAD

An anxiety where the patient feels judged or a situational anxiety where escaping would be difficult or embarrassing.

Agoraphobia

Anxiety in social situations. Patients may not be able to talk (or stop talking), eat in front of others, or use public washrooms

Social anxiety disorder

Anxiety that occurs after experiencing a traumatic event. Symptoms may include re-experiencing the event and severe insomnia.

PTSD

Symptoms are related to a specific fear

Simple phobia

Patients have a sense of impending doom that is unrelated to stressors. They experience panic attacks, which are sudden in onset and may include symptoms like heart palpitations, chest pain, shortness of breath, dizziness

Panic disorder

Often confused for a heart attack.

Panic attack

What are the major classes of drugs used to treat anxiety?

Benzodiazepines Buspirone Antidepressants

First line therapy for anxiety.

Benzodiazepines

Act by potentiating the actions of GABA at the GABA receptor.

BDZs

Describe the mechanism of action of BDZs.

BDZs bind to a different site on the GABA receptor, than GABA. This causes an increased binding of GABA to its receptor. This leads to opening a chloride channel, and a subsequent influx of chloride This causes CNS depression

Why are benzodiazepines safer than barbiturates?

Since they are not GABA agonists, there is a limit to how much CNS depression they may produce, unlike barbiturates

BDZs are useful in treating these 5 things.

``` Anxiety seizures insomnia Alcohol withdrawal Muscle spasm ```

A higher dose of BDZ is used to treat _______, and a lower for _______.

insomnia | anxiety

What are the adverse effects of BDZs?

``` CAR TTW (Benz = car, Try to win - think race) CNS depression Anterograde amnesia Respiratory depression Teratogenic Tolerance Withdrawal ```

Impaired memory of events that occur following dosing of BDZs.

Anterograde amnesia

Describe tolerance in BDZ treatment and how withdrawal symptoms are minimized.

Tolerance does not occur to anxiolytic or sedative effects, but occurs to seizure effects. Withdrawal is minimized by tapering down the concentration of drug slowly.

BDZs are effective in treating these anxiety types.

GAD and SAD

Not a CNS depressant and acts to treat anxiety in a mechanism distinct from BDZs.

Buspirone

The likely mechanism of action of buspirone involves modulation of ________ and/or _________ neurotranmission.

serotinergic | Dopaminergic

Since buspirone is not a CNS depressant, it is useful in treating anxiety in patients who use _______.

alcohol (unlike Benzos, where respiratory depression may occur)

Buspirone: - Shows no signs of _______ or physical ________ What is it's major disadvantage?

tolerance, physical dependence Major disadvantage is that its anxiolytic effects develop slowly - ineffective in treating symptoms that require immediate relief

Buspirone is effective in the treatment of ______ but appears to be ineffective in the treatment of other anxiety types

GAD

Although buspirone is well tolerated and non-sedating, what are some commonly reported side effects?

Dizziness, light-headedness, excitement | LED

Which antidepressants are most effective in treating GAD?

SNRIs, SSRIs, buspirone

Which antidepressants are most effective in treating Panic disorder/aographobia?

SSRIs, TCAs, MAOIs | SSRIs preferred

Which antidepressants are most effective in treating OCD?

SSRIs are the first line therapy

Which antidepressants are most effective in treating social anxiety disorder?

SSRIs are the first line of therapy | BDZs provide immediate relief

Which antidepressants are most effective in treating PTSD?

No evidence for efficacy of any drug in treatment

What must OCD patients also undergo with drug treatment?

Behavioural psychotherapy

Why are SSRIs preferred over MAOIs and TCAs in the treatment of panic disorder/agoraphobia?

Better tolerated