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Pathophysiology and Pharmacology 2 > Mood 1 Emotional Regulation > Flashcards

Mood 1 Emotional Regulation Flashcards

1
Q

Emotional Regulation

A

ability to mange emotional responses to environmental stimuli perceived as aversive or negative

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2
Q

Emotional regulation involves

A

neurotransmitters associated w/ anxiety & depressive states
immunologic responses/inflammation

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3
Q

Emotional states influence

A

immunologic responses
risk for maladaptive emotional responses
manifest clinically through bodily symptoms

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4
Q

Anxiety Types

A

generalized anxiety disorder
social anxiety disorder
panic disorder

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5
Q

Fear-centered anxiety disorders

A

panic disorders & social anxiety disorder
situation associated w/ overwhelming negative consequences
neural structures to process threat aren’t functioning well

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6
Q

Worry-centered anxiety disorders

A

GAD
functional disruptions in neuronal circuitry
increased activity in cortical-striatal-thalmic pathway

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7
Q

Anxiety comorbidities

A

depression
panic disorder: respiratory disease, vestibular dysfunction, thyroid problems, cardiac disease
GAD: chronic pain, unexplained somatic symptoms, sleep disorder

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8
Q

Genetic vulnerability to anxiety

A

variation of 5-ht transporter geene

SSRIs

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9
Q

Classic fear conditioning (consolidation/reconsolidation)

A

amygdala/long-term memory
stronger fear memory
meds disrupt chemicals involved in this process

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10
Q

Neuroanatomic Pathways in Anxiety

A 
Conditioned stimulus (read by thalamus > amygdala/visual cortex)
Amygdala (confers significance on stimuli [thalamus/hypothalamus], holds emotional memories/threat asessment, controls autonomic responses)
Prefrontal cortex (fear learning/extinction, registers/assigns meaning to emotions, weighs pros/cons, balances emotion/thought/controlling attention)
Caudate Nucleus (orchestrates action-reward sequencing, drives behavior w/ recall of past successful outcomes)
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11
Q

Anxiety chemical systems

A

GABA-BZD-receptor system

[gaba/benzodiazepines/glutamate]

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12
Q

GABA

A

primary inhibitory amino acid neurotransmitter

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13
Q

Benzodiazepines

A

partners w/ gaba in maintaining mind-body homeostasis

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14
Q

Glutamate

A

immediate precursor to GABA

extinction

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15
Q

Norepinephrine

A

increases during states of anxiety
results in downregulation of auto receptor (increased autonomic arousal)
r/t BDZ receptors

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16
Q

Serotonin

A

(5-HT)
decreased during states of anxiety
action related to fear learning

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17
Q

Dopamine

A

DA
increased during acute stress
impairs DA reward pathways
phobic responses

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18
Q

Hypothalamic-pituitary-adrenal axis

A 
threatening stimulus (fight or flight)
corticotropin-releasing hormone (ACTH/glucocorticoids)
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19
Q

Specific phobia s/s

A

unreasonable or excessive/persistent fear of specific objects or siuations

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20
Q

Social anxiety disorder s/s

A

fear generated by social or performance situations w/ exposure to unfamiliar or scruntity

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21
Q

GAD s/s

A

excessive worry; difficult to control

worry generates restlesssness, fatigue, difficulty concentrating, irritability, tension, sleep disturbance

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22
Q

Anxiety Meds

A 
SSRIs
Selective norepinephrine reuptake inhibitors (SNRIs)
Tricyclics (TCAs)
monoamine oxidase inhibitors (MAOIs)
Benzodiazepines
Combination therapy
Caution in elderly
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23
Q

Escitalopram (lexapro), Sertaline (zoloft) [class/moa/uses/se/bbw/contra/intxtions/preg]

A

antidepressant
increases availability of serotonin
tx: gneralized anxiety & depression
sexual dysfunction, dizziness, nausea, insomnia, somnolence, confusion, seizures, takes weeks to effect
increased risk of suicidal thinking (notapproved for <12 years)
no breast feeding/MAOI
w/ MAOIs cause serotonin syndrome, hypertensive crisis, hyperthermia and autonomic instability
do not give with St. John’s Worst (serotonin syndrome)
Preg Cat C

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24
Q

Serotonin Syndrome (HARMFUL)

A 
hyperthermia
anticognitive (delirium, confusion)
reflexes (hyper)
myoclonus (jerking/twitching)
fast HR
unconsciousness
loss of GI control
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25
Q

Duloxetine (Cymbalta), Venlafaxine (effexor) [class/moa/uses/se/contra/bbw/intx]

A

serotonin-norepinephrine reuptake inhibitor (antidepressant anxiolytic)
inhibits reuptake of serotonin & norepinephrine
elevates mood
SE: abnormal dreams, sweating, constipation, dry mouth, loss of appetite, weight loss, tremor, abnormal vision, HA, n/v, dizziness, loss of sexual desire
use w/ caution in underlying CV disease, bupropion = no bueno w/ seizures
risk for suicidal actions
bupropin & levodopa increases adverse effects
impaired platelet aggregation

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26
Q

imipramine (Tofranil) [class/moa/uses/se/vvvw/contra/interx/preg]

A

TCA (antidepressants)
blocks reuptake of norepinephrine/serotonin
tx major depression off label anxiety/bedwetting in kids
se: dry mouth, blurred vision, urine retention, HTN, orthostatic hypotension, sedation, anticholinergic effect, cardiac dysrhythmias
don’t give if history of MI/heart block/arrhythmia
contra: narrow: angle glaucoma/severe renal/hepatic disease
intx: MOAIs = neuroleptic malignant syndrome, don’t give w/ oral contraceptives, phenothiazines, St. John’s wort
C

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27
Q

Neuroleptic Malignant Syndrome (FEVER)

A 
fever
enephalopathy
vitals unstable
elevated enzymes (CPK)
rigidity of muscles
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28
Q

Phenelzine (Nardil) [class/uses/se/bbw/contra/interx/preg]

A

MAOIs (antidepressant)
tx: depression/panic disorder (anxiety off label)
se: orthostatic hypotension, diarrhea, HA, insomnia, rebound HTN if discontinued abruptly, overdose: seizures, resp depression, circulatory collapse, coma
increased risk of suicidal thinking, nt approved in peds
contra: CV disease, hepatic/renal impairment, pheocrhomocytoma
INtx: SSRIs (serotonin syndrome), avoid food w/ tyramine (HTN crisis), avoid caffiene for heart, avoid ginseng (HA) ma huang, ephedra, st. john’s wort (HTN crisis)
c

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29
Q

Do not give MOAIs w/

A 
barbiturates
TCAs
antihistamines
CNS depressants
antihypertensives
OTC cold meds
cheese
wine
pickled foods
30
Q

Tyramine Containing Foods

A 
avocados
bananas
raisins
papaya products
canned figs
cheese
sour cream
yogurt
beer
wines
beef/chicken liver
pate
meat extracts
pickled 
pepperoni
salami
sausage
hotdogs
soy sauce
yeast
chocolate
31
Q

Lorazepam (Atiavn) [class/uses/SE/contra/interx/overdose/preg]

A

Benzodiazepines (sedative-hypnotic)
primary tx for anxiety disorders/insomnia
se: drowsiness, dizziness, resp depression, amnesia, ataxia, vision changes, n/a, physical dependence (assess airway)
contra: acute narrow-angle glaucoma, closed-angle glaucoma, liver disease, impaired brain fx, suicidal ideations
interx: can decrease anti-parkinsonism effects of levodopa, don’t admin with kava/valerian/chamomile/hops
overdose: flumazenil reverses CNS depressant
D

32
Q

Nonpharmacologic TX of anxiety

A 
CBT
exposure therapy/counseling
progressive muscle relaxation
psychoeducation
cognitive approaches for automatic thoughts/shcemas
biofeedback techniques
meditation
33
Q

Depression

A

persistent feelings of sadness/lack of interest in life

34
Q

Depression Classifcations

A 
major depressive disorder
persistent depressive disorder
premenstrual dysphoric disorder
substance/medication-induced depression
post-partum depression
seasonal affective disorder
depression due to another medical disorder
35
Q

Major Depressive Disorder def

A

> 1 depressive episodes of >2 weeks over lifetime

w/out history of manic/mixed/hypomanic episodes

36
Q

Major Depressive Disorder s/s

A 
depressed mood
significantly less interest in activities
changes in weight
insomnia/hypersomnia
feelings of worthlessness/guilt
diminished ability to think/concentrate
recurrent thoughts of death or suicide
37
Q

Major Depressive Episode

A

last for 2 weeks +
major symptom: anhedonia (lack of interest)
at least 4 DSM-5 symptoms

38
Q

Persistent Depressive Disorder s/s

A 
depressed mood occurring on more days than not for >2 years
increased overeating or decreased appetite
sleeping too much or too little
lower energy, fatigue
low self-esteem
poor concentration 
difficulty making decisions
feelings of hopelessness
39
Q

Premenstrual dysphoric Disorder

A

severe form of PMS resulting in depression or anxiety

s/s: mood swings, irritability, depressed mood, anxiety, lack of interest, difficulty concentrating

40
Q

Chronic Depression

A

major depression lasting 2 years or longer

no more than a 2 month period of remission

41
Q

Post-partum depression

A

rapid decline of estrogen

PP Psychosis = medical emergency

42
Q

Depression Pathogenesis

A

insufficient firing of key neural networks

noradrenergic pathway, orbitofrontal complex, prefrontal cortex

43
Q

Neurotransmitters r/t depression

A

serotonin (5-HT) regulates obsessions/compulsions
Dopamine (DA) regulates motivation, pleasure and reward
Norepinephrine (NE) regulates alertness, energy

44
Q

Norepinephrine & Depression

A

works with dopamine
responsible for interest and energy
provides sense of hope/purpose in life
deficiency results in negative emotions

45
Q

Serotonin & Depression

A

mediates positive mood/optimism/impulsivity
essential for keeping norepinephrine at appropriate level
projects widely to several areas of brain
pathway to hippocampus/septum/amygdala are inhibitory
other pathways control somatic fx (to hypothalamus = appetite, to brainstem = sleep)
balance maintains mood

46
Q

Dopamine & Depression

A

reward system/deficiency r/t anhedonia

mesolimbic pathway

47
Q

Stress cascade

A

stress response > activates hypothalamic-pituitary adrenal axis (HPA) > increased cortisol > chronic leads to decreased immunity & hippocampus atrophy

48
Q

Effects of hippocampal atrophy

A

deficits in learning/memory formation

mood & emotion

49
Q

Stress Reduction Methods

A 
group/social support
meditation
yoga
biofeedback
self-hypnosis
creative imagery
thought stopping
breathing exercises
regular exercises
proper nutrition
relaxation response
time management
50
Q

Anterior Cingulate Cortex

A

emotional control, volume loss & fx alterations w/ depression

51
Q

Basal Ganglia

A

limbi-cortical-striatel-pallidal-thalamic tract
hypoactive dorsal section of tract
lack of norepinephrine or dysfunction of monoamine pathways
overactive ventral tract
w/ depression

52
Q

Hippocampus

A

excessive prolonged stress & overactivation of HPA axis damages hippocampal neurons = volume loss w/ dpression

53
Q

Amygdala

A

function increased in depression = volume increases

54
Q

Depression TX

A

TCAs
MOAIs
SSRIs
CBT

55
Q

Bipolar Disorders

A

group of mood disorders characterized by mani, hypomanic and depressive episodes
I and II
r/disorder cyclothymic disorder (but not significant enough)

56
Q

Bipolar Disorder Rapid Cycling

A

> 4 depressive and/or manic episodes w/in 12 months
at least 1 week for manic
2 weeks for depressive
periods of remission between

57
Q

Mania

A

abnormal, persistently elevated, expansive or irritable mood
increased energy present every day for one week or longer
flight of ideas
pressured speech
increased participation of goal-directed activities

58
Q

Hypomania

A

feelings of euphoria

mood and behavior changes

59
Q

Depressive episodes

A

do not always manifest

alternate w/ mania/hypomania in bipolar I and II

60
Q

Cyclothymic Disorder

A

reoccuring episodes of hypomanic symptoms alternating with depression over 2 years +

61
Q

Manic Attack s/s (DIG FAST)

A 
distractibility
indiscretion
grandiosity
flight of ideas
activity increase
sleep deficit
talkativeness
62
Q

Bipolar Disorders About

A

no definitive cause/specific pathophysiology
idiopathic
unusual patterns of inflammation/glial cell activation

63
Q

Bipolar Disorders RF

A

stressful life events

heritability factors

64
Q

Bipolar Disorder Manic DX

A

must occur most of the day for a week or more (less if hospitalization required)

65
Q

Bipolar Type I DX

A

at least one manic episode

66
Q

Bipolar Type 2 DX

A

at least one hypomanic episode

67
Q

Children Bipolar DX

A

must assess on basis of personal baseline

68
Q

Bipolar TX

A

mood stabilizers: lithium

antipsychotics/anticonvulsants: valproic acid, risperiodone

69
Q

lithium (Eskalith) [class/moa/use/se/intx/bbw/preg]

A

mood stabilizers
affects sodium transport across cell membranes
tx bipolar for purely manic or depressive episodes
se: HA, lethargy, fatigue, recent memory loss, n, v, anorexia, abdominal pain, diarrhea, dry mouth, muscle weakness, hand tremors, reversible leukocytosis, nephrogenic diabetes insipidus
intx: diuretics, NSAIDS, COX-2 Inhibitors, methyldopa, phenytoin, SSRIs, SNRIs, MOAI (

70
Q

trazodone, refazodone (class/se/bbw/preg)

A 
SARI (acute antidepressant)
SE: orthostatic hypotension, constipation, diarrhea, nausea, vomiting, confusion, dizziness, HA, insomnia, blurred vision, prolonged QT, torsades, seizure, priapism, dysrhythmias
BBW: suicide risk
w/ MOAIs = serotonin syndrome
never with saquinavir, ritonavir
never admin if pregnant
71
Q

buproprion (class/se/bbw/contra/interx/preg)

A

norepinephrine/dopamine reuptake inhibitor
helps w/ smoking cessation
antidepressant
SE: hepatoxic, mild amphetamine effect if prior drug abuse
BBW: suicidal ideation
Contra: bulimia/anorexia (seizures), zyban (same ingredient, seizure disorder, alcohol/drug withdrawal,
Interx: zyban, MOAIs
C

Pathophysiology and Pharmacology 2 (27 decks)

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