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integrated studies in mental health > Mood disorders > Flashcards

Mood disorders Flashcards

1
Q

state the mental illnesses under the anxiety spectrum?

A

Panic disorder
GAD
OCD
Agoraphobia

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2
Q

state the mental illnesses under the AFFECTIVE spectrum

hint: all are depression related

A

Major Depression
Bipolar Disorder
Dysthymia

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3
Q

state the mental illnesses under the PSYCHOSES spectrum

A

Schizophrenia
Schizoaffective

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4
Q

what is affected in affective mood disorders

A

AFFECT 🡺 feeling or emotions

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5
Q

two broad types of Affective (Mood) Disorders

A

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

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6
Q

what is depression?

what are the symptoms?

A

Flattened mood

SIG E CAPS

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7
Q

what is mania?

what are the symptoms?

2

A

abnormally elevated mood

Intense elation or irritability

Hyperactivity, talkativeness, distractibility

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8
Q

what are the Clinical Symptoms of Major Depressive Disorder (MDD)

A

(anhedonia) for Minimum period of 2 weeks

is Not due to normal bereavement

the the abbreviation SIG: E CAPS

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9
Q

FULL MEANING OF SIG: E CAPS

A

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

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10
Q

WHAT ARE THE Physical Symptoms OF DEPRESSION?

HASBF

A

Headache

Sleep disturbances

Fatigue

Back pain

Significant change in appetite resulting in weight loss or gain

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11
Q

epidemiology of depression.

complete the blanks

Depression is common
Lifetime prevalence
____% MDD
____% Dysthymia

Symptom variation across life span:
symptoms in children are ____&____

symptoms in Older adults
____________ and ____________

A

Depression is common
Lifetime prevalence
16.4% MDD
2.5% Dysthymia

Symptom variation across life span
Children
Stomach & headaches

Older adults
Distractibility and forgetfulness

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12
Q

MDD twice as common in __________

A

MDD twice as common in women

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13
Q

what is the epidemioogy of depression in adolescence

what Differences emerge in adolescence?

A

Co-morbidity

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

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14
Q

Bipolar Disorders

Usually involve episodes of depression alternating with mania
DESCRIBE TYPES OF MANIA AND THEIR FEATURES.

A

Mixed episode
Symptoms of both mania and depression in the same week

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

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15
Q

what are the DSM-V Criteria for Manic and Hypomanic Episodes

PEF R GEE

A

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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16
Q

what are the DSM-V Criteria for Manic episodes?

after picking 3 or 4 from the initial criteria

A

For manic episode:
Symptoms last for 1 week OR require hospitalization
Symptoms cause significant distress or functional impairment

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17
Q

what are the DSM-V Criteria for Hypomanic Episodes

after picking 3 or 4 from the initial criteria

A

For hypomanic episode:
Symptoms last at least 4 days
Clear changes in functioning but impairment is not marked

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18
Q

what are the Subtypes of Depressive and Bipolar Disorders?

__________Affective disorder (SAD)
Episodes happen regularly at a particular time of year

_________ onset
Within 4 weeks of giving birth

_________
Inability to experience pleasure (anhedonia)

A

Seasonal Affective disorder (SAD)
Episodes happen regularly at a particular time of year

Postpartum onset
Within 4 weeks of giving birth

Melancholic
Inability to experience pleasure (anhedonia)

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19
Q

MDD pathophysiology
What is going wrong?

7

A

Genes (mutations etc.)
Environment
Genes & Environment (G x E) interactions (Epigenetics)
Endocrine (hormones) system
Brain chemicals
Brain regions
Immune system

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20
Q

fill in the blanks

________ clusters within families
First-degree relatives of patients with MDD 🡺 threefold increased risk of _______
Heritability is approximately _______
Genetic overlap between MDD and other psychiatric disorders e.g. ________; __________).
However, lack of consistent or replicated evidence for various genes and their involvement in MDD
🡺 Genetic variants confer an increased risk only in the presence of exposure to stressors and other adverse environmental circumstances 🡺 we all have different life experiences

A

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).
However, lack of consistent or replicated evidence for various genes and their involvement in MDD
🡺 Genetic variants confer an increased risk only in the presence of exposure to stressors and other adverse environmental circumstances 🡺 we all have different life experiences

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21
Q

Environment (Life Experience)
and MDD pathophysiology

what are the pathophysiology of PSYCHOLOGICAL STRESS

A

Type of stress (chronic or acute)
Controllability of the stress
Response to stressors 🡺 active or passive coping skills
Age at which you experience stress 🡺 early life stress
Parental care

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22
Q

how do Serotonin and Norepinephrine affect depression?

A

Serotonin and norepinephrine are believed to be key neurotransmitters in the etiology of depression

From the raphe nuclei and locus ceruleus, 5-HT and NE, respectively, send projections up to the prefrontal cortex and limbic system where emotional depressive symptoms are thought to be mediated.

Additionally, there are also 5-HT and NE-rich tracts into the spinal cord, which are thought to modulate pain perception.

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23
Q

Both serotonin and norepinephrine mediate a broad spectrum of depressive symptoms
state THE DIFFERENCES IN LEVELS WHEN CHECKING FOR MANIA OR MDD

A

1) MDD
Low levels of NA, 5HT

2) Mania
High levels of NA, low levels of 5HT

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24
Q

what are the three main classes of drugs that are used for the Pharmacotherapy of Depression?

hint: they focus on 5HT and NA

fill in the gaps
ALL drugs take ___________ to bring about clinical _________– effects, even though they immediately increase ______________ of these neurotransmitters.

A

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

ALL drugs take weeks to bring about clinical antidepressant effects, even though they immediately increase extracellular levels of these neurotransmitters.

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25
Q

what are the three stages of the Treatment regimen?

A

An acute stage where the aim is to induce remission.
A maintenance stage where the aim is to prevent relapse into the existing episode.
A prophylaxis stage to avert recurrence after full remission from an episode of depression

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26
Q

list drugs under Tricyclic Antidepressants

CADID

A

Clomipramine
Amitriptyline
Doxepin
Imipramine
Desipramine

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27
Q

what are Tricyclic Antidepressants used to treat?

DOM

NEP

HAS

A

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

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28
Q

what are the CONTRA-INDICATIIONS TCAs

DOSC

A

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

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29
Q

what are the Adverse Effects of TCAs?

WHY SHOULD THEY BE AVOIDED IN THE ELDERLY

HOW DOES ITS DIFFERENT EFFECT AT DIFFERNT RECEPTORS CAUSE THESE SIDE EFFECT.

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.

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30
Q

FACT OF HYPOMANIA

Hypomania
Symptoms of mania but less intense
Four or more days of ____________
Doesn’t interfere with ________
Hypomania alone is not ______________

A

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

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31
Q

WHAT ARE THE PREFERRED USES OF TCAs

A

Depression with

Pain
Fibromyalgia
Migraine
insomnia

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32
Q

consequences of TCA overdose

A

Confusion,

convulsions,

tachycardia

hypotension,

ventricular

arrhythmias.

Ventricular arrhythmias 🡺 death

Suicide!

33
Q

what are the treatment for 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.

34
Q

list drugs under SSRI

A

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

35
Q

STATE THE USES OF SSRI

A

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

36
Q

WHAT IS THE Least preferred use of SSRI

A

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

37
Q

WHAT ARE THE 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

Akathesia and dystonic reactions

Discontinuation or withdrawal syndrome after prolonged treatment 🡺

38
Q

WHAT ARE WITHDRAWAL SYMPTOMS OF SSRI

A

dizziness,
nausea,
headache,
fatigue,
flu-like symptoms, agitation,
impaired concentration,
paraesthesia

sensations of electric shocks, vivid dreaming and anxiety.

39
Q

___________can reduce DA levels

A

5HT can reduce DA levels

40
Q

_______________Occurs when several serotonergic drugs combined

A

Serotonin Syndrome

41
Q

Serotonin Syndrome Often involves ________ as one of the drugs

A

Often involves MAOI’s as one of the drugs

42
Q

WHAT ARE THE Other serotonergic drugs implicated IN SEROTONIN SYNDROM?

A

SSRI’s

TCA’s

Serotonin releasing agents (i.e. MDMA or “ecstasy”)

Dextromethorphan, meperidine, others

43
Q

WHAT ARE THE SYMPTOMS OF Serotonin Syndrome

A

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

44
Q

HOW MANY WEEKS SHOULD BE ALLOWED BETWEEN ADMINISTERING MAOI AND OTHER ANTI DEPRESSANTS?

HOW MANY WEEKS WHEN THE SSRI IS FLUOXETIN?

A

Allow 2 weeks between MAOI and other antidepressant administration

FLUOXETIN ALLOW 5 WEEKS

45
Q

SSRIs 🡺 major risk factor for ____________ in children, adolescents and young adults.

Discontinuation or withdrawal symptom with an increased risk of suicidal ideation if __________

A

SSRIs 🡺 major risk factor for suicide in children, adolescents and young adults.

Discontinuation or withdrawal symptom with an increased risk of suicidal ideation if dose missed.

46
Q

SSRI Is not to be prescribed in children and young adults (apart from ___________)

A

Is not to be prescribed in children and young adults (apart from fluoxetine which has a long half-life)

47
Q

HOW IS THE HALF LIFE OF MOST SSRI?

A

SHORT

48
Q

STATE 3 DACTS ABOUT

Selective Noradrenaline Reuptake Inhibitors

IN REFERENCE TO

TIME TAKEN BEFOR CLINICAL EFFECT

MODE OF ACTION

THE MAIN NRI IN THE UK

A

4-6 weeks before a clinical effect is observed.
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.
The main NRI that is clinically available in the UK is reboxetine.

49
Q

what are the Adverse effects

A

mild atropine-like effects, tachycardia,

postural hypotension and sexual dysfunction.

50
Q

mode of action for Duloxetine and Venlafaxine.

A

Inhibit the reuptake of both 5-HT and NA.

51
Q

venlafaxine indication?

A

Venlafaxine 🡺 sustained increases in blood pressure in some patients.

52
Q

The SNRIs are usually used as a _______________________

A

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

53
Q

___________ enhance both NA and 5-HT neurotransmission.

A

Noradrenaline and Selective Serotonin Antidepressants

54
Q

mechanism of action for mirtazapine?

A

an antagonist at the presynaptic 𝛼2-adrenoceptors and 5-HT2 and 5-HT3 receptors.

55
Q

mirtazapine increases _____________

A

It increases the release of NA by its action at presynaptic 𝛼2 adrenoceptors.

It also increases the release of 5-HT.

56
Q

_______________ prevents sexual dysfunction and insomnia, associated with 5-HT2 receptors and nausea associated with 5-HT3 receptors.
when taking mirtazapine

A

The antagonist activity of the drug on 5-HT2 and 5-HT3 receptors prevents sexual dysfunction and insomnia, associated with 5-HT2 receptors and nausea associated with 5-HT3 receptors.

57
Q

side effects of mirtazapine?

A

Side effects include atropine-like effects, postural hypotension, sedation and weight gain. More rarely, it may cause blood disorders (agranulocytosis)

58
Q

trazodone is an antagonist in _______________

A

Trazodone 🡺 antagonist at 5-HT1A and 5-HT2

59
Q

Antagonist at 5-HT1A autoreceptors like trazodone🡺 increase ________________

A

Antagonist at 5-HT1A autoreceptors 🡺 increase the release of 5-HT

60
Q

____________–will further enhance the postsynaptic effects of 5-HT.

A

Inhibition of 5-HT reuptake will further enhance the postsynaptic effects of 5-HT.

61
Q

what is the main adverse effect of trazodone?

A

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

62
Q

what is the mechanism of action for Bupropion

A

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

63
Q

what is The main adverse effects of bupropion?

A

nausea, constipation, epigastric distress, dry mouth agitation and insomnia.

64
Q

what are the rare side effects of bupropion?

A

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

65
Q

bupropion is a ________

A

Noradrenergic and Dopamine Reuptake Inhibitors

66
Q

______________Used in patients with atypical MDD/ anxiety

A

MAOIs

67
Q

drugs under MAOIs?

A

Phenelzine (Nardil)
Tranylcypromine (Parnate)

68
Q

_______can occur when MAOI is combined with high tyramine foods or sympathomimetics

A

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

69
Q

side effects of MAOIs?

A

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

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

70
Q

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.

what do these interactions cause?

A

hypertensive crisis.

71
Q

Pharmacotherapy of Bipolar conditions?

A

MOOD STABILISERS like:

Antipsychotic drugs (olanzapine; quetiapine; risperidone)

  1. Lithium carbonate
  2. Carbamazepine
  3. Valproate
  4. Benzodiazepines
72
Q

what is used for only acute bipolar disorder treatment?

A

Benzodiazepines

73
Q

what is the first line of treatment for bipolar disorder according to NICE?

A

Antipsychotic drugs (olanzapine; quetiapine; risperidone)

74
Q

what is the projected mechanism of action for lithium carbonate?

A

Affects electrolytes and ion transport (Na+)

Affects release of neurotransmitters (5HT, NA, DA)

Affects second messengers and enzymes that mediate neurotransmitter function.

75
Q

why is lithium carbonate used as more of a prophylaxis therapy for mood disorders?

A

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

76
Q

_______ is also used as Concomitant anti-depressant treatment in patients with incomplete response to treatment for depression in bipolar disorder.

A

lithium carbonate?

77
Q

lithium carbonate is used as Augmenting agent in________

A

Augmenting agent in treatment resistant depression.

78
Q

somatic sequence of mdd?

A

add later

integrated studies in mental health (20 decks)

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