Mood Disorders Flashcards
What are the different categories of mental illnesses and some examples
Anxiety
>Panic disorder, GAD, OCD and Acrophobia
Affective:
>Major disorder, Bipolar disorder and dysthymia
Psychosis
> Schizophrenia and Schizoaffective
What are the two broad categories of affective disorder
- Only depressive symptoms that has
- oscillation between depression and manic symptoms
What is depression
Sadness
Feeling of worthlessness and guilt (that they might be a bother to others)
Changes in sleep and appetite
What is mania
It is abnormal elevated mood
>intense elation irritability
>hyperactivity, talkativeness, distractability
How can depression be diagnosed
DSM-5: SIG: E caps
>Must be over 2 weeks
>Must not be due to bereavement but but can lead to depression
> must have 5 of the following symptoms
S Sleep
I Interest
G: Guilt
E Energy
C Concentration
A Appetite
P Psychomotor retardation
S Suicidality
What are physical symptoms that can manifest due to depression
sadness: Vague aches and pains
Loss of interest: headaches
Overwhelmed: sleep disturbances
Anxiety: fatigue
Diminished interest: back pain
guilt : change in appetite leading to weight loss or gain
What is Bipolar disorder
It is a episodes of depression alternating with mania
What are the hypomania
Symptoms of mania but less intense
>Four or more days of elevated mood
>Doesn’t interfere with functioning
>Hypomania alone is not a DSM diagnostic category
What are the DSM-5 criteria for mania and hypomanic episodes
> Elevated, explosive or irritable mood + 3 of the following:
- Psychomotor agitation or increase in goal-directed behaviour
-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
Manic episode:
- last for 1 week or requires hospitalisation
-causes significant distress or functional impairment
Hypomanic episodes
-lasts at least 4 days
-clear changes in functioning
List some subtypes of depression and BP
SAD: mostly winter
Postpartum: within 4 weeks of birthing
Melancholic: inability to experience pleasure
what is the pathophysiology behind MMD
Genetics: MMD clusters in families
> heritability is 35%
Environment
hormones
Brain chemicals
Brain region
Immune systems
What are the main NT involved in the etiology depression
Serotonin and Norepinephrine
> low levels of NA and 5-HT
What are the main classes of medicines used to treat depression
- Tricyclic antidepressants
- SS/NRIs
3.Monoamine oxidase inhibitors (MAOIs)
What are the stages the treatment regimen for depression
- Remission
- Maintenance: prevent relapse
- Prophylaxis: avert recurrence after remission
List some TCAs
Clomipramine
Amitriptyline
Doxepin
Imipramine
Desipramine
Which other conditions alongside with depression are TCAs preferred
Pain
Fibromyalgia
migraine
Insomnia
Which other conditions alongside with depression are least TCAs preferred
patients with which anticholinergic effects would be harmful- Prostatic hypertrophy
Overweight patients
Suicidal patients
Cardiac patients
patients with dementia
What are the adverse effects of TCAs
mACh receptor antagonist: atropine like side-effects
Histamine H1 antagonist: drowsiness and sedation, weight gain
antagonist activity: postural hypertension, syncope in some Pts and sendation
Which TCAs should be avoided in the elderly
Those that have excessive sedative properties
> Amitriptyline
>Doxepin
What can overdose of TCAs lead to
Confusion, convulsion, tachycardia, hypotension, ventricular arrhythmia (death)
Suicide- one the main reasons it is not the first line
How is TCA overdose treated
Remove remaining drug in the stomach
Anticonvulsant agent- diazepam
Antiarrhythmic drugs and cardiac support
How long do SSRIs take before they have significant clinical affect
4-6 weeks
Side effects may dissuade patients compliance
What advantages do SSRIs have over TCAs and MAOIs
Better tolerated
Less anticholinergic and cardiovascular side effects
Low acute toxicity
List some SSRIs
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
Fluvoxamine (Luvox)
Citalopram (Celexa)
Escitalopram (Lexapro)
