psych mood disorders Flashcards
Major Depressive Disorder - how do you know when it’s depression
it needs to last at least 2 weeks or more, also impairment of functioning.
Major Depressive Disorder - children
could look more like irritatabilty -
Major depressive disorder - symptoms
anhedonia is common. sleep disorders. anergia (lack of energy - affects 97% of ppl) may overeat or anorexia, usually anorexia. usually atypical when ppl eat too much. poor concentration, indecisiveness, brain fog, SI.
Signs and Symptoms of Major Depressive Disorder: (2 things)
Vegetative
Somatic
DSM-5 criteria
vegatative s/sx (veggieBALS)
appetite and weight, sleep, libido, bowel habits.
somatic s/sx
Somatic sxs - could be GI, headache - very common,
types of major depressive disorder
Single episode vs. recurrent
Disruptive Mood Dysregulation Disorder - what ages?
(children) (they thought it was bipolar) between 6-18 ages. constant severe irritability and anger at home and school, with peer. treated w/ therapy, and sometimes med SSRIs, atypical sometimes used.
Persistent Depressive Disorder (formerly called dysthymia) - and how long does it last?
chronic, low grade depression, lasts at least 2 years. can go to school, work, but not thriving. depressed mood. impairment not as severe.
Premenstrual Dysphoric Disorder (aka PMS)
2 weeks before period - luteal phase - mood symptoms. meds - birth control, but BP can backfire on some ppl. antidepressants just during luteal phase. nutrition, coffee sugar can be bad. exercise, sleep. acupuncture. phototherapy.
Substance/Medication Induced Depressive Disorder
alcohol, meds. stimulant binges. antidepressants, antivirals, beta blockers. immune drugs.
Depressive Disorder Due To other Medical Conditions - fetterman
stroke. john fetterman. Parkinson’s. huntingtons, alzheimers. traumatic brain injury. hypothyroidism. lyme disease. toxins. lead. anemia.
MDD with Seasonal Pattern (aka Seasonal Affective Disorder) -
changes in light.
Causative factors – (Apply to all mood/affective disorders) - Genetic/biological - seratonin?
Monozygotic vs. dizygotic twins (50%)
Genetic serotonin deficiency or genetic predisposition for decreased 5HT (this is seratonin)
causative factors - Cognitive/environmental/psychosocial/cultural/societal- learned helplessness
Learned helplessness - chronic stress as a kid, abusive or neglected. therapist might validate. CBT.
is depression treatable?
Depression is very treatable. Studies demonstrating show long-term remission is most likely if psychotherapy is used in conjunction with biological treatments.
vagus nerve- is it invasive?
VNS - vagus nerve - surgical implantation - not used much
integrative approaches -
omega 3, nutrition, exercise.
Meds - how long to stay on them, and how long before they start working
stay on them for at least 6-12 months; many people need to stay on meds indefinitely. Most ADs take at least one month to produce full treatment effects***some ppl longer.
TCAs (tricyclics) - what is the main issue with them? (tricycles are lethal)
not really used anymore bc they have cardiac risks, endocrine risks, sexual side effects, and lethal if OD. used sometimes for migraines, amytripline. sometimes best for severe MDD; cardiac risk; frequently lethal if pt overdoses. know for test*****
MAOIs- what is the issue with them? (mao cheese)
not really used anymore, so many food drug interactions - tyramine reduced diet - smoked, aged, processed - meats, cheeses, sausage, red wine, ripe foods, chocolate. many food/drug interactions (fermented, smoked and cured foods are most dangerous); last med of choice.
SSRI/SNRIs- most common side effect, and what to watch for?
first line treatment; actions & SEs (side effects) more varied from med to med than with TCAs/MAOIs, but SEs generally milder and less dangerous; watch for serotonin syndrome (st. john’s wart and melatonin can cause it) anxious, flushed, cardiac, insomnia headache common at first. most common effect is sexual**in 50% of ppl.
Bupropion - what does it do?
inhibits dopamine uptake - so dopamine increases; unique among ADs in action (increases dopamine/norepinephrine) and potential SEs (decreased appetite, decreased desire to smoke, increased sexual desire). usually doesn’t develop until a month into treatment.
Interpersonal psychotherapy
(basic talk therapy) is the oldest tx for MDD and is still effective most of the time, esp for mild-moderate depression
ECT (induction of a grand mal seizure)
half-second jolt produces about a 30 sec seizure - biggest risk is memory loss.
when is ECT used?
Used for drug-resistant and psychotic depression. ECT is rarely a permanent cure. Some pts benefit from maintenance ECT (monthly)
side effects of ECT
Short term memory loss is common and usually transient (warn both patient and family members about this). Re-orient patient and give NSAIDS/acetaminophen prn for HA (headache) and food bc they are NPO
ECT -how often are treatments, and how many?
Usually 6-12 treatments, given 2-3 times/week; can be done outpatient
Safer to use in pregnancy than most ADs (anti-depressants), esp in 1st trimester
Requires surgical permit and general pre- and post-op nursing care
TMS- how often is treatment, and for how long? (TMJ for 6 weeks)
basically uses MRI to stimulate the brain. Transcranial magnetic stimulation.Still uncommonly used. Non-invasive. Usual course is 5-30 min treatments for 6 weeks.
Bipolar I
(most severe one) – at least one episode of full mania, which is a psychotic state. Requires hospitalization
Bipolar II
(dysphoric or depressive, more depression) – at least one episode of hypomania (lesser form of mania), which is not a psychotic state, and at least one episode of severe depression.
Cyclothymia- and how long does it last?
hypomania alternating with minor depression for at least 2 years. (always treated outpatient)
mania is what state?
mania is a psychotic state
rapid cycling- how many times to consider it rapid?
if episodes happen 4 or more times a year, this is considered rapid cycling***sometimes they happen on the same day = this is called a mixed state. the quicker they fluctuate, the harder it is to treat.
S/Sx Bipolar I - men v. women
slightly more common among men, type 2 slightly more common among women