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OCHT Term III > PSYCH - Panic, Anxiety, Mood Disorders > Flashcards

PSYCH - Panic, Anxiety, Mood Disorders Flashcards

1
Q

Define mood disorders

A

disorders in which extreme variatons in mood (either high or low) are the primal feature

in most cases, these variations are maladaptive

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2
Q

Mood disorders can be broken into two moods which are:

A

mania

depression

*note: these typically occur separately but sometimes can occur simultaneously and create rapidly alternating moods

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3
Q

Define: Mania

A

intense and unrealistic feelings of excitement and euphoria

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4
Q

Define: Depression

A

feelings of extraordinary sadness and dejection

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5
Q

Unipolar vs Bipolar disorders

A

Unipolar: where a person only experiences depressive episodes

Bipolar: where a person experiences both depressive and manic episodes

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6
Q

Manic episode (and criteria/symptoms)

A
  • markedly elevated, euphoric or expansive mood, usually with intermittent bursts of intense irritability or sometimes violence
  • Must persist for >1 week and show 3 or more additional symptoms in the same time period
    • Inflated self-esteem or feelings of grandeur
    • Decreased need for sleep
    • More talkative than normal, feels pressure to keep talking
    • Racing thoughts/ideas
    • Distracted
    • Increase in goal directed activity (work, sex, socially) or psychomotor agitation
    • Excessive involvement in high risk activities (sexual indiscretions, spending large amounts of money, etc.) - due to inability to see future consequences
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7
Q

What is the most common form of mood episode that people present with?

A

Major depressive episode

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8
Q

Major depressive episode (and criteria)

A
  • markedly depressed for majority of the day, most days, for >2 weeks
  • must exhibit at least 3 or 4 other symptoms (or 5?) (different than normal functioning)
    • One symptom must include depressed mood or loss of pleasure
    • Depressed mood
    • Diminished interest in pleasure in activities
    • Decreased ability to think, concentrate
    • Feelings of worthlessness or inappropriate/excessive feelings of guilt
    • Recurrent thoughts of death, suicide
    • Insomnia or hypersomnia
    • Psychomotor agitation or retardation
    • Significant weight loss or gain
    • Fatigue
  • Cause clinically ++distress
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9
Q

If a patient experiences a major depressive episode or a manic episode but not both, do they meet the criteria for mixed episode?

A

no

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10
Q

Signs and symptoms of a manic episode can cause disturbances that can result in what negative impacts?

A
  • social or occupational activities
  • require hospitalization to prevent harm to self, others
  • psychotic features
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11
Q

Major mood disorders occur ______x more frequently than schizophrenia.

_____________ is the most common form, and rates are (higher/lower) in women than men.

A

15-20x

Unipolar major depression

higher in women than men (2:1)

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12
Q

Lifetime risk of developing bipolar disorder is ______%

Is there any difference between sexes?

A

0.4-2.2% (2006)

no discernable difference between sexes (not a genetic trait, may have predispositions x environmental factors)

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13
Q

What types of depression aren’t considered mood disorders?

A
  • depression that results from recent stress
  • dealing with death, grieving
  • postpartum depression
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14
Q

What are specifiers?

A

different patterns of symptoms or features

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15
Q

Specifiers of Major Depression

A

1) Atypical symptoms:

  • Leaden paralysis (heavy feelings in arms or legs)
  • Acutely sensitive to interpersonal rejection for long periods
  • Brightens to positive events
  • More often female than male, respond better to monoamine oxidase inhibitors (MAOI)

2) Melancholic symptoms:

  • early morning awakenings
  • depressed more in the morning
  • more often connected to genetic factors

3) Psychotic symtpoms:

  • Mood-congruent delusions or hallucinations
  • Tx usually requires antipsychotic meds in addition to antidepressants
  • Poorer LT prognosis
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16
Q

Biological Factors that contribute to Unipolar Mood Disorders

A

Genetic influences:

  • prevalence 3x higher among blood relatives w/ Dx than general population
  • Monozygotic twins with one twin who meets diagnosis is 2x more likely than dizygotic twins
  • Sx such as depressed mood do not appear to be heritable, but symptoms such as loss of libido and/or appetite do
  • UMD occurred 7x more often in biological relatives of severely depressed adoptees than control
  • Gene-environmental interaction

Neurochemical: increases in NE activity, very little understood

Hormone Regulatory Systems: increased cortisol levels (feedback loop from HPA axis), failure of feedback mechanisms, thyroid irregularities (hypothyroidism common in depressed people)

Neurophysiological & neuroanatomical: stroke studies

Sleep and Biological Rhythms

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17
Q

Psychosocial factors that contribute to Unipolar Mood Disorders

A

1) Stressful life events

2) Diathesis-stress models: Personality and cognitive predispositions, early adversity and parental loss

3) Psychodynamic: Threats to self-esteem and developmental needs

4) Behavioural

  • Depression resulting from either negative reinforcement increases or positive reinforcement decreases
  • Not typically very reliable

5) Interpersonal Effects: Lack of social support; Marriage and family life

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18
Q

Differences in sex in regard to unipolar mood disorders

A

Women:

  • 2x as likely to develop unipolar mood disorders than men
  • Rumination more prominent in women
  • Women statistically have more “negative” interpersonal events
  • Evidence that development of secondary sex characteristics harder psychologically for females than males

Men:

  • Among school children, boys equally or more likely to be diagnosed
  • Men statistically engage in “distracting” activities

Both/neither

  • Few exceptions in developing countries such as Nigeria and Iran
  • In North America, these differences start in adolescence and continue ~65
  • Hormonal factors not very reliable
  • Sex differences in neuroticism
  • Social factors
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19
Q

Bipolar disorders are distinguished from unipolar disorders by the presence of __________ or __________ symptoms.

A

manic, hypomanic

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20
Q

Hypomanic

A

person experiences abnormally elevated, expansive or irritable mood for at least 4 days

  • similar symptoms as mania, but to a lesser degree
  • less impairment on social, occupational function
  • hospitalization not required
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21
Q

Cyclothymic disorder (and symptoms between depressive and hypomanic episode)

A

Cyclothymic disorder: cyclical mood changes less severe than bipolar. Ppl do not experience delusions and do not show marked impairment caused by manic or major depressive episodes

Cyclothymic depressive episode: dejected, distinct loss of pleasure in activities, low energy, social withdrawal, feelings of inadequacy

Cyclothymic hypomanic episode: spark in creativity and production, increased mental and physical energy

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22
Q

Define:

Bipolar I disorder

Mixed episodes

A

distinguish from MDD by at least one episode of mania or mixed episode

mixed episode: sx of both full blown manic and major depressive episodes for at >1 week. These can be intermixed or rapidly alternating

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23
Q

Bipolar II

A

person does not experience full-blown manic episodes but does experience hypomanic episodes and major depressive episode

  • more common than Bipolar I
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24
Q

Prevalence/Risks in developing Bipolar I and II

A
  • combined ~3% of population will have either
  • equal occurrence in men and woman
  • most will experience periods of remission, relatively Sx free
  • 20-30% experience significant occupational/interpersonal impairment
  • ~60% have chronic occupational/interpersonal impairment between episodes
  • ~10-13% of people who have initial major depressive episode will later have manic or hypomanic episode
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25
Q

Causal Factors in Bipolar Disorder

A

Biological: genetic influences, neurochemical, other brain and thyroid abnormalities

Psychosocial factors: stressful life events, others

Cultural variations

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26
Q

Biological Causal factors of Bipolar Disorder

Genetic influences

A
  • 8-9% of first-degree relatives of those who have bipolar disorder can be expected to receive a diagnosis (~1% in gen. pop.)
  • Concordance rates for monozygotic twins (~60%) significantly higher than dizygotic(~12%)
  • Genes account for 80-90% variance in the likelihood to develop bipolar disorder
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27
Q

Biological Causal factors of Bipolar Disorder

Neurochemical

A
  • Evidence suggests that increased dopamine activity is linked to manic symptoms, particularly hyperactivity, grandiosity, and euphoria
  • Possible that sodium ions have difficulty being transported across neural membranes (evidenced by role of Lithium in tx)
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28
Q

Biological Causal factors of Bipolar Disorder

Other

A
  • Abnormalities in thyroid function
  • Shifting patterns in brain activity and blood flow
  • Basal ganglia and amygdala enlarged in bipolar disorder
  • Increased activation in emotional processing areas of the brain
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29
Q

Psychosocial factors for Bipolar Disorders

A
  • Stressful life events: important in predisposition
  • Other:
    • ​low social support
    • personality and cognitive variables
    • striving and increased sensitivity to reward in the environment predicts increases in manic symptoms
    • pessimistic attributional style (someone who is always negative)
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30
Q

Cultural Variations in unipolar and bipolar mood disorders

A
  • Western countries see higher rates of depression
  • Non-Western countries have more somatic manifestations of depression, vs more psychological manifestations in Western countries
  • Cultural beliefs about autonomy and independence (more common in Western cultures) attributed to greater psychological (internal) manifestations
  • Some cultures show signs of outwards transgression towards others instead of feelings of guilt or self-deprecation
  • Very little is understood about the prevalence discrepancies between countries
  • In Canada, depression higher among Aboriginals
  • Research indicates rates of unipolar depression are inversely proportional to socioeconomic status
  • Research indicates that bipolar disorder is more directly proportional to socioeconomic status
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31
Q

Treatment options and recovery time in mood disorders

A
  • Majority of patients will recover without treatment (often only temporarily) within <1 year
  • more than half of people with mood disorders receive inadequate or no treatment at all
  • Types of treatment:
    • Meds (antidepressants, antipsychotics)
    • Lithium and other mood-stabilizers (anti-manic and anti-depressant effects)
    • Electroconvulsive therapy (usually for immediate & serious suicidal risk)
    • Transcranial Magnetic Stimulation (brief, intense magnetic fields that induce electrical activity in certain parts of the brain)
    • CBT & BA
    • Interpersonal Therapy (not widely available)
    • Family and Marital Therapy
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32
Q

Definition of suicide

A

The act of taking one’s own life

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33
Q

Demographics and prevalence for suicide

A
  • 1 in 10 leading causes of death in most Western countries
  • Approximately one person attempts suicide every 31 seconds
  • Experts believe actual suicide numbers are 2-4x higher than reported numbers due to self-inflicted death being attributed to “other” causes
  • ~40 to 60% of those who commit suicide do so during a depressive episode/during the recovery phrase
  • Depressed people are 50x more likely to commit suicide
  • ~90% of suicide patients have some psychiatric disorder (~60% of these ppl have a mood disorder)
  • Estimates suggest that 20-25% of pts who commit suicide have attempted suicide in the past. Those who have made attempts are higher risk for actual suicide
  • Rates of completed suicide are highest among those aged between 45-54, equally high rate for the elderly (80 and over)
  • Elderly patients are ~50% more likely to commit suicide than the nation as a whole
  • 80% of students who die by suicide have never contacted a mental health professional
  • Aboriginals and Caucasian Americans have the highest rates of suicide
  • Among pts who were hospitalized for suicidal ideation or intent, ~80% denied suicidal ideation the last time they spoke with a clinician
  • Additionally, 50% of those who committed suicide did so while on 15-minute suicide watch or 1:1 observation
34
Q

Risk factors for suicide attempts

A
  • female, young, undereducated, unmarried/divorced, mental disorders
  • 1.5 : 1 ratio W:M - suicide attempts
  • Men (typically older males) are 4x more likely to commit the act
  • partially attributed to stats re: methods of suicide
    • Males: choose quickly, more lethal methods (firearms, hanging)
    • Females: OD on drugs
35
Q

What three factors are interrelated that contribute to a patient following through with suicide?

A

1) suicidal ideation
2) suicidal plan
3) attempted suicide attempts

36
Q

____ % of people who have suicidal ideation will continue to suicidal plans and attempts in the following year.

A

~60%

37
Q

Which population of people have the higher risk of suicide?

A

Those with mood disorders (15%)

38
Q

The average risk of suicide in the general population is ~ ____%

A

1.4

39
Q

Health care professionals are at a (lower/higher) than average risk of suicide.

A

higher

40
Q

Factors affecting suicide

A
  • Generally attributed to hopelessness about the future (also in YAs because they can’t see consequences of the future)
  • Linked to childhood psychopathology, child maltreatment & family instability
  • Low self-esteem
  • Poor problem solving skills
  • Reduced serotonin functioning
  • Race/ethnicity- Aboriginals have significantly higher levels of suicide
  • Religious taboos/beliefs
  • Unemployment
41
Q

True or False. Most people do not wish to die, they just want to end their suffering.

A

True

42
Q

True or False. Months leading up to a person’s suicide, they often communicate clear thoughts about suicidal intent or have engaged in discussions aboure death or dying

A

True

43
Q

Warning signs/behaviours of suicide

A
  • Sleep issues
  • Feelings of hopelessness
  • Severe sadness or mood changes
  • Withdrawal
  • Sudden calmness - euphoric phase because they are at peace
  • Changes in personality/appearance- sudden disinterest/care about appearance
  • Dangerous or self-harming behaviours
  • Recent trauma/life crisis
  • Making preparations- Setting up a will, clearing bank accounts, giving away personal possessions, etc.
  • Threatening or discussing self-harm, suicide
44
Q

Factors to consider as a paramedic when responding to suicide calls

A
  • Consider your body language - getting to a patient’s level tells them you see them as an equal and allows for better and more honest communication
  • Ask clear, direct questions - suicidal ideations, plan, have they gathered needed resources for that plan, have they considered suicide in the past
  • Refer to the MHA - Once a pt threatens suicide (seemingly harmless or not) they must be transported under the MHA. If pt does not come willingly, contact police
  • Be cognizant of your language - Keep things simple. Do not allow the pt to direct the conversation. Be mindful of how you are saying things and remain calm.
  • Take the threat seriously - Even if a pt says they were worked up, or have changed their mind, this should not change plans for transportation
  • Be patient-focused - Avoid bringing in personal experience. Communicate solely about the patient and express your concern for their well-being
  • Be prepared - Suicidal patients may become agitated or unpredictable. Always be mindful of your surroundings and have an exit strategy.
45
Q

Resources for addressing suicide ideations/attempts

A
  • suicide hotlines
  • Speaking to a trusted doctor/clinician or MH professional
  • contacing teacher/supervisor
  • online forums
  • asking for help, expressing your concener
  • MH resources within your service (such as EAP)
46
Q

Anxiety Disorders

A

a group of disorders that are characterized by symptoms of fear and anxiety

47
Q

Neuroses

A

psychological disorders that are characterized by anxiety, depression and unhappiness that does not correspond to the pt’s life circumstances

48
Q

Neurotic Behaviour

A

mental, emotional and/or physical reactions that are drastic and irrational

49
Q

Fear/Panic

A
  • basic emotion that invokes the sympathetic nervous system’s fight or flight response
  • Fear: near instantaneous reaction to any imminent threat (has an adaptive value)
    • distinguish from anxiety
50
Q

Anxiety

A

fear or apprehension about the future (immediate or long term)

a complex mix of unpleasant emotions/cognitions that is more diffuse and oriented to the future than fear

51
Q

Anxiety disorders affect ~ ____% of Canadians.

In 2005, estimated that ______% of the population will be affected by anxiety disorders in their lifetime

A

4.6%

25-30%

52
Q

Anxiety disorders can result in various problems that are ___________ in nature.

a) personal
b) economic
c) health-care related
d) all of the above

A

d) all of the above

53
Q

Anxiety disorders include what conditions?

A
  • Phobic disorders
  • Panic disorders
  • Generalized Anxiety Disorder (GAD)
  • Obsessive-Compulsive Disorder (OCD)
  • PTSD

All disorders on a sliding scale/spectrum

54
Q

Panic Attack

A
  • when fear/panic response occurs in the absence of obvious external danger S&S of panic attack are similar to fear but also include:
    • Sense of impending doom
    • Are broken into three components
      • Cognitive/subjective - “feeling” afraid
      • Physiological - Increased HR, BP
      • Behavioural - stronge urge to escape
55
Q

What are the three components that make up anxiety?

A

1) Subjective/Cognitive: feelings of fear/out of control, -ve mood, self-preoccupation, worries of possible threat/danger, difficulty concentrating

2) Physiological: increased HR and BR, state of tension/over-arousal, higher oxygen demands, diaphoresis

3) Behavioural: Avoidant behaviour, no immediate urge to flee or escape

56
Q

Phobia

A

persistent and disproportionate fear of some specific object or situation that presents little to no legitimate danger, yet produces avoidant behaviours

3 main categories: specific phobias, social phobias, agoraphobia

57
Q

Specific phobias - definition, behaviours, and treatment

A
  • strong and persistent fear that is excessive and/or unreasonable, triggered by a specific object or event
  • When encountering phobic stimulus, often elicits a panic response
  • avoidance of stimulus (ex: heights, blood, snakes, enclosed spaces)
  • lifetime prevalence 12%
  • age of onset varies, more predominant in women
  • results from traumatic conditioning
  • common tx: exposure therapy
58
Q

Social phobias - definitions, behaviours, demographics, tx

A
  • aka social anxiety disorder
  • characterized by disabling fears of one or more specific social situations
  • 3 - 7.2% meet criteria in any given year
  • more common in women > men
  • most common form: fear of public speaking
  • usually begins in adolescence or early adulthood
  • ~1/3 abuse alcohol to reduce their anxiety
  • learned from classifical conditioning, evolutionary fear of others, cognitive vulnerability to rejection
  • Tx: CBT, meds
59
Q

Agoraphobia

A
  • fear of public spaces
  • most commonly avoided: streets, malls, movie theatres, stores
  • attributed to panic attacks in one or more of these settings
  • often frightened by own bodily reactions that will cause arousal
  • usually expands from one setting to generalized settings
  • 0.7% affected in Canada
  • usual onset between 15-24
  • much more common in women
  • results from biochemical + anatomical abnormalities, social factors
  • Tx: meds, CBT
60
Q

Panic disorder

A

characterized by the occurrence of “unexpected” panic attacks that often seem unprecedented

61
Q

Panic Attack: Cognitive S&S

A

Cognitive:

  • Depersonalization: feeling of being detached from one’s body
  • Derealizatoin: feeling that external world is not real
  • Fear of death/dying
  • Fear of “going crazy”, losing control
62
Q

Panic Attack: Physical S&S

A
  • increased HR, palpitations
  • diaphoresis
  • shaking/trembling
  • feeling of choking
  • feeling SOB or “smothered”
  • CP or chest tightness
  • N/V or abdo pain
  • feelings of lightheadedness, dizziness, faint
  • chills, hot flashes
  • paresthesia
  • dilated pupils
63
Q

How long do panic attacks last?

A
  • brief and intense, typically reaching peak intensity at 10 min mark
  • usually subside afer 20-30 minutes, rarely lasting longer than 1 hour
64
Q

Why would patients who experience panic attacks seek emergency medical attention?

A

Because physical nature of panic attacks can be alarming (like chest pain, diaphoresis), 8% will seek medical attention.

Mostly for neurological, cardiac, and respiratory concerns

65
Q

Demographics/prevalence for panic disorder

A
  • 4.7% of adult population has had panic disorder at some point in their lives (2005)
  • Age of onset primarily between 15-24
  • ~ 2x more common in women than men
  • 50% have co-morbidities
  • 80-90% report first panic attack occurred after negative life event
  • Has some genetic and environmental/social causes, not very well understood
66
Q

Treatment for panic disorders

A
  • medications: benzodiazepines (Xanax, clonazepam)
    • quick acting (~30-60 minutes)
    • can cause drowsiness, sedation, impaired cog. function & motor performance
    • addictive
  • antidepressants - particularly SSRIs
  • CBT
  • exposure therapy
67
Q

Factors that paramedics should consider when responding to anxiety/panic calls

A
  • Mindful positioning - Ensure you give the pt space but remain in sight for reassurance
  • Recognize it - Acknowledge that this is an anxiety disorder and it will pass
  • Stay calm
  • Give them time - rushing a pt, or pushing them for diagnostics may aggravate symptoms (only do so in life threatening situations, or where pt harm is evident)
  • Offer your assistance - attempt to coach breathing, give them the opportunity to state their feelings
  • Assume underlying organic causes and rule out medical/traumatic concerns
  • Provide supportive care
  • Initiate transport based on clinical findings
68
Q

Generalized Anxiety Disorder (GAD)

A

disorder where anxiety becomes chronic, excessive, and unreasonable

69
Q

Presentation of GAD

A
  • Excessive and relatively constant state of future-oriented anxiety
  • Pt finds it difficult to cope with worry
  • Restlessness
  • Chronic fatigue/easily fatigued
  • Difficulty concentrating
  • Irritability
  • Muscle tension
  • Sleep disturbances
70
Q

Prevalence & Age of Onset of GAD

A
  • ~3% of population affected
  • 2x as common in women
  • Most common anxiet disorder
  • Majority of pts manage to function normally
  • Pts less likely to seek psychological tx, usually frequent medical complaints
  • Age of onset varies
  • Often occurs alongside other anxiety, mood disorders
71
Q

Causal factors in GAD

A

Psychosocial:

  • cognitive biases
  • unpredictable/uncontrollable life events

Biological:

  • GABA deficiency
  • Hormonal imbalances
  • Strong attribution to the limbic system (BNST - threat anticipation; Amygdala - threat confrontation)
72
Q

Tx for GAD

A
  • Benzos typically over- or mis- used for reduction of somatic symptoms - Valium, Lorazepam (Ativan)
  • Antidepressants (SSRIs and venlafaxine most common)
  • CBT
73
Q

Obsessive-compulsive disorder (OCD)

A

the occurrence of unwanted, intrusive thoughts or distressing images. Usually accompanied by compulsive behaviours that are performed to neutralize obsession or to prevent some dreaded event

74
Q

Obsessions

A

persistent and recurrent intrusive thoughts, images, or impulses experienced as disturbing and/or inappropriate

75
Q

Compulsions

A
  • two diff ways:
    • repetitive behaviours (handwashing, checking appliances, etc)
    • covert mental acts (mantras, counting, praying)
  • very rigid rules on how compulsions are performed
  • goal is to reduce distress or prevent occurrence of negative event
76
Q

Vicious cycle of OCD

OCD is common in what population(s)?

A

1. Obsessive thought - cause marked distressed and interfere with normal functioning/time consuming

2. anxiety

3. compulsive behaviour

4. temporary relief (and then continues in a cycle)

Pt realizes that obsession is excessive and unreasonable but can’t stop (will lead to being late, sores/skin irritations) - common in athletes, performance-based careers

77
Q

Prevalence & Age of Onset of OCD

A
  • Average lifetime prevalence is ~1.6% (2005)
  • 98% of those who seek tx have both obsessions and compulsions
  • Divorced (separated), and unemployed people have higher rates of OCD
  • Typically begins in late adolescence, early adulthood-can also be seen in young children
  • Very little difference in gender
  • Most cases have gradual onset- usually becomes chronic & waxes and weans over time
  • ~1/3 of OCD pts also experience major depressive episodes
  • Most often co-occurs with social phobia, panic disorder, GAD, and PTSD
78
Q

3 main risk factors that can cause OCD/OCD types

A

Genetics: those with 1st degree relatives who developed OCD as a child/teen have significantly higher risk of developing OCD

Brain structure: specific areas affected & neurochemical imbalances

Environment: experiencing physical, sexual or emotional abuse at a young age

79
Q

Treatment of OCD

A
  • behavioural therapy - best when combining exposure and response prevention
  • Cognitive therapy
  • Medications - primarily affecting serotonin (Prozac, clomipramine)
  • Surgery (rare cases)
80
Q

Sociocultural differences in anxiety disorders

A
  • anxiety manifestations can be different from culture to culture
  • Nigeria - fears of witchcraft “feeling of something like water on my brian”
  • India - possession by spirits, sexual inadequacy
  • China - Koro - fear that genitals or sex reproductive organs are shrinking
  • Japan - Taijin Kyofusho - similar to social phobia, fear of embarrassing of offending others

OCHT Term III (25 decks)

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