Psychiatric Disorders Flashcards
DEPRESSION
More common in the (3) patients
Nearly 1 out of 3 patients presenting for
treatment of orofacial pain may have symptoms
consistent with — diagnosis (1)
— is a serious, potentially life
threatening situation which requires referral to
appropriate health care providers for treatment
along with care for the pain disorder (1)
elderly, teenagers, and
chronic pain
depression
MAJOR DEPRESSION: DSM-IV
Diagnostic Criteria
Diagnostic Criteria: At least one of the symptoms is
either:
…or …
3. 5 of more of the following symptoms > 2 weeks:
eight
- Low mood(Feeling blue)
- Anedonia (no longer enjoys pleasurable activities)
- Low energy
- Sleep changes: daily insomnia or hypersomnia
- Significant weight loss/ decreased Appetite
- Suicidal thoughts
- Psychomotor agitation/retardation
- Poor concentration
- Irritability
- Feeling worthless or inappropriate guilt
– out of 9 Symptoms > 2 weeks = major depression
Affects — function
5
social
Locus ceruleus- produces —
Raphe nucleus- produces —
Left frontal cortex & brainstem
Brain is either firing too fast or too slow in releasing (2)
norepinephrine (NE)
serotonin (SER)
norepinephrine and
serotonin
Depression-
less serotonin, more postsynaptic receptors, firing rates of
neurons are faster because they have a hypersensitive neurosynaptic
junction. Causes upregulation.
Anxiety-
–% of people with depression have anxiety
firing rates of neurons are too slow
100
PHYSIOLOGY
More common in individuals who as children experienced:
(5)
People in — personality positions have increased serotonin
Brain is either firing too fast or too slow in releasing norepinephrine and
serotonin
abuse, shyness, high rejection sensitivity, eagerness to please, introverts
alpha
SSRI’s
Selective Serotonin Reuptake Inhibitors (SSRI’s): i.e. Prozac, Paxil
MOA …
Initially this increases firing rate for — weeks
–% of people feel worse; SSRI’s take 4 weeks to work to down regulate
neurons
SSRI’s reduce —
Inhibit reuptake of serotonin at nerve junction
2-3
30
rejection sensitivity (i.e. spouse no longer cares if husband is
upset with her especially if it’s an abusive relationship)
DEPRESSION SYMPTOMS
Ask patient “how long have you been feeling down, had problems with sleep &
appetite?”
Early morning dysphoria-
Grieving individuals usually have their worst symptoms in the —.
The most sensitive symptom is —
— is the main symptom of depression & patient is typically unaware of
this
Family members or spouse is the best source to get the patient history for behavior
unless patient is being abused emotionally or physically
waking up in morning “feeling down” regularly. This is
the worst and pathognomic symptom.
evening
mild depression
Irritability
DEPRESSION SYMPTOMS
Mild depression begins to act like a chronic mild stressor:
MOA
Causes — if patient does not get immediate treatment
Platelets spike causing (2) over time
Cortisol affects NMDA receptor neuronal firing kills brain cells in amygdala & hippocampus
decreased brain mass
clotting & micro-clotting
DEPRESSION
BP is increased which destroys …
Immune system spikes initially then decreases
5 killers:
(5)
lining of blood vessels and causes plaques
Bacteria
Viral
Fungus
Cancer
Parasites
Depression is Major killer of immune system
PSYCHOTHERAPY:
(4)
Lifestyle changes- 5-10% compliance
Regular sleep- REM sleep replenishes
NE, dopamine, replenishes mood,
preserves neurotransmitters
Regular exercise
Sun in the morning
MEDICATIONS:
(2)
SSRI’s: Prozac, Lexapro, Zoloft,
Paxil, Luvox
SSNRI’s: Effexor, Cymbalta- work
better in severe depression
ECT (electroconvulsive therapy):
(3)
Helps if medications fail
Releases neurotransmitters
Down regulates post-synaptic neurons
GENERALIZED ANXIETY DISORDER
Diagnosed when a person has persistent & excessive
anxiety or worry ≥– months
At least 3 of the following
symptoms:
(6)
6
- Restlessness
- Fatigue
- Difficulty concentrating
- Irritability
- Muscle tension
- Sleep disturbance