Psychiatry Flashcards
What are mood disorders?
Group of illnesses that cause serious changes in the emotional status & interfere with day to day activities
What are risk factors for mood disorders?
Family hx & Personal Trauma
What neurotransmitters affect mood?
Serotonin (Obsessions, Compulsions), Norepinephrine (Anxiety, Attention), and Dopamine (Attention, Motivation, and Pleasure)
What are the Depressive Disorders?
Major Depressive Disorder, Substance/Medication-induced depressive disorder, Depressive disorder due to another medical condition, adjustment disorder with depressed mood, premenstrual dysphoric disorder
What are the 9 Major Symptoms of Depressive Episodes?
- Depressed, Hopeless, lacks sense of purpose
- diminished interest in an activity once pleasurable (anhedonia)
- Weight gain or loss, change in appetite
- sleeping habit changes
- changes in energy level
- the persistent feeling of worthlessness
- excessive guilt
- difficulty concentrating
- Suicidal ideation
What are Major Depressive Disorder Criteria?
- Episodes lasting at least 2 weeks
- Changes in affect, Cognition, Neurovegative function
- Must include 5 of the major symptoms; 2 should be:
Persistence of depressive mood & anhedonia
What are the subtypes of MDD?
Depression w/ atypical features
Postpartum Depression
Major Depressive Disorder w/ seasonal pattern
Major Depressive Disorder w/ Psychotic Features
What is Depression w/ Atypical Features?
- Mood Reactivity (Improved mood when exposed to pleasureable or positive events)
- Rejection Sensitivity (feeling anxious & overreact at the slightest evidence of rejection)
Other Features: Hyperphagia, Hypersomnia, Leaden Paralysis
What is postpartum Depression?
Onset occurs before childbirth usually
Depression either during or 4-6 weeks after delivery
What is MDD w/ Seasonal Pattern?
- at least 2 depressive episodes during cold months for the past 2 years
- no hx of depressive episodes appearing in non-seasonal pattern
What is Persistent Depressive Disorder?
Mild symptoms
2 or more:
- change in appetite
- change in sleep
- fatigue
- decreased self-esteem
- decreased concentration
- difficulty making decisions
- hopelessness or pessimism
What are Manic Episodes?
- last at least 1 week
- at least 3 of the 7 symptoms present:
1. Inflated self-esteem or grandiosity
2. More talkative than usual
3. Urgency to keep talking
4. Racing Thoughts
5. Easily Distracted or excessive attention to irrelevant things
6. Need to achieve certain things
7. Reckless
What is the difference between Manic and Hypomanic?
A milder version of at least 3 of the same symptoms as manic episodes
- lasts at least 4 days
How do you treat Mild Depression & Bipolar Disorders?
No medication needed
- Psychotherapy (CBT)
- Talk Therapy
- Interpersonal Therapy
- Physical Activity (~20 mins 3x/week)
- Eating a high-fiber diet
- Bright light therapy (seasonal pattern MDD)
What are the pharmacological options for MDD?
Selective Seratonin Reuptake Inhibitors (SSRIs)
- Fluoxetine, Paroxetine, Sertraline
Serotonin & Norepinephrine Reuptake Inhibitors
- Venlafaxine, Desvenlafaxine, Duloxetine
Atypical Antidepressants
- Bupropion, Mirtazapine
Tricyclic Antidepressants
- Doxepin, Amitriptyline
Monoamine Oxidase Inhibitors (MAOIs)
What is the Acute Phase for pharmacology of MDD?
<12 weeks or until remission (i.e., Absence of sad mood & Anhedonia)
Presence of <3 of 9 symptoms
- Treatment begins with SSRIs
- Sertraline: First-line w/ post partum depression + breastfeeding
- Atypical Antidepressants: Used for those who have inadequate responses or intolerable side effects of SSRIs
- TCA: 2nd-line choices
What is the Continuation Phase for drugs of MDD?
- Dosage kept steady
- Monitor adherence, signs of relapse, & adverse effects
- Up to 9 months
What is the Maintenance Phase for drugs of MDD?
1-3 years to a Lifetime
hx of recurrence & suicide attempts
What are the risk factors for recurrence?
Residual symptoms
Early age of onset
Family hx of mood disorders
What are the treatments for Bipolar Disorders?
- Lithium (Should be avoided in patients with kidney issues)
- Anticonvulsants (i.e., Valproate or Lamotrigene)
- Antipsychotics (i.e., Quetiapine or Lurasidor)
- Benzodiazepines (can also be used for insomnia, agitation, or anxiety)
What is the Acute Phase of the pharmacology of MDD?
<12 weeks or until remission (i.e., Absence of sad mood & Anhedonia)
Presence of <3 of 9 symptoms
- Treatment begins with SSRIs
- Sertraline: First-line w/ post partum depression + breastfeeding
- Atypical Antidepressants: Used for those who have inadequate responses or intolerable side effects of SSRIs
- TCA: 2nd-line choices
Which Neurotransmitter is associated with Anxiety?
GABA (decreased amounts –> Increased Anxity)
What are the 9 Anxiety Disorders?
- Generalized Anxiety Disorders
- Separation Anxiety Disorder
- Selective Mutism
- Specific Phobia
- Social Anxiety Disorder
- Agoraphobia
- Panic Disorder
- Medication-Induced Anxiety Disorder
- Anxiety Disorder due to another medical condition
What are Panic Attacks?
- Short, uninterrupted periods of up to 20 min
- Feel at least 4 symptoms:
Palpitations
Sweating
Dyspnea
Trembling
Paresthesias
Feeling of throat tightness
Chest pain
nausea
Dizziness
Hot Flashes or Chills
Feeling of unreality or detachment
Fear of Dying
Fear of Losing Control
What is CBT?
- Type of Talk Therapy
- Learn different ways of thinking & Reacting to Stress
- Acknowledge patterns of thinking
What medications can be used for Anxiety?
- SSRIs & SNRIs (are first-line medications) - This population is more sensitive to the side effects; may benefit from a reduced dose.
- These can be used alone; but are more effective when used with CBT\
TCAs: Are the second line
Beta-blockers: Can be used to control physical symptoms (trembling & Palpitations)
Benzodiazepines - are used as a last resort (side effects)
Buspirone (non-benzodiazepine anxiolytic) can be given to those with a high risk of abuse
What is a Panic Disorder?
- Recurrent out-of-the-blue panic attacks triggered by a wide variety of things (never a single trigger, frequently no-identifiable trigger)
- Attacks peak within 10 mins
- At least 4 symptoms:
Palpitations
Sweating
Trembling
Dyspnea
Feelings of choking
Chest pain
Nausea
Dizziness or Lightheadedness
Chills or hot flashes
Paresthesias
Feelings of unreality or detachment from self
Fear of Dying
Fear of losing control
