QUIZ 1 Flashcards
mood disorders
Are pervasive alterations in emotions that are manifested by depression, mania, or both?
Mood Disorders
Are the most common psychiatric diagnoses associated with suicide?
Mood Disorders
the most risk factor
with suicide
They interfere with a person’s life plaguing the client with long-term
sadness, agitation, or elation
Biblical personalities who suffered from depression
King Saul, King Nebuchadnezzar and Moses
Famous personalities
Queen Victoria, Abraham Lincoln, artist Vincent Van Gogh
Categories of Mood Disorder
Primary Mood disorders
Primary Mood disorders
Major Depressive Disorder
Bipolar Disorder
Some people with a combination of hallucinations, and delusions
Psychotic Depression
diagnosed when a person’s mood cycles between extremes of mania and depression.
Bipolar disorder
distinct period during which mood is abnormally and persistently elevated, expansive, or irritable. Typically this period lasts about 1 week
Mania
Accompanying symptoms of a manic episode
Inflated self-esteem or grandiosity
Decreased need for sleep
Pressured speech ( unrelenting, rapid, often loud talking without pauses)
Flight of ideas ( racing often unconnected thoughts)
Distractibility
period of abnormally and persistently, elevated, expansive, or irritable mood lasting 4 days and including three or four of the additional symptoms
Hypomania
when the person experiences both mania and depression nearly every day for at least 1 week.
Mixed episode
Bipolar Disorders are described are follows ( for the purpose of medical diagnoses)
Bipolar I disorder
Bipolar II disorder
one or more manic or mixed episodes usually accompanied by major depressive episodes.
Bipolar I disorder
one or more major depressive episodes accompanied by at least one hypomanic episode.
Bipolar II disorder
Related Disorders Classified in the DSM IV TR as mood disorders
Dysthymic Disorder
Cyclothymic Disorder
Substance-Induced Mood Disorder
Mood Disorder due to a General Medical Condition
cha by at least 2 years of depressed mood for more days than not with some additional, less severe symptoms that do not meet the criteria for a major depressive episode.
Dysthymic Disorder
cha by 2 years of numerous periods of both hypomanic symptoms that do not meet the criteria for bipolar disorder.
Cyclothymic Disorder
cha by a prominent and persistent disturbance in mood that is judged to be a direct physiologic consequence of ingested substances such as alcohol, other drugs, or toxins.
Substance-Induced Mood Disorder
cha by a prominent and persistent disturbance in mood that is judged to be a direct physiologic consequence of a medical condition
Mood Disorder due to a General Medical Condition
Other disorders that involve changes in mood
Seasonal Affective Disorder (SAD)
Postpartum or Maternity Blues
Postpartum Depression
Postpartum Psychosis
Subtypes of SAD & which is the most and less common?
Winter depression or fall onset (most
common)
Spring onset (less common)
Manifestation of winter depression or fall onset of SAD
Increased sleep
Increased appetite
Carbohydrate craving, weight gain
Interpersonal conflict, irritability
Heaviness in the extremities
Symptoms of Spring onset SAD
Insomnia
Weight loss
Poor appetite
frequent normal experience after delivery of a baby.
Postpartum or maternity blues
Symptoms maternity blues
Labile mood and affect
Crying spells
Sadness
Insomnia
Anxiety
meets all the criteria for a major depressive
episode with onset within 4 weeks of delivery
Postpartum Depression
psychotic episode developing within 3 weeks of delivery and beginning with fatigue, sadness, emotional lability, poor memory, and confusion and progressing to delusions, hallucinations poor insight, and judgment, and loss of contact with reality.
Postpartum Psychosis
Genetic studies implicate transmission of major depression in the 1st-degree relatives who have ______ the risk of developing depression.
twice
implicate transmission of major depression in 1st-degree relatives who have twice the risk of developing depression.
Genetic studies
1st-degree relatives of people with bipolar disorder have ____ risk for developing bipolar disorder compared with ____in the general population.
3% to 8% & 1%
Monozygotic ( identical )twins have a concordance rate ( both twins having the disorder) ______ higher than that of dizygotic (fraternal)twins.
2 to 4 times
two major biogenic amines implicated in mood disorders
serotonin and norepinephrine
Roles of serotonin in behavior
Mood, activity, aggressiveness, and irritability
Cognition, pain, biorhythms, and neuroendocrine processes
found in the blood or cerebrospinal fluid occur in people with depression.
Serotonin deficits
Norepinephrine levels may be deficient
Depression
Norepinephrine levels may be increased
Mania
energizes the body to mobilize during stress
catecholamine
process by which seizure activity in a specific area of the brain is initially stimulated
Kindling
inhibit kindling, which may explain their efficacy in the treatment of bipolar disorder.
Anticonvulsants
being studied in relation to mood disorders.
Dysregulation of acetylcholine and dopamine
alter mood ,sleep neuroendocrine function
Cholinergic drugs
seems to be implicated in depression and mania.
acetylcholine
are being studied in relation to depression.
Hormonal fluctuations
How many % of clients with depression have evidence of increased cortisol secretion and elevated glucocorticoid activity associated with the stress response.
40%
How many % of people with depression have thyroid dysfunction
About 5% to 10%
looked at the self-appreciation of people with depression and attributed that self-reproach to anger turned inward related to either a real or perceived loss.
Freud
believed that one’s ego aspired to be ideal
Bibring
compared the state of depression to a situation in which the ego is powerless, helpless child victimized by the superego
Jacobson
viewed depression as a reaction to a distressing life experience such as an event with psychic causality.
Meyer
believed that children raised by rejecting or unloving parents were prone to feelings of insecurity and loneliness making them susceptible to depression and helplessness.
Horney
saw depression as resulting from specific cognitive distortions in susceptible people
Beck
depression often appear cranky, have SCHOOL PHOBIA hyperactivity or learning disorders, failing grades, and antisocial behaviors
Children
depression may abuse of substances, JOINING GANGS, engaging in risky behavior underachievers, or dropping out of school.
Adolescents
substance abuse, eating disorders, compulsive behaviors such as workaholism and gambling, and HYPOCHONDRIASIS.
Adults
who are cranky and ARGUMENTATIVE may actually be depressed.
Older adults
Typically it involves 2 or more weeks of sad mood or lack of interest in life activities with at least four other symptoms of depression
Major Depressive Disorder
symptoms of depression (MDD)
anhedonia, and changes in weight, sleep, energy, concentration, decision-making, self-esteem, and goals.
depression ______ with age in women, and ______ with age in men.
decreases & increases
% of people who have one episode of depression will have another.
50% to 60%
second episode of depression there is ___ chance of recurrence
70%
Some people with severe depression ___% have psychotic features
9%
Treatment and Prognosis (MDD)
Psychopharmacology
Major categories of antidepressants
Major categories of antidepressants
Selective Serotonin Reuptake Inhibitors
(SSRIs)
Cyclic Antidepressants
Atypical Antidepressants
Monoamine Oxidase Inhibitors (MAOIs)
the choice of which antidepressant to use is based on:
symptoms
age
physical health needs
drugs that have or have not work in the past
Symptoms of Major Depressive Disorder
according to DSM-IV-TR diagnostic criteria
Depressed mood
Anhedonism
Unintentional weight change of 5% or more in a month
Change in sleep pattern
Agitation or psychomotor retardation
Tiredness
Worthlessness
Difficulty thinking, focusing, or making decisions
Hopelessness, helplessness, and/or suicidal ideation
newest category of antidepressants and effective for most clients
Selective Serotonin Reuptake Inhibitors(SSRIs)
produces a slightly higher rate of mild agitation and weight loss but less somnolence.
Prozac or Fluoxetine
was introduced for the treatment of depression in the mid-50s and the oldest antidepressant.
Tricyclic
what symptoms are relieved by tricyclic
hopelessness, helplessness, anhedonia, inappropriate guilt, suicidal ideation, and daily mood variation
Contraindications of tricyclic antidepressants
Severe impairment of liver function, myocardial infarction
They cannot be given concurrently with MAOI’s because of their anticholenergic side effects
Be used cautiously in clients with :
Glaucoma, benign prostatic hypertrophy, urinary obstruction or retention,
Diabetes mellitus, hyperthyroidism, cardiovascular disease, renal impairment, respiratory disorder
Overdosage can cause
Confusion, agitation, hallucinations, hyperpyrexia, increased reflexes
Tetracyclic Antidepressant
Amoxapine, Maprotiline
may cause extrapyrimidal symptoms, tardive dyskinesia, and neuroleptic malignant syndrome
Amoxapine
Amoxapine MAY CAUSE
may cause extrapyramidal
symptoms, tardive dyskinesia,
and neuroleptic malignant
syndrome
increases appetite and causes
weight gain and cravings for
sweets
Maprotiline side effects
carries risk for seizures (esp. in
heavy drinkers)
severe constipation
urinary retention
stomatitis
used when the client has an inadequate response to or side effects from SSRIs
Atypical Antidepressant
Atypical Antidepressant
Venlafaxine
Buropion
Nefazodone
Mirtazapine
blocks the reuptake of serotonin, norepinephrine, and dopamine
Venlafaxine
modestly inhibits the reuptake of norepinephrine; weakly inhibits the reuptake of dopamine and has no effects on serotonin.
Buropion
inhibits the reuptake of serotonin and norepinephrine and has few side effects. Its half-life is 4 hrs and it can be used in clients with kidney and liver disease.
Nefazodone
inhibits the reuptake of serotonin and norepinephrine and it has few sexual side effects
Mirtazapine
used infrequently because of potentially fatal side effects
Monoamine Oxidase Inhibitors ( MAOI’s)
most serious side effects.A life-threatening condition that results when a client taking MAOIs ingests tyramine-containing foods and fluids or other medications.
Hypertensive crisis
Hypertensive crisis symptoms
Occipital headache
Hypertension
Nausea
Vomiting
Chills
Sweating
Restlessness
Nuchal rigidity
Dilated pupils
Fever
Motor agitation
Hypertensive crisis symptoms can lead to
hyperpyrexia, cerebral hemorrhage , and death.
The MAOI- Tyramine interaction produces symptoms within ____ after ingestion.
20-60 mins.
given for hypertensive crises to dilate blood vessels and decrease vascular resistance.
Phentolamine Mesylate
Other medical treatments and psychotherapy
Electroconvulsive Therapy (ECT)
Psychotherapy
Interpersonal Therapy
Behavior Therapy
Cognitive Therapy
Investigational Treatments
used to treat depressed clients I selective cases such as
those who do not respond to antidepressant or those who experience intolerable side effects
Pregnant women can safely have ECT with no harm to the fetus.
Electroconvulsive Therapy (ECT)
results in less memory loss but needs more treatment to see substantial improvement
Unilateral ECT
more rapid improvement but with increased short term memory loss
Bilateral ECT
used to prevent relapse in depression
ECT
a combination of psychotherapy and medication is still considered the most effective treatment for depressive
Psychotherapy
focuses on difficulties in relationships
Interpersonal therapy
the goals of combined therapy are
symptoms remission
Psychosocial restoration
Prevention of relapse or recurrence
Reduced secondary consequences such as marital discord or occupational difficulties
Increasing treatment compliance
difficulties in relationships such as
Grief reaction
Role disputes
Role transitions
helps the person to find ways to accomplish this developmental task.
Interpersonal therapy
seeks to increase the frequency of the clients positively reinforcing interactions with the environment to decrease negative interactions.
Behavior Therapy
focuses on how the person thinks about the self , others and the future and interprets his or her experiences.
Cognitive therapy
Investigational treatments includes
Transcranial magnetic stimulation ( TMS)
Magnetic seizure therapy
Deep brain stimulation
Vagal nerve stimulation
closest to approval for clinical use
Transcranial magnetic stimulation ( TMS)
