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CMED 311 > Trans 050-051 Mood Disorders > Flashcards

Trans 050-051 Mood Disorders Flashcards

1
Q

o Pervasive and sustained emotion of feeling tone that
influences a person’s behavior and colors his or her
perception of being in the world.
o Can be described as depressed, sad, empty,
melancholic, distressed, irritable, disconsolate, elated,
euphoric, manic, gleeful, etc.
o Some can be seen by the clinician others can only be felt
by the patient.

A

Mood

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2
Q

Mood disorders are sometimes called

A

Affective Disorders

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3
Q

abnormally elevated, expansice or irritable mood

A

Mania

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4
Q

what is a manic episode

A

mania plus 3 or 4 other symptoms

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5
Q

what is a hypomanic episode?

A

hypomania plus 3 or 4 symptoms which is shorter than a manic episode

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6
Q

which is typical of major depressive disorder, decrease/increase in appetite?

A

decreased; increased appetite is atypical symptom

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7
Q

which is typical of major depressive disorder, insomnia or hypersomnia?

A

insomnia is typical. hypersomnia is atypical

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8
Q

Diagnostic criteria for major depressive disorder?

A

• Greater than or equal to 5 of the following in a 2-week period.
• At least one of the symptoms should be either depressed
mood or loss of interest or pleasure.
o Depressed mood most of the day, nearly every day
o Diminished interest or pleasure in all, or almost all,
activities most of the day, nearly every day.
o Weight loss or gain; or decreased or increase in appetite
o A slowing down or speeding up of thought and a
reduction or increase of physical movement.
o Insomnia or hypersomnia
o Fatigue or loss of energy nearly every day.
o Feeling of worthlessness or excessive guilt
o Diminished ability to think or concentrate, or
indecisiveness
o Recurrent thoughts of death, recurrent suicidal ideation
without a specific plan, or a suicide attempt or a specific
plan for committing suicide

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9
Q

depression diagnostic criteria?

A

A major depressive episode must last at least 2 weeks

Patients experiences at least 4 symptoms + (depressed
mood or anhedonia): “SIG-E-CAPS” (SIG: Energy CAPSule)

o Sleep (insomnia or hypersomnia)
o Interests (diminished or pleasure from activities)
o Guilt (inappropriate or excessive; feelings of
worthlessness)
o Energy (Loss of energy or fatigue)
o Concentration (diminished concentration or
indecisiveness)
o Appetite (decrease or increase; weight loss or gain, 5%)
o Psychomotor agitation or retardation
o Suicide (recurrent thoughts of death, suicidal ideation or
attempt)

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10
Q

is the most common mood disorder and is defined by the occurrence of at least a single major depressive episode, although most patients will experience recurrent episodes.

A

Major depression

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11
Q

mood disorders are related to the reduced postive affect and increased negative affect. what are the symptoms?

A

Symptoms related to reduced positive affect include depressed mood: loss of happiness, interest, or pleasure; loss of energy or enthusiasm; decreased alertness; and decreased self-confidence.

Symptoms associated with increased negative affect include depressed mood, guilt, disgust, fear, anxiety, hostility, irritability, and loneliness.

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12
Q

what NT has a dysfunction in the reduced positive affect?

A

Reduced positive affect may be hypothetically related to dopaminergic dysfunction, with a possible role of noradrenergic dysfunction as well.

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13
Q

what NT has a dysfunction in increased negative affect?

A

Increased negative affect may be linked hypothetically to serotonergic dysfunction and perhaps also noradrenergic dysfunction.

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14
Q

what is the finding in the neuroimaging of brain activation in depression

A

Neuroimaging studies of brain activation suggest that resting activity in the dorsolateral prefrontal cortex of depressed patients is low compared to that in nondepressed individuals. Whereas resting activity in the amygdala and ventromedial prefrontal cortex of depressed patients is high compared to that in nondepressed individuals.

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15
Q

Emotional symptoms such as sadness or happiness are regulated by the ____________— two regions in which activity is high in the resting state of depressed patients.

A

ventromedial prefrontal cortex and the amygdala,

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16
Q

Interestingly, provocative tests in which these emotions are induced show that neuronal activity in the amygdala is over/under-reactive to induced sadness (bottom right) but over/under-reactive to induced happiness (top right).

A

over

under

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17
Q

Also known as Pervasive / Persistent Depressive Disorder

A

Dysthymia

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18
Q
  • Depressed mood most of the day, for more days that not, as indicated by either subjective account or observation by others, for at least 2 years.
  • In children or adolescents, mood can be irritable, and duration must be at least 1 year.
A

Dysthymia

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19
Q

Dysthymia vs Major Depressive Disorder

A
  • Dysthymia is distinguished for major depressive disorder by the fact that patients complaint that they have always been depressed.
  • It refers to a subaffective or subclinical depressive disorder.
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20
Q

Criteria of dysthymia?

A

• Presence, while depressed, of 2 or more of the following:
o Poor appetite or overeating
o Insomnia or hypersomnia
o Low energy or fatigue
o Poor concentration or difficulty making decisions
o Feelings of hopelessnes

  • During the 2-year period (1 year for children and adolescents) of the disturbances there should symptoms for more than 2 months at a time
  • MDD may be continuously present for 2 years.
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21
Q

is a less serve form of depression than major depression but long-lasting (over 2 years in duration) and often unremitting.

A

Dysthymia

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22
Q

what is double depression?

A

Patients with unremitting dysthymia who also experience the superimposition of one or more major depressive episodes are described as having double depression. This is also a form of recurrent major depressive episodes with poor inter-episode recovery.

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23
Q

what is mixed-anxiety depression

A

Describes patients with both anxiety and depressive symptoms who do not meet the diagnostic criteria for either an anxiety disorder or mood disorder.
• Presence of subsyndromal symptoms of both anxiety and depression and the presence of autonomic symptoms such s tremor, palpitations, dry mouth, and the sensation of a churning stomach.

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24
Q

medications that can cause drug induced depressive depressive symptoms

A 
isotretinoin
levitiracetem
Topiramate
Vigabatrin
Triptans
BBlocker
Clonidine
methyldopa
reserpine
GnRH
Oral contraceptives
Steroids
Tamoxifen
Interferons
Varenicline
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25
Q

a category of mood disorders defined by the presence of one or more episodes of abnormally elevate mood clinically referred to as a mania or, if milder, hypomania. Individuals who experience manic episodes also commonly experience depressive episodes or symptoms, or mixed episodes in which features of both mania and depression are present at the same time.

A

Bipolar disorder aka manic depression

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26
Q

Bipolar criteria?

A

o Distractibility
o Irresponsibility and erratic uninhibited behavior
o Grandiosity
o Flight of idea
o Activity increased with weight loss and increased libido
o Sleep is decreased
o Talkativeness

DIGFAST

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27
Q

manic vs hypomanic episode?

A
  • A manic episode is a distinct period of an abnormally and persistently elevated, expansive, or irritable mood lasting for at least 1 week.
  • A hypomanic episode lasts at least 4 days and is similar to a manic episode except that it is not sufficiently severe to cause impairment in social or occupational functioning, and no psychotic features are present.
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28
Q

is defined as the occurrence of at least one manic or mixed (full mania and full depression simultaneously) episode. Patients with this disorder typically experience major depressive episodes as well, although this is not necessary for the diagnosis

A

Bipolar 1 Disorder

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29
Q

`is defined as an illness course consisting of one or more major depressive episodes and at least one hypomanic episode.

A

Bipolar 2

30
Q

which type of bipolar disorders have more comorbidities?

A

Bipolar Type 1

31
Q

• Most people are in their teens or early ____ when symptoms of bipolar disorder first appear. Nearly everyone with bipolar disorder develops it before age _____. People with an immediate family member who has bipolar are at higher risk.

A

20s

50

32
Q

what is exitensial theory?

A
  • Existential theorist believed that behavioral deviations result when a person is out of touch with himself or the environment.
  • The person who is self-alienated is lonely, sad, and feels hopeless. Lack self-awareness, coupled with harsh criticism, prevents the person form participating in satisfying relationships.
  • The person is not free to choose from all possible alternatives because of self-imposed restrictions.
  • The person is avoiding personal responsibilities and giving it to the wishes or demands of others.
33
Q

what is kidling theory?

A

• This theory asserts that people who are genetically predisposed toward bipolar disorder can experience a series of stressful events, each of which lowers the threshold at which mood changes occur. Eventually, a moos episode can start (and becomes recurrent) by itself. Not all individuals experience subsequent mood episodes in the absence of positive or negative life events, however.

34
Q

what is cognitive behavioral approach?

A
  • Aaron T. Beck’s cognitive theory proposes that individuals who have a biological vulnerability to bipolar disorders and who hold problematic beliefs about themselves (e.g., the beliefs that they are worthless) can, when those vulnerabilities and beliefs are activated by life stressors, experience symptoms of bipolar disorder.
  • Symptoms in the cognitive-behavioral model, are made up of emotions (e.g., depression or elation), thoughts (e.g., “I’m worthless” or “I’m amazingly talented”) and behaviors (e.g., passivity or excessive activity).
35
Q

what is the neuroendocrine influence in depression?

A

Elevated glucocorticoid activity is associated with the stress response, and evidence of increased cortisol secretion is apparent in about 40% of clients with depression with the highest rates found among older clients.
• About 5%-10% of people with depression have thyroid hormone dysfunction, notably an elevated TSH.

36
Q

what is cyclothymia?

A
  • Symptomatically a mild form of Bipolar II disorder
  • Characterized by at least 2 years of frequently occurring hypomanic symptoms that cannot fit the diagnosis of manic episode and of depressive symptoms that cannot fit the diagnosis of major depressive episode.
  • During the above 2-year period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time.
  • Criteria for a major depressive, manic, or hypnotic episode have never been met.
37
Q

what are the criteria of mixed episode?

A

• At least 3 of the following manic/hypomanic symptoms are present nearly every day during the majority of days of a major depressive episode
o Elevated, expansive mood
o Inflated self-esteem
o More talkative than usual or pressure to keep talking
o Hight of ideas or thought racing
o Increase in energy or goal-directed activity
o Excessive involvement in activities that have a high potential for painful consequences
o Decreased need for sleep

38
Q

what does Rapid cyclers mean?

A
  • Can be applied to Bipolar I and II
  • Presence of at least 4 mood episodes in the previous (2 months that meet the criteria of manic, hypomanic, or major depressive episode.
  • Episodes are demarcated by either partial of full remissions of at least 2 months or a switch to an episode of the opposite polarity
  • The episodes must meet both the duration and symptom number criteria for a major depressive, manic or hypomanic episode.
39
Q

Rapid cycling switches

A

When mania recurs at least four times a year, it is called rapid
cycling (Figure 19A). Patients with bipolar I disorder can also
have rapid switches from mania to depression and back
(Figure 19B). By definition, this occurs at least four times a
year, but can occur much more frequently than that.

40
Q

T or F? individuals with depressive temperament may be at greater risk for the development of a mood disorder later in life.

A

T

41
Q

Individuals with hyperthymic temperament may be at greater risk for the development of a mood disorder later in life. T or F?

A

T

42
Q

is major depressive disorders progressive?

A

These are the possible outcomes for progression of major depressive disorders: If it is recurrent, it could lead to poor inter- episode recovery. If before there is recovery that is happening now there is no recovery that is happening. Hanggang dysthymia na lang sya parati. Or it can lead to Bipolar spectrum. From previous depression lalabas na yung mixed episode or manic episode. Or it can lead to treatment resistance- no improvement.

43
Q

progression in bipolar diosorder that is treatment resistant?

A

rapid cycling

44
Q

Choice of antidepressants is determined by

A

Choice of antidepressants is determined by the side effect profile least objectionable to a given patient’s physical status, temperament, and lifestyle.

45
Q

suggested first-line therapy for mild MDD

A

‘watchful waiting’ to psychotherapy or antidepressants.

46
Q

suggested first-line therapy for mod MDD

A

First-line treatment recommendations for moderate MDD include antidepressant monotherapy, psychotherapy, and the combination of an antidepressant and psychotherapy.

47
Q

suggested first-line therapy for severe MDD

A

First-line treatment recommendations of severe MDD include the combination of an antidepressant and psychotherapy, or ECT

48
Q

First-line pharmacotherapy:

A

(SSRI) Prozac, Escitalopram, Citalopram, Paroxetine, Fluvoxamine

49
Q

s should be considered as an option for second-line therapy

A

Adjunctive dopamine-serotonin receptor antagonists should be considered as an option for second-line therapy

50
Q

Psychotherapy: Observe the patient’s behavior and try to introduce better behaviors to the patient

A

Behavioral therapy

51
Q

Psychotherapy: Focus on communication and relationships of patient

A

Interpersonal psychotherapy

52
Q

psychotherapy: Healing factor is the experience of the group.

A

Group therapy

53
Q

psychotherapy: Focuses on thinking. Changes the automatic thoughts of the patient.

A

Cognitive-behavioral therapy (CBT)

54
Q

Similar to CBT but focuses more on the here and now approach. what psychotherapy?

A

Mindfulness-based cognitive therapy (MBCT)

55
Q

What are the BRAIN STIMULATION METHODS

A

• Electroconvulsive (ECT) – In severe cases like homicidal, suicidal or depressive pregnant women that cannot take medications. • Vagus nerve stimulation (VNS) – Putting something like a pacemaker that will stimulate the vagus nerve. • Transcranial magnetic stimulation (TMS) – Putting a magnet • Deep brain stimulation (DBS) – Surgical technique where in you insert probes into the brain.

56
Q

is based on the concept that a deficit of ‘reinforcers”, such as pleasant activities and positive interpersonal contacts, leaves patients vulnerable to depression • Sample interventions: increase activity level, structured goal setting, interpersonal skills training

A

behavioral Therapy

57
Q

describes a greater awareness of what is happening in the present moment.

A

mindfulness

58
Q

medical treatment in which a small, carefully controlled electrical current is applied to the brain, thereby triggering a seizure. It is a non-invasive (transcranial) technique.

A

electroconvulsive therapy

59
Q

is the direct, intermittent electrical stimulation of the left vagus nerve in the neck via a pulse generator implanted in the chest. It is, therefore an invasive (surgical) technique.

A

Vagal nerve stimulation

60
Q

ECT – VNS is not associated with cognitive side effects. T or F?

A

T

61
Q

a surgical procedure involving implantation of electrodes into the brain, which are then used to stimulate specific brain areas

A

Deep brain stimulation

62
Q

The first class of antidepressants to be developed were

A

monoamine oxidase inhibitors (MAOIs)

63
Q

Both of these classes demonstrated good efficacy in depression, but their use was hindered by significant safety and toxicity issues.

A

MAOI and TCA

64
Q

is an enzyme that will breakdown your dopamine so when you take MAOIs your dopamine, serotonin and norepinephrine will NOT breakdown and their values will increase not only inside the cell but also outside causing increase in activity.

A

Monoamine oxidase

65
Q

were developed in the 1970s and 1980s based on the notion that serotonin deficiencies played an important role in the pathogenesis of depression.

A

Selective serotonin reuptake inhibitors (SSRIs)

66
Q

SSRIs were followed by antidepressants with dual serotonin and noradrenaline actions—the

A

serotonin-noradrenaline reuptake inhibitors (SNRIs)

67
Q

most commonly prescribed antidepressant?

A

SSRI

68
Q

monotherapyt vs adjunctive/augmentation therapy vs combination therapy

A

monotherapy: use of one antidepressant

Adjunctive/augmentation: the use of an antidepressant together with an agent taht is not conventionally used as first line monotherapy in MDD

combination therapy: the use of 2 antidepressants which are both approved as monotherapy for MDD

69
Q

classes of antidepressant monotherapy

A

• Irreversible monoamine oxidase inhibitors (MAOIs)
• Tricyclic antidepressants (TCAs)
• Tetracyclic antidepressants (TeCA)
• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin-noradrenaline reuptake inhibitors (SNRIs)
• Other:
o Noradrenaline reuptake inhibitors (NRIs)
o Noradrenaline-dopamine reuptake inhibitors (NDRIs) o Noradrenergic and specific serotonergic antidepressants (NaSSAs)
o Serotonin antagonist/reuptake inhibitors (SARIs)
o Melatonin agonist and serotonin antagonist
o Multimodal antidepressants

70
Q

COMMON ANTIDEPRESSANTS USED IN THE PHILIPPINES

A
  • Sertraline 25 mg, 50 mg, 100mg
  • Fluoxetine 20 mg
  • Escitalopram 5 mg, 10 mg, 20 mg
  • Duloxetine 30 mg , 40 mg, 50 mg
  • Trimipramine 50 mg
  • Mirtazapine 30 mg, 45 mg
71
Q

is the only classic mood stabilizer and is the gold standard

A

Lithium is the only classic mood stabilizer and is the gold standard. The problem with lithium is you need to monitor it closely because the therapeutic and lethal dose is magkalapit lang so you need to be in the window.

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