Week 11c: Mood disorders, Anxiety, Psychosis Flashcards
major depressive disorder
clinical depression as defined by the DSM-5
Dysthymia
mild, chronic depression for two or more years
bipolar disorder
alternating between manic and major depressive disorder
cyclothymia
alternating between hypomanic and mild depressive phases
characteristics of depression
- depressed mood
- anhedonia
- feelings of worthlessness of excessive guilt
- decreased concentration
- psychomotor agitation or retardation
- insomnia or hypersomnia
- decreased libido
- change in weight or appetite
- thoughts of death or suicidal ideation
PET and MRI findings in bipolar disorder and MDD
show a reduction in the volume of grey matter in the prefrontal cortex with an associated decrease in activity in the region
PET and MRI findings in bipolar disorder and MDD: brain regions with decreased regional glucose metabolism
inferior frontal gyrus, bilateral superior and middle temporal gyrus and bilateral anterior cingulate cortex
PET and MRI findings in bipolar disorder and MDD: brain regions with increased regional glucose metabolism
bilateral hippocampus and left thalamus
4 classes of meds for depression
- TCAs
- SSRIs
- Atypical antidepressants
- MAOIs
prototype drug of TCAs
Imipramine (tofranil)
adverse effects of TCAs
- anticholinergic effects
- confusion, drowsiness
- orthostatic hypotension
- sedation
- sexual dysfunction and weight gain
what is a major contraindication of TCAs
dysrhythmias and recent MI
It may take _____ weeks for TCAs to have a therapeutic effect
2-6 weeks
mechanism of action of SSRIs
prevent the reuptake of serotonin by the presynaptic nerve terminals in the limbic system
when are the therapeutic effects of SSRIs seen
4-6 weeks
SSRIs + TCAs and MAOIs can cause
serotonin excitation syndrome
serotonin excitation syndrome symptoms
hyperpyrexia, hypertension, confusion, sweating, tremors, ataxia
SSRI discontinuation syndrome
occurs when SSRIs are abruptly stopped
Signs and Symptoms of SSRI discontinuation syndrome
- dizziness, confusion
- lethargy
- paresthesia
- vivid dreams
- nausea
Prototype drug for MAOIs
Phenelzine (Nardil)
MAOIs have equal efficacy as SSRIs and TCAs but…
they have a smaller margin of safety
adverse effects of MAOIs
- hepatotoxicity
- orthostatic hypotension
- headache
- insomnia
- diarrhea
adverse effects of lithium
- kidney impairment
- dysrhythmias and circulatory collapse
- leukocytosis
- hypothyroidism and goiter (lithium decreases the production of thyroid hormones)
what are the 3 brain areas associated with anxiety
- limbic system
- reticular formation
- prefrontal cortex
which brain area is associated with emotion, learning and memory
limbic system
stimulation of the reticular formation increases?
arousal and alertness
inhibition of the reticular activating system promotes?
drowsiness and sleep
side effects of short term use of benzodiazepines
- aggression
- dizziness
- drowsiness
- sexual dysfunction
- depression
- blurred vision
side effects of long term use of benzodiazepines?
- cognitive problems
- sleep disturbances
- mental disorders
- immune system suppression
- cancer risk
- addiction
neurotransmitter imbalance in psychosis
overactive dopaminergic pathways in the basal nuclei leads to overstimulation of dopamine type 2 receptors
blocking of the dopamine receptors can produce?
EPS, similar to what happens in PKD
muscle spasms of the back, neck and tongue at onset of treatment
acute dystonia
akathisia
restlessness
unusual tongue and face movements associated with long-term use
Tardive dyskinesia
neuroleptic malignant syndrome signs and symptoms
- high fever, diaphoresis
- muscle rigidity
- tachycardia, blood pressure fluctuations
treatment for NMS
muscle relaxants and antipyretics
