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Neuro Part 2 > Week 8.3 > Flashcards

Week 8.3 Flashcards

1
Q

How do we assess someone’s mood?

A

it must be self-reported

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2
Q

What is a euthymic mood?

A

a normal mood with appropriate valence and moderate variability

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3
Q

What are the clinical features of depression?

A
  • persistent sad or irritable mood
  • anhedonia
  • significant weight or appetite change
  • difficulty sleeping or oversleeping
  • psychomotor retardation
  • difficulty concentrating
  • recurrent thoughts of death/suicide
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4
Q

What are the three depressive disorders?

A
  • major
  • persistent (dysthymic)
  • NOS
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5
Q

What are the criteria for MDD?

A
  • five or more symptoms

- duration of two weeks

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6
Q

Post-partum depression typically begins when?

A

within the first four weeks of delivery

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7
Q

How does PDD compare to MDD?

A

it is longer but less severe

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8
Q

What are the criteria for PDD?

A
  • two or more symptoms

- last for two years or more

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9
Q

What are the criteria for DD NOS?

A

symptoms insufficient to meet criteria for MDD or PDD

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10
Q

Depression is linked to what cardiovascular issues?

A
  • hypertension

- MI

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11
Q

How does the risk of suicide change with age?

A
  • increases throughout life for caucasians

- peaks between 25-35 for AA and Native Americans

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12
Q

What are some risk factors for suicide in depressed patients?

A
  • alcohol or other substance use
  • chronic illness
  • social isolation
  • previous attempts
  • family history
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13
Q

Which brain structure is key to the pathogenesis of depression?

A

the hypothalamus

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14
Q

How does the HPA play a role in depression?

A

hyper-secretion of cortisol is believed to contribute

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15
Q

Most of the physical symptoms of depression come from what mechanism?

A

excessive cortisol release

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16
Q

What is the dexamethasone suppression test?

A
  • used to assess the HPA axis

- should see a decrease in ACTH and cortisol after

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17
Q

What anatomic change has been associated with depression?

A

hippocampal atrophy

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18
Q

What role do cytokines appear to play in depression?

A
  • up regulate subcortical functioning, making us more sensitive to stress
  • down regulate cortical functioning that would regulate and decrease this
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19
Q

What are the three major bipolar mood disorders?

A
  • bipolar I
  • bipolar II
  • cyclothymic disorder
20
Q

Criteria for Bipolar I

A
  • manic episode lasting one week

- three or more characteristic symptoms

21
Q

What are the characteristic symptoms of bipolar disorder?

A
  • inflated self-esteem
  • decreased need for sleep
  • distractibility
  • pressured speech
22
Q

What is Bipolar II?

A

a milder, shorter form of bipolar mood disorder with three symptoms lasting 4 days

23
Q

What are the criteria for cyclothymic disorder?

A
  • two years (1 if adolescent) of numerous hypomanic episodes and depressive episodes not meeting criteria for MDD
  • not without symptoms for more than two months
24
Q

What is a mixed manic episode?

A

one with symptoms of depression and mania

25
Q

What is the kindling effect?

A

as a person ages, episodes of mania become more frequent, shorter, and more severe

26
Q

What are the major complications of bipolar mood disorder?

A
  • suicide
  • social or financial devastation
  • catatonia
27
Q

Describe the neuroanatomic changes associated with bipolar mood disorder.

A
  • frontotemporal hyper-intensities

- alterations to the neuronal phospholipid membranes causing them to depolarize more

28
Q

What NT changes are seen in those with bipolar mood disorder?

A
  • elevated NE
  • elevated glutamate
  • chronic HPA activation
29
Q

The kindling effect of bipolar disorder is often attributed to what mechanism?

A

chronic activation of the HPA axis and the effects of chronic steroids

30
Q

How can bipolar disorder with psychosis be differentiated from schizophrenia?

A
  • bipolar is more cyclic in course

- bipolar has fewer negative symptoms

31
Q

The mental status exam for assessing mood includes what four basic features?

A
  • presentation and behavior
  • cognitive status
  • emotional functioning
  • thought processes and content
32
Q

What two questions can be quickly used in the primary care setting to assess for depression?

A
  • felt down, depressed, or hopeless

- felt little interest or pleasure in doing things

33
Q

Antidepressants have a black box warning for what?

A

suicide

34
Q

Depression is commonly comorbid with what other disorder?

A

anxiety

35
Q

How do tricyclics work?

A

block reuptake of NE and serotonin

36
Q

How do MAOIs work?

A

block metabolism of NE and DA

37
Q

How do SSRIs work?

A

block reuptake of serotonin

38
Q

How do SNRIs work?

A

block reuptake of NE

39
Q

Electroconvulsive therapy is indicated for which patients?

A

those with depression and…

  • psychosis
  • high suicide risk
  • comorbid medical risks
40
Q

What is the primary treatment for bipolar disorder?

A

lithium

41
Q

What are the major disadvantages of lithium?

A
  • it takes a long time to build the necessary steady state levels in the blood
  • therapeutic doses are near toxic
42
Q

Name four drugs used in the treatment of bipolar mood disorders.

A
  • lithlium
  • valproic acid
  • carbamazepine
  • lamotrigine
43
Q

Lithium has what advantages?

A
  • shortens episodes
  • prolongs remission (is prophylactic)
  • lowers suicide potential
44
Q

Advantages of valproic acid?

A

better tolerated by elderly, patients with CNS damage, rapidly cycling patients

45
Q

Why is psychotherapy given before onset of an episode of bipolar disorder?

A

because the therapy focuses primarily on prevention (e.g. sleep hygiene)

Neuro Part 2 (18 decks)

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