Case 12 Flashcards

Question

Conversion of Dopamine to Noradrenaline requires...

Answer 1

DBH enzyme Vitamin C cofactor Cu2+ cofactor

Answer 2

PNMT enzyme | A methyl donor

Answer 3

Locus coeruleus Adrenergic neurons and adrenal medulla

Answer 4

Noradrenergic neurons

Answer 5

Cytosol of dopaminergic neurons

Answer 6

Converts Tryptophan to 5HT

Answer 7

Alertness/Arousal | response to stress and panic

Answer 8

Noradrenergic neurons

Answer 9

Activated by triptans

Answer 10

Activated by hallucinogenic drugs Blocked by atypical antipsychotics

Answer 11

The only ionotropic receptor

Answer 12

Alpha 1 = Gq Alpha 2 = Gi Beta = Gs

Answer 13

``` D1 = Gs D2 = Gi ```

Answer 14

Depression caused by a functional deficit in monoamines (esp. 5-HT and NA)

Answer 15

Depression is caused by underactivity/impaired function of monoamines

Answer 16

Depression is caused by impaired neuronal communication and problems processing information

Answer 17

Supports neuronal survival in hippocampus, cortex and basal forebrain Low in depression

Answer 18

TCAs | Inhibit 5-HT and NA reuptake into presynaptic cleft

Answer 19

Dry mouth Constipation Drowsiness Blurred vision

Answer 20

Drowsiness | Weight gain

Answer 21

Dizziness | Hypotension

Answer 22

Arrhythmias | Long QT syndrome (Torsade de Pointes)

Answer 23

TCAs: ``` On adrenergic vasoconstrictors - cause arrhythmias On barbiturates (sedative hypnotics) - cause severe respiratory depression On acetaminophen (paracetamol) - P reduces metabolism of TCA ```

Answer 24

Can cause arrhythmias

Answer 25

Severe respiratory depression

Answer 26

Paracetamol reduces metabolism of TCA, causing toxicity

Answer 27

SSRIs | Selectively inhibit reuptake of 5-HT into presynaptic cleft

Answer 28

``` Anxiety Gastric upset Headache Weight gain Nausea and vomiting (overactivation of 5HT3) ```

Answer 29

Nausea and vomiting

Answer 30

Sexual dysfunction

Answer 31

Insomnia SSRI dyscontinuation syndrome Sexual dysfunction Increased risk of bleeding

Answer 32

Flu-like symptoms | Changes in sleep, movement, thinking, mood, movement, senses

Answer 33

Hyponatraemia Increased bleeding Serotonin syndrome

Answer 34

``` Increased temperature Increased reflexes Agitation Tremor Sweating Dilated pupils Diarrhoea ```

Answer 35

SSRIs decrease metabolism of Codeine, benzodiazepines, Erythromycin

Answer 36

NRIs | Inhibition of noradrenaline reuptake into synaptic cleft

Answer 37

NRIs: ``` Anorexia Chills Constipation Dry mouth Headache Insomnia Urinary retention ```

Answer 38

Inhibit 5-HT and norarenaline reuptake into presynaptic cleft

Answer 39

SNRIs: Agitation - tremor, increased blood pressure and heart rate Nausea Diarrhoea Anorgasmia

Answer 40

Ventricular dysrhythmias

Answer 41

SNRIs: Conditions with high risk of cardiac arrhythmias Uncontrolled hypertension

Answer 42

Selective Monoamine Oxidase A inhibitor

Answer 43

Non-selective MAO inhibitor

Answer 44

``` MAOI: Dry mouth, Constipation, Drowsiness, Hypotension, Insomnia Weight gain ```

Answer 45

MAOI: Cheese Reaction with foods containing tyramine (beer, wine, aged cheese, marmite) Rage, mania, suicidal behaviour Tyramine = increased release of NA = increased activation of SNS

Answer 46

Phaeochromocytoma Cerebrovascular disease Thyrotoxicosis Bipolar Affective Disorder

Answer 47

Atypical | Inhibits Dopamine reuptake and weakly inhibits NA reuptake

Answer 48

``` Atypical antidepressant: Headache Dry mouth Agitation Insomnia ```

Answer 49

``` Atypical Antidepressant: Acute alcohol withdrawal Acute benzodiazepine withdrawal Hx of seizures Hepatic cirrhosis ```

Answer 50

Alpha-2 adrenergic receptor antagonist Also antagonist of 5HT2A and 5HT3

Answer 51

Atypical Antidepressant: Dry mouth Sedation Weight gain

Answer 52

Presynaptic Alpha-2 receptors are the 'brakes' on noradrenergic neurones. When alpha-2 receptors are blocked, there is no inhibition of NA neurons

Answer 53

Many interactions with conventional drugs due to induction of metabolising enzymes (If StJW is stopped, increase in concentration of interacting drug = TOXICITY) Amount of active ingredient varies between preparations.

Answer 54

NMDA receptor antagonist (the glutamate receptor)

Answer 55

Blocks action of glutamate. Increased in BDNF - causing synaptogenesis Reversal of cellular atrophy due to stress/glucocorticoids

Answer 56

Profound depressive illness

Answer 57

Raised inflammatory cytokines (The sick role) Modulation of HPA axis Raised cortisol Cortisol is neurotoxic - particularly to hippocampus

Answer 58

Variation in a single nucleotide that occurs at a specific position in a genome

Answer 59

Sections of genome are repeated and number of repeats in genome varies between individuals in the human population.

Answer 60

The extent to which a gene is expressed in the phenotypes of individuals carrying it

Answer 61

VCFS deletion | 3q29 deletion

Answer 62

Lateral and posterior hypothalamus

Answer 63

Low blood glucose | High ghrelin

Answer 64

Orexigenic

Answer 65

Adipocytes

Answer 66

Stomach distention | Insulin

Answer 67

Anorexigenic

Answer 68

Gastric mucosa in stomach and small intestine

Answer 69

Empty stomach | Low blood glucose

Answer 70

Orexigenic

Answer 71

L cells in colon/ileum

Answer 72

Calorie intake

Answer 73

``` Anorexigenic Slows peristalsis (to maximise absorption) ```

Answer 74

I cells in duodenal mucosa

Answer 75

Products of protein an fat digestion in duodenum

Answer 76

Anorexigenic Slows gastric emptying Emptying of gallbladder (contraction)

Answer 77

Hyperghrelinaemia (orexigenic) = failed satiety response

Answer 78

VTA Amygdala Ventral Pallidum Nucleus Accumbens

Answer 79

Ventral Pallidum | Nucleus Accumbens

Answer 80

Acts on ghrelin neurons Ghrelin neurons send fibres to NYP and AgRP containing neurones Stimulates release of orexigenic peptides Ghrelin neurons also send inhibitory fibres to POMC containing neurones. Inhibits release of anorexigenic peptides.

Answer 81

Inhibits NYP and AgRP containing neurons. | Stimulates POMC neurons

Answer 82

Inhibits (activates POMC containing neurons)

Answer 83

Stimulates (inhibits POMC containing neurons)

Answer 84

Loss of appetite and weight loss >5% in one month

Answer 85

Craving foods high in CHO + weight gain | Hypersomnia

Answer 86

Decreases appetite

Answer 87

Conflict with parents Mood disruptions Risk behaviour

Answer 88

Activation of HPA axis Zona reticularis to produce androgens Results in secondary sexual characteristics and changes in sweat glands

Answer 89

8-14yrs (11 mean)

Answer 90

9-15yrs (12 mean)

Answer 91

Reactivation of hypothalamic-pituitary-gonadal axis. Pulsatile release of GnRH during sleep. FSH and LH release from A. Pituitary. Gonadal steroid release - oestrogen and testosterone.

Answer 92

Adrenarche Gonadarche Activation of growth axis

Answer 93

Develop neural circuitry for typical male behaviour | Defeminisation

Answer 94

Reproductive behaviours Reorganisation of sensory and association regions Motivation and reward behaviour

Answer 95

Hippocampus

Answer 96

Nucleus Accumbens | Dopaminergic pathways to PFC

Answer 97

Neuronal atrophy due to chronically high cortisol | Leads to dysregulation of HPA system

Answer 98

Elimination of rarely used neural connections in the brain to make it more efficient. Occurs during adolescence

Answer 99

Motor and sensory systems first Then frontal, parietal and temporal cortices (involved in integrating primary function)

Answer 100

Greater control of thoughts and behaviour Long term planning Self evaluation

Answer 101

Improved decision making Better risk and reward system

Answer 102

Occurring over approximately one day | Includes changes in temperature, heart rate, respiration rate and metabolism.

Answer 103

Occur over less than one day | e.g. passing through different stages of sleep

Answer 104

Occurs over more than 1 day | e.g. menstrual cycle

Answer 105

Alpha waves 8-12 Hz Low amplitude, moderate frequency. Drowsy wakefulness (Wakes immediately if aroused)

Answer 106

High amplitude Slower frequency K complexes Sleep spindles (More difficult to arouse than stage 1)

Answer 107

Unique to stage 2 of sleep Suppress cortical arousal Aid sleep-based memory consolidation

Answer 108

Unique to stage 2 of NREM sleep | Immediately follow muscle twitching

Answer 109

Delta waves appear (1-2Hz) Large amplitude, Low frequency Decreased breathing, heart rate and body temperature)

Answer 110

Dominated by delta waves

Answer 111

Jaw clenching

Answer 112

Alpha motor neurons inhibited

Answer 113

Increased blood pressure, respiration and heart rate Because sympathetic NS is partially activated

Answer 114

High blood flow to visual cortex - due to complex visual material in dreams. Low blood flow to inferior frontal cortex - poor temporal organisation and bizarreness)

Answer 115

Limbic system no longer inhibited Limbic system involved in emotion, motivation, long term memory and olfaction

Answer 116

Inhibits REM sleep

Answer 117

Inhibits REM sleep

Answer 118

Promotes REM sleep

Answer 119

Increased melatonin release from pineal gland during darkness. Melatonin causes sleepiness. Leads to severe disruption in mood.

Answer 120

Day shift Evening shift Night shift i.e. Delay > Advance

Answer 121

Delay (go to sleep later - when it is dark in the morning)

Answer 122

Advance (go to sleep earlier - when it is dark in the afternoon)

Answer 123

Ineffective

Answer 124

Cues in the regulation of the body's circadian rhythm e.g. Light

Answer 125

Activity in serotonergic neurones. Decreased activity in reticular formation and cortex. Allows sleep to be initiated.

Answer 126

Activity in noradrenergic neurons

Answer 127

Photopigment found in light sensitive retinal ganglion cells

Answer 128

It can be transplanted - sets the rhythm of the donor animal in the receiving

Answer 129

Increases slow wave, NREM sleep (stages 3 and 4) | Decreases REM sleep (satisfying sleep)

Answer 130

Areas of the brain involved in memory consolidation and retrieval are not shut down.

Answer 131

HLA DR2 and DQ1

Answer 132

Chronic sleep deprivation

Answer 133

Measure time elapsed from start of a daytime nap to the first signs of sleep. Used in diagnosis of sleep disease.

Answer 134

Neuropeptide that regulates arousal, wakefulness and appetite

Answer 135

HLA DR2 and DQ1 Cause a reduction in hypocretin in CSF

Answer 136

Destruction of cells that produce hypocretin | Therefore, reduction in levels of hypocretin in CSF

Answer 137

Excessive daytime sleepiness Falling asleep suddenly, without warning Sleep paralysis (unable to move or speak when waking or falling asleep)

Answer 138

Modafinil - daytime Sodium oxybate - at night Education Psychology

Answer 139

Inhibits DA reuptake Activates glutamatergic circuits Inhibits GABA *Promotes wakefulness* Used in narcolepsy.

Answer 140

A metabolite of GABA. Taken at night by narcolepsy patients.

Answer 141

Sudden muscular weakness caused by strong emotions.

Answer 142

Jaw drop, head slump, leg collapse, slurred speech, double vision etc. Triggered by strong emotion e.g. laughter, anger, surprise

Answer 143

Gamma-hydroxybutyrate (CNS depressant) Antidepressants

Answer 144

CNS depressant used to treat cataplexy. Active ingredient is Sodium Oxybate, a metabolite of GABA.

Answer 145

Partial epileptic seizures during sleep, causing a reduction in REM sleep.

Answer 146

Narcolepsy Sleep apnoea Restless leg syndrome Night terrors

Answer 147

Sleep deprivation often causes seizures in people with epilepsy.

Answer 148

Morphine Barbiturates Benzodiazepines

Answer 149

Reduction in REM sleep | Patient will appear drowsy on waking

Answer 150

Melatonin | Tryptophan

Answer 151

Used to promote a natural sleeping pattern. Can be used for a maximum of 2 weeks.

Answer 152

Avoid napping during the daym particularly after 3pm. | Limit naps to 1 hour

Answer 153

Formation and maintenance of tight junctions between cerebral endothelial cells.

Answer 154

Secrete proteins to contribute to basal membrane

Answer 155

In medulla

Answer 156

Area Postrema

Answer 157

Controls vomiting Fenestrated capillaries allow small molecules to enter brain. Chemoreceptors detect toxins in the blood and trigger vomiting.

Answer 158

Sodium channel blocker | Increases GABA in the brain

Answer 159

Bipolar Epilepsy Migraine

Answer 160

Serotonin transporter

Answer 161

Preparation for danger in the absence of an immediately threatening stimuli

Answer 162

Hippocampus

Answer 163

Lateral nuclear complex of Amygdala

Answer 164

Discrete episodes of intense anxiety accompanied by somatic symptoms

Answer 165

Converts glutamate to GABA

Answer 166

Pentamer B2, a1, B2, a1, G2

Answer 167

Inhibit voltage gated Ca2+ channels Inhibit Adenylyl Cyclase Open K+ channels (hyperpolarisation)

Answer 168

Hypothalamic periventricular nucleus

Answer 169

Benzodiazepines with sustained action: | Diazepam, Alprazolam, Chlordiazepoxide, Clobazam

Answer 170

Nordazapam

Answer 171

Drowsiness, Confusion Retrograde amnesia Impaired coordination

Answer 172

Facilitates GABA-mediated GABA-A receptor Cl- channels

Answer 173

Diazepam, | Chordiazepoxide

Answer 174

Lorazepam | Temazepam

Answer 175

When physical symptoms such as sweating, tremor and tachycardia occur

Answer 176

5-HT1A receptor agonist

Answer 177

Generalised anxiety disorder

Answer 178

Nausea Dizziness Headache Nervousness/Excitement

Answer 179

Epilepsy | Acute porphyria

Answer 180

Disorganised speech and behaviour | Find it hard to do every day tasks

Answer 181

Abnormal movement or behaviour

Answer 182

Mixture of different type of schizophrenia

Answer 183

History of episodes | No current symptoms

Answer 184

Activates Adenylyl Cyclase

Answer 185

Inhibits Adenylyl Cyclase

Answer 186

Nucleus Accumbens Hypothalamus Thalamus Frontal cortex

Answer 187

D1 - Mesolimbic pathway D2 - Mesocortical pathway

Answer 188

Psychosis is caused by dysregulation of dopaminergic pathways. Overactive mesolimbic pathway (D1 - Gs) causing positive symptoms Underactive mesocortical pathway (D2 - Gi) causing negative symptoms

Answer 189

NMDA hypofunction Causes decreased activity in mesocortical pathway (D1) causing negative symptoms Causes increased activity in mesolimbic pathway (D2) cauing positive symptoms.

Answer 190

Dopamine receptor antagonist (non-selective)

Answer 191

Dopamine receptor antagonist (higher affinity for D2 than D1)

Answer 192

Acute dystonia Tardive kinesia Akathisia

Answer 193

Sudden and spastic contraction of muscles, often in face and neck. Caused by blockade of D2 receptors in extrapyramidal system.

Answer 194

Prolonged, involuntary, upward movement of the eyes | A form of acute dystonia

Answer 195

Involuntary, abnormal movements e.g. Oro-buccal-facial causing tongue movements and excessive blinking Caused by D2 blockade in extrapyramidal motor system

Answer 196

Subjective sense of anxiety and restlessness | Caused by D2 blockade in extrapyramidal motor system

Answer 197

``` Sedation Dry mouth Blurred vision Urinary retention Constipation ``` + Acute dystonia Tardive kinesia Akathisia

Answer 198

``` Increased prolactin (gynaecomastia) Hypothermia Anticholinergic effects Hypersensitivity reactions Obstructive jaundice ```

Answer 199

Increased prolactin (gynaecomastia) Hypothermia Anticholinergic effects (fewer than chlopromazine) Hypersensitivity reactions

Answer 200

Atypical | Antagonist of dopamine, serotonin (5-HT2) and other monoamine receptors

Answer 201

``` Seizures Salivation ACh effects (dry mouth, constipation) Weight gain Hyperlipidaemia Hyperglycaemia Risk of agranulocytosis ```

Answer 202

5-HT2A blockade (higher affinity for 5-HT2A than D2) Examples: Risperidone, olanzapine and quetiapine

Answer 203

Weight gain Hypotension Hyperprolactinaemia

Answer 204

Weight gain Hyperlipidaemia Hyperglycaemia

Answer 205

Sedation/Drowsiness Tachycardia Weight gain Constipation

Answer 206

A2 purine receptor antagonist | Partial phosphodiesterase inhibitor

Answer 207

Inhibit of reuptake of monoamines into presynaptic membrane | Increases dopamine release

Answer 208

``` Euphoria Insomnia Increased stamina Anorexia Increased blood pressure Decreased GI motility ```

Answer 209

Inhibits catecholamine reuptake Increases firing of 5-HT in mesolimbic pathway Decreases 5-HT firing of neurons in dorsal raphe nuclei

Answer 210

Tachycardia Vasoconstriction Increased blood pressure

Answer 211

Inhibits 5-HT reuptake | Stimulates 5-HT release

Answer 212

Psychostimulant | Empathogenic

Answer 213

Mimics 5-HT | Agonist of 5-HT2A receptors

Answer 214

Alters perception by affecting how the retina processes information and conducts it to the brain (Psychotomimetic)

Answer 215

THC acts on CB1 receptors in brain and CB2 receptors in peripheral tissues. Inhibits GABA release Therefore, dopamine released from Nucleus Accumbens

Answer 216

Mu-opioid receptor agonist | Acting on receptors in the limbic system

Answer 217

Constipation | Respiratory depression

Answer 218

Ventral Tegmental Area | Nucleus Accumbens

Answer 219

Locus coeruleus | Noradrenergic neurones in brainstem

Answer 220

Low birth weight | Obstetric complications and infection

Answer 221

Cognitive impairment | Motor delay

Answer 222

Enlarged ventricles | Reduced grey matter

Answer 223

``` Cardiac disorders Hx of neutropenia/agranulocytosis Bone marrow disorder Alcoholic and toxic psychosis Uncontrolled epilepsy ```

Answer 224

Aripiprazole | Metformin can also be used to control weight gain

Answer 225

Reduces weight, serum cholesterol and triglyceride levels. | Used in conjunction with clozapine to reduce its side effects.

Answer 226

Certain anxiety disorders e.g. OCD

Answer 227

Personality disorders Substance use Self Harm

Answer 228

An alternative to CBT, Depression Anxiety disorders Bipolar

Answer 229

``` Auditory Visual Tactile Olfactory Gustatory ```

Answer 230

Abnormal thoughts Beliefs that do not form part of the person's culture. Fixed, usually paranoid and persecutory in nature.

Answer 231

Trouble organising thoughts logically, making up meaningless words, feeling as though thoughts are being removed (thought blocking)

Answer 232

Subject of delusion is believed to be true with 100% conviction

Answer 233

``` Affective flattening Alogia Avolition/Apathy Attention Anhedonia ```

Answer 234

Poverty of speech (reduction in amount of speech)

Answer 235

Loss of interest in and pleasure from previously rewarding activities

Answer 236

Lack of motivation and interest in goal directed behaviour

Answer 237

Diminished range of emotional expressiveness

Answer 238

Have their daily dose of clozapine monitored by the psychiatrist. Since nicotine is an enzyme inhibitor. Drastic reduction in smoking could produce toxic effects.

Answer 239

``` Openness Conscientiousness Extraversion Agreeableness Neuroticism ```

Answer 240

Novelty seeking Harm avoidance Reward dependence Persistence

Answer 241

Self-directedness Cooperativeness Self-transcendence

Answer 242

Content Process Flow Form of thought

Answer 243

Long-winded

Answer 244

Loses goal direction

Answer 245

Making up new words

Answer 246

Discourse consisting of a sequence of unrelated or only remotely related ideas

Answer 247

Hyperaesthesia (excessive physical sensitivity) Vivid sounds and colours Seen in mania and autism

Answer 248

Real stimulus False perception e.g. "I saw a man down a dark alley"

Answer 249

No stimulus False perception Can be in any sensory modality

Answer 250

Voices heard within mind Involuntary Internal Seen in personality disorder

Answer 251

Own thoughts spoken aloud

Answer 252

Speaking in 2nd or 3rd person

Answer 253

Feeling detached from your own body and sense of self Seen in anxiety, sleep deprivation, sensory deprivation, drug intoxication

Answer 254

Feeling that everything around you is not real (is plastic, or has a "movie quality") Seen in anxiety, sleep deprivation, sensory deprivation, drug intoxication.

Answer 255

``` Appearance/Behaviour Speech Mood/Affect Perceptions Thoughts Cognition Insight ```

Answer 256

Lying without meaning to (Wernicke-Korsakoff's)

Answer 257

Level of understanding exhibited in relation to symptoms. Do they attribute symptoms to mental disorder? Accept the need for treatment?

Answer 258

Loss of awareness of identity

Answer 259

Patients present with numbness/blindness/paralysis with no organic cause

Answer 260

Understandable in the context of their emotional state e.g. low self esteem - believe they are responsible for a crime

Answer 261

"Someone is trying to kill me"

Answer 262

"I am the new messiah"

Answer 263

"I am already dead"

Answer 264

Perception is normal but has been interpreted delusionally

Answer 265

Insertion, withdrawal, broadcasting i.e. someone is putting thoughts in their head

Answer 266

Affect, impulse, volition Someone is making them do what they are doing

Answer 267

Low mood Anhedonia Anergia

Answer 268

One episode of MANIA | Other episodes of depression/hypomania/mixed affective state

Answer 269

Episode of hypomania Other episodes of depression (more depression than type 1, more suicidal acts) NO MANIA or mixed affective state

Answer 270

Mania is more severe and completely disruptive in daily life. Hypomania lasts for a few days Mania must last for at least one week.

Answer 271

``` Anhedonia Early morning waking Psychomotor agitation/retardation Loss of appetite Weight loss Loss of libido ```

Answer 272

Number of new cases in a population over a period of time

Answer 273

Proportion of people in the population with the condition

Answer 274

Person believes that they are already dead | Seen in psychotic depression and dementias

Answer 275

Induction of Generalised Tonic Clonic Seizure by an electric current under general anaesthetic

Answer 276

Short term memory impairment | Risks associated ith repeated general anaesthetic (1/5000 deaths)

Answer 277

Persistent mild depression

Answer 278

Lung (13.1%)

Answer 279

Stress results in release in TNF-alpha TNF-alpha inhibits activity of tyrosine phosphatase Reduced expression of MHC II Malignant cells escape immune surveillance

Answer 280

SSRIs | SNRIs if SSRIs are ineffective

Answer 281

Avoidance of reminders Flashbacks/Nightmares Negative cognitions (guilt, numbing, shame, anger) Hyperarousal

Answer 282

Hyperactive amygdala and insula Hypoactive mPFC and rACC

Answer 283

Fear or shame that an individual might have that they and their condition will be negatively viewed

Answer 284

When a person or group is shunned, denied protection under the law or dehumanised

Answer 285

Dose-related abdominal pain Constipation Nausea GI disturbance

Answer 286

In manic phase of BPAD Cardiac disease Epilepsy

Answer 287

Benzodiazepine | Acts on GABA-A receptors causing an opening of Cl- channels

Answer 288

Amnesia Confusion Ataxia

Answer 289

If respiratory weakness Chronic psychosis Sleep apnoea

Answer 290

Depression and anxiety disorders

Answer 291

Anxiety and sleep disorders | Status epilepticus

Answer 292

Selective MAO-A inhibitor

Answer 293

Depression Anxiety Psychosis

Answer 294

``` Confusional states (agitation) Dizziness Dry mouth Drowsiness Weight gain Hypotension Insomnia ```

Answer 295

Thyrotoxicosis | Bipolar (may trigger manic episodes)

Answer 296

TCA Limits 5-HT and NA reuptake Also blocks voltage gated Ca2+ channels in CNS

Answer 297

Abdominal pain Restlessness Fatigue Hypertension

Answer 298

Cardiac arrhythmias Acute porphyria In manic phase of BPAD

Answer 299

Prolonged QT interval

Answer 300

The belief that mental health services and research don't deserve as much funding as other health problems

Answer 301

Temporary condition caused by stress - display some symptoms of clinical depression without as many physical/emotional symptoms e.g. sleep and appetite changes

Case 12 Flashcards

(343 cards)