Depression Flashcards
(246 cards)
1
Q
What are disorders of emotions (Including: mania and depression) called?
A
Mood Disorders
2
Q
These disorders are underdiagnosed and undertreated, not very often.
True or False?
A
False
These disorders are highly underdiagnosed and undertreated
3
Q
What is among the leading causes of disability worldwide?
A
Depression
4
Q
8% of adults experience what at some point of their lives?
A
major depressive episodes
5
Q
What is the cause of death in ~15% of individuals with Major Depressive Disorder (MDD)?
A
Suicide
6
Q
Depression is twice as prevalent in men or women?
A
Women
7
Q
Depression is twice as prevalent in women than men.
Why is this?
A
Women are more likely to recognize mental health issues and go to their doctor
8
Q
Neurological basis for the increased prevalence is very well known.
True or False?
A
False
unknown
9
Q
Depression is twice as prevalent in women than men
It is thought that the reason for this is that women are more likely to recognize mental health issues and go to their doctor.
Neurological basis for the increased prevalence is unknown but
hypotheses include differences in what three things in the brain?
A
hormonal statuses, stress systems, or sexual differences in the brain
10
Q
Who are less likely to see help for depression, men or women?
A
men
11
Q
Depression is often masked in men.
True or False?
A
True
12
Q
Why is depression is often masked in men?
A
Due to somatic complaints (For example, somatic complaints include: migraines, back pain, or irritable bowel syndrome. Therefore, often not recognized as depression.)
13
Q
Prevalence of bipolar disorder or manic depression is approximately 1% and _______________ ________________ between men and women.
A
equally distributed
14
Q
Mood disorders are disorders of emotion including what two things?
A
mania and depression
15
Q
Depressive disorders can be divided into what two categories?
A
MDD (depressed mood or loss of interest/pleasure) and Dysthymia (persistent mild depressive disorder)
16
Q
Depressive disorders can be divided into two categories. What is characteristic of MDD (major depressive disorder)?
A
depressed mood or loss of interest/pleasure
17
Q
Depressive disorders can be divided into two categories. What is characteristic of Dysthymia?
A
persistent depressive disorder
18
Q
Criteria for Depression includes the simultaneous presence of ________ or more symptoms (at least one of the symptoms have to be depressed mood OR loss of interest/pleasure) during a ____-___________, period and represent a __________ from previous functioning.
A
Five, 2-week, change
19
Q
What are symptoms of depression?
A
o Depressed Mood o Anhedonia (loss of interest/pleasure) o Changes in weight/appetite o Insomnia or hypersomnia o Psychomotor agitation or retardation o Fatigue or loss of energy o Feeling of worthlessness or excessive guilt o Diminished ability to think or concentrate, or indecisiveness o Thoughts of death or suicidal ideation
20
Q
Common comorbid diagnosis with depression include what 4 things?
A
diabetes, heart disease, autoimmune disorders, and pain
21
Q
What are these known as:
disruptive mood dysregulation disorder
premenstrual dysphoric disorder
substance/medicationinduced depressive disorder
specified and unspecified depressive disorders
A
Other Depressive Disorders
22
Q
The following are examples of risk factors of depression:
- Childhood emotional, physical, and sexual abuse
- Prior episode of depression
- Family history of depressive disorder
True or False?
A
true
23
Q
What are three examples of risk factors for depression?
A
Childhood emotional, physical, and sexual abuse, Prior episode of depression, Family history of depressive disorder, Lack of social support, Stressful life event,
Current substance abuse, Economic difficulties
24
Q
The etiology of depression involves only one factor.
True or False?
A
False (it is multifactoral)
25
Which ones are NOT a part of the dynamic interplay for the multifactorial etiology of depression:
- Genetic predisposition
- Environment
- Stressors
- Chronic Disease
- Life History
- Obesity
- Development
- Biological Challenges (Changes)
Stressors, Chronic Disease, and Obesity
26
Much of the research for the etiology of Depression has focused on what?
deficits in neurotransmitter systems
27
It is believed that Major Depressive Disorders (MDD) arises from this complex interaction of what two things?
genes and environmental factors
28
For the pathophysiology of mental illness we are talking about what happens inside the brain, that portion of the central nervous system that is contained within the ________________.
cranium
29
Doing the math, there are ___________ _____________ neurons or nerve cells and _______-_______ _________________ neuroglia, which support the nerve cells in the brain.
1000 trillion, 10-50 trillion
30
The brain has a mass of about ___________ in adults.
3 lbs (1300 grams)
31
On average, each neuron forms how many synapses with other neurons?
1000 synapses
32
The total number of synapses is about a thousand trillion which is larger than the number of stars in the galaxy.
True or False?
True
33
What Genetic-Environment Interaction is more common amongst first degree relatives than the general population?
MDD (Major Depressive Disorders)
34
Studies suggest a ___________ component to the etiology of mood disorders.
hereditary
35
Heritability for depression has been estimated from twin studies as 31-42% with a ________________ _____________ of environmental effects unique to individuals of 58-67%
substantial contribution
36
Scientists have identified a gene or series of genes that cause depression.
True or False?
False (Scientists have not identified a gene or series of genes that cause depression)
37
What are the certain variations called that increase the risk for depression?
polymorphisms (variations in genes)
38
Genes can predispose individuals to Major Depressive Disorders (MDD)?
True or False?
True
39
What can help:
- control the metabolism of neurotransmitters and their receptors
- the numbers of particular types of neurons and their synaptic connections
- the intracellular transduction of neuronal signals,
- the speed with which all of these can change in response to environmental stressors
Genes
40
What is the most studied in Major Depressive Disorders (MDD)?
Serotonin Transporter Gene
41
The Serotonin Transporter Gene contains a polymorphism that gives rise to what?
two different alleles (long and short)
42
Serotonin Transporter Gene is the most studied in Major Depressive Disorders (MDD)
People usually have two copies of each gene in their DNA, therefore, a person can be __________________ for the short allele or the long allele, or _________________ (one short and one long)
homozygous and heterozygous
43
Serotonin Transporter Gene is the most studied in Major Depressive Disorders (MDD).
The short allele slows down the synthesis of what? (What does this do?)
the serotonin transporter (this reduces the speed with which serotonin neurons can adapt to changes in their stimulation)
44
What is is one of the neurotransmitters implicated in depression?
Serotonin
45
The short allele of the serotonin transporter gene does what?
slows down the synthesis of the serotonin transporter (leading to a dysregulation of serotonin)
46
What is a growth factor that plays an important role in birth, survival and maturation of brain cells during development?
BDNF (brain-derived neurotrophic factor)
47
Brain Derived Neurotrophic Factor is a ________ found in _________ concentrations in the brain
protein and high
48
Brain Derived Neurotrophic Factor is important for what two things?
neuronal cell growth and the synaptic changes that occur through a person's life
49
Brain Derived Neurotrophic Factor is important for what two things?
neuronal cell growth and the synaptic changes that occur through a person's life
50
What activates DNA binding factors that stimulate gene transcription of genes involved in serotonin function (such as the serotonin transporter and tryptophan hydrolase, the serotonin synthesizing enzyme)?
BDNF (brain-derived neurotrophic factor)
51
Do people diagnosed with MDD have higher or lower levels of BDNF?
lower
52
What are the two alleles in gene that codes for BDNF?
Val and met
53
People with met allele increases or decreases a person's vulnerability to depression?
increases
54
A common polymorphism in the gene that codes for BDNF produces alleles called "VAL" and "MET". This polymorphism affects what two things?
the intracellular transport and secretion of BDNF
55
People with the Met allele have a _________ hippocampus at birth, hippocampal _________ activity at rest, hippocampal _________ activation during learning, and ________ hippocampus-dependant memory function
small, hypo, hyper, and poor
56
Why is the hippocampus significant to depression?
it modulates the cognitive aspects of depression
57
Hippocampus is significant to depression because it modulates the cognitive aspects of depression. What two things does this cause?
Memory impairments and feelings of hopelessness (guilt, doom, and suicidality)
58
Studies found that having the ______ allele AND the ___________ allele of the serotonin transporter and psychosocial stress, increases vulnerability to depression
Met and short
59
Studies found low or high levels of BDNF in the hippocampus and prefrontal cortex of symptomatic depressed patients?
low levels
60
Serum studies have shown that serum levels of BDNF are abnormally low in patients with what condition?
MDD (major depressive disorder)
61
While, depression is diagnosed based on symptoms, it is important for scientists to know about __________ so that they can find a way to __________ these levels when treating patients with depression
BDNF and increase
62
Theories suggests that major depression is caused by what two things in the CNS concentrations of neurotransmitters?
a deficiency or dysregulation
63
What two systems modulate many areas of feeling, thinking, and behaving and are implicated in depression?
Noradrenergic and serotonergic
64
Nerve cells communicate by what type of signals?
electrochemical signals
65
Nerve cells communicate by electrochemical signals which cross the paint at which two neurons meet called what?
the synapse
66
Neurotransmitters are released from the what terminal of the neuron?
axonal terminal (presynaptic cell)
67
Neurotransmitters are released from the axonal terminal of one neuron (presynaptic cell), crosses the synapse, and then binds to receptors on the postsynaptic cells causing what?
excitatory or inhibitory action
68
Order the four steps in neuro transmission?
A. Storage and release of the transmitter
B. Binding of the transmitter to receptors on the postsynaptic membrane
C. Removal of the transmitter from the synaptic cleft
D. Synthesis of a transmitter substance
D, A, B, C
69
What are typically stored in the vesicles in the presynaptic axonal terminal and released by the process of exocytosis?
Neurotransmitters
70
Neurotransmitters are typically stored in the vesicles in the presynaptic axonal terminal and released by what process?
exocytosis
71
Where are Neurotransmitters typically synthesized?
the presynaptic neuron
72
Communication between the two neurons begins with what?
a nerve impulse (that stimulates presynaptic neuron)
73
Communication between the two neurons begins with a nerve impulse that stimulates presynaptic neuron followed by movement of the _________________ _________________ to the cell membrane and release of the neurotransmitter into the _____________ ____________.
synaptic vesicle and synaptic cleft
74
What is the second step in neurotransmission?
receptor binding
75
Neurotransmitter moves across the synaptic cleft and binds to receptors where?
on the postsynaptic neuron
76
The action of neurotransmitter is determined by the type of receptor (excitatory or inhibitory).
True or False?
True
77
Binding to an excitatory receptor will result in what?
the opening of an ion channel
78
Many presynaptic neurons also have receptors to which a neurotransmitter does what?
binds
79
Presynaptic receptors function in a positive feedback manner to speed up further release.
True or False?
False (Presynaptic receptors function in a negative feedback manner to inhibit further release)
80
What is the third step in neurotransmission?
Neurotransmitter Removal
81
Precise control of synaptic function relies on the rapid removal of the neurotransmitter from where?
the receptor site
82
A released neurotransmitter can do what three things?
Be taken back up into the neuron (reuptake), Diffuse out of the synaptic cleft, andBe broken down by enzymes into inactive substances or metabolites
83
Which hypothesis suggests that decreased levels of serotonin and NE in the synaptic cleft (due to decreased presynaptic release OR decreased postsynaptic sensitivity) is the underlying pathologic process in depression?
Biogenic Amine Hypothesis
84
The Biogenic Amine Hypothesis suggests that decreased levels of ____________ and ________________ in the synaptic cleft (due to decreased presynaptic release OR decreased postsynaptic sensitivity) is the underlying pathologic process in depression
serotonin and NE
85
The Biogenic Amine Hypothesis suggests that decreased levels of serotonin and NE in the synaptic cleft is the underlying pathologic process in depression. What two things could this be due to?
Decreased presynaptic release or decreased postsynaptic sensitivity
86
Reduction in serotonin may result in depression however, how may it also occur?
With a reduction of serotonin synthesis.
87
Serotonin levels can be depleted by decreasing the level of ________________ (this is a precursor to serotonin)
tryptophan
88
Research has prove that lowering serotonin factors does not induce depression in all people, therefore supporting the genetic and environmental factors.
True or False?
True
89
What other activity has also been implicated in mood disorders?
Dopamine
90
In times of depression and in mania, is dopamine activity increased or decreased?
decreased
91
Effects of genetics, environment, and deficiencies/ dysregulation in the CNS concentrations of neurotransmitters causes what in many areas of the brain?
anatomic changes
92
What is the part of the cerebral cortex that is the outermost part of the brain?
prefrontal cortex
93
What part of the brain is most evolved?
cerebral cortex
94
What is the chief administrator of the brain and is responsible for planning, problem solving, intellectual insight, judgement, and expression of emotion?
Prefrontal Cortex
95
In times of depression, the prefrontal cortex is reduced and less active because of a decrease in the neurotransmission of serotonin, NE, and alterations in the neurotransmission of dopamine in this area.
True or False?
True
96
In times of depression, there is a decrease in what in the prefrontal cortex?
BDNF (brain-derived neurotrophic factor)
97
In times of depression, why does a decrease in neurotransmitter activity lead to a decrease in neuronal volume?
Pruning occurs (pathways are not being used, density of pathways decrease)
98
What type of brain imagery includes:
- Variable brain tissue uptake of an infused radioactive substance
- Subs can be infused to study neurotransmitter receptor activity or concentration in the brain
PET scan (positron emission tomography)
99
What type of brain imagery helps to diagnose structural abnormalities of the brain and can distinguish between grey and white matter?
MRI (magnetic resonance imaging)
100
What type of brain matter includes myelinated axons surrounded by multilayered lipid and protein covering which electrically insulates the axon of a neutron and increases speed of nerve impulse conduction?
white matter
101
What type of brain matter contains neuronal cell bodies, dendrites, unmyelinated axons, axon terminals, and neuroganglia?
grey matter
102
What part of the brain integrates and interprets somatic or bodily, visual, and auditory information that is critical for recognition of the familiar/appropriate interpretation of and response to social contexts?
temporal lobe
103
Part of an appropriate social response is the accurate interpretation of emotions and the ability to response with the socially appropriate level of emotionality and language.
Where is this information integrated?
temporal lobe
104
In short, what is the temporal lobe responsible for?
the modulation and fine-tuning of emotion appropriate to level of intensity
105
The temporal lobe is responsible for planning, problem solving, intellectual insight, judgement, and expression of emotion.
True or False?
What differs that from prefrontal cortex?
true
- pre frontal cortex Contains functional areas for reward, motivation, higher cognitive processes (executive functions), motor planning and execution and regulating the expression of emotion
106
Parts of which system (it controls emotional behaviour), are housed in the temporal lobe?
the limbic system
107
In cases of depression, PET/MRI studies show decreased functioning in which two lobes?
frontal and temporal lobes
108
In cases of depression, the dysregulation of which three neurotransmitters are the culprits in frontal and temporal lobe?
serotonin, dopamine, and NE
109
Where is the amygdala located in the brain?
medial temporal lobe (in the primitive part of our brain )
110
The amygdala receives neuronal signals from which two lobes of the cortex?
temporal and occipital lobes
111
The amygdala communicates with the _____________________ and other parts of the limbic system
hypothalamus
112
The amygdala helps a person relate to the surrounding environment and pattern what?
appropriate behaviour
113
What part of the brain is important in emotional function and regulation, the modulation of affective responses in social settings, sexual arousal, aggression, and fear responses?
Amygdala
114
The amygdala tends to have increased or decreased blood flow and oxygen consumption during depression?
increased
115
What two areas of the brain are important in emotional memory?
Striatum and amygdala (and related brain areas)
116
What is a decreased drive and reward for pleasurable activities called?
anhedonia
117
Striatum and amygdala and related brain areas are important in emotional memory.
They are believed to mediate the anhedonia (decreased drive and reward for pleasurable activities), anxiety, and reduced motivation symptoms of depression.
True or False?
True
118
What two things are involved in the development of mood disorders?
limbic system and basal ganglia
119
What is a part of the limbic system which is a primitive area deep in our brain that regulates our emotional behaviours?
Amygdala
120
What system includes the hippocampus, parahippocampal gyrus, cingulate gyrus, amygdala, and the fornix (bridge like structure which connects the hippocampus with the hypothalamus)?
Limbic System
121
Higher and lower brain centres communicate with the limbic system to do what?
connect thoughts and autonomic nervous system responses to emotions
122
Neurological disorders of the limbic system and basal ganglia are also involved in what?
development of mood disorders
123
What two things mediate cognitive aspects of depression including memory impairments and feelings of worthlessness, hopelessness, guilt, doom, and suicidality?
Neocortex and hippocampus
124
The dysregulation and neuroanatomical changes in the hypothalamus are believed to be responsible for what?
the neurovegetative symptoms of depression
125
The dysregulation and neuroanatomical changes in the hypothalamus are believed to be responsible for what three neurovegetative symptoms of depression?
too much or too little sleep, appetite and energy, and loss of interest in sex (and other pleasurable activities)
126
What are the three active neurotransmitters in the limbic system area?
serotonin, NE, dopamine
127
Serotonin, NE, and dopamine are the active neurotransmitters in the limbic system.
```
Their dysregulation (they are no longer able to do their jobs well)
is the cause of over activity of what part of the limbic system?
```
the amygdala
128
Serotonin, NE, and dopamine are the active neurotransmitters in the limbic system.
Their dysregulation is the cause of over activity of the amygdala.
This results in an overall abnormality of connectivity within the limbic system and causes what three symptoms?
emotional liability, irritability, and suicidality
129
Major Depressive Disorder is associated with multiple endocrine alterations particularly in what?
HPA axis
130
Stress is perceived by the ___________ of the brain and transmitted to the deeper regions of the ____________________ , where ____________ is released onto _____________ receptors
cortex, hypothalamus, CRF, pituitary
131
Within the HPA, the stimulus results in the secretion of what into plasma?
corticotrophin
132
Within the HPA, the stimulus results in the secretion of corticotrophin into plasma leading to stimulation of corticotrophin receptors where?
adrenal cortex
133
Within the HPA, the stimulus results in the secretion of corticotrophin into plasma, stimulation of corticotrophin receptors in the adrenal cortex, and release of what into the blood?
cortisol
134
What two stress hormones are involved in depression?
cortisol and CRF
135
Patients with depression have elevated or diminished cortisol levels in plasma and cerebrospinal fluid?
elevated
136
Patients with depression have elevated cortisol levels in plasma and cerebrospinal fluid and increased levels of what two things?
CRF messenger RNA and protein in limbic brain regions
137
The sensitivity of the hypothalamus to feedback signals (for the shutdown of CRF release) is about half in severely depressed patients.
True or False?
True
138
Disturbances in the function of the HPA axis in depression cause cortisol levels to spike erratically throughout the day.
True or False?
True
139
In the non-depressed person, serum BDNF levels lower with exposure to stress.
True or False?
False (In the non-depressed person, serum BDNF levels do not lower with exposure to stress)
140
In people with MDD, stress activates what two things?
amygdala and NE systems
141
In people with MDD, stress activates the amygdala and NE systems causing symptoms of increased ________________ and ____________.
vigilance and fear
142
In people with MDD, stress activates the amygdala and NE systems causing symptoms of increased vigilance and fear.
People had an exaggerated stress response and increased levels of what two things in the plasma?
CRF and NE in the plasma
143
People exposed to childhood stress had an exaggerated or diminished stress response as adults?
exaggerated
144
In the depressed person, cortisol levels never really return to the normal pattern when depression resolves.
True or False?
False (In the depressed person, cortisol levels return to the normal pattern as depression resolves)
145
Depression has NO effect on thyroid function.
True or False?
False
| 5-10% of persons with depression when tested have a decreased thyroid function
146
Depressed patients with decreased thyroid function are given what in order to reverse this process and speed up the ability to metabolize and respond to treatment with antidepressant medications?
thyroid replacement therapy
147
Alteration in what is common in many mental illnesses including depression, and often is one of the prodromal or early warning signs of relapse?
the sleep-wake cycle
148
Research has shown that normal sleep cycle is often reversed in depressed individuals where the person reaches deep sleep earlier or later in the cycle?
earlier
149
What hormone, produced by the pineal gland, helps to regulate the sleep-wake cycle?
Melatonin
150
When does the pineal gland synthesizes and release melatonin?
at night
151
The rhythm of the sleep wake cycle is regulated by what?
the circadian clock
152
The circadian rhythm's function is to provide a temporal organization for physiologic processes and behaviours to promote what?
effective adaptation to our environment
153
The circadian rhythm's function is to provide a temporal organization for physiologic processes and behaviours to promote effective adaptation to our environment
This involves regular cycles of sleep and waking and body functions such as what two things, based on changes in the 24-hour light-dark solar day?
temperature regulation and hormone secretion
154
Research has shown that some patients with depression have circadian abnormalities of what four things?
mood, sleep, temperature, and neuroendocrine secretion
| Research has shown that some patients with depression have circadian abnormalities of what four things?
155
The sleep cycle usually reverses instantly to normal, after the resolution of depression.
True or False?
False
| It may take weeks to months
156
It is important for patients with depression to attempt to normalize the sleep-wake cycle by doing what two interventions?
sedative medication and teach sleep-hygiene techniques
157
What signals the brain and serve as mediators between immune and nerve cells?
Cytokines
158
The dysregulation of cytokines (these signal the brain and serve as mediators between immune and nerve cells) can result in adverse effects and may manifest as what?
symptoms of MDD (and related disorders)
159
Research shows that depression is rare in infectious and autoimmune diseases.
True or False?
False
| Research shows that depression is common in infectious and autoimmune diseases
160
Exposure to cytokines induces depressive symptoms and cytokine secretion is increased or decreased in MDD?
Increased
161
Antidepressants have anti-inflammatory effects and have been used to treat what?
chronic pain
162
Depression is often masked as physical illnesses and it is believed that what type of pain can be associated with depression?
physical pain
163
Depression is often masked as physical illnesses and it is believed that physical pain can be associated with depression
________________ is a pain-modulating neurotransmitter and the release of _________________ is centrally mediated by ______________.
Serotonin, endorphins, serotonin
164
The decrease in availability and action of serotonin at the nerve synapse may be manifested as what?
increased subjective experiences of pain (and complaints of physical symptoms of which may be indicative of a depressive illness)
165
It is believed that a way a person interprets their environment and thinks about themselves can induce and perpetuate what?
depressive symptoms
166
What type of environmental factor involves distorted negative beliefs and thoughts about the self, the environment, and the future that can induce and perpetuate depressive symptoms?
Psychodynamic Factors
167
Psychodynamic Factors involves distorted negative beliefs and thoughts about what three things?
the self, the environment, and the future
168
What type of environmental factor involves a severe reduction in rewarding activities or an increase in unpleasant events in one's life that result in depression and a further restriction of activity, decreasing the likelihood of experiencing pleasurable activities and intensifying a mood disturbance?
Behavioural factors
169
Psychodynamic Factors involves a severe reduction in rewarding activities or an increase in unpleasant events in one's life that result in depression and a further restriction of activity, decreasing the likelihood of what?
experiencing pleasurable activities (and intensifying a mood disturbance)
170
What type of environmental factor involves loss of a parent or lack of emotional adequate parenting that may delay or prohibit the realization of appropriate developmental milestones?
Developmental Factors
171
Developmental Factors involves what that may delay or prohibit the realization of appropriate developmental milestones?
loss of a parent or lack of emotional adequate parenting
172
What type of environmental factor involves a disruption in family dynamics involving maladaptive circular patterns in family interactions that contribute to the onset of depression in family members?
Family Distress
173
Family Distress involves a disruption in family dynamics involving what?
maladaptive circular patterns in family interactions (that contribute to the onset of depression in family members)
174
What type of environmental factor involves adverse or traumatic life events especially that involve the loss of an important human relationship or role in life that is followed by a depression?
Social Factors
175
Social Factors involve traumatic life events that include the loss of an important human relationship or role.
True or False?
True
176
Antidepressants may increase what two things, which are dysregulated at the synapse?
synaptic sprouting or rewiring of connections
177
What can occur when connections between nerve cells are not used, nerve cells atrophy and volume decreases?
Synaptic pruning
178
With pharmacological treatment, the synaptic connections are used and formed and again and the _________ ____________ in the areas implicated in depressions increases.
brain volume
179
Antidepressant medications are used to treat what?
depression
180
Antidepressant medications effect occur instantaneously.
True or False?
False
| Their antidepressant effects occur only after chronic administration of days to weeks
181
Antidepressant medications normalize levels of what three neurotransmitters in the brain and their neurotransmission at the synapse?
serotonin, dopamine, and NE
182
Antidepressants increase levels of ___________ and affect ____________ ___________ by increasing the activity of neurotransmitters in the synapse and nerve cell volume .
BDNF and synaptic plasticity
183
Antidepressant response takes days to weeks because it requires what?
sufficient time for the levels of BDNF to gradually rise (and exert synaptic and nerve cell sprouting)
184
What type of antidepressant drugs inhibits the reuptake of serotonin?
SSRIs (selective serotonin reuptake inhibitors)
185
Put the Selective serotonin reuptake inhibitors (SSRIs) steps in order:
A: reuptake of serotonin results in less serotonin being released
B: serotonin binds to its postsynaptic receptor
C: SSRIs block the reuptake of serotonin and therefore more will be available in the synaptic cleft
D: serotonin binds to its presynaptic receptor
E: Serotonin/5-HT is released into the synapse
F: SSRIs block the reuptake of serotonin and therefore more will be available in the synaptic cleft
E, B, D, A, F
186
What type of antidepressant drugs blocks the degradation of NE and serotonin?
MAOIs (monoamine oxidase inhibitors)
187
Put the Monoamine oxidase inhibitors (MAOIs) steps in order:
A: monoamine is inhibited and NE is not broken down as quickly and therefore its action is prolonged
B: NE binds with its postsynaptic receptor
C: action of NE is terminated by the enzymes monoamine oxidase and catecholamine 0-methyltransferase
D: NE is released into the synapse
D, B, C, A
188
What type of antidepressant drugs inhibit the uptake of NE and serotonin into the presynaptic terminal allowing NE and serotonin to accumulate in the synapse and thus enhance their action?
TCAs (tricyclic antidepressants)
189
What type of therapeutic effect do MAOI have on the neurotransmitters?
Increase NE, serotonin, and dopamine
190
What type of side effects do MAOI have?
orthostatic hypotension, headache, insomnia, diarrhea
191
What type of therapeutic effect do TCAs have on the neurotransmitters?
Increase NE, serotonin, and dopamine
192
What type of side effects do TCAs have?
Anticholinergic effects, sweating, sedation, orthostatic hypotension
193
What type of therapeutic effect do SSRIs have on the neurotransmitters?
increase serotonin
194
What type of side effects do SSRIs have?
nervousness, insomnia, sexual dysfunction, weight gain
195
What type of antidepressant drugs block the reuptake of serotonin and NE?
SNRIs (serotonin-norepinephrine reuptake inhibitors)
196
Which antidepressant drugs interact with all other antidepressant drugs?
MAOIs (monoamine oxidase inhibitors)
197
Non-pharmacological therapies are believed to work similarly to antidepressant medications, promoting increased what?
connectivity at the synapse and nerve cell growth
198
What is the procedure called that electrically stimulates a generalized seizure?
ECT (electroconvulsive therapy)
199
Electroconvulsive Therapy (ECT) has a 70-90% effective treatment rate for depression and over 1 million people in the world receive ECT.
True or False?
True
200
ECT is given under a general anesthetic with complete muscle relaxation because the _________ _________________ of the seizure does not contribute to the therapeutic effects of the treatment.
motor component
201
During ECT, a brief electrical current is passed through the brain to produce a generalized seizure last 25-150 seconds
Does the patient feel the stimulus or recall the procedure?
No
202
On average, how many ECT treatments are given at 2-day intervals over a period of 2-4 weeks?
6-8
203
The exact mechanism of the antidepressant action of ECT remains unclear.
True or False?
True
204
The exact mechanism of the antidepressant action of ECT remains unclear.
However, it is known to down regulate (occurs when there are excess chemical messengers and the # of active receptors decreases)
______________________________ in much the same way as antidepressant medications, therefore lowering the stress response?
B-adrenergic receptors
205
ECT produces an up-regulation (Up-regulation occurs when there is a deficiency in the messenger) in
which neurotransmitter?
Serotonin
206
ECT produces an up-regulation in serotonin.
There is less serotonin so the number of active receptors for serotonin increases or decreases?
increases
207
ECT increases the influx of _____________ in the brain and has effects on second messenger systems.
calcium
208
ECT increases the influx of calcium in the brain and has effects on second messenger systems.
First messengers in depression are what?
neurotransmitters
209
ECT increases the influx of calcium in the brain and has effects on second messenger systems.
Second messengers are involved in converting the chemical signal into a physiological one that does what?
moves the nerve impulse across the nerve cell and onto the next nerve cell
210
ECT has also been shown to down-regulate levels of BDNF.
True or False?
False (ECT has also been shown to up-regulate levels of BDNF)
211
After symptoms have improved after ECT, what are used to prevent relapse?
antidepressant medications
212
Why is the use of ECT is limited by invasive nature?
Due to the requirement of the general anesthetic and risk of retrograde amnesia
213
ECT is only indicated in patients whose depression is what?
resistant to conventional treatments
214
What type of non-pharmacological treatment for depression uses artificial light to influence the production of melatonin and the function of the catecholamine systems?
phototherapy (light therapy)
215
In Phototherapy, artificial light is believed to trigger what?
a shift in the patient's circadian rhythm (to an earlier time)
216
In Phototherapy, exposure to the light source has produced improvement and relief of depressive symptoms for significant numbers of who?
seasonally depressed individuals
217
Phototherapy produces no change for individuals who are not seasonally depressed.
True or False?
True
218
What type of non-pharmacological treatment for depression includes vagal nerve stimulation, deep brain stimulation, and transcranial magnetic stimulation?
Neurostimulation
219
In Neurostimulation, the techniques are considered treatments for cases of depression that do not respond to medication or ECT.
True or False?
True
220
In Neurostimulation, what uses an implanted stimulator that sends electric impulses to the left vagus nerve in the neck via a lead wire implanted under the skin?
Vagal Nerve Stimulation (VNS)
221
In Neurostimulation, Vagal Nerve Stimulation (VNS) uses an implanted stimulator that sends electric impulses to the left vagus nerve in the neck via a lead wire implanted under the skin.
VNS has antidepressant properties via its effects on what part of the brain?
locus ceruleus (area in the brain stem from which NE neurons originate)
222
What type of non-pharmacological treatment for depression includes implantation of electrodes which are connected to a surgically implanted impulse generator that delivers electrical stimulation to the ventral striatum which has been found to have functional dysregulation in depression?
deep brain stimulation (DBS)
223
In deep brain stimulation, the implantation of electrodes which are connected to a surgically implanted impulse generator that delivers electrical stimulation to the ventral striatum which has been found to have functional dysregulation in depression.
Ventral striatum is connectionally associated with the _______ structures.
limbic
224
What type of non-pharmacological treatment for depression involves stimulation of the dorsolateral prefrontal cortex by using weak electric currents which are induced in the tissue by rapidly changing magnetic fields or electromagnetic induction.
TMS (transcranial magnetic stimulation)
225
In Transcranial Magnetic Stimulation, brain activity can be triggered in the prefrontal cortex which has decreased volume and activity in depression.
True or False?
True
226
In Transcranial Magnetic Stimulation, Vagal nerve and transcranial magnetic stimulation have not been approved in Canada for the treatment of MDD.
True or False?
False
| Vagal nerve and transcranial magnetic stimulation have been approved in Canada for the treatment of MDD
227
What type of non-pharmacological treatment for depression helps to reduce the stressors that trigger episodes
by reducing stressors and negative thinking?
Psychotherapy
228
In psychotherapy, the abnormal activity of the neurotransmitters indicated in depression and the stress response can be reduced, aiding in a more normal functioning of BDNF, neurotransmission, neuroendocrine abnormalities, and reduction and/or prevention of the neuroanatomical changes of depression.
True or False?
True
229
What type of psychotherapy treatment for depression is focused on identifying, analyzing and ultimately changing the habitually inflexible and negative cognition about oneself, others, and the world that occurs with depression?
CBT (cognitive behavioral therapy)
230
The use of cognitive therapy in the acute phase of treatment + medication has grown in the past few years and may be considered first line treatment for who?
mildly to moderately depressed outpatients
231
A psychotherapeutic approach may be especially helpful for patients with what two things?
history of childhood adversity or recent stress
232
In cases of depression, the nurse must recognize when patient may be depressed and recognize the importance of early detection and intervention that can prevent the neuroanatomical changes in the brain from further what?
deterioration
233
In cases of depression, the nurse must recognize the importance of helping patients to manage stress and to focus on prevention of risk factors for depression.
True or False?
True
234
Tutorial Question
Depression is best defined as:
A: A disorder characterized by disturbances in speech and thought +/- hallucinations
B: A disorder characterized by disturbances in mood
C:A disorder characterized by intense episodes of fearfulness
D:A disorder characterized by episodes of irritability, elation, and racing thoughts
B
235
Tutorial Question
5+ symptoms present during the same ___-________ _________________ and represents a change from previous functioning.
1. depressed mood
2. markedly diminished interest or pleasure in activities
3. significant weight loss (not dieting) or weight gain, or change in appetite
4. insomnia or hypersomnia
5. psychomotor agitation or retardation
6. fatigue or loss of energy
7. feelings of worthlessness or guilt
8. diminished ability to think or concentrate (indecisiveness)
9. thoughts of death, suicidal ideation/attempt
2-week period
236
Tutorial Question
Which of the following is a co-morbidity often observed with depression?
```
A: Chronic pain
B: Diabetes mellitus
C: Heart disease
D: Autoimmune disease
E: All of the above
```
E
237
Tutorial Question
Which clinical manifestation of depression is correctly matched to the CNS structure that is thought to be involved?
```
Clinical Manifestation:
A: Lack of sleep
B: Anhedonia
C: Lack of insight
D: Memory loss
E: Loss of appetite
```
CNS Structure:
1. Amygdala
2. Prefrontal cortex
3. Hippocampus
4. Pineal gland
5. Hypothalamus
A4, B1, C2, D3, E5
238
Tutorial Question
Alterations in which of the following endocrine hormones accounts for the increase in body weight observed in some depressive patients?
```
A: Catecholamines
B: Thyroid hormone
C: Cortisol
D: Melatonin
E: Dopamine
```
B
239
Tutorial Question
Risk Factors for Depression
- Childhood emotional, physical and/or sexual abuse(s)
- Prior episode(s) of depression
- Family history of depressive disorder
- Lack of social support
- Stressful life event
Current substance abuse
- Economic difficulties
True or False?
True
240
Tutorial Question
Which of the following statements concerning depression is TRUE?
A: Reductions in 5-HT signaling alone are not always sufficient to cause depression
B: ~10% of Canadians suffer from depression, however, 90% of these will commit suicide
C: The prevalence of depression in females is 2x greater than in males as testosterone is thought to be neuro-protective
D: Monozygotic twins have an equal occurrence of depression, suggesting that genetics plays a large role in the etiology
A
241
Tutorial Question
The etiology of depression is multi-factorial. What makes up 60-70% and what makes up 30-40%?
environment and genetic pre-disposition
242
Tutorial Question
Structural/Functional changes associated with Depression.
Which part of the brain shows a reduction in neuronal cell volume?
prefrontal cortex
243
Tutorial Question
Structural/Functional changes associated with Depression.
Which part of the brain shows a reduction in neuronal volume. Memory, emotion, and behavioural responses?
Limbic system (hippocampus, amygdala)
244
Tutorial Question
Structural/Functional changes associated with Depression.
Which part of the brain shows elevated cortisol levels. Heightened response to stress -> impairment of hippocampal function?
HPA-axis
245
Tutorial Question
How do SSRIs help to treat the symptoms of depression?
A: By increasing synaptic levels of 5-HT
B: By increasing synaptic levels of NE, DA, & 5-HT
C: By increasing synaptic levels of NE & DA
D: By increasing synaptic levels of 5-HT & NE
E: By increasing synaptic levels of NE
A
246
Tutorial Question
When are Vagal Nerve Stimulation and TMS considered in the management of patients with severe depression?
A: Only when a decrease in neuronal volume is confirmed by diagnostic imaging
B: Before aggressive pharmacotherapy and or invasive ECT is considered
C: After NT levels have been normalized through the use of pharmaceuticals
D: When conventional treatments and ECT have "epically" failed
D
