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Depression And Anxiety Flashcards

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0
Q

Depression

A

Core symptoms
- Absence of positive affect, diminished interest or pleasure
- depressed/Low mood
Emotional, cognitive, physical & behavioural symptoms

Significant unintentional weigh loss or gain
Sleep disturbance (too much or less)
Agitation or psychomotor retardation noticed by others
Reduce concentration
Recurrent thought of death
Fatigue or loss of energy

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1
Q

Depression and anxiety

A

Syndrome which is a combination of symptoms that occur at the same time

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2
Q

Cognitive theory of vicious cycle

A

Thoughts-it’s not worth trying
Emotion -sad, hopeless
Physical- agitation, poor sleep
Behaviour - avoid social interaction

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3
Q

Suicide and self harm risk

A

Depressed people have 4 times more risk of suicide than general population

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4
Q

Deliberate self-harm (DSH)

A

Separate suicidal behaviour
Chronic disorder
Intentionally injuring of one’s own body without apparent intent to die
–>separate from suicide ideation

Due to impulsive compulsive to harm themselves without feeling capable of resisting these

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5
Q

Anxiety disorder

A

Where anxiety is out of proportion to the actual risk and is constant or intrusive enough to cause significant disability

Symptoms share similarity with depression but more physical symptom

Fight or flight response ( autonomic system) adrenaline and cortisol

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6
Q

Types of anxiety disorder

A 
Panic disorder 
General anxiety disorder 
Specific phobia 
Obsessive compulsive disorder 
Post traumatic stress disorder
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7
Q

Specific phobia

A 
Anxiety restricted to phobia 
Autonomic system(physical) 
Avoidance
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8
Q

Agoraphobia

A

Fear of market place/crowded place
Fear of leaving the house, taking tube, entering the shop/crowd, public place

Avoidance of crowd

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9
Q

Social phobia

A

Fear of judgement by others
Avoidance of social contact
Low self-esteem

Avoidance of social contact

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10
Q

Obsessive compulsive disorder

A

Recurrent obsessional thoughts and/or compulsive acts

Obsessive and intrusive thoughts are distressing and unwanted idea/image

The more they try to get rid of this thoughts, the more it occurs in their mind –> anxiety

Compulsive acts are for reducing the anxiety and it repeated so many times that become rituals

Intrusive thoughts-anxiety- compulsive acts- feel better- reduce anxiety- compulsive acts ritualized

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11
Q

Post traumatic stress disorder

A

Delayed response to stressful events

  • reliving/re-experiencing the event (can smell, hear, see the event)
  • responding to trigger (avoid trigger) -flashback
  • anxiety over recurrence (constantly on alert)
  • emotional numbing (to avoid/protect the emotional reaction)
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12
Q

Difference from PTSD

A

Acute stress response (last only hours up to a day) / agitation, confusion etc

Chronic stress response (stress hormone keep releasing and affect emotion and physical)

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13
Q

Epidemiology of depression

A

Most common in 45-64y.o
Women are twice more likely to have depression than men in same age
1 in 10 women experience symptoms of depression after having baby (postpartum depression)

Gender difference emerge after puberty (age 12y.o)

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14
Q

Risk factor of depression

A

Women (2:1)
Most common is 32/45-64
Black, minority ethnic group
Previous history /family history of depression
Significant physical lines - pain and disability
Other mental health problem (dementia, schizophrenia)

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15
Q

Epidemiology of anxiety disorder

A

Phobia (agoraphobia +social phobia) is the most common one

GAD is second most common one

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16
Q

Risk factor for anxiety disorder

A

Female (simple phobia, agoraphobia, GAD)

No gender difference in social phobia, panic disorder , OCD

Divorced/widow
Highest in 25-44yo
 lowest in more than 65 yo
People with disability 
Unemployment 
Black, minority ethnic group
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17
Q

Mixed Depression and anxiety

A

66%of those with depressive disorder also have anxiety, worry or panic

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18
Q

Prognosis of depression

A

Episode =6-8 months

Under 20 or over 65 has higher risk of relapse

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19
Q

Biological risk factor

A 
HPA axis 
Nicotine , cannabis 
Lack of Physical activity 
Genetic predisposition 
biochemical imbalance
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20
Q

Psychological risk factor

A

Entrenched negative thinking style
Negative memory bias
Decreased perceived coping (less self esteem)
Other mental health problems

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21
Q

Social risk factor

A 
Negative Life events 
Social network and support 
Financial difficulties/ unemployment 
Childhood environment (abuse, neglect, bullying) 
War
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22
Q

Cause of depression and anxiety - bio psychosocial model

A

Stress- life events, chronic difficulty
Interpretation- ability to cope with difficulty
Biological - activated HPA axis (hypothalamic-pituitary-adrenal)

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23
Q

Types of depressive disorders

A

Major depression: severe symptoms that interfere social functioning

Persistent depressive disorder: depressed mood that last at least 2 years. They can have episode of major depression along with period of less severe symptoms that last 2 years

Psychotic depression: severe/major depression + some psychosis

Postpartum depression:10-15% of women experience

Seasonal affective disorder:onset of depression during the winter

Bipolar disorder/manic -depressive disorder: less common than major depression or persistent depressive disorder

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24
Popular antidepressants
SSRI and SNRI(serotonin and norepinephrine reuptake inhibitor) - Fluoxetine (Prozac) - Sertraline (Zoloft) Tricyclics - older antidepressant Serious side effect of heart condition MAOIs (monoamine oxidase inhibitor)oldest antidepressant-- shouldn't be taken with SSRI, food restriction,
25
Psychotherapy for depression
``` CBT Interpersonal therapy (IPT) ```
26
Electro convulsive therapy (ECT)
Side effect of confusing, memory loss, disorientation that usually last short term. Usually 6-12 treatments Newer treatment -Transcranial magnetic stimulation -stimulation to left dorsalateral prefrontal cortex -Deep brain stimulation -brain peacemaker stimulating subcallosal area
27
Behavioural therapy for anxiety disorder
CBT | Exposure therapy
28
What to include when taking history ?
``` Presenting problem -nature of the problem -recent example Development of problem -onset -course Early life experience/predisposing factor Recent trigger Risk Maintaining factor -biological, social, psychological, environmental, systematic Goal Previous treatment Engagement in current treatment plan Resource and strength ( when they were coping with stress) ```
29
How to take history
Principle of funnelling | -start from open question and the narrow down to closed question
30
Formulation of -4 "P"s model
1. Predisposing factor (what makes the person vulnerable) 2. precipitants (trigger) 3. Perpetuating factor (what keeps the symptom) 4. Protective factor
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CBT
``` Focus on present issues Structures and active Time limited Interacting system Important of empiricism ``` Focus on 5 interacting system - cognition - behaviour - emotion - physiological - environmental
32
Cognition of CBT
1. Core belief: deeply held unconditional belief about self, world and others ( I'm weak, I'm unlovable) 2. dysfunctional assumptions, rules, conditional belief (if I cannot pass the exam, I'm a loser, I must always pass the exams) 3. negative automatic thoughts
33
Cognitive model
``` Early life experience Core belief Assumption and rule Critical incident Belief/rule activated Negative automatic thoughts -emotion, physiology, behaviour ```
34
2 neural pathway for anxiety
Subcortical pathway | Cortical pathway
35
Subcortical fear pathway
Include sensory cortices, dorsal thalamus, amygdala, and physical response system - fast, sensitive without significant conscious evaluation - lead to immediate arousal and avoidance response
36
Cortical fear pathway
Include significant cortical networks involved in - executive working memory - affective appraisal system Heavy involvement of the prefrontal cortex in addition to subcortical structure Slower, evaluative, subjective to more conscious control
37
Neurotransmitter for anxiety
GABA : main inhibitory neurotransmitter reducing anxiety, arousal, muscle tone, alertness, cognitive function - -benzodiazepines (vallium); bind GABA to receptors - --alcohol does it too Serotonin
38
Beck cognitive model -depression
Provides both; developmental account >interaction between life-events and vulnerability in terms of developing a depresogenic cognitive structure And cognitive account >that explains how low mood is maintained by interpretation of ongoing experience
39
Cause of depression & anxiety - biopsychosocial model
Stress; life events, chronic difficulty Interpretation; ability to cope with difficulties Biological; activates HPA axis
40
Anxiety
``` An emotional prediction of danger Normal reaction Not just an arousal Anxiety involves the activation of the fight or flight system Mainly learnt ```
41
Anxiety and arousal are same ?
Anxiety involves increased physiological arousal and activation of the fight or flight system Increased heart rate, blood pressure, adrenaline, muscle tone Arousal =excitement or pleasure Anxiety= unpleasant Anxiety includes arousal but not just arousal
42
Classic conditioning
Anxiety becomes associated with an originally non-threatening stimuli due to co-occurrence with anxiety-inducing situation - ie you experience violence when ur partner is drunk - - smell of alcohol = anxiety
43
Operant conditioning
After a behaviour, the outcome can encourage or discourage the future use of the behaviour Anxiety can act as "punishment" to decrease doing something Or a "reinforcer" if the behaviour leads to an escape from anxiety to increase Ie, checking the light switch to reduce anxiety about house burning
44
Extinction
The association between stimuli and anxiety fade over time as; The newly anxiety-provoking stimuli appears enough times without original anxiety-provoking event (ie smell of alcohol is no longer accompanied by violence) Or behaviour is no longer reinforce
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Cognitive for anxiety
Anxiety can be triggered by our understanding of the situation even if it's completely new
46
Psychological treatment for anxiety
Anxiety is maintained because people use coping strategies that are effective for short term at the expense of maintaining the problem in the long term - general treatment principle - -adjustment of unhelpful belief and appraisal - -extinction of anxiety through exposure - -breaking down maladaptive coping
47
Adjustment of belief and appraisal
This can involve teaching (psychoeducation) And testing out (behavioural experiments, data gathering)
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Extinction through exposure
Anxiety will fade through sustained exposure to feared situation when danger does not occur Graded exposure: the person draws up a hierarchy of situations and how much anxiety they cause Is exposed to each and stays long enough for anxiety to fade before moving on to the next step Can start with imagination, cues and then the actual situation
49
Breaking down maladaptive coping
Maladaptive coping strategies are those that prevent sufficient exposure to feared situation or updating of appraisals Ie dog phobia-avoid park
50
Two main neural pathways to fear
Subcortical pathway Cortical pathway Both pass through the amygdala
51
Subcortical fear pathway
Include sensory cortices, dorsal thalamus, amygdala and physical response systems Fast, sensitive, without significant conscious evaluation Leads to immediate arousal and avoidance response
52
Cortical fear pathway
Includes significant cortical networks involved in >executive working memory >affective appraisal system Heavy involvement of the prefrontal cortex in addition to subcortical structures Slower, evaluative, subjective to more conscious control
53
Neurotransmitter system
As anxiety is so complex, many neurotransmitter system have been implicated Research has focus on two >GABA >serotonin
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GABA
Main inhibitory neurotransmitter, important in reducing neural excitability Increase in GABA function tends to reduce >>anxiety, arousal, muscle tone,alertness, cognitive function Fast acting system, effects felt in minutes to hours
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Direct GABA modulating drugs
Typically bind to GABA or GABA receptor - benzodiazepines - barbituates - alcohol - GHB
56
Serotonin
Released by the raphe nuclei in brainstorm but affect virtually whole of brain Gradual level changes leads to slower modulation of other brain circuits, particularly those involved in emotion 14 different serotonergic receptors
57
Serotonergic drugs in anxiety
Most antidepressants affect serotonin system and have anxiolytic (anti-anxiety) effects Selective serotonin reuptake inhibitors (SSRIs) tend to prevent serotonin from being re-absorbed and so increase its level Most well known fluoxetine or Prozac
58
Depression: some key concept
Cognitive theory of depression aim to explain >>development of depressive thinking style >>immediate cognition -how thinking style biases judgments to maintain poor mood Serotonin and HPA -axis among the most studied biological aspects of depression
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Depression: Beck Cognitive Model
>>thoughts- moment to moment interpretation >>cognitive bias -ways of processing information that focus us on negative aspects and conclusion >>dysfunctional schemas-core network of attitudes and beliefs about the self that can be activated by negative events
60
Beck mode : developmental aspect
Adverse developmental experience Dysfunctional attitudes (schema); cognitive vulnerability Activation by stressful events Pervasive negative cognitive bias: depression
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Beck model: cognitive aspect
When the dysfunctional schema are activated by negative daily events it leads to negative interpretation bias and a drop in mood If this repeatedly happens, there is a shift into a depressive mode which affects, emotion, cognitive and behaviour (depressive episode) As this happens more often, smaller negative events are needed to re-start an episode
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Behavioural Activation Therapy
Attempts to address the negative cycle whereby: Depressed people reduced short-term distress by avoiding activities that promote long-term well-being
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Behavioural activation approach
Graded approach to initiating activities based on perceived effort - monitor activity and mood - identify positive behaviour - ranking from the least to most difficult - set weekly goals and monitor progress Effective but trial quality low
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Mindfulness-based CBT
Based on practicing and applying techniques from mindfulness meditation to disengage with negative thoughts and emotions Initial trials have found it reduces relapse in people who have had three or more episodes of depression
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Does low serotonin cause depression ?
No, but changes to the serotonin system likely play a role in maintaining depressive state Imaging has shown no consistent difference in serotonin receptor Tryptophan depletion does not induce depression But evidence that serotonin transport gene (5-HTTLPR) moderates the relationship between stress and depression
66
Newer theories
Reduced production of new neurones (neuro genesis) in the hippocampus Role of body's response to inflammation (cytokines) as a trigger
67
Depression syndrome
Seasonal affective disorder Psychotic depression Major depressive disorder Postpartum depression
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Negative automatic thoughts (NAT)
Streak of thinking/commentary Common to all of us Often barely aware of NATs With training can bring these thoughts into consciousness Can learn to challenge NAT and thereby reduce distress
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Assumption/rule in CBT
Conditional beliefs/rules that guide action "If.....then...." -If I get lower than 60%, I'm a failure "Should" and "must" -I should always work hard
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Core belief
Deeply held unconditional beliefs about self, world and others Usually arising from early life experience May be reinforced by later experience
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Emotional symptoms of anxiety
``` Apprehension or dread Trouble concentrating Feeling tense and jumpy Anticipating the worst Irritability Restlessness Watching for signs of danger Feeling like your mine's gone blank ```
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Physical symptoms of anxiety
``` Pounding heart Sweating Stomach upset or dizziness Frequent urination or diarrhea Shortness of breath Tremors and twitches Muscle tension Headache Fatigue Insomnia ```
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Self-help for anxiety attack and anxiety disorder
``` Write down your worries Creat an anxiety worry period Accept uncertainty Practice relaxation technique Reduce alcohol and nicotine Exercise Sleep ```
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DSM IV
Depressed mood and/ or loss of interest or pleasure in life activity for at least 2 weeks and at least 5 of the following Core symptoms : Depressed mood most of the day Diminished interest or pleasure in all or most activity Significant unintentional weight loss or gain Insomnia / sleep too much Agitation or psychomotor retardation noticed by others Fatigue or loss of energy Feeling of worthlessness or excessive guilt Diminished ability to think or concentrate or decide Recurrent thought of death

clinical mental health (12 decks)

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