depression & anxiety Flashcards
(28 cards)
NEUROTRANSMITTERS
chemicals that _____ neurotransmission.
- _____ between ______.
travels across the ____ & either ___ or ____ relay of stimulus.
problems that arise with neurotransmitters are associated with _____ & _____ disorders.
chemicals that ENABLE neurotransmission.
- COMMUNICATION between NEURONS
travels across the SYNAPSE & either BLOCKS or FACILITATES relay of stimulus.
problems that arise with neurotransmitters are associated with NEUROLOGIC & PSYCHIATRIC disorders
MAJOR NEUROTRANSMITTERS
name them and say what they are involved in:
1. D______
2. N____
3. S_____
4. G______
- dopamine
- attention, motivation, pleasure, reward
- focus, energy, learning, anti-anxiety - Norepinephrine
- alertness, energy - serotonin
- obsession & compulsions
- happiness, sleep - GABA
- relaxation
DOPAMINE & SEROTONIN
dopamine deficit:
- parkinson-like symptoms:
- anhedonia:
serotonin decficit:
- OCD-like symptoms:
- impulsivity:
both: ____ & ______
dopamine deficit:
- parkinson-like symptoms: slow rxn time, anergia (abnormal lack of energy)
- anhedonia: pleasure center dysfunction
serotonin deficit:
- OCD-like symptoms: obsessive thoughts, compulsive behaviors
- impulsivity: suicide, aggression, susceptibility to cue triggers
both: DEPRESSION & CRAVING
GABA & NOREPI
GABA:
principle _____ neurotransmitter.
GABA dysfunction associated with ____ disorders.
- esp. ____ disorders.
connected to _____ disorder.
NOREPI:
____ neurotransmitter associated with _____ or ____ response.
HIGH levels associated with: _____, _____, & _______.
LOW levels associated with: _______, _____, _______.
GABA:
principle INHIBITORY neurotransmitter.
GABA dysfunction associated with ANXIETY disorders.
- esp. PANIC disorders.
connected to MAJOR DEPRESSIVE disorders.
NOREPI:
EXCITATORY neurotransmitter associated with FIGHT or FLIGHT response.
high levels associated with: ANXIETY, STRESS, HYPERACTIVITY
low levels associated with: LACK OF ENERGY, FOCUS, & MOTIVATION
DEPRESSION
more common: ___, _____, & _____.
those with depression have greater risk of developing _____.
leading cause of ______.
high risk of _____.
associated with ____ & _____.
more common: women, white, those never married
those with depression have greater risk of developing CAD
leading cause of DISABILITY
high risk of SUICIDE
associated with FAM FX & GENETICALLY LINKED
DEPRESSION
____ types
dx requires presence of ______ that are _________ & to ________.
multiple etiologies associated with depression:
MULTIPLE types
dx requires MULTIPLE SYMPTOMS that are INTENSE ENOUGH TO CAUSE DISTRESS & to PERSISTENTLY IMPAIR PSYCHOSOCIAL FX
multiple etiologies associated with depression: NEUROBIOLOGICAL, CHEMICAL, SITUATIONAL, CHRONIC & ACUTE, MEDICATION SE
DEPRESSIVE SYMPTOMS
loss of _____ or _____
F_____
R____ & I______
impaired ______
low ______
____ thinking
____ disturbances
____ disturbances
loss of INTEREST or PLEASURE
FATIGUE
RESTLESSNESS & IRRITABILITY
impaired CONCENTRATION
low SELF ESTEEM
NEGATIVE thinking
SLEEP disturbances
APPETITE disturbances
DEPRESSION TREATMENT
medications
psychotherapy
psychoeducation & support groups
brain stimulation therapy
works best when _____
meds: takes WEEKS to start working
psychotherapy: talk therapy
- cognitive behavioral therapy
brain stimulation therapy - when pt are not responding to meds
works best when these are COMBINED
PANIC DISORDER
characterized by two important psychological symptoms
1. _____ anxiety
2. _____ anxiety
etiology biophysiological & physiologic:
1.
2.
_____ stress can induce circulating stress hormones which stimulate ____.
characterized by two important psychological symptoms:
1. ANTICIPATORY anxiety: fearful expectation of pain anxiety onset
2. AVOIDANCE anxiety: personal strategies used to increase feeling of control and decrease risk of pain anxiety
etiology biophysiological & physiologic:
1. GENETICS, FAM HX
2. EARLY CHILDHOOD stress linked to adult onset anxiety disorders
OVERWHELMING stress can induce circulating stress hormones which stimulate GLUTAMATE
WHAT IS PANIC?
_____ episodes.
____ events going on around pt.
many pt with panic also have _____.
panic attacks:
symptoms of pain attacks:
UNEXPECTED episodes
OUT OF PROPORTION events going on around pt.
many pt with pain also have DEPRESSION
pain attacks: recurrent uncomfortable episodes with sudden onset with symptoms
symptoms of panic attacks: heart palpitations, chest pain, SOA, smothering, dizzy, nausea, fear of losing control, tingling in hands, flushing/chilling
TREATMENT OF PAIN DISORDERS
cognitive behavioral therapy
anti-depressants
benzodiazepines
CBT: reduce fearful thinking and cognitive/physical stress response
anti-depressants: SSRI, SNRI, TCA, MAOI
benzodiazepines: second line, not for ongoing treatment; just breakthrough pain
GENERALIZED ANXIETY DISORDER
____ condition.
anxiety for more than _____.
_____, ______, & _____ worry.
accompanied by ______, _____, ____, _____.
risk factors:
CHRONIC condition.
anxiety for more than 6 MONTHS.
EXCESSIVE, UNCONTROLLED, UNREALISTIC worry.
accompanied by MUSCLE TENSION, AUTONOMIC HYPERACTIVITY, EXAGGERATED STARTLE, DIFFICULTY CONCENTRATING
risk factors: excessive use of certain substances, childhood abuse or fam trauma, genetics
GENERALIZED ANXIETY TREATMENT
CBT
anti-depressants
Buspirone
benzodiazepines
anti-depressants: SSRI, SNRI
- venlafaxine, paroxetine, escitalopram, duloxetine
Buspirone: MOA unknown, no sedation/abuse potential, does not intensify effects of CNS depressants, anxiolytic effects slow
POST TRAUMATIC STRESS DISORDER
3 core symptoms:
chronic activation of ______ in relation to exposure to potentially ____ event.
characterized by:
common problems:
3 core symptoms:
- hyper-arousal
- avoidance of reminders
- re-experiencing events
chronic activation of STRESS RESPONSE in relation to exposure to potentially LIFE THREATENING event.
characterized by: vivid flashbacks, nightmares, emotional blunting, irritability, exaggerated startle
common problems: memory, sleep, depression
PTSD TREATMENT
psychotherapy
EMDR
medications
psychotherapy: trauma-focused, exposure therapy, CBT
EMDR: eye movement desensitization and reprocessing
meds:
- SSRI: paroxetine & sertraline
- SNRI: venlafaxine
SOCIAL ANXIETY DISORDER
intense fear of being ____ by others.
____ fear of _____.
____ evaluation of _____ in social situations.
____ from situations or experience _____.
causes:
intense fear of being CRITICIZED by other.
PERSISTENT fear of HUMILIATION.
NEGATIVE evaluation of EMBARRASSMENT in social situations.
WITHDRAW from situations or experience INTENSE DISCOMFORT.
causes:
- inherited traits
- brain structure: amygdala plays a role in fear response
- environment: may be a learned behavior
TREATMENT OF SOCIAL ANXIETY
CBT
SSRI
benzos
propanolol
CBT - used in combo
SSRI - paroxetine, sertraline
propanolol - use 1-2 hours before activity
OBSESSIVE COMPULSIVE DISORDER
obsessions:
compulsions:
time consuming:
obsessions: repetitive unwanted thoughts
compulsions: repeated activities/rituals
time consuming: may be distressing to individual, friends, fam members
OCD TREATMENT
_____ to treat.
SSRI:
Clomipramine:
deep brain stimulation
EMDR
transcranial magnetic stimulation
VERY DIFFICULT to treat
SSRI: fluoxetine, fluvoamine, sertraline, paroxetine, citalopram, escitalopram
clompramine: TCA - second ling
deep brain stimulation - if meds do not word
GENERAL CONSIDERATIONS FOR DEPRESSION & ANXIETY MEDICATIONS
SSRI & SNRI are ___ b/c of safety risks.
assess _____ risk.
after starting drug, monitor for _____ for efficacy:
- can ____ dose
- ___ drug or drug class
- ___ second drug
SSRI & SNRI are FIRST LINE b/c of safety risks.
assess SUICIDE risk.
after starting drug, monitor for 4-8 wk for efficacy:
- can INCREASE dose
- SWITCH drug or drug class
- ADD second drug
SSRI
MOA:
AE:
med:
several advantages:
teaching points:
MOA: inhibitors of serotonin at nerve endings; more serotonin is available at nerve endings
AE: weight gain, N/V/D, constipation, dry mouth, h/a, nervousness, insomnia, sexual dysfunction
- serotonin syndrome: 2-72 hr post treatment, altered mental status, increased occurrence with MAOIs and other serotonergic drugs
- withdrawal syndrome: dizzy, h/a, sensory disturbances, tremor, anxiety, dysphoria
-suicide risk
- neonatal effect from use during pregnancy: small risk of pulmonary HTN in neonate and abstinence syndrome
med: FLUOXETINE
several advantages: less severe/fewer side effects, few drug-drug & food-drug interactions
teaching points: therapeutic benefit reached in 3-4 wks, avoid use with MAOIs
SNRI
MOA:
AE:
contraindicated:
med:
MOA: blocks neuronal activity of serotonin and norepi
AE: N, h/a, anorexia, insomnia, somnolence, sexual dysfunction, withdrawal syndrome, sweating, blurred vision, increased LFTs
contraindicated: with MAOIs
med: VENLAFAZINE
TRICYCLIC ANTIDEPRESSANTS: TCA
med:
good ____, side effect profile _____.
_____ OVERDOSES
also used to treat ____ & ____.
MOA:
AE:
considerations:
med: AMITRYPTALINE
good EFFICACY, side effect profile TOLERABLE
FATAL OVERDOSES
also used to treat neuropathic pain & nocturnal enuresis
MOA: block reuptake of norepi & serotonin, making more available in synapse
AE: sedation, orthostatic hypotension, sexual dysfunction, cardiac toxicity
- anticholinergic effects: overheated, dry mouth, blurry vision, red, confusion
considerations: significant drug-drug interactions with MAOI - can lead to HTN crisis
MONOAMINE OXIDASE INHIBITORS (MAOI)
typically for _____.
works better for ____ depression.
most serious potential problem:
MOA:
med:
AE:
typically for REFRACTORY DEPRESSION.
works better for ATYPICAL depression.
most serious potential problems: HTN CRISSI when taken with TYRAMINE
MOA: inhibits MAO - enzyme found in liver, intestinal wall, and terminals or neurons
- MAO normally converts norepi, serotonin, and dopamine into inactive product
- decreased MAO increases availability of neurotransmitters at nerve endings
med: PHENELZINE
AE:
- food-drug interactions: tyramine rich food + MAOI = HTN = aged cheese, smoked meets, yeast, red wine
- CNS stimulation, orthostatic hypotension
- significant drug-drug interactions: antihypertensive, SSRI, indirect acting smypatholmimetics, TCA, meperidine
- can lead to rapid increases in BP, stroke, coma
