Flashcards in Depressive Disorders, Anxiety Disorders and Bipolar and Related Disorders Deck (49)
What does NE do in the major depressive disorders?
-down regulates beta-receptors; adrenergic function abnormal in depression
What does DA do?
-decreased in depression
-increased in mania
-SSRI's proved effective as anti-depressants
What is the time period for a major depressive disorder?
-2 week period
-must have either 1.) depressed mood, or 2.) loss of interest or pleasure
Time period for a manic episode
-abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week with at least 3 of the things
What is a hypomanic episode?
-similar to manic episode but is less seere
-episodes only need to last 4 days and must not include psychotic features
What are the 4 neurochemical things involved with these diseases?
-Dopamine: we want to try and upregulate this!
-5HT: good anti depressants
What is very important in managing depression?
What are some of the other things that a major depressive episode can have?
-depressed mood most of the day, nearly every day
-markedly diminished interest or pleasure in all, or almost all, activities most of the day nearly every day
-significant weight loss or weight gain when not dieting
-insomnia or hypersomnia
-psychomotor agitation or retardation
-fatigue or loss of energy nearly every day
-feelings of worthlessness or excessive guilt
-diminished ability to think or concentrate
-recurrent thoughts of death or suicide
What was the list of things for a manic episode?
-inflated self esteem or grandiosity
-decreased need for sleep
-flight of ideas/racing thoughts
-distractibility: can't focus on anything
-increased goal-oriented behavior
-excessive involvement in pleasurable activities: they lovvvve taking risks!
What is major depressive disorder?
-diagnosis require the presence of one or more major depressive episodes and the ABSENCE of any manic, hypomanic, or mixed episodes
What is the difference between hypomania and mania?
-with hypo, you dont get thrown in jail, you just annoy your family
-Type 1 bipolar is mania
-type 2 is hypomania
Tx for Major depressive disorder?
-TCAs: nortriptyline, clompramine; amitriptyline, impramine
-MOAI's: selegiline, tranycypromine
-SSRI's: Fluoxetine, parosetine, sertraline, citalopram
What is ECT used for?
-tx resistant depression
-short term memory loss common
-induces a seizure
-safe and effective
What is Persistent Depressive Disorder (Dysthymia)?
-depressed mood for most of the day that has not been severe enough to meet criteria for major depressive episode
-during 2 years, cannot be w/o sx for >2 mo at a time
What drug gives you priapism?
What does Bupropion do?
-it like upregulates DA and blocks Serotonin reuptake or something like that
-good for overweight chick who is depressed and has low energy
Which drug has the long ass half life?
What is Premenstrual Dysphoric Disorder? (PMDD)
-mood instability with anxiety, depression, irritability
-occur the week before menses
-consistent pattern over the year
Tx for PMDD?
-exercise, diet, relaxation therapy
-SSRIs: sertraline, fluoxetine, paroxetine
Bipolar 1 disorder
-single manic episode is necessary to diagnose
-At least one manic or mixed episode*****
-+/- major depression but not req. for dx
-Can be psychotic episode
-delusions and/or hallucinations
-Worse prognosis than MDD
What is the essential feature of dperession with seasonal pattern?
-onset and remission of major depressive episodes at characteristic times of the year
-often with change of seasons
-sleep more and eat more
-most cases, the episodes begin in fall or winter and remit in summer
Bipolar 2 disorder
-pts have had at least one major depressive episode and onehypomanic episode in the absence of any manic or mixed episodes
-More prevalent than BPD-1
Tx for bipolar disorders?
-Mood stabilizers (1st line): lithium, valproic acid
What is Cyclothymic disorder?
-dysthymic disorder with intermittent hypomanic periods
-pt who, over the last 2 years, experiences repeated episodes of hypomania and depression (not severe enough to meet criteria for major depressive disorder)
Tx for cyclothymic disorder
-Mood stabilizing drugs
-Antidepressants frequently precipitate manic symptoms
What do we have to watch with lithium?
What are the 3 things that you can die from quitting cold turkey?
-involved worry about actual circumsances, events, or conflicts
-often accompanies panic anxiety
-Sx of generalized anxiety fluctuate more than those of panic anxiety
What is panic disorder 1
-recurrent unexpected panic attacks
Panic disorder 2
-at least one attack followed by 1 month or more of one or more
-persistent concern about additional attacks
-worry about the implications of the attack or its consequences
-Significant change in behavior related to the attacks
What is a panick attack?
-discrete period of intense fear or discomfort, in which four or more of the following developed abruptly and reached peak within 10 MINUTES and usually last < 25 minutes: now specified as "unexpected and expected" panic attacks
-anxiety about being in situations from which escape might be difficult of embarrassing or for which help may not be available in the event of panic
-ex: being away from home, sitting in the middle of a row of theater seats, being in an elevator, traveling in a plane
-associated with panic disorder
Social anxiety disorder
-The fear, anxiety, or avoidance is persistent, typically lasting 6 or more months
SAD type A
-a persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar ppl or to possible scrutiny by others. The individual fears that he or she will act in a way that will be embarrassing and humiliating
SAD type B
-exposure to the feared situation almost invariable provokes anxiety, which may take the form of a situationally bound or situationally pre-disposed panic attack
SAD type C
-the person recognizes that this fear is unreasonable*** or excessive
SAD type D
-the feared situations are avoided or else are endured with intense anxiety and distress
Generalized anxiety disorder
-Excessive anxiety and worry occurrring more days than not for at least 6 months, for most of day, about a number of events or activities
-it is difficult to control the worry
-the anxiety and worry are associated with at least three persisting for more days than not of the past 6 months
-recurrent and persistent thoughts, impulses, or images experienced as intrusive and inappropriate and causing marked anxiety or distress
-not simply excessive worries about real-life issues
-person attempts to ignore or suppress these thoughts
-the person recognizes them as a product of his/her own mind
-repetitive behaviors or mental acts that the person feels drive to perform
-Aimed at preventing or reducing distress or preventing some dreaded event/situation
What is the diference between Obessive compulsive personality disorder?
-OCPD is ego-syntonic
-they don't perveive they have a problem
-Dont confuse with OCD
-OCD is ego-dystonic
-they know their compulsions and obsessions are not reasonable
Posttraumatic Stress Disorder
-Person Exposed to a traumatic event in which both were present:
-Person experienced/witnessed actual or threatened death/injury/integrity of self or others
-persistently re-experience traumatic event
-persistent avoidance of stimuli associated with trauma
-persistent sx of increased arousal such as difficulty sleeping, irritability, difficulty concentrating, hypervigilence
time frame for PTSD?
-duration of distrubance and sx is more than 1 month
-clinically significant distress and impairs function
Tx for PTSD
-cognitive processing therapy
-increased risk of substance abuse
-avoid addictive Rx such as benzodiazepines
Which kind of drugs did he say are good for anxiety disorders?
-remember that Buspirone is a partial 5HT agonist
Helpful mnemonic for depression?
-SIG E CAPS
-Sleep- lack of
-Energy lack of
=appetite decreased or increased
Mnemonic for Manic
-Inflated self-esteem/ impulsive
=Flight of ideas