Lecture 11 Flashcards by Viviana Castaneda

What is mood?

Overall state of emotion at a given time
Influenced by internal and external factors

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What is a mood disorder?

Condition that affects a person’s everyday emotional state/mood
AKA affective disorders

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How many adults 18+ have a mood disorder?

1 in 4

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What NT regulate mood?

Serotonin
Norepinephrine
Dopamine

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What are the types of depressive disorders?

Major depressive disorder
Dysthymia/Persistent Depressive Disorder
Seasonal Affective Disorder
Premenstrual Dysphoric Disorder (PMDD)
Disruptive Mood Dysregulation Disorder

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What are the types of bipolar disorder?

Bipolar I disorder
Bipolar 2 disorder (cyclothymia included)

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What are the most recognized systems for psychiatric diagnosis?

DSM
ICD(International Statistical Classifications of Diseases and Related Health Problems)

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What does the DSM require for all psychiatric conditions?

Criteria based diagnostic that requires 3 conditions…
Not caused by the direct effects of any drug or external exposure
Not caused by effects of a medical condition
Significant impairment of social functioning, occupational functioning, or both.

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What percentage of people in the US have a MDD their lifetime? past 12months?

21%
10%

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Who are more likely to have a MDD?

MC younger population (average age 30)
Rates higher in (25-44yo)
Low socioeconomic status
2-3x more in women

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What race is the highest to have a MDD? lowest?

Native Americans
Asians/Pacific Islanders

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What are some genetics/biological facts that increase the risk of MDD?

NT expression sensitivity (serotonin, norepinephrine, glutamate, GABA, dopamine)
Response to antidepressants
FH of depression or alcoholism

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What are some life events that increase the risk of MDD?

Adversity or loss of loved one, job, or relationship
Early childhood trauma
Postpartum period

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What are some medications that increase the risk of MDD?

Glucocorticoids
Interferons

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What personalities increase the risk of MDD?

Low self-esteem
Sensitive to stressors
Insecure or worried
Dependent or unassertive
Introverted

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What social factors increase the risk of MDD?

Lack of close relationships
Close individuals with depression
Maladaptive learned behaviors from close individuals

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What medical conditions are increase the risk for MDD?

Neurologic
Infectious
Cardiac
Endocrine
Cancer
Inflammatory

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How do you diagnose MDD according to the DSM?

Depressed mood or anhedonia for >2weeks and >4 conditions (on another card)

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What are the conditions of the DSM criteria for MDD?

SIG E CAPS
Sleep disturbances
Interested decreased (anhedonia)
Guilt and/or feeling of worthlessness
Energy decreased
Concentration problems
Appteite/weight changes
Psychometer agitation or retardation
Suicidal ideation

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What are the subtypes of MDD?

Catatonic (psychomotor disturbances)
Anxiety
Mixed (insomnia, racing thoughts, increase energy)
Psychotic (hallucinations, delusions)
Seasonal
Atypical (reactivity to pleasurable stimuli)
Melancholic
Peripartum

CAMPSAMP

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How does a MDD present?

At least one major depressive episode that can last over days to weeks (average time 20weeks)

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When is there the highest risk of recurrence for a major depressive episode?

Within the first few months following episodes resolution

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What are the rates of recurrence of a major depressive episode in 1 year? lifetime??

40%
85%

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What are some differentials of MDD?

Other mood disorders
Medication SE
General medical disorders
Substance use/abuse

NOT bereavement

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What are the types of screening for MDD?

Two question screen (PHQ-2) Pt health questionnaire-9 (PHQ-9) Zung self-rated depression scale

What are the non-pharmacological management for MDD?

Psychotherapy Electroconvulsive(ECT) Vagal nerve stimulation Transcranial Magnetic stimulation (TMS)

What are the pharmacological management for MDD?

Supplements Herbals Antidepressants

What are the goals of MDD treatment?

Maintain pt safety Full remission of symptoms Return to baseline functions

What is the preferred treatment for MDD? Whats the MC?

Pharmacotherapy AND psychotherapy MC is just pharmacotherapy

What are a characteristics of a pt to be considered for outpatient treatment in MDD?

Mild/moderate depression No suicidal/homicidal ideation or behavior No psychotic features Minimal to no aggressiveness Intact judgement Able to perform basic ADL and maintain adequate nutritional/hydration status

What are the characteristics of a pt to be considered for inpt treatment in MDD?

Severe depression Suicidal/homicidal ideation or behavior with specific plan or intent Psychosis Catatonia Impaired judgement that puts patient/others at risk for harm Grossly impaired functioning affecting ability to care for self

What are non-pharmacologic treatments for MDD?

Psychotherapy (CBT, interpersonal therapy) Relaxation techniques Exercise Behavioral activation Other(massage therapy, spirituality, yoga, acupuncture)

How does ECT work?

Small electric current to induce cerebral seizure while patient is under general anesthesia

What is indicated for ECT?

Severe, refractory depression Severe suicidality, severe psychosis, catatonia, malnutrition d/t food refusal secondary to depressive illness

What is the most effective treatment for severe MDD?

ECT

What are SE of ECT?

Generally safe Cardiopulmonary HA Nausea Transiet cognitive impairment Muscle aches

How does a vagal nerve stimulation work?

Device implanted in chest wall and connected to one(left) vagus nerve

What is indicated for vagal nerve stimulation?

Refractory epilepsy Refractory depression(questionable efficacy)

How does TMS work?

Metal coil with magnetic field is placed against scalp to induce depolarization of neurons in a focal area Output use without sedation or anesthesia

What is indicated for TMS?

Treatment-refractory depression

What is CI for TMS?

High seizure risk Incompatible implants(metallic, electrical, cochlear)

What are the SE of TMS?

Seizures HA Scalp pain Transient hearing loss

What are the supplements that could be used to treat MDD?

S-Adenosylmethionine (SAMe): raise dopamine levels 5-Hydroxytryptophan (5-HTP): precursor of serotonin Omega-3 Fatty Acids

What herbals can be used for treating MDD?

St. John's wort(increase serotonin, possibly noes and dopamine levels) Saffron Ginkgo biloba: improve mood for pts being treated for memory loss, increase sensitivity of serotonin

What herbs or supplements can increase the risk of bleeding?

Omega-3. Ginkgo biloba

When do you usually see improvement after taking oral antidepressants?

As soon as week 1, but can take up to 4-6 weeks

How long should. a pt be on antidepressants?

6+months after s/s improvement and then you gradual titrate down

What are the types of antidepressants?

SSRI: paroxetine, escitalopram SNRI: venlafaxine Serotonin Modulators: mirtazapine, vortioxetine TCAs: amitriptyline

What are the first gen antidepressant classes?

MAOIs TCAs TeCAs Litium Antipsychotics

What are the 2nd gen antidepressant classes?

SSRIs SNRIs Atypical antidepressants Serotonin modulators Ketamine/Esketamine

What is the MC class of antidepressants?

2nd gen antidepressants

What do most SSRIs have a half life of?

24hours

What medication is usually best used to titrate off an SSRI?

Prozac

What causes serotonin syndrome?

Increased serotongeric activity Usually when starting medications or dosing changes

What are the S/S of serotonin syndrome?

Diarrhea Increased bowel sounds Agitation Hyperreflexia Dry mucous membranes Autonomic instability Hyperthermia HTN Tremor Clonus Seizures Death

How do we diagnose serotonin syndrome?

Clinically

How do you treat serotonin syndrome?

Supportive care D/C serotonergic medications Sedation with benzodiazepines Normalize vitals and hydration status

How do you treat serotonin syndrome?

Supportive care D/C serotonergic medications Sedation with benzodiazepines Normalize vitals and hydration status

What SSRIs do you not take if a pt is on tamoxifen(breast cancer med)

Fluoxetine and Paroxetine

What are usually first-line for MDD?

SSRIs

What do most SSRIs have a half life of?

24hours

Lecture 11 Flashcards

(61 cards)