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Pathophysiology and Pharmacology 2 > Mood 1 Emotional Regulation > Flashcards

Mood 1 Emotional Regulation Flashcards

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1
Q

Emotional Regulation

A

ability to mange emotional responses to environmental stimuli perceived as aversive or negative

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2
Q

Emotional regulation involves

A

neurotransmitters associated w/ anxiety & depressive states
immunologic responses/inflammation

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3
Q

Emotional states influence

A

immunologic responses
risk for maladaptive emotional responses
manifest clinically through bodily symptoms

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4
Q

Anxiety Types

A

generalized anxiety disorder
social anxiety disorder
panic disorder

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5
Q

Fear-centered anxiety disorders

A

panic disorders & social anxiety disorder
situation associated w/ overwhelming negative consequences
neural structures to process threat aren’t functioning well

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6
Q

Worry-centered anxiety disorders

A

GAD
functional disruptions in neuronal circuitry
increased activity in cortical-striatal-thalmic pathway

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7
Q

Anxiety comorbidities

A

depression
panic disorder: respiratory disease, vestibular dysfunction, thyroid problems, cardiac disease
GAD: chronic pain, unexplained somatic symptoms, sleep disorder

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8
Q

Genetic vulnerability to anxiety

A

variation of 5-ht transporter geene

SSRIs

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9
Q

Classic fear conditioning (consolidation/reconsolidation)

A

amygdala/long-term memory
stronger fear memory
meds disrupt chemicals involved in this process

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10
Q

Neuroanatomic Pathways in Anxiety

A 
Conditioned stimulus (read by thalamus > amygdala/visual cortex)
Amygdala (confers significance on stimuli [thalamus/hypothalamus], holds emotional memories/threat asessment, controls autonomic responses)
Prefrontal cortex (fear learning/extinction, registers/assigns meaning to emotions, weighs pros/cons, balances emotion/thought/controlling attention)
Caudate Nucleus (orchestrates action-reward sequencing, drives behavior w/ recall of past successful outcomes)
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11
Q

Anxiety chemical systems

A

GABA-BZD-receptor system

[gaba/benzodiazepines/glutamate]

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12
Q

GABA

A

primary inhibitory amino acid neurotransmitter

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13
Q

Benzodiazepines

A

partners w/ gaba in maintaining mind-body homeostasis

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14
Q

Glutamate

A

immediate precursor to GABA

extinction

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15
Q

Norepinephrine

A

increases during states of anxiety
results in downregulation of auto receptor (increased autonomic arousal)
r/t BDZ receptors

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16
Q

Serotonin

A

(5-HT)
decreased during states of anxiety
action related to fear learning

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17
Q

Dopamine

A

DA
increased during acute stress
impairs DA reward pathways
phobic responses

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18
Q

Hypothalamic-pituitary-adrenal axis

A 
threatening stimulus (fight or flight)
corticotropin-releasing hormone (ACTH/glucocorticoids)
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19
Q

Specific phobia s/s

A

unreasonable or excessive/persistent fear of specific objects or siuations

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20
Q

Social anxiety disorder s/s

A

fear generated by social or performance situations w/ exposure to unfamiliar or scruntity

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21
Q

GAD s/s

A

excessive worry; difficult to control

worry generates restlesssness, fatigue, difficulty concentrating, irritability, tension, sleep disturbance

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22
Q

Anxiety Meds

A 
SSRIs
Selective norepinephrine reuptake inhibitors (SNRIs)
Tricyclics (TCAs)
monoamine oxidase inhibitors (MAOIs)
Benzodiazepines
Combination therapy
Caution in elderly
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23
Q

Escitalopram (lexapro), Sertaline (zoloft) [class/moa/uses/se/bbw/contra/intxtions/preg]

A

antidepressant
increases availability of serotonin
tx: gneralized anxiety & depression
sexual dysfunction, dizziness, nausea, insomnia, somnolence, confusion, seizures, takes weeks to effect
increased risk of suicidal thinking (notapproved for <12 years)
no breast feeding/MAOI
w/ MAOIs cause serotonin syndrome, hypertensive crisis, hyperthermia and autonomic instability
do not give with St. John’s Worst (serotonin syndrome)
Preg Cat C

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24
Q

Serotonin Syndrome (HARMFUL)

A 
hyperthermia
anticognitive (delirium, confusion)
reflexes (hyper)
myoclonus (jerking/twitching)
fast HR
unconsciousness
loss of GI control
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25
Duloxetine (Cymbalta), Venlafaxine (effexor) [class/moa/uses/se/contra/bbw/intx]
serotonin-norepinephrine reuptake inhibitor (antidepressant anxiolytic) inhibits reuptake of serotonin & norepinephrine elevates mood SE: abnormal dreams, sweating, constipation, dry mouth, loss of appetite, weight loss, tremor, abnormal vision, HA, n/v, dizziness, loss of sexual desire use w/ caution in underlying CV disease, bupropion = no bueno w/ seizures risk for suicidal actions bupropin & levodopa increases adverse effects impaired platelet aggregation
26
imipramine (Tofranil) [class/moa/uses/se/vvvw/contra/interx/preg]
TCA (antidepressants) blocks reuptake of norepinephrine/serotonin tx major depression off label anxiety/bedwetting in kids se: dry mouth, blurred vision, urine retention, HTN, orthostatic hypotension, sedation, anticholinergic effect, cardiac dysrhythmias don't give if history of MI/heart block/arrhythmia contra: narrow: angle glaucoma/severe renal/hepatic disease intx: MOAIs = neuroleptic malignant syndrome, don't give w/ oral contraceptives, phenothiazines, St. John's wort C
27
Neuroleptic Malignant Syndrome (FEVER)
``` fever enephalopathy vitals unstable elevated enzymes (CPK) rigidity of muscles ```
28
Phenelzine (Nardil) [class/uses/se/bbw/contra/interx/preg]
MAOIs (antidepressant) tx: depression/panic disorder (anxiety off label) se: orthostatic hypotension, diarrhea, HA, insomnia, rebound HTN if discontinued abruptly, overdose: seizures, resp depression, circulatory collapse, coma increased risk of suicidal thinking, nt approved in peds contra: CV disease, hepatic/renal impairment, pheocrhomocytoma INtx: SSRIs (serotonin syndrome), avoid food w/ tyramine (HTN crisis), avoid caffiene for heart, avoid ginseng (HA) ma huang, ephedra, st. john's wort (HTN crisis) c
29
Do not give MOAIs w/
``` barbiturates TCAs antihistamines CNS depressants antihypertensives OTC cold meds cheese wine pickled foods ```
30
Tyramine Containing Foods
``` avocados bananas raisins papaya products canned figs cheese sour cream yogurt beer wines beef/chicken liver pate meat extracts pickled pepperoni salami sausage hotdogs soy sauce yeast chocolate ```
31
Lorazepam (Atiavn) [class/uses/SE/contra/interx/overdose/preg]
Benzodiazepines (sedative-hypnotic) primary tx for anxiety disorders/insomnia se: drowsiness, dizziness, resp depression, amnesia, ataxia, vision changes, n/a, physical dependence (assess airway) contra: acute narrow-angle glaucoma, closed-angle glaucoma, liver disease, impaired brain fx, suicidal ideations interx: can decrease anti-parkinsonism effects of levodopa, don't admin with kava/valerian/chamomile/hops overdose: flumazenil reverses CNS depressant D
32
Nonpharmacologic TX of anxiety
``` CBT exposure therapy/counseling progressive muscle relaxation psychoeducation cognitive approaches for automatic thoughts/shcemas biofeedback techniques meditation ```
33
Depression
persistent feelings of sadness/lack of interest in life
34
Depression Classifcations
``` major depressive disorder persistent depressive disorder premenstrual dysphoric disorder substance/medication-induced depression post-partum depression seasonal affective disorder depression due to another medical disorder ```
35
Major Depressive Disorder def
>1 depressive episodes of >2 weeks over lifetime | w/out history of manic/mixed/hypomanic episodes
36
Major Depressive Disorder s/s
``` depressed mood significantly less interest in activities changes in weight insomnia/hypersomnia feelings of worthlessness/guilt diminished ability to think/concentrate recurrent thoughts of death or suicide ```
37
Major Depressive Episode
last for 2 weeks + major symptom: anhedonia (lack of interest) at least 4 DSM-5 symptoms
38
Persistent Depressive Disorder s/s
``` depressed mood occurring on more days than not for >2 years increased overeating or decreased appetite sleeping too much or too little lower energy, fatigue low self-esteem poor concentration difficulty making decisions feelings of hopelessness ```
39
Premenstrual dysphoric Disorder
severe form of PMS resulting in depression or anxiety | s/s: mood swings, irritability, depressed mood, anxiety, lack of interest, difficulty concentrating
40
Chronic Depression
major depression lasting 2 years or longer | no more than a 2 month period of remission
41
Post-partum depression
rapid decline of estrogen | PP Psychosis = medical emergency
42
Depression Pathogenesis
insufficient firing of key neural networks | noradrenergic pathway, orbitofrontal complex, prefrontal cortex
43
Neurotransmitters r/t depression
serotonin (5-HT) regulates obsessions/compulsions Dopamine (DA) regulates motivation, pleasure and reward Norepinephrine (NE) regulates alertness, energy
44
Norepinephrine & Depression
works with dopamine responsible for interest and energy provides sense of hope/purpose in life deficiency results in negative emotions
45
Serotonin & Depression
mediates positive mood/optimism/impulsivity essential for keeping norepinephrine at appropriate level projects widely to several areas of brain pathway to hippocampus/septum/amygdala are inhibitory other pathways control somatic fx (to hypothalamus = appetite, to brainstem = sleep) balance maintains mood
46
Dopamine & Depression
reward system/deficiency r/t anhedonia | mesolimbic pathway
47
Stress cascade
stress response > activates hypothalamic-pituitary adrenal axis (HPA) > increased cortisol > chronic leads to decreased immunity & hippocampus atrophy
48
Effects of hippocampal atrophy
deficits in learning/memory formation | mood & emotion
49
Stress Reduction Methods
``` group/social support meditation yoga biofeedback self-hypnosis creative imagery thought stopping breathing exercises regular exercises proper nutrition relaxation response time management ```
50
Anterior Cingulate Cortex
emotional control, volume loss & fx alterations w/ depression
51
Basal Ganglia
limbi-cortical-striatel-pallidal-thalamic tract hypoactive dorsal section of tract lack of norepinephrine or dysfunction of monoamine pathways overactive ventral tract w/ depression
52
Hippocampus
excessive prolonged stress & overactivation of HPA axis damages hippocampal neurons = volume loss w/ dpression
53
Amygdala
function increased in depression = volume increases
54
Depression TX
TCAs MOAIs SSRIs CBT
55
Bipolar Disorders
group of mood disorders characterized by mani, hypomanic and depressive episodes I and II r/disorder cyclothymic disorder (but not significant enough)
56
Bipolar Disorder Rapid Cycling
>4 depressive and/or manic episodes w/in 12 months at least 1 week for manic 2 weeks for depressive periods of remission between
57
Mania
abnormal, persistently elevated, expansive or irritable mood increased energy present every day for one week or longer flight of ideas pressured speech increased participation of goal-directed activities
58
Hypomania
feelings of euphoria | mood and behavior changes
59
Depressive episodes
do not always manifest | alternate w/ mania/hypomania in bipolar I and II
60
Cyclothymic Disorder
reoccuring episodes of hypomanic symptoms alternating with depression over 2 years +
61
Manic Attack s/s (DIG FAST)
``` distractibility indiscretion grandiosity flight of ideas activity increase sleep deficit talkativeness ```
62
Bipolar Disorders About
no definitive cause/specific pathophysiology idiopathic unusual patterns of inflammation/glial cell activation
63
Bipolar Disorders RF
stressful life events | heritability factors
64
Bipolar Disorder Manic DX
must occur most of the day for a week or more (less if hospitalization required)
65
Bipolar Type I DX
at least one manic episode
66
Bipolar Type 2 DX
at least one hypomanic episode
67
Children Bipolar DX
must assess on basis of personal baseline
68
Bipolar TX
mood stabilizers: lithium | antipsychotics/anticonvulsants: valproic acid, risperiodone
69
lithium (Eskalith) [class/moa/use/se/intx/bbw/preg]
mood stabilizers affects sodium transport across cell membranes tx bipolar for purely manic or depressive episodes se: HA, lethargy, fatigue, recent memory loss, n, v, anorexia, abdominal pain, diarrhea, dry mouth, muscle weakness, hand tremors, reversible leukocytosis, nephrogenic diabetes insipidus intx: diuretics, NSAIDS, COX-2 Inhibitors, methyldopa, phenytoin, SSRIs, SNRIs, MOAI (
70
trazodone, refazodone (class/se/bbw/preg)
``` SARI (acute antidepressant) SE: orthostatic hypotension, constipation, diarrhea, nausea, vomiting, confusion, dizziness, HA, insomnia, blurred vision, prolonged QT, torsades, seizure, priapism, dysrhythmias BBW: suicide risk w/ MOAIs = serotonin syndrome never with saquinavir, ritonavir never admin if pregnant ```
71
buproprion (class/se/bbw/contra/interx/preg)
norepinephrine/dopamine reuptake inhibitor helps w/ smoking cessation antidepressant SE: hepatoxic, mild amphetamine effect if prior drug abuse BBW: suicidal ideation Contra: bulimia/anorexia (seizures), zyban (same ingredient, seizure disorder, alcohol/drug withdrawal, Interx: zyban, MOAIs C

Pathophysiology and Pharmacology 2 (27 decks)

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