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Behavioral Dynamics > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

Define Mood

A

Overall state of emotion at a given time which is influenced by internal and external factors

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2
Q

What is a mood disorder?

A

A condition that affects a person’s everyday emotional state/mood (prevalence 1 in 4 adults)

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3
Q

What neurotransmitters effect mood? Where are they made?

A

Serotonin (Raphe nuclei)
Norepinephrine (Locus coeruleus)
Dopamine (Substantia nigra)

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4
Q

What are the types of mood disorders?

A

Depressive and bipolar

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5
Q

What criteria is required for ALL psychiatric conditions?

A
  1. Cannot be caused by a drug or external exposure
  2. Cannot be caused by a medical condition
  3. Must have significant impairment of social and/or occupational functioning
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6
Q

What is the prevalence of major depressive disorder?

A

21% in lifetime, 10% per year

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7
Q

Who is major depressive disorder most common for?

A

Women
Age ~30 years
Native Americans (lowest is asians)
Low socioeconomic status

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8
Q

What is the inheritability of major depressive disorder?

A

35-40%

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9
Q

What is the cause biologically of major depressive disorder?

A

Changes in neurotransmitter expression and sensitivity (serotonin, norepinephrine, glutamate, GABA, dopamine)

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10
Q

What medications can contribute to major depressive disorder?

A

Glucocorticoids, interferons

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11
Q

What is the diagnostic criteria for major depressive disorder?

A

A depressed mood or anhedonia for at least 2 weeks and at least 4 of the following:
-sleep changes
-feelings of worthlessness/guilt
- fatigue
- decreased concentration
- significant appetite or weight change
- activity changes
- recurrent thoughts about death or suicide

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12
Q

What is the mnemonic for major depressive disorder?

A

S - sleep
I - interest decrease
G - guilt

E - energy down

C - concentration down
A - appetite down
P - psychomotor agitation or retardation
S - suicidal ideation

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13
Q

What are the subtypes of major depressive disorder?

A

Anxiety - high levels of accompanying anxiety
Atypical - reactivity to pleasurable stimuli, hyperphagia, hypersomnia
Catatonic - major psychomotor disturbances
Melancholic - anhedonia, psychomotor changes, insomnia, decreased appetitie
Mixed - symptoms of mania
Peripartum - while pregnant or within 4 weeks or birth
Psychotic - with accompanying psychosis
Seasonal - associated with a particular season

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14
Q

What is the average time to resolution of a major depressive disorder episode?

A

20 weeks

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15
Q

When is the highest risk of recurrence of major depressive disorder?

A

Within the first few months following a episode’s resolution

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16
Q

What is the rate of recurrence of major depressive disorder?

A

40% in a year and 85% in a lifetime

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17
Q

What are the screening exams for major depressive disorder?

A

Quick initial -> Two question screen PHQ-2
Evaluate severity -> Patient Health Questionnaire-9 PHQ-9
Rating of sx -> Zung Self-Rated Depression Scale

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18
Q

What is the preferred approach to treating major depressive disorder?

A

A combination of pharmacotherapy and psychotherapy

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19
Q

What is the most common approach to treating major depressive disorder?

A

Pharmacotherapy only

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20
Q

What is electroconvulsive therapy?

A

Use of a small electric current to induce a cerebral seizure while patient is under general anesthesia

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21
Q

What is the indication for electroconvulsive therapy?

A

Severe, refractory depression
Esp if cannot tolerate other therapies (like pregnancy)

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22
Q

What are the adverse events for electroconvulsive therapy?

A

Cardiopulmonary, HA, nausea, transient cognitive impairment, muscle aches

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23
Q

What is vagal nerve stimulation?

A

A device is implanted in the chest wall and connected to one (left) vagus nerve

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24
Q

What is the indication for vagal nerve stimulation?

A

Typically used for refractory epilepsy but can be used for refractory depression

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25
Q

What is transcranial magnetic stimulation?

A

A metal coil with magnetic field is placed against scalp to induce depolarization of neurons in a focal area

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26
Q

What is the indication for transcranial magnetic stimulation?

A

Treatment-refractory depression

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27
Q

What are the CI for transcranial magnetic stimulation?

A

High seizure risk, incompatible implants (bc magnetic)

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28
Q

What are the SE for transcranial magnetic stimulation?

A

Seizures, HA, scalp pain, transient hearing loss

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29
Q

What supplements can be used in major depressive disorder?

A

S-Adenosylmethionine: raises dopamine levels but can trigger manic episodes, preg safe
5-hydroxytryptophan: precuror to serotonin
Omega- 3 Fatty Acids: antiinflammatory effects

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30
Q

What are herbals that can be used in major depressive disorder?

A

St. John’s Wort: increases serotonin, maybe increases NE and dopamine
Saffron: MOA unclear
Ginkgo Biloba: Improved mood in memory loss patients, increases sensitivity to serotonin

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31
Q

How long should a patient be on an oral antidepressant before evaluation?

A

At least 4 weeks

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32
Q

How long should a patient be on an oral antidepressant?

A

At least 6 months after s/s improvement

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33
Q

What are the SSRI drugs?

A

Sertraline
Citalopram
Escitalopram
Fluoxetine
Paroxetine
Fluvoxamine

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34
Q

What is the MOA or SSRI?

A

Selectively decreases the action of 5-HT reuptake pump, leading to increased serotonin levels in the synapse

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35
Q

What are the common CI in all SSRIs?

A

Allergy, use of an MAOI within 2 weeks

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36
Q

What are the common SE of SSRIs?

A

GI upset
Sleep changes
Neuro (HA, dizziness)
Sexual dysfunction
Psych
Prolonged QT, weight gain, bleeding, orthostatic hypotension, serotonin syndrome

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37
Q

What is serotonin syndrome?

A

Diarrhea, increased bowel sounds, agitiation, hyperreflexia, dry mucus membranes, autonomic instability, hyperthermia, HTN, tremor, clonus, seizure, death
Caused by increase in serotonergic activity

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38
Q

What is the treatment for serotonin syndrome?

A

Supportive care
D/c serotonergic medications
Sedation with benzos

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39
Q

What is unique about sertraline?

A

More GI upset
Less QT prolongation
Higher insomnia

40
Q

What is unique about citalopram and escitalopram?

A

Most QT prolongation
Minimal SE
Least hepatic cytochrome enzymes

41
Q

What is unique about fluvoxamine?

A

Shortest half life
Most somnolence
Many DDI due to cytochrome inhibition
Good use with OCD

42
Q

What is unique about fluoxetine?

A

Longest half-life
Higher insomnia
SE of anxiety
Cannot take tamoxifen

43
Q

What is unique about paroxetine?

A

Anticholinergic SE
Increased weight gain, sexual disfunction
DDI 2/2 cytochrome inhibitor
Cannot take tamoxifen

44
Q

What is the MOA for SNRIs?

A

blocks reuptake of 5-HT and norepinephrine, increasing their levels in the synapse

45
Q

Which SNRIs have a greater effect on norepinephrine?

A

Savella/Fetzima

46
Q

What are the SNRI drugs?

A

Venlafaxine
Desvenlafaxine
Duloxetine
Milnacipran
Levomilnacipran

47
Q

What are the common CI for SNRIs?

A

Allergy
MAOI in 2 weeks
Serotonergic drugs
Angle closure glaucoma

48
Q

What are the common SE of SNRIs?

A

GI upset esp constipation
Sleep changes
Neuro (HA, dizziness)
Sexual dysfunction (less than SSRI)
Psych
Diaphoresis, hypertension, serotonin syndrome
Note: less weight gain side effects

49
Q

What is unique about venlafaxine?

A

More SE esp N/V
Most elevated BP

50
Q

What is unique about desvenlafaxine?

A

Synthetic of venlafacixine’s major metabolite
Less SE than venlafaxine esp BP

51
Q

What is unique about duloxetine?

A

Most likely to have DDI
Least elevated BP
Used for chronic pain relief

52
Q

What is unique about milnacipran and levomilnacipran?

A

Anticholinergic SE
Milnacipran/Savella is more for fibromyalgia

53
Q

What is the MOA of Bupropion?

A

Dopamine-norepinephrin reuptake inhibitor and antagonizes nicotonic receptors

54
Q

What is the MOA of mirtazapine?

A

Antagonizes alpha-2 adrenergic receptors and 5-HT2 and 5-HT3 receptors, which causes increased release of serotonin and norepinephrine

55
Q

What are the SE of bupropion?

A

Dry mouth, insomnia, nausea, increased risk of seizures
No weight gain or sexual dysfunction
Think energy boost and sex

56
Q

What are the CI for bupropion?

A

allergy, seizure disorder, anorexia/bulimia, within 2 weeks of MAOI

57
Q

What are the SE of mirtazapine?

A

Drowsiness and weight gain, sexual dysfunction

58
Q

What are the CI of mirtazapine?

A

Allergy, within 2 weeks of MAOI

59
Q

What is the MOA of serotonin modulators?

A

Block reuptake of 5-HT

60
Q

What are the serotonin modulators?

A

Nefazodone
Trazodone
Vilazodone
Vortioxetine

61
Q

What is the MOA of nefazodone and trazodone?

A

antagonize 5-HT receptors causing increased release of serotonin

62
Q

What is the MOA of vilazodone and vortioxetine?

A

Partial agonist of 5-HT receptors mimicking serotonergic effects

63
Q

What are CI to serotonin modulators?

A

allergy, within 2 weeks of MAOI

64
Q

What are SE of serotonin modulators?

A

HA, diarrhea, nausea
SI risk
Serotonin syndrome risk

65
Q

What is unique about nefazodone?

A

Most DDI risk
BBW for hepatotoxicity, name brand pulled from market
SE: less GI and weight gain, no sexual side effects

66
Q

What is unique about trazodone?

A

SE: sedation, nausea, dry mouth, fatigue, constipation, sexual dysfuction (incl priapism)
Doesn’t cause weight change and less sexual dysfunction

67
Q

What is unique about vilazodone?

A

Faster onset of treatment
Less sexual dysfunction

68
Q

What is unique about vortioxetine?

A

Faster onset of treatment
Less sexual dysfunction

69
Q

What is the indication for Ketamine/Esketamine?

A

Patients who fail or do not respond to ECT

70
Q

What is the effect of Ketamine/Esketamine?

A

A rapid robust improvement in depression that fades in about 2 weeks

71
Q

What are the SE of ketamine/esketamine?

A

Abuse potential
Neurotoxicity
Psychotomimetic effects (induces psychosis)

72
Q

What is the MOA of ketamine/esketamine?

A

Opioid and AMPA agonist, NMDA antagonist

73
Q

What are the CI to ketamine/esketamine?

A

Allergy, aneurysmal disease or AV malformation, h/o ICH, inability to tolerate increase in BP

74
Q

What are DDI for ketamine/esketamine?

A

CNS depressants (including opiates), other nasal sprays

75
Q

What is the MOA of MAOa?

A

Breaks down serotonin and norepinephrine

76
Q

What is the MOA of MAOb?

A

Works with MAOa to break down dopamine

77
Q

What is the indication for MAOIs?

A

Treatment-resistant or atypical depression

78
Q

What is an indication for selegiline?

A

Low dose used for Parkinson’s

79
Q

What are the MAOI drugs?

A

Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline

80
Q

What are the CI for MAOI drugs?

A

Allergy, CV disease, pheochromocytoma, hepatic or renal impairment, 2 weeks of other serotonergic drugs

81
Q

What are the DDI for MAOIs?

A

Many. Too many

82
Q

What are the SE of MAOIs?

A

Hypotension, GI upset, urinary hesitancy, headache, myoclonic jerks, edema, SI
Hypertensive crisis when eating aged foods (tyramine)

83
Q

What is the indication for TCAs?

A

Second line for depression 2/2 side effects

84
Q

What is the MOA for TCAs?

A

Inhibits reuptake of 5-HT and norepinephrine

85
Q

What are the tertiary amine TCAs?

A

Amitriptyline and Doxepin
prevent 5-HT>NE reuptake

86
Q

What are the secondary amine TCAs?

A

Nortriptyline and desipramine
Prevent NE>5-HT reuptake
Higher tolerability

87
Q

What are the CI to TCAs?

A

Allergy
2 Weeks of MAOI
Soon after MI

88
Q

What are the SE to TCAs?

A

Anticholinergic
Drowsiness
Sexual dysfunction
Diaphoresis
Tremor
Weight gain/increased appetite
SI
Prolonged QT

89
Q

What is the indication for TeCAs?

A

Refractory of atypical depression

90
Q

What are the TeCAs?

A

Maprotiline (blocks reuptake of NE and 5-HT)
Amoxapine (blocks reuptake of NE, blocks dopamine receptors)

91
Q

What are the TeCA side effects?

A

Similar to TCA, less anticholinergic but more antihistamine

92
Q

What is lithium used for?

A

Typically bipolar, but can be unipolar depression
Many SE and high toxicity risk

93
Q

What is persistent depressive disorder?

A

A patient with ongoing depressive sx most of the time for >2 years with no longer than 2 months w/o sx and at least 2 of the following:
-appetite changes
-sleep changes
-fatigue
- Diminished ability (mental)
- Low self-esteem
-Feelings of hopelessness
Cannot have mania!

Feeling SAD For Life

94
Q

What is the prevalence of persistent depressive disorder?

A

1.5% in the past 12 months

95
Q

What is the treatment for persistent depressive disorder?

A

1st: SSRIs
2nd: TCAs and MAOIs (2nd bc side effects)

Behavioral Dynamics (5 decks)

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