Psych Flashcards
(51 cards)
Depression Symptoms
AS
Anhedonia
Sadness
EASY Energy Appetite Sleep Yearning
ACID
Activity
Concentration
InDecisiveness
SUGR Suicide Unworthiness Guilt Rumination
SIGECAPS Sleep (increased or decreased) Interest (loss of) Guilt (or other negative thoughts) Energy (loss) Concentration problems Appetite (increased or decreased) Psychomotor activity (retardation or agitation) Suicidal thoughts
Depression DDx (14)
Adjustment disorder w/ disturbance of mood Persistent depressive disorder Cyclothymic disorder Bipolar disorder Major depressive episode secondary to substance use or substance withdrawal Major depressive episode secondary to medical condition AD(H)D Disruptive mood dysregulation disorder Generalized anxiety disorder PTSD Premenstrual dysphoric disorder Normal periods of sadness Psychotic disorders Borderline personality disorders
Psychoanalytic theory of depression:
Dysfunction
Precipitant
Key Features
Dysfunctional maturation
Real, threatened or perceived loss
Loss leads to anger and low self esteem; depression is “anger turned inward”
Behavioral theory of depression:
Dysfunction
Precipitant
Key Features
Dysfunctional social skills
Decrease in response contingent positive reinforcement (RCPR)
Not enough reward. dysphoria; clinical depression is a result of the secondary gain
Cognitive/behavioral theory of depression:
Dysfunction
Precipitant
Key Features
Dysfunctional attitudes and beliefs
Environmental stressor
Activation of depressogenic schema trigger negative interpretations of self/future which in turn cause other symptoms of depression
Learned helplessness theory of depression:
Dysfunction
Precipitant
Key Features
Dysfunctional attributional style
Negative events
Frequent “punishment” can cause an internalized, stable, and global interpretation of the world: specifically, a belief that your future actions will have no effect on outcome
Attachment theory of depression:
Dysfunction
Precipitant
Key Features
Dysfunctional object relations
Disrupted affectional bonds between mother and infant
Abnormal mother-infant bonding leads to disruptions in the development of object constancy, which may predispose to marked dependency needs and depression
MDD:
Male/Female
Age of Onset
Risks (3)
Genetic?
Female
30
Poverty
Life stress
Personality disorder
Yes
Approach to evaluating & treating mood disorders
DETRE
Diagnose
- consider other diagnoses
Educate
- side effects, response, treatment, prognosis
Treat
- SSRI, SNRI, DRI, 5-HT, Li, Lamotrigine, Psychotherapy
Re-Evaluate
- adherence, improvement, side effects, dose adjustment
Cumulative Risk Model
molecular and cellular factors interact with environmental and behavioral factors, with risks accumulating sufficiently in some individuals to produce clinical phenotypes
Serotonin (5-HT):
Origins
Involved Structures
Relevant Disorders
Dorsal raphe
Cortex (esp. frontal) Thalamus Midbrain Basal ganglia Cerebellum
Depression
Anxiety
Norepinephrine (NE):
Origins
Involved Structures
Relevant Disorders
Locus ceruleus
Limbic system (amygdala, hypothalamus)
Cortex
Thalamus
Depression
Anxiety
Dopamine (DA):
Origins
Involved Structures
Relevant Disorders
Ventral tegmental area (VTA)
Substantia nigra –> striatum
Tubulo-infidibular (pituitary)
Midbrain –> limbic/cortex
Nucleus accumbens
Schizophrenia
Addiction
HPA Axis
Hypothalamus –> [CRH] –> Anterior Pituitary –> [ACTH] –> Adrenal Cortex –> [Cortisol] –> Hypothalamus & Anterior Pituitary (negative feedback)
When we’re stressed & have to respond, HPA is stress response system
- in Depression, HPA turns on but doesn’t turn off
Yerkes-Dodson Law
Inverted U-shaped curve whereby low levels of anxiety yield low performance, some anxiety enhances performance, while high anxiety lowers performance again
Syndrome
A set of signs & symptoms that occur together, representative of a morbid condition
Known phenomenology
Disorder
A morbid condition w/o a known basis or pathology
Known syndrome w/ time + characteristic associations
Disease
A morbid condition w/ characteristic signs & symptoms, w/ a known etiology, pathology, or physiology
DSM Diagnosis
(1) Identify presenting symptom(s)
(2) Determine if the symptom(s) is/are clinically significant (is it a mental disorder?)
(3) Rule out secondary causes
(4) Determine specific primary disorder
(5) Add subtypes & specifiers
Mini-Mental State Exam
Component of a full mental status exam that ssess only cognitive functions
Anorexia Nervosa:
Epidemiology
Course
Etiology
2nd decade (13-18), female, Caucasian, upper/middle social classes
most lethal, chronic, depression/anxiety comorbidity, improve w/ treatment
familial, serotonin abnormalities, HPA axis abnormalities, multifactorial (psychological, social, cultural, biological/genetic), 5HT abnormalities –> dysphoria
Bulimia Nervosa:
Epidemiology
Course
Etiology
mid-adolescence to late 20s, diverse socioeconomic class, female
substance use problems, fluctuating symptoms w/ varying cycles of remissions & exacerbations, seasonal, psychiatric comorbidity
multifactorial (psychological, social, cultural, biological/genetic), 5HT abnormalities –> dysphoria
Binge-Eating Disorder:
Epidemiology
Course
Etiology
similar to bulimia nervosa, but less severe
impulsive eating w/ no compensatory weight loss efforts
multifactorial (psychological, social, cultural, biological/genetic), 5HT abnormalities –> dysphoria
Monoamine Hypothesis
Depression / anxiety results, in part, from inadequate monoamine neurotransmitter activity in the brain (serotonin, norepinephrine, dopamine)
All antidepressnats work, theoretically, by boosting the availability of one or more of these NTs in certain circuits of the brain
