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42 Cards in this Set

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The most prevalent form of mental illness in the U.S.
_______% of adults suffer from it.
Depression (Unipolar)

17%
A group of mental illnesses that include depresson and manic-depression (bipolar disorder)
Affective disorders
Characterized by swinging between being happy and depressed
Bipolar Disorder (aka manic-depression)
TRUE OR FALSE

Tradegy or trauma can precipitate depression
TRUE
Clinical depression is characterized by:
Intense feelings of sadness, hoplessness, despair and the inability to find pleasure in usual activities
The diagnosis of clinical depression indicates that feelings associated with the illness are ________in both intensity and _________ to the extent that they begin to be incapacitating
increased

duration
What is the definition of Mania?
opposite of depression=enthusiasm, rapid thought and speech patterns, extreme self-confidence/impaired judgement
What are secondary symptoms of depression?
anorexia, sleep disorders, fatigue, lack of self esteem, somatic complaints, irrational guilt, recurrent througths of death and suicide
Symptoms of depression that are used for diagnosis:
1. general dysphoric mood (sadness, irritability, "down in the dumps" attitude)

2. general lack of interest in previously pleasurable activity
What are these?

1. recent stressful incident or misfortune
2.Genetic factors
3. Neurochemical imbalance
Causes of depression
What are the drug categories for Antidepressant Drugs?
1. Tricyclic antidepressants
2. Selective serotonin reuptake inhibitors (SSRI) *NEWER GENERATION
3. Monoamine oxidase(MAO)inhibitors
Which MAO treats what illness?

MAO A treats__________
MAO B treats__________
MAO A =for depression

MAO B =for Parkinson's
Desipramine is the prototype for what group of Antidepressants?
Tricyclic
Tricyclics share a common_____ -______ chemical structure.
three-ring
What is the mechanism of action for Desipramine (the Tricyclic prototype)?
1. Acts by blocking reuptake of norepinephrine (and some dopamine) AND serotonin uptake into nerve terminals

2. Can also block receptors for serotonin, histamine, muscarinic and ? adrenoceptors
TRUE OR FALSE:

Psychological dependence and addiction are the same
FALSE

Addiction is a craving, which is different from your body having a physiological need.
Biggest issue = feel like you're in a fog

Antimuscarinic
-dry mouth, blurred vision, constipation,urinary retention

CVS
-cardiac arrhythmias, orthostatic hypotension, reflex tachycardia

CNS
-sedation and headache
*HIGH POTENTIAL FOR FATAL OVERDOSE and/or SUICIDE RISK =why its use has declined
Tricyclic Antidepressant Side Effects
1. Severe major depression
2. Imipramine has been used to control bed-wetting in children
Therapeutic uses of Tricyclic Antidepressants
Tricyclic Pharmacokinetics:

1. administration
2.onset of action
1. Active orally (widely distributed in body fluids *including the brain)

2. about 2-4 weeks before seeing a response
Tricyclic Pharmacological Actions:
1. Elevates mood, improves mental alertness and increases physical activity

2. Can also reduce morbid preoccupation in 50-70% of patients

3. Physical and psychological dependence has been reported with this drug's use
Tricyclic mech. of action (cont.):

Acts by allowing neurotransmitters to ________ at the synapse leading to prolonged stimulation of receptors and a ________ in its sensitivity.

*change in receptor sensitivity may account for the antidepresseant effects
accumulate

decrease
What are the OT Implications (3 parts)?
Antimuscarinic effects:
Dry mouth=need water, blurred vision=color code,constipation=increase fiber intake, urinary retention

CVS:
cardiac arrhythmias=monitor BP, orthostatic hypotension=avoid sudden mvmt, reflex tachycardia=decrease exercise stress

CNS:
sedation and headache=time tx for time pt has decreased effects
Selective Serotonin Reuptake Inhibitors (SSRIs) are the ___ choice of antidepressant drugs
#1 choice
Fluoxetine is the prototype for what group of Antidepressants?
Selective Serotonin Reuptake Inhibitors (SSRIs)
Selective Serotonin Reuptake Inhibitors (SSRIs)

Mechanism of Action:
Acts specifically to inhibit reuptake of serotonin at nerve terminals
In terms of pharmacological actions, SSRIs are as _________ as tricyclics
potent
sexual dysfunction (loss of libido, delayed ejaculation), insomnia, anxiety, anorexia, tremors, nausea and flatulence
SSRI side effects
_________ are used for treating depression and obsessive compulsive disorder
SSRIs
OT Implications for SSRIs
Biggest problem related to side effects:

Some people stops taking this medication because of its effect on sexual functioning
Monoamine Oxidase Inhibitors are the _____ ______ for treating depression
last resort
Monoamine Oxidase Inhibitors are often given in combination with other antidepressant meds. However, combining meds __________ side effects
increases
Phenelzine is the prototype for which antidepressant drug group?
Monoamine Oxidase(MAO)Inhibitors
1. inhibits MAO, an enzyme that breaks down norepinephrine, dopamine and serotonin.
->allowing these neurotransmitters to accumulate at the synapse=leading to increased activation of postsynaptic receptors

2. Inhibit oxidases responsible for metabolism of compounds such as tyramine (i.e. found in aged cheese)
Monoamine Oxidase(MAO)Inhibitors

Mechanism of Action
Monoamine Oxidase(MAO)Inhibitors allow __________ availability of __________ to be released.
increased

serotonin
Monoamine Oxidase(MAO)Inhibitors:

Administration?

Onset of action?

Contraindications?
1. Active orally

2. Slow onset...minimum of 2 weeks

3. Pts should avoid high tyramine foods(i.e. cheese, salami, chocolate, wine, beer, chicken liver, yogurt, etc) because of risk of hypertensive crisis
Monoamine Oxidase(MAO)Inhibitors

NOTE:
Inhibition of neurotransmitter uptake in peripheral sympathetic system may increase cardiovascular side effects
Monoamine Oxidase(MAO)Inhibitors

Side effects?
Orthostatic hypotension, headache, sexual disturbances, weight gain, anticholinergic effects and seizures
Monoamine Oxidase(MAO)Inhibitors are used for...
Pts with depression who are unresponsive or allergic to tricyclics
What is used for treatment of Mania?
Lithium Salts
Lithium salts (Lithobid, Lithonate)

Mechanism of action?
Helps with...
Administration?
Side Effects?
1. EXACT Mech of Action is UNKNOWN
2.relief from signs and symptoms of Mania *stabilizes mood
3. Active orally
4. Ataxia, tremors, confusion and convulsions

***HAS A NARROW THERAPEUTIC INDEX
Lithium salts work well but take time to kick in so be sure to ______ pt. closely
watch
For all antidepressants, it is important for OTs to watch for...
increased depression in pts while waiting for drug to kick in.