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42 Cards in this Set
- Front
- Back
The most prevalent form of mental illness in the U.S.
_______% of adults suffer from it. |
Depression (Unipolar)
17% |
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A group of mental illnesses that include depresson and manic-depression (bipolar disorder)
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Affective disorders
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Characterized by swinging between being happy and depressed
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Bipolar Disorder (aka manic-depression)
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TRUE OR FALSE
Tradegy or trauma can precipitate depression |
TRUE
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Clinical depression is characterized by:
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Intense feelings of sadness, hoplessness, despair and the inability to find pleasure in usual activities
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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
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increased
duration |
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What is the definition of Mania?
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opposite of depression=enthusiasm, rapid thought and speech patterns, extreme self-confidence/impaired judgement
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What are secondary symptoms of depression?
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anorexia, sleep disorders, fatigue, lack of self esteem, somatic complaints, irrational guilt, recurrent througths of death and suicide
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Symptoms of depression that are used for diagnosis:
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1. general dysphoric mood (sadness, irritability, "down in the dumps" attitude)
2. general lack of interest in previously pleasurable activity |
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What are these?
1. recent stressful incident or misfortune 2.Genetic factors 3. Neurochemical imbalance |
Causes of depression
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What are the drug categories for Antidepressant Drugs?
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1. Tricyclic antidepressants
2. Selective serotonin reuptake inhibitors (SSRI) *NEWER GENERATION 3. Monoamine oxidase(MAO)inhibitors |
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Which MAO treats what illness?
MAO A treats__________ MAO B treats__________ |
MAO A =for depression
MAO B =for Parkinson's |
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Desipramine is the prototype for what group of Antidepressants?
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Tricyclic
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Tricyclics share a common_____ -______ chemical structure.
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three-ring
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What is the mechanism of action for Desipramine (the Tricyclic prototype)?
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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 |
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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. |
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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
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1. Severe major depression
2. Imipramine has been used to control bed-wetting in children |
Therapeutic uses of Tricyclic Antidepressants
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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 |
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Tricyclic Pharmacological Actions:
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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 |
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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 |
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What are the OT Implications (3 parts)?
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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 |
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Selective Serotonin Reuptake Inhibitors (SSRIs) are the ___ choice of antidepressant drugs
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#1 choice
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Fluoxetine is the prototype for what group of Antidepressants?
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Selective Serotonin Reuptake Inhibitors (SSRIs)
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Selective Serotonin Reuptake Inhibitors (SSRIs)
Mechanism of Action: |
Acts specifically to inhibit reuptake of serotonin at nerve terminals
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In terms of pharmacological actions, SSRIs are as _________ as tricyclics
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potent
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sexual dysfunction (loss of libido, delayed ejaculation), insomnia, anxiety, anorexia, tremors, nausea and flatulence
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SSRI side effects
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_________ are used for treating depression and obsessive compulsive disorder
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SSRIs
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OT Implications for SSRIs
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Biggest problem related to side effects:
Some people stops taking this medication because of its effect on sexual functioning |
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Monoamine Oxidase Inhibitors are the _____ ______ for treating depression
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last resort
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Monoamine Oxidase Inhibitors are often given in combination with other antidepressant meds. However, combining meds __________ side effects
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increases
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Phenelzine is the prototype for which antidepressant drug group?
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Monoamine Oxidase(MAO)Inhibitors
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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 |
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Monoamine Oxidase(MAO)Inhibitors allow __________ availability of __________ to be released.
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increased
serotonin |
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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 |
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Monoamine Oxidase(MAO)Inhibitors
NOTE: |
Inhibition of neurotransmitter uptake in peripheral sympathetic system may increase cardiovascular side effects
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Monoamine Oxidase(MAO)Inhibitors
Side effects? |
Orthostatic hypotension, headache, sexual disturbances, weight gain, anticholinergic effects and seizures
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Monoamine Oxidase(MAO)Inhibitors are used for...
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Pts with depression who are unresponsive or allergic to tricyclics
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What is used for treatment of Mania?
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Lithium Salts
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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 |
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Lithium salts work well but take time to kick in so be sure to ______ pt. closely
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watch
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For all antidepressants, it is important for OTs to watch for...
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increased depression in pts while waiting for drug to kick in.
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