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35 Cards in this Set
- Front
- Back
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What is a sustained tone of feeling?
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mood
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General: high mood = ?
low mood = ? |
manic
depression |
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how long must there be depressive symptoms to qualify as a depressive episode?
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2 weeks
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what is the prevalence, gender and socioeconomic epidemiology of depression?
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5%
2:1 female to male unclear on socioeconomic |
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* what brain system plays a central role in the mediation of emotional processes?
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limbic
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What brain regions are associated with increased activity in depression? what show decreased activity?
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Dorsal Region --> underactive (attention, cognition, psychomotor)
Ventral Region --> overactive (vegetative, autonomic, somatic) |
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What are required for a dx of major depressive episode? disorder?
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1. represent change from normal functioning
2. symptoms must occur for at least 2 weeks 3. Symptom List "SIG E CAPS" Sleep Interest Guilt Energy Concentration Appetite Psychomotor retardation Suicidal ideation Disorder: Require episode Level of severity Course specifiers Special Types: Catatonic, melancholic, atypical, postpartum |
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What does bipolar include?
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manic or hypomanic + major depressive disorder
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what is dysthymia?
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chronic depressed mood lasting 2 years in adults, but symptoms fall short of DSM major depressive episode
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in depression, when does the first major depressive episode usually occur?
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mid 20's
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are shorter or longer duration depression patients more likely to have better recovery?
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shorter
longer term = poorer outcome |
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what are the first line treatment for depression?
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SSRI
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what causes Serotonin syndrome?
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Too many serotonin enhancing drugs
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Do the majority of bipolar I disorder patients cycle into major depressive episode?
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yes
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* What defines bipolar I?
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a single manic episode lasting at least week
--> this is more mania than bipolar II Euphoric, Heightened affect, agitation, flight of ideas, gandiosity |
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* what defines bipolar II?
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at least one hypomanic episode (same characteristics of manic episode, but only lasts 4 days and less imparing) AND at least one major depressive episode
--> hypomania in bipolar II is shorter duration and less impairment than bipolar I |
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* in order to be a manic episode, how long must the symptoms last and how many symptoms must be present?
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one week
3 or more: gandiosity decreased need for sleep pressured speech flight of ideas increased distractability increased activity/agitation increased engagement in risky activities Global Criteria |
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What is a mixed episode?
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symptoms of both major depressive episode and manic episode ... meeting criteria for both
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can you be bipolar II if you've had a manic episode?
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no. only hypomanic (no more than 4 days)
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what is Cyclothymic Disorder?
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a "little bipolar"
never had a true Manic or Major Depressive episodes |
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when does bipolar usually onset?
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late teens or early 20s
normally a depressive episode occurs first |
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How many stages are there of manic episodes? what are they
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Stage 1: hypomania
Stage 2: acute mania Stage 3: delirious mania |
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What is the major risk of using antidepressants in an bipolar pt?
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inducing mania
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*What are the structures of the limbic system (involved in mood)?
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Cingulate Cortex
Hippocampus Amygdala Hypothalamus Orbitofrontal cortex N. accumbens, septal n. |
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What pathology is seen in the hippocampus in depression?
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atrophy
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Neuroanatomy can vary in coordination with mood disorders, does the disorder cause the changes or the changes cause the disorder?
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unclear
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What are the two major NTs in mood disorders?
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Serotonin and NorEpi
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* What is the Hypothalamic-Pituitary-Axis response/activity in Depression?
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Hyperactivity --> increased cortisol, ACTH and CRH
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What role do genetics play in depression?
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increased susceptibility (multifactorial inheritance)
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What are four basic principles of antidepressant use?
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1. achieve adequate dosing
2. treat for adequate duration 3. assess adequacy of response 4. ensure adherence (avoid complex dosing schedules, affordability, side effects) |
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*In depression, what is the phase 4-9 months? beyond one year?
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Remission (--> relapse)
Recovery (--> recurrence) |
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What is combination monotherapy?
Is this common in treating bipolar? |
just using multiple drugs to treat the same problem (depression)
YES! |
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* What are the various monotherapies (pharm treatments) for depression?
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1. SSRIs
2. mixed monoamine reuptake inhibitors (DA, NorEpi, 5HT) 3. monoamine receptor antagonist 3. Tricyclic (TCAs) 4. Monoamine Oxidase Inhibitors (MAO-I's) 5. NMDA (glutamate receptors) antagonists |
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How many depression patients do not respond to any drugs?
how many pts have residual symptoms? |
20-40%
50% |
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* What are the three categories of drugs for bipolar?
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1. Antimanics (Lithium, Clozapine)
2. Antidepressants (Lamotrigine 3. Thymoleptics (mood stabilizers) ... Calcium channel blockers, benzos, others, etc. |
