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158 Cards in this Set
- Front
- Back
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T or F: Crucial life events precede only a small number of cases of depression
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True
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How do clinically effective antidepressants increase neurotransmitter concentrations at postsynaptic receptor sites
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by inhibiting their reuptake from the synaptic cleft
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T or F: Depression is caused by a neurotransmitter deficiency
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True
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What psychological event may precede the onset of endocrine disorders such as hyperthyroidism and Cushing's syndrome
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Emotional trauma
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What 2 endocrine systems are extensively studied in psychology
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hypothalamic-pituitary adrenal axis (HPA) and hypothalamic-pituitary-thyroid axis (HPT)
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Half of pts with major depression exhibit hypersecretion of what steroid which returns to normal once depression is cured
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Cortisol
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What are the most commonly observed psychiatric sx in pts who have adult hypothyroidism
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Depression and cognitive decline
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What thyroid hormone will accelerate the therapeutic effect of various antidepressants in women
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T3 - triiodothyronine
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Administration of TRH (thyrotropin-releasing hormone) has what psychological effect in normal subjects as well as those with psychiatric disease
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increased sense of well-being and relaxation
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What 3 categories is depression divided into
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Depressive sx
bipolar disorder non-bipolar |
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In what population is major depressive disorder 2-3 times as common
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adolescent and adult females
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T or F: in prepubertal children, boys and girls are affected equally with major depression
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True
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What is the cardinal feature of a major depressive episode
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depressed mood or loss of interest or pleasure for at least 2 weeks and causes significant distress or impairment in the social, occupational, or other important areas of functioning
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Suffering from depression and not reporting a depressed mood is referred as:
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Masked depression
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Inability to enjoy usual activities is termed:
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Anhedonia
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Do most pts w/ depression observe an increase or decrease in appetite
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Decrease
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What is the most common sleep disturbance in depression
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Insomnia
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How is insomnia classified in depressed pts
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initial, middle, or late
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What type of insomnia is common in depressed pts with significant comorbid anxiety
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Initial
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Hypersomnia is common in what mood disorders
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atypical depression and seasonal affective disorder
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What is the term for significant loss of energy, seen commonly in depressed inds
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Anergia
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Severe form of depression, commonly seen among the elderly is often called:
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Pseudodementia
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When is risk of suicide highest among depressed inds
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Immediately after initiation of tx and during 6-9 mos period following symptomatic recovery
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During what time of season is SAD most commonly seen
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fall and winter, remitting in spring
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To what type of tx does SAD respond well
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light tx and serotenergic agents (SSRIs)
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T or F: Bereavement is not considered a mental disorder even though it may have sx characteristic of a major depressive episode
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True
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When is antidepressant tx justified in bereavement
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when behavioral sx are prolonged or associated with continued functional impairment
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T or F: effectiveness of antidepressants in young pts is controversial
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True
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How long should antidepressants be administered for continuation tx
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At least 6 months
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When should antidepressant maintenance tx for extended periods of time be considered
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-if pt older than 40 y/o and had 2+ prior episodes of illness
-first episode at age 50+ -Hx of 3+ depressive episodes |
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Slow tapering of antidepressants can be considered after how many yrs of tx if the pt is completely
asymptomatic |
5 years
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What is the most serious side effect associated with MAOI use
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acute HTN crisis
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Metabolism of what dietary amino acid is blocked by MAOIs
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Tyramine
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What sx are seen in pts taking MAOIs with acute hypertensive crisis
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pounding H/A, flushing, and blood vessel distention
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What drug is used to treat acute HTN crisis in pts taking MAOIs
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Phentolamine
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What class of drugs does phentolamine belong to
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alpha adrenergic antagonist
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What types of drugs do MAOIs interfere with
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sympathomimetic amines - pseudoephedrine and phenylpropanolamine
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Coadministration of MAOIs with SSRIs provoke what type of syndrome
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central serotonin syndrome
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Central serotonin syndrome is characterized by what symptoms
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restlessness, diaphoresis, tremor, diarrhea, hyperreflexia
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Central serotonin syndrome usually resolves within what time period
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Within 24 hrs after discontinuation of drugs
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MAOIs should not be started within how many weeks of discontinuation of most SSRIs
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2 weeks
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Coadministration of what 2 drug classes can produce side effects such as delirium and hypertension
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TCAs and MAOIs
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T or F: It is advisable to wait at least 2 weeks after discontinuing TCAs before initiating treatment with MAOIs
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True
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Tricyclic-induced side effects are the result of their binding to what 4 specific and non-specific sites
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-Norepinephrine
-Serotonin -Histamine -Muscarinic |
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What food and drugs must be avoided under all circumstances when taking MAOIs
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-Cheese
-Sauerkraut -Amphetamines -Decongestants |
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What food and drugs SHOULD be avoided when taking MAOIs
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-All fermented or aged foods
-Fermented alcoholic beverages -TCA |
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How could TCAs affect the heart
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induce A-V conduction delays
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Is first degree A-V block a relative or absolute contraindication for TCA intake
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Relative
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Is second degree A-V block a relative or absolute contraindication for TCA intake
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Absolute
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SSRIs selectively block the uptake of serotonin, thereby producing the following symptoms
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-nausea
-anorexia -anxiety -sexual dysfunction |
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What two drugs can manage SSRI induced sexual dysfunction
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-bupropion
-nefazodone |
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T or F: All antidepressants can be displaced by other drugs with similar protein-binding characteristics
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True
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What anticoagulant can be easily displaced by antidepressants
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Warfarin
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Will impairement of hepatic or renal function increase or decrease plasma clearance of
antidepressants |
Decrease
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Will impairement of hepatic or renal function potentiate or diminish effects of antidepressants
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Potentiate
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What % of pts with major depressive disorder respond well to adequate antidepressant drug trial
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60-70%
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List 4 reasons for treatment failure with antidepressants
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-inadequate dose
-inadequate duration -prominent side effects -noncompliance |
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What is the minimum duration of antidepressant treatment
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6 weeks
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When antidepressant treatment truly fails, what alternative approaches may a physician try
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-ECT
-Combining TCAs with MAOIs -Augmentation strategy |
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What are the most effective treatments in augmenting the therapeutic effects of TCAs and may be the most important in triggering or facilitating the acute response to antidepressant
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-Lithium carbonate
-thyroid hormone (T3) -sleep deprivation |
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T or F: Antidepressant effects of one night of wakefulness are immediate
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True
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What 2 psychostimulants may be useful in treating refractory depression, but in a limited way
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-amphetamine
-methylphenidate |
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If psychostimulants are ineffectivce, what is another option in treating refractory depression, which potentially has serious side effects
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combine TCA and MAOI
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Name a TCA and an MAOI commonly combined
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Imipramine and phenelzine
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What is a potential negative effect of combining a TCA and an MAOI
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Hypertensive reactions
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If no other options work, what is the final and highly effective and safe alternative to treating
refractory depression |
Electroconvulsive Therapy (ECT)
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90% of all ECT treatments in the US are performed for the treatment of this disorder
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Major depressive disorder
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Urgent need for a rapid response, history of better response, or strong pt preference are all indications for primary use of this depression therapy
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ECT
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Are there absolute contraindications to ECT?
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No
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T or F: ECT cannot be used safely in pregnant and elderly pts
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False, it CAN be used
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T or F: The overall mortality rate of ECT is extremely low
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True
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T or F: There is a relationship between ECT and brain damage
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False, NO relationship
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T or F: Temporary cognitive changes occur with the use of ECT
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True
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All pts experience this state lasting few minutes to a few hours after ECT
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Postictal confusion
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T or F: Avoidance of cognitive demands during acute postictal period, after ECT, is usually all that is necessary for treatment
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True
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Postictal sedation with short-acting benzodiazepine such as ___ may be necessary if pt becomes agitated after ECT
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Midazolam
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Is Interictal confusion during the ECT therapy common or uncommon phenomenon
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uncommon
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Name the two types of memory impairements that occur with ECT
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-retrograde amnesia
-anterograde amnesia |
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T or F: Small group of pts report that their memory never returned to normal after ECT
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True
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During the seizure and acute postictal period, what two nervous systems are stimulated sequentially
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Sympathetic and parasympathetic autonomic systems
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What cardiovascular complications may arise with ECT
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Transient arrhythmia
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With ECT, most cardiovascular changes are minor and the risk of complications can be diminished greatly by the use of ____
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Oxygen
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A typical ECT course involves how many treatments
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6-12
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Multiple monitored electroconvulsive therapy (MMECT) is a treatment course that induces how many seizures during a single treatment
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2-10
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Is MMECT associated with higher or lower frequency of prolonged seizure activity
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higher
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T or F: MMECT is associated with exaggerated cardiovascular response
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True
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T or F: MMECT is associated with decreased cognitive side effects
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False: increased cognitive side effects
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In the US, most ECT treatments are given how many times a week
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3 (eg: Monday, Wednesday, Friday)
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After the remission of a depressive or manic episode, ECT treatment should be conitinued for how many months
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6-12
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Is there a lifetime maximum number of ECT treatments that a pt may have
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No
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T or F: cumulative amnestic disorders are not usually seen with repeated ECT treatments
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True
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What factor plays a major role in a selection of a particular form of psychotherapy
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patient preference
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T or F: Major depressive disorder may be preceded by dysthymic disorder
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True
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What can serve as a predictor of future course and prognosis of major depression
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number of past episodes
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What is the average number of lifetime episodes of major depressive episodes
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five
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Almost 25% of pts relapse within how many months of remission, especially if discontinued their
antidepressant meds |
6 months
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What factors are more important in triggering the first two depressive episodes, and become less
important in subsequent episodes |
psychosocial stressors
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Name the disorder that "lies on the border between the normal and pathological." Whose symptoms are lower in intensity than in major depression
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dysthymic disorder
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Subsyndromal mood disorder has been applied to what disorder
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dysthymic disorder
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T or F: the protracted course of dysthymic disorder makes it the most commonly encountered form of mood disorder
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True
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Who does dysthymic disorder affect more, men or women?
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women
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Vegetative symptoms such as insomnia, loss of appetite, loss of libido, and weight loss are common presentation of this mood disorder
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Major depressive disorder
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This disorder is characterized by chronic, less severe depressive symptoms
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Dysthymic disorder
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Are vegetative states more or less common in dysthymic disorder
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Less
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What should be the initial treatment of choice for dysthymic disorder
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SSRIs
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In pts who do not respond to SSRIs in dysthymic disorder should be given what two drugs (TCAs)
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imipramine and desipramine
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What type of therapy should be used to address impairments in social and occupational functioning in
dysthymic disorder |
Psychotherapy
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Pure dysthymic disorder is a risk factor for developing the following disorder
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major depressive disorder
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This disorder consists of episodes of mania cycling with depressive episodes
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Bipolar I disorder
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This disorder consists of episodes of hypomania cycling with depressive episodes
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Bipolar II disorder
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Is there a clear association between life events and the onset of manic or hypomanic episodes
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No
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What are key risk factors for developing bipolar disorder
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-being female
-family hx -upper socioeconomic class |
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T or F: Someone who already has bipolar disorder faces an increasing risk of a recurrent manic or
depressive episode |
True
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T or F: bipolar disorders are about equally distributed among males and females, but there are more females with more serious bipolar disorder, esp rapid-cycling bipolar disorder
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True
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T or F: Pure (or monopolar) mania is very rare
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True
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T or F: When pts are manic, they sleep little or not at all
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True
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It is difficult to control an acute manic episode clinically if one cannot control what associated symptom
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Insomnia
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Racing thoughts and flight of ideas are cognitive feature of these episodes:
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Mania
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What drug can markedly attenuate the risk of suicie attempts in bipolar pts
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Lithium
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T or F: Hypomania usually does not present with psychotic symptoms
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True
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By definition, pts with rapid-cycling bipolar disorder experience how many affective episodes per year
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Four or more
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The development of this disease in a manic pt predisposes him/her to a more rapidly cycling course
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clincial or subclinical hypothyroidism
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T or F: no lab findings are diagnostic of bipolar disroder
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True
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Pts suffering from what mood disorder are known to have a blunted TSH response to TRH administration
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Bipolar
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Hypothyroidism is very common in pts with what mood disorder
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Bipolar
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T or F: psychotic features associated with schizophrenia or schizoaffective disorder are easily distinguishable from those associated with acute mania
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False: indistinguishable
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T or F: substance abuse is exceedingly common in bipolar disorder
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True
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T or F: Mood disorders complicated by substance abuse are treated in units especially designed to treat aspects of dual diagnosis
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True
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Acute depressive episodes are treated best with these drugs, because they are less likely to trigger the switch into mania or hypomania frequently caused by TCAs
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-SSRIs
-bupropion |
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Acute manic episodes as well as maintenance treatment of bipolar disorder can be managed with what 3 drugs
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-lithium
-valproic acid -carbamazepine |
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If delusional sx and agitation are present in a manic episode, what drugs can be administered
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antipsychotics - haloperidol
benzodiazepines - clonazepam |
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T or F: General treatment principles of bipolar disorder include optimizing sleep and eliminating mood destabilizrs
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True
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What agents have the propensity to destabilize mood
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-TCAs
-steroids -alcohol -stimulants |
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What are the two indications for administration of lithium
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-acute manic or hypomanic episode
-prevention of further episodes of mania and depression |
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What drug is useful in acute manic episodes
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Lithium
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T or F: Bupropion or SSRIs are least likely to produce hypomanic episodes
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True
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Most clinicians use what other drugs in addition to lithium in the acute phase of mania
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-neuroleptics or
-benzodiazepines |
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Once the acute manic episode is resolved, lithium should be continued for at least how many months
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6-12
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If a depressive episode "breaks through" lithium maintenance treatment, what steps should be taken
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-increase lithium dose
-maximize thyroid function -add SSRI -sleep deprivation or ECT for severe depression |
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Does lithium have a wide or narrow therapeutic window and why
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narrow because of its close association between plasma levels and toxicity
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What are benign side effects of Lithium
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-thirst
-fine tremor |
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What are serious side effects of lithium
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-N/V/D
-coarse tremor -muscle weakness -seizures -coma -death |
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T or F: reduction of lithium will quickly ameliorate acute symptoms
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True
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What cardiac drugs are tremors often responsive to
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-atenolol
-propranolol |
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What 4 side effects of lithium have been most frequently reported
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-thirst
-polyuria -memory problems -tremor |
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T or F: Over the long term, some pts on lithium may experience sick sinus syndrome and therefore
routine monitoring of pt's ECG and pulse is necessary |
True
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If pts do not respond to lithium, which anticonvulsants may be administered
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-carbamazepine
-sodium valproate |
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What is a common side effect of carbamazepine, which requires discontinuation
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Rash
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This anticonvulsant can acutely damage the liver, resulting in marked increase in liver enzymes and
sometimes jaundice |
carbamazepine
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Blood dyscrasias including granulocytopenia and agranulocytosis may be side effects of this anticonvulsant
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carbamazepine
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T or F: Valproic acid may be used in acute management of mania
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True
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T or F: combined use of lithium with either carbamazepine or sodium valproate is common
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True
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When is ECT most useful for manic pts
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when they don't respond to medication
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This disorder is characterized by periods of depression alternating with periods of hypomania which are generally of less severity or shorter duration than those in bipolar I disorder. Changes in mood tend to be irregular and abrupt, occurring within hours of each other
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Cyclothymic disorder
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This disorder is frequently confused with cyclothymic disorder because of its strong affective component with marked shifts in mood
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Borderline personality disorder
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This class of drugs tends to improve the symptoms of ADHD but worsen the mood swings of cyclothymic disorder
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Stimulants
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What is the treatment of choice of cyclothymic disorder
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low dose SSRIs in conjunction with lithium
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what two antidepressants are associated with an increased risk for seizures
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-maprotiline
-bupropion |
