Chapter 16:Emotional and Mood Disorders

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  1. What is psychotic depression?
    It is characterized by the expression of intense mood shifts and unusual behaviors. Depressions and loss of contact with reality, hallucinations, delusions, and disorganized speech patterns are the behaviors observed.
  2. What sort of therapy may be performed if the patient suffering from the mood disorder is unresponsive to pharmacotherapy and has serious and life threatening symptoms?
    ECT (electroconvulsive therapy)
  3. ECT therapy is associated with serious complications, including seizure activity and anesthesia.

    True or False?
  4. In general, how do antidepressants treat depression?
    By enhancing mood.
  5. What exactly does the term mood encompass?
    feelings of phobia, obsessive-compulsive behavior, anxiety, and panic; thus, antidepressants, which improve mood, are used for these disorders as well.
  6. Antidepressants are effective at treating pain, but only if the patient has major depressive disorder accompanying their pain.

    True or False?
    • False
    • Antidepressants are effective in treating physiological and psychological aspects of pain, especially in patients without major depressive disorder: such as when people with debilitating disorders like fibromyalgia have associated mood symptoms.
  7. What black box warning must be included with all packages of antidepressants?
    It is an advisory to closely monitor adults and children taking antidepressants for warning signs of suicide, especially at the beginning of treatment and when doses are changed.
  8. ____ are named for their three ring structure and largely replaced the MAOIs.
  9. Tricyclic antidepressants can be used to treat childhood enuresis (bed wetting).

    True or False?
  10. How to TCAs (Tricyclic Antidepressants) work?
    By inhibiting the presynaptic reuptake of both norepinephrine and serotonin.
  11. What serious side effects can occur when taking TCAs? Why do these occur?
    • The most common side effect is hypotension due to alpha1 blockade on blood vessels.
    • The most serious adverse effect occurs when TCAs accumulate in the cardiac tissue -- although rare, cardiac dysrhythmias can occur.
  12. Tricyclics have a short-half life: for this reason, sedation effects are usually limited to the beginning of pharmacotherapy with these drugs.

    True or False ?
    • False
    • Tricyclics have a long half life. Sedation is usually only experienced initially because patients become tolerant to the effect after several weeks of treatment.
  13. What kind of side effects can a patient on Tricyclic antidepressents expect to experience?

    Anticholinergic effects like dry mouth, constipation, urinary retention, excessive perspiration, blurred vision, tachycardia
  14. What are the drugs of choice in the treatment of depression? Why? How do they work?
    SSRIs (Selective serotonin reuptake inhibitors); they have a more favorable side-effect profile than the MAOIs or the TCAs; They slow the reuptake of serotonin by the presynaptic nerve terminals
  15. This neurotransmitter is important for cycling between REM and NREM sleep, pain perception, and emotional states.

  16. Serotonin is metabolized to a less active substance by the enzyme ______.
    Monoamine Oxidase (MAO)
  17. What is the chemical name of serotonin?
    5-hydroxytryptamine (5-HT)
  18. Why does the mechanism by which SSRIs enact a change in the action of serotonin? (Describe the pre and post synaptic terminals)
    More serotonin in the synaptic gap induce the presynaptic receptors to be less sensitive (reducing their uptake) and the postsynaptic receptors to become more sensitive.
  19. SSRIs have a greater efficacy over treating depression than the MAOIs, but are not as effective as the TCAs.

    True or False?

    All three have approximately the same efficacy at relieving depression.
  20. What is the major advantage of the SSRIs over the MAOIs and the TCAs?
    Their greater safety; sympathomimetic effects (increased heart rate and HTN) and anticholinergic effects (dry mouth, blurred vision, urinary retention, and constipation) are less common with this drug class. Sedation is also experienced less frequently.
  21. In general, SSRIs elicit a therapeutic response more quickly than TCAs.

    True or False?
  22. What common symptom of SSRIs are most likely to lead to noncompliance?
    • Sexual dysfunction. Up to 70% of both men and women experience decreased libido and lack of ability to reach orgasm. In men, delayed ejaculation may occur.
    • Weight gain
    • Anxiety, insomnia, nausea, and headache may also occur
  23. Describe the pathogenesis of SES (Serotonin Syndrome).
    • This may occur when the patient is taking another medication that affects the metabolism, synthesis, or reuptake of serotonin along with an SSRI, causing serotonin to accumulate in the body.
    • Symptoms begin as early as 2 hours later or as late as several weeks after initial pharmacotherapy
  24. What can cause SES?
    Concurrent administration of and SSRI with an MAOI, a TCA, or lithium are the most common.
  25. What are the symptoms of SES?
    • Confusion, anxiety, restlessness (mental status changes)
    • hypertension
    • tremors
    • sweating
    • hyperpyrexia
    • ataxia
  26. How is SES treated? What happens if it is left untreated?
    • Conservative treatment involves discontinuing the SSRI.
    • Severe cases may require mechanical ventilation and muscle relaxants.
    • Left untreated, death can occur.
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Chapter 16:Emotional and Mood Disorders
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