psych midterm

absence of depressed or elevated mood

exaggerated feeling of well-being

joy, euphoria,triumph, intense self-satisfaction

feelings of unpleasantness, discomfort, depressed

pervasive and sustained feeling tone or emotion that is experienced internally

severe reduction in intensity of outward expression

complete absence of outward expression

doesn't reflect actual emotional state

• rapid and easily changing outward expression
• outward expression doesn't match the inward feeling

• reduction in intensity and range of outward expression
• less severe than blunted

• prior episode of depression
• family history
• lack of social support
• stressful life event
• substance abuse
• medical comorbidity

• depressed mood or loss of interest or pleasure for at least 2 weeks plus 4 or more of the following:
• weight loss/gain or decreased/increased appetite
• insomnia or hypersomnia
• psychomotor agitation or retardation
• fatigue or loss of energy
• feelings of worthlessness or excessive/ inappropriate guilt
• decreased ability to think/concentrate or indecisiveness
• recurrent thoughts of death, suicidal ideation or behavior

• presence of one or more major depressive episode resulting in difficulty functioning, can function at "full steam"
• progressive, usually recurrent illness
• suicide is the most serious complication
• may exhibit psychotic features, most commonly auditory hallucinations but no manic episodes

• milder, more chronic than MDD
• 2 years of a depressed mood
• onset is childhood to early adulthood

• 2 subtypes: winter depression/fall onset or spring onset
• increased sleep and appetite, weight gain, irritability and interpersonal conflict, feelings of heaviness in the extremeties

• frequent normal experience after delivery of a baby
• symptoms begin approx 1 day after delivery, peak within 3-7 days and amy disappear without treatment
• if they continue past 4-6 weeks after delivery, start thinking about MDD

meets criteria for major depressive episode with onset within 4 weeks of delivery

• psychotic episode within 3 weeks of delivery, up to 8 weeks
• medical emergency that requires immediate treatment
• may have no history of psychosis in their past
• may have past trauma, possibly repressed

• initial symptoms: sleep changes, social withdrawal
• less likely to experience psychosis
• more likely to manifest as anxiety or somatic symptoms, they dont have the words to describe what they are feeling
• para-suicidal risk behaviors- want to see who will care if they get hurt/die
• risk of suicide mortality increases with age

• 8 to 20% of older adults
• 37% in primary care setting
• treatment is successful in 60-80% but response is slower, slower metabolism makes meds take longer to work
• associated with chronic illness and medical side effects
• highest suicide rate: use more lethal means, bodies have harder time compensating, meds can complicate

when we are deciding on medication, titrating dose upward, looking for any side effects or problems

• 6-9 months after acute phase, trying to prevent relapse
• patient needs to be aware that they need to stay on their meds the whole time

can continue some meds indefinitely, may be lifelong for some patients

• need to look at several factors
• patient preference, severity and frequency of past episodes, where patients mood has been since remission, euthymic level, side effects, risk/benefit

• well tolerated, first line treatment, less severe side effects as compared to other groups
• prozac
• zoloft
• luvox
• Paxil and Paxil CR
• Celexa

• oldest meds, work on serotonin, norepinephrine and acetlycholine
• not used much as too side effects, lethal in overdose, not well tolerated
• Norpramin
• elavil
• Pamelor
• Tofranil

• dual action agents, second line drugs, can increase BP
• effexor
• Pristiq
• Cymbalta

• usually reserved for treatment resistant depression, failed other meds
• MAO breaks down serotonin, dopamine, acetlycholine, tyromine
• 2 week washout period btw SSRIs and MAOIs admin
• Nardil
• parnate
• marplan
• eldepryl

• nefazodone: works on serotonin, no sexual side effects
• trazodone: works on serotonin, weak but good for sleep structure
• wellbutrin: contraindicated in seizure disorders, also used for smoking cessation, cant co-admin with zyban, works on dopamine
• remeron: very sedating, stimulates appetite, use caution in elderly b/c of sedation

• stimulator device implanted in the chest, sends electrical impulses to left vagus nerve
• does not induce seizures, thought to stimulate serotonin and norepinephrine to provide anti-depressants
• only for patients whose depression has not responded to 4 other treatments

• magnet places close to head, creates current that excites neurons in the brain
• thought to work on GABA, glutamate and dopamine
• FDA approved for patients who has failed treatment with one anti-depressant, much less invasive

combination of manic or mixed episodes and major depressive episodes

episodes of major depression and hypomania

• mild form of bipolar II
• 2 years of numerous periods of hypomania and relatively mild depressive symptoms that dont meet the criteria for major depressive episodes

• distinct period of abnormally and persistently elevated, expansive or irritable mood lasting at least 1 week ( or any duration if hospitalization is necessary)
• 3 or more of the following:
• inflated self-esteem or grandiosity
• decreased need for sleep
• more talkative than usual or pressure to keep talking
• flight of ideas or subjective experience that thoughts are racing
• distractability
• increase in goal-directed activity or psychomotor agitation
• excessive involvement in pleasurable activities that have potential for painful consequences

• criteria for both manic episode and major depressive episode are met nearly every day during at least a 1 week period
• mood disturbance is sufficiently severe to cause marked impairment in occupational or social functioning or to require hospitalization
• symptoms are not due to direct physical effects of a substance, illegal or medications

• characterized by intense rage episodes for 2-3 hours
• symptoms reflect developmental level of child
• often have other psychiatric disorders
• rare, often overdiagnosed

• more neurological abnormalities and cognitive disturbances
• late onset bipolar disorder only recently recognized
• poorer prognosis

• affected equally
• females at greater risk for depression and rapid cycling
• males at greater risk for manic epsiodes

• lithium carbonate: monitor thyroid and renal function
• depakote: concerned with hepatotoxicity, pancreatitis
• tegretol
• lamictal
• tripeptal
• neurontin
• topamax: cognitive side effects, weight loss

• antidepressants: for depressive phases, can trigger mania, only use if on therapeutic dose of a mood stabilizer
• antipsychotics: for psychosis, mania, lower dosages, for acute and maintenance
• benzos: short term for agitation, sleep aid, can be addicting