psych midterm

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psych midterm
2010-09-15 22:04:49
mood disorders

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  1. euthymic
    absence of depressed or elevated mood
  2. expansive
    exaggerated feeling of well-being
  3. elated
    joy, euphoria,triumph, intense self-satisfaction
  4. dysphoric
    feelings of unpleasantness, discomfort, depressed
  5. mood
    pervasive and sustained feeling tone or emotion that is experienced internally
  6. blunted affect
    severe reduction in intensity of outward expression
  7. flat affect
    complete absence of outward expression
  8. inappropriate affect
    doesn't reflect actual emotional state
  9. labile affect
    • rapid and easily changing outward expression
    • outward expression doesn't match the inward feeling
  10. restricted or constriction affect
    • reduction in intensity and range of outward expression
    • less severe than blunted
  11. risk factors for major depressive disorder
    • prior episode of depression
    • family history
    • lack of social support
    • stressful life event
    • substance abuse
    • medical comorbidity
  12. criteria for major depressive episode
    • 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
  13. major depressive disorder
    • 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
  14. Dysthymic Disorder
    • milder, more chronic than MDD
    • 2 years of a depressed mood
    • onset is childhood to early adulthood
  15. Seasonal Affective Disorder
    • 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
  16. Post Partum or Maternity Blues
    • 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
  17. Post Partum Depression
    meets criteria for major depressive episode with onset within 4 weeks of delivery
  18. Post partum Psychosis
    • 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
  19. depression in children
    • 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
  20. depression in elderly
    • 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
  21. acute phase of pharmacologic interventions
    when we are deciding on medication, titrating dose upward, looking for any side effects or problems
  22. continuation phase of pharmacologic intervention
    • 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
  23. maintenance phase of pharmacologic intervention
    can continue some meds indefinitely, may be lifelong for some patients
  24. discontinuation phase of pharmacologic intervention
    • 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
  25. SSRIs
    • well tolerated, first line treatment, less severe side effects as compared to other groups
    • prozac
    • zoloft
    • luvox
    • Paxil and Paxil CR
    • Celexa
  26. Tri-cyclics
    • 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
  27. SNRIs
    • dual action agents, second line drugs, can increase BP
    • effexor
    • Pristiq
    • Cymbalta
  28. MAOIs
    • 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
  29. Atypical antidepressants
    • 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
  30. Vagus nerve stimulation therapy system
    • 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
  31. transcranial magnetic stimulation
    • 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
  32. Bipolar I
    combination of manic or mixed episodes and major depressive episodes
  33. Bipolar II
    episodes of major depression and hypomania
  34. Cyclothymic Disorder
    • 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
  35. criteria for manic episode
    • 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
  36. criteria for mixed episode
    • 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
  37. Bipolar disorder in children
    • characterized by intense rage episodes for 2-3 hours
    • symptoms reflect developmental level of child
    • often have other psychiatric disorders
    • rare, often overdiagnosed
  38. Bipolar disorder in the elderly
    • more neurological abnormalities and cognitive disturbances
    • late onset bipolar disorder only recently recognized
    • poorer prognosis
  39. gender differences on bipolar I
    • affected equally
    • females at greater risk for depression and rapid cycling
    • males at greater risk for manic epsiodes
  40. Mood stabilizers
    • lithium carbonate: monitor thyroid and renal function
    • depakote: concerned with hepatotoxicity, pancreatitis
    • tegretol
    • lamictal
    • tripeptal
    • neurontin
    • topamax: cognitive side effects, weight loss
  41. other meds used for bipolar
    • 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