Term
| How to diagnose Major Depressive Disorder ? |
|
Definition
At least 5 of the following 9 for 2 weeks:
S I G E C A P S
Sleep (incr or decr)
Interest (decr)
Guilt (incr)
Energy (decr)
Concentration (decr)
Appetite (incr or decr)
Psychomotor activity (incr or decr)
Suicidal ideation (incr) |
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Term
| How to diagnose manic episode ? |
|
Definition
Distinct period of abnormally and persistently elevated, or irritable mood for 1 week
3 of the following 7 symptoms:
Inflated self-esteem / grandiosity
Decr need for sleep
Talkative
Flight of ideas or racing thoughts
Distractability
Incr in goal-directed activity
Excessive risky activities - unrestrained buying, sexual indescretions, bad business investments
Not a Mixed Episode, Not due to substances or general medical condition, MARKED IMPAIRMENT in life |
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|
Term
| How to diagnose Hypomanic Episode ? |
|
Definition
Mild form of mania
4 days of same symptoms as manic episode
Inflated self-esteem / grandiosity
Decr need for sleep
Talkative
Flight of ideas or racing thoughts
Distractability
Incr in goal-directed activity
Excessive risky activities - unrestrained buying, sexual indescretions, bad business investments
DOES NOT cause impairment, hospitalization or psychotic features |
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|
Term
| What are 3 major mood DISORDERS ? |
|
Definition
Major Depressive Disorder
Bipolar 1 Disorder
Bipolar 2 Disorder |
|
|
Term
| What episodes occur in Major Depressive DISORDER ? |
|
Definition
| Major Depressive Episodes only |
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|
Term
| What episodes occur in Bipolar 1 Disorder ? |
|
Definition
Manic Episodes
and
Major Depressive Episodes |
|
|
Term
| What episodes occur in Bipolar 2 Disorder ? |
|
Definition
Hypomanic Episodes
and
Major Depressive Episodes |
|
|
Term
| Prevalence of Bipolar Disorder ? |
|
Definition
Lifetime prevalence of 4.5%
1% each for bipolar 1 and bipolar 2 |
|
|
Term
| Some other Mood Disorders ? |
|
Definition
Dysthymic Disorder
Cyclothymic Disorder
Reactive Sadness
Bereavement
Mood Disorder due to General Medical Condition
Substance-Induced Depression |
|
|
Term
| What is Dysthymic Disorder ? |
|
Definition
At least 2 yrs
Mildly depressive mood |
|
|
Term
| What is Cyclothymic Disorder ? |
|
Definition
At least 2 years
Cycling b/w mild depression and mild mania |
|
|
Term
| What is Reactive Sadness ? |
|
Definition
Hours to day
Following a MINOR event
Rarely interferes with functioning |
|
|
Term
|
Definition
6 to 18 months
normal response to MAJOR loss
intense sadness, pain
no significant loss of self-esteem
pt relates sadness to loss |
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|
Term
| NE is metabolized by what two things ? |
|
Definition
Metabolized by MAO "intraneurally" to MHPG
Metabolized by COMT "extraneurally" |
|
|
Term
| NE is involved in what things ? |
|
Definition
Mood disorders
Learning and memory
Reinforcement
Arousal
Sleep-wake cycle
Anxiety-Stress-Nociception |
|
|
Term
| Cell bodies containing NE are located where ? |
|
Definition
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|
Term
| Opiates have what effect on Locus Ceruleus ? |
|
Definition
Decrease firing of Locus Ceruleus cells
Locus Ceruleus contains inhibitory opioid |
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|
Term
| Opiates have what effect on Locus Ceruleus ? |
|
Definition
Decrease firing of Locus Ceruleus cells
Locus Ceruleus contains inhibitory opioid |
|
|
Term
| What is called "trauma center" in brain ? |
|
Definition
|
|
Term
| Main function of locus ceruleus is ? |
|
Definition
| To determine the brain's global orientation concerning events in the external world and within the viscera |
|
|
Term
| Function of Amphetamine ? |
|
Definition
| Stimulates release of NE at nerve terminals |
|
|
Term
| What is the "Civilizing Neurotransmitter" ? |
|
Definition
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|
Term
| Another name for Serotonin ? |
|
Definition
|
|
Term
| What are serotonin levels in violently aggressive people and in post-mortem studies of suicides ? |
|
Definition
| Low levels of 5-HT and 5-HIAA (the metabolite) |
|
|
Term
| Serotonin is mostly located in what brain structure ? |
|
Definition
|
|
Term
| Is Serotonin linked to a wide variety of disorders ? |
|
Definition
|
|
Term
| Would you expect side-effects if you manipulate 5-HT synapses ? |
|
Definition
|
|
Term
|
Definition
| A metabolite of NE degradation |
|
|
Term
| What metabolite is raised in mania ? |
|
Definition
|
|
Term
| What two metabolites are reduced in depression ? |
|
Definition
|
|
Term
| What is Monoamine theory of mood disorders ? |
|
Definition
|
|
Term
| What is Permissive Theory of Depression or Serotonin "Preventive" theory ? |
|
Definition
|
|
Term
| Lysergic acid diethylamide (LSD) works how ? |
|
Definition
| Stimulates 5-HT receptors as partial agonist |
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|
Term
| What were the first anti-depressant drugs ? |
|
Definition
| TCAs (Tri-Cyclic-Antidepressants) |
|
|
Term
|
Definition
Some block reuptake of NE and some block
reuptake of serotonin
Both do not differ in clinical potency |
|
|
Term
| What therapies are best for mild and moderate mood disorders ? |
|
Definition
| CBT and interpersonal therapy |
|
|
Term
| Standard trt for Bipolar Disorder ? |
|
Definition
Lithium and anti-convulsants (anti-epileptics)
Prophylactic against mania and depression |
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|
Term
| What is effective trt for SAD ? |
|
Definition
|
|
Term
|
Definition
| Neurogenesis in hippocampus |
|
|
Term
| Vagus Nerve Stimulation is FDA-approved only for what ? |
|
Definition
Epilepsy
But can be used off-label for depression |
|
|
Term
| All anti-depressant meds , plus ECT improves what in depressed animals ? |
|
Definition
Neurogenesis in the hippocampus
probably due to stimulation of BDNF (brain derived neurotrophic factor) |
|
|
Term
| Other drugs which increase hippocampal neurogenesis ? |
|
Definition
Mood stabilizers like lithium
Cognitive enhancers like Galantamine
Anesthetics like Ketamine
Steroids
Statins, Viagra |
|
|
Term
| ECT is now used primarily for what 2 disorders ? |
|
Definition
|
|
Term
| What are the technical parts of ECT ? |
|
Definition
6-12 treatments on alternate days
Muscle paralysant for safety
Respiratory support ready
Short-acting general anesthetic
Unilateral application reduces memory loss |
|
|
Term
|
Definition
Brief post-ictal confusion
Small memory loss
No epilepsy
Low mortality |
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|
Term
| Two possible absolute contradictions ? |
|
Definition
High intracranial pressure
Recent myocardial infarction |
|
|
Term
| Some characteristics of Bipolar Affective Disorder ? |
|
Definition
Has the strongest heritability
Lifetime incidence of 1%
No gender difference |
|
|
Term
| Genetic links in mental disorders are ? |
|
Definition
Multifactorial
Polygenic
Mostly unknown loci |
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|
Term
| Former name of Schizophrenia ? |
|
Definition
|
|
Term
| Another name for unipolar depression ? |
|
Definition
| Major Depressive Disorder |
|
|
Term
| Formula for Heritability (H) ? |
|
Definition
| H = 2 * (MZ Correlation - DZ Correlation) |
|
|
Term
Risk of developing Bipolar Disorder in the following ?
DZ Twins
Children of one affected parent
Children of two affected parents
MZ twin of an affected parent |
|
Definition
DZ Twins 20%
Children of one affected parent 20%
Children of two affected parents 60%
MZ twin of an affected parent 75% |
|
|
Term
Risk of developing Schizophrenia in the following ?
DZ Twins
Children of one affected parent
Children of two affected parents
MZ twin of an affected parent |
|
Definition
DZ Twins 15%
Children of one affected parent 15%
Children of two affected parents 35%
MZ twin of an affected parent 35% |
|
|
Term
| Formula for relative risk ? |
|
Definition
Prevalence of first degree relatives of pts
/
Prevalence in first degree relatives of controls |
|
|
Term
| What mental disorder has the highest relative risk ? |
|
Definition
| Bipolar Affective Disorder |
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Term
| How to diagnose Dementia ? |
|
Definition
Memory loss
and
One or more of following :
Apraxia
Aphasia
Agnosia
Loss of executive function |
|
|
Term
| Memory loss just by itself is diagnostic for what ? |
|
Definition
|
|
Term
| What % of dementia pts need bio-psycho-social management ? |
|
Definition
|
|
Term
| The two main types of dementia are ? |
|
Definition
Vascular (multi-infarct)
DAT (Dementia of Alzheimer's Type) |
|
|
Term
|
Definition
Amyloid plaques and neurofibrillary tangles found post-mortem
Cell death and shrinkage in hippocampus and nucleus basalis of Meynert
Incidence: 1 - 2 % / year over 65 |
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|
Term
| What is MCI (Mild Cognitive Impairment) ? |
|
Definition
Is an early transitional condition
-self-reported memory complaint
-memory performace 1.5 SDs below age norms
-not demented
-ADL (Activities of Daily Living) not impaired
Can ask pt: what did you have for breakfast or how did you get to office today |
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|
Term
| What is Dementia of Depression (formerly called pseudo-dementia) ? |
|
Definition
Occurs a lot in elderly
Depression due to loss or
results from isolation
Very treatable |
|
|
Term
| How to differentiate Dementia from Dementia of Depression ? |
|
Definition
Dementia
-slow onset
-attempt to cover deficit by denial, confabulation or humor
-try to answer questions
-supportive care
Dementia of Depression
-rapid onset
-patient will emphasize/complain about deficits
-respond "I don't know"
-anti-depressants and/or social stimulation |
|
|
Term
| Examples of supportive trt for DAT ? |
|
Definition
Protection as needed (cars, stoves)
"Safe return" program
Maintain social involvement, self-esteem
Power of attorney
Online support groups for care-givers |
|
|
Term
| Medicare pays for what and does not pay for what ? |
|
Definition
Pays for 6 months of hospice care
Pays for skilled nursing care
Does not pay for general nursing homes |
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|
Term
| Negatives to tube feeding ? |
|
Definition
No evidence of proloning life or increase in comfort
May increase discomfort and result in complications
Suggestion: Invite family or medical decision-maker to consider refusal to eat as a decision by the pt |
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|
Term
|
Definition
Disturbance of consciousness only (not memory)
-Often substance induced
-Acute cognitive changes in hours to days
-Rapid shifts of emotion
-Hallucinations, illusions
-*Underdiagnosed* in hospital populations (10% of over 65 are delirious on admission) |
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|
Term
| What disorders are neurological in origin (involve cell death) ? |
|
Definition
Vascular Dementia
DAT
MCI
Delirium |
|
|
Term
| What dementia is not neurological in quality ? |
|
Definition
|
|
Term
| Dissociative disorders are neurological or psychological in quality ? |
|
Definition
Psychological
Are result of trauma or conflict |
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