Term
| Typical (or melancholic) depression- |
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Definition
| is characterized by early morning awakening (5:00am with inability to return to sleep), decreased appetite with weight loss, social disengagement. Typical depression generally responds well to Selective serotonin reuptake inhibitors (SSRIs) |
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Definition
(actually more common than typical) which is characterized by neurovegetative signs that are the reverse of those seen in typical depression. Patients hypersomnia and increased appetite, high-fat/ high-carbohydrate “comfort foods”, sensitive to criticism.
Unlike typical depressed patients; they are capable of feeling brief periods of pleasure, pleasure seeking behavior (overeating or shopping)
MAOIs are effective for this group but are 2nd 3rd line agents due to adverse effects
Most effective medications for this groups is *buprioion, venlafaxin and stimulant *methylphenidate |
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Definition
| is the least common subtype and often most severe and disabling. SSRIs and anti-psychotics are considered 1st line agents for this subtype but patient may undergo electroconvulsant therapy if symptoms are refractory to 1st line agents |
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Term
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Definition
Initial phase of tonic-clonic seizure is associated with a sudden loss of GABA input, which leads to a long train of firing lasting for several seconds
Sustained rapid firing clinically manifest as contraction of both agonist and antagonist muscles, and referred to as the tonic phase
As GABA-mediated inhibition begins to be restored, AMPA-mediated and NMDA-mediated excitation begins to oscillate with the inhibitory component.
This oscillation pattern ( involving the motor cortex) causes shaking movements of the body or the clonic phase.
Eventually, GABA-mediated inhibition prevails and the patient becomes flaccid and remains unconscious until normal brain function returns |
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Term
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Definition
are associated with activation of the T-type calcium channel during the awake state
Activity of the T-type calcium channels in the relay neurons (connecting thalamus to cortex) is essential to the 3-per second spike and wave activity observed in absence seizures
Due to the pathophysiologic role of the T-type calcium channels, this channel is targeted pharmacologically for treatment of absence seizures. |
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Term
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Definition
| paroxysmal activity begins in a seizure focus (purple) and spreads to adjacent areas via diffuse neuronal connections. When activity is confined to one region of the cortex that serves a basic function, such as motor movement or sensation, and there is no change in the patient’s mental status, the seizure is referred to as a focal seizure without altered mental status. Seizures that involve brain regions serving more complex functions such as language, memory, and emotions are referred to as focal seizures with altered mental status. |
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Term
| secondary generalized seizure |
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Definition
| paroxysmal activity begins in a focus but then spreads to subcortical areas. Diffuse connections from the thalamus then synchronize the spread of activity to both hemispheres. |
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Term
| Primary generalized seizures |
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Definition
| such as the absence seizure, result from abnormal synchronization between thalamic and cortical cells (see Fig. 15-5B) or from neuronal networks that rapidly involve the bilateral hemispheres. |
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