-
euthymic
absence of depressed or elevated mood
-
expansive
exaggerated feeling of well-being
-
elated
joy, euphoria,triumph, intense self-satisfaction
-
dysphoric
feelings of unpleasantness, discomfort, depressed
-
mood
pervasive and sustained feeling tone or emotion that is experienced internally
-
blunted affect
severe reduction in intensity of outward expression
-
flat affect
complete absence of outward expression
-
inappropriate affect
doesn't reflect actual emotional state
-
labile affect
- rapid and easily changing outward expression
- outward expression doesn't match the inward feeling
-
restricted or constriction affect
- reduction in intensity and range of outward expression
- less severe than blunted
-
risk factors for major depressive disorder
- prior episode of depression
- family history
- lack of social support
- stressful life event
- substance abuse
- medical comorbidity
-
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
-
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
-
Dysthymic Disorder
- milder, more chronic than MDD
- 2 years of a depressed mood
- onset is childhood to early adulthood
-
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
-
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
-
Post Partum Depression
meets criteria for major depressive episode with onset within 4 weeks of delivery
-
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
-
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
-
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
-
acute phase of pharmacologic interventions
when we are deciding on medication, titrating dose upward, looking for any side effects or problems
-
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
-
maintenance phase of pharmacologic intervention
can continue some meds indefinitely, may be lifelong for some patients
-
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
-
SSRIs
- well tolerated, first line treatment, less severe side effects as compared to other groups
- prozac
- zoloft
- luvox
- Paxil and Paxil CR
- Celexa
-
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
-
SNRIs
- dual action agents, second line drugs, can increase BP
- effexor
- Pristiq
- Cymbalta
-
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
-
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
-
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
-
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
-
Bipolar I
combination of manic or mixed episodes and major depressive episodes
-
Bipolar II
episodes of major depression and hypomania
-
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
-
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
-
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
-
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
-
Bipolar disorder in the elderly
- more neurological abnormalities and cognitive disturbances
- late onset bipolar disorder only recently recognized
- poorer prognosis
-
gender differences on bipolar I
- affected equally
- females at greater risk for depression and rapid cycling
- males at greater risk for manic epsiodes
-
Mood stabilizers
- lithium carbonate: monitor thyroid and renal function
- depakote: concerned with hepatotoxicity, pancreatitis
- tegretol
- lamictal
- tripeptal
- neurontin
- topamax: cognitive side effects, weight loss
-
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
|
|