4 - mood & psychosis

positively alter:

1. poor self-concept

2. withdrawal

3. mood

4. sleep

5. apetite

6. acitvity

7. become more sociable

8. decreases anxiety

What is the action of antidepressant drugs?

1. Tricyclic antidepressants (TCAs)

2. Selective serotonin reuptake inhibitors (SSRIs).

3. Monoamine oxidase inhibitors (MAOIs).

4. Serotonin-norepinephrine reuptake inhibitors (SNRIs)

5. Atypical antidepressant

What are the main classifications of antidepressants?

• inhibits the reuptake of norepinephrine and serotonin by the pre-synaptic neurons in the CNS.

• Therefore, the amount of time that norepinephrine and serotonin are available to the postsynaptic receptors is increased

What is the mechanism of action of TCAs?

• 10-14 days before therapeutic effects begin.

• Treatment should be maintained for 3–6 months after improvement.

How long do TCAs take to start working?

How long should TCAs be maintained after improvement?

• MDD

• OCD

• ADHD

• Schizoaffective disorders.

What are the indications (استعمالات) of TCAs?

• Tofranil

What are examples of TCAs?

inhibit the reuptake of serotonin at the presynaptic membrane.

What is the mechanism of action of SSRIs?

1. depression

2. anxiety disorders

3. chronic pain

4. PMDD

What are the indications of SSRIs?

1. prozac

2. Zoloft (Lustral)

What are examples of SSRIs?

Because patients must follow a low-tyramine diet to prevent hypertensive crisis.

Why are MAOIs not considered first-line drugs?

1. severe headache

2. stiff neck

3. flushing cold, clammy skin,

4. tachycardia

5. severe nose bleeding

6. dilated pupils

What are the symptoms of hypertensive crisis?

1. Cheddar, mozzarella,

2. chicken liver,

3. chocolate,

4. coffee,

5. colas,

6. alcoholic beverages.

Which foods contain tyramine?

Nardil

Give an example of an MAOI medication.

By inhibiting the reuptake process,

SNRIs prolong the effects of neurotransmitters on the postsynaptic neuron.

What is the mechanism of action of SNRIs?

1. Effexor

2. Cymbalta.

Give examples of SNRIs.

• Nefazodone

• Mirtazapine

What are examples of atypical antidepressants?

• non-selective monoamine receptor antagonist,
  

  • يمنع الناقل العصبي من الارتباط بالمستقبل → يقلل نشاط المستقبل

• block postsynaptic receptor 5HT2,

• with only minor effects on amine transporters.

How do Nefazodone and Trazodone work?

• BOTH:

1. sedation due to blockage of H1 receptor يحجب الهيستامين = انخفاض الهيستامين = خمول

2. dizziness and orthostatic due to (α1 blockage) الدوار و انخفاض الدم عند الوقوف

• Nefazodone:

1. Hepatotoxic

What are the adverse effects of Nefazodone and Trazodone?

ماهي الاثار الضارة ؟

both are safe in overdose unlike TCS

what are the advantages of Nefazodone and Trazodone?

• Mirtazapine blocks presynaptic α2 receptors,

• increasing both 5-HT and NE release,

• also blocks 5-HT2 receptors. = less anxiety - enhance sleep

هذا المستقبل يقلل النواقل العصبية = الميرتازابين يحجبه بالتالي النواقل العصبيه تفرز

ويحجب مستقبل السيروتونين المسؤول عن القلق و النوم

What is the mechanism of action of Mirtazapine?

Bupropion inhibits the reuptake of dopamine and norepinephrine.

How does Bupropion work?

1. Both drugs have a low incidence of sexual dysfunction (unlike SSRIs)

2. low risk of hepatic drug interactions. نادرا ما يتفاعل مع ادويه الكبد

What are the clinical advantages of Mirtazapine and Bupropion?

IPT is based on the idea that depression is closely tied to interpersonal problems.

What is the main principle of Interpersonal Psychotherapy (IPT) for depression?

1. role transitions

2. interpersonal conflicts,

3. bereavement

4. interpersonal isolation

What are the core interpersonal problems addressed in IPT?

The therapist and patient focus on one or two issues.

• to identify feelings,

• make important decisions,

• implement changes to resolve related problems.

How does IPT help patients resolve interpersonal problems?

• usually brief 16 session

• Focus: examining social relationships with important people in the patient’s life.

  • partner

  • friends

  • family

  • co-workers

What is the typical duration and focus of this type of IPT therapy?

• The goal is to identify the role these relationships play in the patient’s life.

• Find ways of resolving conflicts.

What is the main therapeutic goal regarding these relationships in IPT

1. مناقشة المشكلات البينية (Discussing interpersonal problems) لفهم جذورها.

2. استكشاف المشاعر السلبية (Exploring negative feelings) وتشجيع التعبير عنها لتخفيف الضغط النفسي.

3. تحسين التواصل اللفظي وغير اللفظي (Improving verbal and nonverbal communications) لضمان تواصل فعال مع الآخرين.

4. حل المشكلات (Problem solving) لإيجاد حلول عملية للمشكلات البينية.

5. اقتراح سلوكيات جديدة ومرضيّة أكثر (Suggesting new and more satisfying modes of behaviour) لتعزيز الصحة النفسية.

What are the techniques that are involved in IPT?

• effective in relieving Major Depressive Disorder (MDD)

• prevents relapse when continued after recovery.

What evidence supports the effectiveness of IPT?

1. Dynamic Interpersonal Therapy (DIT)

2. Metacognitive Interpersonal Therapy (MIT)

What are the types of IPT?

• Psychodynamic Interpersonal Therapy,

• type of IPT for depression that integrates psychodynamic principles.

What is Dynamic Interpersonal Therapy (DIT) and its alternate name?

better understand his own thoughts and feelings, as well as the thoughts and feelings of others.

What is the main purpose of DIT?

DIT generally consists of 16 sessions over the course of five months.

How many sessions does DIT usually involve and over what period?

• integrative approach to address personality disorders

by helping clients (therapeutic goal):

1. understand and regulate emotions

2. recognize and modify maladaptive thinking and behavior.

What is Metacognitive Interpersonal Therapy (MIT)?

A 12-week study found that engaging in MIT helped

1. reduce depression symptoms

2. improve the ability to identify emotions.

What evidence supports the effectiveness of MIT in depression?

true

CT (cognitive therapy) is based on the idea that depression is caused by negative schemas and cognitive biases, which lead to maladaptive thinking patterns. ✅❌

1. Helps change opinions about the self.

2. Encourages seeking evidence against overgeneralizations. (such as abilities that the person is overlooking)

3. Teaches monitoring of self-talk and recognition of depression.

4. Helps the person identify and challenge negative beliefs.

5. Learn strategies that promote making realistic and positive assumptions.

What is the main therapeutic goals and techniques of cognitive therapy?

Clients are often asked to

1. monitor their thoughts each day

2. Practice challenging overly negative thoughts.

What daily practice is often assigned to clients in cognitive therapy?

people are encouraged to engage in pleasant activities that might bolster positive thoughts about one’s self and life.

What is Behavioural Activation (BA) in Cognitive Therapy?

true

More than 75 randomized controlled trials have shown that cognitive therapy is effective in relieving symptoms of Major Depressive Disorder (MDD).✅❌

• MBCT is an adaptation (تعديل) of Cognitive Therapy

• focuses on relapse prevention after successful treatment for recurrent episodes of major depression.

What is Mindfulness-Based Cognitive Therapy (MBCT), and what is its main focus?

viewing thoughts merely as “mental events”

rather than

as core aspects of the self or accurate reflections of reality.

What is the "de-centered" perspective taught in MBCT?

use in MBCT to practice a decentred perspective.

A person might say to themselves: “Thoughts are not facts” and “I am not my thoughts.” what is this person using?

• depression and anxiety disorders,

• Cognitive-Behavioral Therapy (CBT)

Because cognitive therapy and behavioral therapy work well together to treat (-&-) the two are often combined in an approach called?

false, (CBT) targets both maladaptive thought patterns and behaviors that contribute to depression.

CBT focuses only on behaviors and ignores negative thought patterns in the treatment of depression.✅❌

To track the events of the week and any self-defeating or negative reactions,

• helping to identify habitual negative response patterns. (automatic negative reactions)

Why might a therapist ask a client to keep a journal in CBT?

practicing positive self-talk

How does CBT help clients develop new ways of thinking and responding?

true

CBT sessions are often accompanied by "homework," which may include

• keeping a journal,

• practicing relaxation activities,

• completing readings,

• using worksheets focused on specific goals.

✅❌

a type of CBT aimed at

1. teaching people how to live in the moment,

2. develop healthy coping strategies,

3. regulate emotions,

4. improve relationships with others.

What is Dialectical Behavior Therapy (DBT), and what is its main focus?

1. group sittings

2. individual therapy

3. phone coaching

In how many therapeutic settings is DBT used, and what are they?

• developing mindfulness skills, perhaps the most important strategy in DBT,

• which helps focus on the present or "live in the moment."

What is “Core Mindfulness” in DBT and why is it important?

• thoughts

• feelings

• sensations

• impulses

What internal aspects does mindfulness help a person focus on?

use senses to tune into what’s happening around them (seeing, hearing, smelling, and touching) in nonjudgmental ways.

How does mindfulness help with external focus in DBT?

Nonjudgmental awareness means noticing experiences as they are without labeling them as good or bad, promoting balanced and calm responses.

What is meant by nonjudgmental awareness in mindfulness?

a skill that helps the patient become more assertive in relationships while keeping relationships positive and healthy.

What is Interpersonal Effectiveness in DBT?

1. saying "no",

2. effective listening and communication,

3. dealing with challenging people,

4. respecting oneself and others.

What key skills does Interpersonal Effectiveness teach in DBT?

By recognizing and coping with intense negative emotions (e.g., anger),

• It reduces emotional vulnerability.

• promotes more positive emotional experiences.

How does Emotion Regulation help with intense negative emotions?

true

Depression is often tied to relationship problems, including marital and family distress.✅❌

false. family therapy

approach is most useful when it is necessary to work on dynamics within the family group.

this approach is called group therapy✅❌

teend and children

Family therapy can be especially helpful for who?

false, group therapy

generally involves anywhere

• from 3 to 15 people.

• It offers everyone the opportunity to give and receive group support in coping with their particular issues

• gives therapists the chance to observe how participants interact in group settings.

this approach is called family therapy✅❌

less expensive than individal therapy

what is the advantage of group therapy?

true

Psychoanalytic therapists spend considerable time listening to patients’ life narratives, which is why the approach is often called the "talking cure."✅❌

false, they seek patterns or significant life events that may contribute to the patient’s current difficulties.

Psychoanalytic therapy ignores life events and patterns, focusing solely on current symptoms.✅❌

true

Psychoanalysts believe that childhood experiences and unconscious feelings, thoughts, and motivations influence mental illness and maladaptive behaviors.✅❌

1. free association,

2. exploration of transference,

3. observing defenses and feelings patients may not be aware of,

4. dream interpretation.

What additional techniques are used in psychoanalytic therapy?

1. temporary amnesia - memory loss

2. Headache,

3. nausea,

4. muscle tension.

what is the side effect of ECT on patients?

1. when there is resistance for medication and psychological therapies (resistant depression)

2. suicidal depression patients

3. mania

ECT is used with who?

true

ECT is considered an important option in the treatment of psychiatrics illnesses including severe depression✅❌