Mood & thought disorders

What are neurotransmitters?

Chemicals that enable neurotransmission.

What do neurotransmitters do?

Allow communication between neurons and other cells.

Where do neurotransmitters travel?

Across a synapse.

What can neurotransmitters do to signals?

Block or facilitate relay of stimulus.

What are neurotransmitter problems linked to?

Neurologic and psychiatric disorders.

How many neurotransmitters exist?

Over 200 identified

What are the major neurotransmitters?

Dopamine

Norepinephrine

Serotonin

GABA

What does blocking reuptake do?

Increases neurotransmitter availability.

What type of neurotransmitter is GABA?

Inhibitory

What is GABA dysfunction is linked to?

Anxiety disorders and major depressive disorder

What anxiety disorder is GABA especially linked to?

Panic disorder

What type of neurotransmitter is norepinephrine?

Excitatory

What response is norepinephrine associated with?

Fight or flight response

What does high norepinephrine cause?

Anxiety

Stress

Hyperactivity

What does low norepinephrine cause?

Low energy

Poor focus

Low motivation

Who is more likely to have depression?

Women

Caucasians

Never married status

What disease does depression increase the risk of?

Coronary artery disease

What is depression the leading cause of?

Disability worldwide

What is the definition of major depressive disorder?

Severe depression with significant impairment.

What is persistent depressive disorder?

Chronic, long-term depression (dysthymia).

What is premenstrual dysphoric disorder?

Severe mood symptoms before menstruation.

What is substance-induced depression?

Caused by drugs or medications.

What is postpartum depression?

Depression after childbirth.

What does the diagnosis of depression require?

Multiple symptoms that cause distress

Impaired psychosocial functioning

What are the causes of depression?

Neurobiological

Chemical

Situational

Chronic/acute illness

Medications

What are depressive symptoms?

Loss of interest in activities (Anhedonia)

Fatigue

Irritability/restlessness

Impaired concentration

Low self-esteem

Pessimistic thoughts

Insomnia or hypersomnia

Weight gain or loss

What is the key medication teaching with depression treatment?

Takes weeks to work

What are the treatments for depression?

Psychotherapy

Cognitive behavioral therapy

Support groups

Education

What is advanced treatment for depression?

Brain stimulation therapy

What is the purpose of cognitive behavioral therapy?

To change negative thinking

What is the best treatment approach for depression?

Combination therapy

What are the different types of anxiety disorders?

Panic disorder

PTSD

GAD

Social anxiety disorder

OCD

What is anticipatory anxiety?

Fear of future panic attacks.

What is avoidance anxiety?

Avoiding triggers

What are the causes of panic disorder?

Genetics and stress

What is the childhood stress effect?

It is linked to adult anxiety

What is the effect of stress hormones?

Increased glutamate production

What are panic attacks?

Sudden, unexpected episodes of extreme panic.

Are panic attacks proportional?

No, out of proportion.

What are clinical manifestations of a panic attack?

Palpitations

Chest pain

Shortness of breath

Dizziness

Nausea

Tingling

Chills

Flushing

What is the pysch reaction to panic attacks?

Fear of losing control

What is the first line treatment for panic disorder?

Cognitive behavioral therapy (CBT)

What are the medications to treat panic disorder?

Selective serotonin reuptake inhibitor

Serotonin norepinephrine reuptake inhibitor

TCA

MAOI

What is second line medication treatment for panic disorder?

Benzodiazepines

What is the duration requirement for generalized anxiety disorder (GAD)?

Over 6 months

What is the type of worry for generalized anxiety disorder?

Excessive and uncontrolled

What are the symptoms for generalized anxiety disorder?

Muscle tension

Hyperactivity

Startled

Poor focus

What is the treatment for generalized anxiety disorder?

Cognitive behavioral therapy

Antidepressants

Buspirone

Benzodiazepines

What are the three core symptoms of PTSD?

Hyperarousal

Avoidance

Re-experiencing

What is the trigger for PTSD?

Life-threatening event

What are common symptoms of PTSD?

Flashbacks

Nightmares

Irritability

Startle

Sleep disturbances

Memory issues

Depression

What is the treatment for PTSD?

Trauma-focused CBT

SSRIs, SNRIs

What is the core fear in social anxiety?

The fear of being judged

What is the behavior with social anxiety?

Avoidance

What brain structure is involved with social anxiety?

The amygdala

What is the treatment for social anxiety?

CBT

SSRIs

Benzodiazepines

What medication is commonly used for performance anxiety?

Propranolol

What is OCD composed of?

Obsessions→ repetitive unwanted thoughts

Compulsions→ repetitive behaviors

What is the impact of OCD?

Time consuming, distressing

What is the first line treatment for OCD?

Selective serotonin reuptake inhibitor

What is the second line treatment for OCD?

Tricyclic antidepressant

What are examples of Benzodiazepines?

Xanax, Valium, Ativan.

What is the risk of benzodiazepines?

Abuse potential

What an important precaution for benzodiazepines?

Avoid alcohol and opioids.

What is the antidote for benzodiazepines?

Flumazenil

What is definition of addiction?

A chronic, relapsing disease by compulsive drug seeking and use, despite harmful consequences.

What is the main neurotransmitter effected with addiction & withdrawal?

Dopamine

What is the brain pathways with addiction and withdrawal?

Alters reward pathway

What is the first step of treatment of with alcohol & withdrawal?

Detox

What is the opioid withdrawal timing?

12-24 hours

What is peak opioid withdrawal timing?

72 hours

What are the symptoms of opioid withdrawal?

Flu-like

GI issues

Cravings

What receptor is involved with alcohol/benzodiazepine withdrawal?

GABA

What are symptoms of alcohol/benzodiazepine withdrawal?

Seizures

Delirium tremens

Death

What is the treatment for alcohol/benzodiazepine withdrawal?

Benzodiazepine taper and vitamin B1

What is the first line antidepressants?

SSRIs and SNRIs (safer)

What must always be assessed before starting antidepressants?

Suicide risk

How long before evaluating effectiveness of antidepressants?

4-8 weeks

If antidepressants don't work, what are the options?

Increase dose

Switch drug

Add another drug

What is the MOA of SSRIs?

Block serotonin reuptake=more serotonin available

What are the side effects of SSRIs?

Nausea/Vomiting

Diarrhea

Constipation

Headache

Nervousness

Insomnia

Weight gain

Sexual dysfunction

What is the timing of serotonin syndrome?

2-72 hours after starting

What are the symptoms of serotonin syndrome?

Altered mental status

What increases the risk of serotonin syndrome?

MAOIs and other serotonergic drugs

What are the withdrawal symptoms of SSRIs?

Dizziness

Headache

Tremor

Anxiety

Dysphoria

What is the pregnancy risk with taking SSRIs?

Small risk pulmonary HTN in neonate

Are SSRIs a teratogenic risk?

Very low overall

What is the onset of SSRIs?

3-4 weeks

What medications should you avoid taking with SSRIs?

MAO inhibitors

What are examples of SSRIs?

Fluoxetine

Paroxetine

Sertraline

Citalopram

Escitalopram

What is the MOA of SNRIs?

Block serotonin AND norepinephrine reuptake

What are the side effects of SNRIs?

Nausea

Headache

Anorexia

Insomnia or somnolence

Sweating

Blurred vision

Sexual dysfunction

What is a special lab concern with duloxetine?

Increased liver enzymes (LFTs)

What is the contraindication with SNRIs?

MAO inhibitors

What are examples of SNRIs?

Venlafaxine, desvenlafaxine, duloxetine

What is the MOA of tricyclic antidepressants (TCA)?

Block reuptake of norepinephrine & serotonin

What is the effect of tricyclic antidepressants?

More neurotransmitters in synapse

What is the major TCA warning?

Fatal overdose

What are the side effects of TCAs?

Drowsiness

Orthostatic hypotension

Dry mouth

Constipation

Urinary retention

Sexual dysfunction

Cardiac toxicity

What interaction does TCAs have with MAOI?

Hypertensive crisis