intro to psychiatry depression and anxiety✅

Psychiatrist

A physician who specializes in the diagnosis and treatment of mental disorders (MD + Residency)

Psychotherapy, Psychopharmacology, Somatic therapies, Lifestyle modification

Psychiatrists treat patient through (4)

DSM-5-TR

dictionary-like descriptor for psychiatric disorders, diagnostic tool

Mental Disorder

a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning

Significant Distress and/or Disability

mental disorders are associated with this in social, occupational, or other important activities

not a mental disorder

An expectable or culturally approved response to a common stressor or loss is

Socially deviant behavior

not mental disorders unless the deviance from normal results from a dysfunction in the individual

Significant Distress and/or Disability

To diagnose a mental disorder the condition must cause

psychotherapies

Involve addressing an individual's thoughts, behaviors, emotions, and relationships through developing insight, changing cognitions and changing behaviors

Pharmacotherapies

Drugs are often symptom specific, not diagnosis specific

Somatic Therapies

Involve stimulating neural circuits

Electroconvulsive therapy, TMS, Deep brain stimulation, Vagal nerve stimulation, Phototherapy

Types of Somatic Therapies (5)

Phototherapy

Form of somatic therapy used to tread seasonal affective disorder

Major Depressive Episode (MDE)

At least five of numbered must be present in 2-week period, and either 1 or 2 must be included (can't be due to substance, or other psychiatric disorder)

Alexithymia

inability to name emotions makes depression diagnosis harder

2/3

chance that a first line antidepressant will work for an individual

50%

likelihood after 1 MDE to have another

80%

likelihood after 2 MDE to have another

Major Depressive Disorder (MDD)

recurrent illness of major depressive episodes

25-30

Avg age of onset for MDD (which can be sudden or gradual)

2-3

MDD is how many times more prevalent if there is a first-degree biological relative who suffers from it

ACES

Negative events that occur in childhood that are associated with increased rates of health conditions, include abuse, neglect, and household, familial, and environmental exposures

Environmental element

There must be an ___ ___ in addition to genetic vulnerability

Medial Prefrontal Cortex, Hypothalamus + HPA Axis, Hippocampus

Brain regions most implicated by major depression, become reduced in volume, likely reflecting impaired neurogenesis

17%

Lifetime prevalence for major depressive disorder (MDD) in adults

women

Lifetime prevalence for major depressive disorder (MDD) in adults is higher for which gender

14.4 Billion/yr

Estimated cost to the Canadian Economy of MDD (people less productive)

reduced signaling (not NT lvls)

Depression is the result of a functional deficiency of noradrenaline (NA) and/or 5-hydroxytryptamine (5-HT, serotonin) at specific synapses in the central nervous system. This "functional deficiency" is caused by

60-80%, 30-40%

Antidepressant Response rates of %, remission %

1yr

Antidepressants should be taken for how long after an MDE

Treatment Emergent Suicidality

patient changes from antidepressants the first week because the patient has increased energy, but mood remains low

MAO inhibitors

allowing the amine neurotransmitters to accumulate within the nerve terminal by preventing their enzymatic breakdown, many side effects

tricyclic antidepressants

Inhibit the active reuptake of NA and 5-HT back into nerve terminals, resulting in an increased functional availability of these neurotransmitter amines at central receptors, many side effects

Selective Serotonin Reuptake Inhibitors

Strong inhibitors of 5-HT reuptake, but unlike the TCAs, they and their metabolites have little effect on NA reuptake into nerve terminals. (First line)

Serotonin-Norepinephrine Reuptake Inhibitors

Inhibit the reuptake of 5-HT and NA from the synaptic cleft (First line)

Electroconvulsive Therapy (ECT)

Used for severe, treatment resistant depression (or with psychotic features) works with antidepressants and antipsychotics, works in 4-6mo. unless used ongoing to prevent relapse

Antidepressants

Useful for the treatment of a number of other disorders, including anxiety disorders, eating disorders, some personality disorders, and chronic pain syndromes.

Anxiety

itself is a normal adaptive response to perceived threats or danger

18%

The 12-month prevalence rate for having an anxiety disorder is around

Panic Disorder

Unpredictable and recurrent attacks of panic characterized by upsetting physical symptoms such as tachycardia, chest pain, sweating, tremor, nausea, and overwhelming sensations of fear or loss of control. (can lead to agoraphobia)

Social Anxiety Disorder

Extreme and persistent anxiety about social situations, leading to avoidance of those situations, or pronounced anxiety attacks on exposure or even on anticipation of exposure to the situation.

Specific Phobias

Clinically significant anxiety provoked by exposure to a specific feared object or situation, often leading to avoidance behaviour.

Generalized Anxiety Disorder

Excessive anxiety and worry, occurring most days for more than six months, with symptoms of motor tension, autonomic hyperactivity, apprehensive expectation, vigilance and scanning.

serotonergic and noradrenergic

Anxiety disorders are thought to be due to overactivity of neural circuits involved in fight/flight/freeze behavior
Mostly involving what synapses (2)

thalamus

hub for interpreting sights and sounds; it takes input and then sends signals to the appropriate part of the cortex

Amygdala

triggers the fear response. It sends signals to the locus ceruleus as well as the hypothalamus and pituitary which active hormonal responses

Hippocampus

stores raw information from the senses along with the emotional tone and links memories to emotional states

locus ceruleus

receives signals from the amygdala and sends signals via noradrenaline to the rest of the body to trigger a classic fear response or flight or fight response.

Antidepressants, Benzodiazepines, Beta-blockers

Antianxiety medications

benzodiazepines

interact with binding sites on the GABA-A receptor and potentiate GABA-mediated increases in chloride permeability