Depression and the Pharmacology of Antidepressant Drugs Flashcards: Set 1

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Four major categories of psychosis:Confusional-delirious states, psychosis associated with focal or multifocal cerebral lesions, bipolar and depressive psychoses, and schizophrenia. These classifications were developed from a neurological point of view.
Most frequent of all psychiatric illnesses:Depression in its varied forms.
Depression in psychiatric consultations:About 50% of all psychiatric consultations relate to depression and about 12% of admissions.
Descriptions of depression:Depression may be thought of those a complex of disturbed feelings-mood or affective disorder. These feelings may include a sense of worthlessness, hopelessness, despair, as well as thoughts of self-harm. Depression may also be associated with reduced energy and libido, reduced ability to concentrate, decreased interest in personal affairs and additional behavioral abnormalities. Furthermore, physical complaints accompany depression including  insomnia, anorexia or overeating, headache, regional pain.
Depressive symptoms of psychotic proportions:Paranoid or somatic delusions having chaotic effects on patient's life and the lives of those close to the patient.
Frequency of elevated mood or mania:About one-third as frequent as depression.
Mania that alternates with or is "intertwined" with depression:Manic-depressive disease a.k.a. bipolar disorder in the classification of DMS-IV (Diagnostic and Statistical Manual of Mental Disorders). Mania may also be seen as a relatively pure but recurrent clinical state.
Hypomania and cyclothymic disorder:These disorders described milder forms of mania and bipolar disorder respectively.
Mixed schizoaffective state:According to DSM-IV a mixed schizoaffective state refers to a combination of depression and schizophrenia.
Dementia and depression:Developing dementia may present as depression; furthermore, a masked depression which causes difficulty in thinking and memory (a.k.a. pseudodementia) tends to be the more common of the two.
Patients and their reaction to a medical or neurological illness:Such individuals may express both sadness and despair along with physical manifestations that can include headaches, loss of appetite, fatigability, anxiety, and sleep disorders. The symptoms in association with medical disease may suggest a depressive reaction.
Major medical illness and depressive symptoms:Various major medical illnesses are frequently accompanied by depressive symptoms.
Examples of chronic and occult diseases which present with symptoms suggestive of depression:Hypothyroidism, hepatitis, myeloma, lymphoma, infectious mononucleosis, metastatic carcinoma, polymyalgia rheumatica are some examples.
Drugs which may induce a depressive reaction:Sedative-hypnotic agents, ß-adrenergic antagonist, ß-interferon, and phenothiazines. Corticosteroids may cause a psychiatric state consisting of a combination of confusion and insomnia with either mood elevation or depression.
Reactive depression and receiving news of a serious medical or neurological disease:Reactive depression in this setting may be the dominant disease manifestation threatening both the life pattern and patient independence. Some degree of reactive depression is expectable when the patient receives a diagnosis of stroke, Parkinson's disease, multiple sclerosis, cancer and other serious illnesses.
Depression and myocardial infarction (heart attack):Depression in the setting may begin towards the end of the patient's hospital stay and may go unnoticed. However, at home the main complaint may be fatigability approaching exhaustion that interferes with both normal life activities and rehabilitation. Other symptoms include irritability, anxiety and despondency. Another set of somewhat less common presentations are represented by insomnia, aimlessness and boredom.
Depression and stroke:Severity of post stroke depression may be most closely correlated with the extent of motor and language dysfunction. Some studies have suggested that greater frequencies and severities of depression may be found with particular lesion locations.
Depression in Parkinson's disease: Depression is a complication of Parkinson's disease in about one in four patients (25%). Weakness and fatigability present not only as depressive symptoms but also as symptoms of motor dysfunction. Both in Parkinson's disease and in Lewy-body disease, L-dopa, a drug used in disease management, may induce depression some patients. L-dopa-induced depression may also include suicidal tendencies, psychotic episodes, and paranoid ideation.
Huntington's chorea and depression:Huntington's disease is frequently associated with depression, with the depression presenting prior to movement disorder and dementia.
Alzheimer's disease and dementia:Alzheimer's disease may present with depressive symptoms. When this presentation occurs early in the disease the relative contributions of the mood disorder and dementia may be difficult to determine. In later stage Alzheimer's disease, depressive symptom presentations tend to diminish.