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MOOD DISORDERS
Adjustment disorder VS MDD VS Dysthymia
Adjustment disorder
Occur within 3 months of the stressor onset (biological or
psychosocial)
Symptoms not more than additional 6 months once stressor
terminates
Involve symptoms and levels of disability and handicap+
marked distress more than normally expected
Symptoms must not represent bereavement (depressed
symptoms begin 2/12 of loss of loved one and dont go
TX ANTIDEPRESSANTS
SSRI
5HT1A: antidepressant, anxiolytic
5HT2: agitation, akathisia, anxiety, insomnia, sexual dysfunction (SE
of SSRI)
5HT3: GIT SE (nausea, diarrhea), headache
Dont use with TCA, MAOI: serotonin toxicity
TCA
-nonselective reuptake inhibitor of NA/5HT
-NA: mostly used to improve biological symptoms: retardation, loss
of appetite, loss of libido, drive to do things
-5HT: more of the emotional aspect
-not used in <16yo (lower therapeutic range increase chance of
OD)
-main SE: anticholinergic (dry mouth, blurred vision, constipation etc
SNRI
SSRI+SNRI
MAOAI: moclobemide
-competitively reversibly inhibit MAOA, increase level of 5HT and NA
and Dopamine
- Dopamine: pleasure, sex, psychomotor activity
MAOI:
-Inhibit MAOA, B, irreversible
-Avoid tyramine (Cheese, marmite, alcohol)HTN crisis as intestinal
MAO inhibited, causing tyramine absorption (sympathomimetic)
*Remember most take 2 weeks to work
May have initial worsening of symptoms because initially when
presynaptic symptoms exposed to increased 5HT/NA will act to
decrease its release, but eventually the constant exposure will
cause downregulation of these presynaptic receptors
presynaptic 5HT1B, 2A: decrease 5HT release
presynaptic alpha2 receptors: decrease NA release
Mirtazapine: block presynaptic Alpha2 receptors, increase
adrenergic transmission, indirectly increase serotonergic
transmission as remove block of postsynaptic 5HT receptors
TX NON PHARMACOLOGICAL: Psychoeducation, CBT, MDT Support
TX FOR SEVERE: ECT/ TMS, may be good for those with psychotic
features etcccc, not too important to know at all
Dysthymia
Chronic low grade depressive symptoms
PSYCHOTIC ILLNESSES
Positive symptoms (mesolimbic DA hyperactivity)
Hallucinations, delusions, disorganized
thinking/speech/behavior/formal thought disorder (loss of normal
flow of thinking seen in speech and writing, tangentlity, loose
association, incoherence)
Negative symptoms (mesocortical DA deficit)
Avolition, self neglect, blunted affect, alogia, social withdrawal,
poverty of thought)
Important definitions
Delusions: False idea about reality
Hallucination: False perception about reality
Brief psychotic disorder:
- >1 week, <1month
- Positive symptoms of schizo predominate
- Proceed from a clearly identifiable psychosocial stress
Schizophreniform disorder:
- Acute, rapid onset, no prodromal period
- Features schizo but shorter (resolved in less than 6 months,
but at least 1 month duration)
- Unlikely to suffer decreased social and occupational
functioning