Fear Response Mechanisms
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Questions and Answers

What is the potential implication of over-activation of the direct pathway and poor activation of the indirect pathway in the orbitofrontal cortex?

  • Improved cognition and eye movement control
  • Impaired inhibitory dopaminergic transmission (correct)
  • Enhanced emotional regulation
  • Increased limb and trunk movements

    • Which type of medications has been found to be most effective in treating certain disorders?

  • Muscle relaxants
  • Low-dose SSRIs
  • Dopamine antagonists
  • Higher-dose SSRIs (correct)

    • Which part of the brain is responsible for regulating mood, emotion, appetite, sleep, and various cognitive functions?

  • Raphe nuclei (correct)
  • Hippocampus
  • Locus coeruleus
  • Substantia nigra

    • Which neurotransmitter is involved in the 'fight or flight' response?

    <p>Noradrenaline</p> Signup and view all the answers

    What is the primary function of the putamen?

    <p>Control of limb and trunk movements</p> Signup and view all the answers

    Which nucleus is associated with emotional regulation?

    <p>Nucleus accumbens</p> Signup and view all the answers

    What is the origin of serotonergic neurons?

    <p>Raphe nuclei</p> Signup and view all the answers

    What is the function of the globus pallidus interna?

    <p>More involved with the putamen functions</p> Signup and view all the answers

    What is the clinical significance of dysregulation of noradrenergic pathways?

    <p>Implicated in various psychiatric disorders</p> Signup and view all the answers

    Which neurotransmitter is involved in modulating anxiety, aggression, and impulsivity?

    <p>Serotonin</p> Signup and view all the answers

    Which structure is involved in the connection between the frontal lobe and the basal ganglia?

    <p>Thalamus</p> Signup and view all the answers

    Which of the following is an associated nucleus of the basal ganglia?

    <p>Substantia nigra pars compacta</p> Signup and view all the answers

    What is the origin of dopaminergic neurons?

    <p>Substantia nigra and ventral tegmental area</p> Signup and view all the answers

    What is the function of the pre-frontal cortex in regulating fear responses?

    <p>To exert a 'top-down' control over cognitive responses or behaviours</p> Signup and view all the answers

    What is the function of the subthalamic nucleus?

    <p>Involved with limb/trunk movements, eye movements, and emotional regulation</p> Signup and view all the answers

    What is the clinical significance of imbalances in serotonin levels?

    <p>Implicated in mood disorders</p> Signup and view all the answers

    What is the approximate female to male ratio for anorexia nervosa?

    <p>10:1</p> Signup and view all the answers

    Which of the following is NOT a risk factor for developing an eating disorder?

    <p>History of substance abuse</p> Signup and view all the answers

    Which is a criterion for diagnosing anorexia nervosa?

    <p>all of the above</p> Signup and view all the answers

    Which of the following individuals is at higher risk of developing an eating disorder?

    <p>A gymnast who is concerned about her weight</p> Signup and view all the answers

    What is a characteristic of binge-eating episodes in bulimia nervosa?

    <p>Eating a large amount of food in a short period</p> Signup and view all the answers

    Which of the following is NOT a criterion for diagnosing anorexia nervosa?

    <p>History of substance abuse</p> Signup and view all the answers

    What is the lifetime prevalence of bulimia nervosa in the female population?

    <p>2-4%</p> Signup and view all the answers

    What percentage of the Canadian population experiences bipolar disorder?

    <p>1.5%</p> Signup and view all the answers

    What is the most common state experienced by individuals with bipolar disorder?

    <p>Depressive state</p> Signup and view all the answers

    What is a characteristic feature of manic psychosis in bipolar disorder?

    <p>Delirium</p> Signup and view all the answers

    What is a key difference between bipolar 1 and bipolar 2 disorders?

    <p>Presence of hypomanic episodes</p> Signup and view all the answers

    What is a necessary step in the diagnosis of bipolar disorder 1?

    <p>Exclusion of hyperthyroidism</p> Signup and view all the answers

    How many symptoms of mania are required to diagnose bipolar disorder 1?

    <p>3 or more</p> Signup and view all the answers

    What is the therapeutic mechanism of TCA's?

    <p>Non-therapeutic block of M, alpha 1, and H1 receptors</p> Signup and view all the answers

    Which receptor is primarily involved in the parasympathetic nervous system?

    <p>Muscarinic receptor</p> Signup and view all the answers

    What is the primary function of alpha-1 adrenergic receptors?

    <p>Responding to catecholamines</p> Signup and view all the answers

    Which medication is an example of an SNRI?

    <p>Venlafaxine (Effexor)</p> Signup and view all the answers

    What is the significance of the suffix '-triptyline' in a medication name?

    <p>Indicates a TCA</p> Signup and view all the answers

    What is the primary function of H1 receptors?

    <p>Responding to histamine</p> Signup and view all the answers

    Which medication is an example of a TCA?

    <p>Amitriptyline (Elavil)</p> Signup and view all the answers

    What is the significance of the suffix '-oxetine' in a medication name?

    <p>Indicates an SSRI</p> Signup and view all the answers

    What is implied by phosphocreatine being a reserve for ATP?

    <p>Chronic deficiency in ATP synthesis</p> Signup and view all the answers

    What is a potential consequence of increased glutamate levels in the frontal cortex?

    <p>Increased shift to glycolysis</p> Signup and view all the answers

    What is a potential mechanism for antidepressants addressing their delayed therapeutic effects?

    <p>Modulating glutamate levels</p> Signup and view all the answers

    Which neurotransmitter is related to depression, according to select theories?

    <p>Serotonin</p> Signup and view all the answers

    What is a potential effect of increased glutamate stimulation on neurons?

    <p>Increased glucose consumption</p> Signup and view all the answers

    What is a potential consequence of reduced expression of genes coding for electron transport chain complexes?

    <p>Impaired oxidative phosphorylation</p> Signup and view all the answers

    What is a primary diagnostic criterion for social anxiety disorder?

    <p>Marked and persistent fear of social or performance situations</p> Signup and view all the answers

    What is a characteristic of specific phobia?

    <p>Phobic object/situation is actively avoided or endured with intense anxiety</p> Signup and view all the answers

    What is the minimum duration required for the diagnosis of specific phobia?

    <p>6 months</p> Signup and view all the answers

    What is a common symptom of post-traumatic stress disorder (PTSD)?

    <p>Exposure to actual or threatened death</p> Signup and view all the answers

    What is the prevalence of specific phobia in the general population?

    <p>12-16%</p> Signup and view all the answers

    What is a characteristic of social anxiety disorder?

    <p>Out-of-proportion fear that they will be harshly judged by others</p> Signup and view all the answers

    What is a common risk factor for developing Major Depressive Disorder (MDD)?

    <p>Exposure to traumatic life events</p> Signup and view all the answers

    What is a characteristic of mania?

    <p>Decreased need for sleep</p> Signup and view all the answers

    What is the duration of symptoms required to diagnose hypomania?

    <p>At least 4 days</p> Signup and view all the answers

    What is a cognitive symptom of Major Depressive Disorder (MDD)?

    <p>Slow thinking</p> Signup and view all the answers

    What is a condition that may cause symptoms of mania?

    <p>All of the above</p> Signup and view all the answers

    What is the predicted ranking of Major Depressive Disorder (MDD) as a cause of disability worldwide by 2030?

    <p>2nd leading cause</p> Signup and view all the answers

    What is a physical symptom of Major Depressive Disorder (MDD)?

    <p>Fatigue</p> Signup and view all the answers

    What is a characteristic of bipolar disorder?

    <p>Both depressive and manic episodes</p> Signup and view all the answers

    What is a condition that may cause symptoms of hypomania?

    <p>All of the above</p> Signup and view all the answers

    What is a mood symptom of Major Depressive Disorder (MDD)?

    <p>Feeling sad or low</p> Signup and view all the answers

    What is a common symptom of Major Depressive Disorder (MDD) according to the DSM-5?

    <p>Impaired ability to make decisions</p> Signup and view all the answers

    What is a possible cause of depression according to the Monoamine Hypothesis?

    <p>All of the above</p> Signup and view all the answers

    What is the result of chronic stress on the hypothalamic-pituitary-adrenal (HPA) axis?

    <p>Excess cortisol secretion and pro-inflammatory agents</p> Signup and view all the answers

    What is a critique of the Monoamine Hypothesis?

    <p>Abruptly decreasing serotonin and/or dopamine doesn't cause depression in a healthy person</p> Signup and view all the answers

    What is a characteristic of bulimia nervosa?

    <p>Presence of binge-eating and inappropriate compensatory behaviors</p> Signup and view all the answers

    What is a possible effect of antidepressants on the glucocorticoid receptor (GR)?

    <p>Restoring the functioning of the GR</p> Signup and view all the answers

    What is a characteristic of depression according to the Stress-induced Depression Hypothesis?

    <p>Chronic stress leads to dysregulation of the HPA axis</p> Signup and view all the answers

    What is a potential physical harm associated with anorexia nervosa?

    <p>Vitamin deficiencies</p> Signup and view all the answers

    What is a possible outcome of HPA axis dysregulation?

    <p>Interference with neurogenesis and reduced glutamate and GABA</p> Signup and view all the answers

    What is the mechanism of action of benzodiazepines?

    <p>Facilitating the binding of GABA to GABA-R</p> Signup and view all the answers

    What is a common feature of eating disorders?

    <p>Undue influence of body shape and weight on self-evaluation</p> Signup and view all the answers

    What is a requirement for diagnosing MDD according to the DSM-5?

    <p>The symptoms must cause significant distress</p> Signup and view all the answers

    What is a potential consequence of self-induced vomiting in bulimia nervosa?

    <p>Gastric dilation or rupture</p> Signup and view all the answers

    What is a criterion for diagnosing bulimia nervosa?

    <p>Recurring episodes of binge-eating and inappropriate compensatory behaviors</p> Signup and view all the answers

    What is a potential consequence of fasting in eating disorders?

    <p>Vitamin deficiencies</p> Signup and view all the answers

    What is a characteristic of anorexia nervosa?

    <p>Recurring episodes of fasting or calorie restriction</p> Signup and view all the answers

    What is a key feature of psychosis?

    <p>Loss of insight into reality</p> Signup and view all the answers

    Which condition is characterized by an acute, fluctuating change in attention and consciousness?

    <p>Delirium</p> Signup and view all the answers

    What is a possible symptom of a Depressive Episode?

    <p>Loss of interest in most activities</p> Signup and view all the answers

    What is a key difference between psychosis and delirium?

    <p>Level of insight into reality</p> Signup and view all the answers

    What is a potential cause of psychosis?

    <p>All of the above</p> Signup and view all the answers

    What is a characteristic of delirium?

    <p>Altered consciousness, including hypervigilance</p> Signup and view all the answers

    What is a potential adverse effect of using hypnotics to treat insomnia?

    <p>Worsening of depression, including suicidal thoughts</p> Signup and view all the answers

    What is a possible symptom of a Depressive Episode, in addition to low mood?

    <p>Fatigue</p> Signup and view all the answers

    What is the mechanism of action of flumazenil?

    <p>Competitive inhibitor of benzodiazepines</p> Signup and view all the answers

    What is a key feature of hallucinations in psychosis?

    <p>They are unformed and non-specific</p> Signup and view all the answers

    Why should flumazenil be used with caution in multi-drug overdose cases?

    <p>It can exacerbate the effects of other drugs</p> Signup and view all the answers

    What is a sign of CNS depression from a probable drug overdose?

    <p>Ataxia</p> Signup and view all the answers

    Why should an intern re-evaluate the treatment plan for a patient with a probable drug overdose?

    <p>The patient may have taken other drugs besides benzodiazepines</p> Signup and view all the answers

    What is the implication for someone who had a benzodiazepine for an in-office procedure, then was given flumazenil to reverse its effects?

    <p>The effects of the benzodiazepine will be reversed</p> Signup and view all the answers

    What is a therapeutic use of flumazenil?

    <p>Removal of benzodiazepine effects after an in-office procedure</p> Signup and view all the answers

    Why is flumazenil used with caution in treating benzodiazepine overdose?

    <p>It can worsen the overdose symptoms</p> Signup and view all the answers

    What percentage of the Canadian population experiences bipolar disorder?

    <p>1.5%</p> Signup and view all the answers

    What is the most common state experienced by individuals with bipolar disorder?

    <p>Depressive state</p> Signup and view all the answers

    What is a necessary step in the diagnosis of bipolar disorder 1?

    <p>Both A and B</p> Signup and view all the answers

    How many symptoms of mania are required to diagnose bipolar disorder 1?

    <p>3 or more symptoms</p> Signup and view all the answers

    What is a characteristic feature of manic psychosis in bipolar disorder?

    <p>Delirium</p> Signup and view all the answers

    What is a key difference between bipolar 1 and bipolar 2 disorders?

    <p>Presence of hypomanic episodes</p> Signup and view all the answers

    What is a key difference between mania and hypomania?

    <p>Duration</p> Signup and view all the answers

    What is a risk factor for developing Major Depressive Disorder (MDD)?

    <p>Chronic pain and chronic disorders</p> Signup and view all the answers

    What is a characteristic of manic episodes?

    <p>Rapid speech and decreased need for sleep</p> Signup and view all the answers

    What is a symptom of MDD?

    <p>Restlessness and agitation</p> Signup and view all the answers

    What is a condition that may cause symptoms of mania?

    <p>All of the above</p> Signup and view all the answers

    What is a diagnostic criterion for MDD?

    <p>Depressed mood and anhedonia</p> Signup and view all the answers

    What is the predicted ranking of MDD as a cause of disability worldwide by 2030?

    <p>2nd leading cause</p> Signup and view all the answers

    What is a characteristic of MDD?

    <p>Depressed mood and anhedonia</p> Signup and view all the answers

    What is a condition that may cause symptoms of hypomania?

    <p>All of the above</p> Signup and view all the answers

    What is a risk factor for developing MDD in Canada?

    <p>Chronic pain and chronic disorders</p> Signup and view all the answers

    Which brain region is involved in the 'top-down' control of fear responses?

    <p>Prefrontal cortex</p> Signup and view all the answers

    What is the primary function of the noradrenergic pathway?

    <p>Regulation of mood, attention, arousal, and stress response</p> Signup and view all the answers

    Which neurotransmitter is involved in modulating anxiety and aggression?

    <p>Serotonin</p> Signup and view all the answers

    What is the origin of dopaminergic neurons?

    <p>Substantia nigra and ventral tegmental area (VTA)</p> Signup and view all the answers

    What is the clinical significance of dysregulation of noradrenergic pathways?

    <p>Implicated in various psychiatric disorders such as depression, anxiety disorders, and ADHD</p> Signup and view all the answers

    What is the clinical significance of imbalances in serotonin levels?

    <p>Associated with mood disorders such as depression and anxiety</p> Signup and view all the answers

    Which nucleus is associated with the regulation of mood, emotion, appetite, sleep, and various cognitive functions?

    <p>Raphe nuclei</p> Signup and view all the answers

    What is the relationship between the noradrenergic, serotonergic, and dopaminergic pathways?

    <p>They overlap and interact with each other</p> Signup and view all the answers

    Study Notes

    Communication to the Amygdala

    • The thalamus plays a role in communication to the amygdala
    • The hippocampus can be activated as part of the process of learning about the cause of fear and how it can be avoided
    • The pre-frontal cortex can exert top-down control over cognitive responses or behaviors to a potential fear-causing stimulus
    • The serotonin-releasing nucleus in the brainstem (raphe nucleus) can have a global modulatory effect on mood, memory, and fear + stress responses
    • The noradrenergic, serotonergic, and dopaminergic pathways all have important nuclei in the brainstem and cross-talk to each other

    Noradrenergic Pathway

    • Neurotransmitter: Noradrenaline (also known as Norepinephrine)
    • Origin: Locus coeruleus in the brainstem
    • Function: Regulates mood, attention, arousal, and stress response; involved in the "fight or flight" response
    • Clinical Significance: Dysregulation of noradrenergic pathways is implicated in various psychiatric disorders such as depression, anxiety disorders, and attention deficit hyperactivity disorder (ADHD)

    Serotonergic Pathway

    • Neurotransmitter: Serotonin (also known as 5-hydroxytryptamine or 5-HT)
    • Origin: Raphe nuclei in the brainstem
    • Function: Regulates mood, emotion, appetite, sleep, and various cognitive functions; involved in modulating anxiety, aggression, and impulsivity
    • Clinical Significance: Imbalances in serotonin levels are associated with mood disorders such as depression and anxiety, as well as obsessive-compulsive disorder (OCD) and eating disorders

    Dopaminergic Pathway

    • Neurotransmitter: Dopamine
    • Origin: Substantia nigra and ventral tegmental area (VTA) in the brain
    • Function: Regulates mood, emotion, motivation, and reward processing
    • Clinical Significance: Over-activation of the direct pathway and poor activation of the indirect pathway may be implicated in certain disorders; higher-dose SSRIs may mediate their positive impact on these circuits

    Basal Ganglia

    • A group of nuclei in the brain involved in movement control and cognition
    • Components:
      • Input nuclei: Putamen, Caudate, Nucleus accumbens
      • Associated nuclei: Globus pallidus externa, Substantia nigra pars compacta, Subthalamic nucleus
      • Output nuclei: Globus pallidus interna, Substantia nigra pars reticulata

    Eating Disorders

    • Anorexia Nervosa and Bulimia Nervosa
    • Lifetime prevalence: 1% for anorexia and 2-4% for bulimia in the female population
    • Higher risk factors:
      • Display "perfectionist" traits
      • Past history of sexual abuse
      • Feel a lack of control in other dimensions of life
      • Expectations regarding weight (e.g. athletes, gymnasts, dancers)

    Anorexia Diagnostic Criteria

    • Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health
    • Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight
    • Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

    Bulimia Diagnostic Criteria

    • Recurrent episodes of binge-eating, characterized by:
      • Eating, in a single period of time, an amount of food that is larger than what most individuals would eat during a similar period of time and under similar circumstances
      • A sense of lack of control over eating during the episode

    Bipolar Disorders

    • Epidemiology: 1.5% of the Canadian population experiences bipolar disorder
    • Clinical Features:
      • Mania, Hypomania, Depression
      • Cyclical changes between these states
      • Manic psychosis, which may include delirium
    • Subtypes:
      • Bipolar 1: At least 1 manic episode and usually depressive episodes
      • Bipolar 2: Major depressive episodes with at least 1 hypomanic episode

    Bipolar Disorders - DDX

    • Exclusion of hyperthyroidism and stimulant drug abuse
    • Clinical diagnosis based on DSM-5 criteria
    • At least 1 episode of mania/hypomania lasting for at least 4 consecutive days AND be present most of the day, almost every day
    • 3 or more symptoms of mania:
      • Inflated self-esteem or grandiosity
      • Decreased need for sleep
      • More talkative than usual or pressure to keep talking
      • Flight of ideas or subjective experience that thoughts are racing
      • Distractibility
      • Increase in goal-directed activity or psychomotor agitation
      • Excessive involvement in activities that have a high potential for painful consequences

    Antidepressants

    • SNRI's (Serotonin & Norepinephrine Reuptake Inhibitors):
      • Examples: Venlafaxine (Effexor), Amitriptyline (Elavil)
    • SSRI's (Selective Serotonin Reuptake Inhibitors):
      • Examples: Fluoxetine (Prozac)
    • MAOI's (Monoamine Oxidase Inhibitors):
      • Examples: Trazodone (Desyrel), Bupropion (Wellbutrin, Zyban)

    Anxiety Disorders

    • Specific Phobia: 12-16% prevalence; characterized by immediate fear/anxiety response to a stimulus, active avoidance or endurance with intense anxiety, fear out of proportion to actual danger, and recognition of excessive fear.
    • Social Anxiety Disorder: 2-7% prevalence; marked and persistent fear of social or performance situations, fear of being judged or evaluated, and avoidance of situations.

    Post-Traumatic Stress Disorder (PTSD)

    • Causes: exposure to actual death, threatened death, physical or sexual violence, or serious injury; can occur in people who have witnessed or experienced traumatic events.
    • Symptoms: recurrent, involuntary, and intrusive memories of the event; avoidance of stimuli associated with the event; negative changes in mood and cognition.

    Eating Disorders

    • Dangers: significant physical harm, including hypotension, bradycardia, dysrhythmias, congestive heart failure, and vitamin deficiencies.
    • Types: Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder.

    Benzodiazepines

    • Mechanism of action: facilitate binding of GABA to GABA receptors, leading to anxiolytic, hypnotic, and anti-seizure effects.
    • Examples: Diazepam (Valium), Triazolam (Halcion).

    Mania and Hypomania

    • Mania: increased talkativeness, rapid speech, decreased need for sleep, racing thoughts, distractibility, and increased goal-directed activity; may include elevated mood, mood lability, impulsivity, and grandiosity.
    • Hypomania: similar to mania, but with shorter duration (at least 4 days) and less severe impairment.

    Major Depressive Disorder (MDD)

    • Epidemiology: predicted to be the 2nd leading cause of disability worldwide by 2030; 4.7-5.4% prevalence in Canada.
    • Risk Factors: exposure to traumatic life events, chronic pain, low income, lack of social support, and family history.
    • Clinical Features: mood symptoms (feeling sad, low self-esteem), physical symptoms (lack of energy, changes in appetite), and cognitive symptoms (slow thinking, difficulty concentrating).
    • Diagnostic Criteria: at least 5 symptoms, including depressed mood and anhedonia, must be present most of the day, every day, for at least 2 weeks.

    Neurobiology of MDD

    • Monoamine Hypothesis: altered levels of monoamine neurotransmitters, such as serotonin and noradrenaline, contribute to depression.
    • Stress-induced Depression Hypothesis: chronic stress leads to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, leading to depression.
    • Other theories: neurotrophic/neuroplasticity hypothesis, cytokine hypothesis/neuroinflammation hypothesis, and circadian hypothesis.

    Antidepressants

    • Mechanism of action: increase levels of neurotransmitters, such as serotonin and noradrenaline, to improve mood.
    • Types: Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), Monoamine Oxidase Inhibitors (MAOIs), and others.
    • Adverse effects: include increased risk of suicide, serotonin syndrome, and overdose effects.

    Fear Response and Regulation

    • The thalamus plays a role in communication to the amygdala
    • The hippocampus can be activated as part of the process of learning about the cause of fear and how it can be avoided
    • The pre-frontal cortex can exert top-down control over cognitive responses or behaviors to a potential fear-causing stimulus
    • The serotonin-releasing nucleus in the brainstem (raphe nucleus) has a global modulatory effect on mood, memory, and fear + stress responses

    Noradrenergic Pathway

    • Neurotransmitter: Noradrenaline (also known as norepinephrine)
    • Origin: Locus coeruleus in the brainstem
    • Function: Regulates mood, attention, arousal, and stress response; involved in "fight or flight" response
    • Clinical Significance: Dysregulation is implicated in depression, anxiety disorders, and attention deficit hyperactivity disorder (ADHD)

    Serotonergic Pathway

    • Neurotransmitter: Serotonin (also known as 5-hydroxytryptamine or 5-HT)
    • Origin: Raphe nuclei in the brainstem
    • Function: Regulates mood, emotion, appetite, sleep, and various cognitive functions; involved in modulating anxiety, aggression, and impulsivity
    • Clinical Significance: Imbalances are associated with mood disorders such as depression and anxiety, as well as obsessive-compulsive disorder (OCD) and eating disorders

    Dopaminergic Pathway

    • Neurotransmitter: Dopamine
    • Origin: Substantia nigra and ventral tegmental area (VTA) in the brain
    • Function: Involved in regulating mood, motivation, and reward processing

    Benzodiazepines and Adverse Effects

    • General warnings/precautions associated with the use of hypnotics to treat insomnia include:
      • Abnormal thinking and behavioral changes
      • Visual and auditory hallucinations, "sleep-X" events
      • The need to evaluate for an underlying primary psychiatric and/or medical illness for the insomnia
    • Hypnotic use coupled with an underlying primary disorder can cause:
      • Worsening of insomnia, worsening of depression (including suicidal thoughts), etc.

    Benzodiazepine Antagonist

    • Flumazenil = BDZ antagonist
    • Competitive inhibitor of BDZ
    • Therapeutic uses include:
      • Removal of effects of BDZ once therapeutic effects no longer needed
      • Treatment of BDZ OD
    • Caution with multi-drug overdose
    • Shorter duration of action than BDZ

    Depression and Bipolar Disorders

    Definitions

    • Psychosis: Hallucination (without insight), delusion, or hallucination (without insight) and delusion; loss of contact with external reality
    • Delirium: Acute, fluctuating change in attention (reduced) and consciousness including disorganized thoughts
    • Depressive Episode: Experience of low or depressed mood, loss of interest in most activities, and additional possible symptoms
    • Mania: Increased talkativeness, rapid speech, decreased need for sleep, racing thoughts, distractibility, increase in goal-direct activity, psychomotor agitation
    • Hypomania: Differentiating factors from mania: duration (at least 4 days), does not cause major deficit in social or occupational functioning

    Major Depressive Disorder (MDD)

    • Epidemiology:
      • Predicted to be the 2nd leading cause of disability worldwide by 2030
      • 4.7-5.4% of the population experience MDD in Canada
      • Risk factors: exposure to traumatic life events, chronic pain and disorders, low income, increased caregiver burden, lack of social support, family history
    • Clinical Features:
      • Mood symptoms: feeling sad/low, lack of interest in general, anhedonia, low self-esteem, feelings of guilt or worthlessness, suicidal thoughts
      • Physical symptoms: lack of energy/tired, difficulty sleeping, restless/agitated, weight loss/gain, low libido
      • Cognitive symptoms: slow thinking, difficulty concentrating, forgetfulness, difficulty planning, difficulty making decisions
    • Diagnostic Criteria (DSM-5):
      • Category A: must include the first two components and a total of 5 or more components
      • Depressed mood and anhedonia must be present most of the day, every day for at least 2 weeks in a row

    Bipolar Disorders

    • Epidemiology: 1.5% of the population experience bipolar disorder in Canada
    • Clinical Features:
      • Mania
      • Hypomania
      • Depression (most of the time spent in depressive state)
      • Cyclical changes between these states are common
    • DDX:
      • Exclusion of hyperthyroidism (TSH and T4)
      • Exclusion of stimulant drug abuse (blood/urine)
      • Clinical based on DSM-5
    • Bipolar Disorder 1:
      • At least 1 episode of mania/hypomania lasting for at least 4 consecutive days AND be present most of the day, almost every day
      • 3 or more symptoms (representing sig change from norm) of mania
      • Cause significant impairment or necessitates hospitalization

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    This quiz covers the neural pathways and brain regions involved in the fear response, including the thalamus, hippocampus, pre-frontal cortex, and raphe nucleus. Learn how these structures interact to regulate fear and anxiety.

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