The document discusses depression in women and improving outcomes. Major depression has a significant public health impact and is the leading cause of disability among women worldwide. Women experience depression rates 1.5-2.5 times higher than men ages 15-54. Key ways to improve outcomes include considering differential diagnoses, treating to remission, measuring symptom improvement, using evidence-based interventions personalized to the individual woman, and providing self-help resources.
The document discusses a proposed subtype of schizophrenia called "schizo-obsessive disorder" where patients have obsessions and compulsions unrelated to their psychosis. A study found that patients with schizo-obsessive disorder had longer hospitalizations, took more medications, and had poorer functioning than those with schizophrenia alone. They also exhibited more negative symptoms and poorer neuropsychological performance. The findings suggest schizo-obsessive patients may have a unique clinical profile within the schizophrenia spectrum. Treatment with serotonin reuptake inhibitors along with antipsychotics may effectively treat their obsessions and improve schizophrenia symptoms.
Anxiety is a normal human emotion that exists on a continuum from mild to severe. It is characterized by expectations not being met and the automatic rationalization of behaviors. Symptoms of anxiety include emotional, cognitive, and physical manifestations. Anxiety disorders affect around 25% of the population and have various theories around their causes including genetic, biological, cognitive-behavioral, and psychosocial factors. Common anxiety disorders include generalized anxiety disorder, panic disorder, phobic disorders, obsessive-compulsive disorder, post-traumatic stress disorder, and dissociative disorders. Treatment involves multidisciplinary interventions such as cognitive-behavioral therapy, medications, and observing nonverbal behaviors and relief patterns.
The document discusses various types of depression including major depressive disorder, dysthymia, premenstrual dysphoric disorder, and seasonal affective disorder. It covers symptoms, screening tools, treatment options such as antidepressant medications and therapy, and factors that influence depression. Safety concerns like suicide risk are also addressed.
The document discusses obsessive-compulsive disorder (OCD) and the role of nurses. It defines OCD and its most common symptoms which involve obsessions and compulsions. Common obsessions include contamination, perfectionism, unwanted thoughts, harm, and religion. Compulsions include checking, cleaning, repeating behaviors, and reassurance seeking. The causes of OCD are largely unknown but involve biological and environmental factors. Prognosis varies but OCD often begins in childhood/adolescence and can be a chronic condition. Medications like antidepressants are used to treat OCD and nurses provide important interventions like advising on medications, creating a therapeutic environment, and offering emotional support.
The document discusses various substances of abuse including definitions of substance abuse, intoxication, withdrawal, tolerance, polysubstance abuse, and dependence. It also discusses specific substances like alcohol, opioids, cocaine, amphetamines, cannabis, hallucinogens, inhalants, and nicotine. For each substance, signs and symptoms of intoxication and withdrawal are described as well as appropriate emergency treatment approaches.
1. Post-traumatic stress disorder (PTSD) is a mental disorder caused by experiencing or witnessing a traumatic event, and causes people to relive the event through flashbacks or triggers.
2. Biofeedback therapy is a proposed treatment that could help people with PTSD learn to control their physiological responses to stress and anxiety by using sensors to monitor their body's reactions.
3. By gaining awareness of their body's stress responses through biofeedback, patients and their families can work to prevent PTSD episodes and outbursts that endanger the patient or others.
This document provides information for those working with traumatized children. It discusses the effects of trauma on children's cognition, behavior, affect, and physical health. It describes common reactions in children like repetitive play, regression, and somatic complaints. The document also covers trauma-informed care, the impact of trauma on the brain, trauma bonding, and treatment options like CBT, prolonged exposure therapy, and EMDR. Key aspects of working with traumatized children are understanding developmental stages and communicating with parents about topics like boundaries and healthy sexuality.
The document discusses post-traumatic stress disorder (PTSD) and issues facing military veterans post-deployment. It describes the three main symptoms of PTSD as hyperarousal, re-experiencing trauma through flashbacks or nightmares, and avoidance/numbing. With sustained exposure to daily trauma over multiple deployments, the development of PTSD is inevitable. The document also outlines the physiological and psychological effects of PTSD and discusses challenges veterans may face reintegrating into civilian life like relationship issues, dangerous behaviors, and substance abuse. Effective treatment involves psychoeducation, teaching coping strategies, and gradually retelling traumatic experiences.
The document discusses a proposed subtype of schizophrenia called "schizo-obsessive disorder" where patients have obsessions and compulsions unrelated to their psychosis. A study found that patients with schizo-obsessive disorder had longer hospitalizations, took more medications, and had poorer functioning than those with schizophrenia alone. They also exhibited more negative symptoms and poorer neuropsychological performance. The findings suggest schizo-obsessive patients may have a unique clinical profile within the schizophrenia spectrum. Treatment with serotonin reuptake inhibitors along with antipsychotics may effectively treat their obsessions and improve schizophrenia symptoms.
Anxiety is a normal human emotion that exists on a continuum from mild to severe. It is characterized by expectations not being met and the automatic rationalization of behaviors. Symptoms of anxiety include emotional, cognitive, and physical manifestations. Anxiety disorders affect around 25% of the population and have various theories around their causes including genetic, biological, cognitive-behavioral, and psychosocial factors. Common anxiety disorders include generalized anxiety disorder, panic disorder, phobic disorders, obsessive-compulsive disorder, post-traumatic stress disorder, and dissociative disorders. Treatment involves multidisciplinary interventions such as cognitive-behavioral therapy, medications, and observing nonverbal behaviors and relief patterns.
The document discusses various types of depression including major depressive disorder, dysthymia, premenstrual dysphoric disorder, and seasonal affective disorder. It covers symptoms, screening tools, treatment options such as antidepressant medications and therapy, and factors that influence depression. Safety concerns like suicide risk are also addressed.
The document discusses obsessive-compulsive disorder (OCD) and the role of nurses. It defines OCD and its most common symptoms which involve obsessions and compulsions. Common obsessions include contamination, perfectionism, unwanted thoughts, harm, and religion. Compulsions include checking, cleaning, repeating behaviors, and reassurance seeking. The causes of OCD are largely unknown but involve biological and environmental factors. Prognosis varies but OCD often begins in childhood/adolescence and can be a chronic condition. Medications like antidepressants are used to treat OCD and nurses provide important interventions like advising on medications, creating a therapeutic environment, and offering emotional support.
The document discusses various substances of abuse including definitions of substance abuse, intoxication, withdrawal, tolerance, polysubstance abuse, and dependence. It also discusses specific substances like alcohol, opioids, cocaine, amphetamines, cannabis, hallucinogens, inhalants, and nicotine. For each substance, signs and symptoms of intoxication and withdrawal are described as well as appropriate emergency treatment approaches.
1. Post-traumatic stress disorder (PTSD) is a mental disorder caused by experiencing or witnessing a traumatic event, and causes people to relive the event through flashbacks or triggers.
2. Biofeedback therapy is a proposed treatment that could help people with PTSD learn to control their physiological responses to stress and anxiety by using sensors to monitor their body's reactions.
3. By gaining awareness of their body's stress responses through biofeedback, patients and their families can work to prevent PTSD episodes and outbursts that endanger the patient or others.
This document provides information for those working with traumatized children. It discusses the effects of trauma on children's cognition, behavior, affect, and physical health. It describes common reactions in children like repetitive play, regression, and somatic complaints. The document also covers trauma-informed care, the impact of trauma on the brain, trauma bonding, and treatment options like CBT, prolonged exposure therapy, and EMDR. Key aspects of working with traumatized children are understanding developmental stages and communicating with parents about topics like boundaries and healthy sexuality.
The document discusses post-traumatic stress disorder (PTSD) and issues facing military veterans post-deployment. It describes the three main symptoms of PTSD as hyperarousal, re-experiencing trauma through flashbacks or nightmares, and avoidance/numbing. With sustained exposure to daily trauma over multiple deployments, the development of PTSD is inevitable. The document also outlines the physiological and psychological effects of PTSD and discusses challenges veterans may face reintegrating into civilian life like relationship issues, dangerous behaviors, and substance abuse. Effective treatment involves psychoeducation, teaching coping strategies, and gradually retelling traumatic experiences.
Anxiety disorders are a group of psychiatric conditions where a patient's reality is retained and there is no deterioration in personality. They are characterized by feelings of apprehension and irrational fear that are out of proportion to the triggering situation. Common types include generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and phobias. Treatment involves medications like SSRIs and benzodiazepines as well as cognitive behavioral therapy.
1. Obsessive Compulsive Disorder (OCD) is characterized by recurrent, persistent obsessions (unwanted thoughts, images, or urges) and compulsions (repetitive behaviors or mental acts).
2. OCD is believed to be caused by a combination of neurobiological factors like abnormal serotonin levels in the brain, genetic predispositions, and psychological and environmental factors like stressful life events or childhood trauma.
3. Treatment for OCD involves pharmacotherapy like SSRIs to target serotonin levels as well as psychotherapy like cognitive behavioral therapy with exposure and response prevention techniques.
This document provides information about Post Traumatic Stress Disorder (PTSD), including its definition, brain areas implicated in the disorder, symptoms, likelihood of developing PTSD, and treatment options. PTSD is defined by the DSM-IV as the development of symptoms following exposure to an extreme stressor involving actual or threatened death, serious injury, or threat to physical integrity. Studies have found differences in the hippocampus, amygdala, and medial frontal cortex in those with PTSD. Symptoms include reliving the traumatic event, nightmares, feeling numb or sad, and avoidance of trauma reminders. The likelihood of developing PTSD depends on factors like trauma severity, injury, perceived life threat, and social support after the event. Treatments include
The document discusses how depression negatively impacts heart health in several ways:
1) Depression increases the risk of cardiovascular disease by causing high blood pressure, arterial damage, irregular heart rhythms, and a weakened immune system.
2) People with depression are more likely to engage in unhealthy behaviors like smoking, excessive drinking, poor diet, and lack of exercise - all of which increase heart disease risks.
3) Depression can worsen the perception of one's health and decrease adherence to medical treatment, leading to increased risk of early mortality from cardiovascular events.
Slides presented by Dr. Tina Savla on April 2, 2012 at the webinar hosted at www.alzpossible.org - review webinar recording at this link. All rights reserved.
This document provides an overview of anxiety, its causes and types, anxiety disorders, and somatoform and dissociative disorders. It defines anxiety and differentiates it from fear. It describes the categories of anxiety including normal, acute, and chronic anxiety. It also outlines the different types of anxiety disorders including generalized anxiety disorder, panic disorder, phobias, obsessive-compulsive disorder, post-traumatic stress disorder, and substance-induced anxiety. The document further discusses somatoform disorders, dissociative disorders, assessments, interventions, medications, and treatments for these conditions.
The document discusses the speaker's informative speech about PTSD. It aims to inform their community about how PTSD can affect both military members and civilians through terrifying experiences or events. PTSD is described as a mental health condition triggered by trauma that causes symptoms like flashbacks, nightmares, anxiety, and avoidance. The speaker notes PTSD can interfere with daily life and discusses treatment options such as seeking help from mental health professionals or faith leaders.
Supercharge your brain and ditch anxiety and depression for good!Patients Medical
Dr. Vivian DeNise of Patients Medical and Dr. Sandlin Lowe of The Amen Clinic New York explain the causes of anxiety and depression, the cutting-edge technology that can be used to diagnose deficiencies in the brain that cause these conditions and several non-invasive holistic medical approaches that we use to treat.
1. Post-traumatic stress disorder (PTSD) is defined as a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as war, natural disasters, terrorist attacks, serious accidents, or physical or sexual abuse.
2. Symptoms of PTSD include re-experiencing the traumatic event through flashbacks or nightmares, avoidance of stimuli associated with the trauma, increased anxiety, and emotional arousal.
3. Treatment for PTSD involves psychotherapy such as trauma-focused cognitive behavioral therapy or EMDR, as well as medication such as antidepressants.
The document discusses post-traumatic stress disorder (PTSD) in children. It explains that PTSD can develop in children after experiencing or witnessing traumatic events like domestic violence, natural disasters, abuse, death of loved ones, or living in a dangerous environment. Common PTSD symptoms in children include bedwetting, clinginess, difficulty sleeping, and acting out the traumatic event. The document provides advice for teachers who suspect a student has PTSD, such as notifying the school counselor, maintaining records of interactions, and being an advocate for the student. Overall, the document aims to educate teachers on childhood PTSD and how to support students suffering from trauma-related symptoms.
1. Early childhood trauma, defined as experiences before age 6 that threaten a child's well-being, can cause long-term psychological disorders like depression and anxiety.
2. Traumatized children exhibit a variety of symptoms including withdrawal, sleep issues, inability to concentrate, and re-enactment of traumatic events.
3. Trauma can permanently alter brain development and negatively impact behaviors, learning, and interpersonal relationships if not treated through therapies like trauma-focused cognitive behavioral therapy (TF-CBT).
Course Description (From www.PESI.com):
Attend this day of training and leave with a brand new toolkit of skills, interventions, and principles for rapid success with traumatized clients. Join Jamie Marich and learn the standard of care for treatment in the field of traumatic stress – and its key ingredients. Implement evidence-based treatment protocols and interventions for establishing safety, desensitizing and reprocessing trauma memories, metabolizing and resolving grief/loss and finally, assisting clients in reconnecting to lives full of hope, connection, and achievement.
Jamie is a certified EMDR Therapist and approved consultant through the EMDR International Association (EMDR). She is additionally a member of the American Academy of Experts in Traumatic Stress, the International Association of Trauma Professionals (IATP), and has earned Certification in Disaster Thanatology.
Jamie began her career in social services as a humanitarian aid worker in post-war Bosnia-Herzegovina opening her eyes to the widespread, horrific impact of traumatic stress and grief.
Objectives:
Describe the etiology and impact of traumatic stress on the client utilizing multiple assessment strategies.
Assess a client’s reaction to a traumatic event and make an appropriate diagnosis.
Explain how grief, bereavement, and mourning are accounted for in the new DSM-5®.
Implement interventions to assist a client in dealing with the biopsychosocial manifestations of trauma, PTSD, and traumatic grief/complicated mourning.
Utilize appropriate evidence-based interventions to assist a client in dealing with the biopsychosocial-spiritual manifestations of trauma.
Explain the effects of trauma on the structure and function of the brain.
This document provides an overview of various psychotherapy approaches, including psychodynamic therapy, psychoanalysis, client-centered therapy, gestalt therapy, cognitive therapies, behavior therapy, group therapy, couples therapy, and family therapy. It discusses techniques used in each approach as well as their effectiveness. Biomedical therapies like drug therapy, electroconvulsive therapy, and psychosurgery are also summarized. The document emphasizes that therapists today often use eclectic approaches and must consider diversity and ethics when working with clients.
This document provides an overview of post-traumatic stress disorder (PTSD) and acute stress disorder from a neurobiological perspective. It defines the two conditions and discusses how stress affects brain regions like the amygdala, hippocampus, and prefrontal cortex. Chronic stress can cause the hippocampus to decrease in size. Current treatments include cognitive behavioral therapy, SSRIs, and exploring new options like virtual reality exposure therapy, MDMA-assisted therapy, and transcranial magnetic stimulation.
The document discusses post-traumatic stress disorder (PTSD) in children, including its core features, causes, assessments, treatments, and recommendations. It reviews two articles on memory/learning deficits in children with PTSD and using eye movement desensitization and reprocessing (EMDR) therapy to treat PTSD in children. Common causes of PTSD in children include natural disasters, terrorism, and physical abuse. Assessments include the Clinician-Administered PTSD Scale and Los Angeles Symptom Checklist. Treatments discussed are EMDR therapy and using video games like Tetris. Support groups and recommended resources are also mentioned.
Acute stress disorder is a mental health condition that develops within one month of a traumatic event and is characterized by dissociative symptoms, re-experiencing of the event, avoidance of trauma-related stimuli, and increased arousal and anxiety. Without treatment, it can lead to post-traumatic stress disorder. Common treatments include medication, cognitive behavioral therapy including exposure therapy, and group or family therapy.
The document discusses post-traumatic stress disorder (PTSD) in military veterans and service members. It provides a brief history of PTSD and how it has been diagnosed over time. Statistics are presented showing high rates of PTSD among recent veterans deployed to Iraq and Afghanistan, with only about half seeking treatment due to fears of stigma. Risk factors, symptoms, treatments and prevention strategies are outlined. The impacts of untreated PTSD include increased crime, substance abuse, domestic violence, broken relationships and poor work performance.
PTSD is an anxiety disorder that develops after exposure to a traumatic or dangerous event. Symptoms include re-experiencing the trauma through flashbacks or nightmares, avoidance of trauma-related stimuli, increased arousal and negative mood, and can start within 3 months of the event and last for longer than a month. Effective treatments include cognitive behavioral therapy such as exposure therapy and cognitive restructuring, as well as antidepressant medication.
Join us each month as we discuss the health topics that matter most to you in The Prevention Plan's 2011 Better Health webinar series. In addition to learning clinically-based information about various health topics, you will also learn practical tips you can apply to your everyday life to help you manage or improve your health.
Winter got you down? Now that the holidays are over, many people enter a state of winter blues. Fortunately, there are ways to boost your mood, many of which you may not have thought of. Join us as we discuss how you can shake those winter blues and get back to being you.
This was a lecture in the course "Significant Medical Conditions in Seniors" presented at Peer Learning in Chapel Hill, NC, USA in 2016 by Michael C. Joseph, MD, MPH.
Disorders of Mood include affective psychosis, bipolar disorder, and depression. They are fundamentally disorders of inappropriate depression or elation that causes distress or impairment. Depression has a lifetime prevalence of 5-20% and bipolar disorder has a prevalence of 1%. Females are diagnosed twice as often as males. Mood disorders have a significant economic impact due to direct healthcare costs and indirect costs from reduced productivity. They are classified as either unipolar or bipolar and have genetic, biochemical, and environmental contributors. Symptoms include changes in mood, sleep, appetite, and energy levels. Treatment involves medication, electroconvulsive therapy, cognitive behavioral therapy, and counseling. The course involves self-limiting episodes but
Depression
Background
Pathophysiology
• The monoamine theory of depression is that it results from a central deficit in the monoamine neurotransmitters serotonin (5-HT) and norepinephrine.
• Other reported physiological features include ↑cortisol and a blunted TSH response.
• However, there is no widely accepted and definitively proven biological model of depression.
Epidemiology
• Time course: for most it is an episodic illness, but for other it follows a more chronic course.
• Incidence: 5% annual risk, 20% lifetime risk.
Presentation
DSM and NICE criteria
These are based on DSM-4, though DSM-5 does not significantly differ.
Major depressive disorder is ≥2 weeks of low mood and/or anhedonia, and at least 4 symptoms out of:
• ↓Energy or fatigue.
• ↓Concentration
• ↓Weight/appetite.
• Disturbed sleep, which commonly includes early waking. Diurnal pattern to symptoms also seen, with symptoms often worse in the morning.
• Slowing of thought and movements (psychomotor slowing) or agitation.
• Ideas of worthlessness or guilt.
• Recurrent thoughts of death or suicide.
• All but the last 2 are considered 'biological' symptoms.
Anxiety disorders are a group of psychiatric conditions where a patient's reality is retained and there is no deterioration in personality. They are characterized by feelings of apprehension and irrational fear that are out of proportion to the triggering situation. Common types include generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and phobias. Treatment involves medications like SSRIs and benzodiazepines as well as cognitive behavioral therapy.
1. Obsessive Compulsive Disorder (OCD) is characterized by recurrent, persistent obsessions (unwanted thoughts, images, or urges) and compulsions (repetitive behaviors or mental acts).
2. OCD is believed to be caused by a combination of neurobiological factors like abnormal serotonin levels in the brain, genetic predispositions, and psychological and environmental factors like stressful life events or childhood trauma.
3. Treatment for OCD involves pharmacotherapy like SSRIs to target serotonin levels as well as psychotherapy like cognitive behavioral therapy with exposure and response prevention techniques.
This document provides information about Post Traumatic Stress Disorder (PTSD), including its definition, brain areas implicated in the disorder, symptoms, likelihood of developing PTSD, and treatment options. PTSD is defined by the DSM-IV as the development of symptoms following exposure to an extreme stressor involving actual or threatened death, serious injury, or threat to physical integrity. Studies have found differences in the hippocampus, amygdala, and medial frontal cortex in those with PTSD. Symptoms include reliving the traumatic event, nightmares, feeling numb or sad, and avoidance of trauma reminders. The likelihood of developing PTSD depends on factors like trauma severity, injury, perceived life threat, and social support after the event. Treatments include
The document discusses how depression negatively impacts heart health in several ways:
1) Depression increases the risk of cardiovascular disease by causing high blood pressure, arterial damage, irregular heart rhythms, and a weakened immune system.
2) People with depression are more likely to engage in unhealthy behaviors like smoking, excessive drinking, poor diet, and lack of exercise - all of which increase heart disease risks.
3) Depression can worsen the perception of one's health and decrease adherence to medical treatment, leading to increased risk of early mortality from cardiovascular events.
Slides presented by Dr. Tina Savla on April 2, 2012 at the webinar hosted at www.alzpossible.org - review webinar recording at this link. All rights reserved.
This document provides an overview of anxiety, its causes and types, anxiety disorders, and somatoform and dissociative disorders. It defines anxiety and differentiates it from fear. It describes the categories of anxiety including normal, acute, and chronic anxiety. It also outlines the different types of anxiety disorders including generalized anxiety disorder, panic disorder, phobias, obsessive-compulsive disorder, post-traumatic stress disorder, and substance-induced anxiety. The document further discusses somatoform disorders, dissociative disorders, assessments, interventions, medications, and treatments for these conditions.
The document discusses the speaker's informative speech about PTSD. It aims to inform their community about how PTSD can affect both military members and civilians through terrifying experiences or events. PTSD is described as a mental health condition triggered by trauma that causes symptoms like flashbacks, nightmares, anxiety, and avoidance. The speaker notes PTSD can interfere with daily life and discusses treatment options such as seeking help from mental health professionals or faith leaders.
Supercharge your brain and ditch anxiety and depression for good!Patients Medical
Dr. Vivian DeNise of Patients Medical and Dr. Sandlin Lowe of The Amen Clinic New York explain the causes of anxiety and depression, the cutting-edge technology that can be used to diagnose deficiencies in the brain that cause these conditions and several non-invasive holistic medical approaches that we use to treat.
1. Post-traumatic stress disorder (PTSD) is defined as a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as war, natural disasters, terrorist attacks, serious accidents, or physical or sexual abuse.
2. Symptoms of PTSD include re-experiencing the traumatic event through flashbacks or nightmares, avoidance of stimuli associated with the trauma, increased anxiety, and emotional arousal.
3. Treatment for PTSD involves psychotherapy such as trauma-focused cognitive behavioral therapy or EMDR, as well as medication such as antidepressants.
The document discusses post-traumatic stress disorder (PTSD) in children. It explains that PTSD can develop in children after experiencing or witnessing traumatic events like domestic violence, natural disasters, abuse, death of loved ones, or living in a dangerous environment. Common PTSD symptoms in children include bedwetting, clinginess, difficulty sleeping, and acting out the traumatic event. The document provides advice for teachers who suspect a student has PTSD, such as notifying the school counselor, maintaining records of interactions, and being an advocate for the student. Overall, the document aims to educate teachers on childhood PTSD and how to support students suffering from trauma-related symptoms.
1. Early childhood trauma, defined as experiences before age 6 that threaten a child's well-being, can cause long-term psychological disorders like depression and anxiety.
2. Traumatized children exhibit a variety of symptoms including withdrawal, sleep issues, inability to concentrate, and re-enactment of traumatic events.
3. Trauma can permanently alter brain development and negatively impact behaviors, learning, and interpersonal relationships if not treated through therapies like trauma-focused cognitive behavioral therapy (TF-CBT).
Course Description (From www.PESI.com):
Attend this day of training and leave with a brand new toolkit of skills, interventions, and principles for rapid success with traumatized clients. Join Jamie Marich and learn the standard of care for treatment in the field of traumatic stress – and its key ingredients. Implement evidence-based treatment protocols and interventions for establishing safety, desensitizing and reprocessing trauma memories, metabolizing and resolving grief/loss and finally, assisting clients in reconnecting to lives full of hope, connection, and achievement.
Jamie is a certified EMDR Therapist and approved consultant through the EMDR International Association (EMDR). She is additionally a member of the American Academy of Experts in Traumatic Stress, the International Association of Trauma Professionals (IATP), and has earned Certification in Disaster Thanatology.
Jamie began her career in social services as a humanitarian aid worker in post-war Bosnia-Herzegovina opening her eyes to the widespread, horrific impact of traumatic stress and grief.
Objectives:
Describe the etiology and impact of traumatic stress on the client utilizing multiple assessment strategies.
Assess a client’s reaction to a traumatic event and make an appropriate diagnosis.
Explain how grief, bereavement, and mourning are accounted for in the new DSM-5®.
Implement interventions to assist a client in dealing with the biopsychosocial manifestations of trauma, PTSD, and traumatic grief/complicated mourning.
Utilize appropriate evidence-based interventions to assist a client in dealing with the biopsychosocial-spiritual manifestations of trauma.
Explain the effects of trauma on the structure and function of the brain.
This document provides an overview of various psychotherapy approaches, including psychodynamic therapy, psychoanalysis, client-centered therapy, gestalt therapy, cognitive therapies, behavior therapy, group therapy, couples therapy, and family therapy. It discusses techniques used in each approach as well as their effectiveness. Biomedical therapies like drug therapy, electroconvulsive therapy, and psychosurgery are also summarized. The document emphasizes that therapists today often use eclectic approaches and must consider diversity and ethics when working with clients.
This document provides an overview of post-traumatic stress disorder (PTSD) and acute stress disorder from a neurobiological perspective. It defines the two conditions and discusses how stress affects brain regions like the amygdala, hippocampus, and prefrontal cortex. Chronic stress can cause the hippocampus to decrease in size. Current treatments include cognitive behavioral therapy, SSRIs, and exploring new options like virtual reality exposure therapy, MDMA-assisted therapy, and transcranial magnetic stimulation.
The document discusses post-traumatic stress disorder (PTSD) in children, including its core features, causes, assessments, treatments, and recommendations. It reviews two articles on memory/learning deficits in children with PTSD and using eye movement desensitization and reprocessing (EMDR) therapy to treat PTSD in children. Common causes of PTSD in children include natural disasters, terrorism, and physical abuse. Assessments include the Clinician-Administered PTSD Scale and Los Angeles Symptom Checklist. Treatments discussed are EMDR therapy and using video games like Tetris. Support groups and recommended resources are also mentioned.
Acute stress disorder is a mental health condition that develops within one month of a traumatic event and is characterized by dissociative symptoms, re-experiencing of the event, avoidance of trauma-related stimuli, and increased arousal and anxiety. Without treatment, it can lead to post-traumatic stress disorder. Common treatments include medication, cognitive behavioral therapy including exposure therapy, and group or family therapy.
The document discusses post-traumatic stress disorder (PTSD) in military veterans and service members. It provides a brief history of PTSD and how it has been diagnosed over time. Statistics are presented showing high rates of PTSD among recent veterans deployed to Iraq and Afghanistan, with only about half seeking treatment due to fears of stigma. Risk factors, symptoms, treatments and prevention strategies are outlined. The impacts of untreated PTSD include increased crime, substance abuse, domestic violence, broken relationships and poor work performance.
PTSD is an anxiety disorder that develops after exposure to a traumatic or dangerous event. Symptoms include re-experiencing the trauma through flashbacks or nightmares, avoidance of trauma-related stimuli, increased arousal and negative mood, and can start within 3 months of the event and last for longer than a month. Effective treatments include cognitive behavioral therapy such as exposure therapy and cognitive restructuring, as well as antidepressant medication.
Join us each month as we discuss the health topics that matter most to you in The Prevention Plan's 2011 Better Health webinar series. In addition to learning clinically-based information about various health topics, you will also learn practical tips you can apply to your everyday life to help you manage or improve your health.
Winter got you down? Now that the holidays are over, many people enter a state of winter blues. Fortunately, there are ways to boost your mood, many of which you may not have thought of. Join us as we discuss how you can shake those winter blues and get back to being you.
This was a lecture in the course "Significant Medical Conditions in Seniors" presented at Peer Learning in Chapel Hill, NC, USA in 2016 by Michael C. Joseph, MD, MPH.
Disorders of Mood include affective psychosis, bipolar disorder, and depression. They are fundamentally disorders of inappropriate depression or elation that causes distress or impairment. Depression has a lifetime prevalence of 5-20% and bipolar disorder has a prevalence of 1%. Females are diagnosed twice as often as males. Mood disorders have a significant economic impact due to direct healthcare costs and indirect costs from reduced productivity. They are classified as either unipolar or bipolar and have genetic, biochemical, and environmental contributors. Symptoms include changes in mood, sleep, appetite, and energy levels. Treatment involves medication, electroconvulsive therapy, cognitive behavioral therapy, and counseling. The course involves self-limiting episodes but
Depression
Background
Pathophysiology
• The monoamine theory of depression is that it results from a central deficit in the monoamine neurotransmitters serotonin (5-HT) and norepinephrine.
• Other reported physiological features include ↑cortisol and a blunted TSH response.
• However, there is no widely accepted and definitively proven biological model of depression.
Epidemiology
• Time course: for most it is an episodic illness, but for other it follows a more chronic course.
• Incidence: 5% annual risk, 20% lifetime risk.
Presentation
DSM and NICE criteria
These are based on DSM-4, though DSM-5 does not significantly differ.
Major depressive disorder is ≥2 weeks of low mood and/or anhedonia, and at least 4 symptoms out of:
• ↓Energy or fatigue.
• ↓Concentration
• ↓Weight/appetite.
• Disturbed sleep, which commonly includes early waking. Diurnal pattern to symptoms also seen, with symptoms often worse in the morning.
• Slowing of thought and movements (psychomotor slowing) or agitation.
• Ideas of worthlessness or guilt.
• Recurrent thoughts of death or suicide.
• All but the last 2 are considered 'biological' symptoms.
This document discusses mood disorders, specifically depression. It provides the DSM-IV criteria for a major depressive episode, including symptoms such as depressed mood, diminished interest, changes in appetite, insomnia, fatigue, feelings of worthlessness, difficulty concentrating, and suicidal thoughts. It also discusses treatment options, focusing on pharmacotherapy. SSRIs are considered a first-line treatment and details are provided about specific SSRIs, their mechanisms of action, indications, and precautions. Risk factors for suicide are briefly covered.
Postpartum period is a critical period in the life of a female from the biopsychosocial perspective. There are a number of psychological conditions which have their origin post pregnancy viz postpartum blues, postpartum depression, postpartum psychosis. Given their lack of awareness and relatively common presentation, it is imperative to know more about these conditions.
Grand Rounds (Martinez Health Center): Trating PTSD in Primary Care a Collabo...Michael Changaris
This slide show explores key aspects of treating PTSD in primary care. It explored assessing for symptoms of trauma, flow chart for treatment and collaborative team development and psychopharmachology.
This document provides information on psychiatric disorders including depression, anxiety, and psychosis. It discusses the introduction, symptoms, types, etiology, clinical manifestations, diagnosis, and management of these conditions. Psychiatric disorders are mental illnesses that can significantly impair daily functioning. They have biological and psychological causes and are treatable through a combination of medications and psychotherapy. Common treatments include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and atypical antidepressants.
This document discusses anxiety disorders and their treatment. It defines anxiety and describes common symptoms. Several types of anxiety disorders are outlined, including generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and phobic disorders. The document then discusses the classification, diagnostic criteria, epidemiology, and treatment options for each disorder type. Treatment involves psychotherapy, medications like SSRIs, benzodiazepines, beta-blockers, and other drug classes. Side effects and considerations for each treatment approach are also reviewed.
The document discusses the evolving role of benzodiazepines in the treatment of anxiety disorders. It notes that while antidepressants are now considered first-line treatment, benzodiazepines are still commonly prescribed and provide advantages like rapid onset of action. Benzodiazepines are particularly useful for initial treatment during the lag period of antidepressants or for residual anxiety when combined with antidepressants. The document concludes that benzodiazepines remain an important treatment option for anxiety disorders despite being considered second-line.
This document provides information on depression, including definitions, symptoms, epidemiology, risk factors, diagnostic tools, treatment options, and prognosis. It defines depression and its various types (mild, moderate, severe). It notes that core symptoms include low mood, loss of interest, fatigue, sleep and appetite disturbances. Risk factors include genetics, life stressors, medical conditions, medications, and substance use. Screening tools and treatment include antidepressants, psychotherapy such as CBT, and ensuring patient education and follow-up care. The prognosis is generally good with treatment, but recurrence is common.
Major Depressive Disorder (MDD), also known as clinical depression, is characterized by continuous feelings of sadness and loss of interest in activities for an extended period of time. MDD affects approximately 3% of the global population. Symptoms include low mood, lack of pleasure, changes in appetite or sleep, feelings of worthlessness, difficulty concentrating, and recurrent thoughts of death. MDD has several subtypes and is caused by biological, genetic, and environmental factors. Treatment involves antidepressant medication and psychotherapy.
Depression (also called major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how we feel, think, and handle daily activities, such as sleeping, eating, or working.
Depression is a common illness worldwide, with an estimated 3.8% of the population affected, including 5.0% among adults and 5.7% among adults older than 60 years. Approximately 280 million people in the world have depression
Generalized anxiety disorder is characterized by excessive, uncontrollable worry about everyday things. It has a lifetime prevalence of 5% in the US and is more common in women, low SES individuals, and those with a family history. Symptoms include restlessness, fatigue, difficulty concentrating, irritability, muscle tension and sleep disturbances. Treatment involves cognitive behavioral therapy to change negative thought patterns, exposure therapy, and medication such as SSRIs, benzodiazepines, and buspirone. Prevention focuses on healthy lifestyle habits and social support systems.
Depression is an alteration in mood characterized by sadness, despair, and loss of interest in usual activities. It commonly affects sleep and appetite. The incidence is higher in women and those who are divorced or separated. It can be mild, moderate, severe, or with psychotic features. Potential causes include biological factors like neurotransmitter levels, genetics, hormones, and brain changes as well as psychological and social stressors. Symptoms include depressed mood, low self-esteem, guilt, impaired thinking, and suicidal thoughts. Treatment involves antidepressant medication, psychotherapy, electroconvulsive therapy, and addressing needs like nutrition, sleep, and social support. Nurses monitor for safety and suicide risk, help patients meet basic needs, and provide
This document provides an overview of psychosis and psychotic disorders, their symptoms, and treatment including psychotropic medications. It discusses key psychotic symptoms like hallucinations, delusions, and thought disorders. It also outlines several psychiatric disorders that involve psychosis such as brief reactive psychosis, schizophrenia, and schizoaffective disorder. The document reviews treatment approaches for psychosis including supportive psychotherapy, cognitive behavioral therapy, and the use of psychotropic medications like antipsychotics.
Major Depressive Disorder is characterized by one or more episodes of depression without a history of mania. Its etiology is complex with several factors like genetics, environment, and biology contributing. Symptoms include decreased levels of neurotransmitters like serotonin and norepinephrine. Treatment involves pharmacological therapies like SSRIs, TCAs, and MAOIs to reduce symptoms as well as psychotherapy. The goals are to reduce acute symptoms, facilitate a return to normal functioning, and prevent future episodes. Treatment is conducted over acute, continuation, and maintenance phases.
Mood disorder characterized by disturbance of mood. it includes mania or depressive syndrome. it includes definition, causes, sign and symptoms, treatment and nursing diagnosis etc.
Major Depressive Disorder (MDD), also known as clinical depression, is a mood disorder characterized by persistent feelings of sadness that impact a person's mood, cognition, and behavior. There are several types of MDD with varying symptoms. Globally over 264 million people suffer from depression. Treatment involves medications like SSRIs and SNRIs as well as psychotherapy through approaches like cognitive behavioral therapy. The goal is to effectively manage symptoms and improve mood.
PSYCHOLOGICAL COMPLICATION DURING PREGNANCY.pdfNANCY MAURYA
The document discusses psychological complications that can occur during pregnancy, including maternity blues, postpartum depression, and postpartum psychosis. Maternity blues occurs in about 50% of women 4-5 days after delivery and involves mood lability, tearfulness, anxiety, and sleep/appetite disturbances. Postpartum depression occurs in 10-20% of mothers within the first 4-6 months after delivery and is associated with psychiatric, obstetric, and psychosocial risk factors. Postpartum psychosis is a psychiatric emergency that occurs in 1-2% of women and requires hospitalization due to symptoms like delusions, hallucinations, and disorientation. Prevention focuses on identifying at-risk women through
Antidepressants are the second most prescribed medication in the US, with 15 million Americans affected by depression each year. Depression is treated through medications and therapy. Antidepressants work by adjusting neurotransmitter levels in the brain like serotonin, dopamine, and norepinephrine. Common classes include SSRIs, SNRIs, TCAs, and MAOIs. While effective, antidepressants can cause side effects like nausea, insomnia, sexual dysfunction, and increased suicide risk initially. Doctors closely monitor patients to improve treatment outcomes and safety.
This document provides an overview of sexually transmitted infections (STIs) for clinicians. It discusses the most common bacterial, viral and parasitic STIs including their epidemiology, diagnosis and treatment recommendations. Screening and prevention strategies are also reviewed, including behavioral counseling, vaccination, condom use and expedited partner therapy. The impacts of STIs on women's reproductive health are highlighted.
This document discusses the differential diagnosis and management of vulvovaginal disorders. It begins by categorizing common conditions into infections (trichomoniasis, bacterial vaginosis, vulvovaginal candidiasis), skin conditions (fungal vulvitis, contact dermatitis, vulvar dermatoses), and psychogenic causes. It then provides detailed guidelines on evaluating, diagnosing, and treating specific infections like trichomoniasis, bacterial vaginosis, and vulvovaginal candidiasis. It also reviews vulvar conditions like lichen sclerosus, contact dermatitis, and classifications of vulvar dermatoses.
This document provides information about migraine in women. Some key points:
- Migraine is 3 times more common in women than men. Hormonally-associated migraines affect 12 million women in the US.
- Migraines are often associated with changes in hormone levels, such as during menstruation, pregnancy, use of oral contraceptives, and menopause.
- Diagnosis of migraine involves evaluating symptoms such as headache duration/intensity, nausea, light/sound sensitivity, visual/sensory disturbances (aura).
- Treatment involves both acute symptomatic relief and preventive medications, though choices are more limited during pregnancy/breastfeeding due to safety.
This document discusses 5 case studies involving GI disorders in women. The first case involves a 32-year-old woman with 5 years of diarrhea and abdominal pain. The next best step is reassurance without further testing, as her symptoms are consistent with irritable bowel syndrome. The second case involves a 38-year-old woman with vomiting after gastric bypass surgery, where an internal hernia is the most likely cause. The third case involves a pregnant woman referred for irritable bowel syndrome, where testing her for celiac disease is the next best step. The fourth case involves constipation, where pelvic floor dysfunction is the most likely diagnosis given her exam findings. The fifth case involves a 58-year-old woman with diarrhea
Here are my recommendations for the 56 year old woman with subclinical hypothyroidism:
1. Her diagnosis is subclinical hypothyroidism based on an elevated TSH of 7.1 and normal free T4.
2. Given her age (56), fatigue, and 3-4 lb weight gain, I would recommend a trial of levothyroxine therapy. Treatment is reasonable for patients with TSH >10 or positive thyroid antibodies, which she does not have data for. However, treatment may modestly improve her lipids and symptoms.
3. She should be monitored every 6 months with TSH checks to ensure her TSH is maintained between 0.5-2.0 and that she does not
The document announces the Women's Health 2012 Congress hosted by the NIH Office of Research on Women's Health. It will feature scientific poster awards for Women's Health and Sex Differences Research. The congress focuses on women's health issues and research.
The document discusses how the Affordable Care Act (ACA) aims to improve access to preventive health services for women by requiring new health plans to cover recommended preventive services without cost sharing. This includes services for cancer screening, chronic disease prevention and management, vaccinations, healthy behaviors counseling, pregnancy-related care, and reproductive health services. The new rules apply to new private health plans starting in 2010 and 2012, with some exemptions for grandfathered and religious plans. Implementation will consider factors like network restrictions, separate billing for visits and services, and ensuring adequate provider training and capacity.
The document summarizes the charge given by the Institute of Medicine to convene a committee of experts to review women's preventive health services and identify gaps. The committee was tasked with recommending services to be included in comprehensive national guidelines. After reviewing evidence, the committee made 8 recommendations, including screening for gestational diabetes, HPV testing, counseling on STIs and HIV, contraception services, lactation support, interpersonal violence screening, and annual well-woman visits.
This document summarizes key aspects of the Affordable Care Act (ACA) and how it benefits women's health and preventive care. It discusses how the ACA expands insurance coverage to over 34 million Americans, strengthens consumer protections, and requires insurers to cover preventive services for women at no additional cost. Specifically, it outlines services that must be covered for pregnant women, various cancer and disease screenings, counseling services, contraception and sterilization coverage, lactation support, and violence screening. It also notes that some existing "grandfathered" health plans are exempt from some ACA requirements but still must cover certain new benefits.
Dr. Iglesia has no conflicts of interest to disclose. The objectives of the document are to develop effective treatment plans, communicate treatment goals, minimize medication side effects, and describe new therapies for overactive bladder in women. Overactive bladder affects millions of Americans, especially women, and prevalence increases with age. New therapies aim to change stereotypes about overactive bladder and provide realistic information about prevalence and severity. Behavioral interventions like pelvic floor exercises and bladder training can be effective treatment approaches.
The document discusses cervical cancer screening guidelines and strategies, comparing the use of Pap tests, HPV tests, and primary HPV screening. It provides information on the epidemiology of HPV and progression to cervical cancer, as well as data from studies showing that primary HPV screening can detect more high-grade cervical lesions than cytology alone.
This document discusses strategies for managing obesity in women. It notes that obesity is influenced by multiple factors including genetics, environment, diet, physical activity, and life events. Key life events that can influence weight gain include pregnancy, menopause, and aging. Maternal obesity increases health risks for both mother and child during pregnancy and the child's future obesity risk. Abdominal obesity, as measured by waist circumference, is a better predictor of health risks than BMI alone. Managing obesity requires addressing its underlying causes through lifestyle changes.
This document is an in memoriam for Trudy L Bush, a professor of epidemiology and preventive medicine at the University of Maryland who passed away in 2001. It summarizes her landmark research on the effects of hormones on various body systems, her trailblazing leadership in the field of women's health, and her tireless commitment to medical education relating to women's health and menopause. The document honors her memory with an annual lecture series.
Evidence based management of cardiovascular disease in women plmiami
1. Evidence Based Management of Cardiovascular Disease in Women discusses the leading causes of death in Americans and how cardiovascular disease is the number one killer of women.
2. The document reviews gender differences in atherosclerosis, such as plaque erosion being more common in women than plaque rupture seen in men, making diagnosis of cardiovascular disease more difficult in women.
3. Prevention strategies discussed include reducing atherosclerosis, preventing plaque rupture and erosion, limiting thrombosis, and recognizing the presence of cardiovascular disease in women.
This document discusses care of cancer survivors and outlines the following key points in 3 sentences:
1) Approximately 3% of the population are cancer survivors, with many being elderly and having multiple comorbidities. 2) Both cancer-related and general medical needs must be addressed in cancer survivors, including surveillance for recurrence, late effects of treatment, and new primary cancers as well as screening and management of comorbidities. 3) The role of primary care physicians in providing ongoing care for cancer survivors along with survivorship care plans is reviewed.
This document discusses factors that influence peak bone mass attained during adolescence and young adulthood. It notes that genetics account for 80% of variability in peak bone mass, and lists several genes associated with bone mineral density and fracture risk. Nutrition, physical activity, body composition, endocrine status like age of menarche, and use of birth control also impact peak bone mass. Regular weight-bearing exercise and adequate calcium, vitamin D, and protein intake during growth can help increase bone mass accrual and attain a higher peak.
This document summarizes best practices in lesbian health based on a presentation by Dr. Patricia Robertson. It finds that lesbians have higher rates of smoking, childhood abuse, obesity, and certain STIs. They have lower rates of Pap smears and mammograms due to cost and prior adverse experiences. The document recommends screening lesbians appropriately, discussing family planning options, ensuring legal protections for partners, and advocating for lesbian health in the community. Providers should encourage disclosure of sexual orientation to provide culturally competent care.
Lee P. Shulman is the Anna Ross Lapham Professor of Obstetrics and Gynecology and Chief of the Division of Clinical Genetics at Northwestern University. He discloses advisory roles and speaking engagements with several genetic testing companies. His research focuses on inherited cancer risk assessment and genetic testing for hereditary cancer syndromes. He provides an overview of the genetics of cancer including tumor suppressor genes and oncogenes, as well as specific hereditary cancer syndromes like BRCA1/2, Lynch syndrome, and Cowden syndrome that increase cancer risk, especially for women's cancers.
This document summarizes evidence-based care of women with rheumatoid arthritis (RA). It discusses that RA is a chronic inflammatory disorder that principally affects the synovial joints. It is characterized by a proliferative response in the synovium leading to bone and cartilage destruction. The document reviews who is affected by RA, common articular features, characteristic deformities, and extra-articular manifestations. It also discusses the natural history of RA and whether there are any gender differences. Current management approaches from 2012 are presented, including early diagnosis, prompt initiation of traditional DMARDs, and appropriate use of biological DMARDs.
This document discusses gender differences in substance abuse. It finds that while males have higher rates of substance use, females are at least as vulnerable to substance abuse and may become dependent more rapidly if given the opportunity. Specifically, females are more likely than males to become dependent on sedatives, anxiolytics, and opioids. Animal studies also show females self-administer more of several substances and acquire drug conditioning faster. Overall, the document suggests the vulnerability to substance abuse is similar between males and females.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
1. Depression in Women
—Improving Outcomes
Katherine L. Wisner, M.D., M.S.
Director, Women’s Behavioral HealthCARE
Professor of Psychiatry, Obstetrics and Gynecology
and Reproductive Sciences, Epidemiology, Clinical
and Translational Science, and Women’s Studies
Western Psychiatric Institute and Clinic/UPMC
WisnerKL@upmc.edu
3. Major Depression:
Public Health Impact
The World Health
Organization estimated that
major depression is the
leading cause of disease-
related disability among
women world-wide.
(Murray & Lopez, 1996)
4. Gender Differences in Prevalence of
Major Depression
Women: 1.5-2.5 X rate relative to men 15-54
Kessler et al (1993) Journal of Affective Disorders
5. Improving
Outcomes
Consider Differential Diagnosis
Treat to Remission; Response at Minimum
Measure Symptom Improvement
Use Evidence Based Interventions
Personalize Antidepressant Choice to the Woman
Optimize the Dose
Special Considerations for Reproductive Related
Depressions (PMDD, Perinatal, Perimenopausal)
Provide Self-Help Resources
6. Major Depression
For two weeks, most of the day nearly every day, 5 of
these (one must be mood or interest):
Depressed mood
Diminished interest/pleasure
Weight loss/ gain unrelated to dieting
Insomnia/ hypersomnia
Psychomotor agitation/ retardation
Fatigue or loss of energy
Feelings of worthlessness/guilt
Diminished ability to concentrate
Recurrent thoughts of death
NIMH--MDD in Women for patients:
www.nimh.nih.gov/health/publications/women-and-
depression-discovering-hope/index.shtml
7. Diff Dx: Bipolar Disorder
Unopposed Antidepressant is not Appropriate, risks
agitation/ rapid cycling
Prevalence=1-1.5%; to 5% for spectrum, Males=Females
Mania/ hypomania alternate with depressive episodes.
Onset in mid to late teens
Postpartum onset particularly common
“Plugged in” symptoms: grandiosity, less need for sleep
but not tired, pressured speech, flight of ideas,
distractibility, increased involvement in goal-directed
activities, psychomotor agitation, excessive involvement in
pleasurable activities with likelihood of painful
consequences
Screen for bipolar disorder MDQ (Mood Disorders
Questionnaire) www.dbsalliance.org/pdfs/MDQ.pdf
8. Treatment and the ‘5 R’s’ for
MDD
Remission Recovery
Relapse Recurrence
Normal mood Pro
gre Relapse +
Symptoms
Severity
ssi
Response
o
50% improvement
nt
+
od
iso
Depression
rde
r
Acute Continuation Maintenance
Time
Adapted from Kupfer DJ. J Clin Psychiatry. 1991;52(Suppl):28-34.
13. Bright Light Therapy
Effective for seasonal (winter)
MDD and non-seasonal MDD
Effective augmentation for
antidepressant partial responses
30-60 minutes of a commercially
available, UV-screened bright
fluorescent light, within 10 mins of
awakening, determine optimal time
Center for Environmental Therapeutics,
www.cet.org
Wirz-Justice et al--Chronotherapeutics for
Affective Disorders: A Clinician's Manual for Light
and Wake Therapy
15. Premenstrual Dysphoric
Disorder
Average age of onset= 26 years
Symptoms increase across time until
menopause
Symptoms of PMDD comparable in severity to
major depression
Somatic symptoms typically improve parallel
to depressive symptoms
Symptoms return when treatment is stopped
16. Prevalence of Premenstrual
Symptoms
Menstruating Women
Mild Symptoms 75%
PMS 20%-40%
PMDD
3%-8%
1.
Steiner M. J Psychiatry Neurosci 2000;25(5):459-468.
2.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. 1994.
19. Depression Recurrence
during Pregnancy
Recurrence risk for women who either maintained
or discontinued antidepressants proximal to
conception (Cohen et al- JAMA. 2006;295:499-507)
Significantly more women who discontinued
(44/65, 68%) compared to women who maintained
(21/82, 26%) antidepressant treatment suffered
recurrent major depressive disorder.
Most recurrences emerged rapidly (50% in the first
trimester, and 90% by the end of second trimester).
20. Reproductive Outcome
Domains
Major birth defects (approx 3% in the
general population)
Growth Effects
Behavioral Teratogenicity
Neonatal Syndrome
These domains are impacted by
both psychiatric disorders and
antidepressants
21. Summary Points
Intrauterine Fetal Death- No conclusive evidence;
women with SRI and/or NDD exposure have higher risk for
miscarriage
Physical Malformations- Specific defects (if any)
are rare and absolute risks are small. Greene, M. F. (2007).
Teratogenicity of SSRIs -- Serious Concern or Much Ado
about Little? NEJM 356: 2732-2733
Growth- Maternal Weight Gain, pregnancy
duration, infant birth weight- SGA inconsistently
reported with SSRI exposure. PTB is a converging finding
for SRI exposed neonates-- MDD is associated with the
same level of risk for preterm birth. PTB and SGA for
depression.
22. Summary Points
Behavioral Teratogenicity- No differences
in cognitive function, verbal comprehension, expressive
language, mood, activity levels, distractibility, behavior
problems, temperament (Nulman et al-- TCA, FLX); Casper
et al (2003) and Pederson et al (2010) reported less
favorable motor (not mental) development in SSRI exposed
vs. depression controls in toddlers. Resolved by 19 months.
Neonatal Syndrome- Time-limited < 2 weeks,
rarely requires medical intervention; most commonly
associated agents are paroxetine>fluoxetine>sertraline>
fluvoxamine= citalopram= escitalopram
PPHN- Risk increased from 1-2/1000 to 6-12/1000 with
exposure to SSRI after 20 weeks gestation; subsequent
studies have not consistently replicated this finding
23. The Clinician’s Conundrum:
Dosing
How do I treat to get the best result for the
maternal-fetal pair?
Toxicity is related to dose! Should I keep the
dose low to reduce exposure?
Does the dose change across pregnancy?
Guidance document by FDA in October, 2004
http://www.fda.gov/downloads/Drugs/GuidanceCompliance
RegulatoryInformation/Guidances/ucm072133.pdf
24.
25.
26. Screening for Depression
in an Obstetrical Hospital
N=10,000 screened, 14%+ on screen
(Edinburgh Postnatal Depression Scale
(EPDS) Cox JL, et al. Br J Psychiatry 1987; 150:782-86
The onset of the identified episodes for the
women (N=826) was:
- during pregnancy, N=276 (33.4%)
- postpartum (within 4 weeks of birth),
N= 331 (40.1%)
- prior to pregnancy, N=219 (26.5%)
www.MedEdPPD.org www.postpartum.net
27. NIMH-funded Study
Wisner KL, Hanusa BH, Perel JM, Peindl
KS, Piontek CM, Findling RL, Moses-
Kolko EL. Postpartum depression: A
randomized trial of sertraline vs.
nortriptyline. J Clin Psychopharm
26:353-360, 2006.
8 week acute phase parallel design,
6 month continuation phase,
no placebo
28. Nortriptyline vs. Sertraline
Response and remission rates did not differ;
At 8 weeks, responders: SERT=56%,
NTP=69%: remitters SERT=46%, NTP=48%
Time to response and remission did not differ
Psychosocial functioning improved similarly
The total side effect burden of each drug similar
No clinical (including O/C) or demographic
variables ID’d responders from nonresponders
Medications similarly efficacious in women with
non-postpartum depression
29. Antidepressants: One Dose Does not Fit All
Wisner et al, J Clin Psychopharm 26:353-360, 2006.
SERT, <100 100 125 or 150 200
mg/day,
N=24 1 (4%) 12 (50%) 4 (17%) 7 (29%)
% remitted
NTP, mg/day, <100 100 125 or 150
N=26,
15 (58%) 7 (27%) 4 (15%)
% remitted
*Start with 25 mg of sertraline or 25 mg of nortriptyline;
half of usual starting dose of any antidepressant
32. Transdermal Estradiol for
Postpartum Depression
NIMH funded, 80 randomized
Replicate Gregoire et al (1996,
Lancet) rapid response to E2 vs. PL
with an antidepressant comparator
Random assignment to E2 patch,
sertraline or PL for 8 weeks
Women with response enter blinded
continuation phase through 28
weeks postpartum
Infant growth and developmental
outcomes at 6.5 months
33. Perimenopausal Depression
E2 has psychotropic properties independent of
hormone deficiency/withdrawal
Not a simple hormone deficiency: Basal plasma
levels E2 do not distinguish women with/without
depression
Mood enhancing effects of E2 in perimenopausal
depression occurs independent of hot flashes
Antidepressants decrease hot flashes
independent of depressive symptoms
34. Dosing: Estradiol Patch for
Perimenopausal Depression
Schmidt et al 2000
• 3 week RCT of E2 vs Placebo
• 34 confirmed perimenopausal women
• 50 ug/d transdermal E2
• 80% response rate to E2 vs 20% to Placebo
Soares et al 2001
• 12 week RCT of E2 vs Placebo
• 50 confirmed perimenopausal women
• 100 ug/d transdermal E2
• 70% response rate to E2 vs 20% to Placebo
35. Iterative Steps in a Comprehensive
Detection
Program Model
Diagnosis
Treatment engagement
Treatment
Symptom improvement
Improved outcomes
courtesy L. Miller (e.g. function, quality of life, parenting, offspring,
relationships, family, health, prognosis)
36. International Biennial Congress of The Marcé Society
www.marcesociety.com
Acting Together Around Childbirth
Paris, October 3-5, 2012
Scientific committee:
Prof. Anne Buist, Dr. Nine Glangeaud-Freudenthal (Congress President),
Prof. Vivette Glover, Ms. Jane Hanley, Prof. Michael O'Hara,
Dr. Oguz Omay, Dr. Anne Laure Sutter, Prof. Katherine Wisner.
INFORMATION & Relations Médicales - Raphaël GASSIN
REGISTRATIONS Web: www.info-congres.com
39. More Information-
Pregnancy
Developmental and Reproductive Toxicity:
www.toxnet.nlm.nih.gov (DART database-free)
Organization of Teratology Information Specialists (OTIS)
www.otispregnancy.org, (866) 626-OTIS, or (866) 626-6847
ACOG Practice bulletin: Use of psychiatric medications
during pregnancy and lactation. Obstetrics and Gynecology
110:1179-1198
Wisner KL et al: Psychiatric Disorders, in Obstetrics:
Normal and Problem Pregnancies, 5th edition. Gabbe SG,
Niebyl JR, Simpson JL, Galan H, Goetzl L, Jauniaux ERM,
Landon M, Editors; Elsevier, pages 1249-1288, 2007.
40. More Information:
Postpartum Depression
Miller LJ. Postpartum Depression.
JAMA 287:762-765, 2002.
www.hfs.illinois.gov/mch
www.psych.uic.edu/clinical/HRSA; 1-800-573-6121
Wisner KL et al.. Clinical Practice: Postpartum depression.
NEJM 347:194-199, 2002.
Wisner KL et al. A major public health problem: Postpartum
depression. JAMA 296:2616-2618, 2006.
Munk-Olsen T. New Parents and Mental Disorders: A Populatio
Based Register Study.
JAMA 2006;296:2582-2589
41. MedEd PPD www.MedEdPPD.org
Professional Information, Free
Provides professionals with the tools to
successfully screen, diagnose, treat, refer, and
engage women with PPD. These include:
• Interactive case studies
• Provider tools including diagnostic instruments
• Educational video presentations and discussions
Mothers and Others, Free
The patient-oriented section of the site
contains many features:
• An easy-to-use online diagnostic test;
• Information about the myths and realities of PPD;
• Experiences of real women with PPD;
• Answers to frequently asked questions from experts in
the field; and
42. Resources: Bipolar Disorder
Is Your Depressed Patient Bipolar? Kaye NS, JABFM
www.jabfm.org/content/18/4/271.full
Patient Resource (NIMH):
www.nimh.nih.gov/health/publications/bipolar-disorder/complete-in
Treatment of Bipolar Disorder: A Guide For Patients and
Families
www.psychguides.com/sites/psychguides.com/files/docs/Bipol
ar%20Handout.pdf
Famous Women with Bipolar Disorder
Carrie Fisher, Patty Duke, Mariette Hartley, Catherine Zeta-
Jones, Jane Pauley, Marilyn Monroe, Judy Garland
Women are approximately 1.7 times as likely as men to report a lifetime history of MDE. Sex difference begins in early adolescence (age 10) and persists through the mid-50s. The sharp divergence in the 50’s is based upon a small sample size and not thought to be reliable. Sex difference in depression is most pronounces among early adolescents, with the highest relative hazard of first onset (OR=2.3) in the age range 10-14. This is a consistent finding throughout the world, regardless of how depression is diagnosed. Since women are no more likely than men to be chronically depressed or to have ana acute recurrence in the past year – therefore higher prevalence is due to higher risk of 1 st onset. The NCS was a congressionally mandated survey with the specific goal of studying the comorbidity of psychiatric disorders. 8000 individuals, ages 15-54 interviewed. Used a supplemental nonresponse survey, with financial incentive, based on previous evidence that survey nonresponders tend to have higher rates of psychiatric d/o. A structured psychiatric interview (DIS-diagnositc interiew schedule – can be administered by trained interviewers who are not clinicians) was administered to a representative US sample. Based on results that respondents underreport stem questions once they recognize that positive responses lead to more detailed questions, they used a life review section before probing any positive stem responses and to facilitate active memory search for lifetime episodes. Anxiety d/o have an approximately 5% 1-yr prevalence form the same study
Three terms are used to describe improvement of a depressed patient after treatment with an antidepressant: response, remission, and recovery. Generally, response refers to at least a 50% reduction in symptoms of depression as assessed by a psychiatric rating scale. Remission is the resolution of essentially all symptoms (e.g., HAMD score 7) . If remission lasts for 6 to 12 months, the remission is considered to be recovery . The terms relapse and recurrence are used to describe a worsening in a patient with depression. If the patient worsens before they have achieved recovery, the term relapse is employed to describe the worsening of symptoms. If the patient experiences a new depressive episode within a few months of recovery, the term recurrence is used. Treatment of MDD can be divided into three phases: acute, continuation, and maintenance. During the acute phase, in which the patient is experiencing depressive symptoms, a primary goal of treatment is to elicit a response to medication or therapy. During the continuation phase, the period after the patient’s symptoms have responded to acute intervention(s), a primary goal of treatment is to prevent a relapse of depressive symptoms. During the maintenance phase, a primary goal of treatment is to prevent a recurrence or another acute episode of depression. Reference: Kupfer DJ. Long-term treatment of depression. J Clin Psychiatry . 1991;52(Suppl):28 -34.
The side effects of antidepressants appear to be closely related to their acute effects on particular neurotransmitter systems. The time course of development of specific side effects is closely linked to that of acute synaptic effects in specific neurotransmitter systems. Side effects often occur within hours to days of initiation of antidepressant therapy, whereas therapeutic effects require weeks. 1 This observation suggests that much of the tolerability of antidepressants is directly a function of acute synaptic effects on monoaminergic and other systems that are brought about by the initiation of antidepressant treatment. 1,2 Clinical data show that specific neurotransmitter effects are associated with distinct side effects. These and other side effects are attributed to drug activity at central or peripheral synapses where the antidepressants either bind to receptors to influence cellular function or alter the concentration of endogenous neurotransmitters. Increasing the levels of specific neurotransmitters may result in different types of short-term and long-term side effects. 1,2 Serotonergic side effects include sexual dysfunction, sleep disturbance, and gastrointestinal upset. 1 –5 Noradrenergic side effects include tremor, tachycardia, dry mouth, and insomnia. 1 Psychomotor activation and aggravation of psychosis are dopaminergic side effects. 1 References: 1. Richelson E. Pharmacology of antidepressant—characteristics of the ideal drug. Mayo Clin Proc . 1994;69:1069 -1081. 2. Sussman N, Ginsburg D. Weight gain associated with SSRIs. Prim Psychiatry . 1998;5:28-37. 3. Stahl SM. Essential Psychopharmacology: Neuroscientific Basis and Practical Applications . 2nd ed. New York, NY: Cambridge University Press; 2000. 4. Richelson E. Prim Psychiatry . 1998;5:40-41. 5. Kapur S, Remington G. Serotonin-dopamine interaction and its relevance to schizophrenia. Am J Psychiatry . 1996;153:466-476.
Massive placental and fetal hormone secretion produce dramatic rise in steroid hormones during pregnancy. Estradiol increases from 100 pg/ml (mean conc across the menstrual cycle) to 16,000 pg/ml (an over 100-fold increase) Within 24 hours of parturition, estrogen drops below follicular levels, and then reequilibrates within a few days. Progesterone rises from 25 ng/ml (mid luteal peak) to 150 ng/ml by term (6-fold higher) and then drops within 24 hours to luteal phase levels and then further to follicular levels by 1 wk postpartum. Estradiol increases 100-fold across pregnancy relative to mean menstrual cycle concentrations and falls to early follicular levels within the 1st week postpartum. Large increases in dihydroepiandosterone via the fetal adrenal gland contribute to pregnancy estrogen increases (ParkerJr 1999). Progesterone reaches concentrations 10-fold higher than mid-luteal levels of the menstrual cycle in late pregnancy, and falls to follicular phase levels within the 1st week postpartum. Allopregnanolone concentration increases follow those of progesterone across childbearing (Luisi et al. 2000). Due to prolonged suppression of the hypothalamic pituitary ovarian axis during pregnancy, ovulation and the associated rise in estradiol and progesterone is generally absent until 6 weeks postpartum. Corticotrophin releasing hormone (CRH) and cortisol produced by the placenta increase 1000-fold and 3-fold in pregnancy, respectively and revert to normal states within 12 weeks postpartum (Chrousos et al. 1998; Mastorakos et al. 2000; Smith et al. 1992). Oxytocin mRNA expression, synthesis, and receptor density are increased several-fold in lactating relative to non-lactating mammals (Numan et al. 2003). neuroplasticity, neurogenesis, and amplification of hormones and peptides have demonstrated relationships to evolutionarily beneficial adaptations in cognitive (ie: spatial navigation Kinsley), emotional (fear reduction; Lonstein, Neumann), and maternal function (Numan review) in preclinical studies. How brain preparations for maternity proceed in humans and how such preparation go awry in women with mental illness (or women with high levels of psychosocial stress) is an important area for future investigation. (do we know anything???) Because healthy maternal adaptation confers benefits to offspring at the level of emotional, cognitive, and physical development (insert refs), insights into mental illness-related aberrant maternal brain preparations could assist in the development of treatments to foster healthier adaptation to the maternal role.
<200pmol/L ==> <60 pg/ml BUT graph makes it look like < 100pmol/L or 30pg/ml 400 pmol/L ==> 110 pg/ml BUT graph makes it look like 500 pmol/L or >130pg/ml Study Design 23 women with MDD onset within 6 mos postpartum, severe illness, E2 concentrations < 60 pg/ml 8 wk open trial 17 -estradiol 1mg SL, 3-8x daily (to 110 pg/ml) Dramatic improvement within 1 week of E2. 91% Ss recovered by week 8 on E2 alone Gregoire et al (Gregoire et al., 1996) randomized 61 women with PPMD to placebo or transdermal 17 -E2 (200 mcg/day) delivered by transdermal patch for 6 months. The mean E2 concentration of actively treated women was 680 pmol/L (as a comparison, the mean E2 concentration across the menstrual cycle is 370 pmol/L). Both the E2 and placebo groups improved across time; however, the E2 treated group improved rapidly (within a month). The outcome measure was the Edinburgh Postnatal Depression Screening Scale (EPDS; Cox et al, 1987). The mean EPDS score for E2-treated subjects was consistent with remission (Peindl et al., 2004) and was 4 points lower than that of the placebo group at study completion. At 3 months of treatment, 80% of the E2 group had EPDS scores <14, but only 31% of placebo group had scores <14. Several lessons learned from Gregoire (a consultant for the proposed study) et al’s work have informed the proposed investigation. Because assessments were done once a month, the time course of response in the early weeks of treatment is unknown and may be substantially earlier. The inclusion of women who took concurrent antidepressant medications (47% and 37% in the E2 and placebo arms, respectively) limits the ability to discern an E2-specific treatment effect. The EPDS is a self-report scale; the validity of the findings would be increased if they were confirmed with a clinician interview-based measure. The exclusion of breastfeeding women and the inclusion of moderately depressed women (mean EPDS=21) also limit the study’s generalizability. An EPDS score of 21 is equivalent to a 17-item HRSD score of approximately 18 (based upon a correlational estimate from our study of 140 women with PPMD). In the Gregoire et al study, women who developed PPMD by 3 months but presented for treatment up to 18 months postpartum were included. This time frame is far removed from the E2 withdrawal at delivery that theoretically contributes to PPMD risk and is the primary rationale for E2 treatment. The dose of 17 -E2, 200 mcg/day, is high by today’s standards. A compelling question is whether response occurs at lower doses (personal communication, Alain Gregoire, M.D.), which will be answered in the proposed study