12- mood disorders Flashcards
Symptoms depression
Low mood, lack of energy enjoyment and interest, depressive thoughts, somatic/biological symptoms eg. Early waking, psychotic symptoms
Adjustment vs deprssion
Sudden vs gradual, fluctuating vs constant, depression has sleep disturbances and weight loss
Mania features
Elated mood, increased energy, pressure of speech, decreased need for sleep, flight of ideas, normal social inhibitions lost, inflated self esteem, psychotic symptoms
Bipolar one
Discrete episodes of mania only or mania and depression
Bipolar two
Discrete episodes of hypo mania or hypo mania and depression
Physical differentials for depresion
Thyroid dysfunction, b12 deficiency anaemia, substance misuse, hypoactive delirium, chronic renal/cvs and liver failure
Mania physical differentials
Iatrogenic eg. Steroid induced. Hyperthyroidism, delirium, infection eg. Encephalitis/HIV/syphilis, head injury, stimulant intoxication
Which brain systems are involved in mood disorders
Limbic system, frontal lobe, basal ganglia
What determines mood
Abnormal Circuits or NT between limbic system, frontal lobe and basal ganglia.
What is affected buy limbic system
Emotion, memory/concentration, memory
Limbic changes that could cause depression (unipolar)
Decreased hippocampal volume, decreased cerebral blood flow and metabolism in amygdala
Limbic changes that can cause bipolar
Altered amygdala volume, increased amygdala activation and volume in mania, decreased volume in anterior Paralympic cortices and activation
Frontal lobe functions
Motor, language (broca’s), purposeful goal directed behaviours, attention, memory, mood, social and moral reasoning
Action of venteromedial prefrontal cortex and orbital prefrontal cortec
Venteromedial- generation of emotions
Orbital- emotional responses, possible connection fo amygdala
Unipolar depression frontal lobe changes
Decreased activity and blood flow in dorsolateral PFC and decreased volume of orbits frontal PFC
Bipolar changes in frontal lobe
Reduced dorsolateral PFC activation
Basal ganglia changes in depression
Decreased basal ganglia volume, reduced activation between striatum, amygdala and PFC
Basal ganglia changes in boipolar
Functional changes in striatum
Two main neurotransmitters for derpession
Serotonin and noradrenaline
Where is serotonin produced
Raphe nuclei in brainstem
Rile of serotonin
Sleep, impulse control, appetite, mood
Evidence that low serotonin causes depression
- SSRIs, SNRI, TCAs and MAOis treat depression by increasing serotonin in synaptic cleft
- 5HIAA (serotonin metabolite) is low in CSF of depresion patients
- tryptophan (serotonin precursor) depletion causes depression
How to treat mild depression
No anti depressants as they don’t work
Who do antidepressants work best in
Severely depressed patients
Where is noradrenaline produced
Locus coeruleus in pons
Functions nordadrenaline
Mood, role in fight or flight, memory functions
Evidence that noradrenaline is decreased in depression
SNRIs increase NA treat depression. Patients who recover who have low NA relapse more, using post mortems
Treatment depression
1st line- SSRIs. Or SNRIs, TCAs if not improving after 6 weeks
If on 3rd treatment if 2 have failed- give lithium
Life threatening- ECT(electroconvulsive therapy)
CBT, social help
Treatment manis
Antipsychotics or mood stabiliser
-long term psycho education on triggers and sign of relapse. Not good in short term
- treat in space of safety where risk to self or others is minimal
Treatment bipolar
Anti depression with mood stabiliser cover- lithium or sodium valproate.
Antipsychotic eg. Quetiapine, ECT/lithium
CBT
Social
