12. Mood disorders

Question 1

what are the two broad classes of mood disorders?

Answer 1

depressive and bipolar disorders

Question 2

what are the core symptoms of depression?

Answer 2

low mood
lack of energy
lack of enjoyment and interest

alongside depressive thoughts, lack of appetite, pain
psychotic symptoms

Question 3

contrast depression and adjustment syndrome

Answer 3

an adjustment reaction occurs after some traumatic event and fewer somatic features, not last as long and fluctuating

Question 4

what are the clinical features of mania?

Answer 4

elevated mood and energy mood, racing thoughts
psychosis
easy identifiable

Question 5

what diagnosis is made after 2 episodes of a mood disorder (mania, or hypomania)

Answer 5

bipolar affective disorders

Question 6

what is bipolar udisorder?

Answer 6

fluctuations in mood
bipolar 1: episodes of mania or mania and depression
bipolar 2: episodes of hypomania or hypomania and depression

Question 7

what are the physical differentials for depression?

Answer 7

hypothyroidism
B12 deficiency 
chronic disease
substance misuse
hypoactive delirium

Question 8

what are the physical differentials for mania?

Answer 8

hyperthyroidism
delirium - hyperactive type
iatrogenic - steroids
infection - encephalitis, HIV
head injury
intoxication

Question 9

what is the function of the limbic system?

Answer 9

emotion, memory, motivation

most important region - Papez circuit

Question 10

what is the Papez circuit?

Answer 10

various cortical areas send input to the hippocampus which projects to the mammilary bodies via the fornix. the mammary bodies project to the thalamus and the hypothalamus. the thalamus projects back to cortex, hypothalamus projects down to the pituitary and autonomics mediating some of the somatic effects

Question 11

what is another part of the limbic system?

Answer 11

amygdala

Question 12

how is papez circuit important?

Answer 12

memory consolidation - hippocampus induces long term potentiation in the cortex to lay down long term memory

Question 13

what changes are visible in depression and bipolar?

Answer 13

in the papez circuit, amygdala, hippocampus, changes in basal ganglia volume and activity

Question 14

what are the functions of the frontal lobe?

Answer 14

motor
language (Broca's)
executive functions - achieving a goal
attention
memory
mood
emotion (anteroinferior - related to amygdala)
social and moral reasoning

Question 15

what are the roles of basal ganglia?

Answer 15

emotion, thought, behaviour

Question 16

decreased levels of which neurotransmitters are evident in depression?

Answer 16

serotonin - produced in raphe nucleus in brainstem: sleep, impulse control, appetite, mood
noradrenaline- produced in locus coeruleus of brainstem: mood, arousal, memory

Question 17

what is the evidence for the neurotransmitters involved in depression?

Answer 17

serotonin: drugs that increase it in depression, treat it
5 HIAA (metabolite of serotonin) is low in CSF of patients with depression
tryptophan (precursor of serotonin) depletes causing depression
noradrenaline: drugs that increase NA treat depression
patients recovered from depression but with low levels of NA more likely to relapse
post mortems suggest low NA in those with depression

Question 18

how is depression treated?

Answer 18

BIOPSYCHOSOCIAL MODEL:
BIO - anti depressants (SSRI’S), electroconvulsive therapy
PSYCHO - CBT
SOCIAL - isolation and financial worries

Question 19

how is acute mania treated?

Answer 19

BIO: antipsychotics, mood stabilisers (lithium)
PSYCHO: not used - educate patients on triggers
SOCIAL: kept safe, finances

Question 20

how is acute bipolar depression (bipolar patients between manic episodes) treated?

Answer 20

BIO: antidepressants with mood stabiliser
PSYCHO: CBT
SOCIAL: same as depression

Question 21

what is important to recognise about valproate?

Answer 21

teratogenic