12. Mood disorders Flashcards
what are the two broad classes of mood disorders?
depressive and bipolar disorders
what are the core symptoms of depression?
low mood
lack of energy
lack of enjoyment and interest
alongside depressive thoughts, lack of appetite, pain
psychotic symptoms
contrast depression and adjustment syndrome
an adjustment reaction occurs after some traumatic event and fewer somatic features, not last as long and fluctuating
what are the clinical features of mania?
elevated mood and energy mood, racing thoughts
psychosis
easy identifiable
what diagnosis is made after 2 episodes of a mood disorder (mania, or hypomania)
bipolar affective disorders
what is bipolar udisorder?
fluctuations in mood
bipolar 1: episodes of mania or mania and depression
bipolar 2: episodes of hypomania or hypomania and depression
what are the physical differentials for depression?
hypothyroidism B12 deficiency chronic disease substance misuse hypoactive delirium
what are the physical differentials for mania?
hyperthyroidism delirium - hyperactive type iatrogenic - steroids infection - encephalitis, HIV head injury intoxication
what is the function of the limbic system?
emotion, memory, motivation
most important region - Papez circuit
what is the Papez circuit?
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
what is another part of the limbic system?
amygdala
how is papez circuit important?
memory consolidation - hippocampus induces long term potentiation in the cortex to lay down long term memory
what changes are visible in depression and bipolar?
in the papez circuit, amygdala, hippocampus, changes in basal ganglia volume and activity
what are the functions of the frontal lobe?
motor language (Broca's) executive functions - achieving a goal attention memory mood emotion (anteroinferior - related to amygdala) social and moral reasoning
what are the roles of basal ganglia?
emotion, thought, behaviour
decreased levels of which neurotransmitters are evident in depression?
serotonin - produced in raphe nucleus in brainstem: sleep, impulse control, appetite, mood
noradrenaline- produced in locus coeruleus of brainstem: mood, arousal, memory
what is the evidence for the neurotransmitters involved in depression?
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
how is depression treated?
BIOPSYCHOSOCIAL MODEL:
BIO - anti depressants (SSRI’S), electroconvulsive therapy
PSYCHO - CBT
SOCIAL - isolation and financial worries
how is acute mania treated?
BIO: antipsychotics, mood stabilisers (lithium)
PSYCHO: not used - educate patients on triggers
SOCIAL: kept safe, finances
how is acute bipolar depression (bipolar patients between manic episodes) treated?
BIO: antidepressants with mood stabiliser
PSYCHO: CBT
SOCIAL: same as depression
what is important to recognise about valproate?
teratogenic
