18 - Mood Disorders Flashcards
What is a mood disorder and what are some examples?
General emotional state is distorted or inconsistent with your circumstances and interferes with your ability to function e.g bipolar and depression
What are the core symptoms of depression?
Symptoms have to be occurring for at least two weeks:
- Low mood
- Lack of energy
- Lack of enjoyment and interest
Apart from the core symptoms of depression, what are some other symptoms of depressive disorders?
- Depressive thoughts, e.g feeling worthless or the future is hopeless
- Somatic/Biological symptoms e.g lack of sleep, early waking, loss of appetite, slow movements
- Psychotic symptoms
What is the difference between a normal adjustment reaction and clinical depression? e.g thinking about sleep pattern and appetite
Depression persists for an abnormal length of time
What are the features of mania?
- Elated mood
- Increased energy and talking really fast
- Decreased need for sleep
- Flight of ideas
- Loss of normal social inhibitions
- Attention cannot be sustained
- Self esteem is inflated (grandiose)
- May have psychotic symptoms like delusions
- Psychomotor agitation e.g pacing around the room
What is bipolar affective disorder?
Diagnosis made when 2 episodes of a mood disorder with at least one of them being hypomania or mania.
Therefore can be bipolar and never even have depressive symptoms
What are the two different types of bipolar disorder?
- Bipolar 1: Full manic episodes with or without depression
- Bipolar 2: hypomanic episodes with major depressive episodes
- Episodes can be years apart or have many cycles in one year
What are some diseases that can cause depressive symptoms?
- Hormone disturbances e.g hypothyroidism
- Vitamin deficiencies e.g Vit B12
- Chronic disease e.g renal, cardiac and liver failure
- Anaemias
- Substance misuse e.g alcohol, cannabis, stimulants
- Hypoactive delirium
What are some diseases that can cause symptoms of mania?
- Iatrogenic e.g steroid induced from chemotherapy
- Hyperthyroidism
- Delirium
- Infection e.g encephalitis, syphilis, HIV
- Head injury
- Intoxication with stimulants
What brain structures are involved in mood disorders?
Limbic system
Frontal Lobe
Basal ganglia
What is the limbic system made up of and what is its function?
Amygdala, hippocampus, thalamus, hypothalamus, basal ganglia, and cingulate gyrus
Involved in motivation, emotion, learning and memory. Acts by influencing the endocrine system and the autonomic nervous system.
(Think about when depressed, limbic system must be involved as lack of ability to store memories and lack of motivation)
What are some possible limbic system changes in the main mood disorders, depression and bipolar?
Mania difficult to study
What are some functions of the frontal lobe?
Inhibitions
What are some functions of the prefrontal lobe?
What are some changes that occur to the frontal lobe in the main mood disorders?
What are some possible changes that occur to the basal ganglia in mood disorders?
Explain which areas of the brain cause each symptom in depression?
What is the role of serotonin in the brain and what changes to the levels of serotonin occur in depression?
- Made in the Raphe Nuclei and transported to all cortical areas and limbic system.
- Is involved in sleep, impulse control, appetite and mood.
- In depression serotonin is low. In CSF of suicide victims 5HIAA (metabolite of serotonin) is really low and tryptophan (precursor of serotonin) causes depression
What is the role of noradrenaline in the brain and what changes to the levels of this neurotransmitter occur in depression?
- Made in locus coeruleus (pons) and projects to cortex and limbic system.
- Involved in mood, arousal and attention, fight or flight, memory
- Decreased in depression and those who have recovered from depression are more likely to relapse if they have low NA
How is depression treated?
Biological: first line is SSRIs e.g fluoxetine.
Then can add SNRIs (like duloxetine) or TCAs or if really resistant can give ECT
Psychological: first line treatment of CBT
Social: help with isolation and social stressors like finances
How do we treat mania?
Biological: first line antipsychotics (dopamine antagonists) or alternatively we can give mood stabilisers (lithium or sodium valproate)
Psychological: psychoeducation to teach bipolar triggers and signs of relapse
Social: treat in a place of safety to minimise risk to themselves and others. Consider consequences of their mania, e.g debt from excessive spending, STIs, pregnancy
What are some of the predisposing, perpetuating and precipitating factors associated with depression?
How is stability maintained in bipolar disorder?
Biological: mood stabilisers like lithium, sodium valproate, quetiapine (also antipsychotic)
Psychological: psychoeducation and CBT to prevent relapses
Social: consider effects on employment and family and education them
