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Semester 4 - Clinical Neuroscience > 18. Mood disorders > Flashcards

18. Mood disorders Flashcards

1
Q

What are 2 types of mood disorders?

A

depressive and bipolar

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2
Q

What are the core symptoms of depression?

A
  • low mood/sadness
  • lack of energy
  • Lack of enjoyment and interest
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3
Q

What are some other typical symptoms of depression?

A

o Depressive thoughts
▪ worthlessness/inappropriate or excessive guilt
▪ suicidal ideation
▪ diminished ability to think/concentrate or indecisiveness

o Somatic/biological symptoms 
▪ Lack of appetite
▪ Pain
▪ psychomotor agitation or retardation
▪ insomnia/hypersomnia
o Severe cases might have psychotic symptoms (e.g. delusions)
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4
Q

What is required to make a diagnosis of depression?

A

If the person has at least 5 symptoms with at least one of these being a core symptom

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5
Q

What may be a differential for depression?

A

Adjustment reaction

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6
Q

What is the difference between adjustment reaction and depression?

A

▪ Essentially, an adjustment reaction typically occurs after some kind of traumatic event and has fewer somatic features
compared to depression
▪ Adjustment reactions do not last as long as depression and tend to have a fluctuating course

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7
Q

What are the features of mania?

A
  • Elated Mood
  • Increased energy
  • Pressure of speech
  • Decreased need for sleep
  • Flight of ideas
  • Normal social inhibitions are lost • Attention cannot be sustained
  • Self esteem is inflated, often grandiose
  • May have psychotic symptoms
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8
Q

what is hypomania?

A

Hypomania refers to symptoms that are still clearly manic but don’t
necessarily reach full diagnostic criteria for mania

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9
Q

What is bipolar I?

A

Discrete episodes of mania only or mania and depression

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10
Q

What is bipolar II?

A

Discrete episodes of hypomania or hypomania and depression

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11
Q

when is diagnosis of bipolar mood disorder made?

A

Diagnosis is made following 2 episodes of a mood disorder at least one of which is mania or hypomania.

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12
Q

What are some physical health differentials for depression?

A 
▪ Hypothyroidism
▪ B12 deficiency
▪ Chronic disease e.g. renal, CVS & liver failure 
▪ Substance misuse 
▪ Hypoactive delirium
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13
Q

What are some physical health differentials for mania?

A

Diagnosis is made following 2 episodes of a mood disorder at least one of which is mania or hypomania.

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14
Q

What different brain structures are involved in mood disorders?

A
  • Limbic system
  • Frontal lobe
  • Basal ganglia
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15
Q

What is the main hypothesis for what determines mood?

A

Mood is determined by functional circuits between these brain areas (limbic system, frontal lobe and basal ganglia).
E.g. the frontal lobe projects to parts of the limbic system which in turn connects to the basal ganglia and the brainstem.

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16
Q

What does the circuits between these different areas affect?

A
  • Cognitive processed (thoughts)
  • Sympathetic output
  • Parasympathetic output
  • Motor systems
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17
Q

WHat are the main parts of the limbic system?

A

Amygdala, hippocampus, thalamus, hypothalamus, basal ganglia, cingulate gyrus

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18
Q

What are the 3 main functions of the limbic system?

A

• Emotion • Motivation • Memory

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19
Q

what is the main emotion circuit of the limbic system?

A

papez circuit

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20
Q

describe the papez circuit

A

o Various cortical areas send input to the
o Hippocampus, which projects to the
o Mammillary bodies
o Via the fornix (white matter, output pathway of the
hippocampus)
o The mamillary bodies project to the thalamus and
hypothalamus
o The thalamus projects back to the cortex
o The hypothalamus projects down to the pituitary
and autonomics mediating some of the somatic
effects
o The amygdala is another part of the limbic system,
but can be grouped with hippocampus in terms if
its connections

21
Q

what is th paper circuit also responsible for?

A

memory consolidation

22
Q

What are the possible limbic system changes in unipolar depression?

A
  • Decreased hippocampal volume (in patients with recurrent depressive disorder)
  • Decreased cerebral blood flow and metabolism in the amygdala
23
Q

What are the possible limbic system changes in bipolar disorder?

A
  • Altered amygdala volume
  • Increased amygdala activation & volume in mania
  • Decreases in volume in anterior paralimbic cortices (inc ventral prefrontal cortex, insular cortex and temporopolar cortex) & activation
24
Q

What are the functions of the frontal lobe? (7)

A
  • Motor function
  • Language (Broca’s area)
  • Executive functions (purposeful goal directed behaviours)
  • Attention
  • Memory
  • Mood
  • Social and moral reasoning
25
Q

What are the functions of the prefrontal cortex?

A

Generation of emotions and emotional responses

26
Q

What are the possible frontal lobe changes in unipolar depression?

A
  • Decreased activity (bloodflow) in dorsolateral PFC

- Decreased volume of orbitofrontal PFC

27
Q

What are the possible frontal lobe changes in bipolar disorder?

A

Reduced dorsolateral PFC activation

28
Q

What are the psychological functions of the basal ganglia?

A
  • Emotion - Cognition - Behaviour
29
Q

What are the possible basal ganglia changes in unipolar depression?

A
  • Decreased basal ganglia volume

- Reduced activation between striatum, amygdala and PFC

30
Q

What are the possible basal ganglia changes in bipolar disorder?

A

Possible functional changes in the striatum

31
Q

what is th over-all involvement of the circuits in depression?

A

• Prefrontal cortex: Slowing of thought, executive dysfunction.
Altered emotional processing.
• Amgydala: Abnormal emotional processing
pless carry out
• Basal ganglia: Impaired incentive behaviour. Psychomotor
changes.

32
Q

WHat are the 2 main neurotransmitters for depressive disorders?

A
  • Serotonin

- Noradrenaline (aka norepinephrine)

33
Q

where is serotonin produced and distributed to?

A

Produced in brainstem (raphe nuclei) and distributed to

cortex and limbic system

34
Q

What is serotonin thought to have roles in as a neurotransmitter?

A
  • Sleep
  • Impulse control (link with suicide)
  • Appetite
  • Mood
35
Q

What is levels of serotonin thought to be in mood disorders, what is the evidence to support?

A

Low

  • SSRI’s, SNRI, TCA’s & MAOi’s all successfully treat depression by increasing levels of serotonin in synaptic cleft
  • 5HIAA (metabolite of serotonin) is low in the CSF of patients with depression (particularly those who have attempted suicide).
  • Tryptophan (precursor for serotonin) depletion causes depression
36
Q

where is noradrenaline produced?

A

Produced in the locus coeruleus of the brainstem and

distributed to cortex and limbic system

37
Q

What are the functions of noradrenaline in the brain?

A

o Mood
o Arousal
o Memory

38
Q

What is levels of noradrenaline thought to be in mood disorders, what is the evidence to support?

A

Low

  • Antidepressants (e.g. SNRI’s, NARI’s and some TCA’s) that increase NA successfully treat depression.
  • Patients who have recovered from depression who show decreased NA levels, have significantly higher rates of relapse.
  • Postmortem studies of depressed patients vs controls
39
Q

What are the biological treatments for depression?

A
  • First line = Selective Serotonin Reuptake inhibitors
  • Other options: SNRI’s, TCA’s etc
  • Life threatening/treatment resistant: Electric Convulsive Therapy
40
Q

WHat are SSRIs, SNRIs, TCAs, and MAOis?

A
  • Selective Serotonin Reuptake inhibitors
  • Serotonin Noradrenaline reuptake inhibitors
  • Tricyclic antidepressants
  • Monoamine oxidase inhibitors
41
Q

What psychological and social treatment can be used for depression?

A
  • psychological: CBT

- social: Help with e.g. isolation, social stressors (including housing, finances)

42
Q

What is the biological treatment for mania?

A
  • Biological - First line: antipsychotics

- Alternatively: mood stabiliser

43
Q

What type of drugs are antipsychotics?

A

Dopamine receptor antagonists

44
Q

Give examples of mood stabalisers used to treat mania?

A
  • lithium

- sodium valporate (teratogenic)

45
Q

What is the psychological and social treatment for mania?

A
  • Psychological - Acutely unlikely to be helpful, longer term - psychoeducation re. BPAD, triggers and signs of relapse
  • Social - Treat in a place of safety - where risk to self and others is minimal. Consideration of implications of mania e.g. debts (excessive spending)
46
Q

What is the biological treatment for bipolar depression?

A

Can use antidepressant - but ONLY with mood stabiliser cover. - ECT Lithium

47
Q

What is the psychological and social treatment for bipolar depression?

A

Same as for unipolar depression:

  • CBT
  • helping with isolation, stressors etc.
48
Q

What is the biological treatment for maintaining stability in bipolar disorder?

A
  • Mood stabilisers e.g. lithium, sodium valproate

- Antipsychotic (used as a mood stabiliser e.g. Quetiapine)

49
Q

What is the psychological and social treatment for maintaining stability in bipolar disorder?

A

Psychological

  • Psychoeducation re. bipolar affective disorder
  • CBT - to help prevent relapses

Social
- Consideration of BPAD on employment e.g. shift work. Involvement of family, education of family etc

Semester 4 - Clinical Neuroscience (19 decks)

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