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PSYCHIATRY > 1b Mood Disorders > Flashcards

1b Mood Disorders Flashcards

1
Q

What are the two methods of disease classification?

A

DSM and ICD

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2
Q

What is the current definition of a Mood Disorder?

A

Where the fundamental disturbance is a change in affect/mood due to depression or to elation

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3
Q

What is a mood change usually associated with?

A

A change in the overall levels of activity

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4
Q

What is the DSM-5 criteria for a depressive episode?

A

Occurance of 2 weeks or more of depressed mood

AND the presence of 4 of the 8 criteria / symptoms of depression

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5
Q

What are the 8 symptoms of depression?

A

Sleep alterations (insomnia or hypersomnia)
Appetite alterations (increased or decreased)
Diminished interest or anhedonia
Decreased concentration
Low energy
Guilt
Psychomotor changes (agitation or retardation)
Suicidal thoughts

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6
Q

What is the diagnosis of someone with depressive episodes and no manic or hypomanic episodes in the past?

A

Diagnosis of major depressive disorder - MDD

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7
Q

What are the subtypes in DSM-5 for MDD?

A
  1. Atypical
  2. Melancholic Features
  3. Psychotic Features
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8
Q

What are the atypical features of MDD?

A

Increased sleep and appetite, along with heightened mood reactivity

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9
Q

What are the Melancholic Features of MDD?

A

No mood reactivity, along with marked psychomotor retardation and anhedonia

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10
Q

What are the psychotic features of MDD?

A

The presence of delusions / hallucinations

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11
Q

What are the three core symptoms of depression?

A

Low mood
Anergia
Anhedonia

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12
Q

What are the biological things which can be affected by depression?

A

Sleep
Libido
Appetite

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13
Q

What are the four things which are implicated in depression?

A

Thoughts
Behaviours
Physiological Symptoms
Feelings

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14
Q

What are the thoughts and feelings of a high mood?

A

Impulsive
Elation and Excitement
Increased Energy and Race Sensation

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15
Q

What is the DSM-5 criteria for a Manic Episode?

A

Euphoric or irritable mood with 3 or more of the 7 manic criteria

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16
Q

What are the 7 criteria of mania?

A

Decreased need for sleep with increased energy
Distractibility
Grandiosity or inflated self-esteem
Flight of ideas or racing thoughts
Increased talkativeness or pressured speech
Increased goal-directed activities or psychomotor agitation
Impulsive behaviour (such as sexual impulsivity or spending sprees)

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17
Q

What needs to occur for a manic episode to be diagnosed?

A

When the symptoms of mania are present for a minimum of 1 week, with notable functional impairment

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18
Q

What does a diagnosis of a manic episode lead to?

A

Type 1 bipolar disorder

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19
Q

What needs to occur for a hypomanic episode to be diagnosed?

A

When symptoms are present for a minimum of 4 days, but WITHOUT notable functional impairment = hypomanic episode

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20
Q

What is diagnosed when there is not a single manic episode but only hypomanic episodes, with at least one major depressive disorder?

A

Type II bipolar disorder

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21
Q

What is “unspecified bipolar disoder”

A

If manic symptoms occur for less than 4 days, or if other specific thresholds are not met for manic or hypomanic episodes, then the DSM-5 diagnosis

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22
Q

What is diagnosed when a patient is hospitalised, irrespective of the duration of the manic symptoms?

A

A manic episode is diagnosed, not hypomanic

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23
Q

What cannot be diagnosed when psychotic features are present?

A

Hypomanic - as psychotic features are characterised by functional impairement

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24
Q

What is diagnosed if the manic or hypomanic episodes are caused by anti-depressants?

A

Diagnosis of bipolar is still made

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25
Q

On the graph of mania and depression, what defines the subtypes of bipolar?

A

The amplitude of the graph

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26
Q

What is the difference between bipolar 1 and 2?

A

Bipolar 1 = Highly manic episodes with highly depressive episodes

Bipolar 2 = Slightly manic, not as much as bipolar 1 though

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27
Q

How many cycles have to occur a year in order for it to be considered rapid cycling?

A

More than 4 cycles per year

28
Q

In bipolar, what are the majority of the episodes?

A

Depressive

29
Q

What is the difference in insight between depression and mania?

A

Insight is preserved in depression

Insight is impaired in mania

30
Q

Which is more heritable between depression and bipolar?

A

Bipolar is heritable, depression is les heritabl

31
Q

What happens to attention biases in depression?

A

Depression is characterised by biases in MAINTAINING?SHIFTING attention = difficulties for depressed people for disengage from negative material

32
Q

What is detected in depressed individuals using a fMRI?

A

Sustained amygdala response to negative stimuli

33
Q

Describe the changes which occur in depressed individuals in the prefrontal cortex?

A

perigenual anterior cingulate cortex (ACC) appears to mediate negative attentional biases

lateral inferior frontal cortex associated with the impaired ability to divert attention from task-irrelevant negative information

34
Q

What part of the brain is associated with impaired ability to divert attention from task-irrelevant negative information?

A

Lateral inferior frontal cortex

35
Q

Which part of the brain mediates negative attentional bias?

A

Perigenual anterior cingulate cortex

36
Q

What memory biases are seen in depression?

A

Preferential recall of negative compared to positive material

37
Q

Describe the perceptual biases seen in depression?

A

Increased recognition of negative faces and/or decreased recognition of happy faces

38
Q

What condition results in enhanced amygdala response to negative faces?

A

Depression

39
Q

What are SSRI’s?

A

Serotonin reuptake selective inhibitors

40
Q

What happened when patients were given noradrenergic anti-depressants?

A

Better recognition of happy faces

41
Q

DO anti-depressants improve happy face facial recognition?

A

Yes

42
Q

What is the gold standard SSRI?

A

Escitalopram

43
Q

What happens to baseline ACC levels in depressed individuals?

A

Elevated during tasks which probe affective circuitry

44
Q

What is the monoamine deficiency hypothesis?

A

Postulates that depressive symptoms arise from insufficient levels of monoamine neurotransmitters seratonin, norepi and/or dopamine

45
Q

What happens to the 5-HT receptor in depression?

A

Hypofunction - only indirect evidence though

46
Q

What effect do clinically useful anti-depressants have on synaptic monoamine levels?

A

All increase

47
Q

What happens to monoamine oxidase A in MDD?

A

Increased

48
Q

What does monoamine oxidase do?

A

Breaks down seratonin

49
Q

What does tryptophan depletion do?

A

triggers relapse in MDD - then successfully treated with SSRI’s or CBT

50
Q

What does monoamine depletion correlate with?

A

Low mood in patients both at risk and MD in remission

51
Q

What is the main way to investigate brain pharmacology?

A

PET imaging

52
Q

How does PET compare to fMRI?

A

Selective, but invasive, radioactive and expensive

53
Q

What is the use of a tracer in measuring brain pharmacology?

A

Tracer injected into the patient
Tracer binds to the specific target

54
Q

How are dopamine receptors quantified?

A

Inject person with tracer
Tracer binds to the receptor
Allows the receptor numbers to be quantified, based on how much tracer is present

55
Q

What challenge is used to quantify dopamine receptor numbers?

A

Amphetamine challenge

56
Q

Which medications (used for ADHD) increases the release of dopamine?

A

Ritilin

57
Q

Why is it difficult to measure serotonin using a pharmacological challenge?

A

Not sure which ligand / tracer to use

58
Q

Is there measurable 5-HT release in patients with depression?

A

No

59
Q

How do tryptamine psychedelics work?

A

They are an agonist for Serotonin 2A receptors

60
Q

What are the three main types of tryptamine psychedelics?

A

Psilocybin
Ayahuasca
LSD

61
Q

How do tryptamine psychedelics relate to seratonin?

A

Very similar chemical structures

62
Q

What are the classic descriptions of the effects of tryptamine psychedelics?

A

Oceanic Boundlessness
Psychological peak / mystical type experiences

63
Q

What is the safety of tryptamine psychedelics?

A

Non-addictive
Low physiological and brain toxicity
Good therapeutic index

64
Q

What are the negative risks associated with psychedelics?

A

Dysphoria, anxiety, nausea, headache, false memories

65
Q

How is bipolar treated?

A

Lithium and anti-psychotics

PSYCHIATRY (7 decks)

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