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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
On the graph of mania and depression, what defines the subtypes of bipolar?
The amplitude of the graph
26
What is the difference between bipolar 1 and 2?
Bipolar 1 = Highly manic episodes with highly depressive episodes Bipolar 2 = Slightly manic, not as much as bipolar 1 though
27
How many cycles have to occur a year in order for it to be considered rapid cycling?
More than 4 cycles per year
28
In bipolar, what are the majority of the episodes?
Depressive
29
What is the difference in insight between depression and mania?
Insight is preserved in depression Insight is impaired in mania
30
Which is more heritable between depression and bipolar?
Bipolar is heritable, depression is les heritabl
31
What happens to attention biases in depression?
Depression is characterised by biases in MAINTAINING?SHIFTING attention = difficulties for depressed people for disengage from negative material
32
What is detected in depressed individuals using a fMRI?
Sustained amygdala response to negative stimuli
33
Describe the changes which occur in depressed individuals in the prefrontal cortex?
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
What part of the brain is associated with impaired ability to divert attention from task-irrelevant negative information?
Lateral inferior frontal cortex
35
Which part of the brain mediates negative attentional bias?
Perigenual anterior cingulate cortex
36
What memory biases are seen in depression?
Preferential recall of negative compared to positive material
37
Describe the perceptual biases seen in depression?
Increased recognition of negative faces and/or decreased recognition of happy faces
38
What condition results in enhanced amygdala response to negative faces?
Depression
39
What are SSRI's?
Serotonin reuptake selective inhibitors
40
What happened when patients were given noradrenergic anti-depressants?
Better recognition of happy faces
41
DO anti-depressants improve happy face facial recognition?
Yes
42
What is the gold standard SSRI?
Escitalopram
43
What happens to baseline ACC levels in depressed individuals?
Elevated during tasks which probe affective circuitry
44
What is the monoamine deficiency hypothesis?
Postulates that depressive symptoms arise from insufficient levels of monoamine neurotransmitters seratonin, norepi and/or dopamine
45
What happens to the 5-HT receptor in depression?
Hypofunction - only indirect evidence though
46
What effect do clinically useful anti-depressants have on synaptic monoamine levels?
All increase
47
What happens to monoamine oxidase A in MDD?
Increased
48
What does monoamine oxidase do?
Breaks down seratonin
49
What does tryptophan depletion do?
triggers relapse in MDD - then successfully treated with SSRI's or CBT
50
What does monoamine depletion correlate with?
Low mood in patients both at risk and MD in remission
51
What is the main way to investigate brain pharmacology?
PET imaging
52
How does PET compare to fMRI?
Selective, but invasive, radioactive and expensive
53
What is the use of a tracer in measuring brain pharmacology?
Tracer injected into the patient Tracer binds to the specific target
54
How are dopamine receptors quantified?
Inject person with tracer Tracer binds to the receptor Allows the receptor numbers to be quantified, based on how much tracer is present
55
What challenge is used to quantify dopamine receptor numbers?
Amphetamine challenge
56
Which medications (used for ADHD) increases the release of dopamine?
Ritilin
57
Why is it difficult to measure serotonin using a pharmacological challenge?
Not sure which ligand / tracer to use
58
Is there measurable 5-HT release in patients with depression?
No
59
How do tryptamine psychedelics work?
They are an agonist for Serotonin 2A receptors
60
What are the three main types of tryptamine psychedelics?
Psilocybin Ayahuasca LSD
61
How do tryptamine psychedelics relate to seratonin?
Very similar chemical structures
62
What are the classic descriptions of the effects of tryptamine psychedelics?
Oceanic Boundlessness Psychological peak / mystical type experiences
63
What is the safety of tryptamine psychedelics?
Non-addictive Low physiological and brain toxicity Good therapeutic index
64
What are the negative risks associated with psychedelics?
Dysphoria, anxiety, nausea, headache, false memories
65
How is bipolar treated?
Lithium and anti-psychotics

PSYCHIATRY (7 decks)

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