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BRS PSYCHIATRY > 1b Mood disorders > Flashcards

1b Mood disorders Flashcards

1
Q

what is the ICD 10 classification for all mood/affective disorders?

A

fundamental disturbance is a change in affect/mood to depression OR elation

  • usually accompanied by change of overall level of activity
  • tend to be recurrent and onset related to stressful events
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2
Q

what is the typical cycle of low mood?

A

negative automatic thinking
negative feelings
physiological related symptoms (fatigue)
negative behaviours - due to thoughts, feelings

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3
Q

what is negative automatic thinking?

A

negative thoughts towards onseself during everyday thoughts/reactions
whats the point
im a bad person

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4
Q

what is CBT based on?

A

addressing cycles of low or high mood

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5
Q

what are negative feelings?

A

irritability
low
flat feelings/apathy

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6
Q

what are negative behaviours?

A

ruminating
laying in bed all day
social isolation

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7
Q

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

A

occurence of 2 weeks+
depressed mood AND 4/8 of:
sleep alterations
appetite alterations
anhedonia
decreased conc
low energy
guilt
psychomotor changes
suicidal thoughts

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8
Q

what are the subtypes of major depressive disorders features?

A

atypical features
melancholic features
psychotic features

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9
Q

what are atypical features of MDD?

A

mainly increased sleep and appetite, heightened mood reactivity

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10
Q

what are melancholic features of MDD?

A

no mood reactivity
psychomotor retardation
anhedonia

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11
Q

what are psychotic features of MDD?

A

prescence of delusions/hallucinations

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12
Q

when can major depressive disorder be diagnosed?

A

in the absence of any manic/hypomanic episodes

and following a major depressive episode

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13
Q

what is the typical cycle of elated/high mood?

A

positive automatic thinking
positive feelings
positive physiological symptoms
postive behaviours/erratic behaviours

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14
Q

what are positive automatic thoughts?

A

positive view of oneself in response to daily life
im the best
i can do it all

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15
Q

what are positive behaviours in mania?

A

impulsivity
increased activity/productivity

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16
Q

what are positive physiological symptoms?

A

increased energy
race sensation

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17
Q

what is a hypomanic episode?

A

symptoms of manic episode present for at least 4 days but without functional impairment

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18
Q

what is a manic episode (DSM-5)?

A

at least 1 week of euphoric/irritable mood with 3/7 of:
decreased need of sleep
distractibility
grandiosity
flight of ideas
pressured speech, talkativeness
goal-directed activities/psychomotor agitation
impulsive behaviour

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19
Q

what type of manic episode leads to a diagnosis of type 1 bipolar disorder?

A

present for at least a week with notable functional impairment

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20
Q

what type of manic episode leads to a diagnosis of type II bipolar disorder?

A

no manic episodes but multiple hypomanic episodes along with at least one major depressive episode

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21
Q

what type of manic episode leads to a diagnosis of unspecified bipolar disorder?

A

if manic symptoms last less than 4 days or other specific thresholds are unmet

22
Q

what is cyclothymia?

A

mood swings without extent of mania or depression

23
Q

when can hypomania not be diagnosed?

A

when psychotic symptoms are present

or if hospitalised

24
Q

what diagnosis is made if manic episode is caused by antidepressants?

A

normal diagnosis of bipolar disorder depending on other characteristics

25
Q

what is bipolar I disorder?

A

majority of cases
first episode is depressive, then manic then more depressive
almost half of the time with symptoms, half free
experience full manic episodes

26
Q

what is the difference between bipolar and unipolar mood disorder?

A

bipolar highly heritable- depression less so

insight preserved in depression, impaired in mania

27
Q

what are attention biases in depression?

A

difficulties for depressed people to disengage from negative material

28
Q

how was attentional bias in depression studied?

A

depressed people had prolonged maintenance of attention to negative pictures, often negative emotional face pictures and reduced attention to positive stimuli

29
Q

what brain abnormalities are observed by fMRI in depressed people?

A

sustained amygdala response to negative stimuli
anterior cingulate cortex appears to mediate negative attentional biases
increased activity in lateral inferior cortex associated with impaired ability to divert attention from task-irrelevant negative info

30
Q

what are memory biases in depression?

A

preferential recall of negative compared to positive material

31
Q

in what population do memory biases present?

A

depressed individuals and:
individuals at risk of affective disorder - neuroticism
recovered depressed individuals

32
Q

what are perceptive biases in depression?

A

reduced recognition of all basic emotions except for sadness

33
Q

what is the brains response to negative faces in depressed people?

A

enhanced amygdala response

34
Q

what is the role of the amygdala in depression?

A

exhibits bias towards detecting cues signalling potential threats like expression of fear
more active in depressed individuals

35
Q

what is the amygdala?

A

region in medial temporal lobe
involved in percepion and encoding of stimuli, reward, punishment
sensitive to detecting and triggering responses to arousing stimuli

36
Q

what is the effect of noradrenergic antidepressants on brain function studies?

A

better recognition of happy faces

37
Q

what is the effect of serotonergic antidepressants in brain studies for depression?

A

decreased recognition of fearful faces

  • but mixed results with citalopram
38
Q

where do serotonergic neurones project from?

A

Raphe nuclei in midbrain

39
Q

what is the role of serotonin?

A

regulation of mood

key role in monoamine deficiency hypothesis of depression

40
Q

what is the monoamine hypothesis of depression?

A

depressive symptoms arise from insufficient levels of monoamine NTs (serotonin, noradrenaline, dopamine)

41
Q

what is PET imaging used for in psychiatry?

A

investigating brain pharmacology

42
Q

how does PET imaging work?

A

injection of radioactive pharmaceutical, binds to specific target
can use to quantify receptors by looking at tracer density

43
Q

how does PET scanning compare to fMRI?

A

more selective, more invasive
radioactive
expensive
less optimal temporal and spatial resolution

44
Q

what is the importance of distinguishing bipolar vs unipolar mood disorders?

A

antidepressants:
- can be ineffective in acute bipolar depression and in prophylaxis
- can cause acute manic/hypomanic episodes
- can worsen long term course of bipolar illness (esp. people with a rapid cycling course)
- leads to more depressive states in bipolar illness over time

45
Q

how to differentiate bipolar affective disorder from borderline personality disorder

A

BPAD - heritable, grandiosity, mood states less effected by environment
BPD - poor self image, fear of abandonment and feelings of emptiness
both have rapid mood swings, unstable interpersonal relationships, sexual behaviour and suicidality

46
Q

how to differentiate bipolar affective disorder from schizophrenia

A

BPAD - episodic delusions/halluc
schiz - chronic delusions/halluc
both - cognitive impairment, depression/negative symptoms

47
Q

what is schizoaffective disorder?

A

features of both bipolar affective disorder and schizophrenia

48
Q

what is an important broad differential from bipolar affective disorder?

A

personality disorders

49
Q

how to differentiate bipolar affective disorder from attention deficit disorder

A

BPAD - family history, recurrent depressive episodes, amphetamines worsen mania
both - impaired concentration, executive function, abnormal working and short term memory

50
Q

what are personality disorders?

A

maladaptive patterns of behaviour, cognition, inner experience exhibited across many contexts, deviating from individuals normal culture

51
Q

what is bipolar II disorder?

A

only experience depressive and hypomanic episodes

less common

BRS PSYCHIATRY (12 decks)

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