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PSYCHIATRY phase 1b > 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 is the triad for psychological symptoms in depression?

A

The world
Oneself
The future

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14
Q

What are the four things which are implicated in depression?

A

Thoughts
Behaviours
Physiological Symptoms
Feelings

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15
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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16
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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17
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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18
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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19
Q

What does a diagnosis of a manic episode lead to?

A

Type 1 bipolar disorder

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20
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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21
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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22
Q

What is “unspecified bipolar disorder”?

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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23
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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24
Q

What cannot be diagnosed when psychotic features are present?

A

Hypomanic - as psychotic features are characterised by functional impairement

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25
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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26
Q

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

A

The amplitude of the graph

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27
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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28
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

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29
Q

In bipolar, what are the majority of the episodes?

A

Depressive

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30
Q

What is the difference in insight between depression and mania?

A

Insight is preserved in depression

Insight is impaired in mania

31
Q

Which is more heritable between depression and bipolar?

A

Bipolar is heritable, depression is less heritable

32
Q

What were thought to be the diffrences between unipolar and bipolar in the 1970s?

It has been weakened or disputed

A

Bipolar has an earlier average age of onset
Shorter depressive episodes in bipolar
Recurrent course in bipolar
Genetic specificity
Differential treatment

33
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

34
Q

What happens to memory biases in depression?

A

strong evidence for biased memory processes.

Preferential recall of negative compared to positive material = one of the most robust findings in the depression literature

Memory biases also present in individuals at risk (neuroticism) and in recovered depressed individuals.

35
Q

What happens to perceptual bias in depression?

A

Decreased recognition of happy faces and increased recognition of sad faces

Reduced recognition of all basic emotions except for sadneess

36
Q

What is detected in depressed individuals using a fMRI?

A

Sustained amygdala response to negative stimuli

37
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

38
Q

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

A

Lateral inferior frontal cortex

39
Q

Which part of the brain mediates negative attentional bias?

A

Perigenual anterior cingulate cortex

40
Q

What memory biases are seen in depression?

A

Preferential recall of negative compared to positive material

41
Q

Describe the perceptual biases seen in depression?

A

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

42
Q

What condition results in enhanced amygdala response to negative faces?

A

Depression

43
Q

What are SSRI’s?

A

Serotonin reuptake selective inhibitors

44
Q

What happened when patients were given noradrenergic anti-depressants?

A

Better recognition of happy faces

45
Q

DO anti-depressants improve happy face facial recognition?

A

Yes

46
Q

What is the gold standard SSRI?

A

Escitalopram

47
Q

What happens to baseline ACC levels in depressed individuals?

A

Elevated during tasks which probe affective circuitry

48
Q

What is the monoamine deficiency hypothesis?

A

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

49
Q

What happens to the 5-HT receptor in depression?

A

Hypofunction - only indirect evidence though

50
Q

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

A

All increase

51
Q

What happens to monoamine oxidase A in MDD?

A

Increased

52
Q

What does monoamine oxidase do?

A

Breaks down seratonin

53
Q

What does tryptophan depletion do?

A

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

54
Q

What does monoamine depletion correlate with?

A

Low mood in patients both at risk and MD in remission

55
Q

What causes a blockade of serotonin synthesis and what is the effect?

A

Blockade of serotonin synthesis by the tryptophan hydroxylase inhibitor p-chlorophenylalanine prevents the antidepressant effects of both MAOIs and TCAs

56
Q

What is the main way to investigate brain pharmacology?

A

PET imaging

57
Q

How does PET compare to fMRI?

A

Selective, but invasive, radioactive and expensive

58
Q

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

A

Tracer injected into the patient
Tracer binds to the specific target

59
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

60
Q

What challenge is used to quantify dopamine receptor numbers?

A

Amphetamine challenge

61
Q

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

A

Ritilin

62
Q

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

A

Not sure which ligand / tracer to use

63
Q

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

A

No

64
Q

How do tryptamine psychedelics work?

A

They are an agonist for Serotonin 2A receptors

65
Q

What are the three main types of tryptamine psychedelics?

A

Psilocybin
Ayahuasca
LSD

66
Q

How do tryptamine psychedelics relate to seratonin?

A

Very similar chemical structures

67
Q

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

A

Oceanic Boundlessness
Psychological peak / mystical type experiences

68
Q

What is the safety of tryptamine psychedelics?

A

Non-addictive
Low physiological and brain toxicity
Good therapeutic index

69
Q

What are the negative risks associated with psychedelics?

A

Dysphoria, anxiety, nausea, headache, false memories

70
Q

How is bipolar treated?

A

Lithium and anti-psychotics

71
Q

Differences between Bipolar affective disorder and borderline personality disorder?

A

BPAD
Episodic
Runs in family; heritability +++
Grandiosity
Mood states typically less affected by environment
BPD
Mood changes over course of hours/days rather than days/weeks
Poor self image
Fear of abandonment
Feelings of emptiness
Hx of self-harm
Hx of trauma/disrupted attachment

72
Q

Difference between bipolar affective disorder and schizoaffective disorder?

A

Both can both can present with psychosis and mood symptoms (both depression and mania)

Typically in Schizoaffective disorder there is more prominent disorganisation of thought, paranoid delusional beliefs and auditory hallucinations

Episodic delusions and hallucinations more likely in schizoaffective disorder

73
Q

Differences between BPAD and ADHD

A

BPAD
Not necessarily present in childhood
Episodic
Family history (heritability+++)
Recurrent depressive episodes
Amphetamines worsen mania
ADHD
Hyperactivity
Impulsivity
Impaired concentration
Impairment of executive function
Abnormal working and short term memory

PSYCHIATRY phase 1b (7 decks)

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