1b Mood Disorders Flashcards
What are the two methods of disease classification?
DSM and ICD
What is the current definition of a Mood Disorder?
Where the fundamental disturbance is a change in affect/mood due to depression or to elation
What is a mood change usually associated with?
A change in the overall levels of activity
What is the DSM-5 criteria for a depressive episode?
Occurance of 2 weeks or more of depressed mood
AND the presence of 4 of the 8 criteria / symptoms of depression
What are the 8 symptoms of depression?
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
What is the diagnosis of someone with depressive episodes and no manic or hypomanic episodes in the past?
Diagnosis of major depressive disorder - MDD
What are the subtypes in DSM-5 for MDD?
- Atypical
- Melancholic Features
- Psychotic Features
What are the atypical features of MDD?
Increased sleep and appetite, along with heightened mood reactivity
What are the Melancholic Features of MDD?
No mood reactivity, along with marked psychomotor retardation and anhedonia
What are the psychotic features of MDD?
The presence of delusions / hallucinations
What are the three core symptoms of depression?
Low mood
Anergia
Anhedonia
What are the biological things which can be affected by depression?
Sleep
Libido
Appetite
What is the triad for psychological symptoms in depression?
The world
Oneself
The future
What are the four things which are implicated in depression?
Thoughts
Behaviours
Physiological Symptoms
Feelings
What are the thoughts and feelings of a high mood?
Impulsive
Elation and Excitement
Increased Energy and Race Sensation
What is the DSM-5 criteria for a Manic Episode?
Euphoric or irritable mood with 3 or more of the 7 manic criteria
What are the 7 criteria of mania?
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)
What needs to occur for a manic episode to be diagnosed?
When the symptoms of mania are present for a minimum of 1 week, with notable functional impairment
What does a diagnosis of a manic episode lead to?
Type 1 bipolar disorder
What needs to occur for a hypomanic episode to be diagnosed?
When symptoms are present for a minimum of 4 days, but WITHOUT notable functional impairment = hypomanic episode
What is diagnosed when there is not a single manic episode but only hypomanic episodes, with at least one major depressive disorder?
Type II bipolar disorder
What is “unspecified bipolar disorder”?
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
What is diagnosed when a patient is hospitalised, irrespective of the duration of the manic symptoms?
A manic episode is diagnosed, not hypomanic
What cannot be diagnosed when psychotic features are present?
Hypomanic - as psychotic features are characterised by functional impairement
What is diagnosed if the manic or hypomanic episodes are caused by anti-depressants?
Diagnosis of bipolar is still made
On the graph of mania and depression, what defines the subtypes of bipolar?
The amplitude of the graph
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
How many cycles have to occur a year in order for it to be considered rapid cycling?
More than 4 cycles per year
In bipolar, what are the majority of the episodes?
Depressive
What is the difference in insight between depression and mania?
Insight is preserved in depression
Insight is impaired in mania
Which is more heritable between depression and bipolar?
Bipolar is heritable, depression is less heritable
What were thought to be the diffrences between unipolar and bipolar in the 1970s?
It has been weakened or disputed
Bipolar has an earlier average age of onset
Shorter depressive episodes in bipolar
Recurrent course in bipolar
Genetic specificity
Differential treatment
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
What happens to memory biases in depression?
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.
What happens to perceptual bias in depression?
Decreased recognition of happy faces and increased recognition of sad faces
Reduced recognition of all basic emotions except for sadneess
What is detected in depressed individuals using a fMRI?
Sustained amygdala response to negative stimuli
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
What part of the brain is associated with impaired ability to divert attention from task-irrelevant negative information?
Lateral inferior frontal cortex
Which part of the brain mediates negative attentional bias?
Perigenual anterior cingulate cortex
What memory biases are seen in depression?
Preferential recall of negative compared to positive material
Describe the perceptual biases seen in depression?
Increased recognition of negative faces and/or decreased recognition of happy faces
What condition results in enhanced amygdala response to negative faces?
Depression
What are SSRI’s?
Serotonin reuptake selective inhibitors
What happened when patients were given noradrenergic anti-depressants?
Better recognition of happy faces
DO anti-depressants improve happy face facial recognition?
Yes
What is the gold standard SSRI?
Escitalopram
What happens to baseline ACC levels in depressed individuals?
Elevated during tasks which probe affective circuitry
What is the monoamine deficiency hypothesis?
Postulates that depressive symptoms arise from insufficient levels of monoamine neurotransmitters seratonin, norepi and/or dopamine
What happens to the 5-HT receptor in depression?
Hypofunction - only indirect evidence though
What effect do clinically useful anti-depressants have on synaptic monoamine levels?
All increase
What happens to monoamine oxidase A in MDD?
Increased
What does monoamine oxidase do?
Breaks down seratonin
What does tryptophan depletion do?
triggers relapse in MDD - then successfully treated with SSRI’s or CBT
What does monoamine depletion correlate with?
Low mood in patients both at risk and MD in remission
What causes a blockade of serotonin synthesis and what is the effect?
Blockade of serotonin synthesis by the tryptophan hydroxylase inhibitor p-chlorophenylalanine prevents the antidepressant effects of both MAOIs and TCAs
What is the main way to investigate brain pharmacology?
PET imaging
How does PET compare to fMRI?
Selective, but invasive, radioactive and expensive
What is the use of a tracer in measuring brain pharmacology?
Tracer injected into the patient
Tracer binds to the specific target
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
What challenge is used to quantify dopamine receptor numbers?
Amphetamine challenge
Which medications (used for ADHD) increases the release of dopamine?
Ritilin
Why is it difficult to measure serotonin using a pharmacological challenge?
Not sure which ligand / tracer to use
Is there measurable 5-HT release in patients with depression?
No
How do tryptamine psychedelics work?
They are an agonist for Serotonin 2A receptors
What are the three main types of tryptamine psychedelics?
Psilocybin
Ayahuasca
LSD
How do tryptamine psychedelics relate to seratonin?
Very similar chemical structures
What are the classic descriptions of the effects of tryptamine psychedelics?
Oceanic Boundlessness
Psychological peak / mystical type experiences
What is the safety of tryptamine psychedelics?
Non-addictive
Low physiological and brain toxicity
Good therapeutic index
What are the negative risks associated with psychedelics?
Dysphoria, anxiety, nausea, headache, false memories
How is bipolar treated?
Lithium and anti-psychotics
Differences between Bipolar affective disorder and borderline personality disorder?
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
Difference between bipolar affective disorder and schizoaffective disorder?
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
Differences between BPAD and ADHD
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
