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Sophie - The Nervous System - Year 2 > 25.1 Mood Disorders > Flashcards

25.1 Mood Disorders Flashcards

1
Q

What are the three most common types of mood disorders?

A

Unipolar depression
Bipolar depression
Anxiety-related disorders

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2
Q

Which clinical condition mimics depression?

A

Hypothyroidism

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3
Q

What comorbidities is depression associated with? Why?

A

Associated with a range of comorbities and altered states that increase the likelihood of death (lowered numbers of lymphocytes, increased proinflammatory cytokines such as IL-6)
Cardiovascular disease
Type 1 diabetes
Slower wound healing
Increased suseptibility to infection
More likely to suffer from substance abuse

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4
Q

What is the biopsychosocial model for depression which predisposes someone to depression?

A

fMRI shows decreased prefrontal cortex activation
Decrease in reward, mood and motivation

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5
Q

What are the three theories on the neurological changes take place within the brain?

A

-Change in neurochemistry: reduced activity of neurotransmitters dopamine and serotonin
-Changes in the hypothalamic-pituitary-adrenal gland axis, with stress altering signalling cascades
-Neuropsychological: alteration in the way that social interactions are interpreted (increased likelihood that an event is viewed as negative)

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6
Q

Which famous theories have been linked to depression?

A

Beck’s (1967) theory of cognitive depression (more likely to see negatives)
Seligman’s theory (1975) of learned helplessness

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7
Q

Define what is meant by bipolar disorder

A

Mood instability which allows for rapid change between depressive and manic states for an individual

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8
Q

How do we know that BPD is different to depression?

A

Antidepressants have a markedly reduced effectiveness

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9
Q

What is anxiety? What type of physiological response does it bring about?

A

Attention focuses on perceived danger
Increase in symapthetic drive (heart rate, sweating, butterflies in stomach, blood to muscles)
Strong urge to avoid

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10
Q

What is the cognitive theory of panic disorder?

A

Persistent panic attacks result from catastrophic misinterpretation of benign body sensations
Sensations that are misinterpreted are mainly those involved in normal anxiety responses
Misinterpretation involves believing the sensations indicate an immediate physical or mental disaster

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11
Q

What is the monoamine theory of depression?

A

Depression is caused by a functional deficit of the monoamine transmitters (NA, 5-HT) whereas mania results from an excess
Supported by the use of drugs which alter monoamine transmission

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12
Q

Name the main classes of antidepressant drugs (4)

A

-Tricyclic antidepressants
-Selective 5-HT reuptake inhibitors (SSRIs)
-MAO inhibitors
-Selective serotonin and noradrenaline reuptake inhibitors (SNRIs)

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13
Q

How do tricyclic antidepressants work?

A

Competitive inhibitor of noradrenaline and 5-HT reuptake

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14
Q

Name a TCA?

A

Tricyclic antidepressant:
Amitriptyline

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15
Q

What is the mechanism of action of SSRIs?

A

Highly selective 5-HT reuptake inhibitors
Increase 5-HT within the synapse

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16
Q

What are the downsides of SSRIs?

A

Not beneficial for mild depression
Prolonged drug treatment results in desensitisation of the receptors
Increased activation of somatodendritic 5-HT1A receptors in the raphe neurons inhibits their normal 5-HT release lowering 5-HT

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17
Q

Name an SSRI?

A

Fluoxetine (Prozac)

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18
Q

What is the mechanism of action of MAO inhibitors?

A

Monoamine oxidase is an enzyme which breaks down cytosolic stores of noradrenaline and 5-HT in nerve terminals
Inhibiting the enzyme increases the abundance inside of nerve terminals ready for release

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19
Q

Name a MAO inhibitor

A

Phenelzine (irreversible, non-competitive inhibitor) which is non selective for MAO-A or B

20
Q

Why are SSRIs preferable over TCAs and MAOs?

A

Less likely to have anticholinergic side effects than TCAs
Do not cause ‘cheese reactions’ like MAO do (interaction of MAOI which tyramine = headache)

21
Q

What is the mechanism of action of SNRIs?

A

Non selective 5-HT and NA uptake inhibitors

22
Q

Name an SNRI?

A

Venlafaxine

23
Q

What is the origin of the monoamine theory of depression?

A

1965
Grew originally out of the association between the clinical effects of various drugs that are known to alleviate the symptoms of depression and their known neurochemical effects on monoaminergic transmission in the brain

24
Q

Which metal has been used in the treatment of bipolar disorder?

A

Lithium (mood stabiliser)

25
Q

What is the mechanism of action of lithium? (3)

A
  • Inhibits voltage-gated Na channels
    As = Mmnovalent cation that can mimic the action of sodium ions in excitable tissues as it is able to permeate VGNC needed for action potential propagation –> inhibits their function (but not pumped out by Na/K ATPase leading to depolarisation of the cell)

-Inhibits inositol phosphatase (blocks PI pathway) –> reduces excitatory toxicity

-Inhibits G protein function (cAMP hormone induced production)

26
Q

What are the side effects of lithium?

A

Nausea and vomiting
Tremor
Weight gain
Hair loss
Polyuria

27
Q

What are the side effects of TCAs?

A

Physical antimuscarinic effects:
-Dry mouth
-Blurred vision
-Constipation
-Urinary retention

28
Q

What are the overall bad side effects of antidepressants?

A

DEPENDENCE
Physical = withdrawl symptoms such as hand tremors and nausea
Psychological dependence = drug seeking behaviour, craving, stress and anxiety

29
Q

What are the major outcomes/goals of CBT?

A

-Behavioural activation = help engage more in the world around them, increasing levels of activity such as exercise and green spaces
-Decrease autonomic negative thoughts = write down negative thoughts and bring them in to discussion, aim is to replace them with more positive thoughts
-Cognitive errors = challenge harmful ways of thinking, decrease overgeneralisation (‘all bad’) and help patients to paint things in a better light than before

30
Q

What are the three classes of anxiolytic (anti-anxiety) drugs?

A

-GABA potentiation
-5-HT agonists
-Beta blockers

31
Q

Name two drugs which potentiate GABAergic transmission?

A

Benzodiazepines
Barbiturates

32
Q

Where do barbiturates act on the GABA receptor?

A

Agonist to the allosteric site which increases the open probability of GABA
(also block AMPA and kainate receptors)

33
Q

Where do benzodiazepines act on GABA receptors?

A

Binds across the interface of the alpha and gamma subunits
Act as a positive allosteric modulator to facilitate the opening of GABA channels

34
Q

Name a benzodiazepine

A

Diazepam

35
Q

How do benzodiazepines act as anxiolytics?

A

Reduce hyperactivity in the brain
Muscle relaxant
Treat insomnia

36
Q

Name a 5-HT1 agonist

A

Buspirone

37
Q

Where are 5-HT1 receptors expressed?

A

On the soma and dendrites of 5-HT producing neurons where they function as inhibitory autoreceptors
Expressed in the cortico-limbic circuit
5-HT1 is coupled to Gi

38
Q

Why may buspirone worsen anxiety in early treatment? Why does this subside?

A

Buspirone is a 5-HT1 receptor agonist and initially activation of this receptor reduces produciton of 5-HT from these neurons
Continued usage results in DESENSITISATION of 5-HT1 receptors
Means that later when 5-HT binds to to 5-HT1 receptors its release is no longer inhibited as the receptor is desensitised

39
Q

Which beta blocker has been used to treat anxiety?

A

Propanolol (non selective beta blocker)

40
Q

how does propranolol work as an anxiolytic?

A

Used to treat the symptoms of anxiety, where physical symptoms such as tremor and tachycardia are troublesome
Block the physical symptoms of anxiety

41
Q

What are the adverse effects of benzodiazepines?

A

Drowsiness
Confusion
Amnesia
Impaired coordination

42
Q

Which anxiolytic drug has the potential to induce drug dependence?

A

Benzodiazepines

43
Q

How do benzodiazepine induce tolerance?

A

Tolerance may be due to a selective loss of GABA A receptors containing the alpha 2 subunit

44
Q

What are the symptoms of benzodiazepine dependence?

A

Cessation of treatment:
-Anxiety
-Tremor
-Cravings
-Loss of appetite

45
Q

Which drugs have hypnotic effects?

A

Benzodiazepines

46
Q

What is meant by hypnotic effect?

A

Induce a sense of calmness
Sedative properties

47
Q

How do benzodiazepines bring about their hypnotic effects?

A

Decrease the time taken to get to sleep
Increase total duration of sleep

Sophie - The Nervous System - Year 2 (46 decks)

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