Mood Disorders Flashcards
two major neurotransmitters involved in depression
norepinephrine and serotonin (5HT)
serotonin regulates
sleep, appetite, libido
serotonin circuit dysfunction results
poor impulse control, low sex drive, decreased appetite, disturbed regulation of body temperature and irritability
decreased levels of norepinephrine results
anergia, anhedonia, decreased concentration, diminished libido (depression)
dopamine neurons in mesolimbic system effects
play a role in reward and incentive behavior processes, emotional expression, learning processes
- especially true in melancholic states in severe MDD
beck’s cognitive theory of depression (beck’s cognitive triad)`
- negative, self-deprecating view of self
- pessimistic view of world
- the belief that negative reinforcement (or no validation for the self) will continue
automatic negative thoughts
repetitive, unintended, not readily controllable
- developed by beck
- consistent in all types of depression, regardless of clinical subtype
learned helplessness (seligman)
anxiety is initial response to stressor, but replaced by depression if person feels no control over outcome
- can explain depression in older adults, impoverished, women
biogenic amine hypothesis of depression
- caused by deficiency of monoamines (esp NE and 5HT)
monoamine
amine containing one amino group
ex: serotonin, dopamine, epinephrine, norepinephrine
receptor sensitivity hypothesis of depression
supersensitivity and upregulation
- post-synaptic neuron tries to compensate for a lack of stimulation (due to deficiency of NE & 5HT)
continuum of depression: transient
in response to life’s everyday disappointments
continuum of depression: mild
normal grief response
continuum of depression: moderate
dysthymic disorder
continuum of depression: severe
major depressive episode or disorder
major depressive episode (general description)
- often following psychosocial stressor (marital, occupational, academic problems)
- many somatic complaints
- tearful, irritable, anxious, phobias
- most serious consequence: suicide
major depressive episode (common symptoms)
- depressed mood
- anhedonia
- anxiety
- psychomotor changes
- somatic symptoms
- vegetative signs
vegetative signs
activities necessary to support life: eating, sleeping, elimination, sex
major depressive episode (criteria)
5+ present during same 2 week period, one of which is either 1) depressed mood or 2) loss of pleasure:
- significant weight loss or gain
- insomnia or hypersomnia
- psychomotor agitation or retardation
- fatigue or loss of energy
- feelings of worthlessness or excessive guilt
- diminished ability to think or concentrate
- recurrent thoughts of death, suicidal ideation, OR attempt OR specific plan
major depressive episode (course)
- prodromal symptoms: may include anxiety, mild depressive symptoms
- majority return to premorbid level of functioning
- 20-30% may have symptoms (that don’t meet full criteria) persist for months to years, may be associated with some disability or distress
major depression: 0 - 3
feeding problems
failure to thrive
lack of playfulness/emotional expression
delay: speech, gross motor development
major depression: 3 - 5
accident prone
aggressiveness
phobias
excessive self-reproach
major depression: 6 - 8
vague physical complaints
aggressiveness
cling to parents/avoid new people and challenges
lag in social, academic skills
major depression: 9 - 12
morbid thoughts
excessive worry
possible reasoning they have disappointed others
possible lack of interest in play or friends
major neurotransmitters involved in bipolar disorder
NE, dopamine, 5HT combinations
ex: increased dopamine, increased NE
decreased 5HT, increased NE
persistent depressive disorder aka
dysthymic disorder
persistent depressive disorder (general description)
depressed mood for at least 2 years
- never more than 2 months without symptoms
- children/teens: at least 1 year
- onset: childhood, adolescence, early adult
- high co-morbidity with anxiety disorders
persistent depressive disorder (criteria)
two or more:
- increased/decreased appetite
- insomnia/hypersomnia
- low energy, fatigue
- low self-esteem
- hopelessness, despair
- decreased concentration/decision making
persistent depressive disorder (common symptoms: children and adolescents)
- irritable, cranky, depressed
- low self-esteem, social skills
- pessimistic
- very, very serious
- poor academic performance
- limited social interaction
mood dysregulation disorder (cheat sheet)
purpose - address potential for overdiagnosis/treatment of BPAD in children
presentation: persistent irritability, frequent episodes of extreme behavioral dyscontrol
pattern typically evolves into unipolar depression or anxiety disorders
bipolar disorder type I
history of at least one manic OR mixed episode
- may have also experienced episodes of depression
bipolar disorder type II
history of depressive episode AND at least one hypomanic episode
- manic or mixed has NEVER occurred
manic episode (criteria)
abnormally, persistently elevated, expansive, or irritable mood for at least 1 week…
+ 3 of the following:
- inflated esteem, grandiosity
- decreased need for sleep
- more talkative, pressured
- flight of ideas, “racing thoughts” (subjective)
- distractable
- increase in goal directed activity, psychomotor agitation
- excessive involvement in pleasurable activities with high potential for painful consequences
manic episode (course)
- frequently follows psychosocial stressor
- begins suddenly, rapid escalation over few days
- lasts from few weeks - several months (more brief, end more abruptly than MDE)
- 50 to 60%: MDE immediately precedes/follows
hypomanic episode (criteria)
- persistent, abnormally elevated mood lasting at least 4 days
- not severe enough to cause marked impairment
- does not require hospitalization
- psychotic features, delusions, hallucinations CANNOT be present
hypomanic episode (course)
- begins suddenly, rapid escalation within a day or two
- may last several weeks to months (more abrupt in onset, briefer than depressive episodes)
- may be preceded/followed by depressive episode
- 5 to 15% eventually develop manic episode
mixed episode (criteria)
1) criteria met for bot manic and major depressive episode (except duration)
2) severe enough to cause impairment OR require hospitalization to prevent harm OR psychotic features
frequently present with: agitation, insomnia, change in appetite, suicidal thoughts, psychotic features
mixed episode (course)
- can evolve from manic or major depressive episode OR on its own
- may last weeks to several months
- may remit with few or no symptoms OR evolve into major depressive episode
- uncommon to evolve into manic
cyclothymic disorder (cheat sheet)
- begins in adolescence, early adult life
- 15 to 50% risk of developing bipolar
- chronic (2+ years) fluctuating mood disturbance involving numerous periods of hypomanic and depressive symptoms
electroconvulsive therapy (ECT) is…
induction of generalized seizure; 85% effective depending on client
electroconvulsive therapy (ECT): indications
- rapid need
- extreme agitation OR stupor
- risks of rx outweigh risk of ECT
- history of poor med response + ECT response
electroconvulsive therapy (ECT): client population
MDD BPAD Manic (Lithium resistant) Rapid cycling Bipolar I (4 episodes in 12 months) psychotic illness
electroconvulsive therapy (ECT): adverse effects
- confusion, delirium shortly afterwards
- memory impairment
- mild transient cardiac arrhythmias
- mortality 0.002 per treatment, 0.01 per patient
