Affective Disorders Flashcards
Mental state examination?
Appearance speech mood thought perception cognition insight
Anhedonia?
Inability to feel pleasure
What is psychomotor retardation?
ETA is when the thoughts slow down and physical activity is reduced.
Hypochondriacs?
A person who believes they have a medical condition that is undiagnosed.
Diagnosis of major depressive disorder?
2 weeks 5 or more symptoms:
- Depressed mood most days,
- Lack of pleasure or interest
- Insomnia or hypersomnia
- Fatigue
- Eating more or less
- Suicidal thoughts
- Guilt or self blame, feelings of worthlessness
- Diminishes ability to think or decide
- Phsychomotor retardation or agitation
Must cause significant distress or functional impairment
Hypothyroidism?
Psychomotor retardation, fatigue
Melancholia?
Type of depression, loss of pleasure, lack of reactivity, depressed empty mood.
In morning, marked agitation, lack of appetite, and feelings of guilt and remorse
Atypical depressions?
Weight increase, excessive sleep, leaden paralysis , mood reactivity interpersonal rejection sensitivity
Manic episode?
1 week most of time: 3 or more of following
Elevated irritable mood, increased energy
- Inflated self esteem or grandiosity
- Decreased need for sleep
- More talkative
- Flight of ideas
- Distractibility
- Increase in goal directed activity
- Excessive involvement in high risk activities
Hypomania?
- at least 4 days
2. Not severe enough to cause hospitalisation/ or marked functional impairment
Mixed affective episode:
- Full criteria for one type of episode
2. And at least 3 symptoms of opposite polarity are present
Features of both depression and mania:
Anxiety, psychotic, catatonia
Catatonia?
Not moving not responding, not communicating
Lifetime prevalence of single depressive episode?
20% for females
10% for males
How many die by suicide of depressive episodes?
8 to 19 %
Bipolar disorder:
- At least 1 manic episode
2. 1 hypomanic disorder needs 1 disorder
Bipolar it’s:
Hypersomnia
Hyperphagia
Family history
Bipolar disorder genetics?
10 times higher risk In 1st degree relatives
Men and women are equally affected
Lifelong risk of recurrence
Rate of suicide of people with bipolar disorder?
20 x than general population
30 to 50% try to commit suicide
Monozygotic accordance rate in bipolar?
70 to 80%
Neurobiology of depression?
Decrease in serotonin and noradrenaline function- hence selective serotonin reuptake inhibitor are given.
Serotonin is affected by stress, generic factors and adverse childhood experience.
Neurobiology of depression?
- Disruption of monoamine transmission
- GABA and glutamate
- HPA axis and glucocorticoids
- Neuroplasticity and neuronal atrophy
- Immune dysfunction
Acute tryptophan depletion studies showed?
Reexacerbation of depression
Which regions are responsible for automatic regulation of emotion?
Prefrontal cortex, anterior cingulate
Regions responsible for voluntary regulation of emotion?
Dorsolateral and ventrolateral prefrontal cortex.
Subgenual cingulate cortex?
Responsible in emotion regulation and processing
HPA dysfunction?
Normally negative feedback of adrenal gland on hypothalamus.
Duxamethasone: a glucocorticoid, no negative feedback, still cortisol release.
Some glucocorticoid receptor alteration
Neuroplasticity in depression?
Subcorticla volume changes in hippocampus etc in people with depression
Decrease in atypical dendrites, spine density, NMDA or AMPA receptors, synaptic proteins, neuronal atrophy
Ketamine treatment?
NMDA receptor blocker, depression treatment.
Stimulates synaptogenesis
Modulates gaba and glutamate deficits
Inflammation and depression?
Lupus and other immune disorders increase of depression. Could be cause of disability but we know stronger association than other disabling conditions.
Increased inflammatory markers Crps in people with depression and correlate with level of depression
TSPO translocator protein On microglia higher in people with depression, a marker of neuroinflammation
Inflammation and serotonin?
Inflammatory pathways take away tryptophan to create inflammatory proteins and hence less to produce serotonin
1st generation antidepressants?
Monoamine oxidase inhibitors (phenelzine and tranylcypromine) and tricyclic antidepressants amytryptilinw
Monoamine oxidase inhibitors?
Phenelzine and tranylcypromine
Non selectively inhibit enzymes in breakdown of drops ins, serotonin and noradrenaline
Tricyclics antidepressants?
Amytryptiline, clomipramine
Nonselectivley inhibit reuptake of monoamine such as dopamine, serotonin and noradrenaline
2nd generation antidepressants?
SSRI, SNRI, alpha and serotonin antagonist, dopamine noradrenaline uptake inhibitor
SSRI?
Sertraline, citalopram, escitalopram, fluoxetine and vortioxetine
SNRI?
Venlafaxine and duloxetine
Serotonin and alpha antagonist?
Mirtazapine
Dopamine noradrenaline reuptake inhibitor?
Bupropion
What is included in atypical depression?
Mood reactivity, significant weight gain or increase in appetite
Hypersomnia
Leaden paralysis
Manic episode diagnosis?
Sufficiently sever to cause marked functional impairment or necessitates hospitalisation to prevent harm to self or other or there are psychotic features
Dysthymia
Chronic form of depression
Cyclothymia?
Mood shifts up and down from baseline but not as bad as bipolar 1 and 2
What is age of onset on major depressive disorder?
25-35 years, but can be any age
Probable bipolarity of depression will have?
Positive family history of Brad
Multiple episodes and early onset
Proinflammatory cytokines induce?
Sickness behaviour
Side effects of SSRIs?
Low toxicity safe, slow titration
Gastrointestinal symptoms
Headache irritability anxiety
Reduction in libido and sexual dysfunction
Side effects of tricyclics?
Constipation, orthostatic hypotension dry mouth drowsiness cardiac toxicity
MAOi side effects?
Dry mouth GI side effects, drowsiness, insomnia, food interactions, hypertension crisis
Mirtazapine side effects?
drowsiness, sedation, hypotension, increased appetite and weight gain
Bipolar disorder genes?
8-10% of 1st degree relatives
Amy-72-80
DZ-14
Mitochondrial alteration in bipolar?
Reduced mitochondrial complex 1 in prefrontal cortex
Altered brain mitochondria morphology and distribution
Reduced mRNA for genes encoding ETC and antioxidants
Many SNPs of miti genes
Central nervous system consumes how much oxygen?
20
Phases of bipolar disorder treatment?
Short-term treatment
to reduce the severity and shorten the duration of the acute episode and achieve remission of symptoms
Long-term treatment
prevention of new episodes and to achieve adequate inter-episode control of residual or chronic mood symptoms
Bipolar treatments
Lithium
Antipsychotics
Anticonvulsants
Antidepressants
Treatment of depressive disorders?
Antipsychotics
Fluoxetine/olanzapine combinations
Antidepressants with anti manic drug
Consider lamotrigine with an anti manic
Treatment of acute manic episodes?
Dopamine antgonist e.g haloperidol olanzapine, respirdone
Valproate
Discontinue any antidepressant
What is long term treatment to prevent new episodes?
Lithium as initial mono therapy (0,6 to 0.8 mmol/l)
Alternatives are valproate, dopamine antagonist, carbamazepine
Lithium details?
Toxicity
Narrow therapeutic index
Blood tests every 3 months for 1st year
Strongest evidence of prevention of relapses of any polarity
Antipsychotics?
D2/d3 antagonist haloperidol
Da partial agonist aripiprazole
Adverse effect. Wight glucose and lipid regulation
Full D2 antagonism haloperidol can cause epses
Valproate shouldn’t be used in?
Women of child bearing potential
Lamotrigine is most effective in?
Prevention of depressive relapses
Adverse effects of long term pharmacological treatment of Bpad?
Weight gain (most medications, particularly Olanzapine and Quetiapine)
Metabolic syndrome (Olanzapine, Quetiapine, Risperidone)
Hyperprolactinemia (Dopamine antagonists)
Tardive dyskinesia (much reduced risk with newer agents)
Liver damage (e.g. Valproate)
Kidney and Thyroid dysfunction (poorly regulated Lithium)
