affective disorders Flashcards
define major depressive disorders (MDD)
recurrent depressive episodes with no history of mania
define bipolar affective disorder (BPAD)
at least one manic episodes +- depressive episodes
diagnostic criteria 1 for MDD >1
- abnormal mood most of the day, nearly everyday for at least 2 weeks
- abnormal loss of all interest and pleasure, nearly everyday, at least 2 weeks
- if <18, abnormal irritable mood, nearly everyday, at least 2 weeks
diagnostic criteria 2 for MDD >5
- abnormal depressed mood
- abnormal loss of all interest and pleasure
- appetite and weight disturbance either increase or decrease
- sleep disturbance (insomnia or hypersomnia)
- activity disturbance
- abnormal fatigue or loss of energy
- feeling of worthlessness/ inappropriate guilt
- decrease ability to think or concentrate
- recurrent thoughts of death, suicidal ideation
does the patient with MDD fully recover?
no. 50% of patient will develop recurrence
aetiology and associated factors of MDD
- high socioeconomic costs
- high economic cost
- premature mortality
- reduced productivity
- absenteeism - sometimes genetically
- precipitated by other disease eg: stroke, dementia, cancer
- aging
- medications
criteria 1 for BPAD
- one manic episode and no past major depressive disorder
- manic episodes not schizoaffective and not superimposed on schizophrenia
- has multiple mood eg: hypomanic, manic, mixed, depressed, unspecified
criteria 2 for BPAD
- presence of >1 major depressive disorder
- presence of >1 hypomanic episode
- no history of manic or mixed episode
- mood episode of 1 and 2 are not superimposed with schizophrenia
- symptoms will cause distress/ impairment in social and occupational
associated factors of BPAD
- strong heritable risk
- environmental triggers
what serotonin and noradrenaline regulate?
- mood
- sleep cyle
- appetite
- motivation
- pain perception
- neuroendocrine function
explain monoamine oxidase inhibitors (MAOIs) -rarely used
- inhibit MAO from degrading serotonin and NA
- cause more serotonin and NA to be release
- 5HT and NA will no be degraded into carboxylic acid
examples of selective, reversible and competition inhibitor MAOIs
- moclobemide
- clorgyline
transient side effects of MAOIs
- postural hypotension
- dry mouth
- blurred vision
- urinary retention
- weight gain
- restlessness
- insomnia
examples of non-selective, irreversible, non-competition inhibitor MAOIs
- phenelzine
- tranylcypromine
what are the serotonin reuptake inhibitosr?
- non-selective tricyclic antidepressant (TCAs)
- selective serotonin reuptake inhibitors (SSRIs)
- serotonin-noradrenaline reuptake inhibitors (SNRIs)
what TCA do?
- binds to 5HT and NA transporters
- prevent reuptake of monoamines from synaptic cleft
- leads to accumulation of 5HT and NA
adverse effects of TCA
- sedation= histamine H1 receptor blockade
- postural hypotension= adrenoreceptor blockade
- dry mouth, blurred vision, constipation= muscarinic acethylcholine receptor blockade
- urinary retention
- poor dental health
examples of TCA
- clomipramine
- imipramine
- amitriptyline
- desipiramine
what is agoraphobia?
an abnormal fear in public places
what SSRI and SNRI do?
- increase synaptic 5HT levels by preventing reuptake and degradation at the transporters
- increase 5HT receptor activation
- enhance postsynaptic responses
- contribute to alleviation of symptoms in depression
examples of SSRI (1st line treatment for MDD)
- citalopram
- fluoxetine
- fluvoxamine
- paroxetine
- sertraline
side effects of SSRI
- nausea
- anorexia
- insomnia
- sexual dysfunction
- anxiety and restlessness
examples of SNRI?
- venlafaxine
- duloxetine
side effects of SNRI
- HTN
- sweating
- weight loss
- blurred vision
- sexual dysfunction
examples of atypical antidepressants
- mirtazepine
- trazodone
- bupropion
uses of mirtazepine
- potent somnorific (calming)
- appetite stimulant
- for insomnia and weight loss
what mirtazepine do?
- blocks 5HT2A, 2C receptor
- decrease neurotransmission at 5HT synapses
- increase neurotransmission NA
explain trazodone
- atypical antidepressant
- prodrug to meta-chlorophenylpiperazine (mCPP)
- block post-synaptic 5HT
- used as somnorific (calming)
- higher dose will cause over-sedating
explain bupropion
- atypical antidepressant
- aminoketone antidepressant
- acts like amphetamine
- weakly inhibits uptake of 5HT, DA and NA
- increase 5HT and DA in brain induces less switching to mania and badly lower seizure threshold
adverse effects of atypical antidepressants
- sweating
- rash
- dyspepsia
- dizziness
- tremor
- agitation
- increase appetite
- hyperlipidemia
- constipation
examples of mood stabilizers
- lithium
- carbamazepine
- valproate
- lamotrigine
- olanzepine
what lithium do?
- enter cells via Na channels
- inhibits inositol synthesis in CNS
- inhibits adrenergic, muscarinic and serotonergic neurotransmission
- increase 5HT synthesis and release
- decrease NA adn DA neuro transmission
adverse effects of lithium
- NSAIDs increase lithium reabsorption in proximal tubule cause toxicated
- inhibits K+ into myocytes cause abnormal T waves
- cause extracellular hyperK+ and intracellular hypoK+ (cardiac arrest)
- narrow therapeutic window
- nausea, vomit, diarrhoea, renal failure, ataxia, tremor if acute lithium intoxication
long term treatment for BPAD
- lithium
- olanzepine
- valproate or combination with those two
