Affective disorders

Question 1

Name three mood disorders

Answer 1

Bipolar affective disorder

Depressive episode

Recurrent depressive disorder

Question 2

What are the two groups of depressive disorder?

Answer 2

Unipolar: patient’s mood is either depressed or normal

Bipolar: patient has episodes of either depressed or elevated mood. The mood deviates from normal in both spectrums.

Question 3

How can you classify if depression is mild, moderate or severe?

Answer 3

Mild: 5 symptoms occuring every day for 2 weeks

Moderate: Symptoms or functional impairment between mild/severe

Severe: most symptoms present, affect functioning.

Chronic depression if symptoms persist >2 years

Question 4

What are the two main neurotransmitters involved in regulating mood?

Answer 4

NorA: Main site of production in the locus ceruleus

5HT: Main site of production is raphe nuclei in medulla

Question 5

Treatment stratgies for depression

Answer 5

Pharmacological:
tri-cyclic antidepressants
MAOIs
SSRIs
Atypical antidepresant

Psychological: CBT

Medical:
Transcranial magenetic stimulation
Electroconvulsive therapy

Question 6

Content of a MENTAL STATE examination

Answer 6

Appearance and behaviour
Speech
Affect (observable mood)
Thoughts (delusions or morbid ideas)
Perceptions (hallucinations or illusions)
Insight (comparing patient and dr. idea about problem)
Cognitions (memory, attention, visuospacial)

Question 7

What are the main actions of tri-cyclic antidepressants?

Answer 7

5HT reuptake blocker

NA reuptake blocker

α1 adrenoreceptor antagonist (postural hypotension)

H1 receptor antagonist (weight gain, sedation)

M1 receptor antagonist (dry mouth, constipation, urinary retention)

Question 8

Why are SSRIs given to patients with depression who have cardiac disease

Answer 8

SSRIs have fewer anticholinergic effects and are less sedating than TCAs.

TCAs have cardiotoxic effect - produce long QT interval, ST elevation, heart block, arrhythmias. Dangerous in overdose.

Question 9

Mechanism of action of SSRIs

Answer 9

Block serotonin reuptake pumps at the presynaptic membrane.

e.g. fluoxetine, paroxetine, sertraline

Cause GI disturbance and sexual dysfunction

Question 10

Monoamine oxidase inhibitors used in depression

Answer 10

Target MAOI-A

Inhibit monoamine oxidase within nerve endings. Cytosolic NA and 5HT increases and more leaves out into the synaptic cleft.

Question 11

State 3 side effects of MAOIs

Answer 11

Increase levels of NorA and 5HT. Leads to:

Postural hypotension

Restlessnes

Convulsions

‘Cheese reaction’. Foods containing tyramine normally broken down by MAO in the gut and liver. Increased blood levels can cause increased neurotransmitter relese = severe hypertension.

Question 12

Serotonin syndrome

Answer 12

Caused by drug interactions of SSRIs

Hyperthermia, CV problems, aggression, tremor, rigidity.

Question 13

Name three atypical antidepressants

Answer 13

NorA reuptake inhibitors (Reboxetine)

Serotonin-NorA reuptake inhibitor (Venlafaxine)

5HT partial agonist (Buspirone)

Question 14

Sedative anti-depressants

Answer 14

e.g. Mirtazapine

Block alpha-adrenergic receptors. a2-receptors inhibit presynaptic release. Blocking receptor increases the amount of NorA in synaptic cleft.

No effect on uptake of aminotransmitters.

Question 15

Why would you give a depressed patient lithium?

Answer 15

General mood stabiliser. Used in prophylaxis for manic/depressive illness.

Must be carefully monitored.

Question 16

Delusion

Answer 16

Unshakeable belief that is implausible and fully embraced by the patient

Question 17

Hallucination

Answer 17

Sensory perceptions that occur without stimulation.