Affective Disorders Features Flashcards
Euthymia
normal mood
Disorders of Mood (3):
- depression
- hypomania
- mania
Subsyndromal Mood Disorders:
- dysthymia:
- cyclomythia:
Affective Disorders:
Prevalence of Affective Disorders:
depressive: mid 20s, modest peak in mid-life 40-60
bipolar disorder: before age 25, average 18
Clinical course of Depressive Illness:
- untreated depressive episodes can
last >6 months - minority last years
- treated depressive episode: 2-3
months - may have ongoing subsyndromal
mood symptoms - 80% will have further episode
Diagnostic Features of a Depressive Episode:
Depression: Features: Low Mood:
- sadness, flat, irritable
- diurnal variation (worse in the
morning)
Depression: Features: Anhedonia:
- loss of enjoyment in things that were
previously pleasurable - hard to look forward to things
Depression: Biological Features:
- appetite change affecting weight
- sleep changes: early morning waking
feeling unrefreshed, hard to get to
sleep, frequent waking, oversleeping - loss of libido
- psychomotor retardation (slow
movements) - low energy
- agitation (less common)
Depression: Psychological Features:
Cognitive: poor conc, attention, hard to read a book, follow TV, study
Low Self-Esteem: worthlessness, guilt, loss of self-confidence
Negative Thinking: hopelessness, helplessness, negative view of the future, suicidal thoughts
Anxiety: broad range of symptoms, health anxiety
Depression: Dissociation:
depersonalisationn: separated from other people by a palne of glass
Depression: Obsessions:
intrusive and repetitive thoughts recognised as patients own
Depression: Phobias:
worsening/new
Physical Health Symptoms:
- headaches
- abdo pain
- GI symptoms: IBS
- pain
Depression: Psychotic Features: Delusions:
- may occur in severe depression
- nihilistic
- poverty
- disease
- guilt
- persecutory
Depression: Psychotic Features: Hallucinations:
- may occur in severe depression
- often in the second person
- putting one down (you’ve done
terrible things)
Melancholic Depresson:
- low mood
- decreased pleasure in usual
activities - decreased emotional reactivity
- loss of appetite
- weight loss
- psychomotor changes
- decreased libido
- diurnal variation of mood
Atypical Depression:
- low mood
- increased appetite
- weight gain
- increased sleep
- anxiety
- fatigue
Depression and Cognition:
- impaired executive function:
reduced concentration and
attention, impact on memory due
to reduced registering of
information - cognitive impairment due to
depression improves with the
treatment of depression
Effect depression on dementia:
- 2 fold increased risk from first
episode, which increases with
number of episodes - depression can also be a prodrome
for dementia - depression is common in people
with dementia
Neurovascular link between depression and dementia:
- frontostriatal vascular damage
- hippocampal atrophy from
chronicly high cortisol - impaired amyloid clearance due to
high cortisol - chronic inflammatory processes
Aetiology of Depression:
Depression and Genetics:
- multiple genes that each have a
small effect - 3x increased risk in first degree
relatives
Depression: Monamine Theory: Overview:
- depressive disorder is due to
abnormalities in one or more
monamine neurotransmitter
systems - reserpine is found to cause
depression and it depletes
monoamines - tricylic antidepressants and
monoamine oxidase inhibitors are
effective at treating depression
The Monoamine Theory: Serotonin:
- tryptophan is a serotonin
precursor - depletion of tryptophan causes
relapse - decreased 5HT receptor binding
- decreased 5HT re-uptake sites in
depressed patients - reduced concentration of 5-HTIAA
metabolite of serotonin in CSF after
suicide attempts - effective anti-depressant drugs
increase serotonin levels, which is a
monoamine
The Monoamine Theory: Dopamine and Noradrenaline:
- inhibition of tyrosine hydroxylase
by AMPT causes depressive relapse - blocks the conversion of tyrosine to
L-dopa - less dopamine and noradrenaline
Problems with Monamine Theory:
- onset of action delayed by several
weeks when monoamine levels rise
quickly - some people respond to one
antidepressant but not another
Depression and Inflammation:
- increased rates of depression in
people with autoimmune condition - administration of cytokines
therapeutically can trigger
depression - post-mortem studies of people
with depression show microglial
activation and neuroinflammation
Neurogenesis:
adult brain contains pluripotent stem cells from which new neurons can be generated
BNDF:
- brain derived neurotrophic factor
- along with other proteins regulate
neurogenesis
Depression and Neurogenesis:
- decreased BDNF in depression
- depression related decrease in
BDNF is restored with successful
treatment - when neurogenesis is limited,
depression like symptoms are
observed - neurogenesis limited prevents
antidepressant action - neurogenesis in people with
depression is decreased
Depression: HPA Axis:
- chronic activation by stress leads to
dysregulation - high cortisol levels in depressed
patients - treatment normalises HPA Axis
- symptoms are relieved
Bipolar Disorder: Type 1:
- at least one manic episode
- most will have multiple manic and
depressive episodes
Bipolar Disorder: Type 2:
- at least one hypomanic and one
depressive episode (not full mania) - most will have multiple episodes
Bipolar disorders are less common than depressive disorders and average age of onset is 30.
True or False?
false
18
before the age of 25
if older, may be due to a neurological disorder
What affective disorder could be shown below?
bipolar disorder
more depressive than manic generally
last overlap is a mixed affective state
Mixed Affective State:
patients will experience both symptoms of mania and depression eg overactive and overtalkative as well as negative thinking and suicidal thoughts
Clinical Features of Mania:
- elevation of mood
- increased energy: overactivity
leading to exhaustion, pressured
for speech, less sleep - loss of social inhibition
- distractibility
- increased self esteem, grandiosity
- perceptual disorder: things seem
more vivid/beautiful - risk behaviours: overspending,
substance abuse,
Mania and Psychosis:
- more severe mania
- delusions: mood-congruent
- hallucinations: auditory, tell them
they are wonderful
Clinical Features of Hypomania:
- similar to manic episode
- psychotic features are absent
***no marked impairment in social or occupational functions
- does not necessitate hospital
admission
Course of Bipolar Bisorder:
- late teens onset usually with
depressive episode - average 10 episode over 25 years
- usually more depressive than
manic episodes - episodes become more frequent
- long term impact on work and
social life - progressive cognitive deficits
- course affected by level of social
support and level of expressed
emotion within the family
Bipolar Disorder: Aetiology and Risk Factors:
- genetic
- neurobiological
- medication: corticosteroids,
thyroxine, L-dopa, anabolic steroid,
stimulants - childhood adversity
- life events
Bipolar Disorder: Aetiology: Genetics:
- 70% risk estimated to be heritable
- no single gene
- risk genes overlap more with those
for schizophrenia than unipolar
depression
Bipolar Disorder: Aetiology: Neurobiology:
- smaller total grey matter volumes
- increased inflammatory markers
- possible role for dopamine due to
a heightened responsivity to
dopamine systems - possible role of glutamate:
anticonvulsants affect glutamate,
glutamate may be increased in
people with bipolar disorder
