Affective Disorders Features Flashcards

1
Q

Euthymia

A

normal mood

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2
Q

Disorders of Mood (3):

A
  • depression
  • hypomania
  • mania
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3
Q

Subsyndromal Mood Disorders:

A
  • dysthymia:
  • cyclomythia:
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4
Q

Affective Disorders:

A
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5
Q

Prevalence of Affective Disorders:

A

depressive: mid 20s, modest peak in mid-life 40-60

bipolar disorder: before age 25, average 18

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6
Q

Clinical course of Depressive Illness:

A
  • 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
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7
Q

Diagnostic Features of a Depressive Episode:

A
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8
Q

Depression: Features: Low Mood:

A
  • sadness, flat, irritable
  • diurnal variation (worse in the
    morning)
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9
Q

Depression: Features: Anhedonia:

A
  • loss of enjoyment in things that were
    previously pleasurable
  • hard to look forward to things
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10
Q

Depression: Biological Features:

A
  • 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)
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11
Q

Depression: Psychological Features:

A

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

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12
Q

Depression: Dissociation:

A

depersonalisationn: separated from other people by a palne of glass

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13
Q

Depression: Obsessions:

A

intrusive and repetitive thoughts recognised as patients own

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14
Q

Depression: Phobias:

A

worsening/new

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15
Q

Physical Health Symptoms:

A
  • headaches
  • abdo pain
  • GI symptoms: IBS
  • pain
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16
Q

Depression: Psychotic Features: Delusions:

A
  • may occur in severe depression
  • nihilistic
  • poverty
  • disease
  • guilt
  • persecutory
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17
Q

Depression: Psychotic Features: Hallucinations:

A
  • may occur in severe depression
  • often in the second person
  • putting one down (you’ve done
    terrible things)
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18
Q

Melancholic Depresson:

A
  • low mood
  • decreased pleasure in usual
    activities
  • decreased emotional reactivity
  • loss of appetite
  • weight loss
  • psychomotor changes
  • decreased libido
  • diurnal variation of mood
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19
Q

Atypical Depression:

A
  • low mood
  • increased appetite
  • weight gain
  • increased sleep
  • anxiety
  • fatigue
20
Q

Depression and Cognition:

A
  • 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
21
Q

Effect depression on dementia:

A
  • 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
22
Q

Neurovascular link between depression and dementia:

A
  • frontostriatal vascular damage
  • hippocampal atrophy from
    chronicly high cortisol
  • impaired amyloid clearance due to
    high cortisol
  • chronic inflammatory processes
23
Q

Aetiology of Depression:

24
Q

Depression and Genetics:

A
  • multiple genes that each have a
    small effect
  • 3x increased risk in first degree
    relatives
25
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
26
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
27
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
28
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
29
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
30
Neurogenesis:
adult brain contains pluripotent stem cells from which new neurons can be generated
31
BNDF:
- brain derived neurotrophic factor - along with other proteins regulate neurogenesis
32
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
33
Depression: HPA Axis:
- chronic activation by stress leads to dysregulation - high cortisol levels in depressed patients - treatment normalises HPA Axis - symptoms are relieved
34
Bipolar Disorder: Type 1:
- at least one manic episode - most will have multiple manic and depressive episodes
35
Bipolar Disorder: Type 2:
- at least one hypomanic and one depressive episode (not full mania) - most will have multiple episodes
36
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
37
What affective disorder could be shown below?
bipolar disorder more depressive than manic generally last overlap is a mixed affective state
38
Mixed Affective State:
patients will experience both symptoms of mania and depression eg overactive and overtalkative as well as negative thinking and suicidal thoughts
39
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,
40
Mania and Psychosis:
- more severe mania - delusions: mood-congruent - hallucinations: auditory, tell them they are wonderful
41
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
42
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
43
Bipolar Disorder: Aetiology and Risk Factors:
- genetic - neurobiological - medication: corticosteroids, thyroxine, L-dopa, anabolic steroid, stimulants - childhood adversity - life events
44
Bipolar Disorder: Aetiology: Genetics:
- 70% risk estimated to be heritable - no single gene - risk genes overlap more with those for schizophrenia than unipolar depression
45
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