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NSB > Affective Disorders Features > Flashcards

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:

A
24
Q

Depression and Genetics:

A
  • multiple genes that each have a
    small effect
  • 3x increased risk in first degree
    relatives
25
Q

Depression: Monamine Theory: Overview:

A
  • 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
Q

The Monoamine Theory: Serotonin:

A
  • 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
Q

The Monoamine Theory: Dopamine and Noradrenaline:

A
  • inhibition of tyrosine hydroxylase
    by AMPT causes depressive relapse
  • blocks the conversion of tyrosine to
    L-dopa
  • less dopamine and noradrenaline
28
Q

Problems with Monamine Theory:

A
  • onset of action delayed by several
    weeks when monoamine levels rise
    quickly
  • some people respond to one
    antidepressant but not another
29
Q

Depression and Inflammation:

A
  • 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
Q

Neurogenesis:

A

adult brain contains pluripotent stem cells from which new neurons can be generated

31
Q

BNDF:

A
  • brain derived neurotrophic factor
  • along with other proteins regulate
    neurogenesis
32
Q

Depression and Neurogenesis:

A
  • 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
Q

Depression: HPA Axis:

A
  • chronic activation by stress leads to
    dysregulation
  • high cortisol levels in depressed
    patients
  • treatment normalises HPA Axis
  • symptoms are relieved
34
Q

Bipolar Disorder: Type 1:

A
  • at least one manic episode
  • most will have multiple manic and
    depressive episodes
35
Q

Bipolar Disorder: Type 2:

A
  • at least one hypomanic and one
    depressive episode (not full mania)
  • most will have multiple episodes
36
Q

Bipolar disorders are less common than depressive disorders and average age of onset is 30.

True or False?

A

false

18
before the age of 25

if older, may be due to a neurological disorder

37
Q

What affective disorder could be shown below?

A

bipolar disorder

more depressive than manic generally

last overlap is a mixed affective state

38
Q

Mixed Affective State:

A

patients will experience both symptoms of mania and depression eg overactive and overtalkative as well as negative thinking and suicidal thoughts

39
Q

Clinical Features of Mania:

A
  • 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
Q

Mania and Psychosis:

A
  • more severe mania
  • delusions: mood-congruent
  • hallucinations: auditory, tell them
    they are wonderful
41
Q

Clinical Features of Hypomania:

A
  • similar to manic episode
  • psychotic features are absent

***no marked impairment in social or occupational functions

  • does not necessitate hospital
    admission
42
Q

Course of Bipolar Bisorder:

A
  • 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
Q

Bipolar Disorder: Aetiology and Risk Factors:

A
  • genetic
  • neurobiological
  • medication: corticosteroids,
    thyroxine, L-dopa, anabolic steroid,
    stimulants
  • childhood adversity
  • life events
44
Q

Bipolar Disorder: Aetiology: Genetics:

A
  • 70% risk estimated to be heritable
  • no single gene
  • risk genes overlap more with those
    for schizophrenia than unipolar
    depression
45
Q

Bipolar Disorder: Aetiology: Neurobiology:

A
  • 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

NSB (50 decks)

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