Affective Disorders -Phelps Flashcards
What is the correlation between short genes for serotonin reuptake transporter and depression?
-people with 2 short alleles are more susceptible to depression with life stressors than those with 2 long alleles
–> this serotonin
transporter does not work as well
Who is MOST susceptible to depression under no stress? Under severe stress?
- no severe stress=2 shorts and a male
- female with 2 short genes and under severe stress is most susceptible to stress
What is the DSM IV criteria for Major Depressive Disorder?
in addition to depression feelings or anhedonia (loss of interests/pleasure):
SIG: E CAPS (5+ for > 2 weeks):
- Suicidal thoughts
- Interests decresed
- Guilt
- Energy decrease
- Concentration decrease
- Appetite disturbance
- Psychomotor changes
- Sleep disturbance
Deep brain stimulation of what region of the brain can decrease depression?
Subgenual cingulate
What factors can contribute to depression?
- genetics
- childhood experiences
- psychodynamic: repressed drives
- psychological: automatic thoughts and mood congruent cognitions (depressed pt’s think differently)
- social: inescapable stress, stuck in a cage with a superior, epigenetic changes (neuroplasticity)
What is neuroplasticity?
Neuroplasticity model->
tug of war between good (trophic factors) and bad (atrophic region) in certain regions of the brain (hippocampus, amygdala, ventral prefrontal cortex)
stress-> increase in atrophic factors –> affect cell volume and neurogenesis
hippocampal volume loss over time in pts with severe mood disorders
What are some atrophic and trophic factors?
atrophic: glutamate and cortisol
trophic: BDNF, bcl-2
brain shrinkage occurs when atrophic»_space; trophic factors
What is the criteria for Dysthymic Disorder?
HE’S 2 SAD:
- Hopelessness
- Energy loss
- Self-esteem is low
- 2 years minimum of depressed mood most of the day, more days than not
- Sleep changes
- Appetite changes
- Decision-making is impaired
What is the criteria for Bipolar I Disorder?
Major depression + > 7 days 3-4 DIGFAST (mania) criteria
- Distractibility
- Insomnia
- Grandiosity
- Flight of ideas
- Activity increase
- Speech (pressured)
- Thoughtlessness (impulsive, risky behavior)
What is the criteria for Bipolar II Disorder?
Major depression + >4 days 3,4 DIGFAST
- Distractibility
- Insomnia
- Grandiosity
- Flight of ideas
- Activity increase
- Speech (pressured)
- Thoughtlessness (impulsive, risky behavior)
Hypomania–> not as severe life effects
typically present with depression
What should be differentials for Major Depressive Disorder?
- medical problems renal, hypothyroidism)
2. medications (interferon, steroids)
What severities of Major Depressive Disorder should be given anti-depressants?
moderate–> severe (HDRS at or below 25)
mild can be as responsive to placebo as they will be to anti-depressants
What is the best treatment for Dysthymic Disorder?
Psychotherapy
What treatment should not be given to Bipolar Disorder?
anti-depressants
What are the 3 mood stabilizers used in the treatment of Bipolar Disorder?
lithium
valproate
carbamazepine
