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Patho > Depression > Flashcards

Depression Flashcards

1
Q

How does depression mask itself in men?

A

as somatic complaints like migraines, back pain or IBS

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2
Q

What is the DSM 5 criteria for depression?

A

five or more symptoms must be present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) anhedonia

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3
Q

What are some common comorbid diagnoses with depression?

A

DM, heart disease, autoimmune disorders and pain

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4
Q

What are some risk factors associated with depression?

A
  1. childhood emotional, physical and sexual abuse
  2. prior episode of depression
  3. family hx of DD
  4. lack of social support
  5. stressful life event
  6. current substance abuse
  7. economic difficulties
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5
Q

What is the etiology of depression?

A

multifactorial; dynamic, interplay amongst genetics, environment, life hx, development and biological changes. More focus now on the deficits in NT system.

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6
Q

_ may increase the risk for depression

A

polymorphisms

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7
Q

What is thought to contribute to the dysregulation of serotonin? (NT)

A

The short allele slows down the synthesis of the serotonin transporter. this is thought to reduce the speed with which serotonin neurons can adapt to changes in their stimulation -> dysregulation

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8
Q

What plays an important role in birth, survival, and maturation of brain cells during development (as well as the synaptic changes that occur throughout a person’s life)?

A

Brain Derived Neurotrophic Factor (BDNF)

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9
Q

What does BDNF do?

A

activates DNA binding factors that stimulate gene transcription of genes involved in serotonin function (serotonin transporter and tryptophan hydrolase, the serotonin synthesizing enzyme).

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10
Q

In a person with MDD what would you expect their levels of BDNF to look like?

A

low

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11
Q

What alleles in gene code for BDNF?

A

val and met, people with met allele increases vulnerability to depression

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12
Q

What structure contributes to memory impairments and feelings of hopelessness, guilt, doom and suicidality?

A

the hippocampus

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13
Q

Where is the major source of Ach found in the brain?

A

[high] in the basal ganglia and motor cortex (derived from choline)

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14
Q

What effect and implication does Ach have for mental illness?

A

Can be excitatory or inhibitory, depending on the area of the brain. Underactivity implicated in Alzheimer disease.

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15
Q

Where is the major source of dopamine found in the brain?

A

Substantia nigra and ventral segmental area in the midbrain (derived from tyrosine)

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16
Q

What effect and implication does DA have for mental illness?

A

Usually, excitatory. Involved in motivation, thought and emotional regulation. Overactivity thought to be involved in schizophrenia and other psychotic disorders.

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17
Q

Where is the major brain source of NE and E found?

A

Locus cerleus in the brain stem

- Derived from dopamine

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18
Q

What effect and implication does NE and E have on mental illness?

A

Can be excitatory or inhibitory, depending on the area of the brain.
Noradrenergic pathways to cerebral cortex, limbic system, and brain stem.
Underactivity thought to be involved in some depressions.

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19
Q

Where is the major brain source of serotonin found?

A

Raphe nucleus in the brain stem

-Derived from tryptophan

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20
Q

What is the effect and implication does serotonin have on mental illness?

A

Involved in the regulation of attention and complex cognitive functions.
Underactivity thought to be involved in some depressions and OCD.

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21
Q

Where is the major source of y-Aminobutyric acid, (GABA). Glutamate, aspartate, and glycine in the brain?

A

no single major source

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22
Q

What effect and implication do y-Aminobutyric acid, (GABA). Glutamate, aspartate, and glycine have on mental illness?

A

GABA and glycine usually are inhibitory; glutamate is excitatory.
Implicated in anxiety disorders.

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23
Q

What are the 4 steps of neurotransmission?

A
  1. The synthesis of a transmitter substance
  2. The storage and release of the transmitter
  3. Binding of the transmitter to receptors on the postsynaptic membrane
  4. Removal of the transmitter from the synaptic cleft
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24
Q

Where are NTs stored and how are they released?

A
  • NTs are typically stored in the vesicles in the presynaptic axonal terminal and released by the process of exocytosis.
25
Q

What often results from the binding of an excitatory NT?

A

b. Binding of an excitatory NT often results in the opening of an ion channel, such as the Na+ channel.

26
Q

What are the 3 ways NTs are removed from the postsynaptic neuron?

A

i. Reuptake
ii. Diffuse out of the synaptic cleft
iii. Broken down by enzymes into inactive substances or metabolites.

27
Q

What is the underlying pathologic process in depression?

A

Decreased levels of serotonin and norepinephrine in the synaptic cleft is the underlying pathologic process in depression.

28
Q

Why is depression higher in patients with Parkinson’s disease?

A

Studies show that the frequency of depression is higher in patients with Parkinson’s disease which is caused by lower rates of dopamine production in the substantia nigra.

29
Q

What functions does the prefrontal cortex carry out?

A

It contains the centres of elaboration of thought, voluntary motor and sensory functions, speech, and memory patterns and has extensive connections with deeper parts of the brain.

30
Q

In some cases of familial MDD and bipolar disorder what do MRI and PET scans reveal about the prefrontal cortex?

A

A reduction in the volume of grey matter in the prefrontal cortex, with an associated decrease in activity in that region. Also, not much neuronal volume because it you don’t use it, you’re going to lose it.

31
Q

What does gray matter contain?

A

Gray matter contains neuronal cell bodies, dendrites, unmyelinated axons, axon terminals and neuroganglia.

32
Q

Which brain region whilst in depression have increased blood flow directed to it and increased O2 consumption?

A

the amygdala (part of limbic system)

33
Q

What is the function of the amygdala?

A

Important in emotional function and regulation, the modulation of affective responses in social settings, as well as sexual arousal, aggression, and fear responses.

34
Q

What brain region mediates the anhedonia, anxiety, and reduced motivation symptoms of depression.

A

amygdala

35
Q

What structures of the brain are part of the limbic system?

A

The limbic system includes the hippocampus, parahippocampal gyrus, cingulate gyrus, amygdala, and a bridge like structure called the fornix which connects the hippocampus with the hypothalamus.

36
Q

What do the neocortex and hippocampus contribute to depression?

A

The neocortex and hippocampus are thought to mediate cognitive aspects of depression, such as memory impairments and feelings or worthlessness, hopelessness, guilt, doom, and suicidality.

37
Q

The dysregulation and neuroanatomical changes in what brain region are thought to be responsible for the neurovegetative symptoms of depression?

A

hypothalamus (too much sleep, appetite and energy, as well as low libido and other pleasurable activities. )

38
Q

What NTs are active in the limbic system?

A

S, NE and DA are the active NTs in these regions of the brain.

39
Q

What two hormones in the HPA axis are increased in persons with depression?

A

CRF, cortisol

40
Q

What happens to the thyroid in depressed people?

A

5-10% of people with depression have a decreased thyroid function, given thyroid medication first to fix the thyroid so it can respond to treatment with antidepressant medication.

41
Q

How does the sleep-wake cycle change in depressed people?

A

Reversed in depressed people where the person reaches deep sleep earlier in the cycle.

42
Q

What is the function of circadian rhythms?

A

Function is to provide a temporal organization for physiologic processes and behaviours to promote effective adaptation to our environment. This involves regular cycles of sleep and waking and body functions such as temperature regulation and hormone secretion based on changes in the day.

43
Q

o Research has shown that some patients with depression have _ abnormalities of mood, sleep, temperature, and neuroendocrine secretion

A

circadian rhythm

44
Q

What cells signal the brain and serve as mediators between immune cells and nerve cells?

A

cytokines

45
Q

In a depressed person what would we expect their cytokine levels to be?

A

increased

46
Q

Besides treating depression, what else do antidepressants treat?

A

they have anti-inflammatory effects and have been used to treat chronic pain

47
Q

What is thought to cause the physical pain of depression?

A

Physical pain associated with depression is thought to occur because serotonin is a pain-modulating NT, and the release of endorphins is centrally mediated by 5-HT.

48
Q

What are the 3 most common antidepressant drugs prescribed?

A

SSRIs, TCAs, MAOIs

49
Q

What is the therapeutic effect of SSRIs?

A

increase serotonin

50
Q

What is the mechanism of action of MAOIs?

A

block the degradation of NE and 5-HT, by inhibiting monoamine oxidase

51
Q

What is the mechanism of action of TCAs?

A

inhibit reuptake of NE, 5-HT and dopamine

52
Q

What are key side effects of SSRIs?

A

nervousness, insomnia, sexual dysfunction, weight gain

53
Q

What are key side effects of TCAs?

A

anticholinergic effects; sweating, sedation, orthostatic hypotension

54
Q

What are key side effects of MAOIs?

A

orthostatic hypotension (hypertensive crisis with tyramine), headache, insomnia, diarrhea

55
Q

When is electroconvulsive therapy (ECT) used and how does it work?

A
  • used in patients whose depression is resistant to conventional treatments
  • Down regulate beta adrenergic receptors in much the same way as antidepressant medications, therefore lowering the stress response.
  • Produces an up-regulation in serotonin.
  • Increases the influx of calcium in the brain and has effects on second messenger systems.
  • Upregulate levels of BDNF.
56
Q

What is light therapy ?

A

-Uses artificial light to influence the production of melatonin and the function of the catecholamine systems.

57
Q

What may be considered the first line of treatment for mild to moderate depressed outpatients?

A

psychotherapy focused

58
Q

Why is VNS believed to have therapeutic effects?

A

It is believed that VNS has antidepressant properties via its effects on the locus coeruleus, an area in the brain stem from which norepinephrine neurons originate.

Patho (4 decks)

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