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B3 CTB > Depression > Flashcards

Depression Flashcards

1
Q

What are the two patterns of depressive states?

A

Unipolar and bipolar

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2
Q

What is a unipolar depressive state and what does it include?

A

Low level of mood affecting quality of life.

Includes dysthymia (low level chronic lasting over 2 years), atypical depression (symptoms improve following positive experiences) and major depressive disorder (clinical depression meeting DSM/ICD criteria).

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3
Q

What is bipolar depressive state and what does it include?

A

Recurrent episodes of mania and depression.

Includes bipolar disorder (periods of mania and depression) and cyclothymia (periods of hypomania and sub threshold depression).

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4
Q

What are unipolar depressive states treated with?

A

CBT and antidepressants.

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5
Q

What are bipolar depressive states treated with?

A

Antipsychotics.

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6
Q

What are the three grades of depression?

A

Mild, moderate and severe.

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7
Q

If key symptoms are present, what other symptoms of depression do you look for? (give three)

A
  • Disturbed sleep (decreased or increased compared to usual).
  • Decreased or increased appetite or weight.
  • Fatigue or loss of energy.
  • Agitation or slowing of movements.
  • Poor concentration or indecisiveness.
  • Feelings of worthlessness or excessive or inappropriate guilt.
  • Suicidal thoughts or acts (major red flag distinguishing moderate and severe cases).
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8
Q

Levels of mood are set by what?

A

insula

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9
Q

In depression, what areas of the brain have decreased activity?

A
  • Prefrontal cortex.

Associated with positive emotions, cognitive function and reward pathways.

  • Hippocampus.

Memory, spatial awareness, interaction with the world.

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10
Q

In depression, what areas of the brain have increased activity?

A
  • Amygdala.
  • Hypothalamus.

Nuclei controlling HPA axis (stress).

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11
Q

The cingulate gyrus is involved in controlling a lot of our ?. The ? is linked to the cingulate gyrus.

A

pleasure responses, subgenual prefrontal cortex

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12
Q

Many theories of depression suggest ? is a major cause.

A

inflammation of the CNS

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13
Q

What is the main site of production of serotonin (5HT)?

A

Raphe nuclei in the brainstem (runs down the seam o the brainstem in all three regions).

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14
Q

Name four things serotonin is involved in.

A
  • Mood.
  • Agitation.
  • OCD.
  • Anxiety.
  • Appetite.
  • Insomnia.
  • Sexual function.
  • Nausea and vomiting.
  • GI function.
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15
Q

Where is the main site of noradrenaline production?

A

Locus Coeruleus and Lateral Tegmental area.

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16
Q

Noradrenaline is particularly involved in ?

A

autonomic nervous system transmission

17
Q

List four functions of noradrenaline.

A
  • Depression.
  • Attention.
  • Energy homeostasis.
  • Agitation.
  • Emotions.
  • Blood pressure.
  • Heart rate.
  • Bladder control.
  • Motor function.
18
Q

There are large interactions between ? and ? neurons centrally.

A

5HT, NA

19
Q

What do interactions between 5-HT and NA do in the cortex and brainstem?

A

Slow down activity in the cortex.

Speed up activity in the brainstem.

20
Q

In the cortex, noradrenaline acts on ? receptors to slow down activity.

A

alpha 2

21
Q

In the CNS, what do inflammatory mediators lead to?

A
  • Microglia activation (effectively white cells of the CNS).

Hyper-activation, can become destructive.

  • Cell dysfunction.
  • Cell death.
22
Q

What is the biggest producer of 5HT in the body?

A

Enteric nervous system of the GI tract (80 - 90 %).

Some of this serotonin can reach the brain (information travels via vagal pathways).

23
Q

Inflammation in the gut can trigger ?.

A

altered activity within the brain

24
Q

Some key areas of the brain are ‘plastic’. What does this mean?

A

Change in response to our experience, for example the hippocampus and amygdala.

25
Q

Depression is associated with decreased ?, meaning there is less potential for connectivity and hence less activity.

A

dendritic arborisation

26
Q

What is the result of the decrease in dendritic arborisation and synapses associated with depression? Why can this cause problems?

A

Get an overproduction of receptors to compensate.

Causes problems when you start treating because it takes a while for the receptor numbers to fall back to normal.

Can take a while for antidepressants to work.

27
Q

Name some pharmacological treatments for depression (drug classes).

A
  • Selective Serotonin Reuptake Inhibitors (SSRIs) - sertraline, citalopram.
  • Tricyclic Antidepressants (TCAs) - amitriptyline, nortriptyline, clomipramine.
  • Monoamine Oxidase Inhibitors (MAOI-A) - moclobemide.
  • Atypical antidepressants (e.g. NRIs) - reboxetine.
  • Mood stabiliser - lithium.
28
Q

Name some non-pharmacological treatments for depression.

A
  • CBT: attempts to identify and change dysfunctional thought patterns in cognition.
  • Exercise and lifestyle changes.
  • Interpersonal therapy (IPT).
  • Transcranial magnetic stimulation (TMS): stimulation of limbic system and prefrontal cortex using magnetic stimulation.
  • Transcranial direct current stimuation (tDCS).
  • Electroconvulsive therapy (ECT): induction of seizures under general anaesthetic using electrodes.
29
Q

What percentage of patients respond to placebo?

A

30 %

30
Q

When is transcranial magnetic stimulation used?

A

For severely depressed patients who don’t respond to antidepressants.

Significantly less stigma that ECT (newer, less invasive).

31
Q

What is the gold standard for severe depression?

A

Electroconvulsive therapy.

50 % of patients show improvement.

32
Q

How does electroconvulsive therapy work? What are the side effects?

A

Exposing the brain to a significant electrical charge to reset cortical and deep cortical activity.

Side effects include memory loss and short term muscle aches.

33
Q

What are some core symptoms and associated symptoms of depression? (Used in ICD-10 criteria for depression)

A

Core:

Persistent low mood

Anhedonia (inability to feel pleasure)

Loss of interests

Associated:

Cognitive - suicidal thoughts, worthlessness, helplessness, hopelessness

Behavioural - psychomotor slowing, agitation

Physiological - sleep changes, weight changes, fatigue, loss of energy

34
Q

What is included in ICD-10 criteria for depression?

A

At least 1 core symptom for over 2 weeks.

Mild depression: 2 core symptoms and 2 associated symptoms.

Moderate depression: 2 core symptoms and 4 associated symptoms.

Severe depression: 2 core symptoms and more than 4 associated symptoms.

35
Q

What is included in DSM-V criteria for depression?

A

Over two weeks, anhedonia, low mood, and 3 other symptoms

Mild depression: more than 1 core symptom and 1-2 associated symptoms OR 5-6 symptoms and mild functional impairment.

Moderate depression: more than 1 core cymptom and 2-3 associated symptoms OR 7-8 symptoms and moderate functional impairment.

Severe depression: All 3 core symptoms and more than 3 associated symptoms OR fewer symptoms plus any of following; severe functional impairment, psychosis or suicidal thoughts.

36
Q

What is depression?

A

A common mental disorder, characterised by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness and poor concentration.

It can be long lasting or recurrent, substantially impairing a person’s ability to function at work/school or cope with daily life.

37
Q

What are the different theories of depression?

A

Monoamine/neurotransmitter theory

Neurohormonal theory

Immune theory

Circadian theory

B3 CTB (13 decks)

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