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NB3 > Depressive Mood And Bipolar Disorder > Flashcards

Depressive Mood And Bipolar Disorder Flashcards

1
Q

What is mood?

A

Low mood without abnormally high mood periods:

  • Major Depressive Disorder
  • Persistent Depressive Disorder
  • Premenstrual Dysphoric Disorder
  • Disruptive Mood Dysregulation Disorder
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2
Q

Summarize major depressive disorder diagnosis

A

Also known as unipolar depression

  • Individual must experience 1+ major depressive episode (MDE) for a diagnosis of MDD
  • Individual cannot have a history of mania or hypomania
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3
Q

What are the necessary characteristics to diagnose major depressive episodes?

A

At least 2 weeks of 5+ of the following, one of which MUST be affective:
Affective
(1) Depressed mood
(2) Anhedonia

Neuro-vegetative

(3) Change in appetite/significant weight change
(4) Insomnia/hypersomnia
(5) Loss of energy

Cognitive

(6) Psychomotor changes
(7) Feeling guilty/worthless
(8) Decreased concentration
(9) Thoughts of death/suicidal ideation

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4
Q

What are the major sleep disturbances?

A

Insomnia
– Initial insomnia
– Night waking (middle insomnia) – Early morning waking (terminal
insomnia)

• Hypersomnia

• Altered sleep architecture – Decreased REM latency – Increased REM time
– Decreased SWS (N3)

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5
Q

What triggers MDD?

A

• Diathesis-Stress Model

• Lifetime risk of developing MDD:
– 7-10% (general population)
– 20% (first degree relative)
– 40%+ (monozygotic twin)

  • Social or physical stressors trigger MDE
  • Individual resilience impacts response to trigger (i.e., coping skills)
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6
Q

What is the etiology and neurobiology of MDD?

A

Amygdala ↑ activity
HPAAxis ↑ activity(chronic)
•Cortisol ↑ levels
• Cytokines ↑ inflammatory response (relates to sickness behavior)

Hippocampus ↓ volume (due to hypercortisolemia?)

Dorsolateral Prefrontal
Cortex ↓ activity/volume

Monoamines ↓ neurotransmission

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7
Q

What are the SSRI & SNRI mechanisms?

A 
SSRI (selective serotonin reuptake inhibitors)
• Fluoxetine,citalopram,sertraline 
• Mostpopular,benignsideeffects
(GI disturbance, sexual dysfunction) 
• Blocks reuptake of 5-HT

SNRI (serotonin-norepinephrine reuptake inhibitors)
• Venlafaxine, duloxetine
• Similar side effects as SSRIs. also increase BP
• Blocks reuptake of 5-HT and norepinephrine

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8
Q

What are tricyclic antidepressants?

A

• Imipramine, amitriptyline

• Blockspresynapticreuptakeof
norepinephrine (NE) and 5-HT

• Lessserotoninagonismrelative
to the SSRI and SNRI

• Alsoblockshistamine,
muscarinic (anticholinergic),
alpha-1 receptors

• Cardiac side effects(e.g.,
orthostatic hypotension)

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9
Q

What are the MAOIs?

A

MAOIs (Monoamine Oxidase Inhibitors)

• Phenelzine, selegiline

• MAOIs prevent enzyme
degradation of the monoamines (5-HT, norepinephrine & dopamine [DA])

  • Diet restrictions to avoid tyramine- induced hypertension (“cheese effect”)
  • Less widely used
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10
Q

What are the non-Medication treatments for depression?

A

Esketamine nasal spray
• Approved 2019 for treatment-resistant depression
• Rapid onset antidepressant effects
• Blocks NMDA receptors

Phototherapy
• Exposure to bright artificial light
• Seasonal MDD (seasonal affective disorder)

Brain stimulation therapies (DLA)
• Electroconvulsive shock therapy (ECT)
• Repetitive transcranial magnetic stimulation (TMS)
• Vagus nerve stimulation (VNS)

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11
Q

What are the types/variations of bipolar disorders?

A

Disorders in which high mood is the common theme
• Bipolar I disorder
• Bipolar II disorder
• Cyclothymic disorder

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12
Q

Describe the diagnosis of Bipolar 1

A

• Individual must experience at least one manic episode

• Symptoms last 1+ week (or any duration if hospitalization is
required)

  • Symptoms cause marked impairment in functioning
  • Most Bipolar I patients also experience major depressive episodes, but not necessary for a BPI diagnosis
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13
Q

Define a manic episode

A

Abnormally elevated mood OR irritability AND increased energy
3+ additional symptoms required:
• Inflated self-esteem/grandiosity
• Decreased need for sleep
• Pressured speech
• Flight of ideas (and/or racing thoughts)
• Distractibility
• Increased goal-directed activity or psychomotor agitation • Excessive involvement in “risky” activities

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14
Q

Describe Bipolar II diagnosis

A
  • At least 1 major depressive episode (MDE) and at least 1 hypomanic episode
  • Change in mood must be “unequivocal” and “uncharacteristic”
  • Hypomanic episode must last 4+ days
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15
Q

Define hypomania

A

Hypomania:
• Same symptoms of mania but different severity

  • Mania is “marked” impairment in functioning; hypomania not
  • Mania can involve psychosis; hypomania not
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16
Q

Describe cyclothymic disorder diagnosis

A
  • Periods of hypomanic symptoms that fluctuate with periods of depressive symptoms for 2+ years
  • Never met criteria for a major depressive episode or a manic episode
  • Similar to Bipolar I, but the mood shifts are not as extreme
17
Q

Describe the etiology and neurobiology of bipolar disorders

A

• Diathesis-Stress Model

• Lifetime risk of developing Bipolar I:
– 1% (general population)
– 20% (first degree relative)
– 80% (monozygotic twin)

• Social or physical stressors trigger swings in moods

  • Individual resilience impacts response to trigger (i.e., coping skills)
  • Manic episodes: ↑ monoaminergic activity (e.g., dopamine)
18
Q

What are the bipolar 1 treatment?

A

Mood Stabilizers: drugs that target the manic phase of BPI
– Lithium
– Anticonvulsants (e.g., valproate)
– Antipsychotics (e.g., olanzapine)

  • Variable mechanisms of action (unknown)
  • Common side effects: hand tremor, polyuria, polydipsia
  • Problems with medication non-compliance due to desired mania

• Antidepressants are NOT FDA-approved for BP depression
– Contraindicated due to the risk of mania induction
– Antipsychotics to treat depressive episode of bipolar (i.e., lurasidone)

19
Q

Describe bipolar II & cyclothymic disorder treatment

A
  • Mood stabilizing drugs (e.g., lithium, valproate)

• Focus on treating the depression phase of BPII (more
problematic phase than hypomania)

– Lurasidone (antipsychotic drug that is FDA-approved for bipolar
depression)
– Taken alone or with lithium or a mood-stabilizing anticonvulsant
(e.g., valproate)
– Side effect can include motor disturbances

NB3 (33 decks)

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