Intro to Psychiatry - Major Depression and Bipolar Disorders Flashcards
A belief that is clearly false that cannot be explained by a persons cultural/religious beliefs or intelligence level, that indicates abnormality in content of thought
Delusion
A sensory perception in the absence of a corresponding external or somatic stimulus that is not under voluntary control
Hallucination
Formed vs. unformed hallucination?
Formed = voice making the command
Unformed = non-specific sound
Hallucination with insight vs. without insight?
With insight = patient knows its not real
Without insight = patient accepts experience as reality
Loss of contact with external reality characterized by hallucination without insight and/or delusion?
Psychosis
Acute, fluctuating changes in attention (reduced) and consciousness including disorganized thoughts, hyper-vigilance, un-responsiveness, and severe agitation
Delirium
What can trigger delirium? (6)
- Medication change
- Infection
- Surgery
- Trauma
- Stroke
- Withdrawal
Experience of low or depressed mood and a loss of interest in most activities?
Depressive episode
Characterized by increased talkativeness, rapid speech, decreased need for sleep, racing thoughts, distractability, increase in goal-direct activity and grandiosity, and psychomotor agitation?
Mania
What’s the difference between mania and hypomania duration?
- Mania = episode lasts at least 1 week
- Hypomania = episode at least 4 days
Does mania or hypomania cause major deficits in social or occupational functioning?
Mania does, hypomania does not
Risk factors for MDD? (4)
- Exposure to traumatic life event
- Chronic pain and chronic disorders
- Low income, lack of support, increased caregiver burden
- Family hx
Symptoms/Signs that MUST be present for MDD?
Depressed mood and Anhedonia (loss of interest/pleasure in most things)
Accompanying signs that may be present in MDD according to DSM-5?
- Changes in weight and/or appetite
- Sleep disturbances
- Psychomotor changes
- Fatigue and low energy
- Sense of worthlessness or excessive guilt
- Impaired concentration/thinking
- Recurrent thoughts about death or suicide
MDD hypothesis: Altered levels of monoamine neurotransmitters serotonin and noradrenaline, and/or dopamine cause depression
Monoamine Hypothesis
What is the monoamine hypothesis based on?
Antidepressant therapies that increase the presence/function of one or more neurotransmitter resulting in reduced depression
Critique of monoamine hypothesis?
abruptly decreasing serotonin and/or dopamine in healthy people doesn’t cause depression
MDD Hypothesis: Chronic stress leads to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis
Stress-induced depression hypothesis
Chronic HPA activation leads to excess _________ secretion and __________ agents that damage glia and neurons => interfere with neurogenesis and reduce _______ and ________.
cortisol
pro-inflammatory
glutamate
GABA
What do antidepressants appear to do regarding stress-induced depression hypothesis?
Restore function of glucocorticoid receptors => improve negative feedback and normalize cortisol levels
Critiques of stress-induced depression hypothesis?
- Hypercortisolism not a feature of all MDD
- Not clear what causes HPA dysregulation
MDD Hypothesis: decreased brain-derived neurotrophic factor (BDNF) caused by increased cortisol levels blocks neurogenesis and causes depression
Neurotrophic and neuroplasticity hypothesis
What do the triggers that elevate cortisol block?
Neurogenesis
According to the cytokine and neuro-inflammation hypothesis of MDD, what pro-inflammatory markers are increased in patients with MDD?
TNF-alpha, IL-1, IL-6, CRP, and macrophage/monocyte activation
In healthy individuals, light inhibits pineal gland from producing ______ by activating neurons with _________?
melatonin; superchiasmatic nucleui
MDD Hypothesis: Stressful events lead to changes in diurnal molecular rhythms in cells that in vulnerable patients triggers MDD
Circadian hypothesis
Link between sleep disturbances and depression?
Bidirectional
MDD Hypothesis: Glutamate may cause excitotoxicity resulting in neuronal atrophy and reduced synaptic connectivity
Excitatory Neurotransmitters Hypothesis
What may reduced GABA in CSF of MDD patients be due to?
Change in serotonin which modulates GABA - GABA in turn modulates glutamate
GABA and glutamate are _____ within glial cells and neurons of the prefrontal cortex
reduced
Excessive accumulation of glutamate within the synaptic cleft results in?
Overstimulation of glutamate-R => Ca2+ influx
How does cytosolic Ca2+ result in necrosis?
activating enzymes like proteases, phospholipases and endonucleases, as well as cause mitochondrial damage via opening mitochondrial permeability transition pore leading to ATP deficiency
Clinical features of Bipolar Disorders (5)
- Mania
- Hypomania
- Depression
- Cyclical changes between states
- Manic psychosis
Bipolar disorder characterized by at least 1 manic episode and usually depressive episodes?
Bipolar 1
Bipolar disorder characterized by at least 1 hypomanic episode and major depressive episodes?
Bipolar 2
What needs to be ruled out before Considering Bipolar 1?
- Hyperthyroidism (TSH, T4)
- Stimulant drug abuse (blood/urine)
Clinical features of Bipolar 1? (3)
- At least 1 episode of mania lasting for at least 4 days
- 3 or more sx of mania
- Significant impairment/need for hospitalization
Clinical features of Bipolar 2? (4)
- No manic episodes experienced before
- Exclusion of schizophrenia, delusional or psychotic disorder
- Clinically significant distress from sx
- Hypomania episode
A _______ episode impairs function and necessitates hospitalization, while a _______ episode does not
manic; hypomanic
Pathophysiology of bipolar disorder? (4)
- Circadian rhythm dysfunction
- Metabolic dysfunction
- Mitochondrial dysfunction
- Glutamate excitotoxicity
Circadian rhythm dysfunction: observations for pts with BD?
- changes in melatonin levels
- changes in melatonin receptor levels in CNS
- changes in cortisol patterns of release
Correlation between polymorphism in CLOCK genes as well as positive response to ________ therapy for patients with BD
Lithium
Metabolic dysfunction: Increased amount of ______ secreted in obese patients with BD that regulates _______ and _______
Leptin; regulates appetite and sleep
Hypothesis suggested about metabolic function and BD?
Body is forced to compensate for high metabolic demand of the brain during manic states
Impairment in mitochondrial function results in the brain shifting toward what?
glycolysis
What is phosphocreatine? Is it increased or reduced in FC of patients with BD?
Phosphocreatine = reserve for ATP
its reduced in patients with BD => implying deficiency in ATP synthesis
What do increased levels of excitatory glutamate result in?
Increased energy demand on the neuron
Why may there be an increased shift in glycolysis?
Increased glutamate stimulation in frontal cortex of patients with BD
