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BMS150 Midterm 2 > Intro to Psychiatry - Major Depression and Bipolar Disorders > Flashcards

Intro to Psychiatry - Major Depression and Bipolar Disorders Flashcards

1
Q

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

A

Delusion

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2
Q

A sensory perception in the absence of a corresponding external or somatic stimulus that is not under voluntary control

A

Hallucination

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3
Q

Formed vs. unformed hallucination?

A

Formed = voice making the command
Unformed = non-specific sound

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4
Q

Hallucination with insight vs. without insight?

A

With insight = patient knows its not real
Without insight = patient accepts experience as reality

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5
Q

Loss of contact with external reality characterized by hallucination without insight and/or delusion?

A

Psychosis

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6
Q

Acute, fluctuating changes in attention (reduced) and consciousness including disorganized thoughts, hyper-vigilance, un-responsiveness, and severe agitation

A

Delirium

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7
Q

What can trigger delirium? (6)

A
  • Medication change
  • Infection
  • Surgery
  • Trauma
  • Stroke
  • Withdrawal
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8
Q

Experience of low or depressed mood and a loss of interest in most activities?

A

Depressive episode

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9
Q

Characterized by increased talkativeness, rapid speech, decreased need for sleep, racing thoughts, distractability, increase in goal-direct activity and grandiosity, and psychomotor agitation?

A

Mania

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10
Q

What’s the difference between mania and hypomania duration?

A
  • Mania = episode lasts at least 1 week
  • Hypomania = episode at least 4 days
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11
Q

Does mania or hypomania cause major deficits in social or occupational functioning?

A

Mania does, hypomania does not

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12
Q

Risk factors for MDD? (4)

A
  • Exposure to traumatic life event
  • Chronic pain and chronic disorders
  • Low income, lack of support, increased caregiver burden
  • Family hx
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13
Q

Symptoms/Signs that MUST be present for MDD?

A

Depressed mood and Anhedonia (loss of interest/pleasure in most things)

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14
Q

Accompanying signs that may be present in MDD according to DSM-5?

A
  • 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
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15
Q

MDD hypothesis: Altered levels of monoamine neurotransmitters serotonin and noradrenaline, and/or dopamine cause depression

A

Monoamine Hypothesis

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16
Q

What is the monoamine hypothesis based on?

A

Antidepressant therapies that increase the presence/function of one or more neurotransmitter resulting in reduced depression

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17
Q

Critique of monoamine hypothesis?

A

abruptly decreasing serotonin and/or dopamine in healthy people doesn’t cause depression

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18
Q

MDD Hypothesis: Chronic stress leads to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis

A

Stress-induced depression hypothesis

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19
Q

Chronic HPA activation leads to excess _________ secretion and __________ agents that damage glia and neurons => interfere with neurogenesis and reduce _______ and ________.

A

cortisol
pro-inflammatory
glutamate
GABA

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20
Q

What do antidepressants appear to do regarding stress-induced depression hypothesis?

A

Restore function of glucocorticoid receptors => improve negative feedback and normalize cortisol levels

21
Q

Critiques of stress-induced depression hypothesis?

A
  • Hypercortisolism not a feature of all MDD
  • Not clear what causes HPA dysregulation
22
Q

MDD Hypothesis: decreased brain-derived neurotrophic factor (BDNF) caused by increased cortisol levels blocks neurogenesis and causes depression

A

Neurotrophic and neuroplasticity hypothesis

23
Q

What do the triggers that elevate cortisol block?

A

Neurogenesis

24
Q

According to the cytokine and neuro-inflammation hypothesis of MDD, what pro-inflammatory markers are increased in patients with MDD?

A

TNF-alpha, IL-1, IL-6, CRP, and macrophage/monocyte activation

25
Q

In healthy individuals, light inhibits pineal gland from producing ______ by activating neurons with _________?

A

melatonin; superchiasmatic nucleui

26
Q

MDD Hypothesis: Stressful events lead to changes in diurnal molecular rhythms in cells that in vulnerable patients triggers MDD

A

Circadian hypothesis

27
Q

Link between sleep disturbances and depression?

A

Bidirectional

28
Q

MDD Hypothesis: Glutamate may cause excitotoxicity resulting in neuronal atrophy and reduced synaptic connectivity

A

Excitatory Neurotransmitters Hypothesis

29
Q

What may reduced GABA in CSF of MDD patients be due to?

A

Change in serotonin which modulates GABA - GABA in turn modulates glutamate

30
Q

GABA and glutamate are _____ within glial cells and neurons of the prefrontal cortex

A

reduced

31
Q

Excessive accumulation of glutamate within the synaptic cleft results in?

A

Overstimulation of glutamate-R => Ca2+ influx

32
Q

How does cytosolic Ca2+ result in necrosis?

A

activating enzymes like proteases, phospholipases and endonucleases, as well as cause mitochondrial damage via opening mitochondrial permeability transition pore leading to ATP deficiency

33
Q

Clinical features of Bipolar Disorders (5)

A
  • Mania
  • Hypomania
  • Depression
  • Cyclical changes between states
  • Manic psychosis
34
Q

Bipolar disorder characterized by at least 1 manic episode and usually depressive episodes?

A

Bipolar 1

35
Q

Bipolar disorder characterized by at least 1 hypomanic episode and major depressive episodes?

A

Bipolar 2

36
Q

What needs to be ruled out before Considering Bipolar 1?

A
  • Hyperthyroidism (TSH, T4)
  • Stimulant drug abuse (blood/urine)
37
Q

Clinical features of Bipolar 1? (3)

A
  • At least 1 episode of mania lasting for at least 4 days
  • 3 or more sx of mania
  • Significant impairment/need for hospitalization
38
Q

Clinical features of Bipolar 2? (4)

A
  • No manic episodes experienced before
  • Exclusion of schizophrenia, delusional or psychotic disorder
  • Clinically significant distress from sx
  • Hypomania episode
39
Q

A _______ episode impairs function and necessitates hospitalization, while a _______ episode does not

A

manic; hypomanic

40
Q

Pathophysiology of bipolar disorder? (4)

A
  • Circadian rhythm dysfunction
  • Metabolic dysfunction
  • Mitochondrial dysfunction
  • Glutamate excitotoxicity
41
Q

Circadian rhythm dysfunction: observations for pts with BD?

A
  • changes in melatonin levels
  • changes in melatonin receptor levels in CNS
  • changes in cortisol patterns of release
42
Q

Correlation between polymorphism in CLOCK genes as well as positive response to ________ therapy for patients with BD

A

Lithium

43
Q

Metabolic dysfunction: Increased amount of ______ secreted in obese patients with BD that regulates _______ and _______

A

Leptin; regulates appetite and sleep

44
Q

Hypothesis suggested about metabolic function and BD?

A

Body is forced to compensate for high metabolic demand of the brain during manic states

45
Q

Impairment in mitochondrial function results in the brain shifting toward what?

A

glycolysis

46
Q

What is phosphocreatine? Is it increased or reduced in FC of patients with BD?

A

Phosphocreatine = reserve for ATP
its reduced in patients with BD => implying deficiency in ATP synthesis

47
Q

What do increased levels of excitatory glutamate result in?

A

Increased energy demand on the neuron

48
Q

Why may there be an increased shift in glycolysis?

A

Increased glutamate stimulation in frontal cortex of patients with BD

BMS150 Midterm 2 (14 decks)

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