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Clinical neuroscience > L19 Mood Disorders > Flashcards

L19 Mood Disorders Flashcards

1
Q

Symptoms of depressive disorders

A

Symptoms occur continually for more than 2 weeks

Core symptoms:

  • low mood
  • lack of energy
  • lack of enjoyment and interest

Other symptoms:

  • feelings of worthlessness, guilt and being a burden
  • biological symptoms - loss of appetite, drinking less fluids and lack of sleep
  • severe = psychotic symptoms
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2
Q

Difference between adjustment and depression

A

Depression:

  • Symptoms are gradual and continuous fro more than 2 weeks
  • lack of interest
  • loss of appetite and weight loss
  • lack of energy
  • low self esteem, guilt and blame
  • sleep disturbance with EMW

Adjustment:

  • acute onset after event with limited time period
  • symptoms fluctuate
  • preoccupied with event
  • reduced or increased appetite
  • feelings of anger and frustration
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3
Q

Features of mania

A
  • elated mood
  • increased energy
  • pressure of speech
  • decreased need for sleep
  • flight of ideas
  • Social inhibition is lost
  • attention not sustained
  • inflated self esteem that is grandiose
  • psychotic symptoms
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4
Q

Bipolar diagnosis

A
  • At least 2 episodes of a mood disorder at least 1 being mania or hypomania
  • normally starts between 15-19 yrs old
  • fluctuate between mania and depression
  • episodes can be years apart
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5
Q

Bipolar I

A

Discrete episodes of mania only or mania and depression

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6
Q

Bipolar II

A

Discrete episodes of hypomania or hypomania and depression

- more likely for severe depression

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7
Q

Euthymia

A

Normal stable mental state or mood

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8
Q

Subsyndromal depression

A

Symptoms of depression aren’t as severe a enough to be diagnosed with depression

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9
Q

Differential diagnosis for depression

A 
Hypothyroidism 
Lack of vit B12
Anaemia 
Chronic disease - renal, CVS, liver failure 
Substance misuse 
Hypoactive delirium
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10
Q

Differential diagnosis for mania

A 
Iatrogenic - steroid use in cancer 
Hyperthyroidism 
Delirium 
Infection - encephalitis, syphilis, HIV 
Head injury 
Intoxication with stimulants
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11
Q

Brain structures involved in mood disorders

A

Limbic system - amygdala and hippocampus
Frontal lobe
Basal ganglia

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12
Q

How do brain structures regulate mood disorders

A

Functional circuits connect the limbic system, basal ganglia and frontal lobe which affect:

  • cognitive processed thoughts
  • sympathetic and parasympathetic output
  • motor systems
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13
Q

Limbic system

A 
Network of neurones in the medial portions of the cortex 
Comprised of: 
- amygdala - feelings 
- hippocampus - memories 
- hypothalamus - homeostasis 
- pineal gland - melatonin regulates sleep 
- corpus callosum 
- anterior thalamic nuclei
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14
Q

Functions of the limbic system

A

Emotion
Motivation
Memory

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15
Q

Changes to limbic system in unipolar depression

A

Decreased hippocampal volume

Decreased cerebral blood flow and metabolism in the amygdala

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16
Q

Limbic system changes bipolar disorder

A

Increased amygdala activation and volume in mania

Decreased volume and activation in anterior paralimbic cortices e.g ventral prefrontal cortex, insular cortex

17
Q

Prefrontal cortex

A

Ventromedial- Generation, processing and expression of emotion

Orbital prefrontal cortex - emotional responses via connections with the amygdala

18
Q

Frontal lobe function

A

2/3rds of the total cortex

  • motor function
  • Broca’s area
  • social and moral reasoning
  • attention
  • memory
  • old
19
Q

Frontal lobe changes in depression

A

Decreased activity and blood flow in the prefrontal cortex

Decreased volume of the orbitofrontal prefrontal cortex

20
Q

Basal ganglia functions

A

Motor functions - direct and indirect pathway

Psychological:

  • emotion
  • cognition
  • behaviour
21
Q

Possible basal ganglia changes in depression

A

Decreased basal ganglia volume

Reduced activation between the amygdala, striatum and prefrontal cortex

22
Q

Overall contribution of brain circuits to depression

A

Prefrontal cortex - slow thoughts, altered emotional processing and executive dysfunction

Amygdala - abnormal emotional processing

Basal ganglia - impaired incentive behaviour and psychomotor changes

23
Q

Neurotransmitters in autoimmune disorders

A

Monoamines:

  • serotonin
  • noradrenaline
24
Q

Serotonin

A

Produced in the brain stem in the raphe nuclei
Transported to cortical areas in the brain and limbic system

Role in:

  • sleep
  • impulse control
  • appetite
  • mood
25
Q

Role of serotonin in depression

A

Low serotonin

Therefore give: 
- SSRI
- monoamine oxidases inhibitors 
- tricyclic antidepressants 
> increase serotonin in the synaptic cleft
  • 5HIAA a metabolite of serotonin is low in CSF of patients with depression that have attempted suicide
  • tryptophan - precursor of serotonin is depleted in depression
26
Q

Noradrenaline

A

Produced in the locus coeruleus in the pons
Projects to the cortex and limbic system

Function:

  • mood
  • behaviour - arousal and attention
  • fight to flight
  • memory function
27
Q

Role of noradrenaline in mood depression

A

Decreased in depression

Treatment:

  • SNRI - serotonin and noradrenaline reuptake inhibitor
  • NARI
  • TCA
28
Q

Treatment of depression

A

Biological:

  • SSRI - prosac
  • SNRI and TCA
  • if life threatening depression or resistance against medication, electroconvulsive therapy is used twice a week

Psychological- CBT

Social - help with isolation (elderly), social stressors e.g housing

29
Q

Treatment of mania

A

Biological:

  • antipsychotics - dopamine antagonists
  • mood stabilisers - lithium and sodium valproate

Psychological:

  • psychoeducation about triggers and relapse
  • as unlikely to engage with CBT

Social:

  • treat in safe place that decreases risk to self and others
  • tackle implications of mania e.g. over spending, STI and pregnancy
30
Q

Why is it hard to treat mania

A

People feel good therefore are less likely to take medication

31
Q

When is sodium valproate contraindicated

A

In women of child baring age

Unless strict pregnancy prevention schemes are implemented

32
Q

Treatment of bipolar depression

A

Biological:

  • antidepressants with mood stabiliser (lithium) to prevent mania
  • ECT

Psychological:

  • CBT
  • psychoeducation

Social:

  • isolation in elderly
  • social stressors
  • employment - shift work as tired
  • involvement and education to family

Clinical neuroscience (20 decks)

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