Lecture 15: Organic affective disorders

Question 1

What is Kraepelin’s triadic system for mental disorders?

Answer 1

3 layer system of

Organic disorders - obvious biological abnormality

Endogenous disorders - subtle biological abnormality –> MDD and Bipolar Disorder

Exogenous disorders - no primary biological abnormality - psychosocial stressor –> Adjustment disorder

Question 2

What were the problems associated with the triadic system?

Answer 2

Organic and endogenous/exogenous disorders not properly defined

When does a severe psychosical stressor stop causing impact to the brain?

Question 3

Define the ICD 1–FO6 general organic mental disorder criteria?

Answer 3

G1 - objective evidence of cerebral or systemic physical disorder or non-psychoactive drug effects

G2 - relationship between onset of symptoms from previous organic cause

G3 - recovery or improvement following removal of physical cause

G4 - absence of other alternative explanation

• If G1, G2 and G4 are met provisional diagnosis is justified
• if G3 met then can be regarded certain

Question 4

Whar is tje DSM crieria mood disorderdue to another medical condition

Answer 4

A - Mood disorder criteria met
B - Condition is a direct pathophysiological consequence
C - The disturbance is not better explained another mental disorder
D - Disturbance does not occur during a delirium
E - Causes psychosocial impairment, needs hospitalisation or has psychotic features

Question 5

How may Parkinson’s cause depression?

Answer 5

Dopaminergic neurons within the substantia nigra degenerate

In Parkinson’s patients may get depressive symptoms or depression before the motor symptoms due to the degneration of these neuron’s

Ventral Tegmental area is closely connected to reward and mesolimbic systems

Question 6

Name some other causes of organic disorders:

Answer 6

• Brain tumour
• Stroke (functional impairment or subtle white structural damage which could disrupt cortical networks increasing vulnerability for depression)
• Diffuse traumatic brain injury (some patients white matter disruption in similar areas as non-organic depression)
• Dementias
• Epilepsy
• -> Pre-ictal - dysphoric or depressied mood occurs during prodrome and disappears on remission of seizure
• -> Inter-ictal - dysthymia, major depressive or dysphoric syndrome during seizure (irritability, fluctuating symptoms, pain and anxiety)

Question 7

What are the lead symptoms of dementia?

Answer 7

Have is a lead symptom - most prominent and first symptom

Impairment of recent memory

Change in behaviour

Impairment in language of speech

Impairment in attention or fluctuating confusional state

Visuo-spatial impairments

Question 8

How do you assess for dementia?

Answer 8

Do a neurological exam - if abnormal referral

Past medical history and collateral history
- No conditions or other physical conditions

Refer if:

• rapid progression (3-6 months) or subacute onset (within weeks rather than months)
• -> check for autoimmune or inflammatory encephalopathies or Creutzfedlt-Jakob

Otherwise check lead symptoms of dementia

Question 9

When can we suspect frontotemporal dementia?

Answer 9

• Younger age of onset compared to other dementias

- Personality changes

Question 10

Name some endocrine organic causes?

Answer 10

Cushing's Syndrome - endogenous (pituitary tumour) or exogenous (steroids)
Hypothyroidism/Hyperthyroidism
Addison's 
Diabetes Mellitus
PCOS - polycystic ovarian syndrome

The meta-analysis has found there are associations between affective disorders and endocrine condition but it is not always clear cut

Question 11

What vitamin deficiency can cause depression?

Answer 11

• Folic Acid
• Vitamin B12

Folic acid deficiency is more likely to cause symptoms than B12
Folic acid is needed to make DNA, proteins, phospholipids and neurotransmitters

Question 12

What are the substance/medication-induced mood disorders? Outline the criteria

Answer 12

A - mood disorder criteria

B - evidence from history or physical exam:

• -> The symptoms developed soon after taking substance or during withdrawal
• -> The substance/medication can (cause the symptoms?)

C - the symptoms are not better explained by another mood condition (i.e. if persist long after)

D - Disturbance does not exclusively occur during a delirium

E - Causes psychosocial impairment

Question 13

Which drugs/substances can cause mania?

Answer 13

• Iproniazid (MAOi)
• Dopamine D2 agonist - Bromocriptin
• Levodopa for Parkinson’s
• Cortisone and adrenocorticotrophic hormone
• Phencyclidine (PCP)
• Amphetamines

Question 14

Which drugs cause depressive symptoms?

Answer 14

Drugs causing depressive symptoms

• Corticosteroids
• Contraceptives
• Interferon-alpha
• Interleukin - 2
• Mefloquine

Drugs causing side effects informally labelled as depression - Propanolol

Question 15

What symptoms may hint to an organic cause?

Answer 15

• Focal neurological symptoms
• Visual
• Early onset before 50
• Unusual presentation
• Cancer
• Other medical condition / systemic condition
• Treatment resistant
• Chronic course
• Can’t carry out ADLs (activities of daily living)

Question 16

Name some neuropsychological tasks?

Answer 16

If an organic cause - passive neuropsychological tasks will be impaired in addition to active tasks

• Recognition memory
• Simple visuo-spatial tasks (copy circles)
• Naming pictures
• Word-to-picture matching test comprehension

Question 17

How may frontal “executive” functions be impaired with neurological patients?

Answer 17

Internal generation of concepts –> lack of spontaneous behaviour

Task switching - set shifting –> perseverative behaviour