Lecture 18/19 - Intro To Pschiatary And Mood Disorders Flashcards
What is meant by a patient being psychotic?
Patient is no longer in touch with reality
What are the different classifications of depression?
Mild
Moderate
Severe
What are the 2 types of bipolar?
Type 1
Type 2
How do you diagnose depressive disorders?
Core symptoms continually every day for at least 2 weeks
What are the 3 core symptoms of depression?
Low mood
Lack of energy
Lack of enjoyment and interest
How do we classify severe depression?
All 3 core symptoms:
Low mood
Lack of energy
Lack of enjoyment
What are some other symptoms of depression that aren’t core symptoms?
Depressive thoughts
Psychotic symptoms
Somatic/biological symptoms
What are some psychotic symptoms of depression?
Hallucinations
Delusions
What aer some biological symptoms of depression?
Change in appetite
Sleep (usually reduced)
Poor concentration
What is the difference between adjustment reactions and depression?
Adjustment is normal after bereavement:
-sudden onset symptoms
-symptoms fluctuate
-time limited
-feelings of anger and frustration
Depression:
-gradual symptoms development
-continuous symtpoms
-low self esteem
-low energy
Read slide 6:
What is indicating a presentation of depression?
Reduced fluid and food intake (weight loss)
Low mood worst in morning (slightly improves in day)
No energy to go to work
Psychomotor retardation (speaks and moves slowly)
Guilty
Low self esteem
What are the features of mania?
Essentially the opposite of depression
Elated mood
Increased energy
Decreased need for sleep
Flight of ideas (thoughts jump from topic to topic
Normal social inhibitions are lost
INCREASED self esteem
Potential. Psychotic symptoms
How does the duration of symptoms for depression and mania differ for diagnosis to take place?
Depression = 2 weeks symptoms
Mania = 1 week symtpoms
What is hypomania?
When patients present with symptoms of mania but the symptoms aren’t enough to meet the diagnostic criteria to diagnose Mania
Slide 8:
What features are indicative of mania?
Bizarre behaviour (lack of inhibition of behaviour)
Flight of ideas (jumps from topic to topic)
Quickly irritable
What is bipolar affective disorder?
When patient has at least 2 episodes of mood disorder with at least one being mania or hypomania
What is Bipolar Type 1?
Where patient has discrete episodes of mania only or mania + depression
What is Bipolar Type 2?
Discrete episodes of hypomania or hypomania + depression
What is the difference between bipolar Type 1 and bipolar Type 2?
Bipolar type 1 = the mania aspect is MANIA
Bipolar type 2 = the mania aspect is HYPOMANIA (mania symptoms dont meet mania diagnostic criteria)
What are some physical health causes of depression symptoms?
Hypothyroidism (hormone disturbance)
B12 deficiency
Chronic disease(renal, CVS and liver failure)
Anaemia
Substance misuse
What are some physical health differential for mania symptoms?
Iatrogenic (STEROID INDUCED)
Hyperthyroidism
Delirium
Infection (encephalitis , HIV, syphilis)
Head injury
Stimulant intoxication
What are the 3 main brain structures involved in mood disorders?
Limbic system
Frontal lobe
Basal ganglia
Label slide 15:
What are the 3 main functions of the limbic system?
Emotion
Motivation
Memory
What structures change in the limbic system in unipolar depression?
Decreased hippocampal volume
Decreased cerebral blood flow and metabolism in amygdala
What structures change in the limbic system in bipolar affective disorder?
Altered amygdala volume
Inc amygdala activation and vol in mania
Decreased volume in anterior Paralimbic cortices
What structures are involved in the papez circuit of the limbic system?
Inputs sent from cortex to HIPPOCAMPUS
HIPOCAMPUS projects to MAMMILARY BODIES via FORNIX (white matter output pathway of hippocampus)
THALAMUSS projects to cortex
HYPOTHALAMUS projects to pituitary and Autonomics
AMYGDALA
Label brain on slide 19
What are the functions of the frontal lobe?
Motor function
Language production (Brocas area)
Executive functions
Attention
Memory
Mood
Social and moral reasoning
What part of the frontal lobe is involved in generation and expression of emotions?
What is the likely structure its connected to?
Inferior portion of anterior frontal lobe
Amygdala
What structural changes can occur to the frontal lobe in unipolar depression?
Decreased blood flow in prefrontal cortex leading to decreased volume
Label slide 23
What are the functions of the basal ganglia?
Motor function
Psychological function:
-emotion
-cognition
-behaviour
What are some diseases that can be caused by impaired motor function in the basal ganglia?
Parkinson’s
Wilson’s disease
Huntington’s disease
What are some structural changes that can occur in the basal ganglia in unipolar depression?
Decreased basal ganglia volume
Reduced activation between striatum, amygdala and pre frontal cortex
What are some structural changes that can occur in the basal ganglia with bipolar affective disorder?
Functioanl changes in striatum
What affect does changes in the prefrontal cortex have in depression and mania?
Altered emotional processing g(slowing of thought and executive dysfunction)
What affect does chnages in basal ganglia have in depression and mania?
Impaired incentive behavaiour
Psychomotor changes
What are the 2 main neurotransmitters involved in mood disorders?
Serotonin
Noradrenaline
What type of neurotransmitters are serotonin and noradrenaline?
Monoamines
What is the monoamine hypothesis of mood disorders?
Depressive disorder is due to abnormality in the availability of neurotransmitters like serotonin and noradrenaline
Where is serotonin produced in the CNS?
Where is it distributed to?
Brain stem (raphe nuclei)
Gets distributed to cortical areas and limbic system
What role does serotonin have?
Sleep
Impulse control
Appetitive
Mood
What are some categories for drugs that are used to treat mood disorders like depression that help increase levels of serotonin?
SSRIs
SNRIs (serotonin + noradrenaline reuptake inhibitors)
TCAs (Tricyclic antidepressants)
MAOis (Monoamine oxidase inhibitors)
What is a metabolite of serotonin that is low in the CSF of patients with depression?
5HIAA
What is the precursor of serotonin that is depleted leading to depression?
Tryptophan
What is an example of an SSRI?
Fluoxetine (Prozac)
What is an example of a SNRI?
Duloxetine
What is an exmaple of a Tricyclic Antidepressant (TCA)?
Amitriptyline
What is an example of a Monoamine oxidase inhibitor?
Venlafaxine
Where is noradrenaline produced?
Where is it projected to?
Locus coeruleus (pons)
Projects to limbic system adn cortex
What are the functions of noradrenaline in the brain?
Mood
Fight or flight response
Memory functions
What is the problem with a patient who recovers from depression but has decreased NA levels?
Have higher rates of relapse
What are the first line biological/drug treatments for depression?
Other options:
1st line = SSRIs
Other = SNRIs, TCAs
What is the treatment for life threatening depression?
ECT ( Electroconvulsive therapy)
What are some Side effects to SSRIs?
Headaches
Nausea
Stomach upset
What is the psychological treatment for depression?
Coonginitve behavioural therapy (CBT)
What is the social treatment of depression?
Help with social stressors like isolation and financial worries
Do SSRIs work in mild depression?
No should give lifestyle advice
Why is bipolar affected disorder more difficult to treat than unipolar depression?
If you give anti depressant you may. Push them. Into a manic episode
What drugs do you use to treat mania?
1st line anti-psychotics
Or mood stabilisers
What are some examples of mood stabilisers?
Lithium
Sodium valproate
Why is sodium valproate very rarely used?
Decreases fertility and is very teratogenic
How do you psychologically treat mania?
How do you socially treat mania?
Psychologically = psycho education about Bipolar affected disorder, triggers and signs of relapse
Social = treat in a place of safety (where risk to self and others is minimal)
What is the drug treatment of bipolar depression?
Can use antidepressant but ONLY with MOOD STABILISER COVER
Like lithium and Electroconvulsion therapy
What is the psychological treatment of bipolar depression?
CBT
What are the drugs given to maintain stability in bipolar disorder?
Mood stabilisers like lithium and sodium valproate
Antipsychotic (Quetiapine)
What are teh psychological methods for maintaining stability in bipolar disorder?
Psychoeduction
CBT (prevent relapse)
What social treatments can be given for maintaining stability in bipolar disorder?
Consider employment challenges
Involve family
