Lecture 4+5+DLA Flashcards
with melancholic features (mood disorder)
lack of mood reactivity, despondency and guilt
depression worse in the morning
early morning awakening
major loss of appetite
with atypical features (mood disorder)
weight increase
sleep increase
mood reactivity
leaden paralysis
with psychotic features (mood disorder)
can be depressive or manic episodes that also have delusions and hallucinations
mood-congruent psychotic features:
congruent with typical themes of that mood state
mood-incongruent psychotic features:
does not involve typical themes of that mood state
with catatonia (mood disorder)
have psychomotor symptoms
mutism immobility waxy flexibility stereotypes odd posture
with peri-partum onset (mood disorder)
depressive or bipolar disorders in which the mood episodes onset during pregnancy or within 4 weeks post-delivery
with seasonal pattern (mood disorder)
Used for depressive or bipolar disorders that show a consistent temporal relationship between time of year and the mood episode
with rapid cycling (mood disorder)
Used for bipolar disorders in which >4 mood
episodes occur per year
Persistent Depressive Disorder (PDD)
must be chronically depressed for more than 2 years
can be a long-lasting major depressive episode
or
dysthymia: chronic depressed mood and 2 or more of the following symptoms: poor appetite / over eating insomnia or hypersomnia low energy low self-esteem hopelessness low concentration
can be:
with persistent MDE
pure dysthymic syndrome (No MDE)
intermittent MDE
treatment for PDD
The same psychotherapeutic and pharmacological methods used for MDD are used for the “dysthymic” subtype of PDD
Brain stimulation therapies used for depression may also be used for PDDs that involve treatment-resistant and/or severe MDEs
Premenstrual Dysphoric Disorder (PMDD)
present in the week before menses onset
improve a few days after menses onset
minimize in the week post-menses
symptoms:
mood lability, irritability, dysphoria, anxiety
physical symptoms, sleep change, appetite change, lethargy
must lead to functional impairment
treatment for PMDD
several SSRI’s are approved for PMDD
Disruptive Mood Dysregulation Disorder
DMDD
Severe temper outbursts at least 3 times/week
Sad, irritable or angry mood almost daily
Reaction is disproportionate to situation
Symptoms are present in multiple settings
the child must be at least 6 years old
symptoms must begin before age 10
cannot diagnose after 18!
Electroconvulsive Therapy (ECT)
Involves electrical induction of a generalized seizure
A patient is pre-treated with a muscle relaxant to prevent injury and an anesthetic to reduce consciousness
treatment for depression and or mania
has many and indiscriminate effects on CNS
Repetitive Transcranial Magnetic Stimulation (rTM)
stimulate the pre frontal cortex
given to those who have failed at least 1 medication trial
minimal side effects
Vagus Nerve Stimulation (VNS)
Intermittent electrical stimulation of the vagus
nerve
used for treatment resistant depression
mild effects of stimulation
takes several months to be working
Experimental Brain Stimulation Therapies
Magnetic Seizure Therapy (MST)
focal seizure induction
reduce memory side effects that you get from ECT
deep brain stimulation (DBS)
for OCD
several target sites
Major depressive disorder (DDD)
also known as unipolar depression
must have had at least one major depressive episode
cannot have a history of mania or hypomania
(go between euthymic and depressed)
major depressive episode (MDE)
at least two weeks with 5+ of the following symptoms
affective:
depressed mood
anhedonia (lack of joy)
neurovegetative:
weight change
sleep disturbance (more/less)
loss of energy
cognitive: psychomotor changes guilty/ worthlessness less concentration thoughts of death
MDE and sleep
decreased REM latency
increased REM time
decreased SWS or N3
MDD etiology and neurobiology
social and physical stress will trigger this
good coping skills may prevent this
high amygdala activity
high HPA activity (increased cortisol levels and increased cytokines)
decreased gray matter volume in the parahippocampal gyrus and hippocampus
deceased monoamines decreased dorsolateral perfrontal cortex (less activity) smaller hippocampus (due to high cortisol?)
what are the SSRI’s
Fluoxetine, citalopram, sertraline
side affects: GI disturbance and sexual dysfunction
blocks the reuptake of 5-HT
the SNRI’s
Venlafaxine, duloxetine
similar side affects as SSRI’s, but increase BP
blocks reuptake of 5-HT and norepi
Tricyclic Antidepressants
Imipramine, amitriptyline
block the presynaptic reuptake of NE and 5-HT
cardiac side effects (hypotension)
Less serotonin agonism relative to the SSRI and SNRI
Also blocks histamine, muscarinic (anticholinergic),
alpha-1 receptors (thus cardiac symptoms)
MAOI Antidepressants
Phenelzine, selegiline
prevent the enzyme from breaking down monoamine transmitters (5-HT, NE, Dopamine)
less used
diet restriction; no tyramine (cheese)
other antidepressant treatments
Esketamine nasal spray
rapid onset effects
blocks NMDA receptors
phototherapy:
exposure to bright artificial light
good for seasonal affective disorder
brain stimulation
bipolar I disorder
have at least one manic episode
symptoms must be more than 1 week ( any duration if needed hospitalization)
must lead to impaired functioning
can also have MDE’s
manic episode def
Abnormally elevated mood OR irritability AND increased energy 3+ additional symptoms
inflated self-esteem decreased need for sleep flight of ideas distracted more risky activates
Bipolar II disorder
at least one major depressive episode
and at least one hypomanic episode
change in mood must be uncharacteristic
hypomanic episode must be 4+ days
hypomania def
No psychosis
no impairment in functioning
not as severe as mania
Cyclothymic Disorder
Periods of hypomanic symptoms that fluctuate with
periods of depressive symptoms for 2+ years
never meets criteria for MDE’s or manic
similar to bipolar I, but mood shift are not as extreme
etiology and neurobiology of bipolar
social or physical stress can trigger mood swing
coping mechanisms can help
manic episodes = more dopamine
Bipolar I treatment
mood stabilizers
lithium
valproate (anti-convulsion)
olanzapine (antipsychotic)
side effects: hand tremor, polyuria, polydipsia
Bipolar II and cyclothymic disorder treatment
mood stabilizers - focus more on depression
lithium and valproate
Lurasidone - can be used for bipolar depression (antipsychotic)
motor disturbance side effect
