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Mood Disorders 1 > mood 1 > Flashcards

mood 1 Flashcards

1
Q

Emotional Regulation

A
  • Ability to manage - emotional responses to environmental stimuli that are perceived as aversive or negative
  • Disruption can lead to anxiety or mood disorder
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2
Q

Depression

A

-Pervasive, debilitating
mental illness that touches all parts of society

-Creates serious negative impact on functioning and interpersonal relationships

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3
Q

Anxiety

A

-Helps individuals adapt to perceived challenge or threat

-Sustained apprehension; avoidance patterns
Can severely limit social interaction and relationships

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4
Q

Bipolar disorders

A
  • Manic
  • Hypomanic
  • Depressive episodes
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5
Q

Pathophysiology of Depression

A

Neurotransmitters and intracellular mechanisms that alter gene expression

Stress response system

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6
Q

Development of anxiety

A

Sympathetic nervous system activation

Neurotransmitters

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7
Q

Emotional Regulation

A

envolves several bodily systems:
Neurotransmitters associated with anxiety & depressive states
-Immunologic responses and inflammation

Emotional states influence immunologic responses

Response engenders state of stress

  • If coping mechanisms fail, risk for maladaptive emotional responses such as depression
  • Manifest clinically through bodily symptoms
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8
Q

Anxiety

A

State of apprehension mixed with fear or worry
-Real or perceived threat
-Somatic responses:
Palpitations, Sweating, Rapid breathing, Nausea

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9
Q

Anxiety Types

A

Generalized anxiety disorder (GAD)
Social anxiety disorder (SAD)
Panic disorder

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10
Q

Anxiety Risk Factors

A
  • genetic
  • familial
  • environmental
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11
Q

Fear-centered anxiety disorders

A

Panic disorder & social anxiety disorder

Situation associated with overwhelming negative consequences

Mediating neural structures that process threat functioning sub optimally

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12
Q

Worry-centered anxiety disorders

A

Functional disruptions in neuronal circuitry
GAD
-Increased activity in cortical-striatal-thalamic pathway

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13
Q

Anxiety- Comorbidities

A

Depression

Panic disorder: respiratory disease, vestibular dysfunction, thyroid problems, cardiac disease

GAD: chronic pain, medically unexplained somatic symptoms, sleep disorders

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14
Q

Anxiety- genetic vulnerability

A

Variation of 5-HT transporter gene (SLC6A4) called 5-HTTLPR

Selective serotonin reuptake inhibitors (SSRIs)

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15
Q

Anxiety- Classic fear conditioning

A

Consolidation: amygdala; long-term memory

Reconsolidation: stronger fear memory

Medications to disrupt chemicals and receptors involved in processes

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16
Q

Neuroanatomic Pathways in Anxiety

A

Conditioned stimulus

-Stimulus read by thalamus -> Amygdala & Visual cortex

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17
Q

Amygdala

A
  • confers significance on stimuli (thalamus or hypothalamus)
  • holds emotional memories and threat assessment
  • controls autonomic responces
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18
Q

Prefrontal cortex

A
  • fear learning and extinction
  • registers and assigns meaning to emotions
  • weights action vs potential reward
  • balances emotion, thought and controlling attention
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19
Q

Caudate nucleus

A
  • orchestrates action-reward sequencing

- drives behavior with recall of past successful outcomes

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20
Q

Neuro-chemical and -transmitter

A

Neural structures correlated with neurotransmitters, neurochemicals, hormones

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21
Q

GABA-BZD-receptor system

A

Gamma-aminobutyric acid (GABA)
-Primary inhibitory amino acid neurotransmitter

Benzodiazepines (BZDs)
-Partners with GABA in maintaining mind–body homeostasis

Glutamate

  • Immediate precursor to GABA
  • Extinction
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22
Q

Norepinephrine ( NE)

A
  • increases during stages of anxiety
  • results in downregulation of auto receptor ( alpha-2)
    • increased autonomic arousal

relationships between NE and BDZ receptors

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23
Q

Serotonic (5-HT)

A
  • decreased 5- HT during states of anxiety
  • action related to fear learning
  • —- occurs through effects on NE and DA
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24
Q

Dopamine (DA)

A
  • increased DA during acute stress
  • involves impairment in DA reward pathways
  • phobic responses
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25
Q

Hypothalamic-pituitary-adrenal (HPA)

A 
threatening stimulus
 --fight or flight
corticotropin-releasing hormone (CRH)
-- ACTH
--glucocorticoids
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26
Q

Panic disorder

A

Recurrent, unexpected episodes of panic
-palpitations, sweating trembling, shortness of breath, chest pain, nausea, dizziness, feelings of unreality, dying or going crazy.
Avoidance of any situation seen as inescapable or there is no help if attacked.

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27
Q

Specific phobia

A

Unreasonable or excessive, persistent fer of specific objects of situations.

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28
Q

Social anxiety disorder

A

fear generated by social or performance situations with exposure to unfamiliar or scrutiny.

29
Q

Generalized anxiety disorder

A

excessive worry, difficult to control

Worry generates restlessness, fatigue, difficulty, concentration, irritability, tension, and sleep disturbance.

30
Q

Pharmacological Treatment

A 
-selective serotonin reuptake inhibitors
 ( SSRIs)
-Selective norepinephrine reuptake inhibitors (SNRIs)
- Tricyclics (TCAs)
-Monoamine oxidase inhibitors (MAOIs)
-Benzodiazepines
-Combination therapy
-Caution in elderly
31
Q

Depression

A

Persistent feeling of sadness and lack of interest in life
Classifications:
Major depressive disorder (MDD)
Persistent depressive disorder (dysrhythmia)
Premenstrual dysphoric disorder
Substance or medication-induced depression
Post-partum depression (PP Psychosis-emergency)
Seasonal Affective Disorder
Depression due to another medical disorder

32
Q

Major Depressive Disorder

A

greater than 1 depressive episodes of 2 weeks or greater over lifetime
with out history of manic, mixed or hypomanic episodes

33
Q

Major Depressive Disorder Symptoms

A

Depressed mood
Significantly less interest in activities
Changes in weight
Insomnia or hypersomnia
Feelings of worthlessness or guilt
Diminished ability to think or concentrate
Recurrent thoughts of death or suicide

34
Q

Major Depressive Episode

A

Last for 2 weeks
1 of 2 major symptoms of anhedonia (lack of interest)
At least 4 DSM-5 symptoms

35
Q

Persistent Depressive Disorder- Clinical Manifestations

A

Depressed mood occurring on more days than not for 2 years or more
Increased (overeating) or decrease appetite
Sleeping too much (hypersomnia) or too little (insomnia)
Lower energy fatigue
Low self-esteem
Poor concentration
Difficult making decisions
Feelings of hopelessness

36
Q

Premenstrual Dysphoric Disorder (PMDD)

A

Severe form of PMS resulting in depression or anxiety

37
Q

PMDD Symptoms

A 
mood swings
irritability
depressed mood
anxiety
lack of interest in usual activities
difficulty concentrating
38
Q

Chronic Depression

A

Major depression lasting 2 years or longer

No more than 2 month period of remission

39
Q

Depression in Pregnancy and Post-partum depression

A

Rapid decline of estrogen

PP Psychosis-medical emergency

40
Q

Depression Etiology and Pathogenesis

A 
Multifactorial
-family history
-symptoms in clusters
-comorbid with chronic medical illnesses
Insufficient firing of key neural networks
-Noradrenergic pathway
-Orbitofrontal cortex (OFC)
-Prefrontal cortex (PFC)
41
Q

Neurotransmitters

A

In depression: complicated reactions between stress and genetic vulnerability
Environmental factors
Monoamines

42
Q

Monoamines

A

Serotonin (5-HT): regulates obsessions and compulsions

Dopamine (DA): regulates motivation, pleasure, reward

Norepinephrine (NE): regulates alertness, energy

43
Q

Norepinephrine and Depression

A 
Works with dopamine 
Responsible for interest and energy 
Provides sense of hope & purpose in life
Is inhibitory in amygdala
Deficiency results in negative emotions
Mechanisms controlling norepinephrine
-Presynaptic alpha-2 (a2) auto receptor
-Transporter
-Enzyme
44
Q

Serotonin (5-HT) and Depression

A

Mediates positive mood, optimism, & impulsivity
Essential for keeping Norepinephrine at appropriate level
Originates in dorsal raphe nuclei in pons & upper brainstem (most)
Project widely to several areas of brain
Pathways to hippocampus, septum, amygdala are inhibitory
Other pathways control many somatic functions
Serotonin pathway to hypothalamus regulates appetite
Pathway to brainstem regulates sleep
Reuptake of Serotonin by specific receptors thought to regulate mood, pain, sleep, & body temperature
Balance in specific receptors critical in maintaining mood

45
Q

Dopamine and Depression

A

Controlled by presynaptic pump, enzymatic destruction

Categorized by:

  • Prevalent symptoms
  • Additional symptom patterns of melancholic or psychotic

Dopamine reward system/deficiency relates to anhedonia (loss of interest)

Mesolimbic pathway

46
Q

Stress and HPA Dysfunction

A

Primes body for fight or flight
Stress cascade
-stress responce-> activates Hypothalamic-pituitary-adrenal (HPA) axis
-Increased cortisol
-Chronic leads to decreased immunity and hippocampus atrophy

Effects of hippocampal atrophy

  • deficits in learning and memory formation
  • mood and emotion
47
Q

Upper temporal parietal region

A

perception of external situations

48
Q

Medial frontal cortex

A

assignment of significance to stimuli

49
Q

Anterior cingulate cortex

A

ability to focus

50
Q

Ventral lateral cortex

A

supression of emotions

51
Q

Orbitofrontal cortex

A

integrative function

52
Q

Glial cells

A

reduced in depression

53
Q

Subgenual prefrontal cortex

A

responce to stress

54
Q

Anterior cingulate cortex

A

emotional control, volume loss and functional alterations

55
Q

Basal ganglia

A

Limbic-cortical-striatal-pallidal-thalamic (LCSPT) tract
Hypoactive dorsal section of tract hypoactive
Lack of Norepinephrine or dysfunction of monoamine pathways
Overactive ventral tract of LCSPT

56
Q

Hippocampus

A

Excessive, prolonged stress & overactivation of HPA axis damages hippocampal neurons
-Excess cortisol, damage to genes, glial cell loss, volume loss

57
Q

Amygdala

A

Function increased in depression

Volume increases

58
Q

Depression Treatment

A

Psychopramacology: Tricyclic antidepressants
MAO inhibitors
Seretonin reuptake inhibotors (SSRIs)
Nonpharmacologic therapies (CBT)

59
Q

Tyramine Containing Foods

A

Avocadoes, bananas, raisins, papaya products including meat tenderizers, canned figs, cheese, sour cream, yogurt, beer, wines, beef or chicken liver, pate, meat extracts, pepperoni, salami, sausage, soy sauce

60
Q

Nonpharmalogic

A 
Cognitive-behavioral therapy (CBT)
Exposure therapy/counseling
Progressive muscle relaxation
Psychoeducation 
Cognitive approaches for automatic thoughts and schemas
Biofeedback techniques
Meditation
61
Q

Bipolar Disorders

A

Group of mood disorders
Characterized by manic, hypomanic, and depressive episodes

Classifications
Bipolar I disorder
Bipolar II disorder

Related disorder: cyclothymic disorder
-Not significant enough to meet criteria for hypomania or depression

Rapid cycling
-≥ 4 depressive and/or manic episodes within 12 months
-At least 1 week for manic or hypomanic episodes
-2 weeks for
depressive episodes
-Period of remission in between switch to opposite mood

62
Q

Mania

A

Abnormal and persistently elevated, expansive, or irritable mood
Increased energy present every day for one week or longer
Flight of ideas
Pressured speech
Increased participation in goal-directed activities

63
Q

Hypomania

A

Feelings of euphoria

Mood and behavior changes

64
Q

Depressive episodes

A

Do not always manifest

Alternate with mania or hypomania in bipolar I and II

65
Q

Cyclothymic disorder

A

Reoccurring episodes of hypomanic symptoms alternating with depression
Occur over ≥ 2 years

66
Q

Bipolar Disorders

A

No definitive cause or specific pathophysiology
Complex combination of genetic, physiologic, environmental, psychosocial factors
Unusual patterns of inflammation and glial cell activation
Linked to mitochondrial dysfunction and oxidative stress

67
Q

Risk factors for bipolar disorder

A

stressful life events

heritability factors

68
Q

Bipolar disorder: clinical manifestations and diagnosis

A

Mania diagnosis: must occur most of the day or for a week or more (less if hospitalization required)

  • Type 1: at least one manic episode
  • Type 2: at least one hypomanic episode

Children: must asses on basis of personal baseline

69
Q

Bipolar disorders: Treatment

A

mood stabilizers: lithium
Atypical antipsychotics, anticonvulsants
-Probably most effective mood stabilizers

valproic acid (Depakene, Depakote) — antiseizure drug

risperidone (Risperdal) — atypical antipsychotic drug

Mood Disorders 1 (10 decks)

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