Mood affective disorders / mood disorders Flashcards
What are mood affective disorders ?
also called mood disorder
0 conditions where there is a disturbance in a person’s mood - the underlying feature.
MAIN TYPES
0 Depression ( uni polar )
0 bipolar disorder (main - depression )
symptoms vary btw individuals - from mild to severe.
What is Bipolar disorder ( manic - depression) ?
Massive shifts in mood , emotions , energy levels. - extreme lows to extreme highs
0 usually happens over days to weeks not suddenly.
0 Lows are the same as major depressive order (uni polar depression )
- symptoms
1. lack of
energy &
focus
2. Hopeless
&
discouraged
3. eating or
sleeping
too much
or too little.
Manic episodes - also experienced ( this is what separates it from major depressive disorder ).
MANIC STATE
0 Energetic
0 Overly happy / optimistic
0 Euphoric
0 High self - esteem.
CONSQUENCES - manic episode
0 pressured speech - constantly & rapidly talking .
0 Racing thoughts - also feel like they don’t need sleep.
0 Full manic episode ( risky - make snap decision e.g gambling - reckless behavior ) - poor decision making (no regard for consequences )
0 delusion of grandeur - false belief in one’s own superiority, greatness, or intelligence.
e. g - personal mission from God - supernatural
- CAN HAVE MIXED EPISODES
( depressive & manic episodes occur at same time )
rapid cycling - 4 or more episodes of mania or depression in a year .
People who have BP often have other disorders e.g anxiety , substance abuse , ADHD , personality disorders.
What are the different types of Bipolar ?
Bipolar 1 - diagnosis
0 Bipiolar 1 - Major low (depressive episode - last lat least 2 weeks ) ———————————————> Major high (manic episode - last at least 1 week or require hosipitalisation)
- untreated manic episodes can last 3-6 months.
Bipolar 2 - diagnosis
0 0 Bipolar 2 - Major low (depressive episode - last lat least 2 weeks ) ———————————————> Hypomania (last at least 4 days )- can last longer
- difference btw 1 and 2 is that 2 has episodes of hypo mania - less severe than manic episodes.
0 Cyclothymia
0 Cyclothymia
Milder lows & highs (or hypomania) - cycles btw these two for at least 2 years.
Causes of Bipolar disorder ?
Unknown
(but genetics + environment - though to have an impact )
person with family history of BP - 10x more likely to have it.
0 Drugs / medicines - can trigger manic episodes e.g SSRI
Treatment of Bipolar disorder ?
No cure
- treatment important - person at risk of hurting themseleves
Lithium salts - mood stabilizers
( better at treating manic episodes vs depressive episodes )- thus need to take other medicines too ( antidepressants )
Antidepressants
- have to be careful some can trigger manic episodes e.g SSRI
0 Antipsychotics
0 Anticonvulsants
0 Benzodiazepines
- these medicines can have severe side effects leading to non - adherence - be aware.
0 Talk therapy
0 Cognitive behavioral therapy . ( especially after manic episode ended )
- help handle stressful situations.
What is Major depressive disorder ( clinical depression / uni polar depression ) ?
Depressive disorder - very serious
0 effects daily life & can lead to person feeling like life is not worth it.
Causes of Major depressive disorder ?
Unknown
but linked with genetics - family history - 3 x more likely - link increases with how closely related they are.
biology - regulation of neurotransmitters
environment & psychology.
Important neurotransmitters in Major depressive disorder ?
Serotonin
Noradrenaline
Dopamine
Medicines that increase the level of these in the synaptic cleft have been shown to be effective antidepressants.
What is the monoamine deficiency theory ?
Underlying pathophysiology of major depresssive disorder is :
0 Depleted levels of serotonin , dopamine , adrenaline in CNS.
these are monomanines ( only have one amine group )
EFFECTS THE NEUROTRANSMITTERS HAVE.
Noradrenaline —- anxiety & attention
Serotonin ———> Obsession & complusions
Dopamine ——- > attention , motivation , pleasure.
HOW - not well known
0 Serotonin -
Tryptophan amino acid ( depleted - used make serotonin) ————–> so serotonin depleted ——–> patient may start to get symptoms of depression.
( why depletion occurs is not known ).
Diagnosis of Major depressive disorder ?
Have or the 9 symptoms
- depressive mood.
- sig weight loss/ gain
- diminished interest / pleasure
- inability to sleep / oversleeping
- Psychomotor agitation ( pacing , wringing hands ) or impairment (slowing of through and movement )
- fatigue
- Hopelessness , guilt, worthlness feelings
- Decreased concentration
- thought of death - sucidal thought / attempt.
0 Has to have sig impact on life
0 and not due to medication / condition.
0 cant be explained by other mental health disorder
0 No manic episode at any point.
CONSIDERED CORE SYMPTOMS- IF ONE IS PRESENT ASK ABOUT OTHER DEPRESSION SYMPTOMS
During the last month have you often been bothered by feeling down, depressed, or hopeless?
Do you have little interest or pleasure in doing things?
Subthreshold - 2 or more but less than 5 symptoms
Mild - more than 5 symptoms but mimas impact on functioning
Moderate - moderate - to just below severe symptoms
Severe - nearly all symptoms- severe impact on functioning.
Different types of depression ?
Postpartum depression - occurs after child birth
- most people have depression before
- so more recently called depressive disorder with peripartum
onset .- during
pregnancy - 4 weeks
after birth.
- during
POSSIBLE CAUSES - not known - but linked to :
0 Hormonal changes - estrogen & progesterone
0 Lifestyle changes - can affect fathers too.
Atypical depression
0 Improved mood in response to pleasurable events - mood reactivity + rejection sensitivity ( anxiety at the slightest rejection ) + heavy limbs (laden paralysis )
normal symptoms
Melancholic depression - No improvement of mood when exposed to pleasurable events,
Dysthmia - persistend depressive diosorder - milder symptoms happen over longer period of time. ( e.g 2 + years and 2 or more symptoms )
0 Change in appetite
0 Change in sleep
0 Hopelessness / pessimistic
0 low self - esteem
0 low concentration
0 fatigue / low energy.
Treatment of major depressive disorder ?
Non -pharmological
- exercise - 20 mins x 3 a week - help alleviate symptoms
- health eating
- Talk therapy - preferred for younger and those with milder symptoms.
- Psychotherapy
cognitive
behavior T
PHARMACOLOGICAL
- anti - depressants
SSRI ( selective serotonin retake inhibitors ) - after serotonin release - usually reabsorbed . - monomaine oxidase inhibitors
- tricyclics (TCA)
(less commonly used )
last resort
ECT - electroconvlusive therapy
( small shock passed through brain under general anesthetic - induces seizure )
How is Serotonin - (5 - HT) made ?
Function
Where is it found
Tryptophan ———— > converted to Serotonin
Serotonin - found in brainstem in cluster of neurones - RAPHE nuclei
-these neurones then project throughout brainstem & brain supplying serotonin to CNS.
0 Serotonin transporter (SERT) - removes serotonin from synaptic cleft via reuptake.
ACTIONS
- Boost mood , feeding , reproductive behaviour.
What are Tricyclic antidepressants (TCA ) ?
Treat Major depressive disorder.
0 increase level of serotonin & noradrenaline - to alleviate symptoms.
What are Tricyclic antidepressants (TCA ) ?
Treat Major depressive disorder.
0 increase level of serotonin & noradrenaline - to alleviate symptoms.
2 TYPES
0 Secondary - selective - only inhibit noradrenaline transporters. (increase noradrenaline in cleft)
- disipramine
- nortriptyline.
0 tertiary - non - selective- inhibit serotonin/ noradrenaline transporters. (increase noradrenaline & serotonin in cleft)
1. amitriptyline
2. imipramine 3. clomipramine
SLOW ACTING - takes time for serotonin & noradrenaline to accumulate in cleft. 2-4 WEEKS BEFORE IMPROVEMENTS SEEN.
SEVERE SIDE EFFECTS - not first line - used when no response to SSRI etc
