Mood disorders Flashcards
what is the ICD 10 classification for all mood/affective disorders?
fundamental disturbance is a change in affect/mood to depression OR elation
- usually accompanied by change of overall level of activity
- tend to be recurrent and onset related to stressful events
what is the typical cycle of low mood?
negative automatic thinking
negative feelings
psychological related symptoms (fatigue)
negative behaviours - due to thoughts, feelings
what is negative automatic thinking?
negative thoughts towards onseself during everyday thoughts/reactions
whats the point
im a bad person
what is CBT based on?
addressing cycles of low or high mood
what are negative feelings?
irritability
low
flat feelings/apathy
what are negative behaviours?
ruminating
laying in bed all day
social isolation
what is the DSM-5 criteria for a depressive episode?
occurence of 2 weeks+ depressed mood AND 4/8 of: sleep alterations appetite alterations anhedonia decreased conc low energy guilt psychomotor changes suicidal thoughts
what are the subtypes of major depressive disorders features?
atypical features
melancholic features
psychotic features
what are atypical features of MDD?
mainly increased sleep and appetite, heightened mood reactivity
what are melancholic features of MDD?
no mood reactivity
psychomotor retardation
anhedonia
what are psychotic features of MDD?
prescence of delusions/hallucinations
when can major depressive disorder be diagnosed?
in the absence of any manic/hypomanic episodes
and following a major depressive episode
what is the typical cycle of elated/high mood?
positive automatic thinking
positive feelings
positive physiological symptoms
postive behaviours/erratic behaviours
what are positive automatic thoughts?
positive view of oneself in response to daily life
im the best
i can do it all
what are positive behaviours in mania?
impulsivity
increased activity/productivity
what are positive physiological symptoms?
increased energy
race sensation
what is a hypomanic episode?
symptoms of manic episode present for at least 4 dys but without functional impairment
what is a manic episode?
at least 1 week of euphoric/irritable mood with 3/7 of: decreased need of sleep distractibility grandiosity flight of ideas pressured speech, talkativeness goal-directed activities/psychomotor agitation impulsive behaviour
what type of manic episode leads to a diagnosis of type 1 bipolar disorder?
present for at least a week with notable functional impairment
what type of manic episode leads to a diagnosis of type II bipolar disorder?
no manic episodes but multiple hypomanic episodes along with at least one major depressive episode
what type of manic episode leads to a diagnosis of unspecified bipolar disorder?
if manic symptoms last less than 4 days or other specific thresholds are unmet
what is cyclothymia?
mood swings without extent of mania or depression
when can hypomania not be diagnosed?
when psychotic symptoms are present
or if hospitalised
what diagnosis is made if manic episode is caused by antidepressants?
normal diagnosis of bipolar disorder depending on other characteristics
what is bipolar I disorder?
majority of cases
first episode is depressive, then manic then more depressive
almost half of the time with symptoms, half free
experience full manic episodes
what is the difference between bipolar and unipolar mood disorder?
bipolar highly heritable
insight preserved in depression, impaired in mania
what are attention biases in depression?
difficulties for depressed people to disengage from negative material
how was attentional bias in depression studied?
depressed people had prolonged maintenance of attention to negative pictures, often negative emotional face pictures and reduced attention to positive stimuli
what brain abnormalities are observed by fMRI in depressed people?
sustained amygdala response to negative stimuli
anterior cingulate cortex appears to mediate negative attentional biases
increased activity in lateral inferior cortex associated with impaired ability to divert attention from task-irrelevant negative info
what are memory biases in depression?
preferential recall of negative compared to positive material
in what population do memory biases present?
depressed individuals and:
individuals at risk of affective disorder - neuroticism
recovered depressed individuals
what are perceptive biases in depression?
reduced recognition of all basic emotions except for sadness
what is the brains response to negative faces in depressed people?
enhanced amygdala response
what is the role of the amygdala in depression?
exhibits bias towards detecting cues signalling potential threats like expression of fear
more active in depressed individuals
what is the amygdala?
region in medial temporal lobe
involved in percepion and encoding of stimuli, reward, punishment
sensitive to detecting and triggering responses to arousing stimuli
what is the effect of noradrenergic antidepressants on brain function studies?
better recognition of happy faces
what is the effect of serotonergic antidepressants in brain studies for depression?
decreased recognition of fearful faces
mixed results with citalopram
where do serotonergic neurones project from?
Raphe nuclei in midbrain
what is the role of serotonin?
regulation of mood
key role in monoamine deficiency hypothesis of depression
what is the monoamine hypothesis of depression?
depressive symptoms arise from insufficient levels of monoamine NTs (serotonin, noradrenaline, dopamine)
what is PET imaging used for in psychiatry?
investigating brain pharmacology
how does PET imaging work?
injection of radioactive pharmaceutical, binds to specific target
can use to quantify receptors by looking at tracer density
how does PET scanning compare to fMRI?
more selective, more invasive
radioactive
expensive
less optimal temporal and spatial resolution
what is the importance of distinguishing bipolar vs unipolar mood disorders?
antidepressants can be ineffective in acute bipolar depressive episodes
can cause acute manic/hypomanic episodes
worsen long term course of bipolar illness
leads to more depressive states in bipolar illness over time
how to differentiate bipolar affective disorder from borderline personality disorder
BPAD - heritable, grandiosity, mood states less effected by environment
BPD - poor self image, fear of abandonment and feelings of emptiness
both have rapid mood swings, unstable interpersonal relationships, sexual behaviour and suicidality
how to differentiate bipolar affective disorder from schizophrenia
BPAD - episodic delusions/halluc
schiz - chronic delusions/halluc
both - cognitive impairment, depression/negative symptoms
what is schizoaffective disorder?
features of both bipolar affective disorder and schizophrenia
what is an important broad differential from bipolar affective disorder?
personality disorders
how to differentiate bipolar affective disorder from attention deficit disorder
BPAD - family history, recurrent deprssive episodes, amphetamines worsen mania
both - impaired concentration, executive function, abnormal working and short term memory
what are personality disorders?
maladaptive patterns of behaviour, cognition, inner experience exhibited across many contexts, deviating from individuals normal culture
what is bipolar II disorder?
only experience depressive and hypomanic episodes
less common
