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BRS2 > mood disorders > Flashcards

mood disorders Flashcards

1
Q

prevalence of bipolar 1

A

1%

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2
Q

prevalence of bipolar 2

A

1.2%

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3
Q

lifetime prevalence of major depressive disorder?

A

10-20%

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4
Q

gender distribution of bipolar 1 and bipolar 2?

A

bipolar 1 -> equal

bipolar2 male to female 2:1

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5
Q

what did mental and substance abuse disorder account for in DALYs ?

A

7%

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6
Q

what are the two disease classification manuals?

A

US DSM -> latest is 5 2013
WHO manual -> ICD
ICD-10 1994
ICD-11 on the way

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7
Q

definition for mood or affective disorder?

A

fundamental disturbance is in mood
depression (with anxiety or without)
or to elation

accompanied by a change to overall level of activity
most symptoms are easily understood in the context of change in mood or activity

disorders tend to be recurrent or related to a stressful event

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8
Q

how would you classify a depressive episode?

A

DSM-5 criteria for depressive episode:​

Occurrence of 2 weeks or more of depressed mood ​

AND the presence of 4 of 8 out of the following: ​

​

Sleep alterations (insomnia or hypersomnia)​

Appetite alterations (increased or decreased)​

Diminished interest or anhedonia​

Decreased concentration​

Low energy​

Guilt​

Psychomotor changes (agitation or retardation)​

Suicidal thoughts

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9
Q

how is the major depressive disorder classified?

A

If no manic or hypomanic episodes in the past are identified, then the diagnosis of a current major depressive episode leads to a longitudinal diagnosis of Major Depressive Disorder (MDD).

Atypical features (which represent mainly increased sleep and appetite, along with heightened mood reactivity)​

Melancholic features (defined by no mood reactivity, along with marked psychomotor retardation and anhedonia)​

Psychotic features (the presence of delusions/hallucinations).

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10
Q

core symptoms for depression triad?

A

low mood
anergia
anhedonia

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11
Q

biological symptoms for depression triad?

A

sleep
libido
appetite

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12
Q

how do you characterise manic episodes

A

Euphoric or irritable mood with 3 or more of 7 manic criteria: ​

Decreased need for sleep with increased energy​

Distractibility​

Grandiosity or inflated self-esteem​

Flight of ideas or racing thoughts​

Increased talkativeness or pressured speech​

Increased goal-directed activities or psychomotor agitation​

Impulsive behaviour (such as sexual impulsivity or spending sprees)

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13
Q

how would type 1 bipolar be diagnosed?

A

minimum mania for a week with notable functional impairment

+ depressive episode as well

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14
Q

how is a hypomanic episode diagnosed?

A

symptoms present for a minimum of 4 days

without notable functional impairment

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15
Q

how is type 2 bipolar disorder diagnosed?

A

no manic episode
only hypomanic
along with one major depressive episode
then DSM -5 diagnosis is type 2

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16
Q

how is unspecified bipolar disorder diagnosed?

A

if the manic symptoms are less than 4 days

17
Q

when can hypomania not be diagnosed?

A

when there are psychotic symptoms

when a patient is hospitalised -> mania is put down

18
Q

can a diagnosis still be made if is it caused by antidepressants?

A

yes in DSM-5 the diagnosis of mania can still be made

19
Q

Are bipolar disorders really mood diorders?

A

this can be difficult –> as they can have mania without euphoric mood and depression without sad mood just anhedonia may be present

20
Q

how is the course of the illness -> think of the graph ?

A

number of cycles per year varies
more than 4 is rapid cycling
and amplitude says either 1 bipolar, 2 bipolar or cyclothymia

21
Q

what are the first episodes in bipolar 1?

A

the first episode tend to be depressive

90-100% will develop more episode after the first manic episode

22
Q

how does insight differ in mania and depression?

A

insight it preserved in depression

and impaired in mania

23
Q

how is depression characterised in terms of biases?

A

is it characterised by biases in maintaining/shifting attention
difficult for people with depression to disengage from negative material -> look at sad image for longer

24
Q

what are some neurofunctional abnormalities in depression?

A

sustained amygdala response to negative stimuli
prefrontal cortex-> peregenual anterior cingulate cortex -> appears to mediate negative attentional biases
laterall inferior frontal cortex associated with impaired ability to divert attention from task irrelevant negative information.

25
Q

What are the memory biases in depression?

A

There are strong evidence for biased memory processes
preferably recall negative compared to positive material

memory biased present in individuals at risk (neuroticism) and in recovered depressed individuals
enhanced amygdala response -> to negative faces

26
Q

how do antidepressants cause facial expression recognition modulation?

A

in healthy samples
either noradrenergic antidepressants (reboxetine, duloxetine) -> better recognition of happy faces

or serotonergic antidepressants
mirtazapine -> decreased recognition of fearful faces
SSRIs citalopram -> mixed results -> both increase and decrease amygdala response to SSRIs

noradrenergic and serotonergic -> reduced recognition of anger and fear

in clinical samples -> early change positive processing
elevated baseline ACC activity

27
Q

what is the monoamine deficiency hypothesis?

A

depressive symptoms arise from insufficient levels of monoamine neurotransmitters serotonin, norepinephrine and/or dopamine

28
Q

How are serotonin levels in individuals who have committed suicide?

A

their serotonin levels are low

29
Q

Can we measure serotonin in a living human brain?

A

We can use PET scanning, but it is really expensive and invasive. with much less optimal temporal and spatial resolution.

Using a 5-HT2A agonist PET tracer and amphetamine

30
Q

How does cerebral serotonin look like in humans?

A

serotonin receptors deficiency

31
Q

How do tryptamine psychodelics work on the brain?

A

The work on the serotonin system.

32
Q

What type of psychodelics are used?

A

tryptamine

33
Q

What are some of the benefits for psychodelics?

A 
Rapid enduring mood improvement 
well being 
reduce OCD 
End of life distress -> reduce 
reduce addiction 
reduce depression 
reduce suicidal tendencies
34
Q

is it important to distinguish between bipolar and unipolar?

A

yes
antidepressants can be ineffective in acute bipolar and in prophylaxis
can cause manic or hypomanic episodes
can worsen long term bipolar illness
can lead to more depressive episodes over time in rapid cycling stages

35
Q

Bipolar affective disorder vs scizophrenia?

A

BPAD -> episodic hallucination/ delusions
schizo -> chronic hallucinations/ delusions

cognitive impairment
schizoaffective shares features in both

36
Q

what are personality disorders?

A

maladaptive patterns of behaviours cognition, inner experience, exhibited across many context and deviating from those accepted by the individuals culture, patterns may develop early and are inflexible and be associated with significant distress or disability.

37
Q

bipolar affective disorder vs borderline personality disorder?

A

BPAD -> run in family, grandiosity, mood typically not state from environment

BPD -> poor self image, fear of abandonment, feelings of emptiness

BOTH rapid mood swings
unstable interpersonal relationships
impulsive sexual behaviour
suicidality

38
Q

BPAD vs Attention deficit disorder

A

BPAD-> family history, recurrent depressive episodes, amphetamines worsen mania.

both -> impaired concentration, impaired executive function, abnormal working and short term memory

39
Q

Organic causes of depression?

A

endo-> hypo and hyper thyroidism, hypo/hyper parathyroidism, cushings Addison’s and hypoglycaemia

infections, SLE, HIV, pancreatic cancer -> cytokines in systemic diseases are considered a cause of depression.

deficiencies -> B12, folic acid

neuro MS, Alzeheimers

medication beta blockers, steroids, anti parkisons
anti cholinergics
IBS, some antibiotics, statins, oestroges, opiate painkillers, acne med

vascular depression -> associated with white matter hyperintensities, impact cognitive function making the individual more likely to react to stressors. (early subcortical dementia)

post stroke depression -> lesions in the left frontal lobe or basal ganglia -> can cause depression with a tendency that the more frontal the lesion the more severe the symptoms.

BRS2 (6 decks)

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