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BRS 1b > Mood disorders > Flashcards

Mood disorders Flashcards

1
Q

What criteria is used to classify mental disorders?

A

DSM-5

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2
Q

What is the WHO’s classification system of mood disorders?

A

ICD-10

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3
Q

What is the Kraepelinian definition of MDI?

A

Any recurrent mood episodes of any kind (depressive or manic) constituted the diagnosis of MDI, thus MDI meant bipolar illness plus unipolar depressive illness.

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4
Q

What is mood disorder?

A

Fundamental disturbance is a change in affect or mood to depression or to elation

Usually accompanied by a change in the overall level of activity.

Recurrent, onset can be related to stress events

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5
Q

What is more common bipolar or MDD (major depressive disorders)?

A

MDD - 10-20%

Bipolar-1 is 1.1%

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6
Q

What is the DSM-5 criteria for depressive episodes in terms of time?

A

Occurrence of minimum of 2 weeks or more of depressed

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7
Q

What are the core symptoms of depressive episodes?

A

Low mood and anhedonia

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8
Q

What are the core symptoms of manic depressive disorder?

A

Low mood
Anergia
Anhedonia

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9
Q

what are the biological symptoms of Manic depressive disorder?

A

Sleep
Libido
Appetite

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10
Q

What is the DSM-5 criteria for mania/bipolar?

A

3 or more of 7 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 of psychomotor agitation
Impulsive behaviour (sexual impulsivity or spending sprees)

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11
Q

How is a manic episode diagnosed?

A

if such symptoms are present for a minimum of 1 week with notable functional impairment, a manic episode is diagnosed -> Type 1 bipolar disorder

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12
Q

What type of bipolar is associated with a manic episode?

A

type 1

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13
Q

How is a hypomanic episode diagnosed?

A

If such symptoms are present for a minimum of 4 days, without notable functional impairment

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14
Q

How is a type-II bipolar disorder made?

A

Only hypomanic episodes along with a last one major depressive episode

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15
Q

If manic symptoms occur for less than 4 days, what is the DSM-5 diagnosis?

A

unspecific bipolar disorder

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16
Q

Why is hypomania not diagnosed in hospitalised patients or those who present with psychotic symptoms?

A

Since per definition this is associated with functional impairment.

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17
Q

What term refers to a swing in mood?

A

Cyclothymia

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18
Q

In bipolar-1 what are the first type of episodes?

A

Depressive episodes (85% of cases)

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19
Q

What type of symptoms are common in the long-term of bipolar disorder?

A

Depressive symptoms

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20
Q

What is prevalent between mania and depression?

A

Anxiety “Anxious distress specifier”

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21
Q

In terms of onset what is the difference between bipolar and unipolar depression?

A

Age of onset is earlier in bipolar (19 years v late 20s)

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22
Q

In terms of depressive episodes what is the difference between bipolar and unipolar depression?

A

Shorter depressive episodes in average <3m

v 6-12m in unipolar

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23
Q

What are the main differences between unipolar and bipolar depression?

A

In terms of bipolar:
Earlier age of onset
Shorter depressive episodes
Recurrent course (More frequent episodes)
Genetic specificity (manic episodes were found in families with manic episodes, but not in families of persons with unipolar depression)
Differential treatment (antidepressants for unipolar depression v neuroleptics)

24
Q

What is the main treatment for mania?

A

Neuroleptics and lithium

25
Q

Which mental disorder has the highest amount of heritability?

A

Bipolar disorder

26
Q

What mood disorder diagnosis can easily be missed and what diagnosis is a patient in that case likely be mis-diagnosed with?

A

Bipolar diagnosis might be missed in a patient due to a lack of insight about mania/hypomania. Patient may end up with a MDD diagnosis despite a history of manic episodes.

Collateral information often useful, in particular if you are in doubt about history details.

27
Q

What are the problems concerned with a mis-diagnosis of bipolar?

A

Incorrect treatment using anti-depressants
-Ineffective in acute bipolar depression and in prophylaxis
-Can cause acute manic/hypomanic episodes
Shown to worsen long-term course of bipolar illness.

Rapid-cycling cases appear to lead to more mood episodes, including depressive states

28
Q

What is attention bias in depression?

A

Depression is characterised by biases in maintaining/shifting attention = difficulties for depressed people to disengage from negative material
Prolonged maintenance of attention to negative stimuli, and reduced to +.

29
Q

What imaging is used in assisting with diagnosis of depression?

A

functional magnetic resonance imaging (fMRI).

30
Q

How does fMRI work?

A

Works by detecting changes in blood oxygenation and flow that occur in response to neural activity - brain more active = increased oxygen consumption to satisfy the blood demand to the active area.

Oxygenated blood has different magnetic susceptibility relative to deoxygenated blood.

Changes in the ratio of oxygenated/de-oxygenated blood.

The haemodynamic response function can be inferred by fMRI by measuring the blood-oxygen level dependent response.

31
Q

Which cerebral region is deeply involved in attentional biases?

A

Amydala response to negative stimuli

Prefrontal cortex:
-Perigenual anterior cingulate cortex (ACC) mediates negative attentional biases

32
Q

Which cerebral cortex mediates negative attentional biases?

A

Preigenual anterior cingulate cortex

33
Q

Which cerebral structure is associated with the impaired ability to divert attention from task-irrelevant negative information?

A

Latereal inferior frontal cortex

34
Q

What type of memory biases exist in patients with depression?

A

preferential recall of negative compared to positive material
Memory biases present in individual at risk (neuroticism) and in recovered depressed individuals.

35
Q

How are cognitive biases assessed?

A

Facial expression recognition (Harmer) task

Results: Recognition of negative faces (Increased) and a decreased recognition of positive expressions.

36
Q

Which personality trait increases risk of developing depressive disorders?

A

Neuroticism

37
Q

What function is performed by the amygdala?

A

The medial temporal lobe region is involved in the perception and encoding of stimuli to current or chronic affective goals, ranging from rewards or punishments to facial expressions of emotion to aversive or pleasant images and films

Sensitive to detecting and triggering responses to arousing stimuli, it exhibits bias towards detecting cues signalling potential threats (fear)

38
Q

What biases are exhibited by the amygdala?

A

Bias towards detecting cues signalling potential threats

39
Q

What types of drugs are used in the treatment of depression?

A

Serotonin re-uptake inhibitors

TCA ADs

40
Q

Which types of drugs are associated with a better recognition of positive facial expressions in depressive treatment?

A

Noradrenergic antidepressants

41
Q

Which antidepressant causes decreased recognition of fearful faces?

A

Mirtazpine (sertonergic antidepressants)

42
Q

What happens to baseline ACC activity in patients with depression in tasks that probe affective circuitry?

A

Elevated

43
Q

Which midbrain nuclei contain serotoninergic cell bodies?

A

Raphe nuclei

44
Q

What does the monoamine deficiency hypothesis state?

A

Postulates that depressive symptoms arise from insufficient levels of monoamine neurotransmitters serotonin (5-HT), NA and/or dopamine

45
Q

Which antihypertensive has been potentially associated with 5HT depletion?

A

Reserpine

46
Q

What is the overall pharmacological aim for antidepressants?

A

Increase synaptic monoamine concentration

47
Q

What do post-mortem evidence of depressed patients suggest in terms of monoamine?

A

There is reduced 5-HT levels in brainstem individuals who committed suicide

48
Q

Which types of receptors are reduced in patients with depression?

A

Lower levels of 5-HT1A-receptors and 5-HT4 receptors.

49
Q

Which enzyme is elevated in MDD?

A

Monoamine oxidase

50
Q

Which inhibitor prevents the antidepressant effects of both MAOIs and TCAs?

A

Tryptophan hydroxylase

This causes tryptophan depletion leading to less serotonin.

51
Q

What does monoamine depletion correlate with?

A

Correlates with low mood both in at risk and MDD in remission

52
Q

What are depressive related traits?

A

Pessimism and dysfunctional attitudes in MDD and traits negativism in health, related to increased 5HT2A receptors

53
Q

Which serotonin receptor is inversely related to concentrations of serotonin?

A

The 5-HT2A receptor

54
Q

Which imaging is used to detect 5HT receptors?

A

PET imaging

55
Q

What is injected in patients during PET scans?

A

Radioactive tracers that binds to a specific target (receptors).

56
Q

After a baseline PET scan is conducted what pharmacological treatment is administered to quantify the number of dopamine?

A

Amphetamine challenge - releases dopamine from dopaminergic neurones, competing with the radiotracer.
-Difference in binding of the tracer represents as a measure the amount of dopamine released in response to the challenge.

BRS 1b (62 decks)

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