Mood disorders Flashcards
What are the 3 spectrums of mental illnesses?
anxiety disorders
affective disorders
psychoses
What are the 4 types of anxiety disorders?
panic disorder
GAD (generalised anxiety disorder)
OCD (obsessive compulsive disorder)
agoraphobia
What are the 3 types of affective disorder?
major depression
bipolar disorder
dysthymia
What are the 2 types of psychoses?
schizophrenia
schizoaffective
What are the 2 broad types of affective disorder?
only depressive symptoms
oscillation between depression and manic symptoms
What is depression?
flattened mood
sadness
feeling worthlessness and guilt
withdrawal from others
changes in sleep and appetite
What is mania?
abnormally elevated mood
intense elation or irritability
hyperactivity, talkativeness, distractibility
What is the diagnostic criteria for MDD (major depressive disorder)?
depressed mood OR loss of interest/pleasure (anhedonia) for a minimum of 2 weeks, that is not due to normal bereavement, plus any 5 of these: :
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor retardation
Suicidality
What are the emotional symptoms of depression?
sadness
loss of interest/pleasure
overwhelmed
anxiety
excessive/inappropriate guilt
diminished ability to think/concentrate
indecisiveness
What are the physical symptoms of depression?
vague aches and pains
headache
sleep disturbances
fatigue
back pain
significant change in appetite resulting in weight loss/gain
What are the somatic consequences of major depressive disorder (MDD)?
cognitive impairment
obesity
diabetes mellitus
heart disease
mortality
cancer
disability
What are the somatic consequences of major depressive disorder (MDD)?
cognitive impairment
obesity
diabetes mellitus
heart disease
mortality
cancer
disability
What are the symptom variation between children and adults with depression?
children - stomach aches and headaches
older adults - distractibility and forgetfulness
MDD is twice as common in women than men. True or False?
True
What is bipolar disorder?
bipolar disorder usually involves episodes of depression alternating with mania
What is mania?
a state of intense elation or irritability
What are mixed episodes?
symptoms of both mania and depression in the same week
What is hypomania?
symptoms of mania but less intense with four or more days of elevated mood and does not interfere with functioning
Hypomania alone is a DSM diagnostic category. True or False?
False - hypomania alone is not a DSM diagnostic category
Explain what the 3 forms of bipolar are?
bipolar I - at least one episode/mania/mixed episodes
bipolar II - at least one major depressive episode with at least one episode of hypomania
cyclothymia - milder, chronic form of bipolar disorder that lasts at least 2 years with numerous periods with hypomanic and depressive symptoms
What is the DSM-5 Criteria for manic and hypomanic episodes?
elevated, expansive, or irritable mood plus 3 of the following (4 if mood is irritable):
psychomotor agitation
excessive talking or pressured speech
flights of ideas; racing thoughts
reduced need for sleep
grandiosity or inflated self esteem
easily distractible
excessive involvement in pleasurable activities with negative consequences
According to the DSM-5 Criteria, how long do symptoms have to have lasted for manic episodes?
symptoms last for 1 week OR require hospitalisation
symptoms cause significant distress or functional impairment
According to the DSM-5 Criteria, how long do symptoms have to have lasted for hypomanic episodes?
symptoms last at least 4 days with clear changes in functioning but impairment is not marked
What are the 3 subtypes of depressive and bipolar disorders?
SAD (seasonal affective disorder)
postpartum onset
melancholic
What is SAD?
seasonal affective disorder is characterised by episodes that happen regularly at a particular time of the year. It is more common in Scandinavian countries e.g. Norway/Sweden, with lack of sunlight
What are the effects of SAD?
impacts the body’s normal circadian rhythm
What is postpartum onset?
occurs as a result of huge changes in progesterone levels. This happens within 4 weeks of giving birth
What is melancholic?
inability to experience pleasure (anhedonia)
How does genes affect MDD?
MDD clusters within families
1st degree relatives of patients with MDD has a 3x increased risk of MDD
What is the limitation of genes as a cause of MDD?
Genetic variants confer an increased risk only in the presence of exposure to stressors and other adverse environmental circumstances
What factors affect MDD?
genes
environment
genes and environment
endocrine system
brain chemicals
brain regions
immune system
What factors affect MDD?
genes
environment
genes and environment
endocrine system
brain chemicals
brain regions
immune system
What is the main determinant of environmental factors in the cause of MDD?
The stress response
What are the 2 types of stress?
chronic stress
acute stress
What neurotransmitters are involved in the pathophysiology of MDD?
serotonin (5-HT)
noradrenaline (NA)
How are serotonin and noradrenaline associated with MDD?
they are associated with low levels of 5-HT and NA
How are serotonin and noradrenaline associated with mania?
they are associated with high levels of NA and low levels of 5-HT
What is the function of the orbital and ventromedial prefrontal cortex?
important in regulating and inhibiting our response to emotions
What is the function of the dorsolateral prefrontal cortex?
key brain region involved in the executive functions including cognition and emotions
What is the function of the hippocampus?
memory formation (good and bad)
What is the function of the amygdala?
fear processing
What is the function of the anterior cingulate cortex?
connected to both the “emotional” limbic system and the “cognitive” prefrontal cortex
How does the immune system affect MDD?
MDD is an inflammatory disorder with prior severe infections and autoimmune diseases increasing the risk of developing MDD
patients with MDD show increased serum levels of cytokines e.g. TNF and IL-6
What are the 3 main classes of drug treatment for depression?
tricyclic antidepressants
SSRIs/SNRIs
MAOIs
What class of drug treatment is first line and why?
SSRIs because of their favourable side effects
Name 5 tricyclic antidepressant drugs
clomipramine
amitriptyline
doxepin
imipramine
desipramine
What are the preferred uses of tricyclic antidepressants?
depression with:
pain
fibromyalgia
migraine
insomnia
What are the least preferred uses of tricyclic antidepressants?
overweight patients
suicidal patients
cardiac patients
patients with dementia
patients in whom anticholinergic effects would be problematic
What are some of the side effects of tricyclic antidepressants?
weight gain
drowsiness
sedation
postural hypotension
What are the consequences of tricyclic antidepressant overdose?
confusion
convulsions
tachycardia
hypotension
ventricular arrhythmia which can lead to death
suicide
How do you treat tricyclic antidepressant overdose?
removal of the remaining drug in the stomach
anticonvulsant agent (diazepam)
antiarrhythmic drugs and further cardiac support
