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BRS YR2 > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

What is the definition of Mood/Affective disorders?

A

a change in affect/mood to depression (with or without associated anxiety) or to elation
(usually accompanied by a change in the overall level of activity)

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2
Q

What is the DSM-5 criteria for a depressive episode?

A
  • 5 or more depressive symptoms which must include low mood and/or anhedonia
  • lasting for 2+ weeks
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3
Q

What is on the DSM-5 criteria?

A
  • sleep alterations (insomnia or hypersomnia)
  • appetite alterations
  • anhedonia
  • decreased concentration
  • low energy
  • guilt
  • psychomotor changes (agitation or retardation)
  • suicidal thoughts
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4
Q

What does a dignosis of Major Depressive Disorder mean?

A
  • no manic or hypomanic episodes in the past
  • diagnosis of a current depressive episode
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5
Q

What are the DSM-5 subtypes of Major Depressive Disorder?

A
  • atypical features
  • melancholic features
  • psychotic features
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6
Q

What does it mean to have the atypical subtype (DSM-5) of MDD?

A
  • increased sleep and appetite
  • heightened mood reactivity
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7
Q

What defines the melancholic subtype (DSM) of MDD?

A
  • no mood reactivity
  • marked psychomotor retardation
  • anhedonia
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8
Q

What defines the psychotic subtype (DSM) of MDD?

A

presence of delusions/hallucinations

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9
Q

How does DSM-5 classify a manic episode?

A
  • euphoric or irritable mood
  • 3/7 of the manic criteria
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10
Q

What is on the DSM-5 manic criteria?

A
  • 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
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11
Q

What is required for a manic episode diagnosis?

A
  • manic symptoms for minimum 1 week
  • notable functional impairment
  • leads to type 1 bipolar disorder
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12
Q

What is required for a hypomanic episode?

A
  • manic symptoms for minimum 4 days
  • NO functional impairment
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13
Q

What would lead to a type I bipolar disorder diagnosis?

A
  • a manic episode is diagnosed
  • can occur with or without depression or hypomania
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14
Q

What would lead to a diagnosis of type II bipolar disorder?

A
  • no manic episodes
  • only hypomanic episodes
  • at least one major depressive episode
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15
Q

When is unspecified bipolar disorder diagnosed?

A
  • manic symptoms present for less than four days
    OR
  • other specific thresolds are not met for manic or hypomanic episods
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16
Q

What is classified as a noteable functional impairment?

A
  • psychotic features (delusions/hallucinations)
  • hospitalisation
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17
Q

What happens if a manic/hypomanic episode is caused by anti-depressants?

A

the diagnosis of bipolar disorder is made with DSM-5

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18
Q

Why are anti-depressant induced manic/hypomanic episodes no longer excluded?

A

shown that it occurs almost exclusively in those with bipolar, not unipolar depression

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19
Q

What is the most consistent clinical feature of mania and mood disorders?

A

psychomotor changes

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20
Q

How common is relapsing following recovery from a mood episode?

A

50-60%

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21
Q

What does more than 4 relapses (mood cycles) in one year mean?

A

rapid cycling

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22
Q

How would you differentiate type 1 and type 2 bipolar disorder?

A

type I: equally experience mania and depression (large amplitude on mood cycles)
type 2: hypomania and depression

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23
Q

What is cyclothymia?

A

mood disorder which causes mood swings less extreme than in bipolar disorder

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24
Q

What type of episode is most likely to be first with type I bipolar?

A
  • 85% have depressive
  • 10% manic
  • 3-5% mixed
    (90-100% will develop more episodes after their first manic episode)
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25
Q

What does bipolar disease mean long term?

A
  • symptomatic 47% of the time
  • 80% of episodes are depressive
  • 20% are manic or mixed
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26
Q

How often does anxiety accompany bipolar disorder?

A
  • 30-70% of bipolar patients
  • worst prognosis and outcomes
  • DSM-5: Anxious Distress Specifier
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27
Q

When is MDD most often diagnosed?

A

childhood

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28
Q

What is used to treat bipolar disorder?

A
  • lithium (mood stabiliser)
  • anti-psychotics
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29
Q

What is used to treat MDD?

A

antidepressants

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30
Q

Why should antidepressants not be prescribed to people with bipolar disorder?

A
  • mostly ineffective for acute symptoms and prophylaxis
  • can cause manic/hypomanic episodes
  • can worsen illness long-term
  • can lead to more mood episodes
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31
Q

How does insight vary with depression and mania?

A

insight is preserved in depression and impaired in mania

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32
Q

What was thought to be different about unipolar and bipolar depression?

A
  • age of onset
  • duration of episodes
  • recurrent course
  • genetic specificity
  • differential treatment
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33
Q

How is depression characterised by biases?

A
  • attention biases (difficulty disengaging from negative material)
  • memory biases (preferential recall of negative material)
  • perceptual biases (increased recognition of negative faces and vice versa)
34
Q

What are the neurofunctional abnormalities seen in depression?

A

(amygdala dysfunction and ACC activation)

  • sustained amygdala response to negative stimuli
  • anterior cingulate cortex appears to mediate negative attention biases
  • increase lateral inferior frontal cortex action impairs the ability to divert attention from irrelevant negative information
35
Q

What is the monoamine deficiency hypothesis for depression?

A

Depressive symptoms arise from insufficient monoamine neurotransmitters (serotonin, noradrenaline and dopamine)

36
Q

What are some examples of SSRIs?

A
  • sertraline
  • fluoxetine
  • citalopram
37
Q

How does an fMRI work?

A

detects changes in blood oxygenation and flow that occurs in response to neural activity (more active, more oxygen consumed, more blood flow to the area)

38
Q

What was the impact of an acute single dose of antidepressants on reaction to negative stimuli?

A
  • noradrenergic antidepressants: increased recognition of happy faces
  • serotonergic antidepressants, mirtazapine: decreased recognition of fearful faces
    citalopram: mixed results
39
Q

What was the impact of 7 day treatment of antidepressants on reaction to negative stimuli?

A

noradrenergic and serotonergic antidepressants: reduced recognition of anger and fear

40
Q

What does an early change in positive processing predict?

A

a good long term response

41
Q

Why is the clinical response to escitalopram after 6 weeks good?

A

early changes (first week) in: amygdala, thalamus, ACC, + insula in response to scared faces

42
Q

What does an elevated baseline ACC activity in depressed patients predict?

A

a positive response to treatment

43
Q

What do clinically useful antidepressants do?

A

increase synaptic monoamine concentrations (serotonin(5-HT), norepinephrine, dopamine)

44
Q

What is indirect evidence of the role of 5-HT in depression?

A
  • depletion causes depression
  • suicides have reduced levels
  • increase monoamine oxidase A in MDD
  • low levels of 5-HT1A and 5-HT4 receptors
45
Q

What is used to investigate brain pharmacology?

A

PET imaging

  • invasive
  • less optimal temporal and spatial resolution
  • injected tracer (ligand)
46
Q

How do we now measure 5-HT release?

A

5-HT2A agonist PET tracer

47
Q

What is the difference in 5-HT release in healthy or MDD patients?

A

Measurable in healthy, unmeasurable in MDD

48
Q

What are the risks of using psychedelics to treat MDD?

A
  • dysphoria
  • anxiety
  • nausea
  • headache
49
Q

What are the advantages of using psychedelics to treat MDD?

A
  • non-addictive
  • low physiological and brian toxicity
  • good therapeutic index
50
Q

How do psychedelics act?

A

stimulate serotonin 2A receptors at the synapse

51
Q

What are the key features of a mental state examination?

A
  • appearance and behaviour
  • speech
  • mood/affect
  • thought
  • perceptions
  • cognition
  • insight
52
Q

What are the 2 different types of insight?

A
  • objective (as seen by the practitioner)
  • subjective (as reported by the patient)
53
Q

What should be included in a past psychiatric history?

A
  • previous episodes?
  • has there been treatment needed before?
  • history of other mental illness
  • previous admissions?
  • collateral history?
54
Q

What should be included in a family history?

A
  • any mental illnesses?
  • who?
  • what are the family relationships like?
55
Q

What should be included in a medication history?

A
  • antidepressants
  • antipsychotics
  • mood stabilisers
  • side effects
  • how long?
  • exact medication + dose?
  • well tolerated?
  • effective?
56
Q

What should be included in a risk assessment?

A 
to self
- current plans
- past attempts 
- self harm 
- self neglect
to others
- more rare
from others
- vulnerability?
57
Q

What are the differentials for depression?

A
  • bipolar?
  • boderline personality disorder
  • schizophrenia
  • attention deficit disorder
58
Q

Why is it important to differentiate between unipolar and bipolar MDD?

A

antidepressants

  • ineffective in acute bipolar depression + prophylaxis
  • can cause acute manic/hypomanic episodes (in bipolar)
  • worsens long term course of bipolar (esp. rapid cycling), more mood episodes
59
Q

What is the definition of a personality disorder?

A
  • maladaptive patterns of behaviour, cognition, and inner experience
  • exhibited across many contexts and deviating from those accepted by the individual’s culture
  • develop early
  • inflexible
  • associated with significant distress or disability
60
Q

Which personality disorders can be difficult to differentiate from bipolar?

A
  • antisocial
  • borderline
  • narcissistic
61
Q

What is antisocial personality disorder?

A

pervasive pattern of:

  • disregard for and violation of the rights of others
  • lack of empathy
  • bloated self-image
  • manipulative and impulsive behaviour
62
Q

What is borderline personality disorder?

A

pervasive pattern of:

  • abrupt mood swings
  • instability in relationships
  • self-image, identity, behaviour and affect
  • often leading to self-harm and impulsivity
63
Q

What is narcissistic personality behaviour?

A

pervasive pattern of grandiosity, need for admiration, and a perceived or real lack of empathy

64
Q

What is common between bipolar affective disorder and borderline personality disorder?

A
  • rapid mood swings
  • unstable interpersonal relationships
  • impulsive sexual behaviour
  • suicidality
65
Q

What are common features of borderline personality disorder that aren’t features of bipolar affective disorder?

A
  • poor self image
  • fear of abandonment
  • feelings of emptiness
66
Q

What are common features of bipolar affective disorder that aren’t features of borderline personality disorder?

A
  • high heritability
  • grandiosity
  • mood states less affected by the environment
67
Q

What features are common between bipolar affective disorder and schizophrenia?

A
  • hallucinations (50% of mania, 10% of depression)
  • cognitive impairment
  • depression, apathy, lack of affect, low energy and social isolation
  • schizo affective shares features of both BPAD and schizophrenia
68
Q

What is the main difference between schizophrenia and bipolar affective disorder?

A

BPAD has episodic delusions/hallucinations where as in schizophrenia they are chronic

69
Q

What are the common features of bipolar affective disorder and attention deficit disorder?

A
  • impaired concentration
  • impairment of executive function
  • abnormal working and short term memory
70
Q

What are the main differences between ADD and BPAD?

A

BPAD has:

  • high heritability
  • recurrent depressive episodes
  • mania worsened by amphetamines
71
Q

What is post stroke depression?

A

(sometimes presistant)

  • retardation in thinking and behaviour
  • lesions in the left frontal lobe or basal banglia
72
Q

In which areas of the brain do lesions tend to cause seizures?

A
  • left frontal lobe
  • basal ganglia
  • more frontal the lesion, the more severe the symptoms
73
Q

What is vascular depression?

A
  • sub cortical dementia
  • common in late life depression
74
Q

What is vascular depression associated with?

A

white matter hyper intensities

  • impacts cognitive function
  • increased vulnerability to stressors
75
Q

How do you manage/prevent/treat vascular depression

A

treat vascular risk factors:

  • diabetes
  • hypertension
  • smoking + alcohol cessation
76
Q

What possible endocrine causes can present like depression?

A
  • hyper + hypothyroidism
  • hyper + hypoparathyroidism
  • hyper + hypoadreno-corticism
  • hypoglycaemia
  • Cushing’s syndrome
  • Addison’s disease
77
Q

What systemic diseases/infections can present with depression-like symptoms?

A
  • viral
  • systemic lupus erythematosus
  • HIV
  • pancreatic cancer
78
Q

Why can systemic diseases/infections present with depression-like symptoms?

A

cytokines manifested are considered to be the cause

79
Q

What vitamin deficiencies can cause depression-like symptoms?

A
  • vit B12
  • folic acid
  • vitamin D
80
Q

What neurological conditions can cause depression-like symptoms?

A
  • MS
  • Alzheimer’s
  • Parkinsons
81
Q

What medications can cause depression-like presentation?

A
  • beta-blockers
  • anti-Parkinson’s
  • anti-cholinergics
  • some antibiotics (ciproflaxin)
  • statins
  • oestrogen
  • opiate pain killers
  • acne medications

BRS YR2 (67 decks)

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