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Mood disorders Flashcards

1
Q

Prevalence of MDD

A

increasing rate of Major depressive disorder (MDD), wth an earlier age of onset

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2
Q

Classification of mental disorders

A

DSM-V (NICE guidelines)
ICD-10 (WHO system)

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3
Q

What is the Kraepelinian definition of MDI?

A

Any recurrent mood episodes of any kind (depressive or manic)

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4
Q

Definition of mood disorders ICD-10

A

Recurrent change in mood/affect to either depression or elation accompanied by a change in overall level of activity

onset related to stressful events

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5
Q

What is a depressive episode?

A

2 weeks or more of a depressive mood, associated with: sleep alterations, change in diet, anhedonia, anergia, low concentration and agitation

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6
Q

How would you diagnose Major Depressive Disorder?

A

Major depressive episode with no manic or hypomanic episodes in the past

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7
Q

What are the three groups of features in major depressive disorder?

A

Atypical (increased sleep, appetite, and mood reactivity) //
Melancholic (anhedonia, blunted affect, decreased mood reactivity and psychomotor retardation) //
Psychotic (delusions/hallucinations)

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8
Q

Core symptoms of depression

A

Low mood
anhedonia
anergia

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9
Q

What are the biological symptoms of depression?

A

sleep
loss of libido
changes in appetite

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10
Q

What are the psychological features of depression?

A

Attitudes towards the world, oneself and about the future

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11
Q

What is a manic episode?

A

Euphoric or irritable mood associated with: less need for sleep, distractibility, inflated self-esteem, impulsivity

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12
Q

How would you diagnose Type 1 Bipolar Disorder?

A

Manic episode for at least 1 week with notable functional impairment

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13
Q

What is hypomania?

A

A milder form of mania - when the symptoms of a manic episode occur for at least 4 days without notable functional impairment (ie psychotic behaviour). It is NOT underactive behaviour

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14
Q

How would you diagnose Type 2 Bipolar Disorder?

A

Hypomanic episodes (no manic episodes), with at least one major depressive episode

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15
Q

What is the diagnosis for manic symptoms that occur for less than 4 days?

A

Unspecified Bipolar Disorder

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16
Q

Exceptions to diagnosis of hypomania

A

Psychotic features
Hospitalised patient

17
Q

What is cyclothymia?

A

Milder version of bipolar disorder - fluctuating mania and depressive episodes but not as severe amplitude

18
Q

How does Type 1 Bipolar Disorder compare to cyclothymia with changes in mood?

A

Much more significant amplitudes in fluctuations between manic and depressive episodes

19
Q

How does Type 2 Bipolar Disorder compare to other bipolar disorders with changes in mood?

A

Similar amplitude of manic episode to cyclothymia // Similar amplitude of depressive episode to Type 1 Bipolar Disorder

20
Q

What will the majority of first episodes in Type 1 Bipolar Disorder be?

A

Depressive (85%)

21
Q

Differences between bipolar and unipolar conditions.

A
  • Age of onset, (earlier in bipolar)
  • Shorter depressive episodes in bipolar
  • Recurrent course, (more frequent episodes in bipolar)
  • Genetic specificity, (manic episodes seem to run in families)
  • Differential treatment, (antidepressants for unipolar depression vs neuroleptics/lithium for mania)
22
Q

Describe the attention biases in depression

A

Prolonged maintenance of attention over negative material
reduced attention to positive stimuli

23
Q

Describe the memory biases in depression

A

Preferential recall of negative material compared to positive
Seen in at risk individuals and those who are recovered

24
Q

Describe the perceptual biases in depression

A

Preferential recognition of negative faces in a line of negative and happy faces

25
Q

What 3 areas of the brain are responsible for this and why?

A

Sustained amygdala response to negative stimuli //
Prefrontal cortex: anterior cingulate cortex (mediates negative attention bias) / lateral inferior frontal cortex (impaired diversion from negative material)

26
Q

Role of the amygdala in perceptual bias

A

Enhanced amygdala response to negative faces
Sensitive to detecting and triggering responses to arousing stimuli e.g. reward/punishment. Bias to detecting cues signalling potential threat such as fearful expression.

27
Q

What is the monoamine deficiency hypothesis?

A

Depressive symptoms arise from insufficient levels of monoamine neurotransmitters: serotonin (5-HT), norepinephrine, dopamine

27
Q

What are five indirect evidences for depression being caused by 5-HT hypofunction?

A

Anti-hypertensive drugs causes 5-HT depletion and was associated with depression //
Useful antidepressants increase synaptic monoamine concentrations//
Post-mortem lower levels of 5-HT in brainstem of those who commited suicide//
MDD has elevated monoamine oxidase A//
Tryptophan depletion triggers relapse in MDD that has be successfully treated with SSRIs

28
Q

Why is there only indirect evidence that depression occurs from 5-HT hypofunction?

A

Difficult to measure serotonin levels in the brain

28
Q

What is the main way of quantifying receptors in the living human brain?
Aka baseline scan

A

PET Imaging: inject a radioactive tracer which binds to a specific receptor - proportion of binding leads to stronger images on scan

28
Q

How do we quantify the amount of transmitter in the human brain?

A

Second PET scan with radio tracer and amphetamine challenge which stimulates NT release. These competitively bind to receptor instead of tracer leading to a weaker image. Subtracting from the baseline scan shows the amount of NT released.

29
Q

Issues with PET radiotracers

A

5HT antagonists are not sufficiently sensitive to pharmacological challenges

5HT2A agonist works but causes a psychedelic effect

30
Q

Conclusion of radio tracer investigation

A

Reduced 5HT release capacity in people with depression

31
Q

Tryptamine psychedelics

A

Psilocybin - 4/5hr oral, 1hr IV
DMT - 4/5hr oral, 10/20min smoke/IV
LSD - 10/12hr oral, Ihr IV

32
Q

Psychedelic action

A

Act on serotonin system, similar to 5HT2A agonist
Different mechanism to SSRI’s

33
Q

What are the effects of psychedelics?

A

Psychological peaks - spiritual experience, blissful state, deeply positive mood

34
Q

How safe are psychedelics?

A

Non-addictive, low toxicity, good therapeutic index

35
Q

Adverse effects of psychedelics

A

Dysphoria, anxiety, headache, nausea

36
Q

Results of phase 2b trial of psychedelics

A

statistically sig reduction in depression symptoms
rapid onset action
sustained response at wk 12 .: high durability

Psych (9 decks)

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