Mood Disorders Flashcards

1
Q

Three core symptoms of depressive disorders

What other features may they have?

A
  • Low mood
  • Lack of energy
  • Lack of enjoyment + interest
    .
  • depressive thoughts
  • lack of appetite + weight loss
  • sleep disturbance - early morning wakening
  • psychotic symptoms
  • low self esteem, guilt, blame
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2
Q

Compare normal adjustment reaction + clinical depression:
- onset + duration of symptoms
- energy
- sleep disturbance
- appetite
- emotions

A

Adjustment reaction:
- symptoms develop suddenly after event
- symptoms fluctuate
- energy not low
- no particular sleep disturbance
- reduced or increaed appetite
- feelings of anger + frustration
.
Depression:
- symptoms develop gradually
- symptoms continuous
- lack of interest
- low energy
- sleep disturbance
- loss of appetite + weight loss
- low self esteem
- feelings of guilt + blame

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3
Q

Features of mania

A
  • elated mood
  • increased energy
  • pressure of speech
  • decreased need for sleep
  • flight of ideas
  • normal social inhibitions are lost
  • attention not sustained
  • self esteem is inflated
  • psychotic symptoms
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4
Q

Compare bipolar 1 + 2

A
  • bipolar 1: discrete episodes of mania only or mania + depression
  • bipolar 2: discrete episodes of hypomania or hypomanina + depression
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5
Q

Diagnosis of bipolar affective disorder

A

Diagnosis made following 2 episodes of a mood disorder at least one of which is mania or hypomaia

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6
Q

What is hypomania?

A

Condition in which you display a revved up energy or activity level
Low level mania

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7
Q

Physical health differentials of depression

A
  • Hypothyroidism
  • vitamin deficiencies e.g. B12
  • anaemia
  • substance misuse
  • hypoactive delirium
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8
Q

Physical health differentials of mania

A
  • iatrogenic e.g. steroid induced
  • hyperthyroidism
  • delirium
  • infection e.g. HIV, syphilis
  • head injury
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9
Q

What parts of the brain are involved in mood disorders?

A

Limbic system
Frontal lobe
Basal ganglia

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10
Q

Functions of limbic system

A

Emotion
Motivation
Memory

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11
Q

Diagnosis of depression

A

Symptoms continually for at least 2 weeks:
At least one core symptoms:
- low mood
- lack of energy
- lack of enjoyment + interest
.
5/9 other symptoms:
- fatigue/loss of energy
- worthlessness
- recurrent thoughts of suicide
- diminished ability to think/concentrate
- psychomotor agitation
- insomnia
- appetite/weight loss

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12
Q

What is early morning waking?

A

Waking up a lot earlier than normal
Often due to stress

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13
Q

Outline the 3 possible circuits involved in production symptoms for mood disorders

A
  • prefrontal cortex: slowing of thought, executive dysfunction + altered emotional processing
  • amgydala: abnormal emotional processing
  • basal ganglia: impaired incentive behaviour + psychomotor changes
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14
Q

Diagnosis of mania

A

Symptoms present for at least a week

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15
Q

Parts of the prefrontal cortex + function

A
  • ventromedial prefrontal cortex involved in generating emotions
  • orbital prefrontal cortex involved in emotional response (connection with amygdala)
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16
Q

What are the two main neurotransmitters for depressive disorders?

A

Serotonin
Noradrenaline

17
Q

What does the monoamine hypothesis suggest?

A

Depressive disorder is due to abnormalities in availability of serotonin + noradrenaline (monoamines)

18
Q

Where is serotonin produced?

A

Raphe nuclei in brainstem

19
Q

What does serotonin have roles in?

A

Sleep
Impulse control (relates to suicide)
Appetite
Mood

20
Q

Evidence to support low serotonin levels in depression

A
  • drugs that increase serotonin in brain treat depression
  • 5HIAA (serotonin metabolite) is low in CSF of patient with depression
  • tryptophan (precursor of serotonin) depletion causes depression
21
Q

Where is noradrenaline produced?

A

Locus coeruleus (pons)

22
Q

Functions of noradrenaline in brain

A
  • mood
  • arousal
  • memory
23
Q

Evidence to support low noradrenaline levels in depression

A
  • antidepressants that increase NA treat depression
  • patients who have recovered from depression but have low NA levels are at high risk of relapse
  • post mortem studies of depressed patients suggests low NA
24
Q

First line treatment of depression

A

Selective serotonin reuptake inhibitors
Cognitive behavioural therapy

25
Q

Treatment of mild depression

A
  • 30 mins exercise 5x week
  • lifestyle advice
26
Q

Treatment of bipolar disorders

A
  • antipsychotics
  • mood stabilisers e.g. lithium
  • patient needs to be kept safe to minimise risks to self + others
  • consider implications of mania e.g. debts
27
Q

Treatment of bipolar depression

A
  • antidepressants with mood stabiliser cover
  • cognitive behavioural therapy
28
Q

Maintaining stability in bipolar disorder

A
  • mood stabilisers e.g. lithium
  • antipsychotics
  • education
  • cognitive behavioural therapy to prevent replace
  • consider effects on employment
  • family support
29
Q

How must antidepressants be given in treatment in bipolar depression?

A

With mood stabiliser cover

30
Q

What is bipolar depression?

A

Bipolar patients between manic episodes