Mood Disorders Flashcards
Three core symptoms of depressive disorders
What other features may they have?
- 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
Compare normal adjustment reaction + clinical depression:
- onset + duration of symptoms
- energy
- sleep disturbance
- appetite
- emotions
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
Features of mania
- 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
Compare bipolar 1 + 2
- bipolar 1: discrete episodes of mania only or mania + depression
- bipolar 2: discrete episodes of hypomania or hypomanina + depression
Diagnosis of bipolar affective disorder
Diagnosis made following 2 episodes of a mood disorder at least one of which is mania or hypomaia
What is hypomania?
Condition in which you display a revved up energy or activity level
Low level mania
Physical health differentials of depression
- Hypothyroidism
- vitamin deficiencies e.g. B12
- anaemia
- substance misuse
- hypoactive delirium
Physical health differentials of mania
- iatrogenic e.g. steroid induced
- hyperthyroidism
- delirium
- infection e.g. HIV, syphilis
- head injury
What parts of the brain are involved in mood disorders?
Limbic system
Frontal lobe
Basal ganglia
Functions of limbic system
Emotion
Motivation
Memory
Diagnosis of depression
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
What is early morning waking?
Waking up a lot earlier than normal
Often due to stress
Outline the 3 possible circuits involved in production symptoms for mood disorders
- prefrontal cortex: slowing of thought, executive dysfunction + altered emotional processing
- amgydala: abnormal emotional processing
- basal ganglia: impaired incentive behaviour + psychomotor changes
Diagnosis of mania
Symptoms present for at least a week
Parts of the prefrontal cortex + function
- ventromedial prefrontal cortex involved in generating emotions
- orbital prefrontal cortex involved in emotional response (connection with amygdala)
What are the two main neurotransmitters for depressive disorders?
Serotonin
Noradrenaline
What does the monoamine hypothesis suggest?
Depressive disorder is due to abnormalities in availability of serotonin + noradrenaline (monoamines)
Where is serotonin produced?
Raphe nuclei in brainstem
What does serotonin have roles in?
Sleep
Impulse control (relates to suicide)
Appetite
Mood
Evidence to support low serotonin levels in depression
- 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
Where is noradrenaline produced?
Locus coeruleus (pons)
Functions of noradrenaline in brain
- mood
- arousal
- memory
Evidence to support low noradrenaline levels in depression
- 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
First line treatment of depression
Selective serotonin reuptake inhibitors
Cognitive behavioural therapy
Treatment of mild depression
- 30 mins exercise 5x week
- lifestyle advice
Treatment of bipolar disorders
- 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
Treatment of bipolar depression
- antidepressants with mood stabiliser cover
- cognitive behavioural therapy
Maintaining stability in bipolar disorder
- mood stabilisers e.g. lithium
- antipsychotics
- education
- cognitive behavioural therapy to prevent relapse
- consider effects on employment
- family support
How must antidepressants be given in treatment in bipolar depression?
With mood stabiliser cover
What is bipolar depression?
Bipolar patients between manic episodes
What questionnaire can be used for patients with depression?
Patient healthy Questionnaire 9
PHQ9
What is the PHQ-9 questionnaire?
What is it used for?
- It is a questionnaire used for patients presenting with depression?
- ranking 9 symptoms of depression based on frequency 0-3
- little interest
- feeling down
- trouble sleeping
- fatigued
- poor appetite or overeating
- feeling bad about yourself
- moving or speaking so slowly/quickly so that other people could have notified
- self harm or suicidal thoughts
What are the two ‘depression identification questions’?
- During the last month, have you often been bothered by feeling down, depressed or hopeless?
- During the last month, have you often been bothered by having little interest or pleasure in doing things?
Treatment for less severe depression
If they do not want treatment:
- active monitoring with option to consider treatment
- ensure adequate social support + aware of sources for help e.g. MIND, depression UK
- initial review: 2-4 weeks
.
If they want to consider treatment:
- offer guided self help first line
- SSRI first line
- CBT, group exercise, group mindfulness, medication + counselling
Treatment for more severe depression
Match treatment to their clinical needs and wishes
- SSRI first line is anti-depressants wanted
- individual CBT
- counselling
- short term psychodynamic psychotherapy
- group exercise
