Mood Disorders Flashcards
Criteria for depressive episode?
DSM-5 criteria
DSM-5 criteria for depressive episode?
2 weeks or more of depressed mood + 4/8 DSM-5 symptoms
DSM-5 symptoms? Depression
-sleep alterations (insomnia or hypersomnia)
-appetite alterations
-anhedonia
-decreased concentration
-decreased energy
-guilt
-psychomotor changes (agitation or retardation)
-suicidal thoughts
Major depressive disorder diagnosis?
If no manic or hypomanic episodes in the past
Depression triads?
Core
Biological
Psychological
Depression core symptoms?
Low mood
Anergia
Anhedonia
Depression biological symptoms?
Sleep
Libido
Appetite
Depression psychological symptoms?
The world
Oneself
The future
Manic episode?
Euphoric or irritable mood with 3 or more of the 7 manic criteria
7 manic criteria?
-decreased need for sleep with increased energy
-distractibility
-grandiosity or inflated self esteem
-flight of ideas or racing thoughts
-increased talkativeness or pressures speech
-increased goal-directed activities or psychomotor agitation
-impulsive behaviour (sexual impulsivity, spending sprees)
Manic episode vs hypomanic episode?
Manic episode - over 1 week, can’t function
Hypomanic episode - over 4 days, can function
Type II bipolar?
Not a single manic episode has ever occurred but only hypomanic episodes
Along with at least one major depressive episode
Unspecified bipolar disorder?
If manic symptoms occur for less than 4 days
Bipolar 1 vs bipolar 2?
Bipolar 1 has more severe amplitudes
More mania
Bipolar two hypomanic
More than 4 cycles per year?
Rapid cycling
Cyclothymia?
Smaller amplitude compared to bipolar 1 or 2
Bipolar vs unipolar?
Bipolar:
-lower age of onset
-shorter episodes
-more frequent episodes
-genetic specificity
-differential treatments
compared to unipolar depression
Differential treatment for bipolar vs unipolar?
Unipolar - antidepressants
Bipolar - neuroleptics and lithium for mania
Insight in depression vs mania?
Depression - insight is preserved
Mania - insight is impaired
Attention bias in depression?
Difficulty disengaging attention from negative material
more typical of anxiety
Memory biases in depression?
Preferential recall of negative compared to positive material
Perceptual biases in depression?
Recognised negative faces more than positive faces
Amygdala dysfunction in depression?
A bias towards detecting cues signalling potential threats, like expressions of fear
Monoamine deficiency hypothesis?
Insufficient levels of monoamine neurotransmitters can cause depressive symptoms
Monoamine neurotransmitters?
-serotonin (5-hydroxytryptamine/5-HT)
-norepinephrine
-dopamine
How to measure monoamine receptors and transmitters levels?
PET imaging and radiotracer
Monoamine scan method?
Measure levels of tracer left in brain (using PET scan) before and after challenge
challenge (e.g. amphetamine) - will cause spike in serotonin which will replace tracer. Higher serotonin = less tracer left
Tryptamine psychedelics
-psilocin
-DMT
-LSD
serotonin receptor agonist - psychedelics are chemically similar to serotonin
Psychedelic risks and benefits?
Benefits - non addictive, low physiological and brain toxicity, good therapeutic index
Risks - dysphoria, anxiety, nausea, headache
Depression cognition?
Can cause pseudodementia
Bipolar antidepressants effect?
Could flip into manic episode
Differential personality disorders? (DSM-5)
Cluster A - paranoid, schizoid, schizotypal
Cluster B - antisocial, borderline, histrionic, narcissistic
Cluster C - avoidant, dependent, obsessive-compulsive personality disorder
Bipolar affective disorder symptoms? BPAD
Episodic
Runs in family
Grandiosity
Mood states typically less affected by environment
Borderline personality disorder symptoms? BPD
-mood changes over course of hours/days (rather than days/weeks in BPAD)
-poor self image
-fear of abandonment
-feelings of emptiness
-Hx of self-harm
-Hx of trauma/disrupted attachment
BPAD and BPD shared symptoms?
-rapid mood changes
-unstable interpersonal relationships
-impulsive sexual behaviour
-suicidality
BPAD and schizophrenia shared symptoms?
Both can present with psychosis and mood symptoms (depression and mania)
typically schizophrenia is more prominent disorganisation of thought, paranoid delusional beliefs and auditory hallucinations
BPAD and ADHD shared symptoms?
-hyperactivity
-impulsivity
-impaired concentration
-impairment of executive function
-abnormal working and short term memory
Possible organic causes of mood disorder?
Endocrine
Systemic
Deficiencies
Neurological
Medications
Other organic causes of mood disorders?
Vascular depression (associated with white matter hyperintensities)
Poststroke depression (lesions in left frontal lobe or basal ganglia)
Medications that can cause mood disorders?
Beta-blockers
Steroids
Anti-Parkinson’s
Some ABx (ciprofloxacin)
Statins
Oestrogen
Opiates
Acne medications
Cluster A personality disorders?
Paranoid, schizoid, schizotypal
Cluster B personality disorders?
Antisocial, borderline, histrionic, narcissistic
Cluster C personality disorders?
Avoidant, dependent, obsessive-compulsive personality disorder
