Mood Disorders Flashcards
Prevalence on bipolar and depression
Bipolar I- m=f
Bipolar II-and MDD f>m
Increasing rate of MDD at early age of onset, lifetime rate is 10-20%
DSM 5 for depressive episode
Occurrence of 2 weeks or more of depressed mold and presence of 4/8 of following
Sleep alteration
Appetite alteration
Diminished interest or anhedonia
Decreased concentration
Low energy
Guilt
Psychomotor changes
Suicidal thoughts
MDD
If no manic or hypo manic episode in last identified then diagnose MDD
Subtypes
Atypical features eg jncrease sleep and appetite along with heightened mood
Melancholic features along with marked psychomotor retardation and anhedonia and no mood reactivity
Psychotic features
Depression triads
Core symptoms-low mood,anergia,anhedonia
Psychological symptoms-the world,oneself,the future
Biological symptoms-sleep,appetite,libido
Cycle of low mood
What’s the point
Feel low flat and irritable
Exhaustion
Lie in bed all day
Cycle of high mood
I’m the best I can DI anything
Elation and excitement
Physiological symptoms cause increased energy and race sensation
Impulsive behavior and increased activity
Mania
Euphoric or irritable mood with 3/7
Decreased need for sleep
Distractibilitu
Grandiosity
Flight of ides or racing thoughts
Increased talkativeness or pressured speech
Increased goal directed activity or psychomotor agitation
Impulsive behavior
If present for minimum 1 week with functional impairment a manic episode diagnosed (type I bipolar disorder)
If present for minimum 4 days wihout notable functional impairment a hypomanic episode discovered
If not a single manic episode has occurred but only hypomanic with one major depressive episode then type II diagnosed
Unspecified bipolar disorder
If manic episodes occur for less than 4 days and no other specific threshold met rhen hypomanic
When can’t hypomania be diagnosed
If psychotic features are present
If a patient is hospitalized it’s manic
Long term status of bipolar disorder
Majority of time symptoms free
Then depressive symptoms
Manic/hypomanic
Cycling/mixed symptoms
Bipolar vs unipolar disorders differences
Bipolar illness had an early age of onset (mean age of about 19 years vs about the late 20s for unipolar depression)
Shorter depressive episodes (in average 3m or less in bipolar vs in average 6-12m in unipolar).
Recurrent course (more frequent episodes in bipolar than unipolar illness, with rapid cycling, defined as four or more episodes yearly happening in about 25% of bipolar illness cases, but in <1% of unipolar depression cases).
Genetic specificity (manic episodes were found in families of persons with manic episodes, but not in families of persons with unipolar depression).
Differential treatment (antidepressants for unipolar depression vs neuroleptics and lithium for mania)
Bipolar and unipolar similarities
MDD is commonly diagnosed in children, far below the mean onset of the late 20s.
Brief depressive episodes that occur multiple times yearly are diagnosed in patients with MDD commonly, whereas such course of illness should be rare if MDD was a different illness than bipolar disorder.
Genetic studies have found high rates of depressive episodes, without mania, in persons with bipolar illness, and also frequent occurrence of bipolar illness in relatives of those with unipolar depression.
Treatment now overlaps considerably, with neuroleptic agents proven effective not only for mania, but also for depression, both in bipolar and unipolar types.
Lithium has been well known to be effective not only for mania, but also for depression, both in bipolar and unipolar types.
Basic pharmacology of tryptamine psychedelics
Psilocin/psilocybin oral 4-5 hours and IV 1 hour
DMT/ayahuasca oral 4-5 hours and smoke or Iv 10-20 mins
LSD oral 10-12 hours and IV 1 hours
Psychedelic
Safety-non addictive low physiological and bracing toxicity ,good therapeutic index
Risks-dysphoria anxiety nausea headache hidden vs false memories
Safety weell established
Monoamine deficiency hypothesis
Depressive syndromes arise from insufficient levels of monoamine neurotransmitters seratonin norepinephrine or dopamine
Indirect evidence for 5HT hypo function in depression
5-HT depletion by the antihypertensive drug reserpine could cause depression.
Clinically useful antidepressants all increase synaptic monoamine (some selectively 5-HT) concentrations.
Post-mortem evidence of reduced 5-HT levels in brainstem of individuals who committed suicide
Lower levels of 5-HT1A-receptors
Monoamine oxidase A increases in MDD
Blockade of serotonin synthesis by the tryptophan hydroxylase inhibitor p-chlorophenylalanine prevents the antidepressant effects of both MAOIs and TCAs (Shopsin 1975 & 1976)
Tryptophan depletion ( brain serotonin) triggers relapse in MDD successfully treated with SSRIs (Delgado 1999) or cognitive behavioural therapy (CBT) (Smith 1997).
Monoamine depletion correlates with mood both in at risk and MDD in remission (Ruhe 2007) .
Depression-related traits; “pessimism” and “dysfunctional attitudes” in MDD, and traits “negativism” and “neuroticism” in healthy, related to 5-HT2A-receptor increase(? Serotonin decreases).
Measuring neurotransmitter and receptors
PET imaging used
Compared to fmri it’s selective but invasive,radioactive and expensive with less optimal temporal and spatial resolution
Use pet to do baseline scan
Inject radioactive tracer which binds to receptors and quantifies how many receptors we have
Then give amphetamine which competes with substrate and repeat scan
How do we measure 5HT
New method using a combination of an agonist radioligand 11C-CIMBI-36 and amphetamine as the pharma challenge works !!!
So now, 5-HT release can be measured in the living human brain
What’s cylcothymia
Cycle between hypo,manic and mild depression
What are majority of first episodes in bipolar I
Depressive symptoms
What else might pt with bipolar face
Anxiety present in 30-70%
When js insight preserved
Preserved in depression and impaired jn mania
Psychedelic (psilocybin)
Decreases depression and depression in BPDII,increase well being,decrease risk of suicidal
Peak experience of psychedelic
Experience unity
Spiritual experience
Blissful state
Insightfullnes
