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Brain and behavior > Mood Disorders > Flashcards

Mood Disorders Flashcards

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1
Q

Most common psychiatric disorders

A

Anxiety Disorders

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2
Q

Cause of psychiatric disorders

A

Mostly gene x environment. Epigenetic effects too.

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3
Q

Structural abnormalities in schizophrenia

A

Larger ventricular size. Deeper sulci

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4
Q

Synaptic plasticity in mood disorders

A

Decreased BDNF in hippocampus and PFC in depressed patients. Antidepressants may normalize BDNF levels.

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5
Q

Diagnostic criteria for MDD

A 
>= 5 symptoms must be present for >= 2 weeks
Sad mood and/or anhedonia
Sleep disturbance
Interest
Guilt
Energy (lack)
Concentration 
Appetite
Psychomotor agitation/retardation
Suicidal Ideation
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6
Q

Screening in the primary care setting

A

PHQ-9

PHQ-2 (Loss of interest or depressed mood)

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7
Q

MDD epidemiology

A

1/4 women, 1/8 men. Prepubertal depression is roughtly the same in boys/girls. 2nd leading cause of burden of disease in the world.

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8
Q

Most common age of presentation for MDD

A

3rd and 7th decades

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9
Q

How long does MDD last?

A

Untreated? 6-13 months
Treated? 3 months.
Tends to be chronic with relapses.

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10
Q

Consequences of untreated MDD

A

Suicide (30% attempt, 15% successful)
Divorce
Decreased productivity
Poor hygiene

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11
Q

Psychodynamic theory of depression

A

Disturbances in infant-mother relationship during the oral phase. Damaged self-esteem and unresolved conflict from real or imagined object loss. Anger towards lost object turned inward.

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12
Q

Cognitive theory of depression

A

Aaron Beck said that depression results from specific cognitive distortions: Negative views of the self, negative views of the environment, negative views of the future

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13
Q

Neurobiological Theory of depression

A

Monoamine deficiency hypothesis and others. Complicated by the fact that deletions of monoamines in healthy volunteers doesn’t cause depression.

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14
Q

Therapeutic latency

A

Although antidepressants produce instant changes in monoamine transmission, the therapeutic effect takes 4-6 weeks to reach its maximum.

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15
Q

Theory of glutamate dysfunction in MDD

A

Chronic stress leads to increased glutamate, which can kill neurons and glia by excitotoxicity. IV ketamine (NMDA antagonist) has rapid antidepressant effect

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16
Q

Depression and the HPA axis

A

Increased CRF and cortisol. Decreased sensitivity of glucocorticoid receptors and feedback system. No suppression with Dex.

17
Q

Structural and functional brain changes in MDD. Which decrease, some increase.

A

Decreased volume and activity of:
ACC, PFC, NAcc

Increased activity of OFC, Amygdala.

18
Q

What happens to the hippocampus with untreated depression?

A

Decrease in volume

19
Q

What do brain changes have to do with depression?

A

Relative lack of cortical regulation of the limbic system during adversity.

20
Q

Most prominent feature of cell pathology in depression?

A

Increases in glial cell density in the neocortex and limbic system

21
Q

Probably the most important deficit in patients with MDD

A

Decreased levels of BDNF leading to decreases in synaptic plasticity.

22
Q

How does antidepressant treatment affect BDNF levels?

A

Normalizes BDNF levels.

23
Q

Final common pathway for all effective therapies for MDD?

A

Enhancement in neural plasticity and cellular resilience

24
Q

Heritability of depression?

A

37%, but there’s not single depression gene. Epigenetics may play a role. Rate in families of affected people is about 1.5-3x higher.

25
Q

Short vs long allele of serotonin transporter gene

A

Those with the short allele may be vulnerable to depression under stress

26
Q

Effectiveness of ECT in depression?

A

Very effective 80% response.

27
Q

Diagnostic criteria for Bipolar I Disorder

A

At least 1 week of abnormally elevated, expansive, or irritable mood, plus 3 or more of the following:

Inflated self-esteem/grandiosity
Decreased need for sleep
Talkativeness
Flight of ideas/racing thoughts
Distractibility, increased goal-directed activity
Excessive involvement in pleasurable activities and high risk taking.

28
Q

Mean age of onset for Bipolar I Disorder

A

18, equal prevalence in men and women.

29
Q

Heritability of Bipolar Disorder

A

65%, search for a gene has been fruitless

30
Q

Protective Factors against suicide

A

Good clinical care, easy access to interventions
Connectedness to family/community
Cultural and Religious beliefs that discourage suicide
Having children

Brain and behavior (55 decks)

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