Mood Disorders Flashcards
Most common psychiatric disorders
Anxiety Disorders
Cause of psychiatric disorders
Mostly gene x environment. Epigenetic effects too.
Structural abnormalities in schizophrenia
Larger ventricular size. Deeper sulci
Synaptic plasticity in mood disorders
Decreased BDNF in hippocampus and PFC in depressed patients. Antidepressants may normalize BDNF levels.
Diagnostic criteria for MDD
>= 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
Screening in the primary care setting
PHQ-9
PHQ-2 (Loss of interest or depressed mood)
MDD epidemiology
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.
Most common age of presentation for MDD
3rd and 7th decades
How long does MDD last?
Untreated? 6-13 months
Treated? 3 months.
Tends to be chronic with relapses.
Consequences of untreated MDD
Suicide (30% attempt, 15% successful)
Divorce
Decreased productivity
Poor hygiene
Psychodynamic theory of depression
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.
Cognitive theory of depression
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
Neurobiological Theory of depression
Monoamine deficiency hypothesis and others. Complicated by the fact that deletions of monoamines in healthy volunteers doesn’t cause depression.
Therapeutic latency
Although antidepressants produce instant changes in monoamine transmission, the therapeutic effect takes 4-6 weeks to reach its maximum.
Theory of glutamate dysfunction in MDD
Chronic stress leads to increased glutamate, which can kill neurons and glia by excitotoxicity. IV ketamine (NMDA antagonist) has rapid antidepressant effect
Depression and the HPA axis
Increased CRF and cortisol. Decreased sensitivity of glucocorticoid receptors and feedback system. No suppression with Dex.
Structural and functional brain changes in MDD. Which decrease, some increase.
Decreased volume and activity of:
ACC, PFC, NAcc
Increased activity of OFC, Amygdala.
What happens to the hippocampus with untreated depression?
Decrease in volume
What do brain changes have to do with depression?
Relative lack of cortical regulation of the limbic system during adversity.
Most prominent feature of cell pathology in depression?
Increases in glial cell density in the neocortex and limbic system
Probably the most important deficit in patients with MDD
Decreased levels of BDNF leading to decreases in synaptic plasticity.
How does antidepressant treatment affect BDNF levels?
Normalizes BDNF levels.
Final common pathway for all effective therapies for MDD?
Enhancement in neural plasticity and cellular resilience
Heritability of depression?
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.
Short vs long allele of serotonin transporter gene
Those with the short allele may be vulnerable to depression under stress
Effectiveness of ECT in depression?
Very effective 80% response.
Diagnostic criteria for Bipolar I Disorder
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.
Mean age of onset for Bipolar I Disorder
18, equal prevalence in men and women.
Heritability of Bipolar Disorder
65%, search for a gene has been fruitless
Protective Factors against suicide
Good clinical care, easy access to interventions
Connectedness to family/community
Cultural and Religious beliefs that discourage suicide
Having children
