Mood disorders Flashcards
Most common psychiatric illness
anxiety disorders
Which is more heritable, bipolar disorder or unipolar depression?
bipolar disorder (risk increased 10 fold over gen population if one parent affected)
Neurons in paraventricular nucleus of hypothalamus secrete what
corticotropin releasing factor
CRF release from hypothalamus does what?
activates synthesis/relesase of adrenocorticotropin (ACTH) from anterior pituitary
Synthesis and release of ACTH leads to
activation of adrenal cortex to release glucocorticoids
sustained glucocorticoid elevation leads to what?
damage hippocampal neurons. May involve reduction in dendritic branching and loss of dendritic spines, where neurons receive their glutamatergic synaptic inputs
Diminished inhibitory control of hippocapmus on HPA axons does what?
leads to further increase in circulating glucocorticoid levels –> ultimately may see atrophy of hippocampus in some patients
Depression diagnosis
5+ symptoms persisting for 2 + weeks, are a change from previous function, patient experiences sad mood or anhedonia
SIGECAPS
sleep, interest, guilt, energy, concentration, anhedonia, psychomotor changes, suicidal ideation
Subtypes of depression
atypical, psychotic depression, melancholic, seasonal affective
Atypical depression
mood reactivity, leaden paralysis, reverse neurovegetative symptoms (increased appetite, weight gain, hypersomnia)
Psychotic depression
often with auditory halucinations, nihilistic delusions
melancholic depression
mood worse in morning, early morening awakening, anorexia, weight loss, guilt, psychomotor retardation
seasonal affective
mood typically worsens in fall/winter, improves in spring/summer
Lifetime risk of depression recurrence
50% after 1 episode, 60-70% after 2 episodes, 90% after 3+
Bipolar disorder
considered a spectrum, ranging from extreme mood swings to cyclothymia to hypomanias + major depression (bioplar II) to frank manias (bipolar I)
Bipolar symptoms
4 domains–manic mood/behavior, dysphoric mood/behavior, psychosis, cognitive symptoms
manic bipolar symptoms
euphoria, grandiosity, pressured speech, impulsivity, excessive libido, social intrusiveness, recklessness, diminished need for sleep
dysphoric mood/behavior
depression, anxiety, irritability, hostility, violence or suicide
psychosis
delusions/hallucinations
cognitive symptoms
racing thoughts, distractivbility, disorganization, inattentiveness
Bipolar diagnosis
Mania diagnosis –> distinct period of abnormally & persistently elevated, expansive or irritable mood, and persistently increased goal-directed activity or energy, present most of day nearly every day lasting at least 1 week (or any duration if hospital necessary), plus 3 or more symptoms (if euphoric), 4 or more symptoms (if irritable)
DIGFAST
pneumonic of manic symptoms of bipolar disorder
Distractibility, Insomnia, Grandiosity, Flight of ideas, Activity, Speech (pressured, non-stop) and thoughtlessness (no thinking through actions, impulsive and reckless)
Hypomania
same as mania but don’t persist as long (4 days) and do not cause such a degree of social impairment as mania
Bipolar I
only have to have mania for this diagnosis
Bipolar II
hypomania+ major depression
which state are patients mostly in
majority of mood state in depression (3:1 for bipolar 1 and 37:1 for bipolar II)
medical illnesses precipitating mood disorders
Endocrine, Infections, CNS, metabolic
Prescribed tx
amantadine, methyldopa withdrawal, IFN, steroids
Suicide epidemiology
11th leading cause of death, 2nd leading cause in 25-34 year olds
4:1 Male:Female
women attempt 2-3x more often
2nd most inherited mood disorder after autism
Bipolar disorder
