Mood Disorders Flashcards
What are common depressive signs and symptoms?
Sad mood, anhedonia, loss of appetite and weight, sleep disturbance, psychomotor retardation, agitation, and suicidal ideation
What are common manic signs?
Elevated or expansive mood, inflated self-esteem or grandiosity, decreased need for sleep, increased verbal output or pressured speech, flight of ideas or racing thoughts, distractibility, increase in goal directed activity, and excessive involvement in pleasurable activities that have a high potential for negative consequences
What are general neuroantatomical changes that are associated with mood disorders?
Disturbance of the limbic system and neurochemical changes
What do functional neuroimaging studies in patients with depression show?
Increased activity in ventral limbic regions (cingulate, amygdala, and ventral striatum) that affect the emotional and autonomic symptoms of mood disorders
What are neurobiological substrates of mania and bipolar disorder?
Reductions in brain volume and blood flow in dorsal medial and dorsal lateral prefrontal cortices
Reductions in size of hippocampus
Reductions in caudate/putamen only found in unipolar depression
What are two major theories regarding depression and serotonin?
A deficit of serotonin activity may directly cause depression
A serotonin deficit serves as a major risk factor for depression but is not a direct cause
Describe the relationship between NE and depression.
People w/ depression may have a NE system that does not handle the effects of stress efficiently
People w/ multiple depressive episodes have fewer NE neurons
People w/ low levels of serotonin trigger a drop in NE levels which leads to depression
Describe the relationship between DA and depression.
Low DA levels may explain why those with dep don’t get the same sense of pleasure our of activities
Decreased ligand binding to the DA transporter and increased DA binding potential in caudate and putamen- suggest functional deficiency of synaptic DA
Describe the relationship between GLU and epression
Multiple lines of evidence suggests that GLU and its receptors have an impact on depression and antidepressant activity
Are women or men more like to have mood disorders?
Women are 50% more likely than men
- women are 70% more likely than men to be depressed
- As women age, the transition into menopause can increase the risk for depression
Bipolar disorder is more common in woman than men with a ratio of 3:2
What are some epidemiological stats regarding major depressive disorder (MDD)?
- One of the most common disorders in the US
- Lifetime prevalence- 16.5%
- 30% of cases are severe
- Average age of onset is 32
at are some epidemiological stats regarding bipolar disorder?
- Lifetime prevalence: 3.9%
- Men have earlier age of onset
- Average age of onset is 25
Do more women or men attempt suicide?
More women attempt suicide but more men die from suicide
What are common presentations of depression in men?
- feeling tired, irritable, lost interest in activities, and sleep disturbance
- more likely to abuse alcohol or substances
- frustrated, discouraged, irritiable, and angry
Is depression a normal part of the aging process?
No. most elderly report being satisfied with their lives.
What are depressive signs and symptoms in the elderly?
Physical manifestations are more common
-Older adults often have medical conditions that result in depressive sx (low testosterone, vitamin deficiencies, thyroid problems, dementia, etc.)
Medication side effects can also contribute to depression
Who has the highest suicide rate in the US?
Elderly patients with depression, especially males
Describe the presentation of depression in children.
- Children will often continue to have episodes throughout adulthood and are mote likely to have severe medical/psychiatric illnesses in adulthood
- Young children will report physical illness, avoid school, become attached to parents
- Older children will sulk, develop behavioral problems, become negative/irritable
- Depression co-occurs with anxiety, eating disorders, substance abuse, and increased risk of suicide
What is a “mixed” state in bipiolar disorder?
A mood episode that includes symptoms of both depression and mania.
Do psychotic symptoms occur in bipolar disorder?
They can develop in the context of severe BD.
Describe the difference between Bipolar I, Bipolar II, Bipolar disorder NOS, and Cylclothymic disorder.
Bipolar 1: Manic or mixed episodes that last at least 7 days, depressive episodes of at least 2 weeks (typically)
Bipolar 2: Depressive episodes shifting back and forth with hypomanic episodes
Bipolar disorder, NOS: Person has symptoms but does not meet criteria for bipolar 1 or 2
Cyclothymic: Milder form where person shifts back and froth between hypomania and mild depression for 2 years
What is rapid cycling bipolar disorder?
Person has 4 or more episodes of major depression, mania, hypomania, or mixed symptoms w/in a 1 year period
What medical complications are patients with BD at risk for?
Thyroid disease, migraines, heart disease, diabetes, obesity, and other physical illnesses
What structures are involved in most anxiety disorders?
Cingulate gyrus, prefrontal cortex, and anterior temporal cortices
Describe the network of interacting brain regions in anxiety disorders.
Central nucleus of the amygdala sense and identifies fear and anxiety-laden stimuli and initiates the emotional response
Hypothalamus, pituitary, and adrenal gland respond to heightened sympathetic responses to stressful stimuli
Cingulate and orbitofrontal cortex are responsible for the “feeling” of anxiety
Interconnected frontal cortex is responsibile for control of reactions
How is the insular cortex implicated in anxiety disorders?
Shows hyperactivity in PTSD, social anxiety, and specific phobias
Insula is part of circuit of Papez which is an internal regulation system that controls visceromotor, neuroendocrine, and pulmonary system
It is activated by negative emotions and regulates autonomic nervous system activity
What are two primary responses in anxiety disorders?
- “defense system” making immediate responses to threatening stimuli
- Behavioral inhibition system: suppression of behaviors that can enhance danger
Describe the neural network implicated in OCD.
Increased activity in the basal ganglia (head of caudate especially) as well as anterior cingulate gyrus and orbitofrontal cortex
Compared to a hyperkinetic movement disorder with unwanted thoughts/compulsions instead of movements
What are comorbidites with OCD?
- Present in 50% of those with Tourette’s syndrome
- OCD tendencies are associated w/ Huntington’s disease, Syndenham’s chorea, and other basal ganglia disorders
What are three general areas of brain dysfunction that have been described in PTSD?
Prefrontal corrtex, amygdala, and hippocampus
Amygdala is involved in the formation of fear related memories.
Amygadlocentric model of PTSD: hyperarousal of amygdala, insufficient top down control by medial prefrontal cortex and hippocampus
How is GABA related to anxiety?
Depletion of GABA results in a reduction in the normal inhibitory regulation of emotion and the sympathetic nervous system
How is serotonin related to anxiety disorders?
Decreased activity of serotonin is felt to limit the inhibition of stress response
How is NE related to anxiety disorders?
Increased NE produces physical symptoms if anxiety and is also linked to flashbacks in those with PTSD
What is the corticotropin-releasing hormone?
Acts as a stress hormone and a neurotransmitter and increased levels helps the body mobilize energy for fight or flight
What is generalized anxiety disorder?
Exaggerated sense of worry and tension throughout the day even though there is little reason for it
What is panic disorder?
Sudden attacks of fear or panic accompanied by physical symptoms
In very severe cases agorophobia can develop
What is OCD?
Characterized by persistent, upsetting thoughts and rituals that are maladaptive coping behavior
Most recognize that their behavior is irrational
What is PTSD?
Develops after a traumatic event
Re-experiencing the trauma, avoidance of places that remind them of the event, hyperarousal to stimuli
Symptoms begin w/in 3 months
What is social phobia disorder?
People become overwhelmingly anxious and/or excessively self conscious in everyday social situations
Physical symptoms are present
Anticipatory anxiety occurs before social activities
What is specific phobia disorder?
Intense or irrational fear of a specific object, person, place, or situation that poses little or no threat
What methods should an evaluation of mood or anxiety disorders include?
Comprehensive diagnostic interview
Review of family history for the suspected disorder or other mental illness
Collateral info from relatives or others
Psychological assessment techniques
Regular assessment during the course of treatmetn
What are expectations for neuropsychological assessment in those with mood disorders?
Intelligence: no reduction
Attention: In acute phase exhibit inefficiencies in sustained attention, working mem, processing efficiency, and overall speed of performance
Processing speed: Those w/ dep lack a sense of urgency and have diminished reaction times; anxious pts be similar to dep pts OR attempt to overperform and be impulsive or error-prone
Language: typically normal
Visuospatial: R hemisphere dysfunction associated w/ bipolar illness and OCD
Mem: Mem and learning functions can be impaired d/t difficulty w/ acquisition w/ limited benefit from repetition, deficits in retrieval, sparing in recognition memory
Executive functions: may be compromised in symptomatic pts but normal in fully recovered pts
Sensorimotor; normal
Describe medication treatments for depression/dysthymia.
-Psychotropic meds can take 4-6 weeks before effective
- SSRIS; fluoxetine, sertraline
- SNRIs: venlfaxine and duloxetine
- NE -DA reuptake inhibitors: bupropion; mild psychostimulant effects, increases risk of seizures
- Tricyclics: bad side effect profile, examples are imipramine and notriptyline
- MAOIs: oldest class, less frequently used but effective in atypical depression; should not be used w/ SSRIs d/t risk of serotonin syndrome, e.g., isocarboxazid and phenelzine
- NMDA receptor agonists: new line of treatment but research is limited, e.g., namenda
Is psychotherapy the best option for depression?
- It is the best option for mild to moderate depression
- For more severe depression a combo of meds and psychotherapy is most effective
- CBT and IPT are the most effective types of psychotherapy
Is ECT effective?
Yes, for moderate to severe cases of depression that is refractory to medication and therapy
It is associated with temporary side effects including confusion, disorientation, and mem loss but research has shown fewer adverse cog side effects one year post treatment
What are mood stabalizing medications used for bipolar disorder?
- Lithium: need to monitor blood levels to avoid toxicity
- Depakote or valproic acid: not recommended for females due to side effects associated with increased testosterone
- Others: lamictal, gabapentin, topiramate, and oxcarbazepine
WHat are atypical antipsychotic medications used w/ BD?
-Used to treat symptoms in acute settings and for severe manic episodes or chronic symptom management
-Used in combo with antidepressants
E.g.: Zyprexa or Abilify
Is psychotherapy effective with BD?
Yes, it has been shown to be effective and combination therapy is thought to be best
How are anxiety disorders treated?
Combination therapy is the most effective approach
Medications help to manage the symptoms and severity
What medications are prescribed for anxiety?
- Antidepressants: SSRIs are most commonly used, tricyclics are used occasionally but not for OCD
- Benzodiazepines: prescribed for short periods of time, associated with cognitive slowing and mem loss of chronically used, examples are Ativan and Xanax
- Beta-blockers: used to treat heat conditions but can manage physical symptoms of anxiety (e.g., proranolol)
- Other meds: buspirone is used to treat GAD
Describe considerations when treating children.
- Children present with somatic/behavioral changes
- Few medications are FDA approved in peds
- Many children present with comorbid disorders
What are anxiety disorders specific to children?
- Separation anxiety disorder
- Social phobia
- Overanxious disorder: excessive anxiety, unrealistic worries, and fearfulness not related to a specific object or situation
- OCD: children do not usually have insight and many develp trichotillomania
What are medical conditions in which OCD symptoms are common?
- Tourette syndrome
- PANDAS: a conrtroversial diagnosis involving rapid onset OCD and tics after streptococcal infection
What is pseudodementia?
Depression in older adults that presents with dementia like symptoms but improves with proper treatment of the mood disorder
What are symptom overlaps between depression and dementia?
Depressed mood, agitation, hx of psychiatric disturbance, psychomotor retardation, impaired immediate mem and learning, defective attention, impaired orientation, loss of interest, limitations in self-care
How many women experience postpartum depression after giving birth?
10-15%
What is serotonin syndrome?
Life threatening drug reaction caused by too much serotonin availability or sensitivity
Occurs when two drugs that affect the body’s level of serotonin are taken together at the same time
