Mood disorders Flashcards
Depression lifetime risk and male:female
About 17 %, 1:2
Mood disorder course is generally…
Relapsing and remitting
Bipolar affective disorder lifetime risk and male:female
About 3%, 1:1
BPAD and depression genetic link
Depressed relatives => increased risk depression
Bipolar relatives => increased risk bipolar AND depression
Childhood experiences associated with later depression
Early childhood abuse
Relentless criticism
Parental loss
Perceived lack of affectio
Vulnerability factors for depression in adults
Unemployment Lack of confiding relationship Lower socioeconomic status Social isolation Women - at home with 3+ children
These decrease resilience to adverse situations.
Life events related to depression
Death of spouse, divorce, separation, jail, death or relative
Risk of depression increases 6 fold in 6 months following events
Life events precipitating mania
Can be negative or positive
Triggers get less important over time
Manic episodes can be triggered by…
Puerperium
Sleep deprivation
Flying across time zones
Physical illnesses which directly cause depression …
Cushiness syndrome Hypothyroidism Stroke Parkinson's disease Multiple Sclerosis Hyperparathyroidism
Pharmacological causes of depression
Beta-blockers
Anti hypertensives
Stimulants (eg cocaine)
Physical causes of mania
Cushing’s syndrome
Head injury
Multiple sclerosis
Steroids, antidepressants, stumulant
Learned helplessness model of depression
Seligman’s studies
Dogs given unavoidable electric shocks gave up trying to escape
Even when conditions were changed
Depressed people ‘learn’ they can’t change their situation
Psychoanalytical theories of depression
Early experience and relationships determine risk
Mental states as ‘internal drama’
Monoamine theory of depression - deficiency in…
Noradrenaline
Serotonin (5-HT)
Dopamine
Noradrenaline affects
Mood and energy
Serotonin affects
Sleep, appetite, energy, mood
Dopamine affects
Psychomotor activity
Findings in depression (monoamines)
Decreased plasma tryptophan (5-HT precursor)
Decreased CSF 5-HIAA (5-HT metabolite) in suicide victims
Decreased CSF dopamine metabolite
Suggesting monoamines deficiency in depression
Reserpine…
Depletes monoamines
Can cause depression
Mania and monoamines
May be related to dopamine overactivity
Amphetamine, cocaine increase DA, can induce mania
Antipsychotics - DAr antagonists - can treat mani
Cortisol and mental health
May mediate between stressful life events and biological changes in depression
? Via damaging hippocampal neurons?
Failure of cortisol suppression in depression, mania, schizophrenia, old age
Diagnosis of depression
Two core symptoms
Two weeks
Core symptoms of depression
Low mood
Anergia
Anhedonia
Cognitive symptoms of depression
Worthless, useless, guilty, hopeless, pessimistic, poor concentration, memory impairment can resemble dementia
Biological symptoms depression
Initial insomnia Early morning waking Decreased appetite for food and sex Diurnal - worse in morning Psychomotor retardation Physical symptoms = aches, pains
Psychotic symptoms
Very severe depression
Auditory hallucinations - degoratory voices
Rare visual hallucinations eg evil spirits
Nihilistic delusions
Persecutory delusions ‘deserve’ persecution/punishment
Depression grading
Mild, moderate, severe, severe with psychotic symptoms
Seasonal Affective Disorder
Low mood in winter
Often reversed biological symptoms
Overeating, oversleeping
Atypical depression
Reversed biological symptoms
May retain mood reactivity
Agitated depression
Depression with psychomotor agitation, not retardation
Restlessness, pacing
Depressive stupor
Psychomotor retardation so profound that become, mute. No eating, drinking, moving
DD - Physical causes (depression)
Hypothyroidism, head injury, cancer, ‘quiet’ delirium
DD - Adjustment disorder
Mild affective symptoms following life event
Not enough to diagnose depression
DD - bereavement
Normal response to loss
Abnormal if v.intense, prolonged (>6 months) or delayed
Substance misuse and depression
Alcohol / drugs may be a form of self medication or cause depression
Dementia - differential
Dementia can begin with affective changes
Or - depression can effect memory = pseudo-dementia
Investigations - depression
Collateral history
Physical examination
Blood tests - TFT, FBC, HbA1c (diabetes and anaemia cause fatigue)
CT / MRI NOT routine, use if suspected head injury
Rating scales for monitoring
Psychological treatment in depression
First step to treat mild depression
Ideally involved in moderate and severe also
CBT, psychodynamic therapy, interpersonal therapy
Cognitive Behavioural Therapy
Help patient notice negative automatic thoughts (NATs)
Which result in poor mood/behaviour
Thought, mood, behaviour are mutually reinforcing
Target thoughts and behaviour, so knock on effect on mood
CBT in depression
Worthlessness belief effects behaviour and mood eg withdrawal
Challenge NATs, expose to positive activities
Made aware of common thinking errors
Build more realistic belief set
Psychodynamic psychotherapy
Patient transfers beliefs etc onto relationship with therapist
Eg ‘I will be rejected’
Put words to these feelings so pt can recognise and challenge hidden beliefs
Electro convulsive therapy in depression
Acts fast - severe / psychotic depression
Anaesthetised, generalised tonic-clinic seizure
Can be some memory loss
Depression prognosis
About 50% will have another episode
Episodes last 8-9 months
Treatment can decrease this to 2-3 months
Psychotic depression poorer prognosis, ECT helps
Up to 15% with major depression take their own lives
