MOod Disorders Flashcards
What are features of depressive disorders
Patient usually have the symptoms continually for 2 weeks and consist of at least 2 core symptoms • CORE SYMPTOMS – Low mood – Lack of energy – Lack of enjoyment & interest
- Depressive thoughts
- Somatic symptoms/Biological symptoms
- In severe cases may have psychotic symptoms
What is the difference betwee a normal adjustment reaction and depression
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Desribe personality as a abuse or depressive symptoms
Our personality is defined by:
• How we get on with people, ability to make relationships • Extrovert or introvert
• How empathetic we are
• How anxious and nervous we are; or how confident
• How we can make plans and stick to these plans
• How we respond in stressful circumstances
• Our overriding mood
Some people have a sense of not being happy within themselves, sometimes related to a feeling of emptiness. This does not necessarily mean that they are depressed
What is mania/hypomaia
- Elevated Mood
- Increased energy
- Pressure of speech
- Reduced sleep
- Flight of ideas
- Normal social inhibitions are lost
- Attention cannot be sustained
- Self esteem is inflated, often grandiose • May have psychotic symptoms
- Only require these symptoms for 1 week
Whar is bipolar disorder
No diagnosis of recurrent mania . You dont have to have an episode of depression to be diagnosed with bipolar
• Made following 2 episodes of a mood disorder at least one of which is mania or hypomania.
• Therefore you don’t ever have to have a diagnosis of depression to be given the diagnosis bipolar disorder.
• Bipolar 1 – episodes of mania
• Bipolar 2 – no episodes of mania, only hypomania - no psychotic symptms
What are examples of physical disorders causing mood disorders
There are many illnesses that can cause depressive symptoms including:
• Hormone disturbance such thyroid dysfunction • Vitamin deficiencies such as vitamin B12
• Heart and lung diseases
• Blood vessels not functioning well
• Kidney disease • Liver disease
Describe a link between alcohol/drug misuse and mood disorder
- People drinking too much over a period is a well known cause of developing depressive symptoms
- A number of recreational drugs cause depressive symptoms, especially drugs that initially induce a feeling of happiness and wellbeing such as XTC or amphetamines.
What are brain structures involeved in mood disorders
Limbic system, frontal lobe, basa ganglia
What are the main functions of the limbic symptoms
Emotion, motivation,memory
What are the frontal lobe functions
- Motor function
- Language (Broca’s area)
- Executive functions (purposeful goal directed behaviours) • Attention
- Memory
- Mood
- Social and moral reasoning
What are the basal ganglia unction
• Motor function; malfunction of the basal ganglia are implicated in neurological illnesses such as - Parkinson's disease - Wilson’s disease - Huntington's disease • Psychological function: - Emotion - Cognition - Behaviour
Describe teh circuits connecting these areas of the brain
The main hypothesis is that mood is determent by functional circuits between these brain areas. E.g. the frontal lobe projects to parts of the limbic system which in turn connects to the basal ganglia and the brainstem. This affects:
• Cognitive processed (thoughts) • Sympathetic output
• Parasympathetic output
• Motor systems
Compare with the symptoms of depression
Describe the main neuroteamissites affected in mood disorders
The two main neurotransmitters for depressive disorders are: • Norepinephrine/Noradrenaline
• Serotonin
Other neurotransmitters important in psychiatric conditions include:
• Dopamine (mania and psychosis)
• Acetylcholine
• GABA
• Glutamate
What are the functions of noradrenaline in the brain
Functions in the brain:
• Mood
• Suggests a role in behaviour (arousal and attention)
• Implicated in memory functions
Made in the locus coeruleus in the brainstem and transported to several areas of the cortex
Decribe the receptors of the NA system
- 4 types of receptors: α 1 and 2 and β 1 and 2
- The function of the β receptors in the brain is not very clear as yet • It is likely that α receptors play a role in arousal and mood
- See for a schematic picture of receptors next slide
Describe the evidence for NA in he cause of depression and treatment
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What s the role of 5ht in the brain
The role of serotonin in the brain: • Sleep • Impulse control • Appetite • Mood • Produced in the brain stem (Raphe nuclei) and transported to cortical areas and limbic system • See next slide
Describe 5ht receptors
Complex, there are many different pre and post serotonergic receptors, Sit in the 5ht reuptake receptor, prevent it from going back into pre synaptic neurone
What are the reasons for implicating 5ht in depression
- 5HIAA depletion in CSF (a metabolite of serotonin) in patients with depression
- Tryptophan depletion (precursor for serotonin) causes depression
- PET studies
- SPET studies
- Reserpine (depletes nerve endings from mono amines)
- Anti-depressant: SSRI, TCA, SNRI’s, MAOI
What causes people to become clinically depressed
Predisposing: Genetics, childhood experiences, female gender (for depression, 1:1 for mania)
Perpetuating (maintaining factors): A stressful job, studies, relationship difficulties, substance misuse, financial strain, housing, unemployment
Precipitating factors: Life events often related to losses such as loss of someone you love, loss of health and break up of relationships.
Describe the epidemiology of depression
- In General Practice studies 1 in 20 people suffer with an episode of depression each year
- Peak onset being 30s/40s
- One of the leading causes of disability worldwide
Describe the epidemiology of mania
- Lifetime risk is about 1-3%
- Mean age of onset is 19
- Male:female 1:1
- Monozygotic twin studies show 40-70% concordance rate
What are the predisposing factors for dpereion
- Genetic
* Childhood experiences • Female gender
Wha are evidence for genetic cause for depression
Evidence for a genetic cause comes from:
• Family studies
• Twin studies
• Adoptee studies • Linkage studies • Association
At a rough estimate it thought that about 50% of the vulnerability to become depressed is genetically determent.
Describe linkage an association studies
Probably many different genes play a role to a more or lesser extend. This mechanism is called Quantitative Trait Loci (QTL)
• Linkage studies have not revealed any particular locations as yet
• Association studies: a number of candidate genes are under investigation, such as the serotonin transporter gene
What are childhood experiences causing depression
• Quality of attachment
• Quality of parental relationships • Loss of a parent
• Bullying
(Causation is cumulative)
What are gender factors in mood disorders
In research woman are consistently found to be more likely to suffer from an affective disorder. This could relate to:
• Social and occupational role
- Marriage is protective for man, but not as much for woman
- Child care is stressful and often falls to the woman
- Number of depressive episode relates to the number of
children
• Men are more likely to distract themselves from depressed mood (Less ruminations).
• Woman are more willing then man to admit to being depressed
What are social stressors as a perpetuating cause for mood disorders
- Social economic status
- Unemployment
- Financial hardship
- Isolation from family and friends
What are treatetnoptons for depression
Central to the available treatments is that the function of the brain is restored:
Medication; Direct effect on the biochemistry of the brain.
Social and psychological interventions such as CBT:
Have an measurable effect on the biochemistry of the brain.
What are medications for depression
• Antidepressants – mostly act on Serotonin and Norepinephrine
• E.g. SSRIs – Sertraline, Citalopram, Fluoxetine
• E.g. SNRIs – Venlafaxine, Duloxetine
• E.g. TCAs – around since the 1950s – hit lots of receptors and therefore have lots of side effects
Also use Mood stabilisers e.g. Lithium, Sodium Valproate Some evidence for use of some antipsychotics e.g. Quetiapine
Not a medication – but ECT is also occasionally used and has very good evidence
What are treatments for bipolar disorder
• Avoid Antidepressants
• Use mood stabilisers – Lithium, Sodium Valproate, Carbamazepine,
Lamotrigine
• Avoid Antidepressants
• Use antipsychotics e.g. Quetiapine, Aripiprazole, Olanzapine
• Avoid Antidepressants!!!
