Mood Disorders Flashcards
What are the features of depressive disorders?
Patient usually have the symptoms continually for 2 weeks and consist of:
Low mood
Lack of energy
Lack of enjoyment and interest (anhedonia)
They must have at least 2 of these three symptoms.
Can go from mild (still at work) to severe (psychotic) - If severe, can be too depressed too not bothered to kill themselves. Sometimes patients could die because they don’t eat / drink
Depressive thoughts
Biological symptoms - lack of appetite, sleep, concentration, libido
Psychotic symptoms
What is an adjustment reaction?
Symptoms develop sudden afte an ‘event’
Symptoms fluctuate
Time limited
Preoccupation with ‘event’
Energy not low
No particular pattern to sleep disturbance
Reduced increased appetite
Feelings of anger and frustration more typical.
How is depression different to adjustment?
Symptoms develop gradually.
Symptoms continuous
Usually at least 2 weeks.
Lack of interest
Low energy
Sleep disturbance with typically EMW
Loss of appetite and weight loss are typical.
Low self esteem and feelings of guilt and blame are typical.
How can our personality be a cause for 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 the difference between mania and hypomania?
Hypomania - at home
Mania - At psychiatric hospital
What are the symptoms of mania / hypomania?
Elevated mood Increased energy Pressure of speech Reduced sleep Flight of ideas Normal inhibitions lost - dangerous Attention cannot to sustained Self esteem is inflated, often grandiose May have psychotic symptoms
Only require these symptoms for a week
What is bipolar disorder?
A diagnosis made following 2 episodes of a mood disorder at least one of which is mania or hypomania.
Therefore, you dont ever have to have a diagnosis of depression to be given the diagnosis of bipolar disorder
What are the two different types of bipolar?
Type 1 - episodes of mania
Type 2 - No mania, only hypomania (no psychotic symptoms)
What physical disorders could cause mood disorders?
Hormone disturbance such thyroid dysfunction Vitamin deficiencies such as vitamin B12 Heart and lung diseases Blood vessels not functioning well Kidney disease Liver disease
How do alcohol and drugs affect mood?
People drinking too much over a period is well known cause of developing depressive symptoms. -Only drink when happy.
A number of recreational drugs cause depressive symptoms, especially drugs that initially induce a feeling happiness and well beoing such as ecstasy or amphetamines.
What brain structures are involved in mood disorders?
Limbic system
Frontal lobe
Basal ganglia
What are the main functions of the limbic system?
Emotion
Motivation
Memory
What are the functions of the frontal lobes?
Motor function Language Executive functions Attention Memory Mood Social and moral reasoning
What are the functions of the basal ganglia?
Emotion
Cognition
Behaviour
What neurotransmitters are involved in psychotic (particularly depressive) disorders?
The two main neurotransmitters for depressive disorders are:
Noradrenaline
Serotonin
Other neurotransmitters important in psychiatric conditions include: Dopamine (mania nd psychosis) Acetylcholine GABA Glutamate
When antidepressants not used?
Mild depression - no evidence
Bipolar disorder - Not work as can make mania worse (if use, make it controlled)
What drugs can be used to treat depression?
Antidepressants: SNRI’s - best TCA - Work on all receptors so bad side effects NARI's SSRIs - normal course of treatment MAOI
Reserpine - not work. It depletes the nerve endings of noradrenaline
What does serotonin do in the brain?
Sleep
Impulse control
Appetite
Mood
Produced in the brainstem and transported to cortical areas in limbic system
How is serotonin implicated in depression?
5HIAA (a serotonin metabolite) depletion in CS in people with depression
Tryptophan (5HT precursor) depletion causes depression
Shown in PET and SPET studies.
What causes people to become clinically depressed?
There are many different causes that can be categorised as follows:
Predisposing: genetics, childhood experiences, female gender
Perpetuating (maintaining factors): 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, los of health and breakup of relationships.
Describe the epidemiology for depression?
1 in 20 people suffer with an episode of depression each each.
Peak onset = 30s/40s
One of the leading cause of disability worldwide.
Despite the epidemiology of mania
Lifetime risk 1-3%
Mean age of onset is 19
Male:Female 1:1
Monozygotic twin show a 40-70% concordance rate.
What factors predispose to depression?
Genetics
Childhood experiences
Family gender
How do we know genes cause depresssion?
Family studies Twin studies Adoptee studies Linkage studies Association
It is thought that about 50% of the vulnerability to become depressed is genetically determent.
How do childhood experiences cause depression?
Quality of attachment
Quality of parental relationships
Loss of a parent
Bullying
Causation is cumulative
Why are women more likely to get depression than men?
Multifactorial
Social and occupational role:
- Marriage is protective for a man but not for a woman
- Childcare is stressful and often falls to the women
- Number of depressive episodes relates to the number of children.
Men are more likely to distract themselves from depressed mood (less ruminations)
Women are more willing than men to admit to being depressed.
Give examples of social stressors that can be a cause of depression
Social economic status
unemployment
Financial hardship
Isolation from family and friends
What are the different forms of treatment?
Medication: direct effect on the biochemistry of the brain
Social and psychological intervention such as CBT: Have a measurable effect on the biochemistry of the brain.
What is amitriptyline?
TCA - dangerous and can kill you if overdose
But, it works so, generally used as second line after SSRIs.
What medications can be used for depression?
Antidepressants:
SSRIs - sertraline, citalopram, fluoxetine
SNRIs - Venlafaxine, duloxetine
TCAs - round since 1950s, lots of side effects as broad action
Also mood stabilisers - Lithium, Sodium Valproate
Antipsychotics - Quetiapine
ECT
Antidepressants for how long after better?
One episode of depression - 6 months -1 year
Two episodes - 1-2years
3 episodes / severe in hospital - 5 years - lifetime
How do you treat bipolar?
NOT ANTIDEPRESSANTS
Use mood stabilisers - Lithium, Sodium Valproate, Carbamazepine, Lamotrigine
Use antipsychotics e.g. Quetiaine, Aripiprazole, Olanzapine
What are the receptors for noradrenaline?
4 types: a 1 and 2 and B 1 and 2
The function of B receptors isn’t clear.
a receptors play a role in arousal and mood.
