Mood disorders

Question 1

what are core symptoms of depression ? how long for ?
how is diagnosis concluded ?
severe cases ?

Answer 1

low mood 
lack of energy
lack of enjoyment and interest 
2 wks at least 2 symptoms
psychotic symptoms

Question 2

what is are differences between a normal adjustment reaction and depression ?

Answer 2

AR=
Develops suddenly 
fluctuations of symptoms 
Time limited
energy not low
no sleep disturbance 
appetite fluctuates 
feelings of anger and frustration rather than low self esteem (Guilt)

Question 3

what are somatic symptoms of depressions?

Answer 3

lack of libido
lack of apetite = weight loss
lack of sleep

Question 4

What can be a predisposing factor in triggering depression ?

Answer 4

Genetics
personality
female
childhood experience

Question 5

what is hypomania ?

Answer 5

a state just below mania

Question 6

what are symptoms of mania?

how long ?

Answer 6

elevated mood
increased mood 
pressure of speech 
reduced sleep
flight of ideas
normal social inhibitions
attention is short 
self esteem is inflated 
psychotic 
1 wk

Question 7

what is bipolar ?

Answer 7

2 episodes of mood disorder at least 1 of which is mania or hypomania . no depressioin can be seen

Question 8

what is bipolar 1? what is affected ?

Answer 8

episodoes of mania

amygdala- overactive

Question 9

what is bipolar 2?

Answer 9

no episodes of mania, only hypomania . no psychotic symptoms .

Question 10

what substances can cause mood disorders ?

Answer 10

Alcohol and drug misuse

Question 11

what brain structures are involved in mood disorders ?

Answer 11

Limbic system
frontal lobe
basal ganglia

Question 12

what does the limbic system control ?

Answer 12

Emotions
motivation
Memory

Question 13

what are frontal lobe functions ?

Answer 13

Motor function
Language (Broca’s area)
Executive functions (purposeful goal directed behaviours)
Attention
Memory
Mood
Social and moral reasoning

Question 14

what is psychological functions of basal ganglia ?

Answer 14

emotion
cognition
behaviour

Question 15

what is the main hypothesis of mood determination ?

what else does it determine

Answer 15

circuits between the brain areas- Limbic system
frontal lobe basal ganglia

thoughts, sympathetic output , parasympathetic , motor systems

Question 16

what are the 2 main neurotransmitters for depression ?

Answer 16

NA

Serotonin

Question 17

what are the main neurotransmitter for mania ?

Answer 17

Dopamine (psychosis as well)

Question 18

what other neurotransmitters are seen in mood disorders ?

Answer 18

Anxiety = GABA
Glutamate
ACh

Question 19

where is NA made and what is its function ?

what type of receptors ?

Answer 19

locus coeruleus in brainstem
mood, arousal and attention and memory function
Alpha 1 / 2 = Arousal and mood
beta 1/2

Question 20

when should you not use anti-depressants ?

Answer 20

for use of mild depression

Question 21

what are the main types of anti depressants ?

Answer 21

NARI
Tricyclic
SNRI

Question 22

what evidence is there for NA causing depression?

Answer 22

AMPT inhibits Tyrosine to L-DOPA and causes depressive symptoms

Question 23

what is serotonin made and what does it do /Transported ?

Answer 23

Brain stem - raphe nuclei

transported to cortical areas and limbic system

Question 24

reasons for 5HT causing depression ( name 2)

Answer 24

5HIAA a metabolite is low in CSF
Tryptophan (precursor) depletion seen
SSRIs work

Question 25

what can be maintaining factors in depression ?

Answer 25

A stressful job, studies,
relationship difficulties, substance misuse, financial strain, housing,
unemployment

Question 26

what can be precipitating factors in depression ?

Answer 26

Life events often related to losses such as loss

of someone you love, loss of health and break up of relationships.

Question 27

what is the epidemiology for depression ?

Answer 27

1 in 20 people with episodes each year
Peak onset 30/40s
50% genetically determined

Question 28

what is the epidemiology for mania ?

how much is genetically linked ?

Answer 28

risk is 1-3%
mean age = 19
male and female
40-70%

Question 29

what childhood experiences can lead to depression?

Answer 29

Quality of attachment
• Quality of parental relationships
• Loss of a parent
• Bullying

Question 30

why do women get depressed more often?

Answer 30

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

Question 31

name some mood stabilisers

Answer 31

lithium and sodium valproate

Question 32

What is first line in depression ?

Answer 32

SSRIs - less side effects

then SNRIs, then TCA - lots of side effects

Question 33

how long do SSRIs take to work ? how long should you take it for ?

Answer 33

6 wks till mood elevation

Take meds after getting better (6 months ) and longer if more episodes

Question 34

side effects of lithium

Answer 34

nephrotoxic , thyroid damage

Question 35

what is sodium valproate ? what must you be careful of it ?

Answer 35

Anti-epileptic

highly tetragenic

Question 36

what other treatment options do you take for depression ?

Answer 36

ECT

Question 37

what medinications should you give / not give for hypo/mania?

Answer 37

Avoid Antidepressants
• Use mood stabilisers – Lithium, Sodium Valproate, Carbamazepine,
Lamotrigine
anti-psychotics