Mood disorders Flashcards
what are core symptoms of depression ? how long for ?
how is diagnosis concluded ?
severe cases ?
low mood lack of energy lack of enjoyment and interest 2 wks at least 2 symptoms psychotic symptoms
what is are differences between a normal adjustment reaction and depression ?
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)
what are somatic symptoms of depressions?
lack of libido
lack of apetite = weight loss
lack of sleep
What can be a predisposing factor in triggering depression ?
Genetics
personality
female
childhood experience
what is hypomania ?
a state just below mania
what are symptoms of mania?
how long ?
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
what is bipolar ?
2 episodes of mood disorder at least 1 of which is mania or hypomania . no depressioin can be seen
what is bipolar 1? what is affected ?
episodoes of mania
amygdala- overactive
what is bipolar 2?
no episodes of mania, only hypomania . no psychotic symptoms .
what substances can cause mood disorders ?
Alcohol and drug misuse
what brain structures are involved in mood disorders ?
Limbic system
frontal lobe
basal ganglia
what does the limbic system control ?
Emotions
motivation
Memory
what are frontal lobe functions ?
Motor function Language (Broca’s area) Executive functions (purposeful goal directed behaviours) Attention Memory Mood Social and moral reasoning
what is psychological functions of basal ganglia ?
emotion
cognition
behaviour
what is the main hypothesis of mood determination ?
what else does it determine
circuits between the brain areas- Limbic system
frontal lobe basal ganglia
thoughts, sympathetic output , parasympathetic , motor systems
what are the 2 main neurotransmitters for depression ?
NA
Serotonin
what are the main neurotransmitter for mania ?
Dopamine (psychosis as well)
what other neurotransmitters are seen in mood disorders ?
Anxiety = GABA
Glutamate
ACh
where is NA made and what is its function ?
what type of receptors ?
locus coeruleus in brainstem
mood, arousal and attention and memory function
Alpha 1 / 2 = Arousal and mood
beta 1/2
when should you not use anti-depressants ?
for use of mild depression
what are the main types of anti depressants ?
NARI
Tricyclic
SNRI
what evidence is there for NA causing depression?
AMPT inhibits Tyrosine to L-DOPA and causes depressive symptoms
what is serotonin made and what does it do /Transported ?
Brain stem - raphe nuclei
transported to cortical areas and limbic system
reasons for 5HT causing depression ( name 2)
5HIAA a metabolite is low in CSF
Tryptophan (precursor) depletion seen
SSRIs work
what can be maintaining factors in depression ?
A stressful job, studies,
relationship difficulties, substance misuse, financial strain, housing,
unemployment
what can be precipitating factors in depression ?
Life events often related to losses such as loss
of someone you love, loss of health and break up of relationships.
what is the epidemiology for depression ?
1 in 20 people with episodes each year
Peak onset 30/40s
50% genetically determined
what is the epidemiology for mania ?
how much is genetically linked ?
risk is 1-3%
mean age = 19
male and female
40-70%
what childhood experiences can lead to depression?
Quality of attachment
• Quality of parental relationships
• Loss of a parent
• Bullying
why do women get depressed more often?
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
name some mood stabilisers
lithium and sodium valproate
What is first line in depression ?
SSRIs - less side effects
then SNRIs, then TCA - lots of side effects
how long do SSRIs take to work ? how long should you take it for ?
6 wks till mood elevation
Take meds after getting better (6 months ) and longer if more episodes
side effects of lithium
nephrotoxic , thyroid damage
what is sodium valproate ? what must you be careful of it ?
Anti-epileptic
highly tetragenic
what other treatment options do you take for depression ?
ECT
what medinications should you give / not give for hypo/mania?
Avoid Antidepressants
• Use mood stabilisers – Lithium, Sodium Valproate, Carbamazepine,
Lamotrigine
anti-psychotics
