Mood disorders Flashcards
What is the leading cause of years-lived-with-disability worldwide?
Mental and substance use disorders
With accurate diagnosis and good compliance what is the antidepressant response rate?
- 50%
- With typical diagnosis and compliance about 25%
How much is life expectancy reduced in men and women with severe and enduring mental illness?
8-15 years for men, 10-18 years for women
What is the current diagnostic classification of a depressive episode (ICD 10)?
- At least 2 of the following; depressed mood, anhedonia, anergia, fatigue, diminished activity
- Plus at least 3 of; reduced concentration, low self-esteem, ideas of guilt, pessimism, reduced appetite, disturbed sleep For at least 2 weeks!
How can severity of depression be quantified?
Beck Depression Inventory, 17-item Hamilton, MADRS
What is the definition of an adequate trial?
- Adequate trial of an antidepressant involves prescription of a specific antidepressant above a specific minimum dose for a minimum of 6 weeks with reasonable certainty the patient took the medication as prescribed
- Number of failed adequate trials determines treatment resistance
There are 5 domains in the RDoC matrix, what are these?
- Negative valence system - fear, anxiety, loss, non-reward
- Positive valence system - reward learning, habits
- Cognitive system - attention, memory, cognitive control
- Social system - attachment, communication, perception self/others
- Arousal/modulatory system - circadian rhythm, sleep/wake cycle
Within each domain of the RDoC matrix there are units of analyses, name some examples of these
Genes, molecules, cells, neural circuits, physiology, behaviour, self-report ratings
What brain structures and pathways are involved in the positive valence system domain?
- Ascending DA systems - mesolimbic/cortical
- Endogenous opiate system (mu opioid receptors)
- Ventral striatum/accumbens
- Amygdala (conditioning/learning)
- Anterior cingulate (attention/conflict)
- Orbitofrontal cortex (rule learning)
What brain structures and pathways are involved in the negative valence system domain?
- Endogenous opioid systems (kappa receptors)
- Ascending serotonin systems NA/CRF/peptide transmitters
- Central nucleus of amygdala
- Ventroanterior and medial hypothalamus
- Periaqueductal gray matter
What are the disordered appetitive functioning features of depression?
- Difficulty finding rewarding stimuli
- Reduced contact with previously rewarding stimuli
- Increased contact with aversive stimuli
- Overall reduction in behaviours - move less, eat less, lose weight, sleep less, less libido
- Low mood
What are the disordered appetitive functioning features of mania?
- Previously neutral stimuli become rewarding
- Increased exploration/overall activity
- Increased appetite for food, activity, sex
- Intolerant of aversion/boredom
- Intolerant of frustration
- Elated mood/irritable
What is the link between cognition and depression?
- Unmedicated patients with depression develop impaired cognitive function (attention, executive function, visuospatial learning and memory)
- Severity of depression correlates with impairment of learning and memory performance
What regions of the brain have been implicated in depression?
- Hippocampus - significant volume reduction
- Amygdala - abnormally increased activity
- Ventral striatum
- Orbitofrontal cortex
- Anterior cingulate
Is it possible to diagnose depression by only using a brain scan?
- Classical significance level (p<0.05) approach not useful in psychiatry
- Solution is a multivariate approach
