Mood Disorders Flashcards
Features of depressive disorder
Usually symptoms continually for 2 weeks
Core symptoms: low mood, lack of energy, lack of enjoyment & interest
Depressive thoughts
Somatic symptoms/ biological symptoms (not drinking/ eating)
May have psychotic symptoms
What is bipolar affective disorder?
Diagnosis after 2 episodes of a mood disorder, at least one of mania or hypomania
You don’t have to have a diagnosis of depression
Manic episodes tend 2-3months
Depressive longer
May be rapid cycling
Difference between bipolar 1 & 2
1 discrete episodes mania only or mania & depression
2 - discrete episodes of hypomania only or hypomania & depression
What does euthymic mean?
Normal/ stable mood
Physical health differentials for depression
Hormone disturbance e.g. thyroid dysfunction
Vitamin deficiencies e.g. VB12
Chronic disease e.g. renal, CVS & liver failure
Anaemia
Substance misuse
Hypoactive delirium
Physical health differentials for mania
Iatrogenic e.g. steroid use Hyperthyroidism Delirium Infection Head injury Intoxication stimulants
3 main brain structures involved in mood disorders
Limbic system
Frontal lobe
Basal ganglia
Main hypothesis for how mood is determined
Functional circuits between brain areas (limbic system, frontal lobe, basal ganglia)
Affects: Cognitive processes Sympathetic output Parasympathetic output Motor systems
Main functions of limbic system
Emotion
Motivation
Memory
Structures in the limbic system
Slide 15
Limbic system changes in unipolar depression vs bipolar affective disorder
Unipolar: decreased hippocampus volume (recurrent)
Decreased cerebral blood flow & metabolism in amygdala
Bipolar:
Altered amygdala volume
Increased amygdala activation & volume in mania
Decreases in volume in anterior Paralimbic cortices (inc ventral prefrontal cortex, insular cortex & temporopolar cortex) & activation
Frontal lobe functions
Forms 2/3 of cortex
Motor function Language - Broca’s Executive functions Attention Memory Mood Social/ moral reasoning
Ventromedial prefrontal cortex vs orbital prefrontal cortex functions
Ventromedial - generation emotions
Orbital - emotional responses
Frontal lobe changes in mood disorders
Unipolar: decreases blood flow in dorsolateral PFC
Decreased volume of orbitofrontal PFC
Bipolar:
Reduced dorsolateral PFC activation
Structures in the basal ganglia
See slide 23
Basal ganglia functions and implications in which diseases?
Motor function, malfunction of basal ganglia implicated in: Parkinson’s, Wilson’s, Huntington’s
Psychological function: emotion, cognition, behaviour
Basal ganglia changes in mood disorders
Unipolar:
Decreased volume
Reduced activation between striatum, amygdala & PfC
Bipolar:
Possible functional changes striatum
Two main neurotransmitters for depressive disorders where are they produced and functions
Serotonin - produces brain stem (Raphe nuclei) -> cortical areas + LS - sleep/ impulse control/ appetite/ mood
Noradrenaline - produced locus coeruleus (pons) & projects to limbic system + cortex - mood/ arrows always/ attention/ memory
Both monoamines
Evidence serotonin low depression
SSRIs work
5HIAA - Metabolite low CSF
Tryptophan precursor depletion causes depression
Evidence NA decreased in depression
SNrIs work
Patients recovered show decreased NA higher rates relapse
Post-mortem depressed lower
Treatment depression
SSRIs, SNRIs, TCas
Life threatening: electric convulsant therapy
Psychological - CBT
Social - help with isolation/ social stressors e.g. housing, finance
Treatment of mania
First line - antipsychotics
Or mood stabiliser
Longer term - psychoeductaion e.g. BPAD, triggers & relapse signs
Social - in place safety, implications to consider e.g. debts
Treatment bipolar depression
Can use antidepressant + mood stabiliser (so don’t become manic)
ECT
Lithium MS
Sodium valproate MS (anticonvulsant)
Antipsychotic - Quetiapine
CBT
Psychoeducation
Social - isolation, social stressors, housing, finance, family, employment
