Mood Disorders

Question 1

Features of depressive disorder

Answer 1

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

Question 2

What is bipolar affective disorder?

Answer 2

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

Question 3

Difference between bipolar 1 & 2

Answer 3

1 discrete episodes mania only or mania & depression

2 - discrete episodes of hypomania only or hypomania & depression

Question 4

What does euthymic mean?

Answer 4

Normal/ stable mood

Question 5

Physical health differentials for depression

Answer 5

Hormone disturbance e.g. thyroid dysfunction

Vitamin deficiencies e.g. VB12

Chronic disease e.g. renal, CVS & liver failure

Anaemia

Substance misuse

Hypoactive delirium

Question 6

Physical health differentials for mania

Answer 6

Iatrogenic e.g. steroid use
Hyperthyroidism
Delirium
Infection 
Head injury
Intoxication stimulants

Question 7

3 main brain structures involved in mood disorders

Answer 7

Limbic system

Frontal lobe

Basal ganglia

Question 8

Main hypothesis for how mood is determined

Answer 8

Functional circuits between brain areas (limbic system, frontal lobe, basal ganglia)

Affects:
Cognitive processes
Sympathetic output
Parasympathetic output
Motor systems

Question 9

Main functions of limbic system

Answer 9

Emotion
Motivation
Memory

Question 10

Structures in the limbic system

Answer 10

Slide 15

Question 11

Limbic system changes in unipolar depression vs bipolar affective disorder

Answer 11

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

Question 12

Frontal lobe functions

Answer 12

Forms 2/3 of cortex

Motor function 
Language - Broca’s
Executive functions 
Attention
Memory
Mood 
Social/ moral reasoning

Question 13

Ventromedial prefrontal cortex vs orbital prefrontal cortex functions

Answer 13

Ventromedial - generation emotions

Orbital - emotional responses

Question 14

Frontal lobe changes in mood disorders

Answer 14

Unipolar: decreases blood flow in dorsolateral PFC

Decreased volume of orbitofrontal PFC

Bipolar:
Reduced dorsolateral PFC activation

Question 15

Structures in the basal ganglia

Answer 15

See slide 23

Question 16

Basal ganglia functions and implications in which diseases?

Answer 16

Motor function, malfunction of basal ganglia implicated in: Parkinson’s, Wilson’s, Huntington’s

Psychological function: emotion, cognition, behaviour

Question 17

Basal ganglia changes in mood disorders

Answer 17

Unipolar:
Decreased volume

Reduced activation between striatum, amygdala & PfC

Bipolar:
Possible functional changes striatum

Question 18

Two main neurotransmitters for depressive disorders where are they produced and functions

Answer 18

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

Question 19

Evidence serotonin low depression

Answer 19

SSRIs work

5HIAA - Metabolite low CSF

Tryptophan precursor depletion causes depression

Question 20

Evidence NA decreased in depression

Answer 20

SNrIs work

Patients recovered show decreased NA higher rates relapse

Post-mortem depressed lower

Question 21

Treatment depression

Answer 21

SSRIs, SNRIs, TCas

Life threatening: electric convulsant therapy

Psychological - CBT

Social - help with isolation/ social stressors e.g. housing, finance

Question 22

Treatment of mania

Answer 22

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

Question 23

Treatment bipolar depression

Answer 23

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