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Clinical Neuroscience > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

What are the features of depressive disorders?

A

Patient has symtpoms continually for 2 weeks consisting of:

  • Core symptoms
  • Depressive Thoughts
  • Somatic Symptoms/ Biological symptoms
  • Psychotic symptoms in severe cases
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2
Q

What are the core symptoms of depressive disorders?

A
  • Low mood
  • Lack of energy
  • Lack of enjoyment and interest in things they would usually enjoy
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3
Q

What are some of the somatic symptoms of depressive disorder?

A
  • Not sleeping
  • Lack of appetite → weight loss
  • Stop drinking fluids → dehydration → electrolyte imbalances
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4
Q

How does depression differ from an adjustment reaction (i.e. adjusting to a normal life event)?

A
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5
Q

List some of the features of mania

A
  • Elated mood
  • Increased energy (psychoagitation)
  • Pressure of speech
  • Decreased need for sleep
  • Flight of ideas
  • Normal social inhibition is lost (flirtatious, driving quick, playing loud music)
  • Attention cannot be sustained
  • Inflated self esteem, often grandiose
  • May have psychotic symptoms
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6
Q

How is a diagnoses of bipolar affective disorder made?

A

Diagnoses made following 2 episodes of a mood disorder, at least one of which is mania or hypomania

(do not need to have had a depressive episode)

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7
Q

What is the difference between Bipolar 1 and Bipolar 2?

A

Bipolar 1: discrete episodes of only mania or depression

Bipolar 2: discrete episodes of hypomania or hypomania and depression

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8
Q

Describe how symptoms can change in bipolar disorder over time

A

Euthymia = stable, normal mood

Episodes of mania or depression can be years apart or close together if rapid cycling bipolar

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9
Q

What pysical health differentials should you try to rule out if someone presents with depression?

A
  • Hormone disturbances e.g. thyroid dysfunction
  • Vitamin deficiences e.g. Vitamin B12
  • Chronic dieases e.g. renal, CVS and liver failure
  • Anaemias
  • Substance misuse e.g. alcohol, cannabis, stimulants
  • Hypoactive delirium (if particularly elderly)
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10
Q

What pyhsical health differentials should you try to exclude if a patient presents with mania?

A
  • Iatrogenic e.g. steroid induced
  • Hyperthyroidism
  • Delirium
  • Infection e.g. encephalitis, HIV, syphillis
  • Head injury
  • (intoxication with stimulants)
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11
Q

What brain structures are involved in mood disorders?

A
  • Limbic system
  • Frontal lobe
  • Basal ganglia
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12
Q

What are the main functions of the limbic system?

A
  • Emotion
  • Motivation
  • Memory
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13
Q

What are some of the possible changes that happen to the limbic system in mood disorders

A
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14
Q

What are the functions of the frontal lobe?

A
  • Motor function
  • Language (Broca’s area)
  • Executive functions (planning, purposeful goal directed behaviours)
  • Attention
  • Memory
  • Mood
  • Social and moral reasoning
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15
Q

What is the prefrontal cortex’s involvement in emotion?

A
  • Ventromedial prefrontal cortex- thought to be involved in generation of emtion
  • Orbital prefrontal cortex - involved in emotional responses
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16
Q

What are some of the possible changes to the frontal lobe in mood disorder?

A
17
Q

What is the function of the basal ganglia?

A
  • Motor function
  • Psychological funtion
    • Emotion
    • Cognition
    • Behaviour
18
Q

What are some of the possible changes to the basal ganglia that occur in mood disorder?

A
19
Q

Which 2 main neurotransmitters are involved in depressive disorders

A
  • Serotonin (5-HT)
  • Noradrenaline

Both are monoamines

Monoamine hypothesis suggests depressive disorder is due to abnormality of these neurotransmitters

20
Q

Where is serotonin produced and what does it play a role in?

A

Produced in the brain stem (Raphe Nuclei) and transported to the cortical areas and limbic system

Has roles in:

  • Sleep
  • Impulse control
  • Appetite
  • Mood
21
Q

What change happens to Serotonin in depression.

What evidence is there to support this?

A

Serotonin thought to be low in depression

Evidence:

  • SSRI, SNRI, TCA and MOAi all successfully treat depression by increasing levels of serotonin in the synaptic cleft
  • 5HIAA (serotonin metabolite) is low in the CSF of patients with depression (particularly those who attempted suicide)
  • Tryptophan (serotonin precursor) depletion causes depression
22
Q

Where is noradrenaline produced and what is its function in the brain?

A

Produced in the locus coeruleus (pons) and projects to the limbic system and cortex

Functions in the brain:

  • Mood
  • Suggested role in behaviour (arousal and attention)
  • Implicated in memory functions
23
Q

What is the involvement of noradrenaline in mood disorders and what evidence is there to support this?

A

Noradrenaline is low in depression

Evidence:

  • Antidepressants (e.g. SNRI’s, NARI’s and some TCA’s) that increase NA, successfully treat depression
  • Patients who have recovered from depression but show decreased NA levels have sgnificantly higher relapse rates
  • Postmortem studies of depressed patients shows NA to be low vs controls
24
Q

What is the first line treatment for depression, reccomended by NICE?

A

Cognitive Behaviour Therapy

25
Q

What is the first line biological agent for treating depression?

A

SSRI

(Selective Serotonin Re-uptake Inhibitors)

26
Q

What biological methods can be used to treat depression?

A
  • SSRIs
  • SNRIs
  • TCAs
  • Electro convulsive therapy
27
Q

How do you biologically treat bipolar in an episode of mania?

A

First line: antipsychotics e.g. Dopamine Antagonist

Alternative: mood stabilist e.g. lithium or sodium valporate

28
Q

How do you pyschologically treat bipolar in an episode of mania?

A

Will be difficult to engage with a patient during mania - acutely unlikely to be helpful

Longterm: psychoeducation to help see what the triggers are and watch for signs of relapse

29
Q

How do you socially treat bipolar in an episode of mania?

A

Treat in a place of safety - where risk to themself and others is minimal

Consider the implications of mania .e.g debts (excessive spending)

30
Q

How do you treat depressive episodes in bipolar?

A

Biological: Can use antidepressants (but only with a mood stabiliser as you don’t want to treat depression so much that they become manic) e.g. ECT or lithium

Pyschologically: CBT

Socially: same as for unipolar depression

31
Q

How do you try and maintain a stable state for someone with bipolar?

A

Biologically: Give mood stabilisers (lithium, sodium valporate)

Psychological: Psychoredeucation and CBT

Socially: Consider how employments e.g. shifts work may affect bipolar and make adjustments. Involve family, educate the family

Clinical Neuroscience (18 decks)

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