Mood Disorders Flashcards
Mood disorders are also known as affective disorders.
What are the 2 broad classes of mood disorders?
- Depressive disorders
- Bipolar disorders- Type 1 and 2
State the symptom duration requirement for diagnosing depression/ depressive disorders?
What are 4 types of symptoms?
Must have had symptoms for at least 2 weeks
- Core symptoms
- Depressive thoughts (suicide?)
- Somatic/ biological symptoms
- Psychosis/ Psychotic symptoms e.g delusions (possible in severe cases)
List the 3 core symptoms of Depressive disorders
List 3 somatic/ biological symptoms
- Low mood
- Lack of energy
- Lack of enjoyment and interest
- Lack of appetite
- Lack of pain
- Waking up early/ not sleeping well
Compare clinical depression and a normal adjustment reaction after a traumatic event
Adjustment reaction;
- Symptoms don’t last as long
- Symptoms fluctuate
- Fewer somatic features (no pattern to sleep disturbance, appetite can increase or decrease, feelings of anger and frustration)
Mania is essentially the opposite of depression.
List 6 symptoms
- Elevated mood + energy levels
- Racing thoughts/ flight of ideas
- Decreased need for sleep
- Loss of normal social inhibitions
- Elevated self esteem
- May have psychotic features/ psychosis
What is Hypomania?
A set of symptoms that are clearly manic but don’t reach full diagnostic criteria for Mania
Describe the diagnosis of Bipolar Affective Disorder
- Can diagnose following 2 episodes of a mood disorder, one of which must be Mania/ Hypomania
- Can be diagnosed with Bipolar disorder, without having been diagnosed depression
Bipolar disorder is essentially ‘fluctuations in mood’
Compare Bipolar 1 and Bipolar 2
Bipolar 1: Episodes of Mania/ Mania and Depression
Bipolar 2: Episodes of Hypomania/ Hypomania and Depression
Untreated, how long do typical Manic and Depressive episodes last?
Manic: 3-6 months
Depressive: 6-12 months
List 6 Physical/ non-psychological causes of Mania
- Hyperthyroidism
- Delirium (hyperactive)
- Iatrogenic
- Infection
- Head injury
- Intoxication (stimulants)
List 3 brain structures/ circuits involved in the neurobiology of mood disorders.
How do they differ in Mood Disorders than when normal?
- Limbic system (Emotion, Memory, Motivation)
- Frontal lobe (Motor + Cognitive effects)
- Basal ganglia (Motor, Cognitive, Behaviour, Emotion)
- Changes in size and activity levels of these structures
(Depression- Decreased Hippocampus volume, Amygdala blood blow and metabolism)
(Bipolar- Increased Amygdala activation and volume)
The Limbic System is composed of many brain regions, however the main emotion circuit is the Papez Circuit.
Describe the Papez Circuit
- Cortical areas send input to Hippocampus (Amygdala can be grouped with HC in terms of its connections)
- Hippocampus projects to Mammillary bodies via Fornix
- Mammillary bodies project to Thalamus + Hypothalamus
- Thalamus projects back to cortex
- Hypothalamus projects to Pituitary and Autonomics-> Somatic effects
How is the Papez circuit involved in memory?
Hippocampus induces LTP int the cortex to consolidate long term memory?
Describe the role of the Frontal Lobe in Mood.
Inferior portions of Anterior Frontal Lobe are involved in the Generation and Expression of emotions
(Ventromedial Prefrontal Cortex- Generation)
Orbital Prefrontal Cortex- Expression, possibly via connections with Amygdala)
According to the Monoamine Hypothesis, decreased levels of what 2 neurotransmitters lead to depression?
Where are these produced?
Where are they distributed to?
(Less evidence for their role in Mania)
- Serotonin, produced in Raphe Nucei in Brainstem
- NA, produced in Locus Coeruleus in Brainstem
- Both are distributed to Cortex and Limbic System
What are Serotonin and NA important for?
Serotonin;
- Mood
- Appetite
- Sleep
- Impulse control (link with suicide)
NA;
- Mood
- Arousal
- Memory
Serotonin is thought to be low in Depression
List 3 pieces of evidence that support this
- Drugs that increase Serotonin in the brain successfully treat Depression
- (A metabolite of Serotonin) 5HIAA is low in the CSF of Depression patients
- (A precursor of Serotonin) Tryptophan depletion causes Depression
Suggest 1 feature of Depression that is not explained by the Serotonin hypothesis
- Despite Serotonin levels rising rapidly after treatment, symptoms only improve over weeks-months
(Might be that Antidepressants act to change the levels of other neurochemicals)
NA is thought to be low in Depression
List 3 pieces of evidence that support this
- Drugs that increase increase NA levels successfully treat Depression
- Patients who have recovered from Depression, but still have low NA levels are at HIGHER risk of relapse
- Post-morgen studies found lower brain NA levels in people with Depression
List 6 Physical/ non-psychological causes of Depression
- Hypothyroidism
- B12 deficiency
- Anaemia
- Chronic disease
- Substance misuse
- Hypoactive delirium
Outline the Biological, Psychological and Social aspects of treating Depression
Biological;
- 1st line: SSRIs
- Electroconvulsive therapy, ECT for severe/ resistant cases
Psychological;
- CBT
Social;
- Help with social stressors (isolation, financial)
Outline the Biological, Psychological and Social aspects of treating Acute Mania in Bipolar disorder
Biological;
- Antipsychotics
- Mood stabilisers (Lithium)
Psychological;
- Unlikely to be helpful in acute phase
- Educate patients about triggers and signs of relapse
Social;
- Keep patients safe to reduce risk to self+others
Outline the Biological, Psychological and Social aspects of treating Acute Depression in Bipolar disorder
Biological;
- Antidepressants with mood stabiliser cover
Psychological;
- CBT
Social;
- Help with social stressors
Outline the Biological, Psychological and Social aspects of treating Maintaining Stability in Bipolar disorder
Biological;
- Mood stabiliser (Lithium, Valproate) with/without Antipsychotics
Psychological;
- Education about Bipolar Disorder
- CBT
Social;
- Family support
- (Consider effects on employment etc)
