Mood Disorders and Mood Stabilizers Flashcards
Depression and mania
Opposite ends (poles) of the mood spectrum.
Mixed mood state
Depression and mania occurring simultaneously. May have depressed mood but trouble sleeping or changes in appetite, etc.
Euthymia
Normal mood
Dysthymia
Depression (depressed mood) less severe than major depression but long-lasting (over 2 years).
Double depression
Alternating between major depression and dysthymia, but not remitting. A form of recurrent major depressive disorder/episodes with poor inter-episode recovery.
Bipolar Disorder
Generally characterized by four types of illness episodes: manic, major depressive, hypomanic, and mixed. Patients may have any combination of these episodes over course of illness.
Rapid cycling
Mania in bipolar disorder occurring at least four times per year. Many patients experience mood switches more frequently than this and can include depressive episodes or shifts between euthymia and mania.
Bipolar II (Bipolar depression)
At least one hypomanic/manic episode following a depressive episode.
Cyclothymic disorder
Mood swings not as severe as full mania and full depression but switches that sit above and below boundaries of normal mood and may interfere with function.
Schizoaffective disorder
Debatable diagnosis for patients with psychotic symptoms and mood cycling.
Tyrosine
Precursor amino acid to norepinephrine (NE), acted on by TOH which converts the amino acid into DOPA. Decarboxylase (DDC) converts DOPA into dopamine (DA). Dopamine beta-hydroxylase (DBH) converts DA into NE via NE neurons.
Norepinephrine functions
Ascending projections from locus coeruleus of brainstem to PFC, basal forebrain, striatum, nucleus accumbens, thalamus, hypothalamus, amygdala, hippocampus, brainstem neurotransmitters, and cerebellum: regulate mood, arousal, cognition. Descending projections down spinal cord regulate pain pathways.
Monoamine hypothesis of depression
Dysfunction in all three monoamines NE, 5HT, and DA in various brain circuits, with different neurotransmitters contribute to depressive symptom profile of different patients.
Monoamine signaling and brain-derived neurotrophic factor (BDNF) release
Depression may be caused by reduced synthesis of proteins involved in neurogenesis and synaptic plasticity.
Monoamine receptor hypothesis of depression
Deficient activity of monoamine neurotransmitters causes upregulation of postsynaptic monoamine neurotransmitter receptors which leads to depression.
Brain-derived neurotrophic factor (BDNF)
Promotes growth and development of immature neurons, including monoaminergic neurons, enhances survival and function of adult neurons, and helps maintain synaptic connections. Important for neuronal survival, decreased levels may contribute to cell atrophy and low levels may even cause cell loss. Low monoamine levels may correspond to this level being low.
Prefrontal Cortex (PFC)
Brain area associated with concentration interest/pleasure, psychomotor fatigue (mental), guilt, worthlessless/suicidality, and mood in depression.
Amygdala
Brain area associated with guilt, suicidality, worthlessness, and most strongly with mood in depression.
Nucleus accubens
Brain region, along with PFC, most associated with pleasure, interests, fatigue and energy in depression.
Striatum and spinal cord (neurotransmitters)
Brain regions associated with psychomotor fatigue (physical) in depression.
Hypothalamus
Brain region associated with sleep and appetite in depression.
Symptom cluster for dopamine with norepinephrine dysfunction
Reduced positive affect - depressed mood, loss of joy, loss of interest or pleasure, loss of energy/enthusiasm, decreased alertness, and decreased self-confidence.
Symptom cluster for serotonin with norepinephrine dysfunction
Increased negative affect - depressed mood, guilt/disgust, fear/anxiety, hostility, irritability and loneliness.
PFC
Brain region associated with racing thoughts, grandiosity, distractibility, talkative/pressured speech, mood and risk-taking behavior in mania.
Basal forebrain
Brain region associated with decreased sleep/arousal in mania.
Nucleus accubens
Brain region associated with racing thoughts, goal-directed actions and grandiosity in mania.
Striatum
Brain region associated with motor agitation in mania.
Hypothalamus and thalamus
Brain regions associated with decreased need for sleep/arousal and appetite changes in mania.
