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Mood > Mood- from LUSUMA notes > Flashcards

Mood- from LUSUMA notes Flashcards

1
Q

Describe a depressed patients thoughts with respect to past, present and future

A

Past: thinking of the past can include feelings of guilt and self blame out of proportion to the circumstances

Present: thoughts of low self esteem and confidence

Future: idea of the future is viewed with ruin and misfortune
-can lead to suicidal thoughts

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2
Q

What are the biological/somatic symptoms of depression?

A

Loss of appetite
Early morning weakening (at least two hours earlier than normal)
Diurnal mood variation (worse in the morning)
Low energy
Weight loss (5% or more of body weight lost in the last month)
Marked loss of libido
Psychomotor retardation (patient is slowed down)

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3
Q

What are the appearance changes of depression?

A 
Evident neglect of dress and grooming 
Facial features- downward turning of the sides of the mouth
                        -furrowing of the centre of the eyebrows
Reduced rate of blinking 
Shoulders bent forward
Head inclined forwards
Patient looks downwards 
Poor eye contact
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4
Q

Name 5 other presentations

A 
Agitation
Masked depression
Atypical depression 
Mania 
Psychotic symptoms
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5
Q

Define agitation

A

Restless and irritable

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6
Q

Define masked depression

A

When patient doesn’t obviously look depressed and often denies being in low mood

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7
Q

Define atypical depression

A

Patients show symptoms like weight gain, decreased appetite, increased sleeping time, together with increased fatigue and variable mood disturbances.

Can be with anxiety

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8
Q

Define psychosis including two psychotic symptoms

A

When patient has lost touch with reality.

Includes delusions and hallucinations

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9
Q

Define delusions

A

Firmly held ideas or beliefs on inadequate grounds, and not in keeping with patients cultural background.

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10
Q

Define hallucinations

A

False perceptions

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11
Q

What is the most common type of hallucination

A

Auditory

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12
Q

What is the central feature of mania?

A

Elevated mood

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13
Q

What does hypo mania mean?

A

Lesser degrees of mania with less severe symptoms

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14
Q

What is the lifetime risk of bi-polar disorder

A

0.5-1.5%

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15
Q

What are the symptoms of mania?

A

High in energy (overactive)
Ideas of high self-importance
Rapid speech, sometimes the patient can’t stop talking, this is known as pressure of speech
Increased sexual desire
Flight of ideas, a rapid sequence of ideas
Reduced sleep
Patient has the impression that his mind is working faster than usual
Patients feel cheerful and generally optimistic about the future
But sometimes patients are irritable rather than euphoric
Delusions and hallucinations
-delusions of possessing certain talents or of being particularly important or rich
-hallucinations tend to be auditory and positive

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16
Q

What is classification of mood disorders outlined in?

A

The ICD 10

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17
Q

How are depression episodes divided?

A

Mild
Moderate
Severe
Severe with psychotic symptoms

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18
Q

What is recurrent depressive disorder?

A

Where depression is viewed as a condition that is repetitive during a lifetime

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19
Q

How is mania divided?

A

Hypo mania
Mania
Mania with psychotic symptoms

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20
Q

What constitutes bipolar affective disorder

A

2 or more episodes of elevated mood and/or 1 episode of lowered mood

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21
Q

What is dysthymia?

A

A chronic lowered mood, not quite meeting the criteria for clinical depression

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22
Q

What is cyclothymia?

A

A persistent instability of mood not quite reaching the criteria for bipolar disorder

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23
Q

What is the point prevalence for depression symptoms between?

A

13-20%

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24
Q

Who are depressive symptoms more common in, men or women?

A

Women

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25
Q

Which social class is at highest risk for depression?

A

Lower

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26
Q

What’s the lifetime risk of depressive illness estimated as?

A

5-17%

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27
Q

How are causes of mood disorders divided?

A

Precipitating
Predisposing
Maintaining

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28
Q

Define a precipitating cause

A

Events that lead directly to the episode. Often due to loss.

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29
Q

Give 3 examples of types of loss.

A

Loss of a loved one death, divorce etc.
loss of a job
Loss of good health

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30
Q

Define a predisposing cause.

A

Relating to someone’s psychological make up.

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31
Q

Give two examples of predisposing causes of depression

A

Genetics

Childhood experiences

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32
Q

Define a maintaining cause

A

A chronic stressful situation

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33
Q

Give three examples of maintaining causes for depression.

A

Marital disharmony
Financial strain
Alcohol/drug abuse

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34
Q

How can causes of mood disorders be further divided? Defining each one.

A

Biological- relating to genetics and changes in brain neurochemistry
Psychological - relating to how people view themselves, the future and the world around them
Social support - relating to someone’s social support, financial situation, hobbies and habits

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35
Q

What is the function of the frontal lobe of the brain?

A

Decision making and movements

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36
Q

What is the function of the temporal lobe of the brain?

A

Emotion and primary auditory cortex

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37
Q

What is the function of the parietal lobe of the brain?

A

Sensation

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38
Q

What is the function of the occipital lobe of the brain?

A

Visual

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39
Q

How have we found out about which parts of the brain are involved in mood disorders?

A 
Brain surgery
Stroke
Imaging 
Rabies of he limbic system
Lesions inflicted on animals
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40
Q

What are the core symptoms of depression?

A

Pervasive low mood for at least two weeks
Lack of enjoyment and interest in activities normally liked by the patient
A lack of energy

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41
Q

What structures are involved in mood disorders?

A 
Striatum
Neocortex: prefrontal cortex 
Limbic system (important for emotion, motivation and memory) 
-cingulate gyrus 
-hippocampus 
-amygdala 
-hypothalamus
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42
Q

Where is the cingulate gyrus?

A

Part of temporal lobe

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43
Q

What is the importance of the hippocampus?

A

Involved in motivation, emotion and memory

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44
Q

What is the importance of the amygdala?

A

Critical for conditioning and emotional processing
Has inputs from many sensory areas
Connected to areas of- autonomic function
- motor function
- neuro-endocrine function

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45
Q

What image techniques can we use to look at the brain?

A 
MRI
CT
fMRI
SPECT
PET
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46
Q

What do MRI scans look at?

A

White matter changes

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47
Q

How do white matter changes relate to treatment?

A

White matter changes = poorer response to treatment

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48
Q

Name a structure that can be measured by MRI?

A

Hippocampus

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49
Q

What happens to the hippocampus in Alzheimer’s disease?

A

It gets smaller

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50
Q

What happens to the hippocampus in depression?

A

It gets smaller

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51
Q

How does hippocampus reduction correlate with depression?

A

Increased reduction = increased duration of illness

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52
Q

What are the two types of illness in psychiatry giving examples?

A

Organic - dementia, delirium

Functional - depression, schizophrenia, anxiety disorders

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53
Q

What does an fMRI look at?

A

Difference between oxygen rich and oxygen poor blood flow

Thus measures neuronal activity in brain and spinal cord

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54
Q

In depression under fMRI which areas of the brain are abnormal?

A

Amygdala and cingulate gyrus.

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55
Q

Which changes shown by imagery are reversed by CBT?

A

Amygdala and cingulate gyrus in fMRI

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56
Q

How do pet and spect scans work?

A

emitting gamma radio-isotopes

Cameras detect emitting radiation and computers quantify

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57
Q

What do PET and SPECT scan look at?

A

Blood flow
Neuronal activity
Receptors

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58
Q

What is the prefrontal cortex composed of?

A

Ventro medial prefrontal cortex
Lateral orbital prefrontal cortex
Dorso lateral prefrontal cortex

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59
Q

Which prefrontal cortex areas malfunction in depression? And how?

A

VMPFC - hyperactivity = increased sensitivity to pain, anxiety and depressive rumination

DLPFC - hypo activity = psychomotor retardation, apathy and attention deficits

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60
Q

How else can the prefrontal cortex malfunction?

A

Disconnection with the limbic system leads to dis regulation of emotional control

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61
Q

What areas are effected in depression wrt neuro endocrine changes?

A

Cortisol/HPA axis
Growth hormones
Thyroid

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62
Q

How is the cortisol HPA axis affected in depression?

A

Increased levels of cortisol

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63
Q

What structural change is dis regulation of cortisol HPA axis associated with?

A

hippocampus atrophy

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64
Q

What change happens wrt growth hormones in depression?

A

Blunted response to growth hormones

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65
Q

What change happens wrt the thyroid in depression?

A

Incipient hypothyroidism

TSH response to TRH is blunted

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66
Q

Name a hormone sometimes used in depression

A

Thyroxine

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67
Q

What happens to cytokines in depression?

A

Over activity

68
Q

What causes the changes in cytokines in depression?

A

Increased sympathetic tone - HPA axis over activity and amygdala dis regulation

69
Q

What are the effects of the cytokine changes in depression?

A 
Fatigue
Loss of appetite 
Loss of libido 
Hypersensitivity to pain
Disrupt other hormone systems ie. Blood glucose control
70
Q

Which neurotrophic factors are affected by depression and how?

A

Brain derived neurotrophic factor is decreased

BDNF

71
Q

What is the role of BDNF

A

Cell maintenance and plasticity in the brain

72
Q

What parts structures of the brain does low BDNF affect

A

Hippocampus reduction

Limbic system

73
Q

Which neuro endocrine systems are affected by reduced BDNF and how?

A

HPA axis as a result of hippocampus reduction

74
Q

What is the importance of REM sleep?

A

Important for psychological therapy

75
Q

What is the importance of NREM sleep?

A

Recovery of muscles and other parts of the body

76
Q

What is a hypnogram?

A

Graph that represents the stages of the sleep cycle

77
Q

How is sleep architecture affected in depression?

A

REM latency is reduced from 35 mins to 18 mins

78
Q

What is REM latency?

A

Time between the start of sleep and the first onset of REM sleep

79
Q

How can sleep architecture be restored?

A

Anti-depressants

80
Q

What are the cognitive therapy rationale?

A

We are not passive recipients of stimuli
We interpret the world via beliefs, attitudes, expectations and values
We use cognition a to make sense of the world
It’s not situations that upset us but the view we take of them
Changes of mood are linked directly to the way we make sense of events

81
Q

How do the cognitive therapy rationale translate into a schemata?

A

Event/situation➡️thoughts➡️emotionls

82
Q

Draw out the cognitive model

A

Thoughts
↗️ ⬆️ ↖️
↙️ ↘️
Physiology ⬅️ ➡️ Emotions
↖️ ↗️
↘️ ⬇️ ↙️
Behaviour
↗️
Environment

Also called hot cross bun model

83
Q

What is the negative cognitive triad?

A

Negative view of self
Negative view of the world
Negative view of the future

84
Q 
What does this refer to
I am...
⬇️
If I do this then this will happen
⬇️
I should.. Or else...
A 
Core belief (schema)
⬇️
basic assumption 
⬇️
Conditioned schemata
85
Q

Give 5 core beliefs

A 
Love- I'm unloveable
Ability- I'm incompetent 
Morality- I'm evil 
Normality- I'm a freak
Worth- I'm worthless
86
Q

Give 5 examples of basic assumptions

A

Everybody must love me
Either I am 100% successful or a total flop
I must always be nice
If people disagree with me then I am no good
I should be able to do everything, to ask for help is weak

87
Q

How are core beliefs and basic assumptions formed?

A 
Early experiences
⬇️
Core beliefs
⬇️
Basic assumptions
88
Q

What does NATs stand for?

A

Negative automatics thoughts

89
Q

Give four examples of NATs

A

Low self esteem
Guilt and self blame
Hopelessness
Suicidal thoughts

90
Q

What is the basis of activity scheduling in CBT?

A

Record activities regularly
Give a mastery rating 0-10 (sense of satisfaction)
Give a pleasure rating 0-10

91
Q

What is the basis of thought challenging in CBT?

A

Discussing thinking errors

92
Q

Draw out the ‘doing nothing’ cycle

A

NATs- self defeating thoughts
↗️ ↖️
↙️ ↘️
Physical signs of depression Emotions- self-defeating emotions
↖️ ↗️
↘️ ↙️
Self defeating actions

93
Q

Give the 12 thinking errors and define them

A

All or nothing- you see a situations as two categories rather than a continuum
Discounting the positive- unreasonably tell yourself that positive feelings, qualities and deeds don’t count
Mental filter - only pay attention to the negative aspects and don’t look at situation as a whole
Emotional reasoning- because you strongly believe something it must be true, ignoring evidence to the contrary
Mind reading- assuming you know what others think without taking taking into consideration other possibilities
Overgeneralisation- making a negative conclusion that goes beyond the current situation
Catastrophising - predicting the future negatively without consider more likely possibilities
Tunnel vision - only see negative side of a situation
Labelling - putting fixed labels on yourself or others without considering evidence that may lead to a less disastrous conclusion
Magnification/minimising - magnify the negatives/minimise the positives
Imperatives you create an precise eyes of how others should behave and overestimate how bad it is that these expectations aren’t met
Personalisation - you assume that when others behave badly it is because of you without considering more likely explanations

94
Q

What types of studies have been used to look at genetics of affective disorders?

A

Family
Twin
Adoption
Sex differences

95
Q

What are the methodological issues of studies looking at genetics in mood disorders?

A

There is no biological diagnosis of depression, diagnosis is made on symptoms
Depression is inherited via quanta time trait loci (many different genes)
Genetic factors can change a persons sensitivity to traumatic events
Genetic factors have an effect a persons environment

96
Q

What are the two main neurotransmitters in mood disorders?

A

Nor-adrenaline

Serotonin

97
Q

Give 4 other neurotransmitters involved in mood disorders.

A

Dopamine
Acetylcholine
GABA
Glutamate

98
Q

What is the role of Nor-adrenaline in the brain?

A

Has an effect on behaviour - arousal and attention

Has a memory function

99
Q

Where is Nor-adrenaline made and transported to?

A

Made in the coeruleus locus and transported to various areas of the cortex

100
Q

Where is the coeruleus locus

A

Between brain stem and limbic system

101
Q

What are the different receptors of Nor-adrenaline?

A

Alpha 1&2

Beta 1&2

102
Q

Which noradrenaline receptors have the biggest association with mood disorders?

A

Alpha- role in mood and arousal

103
Q

What is the evidence for noradrenaline involvement in mood disorders?

A

AMPT -inhibits tyrosine➡️L-DOPA thus reducing noradrenaline. This leads to depressive symptoms

Successful anti depressants have increasing noradrenaline effects on the synaptic cleft

  • NARI - noradrenaline re uptake inhibitors
  • SNRI - serotonin and noradrenaline re uptake inhibitors
  • tricyclic antidepressants - inhibit reputable of serotonin and noradrenaline
104
Q

What is the role of serotonin in the brain?

A

Sleep
Impulse control
Appetite
Mood

105
Q

Where is serotonin produced and transported to?

A

Produced in Raphe nucleus of the brain stem and transported to the limbic system and cortical areas

106
Q

What is the evidence for serotonin involvement in mood disorders?

A

Tryptophan (serotonin precursor) depletion causes depression
5HIAA (serotonin metabolite) is deleted in depressed patients
Post mortem studies show less serotonin secretion in the brain of depressed patients
PET scans show decreased 5HT1A receptor binding in the brain of depressed patients
SPECT scans show decreased 5HT re uptake sites in the brain of depressed patients

Successful anti depressants have increasing serotonin effects on the synaptic cleft

  • SSRI - serotonin selective re uptake inhibitor
  • SNRI - serotonin and noradrenaline re uptake inhibitors
  • tricyclic antidepressants - inhibit reputable of serotonin and noradrenaline
107
Q

What does dopamine release do?

A

Give feeling of pleasure

108
Q

What disease is dopamine associated with?

A

Parkinson’s

109
Q

Which therapy has a big affect on dopamine?

A

ECT

110
Q

Which hypothesis links serotonin, noradrenaline and dopamine to depression?

A

The mono-amine hypothesis

111
Q

What roles does acetylcholine have?

A

Memory
Sleep
Addiction

112
Q

How is GABA made?

A

Synthesised from glutamate

113
Q

What type of neurotransmitter is GABA?

A

Inhibitory

114
Q

What is GABA’s function?

A

Inhibits chloride transport

115
Q

When is ECT used for depression?

A

As a second line treatment
Intolerable to antidepressants
In a matter of urgency - ie suicidal

116
Q

What else is ECT used to treat?

A

Mania
Schizophrenia
Puerperal psychosis (postpartum)

117
Q

What are the NICE guidelines for depression?

A

Only used for rapid short term improvement
If other treatments have failed or if it is a life threatening situation
For a severe depressive episode
For sever or prolonged manic episode

118
Q

Describe the procedure

A

Brief square wave impulses transmitted unilaterally via electrodes on the temples

119
Q

What are the side effects of ECT?

A 
Retrograde or anterograde amnesia 
Status epliepticus (epileptic seizure)
Laryngispasm 
Peripheral nerve palsy 
Cardiac effects
120
Q

Define secure attachment

A

Caregiver is sensitive and responsive to child’s needs

121
Q

Define avoidant attachment

A

Caregiver is rejecting or intrusive

122
Q

Define disorganised attachment

A

Caregiver is unpredictable or frightening

123
Q

Define resistant ambivalent attachment

A

Care giver is inconsistent or neglectful

Also child abuse

124
Q

What percentage of children experience each attachment?

A

Secure 60%
Avoidance 15%
Disorganised 15%
Resistant-ambivalent 10%

125
Q

Give four factors that may affect attachment

A

Alternative child care
Divorce
Death of a parent
Parental mental disorder

126
Q

How is bullying linked to depression?

A

Bullying is likely to cause depression in victims

Also bullies are more likely to become depressed in later life

127
Q

Why are women more likely to be depressed than men?

A

Socio-occupational - child care is stressful and more likely to be a woman’s responsibility

Men are more likely to distract themselves thus less rumination

128
Q

What psychosocial factors affect postnatal depression?

A 
Loss of sleep
Relationship with partner and/or farther
Social adversity 
Difficulty of childcare role
Obstetric complications
129
Q

How does depression affect relation ships?

A

Depression = decreased self confidence and participation in social interaction

130
Q

How does marital status affect depression?

A

Marital disturbance or divorce increases likelihood of depression

Lack of intimate relationships (marriage) increases likelihood of depression

131
Q

Who is depression highest in, divorced or never married?

A

Divorced

132
Q

What are the socioeconomic risk factors for developing depression?

A

Poverty
Low social class
Low level education
Isolation from friends and family

133
Q

Which gender is unemployment a bigger risk factor for depression?

A

Men

134
Q

When looking at life events leading to depression what else do we have to consider apart from the event itself?

A

Other ongoing difficulties
Other theories (attachment)
Level of available support

135
Q

What does IPT stand for?

A

Interpersonal psychotherapy

136
Q

In psychotherapy where can thoughts be stored?

A

Conscious - currently being thought about
Preconscious - not currently in the conscious but can be recalled if required
Unconscious - existing outside the conscious awareness and cannot be recalled

137
Q

What makes up the structural model of the mind in psychotherapy?

A

The Id, superego and ego

138
Q

Describe the id

A

The part of our mind that is driven by biological needs. It seeks instant gratification of desires and needs without regard to possible destructive consequences

139
Q

Describe the superego

A

Evolves as an individual develops and internalises moral standards and what is dictated by authority figures

140
Q

Describe the ego

A

Describes rationale, it is the reality orientated part of a personality
Employs defence mechanisms to protect integrity
Defence mechanisms are often unconscious

141
Q

What are the seven ego defence mechanisms?

A 
Projection 
Sublimation
Reaction formation
Splitting 
Suppression 
Acting out 
Introjection
142
Q

Define splitting

A

Divided experiences and people into good and bad

Prevents a healthy integration of all aspects of others

143
Q

Define projection

A

Projecting the internal conflict outside ones self

144
Q

Define reaction formation

A

Doing the opposite of the initial desire

145
Q

Define sublimation

A

Obtaining gratification in a more acceptable way

146
Q

Define suppression

A

Consciously positioning an internal conflict for later

147
Q

What are the four techniques used in psychotherapy?

A

Transference
Counter transference
Free association
Listening to the conscious and unconscious communication

148
Q

What is transference and how is it used in psychotherapy?

A

Attitudes and feelings attached to past relationships are transferred into the therapist

Allows past experiences to be relived and explored safely

149
Q

What is counter transference and how is it used?

A

Feelings and attitudes felt by the therapist in response to the patient

Allows therapist to see what feelings the patient evokes in others

150
Q

What is free association?

A

Patient is encouraged to suspend judgement and report whatever comes into their mind

151
Q

Expand on listening to conscious and unconscious communication

A

Therapist attentively listens to conscious and unconscious communication and makes interpretations in order to bring the unconscious into awareness

152
Q

In psychotherapy what is melancholia?

A

Where person loses interest in reality and can’t recover easily
Where person believes they are inferior and despicable

153
Q

What do SSRIs do?

A

Block re uptake of serotonin into the presynaptic neurone thus increasing concentration in the synaptic cleft

154
Q

Give three examples of SSRIs

A

Citalopram
Fluoxetine
Sertraline

155
Q

What are common side effects of SSRIs?

A

Nausea
Sexual dysfunction
Weight loss or gain
Hypotension

156
Q

How do TCAs work?

A

Block re uptake of serotonin and noradrenaline into the presynaptic neurone thus increasing concentrations in the synaptic cleft

157
Q

Give three examples of TCAs

A

Lofepramine
Amitriptyline
Clomipramine

158
Q

Give five common side effects of TCAs

A 
Cardio toxic - arrhythmic and heart block
blurred vision 
Urinary retention
constipation
Dry mouth
159
Q

How do MAOIs work?

A

They irreversibly inhibit the enzyme monoamine oxidase which breaks down serotonin and noradrenaline thus increasing their concentrations in the synaptic cleft

160
Q

Give two examples of MOAIs

A

Phenelzine

Trancypromine

161
Q

Give two side effects of MOAIs

A

Hypotension

Dizziness

162
Q

How do SNRIs work?

A

Block re uptake of serotonin and noradrenaline into the presynaptic neurone thus increasing concentrations in the synaptic cleft

163
Q

Give two examples of SNRIs

A

Venlafaxine

Duloxetine

164
Q

Give three side effects of SNRIs

A

Nausea
Constipation
Hypertension

165
Q

WhT are NaSSAs and what do they do?

A

Noradrenaline and specific serotonergic agents

Block alpha 2 adrenoreceptors on presynaptic neurone thus increasing serotonin and noradrenaline in the synaptic cleft

166
Q

Which antidepressant is first line in cardiac patients and why?

A

SSRIs

Have potential anti arrhythmic effect

167
Q

What should you do when prescribing antidepressants for hepatic or renal impairment patients?

A

Use lower starting doses

Mood (2 decks)

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