NEURO: Depression Flashcards
Generally, what are some effects of mental illness of the patient, the family and society.
Effects of Psychological Disorders on the Patient:
Individuals with psychological disorders are at greater risk for decreased quality of life, educational difficulties, lowered productivity and poverty, social problems, vulnerability to abuse, and additional health problems.
Effects of Psychological Disorders on Families/Caregivers:
The burden of caring for a mentally ill individual often falls on the patient’s immediate family or relatives. Families and caregivers of individuals with psychological disorders are often unable to work at full capacity due to the demands of caring for a mentally ill individual, leading to decreased economic output and a reduction in household income
Effects of Psychological Disorders on Society:
In 2001, the WHO estimated that mental health problems cost developed nations between three and four % of their GNP (gross national product).
Discuss the different treatments for mental illness.
Examples of treatment for mental illness is cognitive behavioural therapy and pharmacotherapy.
Although these drugs have certainly helped a lot of people and we are in a better place from where we were 30 years ago, there are still major problems. They do not help everyone (resistance), side effects can be severe in some cases, tolerance, dependence, have a narrow therapeutic window and they do not treat all symptoms.
All this made developing drugs for treating mental disorders expensive and difficult and many pharma have got out of this CNS business.
List some characteristics of affective disorders.
- disorders of mood rather than thought / cognition
- most common is depression
- major cause of premature death and disability
Describe the two types of depression.
1) UNIPOLAR DEPRESSION:
- mood swings in one direction
- most common depressive illness
- 75% cases REACTIVE (induced by environmental factors)
- 25% cases ENDOGENOUS (genetic)
2) BIPOLAR DEPRESSION:
- Oscillation between depression and mania
- Mania: excessive exuberance, enthusiasm, self confidence, impulsive actions, aggression, irritability, delusions of grandiose
- less common
- onset usually in adult life
- strong hereditary tendency (no genes found yet)
What is depression?
There are multiple ways to define it:
DEPRESSIVE DISORDER: a low state marked by significant levels of sadness, lack of energy, low self-worth, guilt or related syndromes
MAJOR DEPRESSIVE DISORDER: severe pattern of depression that is disabling and is not caused by factors such as drugs or a general medical condition
DYSTHYMIC DISORDER (DYSTHYMIA): similar to major depressive disorder but less severe/disabling and more long-lasting (chronic)
Why is diagnosing depression hard?
- wide variety of symptoms that patients can report
- difficult to know when a normal fluctuation in mood becomes depression
- no single objective test to establish diagnosis
What are some symptoms of depression?
EMOTIONAL SYMPTOMS (Q):
- apathy, pessimism, negativity
- low self esteem, feeling guilty
- loss of motivation
- indecisiveness
BIOLOGICAL SYMPTOMS (Q):
- reduced activity
- loss of libido
- sleep disturbance
- loss of appetite
What are some screening questions you could ask in a clinical interview?
- During the past month have you often been bothered by feeling down, depressed or hopeless?
- During the past month have you often been bothered by having little interest or pleasure in doing things?
Who gets depression?
GENDER:
- depression affects around twice as many females as males
- lifetime prevalence of major depression: 10-25 % for women, 5-12 % for men
AGE:
- 1st episode of depression usually late adolescence of early adulthood
- age of onset has been decreasing in recent years
- is life now more stressful?
- are we just diagnosing more people with depression?
What are some important factors to consider when dealing with depression?
SUICIDE:
- suicidal thoughts are common among depressed patients
- 20% depressed individuals will attempt suicide
- 10% of severe depressives will commit suicide
COMORBIDITY:
- depression is often comorbid with other psychiatric conditions (e.g. withdrawal from drugs of abuse)
With co-morbidity, what are some general medical conditions in which you often find depression?
- terminal illness
- chronic illness (e.g. chronic pain)
- thyroid dysfunction
- neurological disease
- stroke
- drug abuse
- Parkinson’s disease
- anxiety
What can cause depression?
GENETIC PREDISPOSITION?
- General population: 3.2%
- First degree relatives of patients: 20%
- Monozygotic twins: 40-50%
ENVIRONMENTAL FACTORS?
- Loss
- Environmental stressors
- Social isolation
What are the different theories of depression?
- the monoamine theory
- the neuroendocrine theory
What is the major theory of depression?
Describe it.
The major theory of depression is the monoamine theory.
- there is an overall reduced activity of central noradrenergic and / or serotonergic systems
- reserpine depletes the brain of NA and 5-HT, inducing depression
- the main antidepressant drugs [amines] act in the brain (Q devise drugs to treat depression)
The lower activity of noradrenergic system leads to an increase in post synaptic receptors. Blocking reuptake to increased amines in synaptic cleft normalises postsynaptic receptor number.
[NA]plasma tends to be higher in depressed patients than in normals – as an increase in anxiety, causes an increase sympathetic activity
What is some evidence against the monoamine theory?
- Difficult to show deficits in brain [NA] & [5-HT] and functioning/ (-) results from CSF, plasma in depressed /individuals respond better to one AD than another
- Most antidepressant drugs take several weeks for therapeutic effect, but an increase in amines is acute (secondary adaptive changes more important)
- Some antidepressants are weak/have no effect on amine uptake (e.g trazodone)/no increase in 5HT and NA but they are still antidepressants!
- Cocaine blocks amine uptake but has no antidepressant effect
- Decrease in 5HT in dipolar linked to aggression rather than depression
