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NSB! > Neurobiology and clinical features of affective (mood) disorders > Flashcards

Neurobiology and clinical features of affective (mood) disorders Flashcards

1
Q

What is Diagnostic Criteria for Research (ICD-10)?

A
  • diagnostic criteria to diagnose patients based on classifications
  • used in the UK
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2
Q

What are affective disorders?

A
  • disorders that affect the way you think and feel
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3
Q

In affective disorders terminology what does euthymia mean?

1 - bad mood
2 - upset
3 - angry
4 - normal mood

A

4 - normal mood
- greek for happy and well

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4
Q

In affective disorders terminology what are the 3 disorders of mood we need to be aware of that have a pervasive (an unwelcome influence on our mood or physical effect) that can affect their friends, family etc..?

1 - depression, hypomania, mania
2 - depression, euthymia, mania
3 - depression, hypomania, euthymia
4 - euthymia, hypomania, mania

A

1 - depression, hypomania, mania
- Depression (low mood)
- Hypomania (elevation of mood)
- Mania (further elevation of mood)

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5
Q

In affective disorders terminology Depression, Hypomania and Mania are all disorders of mood that have a pervasive (an unwelcome influence on our mood or physical effect) affect that can affect their friends, family etc. What is common in patients with mood disorders such as these?

1 - free from other illness
2 - co-morbid physical disorders
3 - co-morbid psychological disorders
4 - co-morbid physical and psychological disorders

A

4 - co-morbid physical and psychological disorders
- metabolic syndrome and anxiety for example

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6
Q

What are subsyndromal mood disorders?

1 - mood disorders that are elevated above the diagnostic criteria, such as depression and mania
2 - mood disorders that are similar but not severe enough to reach diagnostic criteria, such as depression and mania
3 - patient moves from euthymia (normal mood) to depression on and off
4 -patients symptoms range from depressive through mania (really elevated mood)

A

2 - mood disorders that are similar but not severe enough to reach diagnostic criteria, such as depression and mania

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7
Q

What is dysthymia?

1 - low mood (but not sufficient for diagnosis of depression)
2 - cycling between low mood and elevated mood, but insufficient for manic/depressive diagnosis
3 - patient moves from euthymia (normal mood) to depression on and off
4 -patients symptoms range from depressive through mania (really elevated mood)

A

1 - low mood (but not sufficient for diagnosis of depression)
- greek for bad low mood
- chronic low mood

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8
Q

What is Cyclothymia? (cyclo looks like cycling)

1 - low mood (but not sufficient for diagnosis of depression)
2 - cycling between low mood and elevated mood, but insufficient for manic/depressive diagnosis
3 - patient moves from euthymia (normal mood) to depression on and off
4 -patients symptoms range from depressive through mania (really elevated mood)

A

2 - cycling between low mood and elevated mood, but insufficient for manic/depressive diagnosis

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9
Q

In patients with depression (low mood) and hypomania (elevated mood) what other psychotic disorder can the symptoms present as?

1 - psychosis
2 - schizophrenia
3 - generalised anxiety disorder
4 - phobia

A

1 - psychosis

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10
Q

What is recurrent depressive disorder?

1 - low mood (but not sufficient for diagnosis of depression)
2 - cycling between low mood and elevated mood, but insufficient for manic/depressive diagnosis
3 - patient moves from euthymia (normal mood) to depression on and off
4 -patients symptoms range from depressive through mania (really elevated mood)

A

3 - patient moves from euthymia (normal mood) to depression on and off
- depression is diagnosed here

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11
Q

What is the difference between bipolar 1 and 2?

A
  • bipolar 1 = patients symptoms range from depressive through mania (really elevated mood)
  • bipolar 2 = patients symptoms range from depressive through hypomania (elevated mood but not mania)
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12
Q

What is the average age onset and peak of a depressive disorder?

1 - <16 y/o
2 - 40-60s
3 - 40s
4 >50 y/o

A

2 - 40-60s
- onset can be in mid 20s

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13
Q

What is the average age of onset in bipolar disorders?

1 - <16 y/o
2 - 18 y/o
3 - 40s
4 >50 y/o

A

2 - 18 y/o

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14
Q

How long do the majority of untreated depressive episodes last?

1 - >1 month
2 - >3 months
3 - >6months
4 - >12 months

A

3 - >6 months
- minority last years

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15
Q

The majority of untreated depressive episodes last >6 months, although a minority can last years. In comparison how long do treated depressive episodes last for?

1 - 2-3 months
2 - >3 months
3 - >6months
4 - >12 months

A

1 - 2-3 months

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16
Q

If a patient has an untreated (6 months) or treated (2-3 months) depressive episode, what % are likely to have a further episode?

1 - 20%
2 - 40%
3 - 60%
4 - 80%

A

4 - 80%

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17
Q

There is an extensive list of diagnostic features of a depressive episodes, but what are the main 3?

1 - high mood, low energy, loss of enjoyment
2 - low mood, high energy, loss of enjoyment
3 - low mood, low energy, loss of enjoyment
4 - normal mood, normal energy and loss of enjoyment

A

3 - low mood, low energy, loss of enjoyment

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18
Q

A clinical diagnosis depressive episode according to ICD-10 can be mild, moderate or severe based on what?

1 - duration of symptoms
2 - number of symptoms
3 - gender and the number of symptoms
4 - gender and duration of symptoms

A

2 - number of symptoms

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19
Q

A clinical diagnosis of a depressive episode according to ICD-10 must last how long?

1 - >1 week
2 - >2 weeks
3 - >4 weeks
4 - >12 weeks

A

2 - >2 weeks
- symptoms must be present all of or most of the time

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20
Q

A clinical diagnosis of a depressive episode according to ICD-10 must last 2 or more weeks with symptoms present all of or most of the time. What also must be present as a disability?

A
  • reduced social and/or occupational function
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21
Q

A clinical diagnosis of a depressive episode according to ICD-10 must last 2 or more weeks with symptoms present all of or most of the time, with reduced social and/or occupational function. What must the clinician exclude?

1 - other psychological disorders
2 - dementia
3 - major life events

A

3 - major life events
- symptoms are not in context with a major life event, such as loss of relative

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22
Q

In depressive episodes patients have a low mood which can be diurnal. What does diurnal variation mean in this context?

A
  • patients mood can fluctuate throughout the day
  • diurnal = latin for daily variation
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23
Q

When we talk about depressive disorders, people often describe biological features. What are the 4 most common?

A
  • appetite can increase or decrease
  • reduced activity (psychomotor retardation = slower movements)
  • reduced libido
  • altered sleep (cant sleep, and/or wake up unrefreshed, sleep too much)
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24
Q

When we talk about depressive disorders, people often describe psychological features. What are the 4 most common?

A

1 - cognition - poor concentration
2 - low self esteem - worthlessness, guilt and lack of confidence
3 - negative thinking - hopeless, helpless, suicidal thoughts
4 - anxiety - particularly about health

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25
Q

When we talk about depressive disorders, people can present with disassociation, what is this?

1 - physical and mental state are separated
2 - patients feel separated from the world
3 - patients feel depersonalisation (feel separated from from others)

A

3 - patients feel depersonalisation (feel separated from from others)

26
Q

When we talk about depressive disorders, people can present with obsessions, what is this?

A
  • intrusive and repetitive thoughts
  • patients own thoughts
  • NOT delusions
27
Q

When we talk about depressive disorders, people can present with physical symptoms, what are some common signs?

A
  • headaches
  • GIT discomfort
  • pain
28
Q

We know that patients with severe depressive episodes can have features of psychosis, mainly delusions and hallucinations. What is the difference between delusions and hallucinations?

A
  • delusions = a false belief that persists in spite of evidence
    in depression that can be negative and bad
  • hallucinations = senses and feels real but is not
    in depression these can be derogatory, ‘you are rubbish and bad’
29
Q

In patients who are having depressive symptoms, it can be common for them to have cognitive impairments and memory retention problems. It can be difficult to distinguish between depression and dementia, and is described as Cognitive impairment due to depression. How is the clinician able to distinguish between dementia and depression?

A
  • medical history and careful assessment
  • in-depth cognitive testing
  • cognitive function in patients with depression improves with treatment, but not in dementia
30
Q

Does depression increase the risk of dementia?

A
  • yes
  • number of depressive episode is associated with dementia
  • early symptoms of dementia may present as depression (prodrome)
31
Q

A large number of patients with dementia will have depression. There are 4 main hypothesis that link depression with dementia. One of which is vascular damage. What happens here?

A
  • vascular damage leads to frontostriatal problems
  • frontostriatal circuits are neural pathways that connect frontal lobe regions with the basal ganglia
32
Q

A large number of patients with dementia will have depression. There are 4 main hypothesis that link depression with dementia. One of which is hippocampus damage/atrophy. What happens here?

A
  • excessive cortisol releases Ca2+ into hippocampus
  • becomes excitotoxic and damages hippocampus
33
Q

A large number of patients with dementia will have depression. There are 4 main hypothesis that link depression with dementia. One of which is Impaired amyloid clearance. What happens here?

A
  • protein involved in Alzheimer’s disease is not removed
  • B amyloid builds up and blocks neuronal firing
34
Q

A large number of patients with dementia will have depression. There are 4 main hypothesis that link depression with dementia. One of which is chronic inflammation. What happens here?

A
  • may damage the brain and vascular system
  • implicated in aetiology of both depression and Alzheimer’s
35
Q

What % of patients with severe depression die by suicide?

1 - 0.1%
2 - 1%
3 - 10%
4 - 25%

A

3 - 10%
- self neglect or harm to others is also a risk

36
Q

There are a number of factors which can be linked with the aetiology of depression, which can be categorised into biological, psychological and social. Physical illness is a psychological stressor, but physical health, a biological factor can directly cause mood symptoms such as depression. What are 3 main physical illnesses that could lead to mood disorders?

A
  • brain disease
  • endocrine disorders
  • infections including HIV
37
Q

There are a number of factors which can be linked with the aetiology of depression, which can be categories into biological, psychological and social. Physical illness is a psychological stressor, but physical health, a biological factor can directly cause mood symptoms such as depression. What % of patients that attend primary care have depression?

1 - 10%
2 - 15%
3 - 20%
4 - 40%

A

4 - 40%

38
Q

There are a number of factors which can be linked with the aetiology of depression, which can be categories into biological, psychological and social. Physical illness is a psychological stressor, but physical health, a biological factor can directly cause mood symptoms such as depression. Do patients with or without physical illness have better clinical outcomes?

A
  • without depression
  • depression worsens outcomes
39
Q

There is a genetic aetiology of depression with multiple genes being identified, but they are shared across psychological disorder. In first degree relatives what is the risk factor increase from a first degree relative with depression?

A
  • x3
40
Q

In depression there is the monoamine theory, what is this theory?

A
  • low levels of monoamines, serotonin, noradrenalin and dopamine can lead to depression
41
Q

In depression there is the monoamine theory. The theory suggests that depressive disorder are due to abnormalities in one or more monoamine neurotransmitter systems, namely serotonin, noradrenalin and dopamine. In the case of serotonin, how did this theory develop?

A
  • depletion of tryptophan (serotonin precursor) levels causes relapse of depression
  • decreases receptor binding for serotonin
  • decreases serotonin metabolites in CSF
  • anti-depressants increase serotonin levels
42
Q

In depression there is the monoamine theory. The theory suggests that depressive disorder are due to abnormalities in one or more monoamine neurotransmitter systems, namely serotonin, noradrenalin and dopamine. In the case of dopamine and noradrenaline, how did this theory develop?

A
  • if tyrosine hydroxylase is inhibited by 𝛂-methyl-para-tyrosine (AMPT) there will be no down stream effects from L-dopa metabolism
  • low levels of dopamine and noradrenaline are linked with depressive relapse occurs
43
Q

What is the hypothalamic–pituitary–adrenal axis pathway?

A
  • when stressed the hypothalamus stimulates the release of corticotropin-releasing hormone (CRH)
  • CRH stimulates the pituitary gland to release adrenocorticoptropic hormone (ACTH)
  • ACTH stimulates the adrenal glands to release cortisol (CORT)
  • Negative feedback from cortisol to control the axis via the hippocampus
44
Q

A consistent finding in depression is a dysfunctional HPA axis, which results in elevated levels of what?

A
  • cortisol
45
Q

A consistent finding in depression is a dysfunctional HPA axis, which results in elevated levels of cortisol. This has been shown to impair what?

A
  • cognitive function
46
Q

In patients with depression there has been shown to be increased levels of inflammation. If we administer cytokines (synthetic inflammation) what can this then cause?

A
  • trigger depression
47
Q

In patients with depression there has been shown to be increased levels of inflammation. If we administer cytokines (synthetic inflammation) this can then trigger depression. Post-mortem tissue suggests what in the brain is affected following the administration of cytokine?

A
  • neuroinflammation
  • microglial cells
48
Q

What is the lifetime risk of developing depression?

1 - 15-18%
2 - 30-45%
3 - 60-70%
4 - >70%

A

1 - 15-18%

49
Q

What is the lifetime risk of developing a bipolar disorder?

1 - 1%
2 - 30-45%
3 - 60-70%
4 - >70%

A

1 - 1%

50
Q

In the figure below, where euthymia is normal mood, where would bipolar 1 appear?

A
  • range across the whole spectrum
  • will have at least one depressive and manic episodes
  • BUT will more likely have multiple episodes
51
Q

In bipolar 1 patients are able to have a mixed affective state at the same time. What does this mean?

A
  • patient could experience depression, but also present with mania at the same time
52
Q

There are lots of clinical features that can occur together or in isolation in a patient having a manic episode (elevated mood, really happy). What are some of the most common clinical features?

A
  • elevated mood
  • increased energy
  • loss of social inhibition
  • distractibility
  • increases self esteem and grandiosity
  • perceptual disorder (think things are more beautiful than they really are)
  • risky behaviours (gambling, drugs)
53
Q

There are lots of clinical features that can occur together or in isolation in a patient having a manic episode (elevated mood, really happy). Some of the most common clinical features are:

  • elevated mood
  • increased energy
  • loss of social inhibition
  • distractibility
  • increases self esteem and grandiosity
  • perceptual disorder (think things are more beautiful than they really are)
  • risky behaviours (gambling, drugs)

How long would a patient have to present with some of the above symptoms for a diagnosis of mania to be made?

1 - >3 days
2 - >1 week
3 - >2 weeks
4 - >4 weeks

A

2 - > 1 week
- must cause significant impairment in function

54
Q

In severe cases of mania, there can be an associated psychosis. What aspects of psychosis can be present?

A
  • delusions (in line with mood, grandiose)
  • hallucinations (in line with mood, normally auditory)
55
Q

Hypomanias is where patients have an elevated mood, but not to the same level of mania, and therefore do not get the same diagnosis. What sort of clinical features do patients having a hypomanic episode present with, and what is the key feature that is absent, which is present in mania?

A
  • similar symptoms to mania
  • BUT psychotic features are absent (hallucination and delusions)
56
Q

Hypomanias is where patients have an elevated mood, but not to the same level of mania, and therefore do not get the same diagnosis. Episodes of hypomania present with similar clinical features as mania, just without the psychotic aspects (hallucination and delusions). Do they experience any social or occupational dysfunction?

A
  • no
  • does not require hospital admission either
57
Q

What is the usual onset of bipolar disorder and on average how many episode will a patient have over a 25 year follow up?

A
  • onset usually in teens
  • 10 episodes can occur in a 25 year follow up
58
Q

Onset of bipolar disorder is in teens, and patients normally have around 10 episodes in a 25 year follow up, which can become more frequent in nature over time. Are depressive of mania episodes more common?

A
  • depressive
59
Q

Onset of bipolar disorder is in teens, and patients normally have around 10 episodes in a 25 year follow up, which can become more frequent in nature over time. Depressive episodes are more common than mania. What is the long term effect on a patients life and why is this?

A
  • long term impact on social and work life, causing cognitive impairments
  • reduced social support
  • reduced emotional family support
60
Q

In bipolar disorders, what is the reduced life expectancy in men and women?

A
  • men = 9 years
  • women = 13 years
  • BUT 8% of men and 5% of women die by suicide when admitted to hospital
61
Q

In addition to having a reduced life expectancy and higher risk of suicide when administered to hospital, what else can be dangerous in patients experiencing an episode of bipolar disorder?

A
  • accidents (driving for example)
  • risky/dangerous behaviours
  • self neglect
  • harm others
62
Q

Although there are no specific genes for bipolar disorder, there is a high risk in heritability. What is the heritable risk and the risk in monozygotic twins?

A
  • heritable risk = 70%
  • monozygotic twins= 60-70%

NSB! (53 decks)

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