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NSB Lectures > Neurobiology of Affective Mood Disorders > Flashcards

Neurobiology of Affective Mood Disorders Flashcards

1
Q

What is normal mood termed?

A

Euthymia

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2
Q

Name 3 disorders of mood

A

Depression
Hypomania
Mania

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3
Q

Name 2 subsyndromal mood disorders

A

Dysthymia
Cyclothymia

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4
Q

What is cyclothymia?

A

Patient’s mood goes up and down between subsyndromal increased mood and subsyndromal decreased mood

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5
Q

Is dysthymia more prevalent in M or F?

A

F (1:2)

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6
Q

Are depressive orders more prevalent in M or F?

A

F (1:2 approx)

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7
Q

What is the average age of onset of depressive orders?

A

Mid 20s, with modest peak between 40-60

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8
Q

Is bipolar disorder more prevalent in M or F?

A

Equal prevalence 1:1

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9
Q

When is the average of onset for BPD?

A

Ave = 18, normally before 25

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10
Q

What is the term for chronic low (subsyndromal) mood?

A

Dysthymia

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11
Q

What are Ps who have had one depressive episode at risk of?

A

Having subsequent periods of depression

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12
Q

How long can untreated and treated depressive episodes last for?

A

Untreated (> 6months) - can last years

Treated - 2-3 months

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13
Q

What percentage of Ps who have had a depressive episode with go on to have a further episode?

A

80%

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14
Q

What are the main features of a depressive episode?

A

Low mood, dec energy & anhedonia

Also - dec activity, changes in appetite, sleep, dec libido, conc/attention, self-esteem & feelings of guilt/worthlessness

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15
Q

What is the requirement for symptoms in terms of duration etc to diagnose for depression?

A

Most of the time for most days for longer than 2 weeks

+

Reduced social / occupational function

+ NOT in the context of a major life event

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16
Q

What disorder can depression in the context of a major life adjustment be?

A

Adjustment disorder

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17
Q

What are the three main features of depression?

A

Low mood
Reduced energy levels
Andhedonia

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18
Q

What are the biological features of depression?

A

Appetite (red or inc)

Sleep (problems)

Libido (loss)

Activity (slowing)

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19
Q

What are the psychological features of depression?

A

Cognition (poor conc / attention)
Low self-esteem
Negative thinking
Anxiety

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20
Q

Name three additional features that MAY appear in depressed Ps.

A

Dissociation
Obsessions
Phobias
Physical health symptoms

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21
Q

What are the psychotic features that may occur in severe depression?

A

Delusions
Hallucinations

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22
Q

What are obsessions?

A

Recurrent and persistent thoughts that are intrusive and belong to the P.

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23
Q

Which depression is a severe depression that is characterised by a severe loss of pleasure in almost everything?

A

Melancholic depression

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24
Q

Which depression can present with increased appetite & weight gain, increased sleep, anxiety, fatigue & prominent interpersonal sensitivity?

A

Atypical depression

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25
Q

How can depression affect executive function?

A

Can impair executive function - with reduced concentration and attention –> hard to register information = reduced memory

26
Q

What is the term for the impact on cognition by dementia?

A

Cognitive impairment due to depression

27
Q

What can cognitive impairment due to depression be confused with?

A

Dementia

28
Q

How are depression and dementia linked?

A

Depression is a RF for dementia - x2 inc risk from one episode of depression (and risk increases with multiple episodes).

Depression can be an early sign (prodrome) of dementia.

Depression is also common in Ps with dementia

29
Q

What do we think causes a link between depression and dementia?

A

Vascular damage
Hippocampal damage (from chronic high cortisol)
Impaired amyloid clearance (high cortisol)
Chronic inflammation

30
Q

What are the risks to be aware of for Ps with depression?

A

Self-harm
Suicide (10%)
Self-neglect
Harm to others

31
Q

Which physical illnesses can cause mood symptoms?

A

Brain disease
Endocrine disorders
Infections (inc HIV)

32
Q

What percentage to Ps attending primary care have depression?

A

40%

33
Q

How does physical illness link to depression?

A

Medical illness can be a stressor that causes depression.

Also - worse outcomes for physical illness in depressed Ps.

34
Q

Is there a specific gene for depression?

Is there a genetic factor in depression?

A

Not a specific gene - there are multiple genes that play a role.

Yes - 3x inc risk of developing depression if a 1st degree relative has depression

35
Q

Which is the strongest theory for the cause of depression?

A

Monoamine theory

36
Q

What does the monoamine theory suggest?

A

Suggests depression is due to an abnormality in one or more monoamine NT systems

37
Q

What is the precursor of serotonin?

A

Tryptophan

38
Q

Which enzyme converts tyrosine to L-DOPA?

A

Tyrosine hydroxylase

39
Q

What has been shown when tyrosine hydroxylase is inhibited?

A

Levels of Dopamine and Nor decrease - and depressive relapses can occur

40
Q

What are the problems with the monoamine theory?

A

Why some people respond to type of antidepressant and not another?

Why is there a delayed onset of action when NT level changes are immediately?

41
Q

How is thought the HPA axis plays a role in depression?

A

Elevated plasma cortisol levels - which are not inhibiting the HPA axis - leading to impaired cognitive function.

Treatment of HPA has been seen to normalise the HPA axis

42
Q

Why do we think inflammation plays a role in depression?

A

Inc levels of depression in Ps with AI

Cytokines therapeutically can trigger depression

Post mortem studies of Ps with depression have found inflammatory signs

43
Q

Which hormone is linked to neurogenesis?

A

Brain derived neurotrophic factor (BDNF)

44
Q

How is BDNF linked to depression?

A

Low levels of BDNF (and therefore neurogenesis) are seen in Ps with depression

45
Q

What is the link between monoamines and neurogenesis?

A

Is postulated that increasing levels of monoamines increases neurogenesis

46
Q

What are the two types of bipolar disorder? How can you differentiate between them?

A

Type 1 - P has at least one manic episode (often multiple)

Type 2 - has one hypomanic & one depressive episode (often multiple)

47
Q

What is the average onset age for depression?

A

Mid 20s

Mid-life 40-60

48
Q

When is the average age to be diagnosed for bipolar disorder?

A

Before 25 (ave = 18)

49
Q

Which moods do Ps suffer with in bipolar disorder?

A

All of them - from mania to depression

50
Q

What is it called when Ps have symptoms of both mania and depression at the same time?

A

Mixed affective state

51
Q

What are the clinical features of mania?

A

Elevated mood
Increased energy
Loss of social inhibition
Pressured speech
Distractibility
Increased self esteem - grandiosity
Perceptual disorder (inc vividness)
Risky behaviour

52
Q

Which two symptoms of severe mania can overlap with psychosis?

A

Delusions
Hallucinations

53
Q

How does hypomania differ from mania?

A

Similar - however psychotic features are absent, there is NO marked impairment in function (social or occupational) and it does not necessitate hospital admission.

54
Q

How does the onset of bipolar usually present?

A

Onset in late teens with a depressive episode

55
Q

What is more common in bipolar - depressive or manic episodes?

A

Depressive

56
Q

How does bipolar affect life expectancy? Why?

A

Reduces it - by 13 yr M and 9 yr F

Accidents, risky behaviour, self-neglect, suicide

57
Q

What is the aetiology for bipolar thought to be?

A

Genetic
Neurobiological
Medication & substances
Childhood adversity
Life events

58
Q

Which medications can put Ps at a higher rate of developing bipolar?

A

Corticosteriods
Thyroxine
L-Dopa
Stimulants
Anabolic steriods

59
Q

Is there a genetic link for bipolar disorder?

A

Up to 70% is inheritable - is a greater risk if first degree relative, twin concordance studies have been positive.

Thought not to be a single gene - rather hundreds of genes each with small effect

60
Q

What is more of a statistical risk to developing bipolar disease - schizophrenia or unipolar depresson?

A

Schizophrenia

61
Q

Which two NTs have been linked to bipolar disorder?

A

Dopamine

Glutamate (thought to be inc in Ps with bipolar)

NSB Lectures (48 decks)

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