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BRS Year 2 > Psych Mood Disorders > Flashcards

Psych Mood Disorders Flashcards

1
Q

what are mood changes often accompanied by?

A

overall change in the overall level of activity

- other symptoms are secondary to change in mood and activity

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2
Q

are mood disorders recurrent?

A

yes

- onset of individual episodes can be related to stressful events or situations

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3
Q

lifetime prevalence of what % for bipolar I?

A

0.6% (est 1%)

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4
Q

lifetime prevalence of what % for bipolar II?

A

0.8% (est 1.0%)

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5
Q

is rate of MDD inc/dec?

A

inc

- earlier age of onset too

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6
Q

Gender distribution of bipolar-I

A

F=M

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7
Q

Gender distribution of bipolar-II and MDD?

A

F>M

2 : 1

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8
Q

mental and substance abuse disorders accounted for what % of all DALYs worldwide?

A

7%

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9
Q

within mental and substance abuse disorders, MDD accounted for what % of all DALYs worldwide?

A

40%

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10
Q

within mental and substance abuse disorders, bipolar accounted for what % of all DALYs worldwide?

A

7%

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11
Q

thoughts in uni and bipolar depression

A

what’s the point

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12
Q

behaviours in uni and bipolar depression

A

lie in bed all day and ruminate

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13
Q

physiological symptoms in uni and bipolar depression

A

exhaustion

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14
Q

feelings in uni and bipolar depression

A

low, flat, irritable

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15
Q

DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) criteria for depression episode?

A

occurence of 2 weeks or more of depressed mood and the presence of 4/8 of the DSM-5 symptoms.

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16
Q

DSM-5 symptoms (8)

A
  1. sleep alterations
  2. appetite alterations/ weight alterations
  3. diminished interest (anhedonia)
  4. decreased concentration
  5. low energy (anergia)
  6. guilt/ feeling worthless
  7. Psychomotor changes
  8. suicidal thoughts or acts
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17
Q

what types of episodes mustn’t occur for MDD diagnosis?

A

manic or hypomanic episodes

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18
Q

subtypes for symptoms in DSM-5 for MDD

A
  • atypical features (inc sleep, appetite and heightened mood reactivity)
  • melancholic features
  • Psychotic features (e.g. delusions/hallucinations)
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19
Q

manic episodes in accordance with DSM-5?

A

euphoric or irritable mood with 3/7 (at least) of the manic criteria

  • If symptoms present for 1+ weeks with notable functional impairment, a manic episode is diagnosed: leads to DSM-5 diagnosis of type I bipolar disorder
  • If symptoms present for 4+ days without functional impairment: hypomanic episode is diagnosed
  • If no previous manic episode has occurred but only hypomanic episodes present with at least 1 major depressive episode: DSM-5 diagnosis of type II biploar disorder
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20
Q

DSM-5 manic criteria (7)

A
  1. decreased need for sleep and increased energy
  2. distractibility
  3. Grandiosity and inflated self-esteem
  4. flight of ideas/racing thoughts
  5. increased talkativeness/pressured speech
  6. increased goal-directed activities or psychomotor agitation
  7. impulsive behaviour e.g. sexual and spending sprees
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21
Q

what happens in diagnosis of mania/bipolar if not a single manic episode has occured, only hypomanic episodes + at least 1 major depressive episode?

A

DSM-5 diagnosis of type II bipolar disorder

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22
Q

what DMS05 diagnosis if manic symptoms < 4 days, or thresholds for manic/hypomanic episodes aren’t met?

A
  • unspecified bipolar disorder
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23
Q

what cannot be diagnosed using DSM-5 if psychotic features are present?

A

hypomania (psychotic features involves notable impairment by definition)

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24
Q

what is diagnosed using DSM-5 if hospitalisation occurs, irrespective of durations of manic symptoms?

A

manic episode

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25
Q

what is diagnosed using DSM-5 if manic/hypomanic episodes are caused by antidepressants?

A

bipolar disorder

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26
Q

most consistent clinical feature of bipolar disorders

A
  • psychomotor changes
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27
Q

what is the first episode type in bipolar I?

A

depressive

28
Q

what % of the time will people with bipolar disorder be symptom free?

A

just over 50%

29
Q

what % of the time will people with bipolar disorder have symptoms?

A

47%

30
Q

is anxiety prevalent amongst people with bipolar disorder?

A

yes // 30-70% of bipolar patients

- worse prognosis and outcomes if you have MDD and anxiety

31
Q

1980 dichotomy

- bipolar vs unipolar depression age of onset

A

19 vs late 20s

32
Q

1980 dichotomy

- bipolar vs unipolar depressive episodes length

A

3m or less in bipolar, vs 6-12m in unipolar

33
Q

1980 dichotomy

- bipolar vs unipolar recurrence

A

more frequent course cycles in bipolar than unipolar

34
Q

1980 dichotomy

- genetic specifity

A

manic episodes found in relatives of a persons with manic episodes, but not in the families of those with unipolar depression

35
Q

1980 dichotomy

- bipolar vs unipolar differential treatment

A 
bipolar = neuroleptics and lithium
unipolar = antidepressants
36
Q

evidence that bi and unipolar depressions not separate

A
  • MDD commonly diagnosed in children, below age of late 20’s
  • MDD can occur in multiple short episodes in a year
  • genetic studies have found high rates of depressive episodes without mania in persons with bipolar illness, and also frequent occurrence of bipolar illness in relatives of those with unipolar depression
  • treatments overlap (neuroleptics agents effective for mania and depression in uni and bipolar depressions). Li effective not just for mania, but also for depression in bipolar and unipolar types
37
Q

heritability of bipolar (twin studies)

A
  • very heritable

- depression has only half the heritability of bipolar

38
Q

is insight preserved in depression?

A

yes

- impaired in mania

39
Q

when is insight best preserved in mania?

A

moderate mania - hypomania and severe mania sees more severe impairment

40
Q

What mood disorder diagnosis can easily be missed and what diagnosis is a patient in that situation misdiagnosed with?

A 
bipolar diagnosis missed due to lack of insight about mania/hypomania. MDD diagnosis instead despite history of manic episodes. 
Collateral info (ask family/ friends) useful when in doubt about details in history taking. Family members report manic symptoms x2 frequently as patients themselves
41
Q

Problems associated with misdiagnosis

A

antidepressants mostly ineffective in acute bipolar disorder and in prophylaxis.
-> can cause acute manic/hypomanic episodes
-> shows to worse the long-term course of bipolar illness, especially in those with a rapid-cycling course
-

42
Q

attention biases in depression

A
  • hard to disengage from negative material
43
Q

what is seen on fMRI when someone with depressions given negative stimuli?

A

sustained amygdala response
Perigenual anterior cingulate cortex mediates negative attentional bias
increased activity of lateral inferior frontal cortex associated with impaired ability to divert attention from task-irrelevant negative information

44
Q

memory biases in depreesion

A
  • preferential recall of negative compared to positive material
45
Q

facial expression recognition in depression

A
  • increased recognition of negative faces,
  • decreased recognition of happy faces
  • -> also enhanced amygdala response to negative faces
46
Q

what is the amygdala

A
  • a medial temporal lobe region
47
Q

amygdala function

A
  • involved in the perception and encoding of stimuli relevant to current or chronic effective goals.
    Stimuli range from rewards or punishments to facial expressions of emotions to aversive or pleasant images or films.
  • sensitive to detecting and triggering responses to arousing stimuli, exhibits a bias towards detecting cues signaling potential threat
48
Q

[facial recognition]

patient who take noradrenergic antidepressants can identify what better?

A

happy faces

49
Q

[facial recognition]

patient who take serotonergic antidepressants can identify what better (give 2 drug examples)?

A

Mirtazapine: decreased recognition of fearful faces

SSRI citalopram: mixed results (sometimes found to increase fear recognition)

50
Q

what does the 7 day antidepressant treatment involve?

A
  • noradrenergic and serotonergic antidepressants: reduced recognition of anger and fear
  • > reduced amygdala and mPFC response to fear
51
Q

What can we use as a marker of clinical response to antidepressants?

A

Early change in positive processing

In early stages of treatment we can see decreased response to fearful faces

52
Q

what is the gold-standard SSRI?

A

escitalopram
- after 6 weeks treatment, associated with early change (at 1 week) in the amygdala, thalamus, ACC, and insula response to fearful faces

53
Q

How is ACC activity linked to response to treatment for depression?

A

An elevated baseline ACC in depressed patients predicts a positive response to treatment (medication, neurostimulation and CBT)

54
Q

what is the monoamine hypothesis of depression?

A

postulates that depressive symptoms arise from insufficient levels of monoamine neurotransmitter serotonin, norepinephrine, and/or dopamine

55
Q

what can antihypertensive drug reserpine cause (relating to serotonin)

A

depletion of serotonin

56
Q

post-mortem evidence of people who committed suicide shows what levels of 5-HT?

A

low in the brainstem

57
Q

what does (tryptophan hydroxylase inhibitor) p-chlorophenylalanine do to MAOI and TCAs?

A
  • blockade of serotonin synthesis

- prevents antidepressants effects of both MAOIs and TCAs

58
Q

what is the best way to investigate brain pharmacology?

A

PET imaging

  • selective but invasive, radioactive, expensive with less optimal temporal and spatial resolution
  • tracer used is radioactive and binds to a specific target e.g. receptor
59
Q

why don’t we use fMRI to investigate brain pharmacology?

A

it’s not very selective

60
Q

how PET is used to monitor dopamine

A
  • tracer targets dopamine receptors in the brain
  • use to quantify how many receptors are present
    (baseline scan)
61
Q

what is a challenge scane?

A

PET scan taken after patient given pharmacological challenge (e.g. amphetamine to cause release of dopamine) ; causes release of transmitter

  • dopamine will compete with radio tracer
  • less of the tracer can bind to the receptors
  • difference from baseline of binding represents how much dopamine is released from challenge given
62
Q

problem with challenge scan?

A

30-40% of patients don’t respond to challenge

63
Q

What is monoamine oxidase A and how is it affected by MDD?

A

Its an enzyme which breaks down serotonin

It is increased in MDD

64
Q

What is serotonin also known as?

A

5-HT

65
Q

What are the 3 triads of depression?

A

CORE SYMPTOMS:
Low mood
Anergia
Anhedonia

BIOLOGICAL SYMPTOMS:
Sleep
Libido
Appetite

PSYCHOLOGICAL SYMPTOMS:
Oneself
The world
The future

BRS Year 2 (110 decks)

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