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Mood Disorders > Summary > Flashcards

Summary Flashcards

1
Q

Weight loss definition

A

5% in last month

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2
Q

Delusion

A

Firmly held belief not in keeping with pt. cultural background

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3
Q

Bipolar

A

2 or more episodes of elevated/lowered mood

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4
Q

Dysthymia

A

Chronic subthreshold depression

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5
Q

Cyclothymia

A

Persistent mood instability subthreshold bipolar

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6
Q

Frontal lobe

A

Decision making and movements

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7
Q

Temporal lobe

A

Emotion

Primary auditory cortex

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8
Q

Parietal lobe

A

Sensation

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9
Q

Occipital lobe

A

Vision

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10
Q

Techniques for analysing brain

A

Animal testing

Operative

Rabies virus affects limbic system causes personality change

Imaging

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11
Q

Striatum

A

2 parts ventral and dorsal

Ventral- reward system (addiction)

Dorsal- motor function

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12
Q

Cerebrum

A

Large part of brain
Contains 4 lobes

Parietal, frontal, temporal, occipital

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13
Q

Cerebral cortex

A

Outermost layer of cerebrum

  • neocortex almost all of it, divided into different areas e.g. Motor, prefrontal cortex
  • allocortex hippocampus, olfactory
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14
Q

Prefrontal cortex

A

Front part of frontal lobe

High order executive function personality

In psychotic patients observed reduction in volume and number of neuronal connections

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15
Q

Limbic system

A

Structures below cerebrum

Include e.g. Hypothalamus, hippocampus amygdala, limbic cortex

emotion, long term memory, behaviour

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16
Q

Cingulate gurus

A

Limbic

Links behavioural outcomes to motivation

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17
Q

Hippocampus

A

Limbic

Memory, emotion

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18
Q

Amygdala

A

Limbic
Emotional responses reactions

Many sensory inputs

Many motor, neuroendocrine outputs

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19
Q

Hypothalamus

A

Releasing hormones—> ant pit (adenohypophysis)

Oxytocin, ADH—> post pit (neurohypophysis)

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20
Q

MRI

A

Decreased grey matter in limbic and cortical systems e.g. Hippocampus

Increased/structurally poorer white matter

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21
Q

Changes to hippocampus

A

Smaller correlates to length of illness

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22
Q

fMRI

A

Functional MRI blood flow

Amygdala and cingulate gyrus abnormal

Normalise after CBT

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23
Q

PET

A

Positron emission tomography

Radioactive glucose to patient taken up by metabolically active tissue, reduced in brain depressed

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24
Q

Prefrontal cortex 3 parts and function

A

Ventro-medial: pain threshold, aggression, sexual function (hyper=pain, anxiety)

Lateral orbital: assesses risk

Dorsolateral: executive function and attention (hypo= psychomotor retardation)

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25
Q

HPA axis

A

Hypothalamus corticotropin releasing hormone

Ant pit ACTH

Adrenal cortisol (-ve feedback on ant pit and hypothalamus)

Hippocampus inhibits it so atrophy induces dysregulation

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26
Q

HPA axis dysfunction

A

Excess cortisol stress hormone produced

Related to hippocampus atrophy

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27
Q

Thyroid dysfunction

A

TSH response to TRH blunted

Thyroxine sometimes rx

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28
Q

Cytokine dysfunction

A

Overactivity

Possibly due to increased sympathetic tone (high cortisol)

Cause hypersensitivity to pain, loss of appetite libido

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29
Q

BDNF

A

Brain derived neurotrophic factor

Cell maintenance and brain plasticity

Less in depression

Hippocampus atrophy—> HPA

Negative effect on limbic system

30
Q

Sleep architecture changes

A

REM sleep latency shortened from 35 mins to 18 halved

Restored with antidepressants

31
Q

Cognitive model

A

Thoughtsemotionsbehaviour physiology

Thoughts are reactions to stimuli influence emotions and physiology

32
Q

Negative cognitive triad

A
  • ve view of;
  • self
  • world
  • future
33
Q

Cognitive triad context

A

Core belief (schema) e.g. I am unlovable

—>

Basic assumption (I must be loved by everybody)

—>

Conditioned schemata (if I’m not then…is v bad)

34
Q

Cognitive model context

A

Early experience–> core belief—> assumptions—> critical incident activates assumptions

—> NATS ( negative automatic thoughts) emotions (depression) behaviour (social withdrawal) physiology (sleep etc)
All interlinked

35
Q

Activity scheduling CBT

A

Pleasure rating p=0-10

Mastery rating (satisfaction) m=0-10

36
Q

Cognitive techniques: thought challenging

A

All or nothing- only catergorise situations into 2
Discount continuum

Catastrophising- assume the worst in future

Emotional reasoning- if you feel something must be true

Magnification/minimisation- unreasonably magnify negatives

Labelling- fix a label on yourself e.g. Loser discount any evidence to contrary

Mind reading- assume others thoughts

Overgeneralisation- assumptions beyond situation

Personalisation- believe others negative behaviour is because if you

Imperatives-think you know how things should be and overestimate how bad it is when it is not

Tunnel vision/mental filter - only see negatives of situation do not consider the whole

37
Q

2 types of inheritance to predisposing factors

A

Genetic: via quantitative trait loci many genes

Environmental: genes in broad sense determine where you grow up i.e. Who are your parents

38
Q

NA function in brain& where is made

A

Memory

Arousal

Attention

Locus coeruleus in the pons (part of brain stem connecting to limbic system)

39
Q

NA receptors

A

A1,2 B1,2

Alpha arousal and mood

Beta unclear function

40
Q

Evidence for NA in depression

A

AMPT used in eg pheochromocytoma inhibits tyrosine to L DOPA) less NA leads to depressive symptoms

NARIs mechanism of action

41
Q

Serotonin role and production area

A

Sleep

Impulse control

Appetite and mood

Raphe nuclei brain stem

42
Q

Serotonin evidence

A

5HIAA: metabolite of serotonin found in urine low in depression

SPET scan: less 5HT reuptake sites in brain

PET scan: less binding to 5HT1a in brain

Tryptophan depletion precursor to serotonin leads to depression

43
Q

Dopamine

A

Reward seeking

Motor function Learning new skills
–> Parkinson’s

Prolactin secretion

Emotion and response behaviour

Can’t cross blood brain barrier so peripheral levels not associated with cerebral production

44
Q

Acetyl choline

A

Memory

Sleep

Addiction

45
Q

GABA

A

Inhibitory depression transmitter

From glutamate

A and B receptors

Chloride permeability of membrane + by alcohol, benzos

46
Q

NICE guidelines ECT

A
  • if immediate improvement needed e.g. High suicide risk
47
Q

ECT procedure

A

Brief square wave impulses unilaterally

Unilaterally is less effective but also less cognitive impairment

Affects dopamine system

48
Q

ECT side affects

A

Antero and retrograde amnesias

Laryngospasm

Peripheral nerve palsy

Status epilpticus

Caution if CVS patients

49
Q

4 types of attachment childhood

A
  1. Secure 60%
  2. Avoidance 15% rejecting or intrusive
  3. Disorganised 15% unpredictable frightening
  4. Resistant-ambivalent 10% inconstant
50
Q

Gender risk factor

A

Women prevalence higher

  • social factors e.g. Childcare more likely fall to woman stressful
  • men less likely to ruminate
51
Q

Postnatal depression

A

Obstetric complications

Hard work

Loss of sleep

Relationship with father

52
Q

Genes depression

A

Serotonin transporter chrom 17
Reaction to adverse events and SSRIs

BDNF chrom 11 reaction to childhood experiences

53
Q

ID ego superego

A

ID unconscious demands pleasure principal

Ego works on reality principal. Tries to satisfy the demands of the ID through rational thought. Defends itself subconsciously with different mechanisms

Super-ego directs what we do according to moral principles that we have learnt. It is the ideal situation.

54
Q

Defence mechanisms projection

A

You have feelings deemed inappropriate by superego

E.g. Hatred for someone

So convince yourself they hate you

Essentially transference of your own unacceptable thoughts into someone else who doesn’t have them

55
Q

Regression

A

Regress to primitive coping mechanism e.g. Comforting soft toy

56
Q

Displacement

A

Anger at eg boss transferred onto more acceptable and less risky target e.g. Wife

57
Q

Reaction formation

A

Act in opposite to what you feel eg dislike boss and don’t want to work there but start working v hard and being nice to boss

Unplanned kid but overprotective of them

58
Q

Sublimation

A

Unacceptable thoughts to acceptable actions eg

Boxer uses it to deal with aggression

59
Q

Transference psychotherapy

A

Feelings and attitudes from past relationships of the patient are now observed in relationship with therapist

60
Q

Countertransference

A

What the therapist feels, emotions, attitudes towards the patient

What patient evokes in therapist is useful because reflects what they usually evoke in other people

61
Q

Free associations

A

Patient encouraged to suspend judgement and speak mind

62
Q

SSRIs

A

Fluoxetine, sertraline

Nausea hypotension

63
Q

TCAs

A

NA/5HT reuptake

Amitriptyline clomipramine, lofepramine

Cardiotoxic arrhythmias heart block
Dry mouth
Blurred vision
Urinary retention/incontinence

64
Q

MAOIs

A

Prevents breakdown of NA and serotonin

Phenelzine

Hypotension, dizziness

65
Q

SNRIs

A

Nausea constipation hypertension

Duloxetine, venlafaxine

66
Q

NaSSa

NoradrenLine and specific serotonergic agent

A

Mirtazapine

Pre synaptic A2 adrenoreceptor antagonist/blocker on both NA and serotonin neurones

Increases transmission of NA/serotonin

67
Q

SSRI interactions

A

With NSAID = increased bleeding risk

68
Q

Citalopram interactions

A

Antipsychotics QT elongation

69
Q

Renal impairment

A

Start low dose increase slowly

70
Q

CVS patient

A

Avoid TCAs

SSRIs best as antiarrythmic potential

71
Q

Hepatic impairment

A

Start low dose

Leave longer between doses

Citalopram safest

72
Q

Changing

A

Leave at least 6 weeks

Consider pregnancy, other eg renal function

Mood Disorders (1 decks)

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