Week 2 - Depression and Anxiety Flashcards
What do you observe in a mental state examination of a patient?
- Appearance
- Behaviour
- Speech
- Mood
- Thought
- Hallucinations
- Cognition
- Insight
What are the 5 types of depression?
- Atypical depression
- Seasonal affective disorder
- Adjustment disorder
- Bereavement
- Life stress
What are the main types of anxiety?
- Simple phobias
- PTSD
- Generalised anxiety disorder
- Panic disordser
- Health anxiety
- OCD
- Social anxiety disorder
What are 3 non-pharmacological ways of treating depression and anxiety?
- Electrical
- Magnetic
- Psychological treatment
What is involved in electroconvulsive therapy?
- Treatment resistant depression
- Deep brain stimulation
- Controlled seizure
- Vagal nerve stimulation
What things is the limbic system involved in?
- Emotions
- Reward driven activity
- Motivation
- Social behaviours
- Memory of environment and experience
What is the limbic system?
- Model of brain function
- Transitional position between subcortical nuclei and neo-cortex
- Different circuits connect functionally related components
What are the inputs to the hippocampus?
- Sensory information from cortex via entorhinal cortex
- Performant path to dentate gyrus
- Modulatory inputs from septal nuclei and brainstem nuclei influence overall function
What are the outputs from the hippocampus?
- Via subiculum and entorhinal cortex to neocortex
- Via fornix to septal region and mamillary bodies, hypothalamus, and median forebrain bundle
What are properties of working memory?
- Limited capacity
- Rapid decay
- Prefrontal cortex
- Visual and auditory versions of working memory
What are the roles of the hippocampus on episodic memory?
- Long-term potentiation = synaptic plasticity in hippocampus
- Long-lasting change in synaptic function
- Increase in AMPA receptors
- NMDA and Ca dependent
- Synapse specific
- Inputs from sensory cortices via entorhinal cortex
What is responsible for emotions and nwhat are its proeprties?
- Amygdala
- Multiple sub-nuclei
- sensory and limbic inputs
- Organise emotional responses to stimuli
What are the amygdala inputs?
Subcortical sources of sensory and visual information
What are the amygdala outputs?
Stria terminalis - hypothalamus, brainstem, BNST, accumbent
What is labelled?
Amygdala
What happens in fear conditioning?
Fearful faces activate amygdala
What arears of the brain are involved in the reward circuit?
- Midbrain dopaminergic neurons
- Ventral tegmental area to nucleus accumbens
- Median forebrain bundle
- Orbitofrontal and median frontal cortex
- Ventral striatum
- Amygdala
What are the 2 pleasure hotspots?
Nucleus accumbens
Orbitofrontal cortex
What happens in Kluver-Bucy syndrome?
- Bilateral temporal lobe resection where amygdala, hippocampus and other are removed
- No longer aggressive
- Indiscriminate sexual activity
- Cannot discriminate visually between edible and non-edible
What happens in Urbach-Wiethe disease?
- Normal IQ
- Recognise familiar faces and emotion
- Unable to recognise fear face
- No fear
- No deficit in other emotions
- Cannot learn fearful situations
What is the role of the cingulate cortex?
- Handling conflicting information
- Error monitioring
- Arousal
- Overactivity in OCD
What happens in brain in depression?
- Dysfunction of limbic-striatum-frontal cortex
- Amygdala = anxiety
- Hippocampus = memory deficits
- Reward circuits = anhedonia and motivation
- Frontal lobe = motivation, decision making
- Striatum = motor slowing
What is the role of the pre-frontal cortex?
- Inputs to and from key limbic structures
- Important in decisions about reward and appetite
- Motivation and behaviour regulation
- Disorders = psychiatric and personality disorders
What is the first factor involved in emotion processing?
Appraisal
Primary = evaluation of relevance of current istuation ot personal wellbeing
Secondary = evaluation of capacity to deal with situation
What is the second factor involved in emotion processing?
Arousal
Encounter, bodilt reaction, emotion
What is the thrid factor involved in emotion processing?
Expression
Duchenne smile = obtained false smile through electrical sitmulation
Voluntary facial movements = controlled by pyramidal motor system
Involuntary = controlled by extrapyramidal motor system
What is the fourth factor involved in emotion processing?
- Action readiness
- Tendency of an emotion to serve as impusle for action specific to emotion
What is the role of the amygdala in emotion processing?
- Receives auditory, taste, and smell information
- Makes quick evaluation of stimulus
- Involved in automatic, preconscious detection of threat and danger
What is the role of the anterior cingulate cortex in emotion processing?
- Attention to regulate cognitive and emotional processing
What happens to brain in depression?
Hypothalamus, pititary, adrenal cortex hyperactivation
+ cotrisol in saliva, plasma, and urine
+ CRH in CSF
+ size of pituitary and adrenal glands
Impaired negative feedback
How do TCAs work?
- Inhibit serotinin and noradrenaline reuptake
- Sedative
- Anticholinergic side effects
- Cardiovascualr effects can be fatal in overdose
How do MAOIs work?
Tyramine displaces noradrenaline from vesicle storage
How does mirtazapine work?
- Enahnces NA and 5HT transmission
- Blocking of adrenoceptors responsible for noradrenaline release inhibition
- Blocking of receptors responsible for inhibiting 5HT release
What are the properties of benzodiazepines?
- Used in epilepsy, insomnia, alcohol withdrawal, and ST in anxiety
- Positive allosteric modulators on GABAa receptor complex
- Allow GABAa to bind
- Cl- flow into neurone
- Hyperpolarisation = inhibition
What is the therapeutic window of lithium?
0.5-1.0 mmol/L
What is an MMSE?
Mini mental state examination
Max score = 30
Cut-off score = 23
Mild cognitive impairment = 23-26
