Week 20 mood disorders & Schizophrenia

Question 1

Postpartum depression

Answer 1

1 in 20 women experiences depression after giving birth.

aka perinatal depression

Question 2

Mood Episodes

Answer 2

A strong emotion (everybody experiences this, doesn’t mean its a disorder)

becomes a disorder when its significantly distressing and impairs everyday functioning

Question 3

Major depressive episode (MDE)

& required symptoms for diagnosis

Answer 3

Symptoms occur for AT LEAST 2 WEEKS
- significant distress / impairment to lifestyle / relationships
- starts experiencing Anhedonia

MUST HAVE 5 of 9 REQUIRED SYMPTOMS:

1) Depressed mood
2) Decreased interest / pleasure in almost everything
3) Significant weight gain/loss or appetite increase/ decrease
4) Insomnia / hypersomnia
5) Psychomotor agitation (motor activities / fidgeting cuz of restlessness) OR retardation (slowing down actions e.g., brushing teeth)
6) Fatigue / low energy
7) Feeling worthless / excessive
8) Poor concentration / indecisiveness
9) Suicidal

Question 4

Anhedonia

Answer 4

Loss of interest / passion in things previously enjoyable or rewarding

Question 5

Manic / Hypomanic Episode

Answer 5

manic: symptoms at least a week (impairs life significantly)
hypomanic: symptoms at least 4 days (doesn’t necessarily impact life that significantly)

abnormally persistent euphoria or irritability + goal- directed energy (motivation?)

Symptoms: (at least 3 for euphoria & 4 for irritability)

1) ego UP
2) goal oriented activity UP & psychomotor agitation UP
3) reduced need for sleep
4) racing thoughts / ideas
5) distractibility
6) talkativeness UP
7) risky behaviour UP

Question 6

Unipolar mood disorders

Answer 6

Two main types involving depressive mood (major depressive disorder (MDD) and persistent depressive disorder(PDD))

Question 7

MDD

Answer 7

• one or more MDEs (major depressive episode)
• NO history of mania/hypomania
  shorter version of PDD
  can have pdd and mdd at the same time

STATS:

• 16.6% of the population
• 0.5% fit the criteria of the disorder in a year
• 1 in 5 Americans meet criteria at least once in their lifetime
• most common for ppl in their 20’s
• within 3 months, 40% begin recovering
• within 12 months 80% begin recovering
• tends to be a recurrent disorder (meaning 40-50% experience a second MDE)

the younger the patient the worse the symptoms tend to be.

of MDD patients, 59% have anxiety disorder, 32% have impulse control, 24% have substance use disorder

WOMEN experience 2-3 times higher MDD than MEN. (gender differences emerge during puberty)

MDD correlated with socioeconomic status!! (negative correlation is stronger with age 65 +)

Aside from socioeconomic factors in America, white ppl have more documented MDD than black or hispanic ppl. (though in black ppl it tends to be more severe and less often treated)

and then native ppl experience more MDD than white, black, or hispanic.

Question 8

PDD

Answer 8

Persistent Depressive D:
- feeling depressed for most of the day
- for more days than not
- for at least 2 years

SYMPTOMS FOR PDD: (need at least 2)
1) poor appetite or overeating
2) insomnia or hypersomnia
3) fatigue / low energy
4) low self esteem
5) poor concentration / decision making
6) hopelessness

BASICALLY SAME SYMPTOMS AS FOR MDE

Cannot be without symptoms for more than 2 months (for it still being PDD)

Again the symptoms must cause serious impairment to life / functioning.

If person has MDE during PDD (they will get diagnosis of both PDD and MDD)

PDD is just longer version of MDD from my understanding.

Question 9

Bipolar Disorders

Answer 9

A combo of depressive episodes and manic episodes

Three types (BD I, BD II, & cyclothymic disorder)

! use fMRI !

known to be highly heritable —> argued that its a biological phenomenon altogether

LOTS of variability across time, within a person, and with diff ppl

triggers for genetic vulnerability not really known —–> psychosocial triggers suspected

its fundamentally a disorder of emotion (evidence found using fMRI)
- emotional processing and regulation activated differently

sample sizes usually small —> hard to do intergroup comparisons

severe life stressors increase risk of relapse for ppl with BD

ALSO they suffer manic symptoms after attaining a goal —> MAYBE HYPERSENSITIVITY TO REWARDS

also maybe disruptions in sleep rythms/ daily cycle could be impactful to

Question 10

BD I

Answer 10

aka manic-depression

single or recurrent manic episode

depressive episode NOT NECESSARILY PRESENT (but quite common)

Question 11

BD II

Answer 11

single or recurrent hypomanic and depressive episodes

Question 12

Cyclothymic disorder

Answer 12

basically longer version of BD II

depression symptoms cant fully qualify for MDE

must experience symptoms at least half the time

cant be without symptoms for longer than two consecutive months

must cause significant distress to life

Question 13

Social Zeitgeber Theory

Answer 13

daily routines / social interactions impact sleep cycles and mental well being.

Changes in this stuff could increase BD relapse in BD individuals.

Question 14

SSRIs and SNRIs

Answer 14

best treatment for depression:

SSRI: Prevent re-uptake of serotonin, therefore allowing it to stick to receptors for longer. (ex: Fluoxetine)

SNRI: for serotonin AND norepinephrine
(ex: Duloxetine)

Allows them to interact with postsynaptic receptors for longer, hence leading to prolonged neurotransmitter signalling & is linked to a more positive mood and alleviating symptoms of depression.

not as cardiotoxic as tricyclics, but still has side effects like difficulty having orgasms, gastrointestinal issues, insomnia, etc.

Question 15

MAOIs

Answer 15

earliest antidepressant

inhibits the enzyme monoamine oxidase whose role is deactivating dopamine, norepinephrine, and serotonin.

Effective BUT lots of side effects:
- dangerously high blood pressure if they are on antihistamine or eat food containing the amino acid tyramine, (found in aged cheese, soy sauce, and wine)

Question 16

Tricyclics

Answer 16

Second oldest antidepressant

Blocks reabsorption of dopamine, norepinephrine, and serotonin at synapses, which increases their availability.

best for treating vegetative and somatic symptoms of depression.

EXCEPT the side effects are shit, its cardiotoxic

Question 17

Electroconvulsive therapy (ECT)

Answer 17

Giving them a seizure AFTER they’ve taken muscle relaxants WHILE they’re on anesthesia

for peeps with severe depresso that resist other medication

side effects: short term (usually) confusion / memory loss

Question 18

Transcranial Magnetic stimuli (TMS)

Answer 18

• Non invasive
• patient is awake
• pulsating magnetic fields to the cortex

fewer side effects than ECT
- good for ppl with MDD and resistance to other meds

Question 19

Deep Brain Stimulation

Answer 19

experimental treatment
implant electrodes in the brain, connected to neurotransmitters stimulated by a pacer implanted in the chest

if no other medications including ECT and TMS were working

side effects that come with surgery

Question 20

more types of therapy for depresso (I was lazy)

Answer 20

Behaviour Therapy:
- Focuses on increasing pleasant experiences and mastery.

Cognitive Therapy:
- Aims to identify and change distorted automatic thoughts.

Cognitive-Behavioral Therapy (CBT):
- Combines cognitive and behavioral approaches.

Interpersonal Therapy for Depression:
- Targets unresolved grief, interpersonal disputes, role transitions, and deficits.

Short-Term Psychodynamic Therapy:
- Also effective for depression, focusing on limited issues with active therapist involvement.

Question 21

BD Treatment

Answer 21

typically pharmacotherapy (medication rather than therapy)

Lithium is the premium choice
– acts on several neurotransmitter systems
– reduce excitatory, (dopamine/glutamine) and increase inhibitory (GABA)

EFFICIENT but sideffects…
—-impaired cognitive functions
—-physical symptoms: nausea / fatigue and shi

side effects can improve over time BUT HIGH MEDICATION NON COMPLIANCE with BD

SNRI & SSRI NOT used cuz might induce mania / hypomania in BD ppl

Anticonvulsant medications
also used either with or without lithium
(e.g., carbamazepine, valproate)
– typiacally used for epilepsy
– controls abnormal electrical activity in brain

Question 22

Interpersonal and Social Rhythm Therapy (ISRT)

Answer 22

focuses on social Zeitgeber theory (the daily rhythms thing)

tries to prevent BD relapse

focuses on sleep distribution / healthy rhythmic lifestyle

Question 23

Catatonia

Answer 23

reduction in responsiveness to the external environment

• unusual postures for long periods of time
• failing to respond to verbal or motor prompts from another person
• excessive and seemingly purposeless motor activity

Question 24

Schizo Symptoms

Answer 24

• hallucinations
• delusions,
• disorganized speech/ behavior
• abnormal motor behavior
• catatonia
• anhedonia/ amotivation
• blunted affect /reduced speech
• flat affect (reduced facial expressions / alogia (reduced speech)

Question 25

Delusions

Answer 25

strong belief in smth false

(often culturally influenced)

common delusions:

– Thinking that someone’s plotting against you

– Grandiose delusions (super powers and shi)

– Referential delusions (things are happening SPECIFICALLY for them, aka song playing on radio for them)

– ppl think they’re thoughts / actions are being controlled

Question 26

Hallucinations

Answer 26

Can be any of the 5 senses

in adults most common are auditory
the voices are often negative, can be a familiar voice or not.

Question 27

some stats

Answer 27

10%+ of the population experience “psychotic like” symptoms

Adults in kenya: ~19% at some point in their lives experience psychotic like symptoms

Question 28

Functional capacity

Answer 28

being able to take care of yourself / function properly

(becomes a cognitive issue in ppl with schizo)

Question 29

Episodic memory vs Working memory

Answer 29

episodic:
Memory of a specific event / retrieving & learning new info & episodes in life

working:
holding onto info temporarily (30 secs) for manipulation.

(ppl with schizo often have impairments with both of these)

Question 30

Ppl with Schiz have difficulty with:

Answer 30

• episodic memory (events)
• working memory (30s)
• functional capacity (taking care of self)
• processing speed (processing and responding to audio / visual info)

(ppl often have them before developing the disorder and NOT as an outcome of the disorder)

ALSO some issues with social cognition (hard to say if its a cause of the disorder or a prerequisite)

• recognition of emotional expression on other ppl’s faces
• problems with theory of mind (inferring other’s intentions)

Schiz ppl with social cognition issues tend to have worse schiz symptoms & functional capacity

Question 31

what imaging techniques for schiz?

Answer 31

structural & fMRI (NON invasive, uses magnets

and PET (INVASIVE)
- uses positron emissions from brain after injected with radio-labeled isotopes to get brain image

both used for schiz and psychosis

Question 32

reason for delusions in psychosis

Answer 32

cuz of issues with salience detection (your brain pays attention to the wrong things)

supported by ventral striatum and the anterior prefrontal cortex
——these regions show more activity when our brain perceives something as more important (aka salient) in the environment.

If they misfire —> we find the irrelevant things important.

Question 33

reasons for working memory / cognitive control issues in schiz

Answer 33

Related to problems in the function of a region of the brain called the dorsolateral prefrontal cortex (DLPFC)

During times when working memory /cognitive control is used, there are:

– changes in how the DLPFC works
– issues with how the DLPFC connects to other brain regions like:
———- posterior parietal cortex,
———-anterior cingulate
———-and temporal cortex

Question 34

reason for episodic memory problems in schiz

Answer 34

medial temporal lobe defects
– specifically hippocampus (important for creating new memories)

DLPFC also part of the problem for this in schizos cuz it’s important for how we control our memories.

Question 35

Changes in brain structure for schiz

Answer 35

(with the help of magnitude neuroimaging)

• overall reduced brain volume with age increased for schizos than healthies
• antipsychotic meds or like drug drugs wooo could make volume reduction worse

first degree relatives will have similar brain stuff at a lesser degree —> shows that schiz is largely genetic

Question 36

Genetic risks of schiz

Answer 36

• not one gene but a collection of many that create a predisposition
• very heterogeneous (means two different schizos r gonna have very different symptoms) —–> makes it more difficult to tell what genes are responsible

Question 37

Environmental risks of Schiz

Answer 37

risks during pregnancy:
–stress/infection/malnutrition/diabetes
– complications at birth do do with lack of oxygen (hypoxia)
–children born to older fathers

other risks:
- marijuana
- higher chance is grow up in urban setting
- some minority ethnic groups

NONE OF THESE ARE REISKY ENOUGH FOR CLINICAL SETTINGS THO

Question 38

Attenuated Psychotic Syndrome

Answer 38

ppl with attenuated (milder) psychosis symptoms developed recently / causing them high distress ———> 35% of these develop psychotic disorders (most often schiz)

these ppl clinically high risk

Added to section III of DSM-5 (section with disorders that need further study)
—–ppl argued that creating a section like that would lead to creation of disorders when none exist
—– others thought it was good idea so more research will go to helping these ppl

ALSOOO study said non invasive treatment like omega-3 fatty acid and intensive family intervention might help reduce chances of full blown psychosis for these at risk ppl.

Question 39

Antipsychotic Meds

Answer 39

(for schiz) two types.

both: strong block of D2 type Dopamine receptor
helps reduce hallucinations, delusions, and disorganized speech BUT does not fix cognitive defects / negative
associated with distressing motor side effects.

TYPICAL: discovered that it helped by accident 60 ish years ago

ATYPICAL: the new generation of antipsychotics. DON’T necessarily help more, just less motor side effects.
BUT SIDE EFFECTS called “METABOLIC SYNDROME”, cardiovascular illness, weight gain, diabetes, death.

Question 40

Cognitive remediation

Answer 40

shown some evidence of helping cognition and function in schiz.

Cognitive Enhancement Therapy (CET)

imporves cognition
functional outcome
social cognition
protect against gray matter loss
IN YOUNG SCHIZOS