Week 2.3: Organic Affective Disorders Flashcards
This rule suggests that for any symptom, one should first consider an organic cause. If no organic cause is found, then consider other psychiatric disorders.
Kraeplin’s Layer Rule (Triadic Diagnostic System of Mental Disorders)
What are the Layers in the Triadic System?
1) Organic (Top)
2) Endogenous (Middle)
3) Exogenous (Bottom)
These are physical or biological causes of mental disorders, such as brain injuries, neurological diseases, or other medical conditions.
Organic Cause
These are mental disorders thought to arise from internal factors, such as genetic or biochemical imbalances.
Historically, this included mood disorders (like depression) and schizophrenia (psychosis).
Endogenous Layer
These are mental disorders believed to be reactions to external psychosocial stressors.
This category included anxiety disorders and other stress-related conditions.
Exogenous Layer
How does ICD-10 currently define an organic mental disorder?
Justified: If criteria 1,2 and 4 are met
Certain: All criteria are met
What are the Criteria for Organic Mental Disorders (ICD-10)?
1) Objective Evidence
2) Presumed Relationship
3) Recovery or Improvement
4) Absence of Alternative Causes
These are mood or anxiety disorders that meet both the general criteria for organic mental disorders and the specific criteria for the particular affective or anxiety disorder.
Organic Mood or Anxiety Disorders (ICD-10)
These criteria are used to determine whether a mental disorder has an organic (physical) cause.
General Criteria for Organic Mental Disorders (ICD-10)
These criteria are used to diagnose the particular type of mood or anxiety disorder (e.g., manic, bipolar, depressive, mixed affective, or anxiety disorder).
Specific Criteria for Organic Mental Disorders (ICD-10)
What are the Criteria for Mood Disorder due to Another Medical Condition (DSM-5)?
1) Mood Disorder criteria
2) Evidence of Medical Condition
3) Exclusion of Other Mental Disorders
4) Exclusion of Delirium
5) Clinically Significant Impairment or Distress
A state of confusion, disorientation, and cognitive impairment.
Delirium
Parkinson’s Disease
Is a progressive neurological condition involving the degeneration of neurons in the substantia nigra, a small part of the brainstem.
A small part of the brainstem that sends projections primarily to the motor system, affecting movement.
Substantia Nigra
Another part of the dopaminergic system, often referred to as the reward system, which is not necessarily affected in people with Parkinson’s disease and they may not always experience depression.
Ventral Tegmented Area (VTA)
Interactions between serotonin, noradrenaline, dopamine, and glutamate influence brain function.
Monoaminergic Systems
What is the prevalence of depression in people with Parkinson’s disease?
High Prevalence: Up to 50-70%
Early Symptoms: Depression/anxiety may precede the neurological symptoms of Parkinson’s disease, occurring before motor symptoms
Increased Risk: People with depression have a 3x higher risk of developing Parkinson’s disease later, likely due to undiagnosed Parkinson’s presenting initially as depressive symptoms.
Why is thorough evaluation important?
Always consider and investigate atypical symptoms to rule out organic causes.
Can cause affective disorders with symptoms that may initially appear as depression or other mood disorders.
Brain Tumors
Are signs or manifestations of a condition that deviate from the usual or expected presentation.
Might include behaviors or experiences that are not commonly associated with the primary diagnosis. These symptoms can indicate the presence of an underlying organic cause or a different condition altogether.
Atypical Symptoms
What are examples of atypical symptoms?
Unusual Behavior: Actions that are out of character or not typically associated with the diagnosed condition
Neurological Signs: Sudden changes in motor skills, coordination, or sensory perception
Rapid Onset: Develop very quickly and are not consistent with the usual progression of the diagnosed condition.
Cognitive Impairments: Issues with memory, attention, or problem-solving
What is the connection between stroke and depression?
Prevalence: More than half of stroke patients experience depressive symptoms even one year after the stroke.
Left Hemisphere Strokes: Depressive symptoms are more common in patients with strokes affecting the left hemisphere of the brain.
Refers to a group of conditions that affect the blood vessels and blood flow to the brain.
Cerebrovascular Disease
Reduced Blood Flow
Ischemia
Bleeding
Hemorrhage
An interruption of blood supply to the brain, leading to brain cell death.
Stroke
A bulge in a blood vessel in the brain that can burst and cause bleeding.
Aneurysm
Depression in older adults that is not caused by an identifiable physical or organic condition.
This type of depression is often related to psychosocial factors, such as Life Changes, Chronic Illness, or Social Isolation.
Non-Organic Old Age Depression
A disruption in the normal function of the brain caused by a blow, bump, or jolt to the head, or a penetrating head injury.
Frequent cause of white matter disruption in the brain.
Traumatic Brain Injury (TBI)
A type of MRI that specifically measures the diffusion of water molecules in the brain, allowing for the visualization of white matter tracts.
Diffusion Tensor Imaging (DTI)
The part of the brain that contains nerve fibers (axons), which are covered in myelin. White matter is responsible for communication between different brain regions.
White Matter
The first presenting symptom reported by caregivers can help differentiate between dementia syndromes.
Lead Symptom
How can we tell if a neurological examination is needed?
If neurological signs are present, refer to a neurologist. If not, use the lead symptom to guide the diagnosis.
Another neurological condition that can lead to mood disorders.
Epilepsy
Symptoms that occur before a seizure, known as the prodrome of complex partial seizures.
Pre-ictal Depressive Symptoms
Symptoms that occur between seizures.
Interictal Depressive Symptoms
A mood disorder specific to epilepsy, characterized by fluctuating symptoms.
Interictal Dysphoric Disorder
Persistent mild depression
Dysthymia
A feeling or state of intense excitement and happiness
Euphoria
A state of unease or generalized dissatisfaction with life
Dysphoria
An early symptom indicating the onset of a disease or illness
Prodrome
Dysthymia is a chronic, less severe form of depression, while major depression is more severe but may be episodic.
Dysthymia VS Depression
Euphoria: Intense but short-lived happiness, usually without negative consequences.
Mania: Sustained and disruptive elevated mood, often impairing judgment and leading to risky behaviors.
Euphoria VS Mania
Is linked to mood changes due to high cortisol levels.
Cushing Syndrome (Hypercortisolism)
What are non-organic causes of Hypercortisolism?
Exogenous Factors: Receiving cortisol above a certain dose (e.g., medication).
Endogenous Factors: Often caused by a pituitary tumor, which increases adrenal production of cortisol.
What are some of the physical symptoms of hypercortisolism (Cushing syndrome)?
- Rounder face
- Development of a hump on the back
- Easy bruising
- Increased abdominal weight
- Stretch marks
- Women may develop more hair in unusual areas
Is a small, butterfly-shaped gland located in the front of your neck.
It plays a crucial role in regulating various bodily functions through the production of thyroid hormones.
Thyroid
Is essential for regulating metabolism, growth, development, temperature, heart function, and mood. Proper thyroid function is crucial for overall health and well-being.
Thyroid Gland
What are thyroid dysfunctions causing affective disorders?
Hyperthyroidism: Too Much Thyroid Hormones
Hypothyroidism: Too Little Thyroid Hormones
A hormonal disorder common among women of reproductive age, characterized by irregular menstrual periods, excess androgen levels, and polycystic ovaries.
A significant proportion of women with PCOS experience anxiety and mood disorders.
Polycystic Ovarian Syndrome (PCOS)
Obtained from the diet (e.g., leafy greens, fruits, beans, and fortified foods).
A significant proportion of people with folic acid deficiency develop depression
Folic Acid (B9)
Found in animal products (e.g., meat, fish, dairy) and fortified foods.
Can lead to depression, fatigue, and cognitive issues
Vitamin B12
Both vitamins are involved in the methylation cycle and the formation of S-adenosylmethionine (SAM), a crucial methyl donor in the body
Folic Acid (B9) and Vitamin B12
Refers to the chemical processes that occur within a living organism to maintain life, including converting food into energy, building and repairing tissues, and managing waste products.
Metabolism
The powerhouses of cells, are crucial for energy production.
Dysfunction can lead to insufficient energy supply to neurons, contributing to disorders like depression, bipolar disorder, and schizophrenia
Mitochondria
What is the DSM-5 Criteria for Substance or Medication-Induced Mood Disorders?
1) Mood Disorder criteria
2) Evidence of Substance or Medication Influence
3) Exclusion of Other Mood Disorders
4) Exclusion of Delirium
5) Clinically Significant Distress or Impairment
Manic symptoms caused by the use of certain substances or medications. Manic symptoms include elevated mood, increased activity, and sometimes irritability.
Substance-Induced Mania
Is there any relation or causation between substances and affective disorders?
While there is a high prevalence of affective disorders among substance-dependent patients, it is not solely the substances that cause these disorders.
General dissatisfaction with life
Dysphoric Mood
Inability to feel pleasure
Anhedonia
When should we suspect an organic cause of affective disorders?
1) Visual Hallucinations
2) Focal Neurological Symptoms
3) Autoimmune Reactions and Cancers
4) Systemic Disorders (i.e., lupus)
5) Neurological disorders (i.e., MS)
6) Treatment Resistance
7) Unusual Presentation (i.e., depression but actually indifferent)
8) Age of Onset (i.e., after age 50)
9) Inability to Perform Simple Activities
Are crucial for tasks requiring active processing and are disrupted by lesions or disruptions in frontal sub-cortical circuits.
Executive (Frontal) Function
What are Focal Neurological Symptoms?
Seizures
Episodes of unresponsiveness
Weakness in limbs
Sensory problems
Unexplained visual problems
Balance issues
Difficulty with fine movements
Unexplained headaches
Are essential for managing daily life and achieving goals. They involve a range of cognitive processes, including working memory, cognitive flexibility, inhibitory control, planning, problem-solving, self-monitoring, and emotional regulation.
Executive (Frontal) Function
Are common in both organic and non-organic psychiatric disorders, making these tests less useful for differentiation.
Executive Function Impairments
Useful in differentiating organic from non-organic conditions. Impairment in these tasks suggests an organic cause.
Passive Tasks
Commonly impaired in both organic and non-organic psychiatric disorders, making them less useful for differentiation.
Active Tasks
The most active task, requiring significant cognitive effort and flexibility.
Set Shifting (Task Switching)
