Week 2.3: Organic Affective Disorders

Question 1

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.

Answer 1

Kraeplin’s Layer Rule (Triadic Diagnostic System of Mental Disorders)

Question 2

What are the Layers in the Triadic System?

Answer 2

1) Organic (Top)
2) Endogenous (Middle)
3) Exogenous (Bottom)

Question 3

These are physical or biological causes of mental disorders, such as brain injuries, neurological diseases, or other medical conditions.

Answer 3

Organic Cause

Question 4

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).

Answer 4

Endogenous Layer

Question 5

These are mental disorders believed to be reactions to external psychosocial stressors.

This category included anxiety disorders and other stress-related conditions.

Answer 5

Exogenous Layer

Question 6

How does ICD-10 currently define an organic mental disorder?

Answer 6

Justified: If criteria 1,2 and 4 are met
Certain: All criteria are met

Question 7

What are the Criteria for Organic Mental Disorders (ICD-10)?

Answer 7

1) Objective Evidence
2) Presumed Relationship
3) Recovery or Improvement
4) Absence of Alternative Causes

Question 8

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.

Answer 8

Organic Mood or Anxiety Disorders (ICD-10)

Question 9

These criteria are used to determine whether a mental disorder has an organic (physical) cause.

Answer 9

General Criteria for Organic Mental Disorders (ICD-10)

Question 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).

Answer 10

Specific Criteria for Organic Mental Disorders (ICD-10)

Question 11

What are the Criteria for Mood Disorder due to Another Medical Condition (DSM-5)?

Answer 11

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

Question 12

A state of confusion, disorientation, and cognitive impairment.

Answer 12

Delirium

Question 13

Parkinson’s Disease

Answer 13

Is a progressive neurological condition involving the degeneration of neurons in the substantia nigra, a small part of the brainstem.

Question 14

A small part of the brainstem that sends projections primarily to the motor system, affecting movement.

Answer 14

Substantia Nigra

Question 15

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.

Answer 15

Ventral Tegmented Area (VTA)

Question 16

Interactions between serotonin, noradrenaline, dopamine, and glutamate influence brain function.

Answer 16

Monoaminergic Systems

Question 17

What is the prevalence of depression in people with Parkinson’s disease?

Answer 17

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.

Question 18

Why is thorough evaluation important?

Answer 18

Always consider and investigate atypical symptoms to rule out organic causes.

Question 19

Can cause affective disorders with symptoms that may initially appear as depression or other mood disorders.

Answer 19

Brain Tumors

Question 20

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.

Answer 20

Atypical Symptoms

Question 21

What are examples of atypical symptoms?

Answer 21

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

Question 22

What is the connection between stroke and depression?

Answer 22

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.

Question 23

Refers to a group of conditions that affect the blood vessels and blood flow to the brain.

Answer 23

Cerebrovascular Disease

Question 23

Reduced Blood Flow

Answer 23

Ischemia

Question 24

Bleeding

Answer 24

Hemorrhage

Question 25

An interruption of blood supply to the brain, leading to brain cell death.

Answer 25

Stroke

Question 26

A bulge in a blood vessel in the brain that can burst and cause bleeding.

Answer 26

Aneurysm

Question 27

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.

Answer 27

Non-Organic Old Age Depression

Question 28

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.

Answer 28

Traumatic Brain Injury (TBI)

Question 29

A type of MRI that specifically measures the diffusion of water molecules in the brain, allowing for the visualization of white matter tracts.

Answer 29

Diffusion Tensor Imaging (DTI)

Question 30

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.

Answer 30

White Matter

Question 31

The first presenting symptom reported by caregivers can help differentiate between dementia syndromes.

Answer 31

Lead Symptom

Question 32

How can we tell if a neurological examination is needed?

Answer 32

If neurological signs are present, refer to a neurologist. If not, use the lead symptom to guide the diagnosis.

Question 33

Another neurological condition that can lead to mood disorders.

Answer 33

Epilepsy

Question 34

Symptoms that occur before a seizure, known as the prodrome of complex partial seizures.

Answer 34

Pre-ictal Depressive Symptoms

Question 35

Symptoms that occur between seizures.

Answer 35

Interictal Depressive Symptoms

Question 36

A mood disorder specific to epilepsy, characterized by fluctuating symptoms.

Answer 36

Interictal Dysphoric Disorder

Question 37

Persistent mild depression

Answer 37

Dysthymia

Question 38

A feeling or state of intense excitement and happiness

Answer 38

Euphoria

Question 39

A state of unease or generalized dissatisfaction with life

Answer 39

Dysphoria

Question 40

An early symptom indicating the onset of a disease or illness

Answer 40

Prodrome

Question 41

Dysthymia is a chronic, less severe form of depression, while major depression is more severe but may be episodic.

Answer 41

Dysthymia VS Depression

Question 42

Euphoria: Intense but short-lived happiness, usually without negative consequences. Mania: Sustained and disruptive elevated mood, often impairing judgment and leading to risky behaviors.

Answer 42

Euphoria VS Mania

Question 43

Is linked to mood changes due to high cortisol levels.

Answer 43

Cushing Syndrome (Hypercortisolism)

Question 44

What are non-organic causes of Hypercortisolism?

Answer 44

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.

Question 45

What are some of the physical symptoms of hypercortisolism (Cushing syndrome)?

Answer 45

- Rounder face - Development of a hump on the back - Easy bruising - Increased abdominal weight - Stretch marks - Women may develop more hair in unusual areas

Question 46

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.

Answer 46

Thyroid

Question 47

Is essential for regulating metabolism, growth, development, temperature, heart function, and mood. Proper thyroid function is crucial for overall health and well-being.

Answer 47

Thyroid Gland

Question 48

What are thyroid dysfunctions causing affective disorders?

Answer 48

Hyperthyroidism: Too Much Thyroid Hormones Hypothyroidism: Too Little Thyroid Hormones

Question 49

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.

Answer 49

Polycystic Ovarian Syndrome (PCOS)

Question 50

Obtained from the diet (e.g., leafy greens, fruits, beans, and fortified foods). A significant proportion of people with folic acid deficiency develop depression

Answer 50

Folic Acid (B9)

Question 50

Found in animal products (e.g., meat, fish, dairy) and fortified foods. Can lead to depression, fatigue, and cognitive issues

Answer 50

Vitamin B12

Question 51

Both vitamins are involved in the methylation cycle and the formation of S-adenosylmethionine (SAM), a crucial methyl donor in the body

Answer 51

Folic Acid (B9) and Vitamin B12

Question 52

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.

Answer 52

Metabolism

Question 53

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

Answer 53

Mitochondria

Question 54

What is the DSM-5 Criteria for Substance or Medication-Induced Mood Disorders?

Answer 54

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

Question 55

Manic symptoms caused by the use of certain substances or medications. Manic symptoms include elevated mood, increased activity, and sometimes irritability.

Answer 55

Substance-Induced Mania

Question 56

Is there any relation or causation between substances and affective disorders?

Answer 56

While there is a high prevalence of affective disorders among substance-dependent patients, it is not solely the substances that cause these disorders.

Question 57

General dissatisfaction with life

Answer 57

Dysphoric Mood

Question 58

Inability to feel pleasure

Answer 58

Anhedonia

Question 59

When should we suspect an organic cause of affective disorders?

Answer 59

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

Question 60

Are crucial for tasks requiring active processing and are disrupted by lesions or disruptions in frontal sub-cortical circuits.

Answer 60

Executive (Frontal) Function

Question 61

What are Focal Neurological Symptoms?

Answer 61

Seizures Episodes of unresponsiveness Weakness in limbs Sensory problems Unexplained visual problems Balance issues Difficulty with fine movements Unexplained headaches

Question 62

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.

Answer 62

Executive (Frontal) Function

Question 63

Are common in both organic and non-organic psychiatric disorders, making these tests less useful for differentiation.

Answer 63

Executive Function Impairments

Question 64

Useful in differentiating organic from non-organic conditions. Impairment in these tasks suggests an organic cause.

Answer 64

Passive Tasks

Question 65

Commonly impaired in both organic and non-organic psychiatric disorders, making them less useful for differentiation.

Answer 65

Active Tasks

Question 66

The most active task, requiring significant cognitive effort and flexibility.

Answer 66

Set Shifting (Task Switching)