Week 8 Mood & Anxiety Disorders

Question 1

What are the 5 categories of Emotional and Physical Sx of Depression?

HINT; MAFSS

Answer 1

M - Miscellaneous: Increased somatic complaints
A - Appetite Changes: Including dramatic changes in body weight
F - Feelings: intense sadness, loss of interest (anhedonia)
S - Social: Withdrawal and Isolation
S - Sleep: Problems sleeping

Question 2

Is Grief a form of Depression?

A. Yes
B. No

Explain why!

Answer 2

B. No.

Grief dominant feeling is loss and emptiness. It occurs in waves, vacillates with exposure to reminders and decreases with time. People suffering from grief still have the capacity for positive emotional experiences, and they have preserved self-esteem.

Question 3

Depression falls under the classification of

A. Personality Traits and Mood Disorders
B. Personality Disorders and Mood Disorders
C. Mood Disorders and Affective Disorders
D. Projection and Hostility Disorders

Answer 3

C. Mood Disorders and Affective Disorders

‘Affect’ refers to feelings, emotions and desires which together made up ‘Mood’.

Question 4

What are some Signs and Symptoms of Major Depression?

Answer 4

M - Miscellaneous: Increased somatic complaints
A - Appetite Changes: Including dramatic changes in body weight
F - Feelings: intense sadness, loss of interest (anhedonia)
S - Social: Withdrawal and Isolation
S - Sleep: Problems sleeping - In/Hypersomnia

Plus these other signs and symptoms

• Depressed Mood: Intense Sadness
• Fatigue
• Feelings of worthlessness of guilt
• Reduced concentration
• Recurring thoughts of death or suicide

Question 5

For a person to be diagnosed with Disruptive Mood Dysregulation Disorder (DMDD)?

A. They suffer from Bipolar and have temper outbursts
B. Must be diagnosed before the age of 6
C. Suffer from Autism as DMDD is a comorbidity
D. Occurs 3+ times a week for at least 12 months

Answer 5

D. Occurs 3+ times a week for at least 12 months

Essential Feature: Severe temper outbursts with underlying persistent angry or irritable mood.

Onset starts before age 10, cannot be diagnosed before age 6 and or after age 18

Question 6

What percentage of Australians will experience a mental health condition in their lifetime?

A. 25%
B. 35%
C. 45%
D. 55%

Answer 6

C. 45%

In Australia, it’s estimated that 45 per cent of people will experience a mental health condition in their lifetime

In any one year, around 1 million Australian adults have depression and over 2 million have Anxiety

Question 7

Which is correct about Depression?

A. FHx increase the likelihood by 6x
B. Neurotransmitter imbalance
C. Fluctuations of estrogen and progesterone
D. Usually is a co-morbidity to another chronic illness
E. All the above

Answer 7

E. All the above

Others include

• Sunlight Deprivation (Seasonal Affective Disorder)
• Sleep Disorders

Question 8

What are the three emotional components to a perceived or actual threat ‘fight or flight’?

Answer 8

Endocrine and Autonomic: the release of cortisol and sympathetic innervation

Motor: Run, Hide, Fight

Cognitive-Evaluative: Decision making, minimise the threat or downplay the stimulus

Question 9

Which part of the brain plays a strong role in fear processing?

A. Amygdala
B. Cingulate Gyrus
C. Temporal Lobe
D. Substatia Nigra

Answer 9

A. Amygdala

The fear response starts in a region of the brain called the amygdala. This almond-shaped set of nuclei in the temporal lobe of the brain is dedicated to detecting the emotional salience of the stimuli – how much something stands out to us.

When the amygdala is damaged, previously threatening stimuli come to be treated as benign.

Question 10

What is the Hypothalamic - Pituitary - Adrenal axis?

A. Response to emotional stimuli (fear/anxiety)
B. Endocrine and autonomic cascade leading to cortisol release
C. Triggers the release of adrenal cortisol and adrenaline via the same axis
D. A and B

Answer 10

D. A and B

The hypothalamic pituitary adrenal (HPA) axis is our central stress response system.

• Hypothalamic release of corticotropin-releasing factor or hormone (CRF or CRH)
• CRH binds to the Anterior Pituitary gland which causes the release of adrenocorticotropic hormone (ACTH)
• ACTH binds to receptors on the adrenal cortex and stimulates the Adrenal gland release of cortisol.

Question 11

Isolated lesions of the Amygdala with calcifications results in the inability to recognise?

A. The faces as a whole
B. The cannot differentiate between stranger and friend
C. They cannot recognise the emotion on the persons face
D. All the above

Answer 11

C. They cannot recognise the emotion on the persons face

Aka - Urbach-Wiethe disease

The disease does not affect the ability to discriminate fine differences in faces, nor the ability to recognize faces –specifically affects discerning emotions

Furthermore, people suffering from Narcissistic Personality Disorder have structural abnormalities of the amygdala and “reduced feedback modulation of fusiform gyrus by the amygdala during fear processing”

Question 12

If you stimulate the right side of the Amygdala you would experience which emotions?

A. Negative emotions only
B. Both sad and happy emotions
C. Apathy and disinterest
D. None of the above

Answer 12

A. Negative emotions only

Left side stimulation can have both positive and negative emotions according to the lecture slide.

Question 13

Which is not true for the Amygdala

A. Identifies the emotional significance of events
B. Involved in the formation of emotional memories
C. Can both receive and send information to other brain areas.
D. Is a relay station for the primitive and higher parts of the brain

Answer 13

D. Is a relay station for the primitive and higher parts of the brain

From the Cerebral cortex and Hypothalamus (relay station) information of emotional significance is transmitted to the Amygdala.

The Amygdala also receives info from brain regions involved in the processing of stimuli, memory and understanding:

• Association, olfactory cortices and the medial temporal lobe
• Hippocampus (learning and memory)
• Cingulate Gyrus (Social awareness and empathy)
• Hypothalamus

Question 14

Pathophysiology of Depression

When something stressful happens there is an increased level of glucocorticoids. This is due to specific receptors in the Hippocampus, activating the Hypothalamus to secrete Corticotropin-Releasing Hormone (CRH), which leads to activation of the HPA cortisol secretion.

In depressed patients, what happens to the HPA negative feedback loop?

Answer 14

Under normal circumstance - this process creates a negative feedback loop in which the excess cortisol activates the brains glucocorticoid receptors and suppresses the production of CRH.

In depressed patients, this loop no longer works, as the loop no longer works, resulting in excess production of CRH and hence high levels of cortisol.

Chronic excess stress on the HPA –> structural changes in the Hippocampus.

Decrease glucocorticoid receptors in the Hippocampus and Prefrontal Cortex.

Question 15

What does a hyperactive HPA lead to?

A. Changes in the brain leading to minute cortisol production
B. Excess Cortisol
C. Cortisol Hypersensitivity
D. All the above

Answer 15

B. Excessive Cortisol

Chronic excess stress on the HPA –> structural changes in the Hippocampus.

Decrease glucocorticoid receptors in the Hippocampus and Prefrontal Cortex.

Question 16

True or False

Cushing syndrome patients suffer from depression

Answer 16

True

Cortisol influences functions of several neurotransmitter systems involved in depression

• Serotonin (Raphe Nuclei)
• Noradrenaline (Locus Ceruleis)
• Dopamine (Substantia Nigra)

Question 17

Why do we see weight gain in people with depression?

Answer 17

Cortisol and Metabolism changes with insulin release and maintenance of blood sugar levels

These changes can also lead to a decrease in appetite which would result in weight loss

Question 18

True or False

Glucocorticoids decrease the formation of flashbulb memories of events associated with strong emotions, both positive and negative.

Answer 18

False

Glucocorticoids enhance the formation of flashbulb memories

This has been confirmed by studies whereby blockage of either glucocorticoids or noradrenaline activity impaired the recall of emotionally relevant information.

Additional sources have shown subjects whose fear learning was accompanied by high cortisol levels had better consolidation of this memory.

Question 19

Cortisol is a glucocorticoid released by the adrenal gland in response to stressful events. Which of the following is a metabolic effect produced by elevated levels of this hormone?

A. Hyperglycaemia
B. ncreased insulin sensitivity
C. Reduced lipolysis
D. Reduced Proteolysis

Answer 19

A. Hyperglycaemia

Cortisol increases nutrient availability for the brain and vital organs in times of stress by raising blood glucose, amino acids & triglyceride levels.

Elevated blood sugar is achieved by a combination of increased glucose production by the liver (gluconeogenesis) & antagonizing insulin’s action to lower plasma glucose.

Increased breakdown of muscle protein provides fuel for hepatic gluconeogenesis, and increased activity of hormone-sensitive lipase produces increased fatty acid release, which increases insulin resistance.

Question 20

Patients who are on long-term glucocorticoids can experience a number of significant side effects. Most side effects are reversible when drug therapy is tapered to levels physiologically equivalent to normal cortisol.

Which effect, if it developed, would be reversible?

A. Fatigue and Weakness
B. Increased blood pressure
C. Increased likelihood for infections
D. Moon face appearance
E. All the above

Answer 20

E. All the above

Question 21

True or False

High levels of Glucocorticoid leads to changes in serotonergic receptors found in the cerebral cortex and hippocampus

Answer 21

True

Changes have been observed in humans who have committed suicide or suffered from diseases that cause hypersecretion of glucocorticoids.

The continued administration of antidepressants causes changes in the serotonergic receptors that are the opposite of the changes produced by chronic stress. It also reverses the hypersecretion of stress hormones (cortisol)

Question 22

Panic Attacks are linked to what?

A. Underactivity of the Locus Ceruleis and hyperactivity of Raphe Nuclei
B. Hyperactivity of the Substantia Nigra and Dopamine
C. Overactivity of the Locus Ceruleis and hypoactivity of Raphe nuclei
D. Changes in the Hippocampus and Prefrontal Cortex leading to excessive Cortisol

Answer 22

C. Overactivity of the Locus Ceruleis and Hypoactivity of Raphe nuclei

Locus Ceruleis is the primary site of Noradrenaline production in the brain.
The Raphe Nuclei are the primary location in the brain for the production of the neurotransmitter serotonin.

Excessive amounts of NorAdrenaline lead to feels of anxiety

Question 23

Which drug in Ambulance is used as an Anxiolytic?

A. Atropine
B. Morphine
C. Midazolam
D. Ondansetron

What is the presentation of the drug you chose for the answer?

Answer 23

B. Midazolam

5mg/1mL
15mg/3mL

Short-acting CNS depressant
Actions:
- Anxiolytic
- Sedative
- Anti-convulsant

Contras: Known hypersensitivity to benzodiazepines

Question 24

What would we not expect to see on a brain image from a person with a panic disorder?

A. Decrease Benzodiazepine binding
B. Increase GABA levels
C. Decrease serotonin binding
D. Decrease Prefrontal cortex volume

Answer 24

B. Increase GABA levels

GABA is an inhibitory neurotransmitter and therefore decrease amount leads to the unabated excitatory neurotransmitter action.

Question 25

Obsessive-Compulsive Disorder

Which is not correct:

A. 2 - 3% in the general population suffer
B. Female/Male ratio is 3:1
C. Recurrent 70 - 80% with depression
D. Affects women in the ’20s normally

Answer 25

B. Female/Male ratio is 3:1

The ratio is 1:1

Question 26

What is PTSD?

Answer 26

Posttraumatic stress disorder (PTSD) is a syndrome resulting from exposure to real or threatened serious injury or sexual assault.

• combat
• emergency service work
• sexual assault
• workplace accident etc

Question 27

What are the signs and symptoms of PTSD

HINT: PAIN

Answer 27

P - Persistent re-experiencing of the event (flashbacks)
A - Avoidance of Traumatic Triggers
I - Increase arousal or reactivity
N - Negative alterations in cognition and mood

One cannot diagnose PTSD until one month has passed since the traumatic incident. Acute stress disorder, which has similar symptoms, is diagnosed during the first month.

Question 28

What changes can we see in the brain with PTSD?
Choose the correct answer

A. Increased amygdala activation
B. Hyperactivation of the medial prefrontal cortex
C. Changes in the somatosensory areas
D.Hyperactivation of the anterior cingulate cortex

Answer 28

A. Increased amygdala activation

and

Hypoactivation of the medial prefrontal cortex including the orbitofrontal cortex and anterior cingulate cortex (area implicated in affect regulation

Question 29

What is Social Anxiety Disorder?

Answer 29

Marked fear of one or more social or performance situations in which the person is exposed to the possible scrutiny of others and fears he will act in a way that will be humiliating

Exposure to feared scenario almost invariably provokes anxiety

12% of the population is affected

Question 30

Anxiety has been implicated in which three neurotransmitters?

Answer 30

GABA - decreases anxiety
Noradrenaline - increases anxiety
Serotonin - increases anxiety

Question 31

Benzodiazepines work by:

A. Binds to a different site on the receptor to GABA
B. Causes depolarisation
C. Increases effect of GABA
D. A and C

Answer 31

Benzodiazepines facilitate GABA binding to receptors, which enhances chloride channel opening and neuronal inhibition.

This opens the chloride ion channel gate, allow Chloride ions into the cell membrane leading to hyperpolarisation.

Question 32

How are Z drugs different from Benzodiazepines?

Answer 32

Z drugs are not Benzodiazepines however, they bind to the same receptor sites

Short-acting and supposed to be more specific for sedation.

May lead to sleepwalking and bizarre activity

Question 33

5HT-1A receptor agonists drugs such as Buspirone have shown anxiolytic activity.
How do they work?

A. Bind to 5HT-1A receptors and increases serotonin release
B. Acts an antagonist postsynaptically binding to the same receptors as Benzodiazepines
C. Inhibit the release of serotonin by agonising the 5HT-1A receptor
D. Increase the efficacy of Benzodiazepines by synergism

Answer 33

C. Inhibit the release of serotonin by agonising the 5HT-1A receptor

5HT-1A receptors are inhibitory receptors that reduce the release of 5-HT. Therefore decreasing anxiety related to high levels of serotonin.

Question 34

What is the main reason for individuals taking Beta Blockers?

Answer 34

To block muscle tremors and palpations which increase performance. They do not affect mood at all

Question 35

What is the mechanism of action of Anti-Depressants

A. Inhibit reuptake of NA and 5HT
B. Facilitate reuptake NA and 5HT
C. Inhibit neuronal metabolism of NA and 5HT
D. A and C

Answer 35

D. A and C

Question 36

Which is the most commonly prescribed group of drugs from the 4 types of Anti-Depressants

A. Tricyclic Antidepressants
B. Selective Serotonin Reuptake Inhibitors
C. Selective Serotonin NA reuptake Inhibitors
D. Monoamine Oxidase Inhibitors

Answer 36

B. Selective Serotonin Reuptake Inhibitors

They are replacing TCA as they are less lethal in overdoses

A common name is PROZAC

Question 37

How do Tricyclic Antidepressants work?

A. Increase production of NA and 5HT in the CNS
B. Increase the neuronal effects of NA and 5HT binding sites
C. Block the uptake of NA and 5HT by competing for binding sites of the transport protein
D. Increase the duration of NA and 5HT by increasing the refractory period of the neuronal cells

Answer 37

C. Block the uptake of NA and 5HT by competing for binding sites of the transport protein

TCAs are dangerous in acute overdoses leading to confusion and mania and cardiovascular complications.

Known as dirty drugs as they bind to unwanted sites.

Question 38

How do Monoamine Oxidase (MAO) Inhibitors work?

A. Increase the neuronal effects of NA and 5HT binding sites
B. Block the uptake of NA and 5HT by competing for binding sites of the transport protein
C. Irreversibly inhibit the enzyme MAO thus preventing metabolism of NA and 5HT
D. Bind to NA and 5HT receptors and increase NA and 5HT into the synaptic cleft

Answer 38

Monamine oxidase inhibitors irreversibly inhibit the enzyme MAO and therefore prevent the metabolism of noradrenaline and serotonin in neurons

MAO inhibitors: Moclobemide
Non- selective- Phenelzine, Tranylcypromine

Question 39

Even though Lithium is considered a Chinese Drug, why is it used in Western Medicine?

Answer 39

It is used to treat mania. Mechanism of action is unknown but the inorganic ion can mimic the role of Na+ in excitable tissues.