Week Eight - Neuroscience of Mood Disorders Flashcards
What is a mood disorder?
A mental health problem that primarily affects a person’s emotional state. It is a disorder in which a person experiences long periods of extreme happiness, extreme sadness, or both (mania).
What needs to occur to be diagnosed with a mood disorder?
Symptoms must be present for several weeks or longer.
When is depression considered clinical or major?
When the depression continues to be present even when stressful events are over or there is no apparent cause (but usually a specific cause)
How long do symptoms need to last to be diagnosed with clinical depression?
At least 2 weeks
What is postpartum depression?
Depression occurring during pregnancy or after delivery
What is persistent depressive disorder (dysthymia)?
This is a chronic form of depression that can last for at least two years. Symptoms may occasionally lessen in severity during this time.
What is seasonal affective disorder (SAD)?
This is another type of depression that occurs during certain seasons of the year. It typically starts in the late autumn or early winter and lasts until spring or summer.
What is psychotic depression?
Severe depression combined with psychotic episodes, such as hallucinations or delusions.
The episodes may be upsetting or disturbing and often have a theme
Symptoms of MDD/CD?
Serious disruption of normal eating/drinking
Lack of motivation
Persistent feelings of sadness
Loss of interest in previously enjoyed activities
Physical symptoms of MDD/CD?
Chronic pain, headaches, digestive problems, intensive fatigue, sleep disruption
How many DSM-5 criteria do we need to meet to be diagnosed with MDD?
5 in the same two week period
What 4 things have to be occurring to be diagnosed with MDD?
- Symptoms causing clinically significant distress or impairment in social, occupations or other functioning
- Episode not caused by physiological effects, substances or medical condition
- Episode not better explained by another disorder
- No history of manic episode
How many people in low-middle income countries do not receive treatment for their mental disorder? %
What are the barriers to this?
76-85%
Barriers to effective care include
- lack of resources
- lack of trained health-care providers
- social stigma associated with mental disorders.
- inaccurate assessment (many not correctly diagnosed)
A depressive episode can be categorised into what? (3)
mild, moderate or severe
What is recurrent depressive disorder?
Repeated depressive episodes.
During these episodes, the person experiences depressed mood, loss of interest and enjoyment, and reduced energy leading to diminished activity for at least two weeks.
What is mild depression characterised by?
Some difficulty in continuing with ordinary work and social activities but will probably not cease to function completely.
What is most likely to occur in a severe depressive episode?
It is unlikely that the sufferer will be able to continue with social, work or domestic activities, except to a limited extent.
What is bipolar affective disorder?
Consists of both manic and depressive episodes separated by periods of normal mood. Manic episodes involve elevated or irritable mood, over-activity, pressure of speech, inflated self-esteem and a decreased need for sleep.
What is depression the result of?
A complex interaction of social, psychological and biological factors.
Is there an interrelationship between depression and physical health?
Yes, CVD can lead to depression and vice versa.
What has been shown to reduce depression?
Prevention programs
What has been effective in depression prevention for the elderly?
Exercise programs
What are the psychological treatments for depression?
CBT
Behavioural activation/therapy
IPT
MBCT
Individualised or group form
What pharmacology treatments are there for depression?
Antidepressant medication such as:
- SSRI’s
- TCA’s
- SNRI’s
- MAOI’s
- NARI’s
When are antidepressants not the first line of treatment?
ONLY IN MOD-SEVERE CASES
Not:
- children
- adolescents
- mild depression
How do Tricyclic antidepressants work?
3 rings
Mode of action is to block the reuptake of serotonin, noradrenaline, histamines and acetylcholine back into the presynaptic terminal
Why are Tricyclic antidepressants considered dirty drugs?
They are less specific in what they targer - can lead to side effects
What are monoamine oxidise inhibitors mode of action?
Involved in the reuptake and breaking down of NT. By inhibiting this, there is less breakdown of noradrenaline and serotonin transporter and therefore more transmitter available in cleft
What is ECT?
An electric current placed on the brain that induces seizures.
How does ECT apparently work?
It corrects abnormalities in brain functioning
What else is ECT used for?
Mania and schizophrenia (other psychotic disorders)
When should we consider ECT?
When other therapies/meds are not providing benefit.
Only when severe and when delay in improvement could be threatening/damaging
What does Ketamine therapy?
Provides pain-relief and inducing seizures
Low doses are very effective -rapid
Not a one fix dose though
How does Ketamine therapy work?
Works on NMDA receptors (reducing) and then promotes more glutamate and therefore excitation reducing depressive symptoms
What is bipolar disorder characterised by?
Swings in mood from periods of depression to mania. Depressive episodes alternate with manic episodes or mania.
What are the four basic types of bipolar disorder?
Bipolar I
Bipolar II
Cyclothymia
Other/Unspecified
What is Bipolar I?
How long do manic episodes last?
How long do depressive episodes last?
This is the most severe form.
Manic episodes last at least seven days or may be severe enough to require hospitalisation.
Depressive episodes will also occur, often lasting for at least two weeks.
Sometimes symptoms of both mania and depression are present at the same time
What is Bipolar II?
Cycles of depression, also experiencing hypomania (less severe form of mania).
Someone with bipolar II disorder is usually able to handle daily responsibilities and does not require hospitalisation.
What is Cyclothymia Disorder?
A milder form of bipolar disorder.
Continuous irregular mood swings – from mild to moderate emotional “highs” to mild to moderate “lows” – for extended periods of time.
Changes in mood occur quickly and at any time.
There are only short periods of normal mood.
How long do symptoms of Cyclothymia need to be present for an adult to be diagnosed? What about Children?
ADULTS: 2 years
CHILDREN: 1 year
What are ‘other’ and ‘unspecified’ BD defined as?
Symptoms of this type of bipolar disorder do not meet the criteria for one of the other types but people still have significant, abnormal changes in mood.
What treatments are available for Bipolar?
Lithium
Valproic acid
What do treatments of bipolar usually treat?
The mania side of things
How does Lithium work?
Dissolves in blood stream - inhibits excitatory transmission and promotes more GABA to dampen down mania
Side effect of lithium
It can be toxic (needs to be monitored)
What is Valproic acid used for and how does it work?
Typically used for epilepsy
Acts on glutamate to reduce and dampen excitatory activity
What is Premenstrual dysphoric disorder?
Occurs seven to 10 days before menstruation and goes away within a few days of the start of the menstrual period. Researchers believe this disorder is brought about by the hormonal changes related to the menstrual cycle.
What is intermittent explosive disorder?
Marked by episodes of unwarranted anger. It is commonly referred to as “flying into a rage for no reason.” In an individual with intermittent explosive disorder, the behavioural outbursts are out of proportion to the situation.
