12a.) Mood Disorders

Question 1

What mood disorders do you need to be aware of at this stage?

Answer 1

• Depression
• Bipolar
  
  • Type 1
  • Type 2

Question 2

State the 3 core symptoms of depression

Answer 2

• Low mood
• Lack of energy
• Lack of enjoyment & interest

Question 3

How long must patients have symptoms of depression for to be classed as clinically depressed?

Answer 3

Symptoms continually for 2 weeks

Question 4

Alongside the core symptoms of depression, state some other symptoms

Answer 4

Core Symptoms

• Low mood
• Lack of energy
• Lack of enjoyment & interest

Others

• Depressive thoughts: burden, guilty, poor outlook
• Somatic symptoms/biological symptoms: not eating, sleeping or drinking which can lead to weight loss and electrolyte distrubances
• In severe cases psychotic symptoms

Question 5

Explain the difference between an adjustment reaction (e.g. after death of a loved one) and depression

Answer 5

Question 6

What is the typical sleep disturbance pattern in people who are depressed?

Answer 6

Early morning wakening

Question 7

State some features of mania

Answer 7

• Elated mood
• Increased energy
• Pressure of speech (talk very fast)
• Decreased need for sleep
• Flight of ideas
• Normal social inhibitions are lost
• Attention cannot be sustained
• Self esteem is inflated, often grandoise
• May have psychotic symptoms

Question 8

Describe the difference between mania and hypomania

Answer 8

Hypomania is ‘milder’ form of mania

Question 9

What is bipolar affective disorder?

Answer 9

Condition in which someone’s mood varies, GENERALLY, between two states: mania/hypomania and depression.

NOTE: diagnosis is made following 2 episodes of a mood disorder at least one of which is mania or hypomania hence you don’t ever have to have a diagnosis of depression to be given bipolar disorder diagnosis

Question 10

Do you have to have a diagnosis of depression to be given diagnosis of bipolar disorder?

Answer 10

No. Diagnosis is made following 2 episodes of a mood disorder at least one of which is mania or hypomania. Hence, you don’t ever have to have a diagnosis of depression to be given diagnosis of bipolar disorder.

Question 11

Describe the difference between bipolar type 1 and bipolar type 2

Answer 11

• Bipolar type 1: discrete episodes of mania only or mania and depression (need at least 2 episodes)
• Bipolar type 2: discrete episodes of hypomania only or hypomania and depression (need at least 2 episodes)

Question 12

How long does bipolar episodes last?

Answer 12

Varies for individuals but generallyd depressive states last longer than manic states

Question 13

If someone comes in with depressive symptoms, what physical health differentials might you make and want to rule out?

Answer 13

Question 14

If someone comes in with mania symptoms what physical differentials might you make and want to rule out?

Answer 14

Question 15

State 3 brain structures involved in mood disorders

Answer 15

• Limbic system
• Frontal lobe
• Basal ganglia

Question 16

Describe the main hypothesis for mood disorders

Answer 16

Question 17

State the 3 main functions of the limbic system

Answer 17

• Emotion
• Motivation
• Memory (hippocampus & amygdala in particular)

Question 18

We have said that it is thought that the limbic system, frontal lobe & basal ganglia are involved in mood disorders. What possible changes do we think occur in the limbic system for:

• Unipolar depression
• Bipolar affective disorder

Answer 18

Question 19

Where is the pre-frontal area?

Answer 19

Question 20

State some functions of the frontal lobe

Answer 20

• Motor function
• Language (Broca’s)
• Executive functions (purposeful goal directed behaviours e.g. when you go to shop to buy things for a meal, all the things you have to think about and do in the correct order)
• Attention
• Memory
• Mood
• Social & moral reasoning

Question 21

State at least 3 functions of the pre-frontal cortex

Answer 21

Responsible for the so called ‘executive functions’:

• Emotional responses
• Behaviour & judgement
• Attention
• Impulse control
• Plan & organise
• Problem solving
• Decision making

Question 22

The ventromedial prefrontal cortex is thought to be involved in what?

Answer 22

Generation of emotions

Question 23

The orbital prefrontal cortex is thought to be involved in what?

Answer 23

Emotional responses possibly via connection with the amygdala

Question 24

We have said that it is thought that the limbic system, frontal lobe & basal ganglia are involved in mood disorders. What possible changes do we think occur in the frontal lobe in:

• Unipolar depression
• Bipolar affective disorder

Answer 24

Question 25

Basal ganglia have motor functions and psychologica functions; state 3 psychological functions of basal ganglia

Answer 25

* Emotion * Cognition * Behaviour

Question 26

We have said that it is thought that the limbic system, frontal lobe & basal ganglia are involved in mood disorders. What possible changes do we think occur in the **basal ganglia** for: * Unipolar depression * Bipolar affective disorder

Answer 26

Question 27

For **depression**, state what symptoms/features abnormalities in each of the following structures leads to: * Prefrontal cortex * Amygdala * Basal ganglia

Answer 27

* _Prefrontal cortex_: slowing of thought, altered executive function & altered emotional processing * _Amygdala_: abnormal emotional processing * _Basal ganglia_: impaired incentive behaviour, psychomtoor changes

Question 28

What are the two main neurotransmitters involved in depressive disorders?

Answer 28

* Serotonin * Noradrenaline (both are monamines)

Question 29

What is the monoamine hypothesis?

Answer 29

Suggests that depressive disorders are due to abnormality in the availability of monoamines (e.g. serotonin & NA) \*\*BOTH serotonin & NA are low in depression

Question 30

For serotonin, state: * Where it is produced * What it has roles in

Answer 30

* Produced in brain stem (Raphe nuclei) and transported to cortical areas & limbic system * Role in: * Sleep * Impulse control (link with suicide) * Appetite * Mood

Question 31

Describe 3 pieces of evidence to support argument that serotonin is low in patients with depression

Answer 31

Question 32

For noradrenaline, state: * Where it is produced * Functions in brain

Answer 32

* Produced in locus coeruleus (pons) and projects to limbic system & cortex * Functions: mood, role in behavioiur (arousal & attention), implicated in memory functions

Question 33

Describe 3 pieces of evidence to suggest that NA is decreasd in depression

Answer 33

Question 34

Describe the biopsychosocial treatment for depression

Answer 34

* _Biological_ * First liine: SSRIs * Others: SNRIs, TCAs * If life-threatening/resistant depression: ECT * _Psychological_ * First line: CBT * _Social_ * Help with e.g. isolation, social stressors etc..

Question 35

Describe the biopsychosocial treatment of **mania**

Answer 35

* _Biological_ * First line: antipsychotics * Alternatively: mood stabiliser * _Psychological_ * Acutely will be unhelpful but longer term eduction regarding triggers and how to notice signs of relapse is beneficial * _Social_ * Treat in place of safety, consider implications of mania e.g. excessive spending, STIs...

Question 36

Describe the biopsychosocial treatment for **bipolar depression** *\*NOTE: we have to treat it different to unipolar depression as risk of sending them manic*

Answer 36

* _Biological_ * Can use antidepressant BUT ONLY IF ALSO ON a mood stabiliser to prevent going hypomanic/manic * _Psychological_ * CBT * _Social_ * Same as for unipolar depression so help with e.g. isolation, social stressors

Question 37

Describe the biopsychosocial treatment for maintaining stability in bipolar disorder

Answer 37

* _Biological_ * Mood stabilisers * Some antipsychotics can be used as mood stabilisers * _Psychological_ * Psychoeducation * CBT * _Social_ * Consideration of lifestyle on bipolar e.g. shift work, stressful life.... involve family and educate family also