1b Mood Disorders

Question 1

What are the two methods of disease classification?

Answer 1

DSM and ICD

Question 2

What is the current definition of a Mood Disorder?

Answer 2

Where the fundamental disturbance is a change in affect/mood due to depression or to elation

Question 3

What is a mood change usually associated with?

Answer 3

A change in the overall levels of activity

Question 4

What is the DSM-5 criteria for a depressive episode?

Answer 4

Occurance of 2 weeks or more of depressed mood

AND the presence of 4 of the 8 criteria / symptoms of depression

Question 5

What are the 8 symptoms of depression?

Answer 5

Sleep alterations (insomnia or hypersomnia)
Appetite alterations (increased or decreased)
Diminished interest or anhedonia
Decreased concentration
Low energy
Guilt
Psychomotor changes (agitation or retardation)
Suicidal thoughts

Question 6

What is the diagnosis of someone with depressive episodes and no manic or hypomanic episodes in the past?

Answer 6

Diagnosis of major depressive disorder - MDD

Question 7

What are the subtypes in DSM-5 for MDD?

Answer 7

1. Atypical
2. Melancholic Features
3. Psychotic Features

Question 8

What are the atypical features of MDD?

Answer 8

Increased sleep and appetite, along with heightened mood reactivity

Question 9

What are the Melancholic Features of MDD?

Answer 9

No mood reactivity, along with marked psychomotor retardation and anhedonia

Question 10

What are the psychotic features of MDD?

Answer 10

The presence of delusions / hallucinations

Question 11

What are the three core symptoms of depression?

Answer 11

Low mood
Anergia
Anhedonia

Question 12

What are the biological things which can be affected by depression?

Answer 12

Sleep
Libido
Appetite

Question 13

What is the triad for psychological symptoms in depression?

Answer 13

The world
Oneself
The future

Question 14

What are the four things which are implicated in depression?

Answer 14

Thoughts
Behaviours
Physiological Symptoms
Feelings

Question 15

What are the thoughts and feelings of a high mood?

Answer 15

Impulsive
Elation and Excitement
Increased Energy and Race Sensation

Question 16

What is the DSM-5 criteria for a Manic Episode?

Answer 16

Euphoric or irritable mood with 3 or more of the 7 manic criteria

Question 17

What are the 7 criteria of mania?

Answer 17

Decreased need for sleep with increased energy
Distractibility
Grandiosity or inflated self-esteem
Flight of ideas or racing thoughts
Increased talkativeness or pressured speech
Increased goal-directed activities or psychomotor agitation
Impulsive behaviour (such as sexual impulsivity or spending sprees)

Question 18

What needs to occur for a manic episode to be diagnosed?

Answer 18

When the symptoms of mania are present for a minimum of 1 week, with notable functional impairment

Question 19

What does a diagnosis of a manic episode lead to?

Answer 19

Type 1 bipolar disorder

Question 20

What needs to occur for a hypomanic episode to be diagnosed?

Answer 20

When symptoms are present for a minimum of 4 days, but WITHOUT notable functional impairment = hypomanic episode

Question 21

What is diagnosed when there is not a single manic episode but only hypomanic episodes, with at least one major depressive disorder?

Answer 21

Type II bipolar disorder

Question 22

What is “unspecified bipolar disorder”?

Answer 22

If manic symptoms occur for less than 4 days, or if other specific thresholds are not met for manic or hypomanic episodes, then the DSM-5 diagnosis

Question 23

What is diagnosed when a patient is hospitalised, irrespective of the duration of the manic symptoms?

Answer 23

A manic episode is diagnosed, not hypomanic

Question 24

What cannot be diagnosed when psychotic features are present?

Answer 24

Hypomanic - as psychotic features are characterised by functional impairement

Question 25

What is diagnosed if the manic or hypomanic episodes are caused by anti-depressants?

Answer 25

Diagnosis of bipolar is still made

Question 26

On the graph of mania and depression, what defines the subtypes of bipolar?

Answer 26

The amplitude of the graph

Question 27

What is the difference between bipolar 1 and 2?

Answer 27

Bipolar 1 = Highly manic episodes with highly depressive episodes Bipolar 2 = Slightly manic, not as much as bipolar 1 though

Question 28

How many cycles have to occur a year in order for it to be considered rapid cycling?

Answer 28

More than 4 cycles per year

Question 29

In bipolar, what are the majority of the episodes?

Answer 29

Depressive

Question 30

What is the difference in insight between depression and mania?

Answer 30

Insight is preserved in depression Insight is impaired in mania

Question 31

Which is more heritable between depression and bipolar?

Answer 31

Bipolar is heritable, depression is less heritable

Question 32

What were thought to be the diffrences between unipolar and bipolar in the 1970s? | It has been weakened or disputed

Answer 32

Bipolar has an earlier average age of onset Shorter depressive episodes in bipolar Recurrent course in bipolar Genetic specificity Differential treatment

Question 33

What happens to attention biases in depression?

Answer 33

Depression is characterised by biases in MAINTAINING/SHIFTING attention = difficulties for depressed people for disengage from negative material

Question 34

What happens to memory biases in depression?

Answer 34

strong evidence for biased memory processes. Preferential recall of negative compared to positive material = one of the most robust findings in the depression literature Memory biases also present in individuals at risk (neuroticism) and in recovered depressed individuals.

Question 35

What happens to perceptual bias in depression?

Answer 35

Decreased recognition of happy faces and increased recognition of sad faces Reduced recognition of all basic emotions except for sadneess

Question 36

What is detected in depressed individuals using a fMRI?

Answer 36

Sustained amygdala response to negative stimuli

Question 37

Describe the changes which occur in depressed individuals in the prefrontal cortex?

Answer 37

perigenual anterior cingulate cortex (ACC) appears to mediate negative attentional biases lateral inferior frontal cortex associated with the impaired ability to divert attention from task-irrelevant negative information

Question 38

What part of the brain is associated with impaired ability to divert attention from task-irrelevant negative information?

Answer 38

Lateral inferior frontal cortex

Question 39

Which part of the brain mediates negative attentional bias?

Answer 39

Perigenual anterior cingulate cortex

Question 40

What memory biases are seen in depression?

Answer 40

Preferential recall of negative compared to positive material

Question 41

Describe the perceptual biases seen in depression?

Answer 41

Increased recognition of negative faces and/or decreased recognition of happy faces

Question 42

What condition results in enhanced amygdala response to negative faces?

Answer 42

Depression

Question 43

What are SSRI's?

Answer 43

Serotonin reuptake selective inhibitors

Question 44

What happened when patients were given noradrenergic anti-depressants?

Answer 44

Better recognition of happy faces

Question 45

DO anti-depressants improve happy face facial recognition?

Answer 45

Yes

Question 46

What is the gold standard SSRI?

Answer 46

Escitalopram

Question 47

What happens to baseline ACC levels in depressed individuals?

Answer 47

Elevated during tasks which probe affective circuitry

Question 48

What is the monoamine deficiency hypothesis?

Answer 48

Postulates that depressive symptoms arise from insufficient levels of monoamine neurotransmitters seratonin, norepi and/or dopamine

Question 49

What happens to the 5-HT receptor in depression?

Answer 49

Hypofunction - only indirect evidence though

Question 50

What effect do clinically useful anti-depressants have on synaptic monoamine levels?

Answer 50

All increase

Question 51

What happens to monoamine oxidase A in MDD?

Answer 51

Increased

Question 52

What does monoamine oxidase do?

Answer 52

Breaks down seratonin

Question 53

What does tryptophan depletion do?

Answer 53

triggers relapse in MDD - then successfully treated with SSRI's or CBT

Question 54

What does monoamine depletion correlate with?

Answer 54

Low mood in patients both at risk and MD in remission

Question 55

What causes a blockade of serotonin synthesis and what is the effect?

Answer 55

Blockade of serotonin synthesis by the tryptophan hydroxylase inhibitor p-chlorophenylalanine prevents the antidepressant effects of both MAOIs and TCAs

Question 56

What is the main way to investigate brain pharmacology?

Answer 56

PET imaging

Question 57

How does PET compare to fMRI?

Answer 57

Selective, but invasive, radioactive and expensive

Question 58

What is the use of a tracer in measuring brain pharmacology?

Answer 58

Tracer injected into the patient Tracer binds to the specific target

Question 59

How are dopamine receptors quantified?

Answer 59

Inject person with tracer Tracer binds to the receptor Allows the receptor numbers to be quantified, based on how much tracer is present

Question 60

What challenge is used to quantify dopamine receptor numbers?

Answer 60

Amphetamine challenge

Question 61

Which medications (used for ADHD) increases the release of dopamine?

Answer 61

Ritilin

Question 62

Why is it difficult to measure serotonin using a pharmacological challenge?

Answer 62

Not sure which ligand / tracer to use

Question 63

Is there measurable 5-HT release in patients with depression?

Answer 63

No

Question 64

How do tryptamine psychedelics work?

Answer 64

They are an agonist for Serotonin 2A receptors

Question 65

What are the three main types of tryptamine psychedelics?

Answer 65

Psilocybin Ayahuasca LSD

Question 66

How do tryptamine psychedelics relate to seratonin?

Answer 66

Very similar chemical structures

Question 67

What are the classic descriptions of the effects of tryptamine psychedelics?

Answer 67

Oceanic Boundlessness Psychological peak / mystical type experiences

Question 68

What is the safety of tryptamine psychedelics?

Answer 68

Non-addictive Low physiological and brain toxicity Good therapeutic index

Question 69

What are the negative risks associated with psychedelics?

Answer 69

Dysphoria, anxiety, nausea, headache, false memories

Question 70

How is bipolar treated?

Answer 70

Lithium and anti-psychotics

Question 71

Differences between Bipolar affective disorder and borderline personality disorder?

Answer 71

BPAD Episodic Runs in family; heritability +++ Grandiosity Mood states typically less affected by environment BPD Mood changes over course of hours/days rather than days/weeks Poor self image Fear of abandonment Feelings of emptiness Hx of self-harm Hx of trauma/disrupted attachment

Question 72

Difference between bipolar affective disorder and schizoaffective disorder?

Answer 72

Both can both can present with psychosis and mood symptoms (both depression and mania) Typically in Schizoaffective disorder there is more prominent disorganisation of thought, paranoid delusional beliefs and auditory hallucinations Episodic delusions and hallucinations more likely in schizoaffective disorder

Question 73

Differences between BPAD and ADHD

Answer 73

BPAD Not necessarily present in childhood Episodic Family history (heritability+++) Recurrent depressive episodes Amphetamines worsen mania ADHD Hyperactivity Impulsivity Impaired concentration Impairment of executive function Abnormal working and short term memory