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Affective Disorders Flashcards

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1
Q

Mental state examination?

A

Appearance speech mood thought perception cognition insight

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2
Q

Anhedonia?

A

Inability to feel pleasure

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3
Q

What is psychomotor retardation?

A

ETA is when the thoughts slow down and physical activity is reduced.

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4
Q

Hypochondriacs?

A

A person who believes they have a medical condition that is undiagnosed.

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5
Q

Diagnosis of major depressive disorder?

A

2 weeks 5 or more symptoms:

  1. Depressed mood most days,
  2. Lack of pleasure or interest
  3. Insomnia or hypersomnia
  4. Fatigue
  5. Eating more or less
  6. Suicidal thoughts
  7. Guilt or self blame, feelings of worthlessness
  8. Diminishes ability to think or decide
  9. Phsychomotor retardation or agitation

Must cause significant distress or functional impairment

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6
Q

Hypothyroidism?

A

Psychomotor retardation, fatigue

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7
Q

Melancholia?

A

Type of depression, loss of pleasure, lack of reactivity, depressed empty mood.
In morning, marked agitation, lack of appetite, and feelings of guilt and remorse

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8
Q

Atypical depressions?

A

Weight increase, excessive sleep, leaden paralysis , mood reactivity interpersonal rejection sensitivity

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9
Q

Manic episode?

A

1 week most of time: 3 or more of following

Elevated irritable mood, increased energy

  1. Inflated self esteem or grandiosity
  2. Decreased need for sleep
  3. More talkative
  4. Flight of ideas
  5. Distractibility
  6. Increase in goal directed activity
  7. Excessive involvement in high risk activities
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10
Q

Hypomania?

A
  1. at least 4 days

2. Not severe enough to cause hospitalisation/ or marked functional impairment

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11
Q

Mixed affective episode:

A
  1. Full criteria for one type of episode

2. And at least 3 symptoms of opposite polarity are present

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12
Q

Features of both depression and mania:

A

Anxiety, psychotic, catatonia

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13
Q

Catatonia?

A

Not moving not responding, not communicating

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14
Q

Lifetime prevalence of single depressive episode?

A

20% for females

10% for males

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15
Q

How many die by suicide of depressive episodes?

A

8 to 19 %

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16
Q

Bipolar disorder:

A
  1. At least 1 manic episode

2. 1 hypomanic disorder needs 1 disorder

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17
Q

Bipolar it’s:

A

Hypersomnia
Hyperphagia
Family history

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18
Q

Bipolar disorder genetics?

A

10 times higher risk In 1st degree relatives
Men and women are equally affected
Lifelong risk of recurrence

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19
Q

Rate of suicide of people with bipolar disorder?

A

20 x than general population

30 to 50% try to commit suicide

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20
Q

Monozygotic accordance rate in bipolar?

A

70 to 80%

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21
Q

Neurobiology of depression?

A

Decrease in serotonin and noradrenaline function- hence selective serotonin reuptake inhibitor are given.
Serotonin is affected by stress, generic factors and adverse childhood experience.

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22
Q

Neurobiology of depression?

A
  1. Disruption of monoamine transmission
  2. GABA and glutamate
  3. HPA axis and glucocorticoids
  4. Neuroplasticity and neuronal atrophy
  5. Immune dysfunction
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23
Q

Acute tryptophan depletion studies showed?

A

Reexacerbation of depression

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24
Q

Which regions are responsible for automatic regulation of emotion?

A

Prefrontal cortex, anterior cingulate

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25
Regions responsible for voluntary regulation of emotion?
Dorsolateral and ventrolateral prefrontal cortex.
26
Subgenual cingulate cortex?
Responsible in emotion regulation and processing
27
HPA dysfunction?
Normally negative feedback of adrenal gland on hypothalamus. Duxamethasone: a glucocorticoid, no negative feedback, still cortisol release. Some glucocorticoid receptor alteration
28
Neuroplasticity in depression?
Subcorticla volume changes in hippocampus etc in people with depression Decrease in atypical dendrites, spine density, NMDA or AMPA receptors, synaptic proteins, neuronal atrophy
29
Ketamine treatment?
NMDA receptor blocker, depression treatment. Stimulates synaptogenesis Modulates gaba and glutamate deficits
30
Inflammation and depression?
Lupus and other immune disorders increase of depression. Could be cause of disability but we know stronger association than other disabling conditions. Increased inflammatory markers Crps in people with depression and correlate with level of depression TSPO translocator protein On microglia higher in people with depression, a marker of neuroinflammation
31
Inflammation and serotonin?
Inflammatory pathways take away tryptophan to create inflammatory proteins and hence less to produce serotonin
32
1st generation antidepressants?
Monoamine oxidase inhibitors (phenelzine and tranylcypromine) and tricyclic antidepressants amytryptilinw
33
Monoamine oxidase inhibitors?
Phenelzine and tranylcypromine | Non selectively inhibit enzymes in breakdown of drops ins, serotonin and noradrenaline
34
Tricyclics antidepressants?
Amytryptiline, clomipramine | Nonselectivley inhibit reuptake of monoamine such as dopamine, serotonin and noradrenaline
35
2nd generation antidepressants?
SSRI, SNRI, alpha and serotonin antagonist, dopamine noradrenaline uptake inhibitor
36
SSRI?
Sertraline, citalopram, escitalopram, fluoxetine and vortioxetine
37
SNRI?
Venlafaxine and duloxetine
38
Serotonin and alpha antagonist?
Mirtazapine
39
Dopamine noradrenaline reuptake inhibitor?
Bupropion
40
What is included in atypical depression?
Mood reactivity, significant weight gain or increase in appetite Hypersomnia Leaden paralysis
41
Manic episode diagnosis?
Sufficiently sever to cause marked functional impairment or necessitates hospitalisation to prevent harm to self or other or there are psychotic features
42
Dysthymia
Chronic form of depression
43
Cyclothymia?
Mood shifts up and down from baseline but not as bad as bipolar 1 and 2
44
What is age of onset on major depressive disorder?
25-35 years, but can be any age
45
Probable bipolarity of depression will have?
Positive family history of Brad | Multiple episodes and early onset
46
Proinflammatory cytokines induce?
Sickness behaviour
47
Side effects of SSRIs?
Low toxicity safe, slow titration Gastrointestinal symptoms Headache irritability anxiety Reduction in libido and sexual dysfunction
48
Side effects of tricyclics?
Constipation, orthostatic hypotension dry mouth drowsiness cardiac toxicity
49
MAOi side effects?
Dry mouth GI side effects, drowsiness, insomnia, food interactions, hypertension crisis
50
Mirtazapine side effects?
drowsiness, sedation, hypotension, increased appetite and weight gain
51
Bipolar disorder genes?
8-10% of 1st degree relatives Amy-72-80 DZ-14
52
Mitochondrial alteration in bipolar?
Reduced mitochondrial complex 1 in prefrontal cortex Altered brain mitochondria morphology and distribution Reduced mRNA for genes encoding ETC and antioxidants Many SNPs of miti genes
53
Central nervous system consumes how much oxygen?
20
54
Phases of bipolar disorder treatment?
Short-term treatment to reduce the severity and shorten the duration of the acute episode and achieve remission of symptoms Long-term treatment prevention of new episodes and to achieve adequate inter-episode control of residual or chronic mood symptoms
55
Bipolar treatments
Lithium Antipsychotics Anticonvulsants Antidepressants
56
Treatment of depressive disorders?
Antipsychotics Fluoxetine/olanzapine combinations Antidepressants with anti manic drug Consider lamotrigine with an anti manic
57
Treatment of acute manic episodes?
Dopamine antgonist e.g haloperidol olanzapine, respirdone Valproate Discontinue any antidepressant
58
What is long term treatment to prevent new episodes?
Lithium as initial mono therapy (0,6 to 0.8 mmol/l) Alternatives are valproate, dopamine antagonist, carbamazepine
59
Lithium details?
Toxicity Narrow therapeutic index Blood tests every 3 months for 1st year Strongest evidence of prevention of relapses of any polarity
60
Antipsychotics?
D2/d3 antagonist haloperidol Da partial agonist aripiprazole Adverse effect. Wight glucose and lipid regulation Full D2 antagonism haloperidol can cause epses
61
Valproate shouldn’t be used in?
Women of child bearing potential
62
Lamotrigine is most effective in?
Prevention of depressive relapses
63
Adverse effects of long term pharmacological treatment of Bpad?
Weight gain (most medications, particularly Olanzapine and Quetiapine) Metabolic syndrome (Olanzapine, Quetiapine, Risperidone) Hyperprolactinemia (Dopamine antagonists) Tardive dyskinesia (much reduced risk with newer agents) Liver damage (e.g. Valproate) Kidney and Thyroid dysfunction (poorly regulated Lithium)

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