BAB 2a

Question 1

What is the most important classification distinction for a mood disorder?

Answer 1

unipolar vs. bipolar

Question 2

Are reactive or endogenous depressions more severe?

Answer 2

Endogenous

Question 3

Epidemiology of depression.

Answer 3

Lifetime prevalence: 6% (more in women)

Age of Onset: 20-50 (peak in mid-20s)

Question 4

Is Major Depressive Disorder heritable?

Answer 4

No linkage studies have been adequately accepted, but family, twin and adoption studies suggest mood disorders have a genetic basis.

Question 5

What is the diurnal variation of depression?

Answer 5

worse in the morning, better as the day progresses.

Question 6

What are the cognitive changes in depression?

Answer 6

• slowed thoughts, preoccupation, poor attention, can be confused for “dementia” in the elderly
• negativistic thoughts, helplessnes, hopelessness
• suicidality

Question 7

What are: a. Cognitive Theory of Depression, and b. Learned Helplessness Paradigm

Answer 7

a. Cognitive Theory: all or none… “I failed the test, now I won’t be a doctor and won’t have kids.”
b. Learned Helplessness: the dogs that didn’t jump over the hurdle

Question 8

What are some physical signs of depression?

Answer 8

a. obvious ones… poor eye contact, somatic complaints, decreased sex drive, fatigue, anorgasmia
b. agitation, retardation and crying spells
c. anorexia
d. insomnia

Question 9

What are the effects on sleeping?

Answer 9

a. decreased sleep efficiency, frequent wakings
b. shorter REM latency
c. increased REM
d. reduced slow wave delta sleep
e. partial sleep deprivation can temporariy induce remission

Question 10

How does depression commonly start? As depression resolves, what improves first?

Answer 10

Start: “wet” phase

Resolve: sleep, appetite grooming and activity improve first. Mood resolves last.

Question 11

What is a “response” when treating depression?

Answer 11

a 50% improvement in symptoms.

Question 12

What are some morbidities associated with depression?

Answer 12

Up: CVD, MI, risk of illness

Down: immune system, bone density

Question 13

What is dysthymia?

Answer 13

A non-episodic, chronic depression that is less severe and begins insidiously, often in adolescence, and persists for at least 2 years.

Question 14

What are the likely sites for the following:

a. negative thinking
b. mood reactivity
c. psychomotor activity
d. sleep disturbances
e. circadian rhythms

Answer 14

a. negative thinking: prefrontal, hippocampus, limbic
b. mood reactivity: hypothalamus, nucleus accumbens, thalamus amygdala
c. psychomotor activity: connection of prefrontal, thalamus and basal ganglia
d. sleep disturbances: thalamic dyreg, pons and medulla
e. circadian rhythms: suprachiasmatic nucleus of ant. hypothalamus

Question 15

How long does it take antidepressants to work? What is the response rate?

Answer 15

a. 3-6 weeks

b. 60% initial, 90% after readjusting meds

Question 16

What are the 4 vessels of the brain? Which one is protected and why?

Answer 16

a. ant. cerebral
b. post. cerebral
c. int. carotid
d. vertebral

Vertebral is protect bc it supplies the brainstem which is important for breathing, BP, HR, etc.

Question 17

What percent of CO does the brain get? How is distribution managed?

Answer 17

15%

Distribution is managed by each organ demanding it’s supply, -eg exercise = muscles get more blood.

Question 18

What happens when BP goes down in the brain? What is the MAP buffering zone?

Answer 18

When BP goes down, cerebral arteries dilate.

MAP buffering zone: ~60mmHg - ~14-mmHg

Question 19

What are the early effects of glutatmate receptor activation? Aka- early effects of cerebral cell death?

Answer 19

a. Ca++ enters the cell
b. DNA is damaged
c. mitos are killed
d. structural breakdown

Question 20

Why is glutamate released?

Answer 20

cell death from a stroke

Question 21

What are delayed effects of cerebral cell death?

Answer 21

a. new genes are transcribed
b. heat shock proteins are released
c. cytokines are released
d. neuts come… then macs and astrogliosis (BBB is damaged)

Question 22

What the difference between apoptosis and necrosis?

Answer 22

apopotosis: active process, low intensity insults, less damage to surrounding areas (penumbra).
necrosis: passive process, high intensity insults, lots of inflammatory response and damage to surrounding areas (core of stroke).

Question 23

What is the order of events in an ischemic brain injury? (Means of protection)

Answer 23

mins: energy failure, core (thrombolysis)
hours: Glu/Ca++ released, second messenger mediation (Glu/Ca++ antagonists)
more hours: reactive O2 species (free radical scavengers)
days: inflammation and apoptosis, mediated by gene expression (anti-inflammatory and anti-apoptotic agents, growth factors and promoters of plasticity)

Question 24

What does tPA do?

Answer 24

Busts clots.

Question 25

What is a generalized seizure?

Answer 25

affects both cerebral hemispheres from the beginning of the seizure.

Question 26

What is a myoclonic seizure?

Answer 26

Subtype of generalized, bilateral jerk of the body, ver short, consciousness is not impaired.

Question 27

What is a tonic-clonic?

Answer 27

Subtype of generalized, lasts >2mins, loss of consciousness and post-seizure confusion.

• tonic: stiffening and fall, ictal cry (air forced thru vocal cords)
• clonic: rhythmic, bilateral extremity jerking

Question 28

What type of seizure can you see in JME?

Answer 28

myoclonic

tonic-clonic