Lecture 18/19 - Intro To Pschiatary And Mood Disorders Flashcards by Callum Donoher

What is meant by a patient being psychotic?

Patient is no longer in touch with reality

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What are the different classifications of depression?

Mild
Moderate
Severe

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What are the 2 types of bipolar?

Type 1
Type 2

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How do you diagnose depressive disorders?

Core symptoms continually every day for at least 2 weeks

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What are the 3 core symptoms of depression?

Low mood
Lack of energy
Lack of enjoyment and interest

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How do we classify severe depression?

All 3 core symptoms:
Low mood
Lack of energy
Lack of enjoyment

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What are some other symptoms of depression that aren’t core symptoms?

Depressive thoughts
Psychotic symptoms
Somatic/biological symptoms

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What are some psychotic symptoms of depression?

Hallucinations
Delusions

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What aer some biological symptoms of depression?

Change in appetite
Sleep (usually reduced)
Poor concentration

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What is the difference between adjustment reactions and depression?

Adjustment is normal after bereavement:
-sudden onset symptoms
-symptoms fluctuate
-time limited
-feelings of anger and frustration

Depression:
-gradual symptoms development
-continuous symtpoms
-low self esteem
-low energy

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Read slide 6:

What is indicating a presentation of depression?

Reduced fluid and food intake (weight loss)
Low mood worst in morning (slightly improves in day)
No energy to go to work
Psychomotor retardation (speaks and moves slowly)
Guilty
Low self esteem

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What are the features of mania?

Essentially the opposite of depression

Elated mood
Increased energy
Decreased need for sleep
Flight of ideas (thoughts jump from topic to topic
Normal social inhibitions are lost
INCREASED self esteem
Potential. Psychotic symptoms

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How does the duration of symptoms for depression and mania differ for diagnosis to take place?

Depression = 2 weeks symptoms

Mania = 1 week symtpoms

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What is hypomania?

When patients present with symptoms of mania but the symptoms aren’t enough to meet the diagnostic criteria to diagnose Mania

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Slide 8:

What features are indicative of mania?

Bizarre behaviour (lack of inhibition of behaviour)
Flight of ideas (jumps from topic to topic)
Quickly irritable

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What is bipolar affective disorder?

When patient has at least 2 episodes of mood disorder with at least one being mania or hypomania

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What is Bipolar Type 1?

Where patient has discrete episodes of mania only or mania + depression

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What is Bipolar Type 2?

Discrete episodes of hypomania or hypomania + depression

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What is the difference between bipolar Type 1 and bipolar Type 2?

Bipolar type 1 = the mania aspect is MANIA

Bipolar type 2 = the mania aspect is HYPOMANIA (mania symptoms dont meet mania diagnostic criteria)

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What are some physical health causes of depression symptoms?

Hypothyroidism (hormone disturbance)
B12 deficiency
Chronic disease(renal, CVS and liver failure)
Anaemia
Substance misuse

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What are some physical health differential for mania symptoms?

Iatrogenic (STEROID INDUCED)
Hyperthyroidism
Delirium
Infection (encephalitis , HIV, syphilis)
Head injury
Stimulant intoxication

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What are the 3 main brain structures involved in mood disorders?

Limbic system
Frontal lobe
Basal ganglia

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Label slide 15:

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What are the 3 main functions of the limbic system?

Emotion
Motivation
Memory

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What structures change in the limbic system in unipolar depression?

Decreased hippocampal volume Decreased cerebral blood flow and metabolism in amygdala

What structures change in the limbic system in bipolar affective disorder?

Altered amygdala volume Inc amygdala activation and vol in mania Decreased volume in anterior Paralimbic cortices

What structures are involved in the papez circuit of the limbic system?

Inputs sent from cortex to HIPPOCAMPUS HIPOCAMPUS projects to MAMMILARY BODIES via FORNIX (white matter output pathway of hippocampus) THALAMUSS projects to cortex HYPOTHALAMUS projects to pituitary and Autonomics AMYGDALA

Label brain on slide 19

What are the functions of the frontal lobe?

Motor function Language production (Brocas area) Executive functions Attention Memory Mood Social and moral reasoning

What part of the frontal lobe is involved in generation and expression of emotions? What is the likely structure its connected to?

Inferior portion of anterior frontal lobe Amygdala

What structural changes can occur to the frontal lobe in unipolar depression?

Decreased blood flow in prefrontal cortex leading to decreased volume

Label slide 23

What are the functions of the basal ganglia?

Motor function Psychological function: -emotion -cognition -behaviour

What are some diseases that can be caused by impaired motor function in the basal ganglia?

Parkinson’s Wilson’s disease Huntington’s disease

What are some structural changes that can occur in the basal ganglia in unipolar depression?

Decreased basal ganglia volume Reduced activation between striatum, amygdala and pre frontal cortex

What are some structural changes that can occur in the basal ganglia with bipolar affective disorder?

Functioanl changes in striatum

What affect does changes in the prefrontal cortex have in depression and mania?

Altered emotional processing g(slowing of thought and executive dysfunction)

What affect does chnages in basal ganglia have in depression and mania?

Impaired incentive behavaiour Psychomotor changes

What are the 2 main neurotransmitters involved in mood disorders?

Serotonin Noradrenaline

What type of neurotransmitters are serotonin and noradrenaline?

Monoamines

What is the monoamine hypothesis of mood disorders?

Depressive disorder is due to abnormality in the availability of neurotransmitters like serotonin and noradrenaline

Where is serotonin produced in the CNS? Where is it distributed to?

Brain stem (raphe nuclei) Gets distributed to cortical areas and limbic system

What role does serotonin have?

Sleep Impulse control Appetitive Mood

What are some categories for drugs that are used to treat mood disorders like depression that help increase levels of serotonin?

SSRIs SNRIs (serotonin + noradrenaline reuptake inhibitors) TCAs (Tricyclic antidepressants) MAOis (Monoamine oxidase inhibitors)

What is a metabolite of serotonin that is low in the CSF of patients with depression?

5HIAA

What is the precursor of serotonin that is depleted leading to depression?

Tryptophan

What is an example of an SSRI?

Fluoxetine (Prozac)

What is an example of a SNRI?

Duloxetine

What is an exmaple of a Tricyclic Antidepressant (TCA)?

Amitriptyline

What is an example of a Monoamine oxidase inhibitor?

Venlafaxine

Where is noradrenaline produced? Where is it projected to?

Locus coeruleus (pons) Projects to limbic system adn cortex

What are the functions of noradrenaline in the brain?

Mood Fight or flight response Memory functions

What is the problem with a patient who recovers from depression but has decreased NA levels?

Have higher rates of relapse

What are the first line biological/drug treatments for depression? Other options:

1st line = SSRIs Other = SNRIs, TCAs

What is the treatment for life threatening depression?

ECT ( Electroconvulsive therapy)

What are some Side effects to SSRIs?

Headaches Nausea Stomach upset

What is the psychological treatment for depression?

Coonginitve behavioural therapy (CBT)

What is the social treatment of depression?

Help with social stressors like isolation and financial worries

Do SSRIs work in mild depression?

No should give lifestyle advice

Why is bipolar affected disorder more difficult to treat than unipolar depression?

If you give anti depressant you may. Push them. Into a manic episode

What drugs do you use to treat mania?

1st line anti-psychotics Or mood stabilisers

What are some examples of mood stabilisers?

Lithium Sodium valproate

Why is sodium valproate very rarely used?

Decreases fertility and is very teratogenic

How do you psychologically treat mania? How do you socially treat mania?

Psychologically = psycho education about Bipolar affected disorder, triggers and signs of relapse Social = treat in a place of safety (where risk to self and others is minimal)

What is the drug treatment of bipolar depression?

Can use antidepressant but ONLY with MOOD STABILISER COVER Like lithium and Electroconvulsion therapy

What is the psychological treatment of bipolar depression?

CBT

What are the drugs given to maintain stability in bipolar disorder?

Mood stabilisers like lithium and sodium valproate Antipsychotic (Quetiapine)

What are teh psychological methods for maintaining stability in bipolar disorder?

Psychoeduction CBT (prevent relapse)

What social treatments can be given for maintaining stability in bipolar disorder?

Consider employment challenges Involve family