Lecture 74: Mood Disorders Flashcards Preview

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Flashcards in Lecture 74: Mood Disorders Deck (34):
1

Diagnostic Criteria for MDD (not symptoms)

>5 symptoms present for >2 weeks (most of the day) and impair function

2

Diagnostic Criteria for MDD (nine symptoms)

Sad mood, Anhedonia—lack of interest/pleasure, Sleep disturbance-insomnia/hypersomnia, Change in Appetite, Low energy/fatigue, Psychomotor agitation or retardation, Impaired concentration, Guilty feelings, self-blame, Suicidal/thoughts of death

3

Of MDD symptoms, at least one must be...

Sad mood OR anhedonia

4

How is the PHQ-2 used?

Screens for depressed mood/anhedonia; if positive, use PHQ-9

5

Depression and gender prevalence

Twice as common in women after puberty, before menpause

6

Mean age of onset of MDD

Late 20s

7

Untreated episode vs treated episode length

6-13 months; 3 months

8

T/F: Same incidence relapse if continue treatment

False: lower

9

Biggest risk of not treating depression and %

Suicide (30% attempt, 15% complete)

10

Psychodynamic theory of depression and goal of treatment

Disturbance in infant-mother relationship; damaged self-esteem due to loss and anger about this turned inward; goal = relief via understanding of unconscious conflicts

11

Cognitive theory of depression and goal of treatment

Depression results from specific cognitive distortions: negative views about the self, environment, and future; goal = identify and modify distorted thoughts

12

Monoamine Deficiency Hypothesis and problems (2)

NE, DA, 5-HT are deficient (based on mechanism of early antidepressants); deficiency has not be reliably demonstrated AND SSRIs increase 5-HT immediately, but 4-6 weeks for tx to work

13

Amino Acid Neurotransmitter System Dysregulation and supportive drug

Chronic stress --> excess glutamate --> neuronal/glial cell death; ketamine (NMDA antagonist) leads to rapid, transient antidepressant effect

14

Neuroendocrine Dysregulation theory

Dysregulation of HPA stress response system: increased cortisol --> damage hippocampus, removing it's (-) input --> MORE cortisol

15

Dexamethasone suppression test in depressed patients shows...

Decreased negative feedback sensitivity in depressed pts (cortisol cannot shut down HPA axis)

16

Immune system + MDD (two pieces of evidence)

Some people with depression have increased inflammatory markers AND some inflammatory diseases have higher risk of depression

17

Cytokines/monocytes effects on brain in MDD

Monocytes/cytokines can enter brain regions associated with anxiety and depression -->
monocytes/cytokines act on synaptic plasticity mechanisms contributing to stress/depression

18

Major areas of brain change in MDD and major functional changes (what might this lead to?)

Limbic and frontal regions have decreased volume; hypoactivity in frontal regions and hyperactivity in limbic regions (leading to dysregulated emotional expression)

19

Five "smaller" brain areas in MDD

Hippocampus, dlPFC, ACC, amygdala, OFC

20

Neurotrophic Factor hypothesis: findings in depressed pts

Low levels of BDNF found in hippocampus, PFC and serum of depressed patients

21

Heritability of depression (%)

37%

22

Serotonin transporter gene findigns

Double copy of risk allele = increase Pr (MDD) with increased # stressful life events

23

Three treatment categories for MDD

Medications, psychotherapy, neuromodulation (ECT, vagal nerve stimulation, TMS, DBS)

24

Bipolar I Disorder

Depressive episodes + at least one manic or hypomanic episode

25

Define manic episode

At least 1 week of an abnormally and persistently elevated, expansive, or irritable mood plus at least 3 classic symptoms

26

Bipolar I disorder prevalence, gender, age of onset

~1%; equal; 21 years

27

If you experience 4 or more episodes of depression OR mania per year, you are called a...

Rapid cycler

28

% chronically ill w/ bipolar disorder

Only 10%

29

Three categories of neurobiology findings in bipolar disorder

Limbic and prefrontal cortical circuitry changes; HPA/HPT axis dysregulation; decreased neuronal size and density in key areas

30

Special concern for bipolar disorder

High suicide rates

31

If you have a first degree relative with bipolar, increased risk; heritability (%)

8-10x; 65%

32

Top suicide risk factors (5)

Personal or family history of suicide; demographics (older white males); psychiatric disorders; substance abuse; isolation

33

People who commit suicide may have these parts to their personalities (3)

Hopeless, impulsive, aggressive

34

Protective factors against suicide (3)

Clinical care, connectedness (ex: having children), cultural/religious beliefs

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