Mood disorders Flashcards
(35 cards)
1
Q
What are the two broad classes of mood disorders?
A
- Depressive disorders
- Bipolar disorders
2
Q
What needs to have happened in order to make a diagnosis of depression?
A
- Must have had symptoms for at least 2 weeks
3
Q
What are the core symptoms of depression?
A
- Low mood
- Lack of energy
- Lack of enjoyment and interest
4
Q
What are some other symptoms of depression?
A
- Suicidal ideation
- Lack of appetite/weight loss
- Pain
- Sleep disturbance
- Severe cases might have psychotic symptoms
5
Q
What is an adjustment reaction?
A
- Typically occurs after some kind of traumatic event and has fewer somatic features compared to depression
- Adjustment reactions do not last as long as depression and tend to have a fluctuating course
6
Q
What are the symptoms of an adjustment reaction?
A
- Symptoms develop suddenly after an event
- Symptoms fluctuate
- Time limited
- Energy not low
- No particular pattern to sleep disturbance
- Reduced or increased appetite
7
Q
What are the clinical features of mania?
A
- Elevated mood and energy levels with racing thoughts (flight of ideas)
- Decreased need for sleep
- Normal social inhibitions are lost
- Attention cannot be sustained
- Self esteem is inflated, often grandiose
- May have psychotic symptoms
8
Q
What is hypomania?
A
- Refers to symptoms that are still clearly manic but don’t necessarily reach full diagnostic criteria for mania
9
Q
How can we diagnose bipolar disorder?
A
- Following two episodes of a mood disorder, one of which must be either mania or hypomania
- You can be diagnosed with bipolar without ever having been diagnosed with depression
10
Q
What is bipolar 1?
A
- Discrete episodes of mania only or mania and depression
11
Q
What is bipolar 2?
A
- Discrete episodes of hypomania or hypomania and depression
12
Q
What are the physical differentials for depression?
A
- Hypothyroidism
- B12 deficiency
- Chronic disease
- Substance misuse
- Hypoactive delirium
13
Q
What are the physical differentials for mania?
A
- Hyperthyroidism
- Delirium
- Iatrogenic (steroids)
- Infection (e.g. encephalitis, HIV)
- Head injury
- Intoxication (e.g. stimulants)
14
Q
Which brain regions and circuits are implicated by mood disorders?
A
- Limbic system
- Frontal love
- Basal ganglia
15
Q
What are the functions of the limbic system?
A
- Important functions in emotion, memory and motivation
- Composed of many brain regions
- The main emotion circuit is known as the Papez circuit, containing many structures
16
Q
What structures are found in the Papez circuit?
A
- Various cortical areas send input to the
- Hippocampus which projects to the mamillary bodies
- Via the fornix
- The mamillary bodies project to the thalamus and hypothalamus
- Thalamus projects back to cortex
- Hypothalamus projects down to pituitary and autonomics
17
Q
What is the Papez circuit important for?
A
- Emotions
- Memory consolidation
18
Q
Why is the Papez circuit important for memory consolidation?
A
- Hippocampus is able to induce long term potentiation in the cortex to lay down long term memory
19
Q
Outline the motor effects and cognitive effects of the frontal lobe?
A
- Motor
- Language
- Executive functions
- Attention
- Memory
- Mood
- Social and moral reasoning
20
Q
How is the frontal lobe responsible for mood?
A
- The inferior portions of the anterior part of the frontal lobe are involved in the generation and expression of emotions, probably via connections with the amygdala
21
Q
What is the function of the basal ganglia?
A
- In addition to motor functions, the basal ganglia also have important roles in emotion, thought and behaviour
- Changes in basal ganglia volume and activity seen in mood disorders
22
Q
Which neurotransmitters are thought to be involved in mood disorders?
A
- Serotonin
- Noradrenaline
23
Q
Where is serotonin produced?
A
- In the brainstem (raphe nuclei) and distributed to cortex and limbic system
24
Q
What is serotonin important for?
A
- Sleep
- Impulse control
- Appetite
- Mood
25
What is the evidence for decreased serotonin in depression?
- Drugs that increase serotonin in the brain treat depression
- 5HIAA (a metabolite of serotonin) is low in the CSF of patients with depression
- Tryptophan (a precursor of serotonin) depletion causes depression
26
Which features do not suggest that decreased serotonin causes depression?
- Despite levels of serotonin rising rapidly following the use of drugs such as SSRIs, symptoms only improve over the course of weeks to months
27
Where is adrenaline produced?
- In the locus coeruleus of the brainstem and distributed to cortex and limbic system
28
What is noradrenaline important for?
- Mood
- Arousal
- Memory
29
What is the evidence for decreased levels of noradrenaline in depression?
- Drugs that increase levels of noradrenaline treat depression
- Patients who have recovered from depression but still have low levels of noradrenaline are at higher risk of relapse
- Post-mortem studies suggest lower levels of noradrenaline in the brains of those with depression
30
What is the biological treatment for depression?
- Antidepressants
- Selective serotonin reuptake inhibitors are first line
- Consider electroconvulsive therapy for severe or refractory cases
31
What is the psychological treatment for depression?
- CBT
32
What is the social treatment for depression?
- Help with social stressors such as isolation and financial worries
33
What are the biological treatments for mania?
- Antipsychotics
- Mood stabilisers
34
What are the psychological treatments for mania?
- Unlikely to be helpful in acute phase
- Helpful to educate patients regarding recognising triggers and signs of relapse
35
What are the social treatments for mania?
- Patients need to be kept safe so that risks to self and others are minimised
- Important to think about implications of mania such as finances etc.
