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Clinical neuroscience > Mood disorders > Flashcards

Mood disorders Flashcards

1
Q

What are the two broad classes of mood disorders?

A
  • Depressive disorders
  • Bipolar disorders
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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
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3
Q

What are the core symptoms of depression?

A
  • Low mood
  • Lack of energy
  • Lack of enjoyment and interest
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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
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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
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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
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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
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8
Q

What is hypomania?

A
  • Refers to symptoms that are still clearly manic but don’t necessarily reach full diagnostic criteria for mania
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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
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10
Q

What is bipolar 1?

A
  • Discrete episodes of mania only or mania and depression
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11
Q

What is bipolar 2?

A
  • Discrete episodes of hypomania or hypomania and depression
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12
Q

What are the physical differentials for depression?

A
  • Hypothyroidism
  • B12 deficiency
  • Chronic disease
  • Substance misuse
  • Hypoactive delirium
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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)
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14
Q

Which brain regions and circuits are implicated by mood disorders?

A
  • Limbic system
  • Frontal love
  • Basal ganglia
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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
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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
Q

What is the evidence for decreased serotonin in depression?

A
  • 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
Q

Which features do not suggest that decreased serotonin causes depression?

A
  • 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
Q

Where is adrenaline produced?

A
  • In the locus coeruleus of the brainstem and distributed to cortex and limbic system
28
Q

What is noradrenaline important for?

A
  • Mood
  • Arousal
  • Memory
29
Q

What is the evidence for decreased levels of noradrenaline in depression?

A
  • 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
Q

What is the biological treatment for depression?

A
  • Antidepressants
  • Selective serotonin reuptake inhibitors are first line
  • Consider electroconvulsive therapy for severe or refractory cases
31
Q

What is the psychological treatment for depression?

A
  • CBT
32
Q

What is the social treatment for depression?

A
  • Help with social stressors such as isolation and financial worries
33
Q

What are the biological treatments for mania?

A
  • Antipsychotics
  • Mood stabilisers
34
Q

What are the psychological treatments for mania?

A
  • Unlikely to be helpful in acute phase
  • Helpful to educate patients regarding recognising triggers and signs of relapse
35
Q

What are the social treatments for mania?

A
  • 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.

Clinical neuroscience (19 decks)

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