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Nervous System: Unit IV > Mood Disorders > Flashcards

Flashcards in Mood Disorders Deck (13)
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Epidemiology of mood disorders

  • neuropsychiatric disorders = half of all causes of disability worldwide
  • depression impacts 120 million people worldwide
  • 2nd most common psychiatric illness in US


Proposed etiology of mood disorders

  • heritable component (numerous genes)
    • bipolar > unipolar depression
  • likely due to interactions between neurobiologic vulnerabilities, genetics, stress, etc.
  • mood disorders arise from disruptions in neural circuitry
    • amygdala, prefrontal cortex, cingulated, striatum, thalamus, hippocampus
    • serotonin, NE, DA play important roles in these circuits
    • activation of HPA axis connected to stress and depression


HPA axis and depression

  • Hypothalamus induces anterior pituitary to release adrenocortictropin (ACTH) ==> cortisol release @ adrenal gland ==> impacts metabolism and behavior
  • hippocampus inhibits HPA; amygdala excites HPA
  • sustained elevations of glucocorticoids ==> damage to hippocampal neurons ==> decreased ihibition @ HPA ==> hippocampal atrophy in some depressed patients


Dx of depression

  • 5+ sx for 2+ weeks; must have sad mood or anhedonia
    • Sleep (increased/decreased)
    • Interest (decreased)
    • Guilt
    • Energy (decreased)
    • Concentration (decreased)
    • Appetite (increased/decreased)
    • Psychomotor changes (increased/decreased)
    • Suicidal ideation 


Subtypes of depression

  • atypical = mood reactivity, leaden paralysis, reverse neurovegetative symptoms (increased appetite, weight gain, hypersomnia)
  • Psychotic depression (often with auditory hallucinations, nihilistic delusions)

  • Melancholic: mood worse in the morning, early morning awakening, anorexia, weight loss, guilt, psychomotor retardation.

  • Seasonal Affective: Mood typically worsens in the fall and winter, improves in the spring and summer.


Characteristics  of bipolar disorder (general)

  • Bipolar disorder is best considered on a spectrum, ranging from extreme mood swings to cyclothymia to hypomanias + major depression (Bipolar II) to frank manias (Bipolar I).
  • Manias can be induced by medications (most often antidepressants or steroids) or brain injuries (secondary manias)


Domains of bipolar disorder sx

  • manic mood and behavior (euphoria, grandiosity, pressured speech, impulsivity, excessive libido, recklessness, social intrusiveness, and diminished need for sleep,
  • dysphoric mood and behavior (depression, anxiety, irritability, hostility, and violence or suicide)
  • psychosis (delusions and hallucinations)
  • cognitive symptoms (racing thoughts, distractibility, disorganization, and inattentiveness


Dx of bipolar disorder

  • Mania: distinct period of abnormally elevated, increased goal-directed energy for most of the day for 1+ week, +3-4 sx
    • Distractibility
    • Insomnia (decreased need for sleep)
    • Grandiosity
    • Flight of ideas
    • Activities (increased)
    • Speech (pressured, non-stop)
    • Thoughtlessness (impulsive, rechless)
  • Sx must co-occur + ==> significant social/personal disruption


Hypomania = 

  • same sx as mania
  • shorter time course (< or = 4 days)
  • causes less social impairment


DDx for mood disorders (general)

  • mood disorder
  • medical illness
  • substance abuse
  • meds side effects
  • personality


Medical illness precipitation mood disorders

  • Endocrine: e.g. Cushings, Hyper/hypothyroidism, steroids)
  • Infections: e.g. HIV, influenza, meningitis, Creutzfeld-Jakob
  • CNS: e.g. stroke, tumor, Multiple Sclerosis, epilepsy
  • Metabolic: e.g. hypercalcemia 


Substance abuse/withdrawal/medication SEs precipitating mood disorder

  • Substances of Abuse: Cocaine, Alcohol, Amphetamine/stimulants, Hallucinogens (LSD, PCP, mescaline), Benzodiazepines
  • Prescribed treatments: Amantadine, Methyldopa withdrawal, Interferon, steroids, chemotherapy agents


Characteristics of suicide risk

  • suicide = 11th leading cause of death @ all ages (US)
    • 2nd leading cause of death @ 25-34 yo
    • 33,000 completed suicides/yr
  • 10-15% of pts w/severe MDD suicide
  • 4:1 male to female suicide ration
  • women attmpt suicide 2-3x more
  • 50-75% of first attempts end in death