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Mood Disorders > Summary > Flashcards

Summary Flashcards

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1
Q

Weight loss definition

A

5% in last month

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2
Q

Delusion

A

Firmly held belief not in keeping with pt. cultural background

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3
Q

Bipolar

A

2 or more episodes of elevated/lowered mood

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4
Q

Dysthymia

A

Chronic subthreshold depression

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5
Q

Cyclothymia

A

Persistent mood instability subthreshold bipolar

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6
Q

Frontal lobe

A

Decision making and movements

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7
Q

Temporal lobe

A

Emotion

Primary auditory cortex

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8
Q

Parietal lobe

A

Sensation

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9
Q

Occipital lobe

A

Vision

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10
Q

Techniques for analysing brain

A

Animal testing

Operative

Rabies virus affects limbic system causes personality change

Imaging

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11
Q

Striatum

A

2 parts ventral and dorsal

Ventral- reward system (addiction)

Dorsal- motor function

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12
Q

Cerebrum

A

Large part of brain
Contains 4 lobes

Parietal, frontal, temporal, occipital

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13
Q

Cerebral cortex

A

Outermost layer of cerebrum

  • neocortex almost all of it, divided into different areas e.g. Motor, prefrontal cortex
  • allocortex hippocampus, olfactory
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14
Q

Prefrontal cortex

A

Front part of frontal lobe

High order executive function personality

In psychotic patients observed reduction in volume and number of neuronal connections

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15
Q

Limbic system

A

Structures below cerebrum

Include e.g. Hypothalamus, hippocampus amygdala, limbic cortex

emotion, long term memory, behaviour

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16
Q

Cingulate gurus

A

Limbic

Links behavioural outcomes to motivation

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17
Q

Hippocampus

A

Limbic

Memory, emotion

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18
Q

Amygdala

A

Limbic
Emotional responses reactions

Many sensory inputs

Many motor, neuroendocrine outputs

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19
Q

Hypothalamus

A

Releasing hormones—> ant pit (adenohypophysis)

Oxytocin, ADH—> post pit (neurohypophysis)

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20
Q

MRI

A

Decreased grey matter in limbic and cortical systems e.g. Hippocampus

Increased/structurally poorer white matter

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21
Q

Changes to hippocampus

A

Smaller correlates to length of illness

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22
Q

fMRI

A

Functional MRI blood flow

Amygdala and cingulate gyrus abnormal

Normalise after CBT

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23
Q

PET

A

Positron emission tomography

Radioactive glucose to patient taken up by metabolically active tissue, reduced in brain depressed

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24
Q

Prefrontal cortex 3 parts and function

A

Ventro-medial: pain threshold, aggression, sexual function (hyper=pain, anxiety)

Lateral orbital: assesses risk

Dorsolateral: executive function and attention (hypo= psychomotor retardation)

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25
HPA axis
Hypothalamus corticotropin releasing hormone Ant pit ACTH Adrenal cortisol (-ve feedback on ant pit and hypothalamus) Hippocampus inhibits it so atrophy induces dysregulation
26
HPA axis dysfunction
Excess cortisol stress hormone produced Related to hippocampus atrophy
27
Thyroid dysfunction
TSH response to TRH blunted Thyroxine sometimes rx
28
Cytokine dysfunction
Overactivity Possibly due to increased sympathetic tone (high cortisol) Cause hypersensitivity to pain, loss of appetite libido
29
BDNF
Brain derived neurotrophic factor Cell maintenance and brain plasticity Less in depression Hippocampus atrophy---> HPA Negative effect on limbic system
30
Sleep architecture changes
REM sleep latency shortened from 35 mins to 18 halved Restored with antidepressants
31
Cognitive model
Thoughtsemotionsbehaviour physiology Thoughts are reactions to stimuli influence emotions and physiology
32
Negative cognitive triad
- ve view of; - self - world - future
33
Cognitive triad context
Core belief (schema) e.g. I am unlovable ---> Basic assumption (I must be loved by everybody) ---> Conditioned schemata (if I'm not then...is v bad)
34
Cognitive model context
Early experience--> core belief---> assumptions---> critical incident activates assumptions ---> NATS ( negative automatic thoughts) emotions (depression) behaviour (social withdrawal) physiology (sleep etc) All interlinked
35
Activity scheduling CBT
Pleasure rating p=0-10 Mastery rating (satisfaction) m=0-10
36
Cognitive techniques: thought challenging
All or nothing- only catergorise situations into 2 Discount continuum Catastrophising- assume the worst in future Emotional reasoning- if you feel something must be true Magnification/minimisation- unreasonably magnify negatives Labelling- fix a label on yourself e.g. Loser discount any evidence to contrary Mind reading- assume others thoughts Overgeneralisation- assumptions beyond situation Personalisation- believe others negative behaviour is because if you Imperatives-think you know how things should be and overestimate how bad it is when it is not Tunnel vision/mental filter - only see negatives of situation do not consider the whole
37
2 types of inheritance to predisposing factors
Genetic: via quantitative trait loci many genes Environmental: genes in broad sense determine where you grow up i.e. Who are your parents
38
NA function in brain& where is made
Memory Arousal Attention Locus coeruleus in the pons (part of brain stem connecting to limbic system)
39
NA receptors
A1,2 B1,2 Alpha arousal and mood Beta unclear function
40
Evidence for NA in depression
AMPT used in eg pheochromocytoma inhibits tyrosine to L DOPA) less NA leads to depressive symptoms NARIs mechanism of action
41
Serotonin role and production area
Sleep Impulse control Appetite and mood Raphe nuclei brain stem
42
Serotonin evidence
5HIAA: metabolite of serotonin found in urine low in depression SPET scan: less 5HT reuptake sites in brain PET scan: less binding to 5HT1a in brain Tryptophan depletion precursor to serotonin leads to depression
43
Dopamine
Reward seeking Motor function Learning new skills --> Parkinson's Prolactin secretion Emotion and response behaviour Can't cross blood brain barrier so peripheral levels not associated with cerebral production
44
Acetyl choline
Memory Sleep Addiction
45
GABA
Inhibitory depression transmitter From glutamate A and B receptors Chloride permeability of membrane + by alcohol, benzos
46
NICE guidelines ECT
- if immediate improvement needed e.g. High suicide risk
47
ECT procedure
Brief square wave impulses unilaterally Unilaterally is less effective but also less cognitive impairment Affects dopamine system
48
ECT side affects
Antero and retrograde amnesias Laryngospasm Peripheral nerve palsy Status epilpticus Caution if CVS patients
49
4 types of attachment childhood
1. Secure 60% 2. Avoidance 15% rejecting or intrusive 3. Disorganised 15% unpredictable frightening 4. Resistant-ambivalent 10% inconstant
50
Gender risk factor
Women prevalence higher - social factors e.g. Childcare more likely fall to woman stressful - men less likely to ruminate
51
Postnatal depression
Obstetric complications Hard work Loss of sleep Relationship with father
52
Genes depression
Serotonin transporter chrom 17 Reaction to adverse events and SSRIs BDNF chrom 11 reaction to childhood experiences
53
ID ego superego
ID unconscious demands pleasure principal Ego works on reality principal. Tries to satisfy the demands of the ID through rational thought. Defends itself subconsciously with different mechanisms Super-ego directs what we do according to moral principles that we have learnt. It is the ideal situation.
54
Defence mechanisms projection
You have feelings deemed inappropriate by superego E.g. Hatred for someone So convince yourself they hate you Essentially transference of your own unacceptable thoughts into someone else who doesn't have them
55
Regression
Regress to primitive coping mechanism e.g. Comforting soft toy
56
Displacement
Anger at eg boss transferred onto more acceptable and less risky target e.g. Wife
57
Reaction formation
Act in opposite to what you feel eg dislike boss and don't want to work there but start working v hard and being nice to boss Unplanned kid but overprotective of them
58
Sublimation
Unacceptable thoughts to acceptable actions eg Boxer uses it to deal with aggression
59
Transference psychotherapy
Feelings and attitudes from past relationships of the patient are now observed in relationship with therapist
60
Countertransference
What the therapist feels, emotions, attitudes towards the patient What patient evokes in therapist is useful because reflects what they usually evoke in other people
61
Free associations
Patient encouraged to suspend judgement and speak mind
62
SSRIs
Fluoxetine, sertraline Nausea hypotension
63
TCAs
NA/5HT reuptake Amitriptyline clomipramine, lofepramine Cardiotoxic arrhythmias heart block Dry mouth Blurred vision Urinary retention/incontinence
64
MAOIs
Prevents breakdown of NA and serotonin Phenelzine Hypotension, dizziness
65
SNRIs
Nausea constipation hypertension Duloxetine, venlafaxine
66
NaSSa NoradrenLine and specific serotonergic agent
Mirtazapine Pre synaptic A2 adrenoreceptor antagonist/blocker on both NA and serotonin neurones Increases transmission of NA/serotonin
67
SSRI interactions
With NSAID = increased bleeding risk
68
Citalopram interactions
Antipsychotics QT elongation
69
Renal impairment
Start low dose increase slowly
70
CVS patient
Avoid TCAs SSRIs best as antiarrythmic potential
71
Hepatic impairment
Start low dose Leave longer between doses Citalopram safest
72
Changing
Leave at least 6 weeks Consider pregnancy, other eg renal function

Mood Disorders (1 decks)

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