T3L6 affective disorders neurobiology and treatment

Question 1

factors for major depressive disorder

Answer 1

1. adverse childhood experience
2. current stress
3. genetic factors

lead to decrease serotonin and noradrenaline function

also hypothalamic-pituitary-adrenal axis

see s5`

Question 2

aetiology of depression

Answer 2

• multifactorial
• not understood
• genetic factors, previous mood disorders, childhood adversity, psychological presdisposition

Question 3

monoamine function in depression

Answer 3

all antidepressants work on serotonergic/ noradrenergic systems

Question 4

serotonin dysfunction in depression

Answer 4

• decreased serotonin concs in depression
• reduced serotonin transporter in post mortem suicide studies
• the limbic system

Question 5

uses and interractions of noradrenaline, serotonin and dopamine

Answer 5

see s13

pie

Question 6

1st gen antidepressants

Answer 6

1. monoamine oxidase inhibitors eg phenelzine
2. tricyclic antidepressants
   eg amytryptiline

Question 7

2nd gen antidepressants

Answer 7

• SSRI eg citalopram
• SNRI eg venlafaxine
• alpha2 and 5HT2c agonist eg mirtazapine
• dopamine-noradrenaline reuptake inhibitor

Question 8

SSRIs

Answer 8

• efficacy equal to tricyclics
• large spectrum of diseases- OCD, PTSD, panic, social anxiety
• low toxicity and sadfe in overdose

side effects: GI issues, sexual dysfunction, headache, irritation

Question 9

side effects of other antidepressants

Answer 9

Tricyclics: Constipation, orthostatic hypotension, dry mouth, drowsiness, cardiac toxicity in overdose

MAOi: Dry mouth, GI side effects, headache, drowsiness, insomnia, dizziness, food interactions (hypertension crises)

Venlafaxine: nausea,vertigo, headache, insomnia.

Mirtazapine: drowsiness, sedation, hypotension, increased appetite and weight gain

Question 10

HPA dysfunction in mood disorders

Answer 10

s20/21 diagrame

Question 11

inflammation and depression

Answer 11

• raised plasma cytokine levels (IL-6, TNF-a) and inflammatory markers
• high comorbitity between chronic inflammation and depression
• administering cytokines provokes depression
• microglial activation in brain of depressed people

Question 12

neural system involved in depression

Answer 12

^ activity: fear stimuli

• amygdala
• ventral striatum
• prefrontal cortex

v activity: +ve stimuli
- ventral striatum

Question 13

neural systems in depression

Answer 13

s25

Question 14

bipolar disorder heritability

Answer 14

is

Question 15

5 factors into bipolar

Answer 15

1. catechamines
2. oxidative stress
3. stress hormones
4. inflammation
5. neurotrophins

s28

Question 16

bipolar long and short term treatment

Answer 16

short term treatment:
- reduce severity and shorten duration of acute syndrome- remission of symptoms

long term:
- prevention of new episodes and control chronic mood symptoms

Question 17

4 drugs categories for bipolar

Answer 17

1. antipsychotics
   - rapid antimanic effect
   - long term adverse effects on weight and glucose regulation
   - may cause EPSE
2. lithium
   - in food and water
   - pilz
   - antisuicidal
   - efficacy of impulsive and violent behaviour
   - strongest evidence for prevention of relapses of any polarity
   - narrow therapeutic index
3. anticonvulsants
   - eg valproate, carbamazepine
4. antidepressants

Question 18

treatment of bipolar:

1. depressive episodes
2. manic episodes

Answer 18

depressive episodes:

• antipsychotics
• fluoxetine/olanzapine combination
• antidepressants and antimanics co-prescribed

manic episodes:

• dopamine antagonists
• valproate
• discontinue antidepressants

Question 19

bipolar long term treatment

Answer 19

preventing new episodes:

lithium initially

alternatives if lithium poorly tolerated or ineffective:

• valproate
• dopamine antagonist
• carbamazepine

Question 20

adverse effects of long term treatments

Answer 20

• weight gain
• metabolic syndrome
• liver damage eg valproate
• kidney and thyroid dysfunction