Test 2 Flashcards
(135 cards)
Differentiate BiPolar I, Bipolar II, and Cyclothymic?
BP I: cycles b/w manic and hypomanic to depresssion and dysthymia
BI II: like BP I but doesn’t get to mania, only gets up to Hypomania
Cyclothymic: cycles b/w Hypomania and Dysthymia
What’s the correct term for “bipolar” in kids?
Kids Bipolar = Disruptive Moods Dysregulation Disorder
Differentiate Mania and Hypomania?
Hypomania: >4d but <1w, w/lighter and milder manic type sxs, w/ less impairment and can be IMPROVED, functioning, “genius” can occur
Manic: >1w of sxs
contrast emotional responses and feelings
Feelings = conscious experience of emotion
Feelings neurology = pattern of activity across insular cortex, secondary somatosensory cortex, cingulate cortex, hypothalamus, and upper brainstem
Emotions: automatic physiological response experienced
What’s the role of the frontal cortex w/emotional responses and feelings?
Frontal Cortex Necessary for emotional responses, esp social emotions and decision making
What are the 3 divisions of the amygdala, and which part is related to feelings/emotions?
Amygdala =
1 basolateral: receives input from assoc cortices and sensory structures
2 Central: projects out to emotional response structure
3 Corticomedial: projects to olfaction and appetite centers
What changes in brain structure size correlates w/depression?
Depression:
Prefrontal cortex, esp orbitofrontal prefrontal cortex, dorsolateral prefrontal cortex, subgenual prefrontal cortex, amygdala, anterior cingulate cortex, Hippocampus
Prefrontal GABA neuron density reduced
Occipital GABA neuron density reduced
Prefrontal, Anterior Cingulate Cortex neurons and Glial cells in general decreased
What changes in neural activity correlates w/depression?
Depression:
Cerebral cortex in general, esp in frontal lobes activity decreases
Anterior cingulate cortex, subgenual prefrontal cortex, hippocampus, striatum have metabolic changes
Which sided lesions generally leads to mania vs depression?
What occurs w/B/L lesions of DorsoLateral prefronal cortex vs Medial OrbitoFrontal cortex?
Lt lesion → depression
Rt lesion → mania
B/L DorsoLateral Prefrontal → flat
B/L medial OrbitoFrontal cortex → elevated
Where are these NTs neurons located? DA NE 5HT Histamine
DA: Mesostriatal (from SNc = substantia nigra), Mesolimbic (from VTa = ventral tegmental area), and Mesocortical (from VTA and around SN)
NE: Locus ceruleus and Lateral Tegmental area
5HT: Raphe nuclei in midbrain, pons, medulla, Rostral raphe of midbrain and rostral pons, Caudal Raphe nuclei of caudal pons and medulla
Histamine: posterior Hypothalamus
Depression is assoc w/ ___ inflammatory markers and ____ cortisol
Depression is assoc w/ INCREASED inflammatory markers and INCREASED cortisol
Differentiate Premsenstrual Dysphoric Disorder vs Post-Partum Depression sxs?
PPD time frame for occurance?
• PDD Symptoms include: ○ decreased concentration ○ feelings of sadness ○ tension ○ anxiety ○ fatigue ○ mood swings ○ panic attacks Seems to be a biochemical deficiency in the neurotransmitter Serotonin
PPD is major depressive or Bipolar w/w/o psychotic features after childbirth >4w but up to 1 yr post
Maybe d/t Progesterone drop?
How to recognize major depression as assoc feature or consequence of medical condition?
• Criteria
○ A. A prominent and persistent disturbance in mood predominates in the clinical picture and is characterized by either (or both) of the following:
§ Depressed mood or markedly diminished interest or pleasure in all, or almost all, activities. (-)
§ Elevated, expansive, or irritable mood. (+)
○ B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition.
○ C. The disturbance is not better accounted for by another mental disorder (as Adjustment Disorder with Depressed Mood in response to the stress of having a general medical condition).
○ D. The disturbance does not occur exclusively during the course of a delirium.
E. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
Which NTs and neurophysiologic changes are implicated in mood disorders?
DA and 5HT implicated in mood disorders
What are types of General Medical Conditions w/mood disorders?
○ With Depressive Features: if the predominant mood is depressed but the full criteria are not met for a Major Depressive Episode.
○ With Depressive- Like Episode: if the full criteria are met for a Major Depressive Episode, except disturbance only occurs exclusively during course of a delirium
○ With Manic Features: if the predominant mood is elevated, euphoric, or irritable.
○ With Mixed Features: if the symptoms of both mania and depression are not present but neither predominates.
Define dx criteria of Major Depressive disorder
Major depressive disorder: 5+ everyday for 2w+
□ 1. Depressed mood.
□ 2. Loss of interest or pleasure in most or all activities.
□ **3. Insomnia or hypersomnia.
□ **4. Change in appetite or weight.
□ **5. Psychomotor retardation or agitation.
□ **6. Low energy.
□ ***7. Poor concentration.
□ **8. Thoughts of worthlessness or guilt.
□ **9. Recurrent thoughts about death or suicide.
List the associated features of MDD:
catatonic
Major depressive disorder: catatonic
• 1. motoric immobility as evidenced by cataplexy or stupor.
□ Catalepsy: immobile position constantly maintained.
□ Cerea flexibilitas (waxy flexibility) can “mold” limb position when moved like wax.
• 2. excessive motor activity (purposeless movement)
• 3. extreme negativism or mutism;
□ Motiveless resistance to instructions or maintenance of a rigid posture against attempts to be moved; mute.
• 4. peculiarities of voluntary movement
□ as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures), stereotyped movement, prominent mannerisms, or prominent grimacing).
• 5. *echolalia- psychopathological repeating of words or phrases (may be in a mocking tone) or *echopraxia- pathological imitation of movements of one person by another.
□ Consider *Mirror neurons: may be involved in feelings of empathy (an understanding “from the inside”) or role in specific human abilities.
• 6. Either of the following, occurring during the most severe period of the current episode:
□ 1. loss of pleasure in all, or almost all, activities.
□ 2. lack of reactivity to usually pleasurable stimuli when something “good happens,”) does not feel much better, even temporarily).
List the associated features of MDD:
Melancholic
Major Depressive Disorder-Melancholic
• 1. distinct quality of depressed mood (that is, separate from, say, kind of feeling experienced when your beloved dog died).
• 2. depression regularly worse in the morning.
• 3. early morning awakening (at least 2 hours before usual time of awakening).
• 4. marked psychomotor retardation (-) or agitation (+).
• 5. significant anorexia or weight loss.
• 6. excessive or inappropriate guilt.
List the associated features of MDD:
atypical
Major Depressive Disorder-atypical
• A. Mood reactivity (mood actually brightens in response to positive events).
• B. Two or more of the following features:
○ 1. significant weight gain or increase in appetite.
○ 2. hypersomnia
○ 3. leaden paralysis (arms/legs feel “like lead”)
○ 4. long-standing pattern of interpersonal rejection sensitivity resulting in significant social or occupational impairment.
• C. Criteria that are not met for with melancholic features or with catatonic features during the same episode.
Describe dx characteristics of Dysthymia
Dysthymia:
• A. Depressed mood for most of the day, for more days than not for 2yrs (adult) or 1yr (kid)
• B. Presence, while depressed, of two or more of the following:
□ 1. poor appetite or overeating.
□ 2. insomnia or hypersomnia.
□ 3. low energy or fatigue.
□ 4. low self-esteem.
□ 5. poor concentration or difficulty making decisions.
□ 6. feelings of hopelessness.
Discuss dx and tx options for Bipolar disorders?
Major depression disorder
dysthymia
Cyclothymia
BP: mood stabilizers and antipsychotics w/w/o antidpressants, ECT
Major Depression Disorder: SSRI, SNRI, MAOI, antipsychotic, phototherapy, ECT,
Dysthymia: less pharmacotherapy than MDD if possible
Cyclothymia: Mood stabilizers (Lithium, Valproic Acid > Carbamazepine, Lamotrigine> Gabapentin, Toparamate), Antipsychotics [2st gen Thorazine or 2nd gen Quetiapine], Combo w/w/o antidepressants, and ECT
Diagnostic criteria of Cyclothymia?
Cyclothymia:
hypomanic and depressive sxs for 2yrs (adult), 1 yr( kids), but doesn’t meet criteria for Major Depressive or Bipolar… so more chronic but milder
What’s the MonoAmine theory of depression?
Depression’s d/t decreased monoamines, and w/initial tx you get an acute decrease d/t presynaptic autoreceptors
Takes weeks to get an increase in Monoamines
For SSRIs, what're the MOA TI PK *ADEs
SSRIs (Fluoxetine, Paroxetine, Citalopram)
MOA: SSRI
TI: Depression, bulimia, all major anxiety disorders (GAD, PTSD, OCD)
ADE: *Reduced libido, *teratogen (cardiac malformation 1st trimester exposure), GI, serotonin syndrome, discontinuation syndrome, dizzy, paresthesias
