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mood 1 Flashcards

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1
Q

Emotional Regulation

A
  • Ability to manage - emotional responses to environmental stimuli that are perceived as aversive or negative
  • Disruption can lead to anxiety or mood disorder
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2
Q

Depression

A

-Pervasive, debilitating
mental illness that touches all parts of society

-Creates serious negative impact on functioning and interpersonal relationships

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3
Q

Anxiety

A

-Helps individuals adapt to perceived challenge or threat

-Sustained apprehension; avoidance patterns
Can severely limit social interaction and relationships

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4
Q

Bipolar disorders

A
  • Manic
  • Hypomanic
  • Depressive episodes
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5
Q

Pathophysiology of Depression

A

Neurotransmitters and intracellular mechanisms that alter gene expression

Stress response system

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6
Q

Development of anxiety

A

Sympathetic nervous system activation

Neurotransmitters

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7
Q

Emotional Regulation

A

envolves several bodily systems:
Neurotransmitters associated with anxiety & depressive states
-Immunologic responses and inflammation

Emotional states influence immunologic responses

Response engenders state of stress

  • If coping mechanisms fail, risk for maladaptive emotional responses such as depression
  • Manifest clinically through bodily symptoms
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8
Q

Anxiety

A

State of apprehension mixed with fear or worry
-Real or perceived threat
-Somatic responses:
Palpitations, Sweating, Rapid breathing, Nausea

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9
Q

Anxiety Types

A

Generalized anxiety disorder (GAD)
Social anxiety disorder (SAD)
Panic disorder

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10
Q

Anxiety Risk Factors

A
  • genetic
  • familial
  • environmental
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11
Q

Fear-centered anxiety disorders

A

Panic disorder & social anxiety disorder

Situation associated with overwhelming negative consequences

Mediating neural structures that process threat functioning sub optimally

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12
Q

Worry-centered anxiety disorders

A

Functional disruptions in neuronal circuitry
GAD
-Increased activity in cortical-striatal-thalamic pathway

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13
Q

Anxiety- Comorbidities

A

Depression

Panic disorder: respiratory disease, vestibular dysfunction, thyroid problems, cardiac disease

GAD: chronic pain, medically unexplained somatic symptoms, sleep disorders

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14
Q

Anxiety- genetic vulnerability

A

Variation of 5-HT transporter gene (SLC6A4) called 5-HTTLPR

Selective serotonin reuptake inhibitors (SSRIs)

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15
Q

Anxiety- Classic fear conditioning

A

Consolidation: amygdala; long-term memory

Reconsolidation: stronger fear memory

Medications to disrupt chemicals and receptors involved in processes

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16
Q

Neuroanatomic Pathways in Anxiety

A

Conditioned stimulus

-Stimulus read by thalamus -> Amygdala & Visual cortex

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17
Q

Amygdala

A
  • confers significance on stimuli (thalamus or hypothalamus)
  • holds emotional memories and threat assessment
  • controls autonomic responces
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18
Q

Prefrontal cortex

A
  • fear learning and extinction
  • registers and assigns meaning to emotions
  • weights action vs potential reward
  • balances emotion, thought and controlling attention
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19
Q

Caudate nucleus

A
  • orchestrates action-reward sequencing

- drives behavior with recall of past successful outcomes

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20
Q

Neuro-chemical and -transmitter

A

Neural structures correlated with neurotransmitters, neurochemicals, hormones

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21
Q

GABA-BZD-receptor system

A

Gamma-aminobutyric acid (GABA)
-Primary inhibitory amino acid neurotransmitter

Benzodiazepines (BZDs)
-Partners with GABA in maintaining mind–body homeostasis

Glutamate

  • Immediate precursor to GABA
  • Extinction
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22
Q

Norepinephrine ( NE)

A
  • increases during stages of anxiety
  • results in downregulation of auto receptor ( alpha-2)
    • increased autonomic arousal

relationships between NE and BDZ receptors

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23
Q

Serotonic (5-HT)

A
  • decreased 5- HT during states of anxiety
  • action related to fear learning
  • —- occurs through effects on NE and DA
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24
Q

Dopamine (DA)

A
  • increased DA during acute stress
  • involves impairment in DA reward pathways
  • phobic responses
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25
Hypothalamic-pituitary-adrenal (HPA)
``` threatening stimulus --fight or flight corticotropin-releasing hormone (CRH) -- ACTH --glucocorticoids ```
26
Panic disorder
Recurrent, unexpected episodes of panic -palpitations, sweating trembling, shortness of breath, chest pain, nausea, dizziness, feelings of unreality, dying or going crazy. Avoidance of any situation seen as inescapable or there is no help if attacked.
27
Specific phobia
Unreasonable or excessive, persistent fer of specific objects of situations.
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Social anxiety disorder
fear generated by social or performance situations with exposure to unfamiliar or scrutiny.
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Generalized anxiety disorder
excessive worry, difficult to control | Worry generates restlessness, fatigue, difficulty, concentration, irritability, tension, and sleep disturbance.
30
Pharmacological Treatment
``` -selective serotonin reuptake inhibitors ( SSRIs) -Selective norepinephrine reuptake inhibitors (SNRIs) - Tricyclics (TCAs) -Monoamine oxidase inhibitors (MAOIs) -Benzodiazepines -Combination therapy -Caution in elderly ```
31
Depression
Persistent feeling of sadness and lack of interest in life Classifications: Major depressive disorder (MDD) Persistent depressive disorder (dysrhythmia) Premenstrual dysphoric disorder Substance or medication-induced depression Post-partum depression (PP Psychosis-emergency) Seasonal Affective Disorder Depression due to another medical disorder
32
Major Depressive Disorder
greater than 1 depressive episodes of 2 weeks or greater over lifetime with out history of manic, mixed or hypomanic episodes
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Major Depressive Disorder Symptoms
Depressed mood Significantly less interest in activities Changes in weight Insomnia or hypersomnia Feelings of worthlessness or guilt Diminished ability to think or concentrate Recurrent thoughts of death or suicide
34
Major Depressive Episode
Last for 2 weeks 1 of 2 major symptoms of anhedonia (lack of interest) At least 4 DSM-5 symptoms
35
Persistent Depressive Disorder- Clinical Manifestations
Depressed mood occurring on more days than not for 2 years or more Increased (overeating) or decrease appetite Sleeping too much (hypersomnia) or too little (insomnia) Lower energy fatigue Low self-esteem Poor concentration Difficult making decisions Feelings of hopelessness
36
Premenstrual Dysphoric Disorder (PMDD)
Severe form of PMS resulting in depression or anxiety
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PMDD Symptoms
``` mood swings irritability depressed mood anxiety lack of interest in usual activities difficulty concentrating ```
38
Chronic Depression
Major depression lasting 2 years or longer | No more than 2 month period of remission
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Depression in Pregnancy and Post-partum depression
Rapid decline of estrogen | PP Psychosis-medical emergency
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Depression Etiology and Pathogenesis
``` Multifactorial -family history -symptoms in clusters -comorbid with chronic medical illnesses Insufficient firing of key neural networks -Noradrenergic pathway -Orbitofrontal cortex (OFC) -Prefrontal cortex (PFC) ```
41
Neurotransmitters
In depression: complicated reactions between stress and genetic vulnerability Environmental factors Monoamines
42
Monoamines
Serotonin (5-HT): regulates obsessions and compulsions Dopamine (DA): regulates motivation, pleasure, reward Norepinephrine (NE): regulates alertness, energy
43
Norepinephrine and Depression
``` Works with dopamine Responsible for interest and energy Provides sense of hope & purpose in life Is inhibitory in amygdala Deficiency results in negative emotions Mechanisms controlling norepinephrine -Presynaptic alpha-2 (a2) auto receptor -Transporter -Enzyme ```
44
Serotonin (5-HT) and Depression
Mediates positive mood, optimism, & impulsivity Essential for keeping Norepinephrine at appropriate level Originates in dorsal raphe nuclei in pons & upper brainstem (most) Project widely to several areas of brain Pathways to hippocampus, septum, amygdala are inhibitory Other pathways control many somatic functions Serotonin pathway to hypothalamus regulates appetite Pathway to brainstem regulates sleep Reuptake of Serotonin by specific receptors thought to regulate mood, pain, sleep, & body temperature Balance in specific receptors critical in maintaining mood
45
Dopamine and Depression
Controlled by presynaptic pump, enzymatic destruction Categorized by: - Prevalent symptoms - Additional symptom patterns of melancholic or psychotic Dopamine reward system/deficiency relates to anhedonia (loss of interest) Mesolimbic pathway
46
Stress and HPA Dysfunction
Primes body for fight or flight Stress cascade -stress responce-> activates Hypothalamic-pituitary-adrenal (HPA) axis -Increased cortisol -Chronic leads to decreased immunity and hippocampus atrophy Effects of hippocampal atrophy - deficits in learning and memory formation - mood and emotion
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Upper temporal parietal region
perception of external situations
48
Medial frontal cortex
assignment of significance to stimuli
49
Anterior cingulate cortex
ability to focus
50
Ventral lateral cortex
supression of emotions
51
Orbitofrontal cortex
integrative function
52
Glial cells
reduced in depression
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Subgenual prefrontal cortex
responce to stress
54
Anterior cingulate cortex
emotional control, volume loss and functional alterations
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Basal ganglia
Limbic-cortical-striatal-pallidal-thalamic (LCSPT) tract Hypoactive dorsal section of tract hypoactive Lack of Norepinephrine or dysfunction of monoamine pathways Overactive ventral tract of LCSPT
56
Hippocampus
Excessive, prolonged stress & overactivation of HPA axis damages hippocampal neurons -Excess cortisol, damage to genes, glial cell loss, volume loss
57
Amygdala
Function increased in depression | Volume increases
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Depression Treatment
Psychopramacology: Tricyclic antidepressants MAO inhibitors Seretonin reuptake inhibotors (SSRIs) Nonpharmacologic therapies (CBT)
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Tyramine Containing Foods
Avocadoes, bananas, raisins, papaya products including meat tenderizers, canned figs, cheese, sour cream, yogurt, beer, wines, beef or chicken liver, pate, meat extracts, pepperoni, salami, sausage, soy sauce
60
Nonpharmalogic
``` Cognitive-behavioral therapy (CBT) Exposure therapy/counseling Progressive muscle relaxation Psychoeducation Cognitive approaches for automatic thoughts and schemas Biofeedback techniques Meditation ```
61
Bipolar Disorders
Group of mood disorders Characterized by manic, hypomanic, and depressive episodes Classifications Bipolar I disorder Bipolar II disorder Related disorder: cyclothymic disorder -Not significant enough to meet criteria for hypomania or depression Rapid cycling -≥ 4 depressive and/or manic episodes within 12 months -At least 1 week for manic or hypomanic episodes -2 weeks for depressive episodes -Period of remission in between switch to opposite mood
62
Mania
Abnormal and persistently elevated, expansive, or irritable mood Increased energy present every day for one week or longer Flight of ideas Pressured speech Increased participation in goal-directed activities
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Hypomania
Feelings of euphoria | Mood and behavior changes
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Depressive episodes
Do not always manifest | Alternate with mania or hypomania in bipolar I and II
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Cyclothymic disorder
Reoccurring episodes of hypomanic symptoms alternating with depression Occur over ≥ 2 years
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Bipolar Disorders
No definitive cause or specific pathophysiology Complex combination of genetic, physiologic, environmental, psychosocial factors Unusual patterns of inflammation and glial cell activation Linked to mitochondrial dysfunction and oxidative stress
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Risk factors for bipolar disorder
stressful life events | heritability factors
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Bipolar disorder: clinical manifestations and diagnosis
Mania diagnosis: must occur most of the day or for a week or more (less if hospitalization required) - Type 1: at least one manic episode - Type 2: at least one hypomanic episode Children: must asses on basis of personal baseline
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Bipolar disorders: Treatment
mood stabilizers: lithium Atypical antipsychotics, anticonvulsants -Probably most effective mood stabilizers valproic acid (Depakene, Depakote) — antiseizure drug risperidone (Risperdal) — atypical antipsychotic drug
Mood Disorders 1
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