Mood disorders

Question 1

What are the two broad classes of mood disorders?

Answer 1

• Depressive disorders
• Bipolar disorders

Question 2

What needs to have happened in order to make a diagnosis of depression?

Answer 2

• Must have had symptoms for at least 2 weeks

Question 3

What are the core symptoms of depression?

Answer 3

• Low mood
• Lack of energy
• Lack of enjoyment and interest

Question 4

What are some other symptoms of depression?

Answer 4

• Suicidal ideation
• Lack of appetite/weight loss
• Pain
• Sleep disturbance
• Severe cases might have psychotic symptoms

Question 5

What is an adjustment reaction?

Answer 5

• Typically occurs after some kind of traumatic event and has fewer somatic features compared to depression
• Adjustment reactions do not last as long as depression and tend to have a fluctuating course

Question 6

What are the symptoms of an adjustment reaction?

Answer 6

• Symptoms develop suddenly after an event
• Symptoms fluctuate
• Time limited
• Energy not low
• No particular pattern to sleep disturbance
• Reduced or increased appetite

Question 7

What are the clinical features of mania?

Answer 7

• Elevated mood and energy levels with racing thoughts (flight of ideas)
• Decreased need for sleep
• Normal social inhibitions are lost
• Attention cannot be sustained
• Self esteem is inflated, often grandiose
• May have psychotic symptoms

Question 8

What is hypomania?

Answer 8

• Refers to symptoms that are still clearly manic but don’t necessarily reach full diagnostic criteria for mania

Question 9

How can we diagnose bipolar disorder?

Answer 9

• Following two episodes of a mood disorder, one of which must be either mania or hypomania
• You can be diagnosed with bipolar without ever having been diagnosed with depression

Question 10

What is bipolar 1?

Answer 10

• Discrete episodes of mania only or mania and depression

Question 11

What is bipolar 2?

Answer 11

• Discrete episodes of hypomania or hypomania and depression

Question 12

What are the physical differentials for depression?

Answer 12

• Hypothyroidism
• B12 deficiency
• Chronic disease
• Substance misuse
• Hypoactive delirium

Question 13

What are the physical differentials for mania?

Answer 13

• Hyperthyroidism
• Delirium
• Iatrogenic (steroids)
• Infection (e.g. encephalitis, HIV)
• Head injury
• Intoxication (e.g. stimulants)

Question 14

Which brain regions and circuits are implicated by mood disorders?

Answer 14

• Limbic system
• Frontal love
• Basal ganglia

Question 15

What are the functions of the limbic system?

Answer 15

• Important functions in emotion, memory and motivation
• Composed of many brain regions
• The main emotion circuit is known as the Papez circuit, containing many structures

Question 16

What structures are found in the Papez circuit?

Answer 16

• Various cortical areas send input to the
• Hippocampus which projects to the mamillary bodies
• Via the fornix
• The mamillary bodies project to the thalamus and hypothalamus
• Thalamus projects back to cortex
• Hypothalamus projects down to pituitary and autonomics

Question 17

What is the Papez circuit important for?

Answer 17

• Emotions
• Memory consolidation

Question 18

Why is the Papez circuit important for memory consolidation?

Answer 18

• Hippocampus is able to induce long term potentiation in the cortex to lay down long term memory

Question 19

Outline the motor effects and cognitive effects of the frontal lobe?

Answer 19

• Motor
• Language
• Executive functions
• Attention
• Memory
• Mood
• Social and moral reasoning

Question 20

How is the frontal lobe responsible for mood?

Answer 20

• The inferior portions of the anterior part of the frontal lobe are involved in the generation and expression of emotions, probably via connections with the amygdala

Question 21

What is the function of the basal ganglia?

Answer 21

• In addition to motor functions, the basal ganglia also have important roles in emotion, thought and behaviour
• Changes in basal ganglia volume and activity seen in mood disorders

Question 22

Which neurotransmitters are thought to be involved in mood disorders?

Answer 22

• Serotonin
• Noradrenaline

Question 23

Where is serotonin produced?

Answer 23

• In the brainstem (raphe nuclei) and distributed to cortex and limbic system

Question 24

What is serotonin important for?

Answer 24

• Sleep
• Impulse control
• Appetite
• Mood

Question 25

What is the evidence for decreased serotonin in depression?

Answer 25

- Drugs that increase serotonin in the brain treat depression - 5HIAA (a metabolite of serotonin) is low in the CSF of patients with depression - Tryptophan (a precursor of serotonin) depletion causes depression

Question 26

Which features do not suggest that decreased serotonin causes depression?

Answer 26

- Despite levels of serotonin rising rapidly following the use of drugs such as SSRIs, symptoms only improve over the course of weeks to months

Question 27

Where is adrenaline produced?

Answer 27

- In the locus coeruleus of the brainstem and distributed to cortex and limbic system

Question 28

What is noradrenaline important for?

Answer 28

- Mood - Arousal - Memory

Question 29

What is the evidence for decreased levels of noradrenaline in depression?

Answer 29

- Drugs that increase levels of noradrenaline treat depression - Patients who have recovered from depression but still have low levels of noradrenaline are at higher risk of relapse - Post-mortem studies suggest lower levels of noradrenaline in the brains of those with depression

Question 30

What is the biological treatment for depression?

Answer 30

- Antidepressants - Selective serotonin reuptake inhibitors are first line - Consider electroconvulsive therapy for severe or refractory cases

Question 31

What is the psychological treatment for depression?

Answer 31

- CBT

Question 32

What is the social treatment for depression?

Answer 32

- Help with social stressors such as isolation and financial worries

Question 33

What are the biological treatments for mania?

Answer 33

- Antipsychotics - Mood stabilisers

Question 34

What are the psychological treatments for mania?

Answer 34

- Unlikely to be helpful in acute phase - Helpful to educate patients regarding recognising triggers and signs of relapse

Question 35

What are the social treatments for mania?

Answer 35

- Patients need to be kept safe so that risks to self and others are minimised - Important to think about implications of mania such as finances etc.