What are the features of depressive disorders?
Patient has symtpoms continually for 2 weeks consisting of:
- Core symptoms
- Depressive Thoughts
- Somatic Symptoms/ Biological symptoms
- Psychotic symptoms in severe cases
What are the core symptoms of depressive disorders?
- Low mood
- Lack of energy
- Lack of enjoyment and interest in things they would usually enjoy
What are some of the somatic symptoms of depressive disorder?
- Not sleeping
- Lack of appetite → weight loss
- Stop drinking fluids → dehydration → electrolyte imbalances
How does depression differ from an adjustment reaction (i.e. adjusting to a normal life event)?
List some of the features of mania
- Elated mood
- Increased energy (psychoagitation)
- Pressure of speech
- Decreased need for sleep
- Flight of ideas
- Normal social inhibition is lost (flirtatious, driving quick, playing loud music)
- Attention cannot be sustained
- Inflated self esteem, often grandiose
- May have psychotic symptoms
How is a diagnoses of bipolar affective disorder made?
Diagnoses made following 2 episodes of a mood disorder, at least one of which is mania or hypomania
(do not need to have had a depressive episode)
What is the difference between Bipolar 1 and Bipolar 2?
Bipolar 1: discrete episodes of only mania or depression
Bipolar 2: discrete episodes of hypomania or hypomania and depression
Describe how symptoms can change in bipolar disorder over time
Euthymia = stable, normal mood
Episodes of mania or depression can be years apart or close together if rapid cycling bipolar
What pysical health differentials should you try to rule out if someone presents with depression?
- Hormone disturbances e.g. thyroid dysfunction
- Vitamin deficiences e.g. Vitamin B12
- Chronic dieases e.g. renal, CVS and liver failure
- Anaemias
- Substance misuse e.g. alcohol, cannabis, stimulants
- Hypoactive delirium (if particularly elderly)
What pyhsical health differentials should you try to exclude if a patient presents with mania?
- Iatrogenic e.g. steroid induced
- Hyperthyroidism
- Delirium
- Infection e.g. encephalitis, HIV, syphillis
- Head injury
- (intoxication with stimulants)
What brain structures are involved in mood disorders?
- Limbic system
- Frontal lobe
- Basal ganglia
What are the main functions of the limbic system?
- Emotion
- Motivation
- Memory
What are some of the possible changes that happen to the limbic system in mood disorders
What are the functions of the frontal lobe?
- Motor function
- Language (Broca’s area)
- Executive functions (planning, purposeful goal directed behaviours)
- Attention
- Memory
- Mood
- Social and moral reasoning
What is the prefrontal cortex’s involvement in emotion?
- Ventromedial prefrontal cortex- thought to be involved in generation of emtion
- Orbital prefrontal cortex - involved in emotional responses
What are some of the possible changes to the frontal lobe in mood disorder?
What is the function of the basal ganglia?
- Motor function
- Psychological funtion
- Emotion
- Cognition
- Behaviour
What are some of the possible changes to the basal ganglia that occur in mood disorder?
Which 2 main neurotransmitters are involved in depressive disorders
- Serotonin (5-HT)
- Noradrenaline
Both are monoamines
Monoamine hypothesis suggests depressive disorder is due to abnormality of these neurotransmitters
Where is serotonin produced and what does it play a role in?
Produced in the brain stem (Raphe Nuclei) and transported to the cortical areas and limbic system
Has roles in:
- Sleep
- Impulse control
- Appetite
- Mood
What change happens to Serotonin in depression.
What evidence is there to support this?
Serotonin thought to be low in depression
Evidence:
- SSRI, SNRI, TCA and MOAi all successfully treat depression by increasing levels of serotonin in the synaptic cleft
- 5HIAA (serotonin metabolite) is low in the CSF of patients with depression (particularly those who attempted suicide)
- Tryptophan (serotonin precursor) depletion causes depression
Where is noradrenaline produced and what is its function in the brain?
Produced in the locus coeruleus (pons) and projects to the limbic system and cortex
Functions in the brain:
- Mood
- Suggested role in behaviour (arousal and attention)
- Implicated in memory functions
What is the involvement of noradrenaline in mood disorders and what evidence is there to support this?
Noradrenaline is low in depression
Evidence:
- Antidepressants (e.g. SNRI’s, NARI’s and some TCA’s) that increase NA, successfully treat depression
- Patients who have recovered from depression but show decreased NA levels have sgnificantly higher relapse rates
- Postmortem studies of depressed patients shows NA to be low vs controls
What is the first line treatment for depression, reccomended by NICE?
Cognitive Behaviour Therapy
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Introduction and basic topography39
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Somatosensory system34
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Retina and Central Visual Pathway21
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Arterial Blood Supply To the Brain17
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The Motor System23
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Movement Disorders20
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Higher Cortical Function22
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Reticular Formation and Conciousness26
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Neuropathology32
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Confusion in the elderly28
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Headache22
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Stroke34
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Raised ICP23
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Meningitis and Sub-arachnoid haemorrhage46
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Intro to psychiatry7
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Anxiety34
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Mood Disorders31
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Psychosis23
