Psychological disorders characterized by pathological extremes of certain moods.
Mood Disorders
When mood is elevated to the point of euphoria and impairs daily functioning
Mania
Bipolar Disorder is characterized by one or more ______ episodes accompanied by periods of _______
Manic
Depression
Which sex is more affected by bipolar disorder?
Neither, they are both affected equally
What are some Emotional symptoms of a Manic Episode?
Elated
Euphoric
Very sociable
Impatient
What are some Cognitive symptoms of a Manic Episode
Racing thoughts Desire for action Impulsive Talkative Delusions of Grandeur Self-confident
What are some Motor symptoms of a Manic Episode?
Hyperactive Tireless Require less sleep Increased sex dress Fluctuating appetite
What are some Emotional symptoms of a Depressive Episode?
Gloomy
Hopeless
Socially withdrawn
Irritable
What are some Cognitive symptoms of a Depressive Episode?
Slowness of thought Worrying Indecisive Negative self-image Self-blame Guilt
What are some Motor symptoms of a Depressive Episode?
Less active Tired Difficulty sleeping Decreased sex drive Decreased appetite
Depression occurs on a _____
Spectrum
On average, how long does untreated depression last?
9 Months
Sadness is an ________ pain that we must wait out - ______ occurs when we loose sight of its time limited nature and move into a state of learned __________
Emotional
Depression
Helplessness
Depression can be categorized as:
Mild (some difficulties with daily activities)
Moderate
Severe (Unable to continue with daily activities)
What is MDD?
Major Depressive Disorder
What is MDD characterized by?
Periods of sustained sorrowful mood
Feelings of guilt
Sense of worthlessness
Anhedonia
What daily functions are affected by MDD?
Thought - difficulty concentrating or decision making
Sleep - insomnia or fatigue
Appetite
Libido - decrease
What is commonly comorbid with MDD?
Anxiety
Substance abuse disorder
Medical illness
Depression is the most common _______ disorder
Psychiatric
____% of people will experience depression in their life
Twenty
Which sex is roughly twice as likely to suffer from depression?
Female
What is the generally accepted cause of depression?
Complex interaction of social, psychological, and biological factors
The pathology and symptomatology of depression include many __________ loops (psychological and molecular) which contribute to the disease
Feedback
There is a significant _____ component to depression - which likely dictates susceptibility (not cause)
Inherited / Genetic
What are some genes that have been associated with depression?
Serotonin receptors
Serotonin Transporters
BDNF (brain-derived nerve factor growth)
What is the most effective treatment for depression?
A combination of psychotherapy (CBT) and SSRI
What are the main drugs used to treat depression?
SSR
SNRI
TCA (Tricyclic
Antidepressant)
MAOI (Monoamine Oxidase Inhibitors)
What is CBT
Cognitive Behavioural Therapy
What is the goal of CBT?
To help clients recognize and change negative thought processes - Learn new coping skills
Depressed individuals have reduced activity of the _____ allowing the _____ and emotions to go unchecked
PFC (self-control, planning)
Amygdala (emotional processing)
How does CBT work on the brain?
Helps increase activity in PFC so it can exert top-down control over the amygdala and keep emotional responses in check
What does the Monoamine Hypothesis of Depression propose?
That the neuroanatomical basis for depression is decreased availability of noradrenaline and serotonin
Monoamine Hypothesis Evidence:
_________ and __________ systems (which regulate emotion, mood, attention, reward, sleep, appetite and cognition) are affected by depression
Serotonergic
Noradrenergic
The fact that treatments which increase monoamines in the synapse decrease depressive symptoms - supports which theory of depression?
Monoamine Hypothesis
What is the goal of Pharmacological treatment for depression?
Increase neurotransmitters at the synapse
What is MAO?
Monoamine oxidase - an enzyme which degrades (destroys) monoamine NTs (dopamine, serotonin, noradrenaline)
How do MAOIs work?
Block MAO from degrading monoamines
What are NT transporters?
Transmembrane proteins which act to remove NT from the synapse
What do Reuptake Inhibitors (such as SSRIs) do?
Block NT transporter proteins leading to increases presence of NT in synapse
How do TCAs work?
Block reuptake of norepinephrine, serotonin, and dopamine
What is an SSRI?
Selective Serotonin Reuptake Inhibitor
Example: Prozac
What is an NRI?
Norepinephrine Reuptake Inhibitor
Example: Vestra
What is an SNRI?
Serotonin-Norepinephrine Reuptake Inhibitor
Example: Effexor
What are some potential side effects of pharmacological treatment for depression?
Increased anxiety Sexual dysfunction Weight gain Dry mouth Blurred vision Memory impairment
_____ evidence that low levels of NT cause depression
Little
What does the Neuroplasticity Theory of Depression propose?
Depression occurs as a result of decreased neuroplasticity
Neuroplasticity Theory of Depression Evidence:
Several brain regions, including the hippocampus, show ______ volume in depressed patients
Reduced
Neuroplasticity Theory of Depression Evidence:
Antidepressants have been shown to increase _________
Neurogenesis
Neuroplasticity Theory of Depression Evidence:
_______ is down-regulated in response to stress and antidepressants up-regulate ______
BDNF
What does the Immune Hypothesis of Depression Propose?
Proposes that immune reaction plays a causal role in the origin of depression
Evidence for the Immune Hypothesis of Depression:
Depressed patients have _______ levels of Cytokines
Higher
Evidence for the Immune Hypothesis of Depression:
Patients treated with _________ show depressive symptoms, which ceases when treatment ends
Cytokine
Evidence for the Immune Hypothesis of Depression:
Cytokine signalling in the brain alters neuronal function and activates the _____ axis
HPA
What does the Gluccocorticoid Hypothesis of Depression propose?
Proposes that dysfunctional regulation of the HPA axis in the stress response plays a key role in causing depression
The first depressive episode is most likely _______ - triggered by important stressors
Reactive
Subsequent depressive episodes become increasingly _________ - triggered by minor stressors and occur spontaneously
Endogenous
Gluccocorticoid Hypothesis of Depression Evidence:
Abnormal regulation of the ______ _____ is one of the most consistent findings in depressed patients
HPA axis
Depressed people display Hypercortisolemia - which is elevated levels of _______ - chronic stress can lead to over secretion
Cortisol
Dysfunction of the _______ could explain aspects of all the main theories of depression:
Alter NT receptor level - decreased neurotransmission
Decrease Neurogenesis
Decrease BDNF levels
Activation of the sickness response
HPA axis
Resistant depression treatment that acts as a NMDA receptor antagonist, blocking the binding of glutamate to its receptors
Ketamine
Resistant Depression treatment which induces controlled seizures while patient is anesthetized
Electroconvulsive Therapy (ECT)
Major side effect of ECT?
Memory loss
Resistant Depression treatment which induces an electric current in the brain using a magnet over the scalp
Transmagnetic Stimulation (TMS)
What is Broadmann’s Area 25?
Subcallosal Cingulate Area
What five areas is BA 25 connected to?
Amygdala OFC MFC Hippocampus Hypothalamus
What do PET studies show in BA 25 in depressed patients?
Hyperactivity
Surgical implantation of electrodes which release small electric pulses to specific brain regions
Deep Brain Stimulation (DBS)
Define: Hypercortisolemia
High amounts of circulating cortisol
Define: CBT
Cognitive Behavioural Therapy - Psychotherapy which acts to improve coping skills by helping patients recognize and change negative thoughts