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mood disorders

depressive disorders, bipolar / manic depression, and anxiety disorders

the limbic system

controls mood and attitude, involved in storage of emotional memories, and controls appetite and sleep. medial temporal lobe heavily connected to the frontal cortex with some basal ganglia interactions.

depression

low mood most of day, changes in sleep, weight changes, anhedonia loss of pleasure, thoughts of death, fatigue, retardation, guilt, lack of concentration, and delusions.

depression diagnosis

patient self reported experiences, reported behavior by relatives or friends, mental status exam, lab tests to rule out underlying conditions, and rule out dementia.

major depression

also called clinical or unipolar depression. 5+ symptoms without remission for at least 2 weeks. onset 30-40s and 50-60s, genetic role plus environmental triggers, women 2x more than men, men at higher risk for suicide, ~60% of suicides diagnosed with depression.

major depression subtypes

melancholic is the typical view of depression with insomnia, loss of appetite, and anhedonia. atypical with mood reactivity, paradoxical anhedonia, comfort eating, hypersomnia, leaden paralysis, and significant social impairment. dysthymia less severe than major but lasts for at least 2 years. adjustment with depressed mood is a mood disturbance appearing as a psycho response to a stressor resulting in emotional and behavioral symptoms are significant but dont meet criteria for major. catatonic rare and severe form of major involving disturbances of motor and other symptoms where the patient is mute, immobile, or exhibits purposeless and bizarre movements.

hormonal depression

postpartum is intense and sustained that typically sets in within 3 months of labor and lasts longer than the common baby blues, maybe lasting a year or more. affects 10-15% of new mothers and can also occur in new fathers where hormonal vs environmental factors; postpartum psychosis/mania also possible. premenstrual dysphoric disorder PMDD has symptoms of sever PMS from abnormal responses to normal changes in hormones with a genetic component of 3-8% of women.

circadian depression

seasonal affective disorder SAD that comes in winter time and resolves in spring where at least two episodes have occurred in colder months with none at other times over a 2 year period. in winter theres intense hunger, weight gain, hypersomnia, and increased evening depression where treatment includes light therapy.

multimodal depression causes

biological, psychological, sociocultural, and social dimensions. tret with medication and changes in thinking

bio causes of depression

psych side effects are caused by meds that affect monoamine neurotransmitters serotonin norepinephrine and dopamine. problems from affects on NTs not uniform. specific monoamine hypothesis that depression is from pre and/or post synaptic changes in serotonin and/or norepinephrine pathways. other biological aspects are hormonal changes, circadian rhythm changes and stress responses.

psychosocial causes of depression

positive correlation btwn stressful life events and onset of depression where most cases are stressful losses in partner, long term job, health, and income. A.T. Beck cognitive model of depressed patients hold pessimistic views, recurrent patterns of depressive thinking, and disordered info processing. learned hopelessness theory passive resignation produced by repeated exposure to negative events that are perceived to be unavoidable.

pscyhosocial treatmetns

cognitive behavioral therapy; meds like monoamine oxidase inhibitors MAOIs, tricyclic antidepressants, SSRIs, and NSRIs; and stimulation like electroconvulsive shock therapy, transcranial magnetic stimulation TMS, and deep brain stimulation as in parkinsons.

brain involvement

frontal lobes decision making and reward prefrontal, orbital, and anterior cingulate cortex. serotonergic pathway raphe nucleus in brain stem. circadian rhythms in suprachiasmatic nucleus. basal ganglia cognitive and limbic circuits. reward pathways ventral tegmental area and nucleus accumbens dopamine.

mania

symptoms are irritability, delusions, hypersensitivity, hyperactivity, racing thoughts, pressured speech talkativeness, and decreased need to sleep. drug intoxication shows similar effects.

hypomania

symptoms are overly excited energetic euphoric but still coherent, very focused, goal driven, decreased need for sleep, increased impulsivity, and can be a positive feeling state but seen as a precursor for mania. a feature of bipolar and cyclomythia but can appear in schizoaffective a lesser form is caller hyperthymia.

bipolar disorders

bipolar I episodes of sever depression alternate with mania. bipolar II episodes of severe depression alternate with hypomania. cyclothymia dysthymia alternates with hypomania.

mixed affective disorder

combined/simultaneous manic and depressive symptoms like agitation, impulsiveness, anxiety, aggressiveness, confusion, fatigue, morbid or suicidal ideation, panic delusions, and pressured speech.

bipolar causes

genetic link plus environmental trigger with possible anatomical differences in hippocampus, prefrontal cortex, and amygdala. possible uncontrolled changes in hormonal pathways to the hypothalamus-pituitary-adrenal axis that controls interactions among the body that mediate stress.

bipolar treatments

CBT, mood stabilizers like lithium or anticonvulsants, antidepressants used only with mood stabilizers as that can cause an episode, and antipsychotics for manic agitation.

anxiety

diffuse vague feelings of fear and apprehension. becomes disorder when the normal response is inappropriately provoked by homeostatic imbalances and fail to reduce. up to 60% associated with depression and 10-18% prevalence in the US. associated with low levels of GABA and the amygdala that processes fear.

phobias

intense irrational fears that focus on category of objects, events, social settings, and more often seen in females than males.

anxiety treatments

antidepressants like SSRIs, NSRIs, MAOIs; antianxiety short term like ativan, xanax, valium; beta-blockers that stop physical symptoms; and CBT to adjust thought patterns.

generalized anxiety disorder GAD

chronic anxiety for at least 6 months independent of clear external causes, patients anticipate disaster, the worry interferes functioning, and physical symptoms of headaches stomachaches muscle tension and irritability. has some genetic components related to major depression and childhood trauma.

OCD

irrational disturbing thoughts that intrude into consciousness with compulsions like repetitive actions most commonly checking and washing. caused by heightened neural activity in caudate nucleus of basal ganglia associated with initiation of learned habitual activity.

OCD treatment

medication like SSRIs, CBT, and deep brain stimulation.

panic disorder

panic attacks with catastrophic misinterpretations of physiological responses that are very frightening and develop agoraphobia. caused by genetic components and environmental triggers, imbalances in amygdala/limbic systems, and stimulant use.

panic disorder treatmetns

self treat with smoking and alcohol, anti anxiety meds, anti depressants, and behavioral therapy.

PTSD

symptoms last 1 month often 6 months and cause significant impairment in social occupation or other important functional areas. symptoms include re-experiencing, increased arousal, dysphoria, and avoidance. biological basis with alterations in baseline cortisol, anatomic differences, and possible maladaptive learning pathway to fear thru the HPA axis.

frontal lobes

motor function, speech production, working memory, impulse, judgement, etc. prefrontal associated with complex human like functions, emotion, executive function, and working memory. ex phineas gage railroad rod altered personality and oscial functioning.

lobotomy

cutting the connections to and from the prefrontal cortex, won a nobel prize in 1949 later used to treat mental illnesses from 1930s-50s.

dorsolateral prefrontal cortex

highest cortical area responsible for motor planning and organization with integration of sensory and memory info. performs executive function involved in working memory.

frontal convexitiy syndrome

dorsolateral prefrontal damge causes apathy, outbursts, loss of self, motor preservation, psychomotor retardation, and working memory deficits. the wisconsin card sorting task sorts cards into categories with feedback and tests problems with executive function associated with damage due to tendencies to perseverate instead of adapting to new rules.

anterior cingulate cortex

cognitive function sin reward, decisonss, emotion and autonomic functions in regulating blood pressure and heart rate

medial frontal syndrome

akinetic mutism with limited spontaneous movements, sparse verbal output, lower extremity weakness, and incontinence.

orbitofrontal cortex

roles in sensory integration, affective value of reinforcers, decision making, taste ,etc.

orbitofrontal syndrome

disinhibited impulsive behavior, euphoria, emotional liability, poor judgement, lack of concern, and distractibility. patients may have problems with telling right from wrong and little insight into the problem. associated with dementia and may play a role in anti-social personality disorder.

antisocial personality disorder/ psychopathic personality disorder/ sociopathic personality disorder

symptoms are failure to conform to social norms, deceitfulness, impulsivity, irritability, reckless disregard, consistent irresponsibility, lack of remorse, lack of empathy, superficial charm, and substance abuse. prevalence in 3% men 1% women seen in 30-95% of felons. juvenile diagnosis is conduct disorder. no recognized treatment and genetic risk causes.

tourettes syndrome

onset 3-9 years old up to 1/100 people with boys diagnosed 3-4x more than girls, frequently occurs with OCD, ADHD, and depression/anxiety. symptoms are multiple motor tic and at least one vocal tic that wax and wane over time but may be temp suppressed with effort. 10% have coprolalia socially inappropriate exclamations. caused by changes in frontal lobe and basal ganglia development where decreased size of caudate nucleus correlates with higher severity.

tourette treatment

behavioral interventions to reduce a specific tic like CBT and habit reversal training; DBS like for other basal ganglia issues; and medications have variable effects like antipsychotics and antidepressants.

kluver-bucy syndrome

placidity diminished fear repsonses, dietary changes, hyperorality, altered sexuality, visual agnosia, and hypermetamorphosis. associated with damage to the amygdala and limbic frontal connections but cases have been reported in associated with herpes and head trauma.

schizophrenia

positive symptoms like hallucinations ex command hallucinations, delusions of persecution grandeur and control, and disorganized speech like over inclusion and paralogic. negative symptoms like absence of normal cognition in flat and inappropriate affect, poverty of speech, and lack of motivation. cognitive symptoms like problems with working memory and attention. caused by congenital risks and neutrotransmitter excesses or deficits from hyperfronatality hypothesis treated by dopamine blockers and glutamate

tardive dyskinesia

antipsychotic meds that decrease dopamine can cause severe movement disorders of involuntary repetitive purposeless movements.

schizophrenia subtypes

paranoid type most common where delusions are elaborate with mostly positive symptoms. disorganized type with disorganized speech, silly behavior, and less pronounced delusions where patients are incoherent and hebephrenic. residual type primarily displays negative symptoms. catatonic type is rare and unresponsive to surroundings and possible purposeless movement with echolalia and waxy flexibility. undifferentiated type are combinations of hallucinations specific delusion and general disorganization where nothing is most prominent.

schizo spectrum disorders

schizophreniform disorder symptoms of schiz for less than 6 months may have rapid onset and often less social dysfunction. schizoaffective disorder has mood changes and psychosis where symptoms appear to be combined with bipolar/depression. schizotypal personality disorder with paranoia deemed as odd lack close relationships and have magical thinking. schizoid personality disorder lack of interest in social relationships with tendency to be solitary similar to negative schizo symptoms.

diencephalon

thalamus and mammillary bodeies involed in memory. NA damaged the diencephalon causing severe anterograde amnesia