OCD, Major depressive disorder, and Bipolar

Obsessions (OCD)

recurrent intrusive thoughts, impulsive, or images that causes anxiety and cannot be dismissed or put out of one's mind

Compulsions (OCD)

Repetitive action (ritual) a person feels compelled to do

Lifetime prevalence of OCD

~2%

Heritability of OCD

40-50%

OCPD (obsessive compulsive personality disorder)

extensive preoccupation with perfectionism, organization. and control

ego-dystonic

thoughts, impulses, or behaviors that are inconsistent with personal identity; causing distress

anterior cingulate

hyperactivity of the dorsal acc impairs goal-directed behavior (error detection)

CSTC circuit

regulates information flow to cortex, crucial role in habit formation and reward processing (brain lock)

DLPFC (dorsolateral prefrontal cortex)

cognitive control, balancing emotional and deliberative processes

Strep infection (PANDAS)

Molecular mimicry pretending to look like other tissue so the immune system doesn't attack it

OCD Treatment

Exposure, Anafranil, and SSRI/SNRI

OCD spectrum disorders

Hoarding disorder, Trichotillomania, body dysmorphia, excoriation

Complex PTSD

repeated childhood trauma, disordered emotion regulation, identity and relationshipss

Symptoms of Major depressive disorder

depressed mood, loss of interest, change in weight/sleep/appetite, loss of energy, psychomotor retardation, excessive guilt, suicidal

Anhedonia

reduced ability to experience pleasure (symptom of MDD)

Dysthymia

chronic persistent low mood for over two years

Onset insomnia

trouble falling asleep

Middle insomnia

Frequently waking up multiple times in the middle of the night

Terminal Insomnia

the inability to fall asleep after waking up early in the morning

Severe depression

motor retardation, diurnal mood variation, cognitive impairment

seasonal onset depression

hypersomnia, weight gain, sluggishness, anxiety

Psychotic depression

delusions/hallucinations, only during depressive episode

Prevalence of depression

~ 30%

highest risk of onset for depression (age)

ages 15-29 (45-54 for women)

Risk of relapse for depression

over 80% (90% after 3 episodes)

Aaron beck's model

depression caused by negatively biased thoughts

automatic thoughts

"auto-pilot" negative interpretation of events

logical errors

give rise to automatic thoughts (all or nothing thinking)

schemas

core beliefs taken as a given (no one will ever love me)

heritability for depression

0.30-0.40

Serotonin

social drive, stress response, amygdala, anterior cingulate

Tryptophan

a neurotransmitter that affects mood, sleep, and appetite

dopamine

reward/pleasure, goal directed, activity, initiative, and motivation

glutamate

activation

Norepinephrine

attention

Acetylocholine

memory

CRH

neurohormone that coordinates stress response, influences neurotransmitter functions in the brain

Cortisol (stress hormone)

runaway stress response that causes inflammation; body shutdown, reduced BDNF (neuroplasticity)

Estrogen

Modulates serotonin, mood regulation

progesterone

allopregnanolone modulates GABA, lowers anxiety

Testosterone

lowers anxiety and depression; hitting multiple transmitters

Aerobic exercise for depression

Increases BDNF, serotonin and dopamine funtions

Natural sunlight for depression

Resets body clock, makes vitamin d (10,000 Lux P)

SSRIs for depression

prozac, paxil, zoloft, celexa, lexapro

Prozac

Fluoxetine

Paxil

paroxetine

Zoloft

sertraline

Celexa

citalopram

Lexapro

escitalopram

SNRIs for depression

Effexor, Pristiq, Cymbalta

Effexor

Venlafaxine

Pristiq

Desvenlafaxine

Cymbalta

duloxetine

STAR*D trial

more than 4,000 patients recovered for 1 year

Tricyclics

antidepressant with lethal overdose potential, less widely used now

types of Tricyclics

imipramine/Tofranil, amitriptyline/Elavil

Wellbutrin (bupropion)

works on dopamine/reward circuits

Remeron (Mirtazapine)

hits dopamine and serotonin circuits; evidence of higher response rate than SSRI

St. John's Wort

boosts serotonin signals,

Ketamine

anesthetic agent, recreational drug, fast acting

Psychedelics (psilocybin)

used in conjunction with intensive psychotherapy

Transcranial magnetic stimulation

using strong magnetic waves to stimulate targeted brain regions, unclear how long effects lasty

Bipolar disorder

one week or more of elevate or irritable mood and increased energy/activity

DSM criteria for Bipolar (3 or more)

grandiosity/inflated self esteem, decreased need for sleep, extreme talkativeness/distractibility, racing thoughts, increase in goal directed activities

Hypermania

symptoms of mania; less severe, no functional impairment

Mixed episode

symptoms of mania and depression simultaneous

type 1 bipolar

mania; with or without depression history

type 2 bipolar

Hypermania; with depression history

type 3 bipolar

mania induced by drugs (antidepressants, stimulants, marijuana, binge-drinking)

Prevalence of Bipolar

~ 4%

life expectancy of Bipolar

loss of 9-25 years

Heritability of Bipolar

0.80 (most have first degree relative)

Amygdala and bipolar

excessive reactivity (intensity of emotions)

Dopamine circuitry

activation/arousal, goal-directed/reward-based behavior

triggers for mania

sleep deprivation, major life events, light

kindling hypothesis

episode of depression/mania is toxic; episodes get more severe and longer and easily triggered

mood-stablizing medications

Lithium, anticonvulsants, and novel antipsychotics

Lithium

full bipolar remission rate of 30-50%

anticonvulsants

Lamictal, Depakote, Trileptal, Topamax

novel antipsychotics

risperdal, zyprexa, seroquel, geodon,

family-focused therapy (FFT)

treatment for bipolar where patients and families are given education about bipolar and training in communication and problem-solving skills

Miklowitz

emphasizes the role of family tension in bipolar relapse

GWAS

statistical analyses used to identify genetic variants associated with a specific trait or disease