Term
| __________and __________ are the three types of depressive disorders; _________ and ____________, ____________, and __________ are the three types of bipolar disorders |
|
Definition
| major depressive disorder, dysthymic disorder; bipolar I disorder, bipolar II disorder, cyclothymic disorder. |
|
|
Term
| what are the four types of mood episodes and how are they characterized? |
|
Definition
1. major depressive episode
2. manic episode
3. hypomanic episode
4. mixed episode |
|
|
Term
| Melancholia is also known as ____________ |
|
Definition
|
|
Term
| melancholic features include |
|
Definition
1. Anhedonia
2. Sx worse in the morning (diurnal mood variation) 3. Early morning awakening (a.k.a. terminal insomnia) 4. Marked psychomotor agitation or retardation 5. Anorexia and weight loss 6. H/o good response to somatic treatments |
|
|
Term
| how long do sx such as anhednia, weight gain/loss, psychomotor agitation/retardation, depressed mood, and suicidal thoughts have to be present before it is considered a major depressive episode? |
|
Definition
| 2 weeks (critics think it should be changed to 4) |
|
|
Term
| true or false: patients with a mood disorder may experience mood-congruent psychotic symptoms |
|
Definition
|
|
Term
| a _____________ is a false sensory experience and a ___________ is a false belief maintained despite convincing contradictory evidence |
|
Definition
|
|
Term
| a _____________ is a false sensory experience and a ___________ is a false belief maintained despite convincing contradictory evidence |
|
Definition
|
|
Term
| true or false: familial risk is lower for recurrent than isolated major depressive episodes |
|
Definition
| false. higher for recurrent indicating greater genetic contribution |
|
|
Term
| where are the greatest number of SAD (seasonal affective disorder) patients found? |
|
Definition
| in high latitudes (> 30 degrees north or south). immigrants to these areas also at greater risk than natives. |
|
|
Term
| what are some possible etiological factors for postpartum onset depression? |
|
Definition
-Previous depression or latent risk
-Postpartum physiological changes
-Fatigue, stress, sleep deprivation caused by newborn
-Shift in social support / focus from mom to newborn |
|
|
Term
| 1 in _________ deliveries result in postpartum onset dep with psychosis for the mother |
|
Definition
|
|
Term
| what is the possible role of MAOa levels on postpartum depression? |
|
Definition
Estrogen normally inhibits MAOA (i.e., it acts like an MAOI)
When estrogen plummets after delivery, MAOA increases markedly (M = 43% in this study)
increased MAOA -> decreased NE and 5-HT in synapses |
|
|
Term
| what is the typical duration for a manic episode? |
|
Definition
|
|
Term
| what are some of the sx of a manic episode? |
|
Definition
| nflated self-esteem / grandiosity |
|
|
Term
| what is a hypomanic episode? |
|
Definition
Distinct mood disturbance similar to a manic episode
but of lesser intensity (i.e., no “marked impairment” or hospitalization) |
|
|
Term
|
Definition
Mood disturbance that meets the criteria for both major
depressive and manic episodes simultaneously. The features are intermixed or rapidly altering. |
|
|
Term
| what is double depression? |
|
Definition
| ongoing dysthymic disorder punctuated by a major depressive episode. |
|
|
Term
| _____________ may moderate the effect of stressful life events and early abuse on MDE (BUT findings are very contradictory and thus controversial) |
|
Definition
|
|
Term
| ___________ and __________ are antitubercular drugs that were found to be _________ kind of antidepressants |
|
Definition
| iproniazid, isoniazid, MAOIs |
|
|
Term
| antihistamine __________ was found to elevate mood of depressed psychotic patients, it was the first in the class of antidepressants called ___________ |
|
Definition
| imipramine, tricyclic antidepressants (TCAs) |
|
|
Term
| how do TCAs work? where does their name come from? |
|
Definition
| name comes from their structure. work by blocking monoamine transporters thus leaving more NTs in the synapse |
|
|
Term
| Antihypertension drug ___________ found to induce depressive episode in 15-20% of treated patients by inhibiting containment of monoamine neurotransmitters in synaptic vesicles (ie blocking VMAT) |
|
Definition
|
|
Term
| what is the amine hypothesis of depression? |
|
Definition
| Depression is caused by a reduction in central NE and/or 5-HT activity |
|
|
Term
| what is the connection between 5-HIAA levels and depression? |
|
Definition
| 5-HIAA is the primary metabolite of 5-HT, the concentration of 5-HIAA is found to be decreased in the CSF of ~35% of depressed patients |
|
|
Term
| what is the relationship between typtophan and depression? |
|
Definition
5-HT is synthesized from tryptophan. Acute depletion of tryptophan causes a rapid return of depressive symptoms in remitted depressed patients,
especially in those treated successfully with SSRIs.Tryptophan restoration induces rapid recovery.
BUT: Depletion does not induce depression in “normal”
subjects; nor does it worsen depression in currentlydepressed patients.IMPORTANCE OF 5-HT. |
|
|
Term
| what is the evidence supporting an HPA axis dysfunction in depressed patients? |
|
Definition
-dexmethazone non-suppression suggests deficient negative feedback (increased CRH and ACTH secretion and increased cortisol release)
-In animals, excess CRF produces
some of the behavioral signs of
depression
-Excess and prolonged cortisol release
suppresses immune system and
impairs hippocampal functioning which further disinhibits HPA axis activity |
|
|
Term
| how does HPA axis dysnfunction lead to loss of dedritic spines in the hippocampus? |
|
Definition
Cortisol inhibits the gene
transcription factor CREB
Reduction in CREB results in
lessened expression of brain derived neurotropic factor
(BDNF)
Loss of BDNF inhibits growth
of dendritic spines on
hippocampal neurons and
may impair survival of
neurons
Excess cortisol also supresses neurogenesis in the dentate gyrus of the hippocampus |
|
|
Term
| true or false: days depressed has been shown to be correlated with hippocampal volume |
|
Definition
| true, at least in adult women |
|
|
Term
| what are the two defining properties of mood stabilizers? |
|
Definition
1. provide relief from acute episodes of mania or depression and/or prevent them from occurring
2. do not worsen depression or mania or lead to increased cycling. |
|
|
Term
| what are the physiological effects of lithium and other mood stabilizers? |
|
Definition
-Wide-ranging effects on intracellular signaling pathways
including the cAMP - CREB cascade
-Like antidepressants, mood stabilizers induce transcription
of anti-apoptotic genes (e.g., the Bcl-2 family) which enhance
neuronal survival
-Lithium, in particular, prevents depression-related gray
matter loss in the subgenual PFC (an effect not found for
SSRI’s)
-Lithium stabilizes glutamate hyperactivity by increasing
reuptake deactivation |
|
|
Term
| what are some of the chronic effects of antidepressants? |
|
Definition
1. changes in densities of synaptic receptors
-Down-regulation of post-synaptic β1
-adrenergic and 5-HT2A receptors by most (but not all) antidepressants
2. second messenger activation
-increases cAMP activity which stimulates transcription factor CREB |
|
|
Term
| what is the neurotrophin hypothesis of depression? is it well-supported? |
|
Definition
neurotrophin hypothesis links depression to decreased levels of BDNF
-Solid evidence that BDNF upregulation, specifically in the
dentate gyrus, underlies the
therapeutic effects of
antidepressants
But evidence supporting the
idea that depression results
from decreased BDNF activity
is inconsistent |
|
|
Term
| _________is an NMDA receptor antagonist(The NMDAR is an ionotropic receptor for glutamate)which has been shown by recent animal and human studies to have rapid and potent antidepressant effects |
|
Definition
|
|
Term
| what are the problems with using ketamine as a drug for treating depression? |
|
Definition
1. increases psychotic symptoms
2. highly addictive
3. effects only last 2-3 weeks |
|
|
Term
a psychotic state is typically inferred from the
presence of what 3 three things? |
|
Definition
| hallucinations, delusions or disorganization of speech and behavior |
|
|
Term
| what are the 7 primary signs and symptoms of schizophrenia? |
|
Definition
1. disturbances in the form of thought and speech
2. disturbances in the content of thought and speech
3. disturbances of perception
4. disturbances in emotion
5. executive function deficits
6. disturbances in motor function
7. disturbances in global functioning |
|
|
Term
| Severe disturbance lasting at least ___________ including at least ___________ (called the active phase) during which the patient displays at least two of the following: hallucinations, delusions, disorganized speech, grossly disorganized or catatonic behavior, prominent affective flattening, alogia or avolition |
|
Definition
|
|
Term
| _______________ is a shizophrenia spectrum disorder with Psychotic sx lasting more than one day, but less than one month.Typically follows intense stressor. May occur post-partum. |
|
Definition
|
|
Term
| __________________ is a schizophrenia spectrum disorder with psychotic sx lasting 1-6 months |
|
Definition
| shcizophreniform disorder |
|
|
Term
| _________________ is a schizophrenia spectrum disorder characterized by the co-occurrence of mood episode and active-phase schizophrenic sx (Psychotic sx must be evident before or after the mood episode resolves) |
|
Definition
|
|
Term
| what are the 5 subtypes of schizophrenia? |
|
Definition
1. catatonic
2. paranoid
3. disorganized
4. undifferentiated
5. residual |
|
|
Term
true or false: Numerous studies reveal correlations between brain volume
reductions and negative (and sometimes positive) sx |
|
Definition
|
|
Term
| what is the progression of brain volume loss in scz pts? |
|
Definition
| Early right parietal loss spreads to temporal and frontal regions |
|
|
Term
| what is the correlation between gray matter and clinical characteristics in scz? |
|
Definition
Initial gray matter volume correlates strongly with IQ at follow-up
Frontal ctx loss rate correlates strongly with negative sx at follow-up |
|
|
Term
| what are the white matter deficits implicated in scz? |
|
Definition
loss of white matter volume and/or integrity
-dysfunction in oligodendrocytes which produce myelin sheaths potentially due to deficient transcription in genes
underlying ODC production, including
epigenetic silencing (methylation) of a gene for an ODC-specific transcription factor |
|
|
Term
what antihistamine / antiemetic
synthesized by a French drug company became the first antipsychotic medication? |
|
Definition
|
|
Term
| _________________ are the serious side effects of the classic antipsychotics (also called neuroleptics) which lead to parkinsoniam like motor problems |
|
Definition
|
|
Term
| what are the two types of extrapyramidal symptoms? |
|
Definition
1. early onset - parkinsonian like sxproduced when neuroleptics are on board. includes bradykinesia (slow movement)/akinesia, dystonia (muscle spasms in face neck or back) and resting tremors.
2. Late onset: tardive dyskinesia- chronic, sometimes reversible. includes lingual/facial hyperkinesia (tongue rolling, smacking, chewing/sucking, difficulty swallowing), akathesia (extreme restlessness, choreiform movements (writhing/jerking of upper body) |
|
|
Term
| what is the dopamine hypothesis of schizophrenia? |
|
Definition
| says that schizophrenia results from excess activity at DA synapses |
|
|
Term
| what are the three main dopamine pathways in the brain? |
|
Definition
1. mesocoritcal (VTA -> FC and PFC)
2. meoslimbic (VTA -> ventraul striatum (nAC)and other limbic structures (amygdala))
3. nigrostriatal (substantia nigra -> dorsal striatum (caudate + putamen)) |
|
|
Term
| true or false: there is evidence of elevated levels of homovanillic acid (HVA), the primary metabolite of dopamine, in the CSF of schizophrenic individuals |
|
Definition
|
|
Term
| neuropetics bind to the __________ receptor |
|
Definition
|
|
Term
________ was the first of the
“atypical antipsychotics” |
|
Definition
|
|
Term
| clozapine is a (weak/strong) D2 agonist |
|
Definition
|
|
Term
| what is the updated dopamine hypothesis? |
|
Definition
Limbic hyper-DA + frontal hypo-DA
-Negative symptoms reflect inadequate DA activity in frontal cortex (mesocortical system)
-Positive symptoms reflect excessive DA activity in the ventral striatum (mesolimbic system) |
|
|
Term
| true or false: neuroleptics are potent 5-HT2 antagonists |
|
Definition
| false, atypical antipsychotics are |
|
|
Term
| 5-HT activity (excites/inhibits) cortical and striatal DA activity |
|
Definition
|
|
Term
| PCP and K, both of which induce psychotic symptoms in normal individuals, block the ______ Glu receptor, giving us the _______________ hypothesis of schiz |
|
Definition
|
|
Term
The NMDAR has a _____________which must be occupied in order for NMDAR to respond to Glu. ___________ a potent
agonist at the GMS, increases NMDAR activity. |
|
Definition
| glycine modulatory site (GMS), D-serine |
|
|
Term
true or false: Post-mortem studies show elevations of the endogenous GMS
antagonists in the brains of scz pts |
|
Definition
| true, NAAG and kynurenic acid |
|
|
Term
true or false: Deficient Glu activity appears to dysregulate DA
activity |
|
Definition
true. Acute administration of PCP or ketamine increases
mesolimbic DA release
Chronic PCP use diminishes mesocortical DA activity in
addition to increasing mesolimbic DA |
|
|
Term
| what is greatest environmental risk factor for scz? |
|
Definition
| migration (esp if second generate) |
|
|
Term
| what are 2 possible explanations for the increased risk to migrants of scz development? |
|
Definition
Exposure to novel neurotrophic viruses in new country (e.g.,
toxoplasmosis gondii, found in cat feces)
2. Discrimination & social defeat
Viable hypothesis, especially given the strong skin-color effect
Being surrounded by a community of similar others mitigates the risk
Rodent & primate studies reveal DA dysregulation (e.g., DA in NAcc) in
response to chronic social defeat |
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|
