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Behavior - Dr. David Brown PreMidterm Lectures 2
Behavior - Dr. David Brown PreMidterm Lectures 2
70
Medical
Professional
01/22/2013

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Term
How to diagnose Major Depressive Disorder ?
Definition
At least 5 of the following 9 for 2 weeks:
S I G E C A P S

Sleep (incr or decr)
Interest (decr)
Guilt (incr)
Energy (decr)
Concentration (decr)
Appetite (incr or decr)
Psychomotor activity (incr or decr)
Suicidal ideation (incr)
Term
How to diagnose manic episode ?
Definition
Distinct period of abnormally and persistently elevated, or irritable mood for 1 week

3 of the following 7 symptoms:

Inflated self-esteem / grandiosity
Decr need for sleep
Talkative
Flight of ideas or racing thoughts
Distractability
Incr in goal-directed activity
Excessive risky activities - unrestrained buying, sexual indescretions, bad business investments

Not a Mixed Episode, Not due to substances or general medical condition, MARKED IMPAIRMENT in life
Term
How to diagnose Hypomanic Episode ?
Definition
Mild form of mania

4 days of same symptoms as manic episode

Inflated self-esteem / grandiosity
Decr need for sleep
Talkative
Flight of ideas or racing thoughts
Distractability
Incr in goal-directed activity
Excessive risky activities - unrestrained buying, sexual indescretions, bad business investments

DOES NOT cause impairment, hospitalization or psychotic features
Term
What are 3 major mood DISORDERS ?
Definition
Major Depressive Disorder

Bipolar 1 Disorder

Bipolar 2 Disorder
Term
What episodes occur in Major Depressive DISORDER ?
Definition
Major Depressive Episodes only
Term
What episodes occur in Bipolar 1 Disorder ?
Definition
Manic Episodes
and
Major Depressive Episodes
Term
What episodes occur in Bipolar 2 Disorder ?
Definition
Hypomanic Episodes
and
Major Depressive Episodes
Term
Prevalence of Bipolar Disorder ?
Definition
Lifetime prevalence of 4.5%
1% each for bipolar 1 and bipolar 2
Term
Some other Mood Disorders ?
Definition
Dysthymic Disorder
Cyclothymic Disorder
Reactive Sadness
Bereavement

Mood Disorder due to General Medical Condition
Substance-Induced Depression
Term
What is Dysthymic Disorder ?
Definition
At least 2 yrs
Mildly depressive mood
Term
What is Cyclothymic Disorder ?
Definition
At least 2 years
Cycling b/w mild depression and mild mania
Term
What is Reactive Sadness ?
Definition
Hours to day
Following a MINOR event
Rarely interferes with functioning
Term
What is Bereavement ?
Definition
6 to 18 months
normal response to MAJOR loss
intense sadness, pain
no significant loss of self-esteem
pt relates sadness to loss
Term
NE is metabolized by what two things ?
Definition
Metabolized by MAO "intraneurally" to MHPG
Metabolized by COMT "extraneurally"
Term
NE is involved in what things ?
Definition
Mood disorders
Learning and memory
Reinforcement
Arousal
Sleep-wake cycle
Anxiety-Stress-Nociception
Term
Cell bodies containing NE are located where ?
Definition
Locus Ceruleus
Term
Opiates have what effect on Locus Ceruleus ?
Definition
Decrease firing of Locus Ceruleus cells

Locus Ceruleus contains inhibitory opioid
Term
Opiates have what effect on Locus Ceruleus ?
Definition
Decrease firing of Locus Ceruleus cells

Locus Ceruleus contains inhibitory opioid
Term
What is called "trauma center" in brain ?
Definition
Locus Ceruleus
Term
Main function of locus ceruleus is ?
Definition
To determine the brain's global orientation concerning events in the external world and within the viscera
Term
Function of Amphetamine ?
Definition
Stimulates release of NE at nerve terminals
Term
What is the "Civilizing Neurotransmitter" ?
Definition
Serotonin (5-HT)
Term
Another name for Serotonin ?
Definition
5-HT
Term
What are serotonin levels in violently aggressive people and in post-mortem studies of suicides ?
Definition
Low levels of 5-HT and 5-HIAA (the metabolite)
Term
Serotonin is mostly located in what brain structure ?
Definition
Raphe nuclei
Term
Is Serotonin linked to a wide variety of disorders ?
Definition
Yes
Term
Would you expect side-effects if you manipulate 5-HT synapses ?
Definition
Yes
Term
What is MHPG ?
Definition
A metabolite of NE degradation
Term
What metabolite is raised in mania ?
Definition
MHPG
Term
What two metabolites are reduced in depression ?
Definition
MHPG
5-HIAA
Term
What is Monoamine theory of mood disorders ?
Definition
Term
What is Permissive Theory of Depression or Serotonin "Preventive" theory ?
Definition
Term
Lysergic acid diethylamide (LSD) works how ?
Definition
Stimulates 5-HT receptors as partial agonist
Term
What were the first anti-depressant drugs ?
Definition
TCAs (Tri-Cyclic-Antidepressants)
Term
TCAs work how ?
Definition
Some block reuptake of NE and some block
reuptake of serotonin

Both do not differ in clinical potency
Term
What therapies are best for mild and moderate mood disorders ?
Definition
CBT and interpersonal therapy
Term
Standard trt for Bipolar Disorder ?
Definition
Lithium and anti-convulsants (anti-epileptics)

Prophylactic against mania and depression
Term
What is effective trt for SAD ?
Definition
Light therapy
Term
ECT stimulates what ?
Definition
Neurogenesis in hippocampus
Term
Vagus Nerve Stimulation is FDA-approved only for what ?
Definition
Epilepsy

But can be used off-label for depression
Term
All anti-depressant meds , plus ECT improves what in depressed animals ?
Definition
Neurogenesis in the hippocampus
probably due to stimulation of BDNF (brain derived neurotrophic factor)
Term
Other drugs which increase hippocampal neurogenesis ?
Definition
Mood stabilizers like lithium
Cognitive enhancers like Galantamine
Anesthetics like Ketamine
Steroids
Statins, Viagra
Term
ECT is now used primarily for what 2 disorders ?
Definition
Depression and catatonia
Term
What are the technical parts of ECT ?
Definition
6-12 treatments on alternate days
Muscle paralysant for safety
Respiratory support ready
Short-acting general anesthetic

Unilateral application reduces memory loss
Term
Side-effects of ECT ?
Definition
Brief post-ictal confusion
Small memory loss

No epilepsy
Low mortality
Term
Two possible absolute contradictions ?
Definition
High intracranial pressure
Recent myocardial infarction
Term
Some characteristics of Bipolar Affective Disorder ?
Definition
Has the strongest heritability

Lifetime incidence of 1%

No gender difference
Term
Genetic links in mental disorders are ?
Definition
Multifactorial
Polygenic
Mostly unknown loci
Term
Former name of Schizophrenia ?
Definition
Dementia Praecox
Term
Another name for unipolar depression ?
Definition
Major Depressive Disorder
Term
Formula for Heritability (H) ?
Definition
H = 2 * (MZ Correlation - DZ Correlation)
Term
Risk of developing Bipolar Disorder in the following ?

DZ Twins
Children of one affected parent
Children of two affected parents
MZ twin of an affected parent
Definition
DZ Twins 20%
Children of one affected parent 20%
Children of two affected parents 60%
MZ twin of an affected parent 75%
Term
Risk of developing Schizophrenia in the following ?

DZ Twins
Children of one affected parent
Children of two affected parents
MZ twin of an affected parent
Definition
DZ Twins 15%
Children of one affected parent 15%
Children of two affected parents 35%
MZ twin of an affected parent 35%
Term
Formula for relative risk ?
Definition
Prevalence of first degree relatives of pts

/

Prevalence in first degree relatives of controls
Term
What mental disorder has the highest relative risk ?
Definition
Bipolar Affective Disorder
Term
How to diagnose Dementia ?
Definition
Memory loss
and
One or more of following :
Apraxia
Aphasia
Agnosia
Loss of executive function
Term
Memory loss just by itself is diagnostic for what ?
Definition
Amnestic disorder
Term
What % of dementia pts need bio-psycho-social management ?
Definition
100 %
Term
The two main types of dementia are ?
Definition
Vascular (multi-infarct)

DAT (Dementia of Alzheimer's Type)
Term
Characteristics of DAT ?
Definition
Amyloid plaques and neurofibrillary tangles found post-mortem

Cell death and shrinkage in hippocampus and nucleus basalis of Meynert

Incidence: 1 - 2 % / year over 65
Term
What is MCI (Mild Cognitive Impairment) ?
Definition
Is an early transitional condition

-self-reported memory complaint
-memory performace 1.5 SDs below age norms
-not demented
-ADL (Activities of Daily Living) not impaired

Can ask pt: what did you have for breakfast or how did you get to office today
Term
What is Dementia of Depression (formerly called pseudo-dementia) ?
Definition
Occurs a lot in elderly
Depression due to loss or
results from isolation

Very treatable
Term
How to differentiate Dementia from Dementia of Depression ?
Definition
Dementia
-slow onset
-attempt to cover deficit by denial, confabulation or humor
-try to answer questions
-supportive care

Dementia of Depression
-rapid onset
-patient will emphasize/complain about deficits
-respond "I don't know"
-anti-depressants and/or social stimulation
Term
Examples of supportive trt for DAT ?
Definition
Protection as needed (cars, stoves)
"Safe return" program
Maintain social involvement, self-esteem
Power of attorney
Online support groups for care-givers
Term
Medicare pays for what and does not pay for what ?
Definition
Pays for 6 months of hospice care
Pays for skilled nursing care

Does not pay for general nursing homes
Term
Negatives to tube feeding ?
Definition
No evidence of proloning life or increase in comfort
May increase discomfort and result in complications

Suggestion: Invite family or medical decision-maker to consider refusal to eat as a decision by the pt
Term
What is delirium ?
Definition
Disturbance of consciousness only (not memory)
-Often substance induced
-Acute cognitive changes in hours to days
-Rapid shifts of emotion
-Hallucinations, illusions
-*Underdiagnosed* in hospital populations (10% of over 65 are delirious on admission)
Term
What disorders are neurological in origin (involve cell death) ?
Definition
Vascular Dementia
DAT
MCI
Delirium
Term
What dementia is not neurological in quality ?
Definition
Dementia of Depression
Term
Dissociative disorders are neurological or psychological in quality ?
Definition
Psychological

Are result of trauma or conflict
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