N165 Final: Unit 6a

  1. Limbic System
    • a collection of brain regions that controls mood and attitude
    • is involved in storage of highly charged emotional memories, and controls appetite and sleep cycles
  2. Depression
    is a set of neuropsychiatric disorders characterized by symptoms including a pervasive low mood, low self-esteem, changes in sleep (insomnia/hypersomnia), weight loss/gain, anhedonia/loss of pleasure, thoughts of death, fatigue & loss of energy, psychomotor agitation/retardation, feelings of worthlessness and guilt, lack of concentration, and sometimes delusions/hallucination (psychotic depression)
  3. Anhedonia
    the inability to experience pleasure or interest in formerly pleasurable or satisfying activities
  4. Psychomotor agitation
    • is a series of unintentional and purposeless motions that stem from mental tension and anxiety of an individual.
    • This includes pacing around a room, wringing one's hands, uncontrolled tongue movements, pulling off clothing and putting it back on and other similar actions.
  5. Psychomotor retardation
    • (also called psychomotor impairment)
    • is a visible slowing of physical activity such as movement and speech
  6. Types of Depression:
  7. Major depressive disorder (unipolar depression; clinical depression)
    • having 5 or more depressive symptoms (see list for depression above or slides for list) that last without remission for at least two weeks.
    • Usually this disorder is characterized by a loss of pleasure in most or all activities, psychomotor retardation, weight loss, guilt, and insomnia
  8. Melancholic depression
    the most ‘classic’ type of depression – with a low mood (melancholic = sad), insomnia, loss of appetite/weight loss, anhedonia
  9. Atypical depression
    a type of depression with mood reactivity (moods are overly affected by environment), paradoxical anhedonia despite apparent positivity, significant weight gain or increased appetite from comfort eating, hypersomnia (increased sleep), leaden paralysis (a sensation of heaviness in the limbs), and a significant social impairment from hypersensitivity to perceived interpersonal rejection
  10. Dysthymia
    a less severe, but long-lasting depression that lasts for at least two years
  11. Adjustment disorder with depressed mood
    mood disturbance appearing as a psychological response to an identifiable event or stressor or where resulting emotional or behavioral symptoms are significant but do not meet the criteria for a major depressive episode
  12. Catatonic depression
    • a rare and severe form of major depression involving disturbances of motor behavior and other symptoms
    • The patient is mute, immobile or exhibits purposeless or even bizarre movements
  13. Postpartum depression
    • intense, sustained and sometimes disabling depression experienced by women within three months after giving birth that can last as long as three months.
    • Likely due to sudden withdrawal of placental hormones at birth.
    • Postpartum psychosis (= postpartum mania) is also possible.
  14. Premenstrual dysphoric disorder (PMDD)
    • severe, debilitating PMS with abnormal response to normal hormonal levels. Symptoms can be any combination of depression
    • symptoms and typically start about 1 week prior to the onset of menstruation but abruptly end when menstruation begins.
    • Treatment: may include low-dose anti-depressants taken only during the week of symptoms.
  15. Seasonal affective disorder (SAD)
    • depressive disorder related to circadian rhythms in which depressive episodes come on in autumn or winter and resolve in spring.
    • In winter time, patients experience intense hunger, weight gain, hypersomnia, and lower mood in the evening.
    • Treatment: light therapy (phototherapy) to increase daylight exposure time
  16. Causes of Depression:
  17. Biological
    monoamine neurotransmitter, hormonal changes (postpartum, PMDD), circadian rhythm changes (SAD), stress responses from increased cortisol
  18. Monoamine hypothesis
    an early hypothesis about a biological basis for depression based on the observation medications that affect the monoamine neurotransmitters dopamine, norepinephrine, and serotonin may have psychological side effects affecting mood
  19. Specific monoamine hypothesis
    the theory that depression results from presynaptic and/or post-synaptic changes in noradrenergic (norepinephrine) and/or serotonergic (5-HT) pathways
  20. Psychosocial
    Positive correlation between stressful life events and onset of depression
  21. Cognitive model
    a model of depression that states that depressed patients hold pessimistic views of themselves, the world, and the future with recurrent patterns of depressive thinking, resulting in disordered information processing (led to cognitive behavioral therapy)
  22. Learned hopelessness theory
    a model of depression that states that the patient loses hope that life will get better, possibly based on early life experiences, and they believe that negative experiences are due to stable, global reasons
  23. Treatments of Depression:
  24. Psychotherapy:
  25. Cognitive behavioral therapy (CBT)
    an empirically tested and widely used type of psychotherapy for treating depression, in which patients typically meet in groups and are taught to alter their recurrent patterns of depressive thinking so that they can restore normal information processing
  26. Medication:
  27. Monoamine oxidase inhibitors
    antidepressant medication that results in a general increase in monoamines, but carries dietary risks
  28. Tricyclic antidepressants
    antidepressant medication used to treat depression named for its three-ring chemical structure
  29. Selective serotonin reuptake inhibitors (SSRIs)
    an antidepressant drug that acts by blocking the reuptake of serotonin so that more serotonin is available to act on receptors in the brain
  30. Noradrenergic serotonergic reuptake inhibitors (NSRI)
    an antidepressant drug that acts similarly to SSRIs but affects both serotonin and norepinephrine (norepinephrine is also called noradrenaline and is the neurotransmitter of the noradrenergic pathway).
  31. Stimulation:
  32. Electroconvulsive shock therapy (ECT)
    • electric shock therapy used to treat severe cases of depression that have not be effectively treated by other means
    • basically a grand mal seizure is induced in a sedate patient to ‘jumpstart’ or ‘reboot’ the brain.
    • Patients will lose memory of the hours/day of the ECT and may have some fatigue.
  33. Transcranial magnetic stimulation
    depression therapy done by inducing an electrical current in the brain, but can only affect brain regions on the surface of the brain
  34. Deep brain stimulation (DBS)
    therapy used to treat severe depression where electrodes are implanted into the basal ganglia, as in Parkinson’s disease, and stimulate the basal ganglia at a particular frequency (exact frequency set for each patient individually)
  35. Bipolar Disorders:
  36. Mania
    a psychological state characterized by irritability, anger or rage, delusions, grandiose ideas and plans, hypersensitivity, hypersexuality, hyper-religiousity, hyperactivity, impulsiveness, racing thoughts, pressured speech (pressure to keep talking, rapid speech), and a decreased need for sleep
  37. Hypomania
    • is a mood state characterized by persistent disinhibition and euphoric mood but generally less severe than full mania.
    • Characteristic behaviors are being extremely energetic, talkative with a flight of creative ideas, and confident.
    • While hypomanic behavior often generates productivity and excitement, it is considered to be a precursor to mania, which can put the subjects at great risk of harm.
  38. Bipolar Disorder I
    episodes of severe depression alternate with mania
  39. Bipolar Disorder II
    episodes of severe depression alternate with hypomania
  40. Cyclothymia
    dysthymia alternates with hypomania
  41. Mixed affective disorder
    • a disorder characterized by combined manic and depressive symptoms, including agitation, impulsiveness, anxiety, restlessness, aggressiveness, irritability, rage, confusion, fatigue, insomnia, morbid and/or suicidal ideation, panic, paranoia, persecutory delusions, pressured speech, and racing thoughts.
    • Rather than experiencing periods of depression that alternate with periods of mania (as well as with normal mood periods), patients with mixed affective disorder experience manic and depressive symptoms all at the same time.
  42. Causes of Bipolar Disorder
    • Genetic link plus environmental disorder possibly related to anxiety/depression
    • spectrum disorders
    • Uncontrolled changes in hormonal pathways
  43. Hypothalamus-pituitary-adrenal axis
    • major part of the neuroendocrine system that controls reactions to stress and regulates many body processes, including mood and emotion
    • may be abnormal in anxiety and depressive disorders
  44. Treatments of Bipolar Disorder:
  45. Psychotherapy:
    Cognitive behavioral therapy (CBT)
  46. Medication:
  47. Mood stabilizers
    used to prevent mania
  48. Lithium
    the element lithium is used to treat bipolar disorder together with anti-depressants. It acts as a mood stabilizer (preventing mania), but must be carefully managed because it is toxic.
  49. Anticonvulsants (anti-seizure medications)
    generally lower neural activity brain-wide.
  50. Antidepressants (e.g., SSRIs)
    but ONLY with a mood stabilizer (to stop mania)
  51. Antipsychotic medication
    for manic agitation; usually act to directly or indirectly lower dopamine
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N165 Final: Unit 6a
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