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13.05.10 Mood disorders

Bipolar disorder
  • Danger of mixed states - Able to act on depressive thoughts of self-harm
  • Danger of prescribing antidepressants in bipolar (misdiagnosis)
    • Rapid cycling, mania, mixed state, suicide
    • Especially difficult in Bipolar II as they often don't complain when they're hypomanic
  • Epilepsy link: ECT, Antiepileptics in bipolar

Cortical vs Subcortical dementia
  • Cortical
    • Memory, word recall, aphasia
    • Alzheimer's, Pick's disease, Binswanger's disease, Creutzfeldt-Jakob disease
  • Subcortical
    • Changes in personality and a slowing down of thought processes; Language and memory functions largely unaffected
    • Huntington's disease, Parkinson's, AIDS dementia complex

Notes
  • EPSEs are typically bilateral; Parkinson's tends to be more unilateral
  • Memento is not realistic as he retains insight
  • Memantine - Novel Alzheimer's/DLB drug - Blocks NMDA-type glutamate receptors
  • Double depression = Depressive episode on top of dysthymia
  • MMSE cutoff = 27
  • Tractography - Human connectome project
  • Psychosis is TOXIC => Further damage
  • Dementia = "Syndrome of acquired global cognitive deficit, in clear consciousness, with progressive course"
  • Epilepsy as DDx of psychiatric illness
  • Temperament (in-born) vs Personality (developed)
  • 1E11 neurons per brain; 1E5 synapses per neuron
  • Fronto-temporal dementia = Alzeheimer's for the frontal loba; Slow decline
  • Hypersensitivity to antipsychotics in DLB
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