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