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


    • 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