111/112b - Depression and Bipolar Disorders I and II Flashcards
All of the following have been described in association with Major Depression Disorder except:
- Decreased activity in right prefrontal cortext
- Blunted TSH response to TRH
- Short allele of serotonin transport protein
- Volume reduction in hippocampus
- Decreased BDNF
a. Decreased activity in right prefrontal cortext
Decreased activity in the left prefrontal cortex is a biomarker of recurrent MDD
All other findings are associated with MDD
What defines major depressive disorder? (MDD)
- Criteria for MDE have been met (have had at least 1 major depressive episode)
- MDE not better explained by another psychiatric disorder
- there has never been a manic or hypomanic episode
What is the lifetime prevalence of major depressive episodes in the US?
17%
21% females, 12% males
What is the lifeitme prevalence of Bipolar I disorder?
Bipolar II?
Both are ~1%
Tryptophan is a building block for which neurotransmitter?
Serotonin
What are the non-diagnostic but highly suggestive symptoms of a major depressive episode with mixed features?
Irritability, distractibility, and agitation in addtion to depressive symptoms
Which subtype of depression?
Mood reactivity, hypersomnia, leaden paralysis,
Depression with atypical features
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Depression w/ Atypical Features DSM5 Criteria:
- mood reactivity (mood brightens in response to positive events, but doesn’t hang on to the feeling for the rest of the day)
- Two or more of the following: weight gain/increase in appetite, hypersomnia, leaden paralysis (heavy, leaden feelings in arms/legs), or long standing pattern of interpersonal rejection sensitivity
How long must the 5 or more symptoms of depression last for something to classify as a major depressive episode?
2 weeks or more
How are Bipolar I, Bipolar II, and cyclothymic disorder diffentiated?
-
Bipolar I
- Requires history of manic episodes (at least 1)
-
Bipolar II
- Requires history of hypomanic episodes
- NO manic episodes
-
Cyclothymic disorder
- More of a chronic state of ups and downs “undulating, cycling”
- Recurrent mild depressive symptoms and hypomania lasting 2+ years
- No fully syndromal major depressive episodes
Genetic factors are important in [early/late] onset depression
Genetic factors are important in early onset depression
What factors might increase the risk of recurrence of depression?
- Positive family history
- Incomplete treatment response
- Neuroticism (personality trait)
- Hypercortisolemia
What does the “with mixed features” specifier mean?
During a mood episode, at least 3 subthreshold symptoms from the opposing pole are present during a mood episode
Can occur in MDD, Bipolar I, Bipolar II
(In a major depressive episode of MDD, subthreshold symtoms means that the pt does not suddenly have Bipolar I or Bipolar II)
Which subtype of depression?
Pervasive anhedonia, weight loss, early morning awakenings
Depression with melancholic features
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Depression w/ Melancholic Features DSM 5 Criteria:
- criteria of MDE
- loss of pleasure in all activities or lack of reactivity to pleasurable stimuli
- 3 + of the following symptoms: depressed mood, depression regularly worse in the morning, early morning awakening, psychomotor changes, anorexia or weight loss, excessive guilt
What are the core features of depression with melancholic features?
- Pervasive anhedonia
- Lack of reactivity to usually pleasuralbe stimuli
- Depressed mood
- Early morning awakening
- Excessive or inappropiate guilt
- No interest in food -> weight loss, no appedite
- Psychomotor changes (physical signs of distress)
List 4 biomarkers of recurrent MDD
- Decreased immune functioning
- Blunted TSH response to TRH
- Volume reduction: basal ganglia, hippocampus, frontal cortex
- Decreased activity in the left prefrontal cortex
Which of the following is a core symptom of atypical depression?
a) expansiveness
b) hypersomnolence
c) loss of appetite
d) anhedonia
e) thought racing
b) hypersomnolence (excessive sleepiness)
Other core symptoms:
- Weight gain/increased appetite (hyperphagia)
- Leaden paralysis
- Longstanding pattern of interpersonal rejection sensitivity
Which is not a symptom of hypomania:
- excessive sleeping
- increase in goal directed behaviors
- overactive thoughts
- irritable mood
- distractibility
a. excessive sleeping
All other symptoms can be seen in hypomania
Difference between hypomania and mania: Hypomania does not cause a marked impairment in functioning
How does the risk of recurrence of depression change with each depressive episode?
Risk of recurrence increases with each episode
What are the differences between mania and hypomania?
-
Mania causes marked impairment in fuctioning
- Expansive, euphoric, grandiose, possibly irritable, hostile
- Decreased need for sleep
- Extravagant
- Racing thoughts, distractable
- Lasts >1 week
-
Hypomania does not cause marked impairment in functioning
- Similar type of symptoms but much less noticible
- Change is uncharacteristic for the person
- May see increase in goal directed behavior, productivity
- Lasts 4-7 days
Which neurotransmitters are associated with bipolar disorder?
Dopamine and norepinephrine
2nd messengers are also implicated (remember that Li acts on second messengers)
SIGECAPS mnemonic:
- SIGECAPS mnemonic for depressive symptoms: sleep disturbances, interest reduced (anhedonia), guilt + worthlessness, energy loss and fatigue, concentration problems, appetite problem, psychomotor agitation or retardation, and suicidality
Describe mood episodes w/ psychotic features:
-
Mood episodes w/ psychotic features:
- delusions + hallucinations present at any time w/in a depressive, hypomanic, or manic episode
- the psychotic features are labeled as mood-congruent or mood-incongruent (do their psychotic symptoms match w/ their mood episode or are they opposites?)
Criteria for persistent Depressive disorder?
-
Persistent Depressive Disorders Criteria:
- depressed mood most of the day on most days for > 2 years
- presence of two or more of the following symptoms: poor appetite or overeating, insomnia or hypersomnia, fatigue, low self-esteem, poor concentration or difficulty making decisions, feeling of hopelessness
- during the 2 years, never w/o symptoms for more than 2 months, and has never had manic/hypomanic episode