26.9 - Mood Disorders Flashcards
What are mood disorders and what are the main ones?
- Psychiatric diagnosis of low or elated mood with associated symptoms.
- Main mood disorders: Depression and bipolar disorder
What makes mood disorders different from normal experience?
- More intense
- More persistent
- Associated with functional impairment
Describe the classification of depression disorders.
[IMPORTANT]
NOTE: Dysthymic disorder is a type of chronic depressive disorder which is often less severe than acute depression.
What are the symptoms of unipolar depression?
Physical:
- Changed appetite
- Reduced energy
- Reduced libido
- Changed sleep pattern
Psychological:
- Hopelessness
- Helplessness
- Low self-esteem
- Guilt
- Suicidality
- Reduced motivation
- Reduced interest
- Reduced enjoyment (anhedonia)
There is often diurnal variation of mood (morning worst) and early morning wakening (=terminal insomnia).
Describe the prevalence of unipolar depression.
[IMPORTANT]
- 6% 12 months
- 15-18% lifetime risk
- Varies internationally
- Major worldwide cause of disability
Why does unipolar depression increase mortality?
- Unnatural causes (e.g. suicide)
- Natural causes
- Comorbid substance use significantly increases risk
- Comorbid physical health problems
What is the heritability of unipolar depression?
40%
How do life events contribute to unipolar depression?
- 60-80% of people experienced a life event in the 6-12 months prior to first episode
- Less prominent for subsequent episodes
- There is likely to be a genetic-environment interaction
Describe gender differences in unipolar depression.
The ratio of female:male is 2:1
Draw a table of biopsychosocial factors in depression.
Give some example theories for why antidepressants take a couple of weeks to start working.
[EXTRA]
Neurochemical model:
- When the drugs are started, the increase in synaptic serotonin is compensated for by increased pre-synaptic inhibition of the pre-synaptic neuron
- Once these receptors are saturated, desensitisation occurs and thus there is increased serotonin concentration in the synapse that increases transmission
Cognitive neuropsychological theory:
- When the drugs are started, there are immediate neurochemical changes
- This enables new positive associations to be formed
- These then result in a feeling better after a couple of weeks
What is the structure of a formal CBT program for unipolar depression?
Weekly individual sessions of 1 hour x 10-15 + homework
What are 3 big components of CBT for unipolar depression?
- Behavioural activation -> Encouraging the individual to return to activities that bring them joy (e.g. going to the gym)
- Combating automatic negative thoughts (ANTs) -> Identifying, challenging and replacing these thoughts
- Combating cognitive errors -> These may include disqualifying positives, jumping to conclusions, catastrophising, etc.
What are some challenges of delivering CBT to patients with depression?
- Depressive symptoms can reduce engagement
- Non-cognitive maintaining factors e.g. alcohol
- Accessibility
- Willingness to engage
What is an interesting new development in terms of CBT for treating depression?
Computerised CBT:
- May improve wellbeing
- Guided approaches where there is a mix of in person and computerised CBT are likely to be more helpful
- Recommended for mild-moderate anxiety and depression
- High attrition rates
Give some experimental evidence for exercise as a treatment for depression.
[EXTRA]
(Schuch, 2016):
- Found that exercise has a large and significant antidepressant effect in people with depression.
Draw how mood changes in bipolar disorder 1, bipolar disorder 2 and cyclothymia.
Note: In reality, the mood is much less stable than this and the pattern may not be as clear.
Compare bipolar 1 and bipolar 2.
- Both feature elated mood, increased activity, grandiosity, decreased need for sleep, etc.
- Bipolar 1 (mania)
- Impairment in functioning
- Lasts for more than 1 week
- Bipolar 2 (hypomania)
- Change in functioning that is uncharacteristic of the person when not symptomatic. Observable by others.
- Lasts for more than 4 days
What is rapid cycling bipolar disorder?
- Bipolar where there are at least 4 episodes a year.
- Patients are much more likely to be in depressed rather than manic phase
- Treatment is more difficult
Is psychosis part of bipolar?
It can be.
Do depressive or manic symptoms dominate in bipolar disorder?
Depression
What is the average delay to diagnosis of bipolar depression?
10 years -> This is largely due to mis-diagnosis as unipolar depression.
Draw a table of biopsychosocial factors in bipolar disorder.
Draw a diagram to summarise the pathogenesis of bipolar disorder.
Describe the suicide risk in bipolar disorder.
50% of individuals will attempt.
Describe the treatment of mania in bipolar disorder.
Describe the treatment of depression in bipolar disorder.
Describe the maintenance treatment in bipolar disorder.
