Affective Disorders

Question 1

Define mood/affective disorders

Answer 1

Change in affect or mood to depression or elation

usually also a change in activity level and/or anxiety

Question 2

Diagnostic criteria for depression?

Answer 2

[see ppt]

Mood and anhedonia almost daily for 2 weeks/longer PLUS 4 of following:

-fatigue,worthlessness/appetite change,sleeping pattern changes,psychomotor agitation/relaxation,concentrationissues, suicidal thoughts

Question 3

Bipolar disorder clinical features

Answer 3

High highs and low lows

Cycles of low mood and high mood

FAST ideas, too fast

Uninteresting become interesting

Question 4

Diagnostic criteria for bipolar disorder?

Answer 4

[see ppt]

Duration + functional impairment of

Low (depressive) phase
low mood
loss of enjoyment
loss of everyday motivation

Hypo manic phase
elation
observable hyperactivities

Question 5

Illness course of bipolar disorder?

Answer 5

Highly variable: the intensity and amount of highs/lows can vary

50-60% relapse within a year of recovery from a mood episode

NB: can have a variable mood that isn’t apparent but is still fluctuating]- preclinical?

Question 6

Role of anxiety of bipolar disorders?

Answer 6

Associated w/ worse prognosis and outcomes

Question 7

What is Beck’s cognitive behavioural model of depression?

Answer 7

Distortion in the cycle of thoughts

Behaviour -> Thoughts (negative) -> mood (low) -> behaviour etc…

NB: can be influenced by early adverse events/life events/rigid negative schemata about oneself,world,others,future

Question 8

How Beck’s cognitive model after modern adaptation?

Answer 8

Cognitive biases in automatic emotional information blunting

Neurofunctional abnormalities

Question 9

What is emotional information processing?

Answer 9

Series of processes involving attentional, perceptional, appraisal and response preparation operations occuring during salient internal and external events. This impacts the experience and responses to events

Cognitive biases in
- attention
- memory
- face expression perception
|
all lead to emotional dysregulation

NB: insula, hippocampus, anterior cingulate cortex and prefrontal cortex all involved- see ppt

Question 10

How to assess attention biases

Answer 10

Provide a task e.g. colour naming, probe location

Intoduce a distractor: emotional or neural stimulus

See if there is a skewing of bias towards a positive or negative stimulus

Question 11

Examples of specific methods of assessing attention bias?

Answer 11

• stroop task
• face-houses task
• dot probe task

Question 12

Attention biases in depression?

Answer 12

Difficult for depressed people to disengage from negative material

Question 13

Neurofunctional underpinnings of attention biases?

Answer 13

Sustained amygdala response to negative stimuli

Prefrontal cortex
Anterior cingulate cortex appears to mediate -ve attention biases

Lateral inferior frontal cortex associated w/ impaired ability to divert attention from task irrelevant -ve info- Foland Ross and Gotlib, 2012 + Roiser et al, 2012

Question 14

Memory biases in depression?

Answer 14

Strong evidence for biased memory processes

Preferential recall of NEGATIVE compared to positive

NB: this is one of the most robust findings in depression literature

[see studies]

Question 15

Neurofunctional underpinnings of memory biases in depression?

Answer 15

Greater amygdala response and enhanced amyg-hippocam connectivity to remembered negative pics- Hamilton and Gotlib, 2008

Bilateral amyg response during emotional encoding predicted increased negative recall of words- Ramel et al, 2007

Question 16

Experimental evidence of facial recognition in depression?

Answer 16

Increased recognition of -ve faces and decreased for happy faces- Dalili et al,

Enhanced amyg response to -ve faces- Fu et al, 2004&2008

Question 17

What is emotional regulation?

Answer 17

How individuals influence which emotions they have, when they have them and how they experience these

i.e. ability to shift focus/ignore info/control working memory

NB: includes memory acces, attention, face recog, interpretation, prospection AND cognitive control i.e. exec function

Question 18

Emotional regulation in depression?

Answer 18

Increased emotion suppression, ruminations, catastrophising

Decreased reappraisal, +ve autobiog memories

Question 19

Experimental evidence of emotional regulation in depression?

Answer 19

Depressive features of emotional regulation still evident in recovered pts - Ehring et al, 2009

Emotional processing cog. biases modulate emotional regulation -> maladaptive and hinder adaptive strategies - Everaert et al, 2017

Depressed use dysfunctional emotional reg. strategies but not impaired abilities to implement them - Liu & Thompson, 2017

Question 20

Experimental evidence

of emotional regulation in depressed pts

Answer 20

[Study showing distressing images]

maintain emotion phase: Depressed have increased amyg, hippocamp, ACC (ant cing cort), vmPFC (ventmedprefrontcort)

regulate emotion phase:
in healthy: decreased amg and increased ACC
in depressed
increased amyg, insula, ACC, inferlaterPFC AND decreased in DLPFC (to +ve and -ve stimuli-

Question 21

Possible factors causing/correlating w/ depression?

Answer 21

• emotional processing biases in those w/ family history of depression
• genetic vulnerability
• trait predisposition

Question 22

Neuropsychological model of AD action?

Answer 22

Could altering neurochemistry at synpases -> cog biases + neurofunctional abnormalities -> depressive symptoms?

Question 23

How to assess the AD effect on cognitive biases (as opposed to symptoms)>

Answer 23

Use healthy volunteers

Acute single dose
NA ADs produce better recognition of happy faces
5-HT ADs: mirtazapine -> less recog of fearful faces
|
increased and reduced amyg response to SSRIs

7 days treatment
NA and 5-HT ADs reduced recog of anger and fear
|
reduced amyg and mPFC fear response

Warren et al, 2012]- with previous studies too

Question 24

Clinical examples of AD efficacy on cognitive processing in depressed

Answer 24

SSRI is more effective in those with +ve emotional processing- Tranter et al, 2009

Early change in amyg, thalamus, ACC and insula response to fearful faces assoc with clinical respones to escitalopram - Godlewska et al, 2016

Question 25

Evidence of predictors of clinical responses to ADs

Answer 25

Increased basal rACC activity in depressed (for tasks for “affect”)
|
responder to treatment w/ change in depression severity

Not just with drugs, but neurostimulation and CBT too

Klump 2017]- and prev studies too

Question 26

How we can interact with cognitive neuropsychological model of depression

Answer 26

• Cognitive training to modify cognitive bias
• Change interaction with environments (e.g. interpersonal behaviour)

[see pt for diagram to fully understand]

Question 27

Implications for future research for ADs?

Answer 27

• understanding S/Es
• individual response variability
• drug discovery]- use cognitive models to ID new compound, instead of relying on existing ADs/serendipity
• treatment response prediction
• patient satisfaction