Affective Disorders Flashcards
Define mood/affective disorders
Change in affect or mood to depression or elation
usually also a change in activity level and/or anxiety
Diagnostic criteria for depression?
[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
Bipolar disorder clinical features
High highs and low lows
Cycles of low mood and high mood
FAST ideas, too fast
Uninteresting become interesting
Diagnostic criteria for bipolar disorder?
[see ppt]
Duration + functional impairment of
Low (depressive) phase
low mood
loss of enjoyment
loss of everyday motivation
Hypo manic phase
elation
observable hyperactivities
Illness course of bipolar disorder?
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?
Role of anxiety of bipolar disorders?
Associated w/ worse prognosis and outcomes
What is Beck’s cognitive behavioural model of depression?
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
How Beck’s cognitive model after modern adaptation?
Cognitive biases in automatic emotional information blunting
Neurofunctional abnormalities
What is emotional information processing?
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
How to assess attention biases
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
Examples of specific methods of assessing attention bias?
- stroop task
- face-houses task
- dot probe task
Attention biases in depression?
Difficult for depressed people to disengage from negative material
Neurofunctional underpinnings of attention biases?
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
Memory biases in depression?
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]
Neurofunctional underpinnings of memory biases in depression?
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
Experimental evidence of facial recognition in depression?
Increased recognition of -ve faces and decreased for happy faces- Dalili et al,
Enhanced amyg response to -ve faces- Fu et al, 2004&2008
What is emotional regulation?
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
Emotional regulation in depression?
Increased emotion suppression, ruminations, catastrophising
Decreased reappraisal, +ve autobiog memories
Experimental evidence of emotional regulation in depression?
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
Experimental evidence
of emotional regulation in depressed pts
[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-
Possible factors causing/correlating w/ depression?
- emotional processing biases in those w/ family history of depression
- genetic vulnerability
- trait predisposition
Neuropsychological model of AD action?
Could altering neurochemistry at synpases -> cog biases + neurofunctional abnormalities -> depressive symptoms?
How to assess the AD effect on cognitive biases (as opposed to symptoms)>
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
Clinical examples of AD efficacy on cognitive processing in depressed
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
Evidence of predictors of clinical responses to ADs
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
How we can interact with cognitive neuropsychological model of depression
- Cognitive training to modify cognitive bias
- Change interaction with environments (e.g. interpersonal behaviour)
[see pt for diagram to fully understand]
Implications for future research for ADs?
- 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
