Affective Disorders Flashcards
Define affective disorders Describe the clinical presentation of depression Describe the clinical presentation of bipolar disorder Understand the cognitive models of depression Understand the emotion information processing biases in depression, including attention, memory, and facial expression recognition Understand the interaction between emotion information processing biases and emotion regulation Understand the implications of emotion information processing biases for treatment
Define affective disorder
A fundamental disturbance in affect or mood to depression (with or without associated anxiety) or elation, usually accompanied by a change in the overall level of activity
State the diagnostic criteria for major depressive disorder
Feelings of depression and/ or decreased interest or pleasure in previously enjoyable things, plus at least 4 of: feelings of worthlessness or guilt, fatigue, weight or appetite changes, sleep changes, psychomotor changes, loss of concentration or ability to think, recurrent thoughts of death or suicide
How is depression often different in children and adolescents?
It may appear without low mood, instead causing an irritable affect
Describe the symptoms of a depressive phase of bipolar disorder
Low mood and loss of enjoyment, loss of interest in daily activities, sleep changes, appetite changes, loss of concentration, mental and physical slowing, feelings of emptiness or worthlessness, self-doubt, suicidal thoughts
Describe the symptoms of a hypomanic phase of bipolar disorder
Constant elation or euphoria, hyperactivity, irritable mood, increased energy, inappropriate optimism, overestimating personal ability, poor judgement, grandiose plans, speeding up of thought and speech, need for little sleep
Describe the difference between bipolar 1 and bipolar 2
Bipolar 1: Large swings between hypomania and depression
Bipolar 2: Predominant depression
According to Judd et al’s 2002 study, how much of the time are bipolar patients symptom-free?
50%
What is the most common comorbid diagnosis with bipolar disorder?
Anxiety disorder
What is the prevalence of generalised anxiety disorder in patients with bipolar disorder?
42.4%
What is the prevalence of social anxiety disorder in patients with bipolar disorder?
47.1%
What is the lifetime prevalence of any anxiety disorder in patients with bipolar disorder?
93%
What is the lifetime prevalence of alcohol dependence in patients with bipolar disorder?
61.2%
Describe Beck’s cognitive model of depression
A triad of negative thoughts, low mood, and reduced behaviour, all of which influence each other and create a self-perpetuating cycle
Describe three areas which experience cognitive distortion in depression
Attention, memory, emotional information processing
Define emotional information processing
A series of processes involving attentional, perceptual, appraisal, and response preparation operations occuring in an individual during salient internal and external events and impacting on the experience of and response to those events
State the three main components of attention
Allocating (deciding to focus on something)
Maintaining
Shifting (choosing to focus on something else)
How does an emotional bias affect attention?
It means that emotional stimuli are more likely to disrupt the maintenance of attention on a task
State at least 2 ways of measuring attention bias
Stroop test, faces-houses task, dot probe task
Which area of attention is affected by depression?
Shifting attention - it is hard for depressed individuals to disengage from negative material
Which are of the brain appears to mediate negative attention biases?
Perigenual anterior cingulate cortex (in the prefrontal cortex)
Describe the neurofunctional abnormalities associated with attention bias in depression
More sustained amygdala response to negative stimuli and increased activation of the lateral inferior frontal cortex
What is implicit memory involved in?
Priming and associations
What is explicit memory involved in?
Recognition and recall
Describe the memory bias associated with depression (Matthews & MacLeod, 2005)
Individuals with depression have preferential recall of negative material compared to positive material
Which trait predisposes individuals to depression?
Neuroticism
Describe the neurofunctional abnormality associated with memory bias in depression (Hamilton & Gotlib, 2008)
Depressed patients show a great amygdala respinse and enhanced amygdala-hippocampal connectivity when remembering negative pictures
Describe the perception biases in facial expression recognition associated with depression
Depressed individuals have increased recognition of negative faces and decreased recognition of positive faces
Which task is used to test facial expression recognition?
Harmer facial expression recognition task
Describe the neurofunctional abnormality associated with facial expression recognition bias in depression
Individuals with depression have an enhanced amygdala response to seeing negative faces (Fu et al, 2004), even when the faces are shown too quickly for conscious awareness (Suslow et al, 2010)
State at least 4 voluntary emotion regulation strategies
Emotion suppression, rumination, catastrophising, worry, cognitive reappraisal, self-disclosure, autobiographical memories, positive prospection
Which voluntary emotion regulation strategies do depressed patients use less? (Ehring et al, 2008)
Reappraisal, self-disclosure, positive autobiographical memory formation
Which voluntary emotion regulation strategies do depressed patients use more? (Ehring et al, 2008)
Emotion suppression, rumination, catastrophising
Is the ability to use positive emotion regulation strategies impaired in depression? (Liu & Thompson, 2017)
No
On passive exposure to an emotional stimulus, which neurofunctional abnormalities are seen in depression?
Increased activation of the amygdala, hippocampus, anterior cingulate cortex, and ventromedial prefrontal cortex
On regulation and cognitive appraisal of an emotional response, which neurofunctional abnormalities are seen in depression?
Increased activation of the amygdala, insula, anterior cingulate cortex, and inferior lateral prefrontal cortex
Decreased activation of the dorsolateral prefrontal cortex
How does amygdala and anterior cingulate cortex activation change in healthy individuals on emotion regulation?
Amygdala activation decreases, anterior cingulate activation increases
Compare amygdala and anterior cingulate cortex activation on emotion regulation in depressed individuals and healthy individuals
Amygdala: Increased in depression, decreased in health
Anterior cingulate cortex: Increased in both
What is the first line pharmacological treatment for depression?
Selective serotonin reuptake inhibitors (SSRIs)
Describe the effect of a single dose of noradrenergic antidepressants on facial recognition
Better recognition of happy faces
Describe the effect of a single dose of serotoninergic antidepressants on facial recognition
Mixed results - sometimes found to increase fear recognition
Describe the effect of a single dose of mirtazapine on facial recognition
Decreased recognition of fearful faces
Describe the effect of a 7 day course of noradrenergic antidepressants on facial recognition
Reduced recognition of anger and fear
Describe the effect of a 7 day course of serotoninergic antidepressants on facial recognition
Reduced recognition of anger and fear
Describe the effect of a 7 day course of noradrenergic or serotoninergic antidepressants on neural activation associated with facial recognition
Reduced amygdala and medial prefrontal cortex response to fear, even in the absence of changes in subjective mood
Describe the association between neurofunctional responses and a clinical response to escitalopram (Godlweska et al, 2016)
After 6 weeks, a clinical response is associated with early changes in the amygdala, thalamus, anterior cingulate cortex, and insula response to fearful faces
