Affective Disorders Flashcards
What is mood?
moods characterise the state of mind or inner disposition of a person; a mood is a result of prolonged feelings and colour the whole mental life while it lasts (Karl Jaspers, 1913)
What is used to form the criteria used to classify mood disorders?
- using DSM and ICD-10
- the Diagnostic and Statistical Manuel for Mental Disorders
- the International Classification of Disease
What are the four main episodes displayed in mood disorders?
- Major Depressive Episode
- Manic Episode
- Hypomanic Episode
- Mixed Affective Episode
Symptoms of depression
- Depression of mood
- Anhedonia
- Psychomotor retardation
- Diurnal variation of mood
- Thoughts of: guilt, self-reproach, self-blame, worthlessness, depersonalization
- Agitation/ restlessness
- Anxiety/ preoccupation
- Somatic symptoms
- Hypochondriasis
- Weight loss
- Insomnia
- •Suicidal thoughts
What is the Major Depressive Disorder criteria according to DSM V?
five or more symptoms during a 2 week period- must cause clinically significant distress or functional impairment: not caused by any other physiological effects
- Depressed mood most of the day, nearly every day
- Diminished interest or pleasure
- Weight loss/weight gain or appetite decrease/increase
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Fatigue or loss of energy
- Feelings of worthlessness or excessive or inappropriate guilt
- Diminished ability to think or concentrate, or indecisiveness
What are the features of Melancholy
- Loss of pleasure in all, or almost all, activities
- Lack of reactivity to usually pleasurable stimuli
- Profound despondency, despair, empty mood
- Depression regularly worse in the morning
- Early-morning awakening
- Marked psychomotor agitation or retardation
- Significant anorexia or weight loss
- Excessive or inappropriate guilt
What are the features of atypical depression?
- Mood reactivity
- significant weight gain or increase in appetite
- hypersomnia
- leaden paralysis
- interpersonal rejection sensitivity
What is the epidemiology and impact of Major Depressive Disorder?
- Most common in primary care; presents more in females
- 1 in 5-lifetime prevalence for females
- males 10%
- age of onset 25-35 can be at any age
- 8-19% die by suicide
- increased morbidity/mortality from co-existing medical conditions
- decreased work productivity - it’s an immense cost to society
- suicide is the 2nd leading cause of death among 15-29 years
What is Bipolar disorder?
- those who exhibit a mixed state of hypomania and subthreshold depression
How would a Manic episode be diagnosed by DSM V?
- Abnormally and persistently elevated, expansive, or irritable mood
- For a period lasting at least one week and present most of the day, nearly every day:
- Abnormally and persistently increased activity or energy
- •3 or more of the following symptoms
- inflated self-esteem or grandiosity
- decreased for sleep
- more talkative than usual or pressure to keep talking
- flight of ideas or racing thoughts
- distractibility
- increase in goal-directed activity or psychomotor agitation
- excessive involvement in high risk activities
- The mood disturbance is sufficiently severe to cause marked functional impairment or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. The episode is not attributable to the physiological effects of a substance or to another medical condition. Can be associated to psychotic symptoms such as delusions and hallucinations
How would a hypomanic episode be diagnosed by DSM V?
it’s the same as Mania except
- lasts at least 4 days
- the episode is not severe enough to cause marked functional impairment or to necessitate hospitalization
- unequivocal change in function that is uncharacteristic of the individual
- observable by others
What are the types of Bipolar disorders and what are their DSM V definitions?
- Bipolar Disorder Type I
- at least 1 manic episode
- Bipolar Disorder Type II
- one Hypermanic episode and one Depressive episode
Clinical features of Bipolar Disorder(s)
- anxious distress
- psychotic features
- mixed features ?
- rapid cycling
- melancholic, atypical,
- mood congruent/incongruent psychotic features
- seasonal pattern
- others
What classifies as Mixed affective episodes?
- meets the full criteria for either a manic, hypomanic or depressive episode
and
- has at least 3 symptoms of the opposite polarity
What are features that may be associated with both mania and depression?
- Anxiety
- restlessness, tension
- worry, anticipatory anxiety, fear of losing control
- Psychotic symptoms
- Delusions and hallucinations, mood-congruent or incongruent
- Catatonia
- state of unresponsiveness that affects behaviour and motor function
What are the problems of early detection of Bipolar disorder?
- Mean age of onset is 21
- earlier depressive symptoms followed by later mania episodes
Best to take a probabilistic approach when diagnosing early onsets of depressive episodes
What would indicate that presentations of depression are Bipolar Depression?
(probable bipolarity)
- Hypersomnia
- Hyperphagia
- Atypical sx (leaden paralysis)
- Psychomotor retardation
- Psychotic features
- Mood lability; irritability
- Early onset
- Multiple episodes
- Positive family hx of BPAD
What would indicate unipolarity of depressive episodes?
- Initial insomnia/reduced sleep
- Appetite/weight loss
- Increased activity levels
- Somatic complaints
- Late onset
- Long episode duration
- Negative family hx of BPAD
What is the epidemiology and impact of Bipolar Disorder?
- Familial aggregation (10 times higher risk in 1st-degree relatives)
- Men & women affected equally (BP-I)
- Lifelong risk of recurrence | symptomatic almost half their lives
- indiscriminately affects > 1% of the global population
- BP-II more prevalent in women
- mainly diagnosed in young adulthood - impacts the economically active population
- Highly recurrent, with a progressive course | high rate of incomplete remission | low rates of sustained recovery
- rate of suicide 20x higher than general population
What is the age of onset for Bipolar Disorder?
- Early onset group - 17 yrs (3 SD): 42%
- Middle onset group - 24 yrs (5 SD) : 25%
- Late onset group – 32 yrs (12 SD) : 33%
What is the staging of Bipolar disorder?
starting from Latent to IV
What neural systems are involved in depression?
- DLPFC: dorsal lateral prefrontal cortex
- VLPFC: ventral lateral prefrontal cortex
- mPFC: medial prefrontal cortex
- ACC: anterior cingulate cortex
- OFC: orbitofrontal cortex
- Amygdala
- Ventral striatum
Go over the Serotonin (5-HT) and Noradrenaline (NA) pathways in the brain
- 5HT and NA have ascending and descending tracts - ascending to the cerebral cortex and limbic area and descending to the spinal cord
- 5HT cell bodies originate in the raphe nuclei | NA cells originate in the locus coeruleus
- these project into areas that when dysregulated produce symptoms of depression
What is the HPA- Axis?
- Hypothalamus-Pituarity-Adrenal Axis
- used to describe the interactions between these different structures and the impact it has on mood
- control of cortisol release
What role does immune dysfunction and inflammation play in the ethiopathophysiology of MDD
- evidence suggests there is a link between inflammation and depression
- there are increased inflammatory markers in depression
- elevated CRP and pro-inflammatory cytokines (IL-6, IL-1Beta, TNF-alpha)
- Translocator Protein is over-expressed on microglia and astrocytes and can be imaged using TSPO PET radioligands –> give in vivo imaging of neuroinflammation
- Pro-inflammatory cytokines induce “sickness behaviour” that overlaps with MDD symptoms
