Bipolar and Depressive Disorders Flashcards
Is Unipolar disorder more prevalent in males or females?
Females
Is Persistent Depressive Disorder more prevalent in males or females?
Females 2:1
What age in onset of Bipolar and Depressive Disorders?
Under 25 yo in 50% individuals
What specifics must be listed with Bipolar I Disorder?
- Most recent episode: Manic, hypomanic, depressed or unspecified
- Severity: mild, moderate, severe
- With psychotic features
- Remission: partial or full
What are additional features of Bipolar I Disorder?
- Melancholic features
- Anxious distress
- Mixed features
- Atypical features
- Catatonia
- Peripartum onset
- Seasonal pattern
- Rapid cycling
- Psychosis
What is the diagnosis of a Manic Episode?
- Distinct period of elevated, expansive, irritable mood and goal directed activity for at least 1 week.
- 3 or more of the following:
- inflated self esteem (grandiosity)
- decreased need for sleep
- increased speech, talkativeness or pressure of speech
- Flight of ideas/racing thoughts
- distractability (reported/observed)
- increased goal directed activities/psychomotor agitation
- excessive pleasureable activities with negative outcomes - Marked impairment in functioning/hospitalisation/psychotic features
- Not due to medical or substance abuse
What is a Hypermanic episode?
Only lasts for 4 days and does not interfere with functioning
What is a Major Depressive episode?
A. 5 or more of the following for 2 weeks with 1 or 2 present:
1. depressed mood
2. diminished interest or pleasure
3. significant weight loss
4. insomnia or hypersomnia
5. psychomotor agitation or retardation
6. fatigue
7. feelings of worthlessness or inappropriate/excessive guilt
8. diminished ability to concentrate/indecisiveness
9. recurrent thoughts of death/suicide
B. Significant distress and impairment in functioning
C. Not due to medical or substance abuse
What is needed for Bipolar I diagnosis based on most recent episode?
- Hypomanic
- Manic
- Depressed
- Unspecified
What is needed for Bipolar II diagnosis based on most recent episode?
- Major depressive episode
- Hypomanic
- NO Manic episode
What is Cyclothymic Disorder?
Mild bipolar disorder
What is clinical symptoms for Cyclothymic Disorder?
- Present at least 2 years (1 for children/adolescents) with hypermanic and depressive symptoms but NO episodes.
- Must have symptoms for 2 months
Is Cyclothymic Disorder more common in men or women?
Women 3:2
When does onset of Cyclothymic Disorder occur?
Late teens and early 20’s and most develop into Bipolar I.
What are differential diagnosis for Bipolar (Mania)?
- Medical Disorders: epilepsy, Huntington’s Chorea, AIDS, TBI
- Drugs: Amphetamines, Cocaine, Hallucinogens, Opiates
- Psychiatric Disorders: Schizophrenia, Personality Disorders (Borderline, Narcissistic, Histrionic)
What is the prognosis for Bipolar patients?
- Occupational impairment
- Social impairment (higher divorce in bipolar than unipolar)
- Alcohol abuse
- Suicide higher in bipolar than unipolar
What is Persistent Depressive Disorder?
Mild drepression disorder
What is Dysthymia?
Persistent Depressive Disorder
What are DSM-V criteria for Persistent Depressive Disorder?
A. Present for 2 years (1 year in kids)
B. 2 of the following while depressed:
1. poor appetite/overeating
2. insomnia/hypersomnia
3. low energy or fatigue
4. low self esteem
5. poor concentration or difficulty making decisions
6. feelings of helplessness
C. Not without symptoms for 2 months
D. MDD may be present for 2 years
E. Never met criteria for manic episode, hypomanic or cyclothymic disorder
F. Not better accounted for with another disorder
G. Not due to medical or substance abuse
H. Causes significant distress and impairment
What are differential diagnosis for depression?
- Medical conditions: Neurological problems (Parkinsons, Dementing illness, Epilepsy, Stroke, Tumors)
- Pharmacological agents: Illicit or prescription drugs
- Psychiatric Disorders eg Bipolar
- Comorbility - eating disorders or personality disorders, schizophrenia, alcohol and drug abuse, Anxiety disorders
What is the course of depressive episodes?
- 50% of people experience first episode before 40yo
- Untreated last 6-13 months, Treated about 3 months
What is the prognosis for depression?
- Reoccurance increases if history of previous episode
- Coexists with alcohol/drug abuse and anxiety
What is the Life Events perspective of aietiology of Depression?
Stressful event and high EE linked to relapse but stressor not always present
What is the Life Events perspective of aietiology of Bipolar?
- Schedule disruptions eg decreased sleep or inability to achieve a goal precede episode, but attitude impacts episode.
- Family discord leads to poorer recovery
What is the Psychodynamic perspective of aietiology of Depression?
- Freud - depression is a reaction to unconscious loss and this anger is reflected on themselves.
- Dependency on others leads to an increase in depression.
What is the Behavioural perspective of aietiology of Depression?
Reduced positive reinforcement occurs because:
- probability that the individuals behaviour with be followed by reinforcement is low OR
- probability that he individual will be reinforced when he does not emit the behaviour is high because:
- Environment produces a loss of reinforcement
- Lack of requisite skills
- unable to enjoy or receive satisfaction from reinforcement
What is the Cognitive perspective of aietiology of Depression?
- Event->Belief->Consequence
- Learned Helplessness: Depression occurs if personal, global and stable
- Becks Model: Negative views of the world lead to negative views about oneself and negative views about the future.
What is the Interpersonal Theory perspective of aietiology of Depression?
- Social networks are sparse and less supportive
- Social skills deficits (problems solving skills and marital communication)
What is the Life Events perspective of aietiology of Bipolar?
Low social support associated with longer episodes
What is the Biological perspective of aietiology of Depression?
- Twin studies: 52% concordance
- Neurochemical: - Too little catecholamine (noradrenaline) causes depression - Indolamine hypothesis - deficiancy in seratonin
What is the Biological perspective of aietiology of Bipolar?
- Genetics: Bipolar more history than unipolar
- Twin studies: Concordance 80%
- Neurochemical: Too much Catecholamine (noradrenaline) causes mania and too little depression
What are Pharmacotherapy treatments for depression?
- Selective serotonin reuptake inhibitors (SSRI’s)
- Tricyclics
- Monoamine oxidise inhibitors
Side effects: Dry mouth, Orinary retention, sexual dysfunction, constipation, hypertension….
When would electric shock therapy be used and what are side effects?
Used if psychotic and melancholic features, not responding to medication, suicidal and prior positive results.
Side effects: Invasive, past abuses, medical complications
What are Pharmacotherapy treatments for bipolar and the side effects?
Lithium (low adherence)
Side Effects: weight gain, transient nausea, trembling, weakness, impaired co-ordination, memory problems, drinking and passing excessive water, serum levels need to be monitored.
What are the psychological treatments for Bipolar?
- Group therapy
- Psychoeducation
- Family Therapy
- CBT
- Interpersonal (effective for medication adherence only)
What are the psychological treatments for Depression?
- CBT
- Interpersonal Relationship Therapy
Describe Elikin study into treatments for Depression?
Four groups: CBT, IRT, Antidepressant medication, Placebo (control).
Results: All better than placebo but at 18 month followup all the same as placebo
