Cognition in Mood Disorders

Question 1

What ways can we assess cognitive symotoms of MDD?

Answer 1

Self Reports

Interviews

Neurophyciatric tests

Not always congruent.

Question 2

What bed side tests can be used to assess cognitive function and what are the issues with them in assessing depression?

Answer 2

Montreal Cognitive Assessment.

Mini-mental state exam

Not sensitive enough for Depression.

Question 3

What is the predominate test for self rating in the UK and what is it’s advantage?

Answer 3

Perceived Deficit Questionnaire

reflects the persons subjective experience

Question 4

Give examples of machine or paper and pen tests

Answer 4

Digit Symbol Substitution test: Memory and attention

RAVLT: Memory

Depressed patients tend to do worse on this compared to age group match

Trial Making Test: Executive function

Question 5

What is the difference between hot and cold cognition?

Answer 5

Hot cognition is related to emotional stimulus and feedback: VMPFC

Cold Cognition: Reasoning and Logic DLPFC

Question 6

How is cognitive disruption displayed in Depression?

Answer 6

Clinically significant: Sometimes confused for ADHD or Alzhiemers.

Across all domains of cognition

Particularly in Severe or Melancholic MDD.

Mesolimbic deficit as reward function and time demand decisions effected

Question 7

What are the two major factors are cited as hinderances to psychosocial interaction?

Answer 7

Embarrassment and Cognitive disruption.

Question 8

How did the Porter study show cognition was definitely disrupted by Depression?

Answer 8

By controlling for the cofounding factors, drugs, and invasive therapies.

Question 9

What is one of the most common residual symptom of remitting Depression?

Answer 9

Cognitive function Impairment

Still apparent at 6 months

Question 10

What was the first paper on Bi-polar and cognition and where are we now?

Answer 10

1978 out of Scotland, Telford

almost 6000 papers now

Question 11

How do Bi-polar patients fair in cognitive ability?

Answer 11

Between schizophrenia and healthy controls.

BUT: misleading as there are 3 groups in Bi-polar. Like Depression heterogeneous.

Question 12

How does cognitive disability present in Bi-Ploar?

Answer 12

Attention, memory and executive function.

Delayed verbal recovery

During episodes, but can persist

Progressive in some patients

Question 13

What are the two models of bi-polar impairment?

Answer 13

Neurodevelopmental: Like schizophrenia

Neuroprogressive: Most common more step like decline

Question 14

What are the three groups of Bi-polar dysfunction?

Answer 14

Intact, selective and global

Global may follow neurodevelopmetal while other two follow neuroprogressive

Question 15

What could be some contributing factors to the impairment of cognition in Bi-polar?

Answer 15

Mithachondria dysfunction

inflammation

HPA axis dyregulation

Epigenetics

Stress

Neutrophic factors

All of which decrease cognition, but also add to vulnerability to another episode

Question 16

Will antidepressants necessarily treat cognition as it does symptoms?

Answer 16

No, although some have recently been shown to improve cognition. Vortioxetine is particularly useful

Hard to study due to placebo effect of extra time with therapist.

Question 17

What is the theory behind the cognitive disruption in Mood disorders?

Answer 17

Mood disorders lead to stress, Stress leads to disruption of PFC and increased function of amygdala,

Question 18

What drug has been used to deal with GC receptors?

Answer 18

Mifepristone:

Also as abortion pill as it acts on progesterone.

Imporves cognition, but not antidepressants

Question 19

Why is lithium an interesting drug?

Answer 19

Originally thought to be bad for cognition, but recently showed not to impair and could be neuroprotective.

Question 20

What has been a potential successful non pharmacological treatment of mood disorders and what is an example?

Answer 20

Functional remediation

Circuits:

Strategy to improve meta-cognition

Personalised SMART Goals

Daily life practice