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Y2 - BRS - Psych > Depression / Mood Disorders > Flashcards

Depression / Mood Disorders Flashcards

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1
Q

What diagnostic criteria is used to diagnose mood disorders?

A

DSM-V or ICD-10

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2
Q

When was the biggest change in the DSM?

A

DSM-III (1980)

DSM before had been the same for around 100 years, with Manic Depressive Illness (MDI) defined as any recurrent mood episodes of any kind (whether you had bipolar or unipolar) - called the Kraepelinian definition

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3
Q

What defines an illness as a mood disorder as supposed to an affective disorder?

A

Where the fundamental disturbance is a change in affect or mood to depression (with or without associated anxiety) or to elation

Usually accompanied by a change in the overall level of activity

Tend to be recurrent and the onset of
individual episodes can often be related to stressful events or situations

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4
Q

What is MDD?

What is the prevalence of MDD?

What is the prevalence of Bipolar disorder?

A

Major Depressive Disorder

10-20% lifetime rate

1% lifetime rate for Bipolar-I, 1% lifetime rate for Bipolar-II

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5
Q

What is the difference between sex in depression?

What is the difference between sex in bipolar disorder?

A

Twice as many woman suffer depression

Bipolar-I = women and men diagnosed around the same
Bipolar-II = more women than men
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6
Q

What is the impact of mental and substance abuse disorders on DALYs?

A

Accounts for 7% of disability adjusted life years

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7
Q

What is the typical cycle of low mood?

A

Thoughts - What is the point?
Feelings - Low, irritable
Physiological symptoms - Exhaustion, low energy
Behaviours - Lie in bed all day, ruminate

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8
Q

What is the DSM-5 criteria for depressive episode?

A

Occurrence of 2 weeks or more of depressed mood
AND the presence of 4 of 8 out of the following:
• Sleep alterations (insomnia or hypersomnia)
• Appetite alterations (increased or decreased)
• Diminished interest or anhedonia
• Decreased concentration
• Low energy
• Guilt
• Psychomotor changes (agitation or retardation)
• Suicidal thoughts

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9
Q

When is MDD diagnosed?

A

If no manic or hypomanic episodes in the past are identified, then the diagnosis of a current major depressive episode leads to a longitudinal diagnosis of Major Depressive Disorder (MDD)

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10
Q

What are the DSM subtypes for MDD?

A 
Atypical features (which represent mainly increased sleep and appetite, along
with heightened mood reactivity)
Melancholic features (defined by no mood reactivity, along with marked
psychomotor retardation and anhedonia)

Psychotic features (the presence of delusions/hallucinations)

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11
Q

What are the core symptoms of depression?

What are the psychological symptoms of depression?

What are the biological symptoms of depression?

A

Low mood
Low energy
Anhedonia

The world
Oneself
The future

Sleep
Libido
Appetite

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12
Q

What is the typical cycle of high mood?

A

Thoughts - I’m the best
Feelings - elation, excitement
Physiological symptoms - increased energy, race sensation
Behaviours - impulsive, increased activity

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13
Q

What are the DSM diagnosis criteria for Mania/Bipolar?

A

Euphoric or irritable mood with 3 or more of 7 manic criteria:

  • Decreased need for sleep with increased energy
  • Distractibility
  • Grandiosity or inflated self-esteem
  • Flight of ideas or racing thoughts
  • Increased talkativeness or pressured speech
  • Increased goal-directed activities or psychomotor agitation
  • Impulsive behaviour (such as sexual impulsivity or spending sprees)
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14
Q

What is the diagnosis criteria for Bipolar-I?

What is the diagnostic criteria for a hypomanic episode?

What is the diagnostic criteria for Bipolar-II?

What is the diagnostic criteria for Unspecified Bipolar Disorder?

A

Minimum 1 week with notable functional
impairment leading to a DSM-5 diagnosis of type I bipolar disorder

Minimum 4 days, but without notable functional impairment, a hypomanic episode is diagnosed

Only hypomanic episodes present alone with at lead one MD episode = DSM-5 diagnosis of Bipolar-II

Less than 4 days, or if other specific thresholds are not met for manic or hypomanic episodes, then “Unspecified Bipolar Disorder”

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15
Q

What can manic episodes be characterised by?

What can hypomania not be diagnosed?

A

Psychotic features e.g. delusions/hallucinations

If psychotic features are present and/or if patient is hospitalised

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16
Q

Is bipolar disorder still diagnosed even if it is caused by anti-depressants?

A

Yes in the DSM-V, was not considered in the DSM-IV

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17
Q

What is illness course for Bipolar-I?

A

Big mood swings, reaches the thresholds for proper manic and depressive episodes (amplitude of wave is huge in both directions)

18
Q

What is the Bipolar II?

A

Less elation for mania

Greater depressive episodes - reaches the same amplitude as Bipolar-I for depression

19
Q

What is Cyclothymia?

A

‘mood swings’

Not huge either way

20
Q

What percentage of patients relapse within a year of recovery from a mood disorder?

A

50-60%

Patients largely autonomous between episodes

21
Q

What are the stats for the first episode in bipolar I?

A

85% have a depressive as first episode
10% a manic episode
3-5% mixed episode

22
Q

What must not be ignored in people with bipolar disorder?

A

Anxiety

30-70% of bipolar patients have anxiety

Presence of anxiety leads to worse prognosis and outcomes

23
Q

What are the similarities between bipolar and unipolar illness?

A

MDD is also diagnosed young

MDD is also recurrent

Genetics had found frequency occurrence of bipolar illness in relatives of those with unipolar depression

Treatments overlap

Lithium effective in both unipolar and bipolar types

24
Q

What are the differences between bipolar and unipolar illness?

A

Bipolar is has higher heritability

Insight is preserved in depression but impaired in mania

Bipolar illness has an earlier age of onset

More frequent episodes in bipolar than unipolar

Shorter depressive episodes in bipolar than unipolar

25
Q

What are the features of attention bias in depression?

A

Attention biases more typical of anxiety

Depression is characterised by biases in maintaining/shifting attention =
difficulties for depressed people to disengage from negative material

26
Q

What imaging is used in depression?

A

Functional MRI
works by detecting the changes in blood oxygenation and flow that occur in response to neural
activity

27
Q

What does a fMRI show in depression?

A

Sustained amygdala response to negative stimuli

Prefrontal cortex:
Perigenual anterior cingulate cortex (ACC) appears to mediate negative attentional biases

Lateral inferior frontal cortex associated with the impaired ability to divert attention from task-irrelevant negative information

28
Q

What is memory bias?

What memory bias is seen in depression?

A

Preferential recall of negative compared to positive material

Bias = towards negative material or away from positive material

29
Q

What perceptual biases are present in those with depression?

A

Increased recognition of negative faces

AND/OR

Decreased recognition of happy faces

30
Q

What happens when someone with depression passively views emotional facial expressions?

A

Enhanced amygdala response to negative faces

31
Q

What is the amygdala?

A

Medial temporal lobe region is involved in the perception and encoding of stimuli relevant to current or chronic affective goals, ranging from rewards or punishments to facial expressions of emotion to aversive or pleasant images and films

Is generally sensitive to detecting and triggering responses to arousing stimuli, it exhibits a bias towards detecting cues signalling potential threats, like expressions of fear

32
Q

What has facial expression recognition modulation by antidepressants shown with acute single doses?

A

Healthy volunteers models

Acute single dose of:
Noradrenergic antidepressant = better recognition of happy faces

Serotonergic antidepressant = decreased recognition of fearful faces

Neurofunctional: both increased and reduced amygdala response to SSRIs

33
Q

What has facial expression recognition modulation by antidepressants shown with daily treatment for a week?

A

Noradrenergic and serotonergic antidepressants = reduced recognition of anger and fear

Neurofunctional = reduced amygdala and medial prefrontal cortex response to fear

All this occurs before changes in subjective mood

34
Q

What is serotonin?

A

NT in brain
14 different serotonin receptors
Found all over the brain

35
Q

What is the ‘monoamine deficiency hypothesis’?

A

Postulates that depressive symptoms arise from insufficient levels of monoamine neurotransmitters: serotonin (or 5-hydroxytryptamine , 5-HT),
norepinephrine, and/or dopamine

36
Q

What is serotonin also known as?

A

5-HT

37
Q

What is the indirect evidence of 5-HT hypo-function in depression?

A

5-HT depletion via antihypertensive drugs can cause depression

Useful antidepressants increase synaptic monomania cones

Post-mortem evidence of reduced 5-HT in the brainstem of those who committed suicide

Lower levels of 5-HT1A and 5-HT4 receptors

Increased monoamine oxidase A in MDD

Blockade of serotonin synthesis by inhibitor prevents antidepressant effects of MAOIs and TCAs

Tryptophan depletion leading to decreased serotonin triggers MDD relapse

Monoamine depletion correlates with low mood

38
Q

How do you measure receptors and transmitters in the brain?

A

Use of PET scans -
First = injection of radio tracer
Tracer binds to specific target

39
Q

How does a PET scan differ to fMRIs?

A 
More selective
More invasive
Radioactive
More expensive
Less optimal temporal and spatial resolution
40
Q

What is the issue with measuring the release of cerebral 5-HT?

A

No suitable tracer has been found

None are sufficiently sensitive to pharmacological challenges

Y2 - BRS - Psych (8 decks)

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