Introduction to Affective Disorders Flashcards
What are affective (mood) disorders characterized by?
Affective disorders, also known as mood disorders, are characterized by disturbances in an individual’s mood. They are broadly divided into unipolar depression and bipolar disorder.
Which two major classification systems are used for affective disorders?
The Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD).
List some types of depressive disorders included in the DSM-5.
- Disruptive mood dysregulation disorder
- Major depressive disorder
- Persistent depressive disorder (dysthymia)
- Premenstrual dysphoric disorder
- Substance/medication-induced depressive disorder
- Others
What are some categories of mood disorders in the ICD-10?
- Manic episode
- Bipolar disorder
- Major depressive disorder (single episode or recurrent)
- Persistent mood disorders
- Unspecified mood disorders
What are common comorbidities associated with affective disorders?
Affective disorders often co-occur with anxiety disorders, impulse control disorders, and substance use disorders.
What are the negative impacts of mood disorders on individuals and society?
Mood disorders can significantly impair quality of life, cause economic burdens, and increase the risk of dementia.
What is the estimated genetic contribution to unipolar depression and bipolar disorder?
- Unipolar depression: 33-42%
- Bipolar disorder: 80-90%
What is the neurogenesis hypothesis related to depression?
The neurogenesis hypothesis suggests that altered rates of neurogenesis in the adult hippocampus might underlie the development or recovery from major depression.
List some imaging techniques used to study affective disorders.
- MRI
- CT/CAT
- DTI
- PET
- SPECT
- fMRI
- MEG
- EEG
What are the key criteria for diagnosing depression in the DSM-5?
A person must experience five or more symptoms during the same 2-week period, with at least one symptom being depressed mood or loss of interest/pleasure.
What is the monoamine hypothesis of depression?
The monoamine hypothesis suggests that depression is caused by a deficiency of monoamine neurotransmitters (serotonin, dopamine, norepinephrine) in the brain.
How is oxidative stress related to depression?
Oxidative stress, characterized by an imbalance between reactive oxygen species (ROS) and antioxidants, is associated with decreased neurogenesis and can contribute to depression.
What factors should be considered in a holistic approach to mood disorders?
- Genetic factors
- Neurobiological factors
- Psychological factors
- Social factors
- Cultural factors
- Environmental factors
- Early trauma
- Nutrition
- Inflammation
What is the role of NICE in managing affective disorders?
NICE (National Institute for Health and Care Excellence) provides guidelines for clinicians based on research outcomes and health economics.
What is the disease burden of psychiatric disorders, particularly mood disorders?
Psychiatric disorders are the largest single class of disease burden globally. Mood disorders, including bipolar disorder and major depression, are the most significant subpart, contributing more to disability-adjusted life-years than cancer.
(Prince et al., 2007)
What is the economic impact of mood disorders in the European Union?
Mood disorders affect 33.4 million people in the EU, with an estimated economic cost of €113.4 billion in 2011.
(Nutt, 2011)
What are the key features of bipolar disorder?
Bipolar disorder includes multiple phases: mania, hypomania, full-blown depressive episodes, and subsyndromal depression. It is often comorbid with substance abuse, anxiety disorders, and other psychiatric conditions. Mixed states (mania and depression together) are common.
(Young, Lecture 1)
What are the key epidemiological findings for bipolar disorder?
Lifetime prevalence: 1% for bipolar I disorder, 1.1% for bipolar II disorder, and 2.4% for sub-threshold bipolar disorder.
* 75% of patients have psychiatric comorbidities.
* Symptoms of mania increase the risk of substance abuse, while symptoms of depression lead to severe functional impairment.
(Merikangas et al., 2007; Merikangas et al., 2011)
When does bipolar disorder typically onset?
Bipolar disorder typically onsets before the age of 25, with a steep increase in incidence from ages 12 to mid-20s. Later onsets are rare and may represent a different form of the illness.
(Merikangas et al., 2007)
What is Kraepelin’s affective states continuum?
Kraepelin proposed a continuum of affective states ranging from pure mania to pure depression, with intermediate states like depressive mania, excited depression, and inhibited mania. This model highlights the complexity of mood disorders.
(Young, Lecture 1)
What are the key epidemiological findings for Major Depressive Disorder (MDD)?
Lifetime prevalence: 16% in the US and 8.5% in the EU.
* 12-month prevalence: 7% in the US.
* Mean days unable to work or carry out normal activities due to depression: 35 days per year.
* High comorbidity with anxiety disorders (60%) and substance use disorders (24%).
(Kessler et al., 2003)
What are common triggers for major depressive episodes?
Triggers include serious losses, difficult relationships, financial problems, and other stressful life events. Genetic vulnerability, psychological factors, and environmental stressors interact to precipitate depression.
(Young, Lecture 1)
What are the key factors influencing the time course of depression?
Higher incidence in females (ratio ~2:1).
* Increased risk with younger age, prior alcohol or drug abuse, and panic attacks.
* Risk of recurrence increases after each episode.
* Genetic factors like 5-HTT polymorphism influence vulnerability and resilience.
(Eaton et al., 2008)
What is the prevalence of comorbid anxiety disorders in mood disorders?
60% of patients with MDD have comorbid anxiety disorders.
* 75% of patients with bipolar disorder have comorbid anxiety disorders.
* Comorbid anxiety significantly increases the severity and functional impairment in mood disorders.
(Kessler et al., 2003)
How can bipolar disorder be differentiated from borderline personality disorder?
Bipolar disorder: Onset in teens/early 20s, spontaneous mood changes, recurrent suicidal gestures related to depressive episodes.
* Borderline personality disorder: No defined onset, mood changes precipitated by events, chronic impulsivity, self-mutilation, and endorsement of ‘emptiness’ rather than ‘depressed mood.’
(Yatham et al., 2005)
How much depression is actually bipolar disorder?
16% of depressive episodes are bipolar using DSM-IV criteria.
* 31% using modified DSM-IV criteria (allowing antidepressant-induced hypomania).
* Up to 54% using broader definitions.
* Unrecognized bipolarity is overrepresented in treatment-resistant depression.
(Angst et al., 2011; Li et al., 2012)
What are the treatment needs for patients with bipolar depression?
Improved treatment of depression is the top priority for patients.
* Other needs include reduced risk of weight gain, prevention of relapse, and improved quality of life.
* There is a significant gap in evidence-based treatments for bipolar depression.
(McIntyre, 2009)
What are the key considerations in diagnosing mood disorders?
Recurrence and severity of episodes.
* Presence of major depressive episodes.
* Evidence of mania/hypomania or mixed states.
* Psychiatric comorbidities and physical health.
* Age of onset, family history, and treatment history.
* Functional and neurocognitive status.
(Young, Lecture 2)
What are the key requirements for individualized treatment of mood disorders?
Accurate diagnosis, including identification of all comorbidities.
* Balance between efficacy and adverse effects.
* Improved social support, psychoeducation, and adherence to treatment.
* Goal: Meaningful remission with optimal functioning and quality of life.
(Young, Lecture 2)
What are the key conclusions regarding mood disorders?
Mood disorders (MDD and bipolar) are common, complex, and costly.
* Treatment resistance is a significant challenge.
* Individualized treatment approaches are essential for improving outcomes.
(Young, Lecture 2)
What are the main goals of this lecture series on emerging focuses in affective disorders?
To understand major topics in 21st-century research on affective disorders, conceptualize research avenues that progress mechanistic understanding, and grasp the translational potential of these emerging research areas.
What are the key messages from the Lancet’s call to action on depression?
Depression is common but poorly recognized and understood.
* It is heterogeneous and influenced by cultural and contextual factors.
* Prevention is essential, and treatment gaps need to be closed through personalized care and collaborative delivery.
* Increased investment in early detection and long-term, person-centered care is needed.
What are the key messages from the call to action on bipolar disorders?
Bipolar disorder is associated with premature mortality and is highly heritable.
* It is complex, severe, and often underdiagnosed.
* There is an underuse of lithium and overuse of antidepressants.
* Effective treatments are unavailable in low- and middle-income countries.
* Collaborative care and targeting comorbidities are essential.
What technological factors are aiding research in affective disorders?
Activity monitoring (e.g., actigraphy), passive smartphone data, speech/text data, and machine learning.
What social factors are influencing research in affective disorders?
Social media use, cultural considerations, and pandemic impact.
What are some biological markers studied in affective disorders?
Monoamine hypothesis, neuroplasticity, inflammation, genetics, and HPA axis dysregulation.
What is computational psychiatry, and how is it used?
Computational psychiatry uses mathematical models to understand the brain’s processes and predict outcomes.
Why is heterogeneity a challenge in depression research?
Modern diagnostic criteria allow over 1,000 unique symptom combinations, leading to inconsistent findings.
What are future directions for addressing heterogeneity in affective disorders?
Identifying homogeneous subgroups, transdiagnostic approaches, and multimodal integration.
What are some emerging treatments for depression?
Ketamine, psychedelics, and neuromodulation techniques.
What are the challenges in implementing new treatments like ketamine and psychedelics?
Limited duration of effect, potential for abuse, uncertainty in long-term effects, and need for psychotherapeutic integration.
What is personalized medicine in affective disorders?
Using biological and clinical markers to predict individual responses to treatments.
Why is early intervention important in affective disorders?
Delays in treatment are associated with poorer long-term outcomes and improving early intervention services can reduce costs.
What are some prevention strategies for affective disorders?
IPSRT, family-focused interventions, and detection of prodrome.
What are the key takeaways on progress in affective disorders?
Significant progress is being made, driven by technological and social advances, with a focus on prevention, early intervention, personalization, and evidence-based treatments.
