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Understanding Affective Disorders - REVISION > Lecture 2: Introduction to affective disorders > Flashcards

Lecture 2: Introduction to affective disorders Flashcards

1
Q

What are the types of mixed states that Kraepelin proposed?

A
  • Depressive or anxious mania
  • Excited depression
  • Manic with thought poverty
  • Manic stupor
  • Depression with flight of ideas
  • Inhibited mania
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2
Q

Which groups have higher rates of lifetime prevalence for MDD?

A
  • Young adults (16.6%)
  • Women (2:1)
  • Elderly
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3
Q

Which are some factors that increase the risk of MDD?

A
  • Female
  • Youger age
  • 1 or 2 short alleles of 5HTT polymorphism
  • Prior alcohol or drug use
  • Prior panic attack
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4
Q

Which are some possible pathways for MDD?

A
  • Monoamines
  • Glutamate
  • HPA axis
  • GABA
  • Cholinergic/adrenergic balance
  • Endogenous opioid
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5
Q

Which dx has a higher lifetime prevalence of comorbid anxiety: bipolar or MDD?

A

Bipolar

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6
Q

Name some specifiers for BD and MDD

A

Clinical features

  • Psychotic features (mood congruent or mood incongruent)
  • Catatonia
  • Mixed states
  • Melancholic
  • Atypical features
  • Anxious distress

Onset:

  • Peripartum onset
  • Early
  • Late

Remission status:

  • Partial
  • Full

Severity:

  • Mild
  • Moderate
  • Severe

Illness pattern:

  • Seasonal pattern
  • Rapid cycling (only for BD)
  • Single episode
  • Seasonal
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7
Q

Briefly define the “melancholic features” specifier for mood disorders

A

With melancholic features:
➜ a. One of the following is present during the most severe period of the current episode:
1. Loss of pleasure in all, or almost all, activities.
2. Lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens).

➜ b. Three (or more) of the following:

  1. A distinct quality of depressed mood characterized by profound despondency, despair, and/or moroseness or by so-called empty mood.
  2. Depression that is regularly worse in the morning.
  3. Early-morning awakening (i.e., at least 2 hours before usual awakening).
  4. Marked psychomotor agitation or retardation.
  5. Significant anorexia or weight loss.
  6. Excessive or inappropriate guilt.
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8
Q

Briefly outline the criteria for the “atypical” specifier of mood disorders

A

➜ a. Mood reactivity (i.e., mood brightens in response to actual or potential positive events).

➜ b. Two (or more) of the following:

  1. Significant weight gain or increase in appetite.
  2. Hypersomnia.
  3. Leaden paralysis (i.e., heavy, leaden feelings in arms or legs).
  4. A long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment.
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9
Q

Roughly state the comorbidity rates of anxiety with BD and anxiety with MDD

A
  • Anxiety and bipolar: 75%

- Anxiety and MDD: 60%

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10
Q

What is the proportion of patients with MDD that experience severe or very severe impairment?

A
  • Around 59%
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11
Q

How does gender of patients impact in MDD recovery?

A

Gender not related to recovery

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12
Q

What is the proportion of MDD patients who have recurrent or unremitting course?

A
  • Recurrent: 35%

- Unremitting: 15%

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13
Q

What is the median episode length for MDD?

A

12 weeks

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14
Q

Name some possible biological processes involved in MDD

A
  • Neuroplasticity
  • Neurogenesis
  • Neuroendocrine
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15
Q

Name one biological factor than has an impact on the severity of episodes of MDD

A
  • HPA axis

could lead to a more severe mood episode, different episode, or even less severe episode

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16
Q

Name some mental disorders associated with hypoactivity of the HPA axis

A
  • Bipolar II with atypical features
  • BD 1
  • PTSD
17
Q

What is the difference between the mood changes in BD and BPD?

A

BD: spontaneous (no trigger/precipitant)
BPD: due to precipiating events (internal or external)

18
Q

When do BD patients have a higher rate of suicide attempts?

A

During their depressive episodes -if recurrent and associated with (internal/external) triggers, consider BPD

19
Q

Categorise BPD, BD, and MDD in terms of their associated disruptance to the HPA axis

A

1) BPD

2) BD
- BD1 with more than 5 episodes
- BD1 with less than 5 episodes

3) Unipolar depression
- w/ Atypical (release less cortisol)
- w/ Melancholia (release more but receptors not sensible)

20
Q

What should be considered when assessing a patient with probable mood disorder?

A
  • Recurrence
  • Severity
  • Evidence of MDE
  • Evidence of mania/hypomania
  • Comorbidities (psychiatric and physical)
  • Onset
  • Family history
  • Treatment history
  • Neurocognitive and cognitive status
21
Q

According to the BRIDGE study (Angst 2011), how much of depression is bipolar?

A

Depends on definition

  • 16% depression is bipolar (DSM-IV)
  • 31% modified DSM-IV (allows antidepressant/drug induced)
  • Up to 54% using wider definitions bipolar spectrum
22
Q

How prompts us to screen for bipolar depression?

A
  • Family history (mania in first-degree relatives)
  • mixed states
  • onset before 30
  • multiple episodes over lifetime
  • not fully recover between episodes
  • Shorter episode and cycle length
  • More interepisode mood shifts
  • More psychomotor retardation
  • more psychosis
  • More frequent substance abuse
  • Hypersomnia, overeating
  • Antidepressant switches or poor response
  • Atypical symptoms
  • mood instability
  • Interpersonal sensibility

• Usually, people with bipolar usually have two depressive episodes before they present the manic or hypomanic episode.

23
Q

How prompts us to screen for bipolar depression?

A
  • Family history (mania in first-degree relatives)
  • mixed states
  • onset before 30
  • multiple episodes over lifetime
  • not fully recover between episodes
  • Shorter episode and cycle length
  • More interepisode mood shifts
  • More psychomotor retardation
  • more psychosis
  • More frequent substance abuse
  • Hypersomnia, overeating
  • Antidepressant switches or poor response
  • Atypical symptoms
  • mood instability
  • Interpersonal sensibility

• Usually, people with bipolar usually have two depressive episodes before they present the manic or hypomanic episode.

24
Q

How does childhood adversity impact depression?

A
  • 2 in 3 people with treatment-resistant depression had childhood adversity
  • Can impact outcome, severity, chronicity
  • Higher risk of suicidal ideation
25
Q

Who are more vulnerable to depression due to early life stress?

A
  • Females
  • Adults
  • Use of alcohol/drugs
  • Abuse and neglect
26
Q

Name some comorbidities of mood disorders

A
  • Panic attack
  • Phobias
  • PTSD
  • Metabolic disorders
  • Cardiovascular disorders
27
Q

Name some treatments for mood disorders under the biopsychosocial model

A 
Biological treatments:
•	Antidepressants
•	Antipsychotics
•	Mood stabilisers
•	ECT
•	Transcranial magnetic stimulation
Psychological treatments:
•	Brief CBT
•	CBT
•	Interpersonal therapy
•	Mindfulness
•	ACT – Acceptance and commitment therapy
•	Schema therapy
Social treatments
•	Family psychoeducation
•	Formal support groups
•	Community groups
•	Caregivers
•	Employment
•	Enhance their relationship with friends and family
•	Housing
Lifestyle treatments:
•	Exercise
•	Diet
•	Smoking cessation
•	Alcohol cessation
28
Q

What do we mean by Optimised Treatment?

A

Combination of pharmacotherapy and psychological treatments in mood clinics

29
Q

How to improve outcomes in BD?

A

With early, accurate diagnosis and appropriate treatment

30
Q

How can a clinician manage partial remission in MDD?

A

1) Review diagnosis
* Clinical management:

  • Seek for second opinion
  • Re-assess for comorbidities
  • Review adherence and dose
  • Therapeutic strategies:
  • Switch / substitute
  • Augment / combine
  • Increase dose
31
Q

Which are the requirements for individualised treatment?

A
  • Accurate diagnosis
  • All comorbidities identified and addressed
  • Implement strategies: pharmacological (balance efficacy and side effects), psychological (psychotherapy and psychoeducational), social (social support)
  • Aim for remission and quality of life

Understanding Affective Disorders - REVISION (29 decks)

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