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Psychopathology > Lecture 2 - Mood Disorders > Flashcards

Lecture 2 - Mood Disorders Flashcards

1
Q

How can you differentiate clinical from normal depression?

A
  • intensity (given the cause)
  • pervasiveness (impaired functioning)
  • duration
  • qualitative difference: can feel it in the room (heavy, blunt affect, slow/heavy speech)
  • suicidality
  • physical/vegetative symptoms
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2
Q

What is the DSM-5 criteria for Major Depressive Disorder?

A
  • 2 weeks
  • depressed mood (irritability in children)
  • diminished interest/pleasure in activities
  • weight change/appetite change
  • insomnia/hypersomnia
  • fatigue/loss of energy
  • feelings of worthlessness or guilt
  • psychomotor agitation/retardation
  • decreased concentration/indecisiveness
  • thoughts of death/suicide
  • distress and impairment
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3
Q

What is the 12mth, lifetime and childhood prevalence of MDD?

A
  • 12mth: 5.8% (7.4%F, 4.2%M)
  • lifetime: 15.3%
  • childhood: 0.92% (no gender diffs, diagnosis difficult; depression may present as irritability)
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4
Q

What is the course and comorbidity of depression?

A
  • 74% MDD recurrent
  • 69% PDD recurrent

Over 25 years:

  • average 3 episodes
  • 12% recovered
  • 84% recurring
  • 2% unremitting
  • 2% suicided

78% comorbid MDD; 69% in PDD
Depression usually second
No. or prior disorder predicts depression more than specific disorders

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5
Q

How many people with depression seek treatment?

A

60%

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6
Q

What is the comorbidity of MDD?

A

57% F, 66% M

anxiety
substance use
psychotic disorders
medical conditions (epilepsy, Parkinson’s, cancer, hepatitis, cancer, the pill, chemo etc.)

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7
Q

What are the overlapping features of anxiety and depression?

A 
fatigue
can't sleep
can't cope
tense
nervous

> > anxiety may occur first, limit functioning and thus lead to depression

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8
Q

What is the interaction between mood disorders and suicide?

A

60% of suicides are associated with a mood disorder

75% of adolescent

> > key factors: hopelessness and helplessness

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9
Q

What are the 4 causes of depression?

A

GENETICS

  • 40-70% heritable
  • risk in 1st degree relative: 5-25%

NEUROBIOLOGY

  • neurotransmitters: 5HT, DA, NA
  • stress hormones: cortisol, ACTH

STRESSFUL EVENTS

  • 2.5x more likely in depressed patients
  • role of the individual in contributing towards stress outcome (eg. woman leaves abusive relationship but now has no money)
  • associated w poor decision-making

PERSONALITY

  • neuroticism
  • introversion
  • negative self-esteem/self schema
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10
Q

What are the protective factors of depression?

A 
exercise
car ownership
normal weight
physically attractive/tall
genetics
positive social support
old age
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11
Q

Explain Beck’s Cognitive Model of Depression

A

antecedent > beliefs > consequences

NATS

  • automatic, unprompted, immediate, unchallenged
  • triad: self, world, future

SYSTEMATIC LOGICAL ERRORS

  • conclusions about self/world/future reached by errors
  • eg. all-or-nothing, “should”, fortune telling, mental filtering

DEPRESSOGENIC SCHEMAS

  • enduring assumptions (represent organisation of past/current experience)
  • develop over many years
  • inform cog processsing about events
  • may be unconscious
  • activated by stress
  • eg. fear losing control, incompetent
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12
Q

What is the support for Beck’s model?

A
  • depressed people have more NATS and make more logical errors

BUT… are they precipitants, vulnerability markers or products of depression??
Chicken vs. Egg??

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13
Q

What is the DSM-5 criteria for Persistent Depressive Disorder?

A
  • depressed mood for most of the day, more days than not
  • 2 years

2+ of….

  • appetite change
  • insomnia/hypersomnia
  • low energy/fatigue
  • low SE
  • poor concentration/decision-making
  • feelings of hopelessness
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14
Q

What are the prevalence, course and consequences of PDD?

A
  • 12mth prev: 0.5%
  • course: MDD may occur before, during or after
    »> often precedes MDD though (may be a risk factor for MDD)
  • consequences: functional impairment as great, if not greater, than MDD
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15
Q

What is the prevalence of postnatal depression?

A

1/7 (13%)

50-80% experience ‘baby blues’

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16
Q

What are the risk factors of postnatal depression?

A
  • hx of anx/dep (fam hx)
  • stressful pregnancy
  • moving house
  • single parent
  • hx abuse
  • problems with baby’s health/breastfeeding
  • lack of practical, financial or emotional support
  • unrealistic expectations
17
Q

What is a manic episode?

A
  • abnormally and persistently expansive, elevated or irritable mood + increased energy and goal-directed activities
  • 1 week
  • sever enough to cause marked impairment or need hospitalisation

3+ of

  • inflated SE/grandiosity
  • decreased need for sleep
  • talkative/pressured speech
  • distractibility
  • increase in goal-directed behaviour or psychomotor agitation
  • involvement in activities with painful consequences
18
Q

What is a hypomanic episode?

A
  • same criteria as mania
  • only 4 days
  • disturbances observable by others
  • episode not severe enough for marked impairment or hospitalisation
19
Q

What is Bipolar I?

A

1+ manic episode

  • may be mild, moderate or severe
  • not better explained by some form of SZ
20
Q

What is Bipolar II?

A

1+ hypomanic episode; 1+ major depressive episode

  • NEVER had a manic episode
  • not better explained by some form of SZ
  • mild, moderate, severe
21
Q

What is the onset and prev rate of BP-I and BP-II?

A

Onset: 18 BP-I, 2- BP-II

Lifetime Prev: 0.6% BP-I, 0.4% BP-II
12mth Prev: 0.4% BP-I, 0.3% BP-II
» sub-threshold more common

22
Q

What is the course of BP-I?

A
  • may have delusions/hallucinations
  • may have distinct manic and depressive episodes, or may be mixed
  • may have clear recovering b/w episodes or may have rapid cycles (more difficult to treat)
23
Q

What happens if BP-I is not treated?

A
  • length of ‘normal’ b/w eps decreases
  • length of eps increases
  • depressed phase more likely
  • suicide more likley
24
Q

When can mania occur as a secondary phenomena? (5)

A
  • cocaine
  • other stimulants
  • anti-depressants (SSRIs can trigger)
  • CNS disorders
  • L-dopa
25
Q

What is Cyclothymic Disorder?

A
  • 2 years
  • number of subthreshold hypomanic episodes and a number of subthreshold depressive symptoms
  • episodes present at least 50% of the time; no more than 2mths symptom free at a time
  • MDD, manic or hypomanic criteria have never been met
26
Q

What is the risk of suicide in bipolar? What are the 3 predictors?

A

15% lifetime risk

1/4 BP-I
1/5 BP-II

predictors: comorbid PD, previous attempt, more depression

27
Q

What is the comorbidity in bipolar?

A

75% have 1 other lifetime disorder
>50% have >3

anxiety (63%)
behaviour (45%)
substance use (37%)

28
Q

What are the outcomes of bipolar?

A
  • up to 60% in employment over long-term
  • downward drift in occupational status over time
  • Kraepelin: full recovery b/w episodes; favourable outcome relative to SCZ
  • 24% failed to return to work up to 30yrs after first manic episode
  • disjunction b/w symptom and functional recovery
  • 80% symptom remission, but only 43% return to work and 20% working at premorbid competence

YOUNG PEOPLE

  • 80% syndromal remission
  • only 60% not symptom remission (due to anx/dep sx still there)
  • 66% failed to return to previous functioning level at 6mths (61% at 12mths)
29
Q

Explain the treatment delays in bipolar?

A

up to 9-10 years

WHY?

  • diagnosed with MDD (depressive episode often first)
  • atypical clinical presentation of mania
  • hypomanic often pleasant
  • substance use comorbidity (deflect diagnostic attention)
  • reluctance to seek help
30
Q

What are the consequences of delayed treatment in bipolar? (6)

A
  • poorer social adjustment
  • more hospitalisations
  • increased risk of suicide
  • comorbidities develop
  • global impairment of capacity to face development tasks
  • forensic complications
  • shortening of frequency of cycle
31
Q

What are the causes of bipolar? (8)

A

GENETICS

  • risk of 1st degree relative 6%
  • MZ twins 58%, DZ twins 17%

MOLECULAR GENETICS
- chromosome 11 (but more likely to be a number of genes involved)

NEUROCHEMICAL

  • changing levels of neurotransmitters (5HT, NA - too high in mania, too low in dep)
  • changing balance of Na-K at cellular level (lithium restores this balance)
  • changing post-synaptic sensitivity in receptos
  • issues with cerebral glucose metabolism
  • HPA axis (cortisol in MDD)

MANIC DEFENCE

  • predisposing BP factors: unstable SE + unrealistic standards for success
  • grandiose ideas precipitated by intensification of low SE&raquo_space; mood elevation and mania
  • grandiose ideas keep distressing cogs out of consciousness
  • insecure attachment

CIRCADIAN RHYTHM DISRUPTION

  • sleep dep with onset of mania
  • melatonin, cortisol, 5HT
  • sleep-wake regulation/light therapy as proposed treatment
  • sleep critical for mood regulation

DYSREGULATED BAS SYSTEM:

  • behavioural approach system
  • BAS drives approach behaviour + motivation to attain rewards
  • goal-attainment events increase vulnerability to mania; rewarding nature triggers BAS

STRESS

  • stressful events precede mania (and dep)
  • predict relapse
  • trigger more early episodes than later ones

PERSONALITY
- Cluster B (histrionic, narcissistic)

32
Q

What is the relationship between mania and creativity?

A
  • 50-60% describe +ve consequences of the disorder
  • empathy, sensitivity, self-awareness, alertness, enhanced social rships + sexuality, increased appreciation of life, increased creativity
  • poets, writers, visual artists, comedians

Psychopathology (14 decks)

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