Lecture 74: Mood Disorders

Question 1

Diagnostic Criteria for MDD (not symptoms)

Answer 1

> 5 symptoms present for >2 weeks (most of the day) and impair function

Question 2

Diagnostic Criteria for MDD (nine symptoms)

Answer 2

Sad mood, Anhedonia—lack of interest/pleasure, Sleep disturbance-insomnia/hypersomnia, Change in Appetite, Low energy/fatigue, Psychomotor agitation or retardation, Impaired concentration, Guilty feelings, self-blame, Suicidal/thoughts of death

Question 3

Of MDD symptoms, at least one must be…

Answer 3

Sad mood OR anhedonia

Question 4

How is the PHQ-2 used?

Answer 4

Screens for depressed mood/anhedonia; if positive, use PHQ-9

Question 5

Depression and gender prevalence

Answer 5

Twice as common in women after puberty, before menpause

Question 6

Mean age of onset of MDD

Answer 6

Late 20s

Question 7

Untreated episode vs treated episode length

Answer 7

6-13 months; 3 months

Question 8

T/F: Same incidence relapse if continue treatment

Answer 8

False: lower

Question 9

Biggest risk of not treating depression and %

Answer 9

Suicide (30% attempt, 15% complete)

Question 10

Psychodynamic theory of depression and goal of treatment

Answer 10

Disturbance in infant-mother relationship; damaged self-esteem due to loss and anger about this turned inward; goal = relief via understanding of unconscious conflicts

Question 11

Cognitive theory of depression and goal of treatment

Answer 11

Depression results from specific cognitive distortions: negative views about the self, environment, and future; goal = identify and modify distorted thoughts

Question 12

Monoamine Deficiency Hypothesis and problems (2)

Answer 12

NE, DA, 5-HT are deficient (based on mechanism of early antidepressants); deficiency has not be reliably demonstrated AND SSRIs increase 5-HT immediately, but 4-6 weeks for tx to work

Question 13

Amino Acid Neurotransmitter System Dysregulation and supportive drug

Answer 13

Chronic stress –> excess glutamate –> neuronal/glial cell death; ketamine (NMDA antagonist) leads to rapid, transient antidepressant effect

Question 14

Neuroendocrine Dysregulation theory

Answer 14

Dysregulation of HPA stress response system: increased cortisol –> damage hippocampus, removing it’s (-) input –> MORE cortisol

Question 15

Dexamethasone suppression test in depressed patients shows…

Answer 15

Decreased negative feedback sensitivity in depressed pts (cortisol cannot shut down HPA axis)

Question 16

Immune system + MDD (two pieces of evidence)

Answer 16

Some people with depression have increased inflammatory markers AND some inflammatory diseases have higher risk of depression

Question 17

Cytokines/monocytes effects on brain in MDD

Answer 17

Monocytes/cytokines can enter brain regions associated with anxiety and depression –>
monocytes/cytokines act on synaptic plasticity mechanisms contributing to stress/depression

Question 18

Major areas of brain change in MDD and major functional changes (what might this lead to?)

Answer 18

Limbic and frontal regions have decreased volume; hypoactivity in frontal regions and hyperactivity in limbic regions (leading to dysregulated emotional expression)

Question 19

Five “smaller” brain areas in MDD

Answer 19

Hippocampus, dlPFC, ACC, amygdala, OFC

Question 20

Neurotrophic Factor hypothesis: findings in depressed pts

Answer 20

Low levels of BDNF found in hippocampus, PFC and serum of depressed patients

Question 21

Heritability of depression (%)

Answer 21

37%

Question 22

Serotonin transporter gene findigns

Answer 22

Double copy of risk allele = increase Pr (MDD) with increased # stressful life events

Question 23

Three treatment categories for MDD

Answer 23

Medications, psychotherapy, neuromodulation (ECT, vagal nerve stimulation, TMS, DBS)

Question 24

Bipolar I Disorder

Answer 24

Depressive episodes + at least one manic or hypomanic episode

Question 25

Define manic episode

Answer 25

At least 1 week of an abnormally and persistently elevated, expansive, or irritable mood plus at least 3 classic symptoms

Question 26

Bipolar I disorder prevalence, gender, age of onset

Answer 26

~1%; equal; 21 years

Question 27

If you experience 4 or more episodes of depression OR mania per year, you are called a…

Answer 27

Rapid cycler

Question 28

% chronically ill w/ bipolar disorder

Answer 28

Only 10%

Question 29

Three categories of neurobiology findings in bipolar disorder

Answer 29

Limbic and prefrontal cortical circuitry changes; HPA/HPT axis dysregulation; decreased neuronal size and density in key areas

Question 30

Special concern for bipolar disorder

Answer 30

High suicide rates

Question 31

If you have a first degree relative with bipolar, increased risk; heritability (%)

Answer 31

8-10x; 65%

Question 32

Top suicide risk factors (5)

Answer 32

Personal or family history of suicide; demographics (older white males); psychiatric disorders; substance abuse; isolation

Question 33

People who commit suicide may have these parts to their personalities (3)

Answer 33

Hopeless, impulsive, aggressive

Question 34

Protective factors against suicide (3)

Answer 34

Clinical care, connectedness (ex: having children), cultural/religious beliefs