Lecture 8 - Depression & Bipolar Disorder Flashcards
What are symptoms of depression?
- Sadness, loss of pleasure
- Worthlessness
- Guilt
- Foreboding
- Poor sleep
- Appetite changes
What are the signs of depression?
- Withdrawn socially
- Fatigue
- Poor concentration
- Inactivity
- Restlessness
What is a major depressive episode?
- Symptoms must be present nearly every day for at least two weeks
- Symptoms must cause clinically significant distress and/or impairment in social, occupational, or other important areas of functioning
- Symptoms not due to drugs, alcohol, or other medical problem
Why is dysthymia or persistent depressive disorder?
- Depressed mood, at least 50% of the time (i.e., for more days than not), for at least two years
- When low mood is present, accompanied by at least two other symptoms of depression (previous slide)
- Chronic depression, often starts early in life and precedes first instances of major depressive episodes
- May report: feeling drained, pessimistic, avoiding others, social difficulties, always been this way
What is the point prevalence of depression?
USA 2015 = 7.3% in past year (Weinberger et al, 2018)
What is the lifetime prevalence of depression?
recent review estimates 2-20% (Gutierrez-Rojas et al, 2020)
What are the impacts of depression on relationships?
Can have negative impact on parent-child and romantic relationships (Downey & Coyne, 1990)
What are the impacts of depression on completed suicides?
10x increased in adolescents; 5.6x in adults, gender differences (Blair-West et al, 1999)
What are the impacts od depression on illness and mortality?
Greater risk of heart disease (Lett et al, 2004), diabetes (Brown & Newman, 2005), stroke (Liebetrau, 2008)
What are the patterns or recurrence of depression?
- 20% recurrence at 2 months
- 30% recurrence at 6 months
- 40% recurrence at 1 year
- 50% recurrence at 2 years
- 76% recurrence by 5 years
What makes you vulnerable to depression?
- Females are twice more likely
- Family history: 50-80%
- Past history: >3 episodes, risk doubles
- Stressful events
- Poor housing and low income
What are the treatments for depression?
- SSRIs
- Electroconvulsive therapy
- CBT
What are biological factors or depression?
There is a genetic risk; heritability estimates 30-50% (Kendall et al, 2021)
What are SSRIs?
Selective serotonin reuptake inhibitors
- fewer side-effects than older anti-depressants
- generally effective in managing biological signs and symptoms (around 2/3 treated to remission: Thase et al., 2005)
- less effective at preventing risk of relapse when stopped
What is electroconvulsive therapy?
Highly controversial, was widespread, now limited and last treatment option for very depressed and suicidal people but has major ethical implications
What is Beck’s cognitive model of depression?
- Thoughts can produce emotional distress
- Emotions are a function or a personal interpretation of events
- Event -> Interpretation -> emotion
What are schemas?
- Organising cognitive structures that influence an individuals’ representation and experience of world and self
- Influence these through biases in attention, memory, reasoning processes
- Encompass both core beliefs and dysfunctional assumptions
- “Filing cabinet” for our experiences
What is the negative triad of thoughts?
Negative views of the self, the world, and the future
What are the components of CBT for depression?
- Activity monitoring and scheduling
- Tracking NATs
- Challenging NATs
- Identifying and challenging schemas
- Relapse prevention
What are the two kinds of bipolar disorder according to the DSM-V?
Bipolar I Disorder and Bipolar II Disorder
What is Bipolar I Disorder?
One or more manic episodes
What is Bipolar II Disorder?
One or more major depressive episode, plus at least one hypomanic episode (no manic episodes)
What is mania?
A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).
What is hypomania?
- Four days or more of persistently elevated, expansive or irritable mood and persistently increased activity or energy
- As with mania, three / four or more of other symptoms
- Not severe enough to cause marked impairment, hospitalisation not necessary, no psychotic features
- Unequivocal change in functioning & observable by others
What is cyclothymic disorder?
- Brief spells of mild hypomania and mild depression (not sufficient to meet clinical criteria) with rare occasions when no symptoms
- Lasts > 2 years, often much longer
- 15-20% develop bipolar I or II
What is the prevalence of bipolar disroder?
around 1% with the peak onset being between 21 and 25
What is the suicide rate of people with bipolar disorder?
20-30 time that of the general population?
What is the diathesis-stress model?
Diathesis is biological factors and stress is life events
What are the biological factors of bipolar disorder?
- Relatively high heritability rate of over 70% (Smoller et al., 2003)
- Multiple loci associated (Gordovez & McMahon, 2020)
- 10-15% chance of BP in 1st degree relatives of BP
- Treatment often with medication:
- Mood stabilisers (e.g. lithium)
- Antidepressants (e.g. sertraline)
- Antipsychotics (e.g. risperidone)
What are the stress of bipolar disorder?
- Association between life events and the course of BPD (Johnson & Roberts, 1995)
- Mania particularly associated with goal-attainment rather than general positive or negative events (Johnson et al., 2000; Johnson, 2008)
What are prodromes in CBT therapy for bipolar disorder?
Prodromes are warning signs of an episode and illness.
- Identifying and responding to them is associated with a reduced chance of illness
