mood disorders Flashcards
prevalence of bipolar 1
1%
prevalence of bipolar 2
1.2%
lifetime prevalence of major depressive disorder?
10-20%
gender distribution of bipolar 1 and bipolar 2?
bipolar 1 -> equal
bipolar2 male to female 2:1
what did mental and substance abuse disorder account for in DALYs ?
7%
what are the two disease classification manuals?
US DSM -> latest is 5 2013
WHO manual -> ICD
ICD-10 1994
ICD-11 on the way
definition for mood or affective disorder?
fundamental disturbance is in mood
depression (with anxiety or without)
or to elation
accompanied by a change to overall level of activity
most symptoms are easily understood in the context of change in mood or activity
disorders tend to be recurrent or related to a stressful event
how would you classify a depressive episode?
DSM-5 criteria for depressive episode:
Occurrence of 2 weeks or more of depressed mood
AND the presence of 4 of 8 out of the following:
Sleep alterations (insomnia or hypersomnia)
Appetite alterations (increased or decreased)
Diminished interest or anhedonia
Decreased concentration
Low energy
Guilt
Psychomotor changes (agitation or retardation)
Suicidal thoughts
how is the major depressive disorder classified?
If no manic or hypomanic episodes in the past are identified, then the diagnosis of a current major depressive episode leads to a longitudinal diagnosis of Major Depressive Disorder (MDD).
Atypical features (which represent mainly increased sleep and appetite, along with heightened mood reactivity)
Melancholic features (defined by no mood reactivity, along with marked psychomotor retardation and anhedonia)
Psychotic features (the presence of delusions/hallucinations).
core symptoms for depression triad?
low mood
anergia
anhedonia
biological symptoms for depression triad?
sleep
libido
appetite
how do you characterise manic episodes
Euphoric or irritable mood with 3 or more of 7 manic criteria:
Decreased need for sleep with increased energy
Distractibility
Grandiosity or inflated self-esteem
Flight of ideas or racing thoughts
Increased talkativeness or pressured speech
Increased goal-directed activities or psychomotor agitation
Impulsive behaviour (such as sexual impulsivity or spending sprees)
how would type 1 bipolar be diagnosed?
minimum mania for a week with notable functional impairment
+ depressive episode as well
how is a hypomanic episode diagnosed?
symptoms present for a minimum of 4 days
without notable functional impairment
how is type 2 bipolar disorder diagnosed?
no manic episode
only hypomanic
along with one major depressive episode
then DSM -5 diagnosis is type 2
how is unspecified bipolar disorder diagnosed?
if the manic symptoms are less than 4 days
when can hypomania not be diagnosed?
when there are psychotic symptoms
when a patient is hospitalised -> mania is put down
can a diagnosis still be made if is it caused by antidepressants?
yes in DSM-5 the diagnosis of mania can still be made
Are bipolar disorders really mood diorders?
this can be difficult –> as they can have mania without euphoric mood and depression without sad mood just anhedonia may be present
how is the course of the illness -> think of the graph ?
number of cycles per year varies
more than 4 is rapid cycling
and amplitude says either 1 bipolar, 2 bipolar or cyclothymia
what are the first episodes in bipolar 1?
the first episode tend to be depressive
90-100% will develop more episode after the first manic episode
how does insight differ in mania and depression?
insight it preserved in depression
and impaired in mania
how is depression characterised in terms of biases?
is it characterised by biases in maintaining/shifting attention
difficult for people with depression to disengage from negative material -> look at sad image for longer
what are some neurofunctional abnormalities in depression?
sustained amygdala response to negative stimuli
prefrontal cortex-> peregenual anterior cingulate cortex -> appears to mediate negative attentional biases
laterall inferior frontal cortex associated with impaired ability to divert attention from task irrelevant negative information.
What are the memory biases in depression?
There are strong evidence for biased memory processes
preferably recall negative compared to positive material
memory biased present in individuals at risk (neuroticism) and in recovered depressed individuals
enhanced amygdala response -> to negative faces
how do antidepressants cause facial expression recognition modulation?
in healthy samples
either noradrenergic antidepressants (reboxetine, duloxetine) -> better recognition of happy faces
or serotonergic antidepressants
mirtazapine -> decreased recognition of fearful faces
SSRIs citalopram -> mixed results -> both increase and decrease amygdala response to SSRIs
noradrenergic and serotonergic -> reduced recognition of anger and fear
in clinical samples -> early change positive processing
elevated baseline ACC activity
what is the monoamine deficiency hypothesis?
depressive symptoms arise from insufficient levels of monoamine neurotransmitters serotonin, norepinephrine and/or dopamine
How are serotonin levels in individuals who have committed suicide?
their serotonin levels are low
Can we measure serotonin in a living human brain?
We can use PET scanning, but it is really expensive and invasive. with much less optimal temporal and spatial resolution.
Using a 5-HT2A agonist PET tracer and amphetamine
How does cerebral serotonin look like in humans?
serotonin receptors deficiency
How do tryptamine psychodelics work on the brain?
The work on the serotonin system.
What type of psychodelics are used?
tryptamine
What are some of the benefits for psychodelics?
Rapid enduring mood improvement well being reduce OCD End of life distress -> reduce reduce addiction reduce depression reduce suicidal tendencies
is it important to distinguish between bipolar and unipolar?
yes
antidepressants can be ineffective in acute bipolar and in prophylaxis
can cause manic or hypomanic episodes
can worsen long term bipolar illness
can lead to more depressive episodes over time in rapid cycling stages
Bipolar affective disorder vs scizophrenia?
BPAD -> episodic hallucination/ delusions
schizo -> chronic hallucinations/ delusions
cognitive impairment
schizoaffective shares features in both
what are personality disorders?
maladaptive patterns of behaviours cognition, inner experience, exhibited across many context and deviating from those accepted by the individuals culture, patterns may develop early and are inflexible and be associated with significant distress or disability.
bipolar affective disorder vs borderline personality disorder?
BPAD -> run in family, grandiosity, mood typically not state from environment
BPD -> poor self image, fear of abandonment, feelings of emptiness
BOTH rapid mood swings
unstable interpersonal relationships
impulsive sexual behaviour
suicidality
BPAD vs Attention deficit disorder
BPAD-> family history, recurrent depressive episodes, amphetamines worsen mania.
both -> impaired concentration, impaired executive function, abnormal working and short term memory
Organic causes of depression?
endo-> hypo and hyper thyroidism, hypo/hyper parathyroidism, cushings Addison’s and hypoglycaemia
infections, SLE, HIV, pancreatic cancer -> cytokines in systemic diseases are considered a cause of depression.
deficiencies -> B12, folic acid
neuro MS, Alzeheimers
medication beta blockers, steroids, anti parkisons
anti cholinergics
IBS, some antibiotics, statins, oestroges, opiate painkillers, acne med
vascular depression -> associated with white matter hyperintensities, impact cognitive function making the individual more likely to react to stressors. (early subcortical dementia)
post stroke depression -> lesions in the left frontal lobe or basal ganglia -> can cause depression with a tendency that the more frontal the lesion the more severe the symptoms.
