Mood Disorders Flashcards by Dean Whaley

Define Mood Disorders:

Where the fundamental disturbance is a change in effect or mood to depression (with or without associated anxiety) or to elation.

Usually accompanied by a change in the overall level of activity. Most other symptoms are secondary. Tend to be recurrent & episode onset can be related to stressful events/situations.

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What is the prevalence of Mood Disorders?

Lifetime (and 12-month) prevalence estimates of 1.0% (0.6%) for bipolar-I and 1.1% (0.8%) for bipolar-II.
Lifetime rate of major depressive disorder (MDD) is 10-20%
Studies across countries have reasonably consistently documented an increasing rate of MDD with an earlier age of onset.

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What is the Gender Distribution of Mood Disorders?

Bipolar-I: F=M, Bipolar-II and MDD: F>M (2:1 for MDD)

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What is the impact of Mood disorders on DALYs?

In 2010, mental and substance abuse disorders accounted for 7% all Disability-Adjusted Life Years (DALYs) worldwide, and within mental and substance abuse disorders, MDD accounted for 40% and bipolar for 7% of DALYs.

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What are the 2 manuals for Mood Disorder classification?

DSM

ICD

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What is the DSM 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

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How does a major depressive episode become Major Depressive Disorder?

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).

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What are the DSM subtypes for Major depressive disorder?

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).

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What are the biological symptoms triad in depression?

Sleep
Libido
Appetite

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What are the core symptoms triad in depression?

Anergia
Low mood
Anhedonia

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What are the Psychological symptoms triad in depression?

The world
Oneself
The future

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What is the DSM criteria for 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)

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What is the criteria for type 1 bipolar disorder?

If such symptoms are present for minimum 1 week with notable functional impairment, a manic episode is diagnosed, leading to a DSM-5 diagnosis of type I bipolar disorder.

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What is the criteria for a hypomanic episode?

If such symptoms are present for at minimum 4 days, but without notable functional impairment, a hypomanic episode is diagnosed.

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What is the criteria for type 2 bipolar disorder?

If not a single manic episode had occurred ever, but only hypomanic episodes are present, along with at least one major depressive episode, then the DSM-5 diagnosis of type II bipolar disorder is made.

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What is the criteria for Unspecified Bipolar disorder?

If manic symptoms occur for less than 4 days, or if other specific thresholds are not met for manic or hypomanic episodes, then the DSM-5 diagnosis:
“Unspecified Bipolar Disorder”

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What characterizes Manic episodes?

Psychotic features

What can you not diagnose if psychotic features are present?

If psychotic features are present, then hypomania cannot be diagnosed (since such features involve notable impairment by definition).

What classifies if a manic episode is diagnosed or if it hypomanic?

If a patient is hospitalized, irrespective of duration of manic symptoms, a manic episode is diagnosed, not a hypomanic episode. If manic or hypomanic episodes are caused by antidepressants, then the diagnosis of bipolar disorder is still made in DSM-5.

What is the relapse percentage for mood disorders following 1 year?

Research studies report around 50-60% relapsing within a year of recovery from a mood episode
Patients largely autonomous ‘between episod

What happens in Bipolar 1?

The majority of first episodes are depressive;

85% have a depressive as first episode
10% a manic episode
3-5% mixed episode

Most (90-100%) of patients will develop more episodes after their first manic episode.

What percentage of time will patients of Bipolar disorder be symptom free?

53% - symptom free

47% of the time they have symptoms ( Major depressive 33%)

What is the relationship between Bipolar disorder & Anxiety?

30-70% of bipolar patients
DSM-5: “Anxious Distress Specifier”
Worse prognosis and outcomes

What percentage of people with MDD seek help?

65-70% of people with MDD had visited a health professional in the last 6m but only 15-20% for mental health reason. (ECA study) only 21% had received any antidepressant treatment within the same period.

What are the arguments for the separation of Bipolar & Unipolar?

MDD is commonly diagnosed in children, far below the mean onset of the late 20s. Brief depressive episodes that occur multiple times yearly are diagnosed in patients with MDD commonly, whereas such course of illness should be rare if MDD was a different illness than bipolar disorder. Genetic studies have found high rates of depressive episodes, without mania, in persons with bipolar illness, and also frequent occurrence of bipolar illness in relatives of those with unipolar depression. Treatment now overlaps considerably, with neuroleptic agents proven effective not only for mania, but also for depression, both in bipolar and unipolar types. Lithium has been well known to be effective not only for mania, but also for depression, both in bipolar and unipolar types.

What are the differences between Bipolar & Unipolar?

In general, insight is preserved in depression, and impaired in mania. Specifically, about 50% of patients with severe mania and also most patients with hypomania deny such symptoms [despite the actual presence of those symptoms observed by researchers]. Further, insight appears to have a U-shaped curve in relation to severity; it is most impaired in hypomania and in severe mania but may be more present in moderate states of mania

What mood disorder diagnosis can easily be missed & what diagnosis is a patient in that case likely to be misdiagnosed with?

Bipolar diagnosis might be missed in a patient due to lack of insight about manic episodes. MDD diagnosis. You might then give antidepressants which are ineffective in Bipolar and can actually cause manic episodes.

Which attention biases are involved in Depression?

Depression is characterised by biases in maintaining/shifting attention = difficulties for depressed people to disengage from negative material

What can be used to measure neural activity?

fMRI

What are the neurofunctional abnormalities in Attention bias?

Sustained amygdala response to negative stimuli Prefrontal cortex: perigenual anterior cingulate cortex (ACC) (BA 24, 25, and 32) appears to mediate negative attentional biases lateral inferior frontal cortex associated with the impaired ability to divert attention from task-irrelevant negative information

What is Memory bias in depression?

Depression: strong evidence for biased memory processes. Preferential recall of negative compared to positive material = one of the most robust findings in the depression literature

What happens in Memory bias in depression?

Increased Negative memory bias: Free recall tasks meta-analysis = 10% more neg vs pos words Higher-level conceptual memory tasks vs purely perceptual tasksBias: Toward negative material or Away from positive materialMemory biases also present in individuals at risk (neuroticism) and in recovered depressed individuals

What is Perceptual Bias in Depression?

Increased recognition of negative faces and/or decreased recognition happy facesrobust strong evidence of Emotion Recognition deficits in MDD reduced recognition of all basic emotions except for sadness small effect size: may be confounded by medication?

What is the Neurofunctional abnormality in facial expression processing in depression?

Enhaned amygdala response to negative faces Even in absence of awareness But not always replicated

What is the role of the amygdala?

This medial temporal lobe region is involved in the perception and encoding of stimuli relevant to current or chronic affective goals, ranging from rewards or punishments to facial expressions of emotion to aversive or pleasant images and films. While amygdala generally is sensitive to detecting and triggering responses to arousing stimuli, it exhibits a bias towards detecting cues signalling potential threats, like expressions of fear

Which antidepressants cause better recognition of happy faces after an acute single dose?

Noradrenergic antidepressants

Which antidepressants cause a decreased recognition of fearful faces?

Serotonergic Antidepressants; | Mirtazapine, SSRI citalopram (mixed results)

What are the effects of 7 days of treatment with noradrenergic & serotonergic Antidepressants?

reduced recognition of anger and fear | Neurofunctional: reduced amygdala and mPFC response to fear

What is the relationship between early and long term changes?

Early change in positive processing (facial expression recognition after single dose) predicts later response (Tranter et al., 2009)

What is a good predictor of positive response to medication?

Elevated baseline ACC activity in depressed patients during tasks that probe affective circuitry (but also executive functions, or self-referential processes e.g., resting state) Predict positive response to treatment [ ii.e. decrease in depression severity following interventions. Both medication, neurostimulation & CBT]