mood disorders Flashcards
What is happening to the rates of MDD?
increasing rates with earlier age of onset
What are the gender demographics for bipolar I, bipolar II & MDD?
Bipolar I F=M, bipolar II & MDD F>M (2:1)
According to ICD-10, what are mood disorders?
-Fundamental disturbance is change in affect/mood to depression (with or without anxiety) or to elation, with other symptoms mostly secondary to this change in mood and activity. Usually recurrent and onset of events often related to stressful events. Mood change often with change in level of activity
According to DSM-5, what is a depressive episode?
2 weeks or more of depressed mood + presence of 4/8 of following: sleep alterations (insomnia/hypersomnia), appetite change (increased/decreased), anhedonia (diminished interest), decreased concentration, low energy, guilt, psychomotor changes (agitation or retardation), suicidal thoughts
What are key symptoms of depression?
Low mood, anhedonia, low energy
When does diagnosis of major depressive episode lead to longitudinal diagnosis of major depressive disorder?
If no manic or hypomanic episodes in past
What are subtypes of MDD according to DMS-5?
- atypical features (increased sleep, appetite, heightened mood reactivity)
- melancholic features (no mood reactivity, marked psychomotor retardation & anhedonia)
- psychotic features (delusions/hallucinations)
What are the triads of depression?
- core symptoms (anhedonia, anergia, low mood)
- biological symptoms (sleep, libido, appetite),
- psychological symptoms (the world, the future, oneself)
What is the typical cycle of low mood in unipolar and bipolar depression?
Thinking “what’s the point”, feeling low, flat, irritable, physically exhausted, behaviours like lying in bed all day and ruminating
What is the typical cycle of high mood?
Thinking “I’m the best, I can do everything”, feeling elated, excited, physically increased energy & race sensation, impulsive behaviours with increased activity
According to DSM-5 what are manic episodes?
Euphoric or irritable mood with 3 or more of following 7 manic criteria: decreased need for sleep with increased energy, distractibility, grandiosity/inflamed self -esteem, flight of ideas/racing thoughts, increased talkativeness or pressured speech, increased goal-directed activities or psychomotor agitation, impulsive behaviour (sexual impulsivity, spending sprees)
When do manic episodes lead to diagnosis of type-1 bipolar disorder?
When symptoms present for minimum 1 week with notable functional impairment
When is a hypomanic episode diagnosed?
When symptoms present for minimum 4 days but without notable functional impairment
When is diagnosis of type II bipolar disorder made?
Not a single manic episode ever, only hypomanic episodes + at least one depressive episode
When is unspecified bipolar disorder diagnosed?
Manic symptoms for less than 4 days or if other thresholds not met for mania/hypomania
When is an episode definitely diagnosed as manic and not hypomanic?
When they are hospitalized, or if they have psychotic features (delusions/hallucinations) because that means notable impairment
What happens if the manic/hypomanic episode is caused by anti-depressants, according to DSM-5?
Still diagnosed as bipolar
What are the most consistent clinical features for diagnosis of mania?
Psychomotor changes, mood can be variable
How common is relapse of manic episodes and how are they in between episodes?
Very common, around 50-60% relapse within year of recovery of manic episode. In between episodes mostly autonomous
In bipolar I, what is the usual presentation (first episode, following episode etc)?
Usually first episode is depressive, some manic, some mixed. Most develop more episodes after first manic episode
What is the relationship between anxiety and bipolar?
Close association. Anxious distress specifier (DSM-5). Have worse prognosis and outcome
Do people seek help in MDD?
Visit health professionals but not often or mental health reason. Those with 12-month diagnosis of MDD, only 20% get anti-depressants within same time period
What does new evidence point to in the treatment and demographics of mania and depression?
- MDD commonly diagnosed in children (far below mean onset of late 20s).
- brief depressive episodes occurring multiple times yearly common in MDD
- high rates of depressive episodes without mania in those with bipolar
- anti-psychotics/neuroleptics effective for mania and depression (unipolar/bipolar).
- lithium effective for mania and depression
What is difference in insight in depression and mania? What is it associated with?
Insight preserved in depression & impaired in mania. In mania associated with severity - most impaired in hypomania and severe mania but more present in moderate state of mania
What is heritability difference between bipolar and unipolar?
Bipolar more genetic/heritable than unipolar depression
What is attention bias typical of? What attention biases in depression?
More typical of anxiety. In depression, we have biases in maintaining/shifting attention, difficult for them to disengage from negative material (more attention towards negative stimuli)
How does fMRI work?
Blood oxygenation/flow in response to activity (more active area consumes more O2/blood flow to area)
What does fMRI show in depression in terms of negative stimuli? which parts of the brain affected in attention biases?
- Sustained amygdala response to negative stimuli.
- In prefrontal cortex anterior cingulate cortex ACC appears to mediate negative attentional biases.
- Lateral inferior frontal cortex associated with impaired ability to divert attention from task-irrelevant negative information
What biased memory processes are present in depression?
- Preferential recall of negative compared to positive material.
- Negative memory bias - in free recall tasks more negative words recalled.
- Bias towards negative material and away from positive material.
- Memory biases present in those at risk of depression and in recovered individuals
What is seen in facial expression processing in depression?
- Enhanced amygdala response to negative faces even in absence of awareness.
- Amygdala helps perception and encoding of stimuli relevant to current or chronic affective goals, rewards, punishments, emotions.
- Exhibits bias towards detecting cues signalling threat and fear
What is the monoamine hypothesis of depression? What is it the basis for?
Depression due to deficiency of monoamine neurotransmitters (serotonin 5-HT), norepinephrine, and or dopamine. Basis for SSRI treatment
What is indirect evidence for 5-HT hypofunction in depression?
- 5-HT depletion by antihypertensive drug could cause depression
- useful antidepressants all increase synaptic monoamine concentrations
- post-mortem evidence of reduced 5-HT levels in brainstem of those committed suicide
- lower levels 5HT1A and 5HT4 receptors
- monoamine oxidase A increased in MDD (breaks down serotonin)
- tryptophan depletion triggers relapse in MDD
- monoamine depletion correlates with low mood
What are the big 5?
Neuroticism, extraversion, openness for experience, agreeableness & conscientiousness
What is PET imaging and its evaluation?
Best method to identify brain pharmacology. Selective but invasive, radioactive, expensive, less optimal temporal and spatial resolution compared to fMRI. Injection of radioactive tracer that binds to receptor
What do amphetamines release?
dopamine
what does ecstasy release?
serotonin
How can 5-HT be measured in the brain?
By using 5-HT2A agonist pet tracer - mini dose of psychedelic
What are SSRIs in clinical samples associated with?
Better recognition of happy faces and decreased recognition of fearful faces.
