Mood Disorders Flashcards
Major depressive disorder symptoms
Great sadness Apprehensive feelings of worthlessness Guilt Withdrawal from others Loss of sleep/appetite Decreased sexual desire Loss of interest & pleasure in usual activities
What MDD looks like to others
Paying attention to other people difficult
Conversation may be tiresome
May speak slowly, take long pauses, use few words & uncomfortable periods of silence
May want solitude
May become agitated, pace uneasily etc
May neglect their personal hygiene & appearance
Other depressive disorders
Dysthymia disorder; more persistent but less severe form of MDD (2.5-5% prevalence) SAD; >melatonin in winter (1-3%) Chronic fatigue; unknown cause, mostly women Post-natal blues: 50-66% Post-natal depression; 10-15% Bearevment related depression Premenstrual dysphoric disorder Disruptive mood dysregulation disorder Substance/medication induced DD DD due to another medical condition
Possible triggers of MDD
Psychosocial stressors
Illness
Medications
Other; family history of depression, seasonal changes, menopause
Prevelance of MDD
3rd most common reason for seeing GP 17% have depressive disorder 6% have MDD More common in women Recognised in 50% of cases Many more have depressive symptoms (mild depression)
Onset & duration of MDD
Average age of onset is 30
Incidence is increasing
30-50% recover with usual care within 6 months
Typical duration of first episode is 2-9 months of untreated
Poorer prognosis the earlier age of onset; less responsive to treatment, increased chronicity, stronger heritability
4x higher rate of suicide
Co-morbidity
74% with one other disorder
58% with anxiety disorder
38.6% substance use disorder
Future predictions
WHO
by 2020, leasing cause of disability worldwide
Reasons MDD is believed to be over-diagnosed
Catch all diagnosis
Medicalising sadness
Diagnostic criteria very low
No coherent pattern of neurobiological changes or pattern of treatment response
Evidence based for antidepressants is weak & contradictory
Driven by vested interests e.g. drug companies
Reasons MDD is believed to not be over-diagnosed
Increased treatment has outweighed harm
Increased diagnosis rate led to reduced stigma & wider public understanding
Led to neurobiological, genetic & psychosocial risk factor studies
May lead to more preventative treatments in earlier developmental periods
Self-harm
Expression of personal distress
Usually made in private by individual who hurts themselves
30% rise among 10-14 yr olds
1/5 teenager prevalence in UK
Suicide
Around 15% of depressed people kill themselves
Global mortality is 16/100,000
11.7% per 100,00 men
3.3% per 100,000 women
More common in young people; 66% of cases <35 yrs
Women 3x more likely to attempt, men 4x more likely to succeed
Predominantly found in Caucasians
3rd highest cause of death in teenagers
Risk factors; impulsive, irritable, aggressive
56% thought of death, 37% wished to die, 69% had suicidal ideas
Risk & prognostic factors
Temperamental; neuroticism & link to stressful life events
Environmental; adverse childhood experiences, stressful life events
Genetic & physiological; familial risk
Course modifiers; all major non-mood disorders
Aetiology
Biogenetic factors; genetic, neurochemical, neuropathology, neuroendocrine, inflammatory markers
Psychological factors; perception of control, emotion processing, emotion regulation & reward seeking
Sociocultural factors; ethnicity, SES, gender
Genetic factors
2-3x higher rate in those with relatives with mood disorder
MZ; 46% concordance
DZ; 20% concordance
30% variance in depressive symptoms accounted for in inherited factors
10-15% prevelance if close family member
Lower % for MDD in comparison with other major psychiatric disorder
