Mood disorders Flashcards
What is a mood/affective disorder?
- the fundamental disturbance is related to a change in affect/mood–> to depression (w/ or w/out associated anxiety) or to elation
- mood change usually accompanied by a change in overall level of activity
- most are recurrent and onset of episodes often related to stressful events/situations
What is the relative prevalence of bipolar and MDD among men compared to women?
- bipolar-1: F=M
- bipolar-2: F>M
- MDD: F>M (2:1)
What is the DSM-5 criteria for a depressive episode?
- 2 weeks or more of depressed mood AND 4 out of 8 of the following:
- sleep alterations (insomnia or hypersomnia)
- appetite alterations (increased or decreased)
- diminished interest/ anhedonia
- decreased concentration
- low energy
- guilt
- psychomotor changes (agitation or retardation)
- suicidal thoughts
What are the 3 subtypes for MDD in DSM-5?
- atypical features (inc. sleep+appetite, along with heightened mood reactivity)
- melancholic features (no mood reactivity, along with marked psychomotor retardation an anhedonia)
- psychotic features (presence of delusions/hallucinations)
What is the DSM-5 criteria for a manic episode?
- euphoric or irritable mood w/ 3 or ore out of 7 manic criteria:
- decreased need for sleep w/ inc. energy
- distractibility
- grandiosity or inflated self-esteem
- flight of ideas or racing thoughts
- inc. talkativeness or pressured speech
- inc. goal-directed activities or psychomotor agitation
- impulsive behaviour (sexual impulsivity or spending sprees)
How do we distinguish between type 1 bipolar disorder, hypomanic episodes and type 2 bipolar disorder?
- -> if manic symptoms present for minimum 1 week w/ notable functional impairment: MANIC EPISODE–> TYPE 1 BIPOLAR
- -> if manic symptoms present for minimum 4 days w/OUT notable functional impairment: HYPOMANIC EPISODE diagnosed… N.B. if hospitalised OR psychotic features present (delusions/hallucinations), cannot be hypomania
- -> if manic symptoms present for <4 days or other thresholds not met: UNSPECIFIED BIPOLAR
- -> if never had manic episode, but have hypomanic episodes along w/ at least 1 major depressive episode: TYPE 2 BIPOLAR diagnosed
What is cyclothymia?
don’t reach magnitude or mania or depression, but still have significant swings in mood
What is the distribution of symptom free time, depressive symptoms and manic/hypomanic symptoms in long-term bipolar disorder?
symptoms 47% of the time
majority is depressive (33% out of the 47%)
What is the difference in heritability between bipolar and unipolar?
bipolar has highest heritability, whereas unipolar/MDD has around half of that
How does insight differ between bipolar and unipolar?
- insight often preserved in depression
- whereas insight often impaired in mania (50% w/ severe mania deny symptoms…U-shaped- most impaired in severe and hypomania)
What mood disorder can easily be missed and what diagnosis might they be misdiagnosed with?
- bipolar might be missed due to lack of insight about mania/hypomania
- patient might end up w/ MDD diagnosis despite history of manic episodes
- collateral info often useful, esp. if you doubt details in history taking–> family members report manic symptoms twice as frequently as patients themselves
N.B. problematic, as antidepressants can cause acute manic/hypomanic episodes–> worsen long-term course of bipolar illness
What type of attention biases are characteristic of depression?
biases in maintaining/shifting attention–> hard to disengage from negative material:
- prolonged maintenance of attention over negative pictures
- reduced attention to positive stimuli
- also seen in remitted depressed patients and those at high-risk of developing depression
How does fMRI work (basic)?
detects changes in blood oxygenation and flow that occur in response to neural activity–> when a brain area is more active it consumes more oxygen and so blood flow inc. to active area to meet inc. demand
What brain regions show attention biases in depressed patients using fMRI?
- sustained amygdala response to negative stimuli
- perigenual anterior cingulate cortex appears to mediate negative attentional biases
- inc. activity in lateral inferior frontal cortex associated w/ impaired ability to divert attention from task-irrelevant negative info
What type of memory bias is characteristic of depression?
- preferential recall of negative compared to positive material
- bias towards negative memory
- also present in individuals at risk and in recovered depressed individuals
