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Psychology & Neuroscience of Affective Disorders > The impact of affective disorders > Flashcards

The impact of affective disorders Flashcards

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1
Q

What is the disease burden of bipolar disorder and major depression?

A

> Bipolar disorder: 2%

> Major depression: 10%

-> combined they’re larger than other psychiatric disorders

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2
Q

What is the cost of mood disorders?

A

113.4 billion in 2011

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3
Q

What makes bipolar disorder clinically complex?

A

> Phases of:

  • mania
  • hypomania
  • depression
  • subsyndromal depression

> Maintenance

> Mixed cases (manic and depressive symptoms) are common

> Comorbidities

  • cyclothymia
  • substance/alcohol use
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4
Q

Which type of bipolar disorder has a more reliable diagnostic criteria?

A

Bipolar I disorder is more reliable than Bipolar II disorder

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5
Q

What distinguishes bipolar II disorder from major depressive disorder?

A

Bipolar II has presence of hypomania symptoms

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6
Q

What is the onset of bipolar disorder?

A

Early onset:

  • frequently before age 25
  • not before 10
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7
Q

What is the chronicity of bipolar disorder?

A

Lifetime prevalence:

  • 1% for bipolar I
  • 1.1% for bipolar II
  • 2.4% for sub-threshold bipolar disorder
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8
Q

What is the prevalence of severe mood episodes in bipolar disorder, in a 12 month period?

A

> Clinically severe episodes for

  • 68.8% of patients with bipolar II
  • 74.5% of patients with bipolar I
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9
Q

What is the prevalence of patients with bipolar disorder that have psychiatric comorbidity?

A

75%

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10
Q

What are the comorbidities of manic and depressive symptoms in bipolar disorder?

A

> Mania symptoms associated with increased risk for substance use

> Depressive symptoms associated with severe functional impairment

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11
Q

Which model explains the common mixed states in bipolar disorder?

A

Kraepelin’s affective states continuum

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12
Q

What are the various affective states in Kraepelin’s affective states continuum?

A
  1. Pure mania
  2. Depressive or anxious mania
  3. Excited depression
  4. Manic with thought poverty
  5. Manic stupor
  6. Depression with flight of ideas
  7. Inhibited mania
  8. Pure depression
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13
Q

What are the three types of disturbances in Kraepelin’s affective states continuum?

A

> Volition (will) disturbance

> Mood disturbance

> Thought disturbance

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14
Q

What characterises Kraepelin’s state of pure mania?

A
  • Flight of ideas
  • Euphoria
  • Hyperactivity
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15
Q

What characterises Kraepelin’s state of depressive/anxious mania?

A
  • Depressed mood

- Elevated will and thought

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16
Q

What characterises Kraepelin’s state of excited depression?

A
  • Depressed mood and will

- Elevated thought

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17
Q

What characterises Kraepelin’s state of manic with tough poverty?

A
  • Elevated mood and will

- Decreased thought

18
Q

What characterises Kraepelin’s state of manic stupor?

A
  • Elevated mood

- Decreased will and thought

19
Q

What characterises Kraepelin’s state of depression with flight of ideas?

A
  • Depressed mood and thought

- Elevated will

20
Q

What characterises Kraepelin’s state of inhibited mania?

A
  • Elevated mood and thought

- Decreased will

21
Q

What characterises Kraepelin’s state of pure depression?

A
  • Thought inhibition
  • Depressive mood
  • Weakeness of volition
22
Q

What characterises the severity and overall role impairment of major depressive disorder?

A

> Over 40% of people with MDD have severe or very severe MDD

> 60% of people with MDD have severe or very severe overall role impairement
- average 35 days totally unable to work or carry out normal activities due to depression in past 365

23
Q

What is the lifetime prevalence of MDD in the US and EU?

A

> 16% in US

> 8.5 in EU

24
Q

What are the lifetime comorbidities associated with major depressive disorder?

A

> Anxiety: 59%

> Substance use: 24%

> Control of impulsive behaviour: 30%

> Any: 72%

25
Q

What is the suicide risk associated with major depressive disorder?

A

> MDD increases risk of suicide by 20-fold

> Highest risk in first few weeks following discharge form inpatient treatment

26
Q

What are the common triggers associated with major depressive disorder?

A
  • Serious losses
  • Difficult relationships
  • Financial problems
  • Unpredictable stressful life events (SLEs)
27
Q

What is often involved in the onset of depression?

A

Combination of:

  • genetic vulnerability
  • psychological and environmental problems
28
Q

What mediates the risk of onset of depression?

A

Genes

- e.g. serotonin (5-HT) transporter promoter polymorphisms (short vs. long)

29
Q

What is the natural disease course of depression?

A
  • No further episodes (50%)
  • Reccurent (35%)
  • Unremitting (15%)
30
Q

Which factors increase the risk of developing a major depressive disorder (MDD)?

A

> Female sex (ratio female:male = 2:1)

> Younger age

> 1 or 2 short alleles of 5HTT polymorphism
(serotonin transporter gene)

> Prior alcohol or drug abuse

> Prior panic attack

> Risk or recurrence increases after each subsequent episode

31
Q

What is the other name for Borderline Personality Disorder?

A

Emotionally unstable personality disorder

32
Q

What differentiates a borderline personality disorder form a bipolar disorder?

A

Borderline personality disorder:
- no defined onset

  • mood changes precipitated by internal or external events (vs. spontaneous in BD)
  • Recurrent suicidal gestures (vs. mood shifts, episodic suicide attempts in BD)
  • Chronic impulsivity, risk taking (vs. episodic in BD)
  • Self-mutilation common (vs. rare in BD)
  • Sense of ‘emptiness’ (vs. ‘depressed mood’ in BD)
  • No bipolar I, II or recurrent depression in family history
    (present in BD)
33
Q

How did bipolar diagnoses evolve between the DSM-IV and DSM-V?

A

> DSM-IV: 16% depression is bipolar

> Modified DSM-IV: 31% (allows antidepressant/drug induced)

> DSM-V: up to 54%, using wider definitions for bipolar spectrum

-> Bipolarity like under-recognised

34
Q

How are unrecognised bipolar disorder represented in the group treatment resistant patients (TRD)?

A

Unrecognised BD is overrepresented in TRD group

  • 26% of patient who were difficult to treat (DTT) switched to bipolar diagnoses
    vs.
  • 6-9% off treatment responders (ETT) who switched to bipolar
35
Q

What are the four first improvements patients with bipolar disorder would like to see (McIntyre, 2009)?

A
  1. Better treatment of depression
  2. Less risk of weight gain
  3. Prevention of relapse in depression
  4. Improved functionality/quality of life
    - > treatment of depression is an unmet need
36
Q

What does the data favour in pharmacological treatment compared to placebo for bipolar depression (Taylor et al., 2014)?

A

Positive data favours Pharma treatment vs placebo

- for atypical antipsychotics: Quetiapine or Olanzapine + Fluoxetine

37
Q

What are the 10 practical considerations in the diagnosis of mood disorders?

A
  1. Is it recurrent? What is the severity?
  2. Evidence of major depressive episode?
  3. Evidence of mania/hypomania?
  4. Is there a mixed state?
  5. Psychiatric comorbidity?
  6. Physical ill-health?
  7. Age of onset?
  8. Family history?
  9. Treatment history?
  10. What is the functional/neurocognitive status?
38
Q

What is the driver of societal and social costs of disabilities?

A

Functional/neurocognitive deficits

39
Q

What is the importance of evidence of mania or hypomania in the diagnosis of mood disorders?

A

Mania symptoms are historically more reliable than hypomania symptoms
- Bipolar I diagnosis is more reliable then Bipolar II (distinguished by presence of hypomania)

40
Q

What are the key requirements for individualised treatment of mood disorders?

A

> Accurate diagnosis

> Identification of all comorbidities

> Pharmacological efficacy

> Improved social support

> Psychoeducation

> Psychological treatments

> Minimise adverse effects and non-concordance

41
Q

What are the two main mood disorders?

A
  • Major depressive disorder (Unipolar)

- Bipolar disorder

Psychology & Neuroscience of Affective Disorders (16 decks)

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