The Impact of affective disorders

Question 1

What is the largest category of disease burden?

Answer 1

Neuropsychiatric disorders. Of that Depression is the largest component and is bigger than any other disease.

Question 2

What is the cost and prevalence of EU mood Disorders?

Answer 2

113. 4 BIl Euros

33. 4 million

Question 3

What are the components in Bi-Polar disorder?

Answer 3

Mania,
Hypomania
Depression
Subsyndromal depression (chronic)
Mixed state
co-morbity with substance abuse

Question 4

How reliable are the diagnoses of Depression?

Answer 4

Bi polar 1 is good

Bi polar 2 is good

MDD is questionable

Question 5

What separated MDD and Bi-polar 2 diagnosis?

Answer 5

The presence of hypomania in BP2

Question 6

What did Merikangas find regarding Bi-polar depression in onset, prevalence, 12 month severity, co morbidity, mania and depression?

Answer 6

Onset is before 25 usually

Prevalence:
BP 1 is 1%
BP 2 is 1.1%
2.4% for sub-threshold

12 month Severe mood episodes:

68.8% with BP 2 and 74.5% of BP 1

75% of all patients co-morbity

Mania is related to substance use
Depressive states related to function impairment

Question 7

How does BP usually start?

Answer 7

Mid twenties following one or 2 depressive episodes.

Question 8

How did kraeplin conceptualise BP?

Answer 8

Pure mania and Pure Depression at either pole.

6 states in various forms regarding volition, mood disturbances and thought disturbances.

Question 9

What is the epidemiology of MDD in eu and USA?

Answer 9

Lifetime prevalence:
16% in USA
8.5% in EU

12 month Prevalence:
7% in USA

35 work days a year lost to Depression

Question 10

What did Kessler find regarding age, co morbidity and suicide in MDD in general?

Answer 10

Mainly increase in younger people.

High co-morbidity 72%

20 fold increase in suicide: highest in first weeks after discharge.

Question 11

What triggers MDD?

Answer 11

Stressful life events

Combination of GxE

Genes can provide vulnerability and resilience.

5Ht transporter short and long allele of interest here

Question 12

What is the Time course of Depression?

Answer 12

50 % no further
35% recurrent
15% unremitting

Question 13

What factors increase risk of depression?

Answer 13

Females: 2 x
Increase of youngs
Alcohol and prior panic attack 
Presence of 5 HT allele
Previous Major Depression episode

Question 14

What is the relationship between anxiety disorders and Depression?

Answer 14

75% with BP 1 and 2

60% with MDD

Question 15

What is the issue with borderline PD?

Answer 15

20% BP will also satisfy BPD

but there are differences. In particular mood state- Depressed for BP and emptiness for BPD

Question 16

How much depression is BP?

Answer 16

Agnst et al found definition changes it.

DSM IV-16%
DSM V- 31%
Wider- 50%

Probably under recognised

Question 17

Li et al found what regarding depressed patients in Taiwan?

Answer 17

Difficult to treat and Easy to treat were studied.

26 % DTT found to be BP vs 9% of ETT.

Question 18

What did Kessing et al find regarding treatment of BP?

Answer 18

Those who went to mood disorder clinics faired much better than those who had standard care. Saving E3100 pp

Question 19

What does Taylor’s meta-analysis show us about treatment of BP?

Answer 19

There is a hole in evidence based drugs.

Quentapine and Olanzapine with fluxotine are so far the best performers.