The Impact of affective disorders Flashcards
What is the largest category of disease burden?
Neuropsychiatric disorders. Of that Depression is the largest component and is bigger than any other disease.
What is the cost and prevalence of EU mood Disorders?
- 4 BIl Euros
33. 4 million
What are the components in Bi-Polar disorder?
Mania, Hypomania Depression Subsyndromal depression (chronic) Mixed state co-morbity with substance abuse
How reliable are the diagnoses of Depression?
Bi polar 1 is good
Bi polar 2 is good
MDD is questionable
What separated MDD and Bi-polar 2 diagnosis?
The presence of hypomania in BP2
What did Merikangas find regarding Bi-polar depression in onset, prevalence, 12 month severity, co morbidity, mania and depression?
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
How does BP usually start?
Mid twenties following one or 2 depressive episodes.
How did kraeplin conceptualise BP?
Pure mania and Pure Depression at either pole.
6 states in various forms regarding volition, mood disturbances and thought disturbances.
What is the epidemiology of MDD in eu and USA?
Lifetime prevalence:
16% in USA
8.5% in EU
12 month Prevalence:
7% in USA
35 work days a year lost to Depression
What did Kessler find regarding age, co morbidity and suicide in MDD in general?
Mainly increase in younger people.
High co-morbidity 72%
20 fold increase in suicide: highest in first weeks after discharge.
What triggers MDD?
Stressful life events
Combination of GxE
Genes can provide vulnerability and resilience.
5Ht transporter short and long allele of interest here
What is the Time course of Depression?
50 % no further
35% recurrent
15% unremitting
What factors increase risk of depression?
Females: 2 x Increase of youngs Alcohol and prior panic attack Presence of 5 HT allele Previous Major Depression episode
What is the relationship between anxiety disorders and Depression?
75% with BP 1 and 2
60% with MDD
What is the issue with borderline PD?
20% BP will also satisfy BPD
but there are differences. In particular mood state- Depressed for BP and emptiness for BPD
How much depression is BP?
Agnst et al found definition changes it.
DSM IV-16%
DSM V- 31%
Wider- 50%
Probably under recognised
Li et al found what regarding depressed patients in Taiwan?
Difficult to treat and Easy to treat were studied.
26 % DTT found to be BP vs 9% of ETT.
What did Kessing et al find regarding treatment of BP?
Those who went to mood disorder clinics faired much better than those who had standard care. Saving E3100 pp
What does Taylor’s meta-analysis show us about treatment of BP?
There is a hole in evidence based drugs.
Quentapine and Olanzapine with fluxotine are so far the best performers.
