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z. z. PSY3032 Lectures - Abnormal Psychology > Week 8 Lecture 8 - Depressive disorders, bipolar and related disorders - Jo Fielding (DN) > Flashcards

Week 8 Lecture 8 - Depressive disorders, bipolar and related disorders - Jo Fielding (DN) Flashcards

 Lecture content *Mood disorders: Depressive disorders Bipolar and related disorders *Prevalence & life span development of mood disorders *Aetiology of mood disorders *Treatment of mood disorders

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1
Q

What does Jo say is a take home message about mood disorders (right at beginning of lecture)?

A

It is the pattern of episodes; whether they recur, whether they alternate that determines which mood disorder a person has?

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2
Q

What are the two main ‘mood disorder’ categories in DSM-5?

A
  1. Depressive disorders
  2. Bipolar and related disorders

0:22

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3
Q

What are disorders that only involve depressive symptoms commonly referred to as?

How are these disorders differentiated?

A
  • Unipolar
  • Differentiatied by the severity & duration

0:33

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4
Q

What are the subset of the mood disorders that involve manic symptoms referred to as?

How are these differentiated?

A
  • Bipolar
  • Differentiated by intensity, duration & types of symptoms

0:50

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5
Q

What emotions are involved in mood disorders?

A

Involve disabling disturbances in emotion

  • extreme sadness & disengagement of depression
  • extreme elation & irritability of mania

Temporal patterning important in determining diagnoses & treatment

  • dealing with treating current symptoms
  • preventing future episodes
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6
Q

What are the defining features of Depressive Disorders?

A
  • profound sadness
  • inability to experience pleasure
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7
Q

What are the 4 Depressive Disorders covered in the lecture?

A
  • Major Depressive Disorder
  • Dysthymia (Persistent Depressive Disorder)
  • Premenstrual Dysphoric Disorder
  • Disruptive Mood Dysregulation Disorder
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8
Q

What differentiates the 4 Depressive Disorders?

A

differentiated by intensity & duration of symptoms

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9
Q

What disorders come under each of the two main ‘mood disorder’ categories in DSM-5?

A

Depressive disorders

  • Major depressive disorder
  • Persistent (chronic) depressive disorder (dysthymia)
  • Premenstrual dysphoric disorder
  • Disruptive mood dysregulation disorder
  • Substance/medication induced
  • Disorder due to another medical condition
  • Specified/unspecified disorder

Bipolar and related disorders

  • Bipolar I disorder
  • Bipolar II disorder
  • Cyclothymic disorder
  • Substance/medication induced
  • Disorder due to another medical condition
  • Specified/unspecified disorder
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10
Q

What are some additional features of

Depressive disorders?

A

Cardinal symptoms profound sadness &/or ability to experience pleasure

  • Self-recrimination
  • Difficulty paying attention
  • Physical symptoms very common:
    • fatigue, low energy, aches & pains o sleeping problems
    • sexual interest disappears
    • psychomotor retardation
    • psychomotor agitation
  • Initiative may disappear
  • Social withdrawal
  • Neglect appearance
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11
Q

What are some really important components in the diagnosis of Major Depressive Disorder?

A
  • Must not have had a manic episode
  • needs to be almost all of the time for at least 2 weeks
    5: 00 - 7:00 approx
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12
Q

What is DSM-5 criteria for Major Depressive Disorder?

A

At least 5 symptoms,

including (1) depressed mood and/or (2) loss of pleasure

  • Significant weight loss or change in appetite
  • Sleeping too much or too little
  • Psychomotor retardation or agitation
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive/inappropriate guilt
  • Difficulty concentrating
  • Recurrent thoughts of death or suicide (or attempt/plan)
  • Symptoms are present for at least 2 weeks and represent a change from previous functioning

4:50

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13
Q

What are some other features of Major Depressive Disorder?

A

MDD is an episodic disorder

  • Can last for months at a time
  • may become chronic
  • Subclinical depression possible for years
  • Major episodes tend to recur (2/3 of people)
  • Average number of episodes ~4
  • Risk increases each time
  • Controversial criteria re: number of symptoms
  • But impairment appears higher with greater number of symptoms

8:00

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14
Q

What is the time course for Major Depressive Disorder?

A
  • an episodic disorder
    • (symptoms come & go)
  • although can drag on for months
  • tends to recur

5:00-7:00 approx

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15
Q

What is psychomotor retardation?

A
  • physical symptom of depressive disorders
  • when thoughts & movements slow down

3:50

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16
Q

What is psychomotor agitation?

A
  • physical symptom of depressive disorders
  • restlessness, figeting
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17
Q

DSM-5 criteria for Dysthymia - Persistent depressive disorder?

A

Depressed mood for most of the day, for more days than not, for at least 2 years (1 year for children/adolescents)

At least 2 of the following during that time:

  • Poor appetite or overeating
  • Sleeping too much or too little
  • Poor self esteem
  • Trouble concentrating or making decisions
  • Feelings of hopelessness

The symptoms do not clear for more than 2 months at a time

10:15

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18
Q

Which depressive disorder is most likely to require hospitalisation?

Why

A

Dysthymia

because of its chronicity

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19
Q

What are the defining features of Dysthymia (Persistent depressive disorder)

A
  • persistent depressed mood
  • no relief more than 2 years
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20
Q

How does Dysthymia differ from Major Depressive Disorder?

A

Dysthymia (persistent depressive disorder)

  • 2 symptoms
  • 2 years (1yr for child)
  • chronic

Major Depression

  • 5 Symptoms
  • 2 week period
  • episodic
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21
Q

Which two Depressive Disorders are new to DSM-5?

A

Premenstrual Dysphoric Disorder

Dysruptive Mood Dysregulation Disorder

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22
Q

Premenstrual Dysphoric disorder: DSM-5 criteria?

A

In most menstrual cycles, 5+ symptoms present in final week before menses, improving within few days of menses onset:

Including ≥1:

  • Affective lability
  • Marked irritability, anger, arguments
  • Depressed mood, hopelessness, self-deprecating thoughts
  • Anxiety diminished interest in usual activities, difficulty concentrating

Including ≥ 1:

  • Decreased interest in usual activities
  • Difficulty concentrating
  • Lack of energy
  • Change in appetite, overeating, or food craving
  • Sleeping too much or too little
  • Subjective sense of being overwhelmed or out of control
  • physical symptoms
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23
Q

What are the defining features of Premenstrual Dysphoric Disorder?

A
  • affect up & down (moody)
  • impacted concentration, energy, sleep, appetite, physical pain
  • must cause significant distress/impairment
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24
Q

Disruptive mood dysregulation disorder: DSM-5 criteria?

A

Severe recurrent temper outbursts in response to common stressors, out of proportion in intensity or duration to the provocation

  • Temper outbursts are inconsistent with developmental level
  • Temper outbursts tend to occur at least 3 times per week
  • Persistent negative mood between temper outbursts most days, & the negative mood is observable to others
  • Symptoms present for at least 12 months, do not clear for more than 3 months at a time
  • Temper outbursts or negative mood present in at least 2 settings
  • Age 6 +
  • Onset before age 10
  • In past year, no distinct period lasting >1 day where elevated mood & at least 3 other manic symptoms present
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25
Q

What are the defining features of Disruptive Mood Dysregulation Disorder?

A
  • Chronic, severe & persistent irritability
  • negative mood
  • in at least 2 settings, 12 months
  • no mania

Behaviour

  • extreme recurrent temper outbursts
  • inconsistent with developmental level
  • present most of the time
  • must be differentiated from other disorders

14:45

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26
Q

What distinguishes Disruptive Mood Dysregulation Disorder from other disorders?

such as Bipolar, ADHD (may be comorbid), Oppositional Defiance Disorder (children), Intermittent Explosive Disorder.

A

its the level of chronicity that distinguishes this disorder from others with similar symptoms

16:05

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27
Q

Which is rarer Major Depressive Disorder or Dysthymia?

A

Dysthymia

17:20

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28
Q

What other disorders often coexist with Major Depressive Disorder & Dysthymia?

A
  • Anxiety Disorder
    • 60% Depressives also have anxiety
  • Substance-related disorders
  • Sexual dysfunction
  • Personality disorders
  • Cardiovascular disease
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29
Q

What may the varied prevalence rates of Depressive Disorders across cultures be due to?

What may varied symptoms across cultures be due to?

A

Prevalence

  • may vary due to different environmental stressors e.g., Beirut 19%, Taiwan 1.5%

Symptoms

  • may reflect differences in acceptable expression
    • e.g., Latino - nerves, headaches
    • e.g., Asian - fatigue & weakness

Cultural differences - bound to be more complex relationship

17:45 approx

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30
Q

How do symptoms of Depressive Disorders behave across the lifespan?

A

Symptoms change over lifespan

  • children → somatic complaints
  • older adults → distractibility & memory loss
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31
Q

Depressive Disorders: prevalence - lecture slide 1

A
  • MDD one of most prevalent psychiatric disorders (~16%)
  • Dysthymia rarer (~2.5%)
  • Twice as common in women?
    • Reported more often?
  • Three times more common in low SES individuals
  • Prevalence varies across cultures
    • e.g 1.5% in Taiwan, 19% in Beirut
  • Symptoms also vary across cultures
    • Nerves & headaches common in Latino cultures
    • Fatigue & weakness in Asian cultures
  • But may be a complex relationship:
    • Distance from equator?
    • Fish consumption?
    • Wealth disparity & family cohesion important
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32
Q

Depressive Disorders: prevalence - lecture slide 2?

A
  • In most countries prevalence of MDD increased steadily until late 20th century
  • Median age of onset now late teens to early 20s
    • support structures like extended family non-existent
    • marital stability often absent
  • Symptoms appear to change over lifespan:
    • children → somatic complaints
    • older adults → distractibility & memory loss
  • Often comorbid with other psychiatric problems:
    • 60% also meet criteria for anxiety disorder
  • Other comorbidities:
    • substance-related disorders
    • sexual dysfunction
    • personality disorders
    • cardiovascular disease
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33
Q

What differentiates Bipolar disorders from Depressive Disorders?

A

Presence of Mania

  • Manic episode
  • Hypomanic episode

21:30

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34
Q

How does a manic episode differ from a hypomanic episode?

A

Manic

  • Significant impairment
  • psychotic symptoms
  • Symptoms - 1 week or hospitailisation
  • cause distress/functional impairment

Hypomanic

  • **Impairment not marked **
    • but observable to others
  • no psychotic symptoms
  • at least 4 days
  • no hospitalisation
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35
Q

What are the defining features of a Manic episode?

A

extreme dysfunction/impairment

  • elevated, expansive mood
  • psychotic episodes
  • odd behaviour
  • no insight
  • 1 week/ possible hospitalisation
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36
Q

What are the defining features of a Hypomanic episode?

A
  • elevated, expansive or irritable mood
  • goal-directed activity
  • 4 days, most of time
  • no significant impairment
  • no hospitilisation
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37
Q

Why is treatment a patient experiencing mania so challenging for clinicians?

A

the highs of mania are quite pleasurable

they are really enjoying their disorder!

will rarely seek treatment for the mania

normally seek treatment for the depression

25:45

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38
Q

Manic episode: DSM-5 criteria?

A

Manic episode:
Distinctly elevated, expansive or irritable mood, and abnormally increased goal-directed activity for 1 week, most of the day, nearly every day.

At least 3 symptoms noticeably changed from baseline (4 if mood is only irritable):

  • Inflated self-esteem
  • Decreased need for sleep
  • Unusual talkativeness
  • Flight of ideas or subjective impression that thoughts are racing
  • Distractibility
  • Increased goal-directed activity
  • Excessive involvement in activities that are likely to have undesirable consequences
  • Symptoms last for 1 week or require hospitalisation
  • Symptoms cause significant distress or functional impairment
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39
Q

Hypomanic episode: DSM-5 criteria?

A

For a hypomanic episode:

  • Symptoms last at least 4 days
  • Clear changes in functioning that are observable to others, but impairment is not marked
  • Does not require hospitalisation
  • No psychotic symptoms are present
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40
Q

What is a key point which differentiates Bipolar I and Bipolar II?

A

Bipolar I - diagnosis requires

Criteria met for one single manic episode

Bipolar II - diagnosis** **requires

Criteria met for at least one hypomanic episode AND
Criteria met for at least one major depressive episode

28:30 >

41
Q

What one criteria meets the diagnosis of Bipolar I Disorder?

A

one single manic episode

other symptoms exist, but not required for diagnosis

  • hypomania
  • depressive episodes

28:30

42
Q

Bipolar I Disorder: DSM-5 criteria?

A

Criteria met for at least one manic episode

  • If mood is irritable rather than elevated – requires 4 , not 3 ,other symptoms
  • Hypomanic and depressive episodes common (not necessary)
  • Diagnostic code based on:
    • type of current/most recent episode (e.g. manic, hypomanic, depressed)
    • Severity (mild, moderate, severe)
    • Presence of psychotic features
    • In remission/not
  • May or may not be experiencing current symptoms of mania
  • Episodes tend to reoccur
43
Q

Bipolar II Disorder: DSM-5 criteria?

A

Criteria met for at least one hypomanic episode AND

Criteria met for at least one major depressive episode

  • Diagnostic code as for BP I
  • Characterised by recurring mood episodes – usually more frequent and lengthier than BPI
  • Usually present with MD episode - unlikely to complain of hypomania
44
Q

What symptoms characterises Bipolar II Disorder?

A

recurring mood

45
Q

What component of Bipolar II generally promopts an invidiual to seek help?

A
  • the depressive component
  • the hypomania is quite enjoyable, very rare they would seek help for it
    30: 40
46
Q

Cyclothymic Disorder: DSM-5 criteria?

A

For at least 2 years (1 in children/adolescents):

  • Numerous periods of hypomanic symptoms that do not meet criteria for a manic episode
  • Numerous periods with depressive symptoms that do not meet criteria for a MDD
  • Symptoms do not clear for >2 mths
    • cause significant distress/impairment
47
Q

What are the defining features of Cyclothymic Disorder?

A
  • chronic fluctuating mood disturbance
  • distinct periods of hypomania & depressive symptoms
  • > 2 months
  • significant distress/impairment

31:15

48
Q

Which other disorder does Cyclothymic Disorder most resemble?

What differentiates these two disorders?

A

Cylothymic Disorder resembles Bipolar II

Although in Cyclothymic Disorder, the:

  • hypomanic symptoms DO NOT meet ‘manic’ criteria
  • depressive symptoms DO NOT meet major depressive disorder criteria
  • > 2 months
  • must have never previously met criteria for either mania or major depressive disorder
    • as this would be Bipolar I (even just one episode of mania)

31:30

49
Q

Bipolar and related Disorders: Epidemiology

Prevalence?

Onset?

Comorbidities?

(lecture slide)

A

Prevalence:

  • Bipolar I disorder much rarer than MDD
  • Bipolar I ~ 0.6%
  • Bipolar II more difficult to gauge ~ 0.4 – 2%
  • Cyclothymia ~4% of mood disorders
  • Cultural variation may reflect differences in labelling behaviours as manic symptoms

Onset:

  • > half before 25, increasing frequency in children
  • Equally in men & women, women more episodes of depression

Comorbidities:

  • 2/3 meet diagnostic criteria for comorbid anxiety disorder
  • 1/3 report history of substance abuse
50
Q

What other disorders commonly co-exist with the Bipolar Disorders?

A
  • Anxiety Disorders
    • 2/3 have anxiety
  • Substance Abuse
    • 1/3 have history

35:30

51
Q

Which of the Bipolar Disorders is amongst the most severe forms of mental illness?

A

Bipolar I

  • 1/3 remain unemployed 1 year after hospitalisation for mania
  • Unable to work ~25% of the time

36:30

52
Q

What is a high risk in people with Cyclothymia Disorder?

A

50% risk of going on to develop episodes of

  • mania
  • major depression
53
Q

Bipolar and related Disorders: Outcomes/consequences?

lecture slide

A

Bipolar I disorder amongst most severe forms of mental illness

  • 1/3 remain unemployed 1 year after hospitalisation for mania
  • Unable to work ~25% of the time

Suicide attempts:

  • Bipolar I ~1 in 4
  • Bipolar II ~1 in 5

High risk for other medical condition:

  • Cardiovascular disease
  • Diabetes
  • Obesity
  • Thyroid disease
  • Often severe

Cyclothymia = high risk for developing episodes of mania & major depression ~ 50%

54
Q

How are the Seasonal Pattern & Rapid Cycling subtypes (specifiers) different to the other subtypes of MDD & BP disorders?

A

Seasonal Pattern & Rapid Cycling subtypes

  • refer to the overall pattern of the episodes over time

Other subtypes

  • refer to current episode
    47: 30
55
Q

What is Rapid Cycling?

A
  • Unique to Bipolar Disorders
  • Move quickly in & out of depressive or manic episodes
  • >3 manic or depressive episodes
  • increased suicide attempts & episodes of depression
    • 20-40% (60-90% female)
    • people on anti-depressant medication tend to have more cycling
  • increase in frequency over time
  • Can transform to ‘rapid switching pattern’ without breaks
  • most people stop cycling within 2 years
    49: 30
56
Q

What is Seasonal Affective Disorder?

Does it occur in MDD & Bipolar?

When is it likely to occur?

A

Depressed episodes that occur only during certain seasons

Applies to MDD & bipolar disorders

  • Depressive Disorders
    • late autumn > early spring
  • **Biplolar Disorder **
    • depressed in winter, manic in summer

Most involve winter depression

  • Excessive sleep & increased appetite
  • Evidence links melatonin produced by pineal gland
    • Suppressed by light
    • Increases in winter
    • More prevalent in extreme latitudes
    • Trigger in vulnerable people?

50:30

57
Q

Almost all of the subtypes (specifiers) can be applied to both MDD & BP disorders, what are the two exceptions?

A

Rapid cycling subtype

  • only applies to Bipolar
  • not applicable to MDD

Melancholic subtype

  • only applies to depressive component of BP
  • not applicable to mania component of BP

47:50

58
Q

What two new MDD & BP disorder subtypes (specifiers) were added to DSM-5?

A

‘With anxiety’

‘Suicide risk severity’

59
Q

Why are the MDD & BP disorder subtypes (specifiers) useful to a clinician?

A

enables them to build up a heterogeneous (individual) picture of how an individual may be presenting

48:10

60
Q

What are the subtypes of MDD & bipolar disorders covererd in the lecture?

A
  • Psychotic features
  • Mixed
  • Catatonic
  • Melancholic
  • Atypical
  • Postpartum
61
Q

One of the 6 subtypes of MDD & bipolar disorder is Psychotic features, what:

  • happens with mood?
  • is the prevalence?
  • the treatment outcome?
A

Psychotic features:

  • Mood congruent - hallucinations, delusions consistent with mood state
  • Mood incongruent (serious sub-type)
    • thought broadcasting
    • thought insertion
    • continuum - may progress to schizophrenia?
  • Rare: 5-20%
  • poor treatment response
  • greater impairment
62
Q

One of the 6 subtypes of MDD & bipolar disorder is
‘Mixed’, what is the DSM-5 criteria?

A

Mixed:

• At least 3 manic symptoms present during depressive episode, or
• At least 3 depressive symptoms present during a manic episode

63
Q

Describe the ‘Catatonic’ subtype?

A

Catatonic:

  • Marked by motor disturbance
  • Stuporous state or catalepsy
  • thought to reflect end state reaction to imminent doom?

may include

  • echolalia - immitate speach
  • echopraxia - immitating movements

1:00

64
Q

Describe the ‘Melancholic’ subtype?

A

Melancholic:

  • less rare than Psychotic & Catatonic
  • Full criteria met for MDD
  • More severe somatic symptoms
  • Complete loss of interest in just about every activity
    • e.g. loss of libido, anhedonia, guilt
  • early morning awakenings (2am)
  • whether its actually a subtype or exists on a continuum is difficult to determine
    (sounds like a continuum to me, DN!!!)



1:01:20

65
Q

Describe the ‘Atypical’ subtype?

A

Atypical:

  • Applies to depressive episodes & dysthymia
  • Oversleep, overeat
  • Can still find pleasure
  • More common in women, early age of onset
  • More: symptoms, severe, suicide,
  • comorbidity

(DN question: Table 5.2 on slide 24 shows ‘Atypical’ applying to both MDD & BP, but Jo & slide 29 say it applies to depressive episodes & dysthymia. Slide 24, Table 5.2 doesn’t specify its only applicable to the depressive component of bipolar………just sayin…….)

66
Q

Describe the ‘Postpartum’ subtype?

A

Postpartum:

• Onset within first 4 weeks of childbirth
• 13% post-childbirth, hormonal?
• NOT “baby blues” – 80% for few days,
normal stress response

67
Q

What distinguishes Postpartum subtype from the baby blues?

What are some possible causes for Postpartum?

A

Duration & intensity of symptoms distinguish them

Baby blues

  • most women (80%) experience
  • about 3 days after birth

Postpartum

  • some women (13%) develop major depression within first 4 weeks after birth

Cause unclear but may be

  • decline in reproductive hormones after delivery
  • elevated corticotropin producing hormone has been proposed

102:40

68
Q

Does depression require life experience?

How does it appear at different ages?

A

Apparently not

  • Evidence that babies can become depressed
    • Genetics, environment, both?

Depression fundamentally similar across lifespan

Its presentation differs though

  • Babies/Toddlers: sad faces, irritability, fatigue, fussiness, tantrums, eating, sleeping problems
  • Children: loss of enjoyment, loss of sleep, social withdrawal
  • Adults: more exaggerated, severe with age
    • i.e., life experience?

103:35

69
Q

How does the presentation of Mania differ between adults & children?

A

Children under 9 - present with more irritability & emotional swings rather than classic manic states

Children experience “Swings” less distinct than adults

Children: only brief manic states, come in & out throughout a day, not full blown as in adults

70
Q

How do depressive & bipolar disorder comorbidities differ between children & adults

A
  • Adults - anxiety disorder
  • Children - ADHD & CD
    • Up to 90% meet criteria for ADHD
    • raises diagnosis issues

105:30

71
Q

What factors have been described in the Aetiology of Mood Disorders?

A
  • Neurobiological factors, including:
    • Genetic factors
    • Neurotransmitters
    • Neuroimaging
    • Neuroendocrine system
  • Social factors
  • Psychological factors
    • Personality factors
  • Cognitive theories
    • Learned helplessness
72
Q

Describe the genetic factors described as having a neurobiological implication in mood disorders?

A

Genetic factors:

  • Probability of having a mood disorder 2-3 x greater if relative has a mood disorder
    • Severity, recurrence, age at onset predict rate
  • Twin studies support relationship with depression ~37%
  • Bipolar - 90% inc. risk of any mood
  • >160 loci linked – few well studied or replicated
    • “disconfirmation appears to be the rule rather than the exception”
    • Polymorphism of Serotonin transporter gene inc. vulnerability
    • DRD4.2 gene
    • Likely a set of genes that confers vulnerability
73
Q

What is important to note about the influence of genes in mood disorders?

A
  • they don’t cause disorders
  • they confer a vulnerability
  • sets stage for disorder in context of other factors

1:08:00

74
Q

Describe the Neurotransmitters described as having a neurobiological implication in mood disorders?

A

Neurotransmitters:

  • Norepinephrine, dopamine, serotonin most studied
  • Serotonin thought to regulate emotional reaction
  • decreased serotonin dysregulates others?
    • balance rather than absolute levels?
  • dysfunction = altered sensitivity of postsynaptic receptors?
  • increased dopamine = hypomania
    • receptors oversensitive?
  • decreased dopamine = depressive b/h
  • G Protein high in mania, low in depression

108:45

75
Q

What has been hypothesised about the role of neurotransmitter serotonin in the aetiology of mood disorders?

A

BALANCE of neurotransmitterrs is important

Serotonin’s primary function - regulate emotional reaction

  • lower levels seen in mood disorders
  • decreased serotonin thought to lead to dysregulation in other neurotransmitters

when serotonin is low

it allows other neurotransmitters are able to range more widely > imbalance

1:08:40

76
Q

Which neurotransmitter has been thought to contribute to hypomania & depression?

What has been found to trigger instability in this neurotransmitter?

A

Dopamine agonist (L Dopa)

**Hypomania **

  • Increased Dopamine levels

> oversensitive receptors?

Depression (atypical & with psychotic features)

  • Decreased Dopamine levels

Possible Triggers to imbalanced Neurotransmitters:

  • Chronic Stress has been linked to reduced Dopamine levels & depression
77
Q

Describe Neuroimaging evidence described as a Neurobiological factor in the Aetiology of mood disorders?

A

Neuroimaging:

  • Amygdala, prefrontal cortex, hippocampus, sub-genual anterior cingulate
  • Functional imaging
    • elevated activity of amygdala > vulnerability?
    • dimished activation / volume of other regions
  • Theory > react with increased emotion but decreased ability to plan
  • Mania similar to depression
    • basal ganglia more active?
    • changes to neuronal membranes?
    • Kinase C abnormally high?

1:11:25

78
Q

What happens in the amygdala during depression?

What is generally seen in other brain regions?

What are the behavioural outcomes?

A

Amygdala

  • increased activity
  • hyper-reactivity to emotional stimuli

Other regions

  • diminished activation
  • decreased volume in other regions
  • less activity in these regions involved in planning etc

Outcome

  • react with increased emotion
  • less ability to plan

1:11:50

79
Q

What new lines of neurobiological research have shed some light on what differentiates Major Depressive DIsorder from Bipolar Disorder?

A

Manic Episode

  • basal ganglia particularly active
  • involved in reward reactions
    • differentiates from MDD

Bipolar Disorder

  • Changes in **neuronal membranes **
  • influencing how readily they can be activated
    • not seen in MDD

1:12:50

80
Q

Describe Neuroendocrine system involvement (Neurobiological factor) in the Aetiology of mood disorders?

A

Neuroendocrine system:

  • Hypothalamic-pituitary-adrenocortical axis overly active
    • Triggers release of cortisol
  • Known link between depression & high cortisol levels
    • e.g. Cushing’s syndrome, animal studies
  • Dexamethasone suppression test
    • Cortisol not suppressed in MDD – esp psychotic features
    • Normalises when depressive episode ends
    • Poor regulation of HPA axis?
  • Reduced hippocampal volumes
    • Consequence of high cortisol levels?
    • Precedes/contributes to onset of depression?

1:13:35

81
Q

What aspect of the HPA axis is hypothesised to contribute to Depressive Disorders & Bipolar Disorder?

A

poorly regulated cortisol system

1:15:00

82
Q

What Social Factors are considered in the Aetiology of mood disorders?

A

Stressful life events (key take home message)

  • Role well established
  • 42-67% report serious life event prior to depression
  • Loss, humiliation, chronic stressors particularly likely triggers

Lack of social support

  • Sparse social networks, regarded as unsupportive
  • Having a confidante reduces risk from 40% to 4%

Interpersonal problems

  • Expressed emotion predicts relapse
  • Poor IP problem solving predicts onset
  • But depression, constant reassurance-seeking can also create IP problems?

1:16:00

83
Q

Considering personality factors, what tends to be a risk factor for developing Mood Disorders?

A

the propensity to experience negative & positive affect

1:18:25

84
Q

What personality trait predicts Depressive Disorders?

A

Neuroticism

85
Q

What three dimensions does one model use to organise mood disorders?

How do Depressive Disorders, Anxiety Disorders & Comorbid Depression/Anxiety fit in with this model?

A
  • Negative affect
  • Positive affect
  • Somatic Arousal

Depressive Disorders

  • Negative affect - high
  • Positive affect - low
  • Somatic Arousal - moderate

Anxiety Disorders

  • Negative affect - high
  • Positive affect - moderate
  • Somatic arousal - high

Comorbid

  • Negative affect - high
  • Positive affect - low
  • Somatic arousal - moderate

1:19:10

86
Q

What did Beck’s cognitive theory suggest about the aetiology of Depression?

What did he use to illustrate his theory?

A

Negative thinking led to depression

Beck’s Negative triad: Negative views of

  • SELF - WORLD - FUTURE

proposed to be caused by

  • Negative schemata acquired thru experience
  • Schemata lead to negative biases (i.e., cognitive errors)
    • which lead to negative views
  • viscious cycle

121:00

87
Q

What are some Cognitive theories of Depression?

A

Becks negative triad

Learned helplessness

  • (Martin Seligman)
  • later revised to incorporate ‘attributional style”
    • Internal
    • Stable
    • Global
  • revised again to highlight sense of hopelessness
  • sttributions only impt if contribute to hopelessness

123:30

88
Q

What are some social & psychological factors thought to contribute to Bipolar Disorder?

A

Depression:

  • Triggers similar to MDD
  • Negative events important precipitator
  • Predicted by neuroticism, negative cognitions, expressed emotion, lack of support

Mania:

  • One psychosocial model – reflects disturbance in brains reward system
  • Events involving attaining goals predict increases in manic symptoms
    • Getting married, graduating
  • Proposed that life events involving success may trigger cognitive changes in confidence
  • Spiraling into excessive goal pursuit

124:50

89
Q

Describe the integrative theory of mood disorders.

A
  • Depression & anxiety share a common genetic vulnerability explaining between 20% and 40% of the variance in mood disorders
  • Environmental & psychological vulnerabilities explain the rest
  • Often experienced as an inability to cope with life’s stressors (i.e. lack of resilience) leading to learned helplessness and a sense of hopelessness
  • Causes of psychological vulnerabilities can be traced back to childhood adversity
  • Stressful life events act as triggers
  • Interpersonal relationships can act as either protective or risk factors
    126: 50
90
Q

What are some treatment options for Depresssive Disorders?

A

Cognitive therapy

  • Alter maladaptive thoughts
  • Behavioural activation therapy
  • Mindfulness-based Cognitive Therapy
91
Q

What are some psychological treatment options for Bipolar Disorder?

A

Psychological

Psycho-educational approaches

  • educate about disorder management

Cognitive Therapy

Family-focussed treatment

131:00

92
Q

What are biological treatments for Bipolar disorder?

A

Antidepressant medications:

75% show improvement

    1. Selective serotonin re-uptake inhibitors
    1. Mono-amine oxidase (MAO) inhibitors
    1. Tri-cyclic antidepressants

Combining psychotherapy with medication bolsters odds of recovery by up to 20% above either alone

93
Q

What is the drug of first choice for treating Depressive Disorders?

How does it act?

What are some side effects?

A

Selective serotonin re-uptake inhibitors (SSRI’s)

e.g., prozac, sertraline

blocks presynaptic reuptake of Serotonin - leaving higher quantities available in the synapse

Side effects:

may inc suicidal ideation in first few weeks

physical agitation, sexual dysfunction, insomnia, gastrointestinal upset

94
Q

What is typically the last line of medication used for depressive disorders?

Why are they not preferred?

Which subtypes respond well to this medication?

A

Mono-amine oxidase (MAO) inhibitors:

  • Block the enzyme MAO
  • MAO breaks down nor-epinephrine, dopamine & serotonin
  • Increasing availability

Last line because

  • Potentially serious consequences:
  • Consuming tyramine (red wine, cheese, beer) > hypertension
  • Some everyday medications (cold medications) > dangerous interaction

More effective with ‘atypical’ ‘melancholia’ features

95
Q

Which antidepressent was widely used pre SSRI’s, but is not as commonly used now?

A

Tricyclic antidepressants:

  • Named after chemical structure
  • Mode unclear, initial block re-uptake of norepinephrine & serotonin
  • Complex effect on pre- & post-synaptic regulation

Not widely used now

  • Side effects: blurred vision, dry mouth, drowsiness, weigh gain
  • Consequence: ~40% discontinue
  • Lethal if taken in excessive doses
  • increases chance of suicidal behaviour
    136: 30
96
Q

What is the gold standard Biological treatment for bipolar disorder:

A

Mood stabilisers reduce manic symptoms:

  • Lithium remains gold standard
  • Up to 80% experience some benefit
  • 70% relapse in 5 years
    • effects wear off

Side effects = blurred vision > coma, death!

If Lithium is not tolerated:

  • Anticonvulsants (e.g. Valproate)
  • Antipsychotics (e.g. Olanzapine)
97
Q
A
98
Q

Why do so many people discontinue use of Lithium?

A

Flattened affect

Feel nothing, when used to experiencing enjoyable highs

99
Q

When is Electroconvulsive therapy generally resorted to?

How/why does it work?

What are some side effects?

A

When patient is treatment resistant

  • Most dramatic & controversial treatment for MDD
  • 70-130 volt current through brain

How/why it works?

  • Massive functional/structural changes?
  • Increases serotonin levels
  • Blocks stress hormones
  • Neurogenesis in the hippocampus?

Side effects

  • Short-term memory loss
  • Decline in cognitive function 6 months

z. z. PSY3032 Lectures - Abnormal Psychology (20 decks)

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