Week 8 Lecture 8 - Depressive Disorders - Summary (DN) Flashcards
What differentiates Bipolar disorders from Depressive Disorders?
Presence of Mania
Which disorders are amongst the most common of the psychological disorders?
mood disorders
What is the key identifying feature of Bipolar Disorder?
alternation of manic episodes & major depressive episodes
Why are the specifiers (subtypes) useful?
they may predict course or response to treatment
What causes mood disorders?
- Complex interaction of biological, psychological & social factors
- Stress hypothesis & neurohormones
- Learned helplessness, cognitive schemas Interpersonal disruptions
What are effective treatments?
- biological & psychological both effective
- combined = further 20% improvement
What psychological therapies are effective in treating Depressive Disorders?
Cognitive & interpersonal therapies
What is the long term prognosis for mood disorders?
relapse is common
What are the subset of the mood disorders that involve manic symptoms referred to as?
How are these differentiated?
- Bipolar
- Differentiated by intensity, duration & type of symptoms
0:50
What are disorders that only involve depressive symptoms commonly referred to as?
How are these disorders differentiated?
- Unipolar
- Differentiated by the severity & duration
0:33
What are the two main ‘mood disorder’ categories in DSM-5?
- Depressive disorders
- Bipolar and related disorders
0:22
What are the defining features of Depressive Disorders?
- profound sadness
- inability to experience pleasure
What are some really important components in the diagnosis of Major Depressive Disorder?
- Must not have had a manic episode
- needs to be almost all of the time for at least 2 weeks
5:00
What is the time course for Major Depressive Disorder?
- an episodic disorder
- symptoms come & go
- although can drag on for months
- tends to recur
5:00-7:00 approx
What are the defining features of Dysthymia (Persistent depressive disorder)
- persistent, chronic, depressed mood
- no relief
- more than 2 years
How does Dysthymia differ from Major Depressive Disorder?
Dysthymia (persistent depressive disorder)
- 2 symptoms 2 years (1yr for child)
- chronic
Major Depression
- 5 Symptoms, 2 week period
- episodic
What are the 4 Depressive Disorders covered in the lecture?
- Major Depressive Disorder
- Dysthymia (Persistent Depressive Disorder)
- Premenstrual Dysphoric Disorder
- Disruptive Mood Dysregulation Disorder
Which two Depressive Disorders are new to DSM-5?
- Premenstrual Dysphoric Disorder
- Dysruptive Mood Dysregulation Disorder
What are the defining features of Premenstrual Dysphoric Disorder?
- affect up & down (moody)
- impacted concentration, energy, sleep, appetite, physical pain
- must cause significant distress/impairment
What are the defining features of Disruptive Mood Dysregulation Disorder?
- Chronic, severe & persistent irritability
- negative mood in at least 2 settings,
- 12 months, most of the time
- no mania
Behaviour extreme
- recurrent temper outbursts
- inconsistent with developmental level
- must be differentiated from other disorders
14:45
What other disorders often coexist with Major Depressive Disorder & Dysthymia?
- Anxiety Disorder
- 60% Depressives also have anxiety
- Substance-related disorders
- Sexual dysfunction
- Personality disorders
- Cardiovascular disease
How do symptoms of Depressive Disorders behave across the lifespan?
- Symptoms change over lifespan
- children → somatic complaints
- older adults → distractibility & memory loss
Why are the MDD & BP disorder subtypes (specifiers) useful to a clinician?
enables them to build up a heterogeneous (individual) picture of how an individual may be presenting
48:10
How does a manic episode differ from a hypomanic episode?
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
What has been hypothesised about the role of neurotransmitter serotonin in the aetiology of mood disorders?
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
- leads to imbalance
1:08:40
Which neurotransmitter has been thought to contribute to hypomania & depression?
What has been found to trigger instability in this neurotransmitter?
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
What factors have been described in the Aetiology of Mood Disorders?
What theories have tried to explain these disorders?
-
Neurobiological factors, including:
- Genetic factors
- Neurotransmitters
- Neuroimaging
- Neuroendocrine system
- Social factors
- Psychological factors
- Personality factors
Theories
- Cognitive theories
- Learned helplessness
What distinguishes Disruptive Mood Dysregulation Disorder from other disorders?
such as Bipolar, ADHD (may be comorbid), Oppositional Defiance Disorder (children), Intermittent Explosive Disorder.
its the level of chronicity that distinguishes this disorder from others with similar symptoms
16:05
What aspect of the HPA axis is hypothesised to contribute to Depressive Disorders & Bipolar Disorder?
poorly regulated cortisol system 1:15:00
What is important to note about the influence of genes in mood disorders?
- they don’t cause disorders
- they confer a vulnerability
- sets stage for disorder in context of other factors
1:08:00
What social aspect contributes to Depressive Disorders?
Stressors Lack of Support to deal with Stressor 1:17:00
What bolsters the odds of successful treatment for Bipolar Disorder by 20%?
Combining psychotherapy with medication
- bolsters odds of recovery
- by up to 20% above either alone
What happens in the amygdala during depression?
What is generally seen in other brain regions?
What are the behavioural outcomes?
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
What new lines of neurobiological research
have shed some light on what differentiates
Major Depressive DIsorder from Bipolar Disorder?
Manic Episode
- Basal ganglia
- particularly active
- involved in reward reactions
- differentiates Manic from MDD
Bipolar Disorder
- Changes in neuronal membranes
- influencing how readily they can be activated
- not seen in MDD
1:12:50
