Introduction to Affective Disorders

Question 1

What are affective (mood) disorders characterized by?

Answer 1

Affective disorders, also known as mood disorders, are characterized by disturbances in an individual’s mood. They are broadly divided into unipolar depression and bipolar disorder.

Question 2

Which two major classification systems are used for affective disorders?

Answer 2

The Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD).

Question 3

List some types of depressive disorders included in the DSM-5.

Answer 3

• Disruptive mood dysregulation disorder
• Major depressive disorder
• Persistent depressive disorder (dysthymia)
• Premenstrual dysphoric disorder
• Substance/medication-induced depressive disorder
• Others

Question 4

What are some categories of mood disorders in the ICD-10?

Answer 4

• Manic episode
• Bipolar disorder
• Major depressive disorder (single episode or recurrent)
• Persistent mood disorders
• Unspecified mood disorders

Question 5

What are common comorbidities associated with affective disorders?

Answer 5

Affective disorders often co-occur with anxiety disorders, impulse control disorders, and substance use disorders.

Question 6

What are the negative impacts of mood disorders on individuals and society?

Answer 6

Mood disorders can significantly impair quality of life, cause economic burdens, and increase the risk of dementia.

Question 7

What is the estimated genetic contribution to unipolar depression and bipolar disorder?

Answer 7

• Unipolar depression: 33-42%
• Bipolar disorder: 80-90%

Question 8

What is the neurogenesis hypothesis related to depression?

Answer 8

The neurogenesis hypothesis suggests that altered rates of neurogenesis in the adult hippocampus might underlie the development or recovery from major depression.

Question 9

List some imaging techniques used to study affective disorders.

Answer 9

• MRI
• CT/CAT
• DTI
• PET
• SPECT
• fMRI
• MEG
• EEG

Question 10

What are the key criteria for diagnosing depression in the DSM-5?

Answer 10

A person must experience five or more symptoms during the same 2-week period, with at least one symptom being depressed mood or loss of interest/pleasure.

Question 11

What is the monoamine hypothesis of depression?

Answer 11

The monoamine hypothesis suggests that depression is caused by a deficiency of monoamine neurotransmitters (serotonin, dopamine, norepinephrine) in the brain.

Question 12

How is oxidative stress related to depression?

Answer 12

Oxidative stress, characterized by an imbalance between reactive oxygen species (ROS) and antioxidants, is associated with decreased neurogenesis and can contribute to depression.

Question 13

What factors should be considered in a holistic approach to mood disorders?

Answer 13

• Genetic factors
• Neurobiological factors
• Psychological factors
• Social factors
• Cultural factors
• Environmental factors
• Early trauma
• Nutrition
• Inflammation

Question 14

What is the role of NICE in managing affective disorders?

Answer 14

NICE (National Institute for Health and Care Excellence) provides guidelines for clinicians based on research outcomes and health economics.

Question 16

What is the disease burden of psychiatric disorders, particularly mood disorders?

Answer 16

Psychiatric disorders are the largest single class of disease burden globally. Mood disorders, including bipolar disorder and major depression, are the most significant subpart, contributing more to disability-adjusted life-years than cancer.

(Prince et al., 2007)

Question 17

What is the economic impact of mood disorders in the European Union?

Answer 17

Mood disorders affect 33.4 million people in the EU, with an estimated economic cost of €113.4 billion in 2011.

(Nutt, 2011)

Question 18

What are the key features of bipolar disorder?

Answer 18

Bipolar disorder includes multiple phases: mania, hypomania, full-blown depressive episodes, and subsyndromal depression. It is often comorbid with substance abuse, anxiety disorders, and other psychiatric conditions. Mixed states (mania and depression together) are common.

(Young, Lecture 1)

Question 19

What are the key epidemiological findings for bipolar disorder?

Answer 19

Lifetime prevalence: 1% for bipolar I disorder, 1.1% for bipolar II disorder, and 2.4% for sub-threshold bipolar disorder.
* 75% of patients have psychiatric comorbidities.
* Symptoms of mania increase the risk of substance abuse, while symptoms of depression lead to severe functional impairment.

(Merikangas et al., 2007; Merikangas et al., 2011)

Question 20

When does bipolar disorder typically onset?

Answer 20

Bipolar disorder typically onsets before the age of 25, with a steep increase in incidence from ages 12 to mid-20s. Later onsets are rare and may represent a different form of the illness.

(Merikangas et al., 2007)

Question 21

What is Kraepelin’s affective states continuum?

Answer 21

Kraepelin proposed a continuum of affective states ranging from pure mania to pure depression, with intermediate states like depressive mania, excited depression, and inhibited mania. This model highlights the complexity of mood disorders.

(Young, Lecture 1)

Question 22

What are the key epidemiological findings for Major Depressive Disorder (MDD)?

Answer 22

Lifetime prevalence: 16% in the US and 8.5% in the EU.
* 12-month prevalence: 7% in the US.
* Mean days unable to work or carry out normal activities due to depression: 35 days per year.
* High comorbidity with anxiety disorders (60%) and substance use disorders (24%).

(Kessler et al., 2003)

Question 23

What are common triggers for major depressive episodes?

Answer 23

Triggers include serious losses, difficult relationships, financial problems, and other stressful life events. Genetic vulnerability, psychological factors, and environmental stressors interact to precipitate depression.

(Young, Lecture 1)

Question 24

What are the key factors influencing the time course of depression?

Answer 24

Higher incidence in females (ratio ~2:1).
* Increased risk with younger age, prior alcohol or drug abuse, and panic attacks.
* Risk of recurrence increases after each episode.
* Genetic factors like 5-HTT polymorphism influence vulnerability and resilience.

(Eaton et al., 2008)

Question 25

What is the prevalence of comorbid anxiety disorders in mood disorders?

Answer 25

60% of patients with MDD have comorbid anxiety disorders. * 75% of patients with bipolar disorder have comorbid anxiety disorders. * Comorbid anxiety significantly increases the severity and functional impairment in mood disorders. ## Footnote (Kessler et al., 2003)

Question 26

How can bipolar disorder be differentiated from borderline personality disorder?

Answer 26

Bipolar disorder: Onset in teens/early 20s, spontaneous mood changes, recurrent suicidal gestures related to depressive episodes. * Borderline personality disorder: No defined onset, mood changes precipitated by events, chronic impulsivity, self-mutilation, and endorsement of 'emptiness' rather than 'depressed mood.' ## Footnote (Yatham et al., 2005)

Question 27

How much depression is actually bipolar disorder?

Answer 27

16% of depressive episodes are bipolar using DSM-IV criteria. * 31% using modified DSM-IV criteria (allowing antidepressant-induced hypomania). * Up to 54% using broader definitions. * Unrecognized bipolarity is overrepresented in treatment-resistant depression. ## Footnote (Angst et al., 2011; Li et al., 2012)

Question 28

What are the treatment needs for patients with bipolar depression?

Answer 28

Improved treatment of depression is the top priority for patients. * Other needs include reduced risk of weight gain, prevention of relapse, and improved quality of life. * There is a significant gap in evidence-based treatments for bipolar depression. ## Footnote (McIntyre, 2009)

Question 29

What are the key considerations in diagnosing mood disorders?

Answer 29

Recurrence and severity of episodes. * Presence of major depressive episodes. * Evidence of mania/hypomania or mixed states. * Psychiatric comorbidities and physical health. * Age of onset, family history, and treatment history. * Functional and neurocognitive status. ## Footnote (Young, Lecture 2)

Question 30

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

Answer 30

Accurate diagnosis, including identification of all comorbidities. * Balance between efficacy and adverse effects. * Improved social support, psychoeducation, and adherence to treatment. * Goal: Meaningful remission with optimal functioning and quality of life. ## Footnote (Young, Lecture 2)

Question 31

What are the key conclusions regarding mood disorders?

Answer 31

Mood disorders (MDD and bipolar) are common, complex, and costly. * Treatment resistance is a significant challenge. * Individualized treatment approaches are essential for improving outcomes. ## Footnote (Young, Lecture 2)

Question 32

What are the main goals of this lecture series on emerging focuses in affective disorders?

Answer 32

To understand major topics in 21st-century research on affective disorders, conceptualize research avenues that progress mechanistic understanding, and grasp the translational potential of these emerging research areas.

Question 33

What are the key messages from the Lancet's call to action on depression?

Answer 33

Depression is common but poorly recognized and understood. * It is heterogeneous and influenced by cultural and contextual factors. * Prevention is essential, and treatment gaps need to be closed through personalized care and collaborative delivery. * Increased investment in early detection and long-term, person-centered care is needed.

Question 34

What are the key messages from the call to action on bipolar disorders?

Answer 34

Bipolar disorder is associated with premature mortality and is highly heritable. * It is complex, severe, and often underdiagnosed. * There is an underuse of lithium and overuse of antidepressants. * Effective treatments are unavailable in low- and middle-income countries. * Collaborative care and targeting comorbidities are essential.

Question 35

What technological factors are aiding research in affective disorders?

Answer 35

Activity monitoring (e.g., actigraphy), passive smartphone data, speech/text data, and machine learning.

Question 36

What social factors are influencing research in affective disorders?

Answer 36

Social media use, cultural considerations, and pandemic impact.

Question 37

What are some biological markers studied in affective disorders?

Answer 37

Monoamine hypothesis, neuroplasticity, inflammation, genetics, and HPA axis dysregulation.

Question 38

What is computational psychiatry, and how is it used?

Answer 38

Computational psychiatry uses mathematical models to understand the brain's processes and predict outcomes.

Question 39

Why is heterogeneity a challenge in depression research?

Answer 39

Modern diagnostic criteria allow over 1,000 unique symptom combinations, leading to inconsistent findings.

Question 40

What are future directions for addressing heterogeneity in affective disorders?

Answer 40

Identifying homogeneous subgroups, transdiagnostic approaches, and multimodal integration.

Question 41

What are some emerging treatments for depression?

Answer 41

Ketamine, psychedelics, and neuromodulation techniques.

Question 42

What are the challenges in implementing new treatments like ketamine and psychedelics?

Answer 42

Limited duration of effect, potential for abuse, uncertainty in long-term effects, and need for psychotherapeutic integration.

Question 43

What is personalized medicine in affective disorders?

Answer 43

Using biological and clinical markers to predict individual responses to treatments.

Question 44

Why is early intervention important in affective disorders?

Answer 44

Delays in treatment are associated with poorer long-term outcomes and improving early intervention services can reduce costs.

Question 45

What are some prevention strategies for affective disorders?

Answer 45

IPSRT, family-focused interventions, and detection of prodrome.

Question 46

What are the key takeaways on progress in affective disorders?

Answer 46

Significant progress is being made, driven by technological and social advances, with a focus on prevention, early intervention, personalization, and evidence-based treatments.