Mental health 2: Depression and bipolar disorders

Question 1

What is the key difference between a depressive episode and depressive disorder? Use the DSM criteria to demonstrate your response.

Answer 1

Subjects presenting with both disorders need to exhibit at least 5 DSM criteria, and at least one of the first 2 criteria:

1. Depressed most of the day and
2. Marked decrease in pleasure normally attained from activities.

A depressive episode shows demonstration of these symptoms over a period of 2 weeks, whereas depressive disorder features numerous episodes like this, or less commonly one episode longer than 2 weeks.

Question 2

Recall as many of the 9 DSM depression criteria under section A as you can.

Answer 2

1. Depressed mood most of the day, nearly every day
2. Markedly diminished pleasure/interest in activities
3. Significant weight loss or weight gain
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness and excessive guilt nearly every day
8. Diminished ability to concentrate nearly every day
9. Recurrent thoughts of death, suicide, suicide attempts

Question 3

What are section B and C of the DSM depression diagnosis criteria?

Answer 3

B. Clinically significant distress or impairment

C. Not attributed to substance use or other medical condition

Question 4

The 5 depressive symptoms can be broken into 3 categories. What are they?

Answer 4

• Affective symptoms: depressed mood, anhedonia
• Cognitive symptoms: indecisiveness, lack of concentration
• Somatic symptoms: fatigue, sleep or appetite change

Question 5

One week VS 4 days. Which represents the minimum time for a Bipolar 1 manic episode and which for a bipolar 2 hypermanic episode?

Answer 5

4 days: bipolar 2

One week: bipolar 1

Question 6

Cyclothymic disorder is a milder presentation of bipolar 2 disorder. What is the minimum length of time a person must present with these symptoms, and what is the max time they can have breaks from the symptoms?

Answer 6

2 years, 2 months

Question 7

Which type of bipolar is more common in women?

Answer 7

bipolar 2

Question 8

What is the typical onset age for bipolar, and what is the delay in seeking treatment?

Answer 8

15-25 years, 10-20 years

Question 9

What is the 12 month compared to lifetime prevelance of bipolar?

Answer 9

1%

1.3%

Question 10

How many mania episodes would an untreated bipolar subject experience?

Answer 10

8-10

Question 11

What is the relapse rate for people who have been treated for bipolar? State the 1 year relapse rate and the 5 year relapse rate

Answer 11

40% will relapse within one year, 73% within 5 years

Question 12

How many bipolar sufferers will attempt suicide, and how many will complete?

Answer 12

25% will attempt, 10-20 will complete

Question 13

50% of people with bipolar have a comorbidity with anxiety. What are the 3 most common anxiety disorders for this comorbidity?

Answer 13

Panic disorder, GAD and social phobia

Question 14

1% of people have been diagnosed with bipolar. What is the increase in risk for those who have a parent with BP?

Answer 14

10%

Question 15

Describe the Diathesis-Stress Model of aetiological psychological factors which could trigger a depressive episode

Answer 15

Life stressors cause disturbances to circadian rhythm. This leads to the prodromal (overload) stage, leading to poor coping strategies, which triggers an episode.