mood disorders

Question 1

prevalence of bipolar 1

Answer 1

1%

Question 2

prevalence of bipolar 2

Answer 2

1.2%

Question 3

lifetime prevalence of major depressive disorder?

Answer 3

10-20%

Question 4

gender distribution of bipolar 1 and bipolar 2?

Answer 4

bipolar 1 -> equal

bipolar2 male to female 2:1

Question 5

what did mental and substance abuse disorder account for in DALYs ?

Answer 5

7%

Question 6

what are the two disease classification manuals?

Answer 6

US DSM -> latest is 5 2013
WHO manual -> ICD
ICD-10 1994
ICD-11 on the way

Question 7

definition for mood or affective disorder?

Answer 7

fundamental disturbance is in mood
depression (with anxiety or without)
or to elation

accompanied by a change to overall level of activity
most symptoms are easily understood in the context of change in mood or activity

disorders tend to be recurrent or related to a stressful event

Question 8

how would you classify a depressive episode?

Answer 8

DSM-5 criteria for depressive episode:​

Occurrence of 2 weeks or more of depressed mood ​

AND the presence of 4 of 8 out of the following: ​

​

Sleep alterations (insomnia or hypersomnia)​

Appetite alterations (increased or decreased)​

Diminished interest or anhedonia​

Decreased concentration​

Low energy​

Guilt​

Psychomotor changes (agitation or retardation)​

Suicidal thoughts

Question 9

how is the major depressive disorder classified?

Answer 9

If no manic or hypomanic episodes in the past are identified, then the diagnosis of a current major depressive episode leads to a longitudinal diagnosis of Major Depressive Disorder (MDD).

Atypical features (which represent mainly increased sleep and appetite, along with heightened mood reactivity)​

Melancholic features (defined by no mood reactivity, along with marked psychomotor retardation and anhedonia)​

Psychotic features (the presence of delusions/hallucinations).

Question 10

core symptoms for depression triad?

Answer 10

low mood
anergia
anhedonia

Question 11

biological symptoms for depression triad?

Answer 11

sleep
libido
appetite

Question 12

how do you characterise manic episodes

Answer 12

Euphoric or irritable mood with 3 or more of 7 manic criteria: ​

Decreased need for sleep with increased energy​

Distractibility​

Grandiosity or inflated self-esteem​

Flight of ideas or racing thoughts​

Increased talkativeness or pressured speech​

Increased goal-directed activities or psychomotor agitation​

Impulsive behaviour (such as sexual impulsivity or spending sprees)

Question 13

how would type 1 bipolar be diagnosed?

Answer 13

minimum mania for a week with notable functional impairment

+ depressive episode as well

Question 14

how is a hypomanic episode diagnosed?

Answer 14

symptoms present for a minimum of 4 days

without notable functional impairment

Question 15

how is type 2 bipolar disorder diagnosed?

Answer 15

no manic episode
only hypomanic
along with one major depressive episode
then DSM -5 diagnosis is type 2

Question 16

how is unspecified bipolar disorder diagnosed?

Answer 16

if the manic symptoms are less than 4 days

Question 17

when can hypomania not be diagnosed?

Answer 17

when there are psychotic symptoms

when a patient is hospitalised -> mania is put down

Question 18

can a diagnosis still be made if is it caused by antidepressants?

Answer 18

yes in DSM-5 the diagnosis of mania can still be made

Question 19

Are bipolar disorders really mood diorders?

Answer 19

this can be difficult –> as they can have mania without euphoric mood and depression without sad mood just anhedonia may be present

Question 20

how is the course of the illness -> think of the graph ?

Answer 20

number of cycles per year varies
more than 4 is rapid cycling
and amplitude says either 1 bipolar, 2 bipolar or cyclothymia

Question 21

what are the first episodes in bipolar 1?

Answer 21

the first episode tend to be depressive

90-100% will develop more episode after the first manic episode

Question 22

how does insight differ in mania and depression?

Answer 22

insight it preserved in depression

and impaired in mania

Question 23

how is depression characterised in terms of biases?

Answer 23

is it characterised by biases in maintaining/shifting attention
difficult for people with depression to disengage from negative material -> look at sad image for longer

Question 24

what are some neurofunctional abnormalities in depression?

Answer 24

sustained amygdala response to negative stimuli
prefrontal cortex-> peregenual anterior cingulate cortex -> appears to mediate negative attentional biases
laterall inferior frontal cortex associated with impaired ability to divert attention from task irrelevant negative information.

Question 25

What are the memory biases in depression?

Answer 25

There are strong evidence for biased memory processes preferably recall negative compared to positive material memory biased present in individuals at risk (neuroticism) and in recovered depressed individuals enhanced amygdala response -> to negative faces

Question 26

how do antidepressants cause facial expression recognition modulation?

Answer 26

in healthy samples either noradrenergic antidepressants (reboxetine, duloxetine) -> better recognition of happy faces or serotonergic antidepressants mirtazapine -> decreased recognition of fearful faces SSRIs citalopram -> mixed results -> both increase and decrease amygdala response to SSRIs noradrenergic and serotonergic -> reduced recognition of anger and fear in clinical samples -> early change positive processing elevated baseline ACC activity

Question 27

what is the monoamine deficiency hypothesis?

Answer 27

depressive symptoms arise from insufficient levels of monoamine neurotransmitters serotonin, norepinephrine and/or dopamine

Question 28

How are serotonin levels in individuals who have committed suicide?

Answer 28

their serotonin levels are low

Question 29

Can we measure serotonin in a living human brain?

Answer 29

We can use PET scanning, but it is really expensive and invasive. with much less optimal temporal and spatial resolution. Using a 5-HT2A agonist PET tracer and amphetamine

Question 30

How does cerebral serotonin look like in humans?

Answer 30

serotonin receptors deficiency

Question 31

How do tryptamine psychodelics work on the brain?

Answer 31

The work on the serotonin system.

Question 32

What type of psychodelics are used?

Answer 32

tryptamine

Question 33

What are some of the benefits for psychodelics?

Answer 33

``` Rapid enduring mood improvement well being reduce OCD End of life distress -> reduce reduce addiction reduce depression reduce suicidal tendencies ```

Question 34

is it important to distinguish between bipolar and unipolar?

Answer 34

yes antidepressants can be ineffective in acute bipolar and in prophylaxis can cause manic or hypomanic episodes can worsen long term bipolar illness can lead to more depressive episodes over time in rapid cycling stages

Question 35

Bipolar affective disorder vs scizophrenia?

Answer 35

BPAD -> episodic hallucination/ delusions schizo -> chronic hallucinations/ delusions cognitive impairment schizoaffective shares features in both

Question 36

what are personality disorders?

Answer 36

maladaptive patterns of behaviours cognition, inner experience, exhibited across many context and deviating from those accepted by the individuals culture, patterns may develop early and are inflexible and be associated with significant distress or disability.

Question 37

bipolar affective disorder vs borderline personality disorder?

Answer 37

BPAD -> run in family, grandiosity, mood typically not state from environment BPD -> poor self image, fear of abandonment, feelings of emptiness BOTH rapid mood swings unstable interpersonal relationships impulsive sexual behaviour suicidality

Question 38

BPAD vs Attention deficit disorder

Answer 38

BPAD-> family history, recurrent depressive episodes, amphetamines worsen mania. both -> impaired concentration, impaired executive function, abnormal working and short term memory

Question 39

Organic causes of depression?

Answer 39

endo-> hypo and hyper thyroidism, hypo/hyper parathyroidism, cushings Addison's and hypoglycaemia infections, SLE, HIV, pancreatic cancer -> cytokines in systemic diseases are considered a cause of depression. deficiencies -> B12, folic acid neuro MS, Alzeheimers medication beta blockers, steroids, anti parkisons anti cholinergics IBS, some antibiotics, statins, oestroges, opiate painkillers, acne med vascular depression -> associated with white matter hyperintensities, impact cognitive function making the individual more likely to react to stressors. (early subcortical dementia) post stroke depression -> lesions in the left frontal lobe or basal ganglia -> can cause depression with a tendency that the more frontal the lesion the more severe the symptoms.