Seminar 6 - Depression and Bipolar Disorder Flashcards
(16 cards)
Depression
“Depression is different from usual mood fluctuations and short-lived emotional responses to challenged in every day life… it can cause the affected person to suffer greatly and function poorly at work, at school and in the family. At worst, depression can lead to suicide. Over 700,000 people die due to suicide every year. Suicide is the fourth leading cause of death in 15-29-year-olds” -> World Health Organisation 2021
Major Depressive Disorder
Depressive symptoms, including emotional, motivation and cognitive features, negatively impact upon:
- individual ability to work
- interpersonal functioning and ability to sustain relationships
- systems (family, community, workplace)
- personal and family income
Clinical guidelines from National Institute for Health and Care Excellence (NICE, 2009) guidelines suggest:
- depression reflects “a heterogeneous group of disorders”
- comorbidity common
- social circumstances such as poverty, homelessness, unemployment, chronic physical or mental illness, isolation and lack of confiding relationship increase risk of depression
Ubiquitous features reported in international qualitative studies investigating depression (Haroz et al, 2017)
- depressed mood/sadness
- fatigue
- sleep
- social isolation
- weight/appetite
- crying
- suicidal thoughts
- loss of interest
- general pain
- anger
- heart issues
- guilt
- head ache
- hopelessness
- irratiblity
- thinking too much
- concentration
- worry
- anxiety
- impaired function
- weakness
- frustration
- stomach aches
- nervous/tense
- confusion
- head issues
- stressed/overwhelmed
- scared
- self-esteem
- interpersonal problems
- memory problems
- emptiness
- psychomotor agitation/slowing
- restlessness
- feeling trapped
- nausea
Major
Major Depressive Disorder: DSM-5 Diagnostic Criteria (APA, 2013)
Five or more of the following symptoms present during same 2-week period and present change from previous functioning; at least one of the symptoms is either (1) ir (2)
1. depressed mood most of the day, nearly every day
2. markedly diminished interest or pleasure in all, or almost all, activities most off the day, nearly every day
3. significant weight loss or weight gain/decrease or increase in appetite nearly every day
4. insomnia or hypersomnia nearly every day
5. psychomotor agitations or retardation near every day (observed by others)
6. fatigue or loss of energy nearly every day
7. feelings of worthlessness or excessive or inappropriate guilt nearly every day
8. diminished ability to think or concentrate, or indecisiveness, nearly every day
9. recurrent thoughts of death.recurrent suicidal ideation without specific plans, or a suicide attempt to specific plan for committing suicide
Symptoms cause clinically significant distress or impairment
Depression cont
Estimated of 12-month prevalence suggested 5-7% in adults in the UK
- research suggesting young adults there times higher prevalence than individuals ages 60+
- variety of research suggesting prevalence rate 1.5-3 times higher for reported symptoms of depression relative to men
Persistent Depressive Disorder (Dysthymia) - chronic symptoms of depression, lasting 2 years
Lifetime prevalence for unipolar depression approx 18% in Western Populations
Onset often during early adolescent (12-month prevalence 2-4%)
Impairs work, family and social functioning
Costs average workers about 27 lost working days per year (65 days for bipolar)
Majority of individuals who experience one episode will experience additional episodes
Depression risk/Aetiological factors
Setting factors (including cultural factors)
Biological factors
- genetics
- structure, process (e.g. neurotransmission), regulatory dysfunction
Psychological factors
- cognitive schema, belief assumptions
- information processing, attention and memory
- rumination
- optimism/pessimism
Social factors
- attachment
- trauma/loss
- life vents & hassles
- parental psychopathology
- relationship difficulties
- social support
Cognitive theories of depression
Distorted ways of thinking develop in childhood and place one at increased risk of depression later in life
Beck outlines the “cognitive triad”:
- Negative view of oneself -> perceive self as worthless, unlovable and lacking skills required to obtain happiness
- Negative view of the environment/present -> perceive environment as posing excessive demands or obstacles that are impossible to overcome and lead to failure
- Negative view of the future -> perceive future as hopeless and believing one is hopeless to effect change
Cognitive-behavioural maintenance cycle
Feeling depressed -> Negative thoughts: e.g. everything is pointless, nothing is enjoyable -> Withdrawal from activity: e.g. social, self-care, work -> Reduction of positive reward for engaging in activity: less experience of pleasure, achievement or social acceptance -> back to start
Situation:
- thoughts
- mood
- physical sensations
- behaviour
(all linked together)
Nice (2009) recommended treatments for depression
Step/severity -> recommended intervention
Step 1: recognition and assessment, all known and suspected presentations of depression -> assessment, support, psychoeducation, active monioritng and referral for further assessment and intervention
Step 2: Persistent sub threshold depressive symptoms, mild to moderate depression -> low-intensity psychosocial interventions (e.g. cCBT, guided sled help; CBT), psychological interventions, medication and federally for further assessment and interventions
Step 3: Persistent sub threshold depressive symptoms or mild to moderate depression with inadequate response to initial interventions; moderate and severe depression -> medication, high-intensity psychological interventions (e.g. CBT, IPT, BA, couple therapy), combined treatments, collaborative care and referral for further assessment and interventions
Step 4: severe and complex depression; risk to life; severe self-neglect -> medication, high-intensity psychological interventions (CBT, IPT), electroconvulsive therapy, crisis service, combined treatments, multi professional and inpatient care
Antidepressants
Antidepressants widely utilised -> 2017-2018 an estimated antidepressant 7.3 million people in the UK had one or more prescriptions issued (17% of adult population; PHE, 2019)
- selective serotonin uptake inhibitors (SSRIs) -> most commonly prescribed antidepressant type in UK
- tricyclic antidepressants (TCAs)
- monamine oxidase inhibitors (MAOIs)
Efficacy of antidepressants demonstrated across multiple international trials but mechanism of action subject to debate
Bipolar Disorder -> Manic Episode - DSM-5 Criteria (APA, 2013)
Distinct period of abnormally and present elevated, expansive or irritable mood and abnormally and presently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalisation is necessary)
Mood disturbance is sufficiently severe to cause marked impairment in so in or occupational functioning or to necessitate hospitalisation to prevent harm to self or others, or there are psychotic features
During the period of mood disturbance and increased energy of activity, three or more of the following symptoms (four if mood is only irritable) are present to significant degree and represent a noticeable change from usual behaviour:
1. inflated self-esteem or grandiosity
2. decreased need for sleep
3. more talkative than usual or pressure to keep walking
4. flight of ideas or subjective experience that thoughts are racing
5. distractibility (reported or observed)
6. increase in goal-directed activity or psychomotor agitation
7. excessive involvement in activistes that have a high potential for painful consequences
Hypomanic episode - DSM-5 Criteria (APA, 2013)
Diagnostic criteria for a manic episode include the following
- a distant period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day
- displays 3 of the symptoms assessed in main episode
- the episode is associated with an unequivocal change for function
- the disturbance in mood and change in functioning or observe by others
- episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalisation
DSM-5 -> Bipolar and related disorders
Bipolar I disorder
- at least one manic episode has occurred, major depressive episodes are typical but not requires to meet diagnostic criteria
Bipolar II disorder
- individual has experienced at least one hypomanic episode and one major depressive episode
Cyclothmyic disorder
- hypomanic and depressive symptoms are experienced for at least 2 years but which don’t meet criteria for hypomanic episode or MDE
Prevalence and risk factors
Lifetime prevalence of bipolar disorder in UK 1.7%
Often large delay in receiving appropriate diagnosis
There are a number of factors that work together that may make a person more likely to expire ce symptoms of bipolar disorder
these are thought the be a complex mix of physical, environmental and social factors
- family history and genetics
- brain anatomy
- psychosocial stressors e.g. traumatic/abusive experience
Symptoms, maintenance and treatment
Research suggests individuals who meet criteria for bipolar disorder on average spend significant (majority) time “asymptomatic”, next commonly experiencing periods of low mood and least time experiencing manic or mixed symptoms
Variety of cognitive, behavioural and psychological factors may perpetuate symptoms
NICE guidelines on treatment and management of bipolar disorder (NICE 2014) recommended combination of medication(s) and psychosocial therapy dependent upon current symptoms which may include CBT, mood stabilising medication (e.g. lithium carbonate), antipsychotic medication, antidepressant medication
Summary
A number of risk factors and variables are hypothesis to be involved in the aetiology and maintenance of depression and bipolar disorder which include variety of biological, psychological, social and cultural factors
A number of evidence-based treatments exist, psychosocial and psychopharmacological, which have been demonstrated to be helpful in treating symptoms of bipolar disorder and depression
