Week 8 Lecture 8 - Depressive Disorders - Summary (DN)

Question 1

What differentiates Bipolar disorders from Depressive Disorders?

Answer 1

Presence of Mania

Question 2

Which disorders are amongst the most common of the psychological disorders?

Answer 2

mood disorders

Question 3

What is the key identifying feature of Bipolar Disorder?

Answer 3

alternation of manic episodes & major depressive episodes

Question 4

Why are the specifiers (subtypes) useful?

Answer 4

they may predict course or response to treatment

Question 5

What causes mood disorders?

Answer 5

• Complex interaction of biological, psychological & social factors
• Stress hypothesis & neurohormones
• Learned helplessness, cognitive schemas Interpersonal disruptions

Question 6

What are effective treatments?

Answer 6

• biological & psychological both effective
• combined = further 20% improvement

Question 7

What psychological therapies are effective in treating Depressive Disorders?

Answer 7

Cognitive & interpersonal therapies

Question 8

What is the long term prognosis for mood disorders?

Answer 8

relapse is common

Question 9

What are the subset of the mood disorders that involve manic symptoms referred to as?

How are these differentiated?

Answer 9

• Bipolar
• Differentiated by intensity, duration & type of symptoms

0:50

Question 10

What are disorders that only involve depressive symptoms commonly referred to as?

How are these disorders differentiated?

Answer 10

• Unipolar
• Differentiated by the severity & duration

0:33

Question 11

What are the two main ‘mood disorder’ categories in DSM-5?

Answer 11

• Depressive disorders
• Bipolar and related disorders

0:22

Question 12

What are the defining features of Depressive Disorders?

Answer 12

• profound sadness
• inability to experience pleasure

Question 13

What are some really important components in the diagnosis of Major Depressive Disorder?

Answer 13

• Must not have had a manic episode
• needs to be almost all of the time for at least 2 weeks

5:00

Question 14

What is the time course for Major Depressive Disorder?

Answer 14

• an episodic disorder
  
  • symptoms come & go
• although can drag on for months
• tends to recur

5:00-7:00 approx

Question 15

What are the defining features of Dysthymia (Persistent depressive disorder)

Answer 15

• persistent, chronic, depressed mood
• no relief
• more than 2 years

Question 16

How does Dysthymia differ from Major Depressive Disorder?

Answer 16

Dysthymia (persistent depressive disorder)

• 2 symptoms 2 years (1yr for child)
• chronic

Major Depression

• 5 Symptoms, 2 week period
• episodic

Question 17

What are the 4 Depressive Disorders covered in the lecture?

Answer 17

• Major Depressive Disorder
• Dysthymia (Persistent Depressive Disorder)
• Premenstrual Dysphoric Disorder
• Disruptive Mood Dysregulation Disorder

Question 18

Which two Depressive Disorders are new to DSM-5?

Answer 18

• Premenstrual Dysphoric Disorder
• Dysruptive Mood Dysregulation Disorder

Question 19

What are the defining features of Premenstrual Dysphoric Disorder?

Answer 19

• affect up & down (moody)
• impacted concentration, energy, sleep, appetite, physical pain
• must cause significant distress/impairment

Question 20

What are the defining features of Disruptive Mood Dysregulation Disorder?

Answer 20

• 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

Question 21

What other disorders often coexist with Major Depressive Disorder & Dysthymia?

Answer 21

• Anxiety Disorder
  
  • 60% Depressives also have anxiety
• Substance-related disorders
• Sexual dysfunction
• Personality disorders
• Cardiovascular disease

Question 22

How do symptoms of Depressive Disorders behave across the lifespan?

Answer 22

• Symptoms change over lifespan
• children → somatic complaints
• older adults → distractibility & memory loss

Question 23

Why are the MDD & BP disorder subtypes (specifiers) useful to a clinician?

Answer 23

enables them to build up a heterogeneous (individual) picture of how an individual may be presenting

48:10

Question 24

How does a manic episode differ from a hypomanic episode?

Answer 24

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

Question 25

What has been hypothesised about the role of neurotransmitter serotonin in the aetiology of mood disorders?

Answer 25

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

Question 26

Which neurotransmitter has been thought to contribute to hypomania & depression?

What has been found to trigger instability in this neurotransmitter?

Answer 26

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

Question 26

What factors have been described in the Aetiology of Mood Disorders?

What theories have tried to explain these disorders?

Answer 26

• Neurobiological factors, including:
  
  • Genetic factors
  • Neurotransmitters
  • Neuroimaging
  • Neuroendocrine system
• Social factors
• Psychological factors
• Personality factors

Theories

• Cognitive theories
• Learned helplessness

Question 27

What distinguishes Disruptive Mood Dysregulation Disorder from other disorders?

such as Bipolar, ADHD (may be comorbid), Oppositional Defiance Disorder (children), Intermittent Explosive Disorder.

Answer 27

its the level of chronicity that distinguishes this disorder from others with similar symptoms

16:05

Question 28

What aspect of the HPA axis is hypothesised to contribute to Depressive Disorders & Bipolar Disorder?

Answer 28

poorly regulated cortisol system 1:15:00

Question 28

What is important to note about the influence of genes in mood disorders?

Answer 28

• they don’t cause disorders
• they confer a vulnerability
• sets stage for disorder in context of other factors

1:08:00

Question 28

What social aspect contributes to Depressive Disorders?

Answer 28

Stressors Lack of Support to deal with Stressor 1:17:00

Question 28

What bolsters the odds of successful treatment for Bipolar Disorder by 20%?

Answer 28

Combining psychotherapy with medication

• bolsters odds of recovery
• by up to 20% above either alone

Question 29

What happens in the amygdala during depression?

What is generally seen in other brain regions?

What are the behavioural outcomes?

Answer 29

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

Question 30

What new lines of neurobiological research

have shed some light on what differentiates

Major Depressive DIsorder from Bipolar Disorder?

Answer 30

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