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