Mood disorders: Unipolar and bipolar

MDD was first described by hippocrates as what

Melancholia

melancholia arose from a presence of too much __ __

black bile

Emile Kraepelin and classification

believed the chied origin of psych is biological/genetic in nature

• grouped diseases based on class of syndromes not symptoms

Kraepelin and theory of psychosis

refined the concept of psychosis into

1) dmentia praecox: cog disiintegration

2) Manic-depressive illness, mood disturbance, disrupt in affect

Dementia praecox was eventually re labeled into

schizophrenic

who first distinguished uni and bi polar depression

Karl leonhard

MDD introduced in what DSM

3

DSM 5: chnages to MDD

• addition of disruptive mood disregulation disorder

• persistent depresive disorder (dysthymia)

• PRE menstrual dysphoric disorder

• bereavement clase removed

if you have any hiostory of mania can you be diagnosed with MDD

no

DSM criteria: MDD all __symptoms must be present simultaneously over a __ week period

5, 2

MDD DSM criteria: two cardinal symptoms

1. dysphoric mood (sad, empty. tearful)

2. Anhedonia: diminished intereast in almost all activities

DSM criteria: non cardinal symptoms 7

1. weight loss or gain

2. insomnia/hypersomnia

3. psychomotor aggitation or retardation (jiggle or slow)

4. fatigue

5. worthelessnes/guilt

6. diminished ability to concentrate or indecissiveness

7. thoughts of death

Prevalence distinction between uni and bi polar

MDD is 10-20x more common

uni is 2F:M

which mood disorder has an earlier onset

bipolar

forms of unipolar depression 4

1. recurrent depression

2. Melancholia

3. atypical

4. Chronic MDD

Forms of Unipolar: Melancholia

• more biological?

• dosesnt respond to anti depressants as much

• respond to psychotherapy

• no difference in family history

• not stable across episodes

Forms of Unipolar: Atypical

• 15% of patients

• early onset

• more comorbidity

• strongly associated with treatments (MAOIs and less effective SSRI)

which form of unipolar dep does not respond to tricyclics

atypical

Forms of Unipolar: chronic

2+ year episodes

Tripartite model of MDD and GAD

Epidemiology: unipolar

• Lifetime prev 16-17%

• 20-25% for F and 9-12 for M

prevalence of Persistent depressive disorder is higher or lower than other unipolar disorders

lower

cross culture prevalence within North america of unipolar

suggests lower for black americans lower than white

in asian/latin american and north african countries depressions has more ___ presentations

somatic, headache, loss of energy, sleeplessness

Course iof MDD

-onset, mid teens-20s

• 25% preceded by low grade chronic PDD

predictors of loinger episodes unipolar

• personailty dis

• non mood comorbid disorders

at least ___ of people iwth one depressive episode will have another

1/2

suicide is most common in what period of a mood disorder

6 months after recovery

etiology: familial

• higehr rates of mood disorders in family where proband has mood disorder

• gigher rates of MDD in family of proband with MDD

PBI Parker study of stress and adversity in mood disorders

Two dimensions of caregiving: care and overprotection

• depressed patients report parents lower in care, some higehr in overprotection

• interaction poses heightened risk for depression

Stress and Depression: prior to onset of MDD what percentage of women experienced a stressful event

75%

Causality of stress and adversity

1. depressed people more sensitiuve to effects of stress

2. but also generate more stress in their lives

3. important to distinguish between dependent and independent stressors

Behavioural models of depressions: reward and positive reinforcement

• depression is related to a reduction in behaviours that are positively reinforced

• treatment would be to increase the amount of positive behaviours in the world

Behavioural models of depressions: Beck

Cognitive triad

• focused on cognitions that contribute to lack of motivation

• Negative views of world, negative views of future, negative niews of oneself

Behavioural models of depressions: learned helplessness

Puppy study, shocks and gate no gate

• essentially puppy stops trying to get out

Behavioural models of depressions: revised learned helplessness

3 dimensions of attributions to stressor

1. external vs internal

2. global vs specific (eg. if you arenst the favourite than No ONE likes you)

3. stable vs unstable (forver vs now)

what attributional styles are mpost associated with depression

internal, global and stable

Cognitive biases associated with MDD

memory and attentional

stroop task tests what?

colour/word task and MDD patients find it harder to avoid negative words

Bipolar DSM criteria A: 3

1. manic episode at least one week

2. manic episode can consitist of elevated expansive mood or irritability

3. persistent goal directed activity

Bipolar DSM criteria: B

need 3 or 4 (if only irritability in criteria A)

1. grandiosity

2. decreased need for sleep

3. more talkative (pressured speech)

4. distractability (jumping thoughts)

5. goal directed activity

6. increased libido

7. more agitated

8. excessive pleasurable activities

Bipolar has a large overlap with what

unipolar, ADHD and psychosis

To diagnose with Bipolar you need __ impairment

marked

Bipolar 1 vs 2

1. mania plus an episode of MDD

2. Hypomania and depression, milder

   • no hospotalization

   • less interference

cyclothymia

a form of bipolar

• hypomania and shity depressive episodes

• chronic but less severe

• lots of highs and lowsat increased risk for bipolar 1

what form of bipolar can antidepressant meds trigger

cyclothymia

Forms of bipolar: Rapid cycler

a specifier

• 4+ episodes within a year

• can be either type of episode

to be a rapid cycler you need how many episdoes per year

4+

Bipolar: Psychotic Symptoms

loss of contact with reality

• in bipolar its usually mood related not thought

• if they occur during manic episode then they are considered a mood disorder w psychosis

Bipolar Psychotic Symptoms: Mood congruent vs incongruent

1. congruent: align with affective state

   • in mania: grandiose delusions

   • in dep: sad low delusions of sin/disease

2. incongruent:

   • mania: thought insertion mind control

   • dep: anythings happy

an example of mood incongruent psychosis in mania

though insertion or mind control

an example of mood congruent psychosis in mania

delisoons of grandeur

Epidemiology of Bipolar: LT prev and F vs M

• 2-4% for bip 1 amd 2

• prev is not affected by sex

takes __ years for individual with bipolar disorder to receive corect diagnosis

6-10 years

treatments for bipolar

mood stabilizers and anticonvulscents

you are more likely to begin bipolar with a depressive episode T or F

no, its ½

Suicide and bipolar

15X higher than general population

death by suicide is __X more likely in Bipolar patinets than MDD

4

Etiology of Bipolar: Environmental stress and adversity

• stress increases 6 months prior to episode

• frequent relapse following stressful experiences

class of stressors that are important to triggering mania

goal attainment events

• when achieve goal, become very happy, disregulation of mood

How does stress get into the brain? Goddard

kindling:

• stimulated brain repeatedly with electricty to develop seizures

• over time requirelower doses to provoke

• eventually seizures occur spontaneously

kindling and bipolar

idea that each episode of mania requires less stress to trigger

exposure to bright lights can trigger manuic episode how

can change circaidan rhythms

Neurobiology of Bipolar

Striatum

• larger in bipolar patients

• Reward activity in VS is abnormally elevated in patients

there is a failure of pre frontal regions to __ __ VS responses

down regulate

reward consumption related activation is more prominent in what type of Bipolar

1

lithium does what

interrupts dopa signalling in Brian, glutatmate antagonist