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Psychotherapy: 108b/109b - Depression and Bipolar Disorders I and II

Psychology25 CardsCreated about 2 months ago

This flashcard set reviews key diagnostic criteria and epidemiology of Major Depressive Disorder (MDD), including the requirement of at least one major depressive episode without manic/hypomanic episodes. It also distinguishes true neurobiological markers of MDD, highlighting that decreased activity in the left (not right) prefrontal cortex is associated with the disorder.

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All of the following have been described in association with Major Depression Disorder except:

  1. Decreased activity in right prefrontal cortext

  2. Blunted TSH response to TRH

  3. Short allele of serotonin transport protein

  4. Volume reduction in hippocampus

  5. Decreased BDNF

a. Decreased activity in right prefrontal cortext

Decreased activity in the left prefrontal cortex is a biomarker of recurrent MDD

All other findings are associated with MDD

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Key Terms

Term
Definition

All of the following have been described in association with Major Depression Disorder except:

  1. Decreased activity in right prefrontal cortext

  2. Blunted TSH response to TRH

  3. Short allele of serotonin transport protein

  4. Volume reduction in hippocampus

  5. Decreased BDNF

a. Decreased activity in right prefrontal cortext

Decreased activity in the lef...

What defines major depressive disorder? (MDD)

  • At least 1 major depressive episode

  • No periods of mania or hypmania

What is the lifetime prevalence of major depressive episodes in the US?

  • At least 1 major depressive episode

  • No periods of mania or hypmania

What is the lifetime prevalence of major depressive episodes in the US?

17%

21% females, 12% males

What is the lifeitme prevalence of Bipolar I disorder?

Bipolar II?

Both are ~1%

Tryptophan is a building block for which neurotransmitter?

Serotonin

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Psychotherapy: 108b/109b - Depression and Bipolar Disorders I and II
TermDefinition

All of the following have been described in association with Major Depression Disorder except:

  1. Decreased activity in right prefrontal cortext

  2. Blunted TSH response to TRH

  3. Short allele of serotonin transport protein

  4. Volume reduction in hippocampus

  5. Decreased BDNF

a. Decreased activity in right prefrontal cortext

Decreased activity in the left prefrontal cortex is a biomarker of recurrent MDD

All other findings are associated with MDD

What defines major depressive disorder? (MDD)

  • At least 1 major depressive episode

  • No periods of mania or hypmania

What is the lifetime prevalence of major depressive episodes in the US?

  • At least 1 major depressive episode

  • No periods of mania or hypmania

What is the lifetime prevalence of major depressive episodes in the US?

17%

21% females, 12% males

What is the lifeitme prevalence of Bipolar I disorder?

Bipolar II?

Both are ~1%

Tryptophan is a building block for which neurotransmitter?

Serotonin

What are the non-diagnostic but highly suggestive symptoms of a major depressive episode with mixed features?

Irritability, distractibility, and agitation in addtion to depressive symptoms

Which subtype of depression?

Mood reactivity, hypersomnia, leaden paralysis, hypersomnia

Depression with atypical features

How long must the 5 or more symptoms of depression last for something to classify as a major depressive episode?

2 weeks or more

What is the effect of the short allele of serotonin transporter?

  • Increased risk of depression and suicidality in response to stress

  • Likely to have a family history of depression

How are Bipolar I, Bipolar II, and cyclothymic disorder diffentiated?

  • Bipolar I

    • Requires history of manic episodes (at least 1)

  • Bipolar II

    • Requires history of hypomanic episodes

    • NO manic episodes

  • Cyclothymic disorder

    • More of a chronic state of ups and downs “undulating, cycling”

    • Recurrent mild depressive symptoms and hypomania lasting 2+ years

    • No fully syndromal major depressive episodes

Genetic factors are important in [early/late] onset depression

Genetic factors are important in early onset depression

What factors might increase the risk of recurrence of depression?

  • Positive family history

  • Incomplete treatment response

  • Neuroticim (personality trait)

  • Hypercortisolemia

Which of the following best describes bipolar disorder in contrast to unipolar major depressive disorder

  1. bipolar disorders are less likely to be respond adversely to sleep deprivation

  2. bipolar disorders have an earlier age of onset

  3. bipolar disorders are less likely to be psychotic

  4. bipolar disorders are more likely to have a positive response to antidepressant medications

  5. bipolar disorder has less concordance between monozygotic twins than is seen for major depressive disorder

b. bipolar disorders have an earlier age of onset (Maybe??)

This was one of the guiding questions and tbh I’m not sure what the answer is pls suggest an edit to share the answer if you know :)

What does the “with mixed features” specifier mean?

During a mood episode, at least 3 subthreshold symptoms from the opposing pole are present during a mood episode

Can occur in MDD, Bipolar I, Bipolar II

(In a major depressive episode of MDD, subthreshold symtoms means that the pt does not suddenly have Bipolar I or Bipolar II)

Which subtype of depression?

Pervasive anhedonia, weight loss, early morning awakenings

Depression with melancholic features

Describe the neurotrophic hypothesis of bipolar disorder

  • Vulnerable individual

  • -> Atrophy, cellular damage/death with subsequent stressors

  • -> Reduced neurogenesis

More cellular loss, further decreased connectivity with each episode

What are the core features of depression with melancholic features?

  • Pervasive anhedonia

  • Lack of reactivity to usually pleasuralbe stimuli

  • Depressed mood

  • Early morning awakening

  • Excessive or inappropiate guilt

  • No interest in food -> weight loss, no appedite

  • Psychomotor changes (physical signs of distress)

List 4 biomarkers of recurrent MDD

  • Decreased immune functioning

  • Blunted TSH response to TRH

  • Volume reduction: basal ganglia, hippocampus, frontal cortex

  • Decreased activity in the left prefrontal cortex

Which of the following is a core symptom of atypical depression?

a) expansiveness
b) hypersomnolence
c) loss of appetite
d) anhedonia
e) thought racing

b) hypersomnolence

Other core symptoms:

  • Weight gain/increased appetite (hyperphagia)

  • Leaden paralysis

  • Longstanding pattern of interpersonal rejection sensitivity

What is the usual age of onset for MDD vs. Bipolar disorder?

MDD: 24-30

Bipolar disorder: late adolescence-early adulthood

(pls lmk if you have more specifics)

Which is not a symptom of hypomania:

  1. excessive sleeping

  2. increase in goal directed behaviors

  3. overactive thoughts

  4. irritable mood

  5. distractibility

a. excessive sleeping

All other symptoms can be seen in hypomania

Difference between hypomania and mania: Hypomania does not cause a marked impairment in functioning

How does the risk of recurrence of depression change with each depressive episode?

Risk of recurrence increases with each episode

What are the differneces between mania and hypomania?

  • Mania causes marked impairment in fuctioning

    • Expansive, euphoric, grandiose, possibly irritable, hostile

    • Decreased need for sleep

    • Extravagant

    • Racing thoughts, distractable

    • Lasts >1 week

  • Hypomania does not cause marked impairment in functioning

    • Similar type of symptoms but much less noticible

    • Change is uncharacteristic for the person

    • May see increase in goal directed behavior, productivity

    • Lasts 4-7 days

Which neurotransmitters are associated with bipolar disorder?

Dopamine and norepinephrine

2nd messengers are also implicated (remember that Li acts on second messengers)