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Summary 3.4C Affective Disorders

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  • April 21, 2023
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3.4C Affective Disorders

1. Depression Part 1
What is depression?


How do we diagnose major depression, what are the subtypes and what are the general
characteristics of this disease and what are the most important cognitive theories?

General:

 WHO = single largest contributer to global disability

Frequently asked questions:

What are common mental disorders? What is depression?

 impact on the mood or feeling of affected person
 anxiety and somatic complaints

Definitions:

Depressive Disorder:

 sadness, loss of interest/pleaure, feeling of guilt. or low self worth, disturbed
sleep/appetite, feelings of tiredness and poor concentration
 can be long lasting or recurrent

major depressive disorder/ depressive episode: symptoms of depressed mood, loss of
interest and enjoyment, decreased energy → mild moderate or severe

 based on nr symptoms, level distress, intensity symptoms, degree impairment social
and occupational functioning




 first 2 symptoms = highest positive predictive value

Global and regional estimates of health loss:

 losses in health and functioning

Development:

 at least 1/3 of symptomatic cases follow moderate-severe course

Neurocognition:

,  cognitive deficits as core dimension → may be progressive in patients in subdomain
of learning/memory
 reduce life expectancy and increase social and economic burden
 gene environment interaction→ neurobiological changes = altered brain structures
 cognitive affective changes= hypervigilance to threat

What are the diagnostic criteria for major depression according to DSM-5 ?

Symptom profile:

9 symptoms: depressed mood & diminished interest/pleasure = mandatory

, reduced concentration/indecisiveness, feeling worthless/guilt, recurrent thoughts of death,
in/hypersomnia, change appetite/weight, psychomotor agi/retardation, fatigues/loss energy

 at least 5 most of the day, nearly every day for at least 2 weeks

Severity:

 based on numer of symptoms, level of distress & degree impairment

mild deression= few if any symptoms

 intensity is distressing but manageable
 minor impairment social /occupational functioning

severe depression= excess of what is required to make diagnosis

 intensity symptoms is serious distressing and unmanageable
 symptoms markedly interfere with social and occupational functioning

Dysfunctional cognitive schemas:

 negative perception of self, world and furture (cognitive triad) through schemas
characterized by loss, failure, worthlessness and rejection
 negative information processing bias
 cognitive restructuring→ modify schemas to achieve functional role
 cognitive negative biases → impaired ability to use past memories

What are the diagnostic criteria for persistent depressive disorder (dysthymia)
according to DSM-5?

dysthimia: persistent or chronic form of mild depression (less intense and last longer)

 only one core symptom = depressed mood




What are atypical, psychotic and melancholic features of major depression?

,Clinical Subtypes:

melancholic= many somatic symptoms

 either loss of pleasure in almost all activities, or lack reactivity to pleasurable stimuli
→ not depresse dmood (can be present but not required)
 not even highly desired events have mood brighten
 more likely in more severe

and at least 3 of:

1. distinct quality of depressed mood = deapair or empty mood
2. worse depresison in morning
3. psychomotor agi/retardation
4. anorexia/weight loss
5. excessive/ inappropriate guilt




Treatment:

 respond less to psychotherapy

psychotic depression

 presence of delusions/hallucinations → stops when depressive episode ends
 associated with increase suicidiality
 requires specific treatment approach




 increased suicidality

Treatment:

 most effective antipsychotic + antidepressant

What is the typical gender distribution in major depression?

Global and regional estimates of prevalence:

Depression:

 more common among females (5.1%) than males (3.6%)

,  322 million people suffer = 4,4% world population
 Increased by 18.4% between 2005-2015

What are the most important risk factors for depression?

WHo is most likely to get depressed?

 increased by poverty, unemployment, life events, physical illness and substance use
 peaks in older adulthood

Personality traits:

 neuroticism as vulnerability → respond poorly to environmental stress
 Low in conscientiousness → likely to drop out

Antecendent and concomitant psychiatric conditions:

 anxiety conditions→ increased depression → high genetic correlation
 Especially substance use, anxiety & borderline personality disorder

Physical comorbidities

 Particularly cardiometabolic diseases
 Various factors → e.g unhealthy lifestyle & use of antidepressants
 Diabetes mellitus (1.5 x higher risk)

Family history:

 heritability at 37% with higher rate in women than men

Early environmental exposures:

 emotional abuse and neglect highly associated with depression
 early adversity= risk depression onset, maintenance and recurrence

recent environmental exposures:

 major life events, chronic stressors and daily hassels
 caregivers for children with intellectual disabilities, family member with dementia
 dysfunctional cognitive schemas are predictive for onset of new depressive episode

What is the course of depression?

Depression and Other Common Mental Disorders: (WHO)

 suicide deaths = 800 000→ depression is major contributor
 Accounts for 1.5% of all death worldwide

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