Psychology and Neuroscience of Affective Disorders PDF - Module 1 Lecture Transcript

Module: Psychology and Neuroscience of Affective Disorders Week 1 Introduction to affective disorders Topic 1 Introduction to the complex world of mood - part 1 of 3 Dr Patricia Zunszain Senior Lecturer, Department of Psyc...

Module: Psychology and Neuroscience of Affective Disorders Week 1 Introduction to affective disorders Topic 1 Introduction to the complex world of mood - part 1 of 3 Dr Patricia Zunszain Senior Lecturer, Department of Psychological Medicine Lecture transcript Slide 3: So we will start today by looking at the classification of affective disorders, and some of the causes and correlates. We will follow these by looking at the ways in which we can understand affective disorders. And we will mention some of the research methods that are in use. And in the last part today, I will introduce some theories and evidence around depression. Slide 5: Affective disorders are also known commonly as mood disorders, and they are a group of conditions where a disturbance in an individual's mood is the main characteristic. They are very complex neuropsychiatric conditions, and traditionally and broadly, they have been divided into two: those characterized by depressed mood, such as major depression disorder, which is also referred to as clinical depression, unipolar depression, or major depression, and conditions where this depressed mood is cycling with conditions where elevated mood, such as mania or hypomania are appearing. This is known as bipolar disorder, which was formally known as manic depression. Slide 6: Clinicians and researchers currently use two main systems for the classification of affective disorders. These are The Diagnostic and Statistical Manual of Mental Disorders, commonly referred to as DSM, and which is published by the American Psychiatric Association or APA, and the International Classification of Diseases, or ICD, which is produced by the World Health Organization, the WHO. Both classifications offer a common language and standard criteria and they allow medical health professionals to determine and to help communicate the patient's diagnosis after an evaluation, and they also allow to categorize patients using the criteria for research purposes. The classifications are also used for health insurance companies, for pharmaceutical companies and for the legal system, and while the DSM is the most popular diagnostic system for the mental health disorders in the USA, the ICD is used more widely in Europe and in other parts of the world. Week 1 © King’s College London 2019 1.  Slide 7: The DSM is now in its 5th Edition, the DSM-5. Previous editions are sometimes mentioned in lectures, and they appear in many papers commonly when referring to older studies. Those previous editions use Roman numerals so you may find references that indicate III, IV, or V as you can see on the screen, and it is important to note which criteria is being used, as they have some differences. In the DSM-5, depressive disorders include disruptive mood dysregulation disorder, major depressive disorder, persistent depressive disorder or dysthymia, pre-menstrual dysphoric disorder, substance or medication-induced depressive disorder, depressive disorder due to another medical condition, other specified depressive disorder, unspecified depressive disorder, or specifiers for depressive disorders. While for bipolar disorders, we have bipolar I, bipolar II, cyclothymic disorder, substance or medication- induced bipolar and related disorder, bipolar and related disorder due to another medical condition, and as for depression, other specified, unspecified or specifiers for bipolar and related disorders. Slide 8: The international classification of diseases, ICD, is currently in its version number 10, so we call it the ICD 10, and it covers health as a whole. They have a different grouping, and their classification of mental and behavioural disorder conditions considers mood or affective disorders as manic episode, bipolar disorder, major depressive disorder (either a single episode or recurrent), persistent mood or affective disorders and unspecified mood or affective disorder. Slide 9: The comorbidities, that is the additional diseases or disorders that are co-occurring with main effective disorder, are very common. Most of patients also have anxiety disorders in addition to depression and/or bipolar conditions. Some individuals consider anxiety as part of the mood disorders. Slide 10: And again, there are different subtypes of anxiety disorders. According to the DSM, they include separation anxiety disorder, selective mutism, specific phobias, social anxiety disorder, known as social phobia, panic disorder, panic attack specifier, agoraphobia, generalized anxiety disorder, substance or medication-induced anxiety disorder, and those due to another medical condition or other specified or unspecified anxiety disorders. Slide 11: Now within the ICD-10, anxiety is grouped with dissociative stress related somatoform and other non-psychotic mental disorders, and include phobic anxiety disorders or other anxiety disorders, the obsessive-compulsive disorders, reaction to stress and adjustment disorders, dissociative and conversion disorders, somatoform disorders, and other non-psychiatric mental disorders. Slide 12: Now mood disorders, either on their own or without are not just feeling a bit low. They're very serious conditions that cause a lot of suffering to the patients and to their families, and they can start at early age, and they are hard to diagnose in the youth, because they are sometimes confused with normal teenage behaviour, with drug use or with other psychiatric illnesses. And in addition to causing a Week 1 © King’s College London 2019 2.  significant negative impact on the patient's quality of life, all of these affective disorders also cause a considerable economic burden both individual and the society as a whole. Slide 13: In addition to these negative aspects of affective disorders, there are associations with increased risk of dementia. This is a big meta-analysis that included more than 60,000 individuals and that found that depression is associated with a two-fold increase risk of dementia in older age. Slide 14: Can we find out what causes these affective disorders? Well, here it's important to distinguish between cause and correlate. So a cause is something that produces an effect, a result or a condition, while a correlate is a phenomenon that accompanies another phenomenon, is usually parallel to it.is related to it in some way, but it's not necessarily the one causing it. So we need to avoid confusion. We can describe a lot of correlates of effective disorders, but causes are more elusive to identify. Slide 15: What causes or correlates with an effective disorder? Is it nature or is it nurture? In other words, is it genes or is it the environment? Well, will see that both are important. We can think of many factors, including stress, social support, childhood events, your parents or your grandparents experiences, the social economic status, work conditions, your general health status, the role of diet, of exercise, or sleep, importantly exposure of light and the gut microbiome, that is the bacteria that we have in our digestive system, as has been shown by many recent studies, and we will look at several of these factors in detail over the next few weeks. Week 1 © King’s College London 2019 3.