What are the types of unipolar depression (3) and bipolar depression (4)?
Unipolar:
- Major Depressive Disorder
- Dysthymia
- Depressive disorder NOS
Bipolar:
- Bipolar type I
- Bipolar type II
- Cyclothymia
- Mixed state
Name the 5 areas of funcioning in which symptoms of depression span
- emotional
- motivational
- behavioral
- cognitive
- physical
Name the 5 subtypes of depression
- melancholic features
- psychotic features
- catatonic features
- seasonal
- postpartum onset
What is the prevalence, male:female ratio, and mean age of depression?
Prevalence: 15% of adults experience an episode
Male:female = 1:2
The highest rates of depression are during middle adulthood (25-44 years)
What is the etiology of depression?
- genetics (clear evidence, candidate: genen for 5-HTT)
- brain structures (frontal lobes, amygdala, anterior cingulate cortex, hippocampus)
- neurotransmitters (serotonin, norepinephrine, dopamne)
- endocrine system (HPA axis)
Name the treatments of depression (4)
- pharmacotherapy
- ECT
- DBS
- psychotherapy
What is the mechanism of anitdepressants?
Most anitdepressants act on serotonin and NA activity - block the re-uptake. Antidepressants take several weeks before they alleviate symptoms
What is the relevance of neuropsychology in depression?
- neuropsychological deficits contribute to long-term functional outcome
- patients with cognitive deficits tend to show less compliance with regard to antidepressant medication
- patients with cognitive deficits may show an increased risk for suicide
In what neuropsychological areas are primary deficits in depression?
attention
executive functioning
memory
What are the underlying brain structures of depression? + the alterations
- hippocampus: reduced volume & decreased neurogenesis
- basal ganglia: reduced volume
- medial/orbitofrontal PFC: overactivated
- amygdala: overactivated
- mediodorsal thalamus: overactivated
What is the effect of abnormal HPA-axis funtioning in depression?
abnormalities of the HPA axis
- > increased cortisol levels during depressive episodes
- > toxic effect in the hippocampus
What are the effects of antidepressant medication on cognition?
Tricyclic antidepressants inhibit acetylcholine and thereby induce cognitive side effects
Speculated that SNRI’s may have great positive effects on cognitive performance
What are the effects of ECT on cognition?
Significant neuropsychological side-effects (in particular memory deficits)
- neuropsychological side effects resolve withing first 2 weeks
- presumably no great impact for the long term
Name 3 factors that the effects of on neuropsychological functioning depend on in depression
1) unilateral ECT may have a lower risk for cognitive side effects than bilateral ECT
2) elevated basal cortisol levels are associated with a greater decrease of cognitive functioning after ECT
3) greater cognitive resources may protect against adverse effects of ECT on cognition
What is pseudodementia?
Depression with severe cognitive impairment in the elderly
In what 2 aspects can social cognition be divided and how do you measure these?
1) perception of emotion (affect perception)
- measure: faces, eyes, prosody
2) complex social cognition (theory of mind)
- measure: false-belief tasks, cartoons, jokes, stories
