Summary Brain Diseases
Lecture 1 – Affective Disorders (Depression & Bipolar Disorder)
Psychiatric disorders
• Psychiatric disorders:
- Cognitive disorders
- Psychotic disorders
- Affective disorders
- Anxiety disorders
- Addictive disorders
- Eating disorders
- Developmental disorders
- Personality disorders
• Diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (DSM):
- Axis 1: Psychiatric diseases
- Axis 2: Personality disorder
- Axis 3: Somatic diseases
- Axis 4: Psychosocial stress factors
- Axis 5: Level psychosocial functioning
• Percentage of Dutch people that suffer from psychiatric diseases:
- 1/4 (25%) suffers from a psychiatric disorder ever in life
- Psychiatric disorders cause significant distress and impairment in social,
occupational or other important areas of functioning
• Burden of psychiatric disorders (EU):
• Central to the symptomatology of affective disorders are disturbances in the regulation of
specific emotions, but also cognitions, leading to disturbed behavior, usually precipitated by
stressful life-events
• Current neuroanatomical models for the pathophysiology of affective disorders emphasize
the role of disturbances in brain circuits involved in emotion and stress regulation
, → From a neurobiological perspective, all treatments are thought to eventually lead to
changes in these brain circuits
• Difference between psychiatrist and psychologist:
- Psychiatrist:
▪ Is a medical doctor
▪ Diagnosing psychiatric diseases
▪ Treating psychiatric diseases
- Psychologist:
▪ Studied psychology
▪ Helps with problems in daily life
▪ Strengthen resilience and normal development
▪ Does part of treatment of psychiatric diseases
• Affective disorders:
- Depression:
▪ Mild
▪ Moderate/severe
▪ Psychotic
- Bipolar disorder (depression + mania):
▪ Bipolar I & II
▪ Rapid cycling
Unipolar depression:
• Symptoms:
- Key symptoms:
▪ Depressed mood
▪ Loss of interest or pleasure
- Psychological symptoms:
▪ Difficulties to think or concentrate
▪ Anxiety, panic
▪ Indecisiveness
▪ Feeling hopeless
▪ Feelings of guilt
▪ Recurrent thoughts of death or suicidal ideation
▪ Feelings of worthlessness
▪ Delusions, hallucinations
- Physical symptoms:
▪ Sleep disturbances
▪ Less appetite, weight loss
▪ Loss of libido
▪ Pain
▪ Restlessness, inhibition
▪ Fatigue
• Recognizing depression in yourself:
- Difficulty to enjoy
- Worrying
- Depressed mood
, - Overstrained
- Being emotional, crying easily
- Everything is difficult, difficulty deciding
- Diminished concentration
- Sleeping difficulties, less libido
- Recurrent thoughts of death
• Recognizing depression in another person:
- Less interested
- Withdrawing from activities or emotionally
- Difficult to have contacts
- Wants nothing, does nothing
- Is edged up
- Whining
- Sleeping difficulties
• Prevalence:
- Netherlands: 500.000 – 800.000 people
- Now 4th on the list of chronic diseases (costs and invalidity) (WHO)
- In 2020 1:6 had a depression ever in their life
- Women > men
• Impact:
- Negative influence on functioning (work, relations)
- Risk on suicide
- Higher risk on a relapse of the depression
- Higher risk on somatic diseases (heart, cancer)
- Higher risk on psychiatric comorbidity
→ Anxiety disorders, addiction, personality disorders
- High societal costs
→ Medial: 388 million euros
→ Loss of production: 2,1 billion euros
- Loss of quality of life
→ 113.000 lost life years (more than e.g. diabetes, rheumatism)
• Suicide (attempts/considerations) each year:
- In EU 58.000 persons die because of suicide
, - Is in top 10 of causes of death
• Causes:
• Neurobiology of depression (imaging studies):
- Reduced volume of PFC, basal ganglia and hippocampus
▪ Serotonergic system dysfunctions
▪ HPA-axis
- Hyperreactivity and over time a reduced activity (exhaustion):
▪ Reduced BDNF
▪ Dysfunctions immune system
• Treatment:
- Basic interventions:
▪ 1. Psychoeducation
▪ 2. Active follow-up
▪ 3. Structuring daily activities
- Step 1 interventions:
Lecture 1 – Affective Disorders (Depression & Bipolar Disorder)
Psychiatric disorders
• Psychiatric disorders:
- Cognitive disorders
- Psychotic disorders
- Affective disorders
- Anxiety disorders
- Addictive disorders
- Eating disorders
- Developmental disorders
- Personality disorders
• Diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (DSM):
- Axis 1: Psychiatric diseases
- Axis 2: Personality disorder
- Axis 3: Somatic diseases
- Axis 4: Psychosocial stress factors
- Axis 5: Level psychosocial functioning
• Percentage of Dutch people that suffer from psychiatric diseases:
- 1/4 (25%) suffers from a psychiatric disorder ever in life
- Psychiatric disorders cause significant distress and impairment in social,
occupational or other important areas of functioning
• Burden of psychiatric disorders (EU):
• Central to the symptomatology of affective disorders are disturbances in the regulation of
specific emotions, but also cognitions, leading to disturbed behavior, usually precipitated by
stressful life-events
• Current neuroanatomical models for the pathophysiology of affective disorders emphasize
the role of disturbances in brain circuits involved in emotion and stress regulation
, → From a neurobiological perspective, all treatments are thought to eventually lead to
changes in these brain circuits
• Difference between psychiatrist and psychologist:
- Psychiatrist:
▪ Is a medical doctor
▪ Diagnosing psychiatric diseases
▪ Treating psychiatric diseases
- Psychologist:
▪ Studied psychology
▪ Helps with problems in daily life
▪ Strengthen resilience and normal development
▪ Does part of treatment of psychiatric diseases
• Affective disorders:
- Depression:
▪ Mild
▪ Moderate/severe
▪ Psychotic
- Bipolar disorder (depression + mania):
▪ Bipolar I & II
▪ Rapid cycling
Unipolar depression:
• Symptoms:
- Key symptoms:
▪ Depressed mood
▪ Loss of interest or pleasure
- Psychological symptoms:
▪ Difficulties to think or concentrate
▪ Anxiety, panic
▪ Indecisiveness
▪ Feeling hopeless
▪ Feelings of guilt
▪ Recurrent thoughts of death or suicidal ideation
▪ Feelings of worthlessness
▪ Delusions, hallucinations
- Physical symptoms:
▪ Sleep disturbances
▪ Less appetite, weight loss
▪ Loss of libido
▪ Pain
▪ Restlessness, inhibition
▪ Fatigue
• Recognizing depression in yourself:
- Difficulty to enjoy
- Worrying
- Depressed mood
, - Overstrained
- Being emotional, crying easily
- Everything is difficult, difficulty deciding
- Diminished concentration
- Sleeping difficulties, less libido
- Recurrent thoughts of death
• Recognizing depression in another person:
- Less interested
- Withdrawing from activities or emotionally
- Difficult to have contacts
- Wants nothing, does nothing
- Is edged up
- Whining
- Sleeping difficulties
• Prevalence:
- Netherlands: 500.000 – 800.000 people
- Now 4th on the list of chronic diseases (costs and invalidity) (WHO)
- In 2020 1:6 had a depression ever in their life
- Women > men
• Impact:
- Negative influence on functioning (work, relations)
- Risk on suicide
- Higher risk on a relapse of the depression
- Higher risk on somatic diseases (heart, cancer)
- Higher risk on psychiatric comorbidity
→ Anxiety disorders, addiction, personality disorders
- High societal costs
→ Medial: 388 million euros
→ Loss of production: 2,1 billion euros
- Loss of quality of life
→ 113.000 lost life years (more than e.g. diabetes, rheumatism)
• Suicide (attempts/considerations) each year:
- In EU 58.000 persons die because of suicide
, - Is in top 10 of causes of death
• Causes:
• Neurobiology of depression (imaging studies):
- Reduced volume of PFC, basal ganglia and hippocampus
▪ Serotonergic system dysfunctions
▪ HPA-axis
- Hyperreactivity and over time a reduced activity (exhaustion):
▪ Reduced BDNF
▪ Dysfunctions immune system
• Treatment:
- Basic interventions:
▪ 1. Psychoeducation
▪ 2. Active follow-up
▪ 3. Structuring daily activities
- Step 1 interventions:
