True: Depression is significantly more common in the recently unemployed. However, interventions focused on enhancing the sense of mastery through the acquisition of job-search and problem-solving skills, and on inoculation against setbacks, benefit the re-employment and mental health outcomes of the high-risk subjects (Vinokur et al 1995).

True: Bipolar II patients tend to belong to higher social classes. They are relatively over-represented among better educated, socially active and creative people. However, bipolar I disorder is associated with lower social status (Murray et al 1997, p. 322; Sadock & Sadock 2005, p. 1580).

True: Rapid cycling is defined as four or more mood episodes per year. Rapid cycling occurs in 10–20% of individuals with bipolar disorder. Even though bipolar disorder has equal sex incidence, women comprise 70–90% of those with rapid cycling. Rapid cycling is associated with female gender, borderline hypothyroidism, menopause, temporal lobe dysrhythmias, alcohol, minor tranquillizer, stimulant or caffeine abuse, long-term aggressive antidepressant drug use and being of middle or upper social class (DSM-IV-TR; Sadock & Sadock 2005, p. 1639).

False: Females are at higher risk of depression than men at all ages after puberty. Prior to puberty there is an excess of depression in boys. However, the difference may be smaller in the elderly than in younger adults (Gelder et al 2000, p. 1622).

False: The mean age of onset for BPAD is 21 years in hospital studies and 17 years in community studies. There is no sex difference in the age of onset (Gelder et al 2006, pp. 230, 245; Sadock & Sadock 2005, p. 1579).

False: Following Kraepelin’s separation of dementia praecox and manic depressive disorder, in 1933 he added schizoaffective disorders under the rubric of schizophrenia. Kraepelin described six mixed affective states based on the level of mood, and psychic and motor activity: Depressive or anxious mania, Excited depression, Mania with poverty of thought, Manic stupor, Depression with flight of ideas, and Inhibited mania. Thus schizoaffective disorder is not one of Kraepelin’s mixed affective states (Johnstone et al 2004, p. 397; Sato et al 2002; Sims 2004, p. 322).

True: Individuals with lower educational and social achievement have higher vulnerability for affective disorders. The social causation hypothesis suggests that the stress associated with lower social position, e.g. exposure to adversity and lack of resources to cope with difficulties, contributes to affective disorders. The social selection hypothesis suggests that genetically predisposed persons drift down to or fail to rise out of such positions. However, the effect of poverty may be substantially reduced when controlling for the degree of isolation from friends and family (Gelder et al 2000, p. 706; Murali & Oyebode 2004).

True: Low socio-economic status is associated with high prevalence of mood disorders (Murali & Oyebode 2004).

True: The ICD-10 explicitly states that hypomania should not be diagnosed if the change in mood is accompanied by delusions or hallucinations. If these are present the diagnosis is one of mania with psychotic symptoms. The other major distinction ICD-10 makes between hypomania and mania is that, whilst hypomania is associated with some interference with personal functioning and daily living, mania is associated with severe interference.

DSM-IV distinguishes mania from hypomania by the presence of marked impairment in social functioning, need for hospitalization, or the presence of psychotic symptoms.

False: Heritability is the relative influence of genetic factors. Heritability estimate for bipolar disorder is 48–80% (Gelder et al 2006, p. 98; Johnstone et al 2004, p. 431).

True: The first-degree relatives of patients with schizoaffective disorder, BPAD and unipolar depression have a higher than average risk of developing unipolar depression, BPAD and schizoaffective disorder in that order of frequency (Gelder et al 2006, p. 231; Johnstone et al 2004, p. 430).

True: Significant genetic correlations (from +0.4 to +0.6) between major depression and alcoholism in women have been demonstrated. The correlations are higher when using narrower criteria for alcoholism. The co-morbidity in women results from genetic factors that influence the risk of both disorders (Johnstone et al 2004, p. 431).

True: Several regions on chromosome 18 may be linked to BPAD. Other chromosomes of interest include 9, 10, 13, 14 and 22 (Gelder et al 2000, p. 703; Sadock & Sadock 2005, p. 1590).

True: Shortened REM latency is considered a trait marker in depression. It occurs in dysthymia, borderline personality disorder, as well as among clinically well offspring of adults with major depression (Sadock & Sadock 2005, p. 1570).

True: In depression there is increased cortisol production; increased release of hypothalamic beta-endorphin and a pulsatile increase in adrenocorticotrophin (ACTH) (Gelder et al 2000, p. 715; Johnstone et al 2004, p. 437).

False: In the dexamethasone suppression test, salivary and plasma cortisol fall at similar rates. Salivary cortisol is related to unbound plasma cortisol. It is approximately 5% of the total cortisol and the part that is biologically active (Cook et al 1986).

False: Acute caffeine administration increases cortisol and causes dexamethasone non-suppression in normal humans. Chronic caffeine use is unlikely to be a major factor in dysregulation of the HPA axis in depression (Lee et al 1988).

True: The TSH response to TRH is blunted in 20–30% of patients with depression. The clinical significance of this remains unclear (Gelder et al 2000, p. 715; Sadock & Sadock 2005, p. 1600).

False: Some, but not all, studies suggest melatonin secretion is decreased in depressed patients. There is no evidence of a phase shift or of disorders of circadian rhythm in depression.

False: Seasonal affective disorder has been difficult to ascribe to any underlying biochemical abnormality including melatonin disruption (Gelder et al 2000, p. 1352; Johnstone et al 2004, p. 428).

False: Serotonin is a prolactin releasing factor while dopamine is a prolactin release-inhibiting factor. Most studies have found normal basal and circadian prolactin levels in depression. Many studies have shown a blunted prolactin response to various 5-HT agonists (Sadock & Sadock 2005, p. 1600).

False: Bradley & Matthews (1983) tested the negative self-schema model of depression using recall measures for self- and other person-referent positive and negative adjectives. Compared to non-psychiatric controls, depressed patients recalled more negative than positive self-referent adjectives. However, their negative bias in recall applied only to self-referent negative adjectives. They showed a normal positive recall bias towards other-referent adjectives.

False: Morning phototherapy is more effective in most patients compared to midday or evening phototherapy for winter depression. However, others claim that there is no difference in benefits between exposure to bright light over dim light or early morning exposure over midday exposure (Gelder et al 2006, p. 572; Johnstone et al 2004, p. 428).

False: The frequency of episodes and the pattern of remissions and relapses are both very variable. Depressive episodes tend to become more frequent and longer lasting and remissions become shorter after middle age. Manic episodes become less frequent. However, after middle age, there may be an increase of newly diagnosed bipolar patients, often with neurological problems (ICD-10 1992; Jacoby & Oppenheimer 2002, p. 684).

False: The therapeutic effects of ECT are greatest in severe depressions, especially those with marked weight loss, early morning wakening, retardation and delusions. In trials of ECT versus simulated ECT, delusions appear to distinguish patients who respond to ECT from those who respond to placebo treatments (Gelder et al 2006, pp. 249, 258).