Depression/ Schizophrenia Lecture 10

Major Depressive Disorder

Lifetime prevalence 15%, 2x more common for females, Mean age 40, increased risk after losing close
relationship, occurs in all socioeconomic classes; Suicide Risk 10-15% lifetime risk; During Episode MDD
66%

Symptoms: change in sleep pattern, change in appitite, decreased energy, suicidal ideation, anhedonia (no
enjoyment in life); decreased concentration/ memory; depressed mood, worthlessness, helplessness, guilt,
irritability/tearfulness, psychosis? 5/more symptoms for 2 weeks

Course of Illness: Untreated 6-12 months, treated resolved w/in 2 months

Risk for Recurrence: Rule of Thirds- 1/3 Repeat, 1/3 have sporadic case (treated easily), 1/3 never again
Differential Diagnosis: Bipolar Depression, Dysthymia (low grade depression), Grief (no more than 2
weeks), Adjustment dis (less than 2 weeks), Hypothyroidism (lack of energy, sleep more, eat more),
Substance abuse, Stimulant withdrawl, Congestive Heart Failure, Hypoxia, Parkinsons Disease, HIV,
Adrenal Disorders (increase cortical)

Etiology: Genetic, psychoanalytic (anger turned on oneself)

Catecholamines/ Serotonin - not enough of one or the other

Tryptophan + Trp Hydroxylase 5-Hydroxytryptophan + Amino Acid Decarboxylase Serotonin

Metabolism:
Monoamine Oxidase- breaks down serotonin
If Monoamine oxidase blocked, increased serotonin levels in synapse (decrease depression)
Aldehyde Dehydrogenase, 5-Hydroxyindole acetic acid

Treatment:
SSRI- Selective Serotonin Receptor Inhibitors
SNRI- Serotonin Norepinephrine Receptor Inhibitors (increase Serotonin/NE in synapse)
Tricyclics- prolong QT interval in heart not used often
MAOI- Monoamine Oxidase Inhibitor- will cause increase in BP

Schizophrenia:
Lifetime Prevalence 1-2%; Equal Males/Females; onset males late teens, females early twenties Suicide
Risk 10%
Lifelong illness, psychotic exacerbation, Neg symptoms chronic and longstanding
Subtypes: Paranoid, Disorganized, Catatonic, Undifferentiated

Positive Symptoms: Delusions, Paranoia, Hallucinations (auditory/ visual), disorganized thought process
Negative Symptoms: Blunted Affect, Alogia (lack of words), Social Isolation, lack of motivation,
Ahedonia (lack of socialism), lack of hygiene

Schizophrenia Differential:
Psychosis (manic, substance induced, depressive)
Schizioidal PD, Negative symptoms
Schizotypal PD, Positive Symptoms mild
Delirium
Schizoaffective Disorder- Schizophrenia + Bipolar Symptoms

Etiology:
Genetic, with some Environment interaction (not all identical twins have schizophrenia)
Double-bind, psychosocial theories- stress may play a role in onset
Dopamine Theory: Increased Dopamergic Activity (Psychotic Positive Symptoms) in Mesolimbic
Decreased Dopamergic Activity (Negative Symptoms) in Mesocortical
Treatment:
Antipsychotic : D2 Blockers (helps with + symptoms)
Atypicals: D2/4 Blockers, 5HT2 blockers ( decrease - symptoms in mesocortical blockers that has
feedback look and increases Dopamine in mesocortical area in brain)