08 Depression and Schizophrenia

Question 1

Major depressive disorder -lifetime prevalence -gender risk? -mean age -family hx?

Answer 1

-lifetime prevalence-15% -female 2x common -mean age: 40 -family hx-yes

Question 2

Major depressive disorder -course of illness, treated and untreated

Answer 2

-untreated: last 6-12 months -treated: often resolves in 2 months

Question 3

Major depressive disorder -risk of recurrence

Answer 3

Rule of thirds: 1/3 no recurrence 1/3 sporadic recurrence 1/3 regular recurrence

Question 4

Major depressive disorder -differential dx?

Answer 4

-bipolar -dysthymia -grief -adjustment disorder (after loss) -substance induced -withdrawal of stimulant -hypothyroidism -Adrenal disorders -CHF -Hypoxia -Parkinson’s -HIV

Question 5

Major depressive disorder -lifeimte suicide risk

Answer 5

10-15%

Question 6

Serotonin–production

Answer 6

Tryptophan to 5-HT 1. tryptophan OH-lase 2. aa decarboxylase

Question 7

Serotonin–metabolism

Answer 7

5-HT to 5-HIAA, excreted in kidney 1. Monoamine oxidase 2. Aldehyde DH

Question 8

Antidepressant drugs

Answer 8

1. SSRI - selective serotonin reuptake inhibitors 2. SNRI - Serotonin NE reuptake inhibitors 3. Tricyclics - act as SNRIs 4. MAO inhibitors

Question 9

Schizophrenia: -lifetime prevalence -gender risk? -age of onset -genetic risk % (twin/parent)

Answer 9

-lifetime prevalence - 1-2% -gender risk-no -age of onset-late teens/early 20s -twin: 2/3 chance -parent: 15-30%

Question 10

Schizophrenia: -‘positive’ symptoms -‘negative’ symptoms

Answer 10

-delusions -paranoia -hallucinations -disorganized thought -blunted affect -alogia (lack of words) -social isolation -lack of motivation -anhedonia -poor hygiene

Question 11

Schizophrenia: -course of illness, treatability of symptoms? -suicide risk

Answer 11

-lifelong management -positive symptoms-can be controlled -negative symptoms-trouble treating this -10%

Question 12

Schizophrenia: -differential dx

Answer 12

-psychosis -Schizoidal PD - “true hermit” personality -Schizotypal PD -Delirium -Schizoaffective disorder - similar to combo of bipolar and Schizophrenia

Question 13

Schizophrenia: -etiology

Answer 13

-Dopaminergic theory:too much DA in mesolimbic, too little DA in mesocortical

Question 14

Schizophrenia: -treatment

Answer 14

-typical antipsychotics (DA blockers) -atypical antipsychotics (DA and 5-HT2 blockers)