8 - Depression and Schizophrenia Flashcards
What is the lifetime prevalence of major depression? What gender is it more common in? What is the mean age?
15% prevalence
2x more common for women
More common is there’s a family history.
Mean age is 40 but it can occur at any age.
What can increase the risk of major depression?
Losing a close relationship.
How long doe major depression last if untreated? What about when treated?
Untreated: 6-12 mo
Treated: can often resolve in 2 mo
What is the risk of recurrence of MDD?
40% recur within 2 yrs after resolution, up to 85% recur at some point.
What are symptoms of major depressive disorder? What makes someone “qualified” for the diagnosis of MDD?
5 of more symptoms for 2 wk duration:
Change in sleep and appetite Decreased energy Suicidal ideation Anhedonia Decreased concentration and memory Depressed mood Feeling worthless/helpless/ excessive guilt Psychosis can occur
What is the suicide risk for someone with MDD in their life? What about during an episode?
10-15% lifetime risk
During single episode of MDD, 66% consider suicide.
What would a differential for MDD look like (ie what are other pathologies that could look like MDD)?
- Bipolar depression
- Dysthymia (low grade chronic depression)
- Grief
- Adjustment Disorder (symptoms less than 2wks)
- Hypothyroidism
- Substance induced (depressants or withdrawl from stimulants)
- Chronic heart failure/hypoxia
- Parkinsons
- HIV
What is the etiology of MDD?
Genetic: first degree relatives re 2-4x more likely to develop major depression
Functional polymorphism region of 5-hydroxytryptamine transporter - increase risk of depression in response to stressful events.
What nts are involved in MDD?
Catecholamines and serotonin
How is serotonin made?
- Trp gets OH removed by trp hydroxylase to become 5-hydroxytryptophan
- Amino acid decarboxylase removes COOH to become serotonin (5HT)
What are things that can metabolize serotonin? Why are these important?
Monoamine axidases
Aldehyde dehydrogenases
5-Hydroxyindole acetic acid
Blocking these will cause an increase in serotonin.
What are some treatments for MDD?
SSRIs, SNRIs (norepi and serotonin) , Tricyclics (increase levels of norepi and epi) , MAOI’s (serotonin and catecholamines), psychotherapy, ECT, rTMS (magnetic pulses to increase flow and impact nts)
What is the prevalence of schizophrenia? What is the age of onset?
Lifetime prevalence of 1-2%, equal prevalence in males and females .
Male age of onset is late teens. Female is early twenties.
What are the positive symptoms associated with schizophrenia?
Delusions (falsely based beliefs), paranoia, hallucinations (auditory or visual), and disorganized through process.
What are the negative symptoms associated with schizophrenia?
Blunted affect Alogia - lack of spontaneity of speech Lack of motivation Anhedonia Poor hygiene
What is the suicide risk for people with schizophrenia? Why is life expectancy shortened when people have schizophrenia?
10% lifetime risk
Shortened life expectancy due to social isolation and because their psychosis can cause a them to not get the healthcare they need. They also have a higher risk for nicotine addiction.
What is the DSM’s criteria for schizophrenia?
2 or more of the following symptoms persisting for at least 1 month with continuing signs of disturbances for 6 mos:
- delusions
- hallucinations
- disorganized speech
- disorganized behavior or catatonia, negative symptoms.
Describe the course of schizophrenia?
Lifeling illness with psychotic exacerbations.
Negative symptoms tend to be chronic and longstanding.
What are schizoidal PD and schizotypal PD?
Schizoidal: people tend to have negative symptoms
Schizotypal: tend to have lover grade positive symptoms
What is the genetics etiology of schizophrenia?
108 loci implicated with increased risk: major histocompatibility complex on chrom 6, TF factor 4, neurogranin, and zinc factor 4.
micro RNAs implicated
These only account for a small fraction of the heritability.
What are some environmental factors that play a role in the development of schizophrenia?
Chronic psychostimulant use. Migrant status Advanced paternal age Having a cat Prenatal nutrition deprivation Cannabus use Urban residence Winter or spring birth
What is the popular working model of schizophrenia?
That it’s a neurodevelopmental disease that emerges when environmental stress is imposed on a genetically susceptible background.
What can alter epigenetic markers associated with schizophrenia?
Environmental factors.
What structural abnormalities in the brain are associated with schizophrenia?
Decrease in brain volume size, increased size of ventricles.
