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Other special features of depression


Types of Schizophrenia


With psychotic features:

  • Patients with severe depression may develop psychotic symptoms [Delusions / Hallucinations]
  • Psychotic Symptoms may be mood congruent [Like Nihilistic] or mood incongruent [grandiose]
  • Only present in severe depression and hence sometimes called psychotic depression

With atypical features:

  • Reversal of biological symptoms [Hypersomnia, overeating and weight gain]

With melancholic features:

  • Involutional melancholia [Seen in old age]
  • Severe anhedonia, profound guilt, early awakening, weight loss, agitation with HIGH SUICIDE RISK

With catatonic features:

  • May develop catatonic symptoms such as stupor, negativism

Depression


Depression


Major depressive episode in absence of any manic, mixed or hypomanic episode

One of the commonest psychiatric disorder [Lifetime prevalence 17%]

Twice as prevalent in Women, Mean Age = 40 Years

Responsible for Maximum DALY [Disability Adjusted Life Years]

Most common cause of Suicide

More commonly seen in divorced and separated persons

Endogenous Vs Exogenous [Reactive] Depression

Types of Schizophrenia


Types of Schizophrenia


Types of schizophrenia according to ICD-10 classification:

Paranoid:

  • Predominated by hallucinations & Delusions but personality usually preserved
  • Most common type, Late Onset, Good Prognosis

Catatonic:

  • Predominated by catatonic symptoms, BEST Prognosis
  • First Line Treatment – I/V Lorazepam & Electroconvulsive therapy

Hebephrenic:

  • Prominent disorganization symptoms and negative symptoms
  • Early Onset, Bad Prognosis and Severe Deterioration of personality

Undifferentiated:

  • Not conforming to any above subtypes

Residual:

  • Progression to ↓ in Delusion / Hallucination but increase in negative symptoms

Simple:

  • Prominent (-) Symptoms without delusion / hallucination. WORST Prognosis

Post schizophrenic depression:

  • Depressive Episode after resolution of schizophrenia. HIGH RISK of Suicide

TJ Crow:

  • Type 1- Positive Symptoms. Normal Ventricles. Better Prognosis
  • Type 2- Negative Symptoms. Dilated Ventricles. Poor Prognosis
  • Type 3-Behavior Symptoms

Pfropf schizophrenia:

  • Schizophrenia in patients with mental retardation

Von Gogh syndrome:

  • Self-mutilation occurring in schizophrenia patients

Side effects of typical antipsychotics


Side effects of typical antipsychotics


The side effects of typical antipsychotics include:

  1. Movement disorders
  2. Endocrine effects
  3. Sedation

Movement disorders:

  • Movement Disorders also called Extrapyramidal Symptoms
  • Caused by Blockage of Dopamine receptors in Nigrostriatal tract

Acute dystonia:

  • Earliest Side Effect.
  • Sudden contraction of a grp. of muscles [torticollis, trismus, deviation of eye]
  • Mgt – I/V Anticholinergics [benztropine, promethazine, diphenhydramine]
  • To prevent acute dystonia prophylactic use of anticholinergics suggested

Acute akathisia:

  • Most common Side Effect.
  • Inner sense of restlessness along with objective observable movements like fidgeting, pacing
  • Mgt – Beta Blockers [DOC] such as propranolol, anticholinergics and benzodiazepines

Drug Induced Parkinsonism:

  • Triad of Rigidity, bradykinesia and Resting Tremors
  • T/T – Anticholinergics. Prophylactic Anticholinergics can be used to prevent it

Tardive dyskinesia:

  • Develops after prolonged exposure [Tardive]
  • Involuntary movements of tongue [twisting, protusion], jaw [Chewing], lips [smacking, puckering]
  • Movement can be rapid jerky [Choreiform] or slow sinusoidal [athetoid]

Neuroleptic malignant disorder:

  • Potentially fatal side effect
  • Muscle Rigidity, Elevated Temperature, Increased CPK Levels, Leukocytosis and deranged LFT
  • Other Symptoms – diaphoresis, tremors, confusion, autonomic disbalance
  • D2 Receptors in corpus striatum [Muscle Contraction] and in Hypothalamus [Temperature regulation]
  • Mgt – Dantrolene and Dopamine agonists like amantadine and bromocriptine + Supportive measures

Endocrine side effects:

  • Due to blockage of tubero-infundibular tracts
  • Hyperprolactemia causing galactorrhea, menstrual disturbance [Female] and impotence [Males]
  • Movement can be rapid jerky [Choreiform] or slow sinusoidal [athetoid]

Other side effects:

  • Sedation
  • Orthostatic Hypotension
  • Anticholinergic Side Effects

Schizophrenia-Positive Symptoms


Schizophrenia-Positive Symptoms


The symptoms of schizophrenia are divided into:

  1. Positive
  2. Negative
  3. Disorganization
  4. Motor

Positive symptoms:

  • Include – Delusions and Hallucinations
  • Good Prognostic Factor and Responds well to medications
  • Delusions – BIZZARE Delusions, M/C Delusion – Delusion of Persecution
  • Hallucination – M/C Auditory Hallucinations
  • Visual Hallucination if present may raise the suspicion of organic mental disease
  • ↑ Dopamine in Mesolimbic tract [Pathway from Ventral Segmental area to Nucleus accumbens]
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