Depression, Bipolar Syndromes, and Schizophrenia

Frederick Petty, Sriram Ramaswamy, R asad R. Padala, Jean D. Deupree, and David B. Bylund 

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Major depression, bipolar syndromes and schizophrenia are common and often severe mental illnesses. All three of these tend to have an onset in late adolescence or young adulthood. Major depression is characterized by persistent low mood and decreased interest and pleasure, as well as physical and psychological symptoms, including sleep disturbance. 

Antipsychotic medications are indicated in the treatment of acute and chronic psychotic disorders. These include schizophrenia, schizoaffective disorder, and manic states occurring as part of a bipolar disorder or schizoaffective disorder. The co-adminstration of antipsychotic medication with antidepressants has also been shown to increase the remission rate of severe depressive episodes that are accompanied by psychotic symptoms. Antipsychotic medications are frequently used in the management of agitation associated with delirium, dementia, and toxic effects of both prescribed medications (e.g. L-dopa used in Parkinson s disease) and illicit dtugs (e.g. cocaine, amphetamines, andPCP). They are also indicated in the management of tics that result from Gilles de la Tourette s syndrome, and widely used to control the motor and behavioural manifestations of Huntington s disease. 

Chronic use has been associated with an "amotivational syndrome" characterized by loss of interest in social activities, school, work, or other goal-directed activities. Cannabis use is cited as the cause of this phenomenon, but there is no evidence to support any causal relationship. There is evidence, however, that the symptoms of the "amotivational syndrome" are secondary to depression (Musty and Kraback 1995). In contrast to ethanol, there is no evidence to support that cannabis causes an increase in violent behavior (Murray 1986). However, cannabis use may be contraindicated in those with preexisting psychiatric disturbances such as bipolar disorder or schizophrenia. 

The primary indication for ECT in adolescents is the short-term treatment of mood symptoms, depressive or manic (Walter et al., 1999). Mood symptoms in the course of major depression, psychotic depression, bipolar disorder, organic mood disorders, schizophrenia, and schizoaffective disorder respond well to ECT. Psychotic symptoms in mood disorders also respond well to ECT whereas the effectiveness of ECT in the treatment of psychotic symptoms in schizophrenia is doubtful. There are suggestions that other uncommon clinical conditions in adolescents such as catatonia and neuroleptic malignant syndrome also benefit from ECT. The effectiveness of ECT seems to lessen when there is a comorbid personality disorder or drug and/or alcohol problems. There are very few data about usefulness on prepubertal children. 

Developmental disabilities, which again through continued research are often referred to currently as cognitive disabilities, include Tourette s syndrome, dyslexia, and attention deficit hyperactivity disorder. Mental illness includes depression, schizophrenia, bipolar disorder, and borderline personality, to name only a few of the conditions that can destroy the lives of individuals and wreak havoc on family and friends. 

Furthermore, a diet with low contents of FA may be involved in the development of insulin resistance, which suggests that an appropriate dietary intake of n-3 PUFA is considered protective against metabolic syndrome [183]. In addition, diverse psyquiatric impairs (depression, bipolar disorders, schizophrenia, autism) and neurodegenerative diseases such as Alzheimer disease have been associated to decreased blood levels of n-3 HUFA. Besides, there are many examples about the use of pol)nmsaturated FA as drugs. Thus, EPA has shown efficacy as adjunctive treatment, and in some cases as the only treatment in several psyquiatric disorders [184]. It is suggested that the potential of n-3 FA to prevent recurrence and metastasis of mammary cancer when used in adjuvant therapy is associated with a n-6 to n-3 ratio lower than 2 1 [185], On the other hand, fish intake is considered as a protective factor for preventing prostate cancer in addition, in humans low levels of ALA in mammary adipose tissue are associated with an increased risk of breast cancer in women [186]. 

Antipsychotic drugs commonly have been used empirically to manage manic and psychotic illness in bipolar disorder patients. Indeed, standard neuroleptics are a mainstay of the treatment of acute mania (only chlorpromazine is FDA-approved for this indication, although haloperidol has also been widely used) and for manic episodes that break through prophylactic treatment with LF or an anticonvulsant. However, the older antipsychotics are not used routinely for long-term prophylactic treatment in bipolar disorder because their effectiveness is untested, some may worsen depression, and the risk of tardive dyskinesia in these syndromes may be higher than in schizophrenia. 

Since the cannabinoid agonists are not first-line drugs in the treatment of any of the various types of pain or pain syndromes, any potential risk of serious consequences from their use should be considered an absolute contraindication. Preexisting or genetic predisposition to serious psychiatric disorders such as schizophrenia or psychotic disorders, in general, would be an example. Precipitation or worsening of these and less serious psychiatric disorders has been reported. Caution and close monitoring of patients with less serious illnesses such as bipolar disorder, anxiety, or depression is necessary since the symptoms of these disorders could become manifest. 

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