Depression catatonic

Two women developed secondary bipolar disorder associated with glucocorticoid treatment and deteriorated to depressive-catatonic states without overt hallucinations and delusions (103). 

Wada K, Suzuki H, Taira T, Akiyama K, Kuroda S. Successful use of intravenous clomipramine in depressive-catatonic state associated with corticosteroid treatment. Int J Psych Clin Pract 2004 8 131-3. 

For moderate-to-severe depression, antidepressants, with or without combined psychotherapy, must be considered. When depression is so severe that hospitalization is warranted or psychotic or catatonic features are present, psychotherapy should be withheld temporarily and medication (or ECT) is required. 

Because it can be difficult to distinguish a severe, apathetic depression from a patient with catatonic features, an augmenting antidepressant should be considered. These agents may also help a post-psychotic depression, suggesting the importance of identifying subgroups that might benefit from this approach. This combination is also much more effective than antidepressant monotherapy in depression with psychotic features (see also Chapter 6 and Chapter 7). 

Depressive disorders can lead to death in other ways (Table 6-9). For example, depressed individuals are more prone to accidents that result from their impaired concentration and attention. They also often attempt to self-medicate, particularly with alcohol or other sedative agents, which may lead to death as a result of organ toxicity, as well as accidents. Psychotic depressive patients may act irrationally, putting themselves at greater physical risk. Although rare today, patients have died of severe malnutrition secondary to catatonic symptoms that precluded the ability to care for their basic needs. Depression can also contribute to a higher morbidity and mortality rate in patients with co-morbid medical disorders. For example, a large database indicates that depression may predispose to the development of ischemic heart disease and increase the risk of cardiac-related death ( 51). 

In summary, when properly administered, ECT is an effective treatment for the most severe mood and psychotic disorders encountered in clinical practice, especially those warranting hospital care. Its efficacy is even more striking given the fact that 50% of those successfully treated have previously been nonresponsive to one or more adequate courses of medication. Although primarily used for severe depression, it is also an effective antimanic therapy, and may be lifesaving in catatonic states. ECT has also been used successfully to treat special populations, other psychotic disorders, and various organic conditions, such as NMS and Parkinson s disease. 

In clinical studies, major depressive disorder has had four specifiers, including melancholic feature, atypical feature, catatonic feature, and postpartum onset. In the future, we should investigate the distributions of the four specifiers of depression among patients with physical illness and discuss which biological markers could link the depressive disorder and the physical illness. 

Lipid Profile Levels in Patients with Major Depression with Melancholic Feature, Atypical Feature, Catatonic... 

Although there are papers that discuss the relationships between cholesterol, lipid profiles, and major depression [34-39], there are few data that discuss the association between lipid profiles and depressive disorders with different phenotypes. Huang and Chen investigated the correlation between serum lipid, lipoprotein concentration, and major depressive disorder in patients evaluated for general health screening [41]. They found that analysis of covariance after age adjustment revealed significant differences in patients with melancholic feature and patients with atypical feature in serum concentrations of TG and VLDL in men and HDL in women [41]. However, there are still no reports that discuss the relationships between lipid profiles and major depression with postpartum onset or catatonic feature. In the future, large sample numbers will be needed to clarify the clinical differences in this field. 

Depression with psychotic features Delusions Hallucinations Catatonic features... 

The goals of treatment are to reduce the symptoms of acute depression, facilitate the patient s return to a premorbid level (before the onset of the illness) of functioning, and prevent further episodes of depression. Whether or not to hospitahze the patient is often the first decision that is made in consideration of the patient s risk of suicide, physical state of health, social support system, and presence of a psychotic and/or catatonic depression. 

Optimize the dose of mood stabilizing medication(s) before adding on lithium, lamotrigine or antidepressant (e.g., bupropion or an SSRI) if psychotic features are present, add on an antipsychotic ECT used for severe or treatment-resistant depressive episodes or for psychosis or cataton ia... 

Fourth, if response is inadequate, consider ECT for treatment-refractory illness and depression with psychosis or cataton ia ... 

D. Manic-depressive insanity is apparently Insanity C. The evidence is contradictory in regard to catatonic excitement. Paresis produced by lead poisoning is apparently Insanity C. 

Side effects typically effect the CNS, appearing within 2 weeks of therapy and disappearing after drug withdrawal. They include somnolence, headache, tremor, dysarthria, vertigo, confusion, nervousness, irritability, psychotic states, paranoid reactions, catatonic reactions, twitching, ankle clonus, hyperreflexia, visual disturbances, paresis, and seizures. Large doses or concomitant ingestion of alcohol increases the risk of seizures. Cycloserine is contraindicated in individuals with a history of epilepsy and should be used with caution in individuals with a history of depression. 

Acute mania as part of bipolar I disorder is supposed to result from overexcitation of limbic neurons. This can arise either from loss of inhibitory tonic orbitofrontal control of limbic neurons or from various intra- and intercellular alterations (the full mechanism is unknown as yet). Manic episodes are often classified into euphoric (classical), dysphoric, mixed (along with clinical manifestations of major depressive disorder), mania with psychotic/catatonic features, and mania with a rapid cycling course of the disease. 

Psilocybin is rapidly dephosphorylated in the body to psilocin, an agonist of serotonin (5-hydroxytryptamine [S-HTJja) receptors. The stimulating of 5-HT receptors by hallucinogenic drugs has given rise to the hypothesis that schizophrenia maybe caused by an imbalance in the metabolism of 5-HT. Depressive and catatonic states in schizophrenic patients are thought to be the result of 5-HT deficiency. 

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