Depression psychoses associated with

In clinical psychiatric terms, the affective disorders can be subdivided into unipolar and bipolar disorders. Unipolar depression is also known as psychotic depression, endogenous depression, idiopathic depression and major depressive disorder. Bipolar disorder is now recognised as being heterogeneous bipolar disorder I is equivalent to classical manic depressive psychosis, or manic depression, while bipolar disorder II is depression with hypomania (Dean, 2002). Unipolar mania is where periods of mania alternate with periods of more normal moods. Seasonal affective disorder (SAD) refers to depression with its onset most commonly in winter, followed by a gradual remission in spring. Some milder forms of severe depression, often those with an identifiable cause, may be referred to as reactive or neurotic depression. Secondary depression is associated with other illnesses, such as neuro-degenerative or cardiovascular diseases, and is relatively common. 

Although the usefulness of the atypical antipsychotics is best documented for the positive symptoms of schizophrenia, numerous studies are documenting the utility of these agents for the treatment of positive symptoms associated with several other disorders (discussed in Chapter 10 see Fig. 10—2). Atypical antipsychotics have become first-line acute and maintenance treatments for positive symptoms of psychosis, not only in schizophrenia but also in the acute manic and mixed manic-depressed phases of bipolar disorder in depressive psychosis and schizoaffective disorder in psychosis associated with behavioral disturbances in cognitive disorders such as Alzheimer s disease, Parkinson s disease, and other organic psychoses and in psychotic disorders in children and adolescents (Fig. 11—52, first-line treatments). In fact, current treatment standards have evolved in many countries so that atypical antipsychotics have largely replaced conventional antipsychotics for the treatment of positive psychotic symptoms except in a few specific clinical situations. 

The catecholamine hypothesis of mood disorders suggests that increased DA and norepinephrine (NE) activity contribute to hyperactivity and psychosis associated with the severe stages of mania, and reduced activity causes depression. A y-aminobutyric acid (GABA) deficiency theory has been proposed for mania since it inhibits NE and DA activity. Glutamate and aspartate, excitatory amino... 

Suicidal ideation or attempts (suicide completion rates with bipolar I disorder are 10-15% suicide attempts are primarily associated with depressive episodes, mixed episodes with severe depression or presence of psychosis)... 

Loxapine (Loxitane). Loxapine is a medium potency antipsychotic, and it has several interesting features. First, it is chemically very similar to clozapine, the first of the atypical antipsychotics. In the test tube, loxapine actually behaves more like an atypical antipsychotic (more on that later), but when patients are treated with it, loxapine acts more like a traditional typical antipsychotic. A second point of interest is that loxapine is actually the major active metabolite of the antidepressant amoxa-pine (Ascendin). As a result, one can use a single medication (amoxapine) to treat both depression and psychosis. In practice, however, the use of what is essentially a fixed dose combination medication should be avoided. Using amoxapine does not allow separate adjustment of the antipsychotic and antidepressant, and most importantly, amoxapine is the only antidepressant associated with the risk of TD. 

Antipsychotics or neuroleptics are used for intervention in patients with severe and chronic psychosis of an organic as well as induced nature. These drags are used for controlling manic phases in manic-depressive psychosis such as relieving anxiety, fear, excitement associated with somatic diseases, controlling aggression, tics, and other unequal conditions. 

It is also possible that tricyclic antidepressants block presynaptic 2 adrenoreceptors, thus increasing the quantity of releasable norepinephrine and/or serotonin. Tricyclic antidepressants are used for relieving symptoms of depression (especially of the endogenous type), for controlling anxiety associated with depressive conditions, for treating depression in patients with maniac-depressive psychosis, and so on. 

Cognitive/Neuropsychiatric adverse events Use of zonisamide was frequently associated with the following CNS-related adverse events 1) Psychiatric symptoms, including depression and psychosis 2) psychomotor slowing, difficulty with concentration, and speech or language problems, in particular, word-finding difficulties and 3) somnolence or fatigue. 

It is recommended that adult patients with second episodes of depression and who fulfill the criteria for maintenance therapy noted above be maintained for several years (up to 5 years in adult studies), using the same dosage of the antidepressant used to achieve clinical remission during the acute-treatment phase. Maintenance therapy for patients with three or more episodes of MDD, patients with second episodes associated with psychosis, severe impairment, and severe suicidality, and those who proved very difficult to treat should be considered for longer periods of time, even for the life of the patient (AACAP, 1998). 

Psychosis itself can be paranoid, disorganized-excited, or depressive. Perceptual distortions and motor disturbances can be associated with any type of psychosis. 

The hypnogram of a patient with an underlying psychiatric illness may be characterized by a delay in sleep onset, the presence of residual muscular activity causing frequent awakenings, fragmented sleep, reduced REM and slow-wave sleep, and day-time drowsiness. Such disorders are generally not associated with a recent or transient event and the cause cannot usually be identified. Often such changes in the sleep architecture are associated with major psychiatric disorders such as depression, mania, psychosis or severe anxiety states. 

MDMA and MDA abuse has been associated with panic disorder, depression and chronic paranoid psychosis. As these conditions may also occur independently of these drugs, it is difficult to prove causality but it seems reasonable to conclude that some individuals are more vulnerable to such psychiatric disorders which are exacerbated by these drugs. In... 

Venlafaxine (Effexor), approved by the FDA in December 1993, was described in more detail early in this chapter. It is one of the newer antidepressants implicated in causing suicidality. It is a NSRI that also strongly inhibits the reuptake of epinephrine. Its profile is very similar to the SSRIs in producing stimulation, including anxiety, nervousness, insomnia, anorexia, and weight loss. It causes the various emotional and behavioral abnormalities that go along with stimulation, such as agitation and mania, and has been associated with hostility, paranoid reaction, psychotic depression, and psychosis. It can cause hypertension. 

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