1. A. An uninterrupted period of illness during which, at some time, there is either a Major Depressive Episode, a Manic Episode, or a Mixed Episode concurrent with symptoms that meet Criterion A for Schizophrenia.
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1. Note: The Major Depressive Episode must include
Criterion AI: depressed mood.
2. B. During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms.
3. C. Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness.
4. D. The disturbance is not due to the direct physiological effects of a substance (eg, a drug of abuse, a medication) or a general medical condition.
5. Specify type:
1. Bipolar Type: if the disturbance includes a Manic or a Mixed Episode (or a Manic or a Mixed Episode and Major Depressive Episodes)
2. Depressive Type: if the disturbance only includes Major Depressive Episodes
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1. Evidence suggests its resemblance to Affective Disorders
1. No surprise since criteria require full affective syndrome
2. Can schizoaffective patients be distinguished from schizophrenics by high urinary phenylacetic acid levels (Sabelfi et al, 1989)?
15. III Clinical Notes
1. Clinical Characteristics of Depression
2. The principle problems
1. Distinguishing normal from pathological
2. Subtyping Depressive states
1. Reactive vs Endogenous
1. little empirical support for either concept
2. Psychotic vs Neurotic
1. Presence of psychotic features coded in DSM IV by fifth digit
3. Involutional Melancholia
1. Patients with involutional onset report more agitation, initial insomnia, somatization and hypochondriasis. (Brown 1984)
2. Genetically heterogeneous (Stenstedt 1959)
3. Same phenomenology seen at other times (Post 62, Angst 66, Weisman 79)
4. Unipolar vs Bipolar
1. Still considerable debate as to whether these are distinct. Goodwin and Jamison favor a continuum model
5. Primary vs Secondary
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1. Attractive idea but this distinction is without grounding or definition
2. DSM IV skirts the issue by defining secondary as “due to” a medical condition or substance use without saying how it can be determined when depression is “due to” another condition
3. Causes of Secondary Depression
1. Medical Illnesses
1. Damage to Brain Tissue
1. Stroke, trauma, subcortical dementias,MS, HIV
2. Endocrine/Humoral
1. Cushings, Addisons, Hypo/hyperthyroid, paraneoplastic (pancreatic CA), hyperparathyroidism, hyperprolactinemia
3. Latrogenic
Reserpine, steroids, propranolol, thiazides, methyldopa, barbiturates, ACTH, contraceptives, L-dopa, amphetamine, benzodiazepines, metoclopramide, cimetidine, spironolactone
2. Other psychiatric Illness
1. Substance Abuse
2. Anxiety Disorder
3. Eating Disorders
4. Psychotic Disorders
6. Biological (Magic) Markers
1. Urinary MHPG
2. Dexamethasone
3. Decreased REM Latency
4. TRH Stimulation Test
5. CSF 5-HIAA
6. Response to Sleep Deprivation
7. Course Specifiers
1. Melancholic
2. Atypical
3. Postpartum onset
4. Rapid Cycling
5. Seasonal Pattern
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