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I SWEAR IM NOT CRAZY!!A Very Brief Primer
on Affective Disorders and the Affective Spectrum
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The statistics on sanity are that one out of
every four Americans is suffering from some form
of mental illness.  Think of your three best
friends.  If they're okay, then it's you.  Rita
Mae Brown
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OUTLINE

• Introduction
• Major Depressive Disorder
• Pathophysiology
• Schizophrenia
• Pathophysiology
• Post-traumatic Stress Disorder (PTSD)
• Pathophysiology
• Conclusions

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INTRODUCTION

• Affective Disorder Mood Disorder
• Depressive Disorders
• Bipolar Disorders
• Substance-Abuse Mood Disorders
• Too simplistic ? need to look deeper
• Co-morbid common

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INTRODUCTION

• Affective Spectrum Disorder group of conditions
  that do not fit the major, well-established
  categories
• Overlapping manifestations around affective
  disregulation
• Mainly characterized by depression, dysphoria,
  severe personality disorders, or combination
• Hereditary links

Comprehensive Psychiatry Vol 26 1987
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LIST of AFFECTIVE and AFFECTIVE SPECTRUM DISORDERS

• Depressive disorders
• Bipolar disorders
• Substance-induced mood disorders
• Attention-deficit/hyperactivity disorder (ADHD)
• Bulimia nervosa
• Cataplexy
• Dysthymic Disorder
• Schizophrenia
• Schizoaffective disorders
• Social phobias

• Fibromyalgia
• Generalized anxiety disorder
• Irritable bowel syndrome
• Migraines
• Obsessive-compulsive disorder (OCD)
• Panic disorder
• Posttraumatic stress disorder (PTSD)
• Premenstrual dysphoric disorder
• Some personality disorders (e.g. BPD)

Arch Gen Psychiatry, Vol 60 Feb 2003.
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MAJOR DEPRESSIVE DISORDER

• Characteristics
• 1 in 5
• Multiple episodes common
• Co-morbidity VERY common
• Neurobiology traditionally focused on monoamines
  ? Monoamine Hypothesis
• 5-HT
• NE

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PATHOPHYSIOLOGY of DEPRESSION

• Previous studies on MDD already depressed
• 5HT studies
• BDNF
• HPA axis and stress
• CRF
• DA

CMAJ, Vol 180 Feb 3, 2009
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PATHOPHYSIOLOGY of DEPRESSION

• Structural changes
• Abnormal brain activation

CMAJ, Vol 180 Feb 3, 2009
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SCHIZOPHRENIA

• Characteristics
• Symptoms
• 3 Categories
• Affects 0.5 to 1 of world pop.
• Neurobiology reveals an increase in DA?
  mesolimbic pathway
• Environment, genetics/heritability, and social
  interactions factor

JCI, Vol 119 April 2009.
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PATHOPHYSIOLOGY of SCHIZOPHRENIA

• The Dopamine Hypothesis
• DA receptors and brain regions
• Version I vs. Version II
• The Neurodevelopment Hypothesis
• Pathological brain development
• Structural changes in different brain regions

Schizophrenia Bulletin, Vol 35 2009
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POST-TRAUMATIC STRESS DISORDER (PTSD)

• Characteristics
• Symptoms
• 8 of population 5.2 mil in a given yr
• Reflect stress-induced changes in neurobiological
  systems
• Inadequate adaptation to stressors

National Center for PTSD http//ncptsd.va.gov
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PATHOPHYSIOLOGY of PTSD

• Regulation of fear and stress response
• HPA axis
• NTs/NPs
• Brain regions
• PFC
• Amygdala
• Hippocampus
• Brainstem nuclei

CNS Spectrum, Vol 14 Jan 2009
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CONCLUSION

• Dynamic
• Co-morbid
• Similarities
• NTs
• Brain regions
• Mechanisms
• Tip of the iceberg

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TAKE HOME MESSAGE
"Insanity is doing the same thing over and over
again and expecting a different result."Albert
Einstein