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.

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

IntroductionMajor Depressive Disorder

PathophysiologySchizophrenia

PathophysiologyPost-traumatic Stress Disorder

(PTSD) Pathophysiology

Conclusions

Affective Disorder = Mood Disorder Depressive Disorders Bipolar Disorders Substance-Abuse Mood Disorders

Too simplistic need to look deeper Co-morbid common

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 linksComprehensive Psychiatry; Vol 26; 1987

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.

Characteristics 1 in 5 Multiple episodes

common Co-morbidity VERY

common Neurobiology

traditionally focused on monoamines ”Monoamine Hypothesis” 5-HT NE

Previous studies on MDD already depressed 5HT studies

BDNF HPA axis and

stress CRF DA

CMAJ, Vol 180; Feb 3, 2009

Structural changes Abnormal brain

activation

CMAJ, Vol 180; Feb 3, 2009

CharacteristicsSymptoms

3 CategoriesAffects 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.

“The Dopamine Hypothesis” DA receptors and brain

regions Version I vs. Version II

“The Neurodevelopment Hypothesis” Pathological brain

development Structural changes in

different brain regionsSchizophrenia Bulletin, Vol 35; 2009

CharacteristicsSymptoms8% of population; 5.2 mil in a given

yrReflect stress-induced changes in

neurobiological systems Inadequate adaptation to stressors

National Center for PTSD; http://ncptsd.va.gov

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

CNS Spectrum, Vol 14; Jan 2009

DynamicCo-morbidSimilarities

NTs Brain regions Mechanisms

“Tip of the iceberg”

"Insanity is doing the same thing over and

over again and expecting a different

result."Albert Einstein