The unique therapeutic actions of clozapine are attributed to 5HT2 receptors. This is also true of the other atypical antipsychotics: olanzapine, quetiapine, risperidone, aripiprazole, ziprasidone.
Schizophrenia has a high genetic component. Psychotic symptoms are influenced by life stresses. Intrauterine and perinatal insult is associated with higher risk for schizophrenia. There is no gender or racial difference in schizophrenia incidence. Abuse of hallucinogenic drugs, does NOT lead to schizophrenia. Negative symptoms are least likely to respond to drug therapy; paranoid type schizophrenia (no thought disorder, disorganized behavior, or affective flattening) has best prognosis. Schizotypal is the personality disorder most associated with schizophrenia.
Unipolar disease is more common than bipolar in both sexes. Bipolar disease has more genetic components. Bipolar patients tend to have shorter episodes of untreated illness than unipolar patients. Postpartum disorders are more common in bipolar than unipolar disorder.
Buproprion: less risk of rebound mania.
Therapy of depression. After first major episode: 6-9 months of taking antidepressants. If repeated episodes: at least several years and then re-evaluation.
Cognitive behavioral therapy (CBT): corrects distortions in thinking about oneself and their life; negative triad -- towards oneself, the present world, the future
Interpersonal therapy (IPT): Concentrates on relationships, role transitions; suggests depression often occurs in the context of interpersonal conflict, anger turned inward, loss of a loved one.
Psychodynamic psychotherapy (psychoanalysis-lite): Concentrates on unconscious drives
Panic disorder and generalized anxiety disorder are often comorbid with depression.
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