Antipsychotic Medication Ebooks Catalog

The Schizophrenia-free Package

What are you going to find in the Schizophrenia-FreeYour New Life Begins Today e-book: Relationships and Friends: In this chapter, I share with you my way of thinking about friends and relationships. I provide my point of view about how I see this interesting issue. I also give you some tips about how to get friends, deal with friends, and treat relationships. About Schizophrenia and Getting Well: In this chapter, I describe my way of thinking about schizophrenia and other similar mental illnesses. Living on Your Own and Being Independent: In this chapter, I share my perspective about our independence as sufferers and how to live on our own and be independent. Other Sufferers' Recovery Examples: I decided to share other sufferers' stories so you won't feel alone in your illness. Finding Your Mate and Getting Married: Having a mate is one of the most important pillars in your life as a sufferer. In this chapter, you learn some of the most important basics in this matter. Preventing Future Seizures and Getting Help: This chapter shows how to reduce the chance of having future psychotic disorder seizures and, even if you experience one, how to make it as minimal as possible. Dieting and Exercising: This chapter demonstrates how to acquire easy life habits in order to survive your years to come in the healthiest manner possible. Living by Yourself and Earning Your Own Money: This chapter shows how to earn your own money and live by yourself as a result. Ways of Getting Support: There is nothing like a good support system in order to rehabilitate in the best matter possible. This chapter discusses the most basic and powerful ways of getting support. Quitting Smoking: In this chapter, you learn the basic principles of why and how to quit smoking. Learning a Profession and Finding a Job: In this chapter, you learn the most important factors for learning a profession and finding a job.

The Schizophreniafree Package Summary

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Author: Ronen David
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Highly Recommended

I've really worked on the chapters in this book and can only say that if you put in the time you will never revert back to your old methods.

Overall my first impression of this book is good. I think it was sincerely written and looks to be very helpful.

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The ABC Schizophrenia Study

Using the IRAOS interview, the ABC Schizophrenia Study examined a population-based sample of 232 first illness episodes, representing 84 of 276 first treatment episodes, and a representative subsample of 130 subjects, who were compared with two age- and gender-matched control samples -one from the ''healthy'' population (n 130), the other first hospitalized with a diagnosis of depressive episode (n 130). Survival analysis of the duration of early illness course from onset to first admission as target event revealed a distribution of durations of the early illness course that was markedly skewed to the left. One third (33 ) of the broadly defined cases of schizophrenia took less than one year from prodromal onset to develop psychotic symptoms. Only 18 had an acute type of onset of four weeks or less, 15 a subacute type of 4 weeks to one year and 68 a chronic type of onset of one year or more. Only 6.5 started with positive symptoms 20 presented both positive and negative symptoms...

Defining and Operationalizing the Prodromal Stage and the Milestones of the Early Course of Schizophrenia

The clinical end of the early illness stage (first treatment contact or first admission) is easy to define. But this event is determined not only by the increase in serious symptoms and impairment, but also by patients' help-seeking behaviour and the availability of adequate care. A suitable illness-related event to mark the end of the early illness stage is the climax of the first psychotic episode, operationalized as the maximum of positive symptoms 18 . Figure 1.1, based on data from the ABC Schizophrenia Study, depicts the mean durations (and medians) of the intervals between the milestones or stages of evolving schizophrenia. In practice, but also in many epidemiological and clinical studies, the onset of schizophrenia and of many other disorders is defined by the first contact with mental health services. This fact, namely, that the prodromal and the psychotic phase preceding first contact may last a few years, has implications for the interpretation of research results based on...

Schizophrenia Theories Of

Term schizophrenia is a general label for a number of psychotic disorders with various behavioral, emotional, and cognitive features. The term was originated by the Swiss psychiatrist Eugen Bleuler (1857-1939) in 1911, who offered it as a replacement for the term dementia praecox (i.e., precocious madness deterioration insanity). In its literal meaning, schizophrenia is a splitting of the mind, a connotation reflecting a dissociation or separation between the functions of feeling emotion, on one hand, and those of cognition thinking on the other hand. The split in schizophrenia implies a horizontal direction, rather than a vertical direction (as indicated in the disorder called multiple personality, which is confused, often, by laypeople with schizophrenia). In the simplest terms, multiple personality is a split within self, whereas schizophrenia is a split between self and others. Various categories, descriptions, and subtypes of schizophrenia have been developed (e.g., acute,...

Cultural Expression of Neuroses and Psychoses

Symptoms, as Freud emphasized, do not necessarily reveal the underlying pathological process. The important thing to understand is the underlying psychic structure a phobia or an obsession may be the expression of a hysteric or obsessive neurotic structure, or they may be the symptoms of a psychosis. If the structures of a personality or an individual neurosis may be expressed in quite different ways, then it stands to reason that neurotic and psychotic processes would express themselves in different ways in different cultures. The prevalence and forms of mental illness in different cultures is an old concern of psychoanalytic anthropology culturally specific behavioral manifestations of schizophrenia have been discussed for Japan (Caudill, 1959), Italy (Parsons, 1969), and many other cultures. Parsons also raised the question of how people in a community differentiate mental illness from culturally appropriate accusations of witchcraft. Melford Spiro wrote on a case of psychosis in...

First Episode Psychosis An Avoidable Crisis

The onset of a first episode of psychosis often represents a crisis, with the patient and family experiencing considerable trauma and multiple losses. In a small number of cases the onset is very acute and a hitherto completely well person descends into a florid phase of illness which can truly be called an ''episode''. Much more commonly, the so-called ''episode'' is largely an artefact of late presentation. The episode or crisis could have been prevented, since the patient presents after a considerable period of significant symptoms and impaired function, plus several attempts by himself or his family to seek help 39,40 . However, as any clinician knows, there are a number of obstacles to the early detection and treatment of first episode cases (Table 2.6). Typically, an additional critical event such as an overdose or aggressive incident will have been necessary for a new patient to gain access to specialist assessment and care. This means that intervention usually needs to occur...

Criticisms Of Cbt For Schizophrenia And Directions For Future Research

The key assumption that the faulty logic associated with hallucinations and delusions is similar to that seen in other disorders has not been subjected to empirical evaluation, and runs counter to a large body of literature on the neurobiological basis of thought disorder in psychosis. While the validity of this assumption is an important issue for future research to address, CBT treatment strategies may nevertheless be effective in helping patients cope with symptoms. Results for acute inpatients have been less impressive than for stabilized (chronic) outpatients with residual symptoms (Bach & Hayes, 2002 Lewis et al., 2002). Most trials have not recruited patients randomly. Rather, subjects have generally been selected so as to be appropriate for a verbal psychotherapy. Patients with significant cognitive impairment or with substance abuse problems have not been well-represented in these trials. It is questionable if the more abstract, cognitively demanding CBT techniques can...

Schizophrenia and Bipolar Disorder

Schizophrenia is a disorder characterized by psychotic symptoms such as hallucinations, delusions, and disordered thinking, as well as deficits in emotional and social behavior. Numerous family, twin, and adoption studies have provided substantial evidence for genetic factors in the etiology of this dis- order. Nongenetic factors also appear to play an important role. The risk for relatives of an individual with schizophrenia is 6.5 percent, nearly eight times the population rate of the disorder. The concordance rate for monozygotic (identical) twins is 45 percent, and for dizygotic (fraternal) twins the rate is 12 percent. The higher rate for monozygotic twins, who share all their genes, is strong evidence that genes play a role in schizophrenia. Molecular genetic (linkage and association) studies suggest that there are multiple genes with small effects that predispose one to the disorder. In an early study, chromosome 5q was implicated, but was not replicated. Areas on chromosome 6p...

Anthropological Contributions to the Treatment of Psychosis

The treatment of mental illness is a subject of considerable interest for psychoanalytic anthropology, in nonwestern societies and closer to home. Treatment programs of psychosis that integrate native healers into the treatment process have had striking results. A well-known example is the program started by T. Adeoye Lambo at Naro in Nigeria, in which patients were taken into families in the village of Naro and, as part of the treatment, worked and participated in village and family life. Native healers were used alongside psychiatrists as part of the treatment (Lambo, 1964). The psychoanalytic treatment of psychosis in North America was pioneered by two psychoanalysts who are also anthropologists. Bryce Boyer, who, together with his anthropologist wife Ruth, has lived among the Apache and done extensive field work with them (to the extent of being initiated as an Apache shaman Boyer, 1964), was one of the first analysts in the United States to undertake psychoanalytic treatment of...

Schizophrenia and Neuroleptic Drugs

An association with excited delirium is but one manifestation of the increased mortality associated with schizophrenia. Patients with this often devastating disorder suffer an increased incidence of natural disease, particularly cardiovascular disorders, as well as deaths by unnatural means (including suicide and accidents).4142 However, attention has increasingly focused upon abnormalities of cardiac rhythm, particularly prolongation of the QT interval. Several antipsychotic agents (pheno-thiazines, haloperidol, and clozapine) have been implicated, as well as tricyclic antidepressants and other drugs including some antihistamines and antibiotics. such as olanzapine are reputedly less likely to be associated with this phenomenon at therapeutic doses. A number of other factors, such as electrolyte imbalance (particularly hypokalemia and hypomagnesemia), chronic liver disease, and genetically determined abnormalities of cardiac ion channels, also have implicated.44 These factors...

Lists of Prodromal Features of Schizophrenia

Yung and McGorry 41 and Edwards and McGorry 74 have listed the prodromal features in first-episode psychosis most commonly described in the literature. All these symptoms have also been included in the IRAOS and were assessed in the ABC Schizophrenia Study It was also the McGorry group which brought to our attention the existence of two further types of symptoms in incipient psychosis, i.e. attenuated psychotic symptoms and the rarer BLIPS 41 .

Comparison of Prodromal Symptoms in Schizophrenia and Depression

We compared a representative subsample of 130 first admissions for schizophrenia from the ABC study with 130 age- and sex-matched ''healthy'' controls from the general population and 130 first admissions because of a depressive episode. Of the latter group, 70 suffered from a severe depressive episode. All these samples went through IRAOS interviews. Preliminary results show that DUI was significantly longer in depression (7.2 years) than in schizophrenia (5.3 years) (p< 0.05). Equal proportions of both samples had received psychotropic medication before first admission 19 of the patients with schizophrenia and 20 of the depressed patients. As shown in Table 1.5, the two disorders share eight of their ten most frequent initial symptoms. These shared symptoms are primarily core depressive symptoms and indicators of functional impairment. In the further course of the prodromal stage, cognitive and social functioning deteriorate in depressive illness, too, but less markedly than in...

Depressive Symptoms as Prodromal Signs of Schizophrenia

As shown above, depressive symptoms frequently appear long before the first positive symptom 16,114,116 . In the ABC study cohort, the lifetime prevalence of depressive mood of a duration of two or more weeks -assessed until first admission - was 81 . In 39 of cases the symptom was continuously present, in 34 recurrent, and in 8 it occurred only once. Only 19 of the first-episode cases of schizophrenia reported not to have suffered from an episode of depressed mood 114 . A comparison of 57 first-episode patients with schizophrenia with 57 population controls matched by age, sex and place of residence showed that three out of four depressive symptoms were significantly more frequent in patients than in controls 114 . For depressive mood, the lifetime prevalence The depressive syndrome emerging at the early prodromal stage of schizophrenia is presumably for the most part a pattern of response of the brain to fairly mild degrees of dysfunction. It seems to be produced by the same...

Neurotransmitters and the pathogenesis of schizophrenia

In its original form, the dopamine hypothesis of schizophrenia postulated that the positive symptoms of the illness arose as a consequence of the Table 11.2. Risk factors for schizophrenia The deficit syndrome of schizophrenia, characterized by prominent negative symptoms, is presumed to be due to diminished prefrontal cortical activity. In experimental studies in patients, these symptoms often show response to dopaminergic agonists. As there are no dopamine autoreceptors on dopamine terminals in the cortex of the brain, it must be assumed that such agonists are acting on postsynaptic dopamine receptors to alleviate the negative symptoms. A diminished frontal cortical activity, as shown by PET studies for example, appears to be a characteristic feature of the untreated schizophrenic patient which would support the view that, at least in some patients, cortical dopaminergic activity is lower than normal and is not globally increased as was postulated by the original dopamine...

Schizophrenia and Other Psychotic Disorders

Mood Disorder Children Decision Tree

Schizophrenia and related disorders are marked by the presence of psychotic symptoms, primarily delusions and hallucinations. Delusions are defined as fixed false beliefs that are not amenable to arguments or facts to the contrary and that are not shared by others of similar cultural background. Common delusions are of several types. Persecutory delusions are those in which one believes that one is being attacked, followed, harassed, or conspired against. Grandiose delusions are those that involve themes of special powers or abilities. Bizarre delusions are those with patently absurd content, such as believing that one's thoughts are controlled by extraterrestrial beings. Hallucinations are false perceptions experienced in a sensory modality and occurring in clear consciousness. Auditory hallucinations are the most common, followed in order of prevalence by visual, tactile, olfactory, and gustatory. The most prevalent psychosis is schizophrenia, described in detail in the next...

Neuropathological Evidence for Neural Injury before Birth in Schizophrenia

The key neuropathological data for an in utero origin to schizophrenia centre around neuronal migration, and, increasingly, glial proliferation. The presence of neuronal disarray, heterotopias and malpositioning are very suggestive since cytoarchitecture is largely determined during early fetal life, well before the last trimester.5'35. Among the cellular findings are abnormal cytoarchitecture of the entorhinal cortex characterized by poorly formed layer II neuron clusters and laminar disorganization, a reduction and displacement of hippocampal and cortical pyramidal cells, and abnormal development of the subplate.35,37-41 Such studies suggest disturbances of neuronal migration during the late first or early second trimester. An earlier time is excluded since gross abnormalities in the structure and cellular content of the cerebral cortex would be expected if neurogenesis were affected.5 However, these data are not conclusive, since some studies have not found evidence for abnormal...

Differential Diagnosis Childhoodonset Psychosis

The clinical picture of childhood-onset psychosis may include a tendency towards isolation and becoming reserved and withdrawn, but also soft neurological signs, delayed language development and attention deficit. These features, which might be characteristic of children who suffer from ADHD, do sometimes cause diagnostic confusion. They raise the question of whether a child who was diagnosed with ADHD and later with schizophrenia suffered from the outset from early signs of the latter disorder. This question is important, since the traditional treatment for ADHD, i.e. psychostimulants, conflicts with the common treatment for schizophrenia, and there are those who assert that it might even increase the risk of developing the symptoms of the latter disorder. In a recent study, ADHD was diagnosed in 31 of first-degree relatives of schizophrenic patients, much more than should be expected in the general population 53 . In addition, it was found that among these children there were more...

Instruments For Assessing The Onset And Early Course Of Schizophrenia

The success of early intervention programmes depends on the degree to which help-seeking can be mobilized among at-risk persons in the population, for example by carrying out awareness programmes that provide basic information on schizophrenia and its treatment 74,140 . Antistigma and information campaigns play an important role, as successfully demonstrated by the WPA Global Programme Against Stigma and Discrimination Because of Schizophrenia 141 . Another precondition is a well-functioning network of low-threshold pathways to care 142 , that is, easily accessible and as far as possible stigma-free early intervention centres or other suitable mental health services 16,143 .

Diet And Schizophrenia

Although there have been studies that have shown the importance of dietary essential fatty acids (EFAs) for healthy neurodevelopment (Crawford, 1993), until recently there had been no studies of infant feeding practices in relation to subsequent schizophrenia. It has been shown that the children of women pregnant during the Dutch famine (19441945) were significantly more likely to develop schizophrenia in later life (Susser & Lin, 1992). Although these women suffered multiple dietary deficiencies and not just PUFA, it is known that during early development infants require healthy amounts of AA and DHA to maintain normal brain development (Rogers, 1978 Rogan & Gladen 1993 Lucas et al., 1992). What the Dutch data do demonstrate is that dietary impairment in utero, presumably by affecting neurodevelopment of the fetus, can have substantial effects in adulthood. Two initial studies of breast feeding in schizophrenia, one by our group and one in Scotland (McCreadie, 1997), produced...

The Etiology Of Schizophrenia

There are currently two dominant theories as to the etiology of schizophrenia. The most popular postulates abnormal neurotransmitter receptor function within the brain and, to a large extent, concentrates on studying dopamine and serotonin. Although this theory still provides psychiatry with its best tools for dealing with psychosis, namely medications, it has proved sterile ground for developing radical new treatment approaches. The second most dominant theory is known as the neurodevelopmental hypothesis and concentrates on the way the brain develops during the early months of life. Emphasizing the role of genetics married to environmental conditions, the neurodevelopmental hypothesis is fast gaining credence within the research community. The genetic factor is clear, and the most significant risk factor for individuals developing schizophrenia is having someone within your immediate family who has also been a sufferer. It is also clear that there are deficits in the way those who...

Duration Of Untreated Illness And Untreated Psychosis As Indicators Of An Unfavourable Further Illness Course

In current clinical practice, the first treatment contact of persons falling ill with schizophrenia is preceded by incipient psychosis with a mean duration of about a year or more (DUP) and a prepsychotic prodromal phase with a mean of several years (duration of untreated illness, DUI duration of the prodrome+DUP) (see Table 1.1). DUP and, in rare studies, also DUI have been described as prognostic indicators of unfavourable aspects of course and outcome in schizophrenia. The following short-term effects of a lengthy untreated first psychotic episode have been reported delayed and incomplete remission of the first episode versus better therapy response and more rapid remission 14,16,4246 , longer active illness or longer presence of psychotic and negative symptoms 47,48 , reduced level of global functioning 49 and a longer duration of hospitalization and higher treatment costs 45,46,50 . The results on the association between DUP or DUI and medium- or long-term outcome are less...

Goals of Inpatient Care in Early Psychosis

Treatment in hospital aims to reduce the severity of psychotic symptoms, and promote the remission of psychosis through the use of thorough Table 2.16 Some goals of inpatient care in first-episode psychosis Provide information about psychosis and treatment for the patient and family.

Negative Results In Crossnational Studies Of Schizophrenia

In cross-national analyses, no specific relationship between seafood or fish consumption and schizophrenia prevalence nor outcome has been reported. Among eight countries, Christensen and Christensen (1988), reported that better outcome measures for patients with schizophrenia were correlated with a low percentage of fats from animals (r 0.91-0.95, p < 0.01) but not correlated to a higher percentage of dietary fat from vegetable and seafood sources (r 0.23-0.50, p < 0.10). These results are also consistent with a recent analysis of seafood consumption and prevalence rates of schizophrenia (Naoghiul, Weissman, and Hibbeln, unpublished) obtained using a gold standard of cross-national psychiatric prevalence data. Across 14 countries, there was no significant relationship between prevalence rates of schizophrenia and seafood consumption utilizing simple and nonlinear models. In summary, these data suggest that there could be a specific relationship of seafood consumption and omega-3...

Schizophrenia And Its Treatment

Schizophrenia is the most devastating of the major mental illnesses. Its prevalence is stable across cultural and national boundaries, affecting between 0.5 and 1.5 of all populations. In the United Kingdom the economic cost of schizophrenia has been put at some 850 million per year, ranking it third behind strokes and learning disabilities as the most costly illness to the health service (Knapp, 1997). In human terms, the damage caused by schizophrenia is incalculable. It is known, for example, that as many as 12 of schizophrenics eventually commit suicide (Brown, 1997). A cursory review of some of the major symptoms of schizophrenia offers an insight into why it is so devastating. Conceptually, the symptoms can be divided into two broad groups, positive and negative. The positive symptoms, those most readily associated with schizophrenia by the general public, include such things as hallucinations (hearing voices) and delusions. The negative symptoms, not given the attention that...

Interval Timing Sensitivity in Persons at Risk for Schizophrenia

Given the findings of different sensitivities to modality effects in young and aged populations, it is worthwhile to consider whether the existence of modality effects may prove a useful tool for examining the cognitive and neurophysiological bases of timing via studies of patient populations. For example, a number of studies have reported temporal processing deficits in patients diagnosed with schizophrenia (Sz). Overestimation of duration in the seconds range has been reported for verbal One difficulty with studying cognitive processing in a psychiatric population, however, is that performance deficits may be a consequence of a lack of motivation or task comprehension rather than a specific cognitive deficit. In addition, psychiatric patients are often medicated, and most psychoactive drugs have varied effects on cognitive processing. These difficulties may be circumvented through studying unmedicated individuals at genetic risk for the psychiatric disorder in question. The risk to...

Homebased Treatment In Early Psychosis Choice of Treatment Setting

Patients should be cared for in the least restrictive setting that is likely to be safe and to allow for effective treatment 11 . It should not be assumed that every patient with a first episode of psychosis will require admission to hospital. The three most common reasons for admission to hospital in a first episode of psychosis 3 are The first experience of treatment for early psychosis can strongly influence future attitudes to all types of therapy and the mental health system in general. Effective home-based care is likely to be regarded favourably by patients, enhance the therapeutic alliance, improve adherence with medication and other interventions, and facilitate follow-up care.

Schizophrenia

The use of omega-3 fatty acids also seems promising for some symptoms of schizophrenia (see Fenton et al., 2000, for a review). A series of case reports by Rudin (1981 1982) described significant reductions of psychosis after treatment with flax seed oil. More recent open trials have also indicated possible efficacy (Mellor et al., 1995 Puri and Richardson, 1998 Puri et al. 2000). Three double-blind, placebo-controlled trials (Peet and Mellor, 1998 Peet et al., 2000a Peet et al., 2000b) have reported clinical improvements among schizophrenics treated with EPA alone, while one study found no clinical improvements (Fenton, et al., unpublished data). Unfortunately, results in the form of full publications are not yet available for any of the double-blind trials. Of these studies, the most striking report is that when treated with 3 g d of EPA alone, 10 of 30 unmedicated first-episode schizophrenics required no other medications to be free of psychosis (Peet et al., 2000a). In contrast,...

Why Early Psychosis

The umbrella term ''early psychosis'' has been preferred to a narrower focus such as ''first episode schizophrenia'', both for clinical and research purposes, for several reasons 7 . First, it enables the prodromal period, the first episode of psychosis and the so-called ''critical period'' 8 of the early years post-diagnosis to be included in the management focus. Second, it allows for diagnostic flux and evolution to be handled 9 . Third, the clinical needs of patients with early psychosis, and their families, are very similar irrespective of diagnostic subtype. Finally, the negative prognostic expectations associated with a diagnosis of schizophrenia can be minimized by using a more prognostically neutral umbrella term for the clinical programme. The term schizophrenia still is used as a second-line statement, but is explained as no more than a descriptive syndrome, and as a diagnosis rather than a prognosis. This approach works well clinically and for a variety of research...

Connections Between Interval Timing Neuropharmacology And Drug Abuse

Gene-dosage effects of the DAT can be observed. Wild-type mice (+ +) have a normal (100 ) level of the DAT. There is 50 expression of the DAT in heterozygous mice (+ -) and a total lack of the DAT in homozygous mice (- -). Dopamine stays in the synapse 100 times longer in - - mice than in + + mice. Mice without the DAT are five to six times more active than wild-type mice and have been used as an animal model of cocaine and amphetamine addiction, attention deficit hyper-activity disorders, and schizophrenia (see Cevik, this volume Gainetdinov and Other molecular mechanisms underlying the role of dopamine in interval timing may be studied using catechol-o-methyltransferase (COMT) deficient mice. Although there are many proteins involved in the biological actions of dopamine, COMT, because it metabolizes released dopamine primarily in the prefrontal cortex may be a critical marker for schizophrenia and cognitive functions such as interval timing (Egan et al., 2001).

Adaptive Nonresponding Theory See Sleep Theories Of

Compulsive patterns of drug and substance use. The addiction theories, based upon how drug-induced alterations in psychological function cause such a transition to addiction, include the following the traditional hedonic theory -drug-related pleasure, and subsequent unpleasant withdrawal symptoms, are the chief causes of addiction aberrant-learning theory - addiction is due to faulty learning patterns, especially the development of strong stimulus-response connections and habits incentive-sensitization theory - suggests that sensitization of a neural system that attributes incentive salience causes compulsive motivation or desiring to take addictive drugs and frontal cortical dysfunction theory - proposes that malfunctioning of the frontal cortical systems, which normally regulate decision-making and inhibitory control over behavior, leads to faulty judgment and impulsivity in addicted individuals. In attempting to understand and treat addictions, it is suggested that the researcher...

TABLE 114 Drugs Used for Induction of Anesthesiax

KETAMINE Unlike any of the other induction agents, ketamine tends to increase heart rate, blood pressure, and cardiac output. These effects appear to be mediated through central sympathetic stimulation, since ketamine appears to be a weak myocardial depressant in isolated heart preparations. Such effects enhance its attractiveness in settings such as trauma with hypovolemia. It is also a bronchodilator with no suppression of ventilatory drive, making it an excellent choice for patients with known reactive airway disease. In addition, it has significant analgesic and amnestic properties. It can be given intramuscularly in a dose of 4 to 6 mg kg with onset of anesthesia within 5 min. This may be desirable in the combative patient in whom intravenous access has not been secured. Unfortunately, it also carries a number of undesirable side effects. Despite the bronchodilatation, there are marked increases in upper airway secretions, which can occur briskly and complicate airway management....

The Earliest Psychotic Symptoms

In the ABC Schizophrenia Study 18 , the earliest positive symptom, delusions, appeared on average 14.3 months, the first hallucination 8.7 months and the first formal thought disorder 8.2 months before first admission. This result provides no evidence for the hypothesis that delusions are an expression of cognitive coping with the distressing experience of hallucinations. The cumulative prevalence of delusions in the early course was 96 , that of auditory hallucinations 69 and that of thought disorder 62 . The fact that their prevalence approaches 100 reflects the role of positive symptoms as the leading diagnostic criteria for schizophrenia and, hence, also the type of patients included in or excluded from study samples of schizophrenia.

Empirical Basis Of Cbt With Couples And Families

Unfortunately, the area of CBT in couples has substantially more quantitative studies than family therapy (Baucom et al., 1998 Dattilio & Epstein, 2003 Epstein, 2001). The most recent of the family therapy studies include addressing the treatment of schizophrenia in the early 1980s as well as those studies conducted by Barrowclough and Tarrier (1992).

Differential Diagnosis

In some cases, anorexia nervosa is secondary to a serious, underlying psychiatric illness, with the weight loss being only an added problem. A particular diagnostic and therapeutic dilemma may occur for young women with personality disorder or chronic schizophrenia and anorexia nervosa.

Theoretical Bases

Impairment in attention is a common symptom of severe psychiatric illness. Patients with schizophrenia perform poorly on tasks that require vigilance, quick responses, or sustained attention. Because these deficits are evident during and between episodes of active psychosis and have been noted in individuals at risk for schizophrenia, they are considered to be trait or vulnerability markers of the disease. Patients with bipolar and unipolar depression, especially if the illness is treatment refractory or has accompanying psychotic features, also have severe problems with attention. Attention has several aspects, and it is possible for some elements of attention to remain intact while others are deficient. For example, the ability to encode information, which can be measured by Digit Span, is differentiated from the ability to sustain attention and maintain readiness to respond to a signal. Tasks such as the CPT measure vigilance or ability to sustain attention, ability to be ready to...

Psychiatric Disorders

Patients may present with psychiatric symptoms, such as hallucinations, delusions, or other abnormal behavioral changes. The cause is unclear, and treatment has been identical to that for other psychoses. Acute episodes require admission.

Suggested Reading

Rev. 31, 350-356. Kowler, E. (1990). The role of visual and cognitive processes in the control of eye movement. In Reviews of Oculomotor Research 4. Eye Movements and Their Role in Visual and Cognition (E. Kowler, Ed.), pp. 1-70. Elsevier, New York.

Biosocial Theory See Murphys Biosocial Theory

The Swiss physician psychiatrist Eugen Bleuler (1857-1939) formulated theories of schizophrenia and mania-depression that include the following conjectures there are four fundamental symptoms (the four As) of schizophrenia autism, ambivalence, inappropriate affect, and loosening of associations there is a fragmentation of thinking, i. e., a psychological disturbance in which thoughts and actions that are normally integrated are split apart, and thinking processes become confused where actions and ideas are impossible to complete there is a total incapacity to feel sympathy for, or to be concerned with, the welfare of others (Bleuler used the obsolete terms moral idiocy and imbecility) there are inconsistencies in the explanations and reasons that some patients create to justify their previous behaviors (pseudomotivations) there may be episodes of elation or mental disturbance that tend to occur on the anniversary (anniversary excitement) of a significant date in...

Lamarcks Evolution Theory

Lamarckian-Lysenko doctrine Lamarckian-ism Lamarckism. The French naturalist evolutionist Jean-Baptiste Pierre Antoine de Monet Lamarck (1744-1829) presented his theory of evolution in 1800 in a public lecture in which he proposed the first coherent theory of the process of evolution prior to Darwin's theory of natural selection (Lamarck also proposed the heredity predisposition theory, which is used often in relation to pathological conditions, such as schizophrenia, to explain

Atypical neuroleptics

An important breakthrough in the development of novel neuroleptics arose over 25 years ago with the discovery of the dibenzazepine neuroleptic clozapine. This neuroleptic was novel because it attenuated both the positive and negative symptoms of schizophrenia without causing extrapyramidal side effects or elevating serum prolactin concentrations, effects which characterize most typical neuroleptics such as chlorpromazine and haloperidol. Clozapine binds with a high affinity (in the nanomolar range) to D4 and D2 receptors and with lower affinity for the D1, D3 and D5 receptors. The finding that clozapine had a high affinity for the D4 receptors was particularly exciting when it was discovered that an elevated expression of D4 receptors occurred in the brains of schizophrenic patients. However, more recent studies have shown that clozapine also binds with a high affinity to the short form of the D2 receptor. Further evidence for the relative lack of specificity of clozapine, not only...

Treatment Of Hallucinations

For hallucinations in the setting of schizophrenia, medications that alter transmission of dopamine and related neurotransmitters, termed neuroleptics, are the mainstay of treatment. In other settings, the first step in the treatment of hallucinations is to address the condition that underlies their existence. When this is impossible or ineffective, neuroleptic medications may be tried. However, these tend to be less effective in settings that do not involve limbic, striatal, or dopa-minergic pathology. Fortunately, hallucinations in the setting of sensory input disorders, where neuroleptics are least effective, are often less disturbing to those experiencing them, as described previously. Such hallucinations sometimes respond to carbamazepine, a medication often used for seizure prevention, mood stabilization, or control of pain originating in the nervous system. This is consistent with models of aberrant neural activity described previously. Future developments in the treatment of...

Personality Variables

Personality traits have also been explored in high-risk samples. Given the odd, eccentric behaviour of persons with schizophrenia, Squires-Wheeler et al. 69 hypothesized that certain personality disorders, specifically schizoid, schizotypal and paranoid personality disorders, might be more prevalent in the adult offspring of schizophrenic parents. However, no such aggregation was found 69 . In a later follow-up with the same subjects, all from the New York High-risk Project, an experimental scale derived from the MMPI 70 was shown to be an effective predictor of schizophrenia-related psychoses 71 . This revised Schizophrenia Proneness scale predicted schizophrenia with over 95 accuracy. Positive predictive power was 40 , negative predictive power was over 97 , sensitivity was 37.5 and specificity was almost 98 71 . Scores on this scale seem to offer significant promise as a relatively cost effective and efficient predictor, although the researchers caution that further refinement is...

Atypical neuroleptics and their effects on serotonin and dopamine receptors relevance to clinical action

Imaging techniques such as CAT have shown that enlargement of the lateral ventricles is a frequent feature of schizophrenia. Such structural changes do not appear to be associated with the nature or duration of neuroleptic therapy and are found in affective disorders. The changes found in the schizophrenic brain may be triggered by environmental factors such as birth complications. In addition, selective reduction in the size of the temporal lobe commonly occurs in schizophrenics and such changes appear to be lateralized in the left hemisphere. Regional blood flow studies, and the measurement of regional glucose metabolism, has provided evidence of reduced frontal lobe function (hypofunctionality). Atypical neuroleptics such as clozapine and risperidone have been developed because it was found that up to 20 of schizophrenic patients did not respond to ''classical'' neuroleptics of the phenothiazine or butyrophenone type, while those patients who do initially respond to such medication...

Obstetric Complications

The significance of obstetric complications in the development of schizophrenia has led to some disagreement among researchers. In their 1978 review, McNeil and Kaij concluded that obstetric complications are not increased in the births of high-risk offspring 77 . A later meta-analysis arrived at a different conclusion Sacker et al. found small but significant effect sizes indicating that ''the risk of obstetric complications is increased in the births to parents with schizophrenia'' 78 . Specifically, birth weights were lower, there were more birth complications and the baby's condition was poorer 78,79 . Schizophrenic women are thought to be at greater risk for complications because of the association between schizophrenia in young women and smoking, substance abuse and low socioeconomic status 78,79 . In addition to noting a higher incidence of obstetric complications in the births of schizophrenic mothers, complications have been explored as having a causal role in later...

Learned Helplessness In Animals

Widlocher (Eds.), Animal Models of Psychiatric Disorders, vol. 1, Selected Models of Anxiety, Depression, and Psychosis (Basel, Switzerland Karger, 1988), 1-35 Peterson, C., S. F. Maier, and M. E. P. Seligman, Learned Helplessness A Theory for the Age of Personal Control (New York Oxford University Press, 1993) Seligman, M. E. P., Helplessness On Depression, Development, and Death (San Francisco Freeman, 1975).

Performance Of Dyslexics And Nondyslexics On The Rorschach Ink Blot Test

The results of the study surprised Ann. As an experienced clinician she could recognise the presence of psychosis and of organic brain damage, but with the dyslexic children there was no evidence of either. Yet their responses were very different from those of the non-dyslexic controls.

Interventions For Highrisk Children

A major goal of studying children of persons with schizophrenia has been to develop screening and intervention tools. Such efforts are in their infancy, with the first early intervention study being initiated by Falloon 92 slightly over a decade ago. Genetic testing for children who may be at risk would be one means of early detection, although this information A few intervention efforts have recently been launched, often based on the notion that shorter duration between first psychotic episode and subsequent treatment is associated with a better prognosis 95,96 . Improved access to care and increased education efforts have been shown to reduce treatment delay 95 . Other intervention options include pharmacological treatment with antipsychotics initiated during the prodromal phase or perhaps earlier. The risks of such intervention are significant children may be more prone to side effects, including dyskinesias, and need careful monitoring 97 . The benefits of administering these...

Background and History

The use of psychiatry as an instrument of social control had a long history in the former Soviet Union. Soviet authorities chose to have dissenters from official governmental policy labeled with mental illness designations such as schizophrenia, sluggish schizophrenia, or paranoid development of the personality. The labeling of persons as mentally ill is an effective way to discredit their beliefs and actions, and to maintain control over those persons of whom a government disapproves. The prison system has also been the setting for a variety of divided-loyalty dilemmas. The professional may be called upon to evaluate an accused person's competency to stand trial. If treated, the person may become competent to stand trial, but left untreated the psychosis may prevent the person from participating in his or her own defense. In capital cases this can be a matter of life or death. How does a physician understand this obligation to the patient when providing treatment, particularly...

Developing Criteria for Atrisk Mental States and Ultrahigh Risk

The ideas expressed by Bell 23 were first translated into practice in Melbourne, Australia in 1994 at the Personal Assessment and Clinical Evaluation (PACE) Clinic 24 . This approach has now been adopted in a number of other clinical research programmes across the world (e.g. 25-27). These studies have been referred to as ''ultra-high-risk'' (UHR) studies to differentiate them from the traditional high-risk studies that rely on family history as the primary inclusion criteria. Intake criteria for such studies were initially developed from information gleaned from literature reviews and clinical experience with first-episode psychosis patients and have been evaluated and refined in the PACE Clinic over the past eight years. Although the UHR studies ostensibly seek to identify individuals experiencing an initial psychotic prodrome, infallible criteria have not yet been developed towards this end. In addition, ''prodrome'' is a retrospective concept that can only be applied once the full...

Dimensions of Costs

There have been many studies of the cost-effectiveness for specific disorders or illnesses. A few selected topics are addressed here. These are anxiety disorders, affective disorders, physical illnesses, borderline personality disorder, substance abuse, schizophrenia, and general considerations.

Hormonal changes resulting from neuroleptic treatment

Acute dopamine receptor blockade by neuroleptics has long been known to induce a dose-dependent increase in prolactin as a consequence of the decreased activity of the inhibitory D2 receptors that govern the release of this hormone from the anterior pituitary. However, dose-response studies show that the dose of a neuroleptic required to raise the plasma prolactin concentration is lower than that necessary to have an optimal therapeutic effect. Furthermore, the time of onset of the rise in prolactin is short (hours), whereas the antipsychotic effect of a neuroleptic takes many days or even weeks. There is also evidence that raised serum prolactin levels persist throughout drug treatment, which suggests that tolerance of the tubero-infundibular dopaminergic system to the action of neuroleptics does not occur it should be noted that not all investigators agree with such a view. There is little evidence to suggest that a relationship exists between the symptoms of schizophrenia, or the...

Assessing Prodromal Symptoms Before Psychotic Relapses

Table 1.4 The ten most frequent earliest signs of schizophrenia (independent of the course) reported by the patients Table 1.4 The ten most frequent earliest signs of schizophrenia (independent of the course) reported by the patients Various items from scales for the identification of early signs and symptoms of psychotic relapses 102,110 have been integrated in subsequently generated instruments for the assessment of onset and early course in schizophrenia 24-26,111,112 . Systematic studies of the onset and prodromal symptoms of schizophrenia have relied on retrospective assessments of representative samples of first-episode cases of schizophrenia. Table 1.4, taken from the ABC Schizophrenia Study, shows the ten most frequent initial symptoms. These symptoms are equally frequent in men and women, except worrying, an item which is also more frequent in women in population studies. The majority of these items belong to two symptom dimensions, the affective-depressive and the negative...

Changes in cognitive function during neuroleptic treatment

The effects of long-term neuroleptic administration on cognitive and psychomotor function have been the subject of many studies. Some of the early studies undertaken during the 1960s reported that acute doses of phenothiazine neuroleptics caused cognitive impairment in schizophrenic patients, whereas chronic treatment led to improvement. More recent studies, however, have reported improvement in attention and in cognitive function following short-term administration. Detailed studies revealed that memory and fine motor coordination were impaired by many neuroleptics, the amnesic effects probably being related to the central anticholinergic effects of the drugs while the effects on motor control may be ascribed to the blockade of dopamine receptors. In general, it would appear that the hyperarousal state that occurs in schizophrenia is reduced by neuroleptics, thereby leading to an improvement in attention. However, the consensus would now appear to be that a general decrease in...

Attention Deviance and Other Cognitive Markers

Attention deficits have been shown to be highly characteristic of schizophrenic patients and their relatives. According to data gathered from the New York High-risk Project, attention deviance can be reliably detected in preschizophrenic children, and these deficits are stable and enduring over time 43 . In a 1992 review of attentional findings from the New York High-risk Project 42 , the authors indicate that by at least the age of 7 more than a quarter of the high-risk sample had attention deficits. Similar attention deficits were also observed in low-risk children, but these problems persisted beyond childhood only in high-risk subjects 42 . Similar findings emerged from the NIMH Israeli High-risk Project, with adult schizophrenia spectrum cases showing greater attention difficulties at age 11 as compared to control groups 37 . Using samples of patients from Ireland, Israel and Washington, DC, Mirsky 91 found that schizophrenic patients performed most poorly on measures of...

Machiavellian Hypothesis

This approach involves an alleged hypothetical personality trait (typically assessed via scores on the Mach Scale Questionnaire or the Machiavellianism Scale) reflecting one's use of a social conduct strategy whereby other people are manipulated - via deception, opportunism, and deviousness - in order to gain a personal advantage for oneself, often resulting in the detriment of the exploited person(s). The notion of Machiavellianism is named after the Florentine political philosopher and statesman Niccolo Machiavelli (1469-1527) who advanced the strategy of power and control through manipulative political behavior, and was popularized by the American psychologists Richard Christie (1918-1992) and Florence L. Geis (1933- ) in the late 1960s, especially through their Mach Scale in which the respondent if asked to agree or disagree with a series of statements (e.g., the best way to handle people is to tell them what they want to hear), many of which are actual,...

Current Status DecisionsPredictions

Is John X suffering from Schizophrenia, Panic Disorder, Clinical Depression, Attention Deficit, or some other mental disorder Additional validation evidence for the WIST includes studies done in Mexico and Spain with Spanish translations of the instrument. These studies show some support for the WIST's ability to detect the thought impairment associated with schizophrenia, albeit with different rates of efficiency and different cutoff scores. high error rates that the WIST cutoff scores can yield, they should never be used as the sole vehicle for establishing a diagnosis of schizophrenia, any more than any other single indicator should. However, depending on the setting and context of testing, the WIST may prove useful as part of a screening battery or as one index of change in the symptomatology of patients diagnosed with schizophrenia.

Potential cardiotoxicity of antipsychotic drugs

Other factors which predispose to the cardiotoxicity of antipsychotic drugs include raised triglyceride and low density lipoprotein concentrations, diabetes and weight gain. The latter is a frequent side effect of many psychotropic drugs including the TCA antidepressants, and mianserin and mirtazepine, clozapine, olanzapine and to a lesser extent quetiapine and risperidone. Clearly the long-term cardiotoxicity of antipsychotic medications is a cause for concern, particularly in the case of patients on long-term treatment with typical neuroleptics. In CONCLUSION, the use of the classical neuroleptics, as exemplified by the phenothiazines, thioxanthines, butyrophenones and diphenylbutyl-piperidines, has been a landmark in the pharmacotherapy of schizophrenia and psychotic disorders. The efficacy of such drugs in the alleviation of the symptoms of schizophrenia is universally accepted. However, it is also evident that they have a spectrum of adverse effects that frequently renders their...

Jimsonweed Datura Species

Ireatment includes GI decontamination with iesis or lavage, activated charcoal, and supportive care (IV fluids, external cooling, and restraints for patient protection). GI decontamination may be useful for up to 48 h after ingestion if the patient riains symptomatic.14 Physostigmine, a cholinesterase inhibitor, antagonizes both the central and peripheral effects and may be required in 30 to 40 percent of cases.13 It should be considered for severe cases exhibiting hyperthermia, seizures, or frank psychosis. An initial dose of 0.5 mg for children or 1.0 to 2.0 mg for adults is given slowly IV over 5 min. Repeat doses may be required. 13 See ChapterJ 77, Anticholinergic and Antihistaminic Ioxicity, for more discussion.

Neurological Manifestations

The classic neurological symptoms of early disseminated Lyme disease are meningitis, cranial neuritis, and radiculoneurotis. These occur alone or in combination in approximately 15 of untreated patients. A unilateral or bilateral facial nerve palsy is also a relatively common symptom of early disseminated disease. Symptoms usually last for weeks to months but can become chronic. Chronic neurologic manifestations of the disorder, which include encephalopathy, polyneuropathy, and leukoencephalopathy, usually occur late in the illness. Although there have been reports of cases with severe cognitive impairment, including psychosis and dementia, and vasculitic lesions, such cases are rare. A mild chronic Lyme encephalopathy (LE) is the most common neurologic symptom in patients with late-stage disease. Months to years after disease onset, sometimes following long periods of latent infection, a small percentage of patients develop a mild to moderate encephalopathy. The symptoms tend to be...

Crossnational Epidemiology And Major Depression

The analyses of cross-national epidemiological data, collected using high-quality modern diagnostic and epidemiological sampling methods, does provide one method of testing the hypothesis that a lower omega-3 fatty acid status is related to higher prevalence rates of affective disorders, psychotic disorders, or aggressive behaviors. Economic data describing seafood consumption has been useful in these cross-national studies. Although economic data on the production and consumption of seafood cannot accurately be used to quantify dietary intake for an individual, these data can be used to describe trends for the populations of entire countries and thus provide a basis for comparing consumption across countries (World Health Organization, 1996). The financial incentive to produce accurate data also adds some confidence to the accuracy of consumption estimates derived from economic data. When compared cross-nationally, greater amounts of seafood consumption were robustly correlated (r...

Epidemiology And Cause

Science has gained a large amount of information about manic-depressive illness but has been unable to identify specifically how the illness starts. There are most likely several causes for this syndrome of disorders. Studies of families, twins, and adoptions suggest that most cases of manic-depression are genetically inherited. There is general agreement among researchers that genetic components play a more significant role in transmitting bipolar I disorder than major depressive disorder, but this perspective continues to be debated. Family studies report that having a first-degree relative with bipolar I disorder increases the chances of developing manic-depressive illness by 8-18 times over families with no first-degree members having a bipolar disorder history. The likelihood of developing bipolar I disorder is 1.5-2.5 times greater if a first-degree family member has a major unipolar depressive disorder. Perhaps more illustrative of the genetic relationship to manic-depression...

Deficiencies In Gestation And Psychiatric Outcomes

An intriguing possibility is that some level of deficiency in omega-3 status either during interuterine, postnatal, or in later development, could contribute to a lifelong risk of suffering psychiatric illnesses through irreversible neurodevelopmental changes (Peet et al., 1999). For example, studies of periods of famine such as the Dutch Hunger War have generated hypotheses that specific psychiatric illness may be related to nutritional deprivation in specific periods of development. Prenatal malnutrition in the first trimester may increase risk for developing schizophrenia (Susser and Lin, 1992) as reflected in increased sulcal sizes (Hulshoff Pol et al., 2000) whereas later gestational famine during the second and third trimester increased the risk for later affective disorders (Brown et al., 2000). One test of the hypothesis that mothers are deficient in essential fatty acids during gestation has been to examine the composition of maternal plasma on the day of birth and the...

TABLE 2214 The Brief Mental Status Examination

The diagnosis of delirium prompts the search for an underlying disease process. The point that must be remembered is that delirium is secondary to another process that might or might not be related to the central nervous system. Making the diagnostic task more difficult is that chronic cognitive impairment may also be present in the individual patient, therefore making the assessment of the acuity of the mental status change difficult. The main features differentiating delirium from dementia and psychiatric conditions are the relative acute onset of the process (not a feature of dementia) and its fluctuating nature (not a feature of either dementia or psychosis).

Results from Twin Studies of Other Disorders and Conditions

The twin study method has been used to try to determine the extent of genetic or environmental influence on a wide variety of traits and conditions. Among these are sense of humor, which appears to be largely environmentally determined, as MZ and DZ pairs have similar concordance. Examples of other diseases in which MZ concordance exceeds DZ concordance, suggesting a significant genetic component, include addictive behaviors such as cigarette smoking and alcohol drinking, mental illnesses such as schizophrenia, as well as stroke and certain types of high blood pressure. Twin studies of many other disorders are ongoing.

Comments For The Design Of Future Studies Tissue Concentration Studies

Comparisons of tissue concentrations between controls and patients groups may be useful for exploratory analyses, but the groups should be controlled for confounding influences on fatty acid metabolism and catabolism and care should be take in the interpretation of the results. Comparison studies are of little value without careful diagnostic assessment and patient characterization. Consideration should also be given to the observation that improvement of depressive symptoms among subjects with other diagnoses may confound other outcome measures such as improvements in psychosis or cognition. Typically, comparison studies of the tissue composition of the fatty acids only determine if there is a difference between the groups at single point in time. Thus, it may be difficult to make interpretations concerning differences in basal metabolism or causal relationships. A series of critical questions must be addressed. Does this measure reflect differences in dietary intake Does the measure...

Emergency Diagnosis and Management

Psychiatric complication can occur with dopaminergic therapy, including sleep disturbances, vivid nightmares, auditory and visual hallucinations, paranoia, and frank psychosis. The severity of psychiatric side effects, especially visual hallucinations, is related to the treatment dose and duration and can be improved by a drug holiday or a reduction in drug dosage. Psychotropes that are known to cause tardive dyskenesia, such as haloperidol, must be used cautiously in patients with PD due to an increased risk of this complication.

Health Economic Tools

The first tool is the use of the techniques of optimization, which seek to maximize efficiency and minimize costs in the allocation of scarce resources. Economists prefer to use the word allocation rather than rationing for obvious reasons, but the fact remains that in every society today there is a scarcity of health care resources, making rationing ubiquitous. Some economists argue that use of the term rationing would require public policy to come to grips with the realities, as has the state of Oregon. In a uniquely direct method the state listed all of the health conditions in terms of priority, from the most important (life threatening) to the least, and assigned a cost and frequency to each. In going down the list, when the cumulative costs exceeded the dollars available, the state drew a line and everything thereafter was not covered by Medicaid. Thus stroke is very high on the list, whereas anen-cephaly (a condition in which a child is born without a brain) is not...

Major Tranquilizers Thorazine and Relatives

Major tranquilizers revolutionized psychiatry when they were first introduced in the early 1950s. They provided a new and easy way to manage schizophrenia and other severe mental diseases, making patients calm and emotionally quiet. In some cases the major tranquilizers have enabled psychotic persons to lead reasonably normal lives and function outside hospitals. More often, they make them more manageable and docile rather than less crazy.

Clinical Observations

The first is that patients with schizophrenia have a reduced risk of developing inflammatory disorders. The second is that some patients with schizophrenia experience a transient reduction in psychosis when they have a fever. Because metabolism of arachi-donic acid is involved both in inflammation and in fever, this led me to consider the possibility that arachidonic acid metabolism abnormalities might be involved in schizophrenia. There is now substantial evidence that this broad statement is true and considerable progress has been made in identifying the precise biochemical abnormalities that may be involved.

Magnetic Resonance Spectroscopy MRS

31P-MRS (magnetic resonance spectroscopy) can be used to probe phospholipid metabolism in the living human brain. The detailed interpretation of the results is open to much controversy, but there is broad agreement that phospholipid metabolism is abnormal in unmedicated schizophrenia patients and that the abnormality is consistent with an increased rate of phospholipid breakdown (Williamson & Drost, 1999 Pettegrew, Keshavan, & Minchew, 1993 Pettegrew et al., 1991 Shioiri, Kato, Inubushi, Murashita, & Takahashi, 1994). There is also evidence from magnetic resonance imaging that, in some patients with schizophrenia, there are expanded lateral ventricles consistent with loss of brain tissue. Because the main bulk of brain tissue consists of phospholipid, the finding is consistent with phospholipid breakdown (Horrobin, 1998).

Scenarios For Discussion

You have just completed an intake session with a person who is extremely fearful, hears voices, and seems to have a thought disorder. Your provisional diagnosis is some form of schizophrenia, although there are other possibilities you plan to explore during the next session. You meet with your supervisor, review your notes for the intake, state your opinion that the difficulty likely involves a schizophrenic process, and list the questions that you plan to address in your next session. Your supervisor's first comment is, Boy, those schizos really are interesting, aren't they

Genetic Contributions 1 Background

Neurotic symptoms in a patient would ultimately give rise to severe mental illnesses in his or her progeny. In the 1920s, Rudin, Luxenburger, and Schultz from the Munich school of medicine intensively studied the mode of inheritance of schizophrenia and refined the methodology of twin studies. However, they soon found that Mendelian modes of inheritance, which made it easy to calculate the morbid risks for different degrees of relatives of probands, could not be applied to the study of the inheritance of major psychoses.

Alan S Bellack and Wendy N Tenhula

Keywords schizophrenia, cognitive-behavior therapy, psychosis, hallucinations, delusions Although antipsychotic medications are generally effective at reducing the positive symptoms of schizophrenia (e.g., hallucinations, delusions), moderate to high levels of symptoms continue to persist among a large number of schizophrenia patients. As many as 20 of patients may not be responsive to medication, and many others are only partially responsive. Residual symptoms are a source of considerable stress and depression, and may occasionally stimulate self-harm or aggression directed to others. Moreover, people with the disorder are often maintained on multiple antipsy-chotic medications or on high doses in an effort to control residual symptoms, which increase the probability of iatro-genic complications. Psychotic symptomatology has generally been viewed as the domain of psychopharmacology, and there has not been great interest in psychosocial treatments for this aspect of illness. However,...

Overview of the Evidence

The evidence in toto is strongly supportive of the idea that there is an abnormality in AA metabolism in schizophrenia, particularly in patients with predominantly negative syndromes. It is unlikely that the observed phenomenon can be explained by a single enzyme deficit. The most likely possibility is that there are two abnormalities, one in a cytosolic PLA2 and one in an enzyme involved in incorporation of AA, most probably one of the FACL group, but also possibly one of the ACLAT group (Horrobin et al., 1999b). The FACL group is likely to be involved because several members of the group are highly expressed in the brain and because deletion of FACL-4 in variant Alport syndrome is associated with severe mental retardation and also with mid-facial hypoplasia, which is also found in schizophrenia (Horrobin et al., 1999b Piccini et al., 1998). Standard Alport syndrome, which is not associated with mental retardation or deletion of FACL-4, is closely linked to schizophrenia (Shields,...

Lithium Lithane Lithonate

Lithium salts are a relatively new treatment for manic-depressive psychosis, a serious mental illness in which people swing back and forth between extremes of mood, from intense elation (mania) to intense depression. Lithium damps out these mood swings and is especially good at preventing manic episodes, although it is also used to treat depression. It has many side effects and can produce serious toxicity in the nervous system, heart, and kidneys. It has no effects on the mind that recommend it for nonmedical use. Side effects include drowsiness dtfMness nausea excitement hypotens on. fme tremor jitter mess. weanoess headache, heartburn, anorexia increased perspiration, incoordination, allergic type reactions manifested by skin ras* swelling of face and tongue itching, numbness and tingling of limbs, including peripheral neuropathy activation of schizophrenia which may require phenothia me tranquilizer therapy epi leptiform seizures in chronic schi ophren-cs temporary con-fusion,...

Plasma and Red Cell Composition

There are clear abnormalities of fatty acid concentrations in depression that are distinct from those in schizophrenia (Adams, Lawson, Sanigorski, & Sinclair, 1996 Maes et al., 1996 Maes et al., 1999 Peet, Murphy, Shay, & Horrobin, 1998 Edwards, Peet, Shay, & Horrobin, 1998). First, the abnormalities are present in both plasma and in red cells, raising the possibility that the problem may be in fatty acid metabolism in general, rather than membrane phospholipid metabolism in particular. Second, the abnormalities are specifically deficits in the omega-3 fatty acids EPA, DHA, and docosapentaenoic acid (DPA), and particularly in EPA. In contrast to the situation in schizophrenia, AA levels are either normal or elevated.

Nimh Collaborative Depression Efficacy Study

Affective Disorders and Schizophrenia interview to eliminate participants with comorbid diagnoses. Inclusion criteria included the diagnoses of a current episode of major depressive disorder, and a score of 14 or higher on an amended version of the 17-item Hamilton Rating Scale for Depression. Remaining candidates for the trial were excluded if they had additional psychiatric disorders, two or more schizotypal features, history of schizophrenia, organic brain syndrome, mental retardation, concurrent treatment, presence of specific physical illness or other medical contraindications for the use of imipramine, and presence of a clinical state inconsistent with participating in the research protocol (e.g., high suicidality). The 250 patients who passed the clinical and medical screening gave consent to be entered into the study and were randomly assigned to a treatment condition based on a separate computer-generated random order for each of three sites Pittsburgh, Oklahoma City, and...

Inappropriate Antidiuretic Hormone Secretion

Inappropriate antidiuretic hormone secretion (IADHS) may occur in a variety of diseases, including malignancies, acute and chronic pulmonary diseases, central nervous system and endocrine disorders, acute psychosis, and surgical stress. It can be induced by drugs such as phenothiazines, cyclophosphamide, vincristine, thiazides, morphine, carbamazepine, and cisplatin. IADHS may accompany certain malignancies, particularly small-cell lung carcinoma, head neck carcinomas, brain tumors, and lymphomas. The symptoms of IADHS syndrome include anorexia, nausea, headache, confusion, with the possible end result being coma. Laboratory findings include serum hyponatremia, elevated urinary sodium concentrations with normal renal and adrenal homeostasis. Few cases of prostate cancer associated with IADHS syndrome have been reported, and tumors were either poorly differentiated or small cell carcinoma and were almost uniformly metastatic at the time of diagnosis. Most of the patients died a few...

The Phospholipid Hypothesis

The emerging phospholipid hypothesis takes as its basis increasing evidence that phospholipid metabolism is abnormal in schizophrenia. Broadly, it suggests that as a result of this altered metabolism, the cell membranes of schizophrenia sufferers are depleted of certain polyunsaturated fatty acids (PUFAs), including arachidonic acid (AA), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA) (Horrobin et al., 1994 Peet et al., 1999). Currently, there are thought to be several possible mechanisms responsible for this. All of them offer an explanation for schizophrenia that brings together the genetic and the environmental, the neurotransmitter, and the lipid all bound up in a package that suggests that diet may have a crucial role to play in ameliorating or exacerbating the symptoms of this much misunderstood illness. A method for indirectly assessing prostaglandin production has come from the application of what has become known as the niacin skin flush (Ward et al., 1998)....

Integrated Approaches

Some recent articles suggest that research integrating quantitative and molecular approaches with neuroscientific strategies will be the most fruitful way to provide a framework for genetic and environmental effects on organisms. Reiss and Neiderhiser recommend an integrated approach. In their 1991 book Schizophrenia Genesis, Irving Gottesman and Dorothea Wolfgram envision the future promise of neuroscience programs to assist progress in schizophrenia. The increasingly important neurodevelopmental perspective approach to schizophrenia has been championed by Tsuang and colleagues and implemented in recent papers from the Pittsburgh group (Mirnics et al.). In addition, a series of ethical issues have arisen in neuroscience that mirror many of those first generated by behavioral genetics, including issues of reduction, determinism, and responsibility. A new term, neuroethics, has been coined to describe these issues (Marcus).

Behavioral Genetics and Eugenics Contemporary Ethical Concerns

Product of very complex interactions among many genes as well as environmental factors, all of which are very poorly understood. Nobody knows which genes, in what way, to what degree, and at what point in development yield the neural capacities that establish a range of intellectual abilities. This is true whether one's concerns are with happiness, aggressiveness, schizophrenia, or addiction (Hamer Beckwith and Alper). Furthermore, if society's legitimate social goals include shaping human behavior in various ways, there also are available as tools a very large range of social practices and medical interventions.

The Hypothesis of the Neurotoxicity of Psychotic Episodes

In his early writings, Kraepelin 2 had presumed that the ''florid bouts of illness'' - psychotic episodes - lead to a certain amount of irreversible consequences he called ''defects''. This model, implying that schizophrenia shows a deteriorating course in the form of steps, as depicted in the trajectory proposed by Breier et al. 75 , has been revived by Wyatt 76,77 , Loebel et al. 14 and Lieberman et al. 78,79 ''The illness gets gradually worse during that period indicating that untreated psychosis may constitute an active morbid process, 'toxic' to the brain. If this disease process is not treated and suppressed early enough, it may become chronic'' 14,76,79 . McGlashan and Johannessen 80 presume that the plasticity of the brain can be preserved and prevented from deteriorating if the persons affected receive both antipsychotic medication and simultaneously social stimulation at a sensitive stage of the illness. If the duration or severity of psychotic episodes were causally...

Disorders Of Laughter

Disorders of laughter and crying are very rare. Although strong emotional reactions are not uncommon following brain injury, the most common reaction described is fear. Medical research on laughing and crying disorders consists largely of case reports, with few systematic, large-scale investigations. Abnormal laughter, defined as laughter that is involuntary and inappropriate to the situational context, is most often seen in generalized affective or cognitive disturbances such as psychoses (e.g., schizophrenia). Individual cases of hysterical laughter spells, marked by silly, unrestrained, unmotivated, and unprovoked laughter, have been reported, as has epidemic hysterical laughter.

Shared Manifold Hypothesis

- are involved in particular mental activities cf., limited-capacity retrieval hypothesis -posits that STM is of finite capacity and can store only a few facts at one time, and its limited capacity appears to restrict the number of feelings, ideas, and cognitions that can be considered, or carried out, at any given time Miller, 1956 recitation theory - holds that memory may be optimized when material is rehearsed reality monitoring hypothesis - is the hypothesized process act of discriminating between genuine memories that are gained through perception from external reality and the apparent memories that are achieved internally via imagination such discriminations tend to break down in the course of many mental disorders such as schizophrenia and delusional disorder the hypothesis refers, also, to the idea that most people are constantly observing themselves, their social and physical environments, and their alertness to making decisions about goals adjacency effect - refers to a...

Table 172 Medications causing psychiatric symptoms

Toxic psychosis Psychosis Psychosis, depression, insomnia, Depression, insomnia, psychosis Agitation, depression, panic Paranoid psychosis, insomnia, Anxiety, agitation, psychosis, delirium Mania, psychosis Confusion, psychosis, depression Patients presenting with psychosis, particularly command hallucinations, may represent a particularly high violence risk. Acute onset of symptoms in a previously well-functioning individual are unlikely to be the result of schizophrenia or a major affective disorder. Psychosis abnormal thought content

Background And Research

Social skills training has been shown to be effective for a variety of mental health problems. It has been used in different forms throughout the past 20 years in the treatment of social anxiety, panic, depression, shyness, and low self-esteem as well as schizophrenia. The more severe the psy-chopathology is, the more structured and behavioral the interventions would be. Social skills deficit seems to foster psychopathology, and also contribute to the development of psychological dysfunction. Social skills deficit has been linked to a number of psychiatric diagnoses and with all of them, in particular to low self-esteem. Skills acquisition was significant in hospitalized patients with schizophrenia, and group therapy for schizophrenia may reduce the number of inpatient days, when the aim is to balance education with emotional support for chronic patient groups and there have been promising aims to teach psychiatric patients to cope in the community using group treatment. Likewise in...

Applications And Exclusions

Because family therapy does not attempt to modify a person but rather the behaviors exhibited by a system, it is generally applicable to most of the problems seen by mental health practitioners. With children and adolescents, it has been applied to problems ranging from conduct disorder to anxiety and depression. In adults, it has been applied to relationship problems, as an adjunct to the treatment for schizophrenia, depression and anxiety, modifying family reactions to medical illness, and drug and alcohol abuse.

How Good Is the Evidence for Underlying in Utero Events

A variety of prenatal events can adversely affect neuronal development including hypoxia, maternal undernutrition, exposure to viruses and infection, maternal stress and maternal lifestyle and other health problems (key factors are discussed below).16,6467 Meta-analysis suggests that schizophrenics are twice as likely to have been exposed to obstetric complications as controls.67,68 However, most babies with obstetric complications do not develop schizophrenia and most patients with schizophrenia do not have an apparent history of these complications.69 The significance of these findings is highly debated. They might reflect a genetic predisposition,6,18 0,71 which might be to obstetric complications rather than direcdy with mental illness.72 For example, poor pregnancy outcomes occur more frequently among women with schizophrenia and they are at greater risk for increased interventions.7 Obstetric complications do not seem to be particularly specific to schizophrenia since there now...

Clues from the Preterm Infant

Schizophrenia shows a typically remitting and relapsing course.5 If the neurodevelopmental hypothesis is correct, then why should a neurological injury sustained in utero lead to such variable symptoms in adulthood in patients suffering from schizophrenia and affective disorders is further evidence for pathological events in mid-gestation as this is the maximal time of increased glial proliferation and differentiation.165 The impact of prenatal loss of glia is perhaps best illustrated by the neurodevelopmental delay, behavioural abnormalities and increased rate of mental illness in children who are born prematurely,166168 Pathologically, such infants demonstrate highly selective early white matter damage, which leads to long-term reductions in grey matter volume and complexity of neuronal structures.167'169,170 The neurological sequelae of preterm birth (including epilepsy, cerebral palsy and attention deficit) associated with these perinatal white matter lesions seem to be a...

The Social Construction of Illness

Individuals may actively seek some labels and avoid others. Tsunetsugu Munkata points out that in Japan the label neurasthenia is widely adopted to avoid the stigmatizing term schizophrenia, while Peter Conrad has shown how both parents and school professionals embrace the label of hyperkinesis to describe unruly children. Parents accepted the label because it absolved them of blame for their children's conditions school officials accepted the term because it offered an individual-level explanation for restive behavior, allowing them to overlook deficiencies in school organization. Many illness designations signify entities whose precise, objective markers of disease are unclear. Sufferers, however, seek the legitimation of the disease label. Suffering is a powerful determinant of self-labeling, as the proper label serves to excuse and explain behavior that would otherwise be unacceptable. The early labeling theorists concentrated on labeling as a top-down phenomenon, stressing the...

Other Neuropathological Features

There are a number of other features of the neuropathology of schizophrenia, which suggest a fetal insult around mid-gestation. For example, it is known that normal human brain symmetry is determined early in development, during the early second trimester of gestation. Studies have suggested that the left side of the brain is generally more severely affected in schizophrenia than the right,177 and thus that some event occurred during this stage. Similarly, gyrification occurs largely between weeks 16 and 19 weeks of gestation, and sulcal-gyral abnormalities have been found in imaging MRI studies of schizophrenic patients.178'179 Finally, as Clouston himself observed, schizophrenia is associated with an increased risk for other congenital and physical abnormalities, such as cranio-facial abnormalites like cleft palate, which have their origins in mid-gestation.180183

Cerebral Housekeeping or Implementing Plan B

The development of the brain is a highly complex coordinated process that can be roughly divided into neurogenesis, neuronal migration, glial proliferation, and neuronal differentiation. These events occur as part of a specific timetable in discrete critical windows of time, which is presumed to be largely under genetic control.168 This unfolding maturational program can be derailed by environmental events cell proliferation, differentiation, and migration can be slowed or inhibited or cells killed outright. Importandy, because many events only occur at a particular critical window of time,13 '184 even if the event causing this impairment is acute (transient hypoxia due to placental infarction for example), the impairment is irreparable and this has consequences for subsequent neural development. The architectural plan for brain development started in utero does not, of course, reach completion until early adulthood, when final connections are made in the prefrontal and temporal...

Inheritance Patterns and Linkage Studies

Complex disorders such as schizophrenia and bipolar disorder usually do not follow classic Mendelian inheritance patterns, but they can frequently mimic a pattern of autosomal dominance with reduced penetrance. Explanatory models for these complex disorders include multifactorial inheritance (multiple genes with nongenetic components) and epistasis (few genes acting jointly). But, since the mode of inheritance is unknown, a range of analytic methods must be used to study the genetic aspects of these disorders. Linkage and allelic association studies are frequently methods used to investigate possible causal genes for complex psychiatric disorders. However, in large populations, there are likely to be several causal or susceptibility genes and nongenetic causes, as well. Historically, the first positive linkage study to have a major impact on psychiatry was the linkage of bipolar disorder to chromosome eleven in a large Amish family. However, a later assessment of the family failed to...

TABLE 2811 Mental Status in the Emergency Department An Outline

Visual hallucinations do occur in functional psychotic illnesses (schizophrenia or affective disorder), but most often result from organic disease. A patient with visual Accurately diagnosing and understanding behavioral emergencies in the elderly is difficult but important. Syndromes include confusion, agitation, psychosis, and behavioral regression. Diagnoses that cause emergency syndromes such as this in the elderly are listed in Tab ei281-2.

The Measurement Of Treatment Fidelity

The Cognitive Therapy Scale (CTS Young & Beck, 1980) is the principal measure of CBT competence. The CTS consists of 11 items, each of which is rated on a 7-point Likert (each scored from 0 to 6) scale reflecting increasing competence. Six items measure general interpersonal and relationship factors, while five items measure cognitive therapy techniques. Overall total scores of 40 or above are considered as evidence of competent CT (Shaw & Dobson, 1988). The CTS has demonstrated strong internal consistency (coefficient alpha 0.95) and high interrater reliability (0.54-0.87) (Dobson, Shaw, & Vallis, 1985). The CTS has been widely accepted as a measure of overall CT competence, and has even been adopted by the Academy of Cognitive Therapy as the major index of competent practice in cognitive therapy (www.academyofct.org). The CTS has also been adapted for measuring competence in the delivery of cognitive therapy for psychosis (Haddock et al., 2001).

The Alcoholabusing Patient

Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations and is characterized by impaired control over drinking, preoccupation with the drug ethanol, use of ethanol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic.2 Male gender, age of 25 to 34 years, poor education, preexistent psychiatric disorder, and homelessness are common associated factors. However, alcoholism is a disorder that crosses all socioeconomic boundaries and involves all age groups. Among the homeless, estimated at 250,000 on any given night and 3 million people per year in the United States, 20 to 45 percent are alcoholics. 1 Secondary psychiatric diagnoses, including antisocial personality, mania, and schizophrenia, are more common in alcoholics than in the general population. Suicide attempts and problems with drugs other than ethanol are also...

Psychiatric Evaluation

Some homeless patients without documented history of chronic psychiatric illness or substance dependence may present to the ED with psychiatric complaints. The stresses of sustaining life without a home are associated with a variety of diagnoses, including adjustment disorders, substance use, and major depression. 18 Alternatively, some homeless patients have a chronic history of psychiatric illness, including schizophrenia or bipolar disorder, that may be partially responsible for precipitating homelessness.19 The psychiatric assessment of homeless patients is important to providing adequate disposition of medical problems whose management may be compromised by mental illness. In addition, primary pharmacologic therapy can be evaluated or instituted in patients with chronic psychiatric disorders.

Description Of Treatment

The list of conditions treated in groups is extensive. Virtually all models of individual therapies have been used in group therapy. The highest use of intensive group models is with the more common conditions of depression, anxiety states, eating disorders, and personality disorders. Groups of a more supportive nature are widely used as an adjunctive treatment for more severe and chronic conditions such as bipolar disorder and schizophrenia.

Corpus Callosum And Cognition

Despite the remarkably normal presentation of split-brain subjects, profound changes can be observed when the appropriate experimental controls are in place to observe them. However, there remain many claims regarding the role of the corpus callosum in normal and abnormal behavior that are intriguing but require further study to determine if they have merit. Such diverse mental characteristics as lateralization of language, disposition of attention, mnemonic processing, conscious behavior, disorders of learning, and schizophrenia have all been linked to callosal changes. Despite many attempts to link morphological callosal differences to sex differences in lateralization, learning disabilities, and schizophrenia, definitive work in these areas remains elusive, and they will not be discussed here. The possibilities are intriguing, but the problems at this point contain too many degrees of freedom. The callosum appears to be a lever that could unlock our knowledge of brain function, but...

Prenatal Programming of Human Motor Function

There is emerging evidence that one of the developing systems that may be programmed by an adverse intrauterine environment is the human motor system. Programming has been described as a process whereby a disturbance of the environment, at critical stages of development of regulatory systems and their target tissues, alters development in such a way as to perma-nendy change functional capacity and predispose the individual to disease in later life. Adverse conditions in utero have been implicated in long-term alterations in brain structure and function, and possibly the later development of neurological diseases. There is increasing evidence that motor and vision disorders, schizophrenia (discussed elsewhere in this book, Ch. 17), epilepsy and autism may have their origins, at least in part, in altered prenatal neurodevelopment.12 Infants whose growth before birth has been restricted have increased rates of perinatal mortality and morbidity and increasingly, evidence of long-term...

TABLE 2022 Frequency of Presenting Signs and Symptoms in Hypoglycemia

Hypoglycemia has been misdiagnosed as stroke, transient ischemic attack, seizure disorder, traumatic head injury, brain tumor, narcolepsy, multiple sclerosis, psychosis, sympathomimetic drug ingestion, hysteria, altered sleep patterns and nightmares, and depression. -l8,9,1 and l1 Although uncommon, bradycardia has also been reported.12