Psychoses 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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Long Term Outcome of Treatment for Psychosis

Goetz and Stebbins (5) described 11 PD patients in a nursing home with hallucinations, all of whom were never discharged from the nursing home and died within two years. In an open-label extension of the U.S. double-blind clozapine trial, only 25 of completers died over a 26-month observational period. Forty-two percent were in nursing homes, 68 were demented, and 69 were still psychotic (4). A separate study of 39 parkinsonian patients, treated with clozapine for psychosis, found that only 15 had died over a span of five years and 33 had been admitted to nursing homes (115). There are few studies looking at whether or not patients can be weaned off their antipsychotic medications. Fernandez et al. tried to wean off clozapine or que-tiapine in psychiatrically stable PD patients with a history of drug-induced psychosis. The study had to be aborted after enrolling only six patients, who had all been on their antipsychotics for an average of 20 months (116). Five experienced worsened...

Clinical Characteristics in Psychosis of AD

Psychotic signs associated with dementia include delusions, hallucinations, and misperceptions. As noted previously, the vast majority of patients with dementia are likely to develop psychosis, agitation, aggression, or disruptive behavior over the course of their illness. There have been many attempts to biologically and psychologically link psychotic symptoms to agitation and aggression. In schizophrenia, antipsychotics are often assumed to be specific for the treatment of psychosis, and improvement in symptoms of behavioral dyscontrol is believed to be secondary to improvement in psychosis. Unfortunately, this close association in schizophrenia does not appear to apply to patients with dementia. In fact, in a doubleblind placebo-controlled trial that compared risperidone, haloperidol, and placebo, there were no differences among active medications for psychosis (both were effective), but aggression was reduced both in severity and frequency to a greater extent on risperidone...

Xischizophrenia And Other Psychotic Disorders

Delusional ideas (e.g., witchcraft) and auditory hallucinations (e.g., seeing the Virgin Mary or hearing God's voice) may be abnormal in one culture and normal in other cultures (Castillo, 1997). For example, in the Nigerian culture, paranoid fears of evil attacks by spirits are part of the local beliefs involving fears of malevolent attacks by evil spirits (Kirmayer et al., 1995). These fears are examples of the culture-bound syndrome named Ode-ori in Table I. As noted by Kirmayer et al. (1995), these paranoid fears might be misdiagnosed as symptoms of psychosis by the uninformed clinician (p. 509). Variability in language, style of emotional expressions, body language, and eye contact across cultures should be considered when assessing symptoms of Schizophrenia. In the case of Brief Psychotic Disorder, it should be distinguished from culturally sanctioned response patterns. For example, in certain religious ceremonies a person may report hearing voices, which are not considered as...

Neurobiological Mechanisms of Psychosis in Dementia

Based on neuroimaging studies, an association between delusions in dementia and dysfunction in the paralimbic area of the frontal cortex has been found (Sultzer, 1996). Using neuropathological and neuochemical investigations in patients with primary dementia, those with psychosis have been found to have significantly more plaques and tangles in the medial temporal-prosubicular area and the middle frontal cortex (Zubenko et al., 1991) and four to five times higher levels of abnormal paired helical filament (PHF)-tau protein in the entorhinal and temporal cortices (Mukaetova-Ladinska, Harrington, Roth, & Wischik, 1993). A decrease in serotonin in the prosubiculum of the cerebral cortex was found in psychotic versus nonpsychotic dementia patients (Lawlor, Ryan, & Bier-rer, 1995 Zubenko et al., 1991). Acetylcholine decreases in function have been correlated with increased thought disorders (Sunderland et al., 1997), and cholinergic agents have been observed to decrease the emergence...

Assessment of Psychosis in Alzheimers Disease

The Cohen-Mansfield Agitation Inventory (CMAI ) is excellent for detailing patterns of agitation in nursing home patients with AD, but it cannot be used in outpatients because of the intensive observation by an informant that is required (Cohen-Mansfield et al., 1989 Koss et al., 1997). This assessment tool focuses only on agitation and does not assess psychosis. The CUSPAD is useful to assess psychopathology, but it does not have quantitative ratings for items and, hence, is not appropriate for repeated testing to monitor efficacy of a treatment (Devanand et al., 1992). The CUSPAD criteria provide for the definition of a delusion as broad (does not accept caregiver's correction of the false belief ) and narrow (does not accept caregiver's correction of the false belief, and occurs more than three times per week). Hallucinations are defined as vague or clear. The presence of either a delusion (narrow definition) or hallucination (clear) on the CUSPAD is required for a person to have...

Schizophrenia bipolar disorder and major depressive disorder

All three major psychiatric disorders, schizophrenia, bipolar disorder (BP) and major depressive disorder (MDD) affect brain cytoarchitecture. Along with numerous histopathological signals of neuronal malfunction (e.g. reduction in neuronal size, dendritic length and dendritic spines density), these diseases also affect glial cells. There are some indications for loss of astrocytes and GFAP expression in schizophrenia, BP and MDD. In BP and MDD, significant decreases in the numbers and volume of astroglial cells were detected in prefrontal and orbital cortex. It is important to note that none of these psychiatric disorders were considered previously to be associated with reactive gliosis and glial proliferation. Schizophrenia also results in a decrease in the number of oligodendrocytes and reduction in myelin in cortical areas. The consequences of astroglial loss may be multifactorial, as they can include diminished synaptic support, altered clearance of neurotransmitters and impaired...

Pathophysiology of Psychosis and Risk Factors

The pathophysiology of psychosis in PD is poorly understood, but dopaminergic and serotonergic mechanisms have been proposed. One theory is that chronic excessive stimulation of dopamine receptors, particularly in the mesolimbic mesocorti-cal pathways, causes hypersensitization, resulting in psychosis when patients are treated with dopaminergic agents (36). However, exogenous dopamine supplementation by itself is not the only factor in the development of psychosis since all PD medications (anticholinergics, dopaminergics, and amantadine) can induce similar hallucinations despite their different mechanisms of action (25), and PD psychosis was described prior to the use of levodopa (37). Serotonin has been implicated because the atypical antipsychotic drugs are purported to work through their high affinity for 5-HT2 compared to D2 receptors. However, PD patients with psychosis have decreased serotonin content in the brainstem at autopsy (38). Potential explanations for this finding...

Cognitive Therapy for Psychosis

The last decade has seen an exciting development in cognitive therapy approaches for psychosis (Chadwick, Birchwood, & Trower, 1996 Fowler, Garety, & Kuipers, 1995 Morrison, 2002). While outcome research in this area is limited, a range of efficacy and effectiveness

General Treatment of Psychosis

The management of the psychotic PD patient begins by searching for correctable causes, including infection, metabolic derangements, social stress, and drug toxicity. Infections may not always cause fevers in the geriatric population, so a search for urinary tract infections or pneumonias is warranted. Some PD patients who did not manifest psychotic symptoms at home may decompensate upon moving into the hospital environment. In many of these cases, moving the patient into a secure familiar environment or treating the underlying medical illness may ameliorate psychotic symptoms (19). Finally, medications with CNS effects may cause or exacerbate psychosis in PD and are often overlooked. These medications include pain or sleeping medications such as narcotics, anxiolytics, hypnotics, and antidepressants. If psychotic symptoms persist despite identification and correction of the above factors, antiparkinsonian medications are slowly reduced and if possible discontinued. Antiparkinsonian...

Paranoid schizophrenia

Paranoid schizophrenia has delusions, often accompanied by hallucinations, as a prominent symptom. Paranoid schizophrenia usually develops later in life than the other types, and schizophrenic illness starting after middle age nearly always takes this form. It is commoner in women, and in those with impaired hearing. Genetic factors may be less important than in other types of schizophrenia. Contrary to what the public sometimes seems to think, the term 'paranoid schizophrenia' does not necessarily mean the most serious or dangerous form of the illness.

Psychiatric Diagnosis and Management of Psychosis in Dementia

Alzheimer's disease (AD), the predominant form of dementia, comprises 60 to 80 of all cases of dementia (Stoppe et al., 1999). The number of patients with AD represents a growing public health problem that may reach crisis proportions in the future. In 1993, the estimated AD population in the United States was approximately 4 million, and it is estimated to reach 14 million by the year 2050 (Tariot, Podgorski, Blazina, & Leibovici, 1993). AD has been defined as the neurodegenerative illness with the most neuropsychiatric sequelae, including behavioral dyscontrol and psychosis. Behavioral complications and psychosis during AD constitute a tremendous burden to caregivers and are common precipitants of institutionalization (Burns, Jacoby, & Levy, 1990 Cohen et al., 1993 Deimling & Bass, 1986 Weiner, Alexander, & Shortell, 1996). Antipsychotic medications are the treatment of choice for psychosis or behavioral complications associated with dementia (Helms, 1985 Schneider,...

Schizoaffective psychosis

In schizo-affective psychosis, manic or depressive (affective) symptoms coexist with schizophrenic ones, and the illness follows a course of relapses and remissions. The term often gives rise to confusion, however. Sometimes it refers to an episode in which the patient has a mixture of mood and psychotic symptoms at other times, it denotes a patient who has an episode of mood symptoms and then an episode of psychotic symptoms, or vice versa. Both patterns occur.

Psychosis in IPD

Abnormal dreaming and increased sleep disruption may precede the development of psychotic symptoms by weeks to months and provide an important early clue to their potential occurrence. Visual hallucinations are the most common manifestation of the drug-induced psychosis. These hallucinations are usually well-formed, nonthreatening images of people or animals and tend to be nocturnal, recurrent, and stereotyped for each patient (Cummings, 1991). They typically occur on a background of a clear sensorium and may not be particularly troublesome to the patient if insight is retained. However, more disabling symptoms such as delusional thinking (which is frequently paranoid), confusion, and even frank delirium may develop and require immediate intervention (Holroyd, Currie, & Wooten, 2001). In a prospective study of hallucinations and delusions in PD, of 102 consecutive patients with strictly diagnosed PD, 26.5 had psychosis unrelated to delirium. Visual hallucinations occurred most...


Psychosis is a symptom of mental illness characterized by a radical change in personality and a distorted or diminished sense of objective reality. Psychosis appears as a symptom of a number of mental disorders, including mood and personality disorders, schizophrenia, delusional disorder, and substance abuse. It is also the defining feature of the psychotic disorders (i.e., brief psychotic disorder, shared psychotic disorder, psychotic disorder due to a general medical condition, and substance-induced psychotic disorder). Patients suffering from psychosis are unable to distinguish the real from the unreal. They experience hallucinations and or delusions that they believe are real, and they typically behave in an inappropriate and confused manner. A mental illness can exhibited through various forms of psychosis, such as Hallucinations. Psychosis causes false or distorted sensory experience that appear to be real. Psychotic patients often see, hear, smell, taste, or feel things that...


Schizophrenia has probably been more extensively investigated using family, twin and adoption studies than almost any other disorder. The family data are entirely consistent in showing a higher risk in relatives than in the general population. This averages around 10 in siblings and offspring but is usually somewhat lower in parents reflecting the fact that schizophrenia is associated with markedly reduced fecundity. Thus schizophrenia sufferers who have children tend to be those who had their offspring comparatively early and whose onset of disorder is comparatively late (Gottesman, 1991). As with the affective disorders, the pattern seen in families is not Mendelian and single gene explanations, even allowing for incomplete penetrance, are implausible mathematically (O'Rourke et al., 1982) and statistically (McGue et al., 1985). There have now been many twin studies of schizophrenia all of which point to a definite genetic component. However, a criticism of studies carried out...

Simple schizophrenia

'Simple schizophrenia' (another term now seldom used) is characterized by negative symptoms, with gradual deterioration of the personality, flattening of affect, withdrawal from reality, and loss of drive, resulting in a lifestyle of social isolation and self-neglect. Positive symptoms may be few therefore, in some cases, it is debatable whether a diagnosis of schizophrenia is actually justified. However, such patients can be among the most disabled patients with schizophrenia, unable to function independently. Response to medication is often poor. They will clearly stand in need of mental health services such as supported accommodation. So the question of whether or not a particular diagnosis is appropriate may be somewhat academic.


Childhood psychosis is rare, affecting 40 per 100 000 children. Types of such psychoses include disintegrative (developmental) psychosis, in which a child aged 2-8 years, previously normal, becomes emotionally withdrawn, loses speech, deteriorates intellectually, and shows emotional and behavioural disturbance. Schilder's disease, lipoidosis, and SSPE (subacute sclerosing panencephalitis, due to the measles virus) are among the causes of this rare condition. Schizophrenia occasionally starts in childhood.

Family and social factors

Laing (The Divided Self) and many others, as in Bateson's 'double bind', has focused attention on family dynamics and on the attitude of society as primary causes of schizophrenia. In retrospect, the work of Laing and others seems to be more cultural than scientific, coinciding as it did with the 'anti-psychiatry' movement and wider criticism of the Western nuclear family. The main survivor from these ideas has been the concept of 'expressed emotion' (EE), whereby patients with schizophrenia who come from families who react strongly to their behaviours are known to be at increased risk of relapse. Family therapy (Pilling et al., 2002) can reduce the risk of relapse, but this result may not necessarily support the concept of EE, as the therapy could be operating in other ways.

Acute and transient psychotic disorders

Patients occasionally present having become acutely psychotic 'out of the blue', with no previous history. Delusions and hallucinations, with disturbed behaviour, may be prominent for a few days or so, and then completely resolve. Sometimes there are obvious precipitants, such as emotional distress, overwork, or physical illness. Some patients are never heard from again. Others go on to have further episodes. However, most UK psychiatrists would have reservations about accepting that stress, in the absence of predisposition, illicit drugs, or some other definite causative factor, can cause true psychosis. psychotic episode, as the diagnosis of schizophrenia can be very upsetting for the patient, and can have worse consequences for example, it may adversely affect insurance cover and work.

Frontotemporal Dementia

Two neurotransmitter deficits are controversial (Francis et al., 1993 Litvan, 2001 Sparks & Markesbery, 1991). An open label trial of serotonin selective reuptake inhibitors (SSRIs fluoxetine, sertraline, paroxetine) in patients with FTD has demonstrated improvement of behavioral symptoms in some patients (Swartz, Miller, Lesser, & Darby, 1997). Specifically, SSRI treatment improved disinhibition, depression, carbohydrate craving, and compulsions in at least half of the subjects tested. Trials of cholinesterase inhibitors in FTD have not been reported. Although not tested specifically in FTD, some have speculated that dopamine agonists such as bromocriptine may improve executive cognitive function in FTD as has been shown in patients with closed head injuries (McDowell, Whyte, & D'Esposito, 1998). Treatment of psychosis, agitation, sexually inappropriate behavior, and aggression has not been studied in FTD specifically, but medications used in patients with these behaviors...

Clinical features of FRAXE disease

Patients with the expanded FRAXE repeats show mild to borderline mental retardation, with delays in language development a common problem. Some FRAXE patients also exhibit behavioral abnormalities, such as attention deficit, hyperactivity, autistic-like behavior, even schizophrenia and obsessive-compulsive disorder (OCD) (Gecz 2000b Wang et al. 2003). Most patients with FRAXE are not easily distinguished from the general population as there are no consistent physical features in these patients, and FRAXE is considered to be a non-syndromic form of mental retardation. However, among FRAXE patients, reports of a long, narrow face, mild facial hypoplasia, a high-arched palate, irregular teeth, hair abnormalities, angiomata, clin-odactyly, thick lips and nasal abnormalities can be found (Barnicoat et al. 1997 Biancalana et al. 1996 Carbonell et al. 1996 Hamel et al. 1994 Knight et al. 1996 Mulley et al. 1995 Russo et al. 1998). In addition, in some families, the FRAXE fragile site does...

Causes and symptoms

< u influence the development of the disorder in some cases. H There seem to be more cases of PPD in families that have one or more members who suffer from such psychotic > - disorders as schizophrenia or delusional disorder. A core symptom of PPD is a generalized distrust of other people. Comments and actions that healthy people would not notice come across as full of insults and threats to someone with the disorder. Yet, generally, patients with PPD remain in touch with reality they don't have any of the hallucinations or delusions seen in patients with psychoses. Nevertheless, their suspicions that others are intent on harming or exploiting them are so pervasive and intense that people with PPD often become very isolated. They avoid normal social interactions. And because they feel so insecure in what is a very threatening world for them, patients with PPD are capable of becoming violent. Innocuous comments, harmless jokes and other day-to-day communications are often perceived...

Psychiatric and physical complications

A history of drug misuse is often found nowadays in young male patients presenting with serious mental illnesses such as schizophrenia and schizo-affective disorders. Such patients may be especially prone to violent behaviour. In some, the drug misuse appears to have triggered the psychosis others have used the drugs as self-medication for their psychotic symptoms. A typical case would be a young person with a chronic psychotic illness, precipitated and maintained by cannabis use. It may strike the patient as unfair that he should be advised against this drug, which his friends can perhaps take without apparent ill effect. However, cannabis is undeniably a potent exacerbating factor in psychosis.

Recommended dosage

For the treatment of psychosis, adults usually receive a total of 4 mg to 16 mg taken as tablets in three or four doses daily, up to a maximum of 64 mg each day. Injections of perphenazine are also available and are typically given in 5 mg doses every six hours, up to 15 mg per day. Hospitalized patients can receive up to 30 mg per day in the injectable form of perphenazine. The correct dosage of perphenazine must be carefully determined for each patient. Physicians try to find a dose that controls symptoms of the disease without causing intolerable side effects. Dosage guidelines for the treatment of psychosis have not been established for children under the age of 12 years. In children over age 12, the lowest adult dosage is generally used to treat psychosis. Children with severe nausea and vomiting are usually given 5 mg injections every six hours.

Past medical history and functional enquiry

Establish the history and current situation regarding liver disease, pancreatitis, gastritis, GI haemorhage, jaundice, abdominal pain or swelling. Assess the history and current situation regarding hypertension, arrythmias or cardiomyopathy. Establish the history and current situation regarding neuropathy, memory difficulties, cognitive impairment, psychosis or hallucinations. Establish the history and current situation regarding blackouts or fits and anxiety. Consider fetal alcohol syndrome.

Familial Parkinsonism

Less common than ARJP are autosomal dominant forms of early onset PD. The best characterized is the Contursi kindred, a familial PD due to a mutation in the a-synuclein gene (62). The pathology of the Contursi kindred is typical Lewy body PD however, given the young age of onset, by the time the individual dies, Lewy body pathology is typically widespread in the brain. Lewy neurites are also prominent in many cortical areas. Some young onset autosomal dominant PD kindreds, such as the Iowa kindred, have atypical clinical presentations and include family members with dementia and psychosis. The Iowa kindred has a multiplication of the a-synuclein gene (63). Families with duplications have a milder phenotype than those with a triplication of the a-synuclein gene, suggesting a role for overexpression of a-synuclein in the pathogenesis of even sporadic PD (64). The pathology in cases with gene triplication is associated with severe Lewy body-related pathology in the cortex, hippocampus,...

Disorders of female reproductive life

It should be noted at some point that there are general effects of gender on health. Females consult more frequently for all health problems, including neurotic conditions, throughout life. Prevalence of neurotic conditions is higher in females than males. Males have an excess of conduct disorder as children, and of criminality and substance misuse as adults. Males with psychotic disorders such as schizophrenia do worse than females. Females live longer. It has been suggested that men may need special services (Kennedy, 2001).

Conventional Antipsychotic Side Effects

Older patients are more sensitive to the side effects of neuroleptics. At comparable doses, low potency antipsychotics such as thioridazine and chlorpro-mazine are less likely to cause EPS than high potency antipsychotics such as haloperidol, but as many as 50 of all patients between 60 and 80 years of age receiving conventional antipsychotic medication develop either EPS or tardive dyskinesia (Jeste et al., 1995). Low potency antipsychotics are more likely to cause orthostatic hypotension, which increases the risk of falls and fractures (Ray, Federspiel, & Schaffner, 1980). Sedation is one of the most common side effects of antipsychotic drugs, with low potency antipsychotics being potent inducers. In addition, low potency antipsychotics have a greater propensity for anticholinergic side effects thus, sleep may be induced but daytime confusion and disorientation may also ensue. Unfortunately, little work has been done on the effects of antipsychotics on cognition and activities of...

Relationship to Behavioural and Neural Functioning

As for FA, MTR is a non-specific marker of neural damage, such as demyelina-tion. Many of the published MT studies have focused on patients with multiple sclerosis, who show decreased MT in both ROI and whole-brain histogram analyses. In other diseases, results are similar, indicating MTR is a viable marker for affected white and gray matter. MTR has been shown to increase with brain development during the first several years of life (Rademacher et al. 1999 van Buchem et al. 2001) and regional decreases with aging have been found (Armstrong et al. 2004). Differences in MTR were sufficiently large to distinguish patients with mild cognitive impairment from patients with Alzheimer's disease and controls (Kabani et al. 2002a Kabani et al. 2002b). A number of published studies have also used magnetization transfer methods to compare the brains in patients with schizophrenia against healthy control subjects (Foong et al. 2001 Bagary et al. 2003 Kiefer et al. 2004 Kubicki et al. 2005)....

Assessing physical symptoms in psychiatric practice

The assessment depends in part upon the setting. In some cases, for example, the patient on antipsychotic medication who complains of a shakiness of the hands, the most likely diagnosis (extrapyramidal side-effects of medication) will be obvious. Another common instance of side-effects of medication is the patient on tricyclic antidepressants, who complains of a dry mouth. Schizophrenia and delusional disorders (see Chapter 4) somatic delusions and hallucinations may occur in schizophrenia and are sometimes bizarre for example, the belief that the internal organs are upside down. Rare related conditions are characterized by fixed somatic delusions for example, patients with monosymptomatic hypochondriacal psychosis might believe that their skin is infested with parasites or their bodies emit a foul smell.

The Washington Needs Assessment Household Survey

The Washington Needs Assessment Household Survey (WANAHS) was conducted in the State of Washington by Washington State University for The Washington State Department of Social and Health Services. Although primarily a substance abuse survey, it included assessments for major depression, mania, anxiety, panic attacks, and psychosis using a CIDI-based screener developed by Kessler from the NCS. The WANAHS differs from the ECA and NCS in several significant ways first, it was a telephone survey second, it covered only one state and third, it provided significant oversamples of five major ethnic groups, including White, Black, Asian, Native, and Hispanic.

Complex disease aetiology

In the discussion above, an apparently simplyfying assumption is made The phenotype (here disease status) of a disease is defined as a binary character that takes the value 1 if an individual has the disease and 0 if the individual is not affected by the disease. Many human disorders are very het-erogenous and the phenotype can only superficially be classified as binary. Schizophrenia is an example of a highly heterogenous disorder, as are many other psychiatric disorders, as well as cancers and cardiovascular diseases. Classifying disease status as binary might complicate the search for the underlying genetic make-up unnecessarily more differentiated phenotypic information could be useful in disentangling different genetic causes of the disease. Thus, dictomising disease status might reduce the chance of locating important genes and gene variants. Many candidate susceptibility genes for complex disorders are being claimed. A simple search using 'Schizophrenia' as search word in...

Cognitive Remediation

Cognitive remediation is much more popular in the US than the UK (Turkington, Dudley & Warman, 2004). It is a rehabilitative approach, which has traditionally been applied to cognitive deficits in stroke and traumatic head injuries, with good evidence (Cicerone et al., 2000). Therapists using this approach hope to correct the cognitive deficits of schizophrenia, which affect neuropsychological functioning in the affected individuals. Studies show improvement in the laboratory environment, but do not appear to generalise to patients' own environment (Lehman et al., 2004). Trials of cognitive remediation have focussed on attention, verbal memory, visual memory and executive functioning. Although there are few positive results, a meta-analysis of pooled data did not show clear differences between cognitive remediation and controls (Pilling et al., 2002a). Moreover, trials are small in size and not adequately controlled for medication effects. Perhaps the mechanisms of cognitive...

Clinical manifestation

Impairment of alertness, neck stiffness and focal or lateralizing neurological signs (e.g. hemiparesis, aphasia) are not typical of HIVE. Psychotic symptoms without cognitive or motor disturbance do not warrant a diagnosis of HIVE. The coincidence of psychosis with HIVE is rare. Focal and generalized epileptic seizures are rare manifestations of HIVE.

Diagnosis as a Shifting Phenomenon

It should be noted that the diagnosis is formulated at a specific point in the patient's life. This raises the implication that, in certain cases, the diagnosis may represent only a temporary or time-limited statement about the patient thus, it can be a shifting phenomenon. Examples of diagnostic shift are the incipient, emerging psychosis or, conversely, the psychosis proceeding toward remission in which a relatively stable characterology emerges. An additional example is the change in character type that follows psychotherapeutic treatment. This example also reflects the fact that diagnosis may be an evolving phenomenon.

Primary psychotic disorders

Psychosis that occurs independently of infection with HIV is to be seen as a comor-bid condition. Diseases such as schizophrenia, schizophreniform disorder and brief psychotic disorder can be classified into this group. Typical symptoms are delusions, hallucinations, disorganized speech (e.g. frequent derailment or incoherence) or grossly disorganized or catatonic behavior. Etiopathogenetically, a biopsychoso-cial concept, the vulnerability-stress-coping model, is assumed. It is thought that genetic and psychosocial factors determine a predisposition or an increased vulnerability for psychotic decompensation. Therefore, an infection with a neuropathological virus such as HIV could trigger a pre-existing psychosis (Einsiedel 2001).

Integrating Diagnostic Levels

An integrative diagnostic formulation will also indicate qualitative features that add clarity and refinement to the summary description of the patient. In this way, the relative contribution made by each level toward personality functioning can be delineated. The reader of the report can be informed in the diagnostic formulation if, for example, a psychotic process is chronic or acute, incipient and emerging, or progressing toward remission or residual status. The psychosis may be an underlying process in relation to the patient's character structure, or it may be overt.

DSMIV and Dsmivtr The Diagnostic and Statistical Manual

DSM-IV and DSM-IV-TR, which incorporates only minor revisions to DSM-IV, can be considered together as conceptually striving to present diagnostic definitions in descriptive terms that eschew causative and etiological factors. The elimination of some time-honored diagnoses from the nomenclature or their inclusion within other categories reflects observations by clinicians of a declining incidence of patients in these categories. The acute versus chronic dimension of some disorders, for instance, is handled by sorting patients into different diagnostic groupings rather than by the customary use of one category differentiated into subcategories on the basis of duration of dysfunction. For example, an acute schizophrenic reaction or episode is classified outside of the schizophrenia group because, in the approach represented by DSM-IV, the duration of overt symptoms for at least six months is required for consideration of the diagnosis of schizophrenia. Thus, the schizophrenia diagnosis...

Treatment of attempted suicide

A person who has attempted suicide and who is considered a serious danger to him- or herself or to others can be hospitalized against their will. The doctor will base the decision on the severity of the patient's depression or agitation availability of friends, relatives, or other social support and the presence of other suicide risk factors, including a history of previous suicide attempts, substance abuse, recent stressful events, and symptoms of psychosis. If the attempt is judged to be a nonlethal suicide gesture, the patient may be released after the psychiatric assessment is completed.

William P Banks And Ilya Farber

Functional state that is modulated by drugs, depression, schizophrenia, or REM sleep. It is the higher order self-awareness that some species have and others lack it is the understanding of one's own motivations that is gained only after careful reflection it is the inner voice that expresses some small fraction of what is actually going on below the surface of the mind. On one very old interpretation, it is a transcendent form of unmediated presence in the world on another, perhaps just as old, it is the inner stage on which ideas and images present themselves in quick succession.

Conventional Antipsychotics

Evidence from two meta-analytical studies of conventional antipsychotics illustrates that the effects of these agents were consistent and modest, that no single agent showed superiority, and that side effects tended to emerge in a predictable fashion and ultimately define selection of a particular agent. Both reviews examined the use of conventional antipsychotics for behavioral disturbance rather than for specific symptoms or psychoses. Schneider, Pollock, and Lyness (1990) reported the overall result that 59 of patients treated with a conventional antipsychotic showed categorical behavioral improvement versus 41 of those receiving placebo, an 18 drug-placebo difference. This difference is referred to as the effect size, that is, an objective measure of actual drug effect that factors in the effect of placebo. Remarkably, the figure of 18 tends to stand up across trials of most psychotropic agents conducted since that time, as becomes evident in this review. Placebo response rates in...

Physical Psychological And Socioeconomic Sequelae

Apart from the physical injuries sustained by child soldiers, another area of concern for aid agencies and healthcare workers is the psychological health of these children. A recent Belgian study revealed the extent of this problem in a voluntary survey of former child soldiers of Uganda's notorious Lord's Resistance Army. Of the 301 children interviewed, 77 had witnessed at least one killing, 39 had been forced to kill, 39 had abducted other children, 63 had looted and burned civilian homes, and 52 had been seriously beaten. A secondary survey was conducted on a randomly selected subgroup of 75 children, of whom 71 agreed to participate. They completed a questionnaire designed to evaluate the extent of posttraumatic stress disorder (PTSD). A score of greater than 24 on the impact of event scale-revised (IES-R), which is a self-report scale akin to the DSM-IV criteria for PTSD, indicates clinically significant symptoms. The mean IES-R score was 53.5, with 97 of participants falling...

Thiamin Deficiency Affects the Nervous System Heart

Thiamin deficiency can result in three distinct syndromes a chronic peripheral neuritis, beriberi, which may or may not be associated with heart failure and edema acute pernicious (fulminating) beriberi (shoshin beriberi), in which heart failure and metabolic abnormalities predominate, without peripheral neuritis and Wernicke's encephalopathy with Korsakoff's psychosis, which is associated especially with alcohol and drug abuse. The central role of thiamin diphosphate in

Role of Cultural Adaptation and Educational Attainment

The role of acculturation in neuropsychological functioning has been realized with a variety of diverse populations, including individuals with schizophrenia (Chen, Lam, Chen, & Nguyen, 1996 Karno & Jenkins, 1993), AIDS patients (Maj et al., 1993, 1994a, 1994b), and dementia (Jacobs et al., 1997 Loewen-stein, Rubert, Arguelles, & Duara, 1995 Mahurin, Espino, & Hollifield, 1992). Of these, dementias have probably received the most attention and, thus, might reveal the most critical aspects of culture and educational attainment in individuals of a minority status.

Amanda Elkin Sridevi Kalidindi Kopal Tandon and Peter McGuffin

The World Health Organization (WHO) estimates that at least one in four people will experience a clinically significant episode of psychiatric illness at some point in their lives. Although most such disorders are short lived and do not result in specialist care many cases become disabling and the WHO Global Burden of Disease Study (Murray and Lopez, 1997) has estimated that in health economic terms unipolar depression (UPD) vies with cardiovascular disease as the leading cause of disability in adults world wide. Schizophrenia and bipolar affective disorder (BPD) are also major public health problems which feature in the WHO's top ten of economically burdensome diseases. Between them, the affective disorders (UPD and BPD) and schizophrenia also account for over 60 of completed suicides. Therefore we will here focus on these three conditions as the main exemplars of common complex psychiatric disorders with substantial genetic contributions.

Clinical features and epidemiology

Schizophrenia is characterized by hallucinations, delusions, disorder of the form of speech and psychomotor disturbance. These are collectively often called positive symptoms. Negative symptoms are less conspicuous but can be more disabling and include diminished motivation, social withdrawal and cognitive impairment, such that the old name for the syndrome was dementia praecox (early dementia). It typically arises in early adulthood with a lifetime risk of around 1 in both men and women, although the average age of onset is consistently earlier in men.

Positional candidate genes

Despite the fact that there remain ambiguities surrounding linkage findings in schizophrenia, several groups have been sufficiently emboldened to embark on detailed searches within putative linkage regions which has led to the publication within the past two years of a flurry of papers implicating several positional candidate genes in schizophrenia. Essentially, a positional candidate is a gene within a region of the genome identified by linkage studies that could plausibly be involved in the pathogenesis of the disorder. Having identified a candidate, its role is then examined further by testing for allelic association. This involves identifying DNA variants or polymorphisms within the gene and then testing whether a particular allele (an alternative variant) or a particular haplotype (a block of alleles carried together on the same chromosome) is more common in cases than in healthy controls. As an alternative to such case-control comparisons, a within-family design can be used. For...

The Operating Biological Framework

To believe that genotype determines phenotype is a large oversimplification. Thus, for example, population biology sees complex traits, including disease, as highly interactive and impossible to reduce to genetic elements alone ( Strohman, 1996). Other scientists argue that efforts to measure the relative effects of heredity and environment on behavior misconstrues these two factors as independent rather than as interactive forces, and thus, there is an underestimation of the environmental factors on gene expression (Strohman, 1996). The idea that genotype determines phenotype is not even true for twins, where there are subtle differences between phenotypes and change over time. One need only understand the history of the manifestation of schizophrenia among twins to know that the genotype phenotype relationship is far more complex.

See belle indiffrence

Characteristics of some patients with schizophrenia, including lack of initiative reduced self-care poverty of speech, emotion, and action lack of interest in relationships etc. A nonsense word made up by a patient with severe psychosis, usually part of the disorder of the form of thought. Inappropriate repetition of some behaviour, thought, or speech, even though the provoking stimulus, such as a question, has ceased. It is seen in organic disorders and schizophrenia.

Impact of Cultural Values

Moving to typical situations open to overpathologization, numerous authors warn against labeling commonly occurring hallucinations or delusions as signs of schizophrenia or other serious psychopathology (Manson et al., 1985 O'Nell, 1989 Pollack & Shore, 1980). It might not be at all unusual for Indians or Natives to see or hear a recently deceased person or, in some tribes, to believe one has been inhabited or cursed by a witch. Manson et al. (1985), for example, found 20 of a group of clinically depressed Hopi individuals experienced these types of hallucinations without significant social or cognitive impairment. Indians and Natives can also present with a subdued manner and lack of eye contact that seems withdrawn, passive, or indicative of flat affect to the inexperienced clinician. Downcast eyes and a composed demeanor are cultural expressions of interpersonal respect within many tribes and groups. O'Nell (1989), in fact, postulates in her review of the literature the flat...

Symptom Distress in Patients with Advanced Cancer

Prior to death and that the early symptoms were often misdiagnosed as anxiety, anger, depression, or psychosis.60 In a survey of 140 patients with cancer who were referred for neurologic assessment of encephalopathy, a multifactorial cause of this problem was found for most patients. A single cause of the altered mental status was found in 33 of patients whereas 67 had multiple causes. Drugs (especially opioids), metabolic abnormalities, infection, and recent surgery were the most common etiologic fac-tors.61 In important work, Bruera and colleagues studied 66 episodes of cognitive failure in 39 patients admitted to a palliative care service and demonstrated that this condition is often reversible during the last weeks of life.62 Drugs, sepsis, and brain metastasis were found to be the most frequently detected etiologic factors, and 22 (33 ) of the 66 episodes improved, 10 spontaneously and 12 as a result of treatment. Although delirium is more commonly seen at the end of life, it can...

Cognitive Therapy for Different Populations and in Different Settings

Twenty-five years of increasingly sophisticated research suggests that cognitive therapy is effective to a clinically significant degree for a majority of patients with a variety of presenting problems in a range of populations and settings. An evidence-based conclusion is that cognitive therapy is a treatment of choice for people diagnosed with depression, generalized anxiety, panic, bulimia nervosa, psychosis and a range of somatoform disorders. More recently, preliminary outcome studies suggest cognitive therapy is a promising intervention for people diagnosed with personality disorders and substance misuse, but further research is indicated.

Critique Of Clinical Judgment

The relation between experience and validity has also been investigated among psychiatrists. Results indicate that experience is unrelated to the validity of diagnoses and treatment decisions, at least under some circumstances (Hermann, Ettner, Dorwart, Langman-Dorwart, & Kleinman, 1999 Kendell, 1973 Muller & Davids, 1999). For example, in one study (Muller & Davids, 1999), psychiatrists who described themselves as being experienced in the treatment of schizophrenic patients were no more adept than less experienced psychiatrists when the task was to assess positive and negative symptoms of schizophrenia. In another study (Hermann et al., 1999), the number of years of clinical experience was negatively related to validity. Hermann et al. found that psychiatrists trained in earlier eras were more likely to use ECT electroconvulsive therapy for diagnoses outside evidence-based indications (p. 1059). In this study, experienced psychiatrists may have made less valid judgments than...

Mouse Models With Reduced Gsk3 Activity

These GSK-3P heterozygous knockout mice were used by Beaulieu et al. and O'Brian et al. in two recent studies. In the first study Beaulieu et al. demonstrated in dopamine transporter knockout mice that this monoamin-ergic neurotransmitter implicated in multiple brain disorders such as Parkinson's disease, schizophrenia, or attention deficit hyperactivity disorder 42 can exert its behavioral effects by acting on a lithium-sensitive signaling cascade involving Akt PKB and GSK-3 43 . In this study increased dopamine neurotransmission arising either from administration of amphetamine or from the lack of dopamine transporter resulted in inactivation of Akt and concomitant activation of GSK-3a and GSK-3P. These biochemical changes were effectively reversed by the administration of the GSK-3 inhibitor lithium. The GSK-3P heterozygous knockout mice reproduced the effect of lithium in behavioral tests, thus establishing this cascade as an important mediator of dopamine action in vivo.

Cognitive Behaviour Therapy

Although the school of behaviour therapy evolved empirical treatments for the management of schizophrenia, it chiefly focused on social skills and behavioural disturbances (Meichen-baum, 1969). Moreover the behavioural work was dominated by operant reward systems through external reinforcers, both positive and negative. This was an acceptable option in the 1970s. In the postmodern era this began to be seen as mechanistic with no reference to the patient's own attitudes and inner experiences. As management of schizophrenia shifted to the community, there were serious concerns whether the reinforcement-based improvement would generalise to the community settings. Unfortunately studies were not devised to answer this issue. The cognitive behavioural approach, with its success in the management of depression and anxiety disorders (Department of Health, 2001), soon turned its focus to schizophrenia. It had the advantage of collaborative relationship and shared formulation of the patient's...

Psychiatric Assessment and Treatment of Nonpsychotic Behavioral Disturbances in Dementia

Major psychiatric disorders and outside of psychosis or depression in AD, they tend to occur in a subsyndromal fashion. As our understanding of these phenomena improves, the language will sharpen. The figures in the table provide a rough estimate of the likelihood of a patient's experiencing a particular sign or symptom. These features tend to fluctuate in individuals over time, and there is tremendous heterogeneity among individuals. For instance, the study of Devanand et al. (1997) found that affective symptoms tend to fluctuate considerably over a year and psychotic symptoms somewhat less so, while agitation tends to emerge as the illness progresses and tends to persist once it has emerged. The main points, however, are that patterns of signs and symptoms can be predicted, and there is a significant degree of heterogeneity among and within patients.

Psychiatric reports criminal

Court reports should be written in non-technical language, as they will be used by lawyers and other lay persons. All technical words, even those commonplace to psychiatrists, such as 'schizophrenia', should be explained. An unemployed man aged 38 presented himself to casualty with the complaint of 'hearing voices'. He admitted to recent drug use, and the likely diagnosis seemed drug-induced psychosis. He was admitted to a psychiatric ward informally, and rapidly improved with oral antipsychotic medication, but discharged himself before a full assessment had been made. He The court accepted the psychiatrist's recommendation of a community disposal, with the condition of psychiatric treatment. It also imposed a suspended prison sentence. The patient accepted depot antipsychotic medication, which seemed to help the psychosis, but he continued to offend. He therefore breached the terms of his suspended sentence, and was imprisoned.

Bias In Postdiction From Projective Test

Diagnosticians versus diagnostic signs The diagnosis of psychosis versus neurosis from the MMPI. Psychological Monographs, 79(9, Whole No. 602). Goldberg, L. R. (1969). The search for configural relationships in personality assessment The diagnosis of psychosis versus neurosis from the MMPI. Multivariate Behavioral Research, 4, 523-536. Walker, E., & Lewine, R. J. (1990). Prediction of adult-onset schizophrenia from childhood home movies of the patients. American Journal of Psychiatry, 147, 1052-1056.

Humanistic Therapies Theoretical Basis

These givens can live an authentic existence (Heidegger, 1962), true to their experience of the world. However, attempts to avoid the angst, or existential anxiety, which accompanies the awareness of one's essential nothingness (Kierkegaard, 1954) can lead a person into a life of inauthenticity or bad faith (Sartre, 1951), in which, for example, their actions are determined by conformity with values other than their own. Another path to psychological disturbance, but in this case to a likely diagnostic label of psychosis, is an authenticity untrammelled by any acknowledgement of external reality. Although an early meta-analysis suggested less favourable outcomes for humanistic therapies (Smith, Glass & Miller, 1980), more recent meta-analyses have indicated large effect sizes for pre- to post-treatment change in these therapies, particularly with relationship problems, anxiety and depressive disorders and trauma, with treatment gains generally being maintained at follow-up...

Zyprexa see Olanzapine

Syndrome schizoaffective disorder schizoid personality disorder schizophrenia brief psychotic disorder delusional disorder schizoaffective disorder schizophrenia schizophreniform disorder brief psychotic disorder major depressive disorder schizophrenia schizophreniform disorder Cold hands and feet anorexia nervosa Communication. See language Alzheimer's disease brief psychotic disorder delusional disorder schizoaffective disorder schizophrenia schizophreniform disorder shared psychotic disorder substance abuse Dementia

Brief psychotic disorder

Brief psychotic disorder is a short-term, time-limited disorder. An individual with brief psychotic disorder has experienced at least one of the major symptoms of psychosis for less than one month. Hallucinations, delusions, strange bodily movements or lack of movements The person experiencing brief psychotic disorder always has one or more positive psychotic symptoms. The psychotic symptoms are not positive in the everyday sense of something being good or useful. Positive in this context is used with the medical meaning a factor is present that is not normally expected, or a normal type of behavior is experienced in its most extreme form. Positive symptoms of psychosis include hallucinations, delusions, strange bodily movements or lack of movements (catatonic behavior), peculiar speech and bizarre or primitive behavior. an early phase of schizophrenia. Because of the similarities between brief psychotic disorder, schizophreniform disorder and schizophrenia, many clinicians have come...

Cerea flexibilitas waxy flexibility

Delusion that family member has been replaced by a double, usually secondary to schizophrenia or organic brain disease. Severe, 'classical' form of schizophrenia, now rare, with motor immobility (i.e. catalepsy or stupor), negativism, mutism, posturing or stereotyped movements, and echolalia or echopraxia. This is seen in catatonic schizophrenia, and is therefore now rare the patient's limbs can be placed in awkward positions that he will maintain as if he were made from plasticene. Focus on immediate practical matters and inability to deal with abstractions. It may be secondary to organic brain disease or schizophrenia. Krapelin crucially distinguished this psychotic illness ('premature dementia') from manic depressive illness (now termed 'bipolar affective disorder'). His patients had what we would now diagnose as severe schizophrenia with negative symptoms. The term dementia praecox is not now used clinically, however, as the patients do not demonstrate the modern concept of...

False beliefs delusions

The most common types of delusion in schizophrenia would probably be persecutory, but grandiose or nihilistic delusions are also common. At this point, it is worth noting that, strictly speaking, paranoid has a wider meaning than just persecutory the derivation, I understand, is from Greek words meaning 'out of mind', and paranoid has been used to cover, for example, the grandiose or sexual content of delusions also. Onset of schizophrenia may be preceded by a delusional mood in which the patient feels perplexed because the environment seems subtly changed. This feeling may be suddenly followed by a primary delusion (autochthonous delusion), usually linked with an ordinary sense perception (delusional perception). For example, one patient saw a yellow car drive by and took this to mean that he was Christ reincarnated. Delusions are most often paranoid, but may be of any kind. A complex system of secondary delusions may be elaborated from the primary one.

Assessing Behavioral And Psychiatric Symptoms

While behavioral disturbances are not part of the diagnostic symptomatology, they are very common in AD, particularly as the disease progresses. Early in the disease, depression is noted, which may be minimally disturbing to patients and family. Later symptoms such as agitation, psychosis, and wandering can be disturbing and threaten patient safety. While clinicians often deal with these symptoms, there is less information on how to assess, prepare patient and family members, and treat in the earliest stages. Tools found useful for assessing behavioral and psychiatric disturbances in patients with AD are summarized in Table 2.3. While they may be burdensome

Neurological Effects

There is evidence that alterations to n-3 fatty acid metabolism and the composition of the phospholipids in serum and membranes are involved in the pathogenesis of some neurological disorders (Ulbricht & Basch 2006). As a result, there has been much interest in understanding the effects of supplemental n-3 fatty acids in neurological development, cognitive function, depression, schizophrenia, and behavioural problems. Schizophrenia According to a 2003 review, four out of five placebo-controlled double-blind trials of EPA in the treatment of schizophrenia have produced positive results (Peet 2003).

Genetic factors and mental disorders

In recent years, mental health professionals have become increasingly aware of the importance of genetic factors in the etiology (causes) of mental disorders. Since the Human Genome Project began its mapping of the entire sequence of human DNA in 1990, the implications of its findings for psychiatric diagnosis and treatment have accumulated rapidly. A new subspecialty known as biological psychiatry (also called physiological psychology or psychiatric genetics) has emerged from the discoveries of the last two decades. Biological psychiatry got its start in the late 1980s, when several research groups identified genes associated with manic depression and schizophrenia respectively. These studies ran into difficulties fairly quickly, however, because of the com Psychiatric diagnosis relies on a doctor's human judgment and evaluation of a patient's behavior or appearance to a greater degree than diagnosis in other fields of medicine. For example, there is no blood or urine test for...

Characteristics of Antipsychotic Drugs

Chlorpromazine was the first compound identified to have therapeutic benefit for schizophrenia, and surprisingly it emerged from the field of antihistamine research.74 It has high affinity for adrenergic a-1A, -1B, -2B, and -2C, histamine H1, dopamine D2, D3, and D4, serotonin 5HT6 and 5HT7, and muscarinic M1, M3, and M5 receptors.75 It has strong sedative properties and was quickly superseded by drugs such as haloperidol and clozapine that maintained broad receptor interaction profiles and lower frequencies of adverse motor and cardiovascular effects. Compound structures are shown in Figure 7.2. FIGURE 7.3 Dopaminergic pathways in a sagittal section of brain. The nigrostriatal pathway containing about 75 of the DA in the brain originates in the substantia nigra (SN) and projects primarily to the basal ganglia or striatum (ST), the center of movement control. This pathway is implicated in Parkinson's disease and in the extrapyramidal (short term) and tardive dyskinesia (long term)...

Differential diagnosis of paranoid states

Paranoid symptoms are found in many of the common psychiatric conditions described elsewhere in this book, including schizophrenia, affective disorders (depressive illness and mania), drug and alcohol misuse, and the dementias. The following list describes some other syndromes in which paranoid symptoms are a main feature Persistent delusional disorder (older terms include paranoid psychosis, paraphrenia, and paranoia) delusions are present, but, in contrast to paranoid schizophrenia, there are usually no hallucinations, the rest of the personality is preserved, and onset is in later life. The majority of patients have a paranoid premorbid personality, and interviews with informants may be essential to determine whether the symptoms are new (an illness has developed), or whether they have always been present (personality) and have come to light for other reasons. Induced delusional disorder (folie a deux) a rare condition in which the same persecutory delusions are shared by two...

Reality Testing and Cognitive Functioning

Psychosis In the previous chapter, issues of diagnosis with respect to broad conceptions of psychosis, organic impairment, character or personality disorder, and neurosis or the range of anxiety disorders were discussed. At this point it is important to estimate the central concern inherent in formulating such diagnoses, namely reality testing and the nature and qualities of cognitive functioning. Problems with the intactness of reality testing and the integrity of cognitive functioning relate to diagnostic issues concerning psychosis.

Contemporary Theories Of Personality Disorders And Treatment

The interrelationship among biologically based mental disorders and personality organization and type is a topic of tremendous importance to clinicians. Often, clinical syndromes that are considered to have a heavy biological loading such as schizophrenia and affective disorders, especially bipolar disorder, are treated in isolation without focus on the personality adaptation. Both clinical observation and experience underscore the importance of considering the personality as a central component of any clinical syndrome. For example, the personality system of an individual predisposed to psychiatric disorders will have a major impact on the treatment process. The manner in which an individual understands and accepts the constraints of chronic biologically based psychiatric disorder is highly contingent on the individual's personality and defensive structure. Whether medications will be taken as prescribed, the meaning of medication, and the acceptance of their limitations are central...

Psychiatric Disorders

Evaluation of the psychosurgical literature is difficult, partly because of reporting methods, partly because diagnostic categories in psychiatry have changed greatly over the years. It appears, however, that certain categories of illness do respond to surgical intervention (e.g., obsessive compulsive disease, anxiety), whereas others do not (e.g., schizophrenia).

Schizotypal Personality

On the test protocol, the basic differential diagnostic problem for the psychologist involves a distinction between schizoid configurations, schizophrenia itself, and a schizotypal pattern. The main distinguishing features of the schizotypal pattern concern social and interpersonal deficiencies in addition to a plethora of magical and wishful thinking the appearance of some confusion with peculiar ideas regarding causation and the appearance of a combination of a mixed defensive picture that includes obsessive-compulsive, paranoid, and histrionic defenses. Thus, the schizotypal personality tends to produce more ideational content than the schizoid and, for the most part, content that is more coherent and not as fragmented as in the schizophrenic.

Supportive Therapeutics

The exact dose of steroids necessary for each patient will vary depending on the histology (i.e., benign or malignant), size and location of the tumor, and amount of peritumoral edema. In general, most patients with malignant tumors will require between 8 and 16 mg of dexamethasone per day to remain clinically stable. The lowest dose of steroid that can control the patient's pressure-related symptoms should be used 1,21 . This approach will minimize some of the toxicity and complications that can arise from long-term corticosteroid usage, which includes hyperglycemia, peripheral edema, proximal myopa-thy, gastritis, infection, osteopenia, weight gain, bowel perforation, and psychiatric or behavioral changes (e.g., euphoria, hypomania, depression, psychosis, and sleep disturbance) 1,27-31 . Patients with dexa-methasone-induced proximal myopathy will often improve when the dosage is reduced 30,31 . In addition, the proximal leg muscles can usually be strengthened if the patient is...

Limitations and problems of classification

The boundaries between some of the clinical syndromes are not absolute, as illustrated by the need for terms such as 'schizo-affective disorder' to describe an illness with mixed features of two supposedly discrete categories, 'schizophrenia' and 'affective disorder'. Some patients' symptoms do not fit well with any recognized category, and there is a danger that these may be forced into a residual or 'dustbin' category such as 'depression, not otherwise specified'. In insurance-based health systems, this may make the difference between receiving care or not, as insurers may restrict cover to certain 'hard' diagnostic categories.

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Cortical patterns are altered in schizophrenia 68 , Alzheimer's disease 115 , and a wide variety of developmental disorders. By using specialized strategies for group averaging of anatomy, specific features of anatomy emerge that are not observed in individual representations because of their considerable variability. Group-specific patterns of cortical organization or asymmetry can then be mapped out and visualized 85, 118 .

Natural History And Longterm Outcome In Personality Disorder

There are fewer data on natural history and long-term outcome in other personality disorders. Existing findings suggest that the prognosis for schizotypal personality disorder may be limited (Aarkrog, 1981,1993 McGlashan, 1986a Stone, 1993). McGlashan found that these patients fared only slightly better than those with schizophrenia and a Scandinavian study providing a 20-year follow-up of 50 schizotypal individuals showed poor social and occupational functioning (Aarkrog, 1993). Schizoid personality disorder, infrequently seen in psychiatric settings in the absence of comorbidity, also appears stable over time (Wolff &

Mental Illness and Substance Abuse

The prevalence of serious mental illness and substance abuse is high among homeless persons. In a nationwide U.S. survey of homeless people, 39 had mental health problems, 50 had an alcohol and or drug problem, and 23 had concurrent mental health and substance use problems (Burt, 2001). Common psychiatric diagnoses among homeless people include major depression, bipolar disorder, schizophrenia, and personality disorders. A systematic review of the prevalence of schizophrenia in homeless persons found rates ranging from 4 to 16 and a weighted average of 11 in the ten methodologically strongest studies (Folsom and Jeste, 2002). Characteristics associated with a higher prevalence of schizophrenia were younger age, female sex, and chronic homelessness. Marked cross-national variation is seen in the prevalence of schizophrenia, with prevalence rates of 23-46 reported among homeless people in Sydney, Australia (Teesson, et al., 2004).

Range Of Psychopathology And Personality Disorders Within The Scope Of Treatment

The dysfunctional extremes of the different adaptations are seen at the psychotic level. For example, the different types of schizophrenia seem to be different adaptations combined with the Schizoid adaptation. In the paranoid type, the extreme of the Paranoid adaptation is seen along with the Schizoid. In the disorganized type (previously known as hebephrenia), the Antisocial adaptation is seen along with the Schizoid. In the catatonic type, the Passive-Aggressive adaptation is seen along with the Schizoid.

Range Of Psychopathology And Personality Disorders Within Scope Of Treatment

Cognitive therapy was initially developed as a treatment for depression (A. T. Beck, Rush, Shaw, & Emery, 1979) and has subsequently been applied with a wide range of disorders such as anxiety disorders (A. T. Beck & Emery, 1985), substance abuse (A. T. Beck, Wright, Newman, & Liese, 1993), marital and family problems (Epstein & Baucom, 2002), and even schizophrenia (Perris & McGorry, 1998). However, although the principles of cognitive therapy apply across the full range of psychiatric problems, the treatment approach needs to be modified to take into account the characteristics of the individuals being treated. Some have argued that cognitive therapy of depression (A. T. Beck et al., 1979) is not an appropriate treatment for individuals with personality disorders (McGinn & Young, 1996 Rothstein & Vallis, 1991 Young, 1990) and this is indeed the case. Cognitive therapy of depression is a protocol for treating depression and somewhat different protocols are used...

No Is Required For The Induction And Expression Of Behavioral Sensitization To Psychostimulants

Postsynaptic DA receptors in the dorsal striatum and NAc are thought to be involved in psychostim-ulant-induced hyperactivity (16). The D1-class receptors may have a more prominent role than the D2-like DA receptors in the action of psychostimulants (17). However, repeated exposure to psychostimulants that cause behavioral sensitization is more complex and apparently involves multiple neurotransmitter systems. The development of behavioral sensitization to amphetamines has been linked to an amphetamine-induced psychosis in humans (7,11,18,19) and the development of drug craving (11,20). Behavioral sensitization that develops in animal models may persist for a long period, suggesting that drug-induced neuroadaptation, cellular changes, and neural plasticity produced by chronic drug use are long-lasting. An important aspect in the development of behavioral sensitization to psychostimulants is the emergence of a context-dependent locomotion or conditioning. Pairing a specific environment...

Nitric Oxide Synthase

Glutamate-gating of NMDA receptors permits Ca2+ entry that specifically activates neuronal nitric oxide synthase (nNOS), a Ca2+-dependent enzyme that catalyzes the synthesis of the free-radical nitric oxide (NO) from l-arginine (180) (Fig. 1). Because NO may act as an intercellular messenger mediating forms of neuronal plasticity, blockade of nNOS could potentially interfere with the long-term consequences of NMDA receptor activation and might thereby have an influence on the behavioral effects of drugs of abuse or on their addictive properties. In fact, the NOS inhibitors N(G)-nitro-l-arginine-methyl ester (l-NAME) and 7-nitroindazole have been shown to block some of the behavioral effects of drugs of abuse, such as stereotypy induced by methamphetamine (181), sensitization to the behavioral stimulant effects of cocaine (182), and maintenance of cocaine self-administration in rats (183). l-NAME also blocks sensitization to the convulsant effects of cocaine in mice, an effect that can...

Cognitive and Psychiatric Disturbances

On rare occasions, other psychotic states, mimicking schizophrenia or other delusional syndromes, may occur in MS. Limited data suggest that the patient with these symptoms may have more disease in the temporal lobe periventricular area (127,128). Also, one must always consider the possibility of iatrogenic symptomatology in patients being treated with a variety of the medications used in MS.

Anxiety Disorders and Other Mental Disorders

Available data on the rates of anxiety, substance abuse, schizophrenia, and other mental disorders among minority elders is more limited. Using data from the ECA, Eaton, Dryman, and Weissman (1991) report lifetime rates of panic disorder of less than 1 among older African Americans and between 1 and 3 among older Hispanics, rates that are not substantially different from those found among older non-Hispanic whites. The lifetime rates of phobic disorder, however, were found to be considerably higher among older African Americans (15 to 24 ) than among older Hispanics (5 to 10 ) or non-Hispanic whites (7 to 13 ). Blazer, Hughes, George, Swartz, and Boyer (1991) reported that the rates of generalized anxiety disorder were 1 to 3 among older African Americans, and less than 1 among older Hispanics, rates comparable to those reported for older non-Hispanic whites. In a recent study of older Asian Americans, Harada and Kim (1995) reported rates of anxiety disorders ranging from 5 among the...

Which route of administration

Intramuscular injections include ordinary short-acting ones, such as haloperidol 10 mg for severe agitation in a psychotic patient, and long-acting 'depot' preparations where the active medication is esterified and suspended in an oily form from which it is released slowly, such as haloperidol decanoate 100 mg every 4 weeks to keep chronic schizophrenia in remission. Intravenous injections are rarely used, and are unsafe with some psychotropic drugs.

Trichotillomania visual hallucination

Delusion that the patient's thoughts are stopped, apparently by an outside agency in schizophrenia, a Sch-neiderian first-rank symptom. The delusion that the patient's thoughts are being broadcast in schizophrenia, a Schneiderian first-rank symptom. Delusion that thoughts, not one's own, are being inserted into one's mind in schizophrenia, a Schneide-rian first-rank symptom. Delusion that thoughts are being removed from one's mind in schizophrenia, a Schneiderian first-rank symptom.

Treatment general considerations

If a clearly identified mental illness appears directly related to the offending behaviour, the prognosis could be good for both the illness and the offending behaviour. For example, a man with schizophrenia who smashes up a television shop because he believes it is transmitting harmful rays will be unlikely to repeat this behaviour if his delusions resolve with treatment. However, mental disorder may coexist with offending behaviour without being a significant causative factor, so that treatment of the disorder has little impact on the behaviour.

The psychiatric interview

If the patient is too ill or uncooperative to give a history, one should concentrate on the mental state examination. It is necessary to use the limited time available wisely if it is a case of delirium caused by, say, acute infection, the interview will mainly consist of the mental state examination and physical examination. The history will be incoherent, and the priority is finding and diagnosing the underlying acute physical problem. By contrast, in a patient with neurosis, there may be little abnormality on the mental state examination, and physical examination will probably not be done. Therefore, the assessment will concentrate mainly on the history. A patient with psychosis will come somewhere in the middle the history will be important to have, but more time will be spent on the mental state examination, and neurological or other physical examination may also be needed.

The aftermath of suicide effects on those involved

Deaths of young patients were characterized by jumping from a height or in front of a vehicle, schizophrenia, personality disorder, unemployment, and substance misuse. In Hence, there should be a documented risk assessment before discharge from inpatient care, and follow-up of those on the enhanced tier of the Care Programme Approach within 7 days. All this should be straightforward in patients with a clear-cut mental illness such as schizophrenia. There is more difficulty in deciding what is appropriate for other patients who have contact with mental health services, such as 'young people with personality disorder, unemployment and substance misuse', none of which are readily treatable by medical means.

Social aspects see Chapter

First episodes of schizophrenia have in the past routinely received inpatient treatment however, some can be dealt with in the community if there are adequate community mental health services, supplemented perhaps by a crisis team. Emergency admission, sometimes under the Mental Health Act 1983, may be required for acutely disturbed patients.

Relationship with adult disorder

Prospective follow-up studies indicate that children with conduct disorders often continue to behave antisocially in adult life. Neurotic disorders have a better prognosis, but are weakly associated with adult neurosis of the same type. Childhood psychosis has a poor long-term outcome. Retrospective studies of adults with major mental illness, schizophrenia, and bipolar affective disorder show an excess of both conduct and neurotic disorders in childhood. However, only a minority of emotionally disturbed children develop major mental illness when they grow up.

Related conditions Schizotypal disorder

A disorder characterized by eccentric behaviour and anomalies of thinking and affect which resemble those seen in schizophrenia, though no definite and characteristic schizophrenic anomalies occur at any stage. The symptoms may include a cold or inappropriate affect anhedonia odd or eccentric behaviour a tendency to social withdrawal paranoid or bizarre ideas not amounting to true delusions obsessive ruminations thought disorder and perceptual disturbances occasional transient quasi-psychotic episodes with intense illusions, auditory or other hallucinations, and delusion-like ideas, usually occurring without external provocation. There is no definite onset and evolution and course are usually those of a personality disorder. Again, schizotypal disorder is not a diagnosis frequently used in UK clinical practice, in my experience. The ICD-10 avers that it excludes 'schizoid personality disorder', but does not give clear instructions as to how this disorder is to be differentiated. In...

Recovery and rehabilitation

This stands in complete contrast to the old idea of rehabilitation, which was restricted to severely affected psychotic patients. That old idea conjures up pictures of the long-stay 'back wards' of the old psychiatric hospitals, where deteriorated patients with schizophrenia would be rewarded with cigarettes, in return for performing simple tasks such as self-care. Such programmes of 'token economy' would, of course, now be regarded as unethical. Severe, prolonged psychiatric illness, notably chronic schizophrenia, may lead to loss of daily living skills and or socially undesirable behaviour. The result may be breakdown of family relationships, homelessness, poverty, and

Psychological aspects

In recent years, psychologists have used cognitive-behavioural models to try to understand and explain the psychotic phenomena seen in schizophrenia, suggesting, for example, that delusions may have their origin in a person's inbuilt tendency to jump to conclusions about things and to ignore conflicting evidence (this has led to the trial of cognitive-behavioural therapy in psychosis, although

Psychological and social effects

Cannabis usually produces sedation, but it can exaggerate an unpleasant pre-existing mood state of anger, depression, or anxiety. Psychotic symptoms, including perceptual distortions, visual hallucinations, and confusion, can occur. The use of cannabis is often implicated in worsening the clinical course of schizophrenia, precipitating onset or relapse and retarding recovery. Sustained

Psychiatry of adolescence

Schizophrenia, affective disorders, neuroses, eating disorders, substance misuse, and deliberate self-harm may all begin during adolescence, and personality disorders may become clearly evident at this time. Drug misuse and completed suicide in adolescents are becoming increasingly common.

Psychiatry in primary care

GPs are also involved, in collaboration with psychiatric and social services, in the care of those with more severe illnesses such as schizophrenia and affective disorder, which require long-term medication and supervision. Besides being providers of primary mental health care, GPs are involved in shaping local psychiatric services.

Psychiatric conditions

Dilemma, although sometimes they are present together. Both depressive and manic symptoms may occur in combination with symptoms of schizophrenia schizo-affective disorder. Agitated depression and mixed depressive anxiety neurosis are easily mistaken for pure anxiety states. Antisocial personality disorder may be confused with mania.

Prison Medical Service

As previously indicated, surveys of prisoners indicate that up to 50 per cent or more can be diagnosed as having some sort of mental abnormality. Sociopathy and substance misuse are the main diagnoses, but learning disability, functional psychosis, organic brain disease, and epilepsy are also found in excess. In some cases this disorder has not been recognized. Others are in prison because no psychiatric hospital place can be found for them. However, the presence of certain psychiatric disorders, such as personality disorder, substance misuse, or treated chronic mental illness, does not necessarily mean that prison is inappropriate.

Positive and negative symptoms

Symptoms of schizophrenia are sometimes divided into positive, such as delusions and hallucinations, and negative, such as poverty of thought and speech, lack of initiative, social withdrawal, slowness, unreliability, and poor self-care. Positive symptoms are prominent during acute episodes negative symptoms are characteristic of the chronic stage.

Organic and functional

Functional conditions have usually been attributed to some kind of psychological stress, although in many cases it would be more honest to say that their cause is not known. As knowledge advances, some 'functional' conditions are likely to be reclassified as 'organic' (as currently may be happening for schizophrenia), and for this reason the term 'organic' is not used in DSM-IV.