Coping With Schizophrenia and Psychosis

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.

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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

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.

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.

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...

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...

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...

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,...

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...

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.

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 disorder characterized by hallucinations, delusions, or disorganized thinking (13), and is estimated to occur in 20 to 40 of PD patients (14,15). The most common manifestations of psychosis in PD are visual hallucinations (14,16-18). Although visual hallucinations are a common feature of patients with dementia with Lewy bodies (DLB), and may occasionally occur in demented PD patients who are not taking medications, the vast majority of PD patients who develop psychotic symptoms do so on antiparkinsonian therapy, and may return to their nonpsychotic baseline if the PD medications are discontinued (19-21). All antiparkinsonian drugs, not just dopaminergic agents, have been demonstrated to cause psychosis (22-25). Visual hallucinations in PD may occur at any time, and may be vivid and realistic, or out of focus. Patients may experience presence hallucinations (the sensation that someone or something is in the room) or passage hallucinations (brief visions seen in the...


Schizophrenia and schizoaffective disorders are characterized by an imbalance of the dopaminergic system resulting from or consequently affecting glutaminergic, GABA, and serotonergic pathway transmission, with genetic, environmental, and developmental components.72 GPCRs play a major role in the symptomatic treatment of schizophrenia and form the basis for the only available drug treatment, but these drugs unfortunately have no demonstrated abilities to affect disease progression. Most of our knowledge about biochemical processes underlying these disorders comes from compounds found serendipitously to be therapeutically effective in humans. Treatment of schizophrenia is in part a detective story spanning over 50 years (Figure 7.1), during which researchers found that currently available drugs exhibit a broad range of receptor interactions that also produce a range of undesired side


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.

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.

Classification systems

Classification systems include categorical, dimensional, and multiaxial types. In the categorical type of classification, each case is allocated to one of several mutually exclusive groups. This simple method is the most suitable one for clinical settings. Categorical systems are usually used in a hierarchical way, so that each case receives only one main diagnosis. Organic psychoses take precedence over functional psychoses, and functional psychoses over neuroses. This can lead to oversimplification of complex cases, and does not take account of 'comorbidity', in which two psychiatric diagnoses (for example, anxiety state and alcohol misuse) or a physical and a psychiatric diagnosis (for example, diabetes and depression) coexist.

So Should it be Psychiatry Psychology and

The distinctions, and divisions, between psychiatry and psychology may be exaggerated. Organisational differences, based upon education routes, may be more important than is necessary for the functional duties. It has been suggested that psychologists are as (or more) competent to treat neuroses, the more behavioural mental disorders. Psychiatrists could specialise on the psychoses. Psychologists are increasingly being recognised as the lead discipline with regard to treating, or responding to, personality disorders (Blackburn, 1993). They have certainly been prominent in the analysis and prediction of dangerousness (Monahan et al., 2001). An official inquiry into abuses at a secure mental health hospital in England, chaired by a judge, readily meted out criticism of individuals (Fallon et al., 1999). It received a recommendation that the

Evidence And Psychotherapies

The current book will provide an important update on issues such as whether or not all therapies really are equal and whether it really does not matter what the content of therapy is because outcomes are very much the same. We hope to show that, although this conclusion has some truth, in particular in its focus on the need for a positive therapeutic relationship, at the level of specific psychological disorders that range from simple phobias to severe psychoses there is evidence of differential effectiveness of therapies - that some things help and that some things do not.

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).

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.

Psychological Functioning In People With Intellectual Disabilities Mental Illness And Dementia

With a diagnosis of schizophrenia (or one of its variants) or an affective disorder (such as severe depression), or bipolar disorder (manic depression). (For details of the clinical features of these conditions, see sections 4 and 5, of Gelder et al. (2000). For personal accounts of the experience of mental illness, see British Psychological Society (2000) and Solomon (2002)). About 40 of people who experience a single episode of mental illness recover fully. Most of the remainder make at least a partial recovery, although they may continue to need treatment and support at times only a small minority require assistance for almost all their lives (Kuipers and Bebbington, 1987).

Cognitive and Emotional Factors

Accompany mental illness, at least while there is evidence of psychotic symptoms. Over the last 10 years, however, it has become increasingly apparent that, even when a well-established, global, measure of overall intellectual ability is used (for example, the Wechsler Adult Intelligence Scale (3rd edition) Wechsler, 1999), it is an inadequate predictor of the ability to make a particular decision. Indeed, even the verbal parts of such assessments, though they normally correlate positively with judgements of capacity, do not accurately predict decision-making ability (Grisso et al., 1995 Wong et al., 2000). This is, perhaps, not surprising since each subtest normally reflects a variety of skills, including abstract ability, attention, motivation, and educational background (Kaufman and Lichtenberger, 1999). As a result, similar scores, even on a single subtest and in people with the same diagnosis, may reflect different underlying patterns of skills and difficulties. Nevertheless,...

Neurological Disorders

Sometimes, especially in Japan and the Philippines, ephedrine is taken specifically as a psychostimulant. In Japan, BRON, the OTC cough medication containing methylephedrine, dihydrocodeine, caffeine, and chlorpheniramine, is very widely abused, and transient psychosis commonly results (76-78). Reports of ephedrine-related psychosis following prolonged, heavy use are fairly common (101-105). In general, psychosis is only seen in ephedrine users ingesting more than 1000 mg day, and it resolves rapidly once the drug is withdrawn (106). Ephedrine psychosis closely resembles psychosis induced by amphetamines paranoia with delusions of persecution and auditory and visual hallucinations, even though consciousness remains unclouded. Typically, patients with ephedrine psychosis will have ingested more than 1000 mg day. Recovery is rapid after the drug is withdrawn (103). The ephedrine content per serving of most food supplements is on the order of 10-20 mg, making it extremely unlikely that,...

Impulse versus Control

Another major feature in analyzing and reporting the nature of the dynamic interplay between impulse and control concerns the level of maturation in the structure and makeup of the personality. For example, extremely poor controls that enable powerful impulses to initiate immediate behavior sequences reflect a relatively primitive maturational level. On the other hand, the presence of stronger inhibitions indicates other clinical implications. The relation of impulse-control features to maturational aspects of the personality also has a direct bearing on intrapsychic functioning and on diagnostic considerations. Because of the more detailed discussion permitted by analysis of issues stemming from impulse control findings, the initial broad, differential diagnostic concern with reality testing and the possibility of psychosis can be developed, and narrower categories of diagnostic possibilities can be established.

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

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.

Cognitive Therapy Areas Of Application

The last few decades have seen cognitive therapy adapted for mood, anxiety, personality, eating and substance misuse disorders. As well as these formal psychiatric disorders, cognitive therapy has been adapted for relationship problems and the psychological aspects of a range of medical disorders. Most recently cognitive therapy has been applied to the problem of anger generally and its manifestations in conflict specifically, while colleagues, mainly in England, have applied cognitive therapy to people with psychosis. A thorough review of these applications is beyond the scope of this chapter, but a brief overview is provided for the main areas of application. Interested readers may wish to follow up the references describing these adaptations and the following excellent reviews of evidence-based psy-chotherapies (Compas et al., 1998 De Rubeis & Crits-Cristoph, 1998 Fonagy et al., 2002 Kazdin & Weisz, 1998 Rector & Beck, 2001).

Appearance and behaviour

Often the standard of self-care, as reflected in the appearance, may be reduced. In severe cases, where patients lose the ability to care for themselves, there may be self-neglect. More frequently, the patient's appearance will just be somewhat unusual. By saying this, of course, I do not mean that there is anything intrinsically unhealthy about the adoption of particular styles of appearance it is just that clinical experience indicates that fairly outlandish styles of dress may be seen in newly presenting patients with schizophrenia. A misguided sense of 'political correctness' should not be permitted to lead one to ignore such matters. Tactful enquiry may therefore be necessary to find out the meaning to the patient, if, for example, they wear clothes of only one colour.

Diagnosis and Prognosis

Generally speaking, the diagnosis consists of fine discriminations following broader ones. The first consideration is whether the individual's functioning reflects an organic disturbance or psychosis, character disorder, or neurosis. Once the broad area is defined, the specific diagnosis within that area can be evaluated. If a particular disturbing symptom such as an addiction, a sexual dysfunction, or a phobia is affixed to the specific diagnosis, then it also can be defined. When psychosis is present in either manifest or latent terms, another diagnostic level must be addressed. This level is important when the character structure has the potential to weaken, and a deeper level of pathology may be manifested. If neurological impairment has become apparent, this also allows for diagnosis at this basic level of pathology. Cognitive Organization and Reality Testing. Assess the subject's capacity to appreciate reality and to control irrationality ascertain the nature of judgment, logic,...

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.

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...

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.

Statistical Prediction

In one of the best known studies on clinical versus statistical prediction (Goldberg, 1965), MMPI (Hathaway & McKinley, 1942) results were used to discriminate between neurotic and psychotic clients. Goldberg constructed a formula that involves adding and subtracting MMPI T scores Lie (L) + Paranoia (Pa) + Schizophrenia (Sc) - Hysteria (Hy) - Psychasthenia (Pt). Using data collected by Meehl (1959), hit rates were 74 for the Goldberg index and only 68 for the average clinician. Clinicians in this study were not given any information other than the MMPI protocols. The study is well known not so much because the statistical rule did better than clinicians, but because a simple linear rule was more accurate than complex statistical rules including regression equations, profile typologies, Bayesian techniques, density estimation procedures, the Per-ceptron algorithm, and sequential analyses. However, one can question whether the Goldberg index should be used...

Maintenance treatment

Patients who have made a good recovery from a first episode of schizophrenia may be able to taper off their medication after a few months. Those who have persistent symptoms or frequent relapses will usually be advised to stay on long-term medication. However, long-term therapy carries a higher risk of side-effects, so it needs to be monitored carefully, and the dose kept at the minimum necessary for symptom control. In general, patients who have a clear history of schizophrenia, and who are doing well on a small dose of medication that is not causing side-effects, are probably best advised to stay on it indefinitely unless they have strong wishes to the contrary.

Diagnostic Formulations Based on the Clinical Interview

A convenient approach to establishing a first, tentative diagnostic statement is to locate the samples of behavior observed in the interview and testing session within one of four broad diagnostic categories. This approach involves a discrimination among psychosis, organicity, character or personality disorder, and neurosis also referred to as anxiety disorders. A fifth category that is receiving increasing emphasis in psychodiagnostics concerns the group of disorders specific to self-functioning known as narcissistic and borderline personality disorders. Although these disorders are technically included as personality disorders in the current nomenclature, they involve impairments of self-cohesion and stability that are sufficiently specific to enable them to represent a distinct category. Because a discrimination among four or five major categories of diagnosis is being considered, the first step is to rule out or establish the existence of psychosis and or organicity. Following...

Psychiatric services and treatments

The latest trend is for the introduction of early intervention teams these are intended to identify and treat early or even prodromal cases. Their watchword is that, by reducing the duration of psychosis before treatment commences, prognosis can be improved (see Chapter 25 on services for more about organization of care). ECT (see Chapter 24) is an effective treatment for acute psychotic states that have failed to respond to inpatient care and medication. It continues to be widely used in developing countries, and has been a first-line treatment in this setting. However, it is seldom used for schizophrenia now in the UK.

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.

Clinical Features of PD with Dementia

Seventy-four patients (30 ) became demented during this period. The risk for developing dementia with PD was associated with age of onset over 70 years, history of depression, history of confusion or psychosis on L-dopa, an increased motor score, and presenting with facial masking.

Orientation to Time Place and Person

The patient's overall state of consciousness can be clear, clouded, confused, or even stuporous. Clouding, for example, occurs in alcoholism, drug intoxication, delerium, head trauma, and other organic involvement. Stuporous behavior may be seen in forms of schizophrenia such as catatonia, depression, and even hysteria. Detecting and evaluating the patient's state of consciousness during the interview helps the psychologist to discriminate between psychosis and nonpsychosis in this section of the report. In addition, findings regarding the patient's state of consciousness may indicate a preliminary diagnostic hypothesis involving organic impairment. In place disorientation, reality strains in the form of adaptational demands disrupt the patient's knowledge of personal location. It is important in the clinical interview that the patient is encouraged to express an understanding of where the interview is taking place, and why, so that this measure of reality contact can be assessed....

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...

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.

Neurotransmitters mental disorders and medications

Schizophrenia Impairment of dopamine-containing neurons in the brain is implicated in schizophrenia, a mental disease marked by disturbances in thinking and emotional reactions. Medications that block dopamine receptors in the brain, such as chlorpromazine and clozapine, have been used to alleviate the symptoms and help patients return to a normal social setting.

Anxiety and stress related disorders

Anxiety and stress-related disorders can be considered as an exaggerated response to stress. In contrast to psychosis, such patients are free from delusions and hallucinations, and usually retain insight. These disorders include the following range of common, related, and overlapping conditions

Crystal Structures Of Gsk30 Inhibitor Complexes

GSK-3 has been considered a target for adult onset diabetes 34-36 , stroke 37,38 , Alzheimer's disease 39,40 , bipolar disorder 41 , and schizophrenia 42,43 . The ATP binding site has been the preferred site for kinase drug design and the crystallization of inhibitors with GSK-3 P is relatively straightforward. Unphosphorylated protein and ligand readily form diffracting crystals when combined with a mixture of PEG and salt (e.g., 5 ). The PEGION screens from Hampton Research or Nextal Biotechnologies yield crystals under multiple conditions. The crystals typically have the same space group as the native unliganded protein, although exceptions have been observed (e.g., the GSK-3P complex with 6-bromoidurubin, PDB 1UV5 44 ). The space group is P212121 with unit cell dimensions 83, 86, and 127 A, and 90 angles, and there are two GSK-3P inhibitor complexes in the asymmetric unit. The Protein Data Bank contains seven crystal structures of GSK-3P in complex with non-ATP inhibitors, all of...

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...

Laboratory Examination

Prolactin (PRL) When an abnormal value is detected, it is best to repeat the test at least once and preferably twice since errors are common. When PRL is high, the T level is also often abnormal. More elaborate assessment of an abnormal PRL level involves brain imaging magnetic resonance imaging (MRI) or computerized tomography (CT) , visual fields, and pituitary function tests. Patients who have repeatedly abnormal PRL levels, who require more elaborate testing, and where the etiology is not apparent, should be referred to an endocrinologist. Values which are higher than normal infrequently occur in a healthy man. When the PRL level is abnormal, one of the most common pathological causes is the use of an antipsychotic medication. An unusual but serious cause is a prolactin-secreting tumor.

Atypical Antipsychotics

Atypical antipsychotics are typically used to treat psychosis in PD. Table 1 provides a summary of atypical antipsychotic studies in PD. The United States Food and Drug Administration (FDA) recently asked all atypical antipsychotic manufacturers to add a boxed warning to their product labels, saying that atypical antipsychotics, when used in elderly patients with dementia, were associated with a higher risk of mortality (54). However, since the deaths were primarily due to cardiovascular or infectious causes, it is unclear how the atypical antipsychotics cause increased mortality. Since psychosis can be difficult to treat in PD, it is likely that these agents will continue to be utilized until a direct cause and effect relationship is uncovered. Number of psychosis improved

Cholinesterase Inhibitors

In multiple AD trials, cholinesterase inhibitors had mild-to-moderate benefits in both cognition and psychosis (101,102). Cholinesterase inhibitors are also effective for psychosis in DLB patients and are a potential alternative to the atypical antipsy-chotics for PD psychosis. An early open-label study with tacrine showed that five of seven demented PD patients had complete resolution of psychotic symptoms (103) however, the use of this drug has been limited because of hepatic toxicity. Fabbrini et al. (104) administered donepezil (5 mg qhs) to eight nondemented PD patients with visual hallucinations, with or without delusions. At the end of two months, subjects had decreased PPRS scores with hallucinations and paranoid ideation, being the most responsive. However, two patients experienced clinically significant motor decline. Another small open-label study enrolled six patients with PD, dementia, and psychotic symptoms and treated them with 10 mg d of donepezil (105). Five patients...

Adaptive Function of the

The entire ego function system can now be recognized as hierarchical. This recognition helps the psychologist to organize concepts around the basic themes of diagnosis such as in the overall distinction between psychosis and nonpsychosis intrapsychic phenomena such as the manner in which impulses and tensions are regulated and unconscious urges are channeled into acting-out or fantasy and interpersonal activity such as the individual's ability to achieve goals, manage relationships, and function autonomously. From an evaluation of these themes, the psychologist can describe and make inferences about reality testing and cognitive functioning. In addition to these basic dimensions, specific traits that coincide with various cognitive and ego operations can be presented and discussed from an analysis of the results of intellectual and cognitive testing. Table 5.1 summarizes the hierarchical arrangement of the ego functions corresponding to personality disorders and neuroses. Diagnosis...

Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is an effective treatment for primary psychiatric disorders, especially treatment-resistant depression. Experience with ECT for PD psychosis, however, is limited to case studies. ECT has been demonstrated to be beneficial in PD patients with psychosis (112-114), and can transiently improve parkinsonian motor symptoms, but may require a period of hospitalization, and result in significant confusion. ECT should only be considered when patients are resistant to pharmacological therapies.

Obsessivecompulsive disorders

Patients feel a strong obsession to ruminate on a thought topic, and or compulsion to carry out some practical action. Patients know that these symptoms come from within the self in other words, that these are their own thoughts and actions. (Hence, they are quite distinct from the experiences of thought insertion or delusions of control sometimes seen in schizophrenia.) They also know that the thoughts or actions are irrational, and that they are contrary to their own beliefs and well-being they are sometimes described as 'ego dystonic'. They realize that the thoughts and actions are inappropriate and should be under personal control, but attempts to resist them cause increased anxiety and are usually not successful. Common types of obsessional thinking include the following

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...

General Treatment of Dementia

Similar to the guidelines governing the general treatment of psychosis, any sudden change in cognition or behavior is most likely due to a medical cause. Therefore, infections, metabolic and endocrine derangements, and hypoperfusion states should be considered and treated if present. A switch to an unfamiliar environment may also precipitate an acute deterioration in cognitive status, and can be helped to a small degree with reassurance and frequent orientation. Substance abuse, including reliance on over-the-counter preparations containing antihistamines, is another factor that may be commonly overlooked. A review of the medication list is necessary

Bipolar I and II Dysthymic and Cyclothymic Disorders

Differential incidence of Bipolar Disorder I associated with race or ethnicity has not been reported (DSM-IV, 1994, p. 352). Some evidence exists suggesting that clinicians may overdiagnose Schizophrenia rather than Bipolar Disorder I in some ethnic groups (DSM-IV, 1994, pp. 352-353). The DSM-IV (1994) did not provide a description of cultural variants for Bipolar II, Dysthymic, and Cyclothymic Disorders. A major characteristic of Bipolar II and Cyclothymic Disorders is the presence of hypomanic symptoms. As noted by Castillo (1997), these symptoms are culturally accepted in some cultural contexts. For example, members of the Hindu culture generally engaged in meditative trances to achieve a permanent hypomanic state during their religious practices (Castillo, 1997, p. 219). In the case of Dysthymic Disorder, being depressed most of the time over at least two years could be the result of specific cultural variables such as racial discrimination and severe poverty (Castillo, 1997...

Historical background

Over the past 50 years, there have been fundamental changes in the system of mental health care in America. In the 1950s, mental health care for persons with severe and persistent mental illnesses (like schizophrenia, bipolar disorder, severe depression, and schizoaffective disorder) was provided almost exclusively by large public mental hospitals. Created as part of a reform movement, these state hospitals provided a wide range of basic life supports in addition to mental health treatment, including housing, meals, clothing and laundry services, and varying degrees of social and vocational rehabilitation. During the latter half of the same decade, the introduction of neuroleptic medication provided symptomatic management of seriously disabling psychoses. This breakthrough, and other subsequent reforms in mental health policy (including the introduction of Medicare and Medicaid in 1965 and the Supplemental Security Income SSI program in 1974), provided

Recommended dosage

For acutely disturbed adult patients suffering from a psychosis, such as schizophrenia or mania, the usual daily dosage ranges from 100 mg to 1000 mg per day. Some patients may require a higher dosage. There is great variation in individual dosage requirements for chlorpromazine and for other antipsychotic medications. It is usually advisable to begin with a lower dosage, and increase the dosage until sufficient reduction of symptoms is achieved. Maximum reduction of symptoms may take many weeks of continued treatment. Because of the possibility of side effects, which may be severe, lower dosages should be used in outpatients, children, the eld-

Difficulties In Distinguishing Psychopathology From Culturerelated Conditions

Second, assuming that clinicians agree that it is important to consider the impact of cultural variables upon the assessment of multicultural groups, a crucial question would be Why such variables are not currently emphasized by clinicians in their clinical practices At least two answers may be proposed (Paniagua, 1998). First, current standard clinical ratings such as the Minnesota Multiphasic Personality Inventory, the Child Behavior Checklist, the Zung Depression Scale, and the Schedule of Affective Disorders and Schizophrenia (Rut-ter, Tuma, & Lann, 1988) and diagnostic instruments such as the DSM-IV (1994) do not require an assessment of cultural variables that might lead to the identification of culture-bound syndromes (e.g., Table I) or disorders associated with specific cultural contexts (e.g., ADHD, Anorexia Nervosa, etc.). Thus, in clinical practice one would not be concerned with the fact that a given mental health practitioner does not include a screening of cultural...

Guidelines To Distinguish Psychopathology From Culturerelated Conditions

In the first guideline, in addition to a familiarity with culture-bound syndromes and cultural variables that may lead to symptoms of mental disorders (as described above) shared by the particular group, consultation with relatives and folk healers (e.g., medicine men and women among American Indians and curanderos curanderas among Hispanics) could assist clinicians in their recognition of symptoms suggesting a culture-bound syndrome in a given client and the identification of the cultural context impacting on the manifestation of DSM-IV disorders not included in Appendix I (DSM-1V, 1994). For example, if an American Indian client reports that I believe that my weakness, loss of appetite, fainting are the result of the action of witches and evil supernatural forces this statement would be an example of schizophrenia in the case of a clinician unfamiliar with the effect of ghost sickness among American Indians (see Table I). To determine whether this belief is expected in this specific...

Current theories about the origin of mental disorders

Genetics is at this time an important area of research for psychiatric disorders. For example, a specific gene has been associated with bipolar disorder (also known as manic-depressive disorder), but unfortunately, the switch that controls the expression of the disorder is still unknown. It is presently thought that many genes go into the expression or nonexpression of any human characteristic, such as a facial feature or a certain aspect of mental health. Research done on identical twins has provided strong support for a genetic component in the development of schizophrenia. For instance, the average person in the United States has a 1 chance of developing schizophrenia, while the identical twin of a person diagnosed with schizophrenia has a 50 chance, even if he or she has been reared by adoptive parents. Other researchers who are studying schizophrenia have found that during embryonic development, there are nerve cells that do not migrate to their proper position in the...

Depression in the elderly

Severe depression affects 1-2 of the elderly population while 10 have significant depression affecting their life. Milder depression can affect a further 20 . Depression can have bizarre features in the elderly and may be misdiagnosed as dementia or psychosis. Agitated depression is the most frequent type of depression in the aged. 1 Features may include histrionic behaviour, delusions and disordered thinking.

Organic brain syndromes

Localized lesions give rise to focal impairments, such as stroke. This tends to be more the province of neurology. But some types are relevant to psychiatry, and can be considered as psychiatric focal lesions. Examples include Korsakov's psychosis, in which the main abnormality is memory defect this is due to isolated damage to mesial temporal lobe structures, such as the mammillary bodies. Frontal lobe syndrome (disinhibition, etc.) due to frontal lobe tumour is another example.

Performance Subtests Wechsler Scales

It is sensitive to depressive phenomena as well as to the confusion associated with schizophrenia. BLOCK DESIGN. This subtest requires the capacity for abstraction and concept formation along with planning, judgment, visual analysis, and visual-motor coordination skills. Patients with diagnoses of schizophrenia, organic impairment, or intense anxiety may have particular difficulty with this subtest because of the attenuation of the abstract attitude that is necessary for success on it. Patients with depression may also have difficulty succeeding on this subtest because of the complex analysis and synthesis required in a timed context.

Cognitive retraining

Professionals from a variety of fields, such as psychology, psychiatry, occupational therapy, and speech-language pathology, may be involved in cognitive retraining. The techniques of cognitive retraining are best known for their use with persons who have suffered a brain injury. Cognitive retraining has also been used to treat dementia, schizophrenia, attention-deficit disorder, learning disabilities, and cognitive changes associated with aging.

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.

Translinbinding elements

Translin binds consensus sequences in the neighbourhood of breakpoints of chromosomal translocations in haematological malignancies (Aoki et al., 1995). The presence of translin-binding sequence, together with or within Alu repeats, has been detected in the formation of the bcr-abl fusion gene in CML (Jeffs et al., 1998 Martinelli et al., 2000). Translin-binding motifs occur in liposarcoma showing t(12 l6) (ql3 pl 1) in the close vicinity of the translocation breakpoint (Hosaka et al., 2000). TRAX binding sequences have been found within about 150-250kb of the translocation breakpoint at lq42.1, which dislocates and segregates the DISCI and DISC2 candidate genes in patients with schizophrenia (Millar et al., 2000). The alveolar rhabdomyosarcoma is characterised by t(2 13)(q35 ql4) and a fusion gene PAX3-FKHR results out of this translocation. The breakpoints in the derivative chromosome 13 contain sequences that resemble those of translin (Chalk et al., 1997). We have noted earlier...

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

Nitroprusside Nipride

Toxicity nitroprusside is nonenzymatically converted to cyanide, which is converted to thiocyanate cyanide may produce metabolic acidosis and methemoglobinemia thiocyanate may produce psychosis and seizures thiocyanate levels should be < 50 mg L treatment is with sodium nitrite, sodium thiosulfate, hydroxocobalamin or methylene blue Adverse effects hypotension, reflex tachycardia, nausea, abdominal cramps, headaches, restlessness, cyanide and thiocyanate toxicity, CO2 retention.

Assessing Multimethod Association With Categorical Variables

Nominal variables are variables whose values only serve to identify categories without any quantitative meaning. Clinical disorders, for example, are often assessed using nominal variables. The assignment of 1 to paranoid schizophrenia disorder and 2 to major depressive disorder is equally admissible as the reverse. The assignment of numbers to the categories has no impact on the further analysis of the data, because nominal variables are not ordered in a specific manner. Nominal variables can be obtained using a wide array of measurement methods such as self-ratings, peer ratings, and medical and psychological diagnoses (see Neyer, chap. 4, this volume Bakeman & Gnisci, chap. 10, this volume). It is important to note that every subject has to be categorized and that he or she can only be classified into one category. In other words, the categories must be exhaustive and mutually exclusive. In most cases,

Alternative nosologies

The holistic approach to mental disorders places equal emphasis on social and spiritual as well as pharmacological treatments. A biochemist who was diagnosed with schizophrenia and eventually recovered compared the reductionism of the biological model of his disorder with the empowering qualities of holistic approaches. He stressed the healing potential in treating patients as whole persons rather than as isolated collections of nervous tissue with chemical imbalances The major task in recovering from mental illness is to regain social roles and identities. This entails focusing on the individual and building a sense of responsibility and self-determination. Disease. This perspective works with categories and accounts for physical diseases or damage to the brain that produces psychiatric symptoms. It accounts for such disorders as Alzheimer's disease or schizophrenia. Psychiatric Times 18 (November 2001) 4-5. Fisher, Daniel B. Recovering from Schizophrenia. Clinical

Distribution of Prominent GPCR Families with Known Endogenous Ligands in the Central Nervous System

FIGURE 7.1 History of psychiatric drug development. Timeline shows emergence of selected drug mechanisms (solid arrows) and therapeutic agents (plain text) with relevance to schizophrenia (above the line) and depression anxiety (below the line). S2 D2 serotonin 5HT2A + dopamine D2 receptor antagonists. TCA tricyclic antidepressants. MAOI monoamine oxidase inhibitor. SSRI selective serotonin reuptake inhibitor. SNRI selective serotonin and norepinephrine reuptake inhibitor.

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...

Use of Standardized Methods

For many clinicians (especially psychologists), self-report instruments (e.g., the Minnesota Multiphasic Personality Inventory MMPI ) and clinician-administered psychological tests (e.g., the Wechsler intelligence scales, the Rorschach) are invaluable sources of information in the assessment phase. The majority of standardized measures have not been normed on American Indian or Alaska Native populations, however. Lacking such norms, it is difficult to judge whether elevated symptomatology indicate psychopathology or nonpathological cultural variation. For example, Pollack and Shore (1980) reported consistent elevations in the F, Pd, and Sc scales of the MMPI within urban Indian psychiatric patients regardless of gender, age, tribal affiliation, or diagnosis (including schizophrenia and depression). They concluded, It appears that cultural influence overrides individual pathology and personality differences in influencing the pattern of the MMPI (p. 948). In a similar vein, the...

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.

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,...


The EEG is an important aid in the diagnosis and management of epilepsy and other seizure disorders, as well as in the diagnosis of brain damage related to trauma and diseases such as strokes, tumors, encephalitis, and drug and alcohol intoxication. The EEG is also useful in monitoring brain wave activity and in the determination of brain death. Research is active in determining the role of EEG in the diagnosis and management of mental retardation, sleep disorders, degenerative diseases such as Alzheimer's disease and Parkinson's disease, and in certain mental disorders such as autism and schizophrenia.

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 &

Summary And Additional Thoughts

Finally, regardless of the client's race and or ethnicity status, the clinical management of clients with HIV AIDS in mental health services require not only a clear understanding of medical, psychosocial, and multicultural variables, but it is also important to assess and treat the most significant emotional or psychological problems resulting from (a) thinking that one is HIV positive (or that one has AIDS) because of engagement in behaviors considered at risk for HIV infection (e.g., multiple sexual partners, sex without using condoms, anal intercourse, injecting drug use, etc.) (b) being told that one is HIV positive (c) experiencing symptoms suggesting progression toward AIDS, and (d) a recognition that one is about to die because of AIDS (Flaskerud & Miller, 1999 Kalichman, 1995). For example, in the first case Anxiety and Panic Disorders would be expected in many clients seeking mental health services because they think that they has been infected with the virus. In the...

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).

Dynamic Psychotherapy

Monsen et al. (1995) conducted a prospective study of 25 outpatients in a unit specialising in personality and psychosis 23 patients met DSM-III criteria for personality disorder at the outset. Treatment consisted of intensive psychodynamic psychotherapy, based on self-psychology and object relations, delivered over an average of 25.4 months. At the end of therapy 72 of patients no longer met criteria for personality disorder and showed significant change in affect consciousness, characterological defences and symptoms as measured by the clinical scales of the Minnesota Multiphasic Personality Inventory and the Welsh Anxiety and Repression scales. At follow-up (mean period of 5.2 years) these changes remained generally stable.

Epidemiology And Prevalence

Hallucinations are also common in dementia, with a prevalence between 21 and 49 in different studies (Burns et al., 1990 Mega et al., 1996). Visual and auditory hallucinations are most common. Varying degrees of agitation occur in one-third to one-half of AD patients (Cohen-Mansfield, Marx, & Rosenthal, 1989 Devanand et al., 1997), with aggressive behavior being less common (Swearer, Drachman, O'Donnell, & Mitchell, 1988). The large ranges in prevalence rates may be explained, in part, by the various settings where the information was gathered (e.g., outpatient, assisted living, nursing home) and differing methods of assessment. Delusions are most prevalent during the middle phase of illness (Cummings et al., 1987 Mega et al., 1996 Wragg & Jeste, 1989) and are a common precipitant of institutionalization (Stern et al., 1997). The informant (e.g., direct clinical interview with the patient, interview with the caregiver, or chart review), criteria for diagnosis of...

Current Treatment Conventional Antipsychotics

In 33 demented patients in a nursing home, thiothixene (variable dose, 0.25 mg to 18 mg daily) was superior to placebo in the treatment of agitation (Finkel et al., 1995). In a more recent report, haloperidol 2 mg to 3 mg daily and 0.5 mg to 0.75 mg daily were compared in a randomized, double-blind, six-week placebo-controlled trial in the treatment of psychosis and disruptive behaviors in 71 AD outpatients (Devanand et al., 1998). Haloperidol 2 mg to 3 mg daily was efficacious and superior to both low dose and placebo on the Brief Psychiatric Rating Scale (BPRS) psychosis factor (p < .03 andp < .05, respectively) and psychomotor agitation (p < .03 and p < .04, respectively). There were less robust effects on other outcome measures. Response rates using three sets of criteria were greater for haloperidol 2 mg to 3 mg daily (55 to 60 ) compared to haloperidol 0.5 mg to 0.75 mg daily (25 to 35 ) or placebo (25 to 30 ). Extrapyramidal signs (EPS) tended to be greater for...

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...

Controlled Treatment Trials

Psychosis, patients were randomized to a flexible olanzapine dosage (1 mg to 8 mg day) or placebo for eight weeks. Olanzapine was initiated at a dose of 1 mg day, with a 1 mg to 2 mg day increase every 14 days (mean dose 2.4 mg day). On the primary outcome measures, there were no significant differences on efficacy measures (BEHAVE-AD rating scale) or on adverse events for EPS, EKG, weight changes, or laboratory alterations. The lack of efficacy, however, may have been because of too low a dose of olanzapine (Satterlee & Sussman, 1998). In a second multicentered, double-blind, placebo-controlled clinical trial, 206 nursing home patients (mean age 83 years old and mean MMSE 6.9) with psychosis and behavioral dyscontrol during AD were treated. Patients were randomized to either a fixed dose of olanzapine 5 mg day, 10 mg day, 15 mg day, or placebo for six weeks. All patients treated with olanzapine were begun on 5 mg day, which increased by 5 mg day every seven days for the 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.

Fertility and Aging Men An Introduction to the Male Biological Clock

Although increasing maternal age has long been known to be associated with an increased incidence of birth defects, new data show that the age of the male does matter and the genetic quality of sperm does decline with age. Several studies have demonstrated that older men are at higher risk of fathering a child with various genetic diseases such as schizophrenia and Down Syndrome, to name a few. Additionally, there has been an increased risk of miscarriage with increasing paternal age. in 1974. A trend toward advanced parental age is simultaneously occurring in American men. The birth rate among men 25 to 44 years has been steadily increasing since the 1970s, whereas the birth rate of men less than 25 years has been decreasing (Hamilton et al., 2003). An improved understanding of the effects of increased parental age on the developing fetus and newborn is imperative for counseling older couples preparing for childbearing. Advanced paternal age has been suggested to result in increased...

Choice of Conventional versus Atypical Antipsychotic

The propensity for conventional antipsychotics to cause EPS in dementia and to increase the risk of tardive dyskinesia in elderly psychotic patients (Jeste, Lacro, et al., 1999) has led to a growing preference for atypical anti-psychotics in the treatment of patients with dementia who develop psychosis or behavioral dyscontrol. However, it is important to note that there is no evidence of superior efficacy for any atypical antipsychotic compared to any conventional antipsychotic in the treatment of psychosis in dementia. In the only controlled treatment trial comparing an atypical antipsychotic to a conventional antipsychotic, De Deyn et al. (1999) compared the effects of risperidone, haloperidol, and placebo in a double-blind placebo-controlled flexible-dose study for behavioral dysregulation of dementia (not psychosis of dementia). They used a 30 reduction from baseline to endpoint in BEHAVE-AD total score as responder criteria. They found in 344 patients with dementia and...

Schizophreniform disorder

Schizophreniform disorder (SFD) is a time-limited illness wherein the sufferer has experienced at least two of the major symptoms of psychosis for longer than one month but fewer than six months. Hallucinations, delusions, and strange bodily movements or lack of movements (catatonic behavior) are all symptoms that may be observed. Additionally, minimal or peculiar speech, lack of drive to act on one's own behalf, bizarre behavior, a wooden quality to one's emotions or near-absent emotionality are all typical psychotic symptoms that may occur in SFD.

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.

Cns Disorders And Gsk3 Inhibitor Lithium

Lymphocytes of patients with schizophrenia have impaired GSK-3 protein levels and activity 52 , and GSK-3 is reduced in the frontal cortex of postmortem schizophrenic brains 53 . Since the Wnt family of genes plays a central role in normal brain development, it is possible that during development impairment in GSK-3 may lead to abnormal neuronal development.

N igilbglj idrf bgjbr dgjjbr

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 .

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...

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)....

Psychological Science Barriers to Participation in Mediation

It has been specifically acknowledged that by virtue of various psychological disabilities, not all persons may be capable of participating in mediation. 'In order for the mediation process to work, the parties must be able to understand the process and the options under discussion, and to give voluntary and informed consent to any agreement reached' (ADA Mediation Guidelines Work Group, 2000, p. 7). Psychological science has identified several conditions that may impair (and even obviate) meaningful engagement (Drogin, 2000c). Most prominent among these are depression, substance dependence, schizophrenia, and mental retardation.

Criminality and violence in psychiatric patients

There is an excess of offending, including violence, among those with mental disorder. However, antisocial personality disorder and substance misuse are stronger risk factors than mental illnesses such as schizophrenia. The bulk of offending in general, and violence in particular, has nothing to do with mental illness. A recent study, for example (Fazel and Grann, 2006), found that about 5 per cent of violent crimes were committed by those with psychosis (which has a prevalence of about 1 per cent) the association was stronger in females.

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.