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Query: UMLS:C0036341 (schizophrenia)
 60,220 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Residential homes for the elderly are expected to play an important role in the future as places for the social rehabilitation of inpatients with chronic schizophrenia in psychiatric hospitals. A study was performed to investigate the state of adjustment of schizophrenics currently staying in residential homes for the elderly from the viewpoint of clinical psychopathology. The subjects, consisting of 26 schizophrenics (10 males and 16 females) with a mean age of 76.0 years (SD = 5.4), were followed up mean 9.1 years (SD = 5.3). Background factors and clinical features of these subjects were compared in two groups divided according to relapsed (N = 16) or non-relapsed disease (N = 10). The results showed that there was a significant difference in the style of interpersonal relations (passive type and aggressive type). Passive type (N = 19) is autistic and meek. Aggressive type (N = 7) is uncooperative and has persecution mania towards any situation. All relapsed subjects were belonged to passive type. These subjects of the passive type who adjusted better than average during the stable phase experienced relapse more frequently than those of the aggressive type. And when they had a relapse, they revealed the same kind of symptoms as they had once revealed during their younger days, even though they usually seemed to be a better adaptation than the other group. In other words, their apparent stable condition represented unnatural adjustment that could also be described as overadjustment. The study revealed that persistent pathological anxiety underlies their adjustment, while the fundamental structure of schizophrenia, as indicated by the vulnerability of ego, remained unchanged even when they were elderly, and that their disease relapse as a result of any precipitating situation. All but 2 patients, including one who committed suicide and one who left the home due to exacerbated mental symptoms, were found to have adjusted to living in the home while under treatment. So adjustment prognosis of schizophrenia in the home is good.
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PMID:[Clinical psychopathologic study of aged chronic schizophrenics in residential homes for the elderly--relapsed and non-relapsed]. 801 82

Thirty-three years ago, Gaddum and Picarelli classified the serotonin (5-HT) receptors in the guinea-pig ileum into D and M types based on the activity of dibenzyline (D) and morphine (M) to block contractions of intestinal smooth muscles caused by 5-HT. The subsequent location of specific ligand binding sites for 5-HT in the brain has led to the identification of 10 5-HT receptor subtypes in rat brain. While there is some controversy over the functional importance of many of these receptor subtypes, there is evidence that they fall into two major groups according to the nature of their coupling to secondary messengers or ion channels. Thus the 5-HT1 and 5-HT2 receptors appear to occupy the G protein receptor subfamily which may be coupled either to adenylate cyclase (most 5-HT1 subtypes) or phosphatidyl inositol (5-HT2 subtypes). The central "M" receptors (now termed 5-HT3) appear to occupy a ligand-gated ion channel superfamily. The cloning of these receptor subtypes has been of importance in enabling them to be classified as specific protein molecules encoded by specific genes. A problem now arises with regard to the linking of the changes in the cellular activity of the various receptor subtypes with the plethora of behavioural changes that arise as a consequence of the actions of 5-HT in the brain. The present review summarizes the evidence implicating the role of specific 5-HT receptor subtypes in thermoregulation, modulation of cardiovascular function, eating disorders, sleep, sexual activity, anxiety states, aggression, schizophrenia and depression. A summary of the relationship between these receptor subtypes and their possible involvement in the aetiology of these diseases is also given.
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PMID:Serotonin receptors--where are they going? 802 39

Aggressive behavior is a common feature of schizophrenia and is associated with the presence of 'soft' neurological signs. Since early age of onset of schizophrenia has been found to be associated with the negative syndrome, which according to Crow (1982) is related to structural brain abnormalities, I predicted that early age of onset may be a biological risk factor for aggressive behavior in the disease. To test this hypothesis, I investigated in 52 chronic institutionalized schizophrenic patients (mean age = 32.8 years; SD = 8.0), the association between age of onset of the disease and the severity of belligerent behavior. The age of onset was judged from the patient's histories as the age at which florid symptoms first emerged. Patients with early onset schizophrenia had a significantly higher belligerent score compared to those with later-onset schizophrenia (p < .05). These findings support the hypothesis of an association between early age of onset of schizophrenia and the risk of aggressive behavior and suggest, furthermore, that schizophrenic symptoms which emerge early may predict a higher risk of aggressive behavior. Furthermore, this study suggest that the neurochemical mechanisms which underlie the early emergence of symptoms may also predispose to aggressive behavior in schizophrenia. Specifically, since aggressive behavior has been linked to impairment of serotonergic (5-HT) functions, I propose that the timing of onset of schizophrenia may be partly associated with dysregulation of the 5-HT system. In a second study, I investigated whether schizophrenic patients with aggressive (suicide) behavior are characterized by more extensive brain damage and hence greater degree of cerebral atrophy on CT scan. The study, which involved 26 schizophrenic patients (mean age: 31.3 years; SD = 6.8), revealed that patients with aggressive behavior had a significantly greater degree of parieto-occipital atrophy on CT scan (p < .05). In contrast, ventricular size and prefrontal cortical atrophy did not distinguish aggressive from nonaggressive patients. These findings suggest that cortical atrophy may be a neuroradiological marker of aggressive behavior in schizophrenia.
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PMID:Aggressive behavior in schizophrenia: relationship to age of onset and cortical atrophy. 806 5

The authors briefly discuss past and present reasons for the psychiatric security unit system in Norway. They describe the patients in these units at the beginning of 1993 (N = 123). Of these patients, 16% were females, 78% had a main diagnosis of schizophrenia, and 12% were admitted because of personality disorders. Physical restraints had been used for 25%, pharmacological restraints for 17%, and forced pharmacological treatment had been necessary for 26% of the patients during the last six months. There were high rates of behaviour problems related to criminality, abuse, violence and auto-aggression. Nearly all the patients were committed involuntarily, and additional legal restrictions were imposed for one third of them. The majority (63%) of the patients had been in security units for more than one year. The highest levels of security within the security unit system were used for those with the most serious criminality or behaviour problems prior to admission.
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PMID:[Psychiatric security units in Norway. Patients and activity]. 807 36

Interictal violence among epileptic patients could result from factors other than epileptiform activity. We characterized 44 patients who presented for psychiatric evaluation because of violent behavior. Most violent acts consisted of verbal or minor physical aggression. Twenty (45%) of these patients met criteria for a schizophrenic disorder, and one committed murder during a paranoid schizophrenic relapse. In addition to schizophrenia, the violence patients had significantly more mental retardation when compared with 88 age- and sex-matched epileptic patients without prior violent behavior. However, violent and nonviolent patients did not differ on seizure variables such as type and frequency of seizures, auras, electroencephalographic changes, epilepsy age of onset, or anticonvulsant therapy. These findings suggest that interictal violence is associated more with psychopathology and mental retardation than with epileptiform activity or other seizure variables.
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PMID:Interictal violence in epilepsy. Relationship to behavior and seizure variables. 824 25

In a review of psychiatric problems of the Vietnamese population in particular experiences with refugees to the USA are mentioned where with regard to the great influx it was necessary to resolve rapidly in particular problems of the mental health. The group is formed by 20 Vietnamese subjects (11 men and 9 women) who were hospitalized in 1979-1988 at the Prague Psychiatric Clinic, Charles University and who had various jobs in Prague. In six men psychosis was diagnosed (3x schizophrenia or schizoaffective psychosis, 2x depressive phase and 1x manic phase of manic depressive psychosis). In women the psychopathological symptoms were evaluated as neurotic, in 6 of them there were attempts of suicide, while in men suicidal behaviour was recorded only once. Regardless of sex, the suicidal attempts were made with great determination. Aggressive behaviour focused on the environment was found in three men. The authors describe cases of somatizing depression and hysterical manifestations. In the development of symptoms participated psychogenic factors such as separation from the home country, partnership conflicts, incl. unwanted pregnancy and unsatisfactory work. Some psychopathological symptoms reminded of experience with the so-called Gastarbeitersyndrom.
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PMID:[Psychiatric disorders in the Vietnamese]. 850 66

One hundred and fifty-six subjects were randomly chosen from 1,560 patients admitted to two psychiatric hospitals in Israel during 1991. The subjects' files were retrospectively studied to determine whether aggressive behaviour was the reason for psychiatric admission. We examined the relationship between aggressive behaviour, major psychiatric disorders (schizophrenia and affective disorder) and demographic variables (sex, age, family status and education). We also studied the monthly distribution of aggression throughout the year and the correlation to daily photoperiod duration. Forty-six per cent of the admissions related to aggressive behaviour. Schizophrenic patients were overly represented in the aggressive group. The monthly distribution of aggressive behaviour differed between schizophrenic and affective disorder patients. While the latter showed a seasonal pattern of aggressiveness, with a statistically significant peak during spring and winter, schizophrenic aggressive patients were distributed equally throughout the year. No statistically significant correlation was found between the incidence of aggression and the photoperiod duration.
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PMID:Aggressive behaviour as a cause of psychiatric admission: a comparison between schizophrenic and affective disorder patients. 852 11

Pharmacological management of persistent aggression in patients with schizophrenia is a difficult clinical dilemma. Clozapine has been shown to be an effective agent in this regard. This study sought to compare the symptomatic response on the Brief Psychiatric Rating Scale (BPRS) between hostile schizophrenic patients and patients without aggression. While dramatic improvements were evident in aggression, both groups were indistinguishable with respect to BPRS response. These results suggest that clozapine may have a selective antiaggressive effect.
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PMID:Violence and schizophrenia: clozapine as a specific antiaggressive agent. 863 88

When schizophrenia is first diagnosed antipsychotic therapy should be started quickly as the longer the initial psychosis remains untreated the worse the final outcome will be. Aggression or agitation is best managed with a sedative given with a non-sedating antipsychotic until the antipsychotic effects of the latter appear. Because patients' first experiences of side effects are important determinants of compliance, serious consideration should be given to using a drug with low extrapyramidal side effect (EPS) liability, e.g. risperidone. In a recent trial in 183 patients with first episode schizophrenia, risperidone was at least as effective as haloperidol in reducing total PANSS scores, PANSS positive, negative, general psychopathology scores and derived BPRS scores. At endpoint, 63% of the risperidone group had improved by 50% or more (total PANSS) compared with 56% in the haloperidol group. The incidence of EPS was significantly lower in the risperidone group.
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PMID:Managing the first episode of schizophrenia: the role of new therapies. 879 14

Several drugs are apparently effective in treating pathologic anger and aggression. Because many of the studies on aggressive populations allowed the use of concomitant medications, it is unclear whether the efficacy of each drug in a particular population is dependent on the presence of other medications, such as antipsychotic agents. Finally, one needs to be circumspect in inferring efficacy of a particular drug in aggressive patients with neuropsychiatric conditions other than the ones in which some efficacy has been established. Lithium appears to be an effective treatment of aggression among nonepileptic prison inmates, mentally retarded and handicapped patients, and among conduct-disordered children with explosive behavior. Certainly, lithium would be the treatment of choice in bipolar patients with excessive irritability and anger outbursts, and it has been shown to be effective in this population. Anticonvulsant medications are the treatment of choice for patients with outbursts of rage and abnormal EEG findings. The efficacy of these drugs in patients without a seizure disorder, however, remains to be established, with the exception perhaps of valproate and carbamazepine. In fact, dyphenylhydantoin did not appear to be effective in treating aggressive behavior in children with temper tantrums and was found to be effective in only a prison population. There is some evidence for the efficacy of carbamazepine and valproate in treating pathologic aggression in patients with dementia, organic brain syndrome, psychosis, and personality disorders. As Yudofsky et al point out in their review of the literature, although traditional antipsychotic drugs have been used widely to treat aggression, there is little evidence for their effectiveness in treating aggression beyond their sedative effect in agitated patients or their antiaggressive effect among patients whose aggression is related to active psychosis. Antipsychotic agents appear to be effective in treating psychotic aggressive patients, conduct-disordered children, and mentally retarded patients, with only modest effects in the management of pathologic aggression in patients with dementia. Furthermore, at least in one study, these drugs were found to be associated with increased aggressiveness in mentally retarded subjects. On the other hand, atypical antipsychotic agents (i.e., clozapine, risperidone, and olanzapine) may be more effective than traditional antipsychotic drugs in aggressive and violent populations, as they have shown efficacy in patients with dementia, brain injury, mental retardation, and personality disorders. Similarly, benzodiazepines can reduce agitation and irritability in elderly and demented populations, but they also can induce behavioral disinhibition. Therefore, one should be careful in using this class of drugs in patients with pathologic aggression. Beta-blockers appear to be effective in many different neuropsychiatric conditions. These drugs seem effective in reducing violent and assaultive behavior in patients with dementia, brain injury, schizophrenia, mental retardation, and organic brain syndrome. As pointed out by Campbell et al in their review of the literature, however, systematic research is lacking, and little is known about the efficacy and safety of beta-blockers in children and adolescents with pathologic aggression. Although widely used in the management of pathologic aggression, the use of this class of drugs has been limited partially by marked hypotension and bradycardia, which are side effects common at the higher doses. The usefulness of the antihypertensive drug clonidine in the treatment of pathologic aggression has not been assessed adequately, and only marginal benefits were observed with this drug in irritable autistic and conduct disorder children. Psychostimulants seem to be effective in reducing aggressiveness in brain-injured patients as well as in violent adolescents with oppositional or conduct disorders, particu
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PMID:Psychopharmacologic treatment of pathologic aggression. 919 23


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