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Query: UMLS:C0036341 (schizophrenia)
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This study compared demographic and diagnostic characteristics of a sample of homeless outpatient mental health clinic attenders with a domiciled comparison group from the same clinic. Data on demographic variables and DSM-III-R psychiatric diagnoses were collected over a two-year period on a consecutive sample of 166 homeless and 117 nonhomeless clinic attenders. Data on demographics and psychiatric diagnoses of the homeless clinic attenders were further compared with data collected systematically from 900 homeless individuals in the same city. In the clinic, homeless subjects were more often members of ethnic minorities, and homeless women were significantly younger and better educated than their nonhomeless counterparts. Rates of schizophrenia, bipolar disorder, and somatization disorder were not significantly different between homeless and nonhomeless groups. Major depression was about four times as prevalent in nonhomeless men as in homeless men. Homeless men were significantly more likely than nonhomeless men to qualify for a diagnosis of alcohol use disorder, and homeless women were more likely than other women to qualify for a diagnosis of drug use disorder. Both homeless men and women were significantly more likely than their domiciled counterparts to meet criteria for antisocial personality disorder. Personality disorder other than antisocial was more prevalent in nonhomeless men than in homeless men. Combined rates of personality disorder were significantly higher among homeless than nonhomeless women, but not men. Homeless clinic attenders were demographically and diagnostically very similar to a general homeless population in the same city. The only diagnosis that was more prevalent in the homeless clinic than in the homeless community was antisocial personality disorder. We concluded that because of difference in diagnostic prevalence, homeless and nonhomeless individuals in mental health clinics need to be considered independently. Clinicians treating homeless outpatients may benefit from having special facility in diagnosis and management of antisocial personality disorder and substance abuse, along with expertise in other psychiatric disorders in this population.
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PMID:A diagnostic comparison of homeless and nonhomeless patients in an urban mental health clinic. 918 70

Our review evaluating the relationship between violent/homicidal behaviors and mental illness/psychiatric disorders used many different data including that assessing the prevalence of violent/homicidal behaviors in former psychiatric inpatients (just before hospitalization, during hospitalization, and after discharge) as outpatients and in community samples as well as evaluating the prevalence rate of psychiatric disorders in people who actually engaged in violent/homicidal disorders (jail detainees, prison inmates, and community samples). Irrespective of which line of investigation, there was convincing evidence that violent/ homicidal behavior was associated significantly with mental illness. Although earlier investigations failed to control for important variables, such as age and sociodemographics, most studies reviewed in this article did control for these items, further underlining the association of violence and mental illness. The question of whether specific psychiatric diagnostic categories are associated with violent/homicidal behavior is less definite across the various studies reviewed. The presence of substance abuse and dependence and alcohol abuse and dependence as well as antisocial personality disorder are particularly associated with an increased risk of violent/homicidal behaviors. The risk for these latter behaviors in schizophrenia, mood disorders, and anxiety disorders may appear somewhat greater than that for a general population but are not of the same magnitude of that for substance abuse or antisocial personality disorder. Interestingly, our outpatient study found that homicidal behaviors were not associated with any specific psychiatric diagnosis. Although understanding whether specific psychiatric diagnostic categories are more prone to violent behaviors may be of importance, most studies have been shortsighted regarding this evaluation. All the studies presented in this article except the ECA project, presented diagnostic data where either the presence of one psychiatric disorder did not preclude the diagnosis of another or assigned subjects/patients into the severest disorder of a predetermined hierarchy of diagnoses or only selected their principal/primary diagnosis. Thus, the effect of having a solitary psychiatric disorder (only one disorder present) as well as the effect of comorbidity per se on the relationship of psychiatric disorders and violent/homicidal behaviors were unexplored. Only the ECA study by Swanson and colleagues reported on the effect of comorbidity. As reviewed earlier in the article, Swanson et al found that comorbidity of psychiatric diagnostic categories further increased the risk of violent/ homicidal behaviors. In most cases, it was many more times than simply adding the rates of either diagnosis alone. Because more than 54% of respondents of the National Comorbidity Survey study who had one DSM-III-R diagnosis also had at least a second Axis I diagnosis, the association of violent/homicidal behaviors to mental illness may even be stronger than originally believed. Within the relationship of violent/homicidal behaviors and mental illness, this article suggests a number of particular risk factors. As just reviewed, substance/alcohol abuse and antisocial personality disorder as well as the presence of comorbid psychiatric disorders are significant risk factors. Which particular comorbid illness increases the risk still needs further elaboration. Studies must continue to try to define and understand the relationship of violent/homicidal behaviors in mental illness. Although mental disorders per se are significantly associated with violent/homicidal behaviors, it is reasonable to believe that targeting certain subgroups of patients should be helpful. Probably the presence of psychotic symptoms is a significant risk factor in violent/ homicidal behaviors in the mentally ill. Only one of the studies reviewed in this article evaluated this issue. (ABSTRACT TRUNCATED)
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PMID:Violence and homicidal behaviors in psychiatric disorders. 919 22

The validity of subtypes based on antisocial personality disorder (APD) or childhood conduct disorder without adult APD (CD only) in patients with schizophrenia (or schizoaffective disorder) and a substance use disorder (abuse or dependence) was examined. APD patients scored lower on personality measures related to socialization and higher on antisocial behavior, psychopathy, and aggression. APD patients also reported higher rates of aggression and legal problems. APD, and to a lesser extent CD only, was associated with more severe psychiatric symptoms, an earlier age of onset of substance abuse, more severe symptoms of substance abuse, and a stronger family history of substance abuse and psychiatric hospitalization. The findings suggest that schizophrenia patients with APD represent a high-risk subgroup vulnerable to more severe substance abuse, psychiatric impairment, aggression, and legal problems.
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PMID:Antisocial personality disorder, conduct disorder, and substance abuse in schizophrenia. 924 49

This paper investigates the association between various psychiatric disorders and violent behavior using data from a community-based epidemiological study of young adults in Israel (N = 2678). Self-reports of recent fighting and weapon use were elevated among respondents diagnosed with psychotic or bipolar disorders but not among those diagnosed with non-psychotic depression, generalized anxiety disorder or phobias compared to respondents without these disorders. Violence was measured using the Psychiatric Epidemiology Research Interview; psychiatric disorders were diagnosed using a modified version of the Schedule for Affective Disorders and Schizophrenia. The analyses controlled for lifetime substance abuse, antisocial personality disorder and demographic characteristics, thereby extending support for a causal connection between some types of psychiatric disorders and violence. The association between disorder and violence was stronger among respondents with less education, indicating the potentially important role of social and cultural contexts in moderating the association between mental illness and violence.
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PMID:Violence and psychiatric disorders: results from an epidemiological study of young adults in Israel. 935 33

Pseudopsychopathic schizophrenia (PPS) forms a diagnostic unity, comprising aspects of schizophrenic process and antisocial personality disorder. Perusal of the psychiatric literature reveals that this diagnostic entity has fallen into oblivion. Recognition of this neglected category is important from therapeutic, academic and medico-legal points of view.
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PMID:Pseudopsychopathic schizophrenia--a neglected diagnostic entity with legal implications. 940 32

More than 250 studies, covering 29 Northern and five Southern Hemisphere countries, have been published on the birth seasonality of individuals who develop schizophrenia and/or bipolar disorder. Despite methodological problems, the studies are remarkably consistent in showing a 5-8% winter-spring excess of births for both schizophrenia and mania/bipolar disorder. This seasonal birth excess is also found in schizoaffective disorder (December-March), major depression (March-May), and autism (March) but not in other psychiatric conditions with the possible exceptions of eating disorders and antisocial personality disorder. The seasonal birth pattern also may shift over time. Attempts to correlate the seasonal birth excess with specific features of schizophrenia suggest that winter-spring births are probably related to urban births and to a negative family history. Possible correlations include lesser severity of illness and neurophysiological measures. There appears to be no correlation with gender, social class, race, measurable pregnancy and birth complications, clinical subtypes, or neurological, neuropsychological, or neuroimaging measures. Virtually no correlation studies have been done for bipolar disorder. Regarding the cause of the birth seasonality, statistical artifact and parental procreational habits are unlikely explanations. Seasonal effects of genes, subtle pregnancy and birth complications, light and internal chemistry, toxins, nutrition, temperature/weather, and infectious agents or a combination of these are all viable possibilities.
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PMID:Seasonality of births in schizophrenia and bipolar disorder: a review of the literature. 942 62

Studies of psychiatric morbidity in Nigerian prisons have not involved assessment for specific psychiatric disorders. The general aim of this study was to highlight the prevalence of psychiatric morbidity among convicted inmates at a medium security prison in Nigeria. In a one month period in 1996, 100 inmates (93% males, mean age, 31.4 years) of the prison in Benin City, were assessed, using the General Health Questionnaire (GHQ-30) and the Psychiatric Assessment Schedule (PAS). The 34 subjects who scored upto GHQ-30 cut-off, four, had specific axis I DSM III-R diagnoses, including, schizophrenia in two, major depression in two in recurrent mild depression in twenty one, generalised anxiety disorder in eight and somatisation disorder in one. On axis II, six subjects had antisocial personality disorder while another subject had probable mild mental retardation. On Axis III, 15 subjects had chronic physical illnesses, including one with epilepsy. Twenty five inmates had past histories of drug abuse prior to imprisonment, including cannabis (11%) and alcohol (13%). Total PAS scores were significantly predicted only by GHQ scores and length of stay in prison. There was no association between offence committed and psychiatric morbidity. Most subjects with psychiatric morbidity developed these illnesses while in prison. The findings differed from the situation in developed countries where personality disorders and substance use are much more prevalent. The fairly high level of psychiatric disorders underscores the need to improve medical services in the prison.
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PMID:Prevalence of psychiatric morbidity among convicted inmates in a Nigerian prison community. 960 30

Assessment of psychiatric disorders encounters unique complexities in homeless populations. Although the use of structured diagnostic instruments has significantly improved research methodology in this area, questions remain about the validity of using cross-sectional diagnostic methods derived from studies of more general populations. In particular, the validity of structured diagnostic instruments in the assessment of schizophrenia, depression, drug use disorder, and antisocial personality disorder (ASPD) in homeless populations has been questioned. The purpose of this study was to examine the association of psychiatric diagnoses with the weather. It was hypothesized that self-report of psychiatric illness may be affected by prevailing weather conditions. Nine hundred homeless subjects randomly sampled from St. Louis shelters, day centers, and unsheltered locations were interviewed over a 1-year period. Official average daily temperature and amount of precipitation on the day of each subject's interview were compared with lifetime and current psychiatric diagnoses ascertained by the Diagnostic Interview Schedule. Similar analyses were performed in general population data from the Epidemiologic Catchment Area study. The study found that among homeless men, inclement weather on the day of interview was associated with lifetime and current diagnoses of major depression, lifetime drug use disorder, lifetime diagnosis of ASPD, and current alcohol use disorder. These findings, however, were not present in homeless women and not reflected in the general population. The results, although limited, suggest that weather may confound cross-sectional, standardized methods of psychiatric diagnosis in homeless men. Weather-related factors among homeless men are associated with ascertainment of both lifetime and current diagnosis of major depression, as well as lifetime drug use disorder and ASPD and current alcohol use disorder. Possible interpretations of these findings are discussed, with implications for intervention strategies for psychiatric disorders in the larger context of homelessness and social problems.
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PMID:The association of psychiatric diagnosis with weather conditions in a large urban homeless sample. 960 69

This study examined temporal relationships between relative onsets of mental illness and homelessness in a cross-sectional study of 900 homeless people compared with a matched, never-homeless sample from the Epidemiologic Catchment Area study. All psychiatric disorders preceded homelessness in the majority. Only one disorder, alcohol use disorder (in men only), had significantly earlier onset in homeless subjects. Regarding number of symptoms or earlier age of onset of psychiatric disorders, earlier onset of homelessness was associated with several diagnoses: schizophrenia, major depression, generalized anxiety disorder, alcohol and drug use disorders, and antisocial personality. In multiple regression models, history of dysfunctional family background and maternal psychiatric illness were also associated with earlier onset of homelessness, whereas education was protective. Chronicity of homelessness was associated with number of symptoms of alcohol use disorder and earlier age of onset of drug use disorder, presence and number of symptoms of schizophrenia and antisocial personality, and earlier onset of major depression and conduct disorder. In multiple regression models, more education, but not family background problems, was associated with shorter lifetime duration of homelessness. These findings provide information relevant to the roles of mental illness and personal vulnerability factors in the onset and chronicity of homelessness.
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PMID:Correlates of early onset and chronicity of homelessness in a large urban homeless population. 968 39

Any hypotheses concerning the origins of humans must explain many things. Among these are: 1, the growth in brain size around two million years ago; 2, the presence of subcutaneous fat; 3, the near absence of change or cultural progress for around 2 million years after the brain grew in size; 4, the cultural explosion which began somewhere between fifty thousand and one hundred thousand years ago with the emergence of art, music, religion and warfare; 5, the further cultural explosion around ten thousand to fifteen thousand years ago which developed with the emergence of agriculture and which has continued since. Since the brain, like subcutaneous fat, is particularly rich in lipids, and since the microconnections of the brain are substantially lipid in nature, it is suggested that changes in lipid metabolism are what differentiated humans from the great apes. The growth in brain size and in the quality of subcutaneous adipose tissue may have occurred because of changes in the proteins which regulate the rate of delivery of fatty acids to tissues, notably lipoprotein lipases and fatty acid binding proteins. The creativity which occurred one hundred thousand years ago may have resulted from changes in phospholipid-synthesizing, -remodelling and -degrading enzymes which largely determine the microconnectivity of neurons. Family studies and adoption studies indicate that schizophrenia in a family member is associated with an increased risk of the illness in other family members. It is also associated with an increased risk of schizotypy, manic-depression, dyslexia, sociopathy and psychopathy. On the other hand it is also an indication of an increased likelihood of high creativity, leadership qualities, achievements in many fields, high musical skills and an intense interest in religion. I propose that the characteristics which entered the human race about one hundred thousand years ago and which ended around two million years of cultural near-stagnation are precisely those shown by the families of people with schizophrenia. I propose that these features are caused by variations in phospholipid biochemistry which are responsible both for schizophrenia and for our humanity. This would help to explain why schizophrenia is present to approximately the same degree in all races. It is the illness which made us human prior to the separation of the races.
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PMID:Schizophrenia: the illness that made us human. 969 Jul 63


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