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

We present a unique case of an 18-year-old male who had a classic picture of schizophrenia preceded by a well documented history of Tourette Disorder and a developmental disorder. The subject, a member of an ongoing study on first-admission psychosis, has been systematically evaluated and followed up for two years, and the interesting neuropsychological findings are presented and compared to those of the rest of the sample with a diagnosis of schizophrenia. The triad of schizophrenia, Tourette Disorder and developmental disorder is described for the first time in a subject with an adult type schizophrenia. Possible neurodevelopmental impairments explaining the clinical picture are discussed in view of the recent literature.
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PMID:Developmental disorder, Tourette disorder and schizophrenia: a case study. 933 30

Schizophrenia is in essence a developmental disorder, but an unusual one in that the onset of symptoms is markedly delayed. Neuropathologic studies of the brain in schizophrenia have revealed subtle abnormalities that may reflect abnormal neuronal development. A more detailed examination of the cellular and molecular pathology of schizophrenia has been limited by the lack of informative markers that might allow a more complete understanding of the brain defects that characterize this disorder. Recent advances in molecular biology have made available a growing number of probes for examining the expression of specific gene products in brain tissue by using in situ hybridization and immunohistochemistry using antibodies to recombinant antigens. Several recently cloned neural genes are expressed in the forebrain regions which have been implicated in schizophrenia, and may have significant roles in brain development or function. Selected neurotransmitter receptors, neurotrophins and their receptors, and transcription factors of the POU and MADS families are promising candidates for future studies of the cellular and molecular neuropathology of schizophrenia.
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PMID:Cellular and molecular neuropathology of schizophrenia: new directions from developmental neurobiology. 941 46

The management of the behavior of mentally challenged adults when providing required dental care is often a problem, whether in the dental office or in a hospital setting. Our institution has a designated program to provide required dental care to this group of patients. Because of the high incidence of poor cooperation, which may include aggressive antagonistic behavior, many of these patients are scheduled for dental care under general anesthesia with an incomplete preoperative medical assessment. The purpose of this study was to determine the impact and limitations that an incomplete medical assessment may present in the delivery of dental care under general anesthesia to these adults with developmental disability. After approval from the institutional review board, the medical records of 139 patients treated in this program between 1992 and 1994 were reviewed to determine the patient profiles, anesthesia management, and complications. The charts of these patients, who underwent dental and radiographic examination, scaling and prophylaxis, and restoration and extraction of teeth under general anesthesia, were reviewed. There were 149 procedures performed on these patients, some more than once. The mean age was 29.5 yr. Males predominated females by a ratio of 2:1. All had multiple diagnoses, medical problems, and medications. Twenty-three patients had Down's Syndrome, four had schizophrenia disorders, 42 had seizure disorders, 11 had hypothyroidism, seven had heart disease, and 14 had central nervous system and neuromuscular disorders. The remainder had a variety of diagnoses, including rare syndromes. One hundred had intravenous (i.v.), 25 had mask inhalation, and 24 had intramuscular ketamine (Ketalar) induction. Nasotracheal intubation was uneventful in 139 patients, five had difficult visualization of the larynx and intubation. Ten patients experienced intraoperative complications, including nonfatal ventricular arrhythmia, slight fall in blood pressure and hypertension (greater than 20% of preoperative value), and four individuals developed laryngospasm. In the Post Anesthetic Care Unit, five patients experienced minor airway problems resulting in a desaturation of oxygen to a level below 85%. Adults with developmental disabilities can be safely managed under general anesthesia for dental treatment in a hospital setting with minimal morbidity and without extensive preoperative investigations.
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PMID:General anesthesia for the provision of dental treatment to adults with developmental disability. 979 4

Based upon the Illinois Department of Mental Health and Developmental Disabilities' computerized clinical information system, with its integration of client-specific clinical data, a 5-year retrospective study was designed to determine the clinical effectiveness and economic impact of the use of clozapine for treatment-resistant schizophrenia. The study sample consisted of 518 hospitalized, treatment-resistant patients. At the end of 5 years, 78% were well maintained on clozapine. Two hundred forty-three patients had been discharged to the community, and 62 had been transferred for treatment of medical or surgical problems. Clozapine treatment was discontinued in 115 patients (22%). The drug was well tolerated, with a very low incidence of agranulocytosis. Cost savings resulting from the discharge of the 243 clozapine-treated patients amounts to approximately $20 million per year. A disease management algorithm has been developed allowing physicians to begin clozapine treatment for patients not successfully treated with 2 prior antipsychotic agents. Adherence to this protocol throughout the state's mental health system would result in even greater savings.
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PMID:Clozapine for refractory schizophrenia: the Illinois experience. 1003 66

Three problems in identifying genes causing schizophrenia and other developmental disorders may be locus heterogeneity, high disease allele frequency, and unknown mode of inheritance. The DNA polymorphism-diet-cofactor-development (DDCD) hypothesis addresses the first two. The gene-teratogen model addresses the third. The DDCD hypothesis is that schizophrenia results in part from brain abnormality in utero from the aggregate effect of multiple mutations of small effect of genes related to important cofactors (e.g., folate, cobalamin, or pyridoxine) potentiated by maternal dietary deficiency of these cofactors and by pregnancy. The effect results from insufficiency of the cofactors and from resulting effects such as impaired DNA synthesis, immune deficiency, effects on niacin and serotonin metabolism, and teratogens, e.g., hyperhomocysteinemia. The hypothesis addresses all of the unusual features of schizophrenia: e.g., decreased brain gray matter, birth-month effect, geographical differences, socioeconomic predilection, association with obstetrical abnormalities, decreased incidence of rheumatoid arthritis, and association with famine and viral epidemics. In the gene-teratogen model, a teratogenic effect in utero produces a developmental disorder through a teratogenic locus and a modifying or specificity locus, as well as through environmental factors. An example is the major intrauterine effect seen in offspring of phenylketonuric mothers. Thus, the mode of inheritance of genes acting prenatally may in some cases be fundamentally different from that of genes acting postnatally. The model is interesting because it is simple and because teratogenic loci will be difficult to locate by conventional linkage mapping techniques due to misspecification of the affection status of both mother and affected children. A new study design is suggested for identifying teratogenic loci.
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PMID:DNA polymorphism-diet-cofactor-development hypothesis and the gene-teratogen model for schizophrenia and other developmental disorders. 1040 96

Studies of the general population without intellectual disability have suggested an association between atypical handedness and schizophrenia-spectrum disorders (SSDs). Mixed handedness is taken as an index of diminished cerebral dominance or laterality. The present study addressed the question of whether such findings extend to the neurodevelopmentally 'at risk' population of adults with intellectual disability and SSDs compared with appropriate controls. Fourteen patients with a dual diagnosis of intellectual disability and SSD were compared with 14 controls with intellectual disability alone. Assessments of self-reported hand preference and relative hand skill were completed. Self-report of hand preference revealed highly significantly greater mixed-handedness in the SSD group. Furthermore, relative hand skill performance was significantly diminished for the dominant hand. The discrepancy between dominant and non-dominant hand functioning was lower in the SSD group and this association was highly significant. The results of the present study support the usefulness of such detailed laterality assessment in this population. Mixed laterality, over and above that of the population with general intellectual disability and developmental disorder, was associated with SSD. These results are consistent with the neurodevelopmental hypothesis of schizophrenia and its cognitive neuropsychiatric/neuropsychological sequelae.
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PMID:Cerebral dominance and schizophrenia-spectrum disorders in adults with intellectual disability. 1111 18

Both epidemiological findings and clinical observations and have shaped our thinking as regards to the neuropathology of schizophrenia. Epidemiological findings implicating environmental risk factors, including maternal dietary deficiency and urban birth place, suggest schizophrenia is a developmental disorder, whereas clinical observations gave rise to the "dopamine hypothesis." Epidemiological findings lead to complex multifactorial models, while clinical observations lead to more readily to testable, but not necessarily generalizable, hypotheses. Points where findings from these different approaches converge may provide us with new insights and points of departure. In this paper, clinical observations and epidemiological findings are presented which suggests that a subgroup of schizophrenics have abnormalities in phospholipid metabolism. Preliminary clinical trials involving administration of omega-3 fatty acids thus far appear to support this hypothesis.
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PMID:Abnormal phospholipid metabolism in schizophrenia: evidence from epidemiological findings, clinical observations, and preliminary clinical trials. 1153 11

The phenomenon of social withdrawal in adolescence and young adulthood has become one of the major issues in community mental health care. The objective of this paper is to provide an overview on the psychopathological understanding of this condition and the mental health care measures required. Social withdrawal is a condition arising from the backdrop of various psychopathological backgrounds including schizophrenia, mood disorder, anxiety disorder, personality disorder, and some cases with a background of developmental disorder. The importance of establishing policies for treatment and support based upon appropriate assessment of each individual case, the schizoid pathology found in common among many cases, and the issues in psychoanalytic psychotherapy for these schizoid cases are reviewed. Furthermore, the need for systematizing approaches enabling consultations sought by family members, and a guideline and problems pertaining to crisis intervention for cases exhibiting severe violence or antisocial behavior are presented as issues to be addressed in future mental health care.
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PMID:[Social withdrawal in the adolescent and young adult]. 1157 70

One of the leading theories of the neuropathology of schizophrenia is that it is a developmental disorder of "neural connectivity." To assess this theory, it is first necessary to understand how precise neural connections normally are established. Sensory-driven neural activity has been widely recognized as crucial for this process. Recent studies have revealed a similar requirement for endogenous neural activity generated by the nervous system itself, long before there is any sensory input. These patterns of sensory-driven and endogenously generated neural activity sculpt the precise circuits that are crucial to the many complex functions of the adult brain. This article summarizes the principles of activity-dependent neural development as determined from basic neuroscience experiments, particularly those done using the mammalian visual system, to illustrate the role of patterned activity, neuronal competition, and critical periods in shaping neural circuitry. The potential molecular mechanisms involved in these features of activity-dependent neurodevelopment are discussed and possible links to the etiology of schizophrenia are briefly explored.
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PMID:Early brain wiring: activity-dependent processes. 1159 40

The reported prevalence of psychiatric illness among adults with intellectual disability (ID) varies widely between 10 and 39%; however, many methodological problems exist. The aims of the present study were to establish the prevalence of functional psychiatric illness among adults with ID who live in the community, in order to compare the overall rate and types of psychiatric illness between the population with ID and the general population without ID, and to establish the risk factors associated with psychiatric illness in adults with ID. The study was done in two stages. In the first part, a trained psychiatrist interviewed 101 randomly selected adults with ID and their carers using the Mini Psychiatric Assessment Schedule for adults with Developmental Disability (Mini PAS-ADD) to screen for psychiatric caseness. Out of these 101 adults, 90 had sufficient communicative abilities that made the administration of Mini PAS-ADD possible. A second trained psychiatrist interviewed 19 out of the 20 adults who were diagnosed as psychiatric cases according to the initial Mini PAS-ADD interview. This psychiatrist interviewed patients and their carers in line with the full PAS-ADD interview. The second psychiatrist was blind to the initial diagnoses made according to the Mini PAS-ADD questionnaire. A final psychiatric diagnosis was made according to International Classification of Diseases - 10th Revision (ICD-10) criteria. Some 14.4% (95% confidence interval = 7.4-21.4%) of the cohort had a psychiatric diagnosis according to ICD-10 criteria: 4.4% had schizophrenia, 2.2% depressive disorder, 2.2% generalized anxiety disorder, 4.4% phobic disorder and 1% delusional disorder. The overall rate of functional psychiatric illness (point prevalence) was similar to that found in the general population (16%). However, the rates of schizophrenic illness and phobic disorder were significantly higher in the study cohort compared with those in the general population (0.4% and 1.1%, respectively). Increasing age and the presence of physical disability were significantly associated with the occurrence of psychiatric illness. Out of the 11 remaining adults with severe ID, two (18%) had a diagnosis of a psychiatric illness (one mania and one anxiety disorder) according to the Diagnostic Assessment for the Severely Handicapped (DASH) questionnaire.
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PMID:Mental disorder in adults with intellectual disability. 1: Prevalence of functional psychiatric illness among a community-based population aged between 16 and 64 years. 1173 36


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