Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036341 (schizophrenia)
 60,220 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Chronic diseases are roughly speaking lifelong transitions between the states: relapse and recovery. The long-term pattern of recurrent times-to-relapse can be investigated with routine register data on hospital admissions. The relapses become readmissions to hospital, and the time spent in hospital are gaps between subsequent times-at-risk. However, problems of selection and dependent censoring arise because the calendar period of observation is limited and the study population likely to be heterogeneous. We will theoretically verify that an assumption of conditional independence of all times-at-risk and gaps, given the latent individual frailty level, allows for consistent inference in the shared frailty model. Using simulation studies, we also investigate cases where gaps (and/or staggered entry) are informative for the individual frailty. We found that the use of the shared frailty model can be extended to situations, where gaps are dependent on the frailty, but short compared to the distribution of the times-to-relapse. Our motivating example deals with the course of schizophrenia. We analysed routine register data on readmissions in almost 9000 persons with the disorder. Marginal survival curves of time-to-first-readmission, time-to-second-readmission, etc. were estimated in the shared frailty model. Based on the schizophrenia literature, the conclusion of our analysis was rather surprising: one of a stable course of disorder.
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PMID:Correcting for selection using frailty models. 1625 71

Prospective, multiyear epidemiologic studies have proven to be highly effective in discovering preventable risk factors for chronic disease. Investigations such as the Framingham Heart Study have produced blueprints for disease prevention and saved millions of lives and billions of dollars. To discover preventable environmental risk factors for disease in children, the US Congress directed the National Institute of Child Health and Human Development, through the Children's Health Act of 2000, to conduct the National Children's Study. The National Children's Study is hypothesis-driven and will seek information on environmental risks and individual susceptibility factors for asthma, birth defects, dyslexia, attention-deficit/hyperactivity disorder, autism, schizophrenia, and obesity, as well as for adverse birth outcomes. It will be conducted in a nationally representative, prospective cohort of 100,000 US-born children. Children will be followed from conception to 21 years of age. Environmental exposures (chemical, physical, biological, and psychosocial) will be assessed repeatedly during pregnancy and throughout childhood in children's homes, schools, and communities. Chemical assays will be performed by the Centers for Disease Control and Prevention, and banks of biological and environmental samples will be established for future analyses. Genetic material will be collected on each mother and child and banked to permit study of gene-environment interactions. Recruitment is scheduled to begin in 2007 at 7 Vanguard Sites and will extend to 105 sites across the United States. The National Children's Study will generate multiple satellite studies that explore methodologic issues, etiologic questions, and potential interventions. It will provide training for the next generation of researchers and practitioners in environmental pediatrics and will link to planned and ongoing prospective birth cohort studies in other nations. Data from the National Children's Study will guide development of a comprehensive blueprint for disease prevention in children.
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PMID:The National Children's Study: a 21-year prospective study of 100,000 American children. 1707 92

Schizophrenia is a challenging and complex psychiatric disorder. It is a chronic disorder of thought, affect, and cognition that significantly disturbs the individual's ability to function in society and develop interpersonal relationships. The clinical presentation can be extremely varied, with symptoms including delusional thinking, disorganized thoughts and speech, hallucinatory behavior, and negative symptoms (e.g., blunted affect, avolition, alogia, anhedonia). Approximately 1% of the population is affected by schizophrenia worldwide, and women may experience different symptoms, have a later age of onset, may respond to different treatments, and may be more concerned about specific side effects than men. Women with schizophrenia traditionally have been treated in the same way as men and have generally had poorer comprehensive medical care. With the introduction of many new antipsychotic medications in recent years, this review focuses on sex differences in schizophrenia, with an emphasis on differences in treatment and side effects. Additionally, it presents patient counseling issues in sexuality and health outcomes.
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PMID:Treatment considerations in women with schizophrenia. 1719 54

Schizophrenia remains a severe disorder that is associated with a poor outcome in a large subgroup of patients. Major efforts should be made to improve treatment for all patients who have this debilitating disease. Second-generation antipsychotics were a major step forward in this respect; however, important unmet needs remain, such as a better solution for frequent noncompliance problems. Depot formulations are known to have advantages in this respect. However, for a long time, only depot formulations of conventional antipsychotics were available, with their high risk of extrapyramidal adverse effects. Therefore, there has been only very restricted use of depot antipsychotics, which mainly focused on patients with chronic disease who were difficult to treat and had a high risk of noncompliance. The situation may change with the advent of a depot formulation of an atypical antipsychotic. The first depot formulation of an atypical antipsychotic to be introduced to the market is long-acting injectable risperidone. On the basis of the pharmacokinetic properties of the depot formulation, a 2-week interval between administrations is recommended. The antipsychotic efficacy of long-acting risperidone was demonstrated in two 12-week, double-blind, randomised, phase III studies, one versus placebo and the other versus oral risperidone. These two studies, together with one open-label, long-term study over 12 months, belong to the core group of trials that were relevant for the licensing of long-acting risperidone. A relapse-prevention, control group study comparing the long-acting formulation versus oral risperidone was not performed because of the known principal methodological problems of such a comparison. Instead, as much clinical data as possible was collected from observational studies that investigated questions relevant for clinical practice, such as efficacy, safety and tolerability in different subgroups, and transition from pre-treatment with different kinds of antipsychotics to long-acting risperidone. On the basis of these data, it can be stated that the efficacy of the long-term formulation of risperidone is proven, and that the safety and tolerability are more or less comparable to those of oral risperidone. The local tolerability at the injection site is good. Because it is well known that noncompliance is a frequent feature of the treatment of schizophrenia, and considering the advantages of atypical antipsychotics, consideration of whether long-acting atypical antipsychotics should have a broader indication than is the case with the depot formulations of the classical antipsychotics is warranted.
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PMID:Long-acting injectable risperidone for the treatment of schizophrenia: clinical perspectives. 1766 27

Schizophrenia is a chronic disease characterized by periods of relative stability interrupted by acute episodes (or relapses). The course of the disease may vary considerably between patients. Patient histories show considerable inter- and even intra-individual variability. We provide a critical assessment of the advantages and disadvantages of three modelling techniques that have been used in schizophrenia: decision trees, (cohort and micro-simulation) Markov models and discrete event simulation models. These modelling techniques are compared in terms of building time, data requirements, medico-scientific experience, simulation time, clinical representation, and their ability to deal with patient heterogeneity, the timing of events, prior events, patient interaction, interaction between co-variates and variability (first-order uncertainty). We note that, depending on the research question, the optimal modelling approach should be selected based on the expected differences between the comparators, the number of co-variates, the number of patient subgroups, the interactions between co-variates, and simulation time. Finally, it is argued that in case micro-simulation is required for the cost-effectiveness analysis of schizophrenia treatments, a discrete event simulation model is best suited to accurately capture all of the relevant interdependencies in this chronic, highly heterogeneous disease with limited long-term follow-up data.
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PMID:Modelling approaches: the case of schizophrenia. 1862 Apr 58

This paper strives to identify the current impact of Non-Transmissible Chronic Diseases (NTCDs) on sickness and disability benefits paid out by Brazil's National Social Security Institute (INSS) between 2000 and 2002. A total of 17,970 new cases were studied, registered at the two local agencies in Recife, Pernambuco State, Northeast Brazil. Initially the cases were divided up according by major diseases groups, following the CID-10 classification. Osteomuscular diseases (OMDs) and cardiovascular diseases (CVDs) were among the main reasons for granting sickness benefits. Among the disability benefits, CVDs, mental disorders (MDs), and OMDs, were the main reasons. In terms of specific diseases within the major DCNT groups, the main reasons for granting sickness benefits were high blood pressure, diabetes mellitus, arthrosis, breast and intestinal cancer, mood disorders and schizophrenia. For disability benefits, the main causes were cerebrovascular diseases, diabetes mellitus, cancer of the gastro-intestinal tract and schizophrenia. Most (66%) of the recipients were men between 39 and 58 years of age, and the initial value of the benefit was of up to three minimum wages per month.
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PMID:[Impacts of non-transmissible chronic diseases on social security benefits]. 1881 2

Based on a clinical follow-up observation of 20 patients with dissocial personality disorder, a particular variant of prolonged hypochondriac state (postaddictive hypochondriasis) has been singled out. Postaddictive hypochondriasis manifests itself after a transient psychosis arising as an existential crisis. It is a syndrome of nondelusional hypochondriasis, with a clinical picture presented by obsessive thoughts of the damage to mental and/or somatic well-being caused by the illness which are combined with a phenomenon of medical addiction. Postaddictive hypochondriasis is formed as an opposite/reversive phenomenon replacing premorbid addictions by means of antinomic shift. The sample has been stratified into two groups depending on disease course and comorbid disorders. In the first group (n=7), postaddictive hypochondriasis manifests itself in the structure of reversible psychopathic phases and pathologic personality developments. It is not accompanied by a social disability and considered to be a representation of personality disorder dynamics. In contrast, postaddictive hypochondriasis in the second group (n=13) is characterized by chronic disease pattern and a variety of comorbid disorders including additional hypochondriac, phobic and affective syndromes. Postaddictive hypochondriasis in this group is considered as a debut of slow progressive pseudopsychopathic schizophrenia (schizotypic disorder).
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PMID:[Hypochondriasis as a personality pathology (to a problem of postaddictive hypochondriasis)]. 1900 45

Schizophrenia is a chronic disorder, usually necessitating lifelong treatment. Although atypical antipsychotic agents have improved outcomes in schizophrenia, their clinical potential remains limited by patients' nonadherence to medication. Long-acting antipsychotics were developed in the 1960s to enhance treatment adherence and simplify the medication process. However, although conventional long-acting agents assure medication delivery, they are associated with similar side effects to their oral equivalents. The need for an agent combining the advantages of a long-acting formulation with those of an atypical antipsychotic was highlighted in 1997 by the American Psychiatric Association's Practice Guideline for the Treatment of Patients with Schizophrenia. The first long-acting injectable atypical antipsychotic, long-acting risperidone (Risperdal Consta, Johnson & Johnson), has since been developed. This article discusses the efficacy, tolerability and cost-effectiveness of long-acting risperidone in schizophrenia and bipolar disorder patients, and suggests possibilities for how its role in clinical practice may change over the next 5 years.
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PMID:Use of long-acting risperidone in psychiatric disorders: focus on efficacy, safety and cost-effectiveness. 1910 65

Schizophrenia is a chronic disorder generally considered to encompass positive symptoms, negative symptoms and cognitive deficits. Increasing attention has been paid to the social cognitive deficits of the disorder as these dysfunctions are particularly handicapping, predictive of functional outcome and show poor treatment response. Phencyclidine (PCP) is a psychotomimetic drug used to model the different aspects of schizophrenia in experimental animal models. PCP-induced cognitive deficits and hyperlocomotion may be blocked by pretreatment with nitric oxide (NO) synthase inhibitors in rodents. The present study was carried out to evaluate the acute effects of PCP and NO synthase inhibition on social interaction in male Sprague-Dawley rats. The NO synthase inhibitor, L-NAME (10mg/kg) and PCP (2mg/kg) was injected subcutaneously to rats, which were then tested in pairs for social interactive behaviour. Twenty-four hours after the initial test a drug-free social interaction test was carried out to assess the rats' memory of the previous social interaction. The results showed that PCP reduced the time of social interaction on Day 1 compared to controls, and that pretreatment with the NO synthase inhibitor, L-NAME, attenuated this reduction towards control levels. Neither locomotor activity, nor frequency of social interactions were affected by the PCP treatment, suggesting that the PCP-induced effects observed were not due to drug-induced stereotypies. In combination with increasing clinical evidence for the involvement of NO in the pathophysiology of schizophrenia, the present results indicate that NO synthase inhibition may be a potentially new treatment strategy for alleviating social dysfunction in schizophrenia.
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PMID:The importance of nitric oxide in social dysfunction. 1916 79

Psychiatry includes the assessment, treatment, and prevention of complex brain disorders, such as depression, bipolar disorder, anxiety disorders, schizophrenia, developmental disorders (e.g., autism), and neurodegenerative disorders (e.g., Alzheimer dementia). Its core mission is to prevent and alleviate the distress and impairment caused by these disorders, which account for a substantial part of the global burden of illness-related disability. Psychiatry is grounded in clinical neuroscience. Its core mission, now and in the future, is best served within this context because advances in assessment, treatment, and prevention of brain disorders are likely to originate from studies of etiology and pathophysiology based in clinical and translational neuroscience. To ensure its broad public health relevance in the future, psychiatry must also bridge science and service, ensuring that those who need the benefits of its science are also its beneficiaries. To do so effectively, psychiatry as clinical neuroscience must strengthen its partnerships with the disciplines of public health (including epidemiology), community and behavioral health science, and health economics.The authors present a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis of psychiatry and identify strategies for strengthening its future and increasing its relevance to public health and the rest of medicine. These strategies encompass new approaches to strengthening the relationship between psychiatry and neurology, financing psychiatry's mission, emphasizing early and sustained multidisciplinary training (research and clinical), bolstering the academic infrastructure, and reorganizing and refinancing mental health services both for preventive intervention and cost-effective chronic disease management.
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PMID:The future of psychiatry as clinical neuroscience. 1988 7


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