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

This review provides a comprehensive overview of currently available treatments for psychogeriatric disorders, summarizing the efficacy of various treatment approaches based on research evidence. The severe mental illnesses in geriatric age-groups can be classified into the following groups: delirium, dementia, depression, mania, psychotic disorders, and anxiety disorders. There are specific disorders requiring specific treatments within each group. Effective treatments exist for most disorders. Effective treatment for delirium consists of identifying and treating an underlying cause, and the judicious use of medications for specific symptoms. Treatment for the dementias involves two considerations: (1) treatment of the cognitive symptoms; and (2) treatment of the behavioral symptoms. There are no currently FDA-approved, or generally acknowledged as effective, medications for the cognitive symptoms. Some medications marketed for other purposes may be used by some clinicians for treating cognitive symptoms. One medication, tacrine, is available under a treatment IND for patients with Alzheimer's disease (AD). Behavioral symptoms such as agitation, hallucinations, and delusions occur in a majority of patients some time during their illness. The treatment of behavioral symptoms involves behavioral management, environmental manipulations, and the use of medication for control of specific syndromes. The few medications assessed in randomized trials include neuroleptics and benzodiazepines. Neuroleptics such as haloperidol or thioridazine are modestly effective for some symptoms and are probably the treatments of choice for the acute, short-term. Benzodiazepines may be somewhat less effective, have cognitive-impairing side effects, are associated with increased falls, and, therefore, are less preferred. Many other medications have been suggested based largely on clinical experience. They include carbamazepine, trazodone, buspirone, and others. Treatment for depression involves consideration of acute and maintenance treatment, and of the type and severity of illness. For an acute depressive disorder of great severity, or with melancholia or psychosis either electroconvulsive therapy or the combination of antidepressant and neuroleptics may be required. Treatment requires adequate prescribing, patient education, and regular patient monitoring for compliance, symptom change, side effects, and intercurrent medical disorders which may complicate antidepressant therapy. Both antidepressant medications and brief structured psychotherapies, such as interpersonal or cognitive psychotherapies, have efficacy in the acute treatment of elderly depressed outpatients with major unipolar, nondelusional depression. Maintenance treatments are important, however, to prevent relapses or repeated episodes. Treatment recommendations are discussed. The mainstay of treatment for psychotic disorders such as late-onset schizophrenia and late-onset delusional disorder are neuroleptics. Clinical course is variable; maintenance treatments are required. Neuroleptic side effects occur with greater frequency than in younger patients.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Efficacy of treatment for geropsychiatric patients with severe mental illness. 808 81

Acute intermittent porphyria mimics a variety of commonly occurring disorders and thus poses a diagnostic quagmire. Psychiatric manifestations include hysteria, anxiety, depression, phobias, psychosis, organic disorders, agitation, delirium, and altered consciousness ranging from somnolence to coma. Some patients develop psychosis similar to schizophrenia. Psychiatric hospitals have a disproportionate number of patients with this disorder as only difficult and resistant patients accumulate there. Presence of photosensitive porphyrins in the urine is diagnostic. When porphyrins are absent, excess of alpha aminolevulinic acid and porphobilinogen are present in the urine. The definitive test is to measure monopyrrole porphobilinogen deaminase in RBCs. This diagnosis should be entertained in the following situations: (a) unexplained leukocytosis; (b) unexplained neuropathy; (c) etiologically obscure neurosis or psychosis; (d) 'idiopathic' seizure disorder; (e) unexplained abdominal pain; (f) conversion hysteria, and (g) susceptibility to stress. Porphyria is important in psychiatry as it may present with only psychiatric symptoms; it may masquerade as a psychosis and the patient may be treated as a schizophrenic person for years; the only manifestation may be histrionic personality disorder which may not receive much attention. Diagnosis is based on a high index of suspicion and appropriate investigation. Various psychotropic drugs exacerbate acute attacks. While it is important not to use the unsafe drugs in porphyric patients, it is also imperative to look for this diagnosis in cases where these drugs produce unprecedented drug reactions.
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PMID:Porphyria: reexamination of psychiatric implications. 865 42

Schizophrenia is a clinical syndrome of extraordinary importance and complexity. Its early identification is difficult, and our concepts of its main characteristics have undergone many changes in the past century. Electroconvulsive therapy (ECT) was introduced as a treatment for dementia praecox. The initial reports were salutary, and the treatment was widely applied until it was replaced by psychoactive drugs. ECT was reintroduced in the 1970s in the treatment of therapy-resistant disorders. The initial reviews argued that ECT was not applicable in patients with schizophrenia, a conclusion based mainly on experience with chronic forms of the disorder. This article assesses the role of ECT in schizophrenia today. We find it to be an effective treatment for psychosis. ECT is particularly applicable in patients with first-break episodes, especially those marked by excitement, overactivity, delusions, or delirium; in young patients, to avoid debilitating effects of chronic illness; and in patients with syndromes characterized by catatonia, positive symptoms of psychosis, or schizoaffective features.
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PMID:Convulsive therapy in schizophrenia? 868 61

The goal of this paper is to draw conclusions about the usefulness of the standard EEG in psychiatry. In general, two thirds of psychiatric referrals for an EEG are expected to provide useful information. The emphasis in schizophrenia is placed on left-sided abnormalities, especially on the left temporal area. In mood disorders the emphasis is on right-sided foci, in addition to the controversial 6/sec spike and wave complexes, small sharp spikes and positive spikes. In the acute stage of alcoholism, a relationship is seen between the degree of intoxication and the amount of slow activity, while in the chronic stage an increase in slow activity is seen, but another change is fast activity on the temporal areas. During withdrawal a low seizure threshold can be seen as irregular bilateral spike and wave complexes. During abstinence 2-4 yr may be required before slow wave sleep is normal in all regards. Among the organic mental syndromes, delirium shows slow activity, except in delirium tremens, which often is associated with a normal record with fast activity. In dementia the prevalence of EEG abnormalities is related to the degree of impairment. After five sessions of ECT diffuse slow waves are often seen. In other conditions, among developmental disorders about one half of autistic children show abnormalities and epileptiform activity is not uncommon. Mild nonspecific abnormalities are seen in about 40% of dyslexics and also in behavior disorders. Anxiety disorders include anorexia nervosa, showing abnormal background activity related to the effect of starvation on cerebral metabolism. In panic attacks paroxysmal activity can be seen. In borderline personality positive spikes have been (again) associated with impulsivity and 6/sec spike and wave complexes with interpersonal problems. Of the drugs of abuse psilocybin and phencyclidine are often associated with generalized epileptiform patterns and with marijuana the alpha shows a decreased frequency with increased amplitude. Typically, an increase in slow activity is seen with psychotropic drugs if there is a change in the level of awareness. Finally, distinctive personality traits are, at times, seen in temporal lobe epilepsy and the phenomenon of "forced normalization" may appear when seizures stop and psychotic symptoms appear.
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PMID:A review of the usefulness of the standard EEG in psychiatry. 871

Patients with delirium, dementia, depression, and schizophrenia were administered a newly developed test designed to identify delirium in an intensive care unit (ICU) setting. Two alternate forms of the Cognitive Test for Delirium (CTD) were highly correlated. The delirium patients performed least well, and an optimal cutoff score derived from relative-operating characteristic analysis resulted in a sensitivity of 100% and a specificity of 95%. In a follow-up study, the Mini-Mental State Exam could not be administered to 42% of the ICU patients who completed the CTD. Early identification of delirium with the CTD may lead to timely treatment of specific etiologic conditions and a reduction in mortality and morbidity.
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PMID:Validation of a cognitive test for delirium in medical ICU patients. 894 4

Clozapine is an atypical antipsychotic medication with proven efficacy in the management of refractory schizophrenia. It is also recommended for patients who do not tolerate the extrapyramidal adverse effects of traditional antipsychotic medications. However, the therapeutic promise of clozapine has been limited by a higher incidence of agranulocytosis. Currently, plasma clozapine concentrations are not routinely used in clinical management. Therapeutic effects are monitored empirically during a 6 to 8 week titration period in which the dosage is raised to 300 to 450 mg/day. Clozapine nevertheless fulfils a number of criteria which make it a candidate for therapeutic monitoring. These include an identifiable therapeutic range, an unpredictable dose-concentration relationship between patients, a potential for clinically relevant pharmacokinetic interaction with other drugs and a high probability of patient noncompliance. The therapeutic threshold plasma concentration appears to be about 400 micrograms/L. Concentrations above 1000 micrograms/L increase the risk of adverse effects on the central nervous system (confusion, delirium and generalised seizures). There is no evidence to link increased concentrations of clozapine or its metabolite to the development of agranulocytosis. We conclude that therapeutic drug monitoring can play a useful role in the clinical management of patients treated with clozapine. The clinician is advised to primarily use clinical judgement during dosage escalation, but intermittent monitoring is recommended to quickly optimise a therapeutic dosage for each patient. At steady state, occasional measurements could be made when clinical signs indicate possible toxicity or lack of effect (possibly caused by a lack of compliance or drug interaction). Long term monitoring would, in our view, not be necessary.
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PMID:Will routine therapeutic drug monitoring have a place in clozapine therapy? 906 25

Psychiatry is a borderline science that has relations on one hand with the methods of knowledge of natural sciences, on the other with those of the humanities. To investigate the bases of its studies, the psychiatric science often refers to literary and philosophical masterpieces. Therefore, the author analyses some examples of the classic fiction which presents psychopathologic issues. Particularly, the author examines some principal topics: anxiety, psychosomatic illness, depression, schizophrenia and delirium.
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PMID:[Literature and psychiatry]. 910 6

A retrospective investigation of electroconvulsive therapy (ECT)-treated patients in 1992-94 at the Psychiatric Hospital in Aarhus, Denmark showed that en bloc treatment had been given in 39 cases of 420 patient series. The basic diagnoses (according to ICD-10) were severe depressive disorder, bipolar affective disorder mixed state, manic disorder, acute transient psychotic disorder, schizoaffective disorder, and schizophrenia; all patients were in a severely psychotic condition. Eight patients were diagnosed with acute delirium. Delirious symptoms disappeared completely after the first few ECT treatments. Patients were subsequently given supplementary treatment for the underlying disease. ECT is an effective treatment for psychoses complicated by acute delirium.
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PMID:ECT in acute delirium and related clinical states. 915 83

To identify symptomatological characteristics of solvent psychosis, 9 cases of chronic thinner intoxication with psychitaric evidence during the abstinent period are studied. The results were as follows: 1) During intoxication, 7 cases had visual hallucinations and 3 cases had auditory hallucinations. 2) Eight cases had irritabilities or mood disturbances without thinner intoxication. 3) Four cases had convulsions or delirium which were observed only in the withdrawal period, suggesting that these symptoms might be withdrawal signs of thinner dependence. 4) Six cases had Schneiderian first rank symptoms such as auditory hallucinations (i.e. voices commenting, voices arguing), delusions of control (withdrawal of thought, thought insertion, influence of thought) and delusional perception. Hallucinations that appeared in acute intoxication with thinner in 5 of the 6 cases, were second rank symptoms. Five of the 6 cases did not show negative symptoms (i.e. blunting of thought) and they could maintain good emotional contact with other. Symptoms of these 5 cases were different from those of schizophrenia or the flashback phenomenon of thinner dependence. These cases suggest that Schneiderian first rank symptoms and maintenance of emotional contact are important for diagnosis of volatile solvent psychosis.
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PMID:[Clinical manifestation of volatile solvent psychosis]. 925 26

PRAGMATIC APPROACH: For patients with schizophrenia, improvement does not simply mean freedom from delirium, but also implies the acquisition of the personal and relational skills needed for durable stabilization. Consequently, behavioral and cognitive therapies have progressively gained a specific role in the treatment of schizophrenia. BASIC PRINCIPLES: Behavior and cognitive techniques proposed for rehabilitating patients with schizophrenia are based on acquisition of social skills which the patients can use to manage their treatment and their daily familial and interpersonal relationships. FAMILY THERAPY: The aim of family therapy is to improve the emotion expressed within a family by improving the family's capacity for intercommunication, coherence and adaptation to the patient's situation. This individual and familial approach to behavior can provide substantial prolonged benefit for the schizophrenic patient. A PRECIOUS CONTRIBUTION TO THERAPEUTICS: The organization of behavioral and cognitive therapy requires long-term adhesion from patients, health cares and family. In combination with adapted drug therapy and with individually designed objectives, behavioral and cognitive therapies can widen the therapeutic spectrum proposed in this chronic and difficult to manage disease.
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PMID:[Role of behavioral and cognitive techniques in the treatment of schizophrenia]. 925 47


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