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

There is very little published information regarding the co-occurrence of human immunodeficiency virus (HIV)-spectrum illness and psychotic illnesses, including schizophrenia, even though their coexistence in the same patient may severely affect the course of both illnesses. Estimates of the frequency of HIV infection in patients with preexisting mental illness range between 5 and 7 percent. Estimates of new-onset psychosis in patients with HIV-spectrum illness range between 0.2 and 15 percent and may increase as the stage of HIV illness progresses. Regardless of which illness came first, their occurrence together appears to be associated with more morbidity and mortality than would be expected with either illness alone. Patients with new-onset psychosis respond to and tolerate relatively low doses of antipsychotic medication. Whether the presence of HIV decreases the effective daily dose of neuroleptic medication in patients with preexisting psychosis is not yet known. A clearly superior neuroleptic medication for patients with both psychosis and HIV infection has not yet been identified. Further systematic exploration is needed.
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PMID:Schizophrenia and HIV. 887 97

In contrast to the well known chlorpromazine-induced cholestatic hepatitis, we report the case of a schizophrenic patient who presents a cytolytic hepatitis, without any prior hepatic disease. Mr G. was first hospitalized for depressive symptomatology. A pseudo-nevrotic schizophrenia was diagnosed. Pretherapeutic clinical and biological data were normal. A treatment with chlorpromazine 400 mg/day was given. At day 8, the patient was still anxious and began to be agitated. An increase to 500 mg/day of chlorpromazine posology and an addition of haloperidol 200 mg/day was implemented. At day 10, the following clinical symptoms appeared: 38.6 degrees C fever; headache; myalgia; epigastralgia and hypocondrium pain. Biological hepatitis disturbances (ALAT, 984 U/L; ASAT, 414 U/L) and hypereosinophilia with normal white cell count were found. Clinical and biological investigations were normal. Blood-culture, A, B, C hepatitis, HIV and CMV serologies were negative. Neuroleptic treatment was discontinued. Evolution to normality of the disturbances and biological data suggested a cytolytic hepatitis. Mr G... remained treated with flupentixol without side-effects. Phenothiazine-induced cholestatis is frequent, mild, and recovers spontaneously. The biological mechanism is supposed to be immunologic. Prevalence of biological hepatic disturbances is 10 to 20% with chlorpromazine in long-term treatment. More often, symptomatology is the same; jaundice, pruritus, abdominal pain, fever. Although pharmacological data suggest for a cytotoxic activity of phenothiazines, cytolytic hepatitis is poorly described. Maximum range of transaminase blood level reported in previous studies is about 400 U/l. This level is not clearly correlated with hepatic cell lysis. Few cases of hepatic necrosis have been reported. In all cases, preexistent hepatic injuries were observed. Chlorpromazine-induced cytolytic hepatitis is uncommon and cholestatic hepatitis mild. Biological hepatic parameters investigations remain necessary during neuroleptic treatment.
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PMID:[Cytolytic hepatitis during treatment with phenothiazines: apropos of a case]. 903 96

These data are internally consistent and lead to several conclusions, as follows: Elevated levels of psychiatric symptoms were found among IDUs in methadone treatment as compared to their counterparts who were out of treatment. IVDUs who entered treatment had higher symptom levels than those who did not enter treatment. Higher symptom levels were found among injectors than noninjectors, and needle sharers had especially high psychiatric symptom levels. Higher symptom levels were found among those who seroconverted in the 6 months following notification, but not thereafter. Symptom levels did not distinguish between HIV-positive and HIV-negative individuals 24 months following notification of seropositivity. Taken together, these findings indicate that elevated psychiatric symptoms are risk factors for continued high risk behavior, as well as for seroconversion. The data add to those of Brooner and colleagues (1993), who demonstrated that ASPD serves as a risk factor for HIV infection. The fact that antisocial personality disorder and psychiatric severity are associated with risky behavior and with actual HIV infection further expands earlier findings showing that these two factors are associated with poorer treatment outcome. Other axis II disorders (e.g., borderline or narcissistic), as well as other axis I disorders with high symptom levels that were not well represented in these studies (schizophrenia, manic depressive illness), may also show similar elevated rates of risky behavior and seroconversion, although there is a scarcity of data currently available to assess the risk behavior of these patients. The evidence from treatment studies that psychiatrically focused therapies, when combined with substance abuse treatment, can improve overall outcome for patients with clinically significant levels of psychiatric symptoms may be relevant in the design of future risk reduction efforts. That is, these treatment outcome studies may serve as a starting point for exploring the feasibility and efficacy of using psychiatrically focused treatment to reduce risky behavior and HIV infection among psychiatrically symptomatic IDUs.
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PMID:Psychiatric symptoms, risky behavior, and HIV infection. 915 70

Schizophrenia is a serious and often debilitating neuropsychiatric disease of worldwide importance. Current therapy relies on the use of typical antipsychotic medications, which specifically inhibit binding of ligand at the D2 dopamine receptor, and atypical medications which display little activity for this receptor interaction. While atypical antipsychotic agents have been shown to variably inhibit other neuroreceptor-ligand interactions, the exact mechanisms for the therapeutic efficacy of these medications have not been completely defined. Clozapine, an atypical antipsychotic, and nine of its metabolites were studied in vitro for possible antiviral activity against a model of a human neurotropic virus, human immunodeficiency virus type 1 (HIV-1). In an assay for inhibition of virus-induced cytopathic effect (CPE) two metabolites demonstrated antiviral activity (ID50 = 37-85 micrograms/ml) (119-289 microM), while other atypical or novel antipsychotics as well as typical medications had no effect. Based on an ELISA, four chemically similar metabolites inhibited the production of p24, the major internal antigen of HIV (ID50 = 11.6-15.7 micrograms/ml) (38-51 microM). These data suggest that the therapeutic efficacy of some antipsychotics may be due in part to an ability to inhibit viral replication. Antiviral agents may prove to be effective adjuncts in the treatment of schizophrenia.
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PMID:Metabolites of the antipsychotic agent clozapine inhibit the replication of human immunodeficiency virus type 1. 917 28

The present study evaluated smooth pursuit eye movement (SPEM) function in 36 cocaine-dependent patients, with or without a paternal history of alcoholism, and 12 nondrug-dependent normal volunteers. None of the subjects in either group met DSM-III-R diagnostic criteria for schizophrenia, or delusional, major affective, or schizotypal personality disorders. None possessed a history of seizures, significant head injury, HIV-1 infection, or regular medication use. SPEMs were elicited by a pendulum, oscillated at 0.5 Hz, and recorded using electro-oculographic techniques. Tracking accuracy was estimated by the power of the horizontal electro-oculograph at the stimulus oscillation frequency. Analyses revealed that the SPEM tracking accuracy of cocaine-dependent patients without a paternal history of alcoholism was superior to that of the normal control group. SPEM tracking in these patients correlated positively with years of cocaine and polysubstance abuse. In contrast, patients with a paternal history of alcoholism exhibited subnormal SPEM tracking performance. These differences could not be explained by other family history, demographic, or drug use variables.
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PMID:Smooth pursuit eye movement dysfunction in abstinent cocaine abusers: effects of a paternal history of alcoholism. 926 43

This paper reviews the current clinical use of psychotropic drugs and suggests new directions for future drug development. The author reviews the contemporary pharmacotherapy of depression, anxiety disorders, schizophrenia, and bipolar disorder and summarizes current trends in the drug treatment of psychiatric aspects of HIV disease. The increasing use of combination pharmacotherapy is discussed, as well as the impact of pharmacokinetics in clinical psychopharmacology. The use of botanical products for psychiatric disorders and tobacco use in the psychiatric patient are also addressed. Current research is producing drugs that have greater specificity in their mechanism of action effecting faster clinical response with minimum adverse effects.
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PMID:New directions in clinical psychopharmacology. 933 14

Rates of suicidality with HIV-infected, seriously mentally ill individuals were investigated. Fifty asymptomatic HIV-positive psychiatric in-patients were compared to a demographically-matched HIV-negative cohort. The groups were similar, except that seropositive subjects were less likely to be diagnosed with schizophrenia. Both groups had high rates of suicidality, with higher rates associated with non-schizophrenic diagnoses. HIV-positive subjects had higher rates of suicidality, with those diagnosed with schizophrenia showing the greatest difference from their HIV-negative counterparts. HIV-positive patients required less in-patient treatment. These data expand previous reports showing an association between HIV and increased suicidality, even among individuals with already elevated suicidal rates.
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PMID:Suicidality among HIV-positive psychiatric in-patients. 933 83

A review of the literature indicates that women with schizophrenia may have limited knowledge about sexuality, high rates of coerced sex, low contraceptive usage, many unwanted pregnancies, and severe parenting difficulties. Given problems with contraceptive compliance, long-acting hormonal methods are optimal. Since schizophrenic women are especially vulnerable to exacerbations of mental illness during pregnancy, the risks to the mother of withholding pharmacotherapy must be weighed against the slight increase in risks of congenital anomalies associated with such treatment. Postpartum psychotic episodes are also common, with serious consequences for the mother-infant relationship. The quality of child care provided by mothers with schizophrenia may be compromised by a reduced ability to read children's cues and weak social support networks. Mental health services and child welfare agencies need to collaborate to weigh the risks to a child of remaining with a psychotic parent versus those of being removed from the home. Recommended for mental heath practice are the following: incorporation of sex education and assertiveness training into psychosocial rehabilitation programs, HIV education and screening, systems for the early detection of pregnancy in chronically mentally ill women, steps to reduce the likelihood of relapse during the vulnerable postpartum period, improved methods for assessing parenting capability, parenting education, and the incorporation of family planning programs into mental health care delivery systems.
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PMID:Sexuality, reproduction, and family planning in women with schizophrenia. 936 99

Given both the rapid rise in the prevalence of HIV infection among adolescent and adult males (0.6%) and females (0.1%) in the United States from 1984 to 1992 and the associations among HIV, injection drug abuse, homosexuality, and sexual promiscuity, it is important to determine whether individuals diagnosed with schizophrenia are at a higher than average risk of HIV infection. Stereotypes from the recent past about sexuality in both male and female patients were examined as an integral part of a literature review. Data from a dozen or so studies conducted since 1990 confirm and strengthen the impressions that persons with schizophrenia should be considered a group with a much higher than average risk for developing HIV/AIDS and that they have special needs for protection as a public health measure. Mental health service providers need to be aware of these findings.
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PMID:HIV/AIDS risks as a consequence of schizophrenia. 936 3

An emerging body of research on the physical and sexual abuse of seriously mentally ill (SMI) women documents a high incidence and prevalence of victimization within this population. While causal links are not well understood, there is convergent evidence that victimization of SMI women is associated with increased symptom levels, HIV-related risk behaviors, and such comorbid conditions as homelessness and substance abuse. These abuse correlates may influence chronicity, service utilization patterns, and treatment alliance. This article reviews the research literature on the prevalence, symptomatic and behavioral correlates, and treatment of abuse among SMI women, particularly women with schizophrenia. Within each topic, we discuss relevant research findings, limitations of available studies, and key questions that remain unanswered. We also discuss mechanisms that may underlie the relationship between trauma and schizophrenia-spectrum disorders. We conclude by outlining directions for future research in this area.
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PMID:Physical and sexual assault history in women with serious mental illness: prevalence, correlates, treatment, and future research directions. 936 4


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