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

Suicide is distinct from suicide attempt, in terms of male predominance (2:1), presence of serious psychiatric morbidity, and in the choice of rapidly effective means which will not be interrupted. However 1 per cent per year, and 10 per cent overall, of those attempting will progress to completed suicide. Communication of intent is the most significant and frequent danger signal of suicide, and the attempt may be such a communication. Useful prognostic features of the attempt are the medical seriousness of the act (overdose accounts for 90 per cent of attempts, and only 25 per cent of suicides), and the psychiatric seriousness of the patient's mental state. Suicide in the absence of psychiatric illness is rare. Depression is the most common associated illness, and whereas the distinction between major and minor is probably not prognostically significant, the presence of current depression is. The lifetime risk of suicide in depressive illness is 15 per cent. The second largest contributor is alcoholism, in particular alcoholics who have experienced loss of a close personal relationship. Other significant psychiatric diagnoses include schizophrenia, organic brain syndrome and personality disorder. Suicide rates differ internationally, but the identification of significant socio-cultural risk factors is hampered by the official differences in ascertainment which exist. Although suicide rates increase with each decade of life, there has been a steady recent rise in suicide rates in many countries, which has been occurring disproportionately among the group aged 15-34.
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PMID:Problems in studying suicide. 637

Primary alcoholics may display symptoms of affective or psychotic disorders, while mentally ill patients may develop persistent alcohol-related problems. The author discusses the importance of distinguishing alcoholic psychosis from schizophrenia and alcohol-induced confusion from organic brain syndrome. He then outlines the diagnosis and treatment of other alcohol-induced conditions such as alcoholic dementia, antisocial behavior, and drug abuse. After stressing that primary alcoholism can mimic almost any psychiatric disorder, and secondary alcohol abuse can exacerbate any psychiatric symptoms, the author asserts that physicians should routinely include substance abuse as part of the differential diagnosis of psychiatric patients.
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PMID:Alcoholism and other psychiatric disorders. 664 46

In a sample of 1,032 psychiatric inpatients studied for 1 year, chronic patients (more than 6 months' inpatient stay) represented 17.4%, almost half of whom were discharged during a 2-year follow-up; an additional 19.4% died. The incidence of "new" long-stay patients was 8.6/100,000 population, which, if constant over time, would result in a net increase of long-stay patients. Most chronic long-stay patients had a diagnosis of schizophrenia or organic brain syndrome. The two diagnostic groups had strikingly different patterns of deinstitutionalization. Alcoholic patients and those with "other" diagnoses demonstrated chronic dependence on the hospital, characterized by short inpatient stays and high readmission rates.
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PMID:The dynamics of hospitalization in a defined population during deinstitutionalization. 673 21

To characterize violent behavior in hospitalized medical and surgical patients, we reviewed documented violent incidents at the San Francisco General Hospital during a two-year period. Twenty-nine incidents of verbal and physical violence occurred. One patient was gravely ill and three were delirious. All the incidents were associated with increased levels of tension and loss of impulse control. In most cases, contention with the staff regarding pain medication or ward regulations was a precipitating event. Of the 28 patients with mental disorders, 19 were substance abusers, six had organic brain syndrome, tw had neurosis, and one had schizophrenia. The findings suggest that physicians should be more sensitive to patient characteristics and to the situational characteristics of the violent incident. Explicit measures that anticipate and reduce violent behavior are reviewed.
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PMID:Violent Behavior among hospitalized medical and surgical patients. 705 53

A study was made of the Emergency Department records of 49 elderly (65 years old or older) and 49 middle-aged (40-64 years old) patients seen in an urban hospital's psychiatric emergency service. The data were compared for demographic and admission information, psychiatric treatment history, presenting complaints, symptoms, diagnoses, and final disposition status. For the elderly patients, the referral was more likely to be their first contact with psychiatric treatment, and they were more likely to be referred (accompanied) by family or friends than to be self-referred. Among the middle-aged patients, "substance abuse" (e.g., drugs, alcohol) disorders and schizophrenic disorders were more common. The elderly, however, were much more likely to be regarded as having an organic brain syndrome of unspecified cause (34.7 per cent vs 0). Access to treatment was fairly consistent for both groups as measured by the hospital's priority code, total time spent in the emergency department, and final disposition. These results raise important issues concerning the unique psychosocial characteristics and psychiatric treatment needs of elderly patients. This applies particularly to the emergency-department medical clearance of elderly patients with symptoms of organic brain syndrome.
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PMID:Geriatric psychiatry in the emergency department: characteristics of geriatric and non-geriatric admissions. 708 21

In two studies, 145 psychiatric inpatients were each asked to say 100 numbers in random order, using the numbers 1 through 10. Compared with normative data, patients with personality disorders and neuroses were not impaired on the random number generation (RNG) task and patients with chronic alcoholism and primary affective disorder, depression, were significantly imparied, but not as much as those with schizophrenia and organic brain syndrome. The relationship between RNG performance and psychiatric diagnosis may reflect severity of disturbed cognitive functioning. The Randomization Index was sensitive to changes in symptoms during hospitalization. The RNG task provides a brief objective measure of those components of attention, cognitive capacity, and short-term memory that are affected by severity of psychopathology.
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PMID:Random number generation, psychopathology and therapeutic change. 709 1

75 recently admitted female psychiatric inpatients were given the rod-and-frame task and the Minnesota Multiphasic Personality Inventory (MMPI). All patients with an admission diagnosis of schizophrenia, organic brain syndrome, or a reported history of alcoholism or previous electroconvulsive therapy were excluded from the study. Personality disturbance, as measured by the MMPI, for the remaining 75 patients, was significantly less severe for extremely high-error (field dependent) rod-and-frame performers than for other patients in the sample. Hospital records and performance on self-rating scales showed, however, that patients with a high rate of error on rod-and-frame performance were subjectively as uncomfortable as the others tested. Results are discussed in terms of the possible contribution of perceptual impairment to the psychological complaints made by these individuals.
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PMID:Rod-and-frame and MMPI scores for a group of female psychiatric inpatients. 709 3

Geriatric health care practice strives to respond to the medical, psychologic and social needs of the elderly person through coordinating the services of the physician and the psychiatric social worker. In a geriatric clinic at the George Washington University Medical Center, the medical regimen for elderly ambulatory patients is supported and augmented by psychotherapy, counseling, behavioral therapy, and instruction of the family about the patient's need for environmental or residential changes. A review of the records of 40 elderly patients initially enrolled in the geriatric clinic program showed that 20 were in need of mental health support. Among these, 8 had a depressive disorder, 1 had paraphrenia, 2 had longstanding schizophrenia, and the rest showed mental decline secondary to organic brain syndrome. The geriatrician and the psychiatric social worker were able to provide sufficient mental health support for these elderly mental patients to permit them to remain in the community for worthwhile periods. Ambulatory geriatric patients, especially those with mental health impairment, can benefit greatly from services offered in a comprehensive fashion by a geriatrician and a psychiatric social worker.
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PMID:Management of the mental health of ambulatory elderly patients. 739 99

Multiple personality is a syndrome characterized by 2 or more alternating personality states and amnesia. Multiple personality must be differentiated from fugue, possession syndromes, mediumships, hysterical personality, schizophrenia, hypnotic states, organic brain syndrome and simulation. A review of the literature, discussion of diagnosis, and 4 illustrative cases are presented.
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PMID:Multiple personality: diagnostic considerations. 743 76

Several drugs are apparently effective in treating pathologic anger and aggression. Because many of the studies on aggressive populations allowed the use of concomitant medications, it is unclear whether the efficacy of each drug in a particular population is dependent on the presence of other medications, such as antipsychotic agents. Finally, one needs to be circumspect in inferring efficacy of a particular drug in aggressive patients with neuropsychiatric conditions other than the ones in which some efficacy has been established. Lithium appears to be an effective treatment of aggression among nonepileptic prison inmates, mentally retarded and handicapped patients, and among conduct-disordered children with explosive behavior. Certainly, lithium would be the treatment of choice in bipolar patients with excessive irritability and anger outbursts, and it has been shown to be effective in this population. Anticonvulsant medications are the treatment of choice for patients with outbursts of rage and abnormal EEG findings. The efficacy of these drugs in patients without a seizure disorder, however, remains to be established, with the exception perhaps of valproate and carbamazepine. In fact, dyphenylhydantoin did not appear to be effective in treating aggressive behavior in children with temper tantrums and was found to be effective in only a prison population. There is some evidence for the efficacy of carbamazepine and valproate in treating pathologic aggression in patients with dementia, organic brain syndrome, psychosis, and personality disorders. As Yudofsky et al point out in their review of the literature, although traditional antipsychotic drugs have been used widely to treat aggression, there is little evidence for their effectiveness in treating aggression beyond their sedative effect in agitated patients or their antiaggressive effect among patients whose aggression is related to active psychosis. Antipsychotic agents appear to be effective in treating psychotic aggressive patients, conduct-disordered children, and mentally retarded patients, with only modest effects in the management of pathologic aggression in patients with dementia. Furthermore, at least in one study, these drugs were found to be associated with increased aggressiveness in mentally retarded subjects. On the other hand, atypical antipsychotic agents (i.e., clozapine, risperidone, and olanzapine) may be more effective than traditional antipsychotic drugs in aggressive and violent populations, as they have shown efficacy in patients with dementia, brain injury, mental retardation, and personality disorders. Similarly, benzodiazepines can reduce agitation and irritability in elderly and demented populations, but they also can induce behavioral disinhibition. Therefore, one should be careful in using this class of drugs in patients with pathologic aggression. Beta-blockers appear to be effective in many different neuropsychiatric conditions. These drugs seem effective in reducing violent and assaultive behavior in patients with dementia, brain injury, schizophrenia, mental retardation, and organic brain syndrome. As pointed out by Campbell et al in their review of the literature, however, systematic research is lacking, and little is known about the efficacy and safety of beta-blockers in children and adolescents with pathologic aggression. Although widely used in the management of pathologic aggression, the use of this class of drugs has been limited partially by marked hypotension and bradycardia, which are side effects common at the higher doses. The usefulness of the antihypertensive drug clonidine in the treatment of pathologic aggression has not been assessed adequately, and only marginal benefits were observed with this drug in irritable autistic and conduct disorder children. Psychostimulants seem to be effective in reducing aggressiveness in brain-injured patients as well as in violent adolescents with oppositional or conduct disorders, particu
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PMID:Psychopharmacologic treatment of pathologic aggression. 919 23


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