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

Primary care physicians underdiagnose depression, anxiety, and other psychiatric disorders. Decision analysis suggests that subjective estimates of the probability of a condition and the utility (severity and treatability) of identifying that condition play a role in diagnosis. We asked 108 internists (IM) and family practitioners (FP) to rank 25 conditions on ten-point scales for probability, severity, and treatability. FPs ranked depression significantly higher than IMs did on all three scales, anxiety reactions higher in probability and severity, and both alcoholism and drug dependency higher on the severity scale. Ranks for schizophrenia and personality disorder did not differ between specialties. Thirty-eight physicians completed the scales a second time after six to eight weeks. Test-retest agreement ranged from 47% to 100% for different conditions on different scales. Some common psychiatric disorders tended to have low test-retest agreement in probability and severity. With further refinement, this instrument may contribute to the investigation of psychiatric decision making in primary care.
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PMID:Psychiatric disorders in primary care: physician judgements of prevalence and management. 367 74

Psychiatric disorders are common in medical inpatient and outpatient populations. As a result, internists commonly are the first to see psychiatric emergencies. As with all medical problems, a good history, including a collateral history from relatives and friends, physical and mental status examination, and appropriate laboratory tests help establish a preliminary diagnosis and treatment plan. Patients with suicidal ideation usually have multiple stressors in the environment and/or a psychiatric disorder (i.e., a major affective disorder, dysthymic disorder, anxiety or panic disorder, psychotic disorder, alcohol or drug abuse, a personality disorder, and/or an adjustment disorder). Of all patients who commit suicide, 70% have a major depressive disorder, schizophrenia, psychotic organic mental disorder, alcoholism, drug abuse, and borderline personality disorder. Patients who are at great risk have minimal supports, a history of previous suicide attempts, a plan with high lethality, hopelessness, psychosis, paranoia, and/or command self-destructive hallucinations. Treatment is directed toward placing the patient in a protected environment and providing psychotropic medication and/or psychotherapy for the underlying psychiatric problem. Other psychiatric emergencies include psychotic and violent patients. Psychotic disorders fall into two categories etiologically: those that have an identifiable organic factor causing the psychosis and those that have an underlying psychiatric disorder. Initially, it is essential to rule out organic pathology that is life-threatening or could cause irreversible brain damage. After such organic causes are ruled out, neuroleptic medication is indicated. If the patient is not agitated or combative, he or she may be placed on oral divided doses of neuroleptics in the antipsychotic range. Patients who are agitated or psychotic need rapid tranquilization with an intramuscular neuroleptic every half hour to 1 hour until the agitation and combativeness are under control. Haloperidol (Haldol) is the safest neuroleptic. Chlorpromazine (Thorazine), perphenazine (Trilafon), and, in the elderly, thiothixene (Navane) can also be useful if haloperidol (Haldol) is not effective and more sedation is needed; these drugs, however, produce more side effects. Violent patients need to be physically restrained and then given antipsychotic medication or, in the case of drug abuse or alcohol withdrawal, the appropriate drug management.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Psychiatric emergencies. 373 71

What the genetic and family dynamic theory have in common, is that the cause of schizophrenia could be found in the family. Usually the genetic factors and the rearing factors are confounded in the same family. In a study of adoptive children given away for adoption early enough, discrimination between these two sets of factors is possible. A nation-wide sample of offspring of schizophrenic mothers, given away for adoption, has been compared blindly with matched controls, i.e., adopted-away offspring of non-schizophrenic biologic parents. The families have been investigated thoroughly with joint and individual interviews and psychological tests. In the 91 pairs where both the index and control families have been investigated and rated so far, the total number of severe diagnoses (psychosis, borderline, character disorder) is 28.6% (26/91) in the index group and 16.5% (15/91) in the matched control group. Of the 7 psychotic cases, 6 are offspring of schizophrenics and only one a control offspring. The relation of psychopathology of adoptive families to the mental health ratings of the offspring supports the hypothesis that a possible genetic vulnerability has interacted with the adoptive rearing environment.
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PMID:Interaction of genetic and psychosocial factors in schizophrenia. 386 58

Within a prospective, longitudinal study of offspring of schizophrenic mothers (so-called high-risk children), diagnostic outcome (schizophrenia, "schizotypal" personality disorder, other diagnoses, and no mental illness) was predicted by the mother's age at first hospitalization and by institutionalization during the first five years of life. Institutionalization was unrelated to adult psychopathology in a low-risk control group. These results are interpreted as supporting a diathesis-stress model of schizophrenic origin.
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PMID:Institutional rearing and diagnostic outcome in children of schizophrenic mothers. A prospective high-risk study. 401 20

Patients, Danish citizens only, admitted for the first time in 1972 to a Danish psychiatric institution were selected from the national psychiatric register. To be included, the probands had to have been diagnosed as schizophrenics at least once in the period from their first admission to 1 September 1983. The study comprised 370 males and 217 females with a total of 5,298 admissions. The probands' diagnostic pattern during the above period was investigated. More males (51.9%) than females (39.2%) (P less than 0.01) were diagnosed as schizophrenics during their first admission. The average period from a patient's first contact with an in-patient institution until schizophrenia was diagnosed for the first time was 2.2 years for females and 1.7 years for males (P less than 0.05). Personality disorders, reactive psychoses, and not classifiable psychoses were the most frequent diagnoses prior to the first schizophrenia diagnosis. The diagnostic stability of schizophrenia as main diagnosis, after its first application, was 73.6% for males among a total of 2,539 admissions and 71.2% for females among 1,141 admissions. There was greater correlation between the latest and former diagnoses than between the first and subsequent diagnoses. This is valid both when distinguishing between schizophrenia and non-schizophrenia and when focusing on schizophrenia subtypes. The results are discussed, particularly the problem concerning the selection of representative cohorts for schizophrenia research projects.
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PMID:The schizophrenia diagnosis in Denmark. A register-based investigation. 407 25

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

The adverse psychic effects of antiepileptics embrace all categories of psychiatric symptomatology, including disturbances of consciousness (delirium, confusion), psychotic state (schizophrenia-like psychosis, affective disorder), neurotic state, behavior and character disorder. Antiepileptic intoxication can take the form of a psychotic episode. The lowered level of consciousness due to a high blood level of antiepileptics is expressed as inhibitory symptoms such as a lack of initiative, psychomotor slowing, lowering mood, stuporous state and the like. Another group of manifestation of a high blood level of antiepileptics, by contrast, consists of salient positive symptoms such as irritability, hyperkinetic syndrome, hysterical symptoms, aggravation of character change, delirium and confusion. An elevated blood level of antiepileptics by itself is not sufficient to give rise to a psychiatric symptom, which is rather prone to occur in the presence of some trouble or problems (defect in intelligence or personality, fragility of brain function, organic brain damage, psychogenic factors) in the patient.
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PMID:Antiepileptic drugs and psychiatric disorders: mechanism involved in manifestation of psychic symptoms of high blood level of antiepileptics. 642 78

Numerous studies have examined the effects of burn size and depth, age, concomitant injury, and illness upon burn patient mortality and duration of stay in hospital, and other studies have stressed the importance of psychosocial factors in the causation of burns. However, scant attention has been given to the effects of psychosocial factors on burn mortality and length of stay in hospital. Data on psychiatric diagnoses, substance abuse, and factors in severity of injury were abstracted from the charts of patients admitted to the San Diego Regional Burn Treatment Center. Mortality data were analysed using logistic regression. After adjusting for severity of the burn injury, statistically significant increases in mortality are associated with the diagnosis of character or personality disorder, schizophrenia, alcohol intoxication at the time of injury, and a variable indication a psychiatric diagnosis or severe undiagnosed problems. Comments on individual charts suggest that overtly self-destructive behaviour during treatment caused the increased mortality. Data on duration of stay in hospital among survivors were analysed using multiple linear regression. After adjusting for severity of injury, significantly longer stays are associated with suicidal intention, diagnosis of character or personality disorder, schizophrenia, senility and a variable indicating a psychiatric diagnosis or severe undiagnosed problems. Overtly self-destructive behaviour, treatment of psychiatric problems, and the inability of some patients to care for themselves may each contribute to the longer stay in hospital.
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PMID:Behavioural factors in burn mortality and length of stay in hospital. 647 86

Data collected from 6043 psychiatric in-patient records were analysed to assess the impact of a strike at a mental hospital on in-patient services in general hospital psychiatric units in St John's, Newfoundland, Canada. As a whole, during the strike general hospital units showed an increase in the number of involuntary admissions, the number of prior mental hospital admissions of patients, and indications of violent or suicidal behaviour; and a decrease in the occupational status of patients admitted and the prescription of minor tranquillizers. There was also evidence of considerable variation between general hospitals in the extent to which their admission pattern changed during the strike and the permanence of some of the strike effects. The data indicate that all patients showing violent or suicidal behaviour who would normally have been admitted to the mental hospital were treated in the general hospital units during the strike. On the other hand, a large number of patients diagnosed with schizophrenia, personality disorder or mental retardation, who normally would have been admitted to the mental hospital, apparently went without hospitalization during the strike. A substantial proportion of this latter group would usually have been admitted involuntarily.
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PMID:The effect of a mental hospital strike on general hospital psychiatric services. 654 21

The plight of the homeless in New York City and other urban areas has become the focus of increasing attention. In an effort to clarify and understand the problems of the homeless, the authors studied the demographic characteristics, psychiatric diagnoses, histories, and dispositions of 100 homeless patients treated at Bellevue Psychiatric Hospital's emergency service. The most striking finding was that 96.6 percent of the sample had had a previous psychiatric hospitalization. Seventy-two percent of these homeless patients were diagnosed as suffering from schizophrenia; the second most common diagnosis was personality disorder, which accounted for 13.3 percent of the sample. The authors discuss other demographic findings of their study and explore the roots of the problem of homelessness, review the psychiatric literature on the subject, and delineate some of the unique treatment needs of this population.
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PMID:Down and out in the city: the homeless mentally ill. 661 61


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