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

Studied are changes in diagnosis in a random sample of 10% of all first admissions to psychiatric hospitals and psychiatric wards of general hospitals in Israel from 1983 to 1990 with follow-up evaluation to 1991. This included 4,570 hospitalizations of 2,220 patients. Data were extracted from the National Psychiatric Case Registry of the Ministry of Health. Almost 59% of the sample had one admission, 18% had two, 9% had three, and 14% had four or more. From the first admission to the last discharge (a mean of 2.15 years), 59.2% of the patients' diagnoses did not change. In 89.46% of the cases in which the diagnosis changed, the changes took place during the first admission. Diagnostic change differed between diagnostic groups. In descending order of stability in diagnosis from the first admission to the last discharge were neurotic and personality disorder (73.6%), mental retardation (73.5%), schizophrenia (73.0%), organic conditions (70.6%), affective disorders (66.2%), substance abuse (65.6%), childhood disorders (60%), paranoid disorder (43.6%), other nonorganic psychosis (30.3%), and V-codes (25.0%). The average level of diagnostic agreement between the first admission and the last discharge was a kappa of .52. The average length of stay for patients whose diagnosis became more severe was considerably longer than for patients whose diagnosis became less severe or did not change in level of severity. Older age was related to less change in diagnosis. For patients aged less than 18 years, diagnosis changed in 46.7% of the cases, for patients aged 19 to 44, 31.2%, and for patients older than 45, 27.8%.
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PMID:Changes in diagnosis in a 9-year national longitudinal sample. 799 28

This article overviews the development of the borderline personality disorder construct. In the past 25 years, the borderline personality diagnosis has grown remarkably in clinical usage even as its construct has undergone dramatic shifts in the process. It originated as a type of intrapsychic personality organization that reflected psychoanalytic observations and the hope for long-term curative therapies. It was transformed by descriptive observations into a syndrome whose boundaries with first schizophrenia and then affective disorders became the subject of intense study. More recently, it is recognized as a specific type of personality disorder that communicates substantial information about pathogenesis and that helps guide clinical planning and prognostication. The context dependency of the borderline patient's presentation explains why the diagnosis can often elude recognition.
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PMID:Building structure for the borderline construct. 801 Jan 46

Female chronic mental patients are likely to have induced abortions, give up children for others to raise, and to engage in unprotected sexual intercourse. There are few studies, however, on the family planning attitudes and needs of male psychiatric patients. 35 male chronic mental patients aged 23-49 years of mean age 36 at the psychiatric outpatient clinic of a publicly-funded general hospital in the Harris County district of Houston, Texas, responded to interview questions about their social situation, medical and sexual histories, previous children, attitudes toward family planning and contraceptive practices, and sources of information about family planning. Findings on their knowledge of AIDS and health locus of control are reported under separate cover. The hospital serves predominantly indigent and uninsured patients. Men 50 years or older were excluded from consideration in the study because it was thought they would be less likely to father future children. The sample was comprised of 30 black males, 4 white males, and one Hispanic male of mean education 11 years. Five men were currently married and nine more had been married at some point in the past. Patients had been attending the clinic for an average of 7 years, in a range of 0.5-27 years, with 17% reporting histories of psychiatric hospitalization within the past year. Diagnoses taken from patients' charts included schizophrenia among 26, schizoaffective disorder among two, organic mental disorder among four, and major affective disorder among two; one patient had an Axis II diagnosis of a severe personality disorder. All patients were being treated with psychotropic medications and all but three were being treated with neuroleptics. The interviews took place over the course of 9 months. 18 patients reported having fathered a total of 41 children. 60% of the children less than 16 years old, however, were not being raised by their biological father. 57% of the men reported having had sexual intercourse within the last year, with 26% reporting three or more sex partners during the period. 41% of the men who had sexual intercourse during the preceding year and had not wanted children reported that they or their sex partner had not used contraception during the most recent episode of intercourse. Many patients in the sample were therefore at significant risk of fathering unwanted children and contracting and/or transmitting sexually transmitted diseases. The authors discuss strategies for preventing unwanted pregnancies within this population.
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PMID:Family planning needs of male chronic mental patients in the general hospital psychiatry clinic. 803 81

Nonemergent forcible medication is a controversial procedure that has received somewhat less study in acute hospitals and in states where a simple in-house "treatment-driven" clinical review procedure is followed. We reviewed the charts of all patients so medicated by the New Jersey "Rennie" process on a large general acute adult psychiatric service, finding 43 (3%) of 1420 admitted patients so treated. Compared with a population of next-admitted individuals, these "Rennie" patients more frequently had previously required extended emergent forcible medication, had significantly longer hospitalizations (70 versus 26 days), not accounted for by the duration of treatment refusal, but improved with treatment so that almost all were discharged directly back to the community. Rennie patients appeared more likely to be diagnosed with schizophrenia and were significantly more likely to have a known history of assault, threatened assault, or property damage, but significantly less likely to have a known history of suicide threat or attempt. They were also significantly less likely to have a principal or secondary diagnosis of personality disorder or substance use disorder.
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PMID:Nonemergent forcible medication in an acute hospital. 805 76

There are no firm epidemiologic data concerning psychiatric disorders associated with homicide recidivism. The authors studied all homicide recidivists who were incarcerated in Finnish prisons or high-security hospitals and had committed their last offense during the 3-year period July 1, 1988-June 30, 1991. All recidivists (13 subjects) could be considered to suffer from either severe alcoholism combined with personality disorder (N = 11, 85%) or from schizophrenia (N = 2, 15%).
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PMID:Psychiatric disorders and homicide recidivism. 810 57

In a case-record study, all first-contact patients with non-affective functional psychosis from a defined area over 20 years were diagnosed according to operational criteria of varying stringency and emphasis, and incidence rates for each set of criteria determined by sex and age at onset; data on premorbid adjustment were also analysed by sex and age at onset. The overall first-contact incidence of non-affective functional psychosis was approximately equal in men and women; however, the ratio of male to female incidence rates rose progressively when RDC (1.2), DSM-III-R (1.3), DSM-III (2.2), and Feighner (2.5) criteria for schizophrenia were applied. Schizophrenia was most common in young males and least common in older males, with females occupying an intermediate position. Schizophrenia in young males, particularly when stringently defined, was especially likely to be associated with single status, poor work and social adjustment, and premorbid personality disorder. The results suggest that schizophrenia syndrome is heterogeneous, and young males are especially prone to a severe neurodevelopmental form of illness associated with premorbid deficits.
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PMID:Sex and schizophrenia: effects of diagnostic stringency, and associations with and premorbid variables. 814 18

This article delineates the conceptual models used when medications are prescribed for patients with personality disorders and reviews the data on the efficacy of these medications. Studies before 1980 are difficult to interpret because of changes in diagnostic criteria. Nonetheless, early studies on non-DSM-III disorders such as pseudoneurotic schizophrenia, emotionally unstable character disorder, hysteroid dysphoria, and subaffective disorders indicated the potential utility of pharmacotherapy for treating personality disorders. Models to consider in evaluating the possible use of medications for treating personality disorders are: (1) treating the disorder itself; (2) treating symptom clusters within and across disorders; and (3) treating associated axis I disorders. Among the current personality disorders, borderline personality disorder has been the most extensively studied, with antipsychotic agents being the most well-documented treatment. Monoamine oxidase inhibitors, fluoxetine, and carbamazepine show promise. Schizotypal disorders may respond to low-dose antipsychotic drugs. Although heuristically valuable, the symptom cluster approach to treatment has not yet been validated. Axis I disorders, especially depression, are frequently associated with all personality disorders. Dependent personality disorder is linked to panic disorder with agoraphobia, whereas avoidant personality disorder is associated with social phobia and panic. In general, pharmacotherapy for axis I disorders is less effective in the presence of a comorbid personality disorder. Despite the modest benefits seen in many studies, pharmacotherapy can add significantly to the overall treatment of those with personality disorders. Future research must carefully assess the effect of comorbid axis I disorders on responses. The symptom cluster/psychobiologic dimension approach should be investigated in clinical studies.
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PMID:Pharmacotherapy of personality disorders: conceptual framework and clinical strategies. 822 92

The frequency of diagnostic shift was investigated in 267 patients diagnosed with various psychiatric disorders according to the 9th revision of the International Classification of Diseases (ICD-9). Forty-six patients fulfilled the diagnostic criteria for schizophrenic psychosis, 71 for affective psychosis, 66 for neurotic disorder, 24 for personality disorder, and 40 for psychogenic reaction. The remaining 20 patients were diagnosed with heterogenous disorders. The mean follow-up time was 12.5 years. Every episode of inpatient treatment was diagnosed cross-sectionally. Patients with an initial episode of schizophrenic psychosis showed by far the greatest stability (93%). A high stability was found in patients diagnosed with neurotic disorders (79%). Forty-two patients with an index diagnosis of affective psychosis suffered more than one type of episode during the course of disease. The lowest stability was noted in patients with a psychogenic reaction (10%). Eleven percent of patients with a final diagnosis of schizophrenia had an index diagnosis of psychogenic reaction. Our findings demonstrate that the course of disease should be considered in making the final diagnosis.
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PMID:Stability of diagnoses in various psychiatric disorders: a study of long-term course. 823 32

The aim of the study was to further examine the view that matricide is 'the schizophrenic crime' (Gilles, 1965). This report represents a comprehensive, retrospective and national study of all individuals in Scotland who, between 1957 and 1987 inclusive, were charged with the murder or the culpable homicide of their biological mother. Files of High Court indictments were examined for the relevant years to identify offenders prior to disposal, and individuals were followed up with respect to diagnosis and disposal. Twenty-six (twenty-three men and three women) were convicted of the murder or culpable homicide of their biological mother. Only 50 per cent (thirteen subjects) were known to the State Hospital, Carstairs. Six (24 per cent) subjects suffered from schizophrenia, seven (24 per cent) were given no diagnosis, five (20 per cent) suffered from personality disorder, four (16 per cent) from the alcohol dependence syndrome, three (12 per cent) from depressive illness, and one (4 per cent) from hypomania. Thus, whilst schizophrenia is over-represented in this subgroup of offenders, matricide should not be viewed as the schizophrenic crime. Given the prevalence of mental disorder in this group, pre-trial assessment by a Forensic Psychiatrist should be mandatory.
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PMID:Matricide: the schizophrenic crime? 826 66

Personality traits and DSM-III-R personality disorders of first-degree relatives of patients with psychoses were studied using the NEO Five-Factor Inventory (NEO-FFI) and the Personality Diagnostic Questionnaire-Revised (PDQ-R), two self-report instruments. The relatives were compared on their scores for the five personality factors in the NEO-FFI, the prevalence of individual DSM-III-R personality disorders, and their scores for each personality disorder scale in the PDQ-R. The results suggest that there is no difference in personality traits and prevalence of personality disorders, including schizophrenia spectrum disorders, when relatives of patients with schizophrenia, bipolar disorder, and major depression are compared to each other. Relatives of patients with "atypical psychosis," psychotic disorders that do not meet DSM-III-R criteria for any specific nonorganic psychotic disorder, may be a distinctive group.
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PMID:A family study of self-reported personality traits and DSM-III-R personality disorders. 827 46


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