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

In a three-year prospective study of service-based incidence of functional psychoses in Africa, 94 cases of brief reactive psychosis were compared with 56 cases of schizophreniform syndromes, 29 cases of DSM-III schizophrenia and 14 of manic-depressive psychosis. This was supplemented by retrospective study of the same syndromes not in their first episode. Brief reactive psychosis was found to be a composite syndrome. The 50% with preceding depression were a distinct group, in terms of course and demographic features. Of those with intense prodromal anxiety, most were a single episode precipitated by a major life event, a few showed a recurrent long-term pattern. Schizophrenia was heralded, or presented unequivocally months or years later, in 10-20%. The schizophreniform group comprised a range of atypical psychoses intermediate between the transient and major psychoses. The pattern of precipitants and the over-representation of education and paid employment in the acute syndromes, compared with the major psychoses, in a society which was largely first-generation educated, suggested a link with rapid social change.
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PMID:Brief reactive psychosis and the major functional psychoses: descriptive case studies in Africa. 138 28

The study sample is drawn from patients seeking evaluation in a psychiatric intake facility. It concentrates on those who are assigned a diagnosis of psychosis as stipulated in DSM III. The aim is to elucidate the distinguishing characteristics of patients diagnosed as Schizophrenia Disorder. The descriptive validity of this disorder is pursued by systematically comparing clinical and demographic characteristics of patients with this disorder to those diagnosed as Paranoid Disorder, Atypical Psychosis, Brief Reactive Psychosis, Schizoaffective Disorder and Schizophreniform Disorder. These comparisons uncover special characteristics pertaining to the demography and impact of schizophrenia. The results obtained are explained using generalizations drawn from the epidemiology, natural history and clinical manifestations of schizophrenia and other psychoses.
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PMID:On the descriptive validity of DSM III schizophrenia. 150 95

Scandinavian psychiatrists have been pre-eminent in elucidating the concept of reactive psychoses. This diagnosis has never found much acceptance except in Scandinavia, and the new Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition category of brief reactive psychosis is quite different from reactive psychosis as described by most Scandinavian clinicians and researchers. The concept of psychogenic psychoses is, however, not new. Indeed, many psychiatrists of the early 20th century stressed the psychogenic factors in psychotic mental disturbances. Reactive psychoses have generally been considered illnesses distinct not only from schizophrenia but also from manic-depressive psychosis with a distinctive genetic component. Of 283 hospitalized patients at Johns Hopkins for whom long-term follow-ups were available and of whom all were first admissions, Astrup retrospectively diagnosed 91 as reactive psychoses. A contrasting group of 78 "systematic schizophrenics" by Leonhardt's criteria were identified. Stephens found that these two groups differed significantly in that the reactive patients had a) a more acute onset, b) more precipitating stress, c) more affective symptoms, d) more confusion, e) less affective blunting, f) a better premorbid adjustment, g) less premorbid schizoid traits, h) fewer schizophrenic relatives, and i) a much more favorable long term outcome.
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PMID:Reactive psychoses. 711 65

Accurate diagnosis and a clear management approach are the most important considerations in caring for behaviorally disordered emergency department patients. Treating behavioral emergencies often precedes an accurate diagnosis. A useful approach is differentiating emergencies that need nonpharmacological intervention, minimal pharmacological intervention, or maximal pharmacological intervention. Conditions that require nonpharmacological interventions include suicidal state, homicidal state, self-neglect state, abuse state, and conditions primarily requiring an organic workup. Behavioral emergencies usually requiring minimal pharmacological intervention include adjustment disorder, acute grief, rape and assault, and borderline personality disorder. Behavioral emergencies requiring maximal pharmacological intervention include assault, agitated psychosis, exacerbation of bipolar disorder, exacerbation of schizophrenia, brief reactive psychosis, delirium, dementia, substance withdrawal, and substance intoxication accompanied by violent behavior.
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PMID:Management of behavioral emergencies. 775 34

Among 30 women suffering from a postpartum psychosis without affective syndrome, and for whom this episode of illness was the first leading to psychiatric hospitalisation, 19 fulfilled in the long-term course the DSM-III-R criteria for schizophreniform psychosis (SCHF) or brief reactive psychosis (BRP), and 11 fulfilled the criteria for schizophrenia (SCH). The two groups were compared in order to investigate their nosological relation. Patients with SCHF or BRP more often had the symptomatology of cycloid psychoses and signs of confusion, the onset of illness was more frequently abrupt and the age at the index delivery tended to be lower (p < 0.07) than in patients with SCH. No case of SCHF or BRP was observed at the index episode that later developed into SCH. These findings, together with the different liability to puerperal decompensations, suggest that SCHF and BRP beginning in the postpartum period are nosologically distinct from SCH.
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PMID:Follow-up and family study of postpartum psychoses. Part IV: Schizophreniform psychoses and brief reactive psychoses: lack of nosological relation to schizophrenia. 780 28

A group of 119 patients suffering from a severe psychiatric postpartum disorder who were admitted for the first time in their life to a psychiatric hospital has been investigated. The onset of illness occurred within 3 months following delivery. The patients represented 92% of the total sample fulfilling the inclusion criteria. A follow-up investigation was performed after a mean of 21 years (range 2-35 years). Of the patients 66% had nonpuerperal psychotic episodes in later life. The diagnosis, taking into account the long-term course, was affective psychosis in 57%, schizoaffective psychosis in 18%, schizophreniform psychosis in 12%, brief reactive psychosis in 4% and schizophrenia in 9%. A bipolar psychosis was found in 31%. The relation of unipolar to bipolar psychoses corresponded to that in a control group of affectively ill women without puerperal onset. The frequency of a manic syndrome in bipolar psychoses at the index episode was the same as in nonpuerperal episodes, which does not suggest a mania-provoking pathoplastic effect of the puerperium. The comparison with female nonpuerperal controls matched for age and diagnosis revealed evidence of a better long-term course in the index patients. The risk of a puerperal relapse for further pregnancies was 35%. The global morbidity risk for functional psychoses in first-degree relatives was 11%, with affective psychoses representing the majority of secondary cases (6.8%). The index patients showed a nonsignificant lower morbidity risk in relatives than a control group of psychotically ill women without puerperal onset. The major aetiological factor found for postpartum psychoses is the relation of these disorders to functional psychoses. There is strong evidence that the postpartum period tends to provoke affective psychoses and other nonschizophrenic psychoses, but not, or only to a lesser degree, narrowly defined schizophrenias. The liability to puerperal decompensations suggests some common pathophysiological mechanism, the nature of which remains unknown.
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PMID:Follow-up and family study of postpartum psychoses. Part I: Overview. 794 53

The aim of this study was to investigate the concepts of reactive and hysterical psychoses and how they are classified in standardized diagnostic systems. To this end we identified all of the patients who had been admitted to a psychiatric in-patient unit and diagnosed as suffering from psychogenic psychosis, reactive psychosis, hysterical psychosis or hysteria, using ICD-9 criteria. The case notes of these patients were then re-examined and diagnoses reached using DSM-III-R, DSM-IV and ICD-10 criteria and the Present State Examination (PSE)/CATEGO computer program. The objective of this study was to evaluate the agreement between the diagnoses of reactive and hysterical psychosis obtained using ICD-9 criteria with those obtained using the DSM-III-R, DSM-IV, ICD-10 and PSE diagnostic systems. A total of 67 case notes were identified in which the above diagnoses had been made: 27 cases with ICD-9 'hysteria' and 26 cases with 'other reactive and not otherwise specified psychoses'. Using the DSM-III-R criteria, 27 cases were diagnosed as psychotic disorder NOS, 12 as brief reactive psychosis and 11 as bipolar disorder. Using the DSM-IV criteria, 21 cases were diagnosed as psychotic disorder NOS, 11 as mood disorder, 7 as brief disorder without stressor, and 12 as brief disorder with stressor. Using the ICD-10 criteria, 18 cases were diagnosed as unspecified non-organic psychosis, 12 as mood disorder, 10 as acute and transient psychotic disorder without stressor and 13 as acute and transient psychotic disorder with stressor. Using the PSE/CATEGO program, the most common diagnoses were class 'S' schizophrenia (17), class 'P?' uncertain psychosis (16) and class 'M+' mixed and manic affective disorder (11). Using the kappa coefficient a very low level of agreement was found between ICD-9 'hysteria' and 'other reactive and non-specified psychoses' and the corresponding categories of DSM-III-R and the PSE/CATEGO program. We concluded that, although DSM-III-R provides operational criteria for brief reactive psychosis, and DSM-IV and ICD-10 provide such criteria for brief or acute psychotic disorder, these bear little relationship to the original concept of the disorder. The PSE/CATEGO program provides a very systematic approach to symptomatology, but the diagnostic classes have little clinical usefulness.
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PMID:Psychogenic (reactive) and hysterical psychoses: a cross-system reliability study. 906 75

This study evaluated the prevalence and clinical correlates of abnormal subjective experiences across functional psychotic disorders. Patients were recruited from consecutive admissions with the following diagnoses; schizophrenia (n = 40), schizophreniform disorder (n = 40), schizoaffective disorder (n = 21), mood disorder (n = 18), brief reactive psychosis (n = 15), and atypical psychosis (n = 16). Subjective experiences were assessed using the Frankfurt Complaint Questionnaire (FCQ), and the clinical status was assessed with the Scales for the Assessment of Positive and Negative Symptoms (SAPS and SANS) and the Manual for the Assessment and Documentation of Psychopathology (AMDP). Neither the FCQ total score nor individual subjective experiences displayed significant differences across diagnoses. When the clinical predictors of subjective experiences were studied by multiple regression analyses, a different pattern resulted for individual psychotic disorders. In schizophrenic patients, subjective experiences were predicted by female gender, euphoria, lack of insight, greater illness severity, and more positive symptoms. The only predictors of subjective experiences in the schizophreniform disorder group were the negative symptoms. Within the affective disorders group, subjective experiences had no clinical predictors.
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PMID:Subjective experiences in psychotic disorders: diagnostic value and clinical correlates. 947 50

We completed a systematic genome-wide search for evidence of loci linked to schizophrenia using a collection of 70 pedigrees containing multiple affected individuals according to three phenotype classifications: schizophrenia only (48 pedigrees; 70 sib-pairs); schizophrenia plus schizoaffective disorder (70 pedigrees; 101 sib-pairs); and a broad category consisting of schizophrenia, schizoaffective disorder, paranoid or schizotypal personality disorder, psychosis not otherwise specified (NOS), delusional disorder, and brief reactive psychosis (70 pedigrees; 111 sib-pairs). All 70 families contained at least one individual affected with chronic schizophrenia according to DSM-III-R criteria. Three hundred and thirty-eight markers spanning the genome were typed in all pedigrees for an average resolution of 10.5 cM (range, 0-31 cM) and an average heterozygosity of 74.3% per marker. The data were analyzed using multipoint nonparametric allele-sharing and traditional two-point lod score analyses using dominant and recessive, affecteds-only models. Twelve chromosomes (1, 2, 4, 5, 8, 10, 11, 12, 13, 14, 16, and 22) had at least one region with a nominal P value <0.05, and two of these chromosomes had a nominal P value <0.01 (chromosomes 13 and 16), using allele-sharing tests in GENEHUNTER. Five chromosomes (1, 2, 4, 11, and 13) had at least one marker with a lod score >2.0, allowing for heterogeneity. These regions will be saturated with additional markers and investigated in a new, larger set of families to test for replication.
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PMID:A genome-wide search for schizophrenia susceptibility genes. 975 21

A first psychotic episode includes a wide range of disorders with different outcomes: schizophrenia, bipolar disorder, schizophreniform disorder, schizoaffective disorder, drug-induced psychosis, brief reactive psychosis, organic psychoses and delusional disorder. The course and outcome of a first psychotic episode is greatly dependent on its initial management. Major clinical, etiopathogenic and therapeutic advances have been achieved in this field and have allowed specific management strategies to be adopted. The primary task of therapists involved in the management of patients who have experienced a first episode of psychosis is promotion of recovery and prevention of secondary morbidity, relapse and persistent disability. The main guidelines of an early psychosis management are:--to keep in mind that early psychosis is not early schizophrenia. Thus, clinicians and therapists should avoid an early diagnosis of schizophrenia. Diagnosis in early psychosis can be highly unstable. A diagnosis of schizophrenia, with its implications of pessimism, relapse and disability, does not contribute anything positive in terms of guiding treatment. On the contrary, such a diagnosis may damage the patient and family by stigmatizing them and affecting the way they are viewed and managed by healthcare professionals.--To integrate biological, psychological and social interventions: effective medications is useful in reducing the risk of relapse, but is not a guarantee against it. Psychological and social interventions can greatly help promote recovery.--To tailor the various strategies to met the needs of an individual: as an example, it is important to formulate appropriate strategies for the different stages of the illness (prodromal phase, acute phase, early recovery phase and late recovery phase) because patients have different therapeutic needs at each stage.--In the acute treatment, not to concentrate on short-term goals in indicating antipsychotic treatment: prescribing principles for first-episode psychosis are to maximise benefit and minimise side effects because the first experience of medication may influence a patient's future attitudes of therapy of all types. Effective strategies which may reduce long-term morbidity and improve recovery are currently available but their implementation is too often delayed. The time lag between the onset of symptoms and the start of treatment can be many months or years and this delay can have serious consequences. The critical period of the first 2-5 years after the first psychotic episode is a time of maximum vulnerability and of maximum opportunity. Consequently, actions should be undertaken to promote early recognition and assistance in psychotic disorders: understanding of the factors that may cause delay in treatment can help minimise this problem and lead to the initiation of appropriate treatment at the earliest opportunity. Training the general practitioners who have an important part to play in the early recognition is also of crucial importance.
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PMID:[Therapeutic strategies in the first psychotic episode]. 1059 94


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