Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036341 (schizophrenia)
 60,220 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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

A review of 46 subjects who suicided after having contact with a psychiatric hospital is presented. There were 33 men and 11 women, both with a mean age of 37 years. In comparison with a control group, those who suicided had a greater number of hospital admissions, a greater length of hospitalisation, were more often unemployed, had a history of more previous suicide attempts, more often received the diagnosis of schizophrenia or manic depressive illness (depressed phase), were more often overly depressed at their last contact, and were more often prescribed neuroleptic medications. Although these differences emerged, suicide is an infrequent event, and these factors lack specificity in prediction. The important association of psychiatric illness with subsequent suicide is noted.
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PMID:Suicide in association with psychiatric hospitalisation. 386 8

Depressive symptoms and suicidal behavior in 64 adolescent psychiatric patients were assessed by a structured interview and the Schedule for Affective Disorders and Schizophrenia. The medical seriousness of suicidal behavior was associated with conscious intent to die and with the number of previous nonlethal suicide attempts. Suicidal behavior was associated with depressed mood, negative self-evaluation, anhedonia, insomnia, poor concentration, indecisiveness, lack of reactivity of mood, psychomotor disturbance, and alcohol and drug abuse. The results suggest that adolescents can be reliable reporters of their suicide potential and that clinicians need to be sensitive to symptoms of major depressive disorder in assessing potentially suicidal adolescents.
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PMID:Depressive symptoms and suicidal behavior in adolescents. 398 97

Of 48 cases of phenothiazine poisoning that were analyzed, 34 were attributed to suicide attempts, nine to accidental ingestion, and five to drug reactions. As outpatient treatment of schizophrenia increases, cases of over-dose with phenothiazine drugs may be expected to increase also. The prescribing of multiple phenothiazines and antidepressants is probably contributory to the occurrence of mixed drug ingestions. The symptoms and signs of phenothiazine poisoning are largely predictable if the atropine-like, alpha-blocking, quinidine-like, and extrapyramidal actions of phenothiazines are appreciated. Unexplainable tachypnea and paradoxical miosis were noted in severe cases. In one case in the study phenothiazine intoxication was present in the newborn infant of a schizophrenic mother.
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PMID:Phenothiazine poisoning. A review of 48 cases. 440 37

141 female psychiatric patients, suffering from major depression, schizophrenia, alcohol dependence or adjustment disorder, were investigated for their 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA) and cortisol level in the cerebrospinal fluid (CSF). Dexamethasone suppression tests were also performed in 111 cases, and TRH/TSH tests in 40 subjects. Fifty-two patients were hospitalized following a recent suicide attempt, 18 of which were made using a violent method. The other 34 attempters took tranquilizer or sedative overdoses. CSF 5-HIAA was significantly lower in violent attempters in all 4 diagnostic categories. CSF HVA was higher in those taking drug overdoses, but only in depression (and less markedly in schizophrenia). CSF cortisol did not differ among either diagnostic or suicidal subgroups. Dexamethasone suppression was more frequently abnormal in suicidal patients than in nonattempters, and this difference was more important where the overall nonsuppression rate was lower. Maximal TSH response to TRH showed an inverse correlation with CSF 5-HIAA, and it was lowest in the nonattempter group. The difference between violent suicide attempters and nonattempters in their TSH response was significant. Since these biochemical changes were more or less independent of clinical diagnoses, it seems relevant to explore further the biological background of human aggression and suicide as a separate research direction.
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PMID:Biochemical markers in suicidal patients. Investigations with cerebrospinal fluid amine metabolites and neuroendocrine tests. 620 31

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

Serum cortisol levels were significantly higher after administration of 5-hydroxytryptophan (5-HTP), 200 mg orally, in unmedicated patients with affective disorders than in controls. The magnitude of the serum cortisol increase correlated positively with the Schedule for Affective Disorders and Schizophrenia-Change (SADS-C) depression syndrome ratings and correlated negatively with psychotic symptoms in 26 patients with major depression. The serum cortisol response was greater in four depressed and three manic patients who made suicide attempts than in 33 patients who were not suicidal or only had suicidal thoughts. The cortisol response was also greater in patients with bipolar depression than in those with unipolar depression and those with a first-degree relative with an affective disorder. Absence of psychotic symptoms and commission of suicidal acts were associated with an increased cortisol response to 5-HTP in the depressed patients. The cortisol response to 5-HTP in the manic patients also tended to correlate with the SADS-C manic syndrome score.
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PMID:Effect of 5-hydroxytryptophan on serum cortisol levels in major affective disorders. II. Relation to suicide, psychosis, and depressive symptoms. 660 36

The authors describe nine psychiatric inpatients from the same hospital who leaped from a height. Common features included youth, social isolation, diagnosis of schizophrenia, and chronic psychosis despite neuroleptic therapy. All had prolonged hospitalizations and a history of assaults, suicide attempts, or both. The authors suggest that these characteristics in conjunction with a recent change in hospital treatment plan or loss of social supports may identify patients at high-risk for violent self-destructive acts.
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PMID:Nine psychiatric inpatients who leaped from a height. 672 3

Twenty-four hour urinary excretion of 3-methoxy-4-hydroxyphenyl-glycol (MHPG) was analyzed in 48 unipolar and 19 bipolar depressed patients and 16 healthy controls. All patients were interviewed using the Schedule for Affective Disorders and Schizophrenia. Various symptoms and descriptive variables were correlated univariately with urinary MHPG in two random groups, and those items showing a trend in both splits were further reduced by a multiple regression technique, first on each split separately and finally on the pooled sample. Urinary MHPG correlated significantly both in uni- and multivariate tests with age (positively, but only in females), altered motor activity (summed scores of agitation and retardation during the worst week of present or recent depression), and with existence of at least one suicide attempt before the present depressive episode (last items negatively). There were no differences between unipolar and bipolar patients, or between any patient group and the healthy controls. Males excreted about 25% more MHPG than females. Levels of MHPG in urine and cerebrospinal fluid were highly significantly intercorrelated.
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PMID:Depressive symptom patterns and urinary MHPG excretion. 695 58

Exposure of populations with psychosis to traumatic events (among them sexual trauma) has seldom been studied. In addition, the clinical features developed by victims with psychosis after a traumatic event are rarely taken into account. Sixty-four women with schizophrenia and 26 women with bipolar disorder (DSM-III-R diagnosed, 18-45 years, inpatients and outpatients) were interviewed using a clinician-rated battery of instruments, including a semi-structured questionnaire concerning sexual victimization and its impact. In childhood or adolescence, 36% of women with schizophrenia (vs 28% of those with bipolar disorder) had been victims of sexual abuse involving body contact. In the women with schizophrenia, this sexual abuse was associated with addictions, suicide attempts and becoming psychiatric patients earlier. Over their lifetime, the prevalence of rape was 23% in the two clinical groups. In women with schizophrenia, rape was associated with a greater severity of their disorder and addictions. Moreover, a frequent repetition of sexual trauma was observed in women with schizophrenia, whereas such repeated traumas were less frequent in those with bipolar disorder. The results suggest that these two clinical groups are at risk of rape and the study highlight clinical features in victims with schizophrenia that have been described for other groups of victims of sexual abuse.
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PMID:Sexual victimization in women with schizophrenia and bipolar disorder. 775 20


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