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

We present a case example that illustrates the diagnostic and treatment difficulties engendered by adult psychiatric patients with primary behavioral problems and neurocognitive disorders. In the case cited, the neuropsychological evaluation plays a significant role in reconceptualizing a patient who had accrued multiple psychiatric diagnoses including schizophrenia, borderline personality, and impulse control disorder. Formal examination revealed deficits in language, executive, and attentional functions that were far greater than had been expected and led to a major change in treatment strategy, including successful trial of imipramine and nadolol and more structured milieu therapy. The cognitive deficit and intrapsychic conflict models are used to demonstrate the critical aspects of our diagnostic reclassification of the patient to Neurodevelopmental Disorder of Unknown Etiology and Auditory Attention Deficit Disorder.
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PMID:Neurocognitive disorders in psychiatry: a case example of diagnostic and treatment dilemmas. 202 75

It is becoming increasingly recognized that one third to one half of children diagnosed as having attention deficit/hyperactivity disorder (ADHD) continue to exhibit symptoms of the disorder into adulthood. The nature of the clinical picture is not well understood by a substantial number of clinicians. The purpose of this study is to report on the demographic and clinical profile of 56 adults, age 19 to 65 years (48 men, eight women) who present with adult ADHD and meet DSM-III-R criteria for the disorder. Patients underwent a diagnostic work-up consisting of medical and psychiatric evaluation, a structured interview Schedule for Affective Disorders and Schizophrenia-Lifetime Version [SADS-L]), the Symptoms Checklist Revised (SCL-9OR), Conners Attention Deficit Disorder With Hyperactivity (ADDH) scale, structured interview of ADDH, the Global Assessment of Functioning Scale (GAF), and, when available, information from parents was obtained. Ninety-one percent of our sample met the Utah Criteria for adult ADHD. The majority of the sample had additional DSM-III-R diagnoses and only seven had ADHD diagnosis alone. Fifty-three percent of the sample met the criteria for generalized anxiety disorder, 34% alcohol abuse or dependence, 30% drug abuse, 25% dysthymic disorder, and 25% cyclothymic disorder. These findings were similar to those reported in the literature.
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PMID:A clinical and demographic profile of a sample of adults with attention deficit hyperactivity disorder, residual state. 222

A review is presented of the diagnosis and drug treatment of the more common psychiatric and developmental disorders in the pediatric population. Where applicable, DSM III (Diagnostic and Statistical Manual of Psychiatric Disorders, III) criteria are utilized to describe the behavioral syndromes. The indications for usage and appropriate dosages of antipsychotics, antidepressants, anxiolytics, stimulants, and lithium are described. Those disorders discussed are attention deficit disorder, conduct disorders, anxiety disorders, sleep disorders, schizophrenia, autism, Tourette's syndrome, mental retardation, depressive illness, manic depressive illness, eating disorders, and enuresis.
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PMID:Pharmacologic treatment of psychiatric and neurodevelopmental disorders in children and adolescents (Part 1). 241 73

A yin-yang hypothesis is presented linking noradrenergic activity, thromboxane, melatonin, left hemisphere functioning, and cyclic AMP on the one hand, and dopamine, beta-endorphin, calcium, right hemisphere functioning, and cyclic GMP on the other. It is further suggested that there is a yoking of NA, TXA2, serotonin and melatonin in the left hemisphere, and a similar yoking of DA, BE, calcium and cGMP in the right. Evidence is presented to support the hypothesis that each element (NA, TXA2, etc.) on one side can modulate or balance a corresponding element (DA, BE, etc.) on the other. It is suggested that thromboxane is the key element in noradrenergic overactivity and that not taking this into consideration has confounded much prior research. This theory takes into account information processing models as well as pharmacological data and neurochemical theory on coupling of adenylate cyclase to its hormone receptors. Inhibiting noradrenergic overactivity can be obtained by inhibiting thromboxane and concomitantly activating opiate receptors. This protocol may have clinical utility in treating a wide range of disorders such as: anxiety, depression, schizophrenia, sleeplessness, withdrawal states, enuresis, Gilles de la Tourette syndrome, Parkinsonism, Alzheimers, dementia, anorexia, infant ruminations, essential tremor, spasticity of spinal cord injury, diarrhoea, ulcerative colitis, extrapyramidal symptoms, akathisia, neuroleptic malignant syndrome, attention deficit disorder, hyperhidrosis, and possibly AIDS.
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PMID:Inhibiting noradrenergic overactivity by inhibition of thromboxane and concomitant activation of opiate receptors via dietary means. 254 22

Diet clearly influences neurotransmission. This can be important in grossly undernourished children. It can also be important in children in whom normal homeostatic mechanisms governing food intake are bypassed. Subtle differences in behavior can occur with physiologic variation in food intake. Components of foods can also be used as drugs. Starvation can impair neuronal maturation and can have lasting effects upon behavior and intellectual performance. The extent of starvation's impact upon the brain depends upon whether undernutrition occurred during a critical phase in brain development. Short-term fasting has small, but significant, effects upon intellectual performance. Even when gross malnutrition is not present, subtle changes in diet may modulate brain function. Tryptophan, tyrosine, and choline in the diet are used as precursors for neuronal synthesis of serotonin, dopamine and norepinephrine, and acetylcholine, respectively. It is likely that the brain's sensitivity to certain components of the diet exists to permit monitoring of food intake by the central nervous system. Tryptophan, tyrosine, and choline may be useful in treatment of humans with sleep disorders, pain depression, mania, hypertension, shock, or dyskinesias. Other components of the diet that may affect behavior include food additives, sugar, and caffeine. Food additives may exacerbate hyperactive symptoms in a small proportion of children with attention deficit disorder. Given that there is little potential for harm and that there is a subpopulation that may respond, a trial of a diet that contains no food additives may be a valid diagnostic approach for children with attention deficit disorder who do not respond to stimulant therapy or for children for whom stimulant therapy is not desired. Refined sugar has been blamed for many behavioral abnormalities. Subtle effects of carbohydrate upon behavior have been reported, but the existing data do not support the hypothesis that sucrose or fructose exert special effects upon neurotransmission. Caffeine is easily detected as a stimulant by humans, but it has little effect upon cognitive function. Administration of large doses of vitamins has no beneficial effect in most humans with schizophrenia, attention deficit disorder, autism, Down's syndrome, or drug addiction. Large doses of niacinamide may even be harmful, as they may cause hepatic damage.
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PMID:Dietary influences on neurotransmission. 302 51

One important function of the catecholamine innervation of the cerebral cortex may be the control of attention. Of particular interest are the catecholamine projections to the cerebral cortex from the reticular formation, namely the dopamine neurons of the ventral tegmentum of the midbrain and the noradrenergic neurons of the locus coeruleus in the upper pons. Animal studies implicate noradrenaline and dopamine in a wide range of attention-related behaviours involving search and exploratory activity, distractibility, response rate, discriminability and the switching of attention. Most human studies come from the clinical literature relating to schizophrenia, Parkinson's disease and attention deficit disorder. An association has been claimed in each of these conditions between abnormal catecholamine activity (in particular dopamine) and attentional dysfunction. In particular, difficulty with the attachment of appropriate responses to environmental stimuli, akin to those observed in animals with lesions to central dopamine pathways, indicates a role for dopamine in response selection processes. Overall, the animal and human studies reviewed indicate a role for central noradrenaline and dopamine in the early and late processing of information, respectively.
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PMID:Catecholamines and attention. I: Animal and clinical studies. 332 64

The hypothesis is advanced that certain psychoses in adults devolve from attention deficit disorder (ADD), which has a fundamental impact on cognitive and social development and thus affects personality structure and psychodynamics. This 'ADD psychosis' often masquerades as schizophrenia or an affective disorder and hence is frequently misdiagnosed, precluding appropriate clinical intervention. Based upon clinical evidence and empirical research involving phenomenological comparisons, premorbid history, high risk studies, neurodiagnostic evaluations, and pharmacotherapeutic response, it is suggested that ADD psychosis in adults be regarded as a separate diagnostic entity. Distinguishing symptomatology, anamnesis, family history, therapeutics, as well as prognosis, are discussed. The concept of attention deficit disorder (ADD), until recently referred to as minimal brain dysfunction (MBD), has been conceived as a childhood affliction with rather specific and circumscribed manifestations. The diverse features which embrace this syndrome, such as hyperactivity and dyslexia, were first identified and subsumed under the collective banner of MBD about 2 decades ago. The complex hypotheses concerning its possible etiology have been detailed elsewhere and need not be repeated here. Rutter, based on his extensive literature review and seminal studies, has come to regard MBD as a subclinical brain disorder developing from a genetically determined biochemical abnormality, which produces symptoms of hyperactivity, impulsivity, attention deficit, aggressivity, and conduct disturbance. Indeed, factor analytic studies reviewed by Rutter support the co-occurrence of these pathological features in children, yet the empirical evidence for a distinct syndrome and for a precise etiology has been admittedly weak, with some contending that MBD or ADD is simply a catch-all for disparate neurological symptoms of unknown and variable pathogenesis.
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PMID:Attention deficit disorder psychosis as a diagnostic category. 345 65

Thirty-seven adult patients meeting the Utah criteria for attention deficit disorder, residual type, were entered into a double-blind crossover trial of methylphenidate and placebo. A moderate-to-marked therapeutic response occurred in 21 (57%) of the patients while receiving methylphenidate and in four (11%) while receiving placebo, a highly significant difference statistically and clinically. The responding patients showed significant improvement in the following areas: attentional difficulty, motor overactivity, affective lability, and impulsivity. The diagnosis of attention deficit disorder, residual type, should be considered in patients with prominent complaints of impulsivity, restlessness, emotional lability, and hot temper who do not suffer from schizophrenia or major mood disorder and do not have symptoms of schizotypal or borderline personality disorders.
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PMID:A controlled study of methylphenidate in the treatment of attention deficit disorder, residual type, in adults. 388 60

"Attention deficit disorder (ADD) psychosis" merits delineation as a separate entity. It constitutes the end result of the effects of a certain particular neurological deficit (ADD) on personality organization. It is my belief that about 10 percent of psychoses currently diagnosed most often schizophrenic and sometimes affective psychosis must best be considered a separate organic psychosis, i.e., an ADD psychosis. This ADD psychosis, then, is not merely a subgroup of schizophrenia, as I once thought. It merits a separate designation because its etiology, pathogenesis, and life history are different from those of the schizophrenic syndrome. The family histories are also different, as are the psychological findings. The treatment response is so different that it merits urgent consideration. Prognosis, both short range and long range, also seems different from those of the other psychoses.
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PMID:ADD psychosis as a separate entity. 408 48

In 1991 the American Psychiatric Association proposed a draft version of the IV edition of the Diagnostic and Statistical Manual of Mental Disorders--the DSM IV Options Book. Authors of this version wanted to increase clarity of the criteria sets and to provide compatibility with the Tenth Edition of the International Classification of Diseases (ICD - 10). The purpose of this Options Book is to propose some changes in wording, diagnostic divisions and to discuss various options concerning the placement of sections and disorders within the classification. The "Disorders of Infancy, Childhood or Adolescence" section was renamed "Disorders Usually First Evident in Infancy, Childhood or Adolescence" and moved to the front of the classification and also was expended to 11 groups of disorders. Several suggestions have been made about including new diagnostic groupings such as: Rett's Disorder, Eating Disorders and Voice Disorder. The Options Book introduces a superior category for Attention Deficit Disorders (with and without hyperactivity) and for Conduct Disorder/Oppositional Defiant Disorder. Several options are proposed regarding The Anxiety Disorders of Childhood or Adolescence. There is no evidence for a distinction in this category according to the age criterion. One option would be to move these disorders into the adult anxiety section (similarly as in the Mood Disorders and Schizophrenia). In the new version the title "Specific Developmental Disorders" is omitted. The suggestion is to include Phonological Disorder (Articulation Disorders) and Elective Mutism into Speech and Language Disorders section.
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PMID:[Developmental disorders in the fourth edition of the American classification: diagnostic and statistical manual of mental disorders (DSM IV -- optional book)]. 752 63


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