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

Thirty-one outpatient men with schizophrenia were assessed with various measures of lifelong history of physical violence as well as psychopathology, neuropsychological performance, and neurological intactness. Most of the results consisted of nonsignificant positive relationships between physical aggression and neuropsychological performance in these schizophrenia subjects. Some neuropsychological test performances did show significant positive correlations with levels of aggressivity. In contrast with previous studies that have established a relation between neuropsychological impairment (as opposed to performance) and violence in schizophrenia, subjects of the present study were high-functioning outpatients who may not have attained a level of neurological impairment inducing constant uncontrollable outbursts of irritative aggression in their daily living. The importance of defining in detail the clinical characteristics of the subjects studied and the type of violence assessed is discussed, and an ecological interpretation of these counterintuitive results is provided.
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PMID:Neuropsychological correlates of violence in schizophrenia. 763 Nov 72

This study tests the hypothesis that seriously violent offenders pleading not guilty by reason of insanity or incompetent to stand trial are characterized by prefrontal dysfunction. This hypothesis was tested in a group of 22 subjects accused of murder and 22 age-matched and gender-matched controls by measuring local cerebral uptake of glucose using positron emission tomography during the continuous performance task. Murderers had significantly lower glucose metabolism in both lateral and medial prefrontal cortex relative to controls. No group differences were observed for posterior frontal, temporal, and parietal glucose metabolism, indicating regional specificity for the prefrontal deficit. Group differences were not found to be a function of raised levels of left-handedness, schizophrenia, ethnic minority status, head injury, or motivation deficits in the murder group. These preliminary results suggest that deficits localized to the prefrontal cortex may be related to violence in a selected group of offenders, although further studies are needed to establish the generalizability of these findings to violent offenders in the community.
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PMID:Selective reductions in prefrontal glucose metabolism in murderers. 749 31

The goal of this study was to understand how individual clinicians make admission decisions in the psychiatric emergency room. Clinical and demographic data were collected on 7485 consecutive visits to four psychiatric hospitals in Israel during 1991 and 1992. This was about one-third of visits to psychiatric emergency rooms in Israel during this time. Twenty-one decision makers who made at least 50 decisions and admitted more than 15 and less than 85% of patients were included. Decision to admit patients was modeled using step-wise discriminant analysis. Clinicians examined different numbers of patients and admitted at different rates. In one hospital one group of clinicians appears to rely primarily on diagnosis and another group on other variables, predominately previous history, and social or referral factors. The most influential background variable was self-referral which favored not admitting patient. The most influential diagnoses were schizophrenia and affective disorder which favored admission. In another hospital the most important variables in most models were legal status of admission, number of previous hospitalizations, violence and suicide as presenting problems and referral source. All variables except referral source favored admission. Some referral sources favored admission and others did not. In the last hospital studied the most salient variable was self-referral which favored not admitting patient. Decisions in one hospital were not modeled because no clinician met study inclusion criteria. There appears to be variability between clinicians in what information they use to make their decisions in the psychiatric emergency room and what percent of patients they admit.
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PMID:How individual clinicians make admission decisions in psychiatric emergency rooms. 789 18

The authors report the findings of a longitudinal study testing the hypothesis that substance use leads to subsequent violence in the community. Subjects were 103 patients with a Structured Clinical Interview for DSM-III-R diagnosis of schizophrenia or schizoaffective disorder who were seen in an outpatient clinic for the treatment of schizophrenia. Data on substance use and violent behavior were collected by review of medical records. Results indicated that use of drugs and alcohol was associated with increased odds of concurrent and future violent behavior when compared with persons with schizophrenia and no substance use. Odds of violence were particularly elevated for individuals having a pattern of polysubstance use involving illicit substances.
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PMID:A longitudinal study of substance use and community violence in schizophrenia. 798 15

Studies of police psychiatric referrals in the USA and the UK generally show these patients to be ill and in need of care. There are, however, no published Australian studies and such findings may not be validly generalised. This prospective study of consecutive police psychiatric referrals in Adelaide reports psychiatric assessment in 92 cases and observations by police in 69 of these, with no evidence of selection bias. The most common reason for referral was threat of self harm (28%). Mental illness was deemed to be present in 49% and the most common clinical description was "situational crisis" (29%). Schizophrenia was diagnosed in 18%. Clinicians viewed 19% of referrals as inappropriate. Increased relative odds for mental illness were associated with police accounts of psychotic symptoms, and decreased odds with threat of self harm and violence. Increased odds for admission were associated with language difficulties and damage to own property, decreased odds with threat to others, threat of suicide, and threat to self injury. There were 14 cases where possible charges were not being pursued: of these 7 were regarded as ill and 4 were regarded as inappropriate referrals. The rates of major disorders are lower than in other published work. It is proposed that this can be explained by relative ease of referral by police to psychiatry and flexible acceptance criteria.
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PMID:Police referrals to a psychiatric hospital: indicators for referral and psychiatric outcome. 799 80

The authors briefly discuss past and present reasons for the psychiatric security unit system in Norway. They describe the patients in these units at the beginning of 1993 (N = 123). Of these patients, 16% were females, 78% had a main diagnosis of schizophrenia, and 12% were admitted because of personality disorders. Physical restraints had been used for 25%, pharmacological restraints for 17%, and forced pharmacological treatment had been necessary for 26% of the patients during the last six months. There were high rates of behaviour problems related to criminality, abuse, violence and auto-aggression. Nearly all the patients were committed involuntarily, and additional legal restrictions were imposed for one third of them. The majority (63%) of the patients had been in security units for more than one year. The highest levels of security within the security unit system were used for those with the most serious criminality or behaviour problems prior to admission.
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PMID:[Psychiatric security units in Norway. Patients and activity]. 807 36

The authors examined whether jail detainees with schizophrenia, major affective disorders, alcohol or drug use disorders, or psychotic symptoms (hallucinations and delusions) are arrested more often for violent crimes six years after release than detainees with no disorders. Trained interviewers assessed 728 randomly selected male jail detainees using the National Institute of Mental Health Diagnostic Interview Schedule and then obtained follow-up arrest data for six years. Neither severe mental disorder nor substance abuse or dependence predicted the probability of arrest or the number of arrests for violent crime. Persons with symptoms of both hallucinations and delusions had a slightly higher number of arrests for violent crime, but not significantly so. These findings held even after controlling for prior violence and age. The findings do not support the stereotype that mentally ill criminals invariably commit violent crimes after they are released. Future directions for research are suggested.
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PMID:Does psychiatric disorder predict violent crime among released jail detainees? A six-year longitudinal study. 820 5

Interictal violence among epileptic patients could result from factors other than epileptiform activity. We characterized 44 patients who presented for psychiatric evaluation because of violent behavior. Most violent acts consisted of verbal or minor physical aggression. Twenty (45%) of these patients met criteria for a schizophrenic disorder, and one committed murder during a paranoid schizophrenic relapse. In addition to schizophrenia, the violence patients had significantly more mental retardation when compared with 88 age- and sex-matched epileptic patients without prior violent behavior. However, violent and nonviolent patients did not differ on seizure variables such as type and frequency of seizures, auras, electroencephalographic changes, epilepsy age of onset, or anticonvulsant therapy. These findings suggest that interictal violence is associated more with psychopathology and mental retardation than with epileptiform activity or other seizure variables.
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PMID:Interictal violence in epilepsy. Relationship to behavior and seizure variables. 824 25

A review of the published case reports of adverse behavioral episodes or unexpected psychopathology in patients taking benzodiazepines was undertaken in an attempt to determine if these adverse or unexpected events are more likely to occur with alprazolam when compared with other currently marketed benzodiazepines. Adverse behavioral phenomena and unexpected psychopathology were divided into the following categories: (1) anger or violence, (2) impulsive, suicidal, or self-harming behavior, (3) depression, (4) mania, (5) schizophrenia, (6) withdrawal syndromes and (7) physical dependence and abuse liability. It is difficult to draw conclusions from this literature because of the limitations of spontaneously reported cases and the lack of epidemiologic studies. Despite these limitations, it appears that some differences between alprazolam and older benzodiazepines may exist. The older benzodiazepines are more commonly reported to have adverse events than alprazolam (with the exception of mania or hypomania). On the other hand, worsening in post-traumatic stress disorder and an increase in impulsive behavior in patients with borderline personality disorder have only been reported in patients receiving alprazolam. This is probably explained by the fact that only alprazolam has been used to any great extent in these conditions.
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PMID:Adverse behavioral events reported in patients taking alprazolam and other benzodiazepines. 826 90

The goal of this study is to understand how different admission statuses of varying degrees of restrictiveness (informal, voluntary, emergency admission, and involuntary admission on medical certification) are used in the psychiatric emergency room. The study included 656 consecutively admitted patients from a psychiatric emergency room over 28 months. Data were analyzed univariately and using two discriminant function models. Only six (0.9%) patients were informal admissions. Voluntary admissions (24.9%, n = 163) tended to be for patients with affective disorders, those who were self-referred, suicidal risks, those who had a marital or family problem, and those who were over age 60. Nonvoluntary admissions (74.2%) tended to be for patients with schizophreniform symptoms and those referred by police or court. Involuntary admission on medical certification (53.2%, n = 349) tended to be for patients who were family referred, younger than 20 years old, had social interpersonal nonfamily stressors, were suicidal risks, were or had been married, had organic psychotic disorder, history of violence, and manic episode or schizophrenia. Emergency admission patients (21%, n = 138) were characterized by being between 40 to 50 years old, having a diagnosis of psychoactive substance abuse, having previous outpatient treatment, and having been referred by emergency service. The major difference between involuntary admissions and voluntary was that the former were more often actively psychotic or referred by police or court. The major difference between emergency admission and involuntary admission on medical certification seemed to be that patients with a more available support system, whose primary diagnoses was not substance abuse and who were suicidal, were preferred for involuntary admission on medical certification.
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PMID:Differential use of admission status in a psychiatric emergency room. 863 87


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