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

Clozapine (Clozaril) represents the first major advance in the pharmacological treatment of schizophrenia since the introduction of antipsychotics into clinical practice in the 1950s. Studies consistently support its efficacy for reducing positive symptoms in acutely psychotic patients and in treatment-resistant patients, for preventing positive symptom exacerbations as a maintenance treatment, and for reducing symptoms of hostility and violence. There is evidence to suggest that clozapine may improve social and occupational functioning and quality of life and may reduce affective symptoms, hospitalizations, secondary negative symptoms, and tardive dyskinesia. Its most significant side effects include agranulocytosis, seizures, weight gain, hypotension and tachycardia, sedation, and perhaps rebound psychosis (with abrupt discontinuation of medication).
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PMID:Clozapine: efficacy and safety. 874 86

The role of genetics in criminal behaviour can be assessed through family, twin and adoption studies. This paper discusses the major findings of adoption studies that have focused on criminal outcome. Results from adoption studies have consistently revealed a relationship between biological parent criminal behaviour and adoptee criminal outcome. This finding has been noted in the case of property crime, but not in the case of violent crime. Violent crime in adopted-away offspring is not related to violent crime in biological parents. Findings from the Danish Adoption Cohort suggest that violent crime may be genetically related to other types of behavioural deviance. In the Danish Adoption Cohort, there is an increased rate of schizophrenia in the adopted-away offspring of biological fathers who are convicted of violent crimes. This father violence-adoptee schizophrenia relationship cannot be accounted for by the potential confounding factors of rearing social status, age at transfer, knowledge of family history of crime, or biological parents' mental illness.
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PMID:Assessing the role of genetics in crime using adoption cohorts. 886 73

Misidentification syndromes have been regarded as psychiatric curious, but in recent years their importance both in terms of frequency, and because of their links with organic brain pathology and risk of violence has been increasingly realised. Most of the cases reported have been in conjunction with schizophrenia. We report a case of the illusion of Fregoli, the delusional misidentification of a familiar person in a stranger. The patient was manic and exhibited the delusion twice, once with regard to a man and the other concerning a dog.
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PMID:Delusional misidentification: the illusion of Fregoli and a dog. 886 51

Reports of attempted or actual physical assaults by patients in the inpatient, outpatient, and emergency settings of a psychiatric facility within a general hospital were prospectively surveyed during a one-year period. Among 397 patients discharged during the period, 46 patients were responsible for 133 violent incidents. Most incidents occurred on the locked inpatient unit during the daytime and after the first week of admission. Schizophrenia was the only diagnosis significantly associated with violence. Hitting was the most prevalent form of violence, and nurses were the most frequent targets.
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PMID:Patterns of violent incidents by patients in a general hospital psychiatric facility. 892 53

The FDG PET brain scans from 31 offenders with schizophrenia and schizoaffective disorder from a maximum security mental hospital were compared with those of normal controls (N = 6) in terms of relative FDG uptake in a range of regions covering frontal and temporal regions. The patient sample was divided into those who had a history of repetitive violent offending (RVO, N = 17) and those without a repetitive violent history (NRVO, N = 14) according to the violence rating of their pre-admission convictions. Reduced FDG uptake was noted at both the right and left anterior inferior temporal (R and L AIT) regions in NRVOs but only at LAIT in RVOs. NRVOs had significantly lower FDG uptake at RAIT than RVOs. The findings suggest that metabolic changes at AIT may be related to different patterns of violent offending in patients with schizophrenia.
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PMID:Positron emission tomography in male violent offenders with schizophrenia. 910 58

We have recently characterized a functional polymorphism in the catechol-O-methyltransferase (COMT) gene that is responsible for substantial variability in COMT enzymatic activity found in humans. A common low-activity variant of the enzyme contains a methionine residue at amino acid 158 of membrane-bound COMT whereas the common high activity variant has a valine at this site. Considering the role of COMT in dopamine metabolism and the involvement of dopaminergic pathways in the pathogenesis of schizophrenia and violence, we screened 37 patients with schizophrenia to determine whether or not a behavioral association with the COMT polymorphism exists. Patients were assessed for dangerousness on the basis of a history of violent and threatening behavior, crime, cocaine and alcohol abuse, and other antisocial behaviors. We found that schizophrenic patients who were homozygous for the low activity allele were judged by their psychiatrists to be at higher risk for aggressive and dangerous behavior than those who were homozygous for the high activity allele (Kruskal-Wallis statistic = 10.43; P = 0.003).
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PMID:Analysis of a functional catechol-O-methyltransferase gene polymorphism in schizophrenia: evidence for association with aggressive and antisocial behavior. 910 74

Our review evaluating the relationship between violent/homicidal behaviors and mental illness/psychiatric disorders used many different data including that assessing the prevalence of violent/homicidal behaviors in former psychiatric inpatients (just before hospitalization, during hospitalization, and after discharge) as outpatients and in community samples as well as evaluating the prevalence rate of psychiatric disorders in people who actually engaged in violent/homicidal disorders (jail detainees, prison inmates, and community samples). Irrespective of which line of investigation, there was convincing evidence that violent/ homicidal behavior was associated significantly with mental illness. Although earlier investigations failed to control for important variables, such as age and sociodemographics, most studies reviewed in this article did control for these items, further underlining the association of violence and mental illness. The question of whether specific psychiatric diagnostic categories are associated with violent/homicidal behavior is less definite across the various studies reviewed. The presence of substance abuse and dependence and alcohol abuse and dependence as well as antisocial personality disorder are particularly associated with an increased risk of violent/homicidal behaviors. The risk for these latter behaviors in schizophrenia, mood disorders, and anxiety disorders may appear somewhat greater than that for a general population but are not of the same magnitude of that for substance abuse or antisocial personality disorder. Interestingly, our outpatient study found that homicidal behaviors were not associated with any specific psychiatric diagnosis. Although understanding whether specific psychiatric diagnostic categories are more prone to violent behaviors may be of importance, most studies have been shortsighted regarding this evaluation. All the studies presented in this article except the ECA project, presented diagnostic data where either the presence of one psychiatric disorder did not preclude the diagnosis of another or assigned subjects/patients into the severest disorder of a predetermined hierarchy of diagnoses or only selected their principal/primary diagnosis. Thus, the effect of having a solitary psychiatric disorder (only one disorder present) as well as the effect of comorbidity per se on the relationship of psychiatric disorders and violent/homicidal behaviors were unexplored. Only the ECA study by Swanson and colleagues reported on the effect of comorbidity. As reviewed earlier in the article, Swanson et al found that comorbidity of psychiatric diagnostic categories further increased the risk of violent/ homicidal behaviors. In most cases, it was many more times than simply adding the rates of either diagnosis alone. Because more than 54% of respondents of the National Comorbidity Survey study who had one DSM-III-R diagnosis also had at least a second Axis I diagnosis, the association of violent/homicidal behaviors to mental illness may even be stronger than originally believed. Within the relationship of violent/homicidal behaviors and mental illness, this article suggests a number of particular risk factors. As just reviewed, substance/alcohol abuse and antisocial personality disorder as well as the presence of comorbid psychiatric disorders are significant risk factors. Which particular comorbid illness increases the risk still needs further elaboration. Studies must continue to try to define and understand the relationship of violent/homicidal behaviors in mental illness. Although mental disorders per se are significantly associated with violent/homicidal behaviors, it is reasonable to believe that targeting certain subgroups of patients should be helpful. Probably the presence of psychotic symptoms is a significant risk factor in violent/ homicidal behaviors in the mentally ill. Only one of the studies reviewed in this article evaluated this issue. (ABSTRACT TRUNCATED)
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PMID:Violence and homicidal behaviors in psychiatric disorders. 919 22

The case notes of all 64 referred abnormal offenders (mental patients with criminal records) sent to a psychiatric hospital between January 1971 to May 1996 were examined. It was found that severe mental disorder like schizophrenia (27 out of 64) was the most common cause of violent crimes such as homicide. Epilepsy 10.9 (n = 7) was another important neuropsychiatric condition related to violence. Alcohol and cannabis abuse were an associated factor in 21 (32.8%) referred cases. Culture bound syndromes like "Amok Syndrome" and "Spirit Possession Syndrome" were also found as a cause of violent behavior.
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PMID:Mental disorders in abnormal offenders in Papua New Guinea. 921 5

To improve suicide prevention during hospitalization, this study examined risk factors for parasuicide among psychiatric inpatients. A group of 58 psychiatric inpatients (19 with schizophrenia, 20 with depression, and 19 with other diagnoses) who displayed suicidal behavior during hospitalization were compared with two control groups of nonparasuicidal inpatients. For inpatients with schizophrenia, a history of parasuicide was a risk factor; for those with depression, it was suicidal behavior on admission; and for patients with other diagnoses, it was violence during hospitalization.
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PMID:Risk factors for parasuicide among psychiatric inpatients. 928 86

The study examines the relationship between hallucinations/delusions and violent behaviour in a sample of long-stay inpatients with chronic schizophrenia. Thirty-one subjects defined as violent and meeting DSM-111-R criteria for schizophrenia were compared with 31 matched non-violent schizophrenia patients with respect to detailed phenomenologies of auditory hallucinations using the Mental Health Research Institute Unusual Perceptions Schedule (Carter and Copolov, 1993; Carter et al., 1995) and delusions using the Maudsley Assessment of Delusions Schedule (Taylor et al., 1994). Patients in the violent groups were significantly more likely to experience negative emotions, tone and content related to their voices than those in the non-violent group, whilst patients in the non-violent group were more likely to experience positive emotions, tone and content related to their voices. Patients in the non-violent group were significantly more likely to report success in coping with their voices. There was no association between command hallucinations and violent behaviour. Patients in the violent group were more likely to hold persecutory delusional beliefs than those in the non-violent group, while patients in the non-violent group were likely to hold grandiose delusions than those in the violent group. Patients in the violent group were also more likely to report that the delusion made them feel angry, while those in the non-violent group were more likely to report that the delusion made them feel elated. The results suggest specific aspects of the phenomenologies of hallucinations and delusions that should be clinically assessed to determine the likelihood of violence as a result of such psychotic symptoms.
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PMID:Violence in schizophrenia: role of hallucinations and delusions. 932 49


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