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

Nearly thirty years of published research has documented the continuing presence of patient assaults on staff. These studies have included the traditional male patient with a diagnosis of schizophrenia and histories of violence and substance use disorder and the newer female, personality-disordered individual. This study reports on a ten-year longitudinal analysis of assaultive patients in one public-sector mental healthcare system during a period which included the national shift toward managed care initiatives. Data were gathered in the context of the Assaulted Staff Action Program, a crisis intervention program for staff victims. Patient assailants in both inpatient and community settings included both the traditional and newer personality-disordered individuals. The majority of assailants were females. Managed care initiatives appeared to have had little impact on type of assailants. Implications for safety and treatment are discussed.
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PMID:Characteristics of assaultive psychiatric patients: ten year analysis of the Assaulted Staff Action Program (ASAP). 1178 May 99

This article is the first to document the perinatal trauma and neuropsychiatric impairment of a sequential sample of male adoptees who committed murder. It also is the first to report objectively verifiable psychopathology and violence in their biological and adoptive parents. It explores the interaction of these variables in the genesis of violence. Subjects were six adopted murderers on whom data regarding biological and adoptive parents could be obtained. In all six cases, central nervous system (CNS) development was compromised in utero or perinatally. In adolescence and/or young adulthood, three met DSM-IV criteria for Bipolar Mood Disorder, one for Schizophrenia, and two for Schizoaffective Disorder. All subjects had at least one psychotic biological parent. In five cases, subjects were adopted into psychotic or violent households. There was no evidence of a specific "bad seed" for violence. Adoptees' intrinsic vulnerabilities to psychoses and to the impulsiveness and emotional lability often associated with early brain trauma, coupled with maltreatment, predisposed them to homicidal violence. As such, these subjects were similar to other extraordinarily violent, nonadopted, offenders. Conscious feelings regarding adoption did not contribute to the subjects' homicidal rages, so much as did conscious rage toward abusive, rejecting adoptive families.
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PMID:Six adoptees who murdered: neuropsychiatric vulnerabilities and characteristics of biological and adoptive parents. 1201 16

The long-term predictive validity of the Violent Risk Appraisal Guide (VRAG) and the historical part (H-10) of the risk assessment device HCR-20 in predicting violent recidivism was investigated in a sample of (n=106) violent offenders with schizophrenia. An effort was made to validate the 9-bin categorization of different absolute risk to recidivate depending on the individual score on the VRAG. Scores on both devices were retrospectively obtained from various files and registers. Individuals were followed up after discharge from hospital for on average 86 (standard deviation=19.33) months. During follow-up 29% of the sample was reconvicted of a violent crime. Results indicated that both H-10 and VRAG had a moderate ability to predict violent recidivism and that H-10 had a slightly better accuracy. Most of the items in H-10 but only half of those in VRAG correlated significantly with violent recidivism. The 9-bin categorization of VRAG scores produced mixed results. In the Swedish sample there was a linear trend in which increased VRAG scores were associated with higher absolute risk to recidivate. However, the distribution of scores and the figures of absolute risk of recidivation were not replicated. It is concluded that historical factors seem to play an important role for the long-term prediction of future violence among a group of severely mentally ill individuals.
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PMID:Long-term predictive validity of historical factors in two risk assessment instruments in a group of violent offenders with schizophrenia. 1183 14

Patients suffering from schizophrenia or bipolar affective disorder may progressively worsen and become severely disabled, and may then be classified as suffering from severe and enduring mental illness. Concern about risk to self and others focuses on this patient group, and community psychiatric nurses (CPNs) are under pressure to target patients with this diagnosis. CPNs have been accused of neglecting patients with a severe and enduring diagnosis in favour of other patient groups, but if they restrict services at primary care level this may have serious implications for patients. Patients who have had no previous contact with mental health services may have potentially serious and life threatening conditions. For example, depressed men may not be categorized as severely mentally ill, but the suicide rate amongst this patient group is very high, and they may externalize depression and resort to violence if untreated. Depressed men may lack social support and the means to express psychological distress, and these factors may precipitate or exacerbate depression. Early referral and assessment can prevent crises, deterioration in mental health and suicide. CPNs do not necessarily have to provide ongoing care following assessment, but they do have a significant role to play in primary health care referrals for the non-psychotic mentally ill. CPNs act as a filter for the expertise and resources of multidisciplinary mental health teams. General practitioners will have increasing difficulty accessing the resources of multidisciplinary mental health teams if CPNs are unable to accept primary health care referrals. Primary care interventions are very important for the assessment of depression because they may help men to express psychological distress and assist them to access appropriate services and treatment. The experience of working with depressed men in a primary health care setting revealed that many lack confidants, or do not confide in those close to them. The interview schedule designed by Brown & Harris (1978) to gather data on the relationships of depressed women was used to explore the relationships of depressed men who were attending a Mental Health Day Centre.
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PMID:Depressed men: an exploratory study of close relationships. 1187 96

INTRODUCTION: There is an increased likelihood of violence in the mentally ill although the risk is small. AIMS: The study aimed to ascertain the features in a secure hospital population that linked offending and mental illness. METHOD: A survey of patients in the high security hospital serving the province of British Columbia in Canada was carried out. Information on 175 mentally disordered offenders was extracted and included demographic data and specific characteristics of their offences, diagnoses and psychotic symptoms. RESULTS: The most prevalent offences were crimes of violence, but 39% of patients were not primarily violent offenders. Almost two-thirds (61%) had two or more diagnoses. A large majority of the patients were psychotic, schizophrenia being the most common diagnosis. There was a highly significant association between psychosis and violence, but the strength of the association was not increased by the presence of imperative hallucinations or delusions. The sample comprised various ethnic groups, one of which, Native Americans, was over-represented. However, no association was found between violent offending and ethnicity, or age or years of illness. DISCUSSION: The study replicates previous findings of the link between violent offending and psychosis, but not a specific link between violent offending and psychotic drive. A surprising finding was a lack of association between violent offences and substance misuse.
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PMID:Psychosis and offending in British Columbia: characteristics of a secure hospital population. 1204 28

Literature reviews of individual assaultive patients, repetitively violent patients, and restrained assaultive patients document that persons diagnosed with schizophrenia or personality disorder are at the highest risk to become assaultive. While there has been some initial research of possible predictor variables across diagnostic groups, this six-year retrospective study is the first to compare only persons with schizophrenia or personality disorder on basic demographic and the selected clinical variables of history of violence, personal victimization, and substance use disorder. In this study, the variance suggested that persons with schizophrenia and personality disorder were both likely to be assaultive. Assaults by persons with schizophrenia were somewhat proportional to their presence in the population studied. However, personality disordered patients represented a disproportional increase from the population studied. Younger females with a diagnosis of personality disorder and with histories of violence toward others and personal victimization appeared at increased risk to be assaultive and to require restraints. The findings and their implications for safety and clinical care are discussed.
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PMID:Characteristics of assaultive patients with schizophrenia versus personality disorder: six year analysis of the Assaulted Staff Action Program (ASAP). 1205 36

Among the elements of comorbidity found in schizophrenia, it is addiction and violence that figure most among those that preoccupy the entourage of family and cares of patients. These problems can worsen the prognosis of schizophrenia, notably because they further hinder the already complex provision of care and social support, but also because they provoke a cascade of complications and disruptions. On top of these in comorbid manifestations exist fears, preconceived ideas and shady zones. The authors of this article propose a review of the recent literature, on the incidence and nature of these problems, and on the pathways currently being explored as to their origins.
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PMID:[Schizophrenia and comorbidity: addictions and violence]. 1214 2

This article examines neuropsychological deficits associated with several medical disorders (HIV infection, sickle cell disease, diabetes, and Turner syndrome), psychiatric disorders (schizophrenia, conduct disorder, mood disorder, and substance abuse disorder), and traumatic brain injury, especially as a consequence of child and relationship abuse. The literature reviewed includes attention to developmental and sociocultural considerations (gender, ethnicity, interpersonal violence, family function). A brief overview of changes in neuropsychological practice is provided. The focus of the article is on the use of neuropsychological evaluation as a first step in rehabilitation for adolescents with neuropsychological deficits. A complex clinical case evaluated with the Ackerman-Banks Neuropsychological Rehabilitation Battery is included to demonstrate the way in which identification of neuropsychological strengths and weaknesses can be used to develop treatment recommendations.
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PMID:The role of neuropsychological testing and evaluation: when to refer. 1227 Aug 5

Previous papers have reported lower serum albumin levels in patients with schizophrenia. In the present study, the relationships between serum albumin levels and subtypes of schizophrenia, physical violence and suicide attempts were investigated. A review of medical charts over a 1-year period was carried out in a population of 213 Taiwanese psychiatric inpatients that included 106 patients with schizophrenia. The collected data included age, bodyweight, height, serum albumin levels and routine blood biochemistry examinations. These data were compared with data from a healthy control group (n = 32) composed of staff members using analysis of covariance after age adjustment. The statistical results showed significantly lower serum albumin levels in patients with schizophrenia in the acute phase than in the control group. However, no significant differences in serum albumin levels were found between paranoid and non-paranoid schizophrenic patients, between patients who had or had not exhibited physical violence, or between patients who had or had not made a suicide attempt.
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PMID:Decreased serum albumin levels in Taiwanese patients with schizophrenia. 1248 5

There are large-scale preventive programmes to reduce the risk of death and disability caused by several frequent physical diseases. The primary and secondary prevention of schizophrenia, a disorder entailing many years of life in disability, is still being neglected. Prevention is aimed at reducing the incidence, severity or consequences of the disorder. To find ways of preventive intervention in schizophrenia, the aetiological risk factors must be identified, then eliminated or modified. As possible targets pre-, peri- and postnatal complications, urbanicity and early behavioural risk indicators are discussed. As examples of successful early prevention targeted at risk indicators attempts to prevent depression and violence are considered. The most promising approach at present is secondary prevention focused on early illness course. Based on a controlled retrospective assessment of 232 first illness episodes the course of prodromi, impairments and psychotic symptoms prior to the climax of the first episode is shown. Most of the social consequences occur before the first treatment contact, thus making plain the urgent need for preventive action. Tools sufficiently validated are not yet available for early diagnosis and prediction of psychosis onset at the prepsychotic stage. So intervention has to be based on high-risk inclusion criteria, which exclude large proportions of at-risk persons. Appropriate early intervention at the prepsychotic, prodromal and the early psychotic stage as well as relevant ethical considerations are discussed. The frequency of and distress associated with single psychotic symptoms in the general population are potent predictors of a psychosis. The vision of treating this early illness dimension with third-generation, side-effect-free antipsychotics or of preventing its onset by oestrogen-like substances is discussed.
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PMID:Prevention and early intervention in schizophrenia: facts and visions. 1264 8


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