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

An exploratory study was conducted of the strategies that schizophrenia patients and their relatives employ to cope with negative symptoms. Coping strategies and their perceived efficacy were elicited in semistructured interviews conducted separately with patients and relatives. Coping responses were coded according to the following dimensions: behavioral-cognitive, social-nonsocial, and problem focused-emotion focused. Overall, the number of coping strategies was related to perceived coping efficacy for both patients and relatives, regardless of the type of strategy. Perceived coping efficacy tended to be highest for apathy; intermediate for alogia, anhedonia, and inattention; and lowest for blunting. Relatives with more knowledge about schizophrenia used more coping strategies and reported higher levels of coping efficacy. Patient rejection by relatives and distress (either patient or relative) tended to not be related to coping strategies. The findings suggest that patients and relatives use a wide variety of strategies to cope with negative symptoms of schizophrenia. Future clinical work and research need to evaluate whether families may benefit from psychoeducational approaches to teaching them how to better manage negative symptoms.
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PMID:Coping with negative symptoms of schizophrenia: patient and family perspectives. 916 41

There is no clinical sign, cognitive impairment or physiological abnormality pathognomic for schizophrenia. Aetiological factors and neurophysiological abnormalities appear to be heterogeneous. On the other hand, among the three symptomatic dimensions (negative, positive and disorganized), specific negative symptoms may present as early signs in childhood, may exist as essential signs marking disease onset, may be stable during disease progression, may predict an unfavourable long-term outcome, may have a significant genetic component in affected families, and may, be linked to neurological abnormalities when present. Of these symptoms, anhedonia and motivational disorders are the most stable and have the greatest predictive value. They may reflect a vulnerability common to the schizophrenic spectrum and account for the subsequent development of other symptomatic dimensions; this may be observed even when multiple aetiological factors are involved. In relation to their mechanism of action, the therapeutic effects of neuroleptics are consistent with this hypothesis.
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PMID:[Schizophrenia, from classification to dimensions: value of longitudinal studies]. 927 6

There is considerable evidence for the involvement of brain dopaminergic and serotonergic systems in schizophrenia pathology. However, post-mortem studies have been limited by difficulties in separating the effects of chronic exposure to antipsychotics from that of the disease process. Our recent studies directly explored this by comparing groups that were free from antipsychotic treatment for up to a year prior to death and that were maintained on antipsychotics. We have used this approach to identify that there are prominent effects of both disease and of antipsychotic treatment. There appears to be a high association for schizophrenics between elevations of D3 receptors in target regions of the mesolimbic dopamine (DA) system and elevated numbers of 5-HT(1A) receptors in prefrontal cortex (PFc). Antipsychotic treatment was correlated with a reduction of D3 receptors in the ventral striatum and its output structures. It also led to a reduction in the number of 5-HT2 receptors in some regions of the PFc without modifying the concentration of 5-HT(1A) receptors. The limbic loop interconnecting the PFc and ventral striatum may be the site of antipsychotic regulation of certain symptoms in schizophrenia, particularly anhedonia and depression. The positive symptoms of schizophrenia are more likely to be associated with disturbances in the temporal lobe. However, dopaminergic systems in the temporal lobe have historically been thought to be underdeveloped compared to that in the basal ganglia and unlikely to be the target of antipsychotics. Our studies of the expression of the DA D2 receptor in the temporal lobe has shown a complex organization in the perirhinal and temporal cortices that is disrupted in schizophrenia. The disturbances, which might be of neurodevelopmental origin and are unrelated to antipsychotic treatment, include altered laminar distribution of the D2 receptor and modified modular organization of D2 receptors in the superior temporal gyrus. We hypothesize that modified expression of D2 receptors in these regions play a key role in the genesis of hallucinations. Treatment with antipsychotics leading to D2 receptor blockade in temporal cortex may reduce the presence of positive symptoms.
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PMID:Limbic circuits and monoamine receptors: dissecting the effects of antipsychotics from disease processes. 927 86

Mental morbidity in the elderly comprises mainly affective disorders (manic depressive psychosis) and psycho-organic syndrome, delirium and dementia. Psychiatric disorder occurs with physical disorder or handicap and co-morbidity is the hall-mark of geriatric medicine. The prevalence rate is around 89/1000 population. The decreasing age at onset of depression over successive generations contributed by the 'unstable genes' is discussed. Factors affecting the 'quality ageing' are highlighted. Depression, mania and suicide behaviour in the elderly are detailed. Particular attention is drawn to 'vascular depression' resulting from cerebrovascular lesions affecting the striato-pallido-thalamo-cortico-pathways. Vascular depression is characterised by a low frequency of family history of mental disorder/suicide and anhedonia and increased functional disability. Subsyndomal depression is a fairly common occurrence. Anxiety disorders in the elderly though uncommon need to be recognised. Late-onset schizophrenia and somatic hallucinosis are referred to.
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PMID:Psychiatric morbidity in the aged. 936 69

Coined by Sifneos in 1972, alexithymia refers to a relative narrowing in emotional functioning, an inability to find appropriate words to describe their emotions, and a poverty of fantasy life. Although initially described in the context of psychosomatic illness, alexithymic characteristics may be observed in patients with a wide range of medical and psychiatric disorders: Parkinson disease, depression, anxiety, substance abuse and eating disorders. Flattening of affect and poverty of speech, major negative symptoms, referred to chronic schizophrenia: there is a lack of outward display of emotions. Accordingly, some disturbances of alexithymia's scores would be expected in schizophrenic patients. The aims of this study were: first to establish some correlations between alexithymia and some symptoms of schizophrenia, and second to estimate the intensity of alexithymia in negative versus positive and undifferentiated schizophrenic patients. Twenty-nine patients, meeting DSM III-R criteria for schizophrenia have been studied. All of them treated by neuroleptics, were in a stable clinical status for at least one month. The patients were assessed by one trained psychiatrist (IN) using six rating scales: Beth Israel Questionnaire (BIQ) for alexithymia, Positive and Negative Syndrome Scale (PANSS), Depressive Retardation Rating Scale (DRRS), Montgomery and Asberg Depression Rating Scale (MADRS), revised Physical Anhedonia Scale (PAS), and finally, Extrapyramidal Symptom Rating Scale (ESRS). In the total sample, the mean score of BIQ was 4.79 +/- 1.68 (mean +/- SD). Significant correlations were found between alexithymia and blunted affect (r = 0.376; p < 0.05), poverty of speech (r = 0.471; p < 0.01), anxiety (r = 0.370; p < 0.05), total score of DRRS (r = 0.370; p < 0.05), and motor subscore of DRRS (r = 0.429; p < 0.05). The patients with negative symptoms of schizophrenia had significantly higher total scores in alexithymia (p < 0.05), blunted affect (p < 0.0001), poverty of speech (p < 0.0001), anxiety (p < 0.05), total score of DRRS (p = 0.01) and his motor subscore (p < 0.0001) as compared to positive and undifferentiated subtypes. In our study, alexithymia seems to be correlated with negative and depressive symptoms in negative forms of schizophrenia, regardless of medication status.
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PMID:[Negative symptoms, depression, anxiety and alexithymia in DSM III-R schizophrenic patients]. 941 92

1. Negative symptoms of schizophrenia are characterized by amotivation, anhedonia and anergia. These aspects of the symptom profile can be modeled by D3 agonism in animal behavioral models. 2. Serotonergic systems have been implicated in pathophysiologic substrates for this disorder; most notably, in deficit state schizophrenia, as newer 'atypical' neuroleptics which are especially efficacious for treating this syndrome antagonize central 5-HT2 receptors. 3. FC regions may also be important in chronic negative symptoms, as hypofrontality has been associated with these schizophrenic features. 4. The author examined effects of a behaviorally-active dose of the D3 agonist, 7OH, on 5-HT metabolism in FC, and the ability of a low-dose neuroleptic treatment to antagonize this biochemical effect. 5. Acute administration of 7OH induced a selective decrease of 5-HT turnover in the FC without affecting metabolism of this transmitter in more subcortical DA regions. 6. Hal, which has previously been demonstrated to antagonize electrophysiologic, biochemical and behavioral effects of 7OH, was without effect on agonist-induced decreases in 5-HT turnover. 7. The biochemical association between D3 agonism and reductions of FC 5-HT may be significant for pathophysiologic mechanisms of negative symptoms, and antagonism of this effect may differ for neuroleptics with varying efficacy in alleviating these symptoms.
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PMID:Selective effects on prefrontal cortex serotonin by dopamine D3 receptor agonism: interaction with low-dose haloperidol. 942 27

Coined by Sifneos in 1972, alexithymia refers to a relative narrowing in emotional functioning, an inability to find appropriate words to describe their emotions and, a poverty of fantasy life. Although initially described in the context of psychosomatic illness, alexithymic characteristics may be observed in patients with a wide range of medical and psychiatric disorders: Parkinson disease, depression, anxiety, substance abuse and eating disorders. Flattening of affect and poverty of speech, major negative symptoms, referred to chronic schizophrenia: there is a lack of outward display of emotion. Accordingly, some disturbances of alexithymia's scores would be expected in schizophrenic patients. The purpose of this study was to estimate and compare the prevalence of alexithymia in deficit and non-deficit schizophrenia. The term "deficit symptoms" may be used as Carpenter, to refer specifically to those negative symptoms that are not considered secondary. The influence of patients' symptoms has also been studied on alexithymia scores: negative and positive symptoms of schizophrenia, depression, anxiety, anhedonia and effects of neuroleptics. Twenty-five patients, meeting DSM III-R criteria for schizophrenia have been studied. All of them treated by neuroleptics, were in a stable clinical status for at least one month. The patients have been categorized into deficit (n = 12) and non-deficit (n = 13) subgroups by one trained psychiatrist (SD), using the Schedule for the Deficit Syndrome. The subjects have been assessed by the same rater (IN), blind to deficit status, using six rating scales: Beth Israel Questionnaire (BIQ) and Toronto Alexithymia Scale (TAS) for alexithymia, Positive and Negative Syndrome Scale (PANSS), Montgomery and Asberg Depression Rating Scale (MADRS), revised Physical Anhedonia Scale (PAS), and finally, Extrapyramidal Symptom Rating Scale (ESRS). Using TAS, alexithymic characteristics were more prevalent in the deficit subgroup as compared to non-deficit subgroup (83% versus 30.76%; p < 0.01). Significant correlations were observed in the non-deficit subgroup between: TAS and anxiety (r = 0.743; p < 0.01), TAS and depression (r = 0.568; p < 0.05), BIQ and blunted affect (r = 0.636; p < 0.02), BIQ and poverty of speech (r = 0.629; p < 0.02). These correlations were not significant in the deficit group of patients. Alexithymia in schizophrenic patients seems to be a trait characteristic in deficit patients, and a state related to many symptoms, such as flattening of affect, poverty of speech, depression and anxiety in nondeficit patients.
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PMID:[Alexithymia in negative symptom and non-negative symptom schizophrenia]. 945 28

This study extends our prior research by examining the lifetime comorbidity, history of psychosis and suicide attempts, and current symptoms of an unusual group of patients with major affective disorders who have not only been symptomatic for prolonged periods but have also been so functionally impaired that they required years of care in psychiatric facilities or by family members. Twenty-seven of these deteriorated affective patients and 29 patients with deteriorated schizophrenia were recruited from a large state hospital; 27 patients with non-deteriorated affective disorder were recruited from an affiliated outpatient facility. Patients with deteriorated affective disorder, as compared to those with non-deteriorated affective disorder, were far more likely to have a history of psychotic symptoms with suicidal themes and a history of life-threatening suicide attempts and completed suicide. Deteriorated affective patients were also more likely to meet criteria for melancholia and to have attentional deficits, thought disorder and negative symptoms. The deteriorated and non-deteriorated affective groups had similar lifetime rates of psychotic symptoms (bizarre and non-bizarre) and lifetime psychiatric comorbidity. Functional deterioration in schizophrenia, as compared to functional deterioration in affective disorders, was distinguished by a virtual absence of psychotic symptoms with suicidal themes, lower lifetime rates of life-threatening suicide attempts, greater variety and severity of psychotic symptoms, and greater severity of current affective flattening, anhedonia-asociality and disorientation to time. The results of this study extend our previous research by demonstrating that patients with major mood disorders who have experienced extreme functional deterioration evidence a distinct constellation of symptoms that differentiates them from their better outcome peers with mood disorders, and from similarly functionally deteriorated patients with schizophrenia.
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PMID:Lifetime comorbidity, lifetime history of psychosis and suicide attempts, and current symptoms of patients with deteriorated affective disorder. 946 37

The aim of the study is to explore the validity and the reliability of the French version of the SHAPS in two groups of subjects. 208 healthy students and 103 inpatients meeting the RDC criteria for schizophrenia or depression filled out the French versions of the SHAPS and the revised Physical Anhedonia Scale of Chapman and Chapman. The internal consistency of the SHAPS was measured in each group using first the Kuder Richardson coefficient (point biserial) between the items and the total score. The concurrent validity was studied using the Pearson correlation coefficient between the SHAPS and the PAS in each group. The predictive validity was determined by the comparison of the SHAPS score between the two groups. The reliability was studied using a test-retest in a sub-group (n = 32) extracted of the control group. The values of the KR 20 in the healthy and psychiatric groups were respectively 0.47 and 0.80. The mean of the correlations between the items and the total score were respectively 0.35 and 0.52. The values of the correlations between the SHAPS and the PAS were respectively in the normal and psychiatric groups 0.39 (p < 0.001) and 0.34 (p < 0.001). Psychiatric subjects had a higher score (m = 2.33, sd = 2.68) on the SHAPS than the normals (m = 0.89, sd = 1.18) [F (1,303) = 12.26, p = 0.0005]. The test-retest showed a correlation of 0.56 (p < 0.01) between the two passations of the SHAPS. The metrological parameters of the SHAPS were discussed as well as the utility of that scale compared to the PAS.
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PMID:[Validation of the French version of the Snaith-Hamilton Pleasure Scale (SHAPS, Snaith et al. 1995). Determination of the statistical parameters in 208 normal subjects and 103 hospitalized patients presenting with depression or schizophrenia]. 948 29

In the New York High-Risk Project we have followed two samples of subjects (Sample A and Sample B) at risk for schizophrenic or affective disorders and low-risk controls from childhood to adulthood, in an attempt to identify early predictors of later psychopathology. We administered a large number of cognitive, psychometric and other types of measures to both samples as possible psychopathology predictors, including an index of attentional deviance assessed in childhood, the Physical Anhedonia Scale in adolescence, and three measures of social outcome in adulthood ('Suspicious Solitude', 'Social Insecurity', and 'Lack of Empathy'), derived from the Personality Disorders Examination. In the analysis of the combined samples, parental diagnostic group, gender, attentional deviance in childhood, and physical anhedonia in adolescence were used to predict three measures of social outcome in adulthood. While only physical anhedonia was directly related to all three social outcome measures, with the strongest relationship to Suspicious Solitude, attention deviance successfully predicted two of the three outcomes. Subjects at risk for affective disorder did not show increased levels of attention deviance, physical anhedonia, or social dysfunction, relative to the normal control subjects. Attention deviance appears to be a key neurobiological indicator and physical anhedonia appears to be a potentiating factor mediating the relationship between risk for schizophrenia and later social dysfunction.
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PMID:The New York High-Risk Project: attention, anhedonia and social outcome. 954 84


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