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

The clinical data and forensic aspects of 28 individuals charged with murder and 10 charged with attempted murder examined over the last 35 years are recorded. The majority of those aged 40 years or over were criminally insane. A positive family history of psychiatric illness was present in the majority of the criminally insane group. Murder and attempted murder in the setting of a stable marriage was almost invariably the result of serious psychiatric illness. After the clearcut cases of schizophrenia and depressive illness were separated there were left a mixed paranoid group and a large group of individuals with severe personality disorders. Of the forensic aspects a case is made for the wider use of "unfitness to plead" in the severely psychotic. The follow-up of cases strongly suggested that those found not guilty on psychiatric grounds were likely to be held for longer periods than those treated as criminals. The author suggests that the public would be better protected if the Crown sought an insanity verdict in some cases rather than oppose it.
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PMID:Psychiatric aspects of murder and attempted murder. 106 31

This review of the literature does seem to reveal an association between schizophrenia and a variety of antisocial behaviors that include violent crime, and even homicide, especially in North America. The literature consistently shows that since the 1950s, schizophrenics have been involved in crime and arrested more frequently than the general population, they are overrepresented in correctional settings, and they represent the majority of those found not guilty by reason of insanity. Many authors cite changes in mental health policies, particularly de-institutionalization, as one of the major causes of these phenomena. It is important to note that a history of prior arrests and of being male, poor, unskilled, uneducated, and unmarried are perhaps the best predictors of antisocial behaviors in the mentally ill and in the general population alike. Schizophrenic drift and increased family pathology in schizophrenic families, however, may predispose people suffering from schizophrenia to these demographic variables. Interestingly, these variables do not seem as relevant in the emergency room or inpatient wards where violence seems to be mainly affected by the severity of psychopathology, substance abuse, neurologic signs, and the environment within the mental health setting. The implications for the practice of psychiatry are diverse. Clearly clinicians in both hospitals and community mental health settings must have experience, training, and an awareness of the literature relating to the prevention, causes, and management of violence. It behooves us in the mental health field, having vociferously supported the community mental health movement, to assist police in the management of the mentally ill who are now in the community, perhaps by the use of mobile crisis intervention teams and by a considerably increased amount of effort and cooperation. Correctional services require urging to develop resources for identifying and tracking the mentally ill so as to be able to provide programs and continuity of care. Community mental health and criminal justice systems need to cooperate in planning the transition of mentally abnormal offenders from prisons into the community and then providing support and after-care for them. One exemplary program that has developed and benefited from the coordination and planning at the interministerial level is the Inter-ministerial Project (IMP) program in Vancouver. This program identified the people whose histories revealed repeated admissions to both correctional and mental health facilities, bouncing between one and the other. Using a case management approach with a limited caseload, clinicians were able to reduce the number of admissions to both types of facilities. This program should serve as a model for other jurisdictions.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The forensic psychiatric aspects of schizophrenia. 140 22

The geographic distribution of insanity and schizophrenia in the United States is examined for 9 separate years between 1880 and 1963. A concentration of these conditions in Northeastern and Pacific Coast States was remarkably consistent over the 83 years. States with a high prevalence rate had approximately three times more insanity and schizophrenia than those with a low prevalence rate. There is a direct regional correlation of insanity/schizophrenia with urbanization, which is consistent with previous studies. There is also a direct regional correlation of schizophrenia with socioeconomic status, which contradicts previous studies carried out in large cities in which the schizophrenic rates were inversely correlated with socioeconomic status. The apparent discrepancy can be explained by postulating that the direct regional correlations are due to correlations of urbanization and socioeconomic status (cities have higher mean incomes than rural areas) whereas, within a particular city, schizophrenia is more prevalent among lower socioeconomic groups because of drift and other factors. Social, stress and crowding, genetic, and biological factors are discussed as possible explanations for the urban factor associated with insanity/schizophrenia.
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PMID:Geographical distribution of insanity in America: evidence for an urban factor. 207 37

After John Warnock Hinckley jr. had fired shots at President Reagan and had severely injured three others, he was considered not guilty by reason of insanity and brought to a psychiatric hospital. The case caused an unprecedented public interest because the psychiatric testimonies were contradictory (schizophrenia vs. personality disorder). According to the known facts it is very unlikely that a German psychiatrist would have diagnosed Hinckley as schizophrenic. One of the sequels of the sentence was a lowering of the reputation of psychiatrists for their inability to arrive at clear diagnosis. Another sequel was to increase the funds for research in biological psychiatry. Still another sequel was an insanity defense reform bill. The scientific debate and public discussions continue.
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PMID:[The Hinckley case and some sequelae for psychiatry]. 226 96

Thirty-one female insanity acquittess from Connecticut were matched to a group of 31 male NGRIs. The samples were compared with regard to demographic, criminal, and clinical characteristics. Logistic regression analyses were used to determine predictors of criminal recidivism for the sample. Results indicated that women NGRIs were older, more likely to be married, less likely to be substance abusers, had less extensive criminal records, and were released from hospitals sooner than the men. A significant racial difference was noted: white women had less extensive criminal records and were hospitalized for shorter periods than minority women. Results of the logistic regression analyses showed that the strongest independent predictors of criminal recidivism were race and having a diagnosis other than psychosis (schizophrenia, affective or organic disorders). Findings support recent APA policy guidelines on the insanity defense.
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PMID:Part II: Sex differences in persons found not guilty by reason of insanity: analysis of data from the Connecticut NGRI Registry. 237 74

For the last century scientists have attempted to demonstrate high rates of insanity among the Irish. Recent prevalence studies of schizophrenia claim that there is indeed a greater number of cases in the west of Ireland than in other parts of the world. Cultural and genetic hypotheses have been advanced to explain these figures without a critical examination of the studies at the basis of this claim. The relevant underlying research and the resulting hypotheses are reviewed to show that their conclusions are equivocal and ungeneralizable. This is most often due to the method of case collection and inconclusive cross-cultural comparisons. It is hoped that Ireland will not henceforth be considered a high prevalence area for schizophrenia without more reliable research in this topic.
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PMID:The incidence and prevalence of schizophrenia in the Republic of Ireland. 239 78

Risk of relapse and recidivism makes the failure to take antipsychotic medication as prescribed a significant issue in forensic psychiatry. This question may arise in such contexts as the setting of bail, plea bargaining, the insanity defense, and sentencing. We have reviewed the literature on medication noncompliance in schizophrenia and present here the results, organized by topics relevant for the work of forensic mental health experts. Reported rates of noncompliance vary widely, reflecting major differences in the populations studied and the methods used as well as the complexities involved in defining noncompliant behavior. A noncompliance rate of 50 percent has been attributed globally to chronic patients, both medical and psychiatric. The tendency of significant factors to interact precludes a simple typology of noncompliance. However, environmental security and supportiveness correlate positively with adherence; whereas anxiety, paranoia, grandiosity, depression, and side effects correlate negatively. Clinicians' assessments of whether medication is being taken have proven to be unreliable. Although monitoring by chemical measurement, particularly a radioreceptor assay for urine samples, can be useful, depot injection ensures that prescribed medication is being taken. Less invasive means of promoting compliance are described; psychodynamic and ethical issues to be considered in the monitoring and promotion of compliance over extended time periods are presented. We also probe the link between medication noncompliance and behavioral relapse. The time between default and relapse is most often measured in weeks. Whether due to medication withdrawal or not, the relapse pattern of each individual tends to repeat, allowing its recognition before recidivism occurs. Restarting medication at this stage, especially with a dosage increase, is usually effective. In sum, the forensic mental health expert can now readily use a large and diverse literature to assist with a variety of significant issues.
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PMID:Medication noncompliance in schizophrenia: codification and update. 287 51

The hypothesis that schizophrenia is a recent disease can explain why descriptions of schizophrenia-like disorders were rare before 1800, why the prevalence of insanity in the Western world increased during the 19th but remained low in the non-Western world until the 20th century, and why schizophrenia has become milder in the West during recent decades. It also explains why schizophrenia has 'persisted' in spite of its associated low fertility. The evidence for the hypothesis is somewhat frail, but perhaps not more so than that for alternative hypotheses.
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PMID:Schizophrenia as a recent disease. 277 63

Using 35 variables and discriminant analysis procedures, it was found that, of 133 male defendants entering the insanity plea in Colorado, 87 percent were classified correctly into the disposition groups "adjudicated insane" and "convicted." Most positively related to an insanity adjudication were a psychiatric evaluation of insanity and a diagnosis of schizophrenia. Negatively related to the insanity verdict were diagnoses of substance use and personality disorders.
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PMID:Insanity plea: predicting not guilty by reason of insanity adjudications. 336 77

Between 1936 and 1950, detailed abstracts were prepared on all patients admitted to The Phipps Psychiatric Clinic from its opening in 1913 through 1950. Of these abstracts, 74% contained follow-up reports. Except for four papers on schizophrenia and affective disorders published between 1939 and 1943, none of this material has ever been analyzed. The present paper, the first of a series, examines the 8172 first admissions from 1913 through 1940, the period of Adolf Meyer's tenure as Clinic Director. Based on discharge diagnoses, we have sorted the patients into eight diagnostic groups with the following frequencies; schizophrenia, 17%; paranoid state, 3%; manic-depressive, 7%; depression, 27%; organic, 20%; neuroses, 15%; substance abuse, 6%; psychopath, 5%. Our manic-depressive group contains cases discharged primarily as hyperthymergasia, mania, or manic depressive insanity (MDI). Of the 349 cases diagnosed MDI at discharge, 10 had neither a history of nor present symptoms of mania, and these were put in the depression group. Frequencies for most of the diagnoses remained remarkably stable over the 28-year period. Only 9% were discharged recovered, whereas 43% were rated unimproved. Mean length of hospitalization was 76 days, with 10% of the patients readmitted. The mean length of follow-up was 9 years. Correlations of diagnoses, year of admission, length of stay, condition at discharge, age, sex, readmissions, change of diagnoses, somatic treatment, length of follow-up, and deaths in the clinic are presented. Meyer's influence on diagnostic practice is discussed.
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PMID:Inpatient diagnoses during Adolf Meyer's tenure as director of the Henry Phipps Psychiatric Clinic, 1913-1940. 353 8


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