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Query: UMLS:C0036341 (schizophrenia)
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In countries where it has been studied, between 10 and 15% of adolescents appear to have an emotional disorder, and an additional 5-10% have significant emotional symptomatology. Despite this prevalence, pediatricians appear poorly trained to identify children with emotional and behavioral problems. This paper focuses on schizophrenia, affective and chronic stress disorders. Schizophrenia in adolescence has a reported prevalence ranging from 0.9/10,000 hospital admissions for adolescents in Great Britain to 0.4% of cases in a university setting in the United States. For affective disorders, studies have placed the prevalence rates at nearly 3% for boys and almost double that for girls. A much larger percent of adolescents have significant depressive symptomatology. Many youths grow up in chronically stressful environments. This paper reviews the prevalence as well as the major diagnostic and prognostic issues, for the leading chronic mental health disorders of youth.
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PMID:Chronic mental illness in adolescence: a global overview. 188 36

The psychoanalytic treatment of psychotic disorders has had a long and complicated history because of the historic preference of psychoanalysis for neurotics. Nevertheless, it has survived the prejudice of psychoanalysts and empirical psychiatrists and now enters an interdisciplinary phase in which psychotic psychopathology is understood as primarily an emotional disorder, but one that must also be considered from the point of view of neurobiology and neuropsychology as well as sociology. In this contribution, I offer the idea that perhaps the most important subtext in the psyche of the psychotic is what has been called the black hole. This massive deficit is ultimately attributable to a precocious abruption of the mother's physical and psychical presence from the infant, a phenomenon that has hereditary, congenital, perinatal, and continuing developmental reinterpretive elaborations. The psychoanalytic treatment of the psychotic consists of reversing the direction of his or her cataclysmic descent into the black hole and, at the same time, empathically loosening the control that the protective psychotic alterego has on the surviving self. Further, the psychoanalytic treatment of schizophrenia, in particular (as well as many of the other primitive mental disorders), now frequently involves both an interdisciplinary orientation and perspective and choices of interdisciplinary modalities extending across the whole biopsychosocial spectrum.
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PMID:The "black hole" as the basic psychotic experience: some newer psychoanalytic and neuroscience perspectives on psychosis. 235 72

Although recent studies refute the assumption that hysterectomy and sexual sterilization are associate with psychiatric morbidity and longterm psychological sequelae, it is important that gynecologist be familiar with their clients' psychiatric histories, if any. A past history of a psychiatric disorder repeatedly has emerged as the major predictor of an adverse psychiatric outcome following gynecological surgery. The outcome of hysterectomy is influenced more by the presence of a pre-existing psychiatric diagnosis than by physical or demographic factors, including marital status, age, and parity. Hysterectomy candidates with a past or current history of minor or neurotic psychiatric disorders should be monitored for 18 months after surgery for possible depression or anxiety. For women suffering from a major mental disorder, such as schizophrenia or manic-depression, the hysterectomy should be delayed until the psychiatric condition is under control. There is also strong research evidence linking preoperative psychiatric status to adverse reactions to sterilization, especially regret and a deterioration in psychosexual functioning. Interval sterilization appears to be associated with a lower risk of subsequent mental disturbance than procedures performed postabortion or postpartum. Since psychological problems often decrease a woman's capacity to cope with symptoms that would otherwise be tolerable and increase subjective feelings of distress, an assessment should be made as to which is more basic--the gynecological symptoms or the emotional disorder. attention to psychiatric history is also important since mental problems may interfere with treatment and delay recovery from surgery.
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PMID:Psychological aspects of gynaecological surgery. 270 Jan 40

Cognitive aspects of emotionality were psychologically investigated in 250 patients with continuous and paroxysmal progredient schizophrenia and differently pronounced defect. The control group consisted of 100 normal subjects. A set of 7 techniques was applied. In cases of the patient's defect accentuated, cognitive emotional disorder was marked with the emotions and emotiogenic situations underestimation in dealing with other people and cognitive activities. This underestimation was not a uniform one concerning to a larger extent the strong emotions in other subjects, patients' own positive emotions, success in individual problem solving and degree of success in cooperative performance. Weak emotions, negative ones and failure situations were underestimated to a lesser degree, as was the success rating in competitive paradigms.
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PMID:[Psychological research on the cognitive aspect of emotional processes in schizophrenia patients]. 318 62

The psychopathology of acute organic psychosis was investigated by interviewing 74 patients using the Present State Examination (PSE). Their delusions, perceptual disturbance, thought disorder, and emotional disorder were categorised and then compared with those seen in 74 acute schizophrenics. In acute organic psychosis there was a particular pattern to the delusions, perceptual disturbance, and thought disorder, which was quite unlike that seen in acute schizophrenia. These results have implications for theories claiming that schizophrenia is an organic psychosis. It is suggested that the psychopathology in acute organic psychosis has very different origins from that seen in schizophrenia.
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PMID:The phenomenology of acute organic psychosis. Comparison with acute schizophrenia. 342 88

Announcement of schizophrenia diagnostic to the patients is a topical issue in France. The evolution in clinical practices, a better efficiency in therapeutic procedures and the fundamental right of the patient to obtain information have initialised the discussion of its interest. Spontaneous claim for information from the patient is rarely observed although awareness troubles might be reported at the instauration of the mental disorder or during its evolution. Methodological studies concerning the diagnostic announcement are limited. Except the Bayle studies recently published, only a few publications are available in France about the knowledge of their pathology and their need to be clearly informed. French scientific literature deals generally about medico-legal aspects of this information and consisted of survey about diagnostic announcement. International literature is more abundant and presents positive and negative aspects of the announcement. An information procedure of schizophrenia announcement to the patient has been developed in our hospitalisation unit of psychiatry. This procedure has taken place on the basis of the literature data, our specificity and our clinical experiences. For some Anglo-American psychiatrists who have proceeded to semi-structured interview in order to announce the diagnostic, information to the patients might improve the clinical relationship. Thus, compliance to the treatment is significantly increased. The ability of the patient to recognise the symptoms of the disease and to accept their consequences and the treatments is associated to a better social prognosis, daily activities and response to the treatment. The announcement impact justifies the prescription of neuroleptics, treatment that is notoriously perceived as prejudicial by the patients themselves or more commonly in the basic population. To obtain compliance to the treatment, a satisfactory acceptance of the mental disorder is required. Compliance is based on satisfactory information in order to gain the cooperation of the patient and its relative (10). Atkinson has classified four main types of arguments, the ethical principle to be informed, talk to explain and give sense to the symptoms, reduce the feeling of guilt perceived by the patient and his relative and enhance the collaboration between the patient and the nursing staff. According to Ferreri and Bayle studies French psychiatrists reluctance to announce schizophrenia diagnostic are the following: lack of request or of interrogations asked by the patient about their disease, diagnostic and prognosis uncertainty and irreversibility of the disease, complexity of the pathology and its origin which hinder an accessible explanation, cognitive disorders frequently observed with schizophrenic patients which may be associated with difficulties of understanding information, destabilization of the patient-nursing staff relationship and social stigmatisation risks. Other arguments like reluctance to give a "label" to the disease, too abstract diagnostic, a negative social vision and the possibility of discouragement for the relative are classically retrieved in French literature. In fact, divulgation of the term schizophrenia involves a panel of negative representations and is hindered by the confusion in the social imagination of such a term related with lost of control, quintessence of madness, dangerous behaviour possibilities, evil and incurability. Some psychiatrists do not transmit information arguing that significant obstruction of the future may be consecutive to the information. They prefer to use vague terms more socially acceptable like "nervous breakdown or depression, atypical or emotional disorder, dissociative troubles...". Information to the patient about his mental disorder is more frequent in psychiatry for affective, anxious and additive troubles than for schizophrenia. Our procedure of diagnostic announcement has been elaborated after preliminary discussion with the medical and nursing staff. Diagnostic of schizophrenia announcement has been presented by weighing the pros and cons according to the intemational literature. It clearly appeared that benefits for the patients prevail on the drawbacks. Nevertheless, inclusion and clinical supervision have to be carefully precised in particular to verify the ability to receive information. Short term objectives: deliver progressively information to the patient about his disease by means of an active and educational process with hope and optimism using a accessible language (explanation of each terms used with the intention of being well understood); quantify the impact of diagnostic announcement on the schizophrenic patient using clinical rating scales during a period of one month (clinical interview at day 1, day 7 and day 28). Mid term objectives: improve the global supervision and autonomy of schizophrenic by means of a therapeutic project helping the patient to become an active partner in the monitoring of his mental disorder; enhance a psycho-educational program after the procedure of announcement in order to optimise the observance of his treatment, increase his quality of life and answer to the requests of his relative; 45 patients (age 29.3 +/- 8.8 years old) have been included to be informed on their diagnostic since the elaboration of this procedure during a time period of 24 months. Time interval between the beginning of their pathology and the delivering of this information was 4.7 years. Most of them (56%) presented a paranoid type of schizophrenia. In most of the cases, the patients did not know their diagnostic or declared suffering from a diagnostic, which was erroneous; 80% of the 45 patients have complied with the procedure until its end. On more than 24 of following after the instauration of the diagnostic announcement procedure, these patients ha ve presented satisfactory observance to the medical supervision (medical consultation and drug intake); 60% of the patients were regularly present to their medical appointment. The number of patients included (45 patients) appears small compared to the time interval of the study (24 months) but was significant according to the great changes in our clinical approach. Thus, this procedure was not systematically applied, in particular the patients who did not want to be informed on their disease. Is it clinically relevant or not to announce diagnostic of schizophrenia to the patient? This issue remains questioned according to the few studies published at the present time, any consensus has been clearly presented on formal indications or contra-indications. If on an ethical side, this information appears logical, the medical and nursing staff should require special care. Special care must be taken before delivering information to the patients; each situation must be evaluated in order not to comply with an ideology of total and inadequate information, which could have serious consequences. Nevertheless, it appeared clearly that information must be given to stabilized patients with satisfactory insight. Moreover, psychotherapeutic projects become easier because patients awareness and understanding towards pathological symptoms are greatly improved. Partnership between patient and medical staff is the key of this dynamic and psycho-educative procedure, which opens new horizons in our therapeutic prospect.
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PMID:[Schizophrenia diagnostic announcement in a French psychiatric unit]. 1638 12

Diagnosing schizophrenia in children is difficult, especially in the early stages. A possible explanation is that our knowledge of symptoms is insufficient. Moreover, there are no specific classification systems for diagnosing childhood schizophrenia. A seven year-old boy presented with symptoms resulting in differential diagnostic considerations of attention deficit/hyperactivity disorder or a behavioural or emotional disorder. The boy had auditory hallucinations, was socially dysfunctional and had emotional contact disturbances, leading to the schizophrenia diagnosis.
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PMID:[Schizophrenia in a seven year-old boy]. 1843 77

A diagnosis of psychosis has tended to discount the considerable degree of emotional disorder associated with it, in a manner that may also inform psychological treatment options. Depression and anxiety are often associated with schizophrenia. Up to 40% of people have clinical levels of depression and anxiety symptoms could occur in 60% of patients with chronic psychotic disorder. Among emotional problems depression and depressive symptoms are well recognised and treated with success, whereas anxiety is a less known phenomenon and has not been studied as much as depression. Comorbid anxiety disorders or symptoms (social phobia, panic disorder, obsessive compulsive disorder, and post-traumatic stress disorder) occur in patients with psychosis in the same way as in patients who have only anxiety disorder. This comorbidity adversely affects outcome, and it may also reflect on processes underlying the development of psychotic symptoms. The present review highlights some major characteristics of anxiety and psychosis and also some aspects of coping and treatment strategies for anxiety in patients with psychosis.
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PMID:Comorbid anxiety in patients with psychosis. 1978 84

Schizophrenia, described as the worst disease affecting mankind, is a severe and disabling mental disorder. Schizophrenia is characterized by complicated symptoms and still lacks a diagnostic neuropathology, so developing schizophrenia animal models which have quantifiable measures tested in a similar fashion in both humans and animals will play a key role in new therapeutic approaches. According to the symptoms of cognitive impairment and emotional disorder, the N-methyl-d-aspartate (NMDA)-receptor antagonist MK-801 was applied to induce schizophrenia-like behavior in mice. Locomotor activity and prepulse inhibition (PPI) were selected as indices and the effect of clozapine was also investigated in this model. The results showed that compared with the normal group, MK-801-treated mice exhibited significantly increased locomotor activity and impaired PPI, and pre-exposure to clozapine could ameliorate the abnormality and make it back to normal level. These findings suggest that the model we established could be a useful tool for antipsychotic drug screening.
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PMID:[Establishment and application of a mouse model for drug-induced schizophrenia]. 2383 33

Emotional disorders and cognitive dysfunctions are important treatment targets in psychiatric clinical settings. The biological mechanisms of emotional disorders have been studied with methods that include fear conditioning, schizophrenia models are studied with methamphetamine-induced reverse tolerance in rats, and dynamic changes in brain neurotransmitters are studied with microdialysis and high-performance liquid chromatography. We combined these methods in order to evaluate dopamine dynamics in the amygdala and the biological bases and relationships of emotional disorder and cognitive dysfunction. Fear-conditioned rats showed freezing behavior and dopamine release in the amygdala in response to conditioned stimuli. Methamphetamine-induced reverse tolerance rats showed increased dopamine release in the amygdala in response to conditioned stimuli. The increased release of dopamine continued after the freezing behavior had ended. This increased and long-lasting dopamine release may reflect abnormal emotional context processing in cognition in schizophrenia. Antipsychotic drugs, such as haloperidol, aripiprazole, and clozapine, suppress this increased release of dopamine in the amygdala in response to conditioned stimuli. These findings suggest that antipsychotic drugs may stabilize abnormal emotional context processing in cognition in this model. We conclude that the significance of pharmacotherapy in schizophrenia is that antipsychotic drugs stabilize the emotional context processing in cognition and adjust the relationship of emotion and cognition.
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PMID:[Significance of the pharmacotherapy of schizophrenia in the emotional context processing of cognition]. 2506 42


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