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

This study investigates subjective illness theories of patients with schizophrenia, how they define their health problem, what they assume causes their illness and which course of illness they expect. The predictive value of those theories for patients' compliance with antipsychotic medication is tested. A problem-centered interview was conducted with 77 schizophrenic patients at discharge from inpatient or day hospital treatment. All patients were on clozapine treatment. Interviews were analyzed by means of computer-assisted content analysis. In addition, potential determinants of compliance were assessed using the 9th version of the Present State Examination, the UKU side effect rating scale, a checklist for patients' evaluations of the effect of psychotropic drugs, and a helping alliance scale. Compliance with medication was assessed by interviewing patients at discharge and three months later. Only slightly more than one half of the patients considered themselves mentally ill. They tended to endorse psychosocial causes more frequently as compared with biological causes. Slightly more than 25% of the patients each expected an improvement of the illness, a reoccurrence of the acute psychosis, or a chronic course. Whereas the quality of the helping alliance, delusion of grandiosity, and attitude toward psychotropic drugs proved to have an influence on patients' compliance with antipsychotic treatment, the three components of subjective illness theory (definition as mental illness, assumed etiology, and prognosis) did not have a statistically significant influence. Subjective illness theories vary in patients with schizophrenia. Although they might reflect different styles of coping with the illness, there is no evidence that they directly determine compliance with medication. Patients' views of the helping alliance and attitudes toward drugs should be considered in predicting compliance with antipsychotic medication.
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PMID:Subjective illness theory and antipsychotic medication compliance by patients with schizophrenia. 1235 93

Although outcomes of bipolar disorder with onset in late adolescence and adulthood have been reported, little is known about childhood and prepubertal onset mania. There is a considerable overlap between the diagnostic criteria for mania and disruptive behavioral disorders, particularly attention deficit hyperactivity disorder (ADHD). The overlapping diagnostic boundaries need to be described. We aimed to determine the frequency and severity of symptoms and cycling features in our patients. We reported 7 cases (between 7 and 15 years old) with bipolar phenotype features who were being followed in our unit. The Washington University at St. Louis-Kiddie and Young Adult Schedule for Affective Disorders and Schizophrenia-Present state and lifetime-B. Geller et al.1996 (WASH-U-KSADS) was used for the assessment of psychiatric diagnoses and symptomatology. The Turgay DSM-IV Disruptive Behaviour Disorders Scale was used to determine the frequency of comorbidity between ADHD symptoms and bipolar disorder phenotype features. The most frequent severe symptoms observed at the end of the assessment by WASH-U-KSADS were grandiosity, distractibility, and unusual energy. Four of the cases had mixed cycling features. Five of the cases had ultradian cycling features. All these findings suggest that more research should be carried out on psychosocial and psychopharmacological strategies and pathogenetic mechanisms for mania during the prepubertal and early adolescent years.
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PMID:[Case series with childhood bipolar disorder phenotype features]. 1520 70

For schizophrenic disorders, the clinical conception of "acute state" is widely used in clinical settings to assess the effectiveness of therapeutic programs as well as epidemiological studies. Schizophrenic-specific symptomatology modification, need for hospitalization, significant change in care, disturbances in social behavior or suicide attempts were all used to define acute schizophrenic state. The decision to hospitalize is frequently used to define acute state but refers to multiple factors such as mood disorder, suicide attempts, drug abuse or social and environmental problems. Indeed, several and distinct definitions in a criteria basis form are available but no one has reached consensus. Because recognition of acute schizophrenic state remains based on the subjective clinician's advice, epidemiological and therapeutic studies fail in validity and reliability. The aim of the study was to evaluate how a population of French psychiatrists define criteria and therapeutic targets of acute schizophrenic state in their clinical practice. Psychiatrists filled out a self administered interview. At the time the interview was given, clinicians were notified that they were participating in a clinical consensus survey about schizophrenia. Six major indicators for acute state definition based on the literature data were proposed: general schizophrenic symptomatology modification (depression, anxiety, agitation, impulsivity/aggressiveness), specific schizophrenic symptomatology modification (positive symptoms, negative symptoms, disorganization), need for hospitalization, significant change in care, disturbance in social behavior and lastly, suicidal behavior. Minimal duration (1.2 or 4 weeks) of general and specific schizophrenic symptomatology modification required to define acute state were evaluated. The booklet included the 30 PANSS symptoms listed with their definitions. Among this symptom list, clinicians were instructed to select the ten criteria which they estimated best defined the acute state, followed by the ten most important target symptoms to be treated. Out of 2,369 questionnaires, 1,584 were collected on time (66.9%). Among the six majors indicators proposed to define acute state 75% of psychiatrists considered 1 to 3 criteria. Three were more frequently rated, including core schizophrenic symptomatology disturbance (68.4%), general schizophrenic symptomatology disturbance (68.0%) and suicidal behavior (64.9%). The other criteria were rated as follows: need for hospitalization (26.8%), significant change in care (18.3%), and disturbance in social behavior (29.1%). For 53.2% of psychiatrists the definition of acute state requires the presence of specific schizophrenic symptomatology for a minimal duration of one week. Two weeks with general symptomatology was required for 45.5% of psychiatrists to define acute state. Symptoms more often rated within the four first choices for acute state definition included delusions, conceptual disorganization, hallucinatory behavior and excitement. Except for grandiosity, all the PANSS positive subscale items were chosen to be included in the definition (delusions, conceptual disorganization, hallucinatory behavior, excitement, suspiciousness/persecution and hostility). Four items, including anxiety, depression, uncontrolled hostility, inner tension from the general psychopathology subscale were chosen as part of the ten most important criteria to define acute state. On the PANSS negative subscale (blunted affect, emotional withdrawal, poor relationships, passive apathetic withdrawal, difficulty in abstract thinking, lack of spontaneity/flow of conversation and stereotyped thinking), no item was rated to be included in the acute state definition. The highest rated symptoms among the four first choices for treatment included delusions, hallucinatory behavior, excitement and anxiety. The ten most important criteria for treatment were the same as for acute state definition with differences in frequency. Excited state, depression and suspiciousness/persecution were more rated for treatment than definition whereas delusion, hostility and conceptual disorganization were less rated as treatment target than definition criteria. In clinical practice, recognition of acute schizophrenic state is underscored by the association of specific schizophrenic symptomatology (positive symptoms, negative symptoms, disorganization) and general symptomatology (impulsivity/aggressiveness, anxiety, depression, agitation) of schizophrenia. For most clinicians, acute state definition requires specific symptom for a minimum of one week and other non-specific indicators such as suicidal behaviour have to be taken into account. With regard to PANSS criteria, most positive schizophrenic symptoms and some general schizophrenic symptoms are necessary for definition and designated as treatment priorities. Negative symptoms were not taken into account. Hallucinatory behavior is the first symptom rated in definition and is considered by psychiatrists as the absolute therapeutic priority. This survey could be a first step in the construction of an operational and consensual definition. This definition is strongly needed as a valid measurement in therapeutic and epidemiological outcome studies, which remain at least partly based on clinician subjective judgment.
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PMID:[Acute schizophrenia concept and definition: investigation of a French psychiatrist population]. 1597 35

One of the strongest correlations found between clinical symptoms and a biological index is that between the severity of positive symptoms of schizophrenia and the amplitude of the event-related potential (ERP) in the time window of the P300 deflection at left temporal scalp sites. The functional significance of the ERP component at stake is yet unknown. The present study aims at addressing this issue by testing whether or not the correlation a) is found in both the auditory and the visual modality, b) is restricted to the time window of the P300 deflection, and c) is stable over time. 12 patients suffering from schizophrenia were recorded 6 times at two month intervals in two oddball protocols, an auditory and a visual one. The correlation between the scores for the thought disturbance cluster of the PANSS (a cluster including most positive symptoms, i.e., conceptual disorganization, unusual thought content, grandiosity and hallucinations) and the P300 amplitude at left temporal sites was found 1) to occur only in the auditory modality, which, together with the late timing of the component, constrains its functional significance, 2) to appear in a time window adjacent to that of the P300 including at additional electrode sites, which would have to be confirmed by further studies, 3) to vanish along with the repetition of the recording sessions, which suggests that it is related to a processing difficulty that disappears with training.
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PMID:The correlation between positive symptoms and left temporal event-related potentials in the P300 time window is auditory specific and training sensitive. 1602 25

Delusional paranoia has been associated with severe mental illness for over a century. Kraepelin introduced a disorder called "paranoid depression," but "paranoid" became linked to schizophrenia, not to mood disorders. Paranoid remains the most common subtype of schizophrenia, but some of these cases, as Kraepelin initially implied, may be unrecognized psychotic mood disorders, so the relationship of paranoid schizophrenia to psychotic bipolar disorder warrants reevaluation. To address whether paranoia associates more with schizophrenia or mood disorders, a selected literature is reviewed and 11 cases are summarized. Comparative clinical and recent molecular genetic data find phenotypic and genotypic commonalities between patients diagnosed with schizophrenia and psychotic bipolar disorder lending support to the idea that paranoid schizophrenia could be the same disorder as psychotic bipolar disorder. A selected clinical literature finds no symptom, course, or characteristic traditionally considered diagnostic of schizophrenia that cannot be accounted for by psychotic bipolar disorder patients. For example, it is hypothesized here that 2 common mood-based symptoms, grandiosity and guilt, may underlie functional paranoia. Mania explains paranoia when there are grandiose delusions that one's possessions are so valuable that others will kill for them. Similarly, depression explains paranoia when delusional guilt convinces patients that they deserve punishment. In both cases, fear becomes the overwhelming emotion but patient and physician focus on the paranoia rather than on underlying mood symptoms can cause misdiagnoses. This study uses a clinical, case-based, hypothesis generation approach that warrants follow-up with a larger representative sample of psychotic patients followed prospectively to determine the degree to which the clinical course observed herein is typical of all such patients. Differential diagnoses, nomenclature, and treatment implications are discussed because bipolar patients misdiagnosed with schizophrenia are severely misserved.
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PMID:Hypothesis: grandiosity and guilt cause paranoia; paranoid schizophrenia is a psychotic mood disorder; a review. 1805 9

One hundred and four male patients hospitalized for the first time with the diagnosis of first-episode schizophrenia were comprehensively assessed on admission and discharge. Psychopathology, treatment response, and remission rates were evaluated (based on the Positive and Negative Syndrome Scale (PANSS), severity of symptoms only). On admission, the most frequently observed symptoms were lack of judgment and insight (87.6%), suspiciousness/feelings of persecution (82.3%), delusions (77%), poor attention (70%), disturbance of volition (65.4%), conceptual disorganization (64.7%), and active social avoidance (64%). Except for delusions and hallucinations, the positive items of the PANSS correlated significantly with negative symptoms, and conceptual disorganization correlated with the greatest number of negative symptoms. Individual negative symptoms were present in about half the patients. At discharge, the most frequent symptoms were again lack of judgment and insight (in 55.7%), and for negative symptoms they were blunted affect (22.1%), emotional withdrawal (21.2%), and passive/apathetic social withdrawal (19.5%). The positive symptoms of suspiciousness/feelings of persecution and grandiosity persisted in 20.6% of patients. On average, all symptoms were significantly reduced 44 days after admission. The negative symptoms improved less, compared with the positive ones. At discharge there was a high rate of responders (response defined as minimal 30% reduction of total PANSS): 73% and 74% of patients fulfilled the criteria for remission. On admission, the responders (n = 76) had significantly higher scores of most symptoms, both positive and negative ones than nonresponders (n = 28).
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PMID:Psychopathology and treatment responsiveness of patients with first-episode schizophrenia. 1856 64

Latent class analysis (LCA) has emerged as the best suitable statistical tool to identify separate dimensions (latent classes) when analyzing dichotomous data; its objective is to categorize people into classes using the observed items and to identify those items that best distinguish between classes. LCA was applied to the Peters et al. delusions inventory, an inventory in a dichotomous format (Yes/No) aimed at investigating proneness to delusion in the general population. The study involved 82 patients diagnosed with a psychotic disorder and 210 well-matched healthy controls from the community. Four classes were identified in the sample: a normative one, and 3 classes traceable to the 3 major dimensions of psychosis, i.e., paranoia, grandiosity/hypomania, and the schizophrenia-like profile. The coherent multidimensional structure of the model emerging from LCA of Peters et al. delusions inventory suggests that single clusters of symptoms may be indicative of specific diagnostic categories within the spectrum of psychoses, allowing a more subtle determination of their boundaries and correlates.
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PMID:Latent class analysis of delusion-proneness: exploring the latent structure of the Peters et al. delusions inventory. 1897 74

Whether studies agree or disagree on the positive-negative dichotomy in schizophrenia, the relevance of a third component, disorganization, remains a point of debate. Disorganization, as expressed by the scale for the assessment of negative symptoms and positive symptoms (SANS-SAPS) and the positive and negative syndrome scale (PANSS) principal-component analyses, could be considered as permanent and determinant a dimension as the positive and negative components. The aim of this study therefore was to determine whether this disorganization, with the negative and positive components, is stable and has the same composition in the acute and postacute phases of illness. This study was carried out in 57 patients, broadly defined by at least one of four diagnostic criteria (American Psychiatric Association, Langfeldt, Carpenter and Schneider), established with a computerized checklist, and evaluated with SANS-SAPS and PANSS. Principal component analyses (PCA) of these scales were performed at admission and discharge from hospital. The PCA of SANS-SAPS displayed a 3-factor solution, regardless of the phase of illness (acute or postacute), showing that the negative, positive and disorganization components were stable. The PCA of PANSS yielded negative and positive components perfectly stable over time and a disorganization component whose composition varied between admission and discharge. At admission, this component included the conceptual disorganization item negatively correlated with one of depression. At discharge, this disorganization component included two additional items, autistic preoccupation and mannerisms and one depression component appeared. The instability of the PCA of PANSS could express the role played by the phase of illness; in an acute phase, this disorganization component was constituted by more "positive" items such as grandiosity, unusual thought content and active social avoidance whereas in the postacute phase, it included items that reflected more the chronicity of the illness, such as mannerisms and autistic preoccupation. Moreover, the depressive item appeared, in the postacute phase, in a specific depressive component. This result could be due to the fact that depressive symptoms cannot be expressed when positive symptoms are very severe, which explains why no depressive components were shown during the acute phase.
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PMID:Principal-component analyses of PANSS and SANS-SAPS in schizophrenia: their stability in an acute phase. 1969 21

To better understand the problems associated with diagnosis of bipolar disorder, especially problems related to race and ethnicity, this study compared whites, African Americans, and Latinos with bipolar I disorder in the presentation of manic symptoms, depressive episodes, functional impairments (Short Form-12), and self-reports of schizophrenia diagnosis. Data for this study were derived from the 2001 National Epidemiologic Survey on Alcohol and Related Conditions, which are nationally representative of United States households. African Americans and Latinos expressed similar rates in presentation of 14 out of 16 manic symptoms compared with whites, with the exception of grandiosity/self-esteem, in which they were more likely to exhibit this symptom compared with whites. Higher rates of depressive episodes were observed among whites, and these episodes occurred significantly earlier compared with African Americans and Latinos. Latinos had slightly higher vitality scores on the SF-12 measures after adjusting for sociodemographic and clinical factors, but no other differences across the groups were observed. Overall, these data show that the expression and functional impairments of bipolar I disorder is very similar across racial ethnic groups using this community-based sample. This is the first community-based study making such comparisons, with results suggesting that provider biases are more likely to explain problems in misdiagnosis than fundamental differences in the presentation of bipolar disorder across racial/ethnic groups.
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PMID:Racial/Ethnic group differences in bipolar symptomatology in a community sample of persons with bipolar I disorder. 2006 64

Several multi-dimensional self-report scales have been developed to assess delusional ideation in the general population. However, self-ratings of positive symptoms in patients with psychosis are often considered unreliable due to neuro-cognitive disturbance and lack of insight. This study tested associations of self- and observer-rated delusions as well as factors associated with discrepancies. Observer-rated delusions were assessed in 80 in- and outpatients with schizophrenia spectrum disorders by trained raters with the Positive and Negative Syndrome Scale. Self-rated delusions were assessed with the Peters et al. Delusions Inventory and the Paranoia Checklist. Correlations between self- and observer-rated overall delusions ranged from 0.49 to 0.57. Associations between specific delusions of persecution and grandiosity were moderate but unique. Good concordance of ratings was not restricted to outpatients or patients with fewer positive symptoms. Patients with lower self- than observer ratings of delusions were characterised by fewer years of education, lower functioning, more negative symptoms and less insight. The results indicate that patients can reliably provide information with regard to the presence and type of delusional beliefs. Thus, patient ratings are a valid additional source of diagnostic information.
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PMID:Can delusions be self-assessed? Concordance between self- and observer-rated delusions in schizophrenia. 2048 72


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