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

The relationship between violent behavior and length of hospitalization was studied in a retrospective chart review of 253 patients admitted to a university-based acute inpatient unit. Violent behavior was defined as physical attacks on persons or fear-inducing behavior before admission or during initial hospitalization, and its value as a predictor of length of stay was assessed in multiple regression analyses that also included 20 demographic and clinical variables. Violence per se was not an important predictor of length of stay, but violence associated with a diagnosis of schizophrenia was an important predictor. Schizophrenic patients who physically attacked others shortly after admission were more likely to have an extended stay than other patients. The study demonstrates the importance of considering clinically meaningful patterns, such as the interaction between diagnosis and violent behavior, when predicting length of stay.
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PMID:Violent behavior and length of psychiatric hospitalization. 275 70

Twenty-five closed-head-injured adults (24 males, 1 female; M age = 28.8 years) were classified as "recovered" if they had returned to work, school, or a sheltered workshop for which pay was received and "non-recovered" if they did not meet these criteria. Current status was compared with MMPI, Adaptive Behavior Scale (ABS), and "Quality of Life" Rating Scale (QLRS) scores at time of entry into a rehabilitation program. The "non-recovered" group was significantly higher on the PD (Psychopathic deviate) scale. No differences were found between groups on the Sc (Schizophrenia) or K (Validity) scales. The "recovered" group was significantly higher on the ABS Economic Activity domain and significantly lower in the Violent & Destructive, Antisocial, Rebelliousness, Untrustworthiness, Stereotyped Behavior & Odd Mannerisms, and Psychological Disturbance behavior domains. The self-ratings (QLRS) of the "nonrecovered" subjects were significantly more distinct from the ratings made by their relatives or significant others than were those of the "recovered" subjects.
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PMID:Prediction of recovery for closed-head-injured adults: an evaluation of the MMPI, the Adaptive Behavior Scale, and a "Quality of Life" Rating Scale. 369 60

Psychiatric disorders are common in medical inpatient and outpatient populations. As a result, internists commonly are the first to see psychiatric emergencies. As with all medical problems, a good history, including a collateral history from relatives and friends, physical and mental status examination, and appropriate laboratory tests help establish a preliminary diagnosis and treatment plan. Patients with suicidal ideation usually have multiple stressors in the environment and/or a psychiatric disorder (i.e., a major affective disorder, dysthymic disorder, anxiety or panic disorder, psychotic disorder, alcohol or drug abuse, a personality disorder, and/or an adjustment disorder). Of all patients who commit suicide, 70% have a major depressive disorder, schizophrenia, psychotic organic mental disorder, alcoholism, drug abuse, and borderline personality disorder. Patients who are at great risk have minimal supports, a history of previous suicide attempts, a plan with high lethality, hopelessness, psychosis, paranoia, and/or command self-destructive hallucinations. Treatment is directed toward placing the patient in a protected environment and providing psychotropic medication and/or psychotherapy for the underlying psychiatric problem. Other psychiatric emergencies include psychotic and violent patients. Psychotic disorders fall into two categories etiologically: those that have an identifiable organic factor causing the psychosis and those that have an underlying psychiatric disorder. Initially, it is essential to rule out organic pathology that is life-threatening or could cause irreversible brain damage. After such organic causes are ruled out, neuroleptic medication is indicated. If the patient is not agitated or combative, he or she may be placed on oral divided doses of neuroleptics in the antipsychotic range. Patients who are agitated or psychotic need rapid tranquilization with an intramuscular neuroleptic every half hour to 1 hour until the agitation and combativeness are under control. Haloperidol (Haldol) is the safest neuroleptic. Chlorpromazine (Thorazine), perphenazine (Trilafon), and, in the elderly, thiothixene (Navane) can also be useful if haloperidol (Haldol) is not effective and more sedation is needed; these drugs, however, produce more side effects. Violent patients need to be physically restrained and then given antipsychotic medication or, in the case of drug abuse or alcohol withdrawal, the appropriate drug management.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Psychiatric emergencies. 373 71

The role of genetics in criminal behaviour can be assessed through family, twin and adoption studies. This paper discusses the major findings of adoption studies that have focused on criminal outcome. Results from adoption studies have consistently revealed a relationship between biological parent criminal behaviour and adoptee criminal outcome. This finding has been noted in the case of property crime, but not in the case of violent crime. Violent crime in adopted-away offspring is not related to violent crime in biological parents. Findings from the Danish Adoption Cohort suggest that violent crime may be genetically related to other types of behavioural deviance. In the Danish Adoption Cohort, there is an increased rate of schizophrenia in the adopted-away offspring of biological fathers who are convicted of violent crimes. This father violence-adoptee schizophrenia relationship cannot be accounted for by the potential confounding factors of rearing social status, age at transfer, knowledge of family history of crime, or biological parents' mental illness.
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PMID:Assessing the role of genetics in crime using adoption cohorts. 886 73

Recent studies confirm a significantly (several times, in fact) increased risk for schizophrenics to commit severely violent acts compared to the general population. Violent acts of minor degree and threats not followed by forensic detention are even much more common. Data on prevalence depend on study conditions, sample selection, and outcome definitions of violence. In psychiatric hospitals, too, violent and threatening behaviour seems to occur most frequently in schizophrenic patients. However, in this respect findings are inconsistent and display considerable variations across different countries and times (with increasing rates reported within the last decade). Additional risk indicators beside the diagnosis of schizophrenia are male gender, comorbidity with personality disorders, substance abuse, lack of adequate treatment and increasing social disintegration due to an unfavourable course of the illness. The violence risk does not seem to decrease with increasing age in contrast to the general population. Beyond these sociodemographic data and variables related to treatment and course of illness, psychopathological causes of violence are less evident. Even imperative hallucinations are not clearly associated with violence: systematic delusions are associated with severe violent acts, but not with the much more frequent violent acts of minor degree. Most probably, the total of psychopathological symptomatology is associated with the proneness to aggressive behaviour. Neuropsychological and biological findings are also inconsistent.
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PMID:[Schizophrenia and violence: epidemiological, forensic and clinical aspects]. 978 18

Psychiatric in-patient suicides are associated with schizophrenia. In this paper, 62 suicides in patients with schizophrenia, over a 21-year period in a large psychiatric hospital in Melbourne, Australia, were examined. The characteristics, including demographic and clinical data, for the suicides were compared with a comparison group of 22 'alive' in-patients with schizophrenia. Suicide among in-patients with schizophrenia was associated with previous deliberate self-harm, a greater number of episodes of previous deliberate self-harm, pre-admission and intra-admission suicidal thoughts, intra-admission suicidal attempts, fluctuating suicidal ideation, longer length of stay, a greater number of ward transfers, and prescription of a greater number of neuroleptics and antidepressants. Over 40% of suicides occurred after absconding from hospital and a similar number during periods of approved leave. Violent methods (including jumping in front of trains, trams and road traffic, jumping off buildings, hanging and drowning) were most frequently used. It is concluded that psychiatric units should be developed away from readily available methods of suicide. In-patients at high risk should be observed carefully to avoid absconding and suicide. Suicide risk should be examined carefully in patients prior to approving leave, particularly if they have fluctuating suicidal ideation.
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PMID:Suicide among psychiatric in-patients with schizophrenia in an Australian mental hospital. 1046 21

Accurate evaluations of the dangers posed by psychiatric inpatients are necessary, although a number of studies have questioned the accuracy of violence prediction. In this prospective study, we evaluated several variables in the prediction of violence in 63 inpatients with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder. Nurses rated violent incidents with the Overt Aggression Scale. During hospitalization, sociodemographic variables, clinical history, neurological soft signs, community alcohol or drug abuse, and electroencephalographic abnormalities did not differ between violent and nonviolent groups. Violent patients had significantly more positive symptoms as measured by the Positive and Negative Syndrome Scale (PANSS), higher scores on the PANSS general psychopathology scale, and less insight in the different constructs assessed. A logistic regression was performed to discriminate between violent and nonviolent patients. Three variables entered the model: insight into symptoms, PANSS general psychopathology score, and violence in the previous week. The actuarial model correctly classified 84.13 percent of the sample; this result is significantly better than chance for the base rate of violence in this study. At hospital admission, clinical rather than sociodemographic variables were more predictive of violence. This finding has practical importance because clinical symptoms are amenable to therapeutic approaches. This study is the first to demonstrate that insight into psychotic symptoms is a predictor of violence in inpatients with schizophrenia.
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PMID:Violence in inpatients with schizophrenia: a prospective study. 1047 84

Factors leading to risk for violence were evaluated in an offender population of 36 male offenders including 18 Violent, e.g., assault, threatening and 17 nonviolent (break and enter, theft), and 17 nonoffenders. Their scores on the Psychopathy Checklist Revised, Violence Risk Scale-Experimental Version 1, Minnesota Multiphasic Personality Inventory-168, and the Porteus Maze tests showed scores for the inmates with violent offenses were elevated on Psychopathic Deviate, Paranoia, Schizophrenia scales of the Minnesota Multiphasic Personality Inventory, violence risk of the Violence Risk Scale, showed psychopathic orientation on the Psychopathy Checklist Revised, and had a lower test age quotient score on the Porteus Maze test.
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PMID:Risk factors in violent and nonviolent offenders. 1061 97

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

Violent and criminal behavior in the mentally ill remains an issue of major importance and in this context the role of comorbid substance abuse must be addressed. Data on criminal behavior in 282 men with schizophrenia and 261 men with affective disorder were studied. Samples of patients with and without additional substance abuse were compared. Also, non-abusing patients from both diagnostic groups were compared with matched controls from the general population. Substance abuse was found in half of all men in both groups of major mental disorders, and substance abusers had twice as high a probability of having a criminal record. However, compared with the matched sample from the general population, violent criminality was increased in schizophrenic patients without comorbid substance abuse, and patients with affective disorders without substance abuse had a higher probability of committing crimes against property. Men with major mental disorder have an increased probability of becoming criminal even when there is no comorbid substance abuse.
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PMID:Criminality in men with major mental disorder with and without comorbid substance abuse. 1567 36


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