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

Systems of psychiatric diagnosis have been regularly criticized for their low reliability and their inability to fit accurately the kinds of patients coming for treatment. To explore the reasons for these problems, this study utilizes a new method, the biplot, for defining groups of similar patients and the relationships of these groups to key symptom clusters. Using this technique to analyze data from a representative sample of first admissions for psychiatric disorder, results showed: a) symptom clusters representing the classical diagnostic categories, mania, schizophrenia, neurotic depression, and psychotic depression, were readily identified; b) however, only a few patients were clustered near these traditional syndromes. These findings suggest that although syndromes do exist that fit traditional diagnostic categories, the vast majority of patients fall between these syndromes, having characteristics from several of them. For most patients, forcing the diagnostician to choose among the categories requires an arbitrary decision that may contribute to dissatisfaction in the diagnostician who recognizes how misleading the diagnosis can be.
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PMID:Do psychiatric patients fit their diagnoses? Patterns of symptomatology as described with the biplot. 36 91

Diagnostic rates of routine hospital first and total admissions in various categories of functional mental illness in three strongly Schneider-oriented German psychiatric clinics over 40 years were examined. No matter how centers and categories were compared, statistically significant inconsistency was almost always found. Only first admissions for schizophrenia and mania in Munich and Heidelberg, as well as total schizophrenic admissions in Munich and Homburg/Saar, showed no significant diagnostic differences. However, from a practical point of view, actual percentage differences found in schizophrenia and mania were really not that great; indeed, rather similar diagnostic rates were apparent. This was in contrast to actual large percentage discrepancies shown between Munich on the one hand and Heidelberg and Homburg/Saar on the other with respect to manic-depressive illness and psychotic depression.
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PMID:Consistency of Kurt Schneider-oriented diagnosis over 40 years. 83 28

After nearly 30 years of marriage, a 51-year-old man castrated himself in order to fulfill a long-standing fantasy of being a girl. There was a prior history of cross-dressing since childhood, and a reversed erotic role imagery during coitus. There was no history of schizophrenia or psychotic depression. Pair bonding with the wife was very strong. It led the patient to elect low-dose maintenance on androgen so as to permit some degree of continued marital sex. Otherwise the patient would have preferred estrogenization and, perhaps, eventual sex reassignment. The rehabilitative program as a transvestite man has continued for 3 years.
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PMID:Erotic imagery and self-castration in transvestism/transsexualism: a case report. 91 54

Comparative studies of first admission rates to psychiatric hospitals have revealed significant differences in the rates of diagnoses of functional psychoses between the United Kingdom and the United States of America. The present study examined the diagnoses of indigenous patients born between 1921 and 1955 and first admitted to hospitals in New South Wales, Australia, and England and Wales. Admission rates for mania were in striking agreement. The rate in New South Wales for schizophrenia was slightly higher and for psychotic depression considerably less than in England and Wales. A similar trend in diagnostic dissonance would appear to exist between England and Wales and New South Wales as between England and Wales and the United States for schizophrenia and psychotic depression, but this is considerably less in degree.
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PMID:Psychiatric diagnosis in New South Wales compared to England and Wales. 120 48

The authors describe the successful use of an adjunctive group psychotherapy for substance-abusing patients with major psychiatric disorders (bipolar, schizophrenia, schizoaffective, psychotic depression, and atypical psychosis). The group utilizes a psychoeducational approach that focuses on substance abuse causes and consequences, principles of recovery, and relapse prevention strategies. Eight patients with prolonged histories of abuse of cocaine, alcohol, marijuana, or other drugs were enrolled in this weekly group treatment at a community mental health center drug treatment program, while continuing in treatment with their current case manager or primary therapist. Six of the eight patients achieved periods of stable abstinence, documented by self-report, urine toxicology screens, continued group attendance, and improved social functioning. Case examples are utilized to illustrate the group process.
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PMID:Treatment of dual diagnosis patients: a relapse prevention group approach. 136 27

In subtypes of schizophrenia and unipolar depression, both increased and decreased levels of platelet serotonin were found. Hyperserotonemia was usually observed in patients with psychotic features (i.e., in paranoid schizophrenia and psychotic depression). Hyposerotonemia, although less common than hyperserotonemia, was present in nonparanoid schizophrenia and nonpsychotic depression (i.e., in patients without psychotic symptoms). A sex difference in platelet monoamine oxidase activity was observed among healthy subjects, but not among schizophrenic patients. The activity of platelet monoamine oxidase in paranoid and nonparanoid schizophrenic patients did not differ from that in healthy subjects. The findings in this study suggest that biological differences between subtypes of unipolar depression or schizophrenia might depend upon the presence of psychotic symptoms.
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PMID:Platelet serotonin in subtypes of schizophrenia and unipolar depression. 175 25

This article reports on the evidence for the validity of psychotic major depression as a distinct subtype based on cross-sectional and 1-year prospective data from the Epidemiologic Catchment Area study. Consistent with findings from previous clinical studies, only about 14% of major depressions were accompanied by psychotic features. Psychotic as compared with nonpsychotic depression had a more severe course, as reflected in increased risk of relapse, persistence over 1 year, suicide attempts, hospitalization, comorbidity, and financial dependency. These differences could not be explained by differences in demographic characteristics or by symptom severity, as assessed by symptom profile or number of symptoms. The boundary problem with schizophrenia and bipolar affective disorder that is seen in clinical studies was also found in this sample. To our knowledge, this is the first study to examine the validity of psychotic depression in a community sample; the findings are consistent with those from clinical samples. They support the clinical significance of psychotic depression and the continuation of its inclusion as a distinct subtype in DSM-IV.
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PMID:The validity of major depression with psychotic features based on a community study. 184 25

1. Substance abuse and post-psychotic depression are both frequently encountered concomitants of schizophrenia. 2. Substance abuse may be associated with depression-like symptomatology in the course of schizophrenia, and patients may attempt to self-medicate these symptoms with substances of abuse. 3. Antidepressant medication has been found to be a useful adjunct to treatment in at least some cases of substance abuse and some cases of post-psychotic depression. 4. Preliminary evidence exists suggesting that adjunctive antidepressant medication, added to a neuroleptic, may be useful for at least some stable dysphoric substance-abusing schizophrenic patients. 5. It is important to attempt to rule out even subtle neuroleptic-induced akinesia in such patients with a vigorous trial of antiparkinsonian medication.
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PMID:Antidepressant for substance-abusing schizophrenic patients: a minireview. 200 36

Hallucinations can persist for many years after childhood sexual abuse. If we recognise this, we will not mis-diagnose psychosis and we may treat with psychotherapy (talk). The hallucinations are distinct from hallucinations in schizophrenia though patients have frequently been given that diagnosis. They would generally be classified as pseudo-hallucinations. They are generally self-referential. They can involve all sensory modalities. Three case reports illustrate this link. Methods for interviewing and providing ongoing help are discussed. Issues in phenomenology and diagnosis are considered. Post-traumatic stress disorder is the best diagnostic fit, though psychotic depression may explain some cases. Freud's case of Frau P (1896) was an early report of this link.
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PMID:Persisting hallucinations following childhood sexual abuse. 207 33

Forty-three inpatients with RDC schizo-affective depression were given structured interviews and then followed to 1 year using a design closely resembling that of another recent follow-up of schizo-affective patients. In replication of the earlier study, patients with either 'chronic' or 'mainly schizophrenic' schizo-affective disorder had significantly worse outcomes than did patients with nonchronic or 'mainly affective' schizo-affective depression and bipolar patients were significantly more likely to develop manic syndromes. The preceding duration of schizophrenia-like symptoms and a history of schizophrenia-like prodromes appeared to be the most important components of these two distinctions. In both studies, diagnostic subtype was the most robust of various potential outcome predictors. Also in both studies, 'mainly affective' and 'nonchronic' schizo-affective patients had outcomes no different from patients with psychotic depression.
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PMID:Diagnosis and outcome in schizo-affective depression: a replication. 297 Apr 89


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