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

Using patient samples in London hospitals, the authors compared three methods of diagnosing and subdividing depressive illness in terms of their ability to predict outcome. The Catego class D+ selected patients who continued to suffer from episodes of psychotic depression. The Research Diagnostic Criteria selected patients with schizoaffective depressions whose outcome a completely different from that of major depressive disorder. DSM-III had advantages over the other systems, since it divides depression into three subtypes that differ from each other and from schizophrenia. Patients with a DSM-III diagnosis of mood-incongruent psychotic depression had persistent schizophrenic psychopathology, but their outcome differed from that of both schizophrenic and manic-depressive patients.
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PMID:Definitions of depression: concordance and prediction of outcome. 709 24

The observations on 99 cases of psychotic depression as per I.C.D.--8 categories 296.0, 296.2, 298.0 (WHO 1967) which were included and studied during the course of the 'International Pilot Study of Schizophrenia' carried out in nine field research centres in different countries are reported. An attempt is made to high-light and discuss in cross-cultural perspective: (i) the psychopathological similarities and differences among psychotic depressives, and (ii) similarities and differences of psychotic depressives with clinically diagnosed schizophrenics and with corcordant and discrepant groups (WHO 1973) of schizophrenia.
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PMID:Severe depression in different cultures. 718 4

Mood disorders in schizophrenia are common and are associated with a poor outcome, an increased risk of relapse and a high rate of suicide. Consequently, treatment strategies need to take mood disorders into account. In depressed and actively psychotic schizophrenic and schizoaffective patients, treatment with neuroleptic plus antidepressant may be less effective than neuroleptic alone. However, patients with post-psychotic depression on maintenance neuroleptics respond well to tricyclic antidepressants. Mood disorders can be caused by neuroleptics and if so will often improve if the dose is reduced or if the drug is changed. Anticholinergics may also help. In schizoaffective disorder, lithium is usually beneficial, especially for patients with classical affective disorder. Carbamazepine may be more effective in patients with schizoaffective and schizophreniform disorders. At doses comparable with those effective in schizophrenia, clozapine may be as good or better than conventional neuroleptics in schizophrenic patients with psychotic mood disorder or schizoaffective disorder. In patients with high BPRS anxiety/depression scores, risperidone (8 mg/day) was more effective than haloperidol (10 mg/day). Risperidone at a mean dose of 8.6 mg/day was also more effective than haloperidol (mean dose 9.2 mg/day) or levomepromazine (methotrimeprazine -- mean dose 125 mg/day) on the Psychotic Anxiety Scale. Mood-related symptoms are therefore amenable to treatment. Risperidone and clozapine appear to be good candidates for the long-term treatment of mood disorders in schizophrenia, although long-term, double-blind, controlled studies are needed to confirm this.
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PMID:Long-term treatment of mood disorders in schizophrenia. 754 99

Psychiatric comorbidity is common in psychotic disorders, but the chronology of comorbid and principal diagnoses has not been closely examined. Understanding chronology may be important for identifying risk factors, or alternatively, prodromal syndromes, for some patients with psychosis. To address this issue, we examined the rates of antecedent comorbid syndromes in patients with first-episode psychoses. Patients aged > or = 12 years presenting with psychosis were recruited from inpatient and outpatient treatment sites. Patients were excluded if they had been previously hospitalized or if symptoms resulted entirely from substance abuse or medical illness. All diagnoses were made using the Structural Clinical Interview for DSM-III-R-Patient Version (SCID-P). Comorbidity was defined as antecedent if the age of onset of the comorbidity predated the age of the onset of the psychotic disorder by more than 1 year. Seventy-one patients were recruited during a 1-year period and included 39 with bipolar disorder, 18 with schizophrenia spectrum disorders, and 14 with psychotic depression. Comorbidity was present in 69% of patients. This comorbidity was antecedent in over 80% of the patients with concurrent syndromes. Patients with psychotic depression had the highest rates of comorbidity, in particular alcohol abuse and antecedent posttraumatic stress disorder (PTSD). Comorbidity is common in first-episode psychosis and is often antecedent to the psychotic disorder. These antecedent comorbidities may represent risk factors or prodromal syndromes for the psychotic disorder.
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PMID:Chronology of comorbid and principal syndromes in first-episode psychosis. 775 95

Recent research in computational neuroscience has suggested that psychosis associated with disturbed catecholamine neurotransmission may result from disturbances in the gain parameters of neural networks that these same secondary neurotransmitters are thought to control. We propose a mathematical model based upon cooperativity theory used in thermodynamics to explain how the gain parameter that momentarily increases the effect upon the post-synaptic cell of a given weighted connection from the presynaptic cell could be instantiated in the fluctuating electrical conductance of the dendrite of a neuron without requiring extensive ion transport or utilization of the ATP energy cycle. More specifically we propose that catecholamine neurotransmission serves to maintain the dendrite in a cooperative state with regard to changes in electrical conductance due to impulse traffic alone. In this way we supply the neuron with an activity driven gain parameter that not only increases volume of neuronal output at very low energy cost but that also upscales cooperative effects at the mechanico-chemical level of the dendrite to the network level itself. An important implication of this model is that two extreme states for dendritic electrical conductance will occur if cooperativity is lost at the level of catecholamine depletion or excess due to drug effects. These are the AND gate effect in which dendritic conductance is so low that the neuron requires extensive synaptic activity in order to output significantly. We correlate this state with negative symptoms in schizophrenia and psychomotor retardation in depression as well as the rigidity in Parkinsonism. The other extreme is represented by the OR gated dendrite in which conductance is so high that even noisy input to the dendrite will lead to significant nerve cell output. We correlate this condition with the positive symptoms of schizophrenia, the agitated features of psychotic depression and the tremors of Parkinsonism.
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PMID:A theory of cooperativity modulation in neural networks as an important parameter of CNS catecholamine function and induction of psychopathology. 787 Feb 71

The frequency of depression is extremely high in schizophrenia, about 60%. Depression much suffering, as evidenced by out patient suicides. As early as 1920, Mayer Gross, and more recently Widroe, identified this kind of depression under the name of post-psychotic depression. This definition deserves to be interpreted in several ways: depression differentiated negative symptoms; only the mood disorder is then characteristic and the other symptoms are part of the deficiency syndrome, depression can be integrated to schizophrenia or on the contrary it can be considered as independent of it and interpreted as reactive, secondary--for example as a morning phase for delusions, the iatrogenic effect of neuroleptics and depressogenic self-medication should not be overlooked. The issue that must be raised before instituting therapy is whether the disinhibitory effect of antidepressants may lead to the resurgence of delusions. After reviewing the literature and in the light of a personal study, the authors answer in the negative. Based on a preliminary study in 10 patients with essentially paranoid schizophrenia, treated with fluoxetine 20 mg per day, the author observed an improvement in sadness, sleep, death wishes in 7 patients, without exacerbation of delusions. It is legitimate to ask, with Lindenmayer, which place depression could take as a "blind factor" alongside with negative and positive factors of schizophrenia.
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PMID:[Antidepressant treatment of schizophrenic patients]. 790 37

A cohort of 168 psychotic patients underwent computerised tomography (CT) during their first admission. Cortical atrophy was present in 40% of patients. The frequency of atrophy increased with age, but did not differ between patients with schizophrenia, schizoaffective disorder, bipolar disorder or psychotic depression. Other CT findings of note were present in 6.6% of patients, and included four infarctions, three arachnoid cysts, and one each of venous angioma, colloid cyst, cavum vergae and post-traumatic changes. The frequency of CT findings other than atrophy was increased in the psychotic depression group. The findings support the proposal of the onset of psychosis being an indication for CT.
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PMID:Results of computerised tomography during first admission for psychosis. 795 85

This study reviewed all patients (N = 37) treated with ECT in a psychiatric intensive care unit during 1989-91. Diagnoses were: psychotic depression (8); bipolar disorder, manic phase (13); schizoaffective disorder (14); and schizophrenia (2). All patients were very severely disturbed and had failed to respond to medication given at highest levels judged to be safe, usually over 3-4 weeks. Response to ECT was generally rapid and marked, allowing substantial reductions in medication. To achieve the same clinical outcome for each course of ECT, 50% more unilateral than bilateral treatments were required, suggesting that bilateral ECT has a more rapid effect in this highly disturbed population.
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PMID:Electroconvulsive therapy in a psychiatric intensive care unit. 779 13

Post-psychotic depression (PPD) is defined as the development of depression during the phase of remission of schizophrenia. Two groups of DSM-III-R schizophrenics, one with PPD and the other without PPD (30 subjects in each group) were compared. Significantly more patients in PPD group belonged to nuclear families, had longer duration of psychotic phase of the illness, were hospitalised more frequently and had more sadness and anxiety-somatisation during florid illness phase. The PPD group also had more past history of depression. Although PPD patients had better premorbid personal-social adjustment in comparison with non-PPD group, they perceived themselves to be lacking in social support and had experienced more stressful life events. For patients in the PPD group, stepwise multiple regression analysis revealed age of onset, sadness during florid psychotic state, premorbid adjustment, social support and life events as significant determinants of severity of depression in the post-psychotic phase.
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PMID:Post-psychotic depression in schizophrenia. 821 26

This report examines the prevalence and correlates of bizarre delusions and Schneider's first-rank symptoms (FRS) in a first-admission sample with psychosis. A total of 196 patients were assessed with the Structured Clinical interview for DSM-III-R (SCID) and given a consensus diagnosis. Project psychiatrists blind to the consensus diagnoses coded each delusion and hallucination in the sample for both FRS and DSM-III-R bizarreness. Interrater reliability of bizarreness was lower than that of FRS (kappa = .681 v 861). The majority of symptoms (72%) were neither bizarre nor FRS, and of the remainder, bizarre delusions that were not also FRS were extremely uncommon. The prevalence of FRS was 70% in schizophrenia, 29% in psychotic bipolar disorder, and 18% in psychotic depression. For seven schizophrenic patients (7.45%), diagnosis of that disorder depended on the presence of a DSM-III-R bizarre delusion to meet criteria. There was a trend for FRS to be associated with poorer prognostic features in the schizophrenic sample. We concluded that although the constructs of bizarre delusions and FRS overlap, FRS were a more important feature in schizophrenia than bizarreness. The rarity of bizarre delusions that were not FRS, combined with the lower reliability of their assessment as compared with that of FRS, raises questions about the continued emphasis on this phenomenon in the definition of schizophrenia.
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PMID:Bizarre delusions and first-rank symptoms in a first-admission sample: a preliminary analysis of prevalence and correlates. 856 47


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