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

The nosology, classification, and biological basis of psychosis in the elderly have been much debated. Psychotic features are seen in schizophrenia, affective illness, and dementia in the elderly. This article reviews evidence for the biological basis of psychosis in older people. In schizophrenia, there is evidence of gender differences in brain volume loss and dopamine receptor numbers, possibly linked to estrogen loss in women. Neuroimaging evidence of ventricular brain changes and more dopamine receptors have also been documented. In Alzheimer's disease, genetic factors such as PS1 and ApoE4 have been associated with psychotic symptoms, and histopathological studies have revealed differences in neuronal pathology. Radiological studies have shown right and left hemisphere differences in size, blood flow, and glucose metabolism between psychotic and nonpsychotic patients. In affective illnesses, there is evidence of structural brain changes in psychotic depression. Ample evidence suggests that biological substrates underlie many psychotic symptoms. More research will identify causal links between brain changes, symptom appearance, and the effects of psychosocial factors in their genesis.
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PMID:The biology of psychosis in older people. 1465 28

Antipsychotics are commonly used for conditions other than schizophrenia, yet support for such use in the literature is unclear. This article reviews the literature on the pharmacologic treatment of specific types of non-schizophrenic disorders: those associated with psychotic depression, obsessive-compulsive disorder, body dysmorphic disorder, bipolar disorder, and dementia. It focuses on the evidence for using antipsychotics in these conditions, placing emphasis on atypical antipsychotics. Medline/HealthStar and PsycInfo databases were used to identify published trials and reports of antipsychotics used specifically for non-schizophrenic disorders. Numerous studies were found supporting the use of atypical antipsychotics for non-schizophrenic disorders; however, with the exception of dementia, few randomized, double-blind controlled trials have been published examining the efficacy and safety of these agents in non-schizophrenic disorders. In general, most trials were restricted to short-term use as adjunctive therapy. The literature reviewed was primarily comprised of small open-label trials, thus making it difficult to draw definitive conclusions. Despite the limitations of the trials reviewed, atypical antipsychotics represent a promising treatment modality when considering their improved side effect profile compared to conventional agents. Appropriate dosing and the use of antipsychotics in combination with psychosocial treatments are important treatment considerations. Due to the frequent clinical use of atypical antipsychotics as adjunctive therapy, well-designed trials of these agents in non-schizophrenic disorders are necessary.
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PMID:Treatment of non-schizophrenic disorders: focus on atypical antipsychotics. 1469 Jul 72

Psychotic depression is a clinical subtype of major depressive disorder in the recent editions of the psychiatric diagnostic systems ICD-10 (1992) and DSM-IV (1994). Recent evidence suggests that psychotic depressed patients are more impaired on neuropsychologic tests measuring attention as compared to nonpsychotic depressed patients. However, information on this issue between psychotic and nonpsychotic depression is limited. It has become clear that attention is not a single concept; thus we studied both selective and sustained attention using the theoretic model of automatic and controlled information processing. Thirty-two patients with major depressive disorder, 16 psychotics and 16 nonpsychotics, were investigated and compared with 20 patients with schizophrenic disorder and 20 healthy volunteers who comprised the control groups, using Ruff's 2 and 7 selective attention tests. Compared to the healthy controls, both depressed groups were impaired; however, the psychotic depressed group was more severely impaired on both measures. Attentional performance speed and accuracy scores, on both effortless and effortful conditions, were significantly lower in the psychotic depressed group than in the nonpsychotic depressed group. No significant differences were found on attentional performance between the psychotic depressed patients and those with schizophrenic disorder. Attention deficits are thus more prominent in psychotic than in nonpsychotic depression. Furthermore, taking attention as a criterion, psychotic depression, although of mood congruent subtype, lies closer to schizophrenia than to nonpsychotic depression.
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PMID:Attentional disturbances in patients with unipolar psychotic depression: a selective and sustained attention study. 1552 56

Depression is a frequent symptom in psychiatry, either isolated (major depression) or entangled with other psychiatric symptoms (psychotic depression, depression of bipolar disorders). Many antidepressant drugs are available with different pharmacological profiles from different classes: tricyclic antidepressants, monoamine oxydase inhibitors, selective serotonin reuptake inhibitors (SSRI). However, there are some limitations with these drugs because there is a long delay before relief for symptoms, some patients with major depression are resistant to treatment, there is a risk to induce manic symptoms in patients with bipolar disorders and these drugs have no effect on the psychotic symptoms frequently associated to major depression. The leading hypothesis for the search of more efficient new antidepressants has been the amine deficit hypothesis: noradrenaline and/or serotonin deficit and more recently dopamine deficit. Moreover, a dopamine deficit has been also hypothesized as the central mechanism explaining the negative symptoms of schizophrenia. These symptoms are the consequence of a deficit of normal behaviours and include affective flattening, alogia, apathy, avolition and social withdrawal. There is thus a great overlap between symptoms of depression and negative symptoms of schizophrenia. Atypical antipsychotics, in contrast with conventional neuroleptics, have been shown to decrease negative symptoms, most probably through the release of dopamine in prefrontal cortex, thus improving psychomotor activity, motivation, pleasure, appetite, etc. The dopamine deficit in cortical prefrontal areas was thus an unifying hypothesis to explain both some symptoms of depression and negative symptoms of schizophrenia. Studies in animal confirm this view and show that the association of an atypical antipsychotic drug and an SSRI (olanzapine plus fluoxetine) increases synergistically the release of dopamine in prefrontal areas. Moreover, most of the atypical antipsychotics have a large action spectrum, beyond the only dopamine receptors: their effects on the serotonin receptors--particularly the 5-HT2A and 5-HT2C receptors--suggest that their association to SSRI could be a promising treatment for depression. Indeed, SSRI act mainly by increasing the serotonin level in the synapse, thus leading to a non specific activation of all pre- and post-synaptic serotonin receptors. Among them, 5-HT2A/2C receptors have been involved in some of the unwanted effects of SSRI: agitation, anxiety, insomnia, sexual disorders, etc. The inhibition of these receptors could be thus beneficial for patients treated with SSRI. Amisulpride is an unique atypical antipsychotic that selectively blocks dopamine receptors presynaptically in the frontal cortex, possibly enhancing dopaminergic transmission. The antidepressant effect of amisulpride was shown in dysthymia in many clinical studies versus placebo, tricyclic antidepressants, SSRI or others. However, a shorter delay for symptom relief was not demonstrated for amisulpride as compared to comparative antidepressants. Other atypical antipsychotics (clozapine, olanzapine), which act on a large variety of receptors, have shown antidepressant effects--mainly in association with SSRI--in different psychiatric diseases: treatment-resistant major depression, major depression with psychotic symptoms and depression of bipolar disorders, with no increase of manic symptoms in this latter case. Moreover, the delay for symptom relief was greatly shortened. More comparative double-blind studies are required to confirm and to precise the antidepressant effects of atypical antipsychotics. Nevertheless, these studies suggest that atypical anti-psychotics could be of great value in depressive conditions reputed for their resistance to treatment with usual antidepressants. Particularly, new strategies emerge that combine atypical antipsychotics and antidepressants for greater efficacy and more rapid relief of depression symptoms.
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PMID:[Efficacy of atypical antipsychotics in depressive syndromes]. 1573 62

Recent studies have shown a decrease in glial number and glial fibrillary acidic protein (GFAP) levels in the frontal and cingulate cortices of individuals with mood disorders and schizophrenia. In an attempt to verify and expand these findings we examined GFAP messenger ribonucleic acid (mRNA) levels in postmortem sections of the anterior cingulate cortex (ACC) from the Stanley Neuropathology Consortium (SNC). The consortium consists of 15 cases in each of four groups (schizophrenia, bipolar disorder, non-psychotic depression and unaffected controls). By in situ hybridization, we found higher levels of GFAP mRNA in white matter and at the pial surface as compared with gray matter levels in all cases. In the white matter of ACC we detected a significant effect of diagnosis (P<0.04) with GFAP mRNA levels decreased in individuals with schizophrenia and bipolar disorder as compared with normal controls. In the gray matter there was a significant effect of layer (P<0.01) with the highest levels of GFAP mRNA in layer VI in all groups. As in the white matter, the mean GFAP mRNA levels were decreased in individuals with schizophrenia and bipolar disorder as compared with the unaffected controls, however the difference failed to reach statistical significance. Thus, astrocytes positive for GFAP may contribute to the decrease in glial density previously described in subjects with major mental illness, however the relative contribution of astrocytes may vary with diagnosis.
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PMID:Glial fibrillary acidic protein mRNA levels in the cingulate cortex of individuals with depression, bipolar disorder and schizophrenia. 1588 20

Delusion has always been a central topic for psychiatric research with regard to etiology and pathogenesis and to diagnosis, treatment, and forensic relevance. Throughout the history of psychiatry as a scientific discipline, there has been dissent on the issue of whether chronic delusion is a nosological entity of its own or just a specific type of another mental disorder, e.g. schizophrenia, mania, or personality disorder, and there already is a considerable literature on this. This article seeks to elucidate the central lines of thought that have governed the scientific debate on delusions and delusion-associated phenomena since the early 19th century. Special attention is given to the practical relevance of these theoretical considerations for forensic questions and psychiatric research. Due to the complex features of delusions, research in this area may well become paradigmatic for many other complicated psycho(patho)logical phenomena, e.g. consciousness, hallucinations and psychotic depression.
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PMID:Delusion in general and forensic psychiatry--historical and contemporary aspects. 1677 28

Quetiapine is a novel and atypical antipsychotic agent with serotonin 5-HT2A antagonism higher than D2 blockade. However, it has the lowest affinity for serotonin receptors among atypical antipsychotics. Besides its D2 blockade, it is not as great as seen with risperidone and olanzapine and is even less than that of clozapine. Open-label and controlled trials suggest efficacy of quetiapine as an adjunct therapy in patients with obsessive-compulsive disorder, refractory to treatment with selective serotonin reuptake inhibitors. There is one report of quetiapine exacerbating obsessive-compulsive symptoms (OCS). We report 5 cases with bipolar I disorder (n = 3), psychotic depression (n = 1), and schizophrenia (n = 1) in which quetiapine produced de novo OCS. The underlying pathogenetic mechanisms and the risk factors for this action of quetiapine and of atypical antipsychotics, in general, are not yet known. The description of 5 patients with different diagnoses supports the issue of OCS exacerbation or induction with atypical antipsychotics. Clinicians' awareness and close monitoring of the patients is warranted.
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PMID:Quetiapine-induced obsessive-compulsive symptoms: a series of five cases. 1685 58

The diagnosis of psychotic disorders that develop later in life is complicated, as can be seen from the case of a 65-year-old woman. Initially she was admitted to hospital for psychotic depression, but after some time doubts arose regarding the diagnosis. The most striking symptoms were bizarre delusions with acoustic, haptic and gustatory hallucinations. In addition, she showed behavioral and personality changes. It is difficult to establish whether a patient has late-onset schizophrenia or frontotemporal dementia. The similarities and differences between the symptoms of these two disorders are discussed and advice is given to assist with clinicians with diagnosis in the future.
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PMID:[The development of psychotic symptoms in later life: late-onset schizophrenia or frontotemporal dementia? A case study]. 1700 80

Suicide is a major cause of death among patients with schizophrenia. Research indicates that at least 5-13% of schizophrenic patients die by suicide, and it is likely that the higher end of range is the most accurate estimate. There is almost total agreement that the schizophrenic patient who is more likely to commit suicide is young, male, white and never married, with good premorbid function, post-psychotic depression and a history of substance abuse and suicide attempts. Hopelessness, social isolation, hospitalization, deteriorating health after a high level of premorbid functioning, recent loss or rejection, limited external support, and family stress or instability are risk factors for suicide in patients with schizophrenia. Suicidal schizophrenics usually fear further mental deterioration, and they experience either excessive treatment dependence or loss of faith in treatment. Awareness of illness has been reported as a major issue among suicidal schizophrenic patients, yet some researchers argue that insight into the illness does not increase suicide risk. Protective factors play also an important role in assessing suicide risk and should also be carefully evaluated. The neurobiological perspective offers a new approach for understanding self-destructive behavior among patients with schizophrenia and may improve the accuracy of screening schizophrenics for suicide. Although, there is general consensus on the risk factors, accurate knowledge as well as early recognition of patients at risk is still lacking in everyday clinical practice. Better knowledge may help clinicians and caretakers to implement preventive measures. This review paper is the result of a joint effort between researchers in the field of suicide in schizophrenia. Each expert provided a brief essay on one specific aspect of the problem. This is the first attempt to present a consensus report as well as the development of a set of guidelines for reducing suicide risk among schizophrenia patients.
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PMID:Suicide risk in schizophrenia: learning from the past to change the future. 1736 24

Antipsychotic drugs (APDs) are therapeutic in psychotic disorders. They are not specific treatments for schizophrenia (SZ) but useful in bipolar disorder (BD), psychotic depression, Alzheimers disease, and other psychotic diagnoses. In this perspective, we discuss the actions of APDs for the treatment of both SZ and bipolar-1 disorder (BD-1) with a specific focus on the implications of these data for the whole group of psychotic diagnoses. Both schizophrenic and BD-1 are characterized by several symptom dimensions, some overlapping and some distinctive. We discuss a dimensional approach to the diagnosis of BD and SZ and suggest that psychosis is an important dimension of each. In order to define the dimension of psychosis more carefully would require additional research to fill in the gaps in our knowledge. We propose that psychosis is a dimension that cuts through many psychiatric disorders, and the use of this dimension may be useful for clinical and research progress. We discuss the kinds of data necessary to further support the dimensional aspects of psychosis.
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PMID:The neuropharmacology of psychosis. 1756 97


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