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

The association between alcohol and/or drug dependence and major psychiatric conditions such as schizophrenia has received increased attention from the professional community. Terms such as "dual diagnosis" used to designate these clinical occurrences have become common, reflecting the interest mentioned. This chapter reviews the prevalence of the association between substance abuse and psychiatric disorder, the nature of the interactions observed, and some of the implications for patient care and health policy. Following this empirical perspective, we present a developmental-humanistic approach that has been used in the psychotherapeutic management of these problems. Our review of information on dual diagnosis suggests that the association between the two processes--substance abuse and psychiatric disorder--is not fortuitous or just the result of environmental conditions. There are complex physiopathological links at the neurobiological level that deserve research attention.
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PMID:Dual-diagnosis empirical and developmental-humanistic approaches. 158 9

With lifetime prevalence estimates of substance abuse among schizophrenics as high as 47.01%, there is an increasing awareness of the importance of this dual diagnosis and the global deficiencies in our knowledge about this comorbid condition. Patients with substance abuse disorders and schizophrenia are problematic from a clinical, economic, and health care systems perspective. The lack of systematic research into phenomenology, etiology, and treatment approaches (both psychotherapeutic and psychopharmacologic) has hindered the development of an adequate strategy to care for the needs of these patients. Thus, these patients place a significant burden on the mental health delivery system through chronic disability, social dysfunction, frequent rehospitalizations, and poor overall treatment compliance. The authors critically review the contemporary literature relevant to concurrent substance abuse and schizophrenia, highlight major deficiencies in our knowledge, and call for research to reduce the individual, economic, and social costs of this condition.
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PMID:Substance abuse and schizophrenia: impediments to optimal care. 192 26

Treating the chronically mentally ill involves not only working with patients suffering from schizophrenia and other prolonged or recurrent psychotic illnesses, it also means providing treatment for patients with severe personality disorders. Many of these patients are also active substance abusers. This article examines the therapeutic and management issues raised for outpatient clinicians who work with these patients. Consideration is devoted to the special problems in treating the dual diagnosis patient, issues of patient and therapist safety, limit setting, splitting dynamics, and countertransference reactions. A set of recommendations is offered for conducting outpatient group therapy, specifying what is needed from both the clinicians and the facility in which this type of treatment is provided.
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PMID:The Axis II group: treating severely characterologically disturbed patients. 200 33

The relationship between schizophrenia and 'mental handicap' has been obscured by historical changes and varying diagnostic criteria. It has been generally accepted that there is an increased incidence of psychotic illness among people with intellectual retardation, but detailed community surveys are limited. Catatonia, severity of illness and research potential are all to be found in this 'dual diagnosis' group. The value of an historical analysis is underlined.
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PMID:Schizophrenia and mental handicap: an historical review, with implications for further research. 266 6

Research Diagnostic Criteria-diagnosed schizophrenic persons with average intelligence and dual diagnosis mentally retarded schizophrenic persons were tested in a forced-choice letter discrimination task in order to examine the relationship between schizophrenia and retardation from the standpoint of information-processing theory. The subjects consisted of eight schizophrenic persons of average or better intelligence, eight mentally retarded schizophrenic persons, and a control group of eight Research Diagnostic Criteria-diagnosed minor depressive individuals who were matched with the nonretarded schizophrenic group for intelligence. The groups did not differ significantly on the minimum exposure duration needed to identify an unmasked target stimulus at criterion levels of accuracy. When masked stimuli were employed, however, the depressive group obtained significantly more correct detections than both schizophrenic groups. More importantly, the performance of the two schizophrenic groups did not differ significantly. Our data indicated that schizophrenic deficits in information processing are independent of intellectual factors. Thus, vulnerability to a masking stimulus in schizophrenic persons can be attributed to the pathology of schizophrenia. This vulnerability indicates that schizophrenic patients are slow information processors.
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PMID:The effect of mental retardation and schizophrenia on information processing. 705 68

The results of a study on the subjective basic symptoms associated with schizophrenia and drug abuse (especially alcoholism) are presented. A total of 242 psychiatric inpatients (74 with a dual diagnosis of schizophrenia and drug consumption, 81 schizophrenics, and 87 alcoholics) were included. The three groups did not differ with regard to the general score of subjective basic symptoms measured by the Frankfurt Complaint Questionnaire (Frankfurter Beschwerde-Fragebogen, FBF). Further analyses showed that the FBF statements are only partly typical for schizophrenia; another part is connected with alcoholism. Two new scales ("FBF-S" and "FBF-A") were created from the schizophrenia-typical items and the alcoholism-typical items, respectively. In "FBF-S" schizophrenics (with and without alcoholism) had higher scores than patients suffering from alcoholism alone; in "FBF-A" alcoholics (with and without schizophrenia) reached higher scores than schizophrenic patients. Consistent correlations with independent parameters of psychosis and alcoholism confirm the validity of "FBF-S" and "FBF-A". It is concluded that the FBF's capacity to discriminate different diagnoses can be improved and that the model of basic disturbances must be re-evaluated.
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PMID:[Basic symptoms in schizophrenia and alcoholism. A methodological comparative study]. 760 13

There is growing evidence that substance abuse is a major problem in patients with schizophrenia. With respect to alcohol, alledegly the most frequently abused drug among schizophrenics, clinical and epidemiological studies would suggest that the risk of alcoholism is approximately four times greater (Cuffel, 1992; Mueser et al., 1990; Soyka et al., 1993; Soyka, 1994). A variety of hypotheses have been proposed to explain this phenomenon, including the so-called "self-medication hypothesis". Some authors feel that substance abuse in schizophrenics might be due to extrapyramidal and other side-effects caused by neuroleptic treatment or inadequate remission of psychotic symptoms. There remains, at present, an obvious lack of both psychosocial and psychopharmacological studies of treatment in "dual diagnosis" schizophrenics (Mueser et al., 1992). Changes in dopaminergic neurotransmission and dopamine-receptor dysfunction have been linked both to the development of psychotic symptoms and to alcoholism/substance abuse, and thus give rise to the question as to whether some dual diagnosis patients might benefit from neuroleptic treatment in both domains. A number of dopamine receptor subtypes in different regions of the brain seems to be involved in the development of schizophrenia and substance abuse. Modifications of D2-receptor subtype function have been implicated in psychotic symptoms, and changes in the D1- and D2-receptor function in substance abuse such as cocaine abuse and alcoholism (Spealman et al., 1990; 1991; 1992), especially in the mesolimbic dopaminergic reward system. Accordingly, the "ideal" neuroleptic drug for dual diagnosis schizophrenics should be effective in both receptor subtypes.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Successful treatment with flupenthixol decanoate of a patient with both schizophrenia and alcoholism. 762 88

Fifty-three psychiatric hospital inpatients with a dual diagnosis of substance abuse and schizophrenia were given the Brief Symptom Inventory and the Schizophrenia/Substance Abuse Interview Schedule. Mean age was 29; 49 were men. Only 11% were employed. Forty percent abused mainly alcohol, 40% cannabis and 8% amphetamines; 20% abused more than one substance. Mean onset age of drug abuse was 16 years; schizophrenia was diagnosed a mean of 5 years later, and subjects had been admitted to hospital an average of 7 times since then. Most believed that drug abuse initiated or exacerbated their schizophrenia; 80% took drugs primarily to relieve dysphoria and anxiety. Amphetamines improved subjective well-being significantly more than alcohol, but choice of drugs was determined mainly by price and availability. Only cannabis increased positive symptoms of schizophrenia and only amphetamines reduced negative ones. Effectively treating this population requires an integration of psychiatric and drug treatment services, ideally in a community context.
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PMID:Self reports of the interaction between substance abuse and schizophrenia. 762 79

While schizophrenia-like psychosis is known to occur with chronic alcoholism the nosological differentiation of schizophrenia-like psychosis in patients with drug abuse remains difficult. An increased risk for the development of such psychoses has been discussed for various substances, e.g. cannabis. On the one hand this is supported by clinical and epidemiological studies but a final agreement has not been reached. On the other hand high prevalence estimates for substance abuse in schizophrenics have been reported in the angloamerican literature. Prevalence estimates for drug abuse and dependence range between 7-65% and a comparatively distinct abuse pattern in schizophrenics has been discerned: Apart from alcohol schizophrenics tend to abuse cannabis and psychostimulants including cocaine and hallucinogenes, whereas narcotics are abused only infrequently. Whether these recent figures for substance abuse and dependence are due to a real increase (32) or to improved diagnostic instruments and differences in the classification of psychiatric disorders or to selected samples (3, 122) is still a matter of controversy. In comparison with other schizophrenics dual diagnosis schizophrenics show more positive (psychotic) and less negative symptoms. In this review some clinical and neuro-biological problems concerning the concept of drug-induced psychosis and basic principles of pharmacotherapy and psychotherapy in schizophrenic patients with substance abuse are discussed.
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PMID:[Addiction and schizophrenia. Nosological, clinical and therapeutic questions. 2. Substance dependence and schizophrenia]. 805 Jul 73

A special group of psychiatric patients appeared during the last few years; patients who confront their therapists with many diagnostical and therapeutic problems, namely patients with dual diagnosis. These patients suffer from a severe psychiatric illness (such as schizophrenia) and at the same from an addition (e.g. an alcohol-dependency). The management for patients with dual diagnosis is inappropriate as well in psychiatric units as in specialized addition units. Today specialized units for patients with dual diagnosis are non-existent in Switzerland. The following review presents theoretical implications, empirical data and therapeutic possibilities for patients with dual diagnosis.
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PMID:[Dual diagnoses: addiction and other psychiatric disease. Theory, empirical findings and basic therapeutic considerations of a new concept]. 836 22


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