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

A review of epidemiological data regarding the prevalence of substance abuse in schizophrenia and vice versa points out differences which are hard to interpret, owing to inconsistent sampling procedures and to the application of different diagnostic criteria. Stimulant abuse in schizophrenics has apparently increased over the years, eventually alcoholic abuse, whereas no increase is evidenced for cannabis abuse. Patients with dual diagnosis have an increased risk for morbidity and mortality, for psychotic relapse and for social disintegration. No increased risk for schizophrenic psychosis is found for drug abusers. Possible explanations why schizophrenics could show an increased susceptibility to become substance abusers are discussed, and therapeutic recommendations added.
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PMID:[Schizophrenia and substance dependence]. 865 2

There are different opinions about the cause of chronic psychiatric symptoms observed in drug abusers between Japanese and foreign psychiatrists. The Japanese seem to recognize the chronic psychosis as the result of drug abuse. In the other hand, foreigners diagnose these cases as dual diagnosis of drug abuse and psychosis. Authors studied the problem in this research. One of the authors has examined 120 inhalant abusers of all, in- and out-patients in Kanagawa Prefectural Center of Psychiatry, Serigaya Hospital from 1991 to 1995. These patients were classified into three groups: psychosis group (23 patients), dependence group (51 patients) and abuse group (46 patients) according to their clinical courses and psychiatric symptoms. The psychosis group consists of patients who showed psychiatric symptoms such as hallucination, delusion and thought disturbance for long time after detoxification. The dependence group contains patients whose inhalant dependence was severe and met DSM-4 Diagnostic Criteria for Substance Dependence, but manifested no chronic psychiatric symptoms after detoxification. The patients belonging to abuse group were at the earlier stages of inhalant abuse and had no chronic psychiatric symptoms. The average age of the first inhalant abuse was 14.7 years old in the psychosis group, 14.8 years in the dependence group and 14.7 years in the abuse group. The average years of abuse was 9.0 years in the psychosis group, and 8.5 years in the dependence group. There was little difference between these two groups. The psychosis patients manifested chronic symptoms 5.7 years on average after the first abuse of inhalants. About one forth (26.1%) of the psychosis patients and only 5.9% of the dependence patients had family history of schizophrenia. The difference was statistically significant. These results suggest that chronic psychiatric symptoms are caused not only by inhalant abuse, but also by the genetic factors of psychosis of each patient. There have been several reports that many patients with dual diagnosis of substance dependence and other mental disorders are poly-drug abusers. In our study, 43.4% of the psychosis group patients and 19.6% of the dependence group patients had the past history of abuse of other drugs including methamphetamine and marijuana. The difference was, however, not statistically significant.
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PMID:[Inhalant abusers and psychiatric symptoms]. 871 Sep 94

This study examined the reliability, validity, and responsiveness of Lehman's Quality of Life Interview (QOLI) as an outcome measure on 981 acutely ill psychiatric inpatients assessed longitudinally at admission and discharge. Patients were stratified into five diagnostic (DX) (depressed bipolar, depressed unipolar, schizophrenia, mania, and other diagnoses) and two substance use disorder (SA) strata (with and without concurrent substance abuse/dependence) based on DSM-III-R criteria. There was good replication of the factor structure, excellent internal consistency, overall and within DX and SA groups. Intercorrelations showed that the functional and satisfaction indices measure unique aspects of the quality of life. The construct consistency of the QOLI was dependent upon psychiatric diagnosis and life domain. Intercorrelations of functional and satisfaction indices for patients with depression were greater than for manic patients. We demonstrated strong consistency of construct validity for family and social relation domains, but not safety or leisure activities. Construct validity was shown to hold longitudinally. Analyses of DX and SA group differences on satisfaction and functional indices of the 8 life domains supported discriminative validity: Depressed patients reported the most dissatisfaction, followed by schizophrenic patients, and manic patients reported the greatest satisfaction in most life domains. Patients with concurrent substance abuse generally reported less satisfaction and lower quality of life than patients without a dual diagnosis. Examination of longitudinal changes in satisfaction indicated the QOLI is responsive to changes in global life, leisure activities, living situation, and social relations from hospital admission to discharge (an average of 2 weeks). This study supports the use of the QOLI as an outcome measure to assess quality of life in acutely ill hospitalized psychiatric patients.
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PMID:Longitudinal assessment of quality of life in acute psychiatric inpatients: reliability and validity. 909 98

A study on the concept and measurement of the basic disorders of schizophrenia is presented. A total of 151 male adult psychiatric inpatients (51 with a dual diagnosis of schizophrenia and alcoholism, 50 schizophrenics and 50 alcoholics) were included. The aims of this study were: (1) the replication of the previous finding that the Frankfurt Complaint Questionnaire (FBF) contains items that discriminate between schizophrenia and alcoholism; (2) an empirical comparison between FBF and the Bonn Scale for the Assessment of Basic Symptoms (BSABS); (3) testing the relationship between basic and negative versus positive symptoms, as measured by the Positive and Negative Syndrome Scale (PANSS). Regarding (1), the former result was replicated. Regarding (2), FBF subscales and BSABS categories were shown to be significantly but weakly related, even if identical symptoms were included in the inquiry. Regarding (3), FBF and BSABS were found to be more closely related to negative than to positive PANSS items. Theoretical implications and consequences for further research are discussed.
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PMID:[Validity of assessment of schizophrenic basic symptoms]. 919 80

The recent advent of atypical antipsychotic medications has provided new clinical options and set higher expectations for the treatment of schizophrenia and other psychoses. Two such drugs, clozapine and risperidone, are currently employed in the United States. Researchers continue to fine-tune treatment with these agents and to seek possible new uses for them. For clozapine, refinements in use (optimal duration of trial, optimal dose, use of drug plasma level to optimize efficacy) are described, along with side effects and the specificity (or lack thereof) of the drug's action upon primary negative symptoms. Also discussed is use of clozapine in new subgroups of patients--for example, those with first-episode schizophrenia, polydipsia syndrome, or a dual diagnosis. For risperidone, use in patients with first-episode schizophrenia, affective disorders, autism, and other disorders in described. Cost-benefit considerations are presented for both drugs. The psychosocial needs of patients taking these medications and the potential for synergy between novel antipsychotics and modern psychosocial therapies are also discussed.
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PMID:Clozapine and risperidone: refining and extending their use. 938 93

The etiology of the high prevalence of substance use disorders in patients with severe mental illness (schizophrenia or bipolar disorder) is unclear. We review the evidence of different theories of increased comorbidity, organized according to four general models: common factor models, secondary substance use disorder models, secondary psychiatric disorder models, and bidirectional models. Among common factor models, evidence suggests that antisocial personality disorder accounts for some increased comorbidity. Among secondary substance use disorder models, there is support for the supersensitivity model, which posits that biological vulnerability of psychiatric disorders results in sensitivity to small amounts of alcohol and drugs, leading to substance use disorders. There is minimal support for the self-medication model, but the accumulation of multiple risk factors related to mental illness, including dysphoria, may increase the risk of substance use disorder. Secondary psychiatric disorder models remain to be convincingly demonstrated. Bidirectional models have not been systematically examined. Further clarification of etiologic factors, including the identification of subtypes of dual diagnosis, may have implications for developing more effective prevention efforts and treatment.
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PMID:Dual diagnosis: a review of etiological theories. 980 12

There is a small portion of psychiatric patients whose symptom patterns at one point in their lives suggest a severe affective disorder and at another point a diagnosis of schizophrenia. Shifting symptom patterns such as this have heretofore been explained as misdiagnosis or dual diagnosis. An alternate hypothesis is offered--that in some patients, mental illness may be expressed in different and discrete ways at different points in their lives, depending upon intrapersonal, interpersonal, and biological processes. The rationale for the hypothesis derives from selected follow-up and family studies, treatment and drug effects, and the observed similarity of abnormal physiological measures in both diagnostic groups. Clinical implications are that one cannot always rely on family history to support a specific diagnosis on a patient's first presentation. Furthermore, if a patient subsequently presents with a significant change in symptom pattern, the therapist may wish to consider a modification of the original treatment regimen. The notion of shifting symptom patterns does not diminish the usefulness of descriptive diagnostic categories. Rather, it challenges the concept that these categories need be immutable within individuals. Compelling support for the hypothesis will necessitate prospective study of patient charts over time.
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PMID:Schizophrenia and severe affective illness alternating over time in some patients: a hypothesis. 982 35

This research was conducted to teach two adults with schizophrenia and mental retardation to respond to recorded audio prompts in order to eliminate the need for instructor assistance in completing routine prevocational tasks. Studying individuals with dual diagnosis is an important step in moving toward success in community living and vocational placement. A multiple probe design across tasks was conducted. Prior to the investigation, both individuals demonstrated low levels of independent task completion. Following the implementation of the audio prompts, both individuals' task completion performances dramatically increased. These findings suggest that audio prompts may serve as an efficient alternative to instructor promoting, which is often required by individuals with dual diagnosis in prevocational job settings.
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PMID:Recorded audio prompts. A strategy to increase independent prevocational task completion in individuals with dual diagnosis. 992 25

The heterogeneity of signs and symptoms of alcohol disorder was examined in a community sample of 1,955 persons with either alcohol disorder alone or alcohol disorder plus one of four categories of major mental disorder (antisocial personality disorder, schizophrenia, affective disorder, anxiety disorder). When all diagnostic categories were combined, persons with comorbid mental and alcohol disorders showed evidence of more severe alcohol-related symptoms than did persons with alcohol disorder alone. Distinct symptom patterns distinguished the four diagnostic groups, reflecting heterogeneity in the manifestation of comorbid alcohol disorder. Most notably, comorbid antisocial personality disorder and schizophrenia were associated with higher levels of alcohol consumption and more severe social consequences of alcohol use. These findings substantiate the need for development of specialized dual diagnosis programs and suggest that additional specialization may be required to address diagnostic group differences in the characteristics of comorbid alcohol disorder.
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PMID:Symptom heterogeneity in comorbid alcohol disorder. 1017 13

The aim of the present study was to determine the efficacy of any antipsychotic medication for treating people with a dual diagnosis of intellectual disability and schizophrenia. The authors performed an electronic search of Biological Abstracts, the Cochrane Schizophrenia Group's Register of trials, the Cochrane Library, EMBASE, PsycLIT and MEDLINE. Unpublished data were sought from pharmaceutical companies. Both authors independently selected the relevant studies from the reports identified in this way. Only one relevant randomized trial was found by the searches (Foote 1958). This study included four people with a dual diagnosis of schizophrenia and intellectual disability, but results were only available for two subjects. The groups to which the other two people were allocated were unclear. Using the methods described, the reviewers found no trial evidence to guide the use of antipsychotic medication for those with both intellectual disability and schizophrenia. Until the urgent need for randomized controlled trials is met, clinical practice will continue to be guided by evidence from trials involving people with schizophrenia but without intellectual disability.
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PMID:Effectiveness of antipsychotic medication in people with intellectual disability and schizophrenia: a systematic review. 1022 89


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