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

In psychiatric disorders where gross brain structure is preserved, as confirmed through computed tomography and magnetic resonance imaging, neuroSPECT imaging provides further diagnostic insight by demonstrating abnormal brain function related to disturbances in perfusion or metabolism. This paper will focus on how the psychiatrist may incorporate SPECT brain imaging into the diagnostic process for schizophrenia, where frontal lobe hypoperfusion and hypometabolism have been demonstrated; for obsessive compulsive disorder, which has been linked to abnormalities in the basal ganglia, anterior cingulate gyrus, and orbital frontal cortex; and for substance abuse, where use of cocaine can be associated with cortical and subcortical perfusion defects.
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PMID:Regional cerebral blood flow imaging with SPECT in psychiatric disease: focus on schizophrenia, anxiety disorders, and substance abuse. 145 79

The problem of substance abuse disorders in schizophrenia patients is reviewed, including the prevalence of co-morbid disorders, assessment, hypothesized mechanisms underlying abuse, and the clinical effects of abuse on the course of illness and cognitive functioning. The principles of treatment for dual-diagnosis schizophrenia patients are outlined, and the limitations of existing interventions are noted. Gaps in current knowledge about the impact of substance abuse on schizophrenia and its treatment are identified, and suggestions are made regarding promising avenues of research in this area.
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PMID:Comorbidity of schizophrenia and substance abuse: implications for treatment. 146 Jan 48

A survey of patients admitted four or more times to the same acute care psychiatric hospital over a period of 3 years revealed that only 56 of 162 (34%) of such patients were discharged with the same diagnosis on each admission. Instability of diagnosis occurred despite the fact that previous diagnoses were known and that only relatively few diagnoses contributed to this degree of chronicity. Schizophrenia and mania were the most stable diagnoses with considerable overlap between them. Organic disorders were a variable diagnosis, often made in the context of chronicity, substance abuse or uncertainty. A diagnosis of substance abuse usually occurred in the context of other comorbid diagnoses which sometimes took precedence. Instability of diagnosis will continue so long as the diagnostic system is based so heavily on clinical criteria.
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PMID:Stability of psychiatric diagnoses among acutely ill patients. 149 44

Published estimates of the prevalence of substance abuse in schizophrenia were correlated with several aspects of the studies in which they were obtained. Higher estimates of alcohol and stimulant abuse were found in studies published more recently. Rates of alcohol abuse were particularly high in one rural investigation. Rates of stimulant abuse were highest when patients were asked directly about use of stimulants. Increased prevalence estimates in more recent years could not be attributed to method of assessing substance abuse, method of defining substance abuse, or characteristics of the study sample.
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PMID:Prevalence estimates of substance abuse in schizophrenia and their correlates. 152 9

The historical antecedents of the current diagnostic criteria for mania involve the German phenomenologic descriptions of the late 1800s, the introduction of lithium for treatment and prevention of mania (which broadened the definition of mania in this country), the attempts to subclassify bipolar disorder into at least two subtypes, and the differentiation of patients with mania and hypomania from those with depression alone. Current diagnostic criteria for bipolar disorder are delineated in DSM-III-R. The differential diagnosis of bipolar disorder includes other conditions that may have manic-like symptoms, including organic mood disorders such as endocrine or metabolic conditions, drug intoxications, and tumors. Mania occurring in the context of substance abuse would be called a secondary mania. In addition, schizoaffective disorder can be diagnosed if there is a manic syndrome superimposed in the context of schizophrenia. Because of the absence of duration criteria for mania in DSM-III-R, the differential diagnosis within the bipolar disorders is largely based on severity and duration of depression. A problem in studying mania at present is that the prototypic cases have largely disappeared from treatment centers because of the success of lithium maintenance treatment. Patients available for study at psychiatric treatment facilities are largely treatment resistant, atypical, and likely to have experienced considerable amounts of substance abuse in their histories. Among the changes being considered for DSM-IV are to include duration criteria for mania, to separate bipolar II patients (depression and hypomania) from bipolar not otherwise specified, to refine the criteria for hypomania, and to add rapid cycling to the list of parenthetical modifiers for bipolar disorder with mania and bipolar disorder with hypomania.
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PMID:Differential diagnosis of bipolar disorder. 154 21

To evaluate the effects of previous alcohol and drug use on the course and symptoms of schizophrenia, the authors compared 34 patients with schizophrenia who had histories of substance abuse with 17 patients with schizophrenia who were lifelong abstainers. Surprisingly, they did not find that individuals with past histories of abuse were more impaired or had more symptoms.
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PMID:Past substance abuse and clinical course of schizophrenia. 155 46

A total of 247 chronic mentally ill patients committed for emergency involuntary hospitalization in a public intensive treatment unit were grouped on the basis of positive or negative urine toxicology screens for psychoactive substances at admission. Patients whose screens were positive for substance abuse were more likely to live alone or to be homeless, to be committed for making threats, and to have a diagnosis of organic mental disorder or substance abuse disorder. Patients who screened negative were more likely to live in a supervised setting, to be committed for actions such as assaults and suicidal behavior, and to have a diagnosis of schizophrenia or other psychotic disorder.
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PMID:Factors related to emergency commitment of chronic mentally ill patients who are substance abusers. 155 18

The Structured Clinical Interview for DSM-III-R was used to examine the effects of the co-occurrence of psychiatric and substance dependence disorders on diagnostic reliability. The test-retest reliability over a 1-week period was studied in groups of: a) individuals with current substance abuse diagnoses (N = 97), b) individuals with past, but not current, drug histories (N = 146), and c) individuals without substance abuse diagnoses (N = 356; primarily psychiatric patients). A measurement of reliability (Kappa coefficients) was estimated for four general psychiatric categories (psychotic, mood, anxiety, and eating disorders), along with specific most-frequent diagnoses in each category (schizophrenia, major depression, panic disorders, and bulimia nervosa, respectively). Past use and non-drug-use groups were similar in their generally reliable reporting of current and past psychiatric disorders. However, current mood and psychotic disorders were less reliably diagnosed in the group with current substance use disorders.
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PMID:Reliability of dual diagnosis. Substance dependence and psychiatric disorders. 155 65

The purpose of this study was to determine the relationship of ethnic identity to psychiatric diagnosis in white, black, Latino, and Asian clients of the Los Angeles County mental health system. The sample (N = 26,400) consisted of adult inpatient and outpatient clients seen in county mental health facilities between January 1983 and August 1988. Logistic regression analysis was used to determine the relationship of ethnicity to diagnosis in both outpatient and inpatient samples. The covariates included in the analysis were age, gender, socioeconomic status, and primary language. Ethnicity had a significant and consistent relationship to diagnosis in both outpatient and inpatient samples, with black and Asian clients having a greater proportion of psychotic diagnoses than whites, and Latinos a lesser proportion than whites. None of the covariates included in the analysis had a consistent relationship to diagnosis. Whites and Asians received more diagnoses of major affective disorders than blacks or Latinos; blacks and Asians received more diagnoses of schizophrenia and other psychoses than whites, and Latinos received fewer of these diagnoses than whites. Substance abuse was lower for Asians than for the other three groups. Based on the findings, it was concluded that there continues to be a difference in psychiatric diagnosis that is related to ethnicity. Clinical practice issues and recommendations for further research are considered in relationship to these findings.
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PMID:Relationship of ethnicity to psychiatric diagnosis. 158 73

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


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