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

Physicians may have the opportunity to prevent suicide. An awareness of suicide risk factors, such as depression, alcoholism, drug abuse, schizophrenia, and chronic pain or disease, may facilitate suicide prevention. Recognition of acute and chronic suicidal vulnerability occurs through direct questioning. Psychiatric consultation is indicated for patients exhibiting clear self-injury risk, as exemplified by expressed suicide intent, an overt plan for death, or a "gesture." Hospitalization is usually recommended for socially isolated patients presenting with overt suicidal ideation, complicated by injurious self-harm, encephalopathy, or substance abuse. Family involvement and a "no-suicide" contract with the patient, coupled with close outpatient follow-up appointments, should suffice for those exhibiting milder or transient thoughts of suicide without manifest intent to die.
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PMID:A preventive approach to the suicidal patient. 327 11

This chapter has reviewed the specific techniques of measuring fitness for work in individuals with psychiatric impairment. The discussion also considered the estimate of risk associated with various specific conditions and diagnoses. The use of psychiatric measures in work-fitness estimation is warranted in the following situations: 1. applicants with known or suspect history of psychiatric disorder; 2. employees returning to work after an episode of emotional illness or substance abuse; 3. employees referred to the medical department by management for evaluation of performance decrement, absence, abrupt indebtedness, unusual behavior, etc.; and 4. individuals evaluated for high stress or high risk jobs. Applicants' evaluations begin with a thorough medical history, a physical examination, a mental status examination, and basic laboratory studies. The personal history must include a complete work history, with particular attention paid to job duration and reasons for leaving employment. The mental status may be extended by specialized scales, e.g., the Griffiths work behavior rating scale. Unless an applicant has evidence of cognitive dysfunction, the usual battery of psychometric tests will not be helpful. Instruments that measure self-concept and ego strength, e.g., the Stotsky-Weinberg Sentence Completion Test and Miskimins Self-Goal-Other Test, may assist in resolving difficult questions about work fitness, especially in people with a history of schizophrenia. When an employee returns to work after an episode of psychiatric illness, the major questions for the occupational physician are: Is this person capable of returning to his current job? If not, what type of work is he capable of performing? In this instance, the fitness evaluation must add management data about the job to medical data about the patient. The patient-job fit is the crucial issue. For example, a socially-isolated, withdrawn paranoid schizophrenic functioned adequately for years as a third-shift computer operator. The scale of his operational responsibilities allowed him to work alone most of the time, a work environment unsatisfactory to most people but quite suitable for him. To aid in maintaining patient compliance with the treating physician's regimen, the patient should be asked to authorize release of medical information about the illness and to allow continued contact between the occupational physician and the treating doctor. Regularly scheduled follow-up visits are very helpful in maintaining patients on the job. They should include a brief interval history, an abbreviated mental status, relevant laboratory data (e.g., urine chromatography), and support.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Psychiatric conditions in worker fitness and risk evaluation. 328 59

We reviewed studies measuring unsupervised use of psychoactive substances in schizophrenic and control populations and organized the results by substance class. Despite much variation in their methodologies, these studies broadly agreed that schizophrenic groups' use of amphetamines and cocaine, cannabis, hallucinogens, inhalants, caffeine, and tobacco was significantly greater than or equal to use by control groups consisting of other psychiatric patients or normal subjects. Schizophrenic groups' use of alcohol, opiates, and sedative-hypnotics was significantly less than or equal to use by control groups. We discuss the implications of this nonrandom pattern of drug choice for the hypothesis of substance abuse as a form of self-medication in schizophrenia.
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PMID:A review of psychoactive substance use and abuse in schizophrenia. Patterns of drug choice. 331 90

Two hundred thirty-seven relatives of 48 patients with chronic psychosis, diagnosed as either schizophrenia or schizoaffective disorder, along with 380 relatives of psychiatrically normal controls, were studied using systematic diagnostic interviews, information from relatives, and review of medical records where appropriate. A variety of nonbipolar psychotic disorders was found in the relatives of the patients. Comparing relatives of patients with schizophrenia with relatives of patients with schizoaffective disorder, there was no tendency for schizoaffective diagnosis or acute psychoses to aggregate separately from schizophrenia. Increased incidence of bipolar disorder was found in relatives of patients with schizoaffective disorder but not in relatives of patients with schizophrenia. Incidence of major affective disorder (bipolar and unipolar) was increased in relatives of probands with both types of psychoses. If we subdivide the ill probands according to whether or not they had a history of substance abuse, relatives of probands with substance abuse had greater frequency of affective disorder and substance abuse, but there were not significant differences in the number of relatives with nonbipolar psychoses.
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PMID:A controlled family study of chronic psychoses. Schizophrenia and schizoaffective disorder. 335 20

In the framework of a prospective longitudinal investigation, the occupational course of first-admission psychiatric patients was analyzed for the first year (1980) and the fifth (1984) post-discharge from the clinic. Findings indicate that, to quite an important degree, tendencies towards occupational disintegration had existed already immediately after the first in-patient treatment episode. This applied almost totally independent of the clinical diagnosis given at the time of the first hospitalization. Only persons with substance abuse illness had been affected clearly less often, the situation four years later being however comparable. Except for the groups of neurotic and personality disorders, the occupational situation had by then however tightened drastically for all of the diagnostic groups, a structural analysis making it clear that this development had initiated already in the course of the first year. Thus, all patients who had been without work over the entire first year of the five-year period, had already reached the "terminal point" in their employment history. As far as diagnoses are concerned, our study confirms the experience that a schizophrenic illness will by no means always entail a straight course toward an unfavourable outcome. The investigation at the same time however also indicated that non-schizophrenic illnesses take a more unfavourable course than had been expected. In relation to earlier longitudinal catamnestic studies of persons with schizophrenia, the findings for our schizophrenic patients moreover were markedly worse, this discrepancy being presumed to be accounted for by the different methods applied, different selection criteria, as well as differences in economic activity at the time.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Outcome, course and prognosis of the vocational status of psychiatric patients hospitalized for the 1st time--results of a multiple factor study]. 336 18

Knowledge of the personality trait and psychopathology variables that differentiate neuropsychologically impaired and nonimpaired psychiatric patients has been limited relative to the study of higher cortical functions. This study reports findings from the Millon Clinical Multiaxial Inventory (MCMI) developed by Millon (1982) in a sample of hospitalized schizophrenics and depressives who also received the Luria-Nebraska Neuropsychological Battery. The principal findings indicate that neuropsychological dysfunction may be related to substance abuse, including its underlying personality dimensions, in schizophrenia, but only modest support is indicated for the construct of negative symptoms in schizophrenics with neuropsychological dysfunction. Further, the findings do not support the view that psychosis is a characteristic feature of depressives with impaired neuropsychological performance.
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PMID:Personality trait characteristics in relation to neuropsychological dysfunction in schizophrenia and depression. 340 91

A nation-wide cohort of all first admitted patients to all Danish psychiatric institutions over a 1 year period and aged 15 years or more was followed for 10 years in the Danish psychiatric register. Revolving door patients were defined as patients with a minimum of four admissions and 1) no admission or discharge period lasting for more than 1/4 of the observation period or 2) at least four admissions over the first 1/4 of the observation period. The revolving door population comprised 1,397 patients with an incidence rate of 0.42 males and 0.32 females per 1,000. Forty-three point five percent belonged to the same diagnostic group at first and last diagnostic assessment ranging from 28.3% in "organic psychosis" to 57.6% in "neurosis". A multiple contingency analysis showed a number of variables at first admission significantly associated with the outcome "revolving door". Many were conditioned by others and the independent variables were "age group", "main diagnosis" and "sex". Patients aged 15-24 years constituted a high risk group among schizophrenics. The 15-24 age group was further at high risk among females with personality disorder or abuse and males with manic depressive and psychogenic psychosis. Living close to a psychiatric institution was in males associated with the outcome independently of age and diagnosis, in females it was restricted to personality disorder. Revolving door patients were significantly younger than others and more likely to suffer from schizophrenia or alcohol/substance abuse.
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PMID:The use of a psychiatric register in predicting the outcome "revolving door patient". A nation-wide cohort of first time admitted psychiatric patients. 343 27

Between 1936 and 1950, detailed abstracts were prepared on all patients admitted to The Phipps Psychiatric Clinic from its opening in 1913 through 1950. Of these abstracts, 74% contained follow-up reports. Except for four papers on schizophrenia and affective disorders published between 1939 and 1943, none of this material has ever been analyzed. The present paper, the first of a series, examines the 8172 first admissions from 1913 through 1940, the period of Adolf Meyer's tenure as Clinic Director. Based on discharge diagnoses, we have sorted the patients into eight diagnostic groups with the following frequencies; schizophrenia, 17%; paranoid state, 3%; manic-depressive, 7%; depression, 27%; organic, 20%; neuroses, 15%; substance abuse, 6%; psychopath, 5%. Our manic-depressive group contains cases discharged primarily as hyperthymergasia, mania, or manic depressive insanity (MDI). Of the 349 cases diagnosed MDI at discharge, 10 had neither a history of nor present symptoms of mania, and these were put in the depression group. Frequencies for most of the diagnoses remained remarkably stable over the 28-year period. Only 9% were discharged recovered, whereas 43% were rated unimproved. Mean length of hospitalization was 76 days, with 10% of the patients readmitted. The mean length of follow-up was 9 years. Correlations of diagnoses, year of admission, length of stay, condition at discharge, age, sex, readmissions, change of diagnoses, somatic treatment, length of follow-up, and deaths in the clinic are presented. Meyer's influence on diagnostic practice is discussed.
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PMID:Inpatient diagnoses during Adolf Meyer's tenure as director of the Henry Phipps Psychiatric Clinic, 1913-1940. 353 8

As a part of the American-Danish prospective study of children of schizophrenic mothers, psychiatrically hospitalised and untreated cases of schizophrenia spectrum conditions, i.e. borderline schizophrenia, schizoid and paranoid personality disorders, were compared on a number of characteristics. This exploratory analysis revealed that the groups were similar to each other on childhood conditions, sociodemographic variables, premorbid IQ and levels of schizophrenia-related psychopathology. The hospitalised group, however, exhibited higher levels of concomitant psychopathology, such as substance abuse, affective symptoms and psychopathic tendencies. It is suggested that the clinical population may not be representative of the diagnostic category in question owing to co-existence of confounding symptomatology (Berkson's fallacy).
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PMID:A matched-paired comparison of treated versus untreated schizophrenia spectrum cases. A high-risk population study. 357 40

Family therapy for acute inpatient treatment is invaluable. It serves to support the patient as well as the family through the crisis of hospitalization. On intensive treatment milieus, the family treatment augments the other modalities, furthering the reconstitution of the patient by preventing acting out and splitting, providing a holding environment for the family's anxieties, and supporting their interest and involvement in treatment while educating them about the illness and the aftercare needs. The area of inpatient family therapy is still fledgling. Despite early observations about family pathology stemming from inpatient units, the family treatment focus has shifted to outpatient treatment. This has left a vacuum for clinicians whose primary involvement is in inpatient settings. In the past decade, however, more emphasis has been placed on family-oriented units, but the focus has been primarily on the structure and generalized treatment recommendations or on specific interventions tied to illness categories, that is, schizophrenia, anorexia, substance abuse. Unfortunately, these disparate pieces of work have not led to an overall understanding of how to integrate family concepts and treatment strategies for general psychiatric populations into dynamic treatment units. In order to integrate family treatment into a dynamic milieu, an overall assessment of familial ego functioning, strengths and weaknesses, is necessary. Utilizing an ego psychological perspective renders this assessment integratable into the language and interventions of an intensive treatment unit. Identifying drive-taming capabilities, level of object relations, anxiety tolerance, defenses, and adaptive capacities of the whole family allows for the designation of appropriate interventions. These interventions are tailored toward engaging the family's strengths while limiting the destructive nature of existing pathologies. Treatment interventions are based first on the establishment of familial treatment alliances that can withstand the regressive pull of a psychotic or near-psychotic illness. From this the more traditional therapeutic interventions flow, based on the needs of the case. The focus may be purely informative, educative, and supportive or may be more insight oriented, restructuring. The particular choice of interventions, though, is designated by the strengths and weaknesses identified in the assessment. In this manner we can utilize a biopsychosocial model of treatment that is truly integrated and in which the component parts are understood conceptually by all disciplines.
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PMID:Family treatment within a psychodynamic treatment milieu. 360 48


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