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

For the continued availability of electroconvulsive therapy (ECT) in clinical practice on equal footing with other treatments, and without judicial interference, the following points are essential: ECT should be used or not used on the basis of scientific evidence and not because of public opinion or antipsychiatric propaganda. There should be no hesitation to use ECT in conditions where its omission would mean prolonged suffering, risk of suicide, or death from other causes (deep melancholic syndromes, acute lethal catatonia, psychogenic confusion). ECT should not be used where the effect is short-lived or must be paid at the price of an organic syndrome (schizophrenia, paranoid states, organic confusions). Efficiency should be optimal (oxygen, superficial narcosis, absence of benzodiazepines, generalized tonic-clonic seizures of at least 30-sec duration, maintenance treatment with antidepressive drugs). Safety should be optimal, not only for life but also for cerebral functioning (anesthesiological management, unilateral nondominant stimulation, pulse wave stimuli, appropriate number of treatments, not too closely spaced). The mechanism of action should be the object of further investigation. Such research will open possibilities for finding drugs that can compete with ECT.
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PMID:Use and misuse of electroconvulsive treatment. 402 14

A representative sample of 908 hospital records covering admissions between 1920 and 1982 for depression was analyzed in order to assess the switch rate to hypomania/mania. The results are the following: (1) Over the decades of this century there has been a substantial increase in hospital admissions in Zurich for both depression and mania, but the ratio remained constant. (2) Due to this increase the clinicians can observe more spontaneous switches from depression to mania, which favors the assumption of a causal relationship when treatment is applied. (3) 64 of the 908 patients (7.0%) admitted for depression switched to hypomania or mania. Hypomania was observed in 48 cases (5.3%) and mania in 16 cases (1.7%). (4) The analysis of predisposing factors to a switch has resulted in a simple finding. Bipolar patients (including schizomanics) have an 8-fold higher switch rate (28.9%) than the unipolars (3.7%). The switchers are equally distributed over the two sexes and do not differ in the frequency of a family history of affective psychoses, schizophrenia, schizoaffective disorders, or suicide. (5) Bipolarity correlates positively with 'higher number of previous episodes', with 'readmitted' and with 'switch'. Therefore, studies selecting readmissions [Lewis and Winokur 1982] overrepresent switchers purposely. (6) A loglinear analysis together with some univariate strategies show that over the decades (from 1920 to 1982) there was no significant increase in switches of unipolar or bipolar patients. In conclusion, there is no evidence for a treatment-induced switch. This result is in line with Prien et al. [1973] and with Lewis and Winokur [1982].
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PMID:Switch from depression to mania--a record study over decades between 1920 and 1982. 405 86

Sixteen patients in whom schizophrenia was initially diagnosed and who were treated with fluphenazine enanthate or decanoate developed severe depression for a short period after the injection. In five cases this depression is thought to have been responsible for suicide. In 8 out of 10 cases the depression responded to electroplexy (E.C.T.). It is recommended that patients who are treated with fluphenazine should be carefully supervised.
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PMID:Severe depressive mood changes following slow-release intramuscular fluphenazine injection. 580 10

Between 1968 and 1981 there were roughly equal numbers of male and female schizophrenic parasuicides in Edinburgh: males were significantly younger than females at parasuicide (33 v. 37 years), and had received a diagnosis of schizophrenia for a shorter time (3.4 v. 7.2 years). The clinical, epidemiological and social characteristics of such parasuicides are, by and large, those that might be expected from a knowledge of the epidemiology of schizophrenia. Eight per cent of a sample of Edinburgh schizophrenic first-ever parasuicides subsequently committed suicide, when followed up for up to 14 years. This percentage is close to what would be expected for later suicide in non-schizophrenic parasuicides. When all the suicides were considered, similar numbers of male and female schizophrenics killed themselves; their mean ages at death were 42 and 43 years respectively; and the mean duration of the schizophrenic illness was 10 years in both cases, according to hospital records. We found slight evidence that parasuicide is commoner in schizophrenic suicides than in schizophrenic controls but little evidence to support the contention that there may be a specific relationship between suicide (or parasuicide) and the presence of auditory hallucinations, recent discharge from in-patient care, the use of depot neuroleptic medication, or recent parasuicide. From the point of view of the prevention of suicide and parasuicide in schizophrenics, it is noteworthy that we found few differences between the clinical characteristics and management of schizophrenic parasuicides and suicides, and schizophrenic controls.
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PMID:A clinical and epidemiological survey of parasuicide and suicide in Edinburgh schizophrenics. 615 44

Suicidality scores from the Schedule for Affective Disorders and Schizophrenia on 21 unipolar and 12 bipolar depressives were correlated with monoamine metabolites in the cerebrospinal fluid using multiple regression analyses. The single item of Suicidal Tendencies Worst Week correlated highly significantly and negatively with 3-methoxy-4-hydroxyphenylglycol (MHPG) and only to a very slight degree with 5-hydroxyindoleacetic acid (5HIAA). Seriousness of Intent of Worst Suicide Attempt earlier in life correlated significantly and negatively with both MHPG and 5HIAA. Subjective Anger was positively and Overt Anger negatively associated with thoughts of suicide. The results support earlier reports that depressives with low 5HIAA are prone to violent suicides, but also point to the equal, if not even greater involvement of MHPG and noradrenergic neuronal systems in carrying out a wish for death.
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PMID:Symptom patterns in unipolar and bipolar depression correlating with monoamine metabolites in the cerebrospinal fluid: II. Suicide. 617 41

141 female psychiatric patients, suffering from major depression, schizophrenia, alcohol dependence or adjustment disorder, were investigated for their 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA) and cortisol level in the cerebrospinal fluid (CSF). Dexamethasone suppression tests were also performed in 111 cases, and TRH/TSH tests in 40 subjects. Fifty-two patients were hospitalized following a recent suicide attempt, 18 of which were made using a violent method. The other 34 attempters took tranquilizer or sedative overdoses. CSF 5-HIAA was significantly lower in violent attempters in all 4 diagnostic categories. CSF HVA was higher in those taking drug overdoses, but only in depression (and less markedly in schizophrenia). CSF cortisol did not differ among either diagnostic or suicidal subgroups. Dexamethasone suppression was more frequently abnormal in suicidal patients than in nonattempters, and this difference was more important where the overall nonsuppression rate was lower. Maximal TSH response to TRH showed an inverse correlation with CSF 5-HIAA, and it was lowest in the nonattempter group. The difference between violent suicide attempters and nonattempters in their TSH response was significant. Since these biochemical changes were more or less independent of clinical diagnoses, it seems relevant to explore further the biological background of human aggression and suicide as a separate research direction.
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PMID:Biochemical markers in suicidal patients. Investigations with cerebrospinal fluid amine metabolites and neuroendocrine tests. 620 31

A patient with schizophrenia for many years presented after an attempted suicide, a severe drug-induced catatonia. In these circumstances, an hereditary coproporphyria was discovered. Clinical and pathophysiological interrelationships between the two syndromes are discussed.
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PMID:[Severe catatonia, schizophrenia and hereditary coproporphyria. A case report (author's transl)]. 625 1

Suicide is distinct from suicide attempt, in terms of male predominance (2:1), presence of serious psychiatric morbidity, and in the choice of rapidly effective means which will not be interrupted. However 1 per cent per year, and 10 per cent overall, of those attempting will progress to completed suicide. Communication of intent is the most significant and frequent danger signal of suicide, and the attempt may be such a communication. Useful prognostic features of the attempt are the medical seriousness of the act (overdose accounts for 90 per cent of attempts, and only 25 per cent of suicides), and the psychiatric seriousness of the patient's mental state. Suicide in the absence of psychiatric illness is rare. Depression is the most common associated illness, and whereas the distinction between major and minor is probably not prognostically significant, the presence of current depression is. The lifetime risk of suicide in depressive illness is 15 per cent. The second largest contributor is alcoholism, in particular alcoholics who have experienced loss of a close personal relationship. Other significant psychiatric diagnoses include schizophrenia, organic brain syndrome and personality disorder. Suicide rates differ internationally, but the identification of significant socio-cultural risk factors is hampered by the official differences in ascertainment which exist. Although suicide rates increase with each decade of life, there has been a steady recent rise in suicide rates in many countries, which has been occurring disproportionately among the group aged 15-34.
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PMID:Problems in studying suicide. 637

A survey of the records of 1241 men remanded in prison on criminal charges over four months yielded a high prevalence of psychiatric disorder. Of the total prison intake of 2743 men over the same period, 246 (9.0%) showed major symptoms of psychiatric illness and a further 237 (8.6%) symptoms of withdrawal from drugs or alcohol. Symptoms of neurotic disorders were underrecorded, so in terms of diagnosis 237 men (8.7%) were considered to be psychotic. Of these, 166 (70%) were schizophrenic. The influence of affective psychosis was small. The risk of violence among men with schizophrenia was high. Twenty five (9%) non-fatal personal assaults and 24 (21%) offences of damage to property were committed by men with schizophrenia. The presence of mental illness probably influences the decision to remand in custody for some of these offences, but this is unlikely to explain the substantially higher prevalence of schizophrenia among men convicted of homicide (five (11%) ) and arson (six (30%) ) than would be expected in the general population of Greater London (0.1-0.4%). The prevalence of schizophrenia among men convicted of homicide may even be an underestimate, as may the prevalence of affective psychosis and possibly of other psychiatric abnormalities, given the substantial incidence of concurrent suicide in such men.
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PMID:Violence and psychosis. I. Risk of violence among psychotic men. 642 16

The course and outcome at a 13-14-year follow-up of the Agra cases in the International Pilot Study of Schizophrenia (IPSS) was observed by two methods: i) through a mailed questionnaire to assess the key respondents own perception of their state, ii) by a thorough clinical examination and assessment using standard instruments. The results of these two methods were compared and no significant difference found. Based on the second method it was found that 46% of schizophrenics and 43% of manic-depressives had one or two episodes during the first 5 years after inclusion and none in the subsequent period of 8 to 9 years (up to the present follow-up). The results indicate that the illness loses its intensity over a period of years. Mortality among schizophrenics was higher than the expected rate in a general population. The suicide rate was similar to that reported in other studies.
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PMID:Long term course and outcome of the Agra cases in the International Pilot Study of Schizophrenia. 648 51


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