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

The major risk determinants of violence are to be young and male, to have low socioeconomic status and suffering substance abuse. This is true whether it occurs in the context of a concurrent mental illness or not; i.e., mental disorders are neither necessary, nor sufficient causes for violence. Intense motivation is a facilitating factor for violence in clinical and non clinical samples. This explains why 'normal' people, are implicated in planned violence at higher rates than mentally ill (e.g. in criminal acts against property). However mentally ill patients are more easily implicated in impulsive violence or in violence without obvious cause due to veiled motivation fuelled by unidentified symptoms. Subjective or real awareness of competitive disadvantage increases motivation for violence (e.g. paranoid, narcissistic symptoms, etc.). Many psychiatric disorders as antisocial disorder, borderline, schizophrenia, have most of the factors that facilitate the appearance of violence. Antisocial disorder is a good model to study determinants of violence in normal samples as it is present in young males that do not have any psychotic symptom, have stable symptomatology, self control under scrutiny, and their motivations are similar to normal samples. Our evolutionary model suggests that there is a non random association of genetic factors (genes, pseudogenes, promoting areas, etc.), that is, a genetic cluster (cluster DO), whose phylogenetic function is to motivate to be the dominant in social relationships. To be the dominant is a major psychological feature present in many social groups of animals, included primates. DO cluster have sense from an evolutionary viewpoint: when expressed in no pathological way it increases inclusive fitness (transmission of the genes of a person genotype whether by oneself or by relatives reproduction). Features of cluster DO in humans are expressed differently according to sex, age, moral education, level of intelligence, etc. Cluster DO has higher phenotypical expression in males and young people. Primary antisocial personality disorder and other related disorders (cluster B personality disorders, disocial, defiant disorder, etc.), are a pathological manifestation of this cluster DO. Some other genetic clusters that causes the genetic liability to some disorders (e.g. attention deficit disorder) are non random associated with cluster DO, thus explaining clinical comorbidity. According to our model, motivation for dominance usually prevails over motivation for material benefit or antinormative behaviour, this explains some incongruent behaviour in antisocial patients not elucidated by other models. Along with the primary expressed feature of dominance of cluster DO there are other secondary features that have been identified by psychobiological studies: novelty seeking, intolerance for frustration, impulsiveness, fearless, aggressiveness, higher threshold for activation of the sympathetic system, lack of empathy, egoism, non acceptance of rules, defiant and rebellious behaviour, manipulation in social interactions, selfishness and deficits in altruism or in social co-operation.
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PMID:Violence in mental disorders and community sample: an evolutionary model related with dominance in social relationships. 1678 23

Aggressiveness is a frequent and problematic aspect of the treatment of forensic patients. This study examines the correlation of aggressiveness and its subtypes with quality of life enjoyment and satisfaction, personality dimensions and family functioning. The research is conducted on 99 psychiatric patients diagnosed with schizophrenia or psychotic disorder similar to schizophrenia (F20-F29) in two forensic psychiatry institutions. The patients committed criminal offence in state of insanity. These offences had signs of aggressive acts and the patients were therefore admitted to inpatient psychiatric forensic institutions. The research was conducted by using the Aggressiveness Questionnaire (AG-87), the Eysenck Personality Questionnaire, the Quality of Life Enjoyment and Satisfaction Questionnaire and the Family Functioning Scale. The results show that aggressiveness has a negative correlation with the quality of life enjoyment and satisfaction. Regression analyses indicate that bad family relations and psychoticism are significant predictors of aggressiveness and its subtypes. We can conclude that forensic patients who committed aggressive offence in psychotic state, who at the same time score higher values on psychoticism scale and report negative family relations, are more likely to express aggressiveness also during their stay in forensic psychiatric hospital.
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PMID:Predictors of aggressiveness in schizophrenic patients treated in inpatient forensic institutions. 1875 77

New genetic technologies promise to generate valuable insights into the aetiology of several psychiatric conditions, as well as a wider range of human and animal behaviours. Advances in the neurosciences and the application of new brain imaging techniques offer a way of integrating DNA analysis with studies that are looking at other biological markers of behaviour. While candidate 'genes for' certain conditions, including schizophrenia and bipolar disorders, are said to be 'un-discovered' at a faster rate than they are discovered, many studies are being conducted on personality traits such as aggressiveness and anti-social traits. The clinical applicability and implications of these studies are often discussed within the scientific community. However, little attention has so far been paid to their possible policy implications in relation to criminality management and to Criminal Law itself. Similarly, the related ethical issues arising in the field of crime control, and the tensions between enhancing security for society and protecting civil liberties, are currently under-explored. This paper investigates these ethical issues by focusing on the views of those professionals - including judges, lawyers, probation officers and social workers - who work with individuals 'deemed at risk' of violent and aggressive behaviours. It also discusses and problematizes mainstream rhetoric and arguments around the notion of 'risky individuals'.
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PMID:Risky individuals and the politics of genetic research into aggressiveness and violence. 1895 33

Off-label use is an ongoing problem in child and adolescent psychiatry. Except methylphenidate and atomoxetine for attention-deficit/hyperactivity disorder (ADHD), most substances used to treat children and adolescents with psychiatric disorders are prescribed off-label. In additional to aspects of drug safety and efficacy the widespread off-label use raises issues of liability in the case of adverse events. In Germany off-label use also poses problems of reimbursement by the health insurance. In the future we expect, driven by written request of the FDA, numerous new indications for novel antipsychotics in the USA for the treatment of so-called childhood bipolar disorders. Given another diagnostic framework in context in Europe, these so-called bipolar disorders in children are very rarely diagnosed. Anyhow, antipsychotics are widely used in the USA and in Europe to treat impulsivity or aggressiveness in children and adolescents. There is still a lack of European labelling of novel antipsychotics for the treatment of schizophrenia. In clinical practice given the risk of liability and other forensic issues in the treatment of schizophrenic patients, this is still one of the major hindrances in the treatment of young schizophrenic patients in Europe. Whereas these drugs may urgently be needed for treatment of psychotic disorders and of impulsivity or aggressiveness, the indication of bipolar as used in the USA leads to a misconception and does not increase availability of licensed modern antipsychotics for minors.
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PMID:[Off-label use in child and adolescent psychiatry. An ongoing ethical, medical and legal problem]. 1953 77

The term decision making indicates aspects of the executive functions related to the ability to modulate the reward and punishment perception, in order to operate advantageous choices. From the clinical point of view it appears a transnosographic trait that may influence the suicide risk and aggressive acts, increase interpersonal difficulties and modulate therapeutic response: an interesting link between clinical symptomatology and functional daily abilities. We conducted a literature review on its neurophysiology and neuropsychology and the implications in different psychiatric disorders such as schizophrenia, bipolar disorder, unipolar depression, suicide, obsessive-compulsive disorder, substances abuse, personality disorders, aggressiveness and pathological gambling.
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PMID:[The decision making: neuroanatomy, functional exploration and mental disorders]. 2006 95

One of the subjects that most concerns physicians is treatment-resistance. About 30%-60% of schizophrenia patients do not respond adequately to antipsychotic treatment and are known as refractory schizophrenia patients. Clozapine has been the drug of choice in such cases. However, approximately 30% of them do not respond to clozapine either. Here, we describe a patient with an initial diagnosis of refractory schizophrenia who had a history of dramatic aggressiveness. However, in this case, "refractoriness" was a wrong diagnosis. A case of psychosis secondary to epilepsy had been treated as schizophrenia for almost 20 years. Reports like this one are important because they remind us of how a thorough investigation can lead to the correct diagnosis and improve the patient's prognosis.
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PMID:A false case of clozapine-resistant schizophrenia. 2030 May 82

The different lysosomal storage disorders (LSDs) manifest with a wide spectrum of clinical presentations. Most of these disorders are typically diagnosed early in life, due to the severity of the associated phenotypes. However, it is important to appreciate that some of the LSDs present later in adolescence or adulthood. The diverse findings triggering the initial diagnosis, as well as the range of manifestations arising later during the disease course, contribute to the complexity of these issues. Clinical presentations occurring at a more advanced age, especially psychiatric and behavioral manifestations, can be overlooked or misdiagnosed. This review describes different psychiatric and behavioral manifestations encountered in individuals with LSDs, including psychosis, schizophrenia, mood disorders, aggressiveness, early-onset dementia, and conduct disorder. Twelve different disorders are presented, including descriptions of their associated biochemical abnormalities, clinical presentations, pathology, epidemiology, and genetics. In addition, discussions of neurocognitive, behavioral, and psychiatric findings are outlined for each disorder. A greater awareness of these features may help to reduce missed diagnoses, to avoid unnecessary, invasive and expensive testing, and to facilitate an earlier detection of these rare disorders. Earlier diagnosis can enable the implementation of appropriate interventions and improve genetic counseling.
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PMID:Psychiatric and behavioral manifestations of lysosomal storage disorders. 2087 65

The selection of antipsychotics as medications used primarily for treating schizophrenia and disorders similar to schizophrenia is an important aspect of the treatment of forensicpatients. This study examines the effect of antipsychotics selection (typical or atipycal) on the level of aggressiveness, side effects and the hospitalisation length. The research is conducted on 98 psychiatric patients diagnosed with schizophrenia or similar disorders (F 20-F 29) in two forensic psychiatric institutions. The patients committed aggressive criminal offence in state of insanity. The patients are currently treated in inpatient psychiatric institutions. The research was conducted by using the Aggressiveness Questionnaire (AG-87), the Simpson-Angus Scale for the assessment of extrapyramidal side effects, the Barnes Akathisia Rating Scale for the assesment of akathisia and the Abnormal Involuntary Movement Scale. The results show no significant difference between the groups of patients treated with typical and atypical antipsychotics in all the variables.
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PMID:Aggresiveness in institutionalised schizophrenic patients and the selection of antipsychotics. 2164 45

Inability to enjoy normally pleasurable experiences (anhedonia) is a symptom common both to major depression and schizophrenia. It also regularly accompanies and follows stress, and its presence in the two mental illnesses could depend on the fact that both are facilitated and often preceded by stressful events. Anhedonia might possibly accompany stress because the loss of the pleasure of aiming for a goal and achieving it (including defending oneself and escaping from a danger) could lead to immobility, and immobility (playing dead) offers the extreme chance of safety when an animal is facing the worst possible stressful situation--being seized by a predator--as in this case any movement can further stimulate the predator's aggressiveness. Perceiving and connecting sensory information also gives pleasure, and this appears to enhance the clarity of sensations and is an important factor in learning. We propose that anhedonia, by reducing or eliminating the pleasure, might jeopardize the usual appearance of the environment, which must not only be clearly perceived but also continuously interpreted (for instance a foreshortening, or something far off seen as small, must not be seen as a real deformation; the same holds for words, where the meaning has to be grasped from the single letters, and so on). Consequently, anhedonia could in some cases make the environment's image strange, distorted and frightening, and this could cause anxiety, confusion, and give problems in contacts with people and things. As correct information about images and sounds can inhibit visual and auditory hallucinations (considering them, like delusions, as attempts to reconstruct and make sense again of a world that is becoming confused and alien), we propose that anhedonia, interfering with the correct perceiving and processing of sensations, may facilitate them.
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PMID:Might the inability to feel pleasure (anhedonia) explain the symptoms of major depression and schizophrenia, including unmotivated anxiety, delusions and hallucinations? 2203 91

Clozapine is the best treatment option in several clinical circumstances, including treatment-resistant schizophrenia, non treatment-resistant schizophrenia, suicide risk in schizophrenia spectrum disorders, aggressiveness or violence in psychiatric patients, psychosis in Parkinson's disease, prevention and treatment of tardive dyskinesia. However, clozapine is associated with many serious side effects. Furthermore, monitoring requirements, i.e., frequent blood draws and frequent visits, discourage clozapine use. Therefore, the drug is underused. The only way to avoid the underuse of clozapine is full awareness of its side effects and competence to minimize them. The aim of the paper is reviewing the safety profile of clozapine and the suggested strategies in the management of its side effects, including neutropenia, eosinophilia, seizures, myocarditis, weight gain, diabetes, metabolic syndrome, hypersalivation, fever, constipation, ileus, urinary incontinence, sweating. The neuropsychiatric side effects of clozapine are not discussed in this review.
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PMID:Clozapine safety, 35 years later. 2212 92


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