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

This review provides a comprehensive overview of currently available treatments for psychogeriatric disorders, summarizing the efficacy of various treatment approaches based on research evidence. The severe mental illnesses in geriatric age-groups can be classified into the following groups: delirium, dementia, depression, mania, psychotic disorders, and anxiety disorders. There are specific disorders requiring specific treatments within each group. Effective treatments exist for most disorders. Effective treatment for delirium consists of identifying and treating an underlying cause, and the judicious use of medications for specific symptoms. Treatment for the dementias involves two considerations: (1) treatment of the cognitive symptoms; and (2) treatment of the behavioral symptoms. There are no currently FDA-approved, or generally acknowledged as effective, medications for the cognitive symptoms. Some medications marketed for other purposes may be used by some clinicians for treating cognitive symptoms. One medication, tacrine, is available under a treatment IND for patients with Alzheimer's disease (AD). Behavioral symptoms such as agitation, hallucinations, and delusions occur in a majority of patients some time during their illness. The treatment of behavioral symptoms involves behavioral management, environmental manipulations, and the use of medication for control of specific syndromes. The few medications assessed in randomized trials include neuroleptics and benzodiazepines. Neuroleptics such as haloperidol or thioridazine are modestly effective for some symptoms and are probably the treatments of choice for the acute, short-term. Benzodiazepines may be somewhat less effective, have cognitive-impairing side effects, are associated with increased falls, and, therefore, are less preferred. Many other medications have been suggested based largely on clinical experience. They include carbamazepine, trazodone, buspirone, and others. Treatment for depression involves consideration of acute and maintenance treatment, and of the type and severity of illness. For an acute depressive disorder of great severity, or with melancholia or psychosis either electroconvulsive therapy or the combination of antidepressant and neuroleptics may be required. Treatment requires adequate prescribing, patient education, and regular patient monitoring for compliance, symptom change, side effects, and intercurrent medical disorders which may complicate antidepressant therapy. Both antidepressant medications and brief structured psychotherapies, such as interpersonal or cognitive psychotherapies, have efficacy in the acute treatment of elderly depressed outpatients with major unipolar, nondelusional depression. Maintenance treatments are important, however, to prevent relapses or repeated episodes. Treatment recommendations are discussed. The mainstay of treatment for psychotic disorders such as late-onset schizophrenia and late-onset delusional disorder are neuroleptics. Clinical course is variable; maintenance treatments are required. Neuroleptic side effects occur with greater frequency than in younger patients.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Efficacy of treatment for geropsychiatric patients with severe mental illness. 808 81

86 cases of narrowly defined postpartum psychosis were investigated with regard to onset and course of symptomatology. The most frequent initial symptoms were restlessness, paranoid symptoms, catatonic excitement, anxiety, sleep disturbances and depressed mood. 16 patients had died at the time of follow-up. Concerning the further course of the disease 64% of the 61 women who were followed up (average 26 years from onset), had recurrences of illness. The most frequent longitudinal diagnosis, in 49% of the 61 cases, was 'schizoaffective disorder'; only 28% of patients were diagnosed as having schizophrenic disorders at follow-up.
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PMID:Postpartum psychoses: onset and long-term course. 823 36

Paraneoplastic limbic encephalitis is seldom mentioned in the psychiatric literature and premortem diagnosis is rare. Affective symptoms, agitation, and memory impairment are the core features, which can predate the diagnosis of carcinoma. We report the case of a patient with bronchial carcinoma, whose clinical picture could hardly be distinguished from that of endogenous schizophrenia.
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PMID:[Schizophreniform psychosis in paraneoplastic limbic encephalitis]. 839 60

Antipsychotic agents, most often used for treatment of schizophrenia, are sometimes prescribed for the agitated patient with an organic brain disorder. We report the case of a brain-injured patient who was prescribed chlorpromazine for agitation and who developed a delusional state while taking this antipsychotic agent. The emergence of this delusional state coincided with the exacerbation of certain cognitive deficits. Possible mechanisms for this phenomenon are discussed. Caution is advised when prescribing neuroleptics for patients with traumatic brain injury, especially those agents with significant cognitive side-effects or with a significant potential to precipitate seizures.
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PMID:Chlorpromazine-induced psychosis after brain injury. 842 19

SCH 39166 is the first selective D1 dopamine receptor antagonist developed for the treatment of schizophrenic patients. To examine potential antipsychotic effect, tolerability and safety, SCH 39166 was given orally to 17 acutely ill drug free schizophrenic patients (DSMIIIR) in an open 4-week study. Doses were escalated from 10 to 100 mg b.i.d. according to a fixed schedule over 17 days and remained at 100 mg b.i.d. for another 11 days. The drug was withdrawn prematurely in ten patients because of deterioration or refusal to take SCH 39166. In the nine patients participating for more than 2 weeks, none had an apparent reduction of BPRS or CGI scores. Side effects were agitation, akathisia and emesis in single patients. After withdrawal of SCH 39166 of the patients improved when treated with classical neuroleptics or clozapine. The result of the study does not support the prediction that selective D1 dopamine receptor antagonism will produce antipsychotic effects in schizophrenia.
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PMID:Lack of apparent antipsychotic effect of the D1-dopamine receptor antagonist SCH39166 in acutely ill schizophrenic patients. 858 11

Acute intermittent porphyria mimics a variety of commonly occurring disorders and thus poses a diagnostic quagmire. Psychiatric manifestations include hysteria, anxiety, depression, phobias, psychosis, organic disorders, agitation, delirium, and altered consciousness ranging from somnolence to coma. Some patients develop psychosis similar to schizophrenia. Psychiatric hospitals have a disproportionate number of patients with this disorder as only difficult and resistant patients accumulate there. Presence of photosensitive porphyrins in the urine is diagnostic. When porphyrins are absent, excess of alpha aminolevulinic acid and porphobilinogen are present in the urine. The definitive test is to measure monopyrrole porphobilinogen deaminase in RBCs. This diagnosis should be entertained in the following situations: (a) unexplained leukocytosis; (b) unexplained neuropathy; (c) etiologically obscure neurosis or psychosis; (d) 'idiopathic' seizure disorder; (e) unexplained abdominal pain; (f) conversion hysteria, and (g) susceptibility to stress. Porphyria is important in psychiatry as it may present with only psychiatric symptoms; it may masquerade as a psychosis and the patient may be treated as a schizophrenic person for years; the only manifestation may be histrionic personality disorder which may not receive much attention. Diagnosis is based on a high index of suspicion and appropriate investigation. Various psychotropic drugs exacerbate acute attacks. While it is important not to use the unsafe drugs in porphyric patients, it is also imperative to look for this diagnosis in cases where these drugs produce unprecedented drug reactions.
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PMID:Porphyria: reexamination of psychiatric implications. 865 42

The literature review of combination therapy of schizophrenia with neuroleptics and benzodiazepines is presented. Early trials from the 60s are difficult to evaluate because of the heterogeneity of the patients' groups selected, non-standardized evaluation methods and different diagnostic criteria. The more recent trials, methodologically more correct, were aimed at the allevation by the benzodiazepines of anxiety and agitation symptoms often observed in schizophrenia. The trials aimed at the efficacy of co-therapy with neuroleptics and benzodiazepines, (mainly alprazolam) in schizophrenia were less frequent. As the result, not univocally positive effect of such a therapy was found. The differences in clinical effect might be caused by the individual susceptibility to the anxiolytics. The attempts to correlate various clinical effects of combination therapy with neuroleptics and benzodiazepines and the biological changes in central nervous system in schizophrenia, are also discussed.
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PMID:[Schizophrenia combination therapy with neuroleptics and benzodiazepines]. 872 39

This open prospective study was undertaken to determine the efficacy and safety of a fixed dose (6 mg) of risperidone in psychotic patients. Hospital in-patients who fulfilled DSM-111-R criteria for schizophrenia, schizoaffective and bipolar disorders were eligible for entry into the study (n = 15). Patients who were on other antipsychotics had a washout period of 1 week before they were started on the drug. A fixed dose of risperidone was administered (6 mg). The Brief Psychiatric Rating Scale (BPRS), Negative Symptom Rating Scale (NSRS) and Abnormal Involuntary Movement Scale were used to measure psychopathology and extrapyramidal side-effects. Five patients dropped out of the study. Two patients became very agitated and potentially aggressive, one patient became very restless and did not respond to benzodiazepines, and one dropped out because of restlessness that did not respond to clonazepam. Of the 10 patients who completed the study, 50 per cent reduction on BPRS and NSRS was achieved by five and six patients respectively. There was a marginally significant trend towards a greater reduction in the magnitude of negative symptoms. Four patients required treatment with anticholinergic drugs. Risperidone was effective in resistent psychotic patients, but agitated and impulsive psychotic patients with positive symptoms may not be best candidates for treatment with risperidone. On average, negative symptoms respond better than positive symptoms.
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PMID:Efficacy and safety of risperidone in psychotic patients: an open study. 872 91

When schizophrenia is first diagnosed antipsychotic therapy should be started quickly as the longer the initial psychosis remains untreated the worse the final outcome will be. Aggression or agitation is best managed with a sedative given with a non-sedating antipsychotic until the antipsychotic effects of the latter appear. Because patients' first experiences of side effects are important determinants of compliance, serious consideration should be given to using a drug with low extrapyramidal side effect (EPS) liability, e.g. risperidone. In a recent trial in 183 patients with first episode schizophrenia, risperidone was at least as effective as haloperidol in reducing total PANSS scores, PANSS positive, negative, general psychopathology scores and derived BPRS scores. At endpoint, 63% of the risperidone group had improved by 50% or more (total PANSS) compared with 56% in the haloperidol group. The incidence of EPS was significantly lower in the risperidone group.
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PMID:Managing the first episode of schizophrenia: the role of new therapies. 879 14

This report describes two cases of schizophrenia inpatients with polydipsia, intermittent hyponatremia, and water intoxication. Case 1, a 38 year-old male, developed polydipsia after seven years duration of schizophrenia, with a daily intake of water of more than 10 liters as a result of auditory hallucination suggestion. Nocturnal hyponatremia, agitation and exacerbation of psychosis were noted during admission. After 12 treatments of electroconvulsive therapy, the symptoms of psychosis and polydipsia declined. Case 2, a 42 year-old male, had also been a case of schizophrenia for about twenty years, and developed polydipsia with more than 5 liters of daily water intake in a chronic psychiatric hospital for a period of 5 years schizophrenia. He claimed that he enjoyed the pleasure of drinking water. The symptom of water intoxication had been noted intermittently in the past year, leading to at least two seizures. Finally the patient was transferred to our ward due to agitated mood, self-destructive behavior, consciousness loss, and motor weakness. The clinical features, differential diagnosis and treatment concept of polydipsia and water intoxication were also discussed in context.
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PMID:[Polydipsia and water intoxication in schizophrenia patients: report of two cases]. 881 59


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