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

A prospective research design was used to identify patient and family variables that would predict relatives' attendance at an educational workshop on schizophrenia at a state psychiatric hospital. Data were collected from patient charts and telephone interviews with relatives. Thirty-two percent of the 84 invited relatives attended the workshop. Significant predictors of attendance included relatives' proximity to the hospital, previous number of visits with the patient, knowledge about schizophrenia, and familiarity with the National Alliance for the Mentally Ill. The findings suggest that a substantial proportion of relatives of the seriously mentally ill desire information and help in coping with their ill family member. Relatives' participation might be further increased by conducting workshops at more convenient sites and encouraging attendance by those less knowledgeable about schizophrenia.
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PMID:Predictors of relatives' attendance at a state hospital workshop on schizophrenia. 229 80

This paper is divided into two parts. In Part I, I contend that the current thrust to synthesize clinical and critical medical anthropology is misdirected and may serve to further fragment, rather than unify their concerns. I then suggest that instead of focusing on their differences, either in levels of analysis ('micro-' versus 'macro-') or in objects for analysis, we should emphasize instead the perspective that they share--one drawn from the common task their work assumes as a critical, emancipatory science of mankind. In Part II, keeping in mind this short prolegomenon, I utilize data regarding the National Alliance for the Mentally Ill (NAMI) to illustrate that medical knowledge is reducible to neither natural nor social forces; it is instead produced by living actors who are constrained by their social and historical conditions and the exigencies of the mode of production in which these actors produce. I show how NAMI members have succeeded in changing 'blame-the-family' ideologies about schizophrenia etiology and treatment, but I also explain how the medicalized alternative they produced in redefining schizophrenia as a disease of the brain is itself limited and fraught with contradictions (e.g. reinforcing a depersonalizing mind/body separation that inhibits healing). These contradictions highlight the difficulty of transcending the assumptions implicit in medical categories since they are tied to the dominant epistemology of the mode of production in which they are produced--one that binds our world views and limits the options we can generate. Anthropologists must draw attention to these constraints as an initial step to transcending them.
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PMID:Contradictions in the social production of clinical knowledge: the case of schizophrenia. 233 75

This survey was carried out in a psychiatric day hospital over three years on all patients admitted. The aim was to assess the patients' state at discharge, and to identify the factors to explain the clinical changes, in particular to evaluate the impact of the various types of therapy proposed. The patients were evaluated when they entered the hospital and at discharge using mainly validated translated English-language questionnaires ("Health Sickness Rating Scale" of Luborsky, "Helping Alliance questionnaire" of Luborsky), but also two instruments developed and validated by our team: "Clinical Evaluation Profile", and the "Commitment Scale". The results provide not only a good description of the patients' state at arrival but also of their evolution. The factors found to be important in the evaluation were similar to those identified in most of previous studies, i.e. the initial severity, and quality of the therapeutic relationship, but we also found that the degree of commitment of the patients to the various therapies offered was important. In addition, we found that, when using the commitment scale in homogeneous subgroups of patients (identified using the CIM 9 diagnostic scale) were examined, the favourable outcome of a given psychotherapeutic approach was dependent on the type of the pathology. Thus, patients with personality disorders and high scores at the commitment scale benefited above all from group therapy. The reverse was found for patients with neurotic disorders. For patients suffering from schizophrenia the most important factor was the commitment to the background milieu of the hospital. These observations are in contradiction with some of the main conclusions (known as the equivalence paradox) from english and american studies over the last 40 years of Psychotherapy Research, which state that all psychotherapies are equivalent, and that the reason why some give successful results, and other do not can, only be by non specific factors (i.e. the quality of the therapeutic bond, patients' motivations, etc.). From our results, if homogeneous subgroups of patients are considered and if we use subjective (commitment to the therapy) instead of hard data (as for example having this type of therapy or an other one, or the length of therapy, ect.), we can distinguish the effect of the various psychotherapeutic approaches at least in a psychiatric institution.
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PMID:[Psychotherapeutic process in a day hospital: results of a survey and importance of qualitative data]. 764 68

Noncompliance with neuroleptic treatment is a major barrier to delivery of effective treatment for schizophrenia outpatients. This article describes the development of a standardized measure for the assessment of attitudinal and behavioral factors influencing patient compliance with neuroleptic treatment. The Rating of Medication Influences (ROMI) scale was developed as part of a longitudinal study of neuroleptic noncompliance in schizophrenia and administered to 115 discharged schizophrenia outpatients. Analyses of the following were conducted to assess the scale's psychometric properties: (1) interrater reliability, (2) internal consistency, (3) principal components, (4) correlation with other subjective measures, and (5) correlation with independent family reports. Most (95%) of the ROMI patient-report items were reliable, whereas rater-judgment items were not reliable. The rater section was dropped. A principal components analysis of the reliable patient-report items yielded three subscales related to compliance (Prevention, Influence of Others, and Medication Affinity) and five subscales related to noncompliance (Denial/Dysphoria, Logistical Problems, Rejection of Label, Family Influence, and Negative Therapeutic Alliance). There were significant correlations between these subscales, and independently obtained family-report ROMI items were significant. The Denial/Dysphoria subscale correlated strongly with two other published measures of dysphoric response to neuroleptics, whereas the other noncompliance subscales did not. The ROMI is a reliable and valid instrument that can be used to assess the patient's subjective reasons for medication compliance and non-compliance. The subscale findings suggest that the ROMI provides a more comprehensive data base for patient-reported compliance attitudes than the other available subjective measures. Indications for use of the ROMI and other subjective measures of neuroleptic response are reviewed.
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PMID:Rating of medication influences (ROMI) scale in schizophrenia. 791 62

The National Alliance for Research on Schizophrenia and Depression (NARSAD) celebrated its tenth anniversary this year. The organization raises and distributes funds for scientific research on brain disorders. As a member of NARSAD's scientific council since the organization was founded, I have been greatly impressed by the energy and commitment of NARSAD's leaders and staff and the many individuals who volunteer as members of the board of directors and the scientific council. I asked Constance E. Lieber, president of the board of directors, and Herbert Pardes, M.D., president of the scientific council, both of whom have been deeply involved with NARSAD since its inception, to agree to an interview with Psychiatric Services. The following is an edited transcript of the interview.
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PMID:NARSAD: a decade of support for psychiatric research. Interview by John A Talbott. 940 59

Advocacy organizations such as the National Alliance for the Mentally Ill (NAMI) and patient consumer groups are playing an ever-increasing role in public health policy and patient care in schizophrenia. The recovery philosophy which recognizes the unique contributions of those who have experienced mental illness is now a part of treatment approaches in many states. Several states have extended these consumer initiatives to incorporate advance directives, an approach that has generated much debate. The NAMI destigmatization campaign, grounded in the neurobiology of major mental illness, is an unprecedented, concerted effort to change public opinion and to achieve parity at all levels for persons with severe and persistent mental illness. This article describes and chronicles these initiatives and explores their implications for the management of schizophrenia into the next millenium.
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PMID:Advocacy, recovery, and the challenges of consumerism for schizophrenia. 955 99

This study identified the unique and primary contributions of several concurrent risk factors for poor adherence to treatment recommendations in a clinic population of individuals with chronic psychotic disorders, i.e. 48% had DSM-IV diagnoses of schizoaffective disorder, 38% had schizophrenia, paranoid type, 12% had schizophrenia, undifferentiated type, and 2% had affective disorder with psychotic features. The target cohort consisted of 87 consecutive admissions to a continuing day treatment program. As part of a services-oriented quality assurance program, clinical staff completed rating scales for all patients. These included the BASIS-32 rating scale, which consisted of the following five subscales: psychosis; depression/anxiety; impulsive/addictive behavior; relation to self and others; and daily living and role functioning, and the Working Alliance Inventory-short form (therapist version), which consisted of the following three subscales: goal; task; and bond. These data were used to identify risk factors that weaken a patient's adherence to medication and non-medication treatment during the first 2 weeks of treatment in the clinic. Medication treatment consisted of both typical and atypical neuroleptic medications, with most patients being on multiple medications. Correlational analyses suggested that many of the risk factor variables were significantly associated with poor treatment adherence. Regression analyses suggested that the degree of psychoticism was most strongly associated with poor adherence to medication treatment and that difficulties relating to self and others were the strongest predictor of poor adherence to non-medication treatment. A large-sample services research design such as this can begin to determine patterns of associations between previous identified risk factors and poor treatment adherence in individuals with chronic psychotic disorders.
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PMID:Interactive risk factors for treatment adherence in a chronic psychotic disorders population. 1070 73

Winter birth, urban birth and/or childhood residence, and perinatal complications have each been identified as environmental risk factors for the later development of schizophrenia, schizoaffective disorder, and bipolar disorder. A preliminary case-control study also identified cat exposure in childhood as a possible risk factor. To assess selected environmental events, including childhood exposure to pets, as possible risk factors for these diseases, a case-control telephone survey was carried out by the University of Maryland Survey Research Center for 264 mothers of cases and 528 mothers of matched controls. The cases were randomly selected mothers who were members of the National Alliance for the Mentally Ill, and whose children had been diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder. The controls were mothers randomly selected from the same telephone exchanges. For five of the 19 major variables, there were statistically significant differences between cases and controls: fever during pregnancy, complications during delivery, city or suburban residence at birth, cat ownership between birth and age 13, and breast-feeding. In a multivariate logistic regression including these five variables, each variable made a significant contribution. The finding of perinatal complications, urban/suburban residence at birth, and cat ownership in childhood as risk factors for the later development of psychoses confirmed previous studies. Previous research on breast-feeding as a risk factor has yielded contradictory results. Additional research is needed to ascertain how such environmental risk factors interact with genetic risk factors. Understanding these could lead to better treatments and possible prevention strategies.
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PMID:The antecedents of psychoses: a case-control study of selected risk factors. 1109 81

The National Alliance for the Mentally Ill is challenging the funding policies of the National Institute of Mental Health (NIMH), claiming that NIMH spends a disproportionate amount on AIDS research. A review of 2,277 abstracts of NIMH-funded projects in 1997 showed that the agency spent 14.2 percent of its budget studying behavioral aspects of HIV and 13.5 percent on schizophrenia. NIMH responded that HIV was a serious and significant health threat among mentally ill persons, including the homeless. The quarrel was fueled by a 1999 New England Journal of Medicine article suggesting that AIDS receives a disproportionate share of spending compared to other diseases, such as breast cancer and emphysema.
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PMID:Mental health advocates complain about NIMH priority for AIDS. National Institute of Mental Health. 1136 24

Although therapeutic alliance in schizophrenia has been linked with treatment adherence and outcome, less is known about its clinical correlates. This study explored neurocognition as a possible predictor of perceived therapeutic alliance among people with schizophrenia in cognitive behavior therapy. Twenty-four participants with schizophrenia spectrum disorders and their therapists were administered the Working Alliance Inventory, Short Form after 3 months of therapy. Totals for clients and therapists were correlated with measures of verbal memory, premorbid intelligence, visual spatial reasoning, executive function, and attention, all obtained before beginning therapy. Poorer performance on verbal memory was significantly related to client report of stronger alliance, whereas better performance on visual spatial reasoning was significantly related to therapist report of stronger alliance. Client and therapist ratings of therapeutic alliance were significantly and positively related. Clients' abilities may differentially affect therapist and client perception of therapeutic alliance in schizophrenia.
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PMID:Neurocognitive correlates of therapeutic alliance in schizophrenia. 1523 22


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